Understandable Speech Research Articles

Measuring speech perception with recovered envelope cues using the peripheral auditory model

Speech perception refers to how understandable speech produced by a speaker would be by a listener. The human auditory system usually interprets this information using both envelope (ENV) and temporal fine structure (TFS) cues. While ENV is sufficient for understanding speech in quiet, TFS cues are necessary for speech segregation in noisy conditions. In general, ENV can be recovered from the TFS (known as recovered ENV); however, the degree of ENV recovery and its significance on speech perception are not clearly known/understood. In order to systematically assess the relative contribution of the recovered ENV for speech perception, this study proposes a new speech perception metric. The proposed metric employs a phenomenological model of the auditory periphery developed by Zilany and colleagues (J. Acoust. Soc. Am. 126, 283–286, 2014) to simulate the responses of the auditory nerve fibers to both original and recovered ENV cues. The performance of the proposed metric was evaluated under different types of noise (both steady-state and fluctuating noise), as well as several classes of distortion (e.g., peak-clipping, center-clipping, and phase jitter). Finally, to validate the proposed metric, the predicted scores were compared with subjective evaluation scores from behavioral studies. The proposed metric indicates a statistically significant correlation for all cases and accounts for a wider dynamic range compared to the existing metrics.

Recommendations for patient engagement in guideline development panels: A qualitative focus group study of guideline-naïve patients

BackgroundPatient and consumer engagement in clinical practice guideline development is internationally advocated, but limited research explores mechanisms for successful engagement.ObjectiveTo investigate the perspectives of potential patient/consumer guideline representatives on topics pertaining to engagement including guideline development group composition and barriers to and facilitators of engagement.Setting and participantsParticipants were guideline-naïve volunteers for programs designed to link community members to academic research with diverse ages, gender, race, and degrees of experience interacting with health care professionals.MethodsThree focus groups and one key informant interview were conducted and analyzed using a qualitative descriptive approach.ResultsParticipants recommended small, diverse guideline development groups engaging multiple patient/consumer stakeholders with no prior relationships with each other or professional panel members. No consensus was achieved on the ideal balance of patient/consumer and professional stakeholders. Pre-meeting reading/training and an identified contact person were described as keys to successful early engagement; skilled facilitators, understandable speech and language, and established mechanisms for soliciting patient opinions were suggested to enhance engagement at meetings.ConclusionsMost suggestions for effective patient/consumer engagement in guidelines require forethought and planning but little additional expense, making these strategies easily accessible to guideline developers desiring to achieve more meaningful patient and consumer engagement.

The Clinical Manifestations and Genetic Implications of Baraitser–Winter Syndrome Type 2

An 18-year-old Caucasian male was born by cesarean section weighing 2.6 kg (5 lb 14 oz) at birth after an uncomplicated pregnancy with no perinatal complications. Around 4 to 5 months of age, the patient's mother initially became concerned as he was experiencing signs of developmental delay and a mild floppy tone, in addition to facial features that resembled some form of mental retardation. The patient's older brother also experienced similar developmental symptoms and facial features that presented around the same age period as our patient. It was initially thought to be Down syndrome; however, both the patient and his brother tested negative for Down syndrome on chromosomal analyses. There was also a question of whether the patient had some form of autism spectrum disorder, but doctors were unable to specifically confirm this. Now at the age of 18 years, the patient has no understandable speech with distinctive facial features such as a broad nasal bridge and prominent epicanthic folds, lissencephaly, smaller than average head size, intellectual disability, and hearing loss. It was discovered, through trio-based exome sequencing, that the patient had a de novo missense mutation (p.Ser155Phe) in the ACTG1 gene, which has been linked to the rare syndrome known as Baraister-Winter syndrome type 2. Baraitser-Winter syndrome 2 is a unique variant that is clinically similar to Baraitser-Winter syndrome type 1; however, only seven previous cases have been reported.

