Language Disabilities Research Articles

Four heterozygous de novo variants in ASXL3 identified with Bainbridge–Ropers syndrome and further dissecting published genotype–phenotype spectrum

Bainbridge–Ropers syndrome (BRPS) is a recently described neurodevelopmental genetic disorder associated with de novo truncating variants in additional sex combs like 3 (ASXL3) on chromosome 18q12.1. Trio-based exome sequencing was conducted on patients admitted to the Children’s Hospital Affiliated to Shandong University and diagnosed with unexplained intellectual disabilities or developmental delay between June 2022 and January 2024. De novo truncation of ASXL3 was identified in four patients, and the pathogenic variants and their de novo status were validated using Sanger sequencing. Comprehensive clinical phenotype–genotype information of all previously reported patients with BRPS was collected and summarized. The common clinical manifestations observed in the four patients included language and intellectual disabilities or psychomotor retardation. Genetic analysis revealed that patient 1 carried a de novo heterozygous variant, c.1667_1668del (p.Thr556Arpfs*3), whereas patient 2 had a novel heterozygous frameshift variant of ASXL3, c.3324del (p.Lys1109Serfs*34). These two variants have not been documented to date. Additionally, patients 3 and 4 exhibited a de novo variant, c.4678C > T (p.Arg1560Ter). Based on the combined assessment of clinical phenotypes and genetic testing results, it was postulated that all four children presented with BRPS syndrome caused by pathogenic variations in ASXL3. The present study complements the range of ASXL3 mutational and phenotypic spectra in the population, highlighting subtle distinctions in clinical manifestations between Chinese patients and other racial groups. The reporting of additional cases will contribute to further elucidating the function of ASXL3 and establishing a solid foundation for clinical diagnosis and treatment.

Cognitive interviews on the Swedish occupational balance questionnaire

Background The Occupational Balance Questionnaire (OBQ11) is a commonly used instrument for measuring self-rated occupational balance. It needs further development, and therefore an additional 11 tentative items have been developed. One aspect of this is studying the interpretations and reasoning of people responding to the items/instrument. Aim The aim of this study was to explore and describe how adults interpret and reason in relation to OBQ11 overall, the individual items in the instrument as well as the new tentative items. Method Cognitive interviews were conducted with eight participants varying in age, gender, living situation, education, native language, and self-reported disability. They were included using a combination of purposive and convenience sampling. The interviews were analysed using a content analysis with an inductive approach. Results The analysis resulted in three main categories: ‘Difficulties understanding the items’ (with two subcategories), ‘Structure of the instrument’ (with four subcategories) and ‘Missed perspectives in the instrument’ (with four subcategories). Conclusions The participants considered the items and the instrument relevant for assessing occupational balance. However, the results also revealed the need for more clarifications and changed item order prior to introducing a potential new version of the instrument.

Community-Supported Shared Infrastructure in Support of Speech Accessibility.

The Speech Accessibility Project (SAP) intends to facilitate research and development in automatic speech recognition (ASR) and other machine learning tasks for people with speech disabilities. The purpose of this article is to introduce this project as a resource for researchers, including baseline analysis of the first released data package. The project aims to facilitate ASR research by collecting, curating, and distributing transcribed U.S. English speech from people with speech and/or language disabilities. Participants record speech from their place of residence by connecting their personal computer, cell phone, and assistive devices, if needed, to the SAP web portal. All samples are manually transcribed, and 30 per participant are annotated using differential diagnostic pattern dimensions. For purposes of ASR experiments, the participants have been randomly assigned to a training set, a development set for controlled testing of a trained ASR, and a test set to evaluate ASR error rate. The SAP 2023-10-05 Data Package contains the speech of 211 people with dysarthria as a correlate of Parkinson's disease, and the associated test set contains 42 additional speakers. A baseline ASR, with a word error rate of 3.4% for typical speakers, transcribes test speech with a word error rate of 36.3%. Fine-tuning reduces the word error rate to 23.7%. Preliminary findings suggest that a large corpus of dysarthric and dysphonic speech has the potential to significantly improve speech technology for people with disabilities. By providing these data to researchers, the SAP intends to significantly accelerate research into accessible speech technology. https://doi.org/10.23641/asha.27078079.

