Severe Language Disability Research Articles

Factors Influencing Aphasia Outcome in Patients with Occlusive Stroke

AbstractBackground: Aphasia related to ischemic stroke is a major health problem affecting the quality of life profoundly.Aim of Study: Is to assess factors influencing aphasia outcome in patients with occlusive stroke and the role of functional magnetic resonance imaging in detection the patterns of post-stroke language recovery.Patients and Methods: This was a prospective cohort study done at Neuropsychiatry Department and Center of Psychiatry, Neurology and Neurosurgery, Diagnostic Radiol-ogy, Tanta University, from January 2017 to January 2018. Aphasia Rapid Test (ART) at day 1 and follow-up at day 8 which is a bed side clinical test to assess aphasia severity, Diffusion Tensor Imaging (DTI) and fMRI were done at day 8 to assess aphasia severity. A total of 34 cases were finally included in this study after fulfilling the inclusion and exclusion criteria, 12 patients who had receptive or global aphasia, were not suitable for fMRI, their native language Arabic, age Results: The total number of the studied patients was 34 of them 18 patients (52.9%) were males and 16 patients were females (47.1%). The age of the studied patients ranged from 28-79 years. The older group of patients had severe language disability also those with global aphasia and perisylvian lesion, risk factors as HTN, DM, Cardiac Disease, Dyslipidemia had worse prognosis, those with no reconstruction of the Arcuate Fasiculus in DTI and fMRI data analysis showed negative effect of the site contralateral to lesion.Conclusion: Age was a significant factor with the higher age group had the worst prognosis regarding aphasia. Large lesion sizes and those with damage to strategic language areas had a bad prognosis. fMRI and DTI were the cornerstone of our study and they were a highly reliable tools in the prognosis of language outcome, with those who had activity in the perilesional and bilateral activity (perilesional and contralateral homotopic) in fMRI to have better outcome than those with only contralateral activity, also DTI to delineate the AF and the degree of its integrity and reconstitution.

重度言語障害者の補助代替コミュニケーション(AAC) : 最近の言語臨床と研究の動向から

重度言語障害者の補助代替コミュニケーション(AAC) : 最近の言語臨床と研究の動向から

Can Severely Language Delayed 3-Year-Olds Be Identified at 18 Months? Evaluation of a Screening Version of the MacArthur–Bates Communicative Development Inventories

To evaluate the effectiveness of a screening instrument (the Swedish Communication Screening at 18 months of age; SCS18), derived from the Swedish MacArthur-Bates Communicative Development Inventory, in identification of 18-month-old children who will be severely language disabled by 3 years of age, the authors (a) analyzed which SCS18's component yielded the best prediction, (b) compared the productivity figures of the SCS18 with those of the traditional method of identification, and (c) tried different cutoff criteria of the SCS18. Half of the child health care (CHC) centers in a Swedish county were randomly selected to use the SCS18 (e.g., a checklist supporting parents in assessing their child's word production, word comprehension, and communicative gestures). Remaining CHC centers used an informal assessment. Expressive and receptive language was subsequently judged with an observation for 3-year-olds that is routine in the county. An unselected population of 2,080 children participated at 18 months of age and again at 3 years of age. Number of spoken words yielded the best prediction, and SCS18 was superior to the traditional method. A sensitivity of 50%, however, was not enough, and a stricter criterion resulted in too many false positives to be acceptable as routine. Although the SCS18 has strength, the age of 18 months seems to be too early for identification of severe language disability.

Screening for developmental language disability in 3-year-old children. Experiences from a field study in a Swedish municipality.

This study evaluates a screening instrument for identification of severe developmental language disability (DLD) in 3-year-old children, which is used as a routine assessment at several child health centres (CHCs) in Sweden. The results are reported in terms of clinical outcome (false- and true-positive rates), kind and extent of DLD, signs of comorbidity and relation between nurses' and parents' observations. More than 60 CHC nurses, all with experience of the screening instrument, assessed in all 2359 3-year-old children (98% of the whole population) by direct observation of their language comprehension, language production and level of co-operation. In addition to the screening parents answered a questionnaire. Children who failed the screening had their hearing assessed and were clinically examined by trained speech and language therapists. Forty-four (34 boys and ten girls) of the 65 referred children were clinically examined. Apart from two false-positive cases most of them were diagnosed as generally and severely language disabled. According to the nurses' observations attention deficit was common among the referred boys, which was later confirmed by the speech therapist in two-thirds of them. Agreement between nurses and parents was poor and only half of the parents were concerned about their child's language development. In the light of this result, continued application of the screening and the use of parent questionnaires is discussed.

Can severe language disability be identified in three‐year‐olds? Evaluation of a routine screening procedure

This study evaluates the predictability of a new language screening procedure in 3‐y‐olds. It is used in several Child Health Centres (CHC) in Sweden and has the character of a field study involving more than 60 CHC nurses. The main questions concern the (i) development in 3‐y‐olds assessed as severely language delayed and (ii) whether there are any earlier unknown severely disabled children identified at 4 y of age. Ninety‐six percent of the original study population participated in the follow‐up. The calculations are based on results from 2237 children. A well‐established screening routine, which has been shown capable of predicting the risk of not being able to follow expected schooling, and case records were used as an acceptable proxy outcome measure, pending a better gold standard. In the group of severely disabled 3‐y‐olds, sensitivity, specificity and positive predictive values were 86, 99 and 43%, respectively. Finally, three false‐negatives were identified. In light of the present results, continued application of the 3‐y screening is discussed.

