Toni Rietveld

Statistical Techniques for the Study of Language and Language Behaviour

A textbook on statistical techniques covering an unusually wide range of techniques and subjects, from classic techniques like analysis of variance and multiple regression to reliability and agreement analysis, matrix algebra, factor analysis, log linear modeling, and logistic regression. The emphas

Cognitive and Graded Activity Training Can Alleviate Persistent Fatigue After Stroke: A Randomized, Controlled Trial

Background and Purpose— Fatigue is a common, persistent consequence of stroke, and no evidence-based treatments are currently available to alleviate fatigue. A new treatment combining cognitive therapy (CO) with graded activity training (GRAT), called COGRAT, was developed to alleviate fatigue and fatigue-related symptoms. This study compared the effectiveness of the COGRAT intervention with a CO-only intervention after a 3-month qualification period without intervention. Methods— This randomized, controlled, assessor-blind clinical trial was conducted in 8 rehabilitation centers. Eighty-three stroke patients (>4 months after stroke) were randomly assigned to 12 weeks of CO or COGRAT after qualification. Seventy-three patients completed treatment and 68 were available at follow-up. Primary outcomes (Checklist Individual Strength–subscale Fatigue (CIS-f); self-observation list–fatigue (SOL-f)) and secondary outcomes (Hospital Anxiety and Depression Scale, Stroke-Adapted Sickness Impact Profile, SOL-pain, SOL-sleep-D, 6-minute walk test) were collected at baseline (before and after qualification period) and after treatment (immediate and 6-month follow-up). Results— The qualification period showed stable outcome measures. Both treatments showed significant beneficial effects on fatigue (CIS-f: &eegr;p2=0.48, P<0.001) and other outcomes (except pain and anxiety) with intention-to-treat analyses. Gains for the COGRAT group exceeded those in the CO group on number of individuals showing clinical improvement on the CIS-f (≥8 points: 58% versus 24%) and on physical endurance (&eegr;p2=0.20, P<0.001). Conclusions— A 12-week cognitive therapy program can alleviate persistent fatigue after stroke. The best results are obtained when cognitive therapy is augmented with graded activity training. Clinical Trial Registration— URL: http://www.trialregister.nl. Unique identifier: NTR2704.

Language-specificity in the perception of paralinguistic intonational meaning.

This study examines the perception of paralinguistic intonational meanings deriving from Ohalas Frequency Code (Experiment 1) and Gussenhovens Effort Code (Experiment 2) in British English and Dutch. Native speakers of British English and Dutch listened to a number of stimuli in their native language and judged each stimulus on four semantic scales deriving from these two codes: SELF-CONFIDENT versus NOT SELF-CONFIDENT, FRIENDLY versus NOT FRIENDLY (Frequency Code); SURPRISED versus NOT SURPRISED, and EMPHATIC versus NOT EMPHATIC (Effort Code). The stimuli, which were lexically equivalent across the two languages, differed in pitch contour, pitch register and pitch span in Experiment 1, and in pitch register, peak height, peak alignment and end pitch in Experiment 2. Contrary to the traditional view that the paralinguistic usage of intonation is similar across languages, it was found that British English and Dutch listeners differed considerably in the perception of “confident,” “friendly,” “emphatic,” and “surprised.” The present findings support a theory of paralinguistic meaning based on the universality of biological codes, which however acknowledges a language-specific component in the implementation of these codes.

Language skills of young children with unilateral cleft lip and palate following infant orthopedics: A randomized clinical trial

