Speech Disorders

Attention! The related software (PANM script) can be downloaded from here:
https://drive.google.com/drive/folders/0B4QKykn2bzqQa0JQRTZtU08yZWs?resourcekey=0-kYz6XS59uRJCKj4YuhaqhQ
Background: This study aimed to introduce a low-cost system measuring nasalance, which can often be performed with high-cost systems, and to present the normative nasalance values for adults using this system.
Materials and Methods: This study included 96 standard native Turkish-speaking literate volunteers who had no hearing and speech problems or nasal obstruction. Nasalance values were measured using the system developed by the principal author, which is called the Praat-Assisted Nasalance Meter, using speech materials and related methods.
Results: The participants were 18-65 (average, 33.7) years old. They were divided into three groups according to their age: 18-25, 26-40, and 41-65. A significant difference was found in the nasalance values between the genders. For nearly all speech materials, higher nasalance values were measured in women than in men.
Conclusion: There is no generally accepted rule to ascertain if a speaker’s resonance is abnormal according to nasalance values. Therefore, the proposed threshold values should not be considered absolute values but should be decided with perceptual evaluation.

Amaç: Bu çalışmanın amacı, genellikle yüksek maliyetli sistemlerle gerçekleştirilebilen nazalans parametresi ölçümü için kullanılabilecek kendi geliştirdiğimiz düşük maliyetli bir sistemi tanıtmak ve bu sistem kullanılarak erişkinler için belirlenen normatif nazalans değerlerini sunmaktır.
Gereç ve Yöntemler: Standart Türkiye Türkçesi konuşan ve okuma yazma bilen 96 gönüllü çalışmaya dahil edildi. Deneklerin işitme ve konuşma problemi, burun tıkanıklığı yapan herhangi bir hastalığının olmamasına dikkat edildi. Birinci yazar tarafından geliştirilen ve Praat Yardımlı Nazalans Ölçer (PYNÖ) adı verilen sistem yardımıyla aşağıda belirtilen konuşma malzemesi ve yöntem kullanılarak nazalans ölçümü yapıldı.
Bulgular: Çalışmaya katılan 96 konuşmacının yaşları 18 ile 65 arasında değişiyordu (ortalama 33,7 yıl). Katılımcılar yaşlarına göre 18-25, 26-40 ve 41-65 şeklinde üç gruba ayrılarak incelendi. Elde edilen değerler cinsiyet grubuna göre karşılaştırıldığında aradaki farkların istatistiksel olarak anlamlı olduğu görüldü. Hemen her konuşma malzemesi için kadınlarda erkeklerden daha yüksek nazalans değerleri elde edildi.
Sonuç: Bir konuşmacı üzerinde ölçülen nazalans ölçüm sonuçlarının anormal olduğunu söylemek için genel kabul gören bir kural yoktur. Bu nedenle, bu çalışmada önerilen eşik değerler mutlak değerler olarak düşünülmemeli, algısal değerlendirmeyle birlikte karar verilmelidir.

This study examined the 7-year psychiatric outcome of 202 speech/language (S/L) impaired and control children selected from a community sample at age 5 years. Children with S/L at age 5 years were more likely to be psychiatric cases at age 12.5 years than were normal controls, even if their S/L improved. Controlling for concurrent psychiatric disorder, S/L impairment at age 5 years was still associated with an increased rate of psychiatric disorder at 12.5 years. Psychiatric disorder at age 12.5 years was more likely to co-occur with language disorder than with speech disorder.

Little is known about how AAC use in preschool may impact language development for children with complex communication needs (e.g., children with autism, cerebral palsy, Down syndrome, and other developmental disabilities). We developed two surveys (a) to describe children ' s use of AAC in preschool classrooms, as well as the use of prompts and question asking, and augmented input by their communication partners; and (b) to describe teachers ' experience, training, and perceived support in providing AAC. We then examined the relationship between children ' s experience of AAC, including the use of prompts, question asking, and augmented input by their partners, and the growth of receptive and expressive language for 71 children with developmental disabilities over a two-year period. The use of AAC by peers to provide augmented input was associated with stronger language growth; the use of prompting and question asking by teachers was associated with weaker language growth. Teachers reported that they received little training regarding ways to support a child ' s use of AAC. Results suggest the need for further research on promoting AAC use at the preschool level, including research to promote peer interactions for AAC users.

