Cochlear Implantation for Children and Adults with Severe-to-Profound Hearing Loss

Semin Hear 2018; 39: 390-404
DOI: 10.1055/s-0038-1670705

Cochlear implants (CIs) have proven to be a useful treatment option for individuals with severe-to-profound hearing loss by providing improved access to one's surrounding auditory environment. CIs differ from traditional acoustic amplification by providing information to the auditory system via electrical stimulation. Both postlingually deafened adults and prelingually deafened children can benefit from a CI; however, outcomes with a CI can vary. Numerous factors can impact performance outcomes with a CI. It is important for the audiologist to understand what factors might play a role and impact performance outcomes with a CI so that they can effectively counsel the recipient and their family, as well as establish appropriate and realistic expectations with a CI. This review article will discuss the CI candidacy process, CI programming and postoperative follow-up care, as well as considerations across the lifespan that may affect performance outcomes with a CI.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Conventional Amplification for Children and Adults with Severe-to-Profound Hearing Loss

Semin Hear 2018; 39: 364-376
DOI: 10.1055/s-0038-1670699

The primary goal of amplification is to restore audibility without causing discomfort; for someone with severe-to-profound hearing loss, the reduced dynamic range poses unique challenges in hearing-assistive device fitting. These challenges, including physiological limitation, processing difficulties, technology constraints, and other confounding factors, must be considered when selecting, fitting, and counseling for appropriate amplification. Many of the advanced features in hearing aids do not adequately address the unique characteristics of patients with severe-to-profound hearing loss. This review article will attempt to unravel some of the challenges and associated considerations when fitting adults and children with severe-to-profound hearing loss.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Important Information Regarding Continuing Education Units for Seminars in Hearing through AAA and ASHA

Semin Hear 2018; 39: 345-346
DOI: 10.1055/s-0038-1675567

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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Electric and Acoustic Stimulation in Cochlear Implant Recipients with Hearing Preservation

Semin Hear 2018; 39: 414-427
DOI: 10.1055/s-0038-1670707

Hearing loss affects 30 million people in the United States, and a subset of these patients have normal low-frequency hearing and ski-sloped high-frequency hearing loss. For these patients, hearing aids alone may not provide adequate benefit. Cochlear implantation alone has been utilized to improve speech perception. The addition of high-frequency electric hearing to low-frequency acoustic hearing in these patients is beneficial. Technical improvements have allowed preservation of low-frequency hearing in cochlear implant recipients, allowing for electric and acoustic stimulation in the same ear with significant improvements in speech perception, sound localization, music appreciation, and quality of life.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Consequences and Treatment Options for Severe-to-Profound Hearing Loss

Semin Hear 2018; 39: 347-348
DOI: 10.1055/s-0038-1670701

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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The Use of Frequency Lowering Technology in the Treatment of Severe-to-Profound Hearing Loss: A Review of the Literature and Candidacy Considerations for Clinical Application

Semin Hear 2018; 39: 377-389
DOI: 10.1055/s-0038-1670700

This article provides a review of the current literature on the topic of frequency lowering hearing aid technology specific to the treatment of severe and profound levels of hearing impairment in child and adult listeners. Factors to consider when assessing listener candidacy for frequency lowering technology are discussed. These include factors related to audiometric assessment, the listener, the type of hearing aid technology, and the verification and validation procedures that can assist in determining candidacy for frequency lowering technology. An individualized candidacy assessment including the use of real-ear verification measures and carefully chosen validation tools are recommended for listeners requiring greater audibility of high-frequency sounds, when compared with amplification via conventional hearing aid technology.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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The Physiologic and Psychophysical Consequences of Severe-to-Profound Hearing Loss

Semin Hear 2018; 39: 349-363
DOI: 10.1055/s-0038-1670698

Substantial loss of cochlear function is required to elevate pure-tone thresholds to the severe hearing loss range; yet, individuals with severe or profound hearing loss continue to rely on hearing for communication. Despite the impairment, sufficient information is encoded at the periphery to make acoustic hearing a viable option. However, the probability of significant cochlear and/or neural damage associated with the loss has consequences for sound perception and speech recognition. These consequences include degraded frequency selectivity, which can be assessed with tests including psychoacoustic tuning curves and broadband rippled stimuli. Because speech recognition depends on the ability to resolve frequency detail, a listener with severe hearing loss is likely to have impaired communication in both quiet and noisy environments. However, the extent of the impairment varies widely among individuals. A better understanding of the fundamental abilities of listeners with severe and profound hearing loss and the consequences of those abilities for communication can support directed treatment options in this population.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Bimodal Hearing in Individuals with Severe-to-Profound Hearing Loss: Benefits, Challenges, and Management

Semin Hear 2018; 39: 405-413
DOI: 10.1055/s-0038-1670706

Binaural hearing offers numerous advantages over monaural hearing. While bilateral implants are a successful treatment option for some patients, many individuals choose to achieve binaural hearing by using a cochlear implant with a contralateral hearing aid. Compared with monaural hearing, benefits of bimodal hearing include improved speech perception in quiet and in noise, improved localization, and more natural sound quality. Despite the advantages, there exist disadvantages to bimodal hearing, primarily related to binaural integration. Management of these devices can be challenging in that the hearing aid and cochlear implant may be managed by different clinicians. When fitting devices, strategies are recommended to optimize the integration of input from both devices. In managing bimodal devices, recommended outcomes measures include those that would reflect bimodal benefit, such as speech understanding in noise and spatial sound quality perception.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Profound Hearing Loss: Addressing Barriers to Hearing Healthcare

