Speech Difficulties Research Articles

Clinical presentation and diagnosis of adult-onset leukoencephalopathy with axonal spheroids and pigmented glia: a literature analysis of case studies.

Because adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is a rare, rapidly progressive, debilitating, and ultimately fatal neurodegenerative disease, a rapid and accurate diagnosis is critical. This analysis examined the frequency of initial misdiagnosis of ALSP via comprehensive review of peer-reviewed published cases. Data were extracted from a MEDLINE search via PubMed (January 1, 1980, through March 22, 2022) from eligible published case reports/series for patients with an ALSP diagnosis that had been confirmed by testing for the colony-stimulating factor-1 receptor gene (CSF1R) mutation. Patient demographics, clinical symptoms, brain imaging, and initial diagnosis data were summarized descriptively. Categorical data for patient demographics, symptoms, and brain imaging were stratified by initial diagnosis category to test for differences in initial diagnosis based on each variable. Data were extracted from a cohort of 291 patients with ALSP from 93 published case reports and case series. Mean (standard deviation) age of symptom onset was 43.2 (11.6) years. A family history of ALSP was observed in 59.1% of patients. Cognitive impairment (47.1%) and behavioral and psychiatric abnormalities (26.8%) were the most frequently reported initial symptoms. Of 291 total cases, an accurate initial diagnosis of ALSP was made in 72 cases (24.7%) and the most frequent initial misdiagnosis categories were frontotemporal dementia (28 [9.6%]) and multiple sclerosis (21 [7.2%]). Of the 219 cases (75.3%) that were initially mis- or undiagnosed, 206 cases (94.1%) were later confirmed as ALSP by immunohistology, imaging, and/or genetic testing; for the remaining 13 cases, no final diagnosis was reported. Initial diagnosis category varied based on age, family history, geographic region, mode of inheritance, and presenting symptoms of pyramidal or extrapyramidal motor dysfunction, behavioral and psychiatric abnormalities, cognitive impairment, and speech difficulty. Brain imaging abnormalities were common, and initial diagnosis category was significantly associated with white matter hyperintensities, white matter calcifications, and ventricular enlargement. In this literature analysis, ALSP was frequently misdiagnosed. Improving awareness of this condition and distinguishing it from other conditions with overlapping presenting symptoms is important for timely management of a rapidly progressive disease such as ALSP.

Methods of Overcoming Speech Disorders in Children (Study of the Experience of Prophet Moses in the Quran)

<p><em>The Qur'an gives instructions to everyone, including various goats. In Islam, a, -l-Quran as a holy book that has medicinal powers (Shifa), especially in everyone who reads and listens to it with confidence. This paper aims to explore and analyze children who have difficulty speaking. Qualitative methods were used in subjects of several children aged 3 to 6 years, data were collected through interviews, observation and documentation of the author's intersubjectivity. Furthermore, interactive model techniques are carried out, namely data collection, data reduction, data presentation and conclusions. The findings explain that speech difficulties have actually been practiced since the time of Prophet Moses who asserted that when Prophet Moses asked Allah for prayers against him, this practice in the Qur'an illustrates that, in practice with methods and beliefs in the Quran has a good influence in overcoming speech difficulties in children</em></p>

Individual differences in talker discrimination among adult cochlear implant users

Real-world speech communication involves interacting with talkers with diverse voices and accents. Adult cochlear implant (CI) users often demonstrate poor discrimination of talkers’ voices relative to their normal-hearing peers, which may contribute to difficulties in understanding speech produced by multiple talkers. However, the factors underlying poor talker discrimination ability are not well understood. The current study examined auditory and cognitive-linguistic factors that support talker discrimination, and explored the association between talker discrimination and sentence recognition across CI users. In an AX talker discrimination task, 25 adult CI users indicated whether word pairs were produced by the same talker or by two different talkers. Participants also completed measures of spectrotemporal processing, cognitive-linguistic skills, including fluid intelligence, working memory capacity, inhibitory control, and phonological processing, and sentence recognition. Results showed that talker discrimination scores (accuracy, sensitivity) were moderately to strongly correlated with spectrotemporal processing, fluid intelligence, inhibitory control, and phonological processing. Talker discrimination scores were also related to sentence recognition accuracy scores across CI users. These preliminary findings suggest that both auditory and cognitive-linguistic processes support talker discrimination, and, furthermore, may underlie the relationship between talker discrimination and sentence recognition in adult CI users.