The first double-blind placebo-controlled clinical trial of an atypical neuroleptic medication is being conducted in symptomatic treatment-seeking patients meeting new diagnostic criteria for a putative prodromal syndrome. This identifies them as being at high risk for developing psychosis in the near future. The study aims include prevention of psychosis onset and disability, as well as palliation of ongoing symptomatology.

Children with the 22q11.2 deletion syndrome (22q11DS) are at an increased risk of psychiatric problems from pre-adolescence; little is known, however, about behavioral problems at a preschool age and the relationship between speech and behavior in this group. Parents of 90 children (aged 1.42-5.99 years) with 22q11DS filled out the Child Behavior Checklist, documenting behaviors including speech problems. Their profiles were compared with those of a comparison group consisting of 33 children with nonsyndromic orofacial clefts without 22q11DS, since both children with 22q11DS and children with clefts are expected to have speech problems. In the 22q11DS group, data on intelligence was acquired by means of formal tests. Parents of children with 22q11DS reported significantly higher mean scores on withdrawn behavior, affective problems and pervasive developmental problems compared to children with nonsyndromic clefts. Approximately 30% of children with 22q11DS had a score above the 97th percentile on at least one of the behavior subscales, indicating psychopathology. In children with 22q11DS, the reported behavioral problems were not associated with speech problems. Behavioral problems were found in 30% of young children with 22q11DS and were unlikely to be caused by speech problems. Within the 22q11DS group, behavioral problems were not related to the degree of cognitive impairment. This shows that many children with 22q11DS, known to be at an increased risk of psychiatric problems from pre-adolescence, already show behavioral problems before the age of 6 years.

Forty five patients (23 boys and 22 girls) with elective mutism (8.7 ± 3.6 years old), who were referred to a university department and a child guidance clinic within a 15-year-period, were followed up on average 12 years later. For 41 of them, sufficient information could be obtained at follow-up, and 31 patients could be investigated personally. At follow-up, an interview and a standardized psychopathological examination were carried out as well as two standardized biographic inventories. The main results were: 1) a high load of individual and family psychopathology was characteristic of the patients. The disorder started already at age 3 to 4 and referral age was 8 years on average. 2) In 16 out of 41 patients (39 %), a complete remission could be observed. All other patients still revealed some communication problems. 3) The formerly mute patients described themselves as less independent, less motivated with regard to school achievement, less self-confident and less mature and healthy in comparison to a normal reference group. 4) A poor outcome could be best predicted by the variable "mutism within the core family"at the time of referral.

There is limited information on long-term outcomes among children with Duarte galactosemia and controversy about treatment of this potentially benign condition. This study examined developmental disabilities and issues that required special education services within a population-based sample of children with Duarte galactosemia. Methods: Children born between 1988 and 2001 who were diagnosed with Duarte galactosemia and resided in the five-county metropolitan Atlanta area at birth and from 3 to 10 years of age were linked to the (1) Metropolitan Atlanta Developmental Disabilities Surveillance Program, an ongoing, population-based surveillance system for selected developmental disabilities and (2) Special Education Database of Metropolitan Atlanta. Special education records were reviewed for children who linked. Clinical genetics records were reviewed to assess laboratory levels at the time of diagnosis and metabolic control during treatment. Results: Of the 59 eligible children, none were found to have intellectual disability, cerebral palsy, hearing loss, vision impairment, or an autism spectrum disorder. However, five, 8.5% of 3 to 10 years or 15.2% of eligible 8 years, were identified as having received special education services, four of whom were confirmed with a speech or language disorder, or were receiving services for speech or language or both compared with 4.5% and 5.9% of children without Duarte galactosemia, respectively. Conclusions: Despite galactose restriction until 1 year, select developmental issues associated with special education, specifically involving speech and language, have been found among some children with Duarte galactosemia.

These two studies were aimed at extending the assessment of technology-aided programs for post-coma persons with extensive motor impairment and lack of speech. Specifically, Study I assessed a new program arrangement, in which stimulation access and caregiver attention could be obtained with variations of the same response (i.e., single- versus double-hand closure) by three participants who were diagnosed at the upper level of the minimally conscious state at the start of the study. Study II was aimed at enabling two persons who had emerged from a minimally conscious state to engage in leisure activities, listen to audio-recordings of family members, and send and receive messages. The responses selected for these participants were hand pressure and eyelid closure, respectively. The results of both studies were positive. The participants of Study I increased their responding to increase their stimulation input and caregiver interaction. The participants of Study II managed to success...