Abstract C137: Exploring cardiotoxicity risk factors among patients diagnosed with breast cancer

Abstract Introduction Heart disease is the second most common cause of death for cancer survivors after their cancer diagnosis. Patients diagnosed with cancer, especially those with left-side breast cancer are at higher risk for treatment related toxicity. This burden is exacerbated for vulnerable patients that experience structural and chronic risk factors such as language barriers and disability which contribute to poorer survival. This study compared multi-level factors and their effect on age of diagnosis. Methods We explored a diverse population of N=1795 patient electronic medical records for patients diagnosed with left-side breast cancer and compared characteristics of patients by age, race, ethnicity, history of heart disease, disability status. Descriptive and Kruskal-Wallis ANOVA models were used to compare groups. Results The mostly female cohort of language diverse patients had an average of 66 years, most were White (64.5%), retired (52.1%), and on Medicare (43.2%). Approximately 17.8% were Latine and 13.3% needed an interpreter. Disability status was 9.7% and 8.8% had a history of heart disease. Patients diagnosed with breast cancer who were disabled were younger compared to those without a disability (60 yrs vs 67, p<.0001). When we compared language proficiency, we found this difference persisted as patients with a disability and were limited English were younger compared to patients that experienced neither (61yrs vs 67, p<.0001). Discussion This exploratory analysis is one of the first to explore the role of disability among minoritized and limited English proficient patients with breast cancer. More research is necessary to understand how to best plan and support diverse and disabled patients diagnosed with cancer to minimize their risk and improve outcomes. Citation Format: Melody K Schiaffino, Van "Vannie" K. Nguyen, Dominique Rash, Alicia Fernandez. Exploring cardiotoxicity risk factors among patients diagnosed with breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C137.

Wellbeing in stroke and aphasia (WISA): protocol for a feasibility study setting up an accessible service offering psychological therapy to people with post-stroke aphasia

Background and aimFollowing a stroke, around a quarter of people will have aphasia, a language disability. Aphasia can have a devastating long-term impact on a person’s psychological wellbeing, yet their language difficulties make it challenging to access mental health care. The Wellbeing In Stroke and Aphasia (WISA) study aims to evaluate the feasibility of setting up an accessible psychological service for people with aphasia.MethodsThe service will be open to people with post-stroke aphasia (n = 30) who live in the UK, are able to access the service either in the university clinic or via telehealth and are not currently receiving therapy from a mental health professional. Participants will be offered up to 8 therapy sessions over 6 months, either one-to-one, with family, or in a group. The intervention is Solution Focused Brief Therapy (SFBT), a brief psychological therapy, delivered by speech and language therapists with training in SFBT under the supervision of a stroke-specialist clinical psychologist. As part of this service, a protocol for addressing mental health care has been developed. Feasibility will be assessed by monitoring referral rates, therapy received, discharge processes, resource capability, costs, challenges, and adverse events. Patient-reported outcome measures collected pre and post intervention will assess mental wellbeing, mood, participation, and satisfaction with therapy and the service. A purposive sample will take part in in-depth interviews following therapy.DiscussionGiven the high levels of psychological distress in this client group, there is a need to investigate innovative ways to provide accessible and acceptable psychological support.

Data visualization and decision making in adults with acquired and developmental language disabilities: A scoping review.