Semin Hear 2018; 39: 428-436
DOI: 10.1055/s-0038-1670708

The impact of profound hearing loss on infants and adults is variable and greatly influenced by improved audition derived from hearing aids and cochlear implants. However, barriers to healthcare, hearing healthcare in particular, can offset the benefits provided by these sensory devices. Common barriers include cost, location, availability of trained professionals, acceptance of the hearing loss, language and cultural differences, secondary disabilities, and mental health issues. These barriers and their distinct presentations vary somewhat by age, language, and where people live (urban vs. rural), and can interfere with receiving testing and devices in a timely manner. They also can limit auditory, speech and language therapies, and interfere with acceptance of the hearing loss and devices. Rehabilitation should focus on eliminating or reducing the adverse impact of these barriers on patients and their families. Some of which can be done through professional training and multidisciplinary activities, counseling, and community outreach.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Self-Assessment Questions

Semin Hear 2018; 39: C1-C8
DOI: 10.1055/s-0038-1673388

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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Cochlear Implantation for Children and Adults with Severe-to-Profound Hearing Loss

Semin Hear 2018; 39: 390-404
DOI: 10.1055/s-0038-1670705

Cochlear implants (CIs) have proven to be a useful treatment option for individuals with severe-to-profound hearing loss by providing improved access to one's surrounding auditory environment. CIs differ from traditional acoustic amplification by providing information to the auditory system via electrical stimulation. Both postlingually deafened adults and prelingually deafened children can benefit from a CI; however, outcomes with a CI can vary. Numerous factors can impact performance outcomes with a CI. It is important for the audiologist to understand what factors might play a role and impact performance outcomes with a CI so that they can effectively counsel the recipient and their family, as well as establish appropriate and realistic expectations with a CI. This review article will discuss the CI candidacy process, CI programming and postoperative follow-up care, as well as considerations across the lifespan that may affect performance outcomes with a CI.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Conventional Amplification for Children and Adults with Severe-to-Profound Hearing Loss

Semin Hear 2018; 39: 364-376
DOI: 10.1055/s-0038-1670699

The primary goal of amplification is to restore audibility without causing discomfort; for someone with severe-to-profound hearing loss, the reduced dynamic range poses unique challenges in hearing-assistive device fitting. These challenges, including physiological limitation, processing difficulties, technology constraints, and other confounding factors, must be considered when selecting, fitting, and counseling for appropriate amplification. Many of the advanced features in hearing aids do not adequately address the unique characteristics of patients with severe-to-profound hearing loss. This review article will attempt to unravel some of the challenges and associated considerations when fitting adults and children with severe-to-profound hearing loss.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Important Information Regarding Continuing Education Units for Seminars in Hearing through AAA and ASHA

Semin Hear 2018; 39: 345-346
DOI: 10.1055/s-0038-1675567

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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via IFTTT

Electric and Acoustic Stimulation in Cochlear Implant Recipients with Hearing Preservation

Semin Hear 2018; 39: 414-427
DOI: 10.1055/s-0038-1670707

Hearing loss affects 30 million people in the United States, and a subset of these patients have normal low-frequency hearing and ski-sloped high-frequency hearing loss. For these patients, hearing aids alone may not provide adequate benefit. Cochlear implantation alone has been utilized to improve speech perception. The addition of high-frequency electric hearing to low-frequency acoustic hearing in these patients is beneficial. Technical improvements have allowed preservation of low-frequency hearing in cochlear implant recipients, allowing for electric and acoustic stimulation in the same ear with significant improvements in speech perception, sound localization, music appreciation, and quality of life.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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via IFTTT

Consequences and Treatment Options for Severe-to-Profound Hearing Loss

Semin Hear 2018; 39: 347-348
DOI: 10.1055/s-0038-1670701

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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The Use of Frequency Lowering Technology in the Treatment of Severe-to-Profound Hearing Loss: A Review of the Literature and Candidacy Considerations for Clinical Application

Semin Hear 2018; 39: 377-389
DOI: 10.1055/s-0038-1670700

This article provides a review of the current literature on the topic of frequency lowering hearing aid technology specific to the treatment of severe and profound levels of hearing impairment in child and adult listeners. Factors to consider when assessing listener candidacy for frequency lowering technology are discussed. These include factors related to audiometric assessment, the listener, the type of hearing aid technology, and the verification and validation procedures that can assist in determining candidacy for frequency lowering technology. An individualized candidacy assessment including the use of real-ear verification measures and carefully chosen validation tools are recommended for listeners requiring greater audibility of high-frequency sounds, when compared with amplification via conventional hearing aid technology.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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The Physiologic and Psychophysical Consequences of Severe-to-Profound Hearing Loss

Semin Hear 2018; 39: 349-363
DOI: 10.1055/s-0038-1670698

Substantial loss of cochlear function is required to elevate pure-tone thresholds to the severe hearing loss range; yet, individuals with severe or profound hearing loss continue to rely on hearing for communication. Despite the impairment, sufficient information is encoded at the periphery to make acoustic hearing a viable option. However, the probability of significant cochlear and/or neural damage associated with the loss has consequences for sound perception and speech recognition. These consequences include degraded frequency selectivity, which can be assessed with tests including psychoacoustic tuning curves and broadband rippled stimuli. Because speech recognition depends on the ability to resolve frequency detail, a listener with severe hearing loss is likely to have impaired communication in both quiet and noisy environments. However, the extent of the impairment varies widely among individuals. A better understanding of the fundamental abilities of listeners with severe and profound hearing loss and the consequences of those abilities for communication can support directed treatment options in this population.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Bimodal Hearing in Individuals with Severe-to-Profound Hearing Loss: Benefits, Challenges, and Management

