bluuebunny/crossref_metadata_2025 huggingface dataset:
Auditory Integration Training
Authors: Madell Jane R.
Published: July 2014

Auditory integration training (AIT) is a developing treatment for auditory disorders that include sensitivity to sound, auditory attention problems, and auditory processing disorders. Although there is limited published research, a growing body of anecdotal and clinical data is being reported at professional meetings. This article discusses some of the issues related to AIT and presents preliminary data indicating that word recognition scores in the presence of competing noise improves for children with a variety of disorders who have been treated with AIT.
Is Sensory Integration Effective for Children With Language-Learning Disorders?
Authors: Griffer Mona R.
Published: July 2014

Sensory integration therapy has become widely accepted as an intervention for enhancing language-learning disorders and academic difficulties in hildren. However, much controversy surrounds this approach because of the small amount of empirical evidence to support its application to this clinical population. The purpose of this article is threefold: review the relevant research pertaining to treatment efficacy studies involving sensory integration conducted over the last three decades, discuss the perspectives from which various researchers and clinicians view language disorders in children, and discuss parameters for evaluating efficacy studies and the clinical use of sensory integration, suggesting directions for future research.
The Effect of Examiner's Race on the Performance of African American Children on the SCAN
Authors: Smith Tina T. , Bradham Tamala , Chandler Leah , Wells Christina
Published: July 2014

Purpose:
With African American children, processingdependent central auditory nervous system (CANS) tests, such as the Screening Test for Auditory Processing Disorders (SCAN) (Keith, 1986), may be less culturally biased than traditional knowledge-dependent standardized language measures. Keith found that African American children received lower scores on the SCAN than did Anglo American children. The primary purpose of this study was to determine whether middle-class African American children might improve their SCAN performance when tested by an African American versus an Anglo American examiner.

Method:
The SCAN was administered twice to 47 African American children, ages 5–10 years. Half of the participants were tested by an African American examiner first and then by an Anglo American examiner, with the order of testing counterbalanced for the remaining half of the participants. Data were also analyzed by grade level.

Results:
A 2 (examiner race) x 3 (grade level) analysis of variance did not reveal a significant effect for examiner race, but did show a main effect for grade level on certain SCAN subtests; however, effect size results revealed that the magnitude of differences between mean scores on the Competing Words subtest and the composite score were large enough to be potentially significant. Results also indicated a significant learning effect.

Clinical Implications:
Although examiner race did not appear to influence SCAN performance for this group of children, the possibility of a race effect needs further investigation with a larger sample, as does the clinical utility of the SCAN as a processing-dependent measure. The significant learning effect also suggests potential problems with the test-retest reliability of the SCAN.
The Efficacy of Phonological Awareness Intervention for Children With Spoken Language Impairment
Authors: Gillon Gail T.
Published: July 2014

Purpose:
This study investigated the efficacy of an integrated phonological awareness intervention approach for children with spoken language impairment (SLI) who demonstrated early reading delay. Ninety-one, 5- to 7-year-old New Zealand children participated in this study: 61 children with SLI and 30 children with typically developing speech and language skills. All of the children with language impairment exhibited expressive phonological difficulties and some also had delayed semantic and syntactic development.

Method:
The children with SLI participated in either: (a) an integrated phonological awareness program, (b) a more traditional speech-language intervention control program that focused on improving articulation and language skills, or (c) a minimal intervention control program over a 4 1/2-month time period.

Results:
Effects of the interventions on phonological awareness ability, reading performance, and speech production were examined. The children who received phonological awareness intervention made significantly more gains in their phonological awareness ability and reading development than the children receiving the other types of speech and language intervention. Despite significant delays in phonological awareness prior to training, children who received the phonological awareness intervention reached levels of performance similar to children with typically developing speech and language skills at post-test assessment. The phonological awareness intervention also improved the children's speech articulation.

Clinical Implications:
The findings suggest that integrated phonological awareness intervention may be an efficient method to improve phonological awareness, speech production, and reading development of children with SLI. Findings are discussed with reference to a speech-literacy link model.
Part II
Authors: Hall Penelope K.
Published: July 2014

In a previous letter to the parent(s) of children with developmental apraxia of speech (DAS), the speech characteristics often exhibited as part of the disorder were described. In this second letter, the issues involved in current thinking about the nature of the disorder are explored. Also shared is information concerning what is thought to be known about the causes of the disorder. An appendix of publications exploring these issues appears at the end of the letter.
Does It Matter What Your Client Thinks? The Role of Theory in Intervention
Authors: Hewitt Lynne E.
Published: July 2014