Accessibility of data visualization has been explored for users with visual disabilities but the needs of users with language disabilities have seldom been considered. This scoping review synthesised what is known about data visualization for adults with language disabilities, specifically the acquired language disability, aphasia and Developmental Language Disorder. It sought to extract key findings and identify what practices support effective visualization for decision making for people with language disabilities. Papers were included if they investigated visualization of data, and the consumers of the data visualization were people with aphasia or developmental language disability. Seven databases were searched: CINAHL, Academic Search, Medline, PsychINFO, Ovid, ACM Digital Library and IEEE Xplore. Included studies were charted to extract title, author(s), year, country, paper type, scientific field, participant number(s), participant group(s), main topic, subtopic, method, task description, task category, data visualization, summary, key findings relevant to the review question, and guidelines or recommendations. Narrative synthesis was used to describe how people with language disability have interacted with data visualization from a range of literature. Six studies (seven publications) were included in the review. One study came from the field of health, one from a disability rights collaboration and four studies from computer science. No studies satisfying the review criteria explored data visualization for Developmental Language Disorder; however, five studies explored participants with cognitive disabilities that included impairments of language, so these were included. A range of visualization designs were found. Studies predominantly explored understanding of visualization (4/6). One study explored how to express data visually, and one explored the use of the visualization that is, for an action, choice, or decision. Cognitively accessible data visualization practices were described in four papers and synthesized. Supportive practices reported were reducing the cognitive load associated with processing a visualization and increasing personal relevance of data visualization. Accessible data visualization for adults with aphasia and Developmental Language Disorder has only minimally been explored. Practices to specifically support users with language disability are not yet apparent. As data use in making everyday decisions is widespread, future research should explore how people with language disabilities make use of data visualization. What is already known on this subject Visual resources are used widely to support people with language disabilities in understanding of language. That is, icons, maps timelines and so forth, are used to support auditory processing. However, data visualization is used routinely by people without a language disability to support everyday decisions for example, visualization of live traffic data is used to provide users with the best route to their destination. It is unclear whether any work has explored data visualization for people with language disabilities. What this paper adds to existing knowledge This paper brings together research on the use of data visualization by adults with either Developmental Language Disorder or aphasia, collectively people with language disabilities. It highlights a gap in the design of inclusive data visualization for language disabilities and the minimal research exploring the use of data visualization for decision making in these populations. What are the clinical implications of this work? Access to data can be empowering. It has potential to enable agency in decisions and increase social participation. The existing gap in knowledge about how to design inclusive data visualization for people with language disabilities thus poses a risk of exclusion and threats to informed decision making. Highlighting the current field of literature may drive research and clinical activity.

Chromosomal instability in a patient with ring chromosome 14 syndrome: a case report

BackgroundRing chromosome 14 syndrome is a rare disorder primarily marked by early-onset epilepsy, microcephaly, distinctive craniofacial features, hypotonia, intellectual disability, and delay in both development and language acquisition.Case presentationA 21-year-old woman with a history of epileptic seizures since the age of 1.5 years presented with distinctive craniofacial features, including a prominent and narrow forehead, sparse and short eyebrows, palpebral ptosis, horizontal palpebral fissures, a broad nasal bridge, a prominent nasal tip, a flat philtrum, hypertelorism, midfacial hypoplasia, horizontal labial fissures, a thin upper lip, crowded teeth, an ogival palate, retrognathia, and a wide neck. Additional physical abnormalities included kyphosis, lumbar scoliosis, pectus carinatum, cubitus valgus, thenar and hypothenar hypoplasia, bilateral hallux valgus, shortening of the Achilles tendon on the left foot, and hypoplasia of the labia minora. Chromosomal analysis identified a ring 14 chromosome with breakpoints in p11 and q32.33. An aCGH study revealed a ~ 1.7 Mb deletion on chromosome 14qter, encompassing 23 genes. Genomic instability was evidenced by the presence of micronuclei and aneuploidies involving the ring and other chromosomes.ConclusionThe clinical features of our patient closely resembled those observed in other individuals with ring chromosome 14 syndrome. The most important point was that we were able to verify an instability of the r(14) chromosome, mainly involving anaphasic lags and its exclusion from the nucleus in the form of a micronucleus.