Language Acquisition on Students Who Experience the Speech Delay

The acquisition of language in children is one of the greatest and most amazing human achievements, which is why this problem has received great attention for analysis. Language acquisition and speaking are both interrelated aspects. Talking is the most effective form of communication. Aspects of biological maturity, and cognitive and social environment affect the acquisition of children's language and speaking abilities. However, not all children have good language development, some children experience disturbances in their biological aspects so that the acquisition of language and speech is delayed. These problems are interesting for further analysis related to the factors of language development in children with (speech delay). The research findings indicate that several words were mispronounced, leading to information that did not match the child’s intended meaning based on the observations and interviews that the researchers conducted during the study. The study revealed that toddlers with speech impairments had trouble pronouncing and articulating words clearly. Even simple words in daily activities at home were shaky in some cases. Researchers can also draw the conclusion that, despite the fact that the child interacts often with parents, relatives, and neighbors in their social milieu, the youngster nonetheless exhibits speech difficulties. This is a result of the child's frequent inability to articulate the thoughts that are going through his mind, even in a single sentence.

Sensorineural hearing loss and cognitive impairment: three hypotheses.

Sensorineural hearing loss (SNHL) is a category of hearing loss that often leads to difficulty in understanding speech and other sounds. Auditory system dysfunction, including deafness and auditory trauma, results in cognitive deficits via neuroplasticity. Cognitive impairment (CI) refers to an abnormality in the brain's higher intellectual processes related to learning, memory, thinking and judgment that can lead to severe learning and memory deficits. Studies have established a strong correlation between SNHL and CI, but it remains unclear how SNHL contributes to CI. The purpose of this article is to describe three hypotheses regarding this relationship, the mainstream cognitive load hypothesis, the co-morbidity hypothesis, and the sensory deprivation hypothesis, as well as the latest research progress related to each hypothesis.

Effectiveness of Proprioceptive Neuromuscular Facilitation Technique on Balance and Mobility in Chronic Stroke Patient

This comprehensive review explores the multifaceted impact of stroke, a cerebrovascular disorder, on individuals, emphasizing the physical, emotional, and cognitive dimensions of its aftermath. Stroke is a major global health concern, contributing significantly to mortality and disability. The immediate consequences involve neurological impairments such as paralysis, speech difficulties, and impaired vision, while the emotional toll includes coping with loss and adjusting to new realities. Long-term cognitive implications affect memory, attention, and executive function, adding complexity to the recovery journey. Communication challenges, physical limitations, and the risk of secondary complications are discussed, highlighting the importance of a continuum of care. The role of caregivers is explored, emphasizing the emotional, physical, and financial burdens they face. Technological innovations, such as virtual reality and robotics, are introduced as promising tools in stroke rehabilitation. The focus then shifts to balance and mobility issues in stroke survivors, particularly the impact of proprioceptive neuromuscular facilitation (PNF) techniques. Proprioceptive neuromuscular facilitation emerges as a dynamic and versatile therapeutic approach, offering promise for improved functional outcomes and enhanced quality of life in the evolving landscape of stroke care and rehabilitation. The review delves into the neurophysiological ballet of PNF, emphasizing neuromuscular stimulation, neuroplasticity, and motor learning. Clinical applications of PNF in orthopaedic, neurological, geriatric, and paediatric rehabilitation are discussed, highlighting its versatility.

Characterizing Speech Errors Across Primary Progressive Apraxia of Speech Subtypes.

Apraxia of speech (AOS) is a motor speech disorder affecting articulatory planning and speech programming. When AOS is the sole manifestation of neurodegeneration, it is termed primary progressive apraxia of speech (PPAOS). Recent work has shown that there are distinct PPAOS subtypes: phonetic, prosodic, and those that do not clearly align with either (mixed). PPAOS subtypes differ with respect to the predominating motor speech difficulties, as well as disease progression and underlying pathology. Because past studies have determined PPAOS subtype based on clinical impression, the goal of the present study was to quantitatively determine the distribution of speech error types across PPAOS subtypes in a word repetition task and to investigate how word complexity affects the type and number of speech errors across PPAOS subtypes. Forty-five patients with PPAOS (13 phonetic, 23 prosodic, and nine mixed) and 45 healthy controls produced multiple repetitions of words that varied in phonetic complexity. Sound additions, deletions, and substitutions/distortions (phonetic errors) and within-word segmentations (prosodic errors) were calculated. All three PPAOS groups produced significantly more errors than controls, but the total number of errors was comparable among subtypes. The phonetic group produced more phonetic-type errors compared to the prosodic group but comparable to the mixed group. The prosodic group produced more segmentations compared to the phonetic and mixed PPAOS groups. As word complexity increased, the total number of errors increased for PPAOS patients. The phonetic and prosodic groups were more likely to produce phonetic- and prosodic-type errors, respectively, as word complexity increased. This study provides novel quantitative data showing that PPAOS subtype can be supported by the type and distribution of speech errors in a word repetition task. This may facilitate earlier, more reliable differential diagnosis and aid in disease prognosis, as PPAOS subtypes have distinct disease trajectories.