Semin Hear 2018; 39: 405-413
DOI: 10.1055/s-0038-1670706

Binaural hearing offers numerous advantages over monaural hearing. While bilateral implants are a successful treatment option for some patients, many individuals choose to achieve binaural hearing by using a cochlear implant with a contralateral hearing aid. Compared with monaural hearing, benefits of bimodal hearing include improved speech perception in quiet and in noise, improved localization, and more natural sound quality. Despite the advantages, there exist disadvantages to bimodal hearing, primarily related to binaural integration. Management of these devices can be challenging in that the hearing aid and cochlear implant may be managed by different clinicians. When fitting devices, strategies are recommended to optimize the integration of input from both devices. In managing bimodal devices, recommended outcomes measures include those that would reflect bimodal benefit, such as speech understanding in noise and spatial sound quality perception.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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via IFTTT

Profound Hearing Loss: Addressing Barriers to Hearing Healthcare

Semin Hear 2018; 39: 428-436
DOI: 10.1055/s-0038-1670708

The impact of profound hearing loss on infants and adults is variable and greatly influenced by improved audition derived from hearing aids and cochlear implants. However, barriers to healthcare, hearing healthcare in particular, can offset the benefits provided by these sensory devices. Common barriers include cost, location, availability of trained professionals, acceptance of the hearing loss, language and cultural differences, secondary disabilities, and mental health issues. These barriers and their distinct presentations vary somewhat by age, language, and where people live (urban vs. rural), and can interfere with receiving testing and devices in a timely manner. They also can limit auditory, speech and language therapies, and interfere with acceptance of the hearing loss and devices. Rehabilitation should focus on eliminating or reducing the adverse impact of these barriers on patients and their families. Some of which can be done through professional training and multidisciplinary activities, counseling, and community outreach.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Self-Assessment Questions

Semin Hear 2018; 39: C1-C8
DOI: 10.1055/s-0038-1673388

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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The Mandarin Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and Its Reliability

Purpose

The purpose of this study is to develop the Mandarin version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and evaluate its reliability compared with the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS).

Method

The Mandarin version of the CAPE-V tool was translated from the validated English version with phonemic adaptations, content adjustment, and scale modification. Sixty dysphonic, 20 normal, and 20 repeated voice samples were included in this study. Ten of these were used for preassessment training; the remaining 90 were evaluated using the Mandarin CAPE-V and GRBAS for comparison of their interrater and intrarater reliabilities.

Results

Intrarater reliability was measured by Pearson r for the CAPE-V and Spearman rho for the GRBAS. Average CAPE-V Pearson r ranged from 0.80 for strain to 0.91 for overall severity, compared with average GRBAS Spearman rho of 0.83 for strain to 0.89 for asthenia. Interrater reliability was measured by an intraclass coefficient (ICC). Average CAPE-V ICCs ranged from .57 for pitch to .81 for overall severity, compared with average GRBAS ICCs of .60 for asthenia to .83 for grade.

Conclusions

The Mandarin CAPE-V addresses some limits of the English version. It also demonstrates good intrarater and interrater reliability, comparable to those of GRBAS.

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Perceptual Organization of Interrupted Speech and Text

Purpose

Visual recognition of interrupted text may predict speech intelligibility under adverse listening conditions. This study investigated the nature of the linguistic information and perceptual processes underlying this relationship.

Method

To directly compare the perceptual organization of interrupted speech and text, we examined the recognition of spoken and printed sentences interrupted at different rates in 14 adults with normal hearing. The interruption method approximated deletion and retention of rate-specific linguistic information (0.5–64 Hz) in speech by substituting either white space or silent intervals for text or speech in the original sentences.

Results

A similar U-shaped pattern of cross-rate variation in performance was observed in both modalities, with minima at 2 Hz. However, at the highest and lowest interruption rates, recognition accuracy was greater for text than speech, whereas the reverse was observed at middle rates. An analysis of word duration and the frequency of word sampling across interruption rates suggested that the location of the function minima was influenced by perceptual reconstruction of whole words. Overall, the findings indicate a high degree of similarity in the perceptual organization of interrupted speech and text.

Conclusion

The observed rate-specific variation in the perception of speech and text may potentially affect the degree to which recognition accuracy in one modality is predictive of the other.

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Bilingual Speech Sound Development During the Preschool Years: The Role of Language Proficiency and Cross-Linguistic Relatedness

Purpose

The purpose of this study was to investigate typical Spanish–English speech sound development longitudinally in a group of bilingual preschoolers enrolled in a Head Start Program and to examine the extent to which such development is linked to language proficiency. The study also aimed to identify whether speech development is related cross-linguistically and to improve our understanding of error patterns in this population.

Method

Thirty-five bilingual preschool children produced single-word speech samples in Spanish and English both at the beginning of their first and their second year in a Head Start Program. Conversational samples in both languages were also collected at these data points to calculate mean length of utterance in words (MLUw) and thus assess the children's linguistic proficiency. The phonetically transcribed speech samples were compared over time in terms of segmental accuracy measures and error pattern frequencies. Correlation analyses were run to examine the relation between segmental accuracy measures across languages and between speech sound production and MLUw.

Results

One-way within-subject analysis of variance revealed significant improvements in accuracy over time in both languages, but not always for cross-linguistically unshared segments, nor for all consonant manner classes. Overall error rates decreased over time in both languages; although, certain error types showed no change. Cross-linguistic interactions were low in both languages. The results also revealed significant cross-linguistic correlations in segmental accuracy between Spanish and English, as well as between MLUw and speech sound production in both languages on a range of measures, with language-specific differences in Year 2 of the Head Start Program, but not in Year 1.

Conclusions

This study is the first to document developmental changes in the speech patterns of Spanish–English bilingual preschool children over 1 year. Accuracy rates improved significantly in both languages, suggesting that enhanced exposure to the majority language at school may not impede phonological development in the home language. Bootstrapping effects were particularly pronounced on cross-linguistically shared sounds, which suggests that the same underlying skills are utilized in both languages, whereas language-specific singleton consonants and consonant clusters did not appear to benefit from exposure to the other language. The results also suggest an intricate link between phonological skills and morphosyntactic performance at the early stages of development, but a more complex pattern thereafter with differences that may be based on language-specific phonological properties.