Tensions of perceiving and practice: an intersectional raciolinguistic DisCrit inquiry

ABSTRACT This longitudinal qualitative case study contextualizes the dynamic interplay of race, language, and disability through a conceptual framework grounded in the principles of Raciolinguistics, DisCrit theory, and Intersectionality to surface the tensions between the way a language-racialized student labeled as a ‘long-term English learner’ and disabled is institutionally perceived by mechanisms of education policy and practice and the ways the student perceives herself. Findings shed light on how racism, linguicism, and ableism intersect and overlap to disenfranchise one student through dynamic encounters with institutional mechanisms of education policy and practice. In centering student voice, we bear witness to a narrative that speaks against the institutional record that depicts language use and disability as deficient. Findings illustrate two critical tensions: 1) the student perceives herself as a powerful language user who, unlike the process and practices of the school, see her as not fully capable of engaging with grade-level content, and 2) the student’s classification as having a disability contrasts with her belief that she is just like other students, highlighting the tension between her self-identification and the institutional classification ascribed to her.

Interventions for School-Aged Children with Auditory Processing Disorder: A Scoping Review.

(1) Background: Auditory processing (AP) disorder is associated with learning difficulties and poses challenges to school-aged children in their daily activities. This scoping review identifies interventions and provides audiologists with protocol insights and outcome measures. (2) Methods: A systematic search of both peer-reviewed and grey literature (January 2006 to August 2023) covered ten databases. Studies included had the following characteristics: (i) published in French or English; (ii) participants were school-aged, and had a normal audiogram, AP difficulties or disorder, and no cognitive, developmental, congenital or neurological disorder (with the exception of learning, attention, and language disabilities); (iii) were intervention studies or systematic reviews. (3) Results: Forty-two studies were included, and they predominantly featured auditory training (AT), addressing spatial processing, dichotic listening, temporal processing and listening to speech in noise. Some interventions included cognitive or language training, assistive devices or hearing aids. Outcome measures listed included electrophysiological, AP, cognitive and language measures and questionnaires addressed to parents, teachers or the participants. (4) Conclusions: Most interventions focused on bottom-up approaches, particularly AT. A limited number of top-down approaches were observed. The compiled tools underscore the need for research on metric responsiveness and point to the inadequate consideration given to understanding how children perceive change.

Neurophenotype and genetic analysis of children with Aicardi-Goutières syndrome in China.

Aicardi-Goutières syndrome (AGS) is a rare genetic disorder mainly affecting the central nervous system and autoimmunity. However, research on AGS among Chinese patients is limited. To summarize the neurologic phenotypes and genetic causes in pediatric AGS patients, providing insights for early recognition and diagnosis in the Chinese population. Clinical features and neuroimaging results of the patients diagnosed with AGS from Beijing Children's Hospital between January 2018 and January 2022 were collected. Whole exome sequencing was used for genetic analysis. A total of 15 patients was included, all presenting with various neurological symptoms, including developmental delay (100%), motor skill impairment (100%), language disability (78.6%), dystonia (93.3%), microcephaly (73.3%), sleep disorders (26.7%), regression (20.0%), vessel disease (6.7%), and epilepsy (6.7%). Neuroimaging revealed intracranial calcification (86.7%), cerebral atrophy (73.3%), and leukodystrophy (73.3%). Seven genes were identified, with TREX1 being the most common (40.0%, 6/15), followed by IFIH1 (20.0%, 3/15). Variant c.294dupA (p.C99Mfs*3) was detected in four unrelated patients, accounting for 66.7% (4/6) patients with the TREX1 variant. A literature review showed that TREX1 gene mutations in 35.6% (21/59) of AGS patients among the Chinese population. Neurological symptoms are the most prevalent and severe presentation of AGS. Diagnosis may be considered when symptoms such as developmental delay, dystonia, microcephaly, brain calcification, and leukodystrophy emerge. TREX1 mutations are predominant in the Chinese population.

Positive effects of speech and language therapy group interventions in primary progressive aphasia: A systematic review.