Kamhi (2000) presents a case study of a child with a phonological impairment whose view of the intervention process led her to refuse to work on her goals with anyone other than her clinician. In this response, the potential clinical impact of discrepant views among the participants in a clinical intervention is discussed. In particular, it is argued that subjectivity is inherent in all interactions, but that different theories place differing emphasis on the importance of the subjective states of interactional participants. Three prominent theories of intervention are discussed: social interactionist, behaviorist, and information processing. It is argued that discrepancies between a clinician's and a client's view of what is happening during clinical interactions may complicate intervention. It is further argued that theoretical eclecticism may have a particularly negative impact, as it will increase the likelihood of misunderstandings. A conclusion is that, when clashes in perspectives arise, they force the clinician to make explicit what he or she believes—what causes disorders, what processes work to remediate them, and why.
Facilitating Language Development for Inner-City Children: Experimental Evaluation of a Collaborative, Classroom-Based Intervention
Authors: Hadley Pamela A. , Simmerman Alice , Long Michele , Luna Michael
Published: July 2014

Purpose:This study explores the effectiveness of a collaborative, classroom-based model in enhancing the development of vocabulary and phonological awareness skills for kindergarten and first-grade children in an inner-city school district.

Method:Four regular education teachers from the neighborhood school were randomly selected for participation. Children were randomly assigned to classrooms following usual school procedures. Two classrooms served as standard practice controls. In the other two classrooms, a collaborative service delivery model was implemented. One certified speech-language pathologist taught in each experimental classroom 2½ days per week. The speech-language pathologist and the regular education teachers engaged in joint curriculum planning on a weekly basis. Vocabulary and phonological awareness instruction was embedded into ongoing curricular activities. Additionally, explicit instruction in phonological awareness was planned for a 25-minute small-group activity center weekly.

Results:Following the 6-month intervention, superior gains were noted in receptive vocabulary, expressive vocabulary, beginning sound awareness, and letter-sound associations for children in the experimental classrooms as compared to children in the standard practice control classrooms. The children in the experimental classrooms also showed greater improvement on a deletion task in comparison to the children in the standard practice classrooms. Importantly, this task was never used as an instructional activity, and thus demonstrated generalization to a novel phonological awareness task.

Clinical Implications:The results are discussed with regard to the positive benefits of collaboration in facilitating the language abilities of inner-city children who are at risk for academic difficulties in the early elementary grades.
Acoustical Barriers to Learning
Authors: Nelson Peggy B. , Soli Sig
Published: July 2014

There are surprisingly large numbers of children with various auditory disorders in the schools. Their classrooms are often noisy, reverberant, and active places of learning. For these children, their auditory problems plus the poor classroom acoustics cause significant learning problems. Poor listening conditions can affect all children, but they affect those with auditory disorders more. Improving classroom acoustics can significantly reduce the negative educational impact of auditory disorders. This article reviews relevant literature on acoustical barriers to successful learning and provides guidance for school personnel making decisions regarding classroom facilities.
Classroom Acoustics for Children With Normal Hearing and With Hearing Impairment
Authors: Crandell Carl C. , Smaldino Joseph J.
Published: July 2014

Past investigations demonstrate that the acoustical environment of a classroom is a critical factor in the academic, psychoeducational, and psychosocial achievement of children with normal hearing and with hearing impairment. This article examines several acoustical variables, such as noise, reverberation, and speaker-listener distance, which can deleteriously affect speech perception in classrooms. Moreover, the discussion examines the effects of these variables on the speech perception abilities of both children with normal hearing and children with hearing loss. Finally, appropriate acoustical criteria are suggested for children in educational settings.
Following Directions
Authors: Semel Eleanor
Published: July 2014

In the August 2001 issue of
AJSLP
(Vol. 10, No. 3, pp. 246–247), the authors listed for the computer program ‘Following Directions: One- and Two-Level Commands’ are Wilson and Fox. In fact, the author is Eleanor Semel.
Stuttering and Phonology
Authors: Nippold Marilyn A.
Published: July 2014

In the April 2002 issue, in the "Stuttering and Phonology: Is There an Interaction?" article by Marilyn A. Nippold, an editing error (on p. 101, left column) misrepresented who performed certain analyses. Below is the correct wording of the sentence in question, with the operative words in bold:

Subsequent analyses by
this author
[meaning Marilyn A. Nippold] indicated that the 20 children obtained a mean percentile rank of 57.25 on the GFTA (range=23–99); a mean overall score of 21.50 (range = 14–34) on the SSI-3; a mean WWD (percent) of 14.08 (range = 5ndash;33); and a mean TD (percent) of 17.54 (range = 10.30–36).
A Fluency Disorders Prevention Program for Preschoolers and Children in the Primary Grades
Authors: Cooper Eugene B. , Cooper Crystal S.
Published: July 2014

