Elzbieta Szelag

Training in rapid auditory processing ameliorates auditory comprehension in aphasic patients: A randomized controlled pilot study

Experimental studies have often reported close associations between rapid auditory processing and language competency. The present study was aimed at improving auditory comprehension in aphasic patients following specific training in the perception of temporal order (TO) of events. We tested 18 aphasic patients showing both comprehension and TO perception deficits. Auditory comprehension was assessed by the Token Test, phonemic awareness and Voice-Onset-Time Test. The TO perception was assessed using auditory Temporal-Order-Threshold, defined as the shortest interval between two consecutive stimuli, necessary to report correctly their before-after relation. Aphasic patients participated in eight 45-minute sessions of either specific temporal training (TT, n=11) aimed to improve sequencing abilities, or control non-temporal training (NT, n=7) focussed on volume discrimination. The TT yielded improved TO perception; moreover, a transfer of improvement was observed from the time domain to the language domain, which was untrained during the training. The NT did not improve either the TO perception or comprehension in any language test. These results are in agreement with previous literature studies which proved ameliorated language competency following the TT in language-learning-impaired or dyslexic children. Our results indicated for the first time such benefits also in aphasic patients.

The Application of Timing in Therapy of Children and Adults with Language Disorders

A number of evidence revealed a link between temporal information processing (TIP) and language. Both literature data and results of our studies indicated an overlapping of deficient TIP and disordered language, pointing to the existence of an association between these two functions. On this background the new approach is to apply such knowledge in therapy of patients suffering from language disorders. In two studies we asked the following questions: (1) can the temporal training reduce language deficits in aphasic patients (Study 1) or in children with specific language impairment (SLI, Study 2)? (2) can such training ameliorate also the other cognitive functions? Each of these studies employed pre-training assessment, training application, post-training and follow-up assessment. In Study 1 we tested 28 patients suffering from post-stroke aphasia. They were assigned either to the temporal training (Group A, n = 15) in milliseconds range, or to the non-temporal training (Group B, n = 13). Following the training we found only in Group A improved TIP, accompanied by a transfer of improvement to language and working memory functions. In Study 2 we tested 32 children aged from 5 to 8 years, affected by SLI who were classified into the temporal training (Group A, n = 17) or non-temporal training (Group B, n = 15). Group A underwent the multileveled audio-visual computer training Dr. Neuronowski®, recently developed in our laboratory. Group B performed the computer speech therapy exercises extended by playing computer games. Similarly as in Study 1, in Group A we found significant improvements of TIP, auditory comprehension and working memory. These results indicated benefits of temporal training for amelioration of language and other cognitive functions in both aphasic patients and children with SLI. The novel powerful therapy tools provide evidence for future promising clinical applications.

Electrophysiological Indicators of the Age-Related Deterioration in the Sensitivity to Auditory Duration Deviance.

The present study investigates age-related changes in duration discrimination in millisecond time domain. We tested young (N = 20, mean age = 24.5, SD = 2.97) and elderly (N = 20, mean age = 65.2, SD = 2.94) subjects using the mismatch negativity (MMN) paradigm. White-noise bursts of two different durations (50 and 10 ms) were presented in two oddball blocks. In one block (Increment Condition), the repetitive sequence of 10 ms standards was interspersed by occasional 50 ms deviants. In the Decrement Condition, the roles of the two stimuli were reversed. We analyzed the P1-N1 complex, MMN and P3a and found the effect of age for all these components. Moreover, the impact of stimulus presentation condition (increment/decrement) was observed for MMN and P3a. Our results confirmed the previous evidence for deteriorated duration discrimination in elderly people. Additionally, we found that this effect may be influenced by procedural factors.

The Treatment Based on Temporal Information Processing Reduces Speech Comprehension Deficits in Aphasic Subjects

Experimental studies have reported a close association between temporal information processing (TIP) and language comprehension. Brain-injured subjects with aphasia show disturbed TIP which was evidenced in elevated temporal order threshold (TOT) as compared to control subjects. The present study is aimed at improving auditory speech comprehension in aphasic subjects using a specific temporal treatment. Fourteen patients having deficits in both speech comprehension and TIP were tested. The Token Test, phoneme discrimination tests (PDT) and Voice-Onset-Time (VOT) Test were employed to assess speech comprehension. The TOT was measured using two 10 ms tones (400 Hz, 3000 Hz) presented binaurally. The patients participated in eight 45-min sessions of either the specific temporal treatment (n = 7) aimed at improving the perception of sequencing abilities, or in a non-temporal control treatment (n = 7) on volume discrimination. The temporal treatment yielded an improvement in TIP. Moreover, a transfer of improvement from the time domain to the language domain was observed. The control treatment did not improve either TIP or speech comprehension in any of the applied tests.

