Ignacio Moreno-Torres

From 1-word to 2-words with cochlear implant and cued speech: a case study.

This paper describes early language development in a deaf Spanish child fitted with a cochlear implant (CI) when she was 1;6 years old. The girl had been exposed to Cued Speech (CS) since that age. The main aim of the research was to identify potential areas of slow language development as well as the potential benefit of CI and CS. At the beginning of this research the child was 2;6 years (she had been using the CI for 12 months). Adult–child 30‐minute sessions were videotaped every week for 1 year (13–24 months of CI use), and transcribed according to CHAT norms. Measures of phonemic inventory, intelligibility, lexicon, and grammar development were obtained. Part of the data were compared with data from two normally hearing (NH) children with the same mean length of utterance (MLU). In order to confirm trends observed during these 12 months of observation, an extra set of data was obtained in the next 3 months (25–27 months of CI use). Results in the initial 12 month period (13–24 months of CI use) showed irregular language development in the deaf child. The development of her phonemic inventory and lexicon progressed at a rate that was similar to, or faster than, that of NH children. However, the slow acquisition of articles and also the slow development of MLU suggested that the child might have problems with grammar. Data from the next 3 months (25–27 months of CI use) confirmed this trend. Results are discussed in relation to similar studies in other languages. Potential benefits of CS are also discussed.

Foreign accent syndrome: a multimodal evaluation in the search of neuroscience-driven treatments.

Foreign accent syndrome (FAS) is a rare condition which is placed in the mildest end of the spectrum of speech disorders. The impairment, not severe enough to elicit phonological errors, is associated with various alterations in the fine execution of speech sounds which cause the impression of foreignness. There is a growing interest in the study of linguistic and paralinguistic components, psychosocial aftermaths, and neural basis of FAS, but there are not yet neuroscience-driven treatments for this condition. A multimodal evaluation was conducted in a single patient with the aim of searching for clues which may assist to design neuroscience-driven therapies. The patient was a middle-aged bilingual woman who had chronic FAS. She had segmental deficits, abnormal production of linguistic and emotional prosody, impaired verbal communication, and reduced motivation and social engagement. Magnetic resonance imaging showed bilateral small lesions mainly affecting the left deep frontal operculum and dorsal anterior insula. Diffusion tensor tractography suggested disrupted left deep frontal operculum-anterior insula connectivity. Metabolic activity measured with positron emission tomography was primarily decreased in key components of networks implicated in planning and execution of speech production, cognitive control and emotional communication (Brodmanns areas 4/6/9/10/13/25/47, basal ganglia, and anterior cerebellar vermis). Compensatory increases of metabolic activity were found in cortical areas (left anterior cingulate gyrus, left superior temporal gyrus and right prefrontal cortex) associated with feedback and focal attention processes critical for monitoring and adjustment of verbal utterances. Moreover, bilateral structural and functional abnormalities probably interrupted the trajectory of the lateral and medial cholinergic pathways causing region-specific hypoactivity. The results from this study provide targets for further investigation and some clues to design therapeutic interventions.

The emergence of productive speech and language in Spanish-learning paediatric cochlear implant users

It has been proposed that cochlear implant users may develop robust categorical perception skills, but that they show limited precision in perception. This article explores if a parallel contrast is observable in production, and if, despite acquiring typical linguistic representations, their early words are inconsistent. The participants were eight Spanish-learning deaf children implanted before their second birthday. Two studies examined the transition from babbling to words, and the one-word period. Study 1 found that the participants used the same sound types in babbling and in words, indicating that production is guided by stored motor patterns. No clear evidence of inconsistent production was observed. Study 2 found that in the one-word period CI users develop typical prosodic representations, but that their productions are highly unstable. Results are discussed in terms of the role of auditory feedback for the development of productive language skills.

Segmental and suprasegmental errors in Spanish learning cochlear implant users: Neurolinguistic interpretation

This study aims at investigating the impact of cochlear implant (CI) use for phonological development. The main participants were a group of 14 deaf children who had received their CIs in the second year of life, and who had been wearing them for 24 months. A group of normally hearing (NH) children aged 24 months old was also evaluated. Data was obtained from a non-word repetition (NWR) task. Various segmental and suprasegmental measures were obtained from the NWR data. The CI children scored significantly below the controls for one feature (i.e. place of articulation) and for segment substitutions. Suprasegmental analyses revealed that the CI children made fewer errors with unfooted syllables and more stress errors than the NH children. Stress errors were correlated with segmental/feature errors in the CI children exclusively. We conclude that CI users struggle to acquire consonants, which may cascade into further prosodic deficits. The results are interpreted in terms of a motor control model of speech production. We suggest that CIs provide sufficient information to learn rudimentary auditory representations for syllables; however, such auditory representations might not be detailed enough to implicitly derive the somatosensory consequences of the individual consonants.

