De la teoría fonológica a la identificación temprana de las dificultades específicas de aprendizaje de la lectura

Publication date: Available online 18 January 2016
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Juan L. Luque, Almudena Giménez, Soraya Bordoy, Auxiliadora Sánchez
Se revisa el marco teórico de investigación generado en torno a la teoría fonológica de la dislexia evolutiva. Este marco ha habilitado la posibilidad de realizar una identificación temprana de las dificultades específicas de aprendizaje de la lectura y ha justificado su necesidad práctica. Cuatro son las aportaciones fundamentales. Primero, la teoría fonológica defiende que la dislexia evolutiva se produce como consecuencia de un déficit fonológico general que afecta a diversos componentes del sistema fonológico, entre los que destacan la conciencia fonológica, la velocidad de los procesos léxicos y la memoria verbal a corto plazo. Segundo, la teoría fonológica ha puesto de manifiesto que la causa primaria de la dislexia está presente desde el periodo embrionario y produce consecuencias sobre el desarrollo del lenguaje oral durante todo el periodo previo al aprendizaje de la lectura. Tercero, la teoría fonológica ha defendido la tesis del lenguaje oral como causa primaria del déficit, y con ello ha revelado las relaciones entre los trastornos específicos del lenguaje y la dislexia evolutiva. Cuarto, la investigación ha mostrado el significativo impacto de los programas de prevención e intervención temprana, lo que obliga a complementar las estrategias reactivas y tardías de diagnóstico, con estrategias proactivas de prevención y/o identificación e intervención temprana. Finalmente, se argumenta que si las causas primeras y los sistemas de prevención e intervención de estas dificultades están directamente vinculados con el desarrollo del lenguaje, entonces la logopedia debería tener un papel protagonista en la implementación de las estrategias proactivas en el contexto escolar.This paper presents a review of the research issued from the frame of the Phonological Theory of developmental dyslexia. This theory has set up the means to make an early identification of specific learning difficulties in reading, and has provided theoretical support for its implementation. There are four fundamental contributions. First, the Phonological Theory argues that developmental dyslexia is a consequence of a general phonological deficit that affects different components of the phonological system being phonological awareness, lexical processing speed and verbal short-term memory the most relevant. Second, the Phonological Theory has pointed out that the primary cause of dyslexia is present from the embryonic period and that it affects oral language development before learning to read. Third, the Phonological Theory has considered oral language as the main cause of the deficit, and consequently, has highlighted the relations between Specific Language Impairment and Developmental Dyslexia. Fourth, since research has proved the significant impact of Programs for prevention and early intervention, a clear need for adding proactive strategies of early prevention and/or identification to the late reactive diagnosis strategies has arisen. Finally, it is argued that if primary causes as well as prevention and intervention resources are directly attached to language development, then, speech therapists should play a main role in the implementation of proactive strategies in the school context.



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De la teoría fonológica a la identificación temprana de las dificultades específicas de aprendizaje de la lectura

Publication date: Available online 18 January 2016
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Juan L. Luque, Almudena Giménez, Soraya Bordoy, Auxiliadora Sánchez
Se revisa el marco teórico de investigación generado en torno a la teoría fonológica de la dislexia evolutiva. Este marco ha habilitado la posibilidad de realizar una identificación temprana de las dificultades específicas de aprendizaje de la lectura y ha justificado su necesidad práctica. Cuatro son las aportaciones fundamentales. Primero, la teoría fonológica defiende que la dislexia evolutiva se produce como consecuencia de un déficit fonológico general que afecta a diversos componentes del sistema fonológico, entre los que destacan la conciencia fonológica, la velocidad de los procesos léxicos y la memoria verbal a corto plazo. Segundo, la teoría fonológica ha puesto de manifiesto que la causa primaria de la dislexia está presente desde el periodo embrionario y produce consecuencias sobre el desarrollo del lenguaje oral durante todo el periodo previo al aprendizaje de la lectura. Tercero, la teoría fonológica ha defendido la tesis del lenguaje oral como causa primaria del déficit, y con ello ha revelado las relaciones entre los trastornos específicos del lenguaje y la dislexia evolutiva. Cuarto, la investigación ha mostrado el significativo impacto de los programas de prevención e intervención temprana, lo que obliga a complementar las estrategias reactivas y tardías de diagnóstico, con estrategias proactivas de prevención y/o identificación e intervención temprana. Finalmente, se argumenta que si las causas primeras y los sistemas de prevención e intervención de estas dificultades están directamente vinculados con el desarrollo del lenguaje, entonces la logopedia debería tener un papel protagonista en la implementación de las estrategias proactivas en el contexto escolar.This paper presents a review of the research issued from the frame of the Phonological Theory of developmental dyslexia. This theory has set up the means to make an early identification of specific learning difficulties in reading, and has provided theoretical support for its implementation. There are four fundamental contributions. First, the Phonological Theory argues that developmental dyslexia is a consequence of a general phonological deficit that affects different components of the phonological system being phonological awareness, lexical processing speed and verbal short-term memory the most relevant. Second, the Phonological Theory has pointed out that the primary cause of dyslexia is present from the embryonic period and that it affects oral language development before learning to read. Third, the Phonological Theory has considered oral language as the main cause of the deficit, and consequently, has highlighted the relations between Specific Language Impairment and Developmental Dyslexia. Fourth, since research has proved the significant impact of Programs for prevention and early intervention, a clear need for adding proactive strategies of early prevention and/or identification to the late reactive diagnosis strategies has arisen. Finally, it is argued that if primary causes as well as prevention and intervention resources are directly attached to language development, then, speech therapists should play a main role in the implementation of proactive strategies in the school context.