Words derive their structure not only from the sounds they include but also from the organization of those sounds within the word. This organization is the phonotactic level of the word: roughly, its shape including the sequence of its elements. Often, children with immature or disordered phonologies demonstrate phonotactic as well as phonetic limitations. Sometimes, the child may produce an age-appropriate variety of consonants and vowels but be unable to use them in the configurations required by the language: final consonants, clusters, multisyllabic words, and so forth. In such cases, the most appropriate therapy goals may be phonotactic, rather than phonetic, ones. Studies have shown that clinical focus on a new word or syllable shape may generalize well beyond the specific sound or sounds targeted in that position. These ideas are explored in this article, along with specific therapy results and recommendations for various phonotactic limitations.

Moebius syndrome is a congenital, nonprogressive disorder clinically characterized by loss of facial expression, impaired stomatognathic system functions, incapacity to close the eyelids, and several oral impairments. The purpose of this paper was to present the clinical manifestations and the dental treatment in a 5-year, 2-month-old male Moebius syndrome patient. The child presented with facial asymmetry, difficulty performing facial mimic movements and pronouncing some letters, and compromised suction, mastication, breathing, and deglutition. An intraoral examination revealed hypofunction of the perioral muscles, cheeks and tongue, ankyloglossia, anterior open bite, and absence of carious lesions and dental anomalies. The dental treatment consisted of frenectomy and further placement of a removable orthodontic appliance with a palatal crib for correction of the anterior open bite. After 12 months of follow-up, anterior open bite decreased and speech, deglutition, and mastication ...

Acoustical measures of vocal function are routinely used in the assessments of disordered voice, and for monitoring the patient's progress over the course of voice therapy. Typically, acoustic measures are extracted from sustained vowel stimuli where short-term and long-term perturbations in fundamental frequency and intensity, and the level of "glottal noise" are used to characterize the vocal function. However, acoustic measures extracted from continuous speech samples may well be required for accurate prediction of abnormal voice quality that is relevant to the client's "real world" experience. In contrast with sustained vowel research, there is relatively sparse literature on the effectiveness of acoustic measures extracted from continuous speech samples. This is partially due to the challenge of segmenting the speech signal into voiced, unvoiced, and silence periods before features can be extracted for vocal function characterization. In this paper we propose a joint time-frequency approach for classifying pathological voices using continuous speech signals that obviates the need for such segmentation. The speech signals were decomposed using an adaptive time-frequency transform algorithm, and several features such as the octave max, octave mean, energy ratio, length ratio, and frequency ratio were extracted from the decomposition parameters and analyzed using statistical pattern classification techniques. Experiments with a database consisting of continuous speech samples from 51 normal and 161 pathological talkers yielded a classification accuracy of 93.4%.

report bears on the behavior of 188 unilateral stroke subjects when administered an aphasia screening test comprising a short interview as well as naming, repetition, word-picture matching and sentence-picture matching tasks. All subjects were unilingual lusophone adult (40 yr of age or older) right-handers. Furthermore, they were either totally unschooled illiterates or they had received school education and thereafter retained writing skills and reading habits. Subjects were tested less than 2 months after a first unilateral stroke. In all tasks, global error scores were greater among left and right brain-damaged illiterate and literate subjects than among their controls. In repetition and matching, these differences were statistically significant for the left but not for the right-stroke groups, irrespective of the literacy factor. In naming, on the other hand, significant differences were found not only for the two left-stroke groups but also for the right-stroke illiterate group although not for the right-stroke literate one. Likewise, some degree of word-finding difficulty and of reduction in speech output as well as a sizeable prodllction of phonemic paraphasias were observed in the interviews of several right-stroke illiterates, clearly less in those of right-stroke literates. These findings lead us to suggest that cerebral representation of language is more ambilateral in illiterates than it is in school educated subjects although left cerebral "dominance" remains the rule in both.