Primary progressive aphasia (PPA) is a neurodegenerative condition characterised by a prominent and progressive deterioration in language abilities, which significantly impacts quality of life and interpersonal relationships. Speech and language therapy plays a crucial role in offering interventions. Group intervention is one mode of delivery that could benefit communication functioning and overall wellbeing of people with PPA (pwPPA) and their care partners. Group interventions are also more efficient than one-to-one intervention and may facilitate peer support. The aim of this review was to systematically evaluate the current evidence for the effectiveness of speech and language therapy groups for pwPPA and their care partners. Specifically, this paper considered three questions: 1.What evidence-based speech and language therapy groups for pwPPA and their care partners have been reported to date? 2.Are group communication interventions effective in improving quality of life and communication function for pwPPA and their care partners? 3.Are group communication interventions that are designed for people with communication difficulties of other aetiologies (such as stroke) effective for pwPPA? In addition, this review aimed to describe the structure and content of groups, including aims, disciplines involved, size and frequency of group meetings, and outcome measures. MEDLINE, CINAHL and PsycINFO were used to retrieve articles of interest. A total of 10 studies published between 2009 and 2022 met the eligibility criteria and therefore were included in this study. Data were extracted from the articles regarding the structure and content of groups. Although evidence is currently limited, results suggest that speech and language therapy group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being. The importance of multidisciplinary input and care partners' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision and one-off group sessions may be feasible and can benefit psychosocial well-being. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. The literature on speech and language therapy group interventions for PPA shows promise of positive effects on communication function and psychosocial well-being of both pwPPA and their care partners. Speech and language therapists can consider these published interventions when designing and implementing similar groups, but more robust evidence is required to confirm the relative effectiveness of this approach. What is already known on this subject Speech pathology led group intervention shows some promise in benefitting communication functioning and overall well-being of pwPPA and their carers, but there has been no systematic evaluation of all the evidence regarding the efficacy of speech and language therapy led groups. Establishing feasibility, acceptability and efficacy of speech and language therapy group interventions for pwPPA and their carers may present a valuable addition for managing this progressive language disability. What this paper adds to existing knowledge Although evidence is currently limited, results from this systematic review suggest that speech and language therapy led group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being for pwPPA and their carers. The importance of multidisciplinary input and carers' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision for carers may be feasible and can benefit psychosocial wellbeing. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. What are the potential or actual clinical implications of this work? A synthesis of the evidence base for speech and language therapy led PPA groups, as well as a description of the group components and formats, will be valuable for clinical service planning, and will guide future examination of group options for pwPPA and their carers. Speech and language therapists can also consider the research findings from this systematic review when designing and implementing similar groups in their local context.

Clinical and socioeconomic predictors of shunt malfunction in the pediatric emergency department.

The aim of this study was to delineate the clinical and socioeconomic variables associated with shunt revision in pediatric patients presenting to the emergency department (ED) with concerns of ventricular shunt malfunction. A retrospective analysis of pediatric ED consultations for shunt malfunction over a 1-year period was conducted, examining clinical symptoms, radiographic findings, and socioeconomic variables. Sensitivities, specificities, and positive and negative predictive values were calculated for each presenting symptom collected. Logistic regression models were used to estimate the odds ratios for shunt revision based on these variables, and multivariate analyses were used to adjust for potential confounders. Of the 271 ED visits from 137 patients, 19.2% resulted in shunt revision. Increased ventricle size on imaging (OR 11.38, p < 0.001), shunt site swelling (OR 9.04, p = 0.01), bradycardia (OR 7.08, p < 0.001), and lethargy (OR 5.77, p < 0.001) were significantly associated with shunt revision. Seizure-like activity was inversely related to revision needs (OR 0.24, p < 0.001). Patients with private or self-pay insurance were more likely to undergo revision compared with those with public insurance (p = 0.028). Multivariate analysis further confirmed the significant associations of increased ventricle size, lethargy, and bradycardia with shunt revision, while also revealing that seizure-like activity inversely affected the likelihood of revision. Patients with severe cognitive and language disabilities were more likely to be admitted to the hospital from the ED but were not more likely to undergo revision. Clinical signs such as increased ventricle size, shunt site swelling, bradycardia, and lethargy may be strong predictors of the need for shunt revision in pediatric patients presenting to the ED with concerns of shunt malfunction. Socioeconomic factors play a less clear role in predicting shunt revision and admission from the ED; however, the nature of their influence is unclear. These findings can help inform clinical decision-making and optimize resource utilization in the ED.