“Medically necessary” orthodontic care: Challenges and applications

Medicine targets health in issues of saving life and improving quality of life. Most orthodontic procedures deal with the latter goal. Medical necessity is presented within the scope of pediatric orthodontics, stratified in medically guided treatment, when orthodontic procedures contribute to the correction of a systemic problem, whether or not associated with a local orofacial problem (respiration and sleep disorders, emotional problems, and hospital calls); and orofacial-guided treatment, when addressing growth matters, craniofacial anomalies, and orofacial functions (mastication, understandable speech, and temporomandibular pain). Medical necessity that may involve the care of the orthodontist alone or in a medical team, also brings up the issue of separation between dentistry and medicine, at educational and various operational levels, posing a challenge regarding their integration in the context of health being indivisible.

Decoding four different sound-categories in the auditory cortex using functional near-infrared spectroscopy

The ability of the auditory cortex in the brain to distinguish different sounds is important in daily life. This study investigated whether activations in the auditory cortex caused by different sounds can be distinguished using functional near-infrared spectroscopy (fNIRS). The hemodynamic responses (HRs) in both hemispheres using fNIRS were measured in 18 subjects while exposing them to four sound categories (English-speech, non-English-speech, annoying sounds, and nature sounds). As features for classifying the different signals, the mean, slope, and skewness of the oxy-hemoglobin (HbO) signal were used. With regard to the language-related stimuli, the HRs evoked by understandable speech (English) were observed in a broader brain region than were those evoked by non-English speech. Also, the magnitudes of the HbO signals evoked by English-speech were higher than those of non-English speech. The ratio of the peak values of non-English and English speech was 72.5%. Also, the brain region evoked by annoying sounds was wider than that by nature sounds. However, the signal strength for nature sounds was stronger than that for annoying sounds. Finally, for brain-computer interface (BCI) purposes, the linear discriminant analysis (LDA) and support vector machine (SVM) classifiers were applied to the four sound categories. The overall classification performance for the left hemisphere was higher than that for the right hemisphere. Therefore, for decoding of auditory commands, the left hemisphere is recommended. Also, in two-class classification, the annoying vs. nature sounds comparison provides a higher classification accuracy than the English vs. non-English speech comparison. Finally, LDA performs better than SVM.

Improvement of stuttering with use of methylphenidate in a child who was diagnosed with concomitant stuttering and ADHD

Stuttering is a psychological, neurological and neurophysiological rhythmic disorder in an understandable speech that is characterized by hesitation in speech flow, standstill with repeating a word or a sound, extension of a sound. Etiology of stuttering is not exactly known. In this case presentation, it is aimed to discuss the disappearance of stuttering in an 11 year old child who was diagnosed with stuttering and ADHD after treating with methylphenidate extended release.

Factors influencing the longevity and replacement frequency of Provox voice prostheses.

This study aimed to assess the factors that influence the longevity and replacement frequency of Provox voice prostheses following their placement. The medical records of 27 patients who received Provox voice prostheses after total laryngectomy and attended follow-up regularly between 1998 and 2012 were retrospectively reviewed. The success rate of the Provox voice prostheses (i.e. whether speech was achieved), quality of speech achieved, number and type of complications encountered, frequency of prostheses replacement and reasons for prostheses replacements were evaluated. All 27 patients were men and their mean age was 63.0 (range 43-78) years. The mean follow-up period was 60.3 (range 1-168) months. Fluent and understandable speech was achieved in 85.0% of the patients. The mean duration before prosthesis replacement had to be performed was 17.1 (range 1-36) months. The most frequent complication was fluid leakage through the prosthesis. There was a strong positive correlation of 77.1% between the longevity of prostheses and postoperative follow-up duration (r = 0.771; p < 0.01). The voice prosthesis is a tool that can be delivered in a practical fashion and replaced easily with no serious complications. It is a means by which speech can be restored, with a high success rate, after total laryngectomy. In the present study, we found that postoperative follow-up duration was the most important factor influencing the longevity of the Provox voice prosthesis.