Background  The level of language development reached in pre-school age is considered the most reliable predictor of reading acquisition. In normally developing children, learning to read is strongly related to early language skills, and in particular to phonological processing abilities. In dyslexic children, reading abilities seem to show a correlation with phonological awareness.Methods  A group of 65 children (aged 5–6 years) were recruited and submitted to an in-depth neuropsychological assessment [i.e. metaphonological skills, intelligence, verbal short-term memory (VSTM) and other aspects of receptive and expressive language]. We were able to identify 14 children with significant metaphonological difficulties (MD): 11 children with exclusively MD, and the other three children with specific language impairment. This study compares the neuropsychological profile obtained from children with MD with that of a peer group without any language impairment (N).Results  The performances of the MD were within the normal ability range in almost all the administered tests but significantly lower compared with those of their peers without language impairment (N) in some items of the intelligence scale (Wechsler Preschool and Primary Scale of Intelligence) and in the tests of VSTM and of receptive/expressive language. Nevertheless, there were not statistically significant differences between MD and N in output phonology.Conclusions  In pre-school age, in a group of non-clinical children, with a range of abilities, those with MD appear to be at the lower end of the normal range in many other verbal skills. These children could be considered at-risk for possible subsequent difficulties learning to read and thus need to be identified and to warrant prompt treatment.

C hild abuse, neglect, and trauma are global problems. Abuse has been defined as when "a person willfully or unreasonably does, or causes a child or young person to do, any act that endangers or is likely to endanger the safety of a child or young person or that causes or is likely to cause a child or young person (a) any unnecessary physical pain, suffering or injury; (b) any emotional injury; or (c) any injury to his or her health or development" (Chan, Elliott, Chow, & Thomas, 2002, p. 361). Trauma may involve witnessing domestic parental or community violence or warfare or experiencing severe loss in natural disasters. The United Nations (UN) maintains that violence is one of the most serious problems affecting children today. The World Health Organization (WHO) estimates that 40 million children below the age of 15 experience abuse and neglect requiring health and social care. At any given time, 300,000 child soldiers, some as young as 8 years, are in armed conflicts in more than 30 countries. In Central and Eastern Europe, 1.5 million children live in orphanages that provide minimal care. Two million children are exploited through prostitution and pornography (UNICEF, n.d.). In the United States, reports of child abuse and neglect have been increasing by approximately 10% a year since 1976 (Children's Defense Fund, 1999). Although fewer parents are reporting a belief in the use of corporal punishment, a 1995 survey in the United States showed that 5% of parents admitted to disciplining their child by hitting the child with an object, kicking the child, beating the child, or threatening the child with a knife or gun. Violence can have severe implications for children's development even when it does not lead to obvious physical injury or death. Violence affects children's health, their ability to learn, and even their willingness to go to school. Much violence toward children is hidden. Children may fear reporting the abuse, or both the abuser and child may see nothing wrong with the violence, viewing it as justifiable punishment. Because of concern regarding violence to children, in 2001, the United Nations called for a comprehensive global study of violence against children. A number of children who are seen by speech-language pathologists (SLPs) are likely to have experienced some type of abuse, neglect, or trauma for several reasons. One reason that the caseloads of SLPs are likely to have a number of children who have experienced abuse and neglect is because children with disabilities are more likely to be abused than are children without disabilities (Sullivan & Knutson, 2000). A second reason is that children who experience abuse, neglect, or trauma are more likely to develop disabilities that affect their cognitive and language abilities (Coster & Cicchetti, 1993; Osofsky, 1995). Abuse is more common among children who were born premature or of low birth weight, who have had prolonged illnesses, or who have developmental disabilities (Lynch, 1976; Martin, 1976). This increase in abuse of children with disabilities may be related to the increased stress their families experience as a result of the additional and unrelenting needs of these children or adults' lack of understanding of the children's limitations. Sullivan

This study investigated two mechanism-based treatments for expressive aprosodia, a disturbance in emotional prosody thought to be governed by the right hemisphere. The 3 participants all suffered right CVA's resulting in expressive aprosodia. Presence of expressive aprosodia was determined by performance on two batteries of emotional communication. A single subject ABAC design was employed in which two treatments, one imitative and one cognitive linguistic, were assigned in random order. All participants in this study were randomly assigned to begin with the cognitive linguistic treatment. Probes of treated and untreated emotions were completed during baseline and therapy phases. Probe items were judged by a reliable, trained rater blind to time of testing. Visual and statistical analyses were completed. These analyses confirmed that both treatments were active. For example, effect size calculations confirmed modest to substantial treatment effects for both treatments in all 3 p...