Repeating with the right hemisphere: reduced interactions between phonological and lexical-semantic systems in crossed aphasia?

Knowledge on the patterns of repetition amongst individuals who develop language deficits in association with right hemisphere lesions (crossed aphasia) is very limited. Available data indicate that repetition in some crossed aphasics experiencing phonological processing deficits is not heavily influenced by lexical-semantic variables (lexicality, imageability, and frequency) as is regularly reported in phonologically-impaired cases with left hemisphere damage. Moreover, in view of the fact that crossed aphasia is rare, information on the role of right cortical areas and white matter tracts underpinning language repetition deficits is scarce. In this study, repetition performance was assessed in two patients with crossed conduction aphasia and striatal/capsular vascular lesions encompassing the right arcuate fasciculus (AF) and inferior frontal-occipital fasciculus (IFOF), the temporal stem and the white matter underneath the supramarginal gyrus. Both patients showed lexicality effects repeating better words than non-words, but manipulation of other lexical-semantic variables exerted less influence on repetition performance. Imageability and frequency effects, production of meaning-based paraphrases during sentence repetition, or better performance on repeating novel sentences than overlearned clichés were hardly ever observed in these two patients. In one patient, diffusion tensor imaging disclosed damage to the right long direct segment of the AF and IFOF with relative sparing of the anterior indirect and posterior segments of the AF, together with fully developed left perisylvian white matter pathways. These findings suggest that striatal/capsular lesions extending into the right AF and IFOF in some individuals with right hemisphere language dominance are associated with atypical repetition patterns which might reflect reduced interactions between phonological and lexical-semantic processes.

Mild Developmental Foreign Accent Syndrome and Psychiatric Comorbidity: Altered White Matter Integrity in Speech and Emotion Regulation Networks

Foreign accent syndrome (FAS) is a speech disorder that is defined by the emergence of a peculiar manner of articulation and intonation which is perceived as foreign. In most cases of acquired FAS (AFAS) the new accent is secondary to small focal lesions involving components of the bilaterally distributed neural network for speech production. In the past few years FAS has also been described in different psychiatric conditions (conversion disorder, bipolar disorder, and schizophrenia) as well as in developmental disorders (specific language impairment, apraxia of speech). In the present study, two adult males, one with atypical phonetic production and the other one with cluttering, reported having developmental FAS (DFAS) since their adolescence. Perceptual analysis by naïve judges could not confirm the presence of foreign accent, possibly due to the mildness of the speech disorder. However, detailed linguistic analysis provided evidence of prosodic and segmental errors previously reported in AFAS cases. Cognitive testing showed reduced communication in activities of daily living and mild deficits related to psychiatric disorders. Psychiatric evaluation revealed long-lasting internalizing disorders (neuroticism, anxiety, obsessive-compulsive disorder, social phobia, depression, alexithymia, hopelessness, and apathy) in both subjects. Diffusion tensor imaging (DTI) data from each subject with DFAS were compared with data from a group of 21 age- and gender-matched healthy control subjects. Diffusion parameters (MD, AD, and RD) in predefined regions of interest showed changes of white matter microstructure in regions previously related with AFAS and psychiatric disorders. In conclusion, the present findings militate against the possibility that these two subjects have FAS of psychogenic origin. Rather, our findings provide evidence that mild DFAS occurring in the context of subtle, yet persistent, developmental speech disorders may be associated with structural brain anomalies. We suggest that the simultaneous involvement of speech and emotion regulation networks might result from disrupted neural organization during development, or compensatory or maladaptive plasticity. Future studies are required to examine whether the interplay between biological trait-like diathesis (shyness, neuroticism) and the stressful experience of living with mild DFAS lead to the development of internalizing psychiatric disorders.

Lexical and Grammatical Development in a Child with Cochlear Implant and Attention Deficit: A Case Study.

This is the first study to explore lexical and grammatical development in a deaf child diagnosed with Attention Deficit Hyperactivity Disorder, Inattentive sub-type (ADHD/I). The child, whose family language was Spanish, was fitted with a cochlear implant (CI) when she was 18 months old. ADHD/I, for which she was prescribed medication, was diagnosed 3;6 years later. Speech samples were videotaped over the first 4 years of CI use and during a follow-up session 1 year later. Samples were transcribed according to CHAT conventions and several measures of expressive language were obtained. Receptive language was evaluated with standardized tests. Results show that while some aspects of her development seemed relatively positive (e.g., acquisition of verbal morphemes at the same auditory age as typical children), other characteristics were atypical for a CI user: (1) preference for paralexical expressions in early lexicon; (2) lexical errors in colours and other abstract words; and (3) low MLU and varied grammatical errors including disorganized discourse. Medication had a positive effect on all these characteristics, providing evidence of a link with ADHD/I. This study concludes that ADHD/I had a direct impact on the lexical and grammatical development in this child, as well as an indirect influence over her communicative style. More studies are needed to explore language characteristics of children with CI and ADHD.

