DEVELOPMENT OF EXPRESSIVE VOCABULARY AND GRAMMAR IN YOUNG CHILDREN WITH REPAIRED CLEFT PALATE, CHILDREN WITH A HISTORY OF OTITIS MEDIA, AND CHILDREN WITH TYPICAL DEVELOPMENT

This Dissertation composes of two related studies. Study1 aimed to investigate the expressive vocabulary skill of 40 children with repaired cleft palate (CP), 29 children with histories of otitis media (OM), and 25 typically developing (TD) children at 18 and 24 months of age and compared the three groups in terms of the vocabulary growth from 18 to 24 months of age. In addition, the contribution of factors such as hearing level, tympanogram status, size of consonant inventory, maternal education level, and gender to the development of expressive vocabulary was explored. The purpose of the second study was to examine the lexical-grammatical skills of 26 children with CP with consistent velopharyngeal (VP) closure, 27 children with OM, and 20 TD children at two years of age. Further, the association between early vocabulary skills and grammatical attainment as well as the precursors of early lexical-grammatical development were explored. The MacArthur Communicative Development Inventory: Words and Sentences (CDI-WS; Fenson et al., 2007) was employed to measure the size of vocabulary as well as the grammatical ability of children in the three groups. Consistency of VP function was made objectively through nasal ram pressure (NRP) monitoring. For the second study, however, NRP data for four children with CP were missing and assessment of VP function was based on perceptual judgments. Because these studies are part of a larger longitudinal study, sound-field audiometry screenings were performed at 12 and 24 months of age. Bilateral tympanogram data were obtained at 18 and 24 months of age. Results of the first study showed that children with CP produced a significantly smaller number of words at 24 months of age and a significantly slower rate of vocabulary growth from 18 to 24 months of age when compared to TD children (p< 0.05). The observed difference remained significant when the model was adjusted for the effect of hearing level, tympanogram status, size of consonant inventory, and sociodemographic variables. However, among all variables, only the tympanogram status significantly predicted the vocabulary growth from 18 to 24 months of age across the three groups. Findings of the second study revealed significant differences among the three groups with respect to the size of vocabulary and mean number of morphemes in their three longest utterances (M3L). The difference between CP and TD groups remained statistically significant when adjusting singly for hearing level, tympanogram status, and gender. Further, significant positive associations were found between the number of words and M3L and sentence complexity in each group (p< 0.05). Weak performance of children with CP on measures of expressive vocabulary and grammar were accounted for by poorer hearing levels, more frequent instances of abnormal tympanogram status, as well as lower levels of maternal education. Findings highlighted the importance of comprehensive speech and language assessments to identify children with CP who need intervention services as early speech and expressive language management has the potential to considerably mitigate the effects of later language delays.Doctor of Philosoph

Velopharyngeal Status of Stop Consonants and Vowels Produced by Young Children With and Without Repaired Cleft Palate at 12, 14, and 18 Months of Age: A Preliminary Analysis

The objective was to determine velopharyngeal (VP) status of stop consonants and vowels produced by young children with repaired cleft palate (CP) and typically developing (TD) children from 12 to 18 months of age

Assessing Oromotor Capacity in ALS: The Effect of a Fixed-Target Task on Lip Biomechanics