Tool Development for Human Audible Spectrum Compensation

Communication relies on good understanding. Humans relate to each other through visual, audible and tactile communication. It is imperative that the audible communication message reaches the receiver in good conditions, in order to keep a healthy, smooth and understandable speech. There are some disturbances in human speech and communication when hearing damage is present. Nowadays, hearing loss is a frequent injury, caused by noise pollution, daily stress or noisy workplaces. Yet, it can be treated by several ways. This project consists in developing a tool that captures the emitter's voice audible spectrum, filters the noise and other frequencies, and compensates the message, enabling the listener/receiver understanding. The purpose of this research is not aimed to substitute nor compete with hearing aids in the market, which are well-developed, certified and prescribed by Otorhinolaryngology clinicians. The focus of this study is to identify the issues of human hearing loss and to develop an algorithm for hearing compensation by using filtering techniques in a simulated environment applied to a hearing model.

English

This paper provides an innovative form of ―Translation of unintelligible speech of user into synthetic speech using augmentative and alternative communication (AAC) device‖. This AAC device converts the meaningless speech into understandable speech .The development of this system is carried out by building small vocabulary from both the utterance and from the inaudible speech of the autism people. Experiments showed that this method is successful in generating good recognition and translation performance on highly unintelligible speech, even when recognition perplexity is increased.

The Use Of Anterolateral Thigh Flap (ALTF) For Functional Tongue Reconstruction With Postoperative Quality Of Live Evaluation.

The use of microsurgery for oral reconstruction of cancer patients, has become standard treatment in restoring oral function. The free anterolateral thigh flap is one of the most preferred options in reconstruction after total, subtotal or hemiresection of the tonque due to squamous cell cancer. The aim of the study was to present the reconstructive method using anterolateral thigh free flap with evaluation of quality of live. Clinical material includes 46 consecutive patients with tongue cancer, who underwent complex surgical treatment between 2009 and 2011. There were 36 males and 10 females and the M: F ratio was 3.6: 1. All of them were reconstructed using the anterolateral thigh free flap. The quality of life was evaluated 6 months after completing the treatment, based on postoperative functional and aesthetic status. The overall flap survival rate was 96%. Surgical complications were observed in 8 patients (17%). Donor site was closed primarly in 42 cases and in remaining 4 skin graft was required. In all 46 cases understandable speech and return to unrestricted diet mastication and swallowing were achieved. The mean follow-up period after treatment was 32 months. Analysis of aesthetic effects evaluated in 23 cases and shows generally very good results. According to average transformed scores the QOL can be characterized as excellent for >90, very good for 76-90, good for 51-75, moderate for 25-50 and bad for <25 points. Anterolateral thigh flap, with its versatility in design, long pedicle with a suitable vessel diameter, low donor site morbidity, and very good aesthetic effects, could be the ideal flap for functional tongue reconstruction.

Aging and lexical neighborhood effects in competing speech perception

Little is known about the extent to which lexical neighborhood effects are influenced by the presence of to-be-ignored messages. When the competing signal is understandable speech, words in the masker may activate their own lexical neighbors, causing increased competition for word identification. Older adults may have particular difficulty inhibiting lexical activation. This poster will present results of an examination of lexical neighborhood influences on competing speech perception. Sentences were developed in which we manipulated the neighborhood density and frequency of key words to create lexically easy (low density or high frequency of usage) and lexically difficult (high density or low frequency) stimuli lists. Pairs of sentences were created in which one sentence was lexically easy (in terms of density or frequency) and one was difficult. The target sentence was always spoken by the same talker and could be either lexically easy or difficult. Participants were younger (18–23 years), middle-aged (45–59 years), and older (&amp;gt;60 years) adults; they also completed a battery of cognitive tests. This poster will show results of analyses comparing lexical neighborhood effects among the participant groups, as well as how these effects are influenced by hearing loss and cognitive abilities. [Work supported by NIH DC012057.]