Time-in/time-out as a response to noncompliance and inappropriate behavior with children with developmental disabilities: Two case studies

Time-in and time-out were used to treat inappropriate and noncompliant behaviors in a child with severe language disabilities and a child with a moderate mental disability and cerebral palsy. The target behaviors for Jeremy were compliance with first-time presented teacher instructions, elopement and aggression. Prior to intervention, archival baseline data for Jeremy suggested a compliance rate with teacher directives of approximately 9% and a high frequency of elopement and aggression. Following implementation of a compliance training package, compliance to teacher directives increased to 97% within the first week of intervention and minimal instances of elopement and aggression. Two, 24, and 40-week follow-up compliance checks yielded mean rates of 98%, 99%, and 98% respectively and no elopement or aggression. Reduction in object tossing behaviors was targeted for Jenny. Archival baseline, indicated through parent report, suggested tossing rates of 80% of the times objects were in hand. Frequency of object tossing behavior decreased to a near-zero level during intervention. The use of this intervention package with children in an effort to deter future chronic noncompliance and inappropriate behavior is discussed. © 1997 John Wiley & Sons, Inc.

Factors affecting course and survival in Alzheimer's disease. A 9-year longitudinal study.

To evaluate mean survival and to identify prognostic factors in a cohort of patients with Alzheimer's disease (AD). Multicentric 9-year cohort analytic study. Seven neurology departments throughout Italy between April 1982 and January 1984. We recruited a consecutive sample of 145 patients affected by probable AD (Multicenter Italian Study on Dementia protocol, National Institute of Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria). Five were misdiagnosed, and 21 could not participate in the longitudinal study. The clinicodemographic characteristics of the 119 enrolled patients (49 men, 70 women; mean age, 64.7 years; SD, 4.1 years; mean duration of disease, 3.1 years; SD, 1.8 years) did not differ from those of the 26 excluded patients. All underwent extensive cliniconeuropsychological testing every 6 months for at least 2 years until the patient died or our survey ended (April 30, 1991). Mean follow-up was 5.1 years (SD, 2.5 years). Death, severe functional impairment (a score > or = 17 on the Blessed Dementia Scale), and severe cognitive impairment (a score of < or = 7 on the Information-Memory-Concentration Test). Survival curves obtained by the Kaplan-Meier method indicated that (1) patients with early- and late-onset disease (ie, before or after age 65 years) showed no difference either in relative survival or in time to reach predetermined functional and cognitive end points; (2) severely aphasic patients became profoundly demented significantly sooner than those with mild to moderate aphasia (P < .0001). Among clinicodemographic variables analyzed by a Cox model, severe language disability and functional loss proved to be the best predictors of death independent of age at onset or degree of dementia. Age at onset did not influence course and survival in AD. Severe aphasia appears to be the best predictor of death and unfavorable course.

Embedding instruction in art activities to teach preschoolers with disabilities to imitate their peers

The purpose of this study was to evaluate the effectiveness of embedding a procedure called progressive time delay (a direct teaching strategy) in art activities to teach preschoolers with disabilities to imitate their peers. Three children (one with autism, one with developmental delays and visual impairments, and one with severe language disabilities with autistic features) participated in the study. Five requests to imitate their peers were embedded into each daily art activity for each child and their responses were recorded. A multiple probe design across subjects was used to evaluate the procedures. The findings indicated that embedding the progressive time delay procedure into art activities produced high levels of imitation of the novel responses of their peers in a nearly errorless fashion. In addition, the levels of peer imitation increased in a generalization (transfer) activity (i.e., fine motor area) after instruction was used in the art activities. The results are discussed in terms of delivering instruction during ongoing preschool activities in classrooms enrolling both children with and without disabilities.

The assessment of severe language disabilities: Communicative and cognitive considerations

Abstract The use of applied behavioral analysis techniques has resulted in impressive gains in speech and language instruction. Nevertheless, questions remain with regard to the real life validity of teaching gains, as generalization tends to be limited. So far, the role of assessment has been minimal with a rather exclusive focus on speech and language as isolated phenomena. This paper argues that current teaching techniques may be upgraded through assessment practices that incorporate non-verbal as well as verbal communicative behavior, and cognitive development in relation to speech and language skills. Questions to be addressed and strategies to be used to obtain the relevant information are discussed. In addition, it is pointed out that the approach taken may serve to classify students on the basis of assessment profiles that provide starting points for intervention, rather than on the basis of global diagnostic labels.

Language disability: A case study

This paper has described the intertwining of linguistic, cognitive, and emotional development in a boy who has a severe language disability. Development proceeded through the usual stages and at the expected ages, yet there were interesting shifts and interactions that appear to be a function of Tony’s individual developmental style, and also, possibly, of intervention. One is particularly struck by the diminishing significance of language comprehension difficulties; expressive problems continue to be troublesome, but verbal conceptual ability has developed well and Tony has acquired an enthusiasm and affection for words. He will continue to struggle with verbal expression, but he knows his difficulty well and has made enough strides in working with it to hold his own in a relatively demanding private school. Early identification of the problem and intervention that has spanned nearly seven years have permitted the observation of developmental regressions and advances which, if viewed statically, might have been misinterpreted. More important, the continued involvement has made possible an emotional commitment between student and therapist that, one hopes, has had a steadying effect and that has led to the investment of verbal content with more richly textured meanings.