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De la teoría fonológica a la identificación temprana de las dificultades específicas de aprendizaje de la lectura

Publication date: Available online 18 January 2016
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Juan L. Luque, Almudena Giménez, Soraya Bordoy, Auxiliadora Sánchez
Se revisa el marco teórico de investigación generado en torno a la teoría fonológica de la dislexia evolutiva. Este marco ha habilitado la posibilidad de realizar una identificación temprana de las dificultades específicas de aprendizaje de la lectura y ha justificado su necesidad práctica. Cuatro son las aportaciones fundamentales. Primero, la teoría fonológica defiende que la dislexia evolutiva se produce como consecuencia de un déficit fonológico general que afecta a diversos componentes del sistema fonológico, entre los que destacan la conciencia fonológica, la velocidad de los procesos léxicos y la memoria verbal a corto plazo. Segundo, la teoría fonológica ha puesto de manifiesto que la causa primaria de la dislexia está presente desde el periodo embrionario y produce consecuencias sobre el desarrollo del lenguaje oral durante todo el periodo previo al aprendizaje de la lectura. Tercero, la teoría fonológica ha defendido la tesis del lenguaje oral como causa primaria del déficit, y con ello ha revelado las relaciones entre los trastornos específicos del lenguaje y la dislexia evolutiva. Cuarto, la investigación ha mostrado el significativo impacto de los programas de prevención e intervención temprana, lo que obliga a complementar las estrategias reactivas y tardías de diagnóstico, con estrategias proactivas de prevención y/o identificación e intervención temprana. Finalmente, se argumenta que si las causas primeras y los sistemas de prevención e intervención de estas dificultades están directamente vinculados con el desarrollo del lenguaje, entonces la logopedia debería tener un papel protagonista en la implementación de las estrategias proactivas en el contexto escolar.This paper presents a review of the research issued from the frame of the Phonological Theory of developmental dyslexia. This theory has set up the means to make an early identification of specific learning difficulties in reading, and has provided theoretical support for its implementation. There are four fundamental contributions. First, the Phonological Theory argues that developmental dyslexia is a consequence of a general phonological deficit that affects different components of the phonological system being phonological awareness, lexical processing speed and verbal short-term memory the most relevant. Second, the Phonological Theory has pointed out that the primary cause of dyslexia is present from the embryonic period and that it affects oral language development before learning to read. Third, the Phonological Theory has considered oral language as the main cause of the deficit, and consequently, has highlighted the relations between Specific Language Impairment and Developmental Dyslexia. Fourth, since research has proved the significant impact of Programs for prevention and early intervention, a clear need for adding proactive strategies of early prevention and/or identification to the late reactive diagnosis strategies has arisen. Finally, it is argued that if primary causes as well as prevention and intervention resources are directly attached to language development, then, speech therapists should play a main role in the implementation of proactive strategies in the school context.



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Cochlear Implant Access in Six Developed Countries

Background: Access to cochlear implantation varies greatly around the world. It is affected by factors that are specific to each country's health care system, by awareness, and by societal attitudes regarding deafness. Methods: Cochlear implant clinicians and researchers from six countries explored and discussed these variations and their likely causes: Robert Briggs from Australia; Wolfe-Dieter Baumgartner from Austria; Thomas Lenarz from Germany; Eva Koltharp from Sweden; Christopher Raine from the United Kingdom, and Craig Buchman, Donna Sorkin, and Christine Yoshinago from the United States. Results: Utilization rates are quite different for the pediatric and adult demographics in all six countries. Pediatric utilization ranges in the six countries (all in the developed world) ranged from a low of 50% in the United States to a high of 97% in Australia. Adult utilization is less than 10% everywhere in the world. Conclusions: Pediatric access to care was excellent for children with the exception of Germany and the United States where there is an inadequate referral system. Adult utilization was low everywhere because of the lack of screening for adults and the fact that primary care physicians and even audiologists are unfamiliar with CI candidacy criteria and outcomes, and hence typically do not make patient referrals.