Total Lower Lip Reconstruction Using Free Neurotendinofasciocutaneous Anterolateral Thigh Composite Flap: A Case Report

Total lower lip reconstructions are challenging procedures because of poor aesthetic and functional outcomes and limited availability of donor tissues that anatomically imitate the lip. We hereby report the free neurotendinofasciocutaneous anterolateral thigh composite flap as a new reconstructive option. A 48-year-old man presenting with a squamous cell carcinoma of the lower lip underwent wide resection of tumor, bilateral neck dissection, and lower lip reconstruction with the mentioned flap where the lateral femoral cutaneous nerve and tensor fascia lata tendon were included. No complication was encountered postoperatively. The flap survived totally. Understandable speech, oral competence, and uneventful nutrition were obtained. Furthermore, tactile, pain and heat sensations, and two-point discrimination of 12 mm at the flap were regained. In reconstruction of the lower lip, this flap was first described in the literature and can be a good candidate as a reconstructive option.

In search of the optimal surgical treatment for velopharyngeal dysfunction in 22q11.2 deletion syndrome: a systematic review.

BackgroundPatients with the 22q11.2 deletion syndrome (22qDS) and velopharyngeal dysfunction (VPD) tend to have residual VPD following surgery. This systematic review seeks to determine whether a particular surgical procedure results in superior speech outcome or less morbidity.Methodology/ Principal FindingsA combined computerized and hand-search yielded 70 studies, of which 27 were deemed relevant for this review, reporting on a total of 525 patients with 22qDS and VPD undergoing surgery for VPD. All studies were levels 2c or 4 evidence. The methodological quality of these studies was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias. Heterogeneous groups of patients were reported on in the studies. The surgical procedure was often tailored to findings on preoperative imaging. Overall, 50% of patients attained normal resonance, 48% attained normal nasal emissions scores, and 83% had understandable speech postoperatively. However, 5% became hyponasal, 1% had obstructive sleep apnea (OSA), and 17% required further surgery. There were no significant differences in speech outcome between patients who underwent a fat injection, Furlow or intravelar veloplasty, pharyngeal flap pharyngoplasty, Honig pharyngoplasty, or sphincter pharyngoplasty or Hynes procedures. There was a trend that a lower percentage of patients attained normal resonance after a fat injection or palatoplasty than after the more obstructive pharyngoplasties (11–18% versus 44–62%, p = 0.08). Only patients who underwent pharyngeal flaps or sphincter pharyngoplasties incurred OSA, yet this was not statistically significantly more often than after other procedures (p = 0.25). More patients who underwent a palatoplasty needed further surgery than those who underwent a pharyngoplasty (50% versus 7–13%, p = 0.03).Conclusions/ SignificanceIn the heterogeneous group of patients with 22qDS and VPD, a grade C recommendation can be made to minimize the morbidity of further surgery by choosing to perform a pharyngoplasty directly instead of only a palatoplasty.

The social validity of script training related to the treatment of apraxia of speech

Background: Social validity is an important yet under-examined aspect of treatment efficacy that determines how the effects of treatment are perceived by people other than the clinician/researcher. This is particularly true of treatments to improve the speech of adults with acquired neurogenic disorders. Aims: The purposes of this investigation were to evaluate the social validity of a modified script training treatment protocol, to explore how aspects of a client's speech correspond to varying rater judgements, and to determine which of the listener ratings were most predictive of ratings of overall quality. Methods & Procedures: A total of 124 young, naïve listeners were asked to rate the quality of speech of an 81-year-old woman with moderate–severe apraxia of speech during utterances with varying levels of script correctness (low, medium, high), number of errors (low, high), and rate (slow, faster). Judgements were made on the understandability, ease of production, naturalness, and overall quality of speech. Outcomes & Results: All main effects and interactions were statistically significant. As script correctness, speaking rate, and number of errors increased, listener ratings were significantly more favourable. Interactions demonstrated increasing correctness, error, and rate with significantly more favourable listener ratings. The listener ratings that predicted improved perceptions of overall quality, weighted highest to lowest, were: understandability, naturalness, and ease of production. Error types were analysed and revealed that phrase repetitions appeared to be perceived positively and that unintelligible words and interjections appeared to be perceived negatively. Conclusions: The modified script training protocol applied to a woman with marked apraxia of speech appeared to be socially valid with these naïve raters. Listeners appeared to be sensitive to the amount and the quality of speech output generated by the speaker. Listeners appeared to perceive struggle behaviours as negative, increased speech output (including repetitions and empty speech) as positive, faster speech (closer to a normal speaker's average word per minute) as preferable to slow speech, and more understandable speech and more natural speech as better quality speech. Based on these data, the accuracy and fluency of script production are important treatment goals.