Orthodontic Risk Perspectives among Orthodontists during Treatment: A Descriptive Pilot Study in Greece and Slovakia.

This study explores orthodontists' perspectives on risks associated with orthodontic treatment, as described by Greek and Slovak orthodontists. Informed by the foundational importance of effective communication of risk perspectives in health sciences, particularly in facilitating valid consent and shared decision-making, this research addresses gaps identified in the literature concerning the consistent communication of potential treatment risks based on demographic and cultural characteristics. This study identifies 15 potential critical risks during orthodontic treatment. These risks include root resorption; temporary undesired changes to the occlusion; sleep difficulties; not achieving an ideal result; development of black triangles between teeth; taking additional X-rays; speech difficulties; using a protective splint during sports; duration of treatment; number of visits; transmission of infectious diseases; and swallowing orthodontic appliances. A questionnaire, distributed electronically to orthodontists in Greece (N1 = 570) and Slovakia (N2 = 210) from September 2022 to December 2022, aimed to assess risk communication practices, taking into consideration socio-demographic factors, such as country, gender, age, and academic-degree-related variations. A total of 168 valid questionnaires (91 from Slovakia and 77 from Greece) were obtained, indicating significant disparities in the risks emphasized and preferred forms of consent. The Greek orthodontists focused more on the risks involved, such as relapse, root resorption, temporal occlusal changes, and failure of desired movement, while the Slovak practitioners tended to be more interested in sleeping difficulties, temporal occlusal changes, and not achieving an ideal result. They also obtained written or digital consent from patients or their parents/guardians more frequently than the Greek team. Male orthodontists discussed specific risks more frequently, including relapse and extractions, whereas females preferred written or digital consent. PhD-trained orthodontists prioritized certain risks, indicating the need for tailored approaches. This study underscores the dynamic nature of risk assessment in orthodontic practice, emphasizing its ethical and strategic dimensions. The findings advocate for tailored risk communication strategies that recognize individual, contextual, and cultural factors, and the need for an orthodontic informed consent protocol for a tailored communication approach for patients to elevate the standard of care in European orthodontics. The reliance on digital tools reflects contemporary trends in enhancing patient understanding, thereby supporting ongoing innovation in orthodontic practices.

Application of supraclavicular island flap in oral and maxillofacial reconstruction.

(a) Evaluate the reliability of the supraclavicular flap in cervico-orofacial region; (b) investigate the role of computed tomography angiography (CTA) in predicting the post-operative viability of the flap; (c) assess the speech, feeding, and esthetics after reconstruction using this flap. Eleven patients included in this study underwent either conventional or delayed harvesting of the supraclavicular flap (SCF). All the patients had diagnostic computed tomography angiography (CTA) of the supraclavicular flap before the surgery. The mean harvesting time of the flap was 45.45 ± 4.16min. The average length of the flap was 22.64 ± 1.12cm, whereas the mean width of the flap was 6.14 ± 1.14cm. The flap survived in 9 patients, while two patients had complete flap loss. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. Only two patients complained of weakness in the donor site. None of the patients reported that the weakness or pain at the donor site affected their daily activities or quality of life. The pedicled SCF represents a safe and feasible option that can be used to reconstruct a wide array of maxillofacial oncologic defects. However, a study with a larger sample size is recommended to achieve more reliable clinical results for the modified delayed technique modification in terms of their effect on the survival of the supraclavicular flap.

'Communication is difficult': Speech, language and communication needs of people with young onset or rarer forms of non-language led dementia.