Thalamic aphasia and SARS-CoV-2 infection (COVID-19)

Damage to the thalamus that results in thalamic aphasia, a language disability, is typically associated with vascular events, tumours, or degenerative disorders. There is growing interest in examining the relationship between COVID-19 and thalamic aphasia due to its association with several neurological problems, including strokes and minor lesions that may affect the thalamus. The virus's ability to induce hypercoagulable states and systemic inflammation, which may result in thalamic ischemic strokes and interfere with language processing networks, has sparked this interest. In light of the COVID-19 pandemic's continuous nature, more investigation is necessary to fully comprehend the virus's neurological effects, particularly any potential connections to thalamic aphasia, in order to diagnose and treat thalamic aphasia, forecast language recovery, and customise rehabilitation plans for those affected, including those recuperating from COVID-19-related neurological complications.

Neurorazvojni ishod preterminske novorođenčadi

Preterm birth is the leading cause of neonate mortality and the second cause of death for children under 5 years of age in the world. The neonates born with very low birth weight (&lt;1500 g) and extremely low birth weight (&lt;1000 g), as well as neonates born very preterm and extremely preterm are at high risk for neurodevelopmental disabilities. Three common and frequent forms of brain injury in preterm neonates are intraventricular hemorrhage, white and gray brain matter injury. Motor developmental delay is early identified in premature neonates, especially during the first three years of life. The major motor deficit is cerebral palsy, but in school age, minor motor dysfunctions are diagnosed and named developmental coordination disorder. The second domain in which developmental delays are identified is cognitive development. Children born prematurely have lower intelligence quotient and a high risk of speech and language disabilities. The low gestational age and low birth weight are the risk factors for emotional disorders, attention deficit/hyperactivity disorders and autism spectrum disorders. The frequency of visual impairment and hearing loss decreased with enlarging gestational age at birth. Intracranial hemorrhage and neonatal seizures are identified as prominent risk factors for later-onset epilepsy. A key strategy to reduce neurodevelopmental disability is the prevention of preterm delivery. Transport of pregnant women with a risk of preterm delivery and delivery in tertiary centers, prenatal administration of glucocorticoids and magnesium sulfate decreases the risk of preterm brain injury and improves neurodevelopmental outcomes. Also, the program "Neonatal Individualized Developmental Care and Assessment Program" and the application of the "skin-to-skin contact" method (Kangaroo Mother Care) have favorable effects on the neurodevelopmental outcome in premature neonates. Future research should make new recommendations for neuroprotection of the preterm neonates.

Preferred Communication Strategies for People with Communication Disabilities in Health Care Encounters: a Qualitative Study.

People with communication disabilities (CDs), which includes disabilities in speech, language, voice and/or hearing, experience health and healthcare disparities. A barrier to accessing high-quality, equitable care is the lack of effective communication between patients and their providers. In designing a patient-prompted tool to facilitate communication, we analyzed qualitative feedback on communication strategies and the experience of people with CDs, caregivers, and providers in healthcare encounters. We aimed to describe communication strategies that patients with CDs find most useful and optimize a tool for patients to share their communication strategy preferences during clinical encounters. While patient-provider communication is paramount in every interaction, we aimed to highlight the intricacies of optimizing communication for this population. We performed a qualitative study utilizing focus groups and interviews with patients with CDs, their caregivers, and healthcare providers. A total of 46 individuals participated in focus groups or interviews; 26 participants self-reported a CD, nine were caregivers, and 11 were providers. Participants represented diverse types of CDs, including stuttering, aphasia, hearing loss, and people with autism or cerebral palsy who use assistive technology to communicate. Analysis of qualitative interview and focus group data was guided by a qualitative content analysis approach. We identified three themes: (1) While communication strategies should be individualized, participants agreed upon a consolidated list of best strategies and accommodations. We used this consolidated list to finalize tool development. (2) Patients and providers preferred disclosure of the CD and desired communication strategies before the appointment. (3) Providers often do not use communication strategies and accommodations during clinical encounters. For patients with CDs, it is critical to acknowledge and document the CD and individualize communication strategies during healthcare visits to facilitate communication. Studies are needed to evaluate whether improved communication strategy usage leads to improved health outcomes for this population.