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Pilot Study of Audiometric Patterns in Fuchs Corneal Dystrophy

Purpose

Although Fuchs corneal dystrophy (FCD) is considered an eye disease, a small number of studies have identified genes related to both FCD and hearing loss. Whether FCD is related to hearing loss is unknown.

Method

This is a case–control study comparing pure-tone audiometry hearing thresholds in 180 patients with FCD from a hospital-based ophthalmology clinic with 2,575 population-based controls from a nationally representative survey, the National Health and Nutrition Examination Survey (from cycles 2005-06 and 2009-10). Generalized estimating equations were used to compare mean better-hearing ear thresholds in the 2 groups adjusted for age, sex, race, and noise exposure.

Results

Patients with FCD had higher hearing thresholds (worse hearing) in lower frequencies (mean difference at 0.5 kHz = 3.49 dB HL) and lower hearing thresholds (better hearing) in higher frequencies (difference at 4 kHz = −4.25 dB HL) compared with population-based controls.

Conclusion

In the first study to use objectively measured hearing, FCD was associated with poorer low-frequency and better high-frequency audiometric thresholds than population controls. Further studies are needed to characterize this relationship.

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Examining Factors Influencing the Viability of Automatic Acoustic Analysis of Child Speech

Purpose

Heterogeneous child speech was force-aligned to investigate whether (a) manipulating specific parameters could improve alignment accuracy and (b) forced alignment could be used to replicate published results on acoustic characteristics of /s/ production by children.

Method

In Part 1, child speech from 2 corpora was force-aligned with a trainable aligner (Prosodylab-Aligner) under different conditions that systematically manipulated input training data and the type of transcription used. Alignment accuracy was determined by comparing hand and automatic alignments as to how often they overlapped (%-Match) and absolute differences in duration and boundary placements. Using mixed-effects regression, accuracy was modeled as a function of alignment conditions, as well as segment and child age. In Part 2, forced alignments derived from a subset of the alignment conditions in Part 1 were used to extract spectral center of gravity of /s/ productions from young children. These findings were compared to published results that used manual alignments of the same data.

Results

Overall, the results of Part 1 demonstrated that using training data more similar to the data to be aligned as well as phonetic transcription led to improvements in alignment accuracy. Speech from older children was aligned more accurately than younger children. In Part 2, /s/ center of gravity extracted from force-aligned segments was found to diverge in the speech of male and female children, replicating the pattern found in previous work using manually aligned segments. This was true even for the least accurate forced alignment method.

Conclusions

Alignment accuracy of child speech can be improved by using more specific training and transcription. However, poor alignment accuracy was not found to impede acoustic analysis of /s/ produced by even very young children. Thus, forced alignment presents a useful tool for the analysis of child speech.

Supplemental Material

https://doi.org/10.23641/asha.7070105

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Changes in English Past Tense Use by Bilingual School-Age Children With and Without Developmental Language Disorder

Purpose

The purpose of this study is to examine changes in English past tense accuracy and errors among Spanish–English bilingual children with typical development (TD) and developmental language disorder (DLD).

Method

Thirty-three children were tested before and after 1 year to examine changes in clinically relevant English past tense errors using an elicited production task. A mixed-model linear regression using age as a continuous variable revealed a robust effect for age. A 4-way repeated-measures analysis of variance was conducted with age (young, old) and language ability group (TD, DLD) as between-subjects variables, time (Time 1, Time 2) and verb type (regular, irregular, and novel verbs) as within-subject variables, and percent accuracy as the dependent variable. Subsequently, a 4-way repeated-measures analysis of variance was conducted to measure the overall distribution of verb errors across 2 time points.

Results

Overall, children produced regular and novel verb past tense forms with higher accuracy than irregular past tense verbs in an elicitation task. Children with TD were more accurate than children with DLD. Younger children made more improvement than older children from Time 1 to Time 2, especially in the regular and novel verb conditions. Bare stem and overregularization were the most common errors across all groups. Errors consisting of stem + ing were more common in children with DLD than those with TD in the novel verb condition.

Discussion

Contrary to an earlier report (Jacobson & Schwartz, 2005), the relative greater difficulty with regular and novel verbs was replaced by greater difficulty for irregular past tense, a pattern consistent with monolingual impairment. Age was a contributing factor, particularly for younger children with DLD who produced more stem + ing errors in the novel verb condition. For all children, and particularly for those with DLD, an extended period for irregular past tense learning was evident. The results support a usage-based theory of language acquisition and impairment.

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Characteristics of Speech Rate in Children With Cerebral Palsy: A Longitudinal Study

Purpose

The purpose of this longitudinal study was to examine the effect of time and sentence length on speech rate and its characteristics, articulation rate and pauses, within 2 groups of children with cerebral palsy (CP).

Method

Thirty-four children with CP, 18 with no speech motor involvement and 16 with speech motor involvement, produced sentences of varying lengths at 3 time points that were 1 year apart (mean age = 56 months at first time point). Dependent measures included speech rate, articulation rate, proportion of time spent pausing, and average number and duration of pauses.

Results

There were no significant effects of time. For children with no speech motor involvement, speech rate increased with longer sentences due to increased articulation rate. For children with speech motor involvement, speech rate did not change with sentence length due to significant increases in the proportion of time spent pausing and average number of pauses in longer sentences.

Conclusions

There were no significant age-related differences in speech rate in children with CP regardless of group membership. Sentence length differentially impacted speech rate and its characteristics in both groups of children with CP. This may be due to cognitive–linguistic and/or speech motor control factors.