Objectives The paper presents a research study investigating the effectiveness and acceptability of community speech and language therapy provision for preschool children with early speech/ language delays. As a 'worked example' , it demonstrates the value of a multimethod approach to evaluation. Methods The paper examines how the research findings of a pragmatic randomized controlled trial (RCT), a survey questionnaire and qualitative in-depth interviews, which were the methods used in the evaluation, overlap and complement each other. Results There was little evidence to establish the effectiveness of the speech and language therapy provided in the trial. This lack of difference was reflected in responses of parents to items on the questionnaire. The findings of the RCT, questionnaire and interviews all cast considerable doubt on the prospect of spontaneous resolution of the children's difficulties. Although the RCT showed few differences between the children allocated to immediate therapy or 'watchful waiting' , the questionnaire and interviews revealed the circumstances in which the parents felt that these intervention strategies had been acceptable and unacceptable. Conclusions Although the trial provided information about the progress of the children, the questionnaire and interview components highlighted the advantages and limitations of the intervention from the viewpoint of parents, thereby helping to explain the RCT findings. Thus, the study demonstrates how a multimethod approach to evaluation can yield useful information to explain the findings of RCTs.

The purpose of the present study was to assess differences in stuttering, phonological, and diadochokinetic behaviors in young children who exhibit both stuttering and disordered phonology and children who exhibit only one of the disorders. Subjects were 21 male children (aged 4 to 6 years), representing three groups of seven children each: (a) stuttering and normal phonological abilities (S+NP), (b) stuttering and disordered phonology (S+DP), and (c) normal fluency and disordered phonology (NF+DP). Stuttering behavior was assessed during a 30-minute conversational speech task; phonological behavior was assessed during a 162 item picture-naming task; and diadochokinetic abilities were assessed during bi-and multisyllable productions. Results indicated that the S+DP group produced significantly more sound prolongations and significantly fewer iterations per whole-word repetition than the S+NP group. However, there were no differences between the two groups in other stuttering indices. Moreover, no differences were noted between the S+DP and NF+DP groups in phonological behavior. Diadochokinetic rates did not differ among the three groups. The possibility of two types of stuttering, one occurring with and one without disordered phonology, is discussed.

This article reviews recent literature on the physical and psychosocial correlates of head and neck cancer, with a focus on quality-of-life issues, rehabilitation outcomes, and changes in the literature from the previous decade. These studies have shown that head and neck cancer has an enormous impact on the quality of life of patients. The most important physical symptoms are speech problems, dry mouth and throat, and swallowing problems. Pain is also frequently reported. Disturbances in psychosocial functioning and psychological distress are reported by a considerable number of patients; worry, anxiety, mood disorder, fatigue, and depression are the main symptoms. Cancer of the head and neck has a negative effect on social, recreational, and sexual functioning. Despite a growing number of longitudinal studies, little is known about the rehabilitation outcomes over a longer period of time. Future research is necessary to form a consensus about the further development and use of specific instruments to study patients with cancer of the head and neck, to conduct more prospective studies, and to develop programs that are aimed at maximizing rehabilitation outcomes and evaluate these programs with randomized designs.

This paper reviews some of the methodological issues involved in the design of a randomized controlled trial currently underway in Bristol. The trial compares the progress of preschool children randomly allocated to a`watching±waiting' control group with the experimental group who have immediate access to therapy. This paper reviews a number of relevant studies, which have either followed up preschool children with early language delays or have investigated the effects of therapy with this age group. The basic design of the trial is outlined along with a discussion of the sample, the measurements used and the therapy given.

Few speech and language therapists work with psychiatric patients. This study investigates how the specific communication problems of this population are addressed by care staff: Following a survey to determine the prevalence of speech and language problems in a psychiatric population, subjects assessed as having moderate or severe dificulties were selected for further study in order to investigate how they were currently being managed by thepeople responsible for their care. Key workers or charge nurses were interviewed, and ward and department nursing care plans were examined for mentions of speech and language problems, for aims in connection with these problems and for strategies to achieve these aims. Speech and language problems were not mentioned in 40% of the nursing care plans inspected. Where speech and language problems were mentioned there were aims in connection with half of these and strategies to achieve the aims in only 10% of the sample. The reasons for failure to mention speech and language in nursing care plans and for discrepancies between the results of speech and language therapy assessment and assessments of ward and department staff are discussed.