A fluency disorders prevention program for classroom use, designed to develop the feeling of fluency control in normally fluent preschool and primary grade children, is described. The program addresses the affective, behavioral, and cognitive aspects of fluency and features activities that not only develop the child’s fluency motor skills but also teach the language of fluency by developing the child’s metalinguistic skills.
Early Language Intervention
Authors: Wilcox M. Jeanne , Kouri Theresa A. , Caswell Susan B.
Published: July 2014

This investigation focused on the effectiveness of classroom versus individual interventions in promoting initial lexical acquisition for young preschool children with language delays. Twenty children aged 20–47 months were randomly assigned to individual and classroom-based early intervention programs. Progress was measured in terms of children’s spontaneous and productive use of the target items in treatment and home-based generalization settings at mid- and posttreatment measurement points. Results indicated that use of target words as measured by treatment data was equal for children in the two intervention conditions. Differences were apparent when home generalization data were considered. Children in the classroom intervention condition demonstrated a greater degree of productive use of target words in the home generalization measures than did children in the individual intervention condition. The children also demonstrated differences in use of target words in treatment versus home settings. A fair amount of individual variation was apparent in lexical learning in each of the treatment conditions, and pretreatment cognitive aptitude was found to play a role in this variation for children in the classroom intervention condition. It was concluded that, with respect to initial lexical training, classroom-based intervention is associated with superior generalization of lexical targets to the home environment. Additionally, given differences in children’s target word use in different settings, it was concluded that treatment progress data in isolation are not likely to provide complete information regarding children’s lexical learning.
Analyzing the Potential Benefit of Microcomputer Use for Teaching Figurative Language
Authors: Nippold Marilyn A. , Schwarz Ilsa E. , Lewis Molly
Published: July 2014

Microcomputers offer the potential for increasing the effectiveness of language intervention for school-age children and adolescents who have language-learning disabilities. One promising application is in the treatment of students who experience difficulty comprehending figurative expressions, an aspect of language that occurs frequently in both spoken and written contexts. Although software is available to teach figurative language to children and adolescents, it is our feeling that improvements are needed in the existing programs. Software should be reviewed carefully before it is used with students, just as standardized tests and other clinical and educational materials are routinely scrutinized before use. In this article, four microcomputer programs are described and evaluated. Suggestions are then offered for the development of new types of software to teach figurative language.
The Early Identification of Beginning Stuttering I
Authors: Gordon Pearl A. , Luper Harold L.
Published: July 2014

Speech-language pathologists often struggle with the differentiation of stuttering from normal disfluencies in young children. Differential diagnostic protocols are frequently used to aid clinicians in this complex clinical task. In this article the general format and criteria, clinical data collection procedures, documentation, and relative use of quantification in six protocols are examined and discussed. In a forthcoming companion article, we will discuss problems encountered with the use of differential diagnostic protocols and offer suggestions for future research and the use of these protocols.
Maintaining the Integrity of Home Linguistic Varieties
Authors: Campbell Lynda R.
Published: July 2014

Many young African American children use a linguistic variety commonly referred to as Black English Vernacular (BEV) that is different from the linguistic standard expected and required in schools. Maintaining students’ home linguistic varieties (as one form of communication) is important for self-esteem and self- and group-identity. Because speech-language pathologists may serve as consultants to early childhood teachers, and may also provide second dialect instruction, what are some possible practices that may lessen the possibility of jeopardizing the integrity of students’ home linguistic varieties?
Ongoing Assessment in the Management of Stuttering
Authors: Hillis James W.
Published: July 2014

A rationale is offered supporting the need for ongoing or time-series assessment in the treatment of stuttering. Several measurement strategies and their reliability/validity are reviewed. An example of time-series assessment in clinical treatment is provided. Finally, some frequently voiced concerns regarding the theory and validity of measurement in the treatment of stuttering are discussed.
Phoneme Effects on Vocal Effort and Vocal Quality
Authors: Watterson Thomas , McFarlane Stephen C. , Diamond Kari L.
Published: July 2014

This study demonstrated that "vocal effort" is a legitimate laryngeal perception that can be detected by many subjects who have voice disorders and by some normal control subjects. Further, subjects with voice disorders found that the degree of vocal effort in speech was greatest for voiceless obstruent consonants, followed by voiced obstruents; sonorants and nasals required the least effort. A panel of listeners, however, could not detect differences in roughness, breathiness, intonation, or overall vocal quality as the perceived vocal effort varied.
Data Collection
Authors: Olswang Lesley B. , Bain Barbara
Published: July 2014

For many of us, not having data concerning a client’s progress during treatment is tantamount to being unprepared for a lecture, or showing up at a birthday party without a present—totally unthinkable. This zealous position is based on the assumption that clinical decisions regarding treatment efficacy should be based on data. Data, in this case, refers to both quantitative and qualitative information that provides evidence for deciding the course of treatment. This is not to say that data can and should be collected on every aspect of the clinical process. Indeed, intuitive decision-making on the part of the speech-language pathologist is often warranted. But in general, a series of decisions regarding whether or not treatment is working, can and should be based on data. This article examines the ways in which we can measure treatment progress, and provides guidelines for the reader in the use of a data-based, decision-making model.
Normal Speech and Hearing by Age 5 as a Goal for Children With Cleft Palate
Authors: Blakeley Robert W. , Brockman Janet H.
Published: July 2014