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Using the Implant Electrode Array to Conduct Real-time Intraoperative Hearing Monitoring During Pediatric Cochlear Implantation: Preliminary Experiences

Objectives: To present the preliminary experiences and findings from a pilot study evaluating a novel technique for monitoring cochlear electrophysiological function during electrode insertion in cochlear implantation surgery. Study Design: Prospective pilot cohort study. Setting: Tertiary academic neuro-otology center. Patients: Pediatric patients with residual hearing undergoing hearing preservation cochlear implant surgery. Intervention: Monitoring of intraoperative cochlear microphonics during cochlear implant surgery. Main Outcome Measure: Intraoperative intracochlear microphonic measurement, preservation of these responses postoperatively and preservation of hearing as measured by audiometry. Results: Intracochlear microphonics could be identified in both patients presented and were preserved during the surgical procedure and postoperatively. The preservation of intracochlear microphonics correlates with preservation of hearing. Conclusion: The novel approach using the electrode array to detect and measure intracochlear microphonics during cochlear implantation surgery shows promise as an instrument to alert the operating surgeon to hair cell damage during electrode insertion. Further refinement of the technique is required to better understand the measurements and correlate these with pre- and postoperative hearing and risk of hearing loss from surgery. Improvements in the software algorithm will reduce the time required for each measurement, leading to the development a more real-time monitoring technique.

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Measuring Success: Cost-Effectiveness and Expanding Access to Cochlear Implantation

Only a small fraction of patients with profound sensorineural hearing loss have access to cochlear implantation with the majority of these affected people living in developing countries. Cost effectiveness analysis (CEA) is an important tool to demonstrate the value of this technology to healthcare policy makers. This approach requires that hearing healthcare professionals incorporate methods of assessing long-term benefits of cochlear implantation that include psychosocial, quality of life, and disability outcomes. This review explores different aspects of CEA methodology relevant to cochlear implants and discusses ways that we can improve global access by addressing factors that influence cost-effectiveness.

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Outcomes of Adolescents With a Short Electrode Cochlear Implant With Preserved Residual Hearing

Objective: The purpose of this study was to determine if adolescents with preserved residual low-frequency hearing can develop improved speech perception and maintain localization abilities by combining their acoustic hearing with electrical processing from a short electrode cochlear implant. Study Design: Repeated-measure, single-subject experiment. Setting: Research hospital. Patients: Adolescents with sensorineural hearing loss with a pure-tone average (PTA) between 60 and 90 dB HL between 125 and 1500 Hz and profound loss at higher frequencies. Intervention(s): rehabilitative. Main Outcome Measure(s): Five adolescents received a short electrode cochlear implant in their poorer ear. Audiometric, speech perception in quiet (CNC words), localization, speech production, and language outcomes were collected pre- and postoperatively at 4, 8, 12, and 24 months. Results: Functional hearing preservation was accomplished in all subjects at initial activation and was maintained through 24 months. In the Combined and Hybrid conditions, all subjects showed significant improvements by 4 months postimplantation, with exception of Subject 2 in the Combined condition, who showed a significant improvement by 8 months postimplantation. Results also indicated that all subjects continue to have localization abilities postimplantation. Conclusions: All of the subjects have benefitted from the combined electric and acoustic processing for speech perception abilities. The results from this study suggest that it could be worthwhile to consider acoustic and electric hearing in the adolescent population that have some low-frequency residual hearing and are struggling with hearing aids.

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The Utility of a Predictive Model for Cochlear Implant Operating Time

Objective: This study analyzes multiple factors and their significance in determining the operative timing for cochlear implants at one institution over a 10-year period. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: All patients including both adult and pediatric undergoing cochlear implantation from 2002 through January 2012. Intervention(s): Cochlear implantation. Main Outcome Measure(s): The overall operative room time and surgical duration for patients undergoing cochlear implantation. Individual factors analyzed for influence on timing included center experience, surgeon experience, location (main OR, children's OR, outpatient OR), patient age, patient sex, bilaterality, anatomical consideration, complications, and the involvement of residents and fellows. Results: ANOVA analysis of individual factors. Factors associated with increased surgical duration included bilateral implants, abnormal inner ear anatomy, and intraoperative complications. Factors associated with time outside the operation included surgical duration, the surgical suite type, and the availability of a fellow. Total operating room time was significantly reduced in an outpatient setting and in quicker performed procedures. Conclusions: The influence of factors affecting both surgical duration and time in the operating room can be predicted and used to provide more accurate estimates of operating room time.