SpeecManguage disorders are common in the fragile X syndrome. [Howard-Peebles, 1979: A m J Hom Genet 31:214-222; Renier et al., 1983: J Ment Defic Res 2751-59; Sparks, 1984: Birth Defects and Speech-Language Disorders, pp. 39-43; Hanson et al., 1986: Am J Med Genet 23:195-2063.

■ Abstract Active behavior problems in children with ADHD are often aggravated in situations which require sustained attention. Building on the 'optimal stimulation' hypothesis , this study explored the effects of color stimulation on graphomotor control in children with ADHD.A sample of 66 children with ADHD (n = 19 from primary education, n = 28 children with additional speech disorders, n = 19 children with additional learning disabilities) and matched controls participated in the investigation. Subjects performed a copying task on standard white and on colored paper in balanced order across classes. Positive effects of the color stimulation on graphomotor behavior control and, consequently, on qualitative aspects of the handwritings were expected. Results broadly confirm the predictions. Effects are explained as added external stimulation facilitating behavioral inhibition and regulation of selective attention and graphomotor coordination. Reduction of visual stress as an alternative explanation is considered.

Purpose This systematic review aimed to determine the effects of augmentative and alternative communication (AAC) intervention on speech production in children with autism or pervasive developmental disorder-not otherwise specified. Method A systematic review methodology was utilized to limit bias in searching, selecting, coding, and synthesizing relevant treatment studies. This involved a multifaceted search for studies written between 1975 and May 2007 using various bibliographic databases, dissertation databases, hand searches of selected journals and published compilations of AAC theses and dissertations, and ancestry searches. To be included, studies had to meet stringent criteria. A coding manual and form facilitated data extraction in terms of participant characteristics, treatment characteristics, design and measurement, and outcomes. Results Nine single-subject experimental design (27 participants) and 2 group studies (98 participants) were included. Results indicated that ...

Like other areas of speech-language pathology, the behavioural management of voice disorders lacks precision regarding optimal dose -response relationships. In voice therapy, dosing can presumably vary from no measurable effect (i.e., no observable benefi t or adverse effect), to ideal dose (maximum benefi t with no adverse effects), to doses that produce toxic or harmful effects on voice production. Practicing specifi c vocal exercises will inevitably increase vocal load. At ideal doses, these exercises may be non-toxic and benefi cial, while at intermediate or high doses, the same exercises may actually be toxic or damaging to vocal fold tissues. In pharmacology, toxicity is a critical concept, yet it is rarely considered in voice therapy, with little known regarding " effective " concentrations of specifi c voice therapies vs " toxic " concentrations. The potential for vocal fold tissue damage related to overdosing on specifi c vocal exercises has been under-studied. In this commentary, the issue of dosing will be explored within the context of voice therapy, with particular emphasis placed on possible " overdosing " .

Aim The aim of this paper is to examine the natural history of early speech and language delay in preschool children over a 12-month period. Methods The study reports data on 69 children under the age of 3.5years who were referred for speech and language therapy because of early speech and language delay. The children were monitored over a 12-month period but received no direct intervention during that time. Assessment of their comprehension, expressive language and their phonology took place at baseline and again at 6 and 12months after baseline.

The features of apraxia of speech (AOS) are presented with regard to both traditional and contemporary descriptions of the disorder. Models of speech processing, including the neurological bases for apraxia of speech, are discussed. Recent findings concerning subcortical contributions to apraxia of speech and the role of the insula are presented. The key features to differentially diagnose AOS from related speech syndromes are identified. Treatment implications derived from motor accounts of AOS are presented along with a summary of current approaches designed to treat the various subcomponents of the disorder. Finally, guidelines are provided for treating the AOS patient with coexisting aphasia.