The authors report the results of a 4-year project to influence speech and hearing outcomes, employing direct program-management strategies with both multidiscipline professionals and family members of children born with oral clefts. Early and continuing speech and hearing diagnosis (12–60 months), parent education as speech aides, timely professional speech habilitation, including use of
temporary
speech appliances, and early medical care for ears were used in seeking a goal of normal oral-nasal resonance balance, developmentally normal articulation
1
and normal hearing by age 5 for 90% of children with cleft palate ± cleft lip. The project involved 41 children. This resulted in normal oral-nasal resonance in 93% (38) of the group at age 5. Normal developmental articulation proposed by Sander for "customary production" was also achieved by 93% at age 5. Thirty-eight of the 41 subjects produced 14 of 15 test phonemes correctly. Of the 15 test phonemes, /
r
/ was most frequently in error. Twenty-seven percent (11) failed to produce this phoneme sucessfully. Sander norms require that 66% (not 100%) of 5-year-olds correctly produce this phoneme in two positions. When oral-nasal resonance balance and articulation were combined in each child, those children who achieved
both
normal oral-nasal resonance balance and normal articulation (per age expectancy) amounted to 88% (36). During the project, 98% (40) had normal hearing in at least one ear at age 5. Language screened normally for the group, as well. Twenty-two percent (8) of the subjects wore temporary speech appliances during the project. The effect of associated anomalies/abnormalities in 15 of the 41 subjects is also reported.
Eliciting Prespeech Vocalizations in a Young Child With Profound Hearing Loss
Authors: Ertmer David J. , Stark Rachel E.
Published: July 2014

The usefulness of a real-time spectrographic speech display (SSD) in eliciting imitative and spontaneous prespeech vocalizations was explored through a case study. A 3-year, 10-month-old boy who exhibited a profound bilateral hearing loss participated in six speech training sessions. The subject received instruction that used SSD feedback to stimulate imitative production of disyllables. In addition, spontaneous vocalizations with and without SSD feedback were classified according to the developmental levels observed in infants with normal hearing (Stark, 1989). Improvement in the ability to imitate disyllables was observed. The subject also produced a higher proportion of later-developing vocalizations when using SSD feedback than when vocalizing without SSD feedback. Implications for assessment of speech development and for speech training are discussed.
Vocal Fold Diadochokinetic Function of Individuals With Amyotrophic Lateral Sclerosis
Authors: Renout Karen A. , Leeper Herbert A. , Bandur Donna L. , Hudson Arthur J.
Published: July 2014

This study relates over time the changes in voluntary opening and closing of the vocal folds (vocal fold diadochokinesis, or VFDDK) of patients with amyotrophic lateral sclerosis (ALS). The rate, pattern, and periodicity of VFDDK were examined for 12 ALS subjects with bulbar and 14 subjects with nonbulbar signs of the disease. The acoustical data were analyzed with a commercially available computer-based speech analysis system. ALS patients with bulbar and nonbulbar symptoms demonstrate reduced rate and aperiodic VFDDK as the symptomatology of the neuromotor system progresses. Individuals with bulbar signs show a greater change in vocal fold activity than do the nonbulbar group. Discussion of the clinical implications for initial diagnosis and monitoring of changes over time in motor control of laryngeal function is presented.
Self-Monitoring Abilities of Two Adults With Traumatic Brain Injury During Verbal Learning
Authors: Kennedy Mary R. T. , Yorkston Kathryn M. , Rogers Margaret
Published: July 2014

Adult survivors of traumatic brain injury (TBI) often display learning and executive function deficits. In this study, two adults with TBI and two control subjects were required to self-monitor their learning by making "judgment-of-learning" (JOL) predictions about future recall. Control subjects were highly accurate when predictions were delayed from the learning episode, but not as accurate when predictions were made immediately following learning. Delayed monitoring accuracy of subjects with TBI was the same as their immediate monitoring accuracy. One subject overpredicted his recall ability, whereas the other displayed poor relative predictive accuracy. Proportions of recall, predictions of recall, and correlations between recall and predictions were necessary in order to identify the different types of monitoring difficulty demonstrated by these subjects with TBI.
Lexical Retrieval Behaviors of Subjects With Aphasia and Subjects Without Brain Damage on a Rebus Riddle Task
Authors: Marshall Robert C. , Freed Donald B.
Published: July 2014