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Long-term Communication Outcomes for Children Receiving Cochlear Implants Younger Than 12 Months: A Multicenter Study

Objective: Examine the influence of age at implant on speech perception, language, and speech production outcomes in a large unselected paediatric cohort. Study Design: This study pools available assessment data (collected prospectively and entered into respective databases from 1990 to 2014) from three Australian centers. Patients: Children (n = 403) with congenital bilateral severe to profound hearing loss who received cochlear implants under 6 years of age (excluding those with acquired onset of profound hearing loss after 12 mo, those with progressive hearing loss and those with mild/moderate/severe additional cognitive delay/disability). Main Outcome Measure(s): Speech perception; open-set words (scored for words and phonemes correct) and sentence understanding at school entry and late primary school time points. Language; PLS and PPVT standard score equivalents at school entry, CELF standard scores. Speech Production; DEAP percentage accuracy of vowels, consonants, phonemes-total and clusters, and percentage word-intelligibility at school entry. Results: Regression analysis indicated a significant effect for age-at-implant for all outcome measures. Cognitive skills also accounted for significant variance in all outcome measures except open-set phoneme scores. ANOVA with Tukey pairwise comparisons examined group differences for children implanted younger than 12 months (Group 1), between 13 and 18 months (Group 2), between 19 and 24 months (Group 3), between 25 and 42 months (Group 4), and between 43 and 72 months (Group 5). Open-set speech perception scores for Groups 1, 2, and 3 were significantly higher than Groups 4 and 5. Language standard scores for Group 1 were significantly higher than Groups 2, 3, 4, and 5. Speech production outcomes for Group 1 were significantly higher than scores obtained for Groups 2, 3, and 4 combined. Cross tabulation and χ2 tests supported the hypothesis that a greater percentage of Group 1 children (than Groups 2, 3, 4, or 5) demonstrated language performance within the normative range by school entry. Conclusions: Results support provision of cochlear implants younger than 12 months of age for children with severe to profound hearing loss to optimize speech perception and subsequent language acquisition and speech production accuracy.

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Method of Speech Stimulus Presentation Impacts Pediatric Speech Recognition: Monitored Live Voice Versus Recorded Speech

Objective: To characterize the potential differences in speech understanding performance on word and sentence tests assessed using live voice and recorded speech measures for pediatric cochlear implant (CI) recipients. Study Design: This clinical study used a combination of retrospective and prospective study designs exploring within-subject performance for recorded versus monitored-live-voice presentation methods on pediatric word and sentence measures. Methods: Word and/or sentence recognition was obtained for 29 pediatric CI recipients using both recorded stimuli and monitored-live-voice (MLV) within a single-test session with a single experimenter for each session. The difference score was calculated for word and sentence measures allowing a comparison across conditions. Setting: Ambulatory. Patients: Pediatric patients aged 4 to 17 years. Intervention(s): Cochlear implants. Main Outcome Measure(s): Speech recognition testing. Results: There was a significant difference between recorded and MLV speech understanding with mean recorded word scores being 13-percentage points lower than those obtained via MLV. Conclusions: The results of this project suggest that the use of MLV for the assessment of speech perception in the pediatric Audiology clinic may overinflate children's performance and thereby runs the risk of failing to identify poorer or at-risk performance.

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Language Development in the First Year of Life: What Deaf Children Might Be Missing Before Cochlear Implantation

Objectives: Language development is a multifaceted, dynamic process involving the discovery of complex patterns, and the refinement of native language competencies in the context of communicative interactions. This process is already advanced by the end of the first year of life for hearing children, but prelingually deaf children who initially lack a language model may miss critical experiences during this early window. The purpose of this review is twofold. First, we examine the published literature on language development during the first 12 months in typically developing children. Second, we use this literature to inform our understanding of the language outcomes of prelingually deaf children who receive cochlear implants (CIs), and therefore language input, either before or after the first year. Conclusions: During the first 12 months, typically developing infants exhibit advances in speech segmentation, word learning, syntax acquisition, and communication, both verbal and nonverbal. Infants and their caregivers coconstruct a communication foundation during this time, supporting continued language growth. The language outcomes of hearing children are robustly predicted by their experiences and acquired competencies during the first year; yet these predictive links are absent among prelingually deaf infants lacking a language model (i.e., those without exposure to sign). For deaf infants who receive a CI, implantation timing is crucial. Children receiving CIs before 12 months frequently catch up with their typically developing peers, whereas those receiving CIs later do not. Explanations for the language difficulties of late-implanted children are discussed.

