Babbling, speech and language in children with neurological disabilities : development, validity of measures and effect of intervention

Children with neurological disabilities (ND) such as cerebral palsy, Down syndrome or other genetic syndromes often have speech and language disorder. In Sweden, children with ND often receive team-based habilitation services – with teams including speech and language pathologists – from an early age, but even so, many things are still unknown when it comes to the expected development of speech and language abilities. Furthermore, service delivery for speech and language difficulties has rarely been studied in the Swedish context and even internationally there is a lack of studies examining the effects of intervention. Babbling is an important precursor to speech and has been studied in many groups of children at risk of speech and language disorder. Thus, it shows promise as a field of study for children with neurological disabilies as well. One commonly studied babbling milestone is the onset of canonical babbling, when children produce speech-like syllables consisting of consonants and vowels. However, the most frequently used canonical babbling measure – the canonical babbling ratio (CBR) – has not been thoroughly validated. This thesis aimed to validate the CBR measure, to examine babbling, speech and language in a group of children with ND and to evaluate an intervention for young children with ND, specifically cerebral palsy. The thesis consists of five studies. In study I and II, a new and simplified version of the CBR measure (CBRUTTER ) was validated. It was found to be valid compared to other versions of the CBR and to babbling observation, suggesting it as an alternative to more laborious measures. Study II also evaluated the CBR criterion for the canonical babbling stage. A child is commonly considered to be in the canonical babbling stage when 15% or more of their babbling is canonical, that is a CBR of ≥ 0.15. Study II suggests that 0.14 may be a more appropriate criterion and emphasizes the need for proper discussion among babbling researchers on criteria for having entered the canonical babbling stage. In study I, III and IV, babbling, speech and language were examined at ages 1, 5 and 7 in a group of 18 children with neurological disabilities who received habilitation services from an early age. Compared to data from typically developing children, babbling milestones were delayed in the group of children with ND. At 5 and 7 years of age, speech and language disorder was very common, with only one participant presenting with results at age level on all measures. The severity of speech and language disorder was very varied, but a majority of participants had severe communication activity limitations. Despite this, parents rated the frequency of received SLP services as low. The results accentuate the need to closely follow speech and language development in children with ND, and to provide intervention as needed. In study V, a parent-implemented intervention for speech/language disorder was examined in young children with cerebral palsy. In a single case A-B study, four children received an intervention aimed at improving expressive vocabulary using a focused stimulation technique. Two children clearly improved their expressive vocabulary following the intervention, one showed less clear gains and one did not improve. Focused stimulation may thus be successful in children with cerebral palsy and speech/language difficulties and could be a valuable addition when it comes to SLP intervention options in children with neurological disabilities. In summary, this thesis presents new insights on the validity of the CBR measure, emphasizes the need to assess speech and language in children with neurological disability, and suggests an intervention for young children with cerebral palsy

Toxicokinetic-toxicodynamic modelling of survival of Gammarus pulex in multiple pulse exposures to propiconazole: model assumptions, calibration data requirements and predictive power

Toxicokinetic-toxicodynamic (TKTD) models quantify the time-course of internal concentration, which is defined by uptake, elimination and biotransformation (TK), and the processes which lead to the toxic effects (TD). TKTD models show potential in predicting pesticide effects in fluctuating concentrations, but the data requirements and validity of underlying model assumptions are not known. We calibrated TKTD models to predict survival of Gammarus pulex in propiconazole exposure and investigated the data requirements. In order to assess the need of TK in survival models, we included or excluded simulated internal concentrations based on pre-calibrated TK. Adding TK did not improve goodness of fits. Moreover, different types of calibration data could be used to model survival, which might affect model parameterization. We used two types of data for calibration: acute toxicity (standard LC50, 4 d) or pulsed toxicity data (total length 10d). The calibration data set influenced how well the survival in the other exposure scenario was predicted (acute to pulsed scenario or vice versa). We also tested two contrasting assumptions in ecotoxicology: stochastic death and individual tolerance distribution. Neither assumption fitted to data better than the other. We observed in 10-d toxicity experiments that pulsed treatments killed more organisms than treatments with constant concentration. All treatments received the same dose, i.e. the time-weighted average concentration was equal. We studied mode of toxic action of propiconazole and it likely acts as a baseline toxicant in G. pulex during 10-days of exposure for the endpoint surviva