Speech and Text based Assistive Application for Special Needs Individuals

As per the survey report released last year on disability by National Statistics Office, it was seen that people with some kind of mental or physical disability is around 2.2% of India’s total population. The project, “Saksham” that suggests be independent, aims to eliminate the need for human assistance and to provide equal opportunities and a more normal way of life to those with language or other disabilities. In the direction of building individual strength and also get great improvement in the academic performance of adults and kids with special needs, Assistive technology is now being used as an innovative tool. The entire application have been developed keeping in mind that it needs to provide all our users with instantaneous access to selected features specially catered to help them in completing their daily tasks.

The Impact Of Action- Oriented Approach On Teaching English To Students With Mild Specific Language Learning Difficulties

Students with mild specific language learning difficulties encounter numerous challenges when acquiring the English language, and require a significantly longer period of time to attain independent language proficiency compared to their non-disabled counterparts. The objective of this investigation is to analyze the impacts of implementing An Action-Oriented Approach in the instruction of English language to secondary school students who exhibit Mild Specific Language Learning Difficulties. In order to accomplish this objective, a training program utilizing the Action Oriented Approach was administered to a cohort of 15 students who exhibit Mild Specific Language Learning Difficulties, as developed by a team of experts. The study employed quantitative data collection instruments, namely Unit-based Achievement Tests for four units and Classroom Observation Forms administered to students with Mild Specific Language Learning Difficulties both prior to and following the training programme. The quantitative data were subjected to analysis using the SPSS 21 statistical software and R Program version 3.2.5. The findings of the study suggest that individuals with mild speech and language learning difficulties exhibit a delay in their learning progress. Nevertheless, employing suitable pedagogical approaches and methodologies can enable students with mild speech and language learning difficulties to achieve a level of learning commensurate with that of their peers. The results of Unit-based Achievement Tests indicate that students with Multiple Severe Learning and Language Disabilities (MSLLD) may exhibit greater progress in their academic development compared to their typically developing peers. Finally, the research findings suggest that the Action Oriented Approach is advantageous in instructing English language skills to students who experience minor challenges in learning the language.

Disparities in cardiovascular mortality after diagnosed depression among people with disability

Abstract Background Persons with depression are more likely to eventually develop CVD or CVD related deaths. Depression history could be said a predictor or marker of cardiometabolic risk. However, potential disparities in cardiovascular mortality after diagnosis depression among people with and without disability rarely haven't been investigated. Methods We conducted a retrospective cohort study with a data set linking the National Disability Database, the Korean National Health Insurance Claims Database, and Cause of Death Database. To identify cases of depression and cardiovascular mortality, we used the ICD-10 code. Results Even after excluding people with brain injury and heart problems, people with disabilities had a 2.82 times higher cardiovascular specific mortality than the non-disabled (6.5 vs 2.3 people per 1000), especially in those with severe disabilities (7.5 vs 2.3 people per 1000). In survival analysis, the median survival time was 78.6 months and 71.6 months in the non-disabled and those with severe disability, respectively (Log-rank, p&amp;lt;.0001). This higher likelihood was more evident for people with severe disability(aHR=2.02, p&amp;lt;.0001), disability due to renal failure (aHR=3.43, p&amp;lt;.0001), speech and language disabilities (aHR=2.67, p&amp;lt;.0001), and hearing disabilities (aHR=2.29, p&amp;lt;.0001). Conclusions Although people with disabilities were known to be in poor health, disparities were found in cardiovascular mortality after depression history, especially in severe disabilities, renal failure, speech and language, and/or hearing disabilities. This emphasizes the importance of regular screening for cardiovascular risk factors in the disabled with depression, and we should do more efforts to develop policies supporting mental and cardiovascular health. Key messages • Patients with disabilities had a higher cardiovascular diseases specific mortality, and had a shorter survival time than the non-disabled. • Patients with severe disabilities, renal failure, speech and language, and/or hearing disabilities had a higher cardiovascular diseases specific mortality.