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Development of Phonological, Lexical, and Syntactic Abilities in Children With Cochlear Implants Across the Elementary Grades

Purpose

This study assessed phonological, lexical, and morphosyntactic abilities at 6th grade for a group of children previously tested at 2nd grade to address 4 questions: (a) Do children with cochlear implants (CIs) demonstrate deficits at 6th grade? (b) Are those deficits greater, the same, or lesser in magnitude than those observed at 2nd grade? (c) How do the measured skills relate to each other? and (d) How do treatment variables affect outcome measures?

Participants

Sixty-two 6th graders (29 with normal hearing, 33 with CIs) participated, all of whom had their language assessed at 2nd grade.

Method

Data are reported for 12 measures obtained at 6th grade, assessing phonological, lexical, and morphosyntactic abilities. Between-groups analyses were conducted on 6th-grade measures and the magnitude of observed effects compared with those observed at 2nd grade. Correlational analyses were performed among the measures at 6th grade. Cross-lagged analyses were performed on specific 2nd- and 6th-grade measures of phonological awareness, vocabulary, and literacy to assess factors promoting phonological and lexical development. Treatment effects of age of 1st CI, preimplant thresholds, and bimodal experience were evaluated.

Results

Deficits remained fairly consistent in type and magnitude across elementary school. The largest deficits were found for phonological skills and the least for morphosyntactic skills, with lexical skills intermediate. Phonological and morphosyntactic skills were largely independent of each other; lexical skills were moderately related to phonological skills but not morphosyntactic skills. Literacy acquisition strongly promoted both phonological and lexical development. Of the treatment variables, only bimodal experience affected outcomes and did so positively.

Conclusions

Congenital hearing loss puts children at continued risk of language deficits, especially for phonologically based skills. Two interventions that appear to ameliorate that risk are providing a period of bimodal stimulation and strong literacy instruction.

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Erratum

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Hearing Loss Treatment in Older Adults With Cognitive Impairment: A Systematic Review

Purpose

The purpose of this systematic review was to assess studies of treating hearing loss in older adults with cognitive impairment. Of interest to this review is identifying clinical adaptations that may be used to tailor hearing loss treatment to older adults with cognitive impairment in order to better serve this vulnerable population.

Method

A systematic search with controlled vocabulary and key word terms was applied to PubMed, the Cochrane Library, Embase, CINAHL, and PsycINFO. Search concepts included terms related to hearing loss and cognitive impairment. The overall search resulted in 4,945 unique references, 50 of which were eligible for full-text review and 13 of which were included in the final review. Included manuscripts were categorized according to the American Speech-Language-Hearing Association's levels of evidence and the National Institutes of Health Quality Assessment Tools.

Results

Only 1 study implemented a randomized controlled trial design to assess cognitive function and behavioral symptoms after treatment with hearing aids. Other quasiexperimental studies evaluated dementia-related symptoms and/or auditory function after treating hearing loss in pre/post research designs. Finally, evidence from case studies suggested that hearing loss treatment is feasible, reduces stressful communication for caregivers, and improves dementia-related behavior problems.

Conclusion

Based on the systematic review, evidence suggests that treating hearing loss in persons with cognitive impairment can have benefits to communication and quality of life. Because of the quasi- and nonexperimental nature of most of the evidence found in this review, further studies are necessary to understand the effect of treatment in the context of a variable and progressive disease.

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Explaining Reading Comprehension in Children With Developmental Language Disorder: The Importance of Elaborative Inferencing

Purpose

Reading comprehension is a key indicator of academic and psychosocial outcomes. Children with developmental language disorder (DLD) tend to find reading comprehension challenging. This study aimed to explore the literal and inferential (cohesive, elaborative, and lexical) comprehension of children with DLD, their typically developing (TD) peers, and, uniquely, a group of children with low language (LL) proficiency.

Method

Children aged 10–11 years with either typical development (n = 16), LL proficiency (n = 14), or DLD (n = 14) were recruited from 8 primary schools. They completed a battery of standardized language and literacy assessments. Responses to literal and inferential questions on the Wechsler Individual Achievement Test–Second UK Edition (Wechsler, 2005) were analyzed.

Results

A disproportionate difficulty in answering inferential relative to literal questions was found for the DLD group compared to the LL and TD groups. Children with DLD were significantly poorer at elaborative inferencing than both their peers with LL proficiency and TD peers, but there were no group differences in cohesive or lexical inferencing. There was a significant positive association between inferencing ability and vocabulary knowledge, single word reading accuracy, grammatical skill, and verbal working memory. The importance of single word reading accuracy was especially evident as a partial mediator of the relationship between vocabulary knowledge and inferencing ability.

Conclusions

These results indicate that interventions targeting the reading comprehension of children with DLD should focus on elaborative inferencing skill. There are also clinical implications as the development of new standardized assessments differentiating between inference types is called for.

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The Mandarin Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and Its Reliability

Purpose

The purpose of this study is to develop the Mandarin version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and evaluate its reliability compared with the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS).

Method

The Mandarin version of the CAPE-V tool was translated from the validated English version with phonemic adaptations, content adjustment, and scale modification. Sixty dysphonic, 20 normal, and 20 repeated voice samples were included in this study. Ten of these were used for preassessment training; the remaining 90 were evaluated using the Mandarin CAPE-V and GRBAS for comparison of their interrater and intrarater reliabilities.

Results

Intrarater reliability was measured by Pearson r for the CAPE-V and Spearman rho for the GRBAS. Average CAPE-V Pearson r ranged from 0.80 for strain to 0.91 for overall severity, compared with average GRBAS Spearman rho of 0.83 for strain to 0.89 for asthenia. Interrater reliability was measured by an intraclass coefficient (ICC). Average CAPE-V ICCs ranged from .57 for pitch to .81 for overall severity, compared with average GRBAS ICCs of .60 for asthenia to .83 for grade.

Conclusions

The Mandarin CAPE-V addresses some limits of the English version. It also demonstrates good intrarater and interrater reliability, comparable to those of GRBAS.