People with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy and young onset Alzheimer's disease may experience language and communication difficulties. However, the role of speech and language interventions for people with these non-language led dementias has received little attention. This study aimed to explore the experiences and perspectives of people living with these conditions, and their families, regarding their language and communication difficulties and how speech and language therapy could address these needs. This study employed a qualitative design to explore the experiences of people living with or caring for somebody with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy or young onset Alzheimer's disease, and to understand their opinions about speech and language therapy. Participants were recruited from a support service connected to a dementia clinic to attend one of five focus group meetings. Videorecorded focus groups and interviews were transcribed, and reflexive thematic analysis was used to analyse data from people affected by each type of dementia. A total of 25 participants were recruited to the study, with representation across the different forms of non-language led dementias. The four main themes identified were: (1) communication difficulties as a key difficulty, (2) loss and loneliness, (3) speech and language therapy, and (4) the role of the caregiver. Sixteen subthemes were also identified which highlighted individual issues across disease types. Although all the forms of dementia studied here are not considered to be language-led, people with these conditions and/or their care partners identified speech, language and communication as common challenges. These communication difficulties were reported to have a negative impact on their social participation and mental health and participants felt speech and language interventions could help. There is a need for research exploring speech and language interventions developed for and with people with non-language led dementias and their care partners, to ensure they meet the needs of the people they are designed for. What is already known on the subject People with primary progressive aphasia present with speech, language and communication difficulties, and several speech and language interventions have been developed to meet the needs of this population. However, people with non-language led dementias may also experience speech, language and communication difficulties, and little is known about interventions that may address these difficulties. What this paper adds to existing knowledge People living with or caring for somebody with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy and young onset Alzheimer's disease report experiencing speech, language and communication difficulties that impact on the person with dementia's social participation and mood. Participants in this study also shared their opinions about how speech and language interventions could help, from the earliest stages of the disease. What are the potential or actual clinical implications of this work? Speech and language therapists need to address the individual speech, language and communication needs of people with dementias, even those that are not thought to be language-led. Current speech and language therapy service provision does not meet the needs of people with non-language led dementias and further research is required to develop interventions and services to meet these needs.

Speech-Language Pathologist's Pattern of Practice in the Rehabilitation of Head and Neck Cancer patients across Hospitals in India.

India has a significant burden of Head and Neck cancer (HNC) patients. Patients afflicted with HNC often encounter difficulties in speech, voice, and swallowing, either due to the disease itself or the treatment they receive. The rehabilitation of HNC patients is crucial, and Speech and Language Pathologists (SLPs) have a significant role in it. The current study aimed to understand the practices followed by SLPs in India while rehabilitating HNC patients. A questionnaire was developed and validated by five Speech-language pathologists, before circulation as an E-survey. The target participants were SLPs working in hospitals across India. The final online version of the questionnaire remained open for eight weeks. A total of 75 Hospital-based SLPs working in India participated in the survey. The responses depict notable trends and differences in the assessment and management approaches. HNC patients who had undergone surgery were more likely to be referred for rehabilitation than those who received non-surgical treatments. Only 36% of the SLPs reported getting pre-operative referrals for HNC patients. The time point for initial assessment and intervention, as well as the protocols used, varied across different hospitals. About 50% of participants had instrumental swallow evaluation facilities in their hospitals, and the majority of hospitals only used instrumental swallow evaluation for 1-3 assessments per week. Variability exists in several aspects of SLP practice for HNC patients offered across Hospitals in India. All HNC patients do not get access to speech-language pathology services. Developing standardized protocols towards early evaluation, intervention and enhancing compliance could improve SLP-led rehabilitation of HNC patients in India.

Effects of Cycloastragenol on Alzheimer's Disease in Rats by Reducing Oxidative Stress, Inflammation, and Apoptosis.