OBJECTIVE To investigate the effects of infant orthopedics (IO) on the language skills of children with complete unilateral cleft lip and palate (UCLP). DESIGN In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed up longitudinally: one group was treated with IO based on a modified Zurich approach in the first year of life (IO group); the other group did not receive this treatment (non-IO group). At the ages of 2, 2(1/2), 3, and 6 years, language development was evaluated in 12 children (six IO and six non-IO). Receptive language skills were assessed using the Reynell test. Expressive language skills of the toddlers were evaluated by calculating mean length of utterance (MLU) and mean length of longest utterances (MLLU); in the 6-year-olds, the expressive language skills were measured using standardized Dutch language tests. PATIENTS The participants had complete UCLP without soft tissue bands or other malformations. RESULTS IO did not affect the receptive language skills. However, the expressive language measures MLU and MLLU were influenced by IO. At age 2(1/2) and 3 years, the IO group produced longer utterances than the non-IO group. In the follow-up, the difference in expressive language between the two groups was no longer significant. CONCLUSIONS Children treated with IO during their first year of life produced longer sentences than non-IO children at the ages of 2(1/2) and 3 years. At 6 years of age, both groups presented similar expressive language skills. Hence, IO treatment did not have long-lasting effects on language development.

Word prosodic structure and vowel duration in Dutch

Abstract This paper focuses on the relation between word prosodic structure and vowel duration in Dutch, to the exclusion of phrase-final lengthening and accentual lengthening. Measurements of vowel durations in reiterant speech showed that main stress, secondary stress, and right/left-edge position determine vowel duration. In addition, the experiments made it clear that the durational differences between long and short vowels only surface in syllables with (main or secondary) stress. The observations were summarized in rules which were implemented in a diphone-based Text-To-Speech system (KUN-TTS). The resulting durations showed high correlations with vowel durations measured both in reiterant and lexical words.

Phonological Development of Toddlers With Unilateral Cleft Lip and Palate Who Were Treated With and Without Infant Orthopedics: A Randomized Clinical Trial

OBJECTIVE To investigate the phonological development of toddlers from 2 to 3 years of age with complete unilateral cleft lip and palate (UCLP) treated during the first year of life with and without infant orthopedics (IO). DESIGN In a randomized clinical trial (Dutchcleft), two groups of children were followed up: one treated with IO (IO group) and another that did not receive IO (non-IO group). Phonological skills were analyzed at 2, 2.5, and 3 years of age using a system for assessing phonological development of Dutch children (Fonologische Analyse van het Nederlands: FAN). The analysis included number of acquired consonants, order of phonological development, use of phonological processes, and occurrence of nasal escape. PATIENTS Criteria for inclusion were complete UCLP, no soft tissue bands, no other malformations, parents fluent in Dutch, birth weight of a minimum of 2500 g, and gestation time of a minimum of 38 weeks. INTERVENTIONS IO treatment based on a modified Zurich approach was started within 2 weeks after birth and used until soft palate closure at 12 months of age. Children in the non-IO group visited the clinic for an extra check-up at 6 weeks as well as before and after lip repair and soft palate closure. All other interventions were the same across groups. RESULTS Phonological development of most 2.5-year-old IO children was normal or delayed. Most children in the non-IO group followed an abnormal developmental pattern. At age 3, the children in the IO group had acquired more initial consonants. There were no group differences in the use of phonological processes or the occurrence of nasal escape. CONCLUSIONS Children treated with IO during their first year of life followed a more normal path of phonological development between 2 and 3 years of age.

An intelligibility assessment of toddlers with cleft lip and palate who received and did not receive presurgical infant orthopedic treatment.

A randomized, prospective, clinical study was performed investigating the effects of presurgical infant orthopedic treatment (PIO) in children with unilateral cleft lip and palate (UCLP). The influence of PIO on speech intelligibility was evaluated with two groups, each consisting of 10 children with UCLP. One group used PIO during the first year of life, whereas the other group did not use the device. Eight children without cleft served as a second control group. Intelligibility was assessed by lay listeners using two methods: transcription and listener rating. The ratings proved to be reliable and to have sufficient validity, but they did not completely reflect intelligibility defined as the proportion of words understood by the listener. Children in the treatment group were rated as exhibiting greater intelligibility than those in the nontreatment group. However, data obtained by means of transcriptions indicated that, in fact, there were no group differences in actual intelligibility. Only in comparison with their noncleft peers were the children with cleft lip and palate significantly less well understood.