This study compared the lexical retrieval behaviors of subjects with aphasia (APH) and subjects with no brain damage (NBD) on a Rebus Riddle task. Most differences between the groups were quantitative. APH subjects solved significantly fewer riddles (49%) than the NBD subjects (82%); their riddle-solving times were significantly longer (
M
=27.47 seconds) than those of the NBD group (
M
=8.86 seconds). Riddle-solving time differences resulted from relative absence of behaviors in the correct responses of the NBD group (73%) compared to the APH group (23%). Qualitative analyses revealed similar distributions of lexical retrieval behaviors across the correct responses, cuing successes, and cuing failures for both groups. The Rebus Riddle task was sufficiently difficult to evoke lexical retrieval behaviors by NBD subjects. APH subjects' riddle-solving efforts demonstrated an increase in the frequency of these behaviors, but the types of lexical retrieval behaviors exhibited by both groups were similar.
Ability of Subjects With Aphasia to Visually Analyze Written Language, Pantomime, and Iconographic Symbols
Authors: Thorburn Laura , Newhoff Marilyn , Rubin Scott S.
Published: July 2014

Considerable debate exists regarding aphasia and its relationship to deficits observed in the ability to analyze visual stimuli. In this investigation, the ability of patients with aphasia to comprehend various types of visual stimuli was compared to that of subjects with no known neurological impairment. The types of visual stimuli of interest were: written language, pantomime, and iconographic symbols. Results indicated that individuals with aphasia, in comparison to the controls, demonstrated inferior performance on their comprehension of pantomime and written language. However, for iconographs, patients with aphasia performed comparably to the controls. Directions for future research are discussed.
Spectral Analysis of Sound Errors in Persons With Apraxia of Speech and Aphasia
Authors: Wambaugh Julie L. , Doyle Patrick J. , West Joan E. , Kalinyak Michelene M.
Published: July 2014

Incorrect productions of [∫] were compared to correct productions of [s] and [∫] in two subjects with apraxia of speech and aphasia. Frequencies of the peak spectral energy (FPSE) were extracted from power spectrums of monosyllabic words. In addition, in order to verify that [s] and [∫] could be differentiated in terms of FPSE, we obtained speech samples of correct productions of [s] and [∫] from two normal male speakers. A perceptual task was also completed by requiring two listeners to categorize recorded productions. Results revealed significant differences among sound categories for Subject 1, but not for Subject 2. That is, Subject 1's incorrect [∫] productions were acoustically different from his homonymous [s] productions, whereas the productions were not acoustically different for Subject 2. These findings suggest that Subject 1's /∫/errors were not errors of substitution, but would be more appropriately characterized as distortions. Conversely, this spectral analysis did not clarify the nature of Subject 2's incorrect /∫/ productions; both substitution and distortion remained possible appropriate descriptors of his sound errors.
Increased Tracheostoma Valve Seal Duration in Patients With Recessed or Irregular Stomas Using a Modified Application Method
Authors: Canady Claudia J. , Martinez J. Ann
Published: July 2014

The effectiveness of using a skin barrier product in the application of tracheostoma valves to the peristomal skin of laryngectomized patients was investigated. Three patients who expressed a desire to use the tracheostoma valve but had experienced limited or unsuccessful use due to seal failure resulting from stoma irregularities and/or recessed stomas served as case study subjects. Each subject received six applications, three using the manufacturer's prescribed method and three with the procedure modified by use of a skin barrier product. The modified application method included an additional layer of a skin barrier product with an airway hole applied to the peristomal skin under the housing. Results of the study indicated that the addition of a skin barrier product in the application of the tracheostoma valve housing in subjects with recessed or irregular stomas dramatically increased mean seal duration. Subject A showed an increase from 1 hour 8 minutes to 9 hours 26 minutes, subject B's mean seal duration increased from 21 minutes to 3 hours 45 minutes, and subject C was able to change from 11 minutes to 8 hours 22 minutes with the modified technique.
A Clinical Trial of an Operant Treatment for School-Age Children Who Stutter
Authors: Lincoln Michelle , Onslow Mark , Lewis Christine , Wilson Linda
Published: July 2014

The purpose of this investigation was to determine the effectiveness of a nonprogrammed, operant treatment for school-age children who stutter. The treatment was administered by clinicians and parents to 11 children between the ages of 7 and 12 years. A median of 12 one-hour treatment sessions was required to achieve less than 1.5% syllables stuttered during within-clinic and beyond-clinic speaking situations. The children’s speech was assessed in three everyday speaking situations over a 12-month post-treatment period. All children maintained decreased stuttering rates at 12 months post-treatment. In addition, surveys found that parents were “satisfied” or “very satisfied” with their children’s speech post-treatment. These results suggest that a nonprogrammed operant treatment for stuttering may be effective with school-age children who stutter.
Effect of Intraoral Prostheses on Swallowing Function in Postsurgical Oral and Oropharyngeal Cancer Patients
Authors: Pauloski Barbara Roa , Logemann Jerilyn A. , Colangelo Laura A. , Stein David , Beery Quinter , Heiser Mary Anne , Cardinale Salvatore
Published: July 2014