The Transfer Patterns of Vulnerable Populations with Acute Cardio-Cerebrovascular Diseases

Abstract Background In Korea, cardio-cerebrovascular diseases (CCDs) are the second leading cause of death. As providing appropriate treatment within the golden hour is crucial for managing acute onset CCDs, health outcomes vary depending on the accessibility of hospital. This study aimed to investigate the healthcare accessibility of vulnerable populations based on the transfer patterns with acute CCDs. Methods We analyzed the transfer times to final treatment hospital using the Korean National Health Insurance claim database from 2016 to 2021. We used multivariate logistic regression analysis on whether patients were transferred between hospitals after adjusting for age, gender, income level, and residence. Results The risk of transfer between hospitals was lower in socially vulnerable groups (elderly, low-income groups, and people with disabilities) compared to other groups (adjusted Odds Ratio [aOR]=0.65; 95% Confidence Interval [CI] 0.64-0.67 for people with disabilities vs people without disabilities), while it was higher in geographically vulnerable groups (rural) compared to other groups (aOR=2.05; [CI] 2.01-2.09 for rural vs metropolitan). Additionally, people with mild disabilities and those with visual, hearing, language, or physical disabilities showed higher transfer risk compared to other groups. Conclusions The risk of transfer showed opposite patterns between the two vulnerable groups with high mortality rates. The geographically vulnerable group had a higher risk due to absence treatable hospitals, while the socially vulnerable group might not have transferred even when it was necessary due to economic and physical constraints. The possibility of transfer was higher among the high-income group, which was assumed to be transferred to hospitals with better medical services. In fact, among patients hospitalized at teaching hospitals, 40% belong to the top 20% of income level. Efforts to improve accessibility for all in medical services should be continued. Key messages • The risk of being transferred between hospitals showed opposite patterns between socially vulnerable and geographically vulnerable groups with high mortality rates. • Measures are needed to improve access to quality hospitals, and monitoring is necessary for situations where necessary transfers are not carried out.

The role of unidentified bright objects in the neurocognitive profile of neurofibromatosis type 1 children: a volumetric MRI analysis.

Cognitive impairment is described in 80% of Neurofibromatosis type 1 (NF1) patients. Brain focal areas of T2w increased signal intensity on MRI, the so-called Unidentified Bright Objects (UBOs) have been hypothesized to be related to cognitive dysfunction, although conflicting results are available in literature. Here, we investigated the possible relation between UBOs' volume, cognitive impairment, and language disability in NF1 patients. In this retrospective study, clinical and MRI data of 21 NF1 patients (M/F = 12/9; mean age 10.1 ± 4.5) were evaluated. Brain intellectual functioning and language abilities were assessed with specific scales, while the analyzed MRI sequences included axial 2D-T2-weighted and FLAIR sequences. These images were used independently for UBOs segmentation with a semiautomatic approach and obtained volumes were normalized for biparietal diameters to take into account for brain volume. Possible differences in terms of normalized UBOs volumes were probed between cognitively affected and preserved patients, as well as between subjects with or without language impairment. Patients cognitively affected were not different in terms of UBOs volume compared to those preserved (p = 0.35 and p = 0.30, for T2-weighted and FLAIR images, respectively). Similarly, no differences were found between patients with and without language impairment (p = 0.47 and p = 0.40, for the two sequences). The relation between UBOs and cognition in children with NF1 has been already investigated in literature, although leading to conflicting results. Our study expands the current knowledge, showing a lack of correlation between UBOs volume and both cognitive impairment and language disability in NF1 patients.