Use of a Perceptual Evaluation Instrument to Assess the Effects of Infant Orthopedics on the Speech of Toddlers With Cleft Lip and Palate

OBJECTIVE To investigate the effects of infant orthopedics (IO) administered in the first year of life on the speech characteristics of 2.5-year-old children with complete unilateral cleft lip and palate (UCLP) using a perceptual evaluation instrument with equal-appearing interval (EAI) scales. DESIGN In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally. One group received IO based on a modified Zurich approach (IO group), and the other group did not (non-IO group). The appliance was used until soft palate closure at age 12 months. Hard palate closure is delayed until 9 years of age. PARTICIPANTS Three groups of 2.5-year-old toddlers participated in this investigation: 10 IO, 10 non-IO, and 8 noncleft controls matched for age and socioeconomic status. METHOD Five trained listeners assessed the childrens speech in a blinded perceptual rating procedure. They judged 13 specific speech characteristics and indicated their total impression of speech on EAI scales. RESULTS The reliability and consistency of 11 of the rating scales was good. The intelligibility rating scale was the single speech characteristic that distinguished the IO group from the non-IO group; the IO group was judged to be superior. The cleft groups differed from the noncleft group on 9 of the 11 scales. CONCLUSIONS Evaluation of speech by means of the present newly developed perceptual rating instrument showed that the IO group obtained significantly higher ratings for intelligibility than the non-IO group. The groups did not differ regarding any of the other speech aspects.

Direct versus indirect treatment for preschool children who stutter: The RESTART randomized trial

Objective Stuttering is a common childhood disorder. There is limited high quality evidence regarding options for best treatment. The aim of the study was to compare the effectiveness of direct treatment with indirect treatment in preschool children who stutter. Methods In this multicenter randomized controlled trial with an 18 month follow-up, preschool children who stutter who were referred for treatment were randomized to direct treatment (Lidcombe Program; n = 99) or indirect treatment (RESTART-DCM treatment; n = 100). Main inclusion criteria were age 3–6 years, ≥3% syllables stuttered (%SS), and time since onset ≥6 months. The primary outcome was the percentage of non-stuttering children at 18 months. Secondary outcomes included stuttering frequency (%SS), stuttering severity ratings by the parents and therapist, severity rating by the child, health-related quality of life, emotional and behavioral problems, and speech attitude. Results Percentage of non-stuttering children for direct treatment was 76.5% (65/85) versus 71.4% (65/91) for indirect treatment (Odds Ratio (OR), 0.6; 95% CI, 0.1–2.4, p = .42). At 3 months, children treated by direct treatment showed a greater decline in %SS (significant interaction time x therapy: β = -1.89; t(282.82) = -2.807, p = .005). At 18 months, stuttering frequency was 1.2% (SD 2.1) for direct treatment and 1.5% (SD 2.1) for indirect treatment. Direct treatment had slightly better scores on most other secondary outcome measures, but no differences between treatment approaches were significant. Conclusions Direct treatment decreased stuttering more quickly during the first three months of treatment. At 18 months, however, clinical outcomes for direct and indirect treatment were comparable. These results imply that at 18 months post treatment onset, both treatments are roughly equal in treating developmental stuttering in ways that surpass expectations of natural recovery. Follow-up data are needed to confirm these findings in the longer term. Trial Registration isrctn.org ISRCTN24362190

Speaking in ellipses: The effect of a compensatory style of speech on functional communication in chronic agrammatism

This study investigated whether a Dutch and adapted version of Reduced Syntax Therapy (REST) could stimulate and automatise the production of ellipses in Dutch-speaking, chronically agrammatic speakers (N = 12). Ellipses are syntactic frames in which slots for grammatical morphology tend to be lacking (e.g., everybody inside). When elliptical style is applied on a regular basis, the linguistic impairment is circumvented, at least for the greater part. We therefore hypothesised that REST increases participants’ functional communication skills (i.e., communicative efficacy and efficiency). This is of relevance because not all chronically agrammatic speakers become skilled at employing ellipses independently. The results of the present study suggested that when elliptical style is applied regularly, chronically agrammatic speakers get their message across more efficiently when compared to error-strewn production of sentential style.