As individuals age, they may develop Alzheimer's disease (AD), which is characterized by difficulties in speech, memory loss, and other issues related to neural function. Cycloastragenol is an active ingredient of Astragalus trojanus and has been used to treat inflammation, aging, heart disease, and cancer. This study aimed to explore the potential therapeutic benefits of cycloastragenol in rats with experimentally induced AD. Moreover, the underlying molecular mechanisms were also evaluated by measuring Nrf2 and HO-1, which are involved in oxidative stress, NFκB and TNF-α, which are involved in inflammation, and BCL2, BAX, and caspase-3, which are involved in apoptosis. Sprague-Dawley rats were given 70 mg/kg of aluminum chloride intraperitoneally daily for six weeks to induce AD. Following AD induction, the rats were given 25 mg/kg of cycloastragenol daily by oral gavage for three weeks. Hippocampal sections were stained with hematoxylin/ eosin and with anti-caspase-3 antibodies. The Nrf2, HO-1, NFκB, TNF-α, BCL2, BAX, and caspase-3 gene expressions and protein levels in the samples were analyzed. Cycloastragenol significantly improved rats' behavioral test performance. It also strengthened the organization of the hippocampus. Cycloastragenol significantly improved behavioral performance and improved hippocampal structure in rats. It caused a marked decrease in the expression of NFκB, TNF-α, BAX, and caspase-3, which was associated with an increase in the expression of BCL2, Nrf2, and HO-1. Cycloastragenol improved the structure of the hippocampus in rats with AD. It enhanced the outcomes of behavioral tests, decreased the concentration of AChE in the brain, and exerted antioxidant and anti-inflammatory effects. Antiapoptotic effects were also noted, leading to significant improvements in cognitive function, memory, and behavior in treated rats.

Metronidazole: A culprit to balance and speech

In a country like India, oral metronidazole is the commonly prescribed drug of choice for entities such as amebiasis and visceral abscesses. Oral such cases, it is usually well tolerated and safe but can cause serious neurological adverse events. Peripheral neuropathy commonly encounters in practice but central nervous system toxicity is also well documented as it crosses the blood–brain barrier easily. Neurological toxicity of metronidazole may be due to prolonged administration, high doses, or high cumulative doses. Magnetic resonance imaging (MRI) of brain is the modality of choice to evaluate brain involvement. In the brain, the splenium of the corpus callosum, dentate nucleus of the cerebellum, and posterior pons involvement are commonly seen and diagnostic. Here, we have an interesting case report of a patient who was on oral metronidazole treatment for his large liver abscess, presenting with a complaint of neurological symptoms of unsteady gait, vertigo, dysdiadochokinesia, and difficulty in speech. Moreover, thus suspected as metronidazole drug toxicity and further investigated for the same, and MRI typically shows cerebellar and posterior corpus callosal involvement.

Prevalence and heritability of parental-reported speech and/or language difficulties in a Swedish population-based twin sample.

Research on genetic and environmental influences on speech and/or language difficulties (SaLD) is sparse, with inconsistent heritability estimates. We aimed to estimate the prevalence of parental reported SaLD and the relative contributions of genetic and environmental factors for the phenotype using a Swedish population-based twin sample. We hypothesized that there would be a stronger genetic than environmental effect on SaLD. Data were collected from The Child and Adolescent Twin Study in Sweden. The study sample included 16,774 twin pairs (16,946 males, 16,602 females), of which 5141 were monozygotic, 5861 dizygotic (DZ), and 5772 opposite-sex DZ pairs. The language items in the Autism-Tics, Attention-Deficit Hyperactivity Disorder, and other Comorbidities inventory were used to categorize individuals as having parental-reported SaLD. A classical twin design was used to estimate the relative contribution of genetic and environmental factors to the liability of SaLD. The prevalence of SaLD was 7.85% (95% confidence interval (CI) [7.57%-8.15%]) and 7.27% (95% CI [6.99%-7.55%]) when excluding individuals with autism and intellectual disability (ID). We also found that SaLD were significantly more prevalent in males than females with a ratio of 2:1. The heritability was estimated to be 75% (95% CI [67%-83%]) for SaLD. Shared environment played a significant role with an estimated contribution of 22% (95% CI [14%-30%]). The heritability estimate was reduced to 70% but with overlapping CI when excluding individuals with autism and ID. We provide evidence that SaLD is common in the population and under strong genetic influence. Future studies should focus on mapping the genetic architecture of SaLD and related disorders.

Difficulty Student Understand English Speech in the Second Semester of the English Study Program

Listening is a crucial skill that needs to be mastered in English language acquisition. However, several obstacles hinder the mastery of listening, such as difficulties in comprehending spoken language. In this scenario, there are a significant number of students who cannot comprehend the English language. The objective of this study is to identify the factors that contribute to students' difficulty in comprehending spoken English. The participants of this study consisted of English major students enrolled in the second semester at STAIN Gajah Putih Takengon. The focus of this research was to investigate the challenges that these students encounter when comprehending spoken language in the listening domain. The research methodology employed is qualitative. Regarding the internal instruments, this study employs observation, tests, and interviews. Research findings indicate that there are multiple factors that contribute to students' inability to comprehend English speech. The primary factors that influence students' listening skills are lack of concentration, speaking speed, and originality. The conclusion that can be inferred from this study is that the speed of speech delivery and a lack of concentration in listening are contributing factors to difficulty in understanding speech.