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Perceptual Organization of Interrupted Speech and Text

Purpose

Visual recognition of interrupted text may predict speech intelligibility under adverse listening conditions. This study investigated the nature of the linguistic information and perceptual processes underlying this relationship.

Method

To directly compare the perceptual organization of interrupted speech and text, we examined the recognition of spoken and printed sentences interrupted at different rates in 14 adults with normal hearing. The interruption method approximated deletion and retention of rate-specific linguistic information (0.5–64 Hz) in speech by substituting either white space or silent intervals for text or speech in the original sentences.

Results

A similar U-shaped pattern of cross-rate variation in performance was observed in both modalities, with minima at 2 Hz. However, at the highest and lowest interruption rates, recognition accuracy was greater for text than speech, whereas the reverse was observed at middle rates. An analysis of word duration and the frequency of word sampling across interruption rates suggested that the location of the function minima was influenced by perceptual reconstruction of whole words. Overall, the findings indicate a high degree of similarity in the perceptual organization of interrupted speech and text.

Conclusion

The observed rate-specific variation in the perception of speech and text may potentially affect the degree to which recognition accuracy in one modality is predictive of the other.

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Bilingual Speech Sound Development During the Preschool Years: The Role of Language Proficiency and Cross-Linguistic Relatedness

Purpose

The purpose of this study was to investigate typical Spanish–English speech sound development longitudinally in a group of bilingual preschoolers enrolled in a Head Start Program and to examine the extent to which such development is linked to language proficiency. The study also aimed to identify whether speech development is related cross-linguistically and to improve our understanding of error patterns in this population.

Method

Thirty-five bilingual preschool children produced single-word speech samples in Spanish and English both at the beginning of their first and their second year in a Head Start Program. Conversational samples in both languages were also collected at these data points to calculate mean length of utterance in words (MLUw) and thus assess the children's linguistic proficiency. The phonetically transcribed speech samples were compared over time in terms of segmental accuracy measures and error pattern frequencies. Correlation analyses were run to examine the relation between segmental accuracy measures across languages and between speech sound production and MLUw.

Results

One-way within-subject analysis of variance revealed significant improvements in accuracy over time in both languages, but not always for cross-linguistically unshared segments, nor for all consonant manner classes. Overall error rates decreased over time in both languages; although, certain error types showed no change. Cross-linguistic interactions were low in both languages. The results also revealed significant cross-linguistic correlations in segmental accuracy between Spanish and English, as well as between MLUw and speech sound production in both languages on a range of measures, with language-specific differences in Year 2 of the Head Start Program, but not in Year 1.

Conclusions

This study is the first to document developmental changes in the speech patterns of Spanish–English bilingual preschool children over 1 year. Accuracy rates improved significantly in both languages, suggesting that enhanced exposure to the majority language at school may not impede phonological development in the home language. Bootstrapping effects were particularly pronounced on cross-linguistically shared sounds, which suggests that the same underlying skills are utilized in both languages, whereas language-specific singleton consonants and consonant clusters did not appear to benefit from exposure to the other language. The results also suggest an intricate link between phonological skills and morphosyntactic performance at the early stages of development, but a more complex pattern thereafter with differences that may be based on language-specific phonological properties.

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Pilot Study of Audiometric Patterns in Fuchs Corneal Dystrophy

Purpose

Although Fuchs corneal dystrophy (FCD) is considered an eye disease, a small number of studies have identified genes related to both FCD and hearing loss. Whether FCD is related to hearing loss is unknown.

Method

This is a case–control study comparing pure-tone audiometry hearing thresholds in 180 patients with FCD from a hospital-based ophthalmology clinic with 2,575 population-based controls from a nationally representative survey, the National Health and Nutrition Examination Survey (from cycles 2005-06 and 2009-10). Generalized estimating equations were used to compare mean better-hearing ear thresholds in the 2 groups adjusted for age, sex, race, and noise exposure.

Results

Patients with FCD had higher hearing thresholds (worse hearing) in lower frequencies (mean difference at 0.5 kHz = 3.49 dB HL) and lower hearing thresholds (better hearing) in higher frequencies (difference at 4 kHz = −4.25 dB HL) compared with population-based controls.

Conclusion

In the first study to use objectively measured hearing, FCD was associated with poorer low-frequency and better high-frequency audiometric thresholds than population controls. Further studies are needed to characterize this relationship.

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Examining Factors Influencing the Viability of Automatic Acoustic Analysis of Child Speech

Purpose

Heterogeneous child speech was force-aligned to investigate whether (a) manipulating specific parameters could improve alignment accuracy and (b) forced alignment could be used to replicate published results on acoustic characteristics of /s/ production by children.

Method

In Part 1, child speech from 2 corpora was force-aligned with a trainable aligner (Prosodylab-Aligner) under different conditions that systematically manipulated input training data and the type of transcription used. Alignment accuracy was determined by comparing hand and automatic alignments as to how often they overlapped (%-Match) and absolute differences in duration and boundary placements. Using mixed-effects regression, accuracy was modeled as a function of alignment conditions, as well as segment and child age. In Part 2, forced alignments derived from a subset of the alignment conditions in Part 1 were used to extract spectral center of gravity of /s/ productions from young children. These findings were compared to published results that used manual alignments of the same data.

Results

Overall, the results of Part 1 demonstrated that using training data more similar to the data to be aligned as well as phonetic transcription led to improvements in alignment accuracy. Speech from older children was aligned more accurately than younger children. In Part 2, /s/ center of gravity extracted from force-aligned segments was found to diverge in the speech of male and female children, replicating the pattern found in previous work using manually aligned segments. This was true even for the least accurate forced alignment method.