Loss of regional accent after damage to the speech production network.

Lesion-symptom mapping studies reveal that selective damage to one or more components of the speech production network can be associated with foreign accent syndrome, changes in regional accent (e.g., from Parisian accent to Alsatian accent), stronger regional accent, or re-emergence of a previously learned and dormant regional accent. Here, we report loss of regional accent after rapidly regressive Broca’s aphasia in three Argentinean patients who had suffered unilateral or bilateral focal lesions in components of the speech production network. All patients were monolingual speakers with three different native Spanish accents (Cordobés or central, Guaranítico or northeast, and Bonaerense). Samples of speech production from the patient with native Córdoba accent were compared with previous recordings of his voice, whereas data from the patient with native Guaranítico accent were compared with speech samples from one healthy control matched for age, gender, and native accent. Speech samples from the patient with native Buenos Aires’s accent were compared with data obtained from four healthy control subjects with the same accent. Analysis of speech production revealed discrete slowing in speech rate, inappropriate long pauses, and monotonous intonation. Phonemic production remained similar to those of healthy Spanish speakers, but phonetic variants peculiar to each accent (e.g., intervocalic aspiration of /s/ in Córdoba accent) were absent. While basic normal prosodic features of Spanish prosody were preserved, features intrinsic to melody of certain geographical areas (e.g., rising end F0 excursion in declarative sentences intoned with Córdoba accent) were absent. All patients were also unable to produce sentences with different emotional prosody. Brain imaging disclosed focal left hemisphere lesions involving the middle part of the motor cortex, the post-central cortex, the posterior inferior and/or middle frontal cortices, insula, anterior putamen and supplementary motor area. Our findings suggest that lesions affecting the middle part of the left motor cortex and other components of the speech production network disrupt neural processes involved in the production of regional accent features.

Post-stroke Aphasia

Aphasia is a generic term used to describe a range of impairments in language function following acquired brain damage typically involving the left hemisphere [1–3]. Aphasia may affect all modes of expressive and receptive communication including speaking, understanding, writing, reading, and gesturing [1–3]. This definition seems superficial because it merely describes the surface behavioral deficits of aphasia (e.g., word-finding difficulty and reduced fluency) and mentions nothing about the underlying source of functional impairments. Some scientists prefer to describe aphasia as a multimodal impairment of the integral constituents of language, such as phonology, syntax, morphology, and lexical semantics [4]. Aphasia should not be regarded as a domain-specific language disorder because other cognitive skills (e.g., attention, learning, and memory and executive function) essential for normal processing of language are usually impaired as well. A growing body of evidence indicates that the adequate functioning of these nonlanguage cognitive functions is crucial for the recovery of aphasia and communication deficits [5]. This would imply that formal assessment of aphasia should not be restricted to the language domain; rather it needs to be expanded to include other cognitive and behavioral domains (see later). A new conceptualization of aphasia as a “discrete acquired disorder with a variety of aetiologies but specific characteristics” has been proposed as it provides a more informative viewpoint that may be useful to enhance public awareness of this still under-recognized condition [6]. In this chapter, we present an overview of acute and chronic post-stroke aphasia (PSA) covering epidemiology, pathophysiology, diagnosis, and treatment.

El desarrollo vocal en niños sordos de familias hispanohablantes

El desarrollo vocal es un proceso que precede a la produccion de las primeras palabras; durante este proceso el nino comienza a emitir sonidos cada vez mas parecidos a los del adulto, aumentando poco a poco la complejidad de las silabas, las palabras y la variedad de los sonidos. A pesar del interes clinico de este proceso, hasta la fecha pocos estudios han examinado el desarrollo vocal en bebes de familias hispanohablantes. Este articulo representa un esfuerzo por llenar ese vacio. En el el lector encontrara un analisis de los patrones tipicos de desarrollo vocal en ninos de diferentes contextos linguisticos, con especial atencion al caso de los ninos que aprenden espanol. Tambien se presenta un procedimiento para evaluar el desarrollo vocal mediante muestras espontaneas de produccion y se describe una propuesta de intervencion para ninos con retraso en su desarrollo vocal. Los analisis y propuestas recogidos deben ser de interes para logopedas, audiologos, maestros de sordos y terapeutas del lenguaje infantil en general. Los autores confian que este trabajo sirva de estimulo para abordar nuevas investigaciones sobre el desarrollo vocal de ninos que familias hispanohablantes.