J. van Borsel

Repetitions in final position in a nine-year-old boy with focal brain damage

This paper describes the final repetitions displayed by a nine-year-old boy with a history of cerebral trauma. The dysfluencies that he evidenced are somewhat different from those reported in previous studies in that his final repetitions tended to involve an entire syllable or the nucleus and coda of a syllable rather than an individual sound. Also, they co-occurred with whole-word repetitions of terminal words of utterances. This raises the possibility that this symptomatology represents a form of palilalia.

Speech fluency in prader-willi syndrome

This study investigated speech fluency in 15 individuals with Prader-Willi syndrome (PWS), chronological age from 9;9 to 20;0, total IQ (WISC-R) from 40 to 94. Speech samples, collected in 4 different speech modalities (spontaneous speech, repetition, monologue, and automatic series) were analyzed for frequency, type and distribution of dysfluencies. It was found that dysfluent speech behavior is a common symptom in PWS, but also that this dysfluency does not conform completely to the pattern of stuttering. Rather a mixed clinical picture with features characteristic and uncharacteristic of stuttering emerges.

Speech intelligibility of children with unilateral cleft lip and palate (Dutch cleft) following a one-stage Wardill–Kilner palatoplasty, as judged by their parents

This study determined the intelligibility (words, sentences and story telling) of 43 children (mean age 4.9 years) with unilateral cleft lip and palate who received a Wardill-Kilner palatoplasty, as judged by their parents and determined the influence of age and gender. A comparison with normative data for intelligibility of 163 Dutch speaking children was made. Each child and the parents completed The Dutch intelligibility test. Measures reported include group mean intelligibility percentages for words, sentences and story telling for children aged 2.5-5.0 and 5.0-7.6 years. A significant correlation between age of the children and intelligibility was measured. No significant gender-related differences were found. An interesting finding is the absence of significant difference in intelligibility percentage between the children with cleft palate and the normative data for story telling. The reported intelligibility percentages provide important prognostic reference information for surgeons who perform palatoplasty and speech pathologists who assess the speech production of children with cleft palate.

Electrophysiological registration of phonological perception in the subthalamic nucleus of patients with Parkinson’s Disease

Phonological processing is usually associated with the activation of cortical areas, especially in the left cerebral hemisphere. This study examined if phonologically elicited evoked potentials can be recorded directly from the subthalamic nucleus in patients with Parkinsons Disease (PD). Seven PD patients who had undergone implantation of deep brain electrodes for the stimulation of the subthalamic nucleus were included. Local field potentials were recorded in a pre-attentive auditory phonological task, an attentive auditory phonological discrimination task, and a word recognition task. Auditory evoked potentials related to phonological, but not lexical processing, could be demonstrated in the subthalamic nucleus for all three tasks. Only minor changes were found after levodopa administration. This study demonstrates that the subthalamic nucleus is involved in early phonological perception, which puts the subthalamic nucleus in a position to modify phonological perception in a larger cortico-subcortical network.

Disfluency: it is not always stuttering.

To the Editor : Disfluency refers to normal, abnormal, or ambiguous breaks in the continuity of producing phonologic, lexical, morphologic, and/or syntactic language units in oral speech (1). It appears to be common in neurofibromatosis type 1 (NF1) and has been variously described as reduced or fast rate (2–4), deliberate paced rhythm (5), irregularities in speech rate and rhythm (6), sloppy or labored articulation (4), and stuttering (6). These divergent findings generally resulted from perceptual studies which, except for Alivuotila et al. (4), did not include control participants. Therefore, to further delineate disfluency in NF1, we calculated the frequency of disfluencies and measured speaking rate in a group of NF1 patients and controls, and looked for similarities with known fluency disorders. Patients were 30 NF1 adults, 15 males and 15 females, fulfilling the National Institutes of Health (NIH) diagnostic criteria for NF1. Controls included 30 age(p > 0.05) and gender-matched adults (p > 0.05) without NF1 who did not have speech-language disorders. Selected fragments from video-recorded spontaneous speech were subjected to an in-depth fluency analysis (Table S2, Supporting information). Disfluencies were classified as ‘stutter-like disfluencies’ (part-word repetitions, single-syllable word repetitions, and disrhythmic phonations) or ‘other disfluencies’ (interjections, revisions/abandoned utterances, and multisyllable/phrase repetitions) (7) and their frequency of occurrence was determined. Speaking rate was measured as both speech and articulation rate (i.e. the number of syllables per second with and without inclusion of pause intervals, respectively). Additionally, pauses were analyzed according to their number and duration, and a measure of articulation rate variation was calculated. The latter can be associated with the occurrence of rapid bursts of speech. Statistical analysis for comparison of NF1 patients and controls included two-way analyses of variance with ‘group’ and ‘gender’ as fixed factors (α = 0.05). As interaction terms were not significant, main effects were interpreted directly. Results (Table 1) showed that differences between NF1 adults and controls were especially marked for speaking rate. NF1 adults had a faster articulation rate, showed more articulation rate variation, and paused more and longer than controls. However, speech rate was similar between groups. Given the faster articulation rate, this seems contradictory, but can readily be explained. Speech rate is a function of articulation rate and pausing. As NF1 adults also Table 1. Results [mean and (SD)] of the in-depth fluency analysis

De behandeling van jonge stotterende kinderen

Bij de behandeling van stotteren vormen jonge kinderen een aparte groep. Vaak is het stotteren, in tegenstelling tot bij volwassenen, nog niet definitief aanwezig en bestaat de kans op herstel, eventueel zelfs spontaan herstel. Ook nemen anderen en met name de ouders meestal een heel belangrijke plaats in het behandelingsproces in. En ten slotte vraagt het feit dat het om kinderen gaat specifieke, aan leeftijd en mogelijkheden aangepaste werkvormen. In dit katern gaan we achtereenvolgens in op de vraag of behandelen al dan niet wenselijk is bij jonge kinderen, schetsen we het probleem van de keuze van een behandeling, en geven we een kort overzicht van mogelijke behandelvormen. Daarna gaan we uitvoeriger in op enkele van de meest gebruikte therapieen en benaderingen in ons taalgebied.