Barbara L. Ekelman

Turn-taking and speech act patterns in the discourse of senile dementia of the Alzheimer's type patients

Conversational discourse patterns of 11 normal elderly and 11 senile dementia of the Alzheimers type (SDAT) patients engaged in dyadic interaction with an examiner were examined. Differences in word usage, turn taking, and speech act production were investigated both for the two-subject groups and for the examiners conversations with each group. Compensatory shifts in discourse by participants are identified. For the subject, differences were shown on words per turn with SDAT subjects speaking in shorter turns and in nonverbal responses with SDAT subjects using this strategy more frequently. Speech act categories of Requestives and Assertives also differed with SDAT subjects using more Requestives and fewer Assertives. The SDAT subjects had significantly more occurrences of unintelligible utterances. For the examiner, words per turn differed with the examiner using shorter turns with SDAT subjects. No differences were shown in the examiners patterns of speech act usage, nonverbal responses, or intelligibility. In general, these results indicate significant discourse differences in the words per turn level for all participants and speech act levels of conversation for SDAT subjects. They also indicate generally maintained interaction patterns by speakers so that the discourse genre of conversation is sustained. The pattern of compensatory shifts in discourse suggests retained flexibility in the communication system of early and mid stage SDAT patients.

Spoken syntax in children with acquired unilateral hemisphere lesions.

The spoken syntax of eight left hemisphere lesioned and eight right hemisphere lesioned children were compared to matched controls. The childrens lesions were acquired between 0.08 and 6.17 years of age (mean = 1.33 years), and at the time of testing they were between 1.67 and 8.15 years of age (mean = 4.19). Based on analyses of spontaneous language samples, left hemisphere lesioned subjects performed more poorly than did their controls on most measures of simple and complex sentence structure. In contrast right lesioned subjects performed similarly to their controls on these measures, except for a tendency to make more errors in simple sentence structures. These findings provide further evidence that the left and right hemispheres are not comparable in supporting syntactic abilities.

Cognitive profiles of children with early onset of unilateral lesions

The level and pattern of Wechsler Intelligence Scale for Children‐Revised (WISC‐R) performance for 18 left‐lesioned (LL) and 13 right‐lesioned (RL) children with clearly defined unilateral involvement and no ongoing seizure disorders were compared to normal controls matched by age, sex, race, and social class. Verbal IQ (VIQ), Performance IQ (PIQ), and Full Scale IQ (FIQ) were well within normal limits for all groups, although RL children scored significantly lower than right controls. No significant differences between VIQ, PIQ, and FIQ were found within the LL or RL or control groups; thus VIQ and PIQ discrepancy was not found to relate to lesion laterally. When WISC‐R subtests were recategorized according to Kaufmans factors, the Freedom from Distractibility factor was impaired in both LL and RL children, whereas RL children were also deficient on the Perceptual Organization factor. Level and pattern of cognitive performance are discussed in relation to age of lesion onset and site of lesion within a ...

Lexical retrieval in left and right brain lesioned children.

Performance on two measures of lexical retrieval for 19 left and 13 right brain lesioned children was compared to that of control subjects matched by age, sex, race, and social class. On the Word-Finding Test, left lesioned subjects were significantly slower in response time than left controls when given semantic and visual cues and made more errors when given rhyming cues. On the Rapid Automatized Naming Test, left lesioned subjects were significantly slower than left controls in naming all semantic categories, including colors, numbers, objects, and letters. In contrast, right lesioned subjects responded as quickly as or more quickly than did right controls in all access conditions and in naming semantic categories yet tended to produce more errors than their controls, suggesting a speed-accuracy tradeoff. Children sustaining left brain lesions before 1 year of age appeared to be as impaired as those whose lesions occurred after 1 year of age. Diverse lesion sites within the left hemisphere were associated with increased lexical retrieval latencies.

Unilateral brain lesions in childhood; performance on the revised token test

Comprehension of connected language as assessed by the Revised Token Test (RTT) was studied in 17 children with left hemisphere lesions (LL) and 11 with right hemisphere lesions (RL). LL childrens significantly lower performance on several subtests than left controls (LC) matched by age, sex, race, and social class appeared to be related to the memory demands of these subtests rather than the limited syntactic elements assessed by the RTT. LL subjects requested significantly more command repetitions than control or RL subjects and when a repetition was not requested LL subjects often responded with immediacy. Although RL children tended to perform lower than right matched controls (RC), these differences were not significant nor readily related to either the memory or specific linguistic structures assessed. RL subjects required fewer command repetitions than LL subjects and exhibited a significantly greater frequency of immediate responses than controls or LL subjects. While based on few children, a trend for LL children with retrorolandic lesions to perform more poorly than those with left prerolandic lesions was suggested. No systematic difference in performance was apparent for children with left cortical vs. left subcortical lesions or among discrete sites of lesions within the right hemisphere. Children with left lesions prior to 1 year of age performed no better and, in several instances, significantly poorer than LL patients sustaining lesions after 1 year of age. Among RL subjects, those sustaining lesions after 1 year of age had greater difficulty than those with lesion onset before 1 year of age, especially on linguistic elements which seemed to be dependent upon visual spatial properties. Further studies are needed to evaluate the comprehension of more complex linguistic structures among children with unilateral brain lesions as well as to study the role of more basic factors such as memory and attention in explaining the present findings.