This study investigated the effect of intraoral-prostheses on swallowing function in 13 postsurgical oral and oropharyngeal cancer patients. Three subjects had resections of the soft palate with no involvement of the tongue. Ten subjects had resections of the posterior oral cavity or oropharynx including resection of the oral tongue, tongue base, soft palate, tonsil, and/or mandible. Patients received either an obturator only, a maxillary reshaping/lowering prosthesis, or an obturator combined with a maxillary reshaping/lowering prosthesis. Swallowing was examined with and without the prosthesis 3 months posthealing using videofluoroscopy; results are presented in the form of case reports. The majority of patients had either unchanged swallowing function or mixed results (i.e., improvement for some but not all bolus consistencies) when using an intraoral prosthesis. The extent of surgical resection, type of reconstruction, and postoperative radiotherapy had an impact on the type of prosthesis constructed and the patient’s ultimate swallowing ability. Despite the swallowing dysfunction demonstrated by some of the patients, all were able to maintain oral intake either with or without the prosthesis in place.
Dysphonia Following Nonsurgical Management of Advanced Laryngeal Carcinoma
Authors: Orlikoff Robert F. , Kraus Dennis H.
Published: July 2014

Traditionally, laryngectomy has been the medical treatment of choice for patients with advanced cancer of the larynx, and voice clinicians have been largely concerned, not with these patients’ dysphonia, but with subsequent alaryngeal voice restoration. Recently, there has been a trend in the management of advanced laryngeal cancer to treat patients with radiation therapy or chemoradiation with the intent of larynx preservation. Although such organ preservation treatment may render the patient free of disease, voice complaints and communicative disabilities frequently continue. These dysphonias represent a new challenge for the voice clinician, who must help the patient cope with what are often highly variable and unpredictable vocal characteristics. This article discusses how advanced glottic cancer and its treatment may contribute to such vocal disturbance, provides some illustrative case examples, and suggests how the clinician can best devise strategies for management.
Real-Time Spectrographic Displays in Vowel Production Training With Children Who Have Profound Hearing Loss
Authors: Ertmer David J. , Stark Rachel E. , Karlan George R.
Published: July 2014

The effectiveness of vowel production training with real-time spectrographic displays was assessed for two children with profound hearing loss. A multiple-baseline design across behaviors, with replication across subjects, was implemented to determine if vowel production accuracy improved following the introduction of treatment. Listener judgments of vowel correctness were obtained during the baseline, training, and follow-up sessions. Data were analyzed through visual inspection of changes in levels of accuracy, changes in trends for accuracy data, and changes in variability within and across phases. One subject showed significant improvement for all trained vowel targets; the second subject showed significant improvement for the first trained target only. Performance trends for training sessions suggest that continued treatment would have resulted in further improvement for both subjects. Vowels that received the most training were maintained at higher levels than those that were introduced later in training. Some generalization of practiced vowel targets to untrained words was observed in both subjects.
Oral Language Skills of Female Juvenile Delinquents
Authors: Sanger Dixie D. , Hux Karen , Belau Don
Published: July 2014

The language performances of female delinquents and nondelinquents were compared on composite scores from a standardized test (the Test of Language Competence-Expanded) and an informal language sample analysis procedure (a modified version of the Clinical Discourse Analysis). Participants included 28 Caucasian, institutionalized, adolescent, female delinquents with no previous identification of learning or language difficulties and 28 nondelinquent females of similar age. Delinquent participants scored significantly lower than nondelinquents on the standardized measure and on the percentage of utterances in the language samples that had syntactic and morphological errors. However, significant group differences did not emerge on pragmatically based aspects of the language sample analysis. Based on results of the standardized testing, 4 (14.29%) delinquent participants and no nondelinquent participants were potential candidates for language intervention services.
Simple Adjustments Can Improve Ventilator-Supported Speech
Authors: Hoit Jeannette D. , Banzett Robert B.
Published: July 2014