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Speech Recognition of Bimodal Cochlear Implant Recipients Using a Wireless Audio Streaming Accessory for the Telephone

Objective: The goals of the present investigation were (1) to evaluate recognition of recorded speech presented over a mobile telephone for a group of adult bimodal cochlear implant users, and (2) to measure the potential benefits of wireless hearing assistance technology (HAT) for mobile telephone speech recognition using bimodal stimulation (i.e., a cochlear implant in one ear and a hearing aid on the other ear). Study Design: A three-by-two-way repeated measures design was used to evaluate mobile telephone sentence-recognition performance differences obtained in quiet and in noise with and without the wireless HAT accessory coupled to the hearing aid alone, CI sound processor alone, and in the bimodal condition. Setting: Outpatient cochlear implant clinic. Subjects: Sixteen bimodal users with Nucleus 24, Freedom, CI512, or CI422 cochlear implants participated in this study. Intervention (s): Performance was measured with and without the use of a wireless HAT for the telephone used with the hearing aid alone, CI alone, and bimodal condition. Main Outcome Measure(s): CNC word recognition in quiet and in noise with and without the use of a wireless HAT telephone accessory in the hearing aid alone, CI alone, and bimodal conditions. Results: Results suggested that the bimodal condition gave significantly better speech recognition on the mobile telephone with the wireless HAT. Conclusions: A wireless HAT for the mobile telephone provides bimodal users with significant improvement in word recognition in quiet and in noise over the mobile telephone.

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Beyond Early Intervention: Supporting Children With CIs Through Elementary School

Background: The development of cochlear implants (CIs) and the broader availability of early intervention, made possible by newborn hearing screening, have raised prospects that deaf children can be mainstreamed at the start of elementary school and fare well with minimal support. This report examines the veracity of that perspective. Methods: This report specifically: (1) reviews progress made by deaf children in spoken language acquisition over the past 25 years; (2) presents data collected from 104 children in the early elementary grades (49 with normal hearing (NH) and 55 with severe-to-profound hearing loss who use CIs); (3) describes language acquisition that typically occurs in elementary school; and (4) highlights intervention strategies for school-age deaf children with CIs. Results: The spoken language skills of deaf children have improved thanks to CIs and early intervention, but remain below those of children with NH. The amount of deficit varies across the language construct examined, with the greatest deficit found for skills dependent upon phonological (speech-sound) sensitivity, and the mildest associated with morphosyntactic (grammatical) skills. There is substantial development in both phonological and morphosyntactic skills that typically occurs during the elementary school years. Conclusion: Both the data and theoretical models of language acquisition indicate that even with the availability of CIs and early intervention, deaf children are behind their peers with NH when they enter school. And there is much language learning that lies ahead for them. Thus, there is a need for us to enhance our intervention with deaf children during the early elementary grades.

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Cortical Plasticity and Reorganization in Pediatric Single-sided Deafness Pre- and Postcochlear Implantation: A Case Study

Hypothesis: The purpose of this study was to examine changes in cortical development and neuroplasticity in a child with single-sided deafness (SSD) before and after cochlear implantation (CI). Background: The extent to which sensory pathways reorganize in childhood SSD is not well understood and there is currently little evidence demonstrating the efficacy of CI in children with SSD. Methods: High-density 128-channel electroencephalography (EEG) was used to collect cortical auditory evoked potentials (CAEP), cortical visual evoked potentials (CVEP), and cortical somatosensory evoked potentials (CSSEP) in a child with SSD, pre-CI and at subsequent sessions until approximately 3 years post-CI in her right ear which occurred at age 9.86 years. Behavioral correlates of speech perception and sound localization were also measured. Results: Pre-CI, high-density EEG showed evidence of delayed auditory cortical response morphology, auditory cortical development strongly contralateral (to the normal hearing ear), evidence of increased cognitive load, and cross-modal reorganization by the visual and somatosensory modalities. The post-CI developmental trajectory provided clear evidence of age-appropriate development of auditory cortical responses, and decreased cross-modal reorganization, consistent with improved speech perception and sound localization. Conclusion: Post-CI, the child demonstrated age-appropriate auditory cortical development and improved speech perception and sound localization suggestive of significant benefits from cochlear implantation. Reversal of somatosensory recruitment was clearly apparent, and only a residual amount of visual cross-modal plasticity remained postimplantation. Overall, our results suggest that CI in pediatric SSD patients may benefit from a highly plastic cortex in childhood.

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