Effectiveness of Frenuloplasty in Ankyloglossia on Speech Quality: A Systematic Review

BACKGROUND: Ankyloglossia, known as tongue-tie, is an inherited anomaly and is caused by a short nonelastic frenulum that causes limited tongue movement. Because of the limitations of tongue movement, it can affect the quality of speech. Ankyloglossia treatment is to divide or separate fibrous bands or frenuloplasty. The purpose of making this systematic review is to systematically review the results of frenulopasty governance in cases of ankyloglossia related to speech quality. AIM: The aim of this systematic review is to explain the original study in patients with Ankiloglosia who underwent a frenectomy procedure on the tongue tie. This study included research evaluating results related to speech quality. METHODS: PubMed, EMBASE, and Cochrane Databases, No restrictions on published studies until September 10, 2021. Studies are included if subjects of all ages have ankyloglossia and performed frenuloplasty procedures. The results assessed were the level of speech quality in the subjects of preoperative ankyloglossia and postoperative frenuloplasty. RESULTS: Overall, 473 abstracts resulted from literature searches; 13 studies met the criteria for data extraction and analysis. Of the 13 studies, eight studies were Randomize control trial studies and 5 case–control studies. Three studies evaluated speech outcomes using Likert scores, 3 studies using questionnaires, and 7 studies using different assessments pre-operative and post-operative speech quality. CONCLUSION: Frenuloplasty in subjects with ankyloglossia mostly gives good results in terms of speech quality. Improvements in articulation and mention of consonant phonation improve after frenuloplasty. Frenuloplasty with the 4 flap Z-Plasty Technique provides better results compared to conventional and horizontal vertical frenuloplasty. A long-term study of the correlation of ankyloglossia and speech difficulties and the effects of frenuloplasty is needed.

Effects of Age on the Auditory Cortex During Speech Perception in Noise: Evidence From Functional Near-Infrared Spectroscopy.

Age-related speech perception difficulties may be related to a decline in central auditory processing abilities, particularly in noisy or challenging environments. However, how the activation patterns related to speech stimulation in different noise situations change with normal aging has yet to be elucidated. In this study, we aimed to investigate the effects of noisy environments and aging on patterns of auditory cortical activation. We analyzed the functional near-infrared spectroscopy signals of 20 young adults, 21 middle-aged adults, and 21 elderly adults, and evaluated their cortical response patterns to speech stimuli under five different signal to noise ratios (SNRs). In addition, we analyzed the behavior score, activation intensity, oxyhemoglobin variability, and dominant hemisphere, to investigate the effects of aging and noisy environments on auditory cortical activation. Activation intensity and oxyhemoglobin variability both showed a decreasing trend with aging at an SNR of 0 dB; we also identified a strong correlation between activation intensity and age under this condition. However, we observed an inconsistent activation pattern when the SNR was 5 dB. Furthermore, our analysis revealed that the left hemisphere may be more susceptible to aging than the right hemisphere. Activation in the right hemisphere was more evident in older adults than in the left hemisphere; in contrast, younger adults showed leftward lateralization. Our analysis showed that with aging, auditory cortical regions gradually become inflexible in noisy environments. Furthermore, changes in cortical activation patterns with aging may be related to SNR conditions, and that understandable speech with a low SNR ratio but still understandable may induce the highest level of activation. We also found that the left hemisphere was more affected by aging than the right hemisphere in speech perception tasks; the left-sided dominance observed in younger individuals gradually shifted to the right hemisphere with aging.

Processing Speed and Attentional Shift/Mental Flexibility in Patients with Stroke: A Comprehensive Review on the Trail Making Test in Stroke Studies.