Conclusions

Alignment accuracy of child speech can be improved by using more specific training and transcription. However, poor alignment accuracy was not found to impede acoustic analysis of /s/ produced by even very young children. Thus, forced alignment presents a useful tool for the analysis of child speech.

Supplemental Material

https://doi.org/10.23641/asha.7070105

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Changes in English Past Tense Use by Bilingual School-Age Children With and Without Developmental Language Disorder

Purpose

The purpose of this study is to examine changes in English past tense accuracy and errors among Spanish–English bilingual children with typical development (TD) and developmental language disorder (DLD).

Method

Thirty-three children were tested before and after 1 year to examine changes in clinically relevant English past tense errors using an elicited production task. A mixed-model linear regression using age as a continuous variable revealed a robust effect for age. A 4-way repeated-measures analysis of variance was conducted with age (young, old) and language ability group (TD, DLD) as between-subjects variables, time (Time 1, Time 2) and verb type (regular, irregular, and novel verbs) as within-subject variables, and percent accuracy as the dependent variable. Subsequently, a 4-way repeated-measures analysis of variance was conducted to measure the overall distribution of verb errors across 2 time points.

Results

Overall, children produced regular and novel verb past tense forms with higher accuracy than irregular past tense verbs in an elicitation task. Children with TD were more accurate than children with DLD. Younger children made more improvement than older children from Time 1 to Time 2, especially in the regular and novel verb conditions. Bare stem and overregularization were the most common errors across all groups. Errors consisting of stem + ing were more common in children with DLD than those with TD in the novel verb condition.

Discussion

Contrary to an earlier report (Jacobson & Schwartz, 2005), the relative greater difficulty with regular and novel verbs was replaced by greater difficulty for irregular past tense, a pattern consistent with monolingual impairment. Age was a contributing factor, particularly for younger children with DLD who produced more stem + ing errors in the novel verb condition. For all children, and particularly for those with DLD, an extended period for irregular past tense learning was evident. The results support a usage-based theory of language acquisition and impairment.

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Characteristics of Speech Rate in Children With Cerebral Palsy: A Longitudinal Study

Purpose

The purpose of this longitudinal study was to examine the effect of time and sentence length on speech rate and its characteristics, articulation rate and pauses, within 2 groups of children with cerebral palsy (CP).

Method

Thirty-four children with CP, 18 with no speech motor involvement and 16 with speech motor involvement, produced sentences of varying lengths at 3 time points that were 1 year apart (mean age = 56 months at first time point). Dependent measures included speech rate, articulation rate, proportion of time spent pausing, and average number and duration of pauses.

Results

There were no significant effects of time. For children with no speech motor involvement, speech rate increased with longer sentences due to increased articulation rate. For children with speech motor involvement, speech rate did not change with sentence length due to significant increases in the proportion of time spent pausing and average number of pauses in longer sentences.

Conclusions

There were no significant age-related differences in speech rate in children with CP regardless of group membership. Sentence length differentially impacted speech rate and its characteristics in both groups of children with CP. This may be due to cognitive–linguistic and/or speech motor control factors.

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Development of Phonological, Lexical, and Syntactic Abilities in Children With Cochlear Implants Across the Elementary Grades

Purpose

This study assessed phonological, lexical, and morphosyntactic abilities at 6th grade for a group of children previously tested at 2nd grade to address 4 questions: (a) Do children with cochlear implants (CIs) demonstrate deficits at 6th grade? (b) Are those deficits greater, the same, or lesser in magnitude than those observed at 2nd grade? (c) How do the measured skills relate to each other? and (d) How do treatment variables affect outcome measures?

Participants

Sixty-two 6th graders (29 with normal hearing, 33 with CIs) participated, all of whom had their language assessed at 2nd grade.

Method

Data are reported for 12 measures obtained at 6th grade, assessing phonological, lexical, and morphosyntactic abilities. Between-groups analyses were conducted on 6th-grade measures and the magnitude of observed effects compared with those observed at 2nd grade. Correlational analyses were performed among the measures at 6th grade. Cross-lagged analyses were performed on specific 2nd- and 6th-grade measures of phonological awareness, vocabulary, and literacy to assess factors promoting phonological and lexical development. Treatment effects of age of 1st CI, preimplant thresholds, and bimodal experience were evaluated.

Results

Deficits remained fairly consistent in type and magnitude across elementary school. The largest deficits were found for phonological skills and the least for morphosyntactic skills, with lexical skills intermediate. Phonological and morphosyntactic skills were largely independent of each other; lexical skills were moderately related to phonological skills but not morphosyntactic skills. Literacy acquisition strongly promoted both phonological and lexical development. Of the treatment variables, only bimodal experience affected outcomes and did so positively.

Conclusions

Congenital hearing loss puts children at continued risk of language deficits, especially for phonologically based skills. Two interventions that appear to ameliorate that risk are providing a period of bimodal stimulation and strong literacy instruction.

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Erratum

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Hearing Loss Treatment in Older Adults With Cognitive Impairment: A Systematic Review

Purpose

The purpose of this systematic review was to assess studies of treating hearing loss in older adults with cognitive impairment. Of interest to this review is identifying clinical adaptations that may be used to tailor hearing loss treatment to older adults with cognitive impairment in order to better serve this vulnerable population.

Method

A systematic search with controlled vocabulary and key word terms was applied to PubMed, the Cochrane Library, Embase, CINAHL, and PsycINFO. Search concepts included terms related to hearing loss and cognitive impairment. The overall search resulted in 4,945 unique references, 50 of which were eligible for full-text review and 13 of which were included in the final review. Included manuscripts were categorized according to the American Speech-Language-Hearing Association's levels of evidence and the National Institutes of Health Quality Assessment Tools.