Chemotherapy-enhanced accelerated radiotherapy for intermediate-volume hypopharyngeal cancer.

5576 Background: To evaluate the safety and efficacy of accelerated radiotherapy (RT) with delayed concomitant, low dose chemotherapy as a radiosensitizer in patients with squamous cell carcinoma of the hypopharynx that was judged as amenable to margin-free resection with curative surgery necessitating total laryngectomy. Methods: Patients aged 20-75 years with previously untreated, histologically proven T2 – 4 disease were eligible for the study. Those who have unresectable and/or bilateral lymph node metastasis or distant organ metastasis were ineligible. A total dose of 40 Gy/4 weeks using 2 Gy once daily fractionation to the entire neck followed by boost RT administering 30 Gy/2 weeks (1.5 Gy twice daily fractionation) to the primary tumor was administered. Cisplatin 80 mg/m2 bolus followed by 4-day continuous infusion of 5-fluorouracil (FU) 400 mg/m2/day was administered concomitantly during boost RT. Primary endpoint was completeness of the protocol within overall treatment time of less than 49 days. Results: Thirty-five patients were enrolled between October 2002 and March 2008. Volume of the primary tumor was estimated as 5–49 mL (median 15 mL) and 29 patients (83%) had that of 10-40 mL. Acute adverse events were acceptable, and grade >=3 acute reactions were observed in 13 (37%) of patients. All patients could complete this protocol as planned within 49 days (39–48 days, median 44 days). After median follow-up period for surviving patients of 54 months (22–86 months), overall and local recurrence-free survival rate at 3 years were 91% (95% confidence interval, 81%-100%), and 86% (74%-97%), respectively. All of the patients who were alive and free from local failure retained their normal understandable speech, and all surviving patients maintained their normalcy of diet without feeding tube dependency at the time of last follow-up. Conclusions: This regimen was feasible with encouraging oncological and functional outcomes in selected patients with intermediate-volume hypopharyngeal cancer. Further study is warranted to scrutinize adequate patient selection and outcomes to maximize therapeutic ratio using this strategy. No significant financial relationships to disclose.

Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion

High rates of overall survival (OS) and laryngeal preservation were achieved in two sequential phase II clinical trials in patients with stage III/IV laryngeal squamous cell carcinoma (SCC). Patients were treated with chemoradiation after a >50% primary tumor response to one cycle of neoadjuvant chemotherapy (IC). We analyzed outcomes for T4 patients with cartilage invasion from both studies. Retrospective. Records from 36 patients with T4 SCC of the larynx with cartilage invasion alone (n = 16) or cartilage invasion and extralaryngeal spread (n = 20) were retrospectively reviewed. All were treated with one cycle of cisplatin (100 mg/m(2)) [or carboplatin (AUC 6)] and 5-fluorouracil (1,000 mg/m(2)/d for 5 days) (P+5FU). Those achieving >50% response at the primary tumor received chemoradiation (70 Gy; 35 fractions with concurrent cisplatin-100 mg/m(2) [carboplatin (AUC 6)] every 21 days for 3 cycles), followed by adjuvant P+5FU for complete histologic responders (CHR). Patients with <50% response after IC underwent total laryngectomy and postoperative radiation. Twenty-nine of 36 patients (81%) had >50% response following IC. Of these, 27 received definitive chemoradiation, 23 (85%) obtained CHR, with 58% laryngeal preservation rate. The 3-year OS was 78%, and the disease-specific survival was 80% (median follow-up 69 months). Following chemoradiation, 8/11 (73%) patients with an intact larynx had >75% understandable speech, 6/36 (17%) were g-tube dependent and 6/36 (17%) were tracheostomy dependent. Our results suggest that chemo-selection is a feasible organ preservation alternative to total laryngectomy for patients with T4 laryngeal SCC with cartilage invasion.