The Trail Making Test (TMT) is one of the most commonly administered tests in clinical and research neuropsychological settings. The two parts of the test (part A (TMT-A) and part B (TMT-B)) enable the evaluation of visuoperceptual tracking and processing speed (TMT-A), as well as divided attention, set-shifting and cognitive flexibility (TMT-B). The main cognitive processes that are assessed using TMT, i.e., processing speed, divided attention, and cognitive flexibility, are often affected in patients with stroke. Considering the wide use of TMT in research and clinical settings since its introduction in neuropsychological practice, the purpose of our review was to provide a comprehensive overview of the use of TMT in stroke patients. We present the most representative studies assessing processing speed and attentional shift/mental flexibility in stroke settings using TMT and applying scoring methods relying on conventional TMT scores (e.g., time-to-complete part A and part B), as well as derived measures (e.g., TMT-(B-A) difference score, TMT-(B/A) ratio score, errors in part A and part B). We summarize the cognitive processes commonly associated with TMT performance in stroke patients (e.g., executive functions), lesion characteristics and neuroanatomical underpinning of TMT performance post-stroke, the association between TMT performance and patients' instrumental activities of daily living, motor difficulties, speech difficulties, and mood statue, as well as their driving ability. We also highlight how TMT can serve as an objective marker of post-stroke cognitive recovery following the implementation of interventions. Our comprehensive review underscores that the TMT stands as an invaluable asset in the stroke assessment toolkit, contributing nuanced insights into diverse cognitive, functional, and emotional dimensions. As research progresses, continued exploration of the TMT potential across these domains is encouraged, fostering a deeper comprehension of post-stroke dynamics and enhancing patient-centered care across hospitals, rehabilitation centers, research institutions, and community health settings. Its integration into both research and clinical practice reaffirms TMT status as an indispensable instrument in stroke-related evaluations, enabling holistic insights that extend beyond traditional neurological assessments.

Understanding Speaking Difficulties of Accountancy Business and Management Students at Leyte National High School

This paper explored understanding the speaking difficulties of Grade 11 and 12 Accountancy, Business and Management students at Leyte National High School, Tacloban City. Respondents were 239 grade 11 and 170 grade 12 ABM students. During class recitation, students have difficulties in expressing their thoughts and ideas using the English language. Though, results presented that majority of the ABM students are having moderate anxiety in speaking the English language, which means that in general they do not feel anxious about speaking the English language, although they are still anxious in certain situations. On the other hand, grade 11 and 12 ABM students are having specific difficulties in grammar, vocabulary, and pronunciation. They also fear of making mistakes and that they lack confidence. Moreover, poor grammar skills, poor pronunciation skills and lack of vocabulary are considered major factors affecting speaking difficulties for grade 11 ABM students. While grade 12 ABM students considered lack of vocabulary and poor grammar skills as major factors affecting speech difficulties

ANALYSING MULTIPLE SCLEROSIS IN AYURVEDA

INTRODUCTION AND BACKGROUND: Multiple Sclerosis (MS) is a disease characterized by a triad of inflammation, demyelination, and gliosis. It is a debilitating disorder due to its progressive nature. The probable causes may be hereditary, environmental and autoimmune. It covers a wide spectrum of clinical features like pain, weakness and diminished sensation of different parts of body, deficit of senses, affliction of muscle tone, power and coordination, speech difficulties etc. It is a herculean task to manage such syndromes. Ayurveda stands unique in such progressive incapacitating diseases by improving the Quality of Life especially HRQOL. Health-related quality of life is an important factor for evaluating the effect of interventions, which can be achieved following Ayurveda principles. The time-honored panacea – Ayurveda has a scope in this regard in improving the quality of life of the ailing community. METHODOLOGY: Reviewing the literature, published articles and available case sheets. RESULT: It is observed as a single disease having multiple dimensions. It is difficult to cure the condition; the HRQOL can be improved through Ayurveda management. To achieve this, the concept of Vikalpa Samprapti(Etiopathogenesis) and Anukta Vyadhi(Disease which are not explained in Clas-sics) aids. DISCUSSION: Vikalpa Samprapti is important in understanding and detailing any Anukta Vyadhi. The site of affliction and clinical features are the only evident facts making the disease complex to understand and manage. Ayurveda identifies each disease based on Samprapti Ghatakas(Components in disease manifesta-tion) and approaches each individual based on Rogi Pareeksha(Examination of patient). Avalambhaka, Tarpaka, Sadhaka, Udana, Vyana, and Apana have their Adhishtana (abode) and function close to the Shirohridaya, which also controls the Madhyama Rogamarga. This Sthana along with the aforesaid controls the higher mental function, motor sensory function, which gets impaired on Dosha Dushti along with Dhatu Paaka, makes the Ro-ga progressive and an incapacitating morbidity.