Six subjects who were tracheostomized and chronically ventilator-supported because of neuromuscular disease or injury were studied to determine if their speech could be improved. Using subjects' own portable ventilators, adjustments were made that reduced inspiratory flow and added positive end-expiratory pressure (PEEP). These adjustments resulted in increases in speaking time per ventilator cycle, increases in number of syllables produced per cycle, and decreases in peak tracheal pressure. Improvements in speech were perceptible to listeners in 3 of the 6 subjects. Listeners preferred speech produced under the ventilator-adjusted condition primarily because the quantity of speech produced per ventilator cycle increased, loudness fluctuation decreased, and voice quality improved. The only subject who showed no perceptible benefit from the adjustments had a substantial air leak around her tracheostomy tube. Importantly, gas exchange was not compromised in any of the subjects. We believe that adjustments such as prolonging inspiration and adding PEEP, when implemented in collaboration with appropriate health-care professionals, represent a simple, inexpensive, and safe intervention for improving speech in certain ventilator-supported individuals.
When Is "Watch and See" Warranted? A Response to Paul's 1996 Article, "Clinical Implications of the Natural History of Slow Expressive Language Development"
Authors: Kleeck Anne van , Gillam Ronald B. , Davis Barbara
Published: July 2014

We commend Paul for undertaking an investigation that concerns critical clinical and theoretical issues. This type of longitudinal developmental research is exactly what is needed to advance the scientific basis of our profession. We also respect Paul's attempt to construct a firm bridge between her findings and their clinical implications. The necessary and sufficient data that completely solve a clinical problem are rarely available. Because clinicians do not have the luxury of waiting until the best data imaginable are collected and analyzed before acting, it is helpful for researchers to generalize their results to the extent possible. However, because of its potential clinical, economic, and educational implications, we believe that a broad social policy like Paul's "watch and see" recommendation should be based on unambiguous evidence.

We have suggested that a number of the children in Paul's cohort may have been within the normal range in language development at the beginning of the study. Without individual data, it is impossible for us to know whether or not this was the case. To the extent that our suspicions hold true, Paul's study tells us that a number of children who function at the low end of the normal range of language development between 20 and 34 months stay within the normal range throughout the preschool and early school-age years.

Paul's suggestion of "watch and see" seems reasonable enough for the 74% of the children who tested within the normal range by kindergarten and first grade, but it may not have been sufficient for the 26% who did not. We believe children like those in this latter group would probably benefit from preschool language intervention and that very valuable language learning time could be lost if Paul's general "watch and see" policy were implemented.

It is possible that children with good outcomes and children with language delays that were significant and persistent had different profiles with respect to expressive vocabulary, receptive vocabulary, speech, and communicative intentions at the onset of the study. If so, one broad social policy may not be sufficient. We have asked Paul to provide additional data about the nature of the language difficulties exhibited by the children at the outset of her study, the predictors of continued language delay, and the results of language intervention efforts. It is our hope that Paul can provide the kinds of additional data and analyses we have requested in this discussion, and that this data can serve as the basis for refinements in definitions of early language delay, decisions about providing clinical services to very young children, and methods for analyzing intervention efficacy.
Development of a Parent Report Measure for Profiling the Conversational Skills of Preschool Children
Authors: Girolametto Luigi
Published: July 2014

A rating scale was developed for parents to use in profiling the conversational skills of their toddlers and young preschoolers with expressive skills between 12–36 months. The scale items were tested on 60 children with language delays and measured parental perceptions of two types of conversational interactions specifically designed to respond to the partner (i.e., answer questions, continue the topic of conversation) and to assert (i.e., request, initiate topics). Evaluation of the psychometric properties of the rating scale indicates that the individual items within each set are correlated with the total scale scores for responsiveness and assertiveness, respectively. Alpha coefficients were stable when calculated for two different samples. Moreover, administering the scale twice to a subset of 20 parents yielded a high degree of short-term test-retest reliability. The profiles of 6 children are presented to illustrate the clinical usefulness of the rating scale as a means of identifying areas of deficit and selecting potential treatment goals. The rating scale provides a clinically useful tool for including parental perceptions in the overall assessment of the young child's communicative ability.
Online Examination of Language Performance in Normal and Neurologically Impaired Adults
Authors: Shapiro Lewis , Swinney David , Borsky Susan
Published: July 2014

This article describes how we and others have exploited online methodology to investigate normal and disordered language processing in adults. Online tasks can be used to measure effects occurring at various temporal points during ongoing processing and are often sensitive to fast-acting, automatic processes, as well as to processes that rely on the integration and interaction of several types of information. Online tasks can be compared to their offline counterparts, tasks such as sentence-picture matching, categorization, word generation and repetition. These tasks are often used by clinicians as part of their assessment and treatment repertoire and measure effects observed at the end-points of perhaps several processes. They can thus mask a patient's strengths (and weaknesses) in any single area, including subcomponents of the language domain. We review several online lexical and syntactic processing experiments and end with a discussion of the clinical benefits of this work.
Environmental Noise
Authors: Ingrisano Dennis R-S , Perry Cecyle K. , Jepson Kairsten R.
Published: July 2014