Materiell kultur bland hantverkare i Ekenäs på 1800-talet

Syftet med denna artikel är att undersöka ekenäshantverkarnas livsform och att visa att de tillhörde borgerskapet i staden. Enligt Börje Hanssen (1952, s. 520) bildade urbana hantverkare och lägre tjänstemän en egen urban klass som han kallar "det ringare borgerskapet". Med hjälp av Hanssens teori om urbana och pagana livsformer på 1600- och 1700-talen försöker jag bestämma vilken hantverkarnas klasstillhörighet och livsform egentligen var. Detta gör jag genom att främst undersöka deras boendemiljö och klädsel på basen av bouppteckningar fr.o.m. mitten av 1800-talet. De första årtiondena borde ha varit en ganska bra tid för hantverkarna, eftersom hantverket blomstrade under 1850-talet i Ekenäs. Efter skråsystemets avveckling 1868 kan hantverkarnas ställning däremot ha blivit en helt annan, eftersom näringsfriheten kan ha försvagat hantverkarnas ställning. Under den senare delen av 1800-talet skedde inga större förändringar, och eftersom industrialismen inte hade kommit igång på allvar ännu, är det också lämpligt att avsluta undersökningen i slutet av 1880-talet

Cognitive development of very preterm born children at 11 years of age

Very preterm birth poses a risk to adverse neurodevelopment. Specific cognitive impairments can be assessed at five years of age. Milder cognitive impairments, however, may only grow into deficits at school age. This thesis is a part of the regional and multidisciplinary follow-up project PIPARI (PIeniPAinoisten RIskilasten käyttäytyminen ja toimintakyky imeväisiästä kouluikään). The thesis consists of three original studies that present data on 11-year-old very preterm born children (birth weight ≤1500g and/or <32 gestational weeks) born between 2001 and 2004. In Study I, the cognitive profile of the very preterm born children and the associated risk factors were evaluated. In Study II, the educational abilities and received support services of the very preterm born children were compared against the controls. In Study III, the executive functions of the very preterm born children at home and at school were compared against the controls and associated risk factors were evaluated. The main findings of the thesis were that the cognitive profile of the children born very preterm was within the average range but with results significantly lower than the mean test norms. General cognitive development at five years of age was highly correlated with general cognitive development at 11 years of age. Very preterm born children without severe cognitive impairment had age-appropriate academic and classroom performance at school, but they received significantly more support services than the controls. Compared to the controls, very preterm born children without severe cognitive impairment only had more problems in terms of their working memory at school. In this thesis, the most clinically significant risk factors for adverse cognitive development at 11 years of age were major pathologies observed with brain magnetic resonance imaging at term, low paternal education, surgical necrotizing enterocolitis and male gender. The findings suggest that children born very preterm meet everyday challenges at middle school age better than their cognitive profile would let us to expect. The most important goal in long-term follow-up of school age very preterm children is to evaluate their performance in everyday life and to provide knowledge about how preterm birth may affect learning and to provide detailed cognitive assessments with low threshold if problems emerge.Pikkukeskosena syntyneiden lasten kognitiivinen kehitys 11-vuotiaana Pikkukeskosuuteen liittyy kehityksellisiä riskejä. Kapea-alaiset kognitiivisen kehityksen häiriöt voidaan tutkia viiden vuoden iässä. Lievemmät kognitiivisen kehityksen häiriöt saattavat kuitenkin tulla esille vasta kouluiässä. Tämä väitöskirja on osa alueellista ja moniammatillista PIPARI-projektia (PIeniPAinoisten RIskilasten käyttäytyminen ja toimintakyky imeväisiästä kouluikään). Väitöskirja koostuu kolmesta alkuperäistutkimuksesta, jotka kuvaavat vuosina 2001-2004 syntyneiden pikkukeskosten (syntymäpaino ≤1500g ja/tai <32 raskausviikkoa) suoriutumista 11-vuotiaana. Tutkimuksessa I arvioitiin pikkukeskosten kognitiivinen profiili ja siihen yhteydessä olevia riskitekijöitä. Tutkimuksessa II pikkukeskosten koulusuoriutumista ja heidän saamiaan tukitoimia verrattiin täysiaikaisina syntyneiden verrokkilasten suoriutumiseen ja tukitoimiin. Tutkimuksessa III pikkukeskosten toiminnanohjauksen taitoja kotona ja koulussa verrattiin verrokkilasten suoriutumiseen sekä arvioitiin yhteydessä olevia riskitekijöitä. Tämän väitöskirjan yhtenä päälöydöksenä oli, että pikkukeskosten kognitiivinen profiili on ikäryhmän normaalialueella, mutta tulokset ovat kuitenkin merkittävästi ikäryhmän keskitasoa heikompia. Yleinen kognitiivinen kehitys viisivuotiaana ennusti hyvin yleistä kognitiivista kehitystä 11-vuotiaana. Pikkukeskoset, joilla ei ollut vaikeaa kognitiivisen kehityksen häiriötä, suoriutuivat ikätasoisesti koulussa, mutta saivat verrokkiryhmää enemmän tukitoimia. Pikkukeskosilla, joilla ei ollut vaikeaa kognitiivisen kehityksen häiriötä, oli koulussa työmuistiongelmia verrokkiryhmää useammin. Tässä väitöskirjassa kliinisesti merkitsevimpiä riskitekijöitä heikolle kognitiiviselle kehitykselle olivat merkittävä aivovamma lasketun ajan magneettikuvauksessa, isän matala koulutustaso, leikkaushoitoa vaatinut keskosen vaikea suolisairaus ja poika sukupuoli. Tutkimustulosten mukaan pikkukeskosten suoriutuminen arkipäivän haasteista alakouluiässä on parempaa kuin heidän kognitiivinen profiilinsa antaisi odottaa. Tärkein tavoite kouluikäisten pikkukeskosten seurannassa on arvioida heidän suoriutumistaan päivittäisistä haasteista, tarjota lisätietoa keskosuuden vaikutuksista oppimiseen sekä tarjota yksityiskohtaisia kognitiivisia tutkimuksia matalalla kynnyksellä, mikäli ongelmia ilmene