Temporal Information Processing and its Relation to Executive Functions in Elderly Individuals

Normal aging triggers deterioration in cognitive functions. Evidence has shown that these age-related changes concern also executive functions (EF) as well as temporal information processing (TIP) in a millisecond range. A considerable amount of literature data has indicated that each of these two functions sets a frame for our mental activity and may be considered in terms of embodied cognition due to advanced age. The present study addresses the question whether in elderly subjects the efficiency of TIP is related to individual differences in EF. The study involved 53 normal healthy participants aged from 65 to 78. In these subjects TIP was assessed by sequencing abilities measured with temporal-order threshold (TOT). It is defined as the minimum time gap separating two auditory stimuli presented in rapid succession which is necessary for a subject to report correctly their temporal order, thus the relation ‘before-after.’ The EF were assessed with regard to the efficiency of the executive planning measured with the Tower of London-Drexel University (TOLDX) which has become a well-known EF task. Using Spearman’s rank correlations we observed two main results. Firstly, the indices of the TOLDX indicated a coherent construct reflecting the effectiveness of executive planning in the elderly. Initiation time seemed dissociated from these coherent indices, which suggested a specific strategy of mental planning in the elderly based on on-line planning rather than on preplanning. Secondly, TOT was significantly correlated with the indices of TOLDX. Although some of these correlations were modified by subject’s age, the correlation between TOT and the main index of TOLDX (‘Total Move Score’) was rather age resistant. These results suggest that normal aging may be characterized by an overlapping of deteriorated TIP and deteriorated EF.

Cross-modal comparisons of stimulus specificity and commonality in phonological processing.

Phonological processing is a fundamental ability which underlies language comprehension. Functional neuroanatomy of phonology constitutes a matter of ongoing debate. In the present study, subjects performed visual (rhyme detection) and auditory (identification of spoken words starting with a given consonant) tasks that were contrasted with matched nonverbal tasks. We identified regions critical for phonological processing which were either stimulus specific or supramodal. The results revealed a high degree of modality specificity in both visual and auditory networks. Moreover, we observed a modality independent region in the left middle temporal gyrus (MTG)/superior temporal sulcus (STS), between a more anterior temporal area with auditory specificity and a more posterior temporal area with visual specificity. This dissociation in functional neuroanatomy suggests that this area may be a core region for supramodal phonological processing, acting as a gateway between spatially separate, but stimulus specific, phonological processes and more general linguistic functions.

Nonlinear Timing and Language Processing in Norm and Pathology

Many experimental data have indicated that nonlinear temporal processing plays a crucial role in human cognition, including our language communication. We summarize briefly the neuropsychological findings on typical temporal frame underlying language processing. Concentrating on millisecond (the high-frequency processing system) and multisecond (the low-frequency system) timing mechanisms, we provide evidence on temporal dynamics of both speech reception and expression with the special concern on temporal integration and temporal resolution of the signal. The examples of nonlinear temporal processing are discussed in cross-linguistic scenario. Finally, we provide some examples on time distortion in language-disordered population and discuss future applications of training in temporal processing in amelioration of language functions.

Temporal Information Processing and Language Skills in Children with Specific Language Impairment

Deficits in temporal information processing (TIP) have been proposed as a one of the crucial mechanisms underlying language disorders. The aim of the present study was to investigate the relationship between TIP and language skills in children with Specific Language Impairment (SLI). In case of SLI, normal patterns of language acquisition are disturbed, while its etiology is not associated with neurological or environmental factors. In the present paper we assessed in twenty seven SLI children, aged from 5 to 8 years, both the efficiency of TIP and language skills. The result revealed significant correlation between efficiency of TIP and the global language skills. These data may provide one more evidence for the debate on SLI etiology, confirming auditory information processing abnormalities in SLI children.