Objectives: Several surgical techniques are available for the treatment of velopharyngeal insufficiency (VFI). Each method has its own complications and non-dynamic roles. So the aim of this study was to present a novel physiological surgical technique designed by the author for reconstruction of the velopharyngeal sphincter in VFI. Methods: This prospective study included six patients with VFI (two males and four females) with ages from 5 to 20 years (mean: 12.50 years). Speeches, nasopharyngeal and oral endoscopies for velopharyngeal valve closure were measured according to a 5-point scale where 0 was equivalent to normal and 4 meant a severe (constant) deviation. They were scheduled for cerclage sphincter pharyngoplasty after failure of appropriate speech therapy. Under general anaesthesia and the patient in semiflower's position; two level cerclages (1-0 polypropylene suture materials) were inserted behind the muscles of the velopharynx. The first at the level of junction of posterior and middle one-thirds of the soft palate passing through soft palate, left lateral pharyngeal wall, posterior pharyngeal wall, right lateral pharyngeal wall and the soft palate. The second was at 3 mm in front of the latter. The surgical technique was described in details. Results: Before surgery five patients (83.3%) had sever hypernasality (rating scale 3). After the cerclage operation and speech therapy four patients (66.6%) significantly improved to normal nasality (rating scale 0) and the remaining two patients improved to mild and moderate hypernasality (rating scale 1 and 2), respectively ( p < 0.05). By endoscopy the closing activity was (rating scale 3) in five patients (83.3%) and (rating scale 2) in one patient (18%). After the cerclage operation and speech therapy five patients (83.3%) changed significantly to complete closure (rating scale 0) and to (rating scale 1) in one patient ( p < 0.05).

Butalbital (Fiorinal ® ), used in the treatment of migraines and muscle pain, is the most commonly encountered barbiturate in impaired driving cases. It has central nervous system (CNS) depressant properties, including sedation, drowsiness, and feelings of intoxication, which can contribute to driving impairment. Twenty-six driving under the influence cases are reviewed including results from field sobriety tests and toxicology testing. Blood samples were screened using enzyme multiplied immunoassay technique immunoassay, and the presence of butalbital was confirmed and quantified using gas chromatography/mass spectrometry, gas chromatography with flame ionization detection, or gas chromatography nitrogen/phosphorus detection. Butalbital concentrations ranged from 1.0 to 30.2 mg/L, with a mean and median of 16.0 mg/L. General impairment indicators in these cases included horizontal and vertical nystagmus, lack of convergence, poor motor coordination, and balance and speech problems, which are common to CNS depressant intoxication, similar to that associated with alcohol. These findings indicate the importance of toxicological testing for butalbital in cases where CNS depressants are indicated. Rieders Family Renaissance Foundation,

This study focuses on the comorbidity between attention-deficit/hyperactivity disorder (ADHD) symptoms and speech sound disorder (SSD). SSD is a developmental disorder characterized by speech production errors that impact intelligibility. Previous research addressing this comorbidity has typically used heterogeneous groups of speech–language disordered children. This study employed more precise speech–language diagnostic criteria and examined ADHD symptomatology in 108 SSD children between the ages of 4 and 7 years old with specific language impairment (SLI) (n = 23, 14 males, 9 females) and without SLI (n = 85, 49 males, 36 females). We also examined whether a subcategory of SSD, persistent (n = 39, 25 males, 14 females) versus normalized SSD (n = 67, 38 males, 29 females), was associated with ADHD and/or interacted with SLI to predict ADHD symptomatology. Results indicated that participants in the SSD + SLI group had higher rates of inattentive ADHD symptoms than those in the SSD-only and control groups. In addition, an unexpected interaction emerged such that children with SLI and normalized-SSD had significantly higher ADHD inattentive ratings than the other subgroups. A proposed explanation for this interaction is discussed.

In this paper are the findings of a 3-year research project into communication between 15 people with Motor Neurone Disease (MND) and their closest communication partners, as the disease progressed. Data were collected through video recordings, narratives, and field notes. The purpose of the communication and the use of augmentative and alternative communication (AAC) according to the perceptions of people with MND and their partners were examined. For the people in this study, it appeared that AAC was less successful than anticipated. The participants gave a number of reasons, which were interpreted by the researcher to include (a) the need for social closeness, which may not be possible when using a device; and (b) the complexity of learning how to use a high technology device combined with inadequate training. Both theoretical and practical issues are raised for professionals who work with and provide services to families with MND.

Children with cerebral palsy (CP) often have speech, language, and/or communication disorders 1 and are referred to speech and language therapy (SLT). They may also be referred to SLT services for dysphagia: treatment of which is beyond the scope of this review. Although the exact prevalence of the communication disorders associated with CP is not known, it has been estimated that approximately 20% of children with a diagnosis of CP have severe communication impairment and are classified as non-verbal. 2 Many more will have less severe speech and communication disorders as a consequence of their motor impairment, or disorders arising from speech, language, and cognitive processing deficits associated with CP.