The parallelism argument and the problem of moral luck

Robert Hartman’s parallelism argument aims to show that resultant moral luck exists. The gist of the argument is this: because there is circumstantial moral luck in a particular circumstantial luck scenario and that scenario is analogous in important ways to a particular resultant luck scenario, the resultant luck scenario is plausibly an instance of resultant moral luck. I argue that there is a principled way of denying that circumstantial moral luck is present in the circumstantial luck scenario. Doing so is not enough, however, to reject Hartman’s general analogical line of reasoning since an alternative parallelism argument based on a resultant luck scenario and a circumstantial luck scenario of another kind can be made. Nevertheless, I argue that the analogy between the circumstantial luck scenario and the resultant luck scenario in both the alternative parallelism argument and its original counterpart is too weak to support the claim that resultant moral luck is present in the resultant luck scenario

Predictive value of psychological assessment at five years of age in the long-term follow-up of very preterm children

The aims of this study were to 1) assess the predictive value of psychological assessment at five years of age on the need for educational support in very preterm children, and 2) report the neuropsychological profile of very preterm children at eleven years of age and risk factors for poorer neuropsychological functions. A cohort of 167 very preterm children was included (birth weight???1500?g and/or gestational age <32?weeks). At five years of age, intellectual functioning was assessed with Wechsler Preschool and Primary Scale of Intelligence-Revised and neuropsychological performance with NEPSY II. At eleven years of age, neuropsychological functions were assessed using NEPSY II and data on educational support services collected using a questionnaire. Lower full-scale intelligence quotient and poorer performance in subtests inhibition, comprehension of instructions, memory for designs, visuomotor precision and design copying at five years of age were associated with a need for educational support. Neuropsychological performance at eleven years of age was overall within the average range but below the mean, with the poorest performance in tasks assessing visual memory and visuospatial functions. The results offer a novel perspective to timing and measures of follow-up of very preterm children, since they show that need for long-term educational support can be identified at five years of age. The findings also highlight the clinical value of psychological assessments including evaluation of both intellectual functioning and neuropsychological performance, covering detailed information about non-verbal functions, in the follow-up of very preterm children up to eleven years of age.Peer reviewe

Moral Principles: A Challenge for Deniers of Moral Luck

On a common characterization, moral luck occurs when factors beyond agents' control affect their moral responsibility. The existence of moral luck is widely contested, however. In this paper, I present a new challenge for deniers of moral luck. It seems that some factors beyond agents’ control – such as moral principles about blame- and praiseworthiness – clearly affect moral responsibility. Thus, moral luck deniers face a dialectical burden that has so far gone unnoticed. They must either point to a relevant difference between factors like moral principles and the kind of factors that according to them do not affect moral responsibility or show how they can avoid having to point to such a difference. I argue that no obvious way to meet the challenge presents itself and that it thus amounts to a serious worry for deniers of moral luck