The effects of environmental noise were estimated from automatic computer-assisted analyses of voice samples. Signals consisted of a live voice sample and a synthesized triangular waveform. Noise was generated from a personal computer fan. Six different A-weighted signal-to-noise [S/N(A)] conditions were created for the live voice and synthetic signal— 25, 20, 15, 10, 5, and 0 dB. Results revealed that automatic estimates were systematically affected by different S/N levels. As the noise floor increased, baseline estimates of jitter and shimmer also increased in value. Results are discussed with reference to safeguards and standards in voice recording and analysis.
Preparing Students to Understand and Honor Families as Partners
Authors: Bruce Melissa C. , DiVenere Nancy , Bergeron Cathy
Published: July 2014

As service providers, speech-language pathologists are in the midst of a transition from the “expert” model of intervention to forming partnerships with families and serving as resources. Although the shift from client-centered to family-centered service delivery is underway, little information has been made available on steps being taken at the pre-service training level to accomplish this change and the success of such efforts. This paper describes an innovative approach to preparing speech-language pathology students to be family centered in their professional interactions and service delivery. Over a 4-year period, 41 students embarking on their first semester of clinical training were paired with families of children with special needs for a family visit of 2 to 4 hours in length. The components of the training included pre-visit classroom exercises focused on personal values clarification and language sensitivity, visit orientation for the students and families, a family visit, journal writing by students about the visit experience, and post-visit class discussion of the visit experiences and learning outcomes. Pre- and post-measurement of students’ attitudes regarding a family’s role in intervention reflected a statistically significant change in students’ responses to questionnaire items. The students’ responses indicated an increase in family-centered attitudes and demonstrated the effectiveness of this approach in shaping those attitudes.
Physical Examination of the Diaphragm by the Speech-Language Pathologist
Authors: Hixon Thomas J. , Hoit Jeannette D.
Published: July 2014

A protocol is presented for use by the speech-language pathologist in conducting a physical examination of the diaphragm. Five clusters of performance activities are used to reveal the nature and degree of possible diaphragm dysfunction. A worksheet is offered to guide the examiner.
Expressive Vocabulary Development and Word Combinations of Spanish-English Bilingual Toddlers
Authors: Patterson Janet L.
Published: July 2014

Parent reports of their children’s expressive vocabulary and word combinations were obtained for 102 21- to 27-month-old children who were exposed to Spanish and English on a regular basis. The data were collected using an adapted version of the Language Development Survey (Rescorla, 1989). Expressive vocabulary size increased with age, and the girls’ mean vocabulary was larger than the boys’ mean vocabulary. Means, medians, and ranges of expressive vocabulary size and percentage of children combining words are presented, and potential screening guidelines are discussed.
Treatment of Vocal Nodules
Authors: Pannbacker Mary
Published: July 2014

This paper provides a review of treatment options and outcomes for vocal fold nodules. Topics addressed in this paper include: (a) frequency of occurrence of vocal nodules; (b) factors affecting treatment decisions, including age, duration of nodules, extent of dysphonia, and choice of treatment; (c) types of treatment (voice treatment and/or surgery); and (d) pertinent efficacy research.
Nasalance in the Speech of Children With Normal Hearing and Children With Hearing Loss
Authors: Fletcher Samuel G. , Mahfuzh Fuad , Hendarmin Hendarto
Published: July 2014

Three new tests were introduced in this study to compare nasal resonance and speaking time of 30 children 8 to 11 years old who were profoundly deaf with that of 30 children with normal hearing in a matched control group. The ANS-P plane was introduced to position the palatometer sound separation plate. This enabled the plate to be brought easily and repeatedly into the desired standard position despite widely varying facial contours of the subjects. The findings from this study showed the group with hearing loss had significantly more nasalance than did the normal group when nasal consonants were absent and significantly less when an utterance was loaded heavily with nasal consonants. These differences were interpreted as evidence of some limitation in the ability of the children with hearing loss to monitor and control nasal versus oral sound emission. Speaking time was longer in the group of children with hearing loss but was not related to the nasalance score.
Articulation in Beckwith-Wiedemann Syndrome: Two Case Studies
Authors: Borsel John Van , Morlion Bieke , Snick Kathleen Van , Leroy Jules S.
Published: July 2014

Beckwith-Wiedemann syndrome (BWS) is a genetic disorder with abdominal wall defects, gigantism, and macroglossia as its main characteristics. A number of investigators have reported the presence of articulation errors in individuals with BWS due to macroglossia. However, few data are available on the exact nature of the articulation problems of subjects with BWS. This paper presents two case studies that highlight the articulatory characteristics associated with BWS. Subjects were a boy aged 5 years 9 months and a girl aged 3 years 6 months. A phonetic analysis was conducted in which it was found that primarily consonants with an anterior place of articulation were affected. The error patterns appeared to be related to inappropriate tongue and lip postures. An observer experiment in which naive and expert observers rated speech samples from three modes of presentation (auditory-only, visual-only, and audiovisual) showed that the subjects’ speech was more disturbed visually than auditorily.