Results

Only 1 study implemented a randomized controlled trial design to assess cognitive function and behavioral symptoms after treatment with hearing aids. Other quasiexperimental studies evaluated dementia-related symptoms and/or auditory function after treating hearing loss in pre/post research designs. Finally, evidence from case studies suggested that hearing loss treatment is feasible, reduces stressful communication for caregivers, and improves dementia-related behavior problems.

Conclusion

Based on the systematic review, evidence suggests that treating hearing loss in persons with cognitive impairment can have benefits to communication and quality of life. Because of the quasi- and nonexperimental nature of most of the evidence found in this review, further studies are necessary to understand the effect of treatment in the context of a variable and progressive disease.

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Explaining Reading Comprehension in Children With Developmental Language Disorder: The Importance of Elaborative Inferencing

Purpose

Reading comprehension is a key indicator of academic and psychosocial outcomes. Children with developmental language disorder (DLD) tend to find reading comprehension challenging. This study aimed to explore the literal and inferential (cohesive, elaborative, and lexical) comprehension of children with DLD, their typically developing (TD) peers, and, uniquely, a group of children with low language (LL) proficiency.

Method

Children aged 10–11 years with either typical development (n = 16), LL proficiency (n = 14), or DLD (n = 14) were recruited from 8 primary schools. They completed a battery of standardized language and literacy assessments. Responses to literal and inferential questions on the Wechsler Individual Achievement Test–Second UK Edition (Wechsler, 2005) were analyzed.

Results

A disproportionate difficulty in answering inferential relative to literal questions was found for the DLD group compared to the LL and TD groups. Children with DLD were significantly poorer at elaborative inferencing than both their peers with LL proficiency and TD peers, but there were no group differences in cohesive or lexical inferencing. There was a significant positive association between inferencing ability and vocabulary knowledge, single word reading accuracy, grammatical skill, and verbal working memory. The importance of single word reading accuracy was especially evident as a partial mediator of the relationship between vocabulary knowledge and inferencing ability.

Conclusions

These results indicate that interventions targeting the reading comprehension of children with DLD should focus on elaborative inferencing skill. There are also clinical implications as the development of new standardized assessments differentiating between inference types is called for.

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Paretic propulsion as a measure of walking performance and functional motor recovery post-stroke: a review

Publication date: Available online 25 October 2018

Source: Gait & Posture

Author(s): Sarah A. Roelker, Mark G. Bowden, Steven A. Kautz, Richard R. Neptune

Abstract

Background

Although walking speed is the most common measure of gait performance post-stroke, improved walking speed following rehabilitation does not always indicate the recovery of paretic limb function. Over the last decade, the measure paretic propulsion (Pp, defined as the propulsive impulse generated by the paretic leg divided by the sum of the propulsive impulses of both legs) has been established as a measure of paretic limb output and recently targeted in post-stroke rehabilitation paradigms. However, the literature lacks a detailed synthesis of how paretic propulsion, walking speed, and other biomechanical and neuromuscular measures collectively relate to post-stroke walking performance and motor recovery.

Objective

The aim of this review was to assess factors associated with the ability to generate Pp and identify rehabilitation targets aimed at improving Pp and paretic limb function.

Methods

Relevant literature was collected in which paretic propulsion was used to quantify and assess propulsion symmetry and function in hemiparetic gait.

Results

Paretic leg extension during terminal stance is strongly associated with Pp. Both paretic leg extension and propulsion are related to step length asymmetry, revealing an interaction between spatiotemporal, kinematic and kinetic metrics that underlies hemiparetic walking performance. The importance of plantarflexor function in producing propulsion is highlighted by the association of an independent plantarflexor excitation module with increased Pp. Furthermore, the literature suggests that although current rehabilitation techniques can improve Pp, these improvements depend on the patient’s baseline plantarflexor function.

Significance

Pp provides a quantitative measure of propulsion symmetry and should be a primary target of post-stroke gait rehabilitation. The current literature suggests rehabilitation techniques that target both plantarflexor function and leg extension may restore paretic limb function and improve gait asymmetries in individuals post stroke.

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Paretic propulsion as a measure of walking performance and functional motor recovery post-stroke: a review

Publication date: Available online 25 October 2018

Source: Gait & Posture

Author(s): Sarah A. Roelker, Mark G. Bowden, Steven A. Kautz, Richard R. Neptune

Abstract

Background

Although walking speed is the most common measure of gait performance post-stroke, improved walking speed following rehabilitation does not always indicate the recovery of paretic limb function. Over the last decade, the measure paretic propulsion (Pp, defined as the propulsive impulse generated by the paretic leg divided by the sum of the propulsive impulses of both legs) has been established as a measure of paretic limb output and recently targeted in post-stroke rehabilitation paradigms. However, the literature lacks a detailed synthesis of how paretic propulsion, walking speed, and other biomechanical and neuromuscular measures collectively relate to post-stroke walking performance and motor recovery.

Objective

The aim of this review was to assess factors associated with the ability to generate Pp and identify rehabilitation targets aimed at improving Pp and paretic limb function.

Methods

Relevant literature was collected in which paretic propulsion was used to quantify and assess propulsion symmetry and function in hemiparetic gait.

Results

Paretic leg extension during terminal stance is strongly associated with Pp. Both paretic leg extension and propulsion are related to step length asymmetry, revealing an interaction between spatiotemporal, kinematic and kinetic metrics that underlies hemiparetic walking performance. The importance of plantarflexor function in producing propulsion is highlighted by the association of an independent plantarflexor excitation module with increased Pp. Furthermore, the literature suggests that although current rehabilitation techniques can improve Pp, these improvements depend on the patient’s baseline plantarflexor function.

Significance

Pp provides a quantitative measure of propulsion symmetry and should be a primary target of post-stroke gait rehabilitation. The current literature suggests rehabilitation techniques that target both plantarflexor function and leg extension may restore paretic limb function and improve gait asymmetries in individuals post stroke.

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