私と歴史学 : 出会いとその面白さ(第二回,早稲田大学史学会・連続講演会「わたしと歴史学、わたしと考古学」,彙報)

Som pedagoger i förskolan ska vi skapa meningsfulla miljöer för barnen. För att kunna göra detta behöver vi hitta former för barns delaktighet, så att de får vara med och påverka. Syftet med vår undersökning är att i förskolan studera relationen mellan barns inflytande och den pedagogiska miljön. Studien innefattar både barns inflytande över miljön och hur miljön kan ge barn inflytande. Åtta förskollärare på fyra olika förskolor har intervjuats för att ge en bild av hur barns delaktighet på olika sätt kan ta sig uttryck i miljön. På alla förskolorna är barnen delaktiga i den pedagogiska miljön. Delaktigheten ser dock ut på olika sätt. På några förskolor får barnen mer direkt inflytande, på andra mer indirekt. Hur miljön utformas för att ge barn inflytande har i denna studie visat sig vara relaterat till barngruppens ålderssammansättning. Även hur stor genomslagskraft tron på det kompetenta barnet har haft i arbetslaget, är av stor betydelse i detta sammanhang

Optimal peripheral nerve stimulation intensity for paired associative stimulation with high-frequency peripheral component in healthy subjects

Publisher Copyright: © 2022, The Author(s).Paired associative stimulation (PAS) with high-frequency peripheral nerve stimulation (PNS), called “high-PAS”, induces motor-evoked potential (MEP) potentiation in healthy subjects and improves muscle activity and independence in incomplete spinal cord injury patients. Data on optimal PNS intensity in PAS are scarce. In a high-PAS protocol, PNS intensity is defined as “minimal intensity required to produce F-responses”. We sought to further refine this definition and to investigate how PNS intensity affects PAS outcome. Two experiments were performed on 10 healthy subjects where MEP amplitude change was measured 0, 30, and 60 min after PAS. In the first experiment, the intensity required to achieve 7/10 persistence of F-responses was used to define PNS intensity level. In the second experiment, we used the intensity required to achieve 1/10 persistence (“baseline”). In addition, we applied this intensity at + 25%, − 25%, and − 50% levels. In the first experiment, PAS did not produce significant MEP potentiation. In the second experiment, PAS produced statistically significant MEP potentiation, with PNS intensity of “baseline” and “baseline − 25%” levels but not at + 25% or − 50% levels. In conclusion, for PAS utilizing high-frequency PNS, the intensity required to achieve 1/10 F-response persistence or the intensity 25% lower produces significant MEP potentiation in healthy subjects.Peer reviewe

Characterisation of Dichelobacter nodosus and detection of Fusobacterium necrophorum and Treponema spp. in sheep with different clinical manifestations of footrot

AbstractThe aim of this study was to determine the proportion of Dichelobacter nodosus, Fusobacterium necrophorum and Treponema spp. in sheep with different clinical manifestations of footrot compared to healthy sheep both at flock and individual level. The second aim was to characterise D. nodosus with respect to virulence, presence of intA gene and the serogroups.Swab samples (n=1000) from footrot-affected (n=10) and healthy flocks (n=10) were analysed for the presence of D. nodosus, F. necrophorum and Treponema spp. by real-time PCR and culturing (D. nodosus only). Dichelobacter nodosus isolates (n=78) and positive swabs (n=474) were analysed by real-time PCR for the aprV2/B2 and the intA genes and by PCR for the fimA gene (isolates only).D. nodosus was more commonly found in flocks affected with footrot than in clinically healthy flocks. A significant association was found between feet with severe footrot lesions and the aprV2 gene and between feet with moderate or no lesions and the aprB2 gene, respectively. F. necrophorum was more commonly found in flocks with footrot lesions than in flocks without lesions. No significant association was found between sheep flocks affected with footrot and findings of Treponema spp. or the intA gene. Benign D. nodosus of six different serogroups was detected in twelve flocks and virulent D. nodosus of serogroup G in one.In conclusion, D. nodosus and F. necrophorum were more commonly found in feet with footrot than in healthy feet. The majority of D. nodosus detected was benign, while virulent D. nodosus was only detected in a single flock