Scholastic aptitude and achievement among children with unilateral brain lesions

Cognitive abilities, scholastic aptitude and academic achievement were studied for 20 left hemisphere lesioned (LL) and 12 right hemisphere lesioned (RL) children in comparison with matched peers. On the Cognitive clusters, both LL and RL children performed significantly poorer than controls on the reasoning, perceptual speed and memory clusters. For the Scholastic Aptitude clusters, lesioned subjects performed significantly lower than controls on all clusters except for the knowledge cluster. On the Academic Achievement clusters, LL performed significantly poorer on the written language cluster while RL performed lower on the reading, math and written language clusters. Age of lesion onset, site of lesion and IQ differences are discussed in relationship to the ability clusters measured.

Syntactic Findings in Developmental Verbal Apraxia.

Spontaneous language samples of eight children diagnosed as presenting developmental verbal apraxia were analyzed in terms of their mean length of utterance, Developmental Sentence Scores, use of 14 grammatical markers, and yes-no and wh-question forms. Although MLUs were greater than the range associated with stage V syntactic development, all children demonstrated difficulties with stage V and beyond grammatical markers and many omitted stage II markers. Developmental Sentence Scores were generally well below chronologic age expectations and revealed notable difficulties with personal pronoun and main verb selection. Omissions or noninversions of auxiliary and/or copulas in yes-no and wh-questions were apparent. Omissions of regular and irregular third-person singular markers, inconsistent use of regular and irregular past tense, and difficulty with question transformations provide evidence that at least some of the errors presented by this group of apraxic children cannot be attributed to motor speech and/or phonologic limitations but rather they evidence concomitant syntactic disorders.

Intelligence and hypoxemia in children with congenital heart disease: fact or artifact?

Previous studies have reported lower intelligence for cyanotic than for acyanotic children with congenital heart disorders, a finding attributed to the degree of hypoxemia present. Several important variables have not been examined consistently, however, including coexisting neurologic or genetic disorders, definitive surgery, degree of sickness, age at testing sex and social class. The present study examined the relation of these variables to obtained intelligence measures for 82 consecutively admitted children, excluding children with abnormal neurologic examinations and those having received definitive surgery. Consistent with earlier reports, intelligence quotients for the acyanotic children (112.81 +/- 14.52 mean +/- SD) were significantly higher (t = 2.60; p = 0.006) than for the cyanotic group (103.50 +/- 15.81). Although sex, race and social class were not significantly different between the 28 cyanotic and the 54 acyanotic children, the cyanotic children were significantly sicker (x2 = 9.12; p = 0.005) and younger (t = 4.10; p = 0.001). However, when young and old children and the degree of sickness within cyanotic and acyanotic groups were compared, no significant differences were found. These findings demonstrate that intelligence differences between cyanotic and acyanotic children persist when the effect of neurologic abnormalities and definitive surgery is removed and remain despite the severity of sickness or childs age at testing.

Fluency of conversational speech in children with unilateral brain lesions

The spontaneous conversational speech of 20 children with unilateral left hemisphere lesions and 13 with right lesions was compared to normally developing peers matched by age, sex, race, and social class for instances of stuttering type nonfluencies, normal nonfluencies, and rate of speech. Both left and right lesioned children provided quantitatively more and qualitatively different patterns of nonfluencies than their neurologically normal peers. Left and right lesioned children produced more stuttering types of nonfluencies than their controls, but neither lesioned group produced a greater number of normal nonfluencies than controls. Left lesioned children also had a slower rate of speech as measured by number of syllables per second during either stuttered or fluent speech. Considerable variability was observed among lesioned children. Implications for neurogenic theories of developmental fluency disorders are discussed.

Auditory temporal perception of children with left or right brain lesions

Twenty left and 12 right brain lesioned children were administered Tallals Repetition Task in which they were required to discriminate, associate and sequence two nonverbal auditory stimuli. Unlike adults with left hemisphere injury or children with developmental language disorders previously described by Tallal, neither left nor right brain-lesioned children differ significantly from control subjects matched by age, sex, race and social class. These results contrast with earlier reports of impaired spoken syntax and delayed lexical retrieval among many of these same left lesioned children, suggesting that prelinguistic auditory processing and higher language deficits may be dissociable among young left hemisphere impaired children. The findings demonstrate that the higher level language deficits seen in the left brain lesioned children cannot be attributed to difficulty in more preliminary analyses of the acoustic stimuli.