Functional organ preservation with definitive chemoradiotherapy for T4 laryngeal squamous cell carcinoma

BackgroundRandomized trials established chemoradiotherapy as standard treatment for advanced laryngeal cancer. Patients with large-volume T4 disease (LVT4) were excluded from these trials. The purpose of this study was to report T4 laryngeal cancer patient outcome, including those with LVT4 disease, treated with chemoradiotherapy. Patients and methodsThis study is a retrospective subset analysis of 32 patients with T4 laryngeal carcinoma including LVT4 tumors treated on three consecutive protocols investigating paclitaxel (Taxol), 5-fluorouracil, hydroxyurea, and 1.5-Gy twice daily (BID) radiotherapy (TFHX). ResultsMedian follow-up is 43 months. Four-year locoregional control (LRC), disease-free survival (DFS), overall survival (OS), and laryngectomy-free survival (LFS) was 71%, 67%, 53%, and 86%, respectively. Four patients required laryngectomy for recurrent or persistent disease. Of disease-free patients with ≥1 year follow-up, 90% demonstrated normal or understandable speech. None required laryngectomy for complications. Among LVT4 patients, 4-year LRC, DFS, OS, and LFS was 71%, 65%, 56%, and 81%, respectively. Induction chemotherapy improved 4-year LRC (90% versus 46%, P = 0.03) and DFS (84% versus 42%, P = 0.03). ConclusionsPromising control and functional outcomes are achieved with TFHX for T4 laryngeal patients. LVT4 disease had outcomes similar to patients with less advanced disease treated on Radiation Therapy Oncology Group 91-11. Induction chemotherapy improved outcomes, warranting further investigation.

Triple Skin Island Fibula Free Flap: A Good Choice for Combined Mandible and Tongue Defect Reconstruction

Resections of malignant tumors involving the mandible and anterior tongue result in complex defects that are still real challenges for reconstructive surgeons. Whereas there are preferred methods for mandible reconstruction involving isolated or limited loss of soft tissues, there are no standards for extended bone-soft tissue intraoral defects. This article documents the modification of the fibula free flap where triple skin islands are used for reconstruction of anterior tongue and floor of the mouth. The technique also includes filing the submandibular space with an isolated part of the flexor hallucis longus muscle, based on individual perforator. The details of flap designing, harvesting, and insetting are also presented. Eight such reconstructions have been performed on patients who underwent complex resection of the anterior mandible together with the mobile part of the tongue. Flap survival rate was 100%. In all eight cases, understandable speech and return to unrestricted diet mastication and swallowing were achieved. Analysis of aesthetic effects showed generally very good results. The presented modification of fibula free flap can be an alternative to double flaps in complex reconstruction of the mandible and mobile tongue.