This work is licensed under a Creative Commons Attribution 4.0 International License.Alternating motion rate (AMR) is a standard measure often included in neurological examinations to assess orofacial neuromuscular integrity. AMR is typically derived from recordings of patients producing repetitions of a single syllable as fast and clear as possible on one breath. Because the task places high demands on oromotor performance, particularly articulatory speed, AMRs are widely considered to be tests of maximum performance and, therefore, likely to reveal underlying neurologic deficits. Despite decades of widespread use, biomechanical studies have shown that speakers often circumvent the presumed speed challenge of the standard AMR task. Specifically, speakers are likely to manipulate their displacements (movement amplitude) instead of speed because this strategy requires less motor effort. The current study examined the effectiveness of a novel fixed-target paradigm for minimizing the truncation of articulatory excursions and maximizing motor effort. We compared the standard AMR task to that of a fixed-target AMR task and focused specifically on the tasks' potential to detect decrements in lip motor performance in persons with dysarthria due to amyotrophic lateral sclerosis (ALS). Our participants were 14 healthy controls and 17 individuals with ALS. For the standard AMR task, participants were instructed to produce the syllable /bα/ as quickly and accurately as possible on one breath. For the fixed-target AMR task, participants were given the same instructions, but were also required to strike a physical target placed under the jaw during the opening phase of each syllable. Lip kinematic data were obtained using 3D electromagnetic articulography. 16 kinematic features were extracted using an algorithmic approach. Findings revealed that compared to the standard task, the fixed-target AMR task placed increased motor demands on the oromotor system by eliciting larger excursions, faster speeds, and greater spatiotemporal variability. In addition, participants with ALS exhibited limited ability to adapt to the higher articulatory demands of the fixed-target task. Between the two AMR tasks, the maximum speed during the fixed-target task showed a moderate association with the ALSFRS-R bulbar subscore. Employment of both standard and fixed-target AMR tasks is, however, needed for comprehensive assessment of oromotor function and for elucidating profiles of task adaptation

Home-Based Music Therapy to Support Bulbar and Respiratory Functions of Persons with Early and Mid-Stage Amyotrophic Lateral Sclerosis—Protocol and Results from a Feasibility Study

Respiratory failure, malnutrition, aspiration pneumonia, and dehydration are the precursors to mortality in ALS. Loss of natural communication is considered one of the worst aspects of ALS. This first study to test the feasibility of a music therapy protocol for bulbar and respiratory rehabilitation in ALS employs a mixed-methods case study series design with repeated measures. Newly diagnosed patients meeting the inclusion criteria were invited to participate, until the desired sample size (n = 8) was achieved. The protocol was delivered to participants in their homes twice weekly for six weeks. Individualised exercise sets for independent practice were provided. Feasibility data (recruitment, retention, adherence, tolerability, self-motivation and personal impressions) were collected. Bulbar and respiratory changes were objectively measured. Results. A high recruitment rate (100%), a high retention rate (87.5%) and high mean adherence to treatment (95.4%) provide evidence for the feasibility of the study protocol. The treatment was well tolerated. Mean adherence to the suggested independent exercise routine was 53%. The outcome measurements to evaluate the therapy-induced change in bulbar and respiratory functions were defined. Findings suggest that the protocol is safe to use in early- and mid-stage ALS and that music therapy was beneficial for the participants’ bulbar and respiratory functions. Mean trends suggesting that these functions were sustained or improved during the treatment period were observed for most outcome parameters: Maximal Inspiratory Pressure, Maximal Expiratory Pressure, Peak Expiratory Flow, the Center for Neurologic Study—Bulbar Function Scale speech and swallowing subscales, Maximum Phonation Time, Maximum Repetition Rate—Alternating, Maximum Repetition Rate—Sequential, Jitter, Shimmer, NHR, Speaking rate, Speech–pause ratio, Pause frequency, hypernasality level, Time-to-Laryngeal Vestibule Closure, Maximum Pharyngeal Constriction Area, Peak Position of the Hyoid Bone, Total Pharyngeal Residue C24area. Conclusion. The suggested design and protocol are feasible for a larger study, with some modifications, including aerodynamic measure of nasalance, abbreviated voice sampling and psychological screening

Associations between age, sex, APOE genotype, and regional vascular physiology in typically aging adults

Altered blood flow in the human brain is characteristic of typical aging. However, numerous factors contribute to inter-individual variation in patterns of blood flow throughout the lifespan. To better understand the mechanisms behind such variation, we studied how sex and APOE genotype, a primary genetic risk factor for Alzheimer's disease (AD), influence associations between age and brain perfusion measures. We conducted a cross-sectional study of 562 participants from the Human Connectome Project - Aging (36 to >90 years of age). We found widespread associations between age and vascular parameters, where increasing age was associated with regional decreases in cerebral blood flow (CBF) and increases in arterial transit time (ATT). When grouped by sex and APOE genotype, interactions between group and age demonstrated that females had relatively greater CBF and lower ATT compared to males. Females carrying the APOE ε4 allele showed the strongest association between CBF decline and ATT incline with age. This demonstrates that sex and genetic risk for AD modulate age-associated patterns of cerebral perfusion measures