12q12 deletion: A new patient contributing to genotype–phenotype correlation

Interstitial deletions involving the long arm of chromosome 12 are rare events. To our knowledge only 16 patients have been reported in literature [Funderburk et al., 1984; Meinecke and Meinecke, 1987; Watson et al., 1989; Ferro et al., 1995; Tonoki et al., 1998; Brady et al., 1999; Sathya et al., 1999; Gallego et al., 2000; Rauen et al., 2000, 2002; Rapley et al., 2001; Petek et al., 2003; Plotner et al., 2003; Perez Sanchez et al., 2004; James et al., 2005; Klein et al., 2005], 6 of those are proximal 12q deletions [Meinecke and Meinecke, 1987; Watson et al., 1989; Tonoki et al., 1998; Sathya et al., 1999; Gallego et al., 2000; Perez Sanchez et al., 2004]. Miyake et al. [2004] highlighted the genotype–phenotype relationship among the genes deleted in a 6.2 Mb region overlapping the chromosomal band 12q12, and the clinical features shown by two affected males. Both infants, one from Argentina (Patient 1) with del (12) (q11q13) first reported by Gallego et al. [2000], and the other from Japan (Patient 2) with del (12)(q12q13.12) first reported by Tonoki et al. [1998], had an overlapping phenotype. Among the genespresent in this region,YAF2 andAMIGO2were considered the candidate genes for growth and psychomotor retardation. In this report we describe a 10-year-old boy (Fig. 1) showing a 4.5 Mb 12q12 de novo deletion at array-CGH, that involves the majority of the genes already reported by Miyake et al., with the exception of PDZRN4, AMIGO2, and SLC38A4. Family history was unremarkable, and he is 5th child of nonconsanguineous parents, three sisters and one brother are healthy. He was born at the 42nd week of a pregnancy which was characterized by intrauterine growth retardation (IUGR) from the 7th month and poor fetal movements. At birth, weight was 2,800 g (10th–25th centile), length 45 cm (<10th centile) and occipitofrontal circumference (OFC) 33 cm (25th centile). No perinatal condition was reported. At 3 months, a karyotype and a brain CT scan were performed to investigate dysmorphic features; and both were normal. He presented with developmental delay (walking at 2.5 years, speech over 5 years after speech therapy, sphincter control at 4 years), failure to thrive, poor feeding, moderate congenital sensorineural deafness and recurrent respiratory infections. During infancy he underwent four surgical treatments: at 6 months for a fold of urethral mucosa, at 2.5 years orchyopexy, at 4 years for hydrocele, and at 9 years a prosthesis for right testicular atrophy. At 10 years hisweight was 3.6 SD with a BMI of 15, his height 2 SD and the OFC 4 SD. The distinctive clinical features are summarized in Table I. Additional features include a long and flat philtrum, a single palmar crease with low-set thumbs and unusual dermatoglyphics, large thorax, and a short and broad hallux with onchodystrophy. He also had a hyperkeratotic skin with a sebaceous nevus in left retroauricular region, that on histological examination was syringocystadenoma papilliferum. The Romberg test was unsteady. Limb radiographs showed multiple epiphyseal dysplasia on long, carpal, and tarsal bones and knees. The psychomotor testing (WISC-R, CPM of Raven, VMGT Bender) showed moderate mental retardation with poorly understandable speech due to multiple

Lateralized irrelevant speech alters visuospatial selective attention mechanisms

Recent studies indicate that the coordination of spatial attention across modalities may in part be mediated by a supramodal attentional system. We try to extend the concept of a supramodal system and hypothesized that involuntary modulations of auditory attentional processes by irrelevant speech signals influence visuospatial attention, suggesting crossmodal links between vision and speech. In order to test this we recorded event-related brain potentials (ERPs) of 12 healthy subjects in a visuospatial selective attention task. The task to identify target stimuli appearing at lateral visual field locations caused the expected enhancements of the early P1 and N1 ERP components to attended visual stimuli. Understandable and ununderstandable task irrelevant speech was presented either at the visually attended position or in the opposite visual field location. Speech contralateral to unattended visual stimuli led to a decreased N1 amplitude. This effect was stronger for understandable speech. Thus, speech influences the allocation of visual spatial attention if it is presented in the unattended location. The results suggest crossmodal links of speech and visuospatial attention mechanisms at a very early stage of human perception.