Look at Mummy: challenges in training parents to deliver a home treatment program for childhood apraxia of speech in a rural Canadian community

Introduction: Children requiring speech pathology services in rural and remote locations face many barriers in accessing adequate services. This has particular consequences for children who need intensive treatment for therapy to be effective, such those with childhood apraxia of speech (CAS). Parent training has been used to overcome speech pathology service delivery barriers for a range of other communication disorders. However, the effectiveness of training parents to deliver a motor-based treatment for CAS within rural and remote contexts has not been evaluated. This study examined the effectiveness and feasibility of training parents in a rural community to use the treatment approach of dynamic temporal and tactile cueing (DTTC) in order to provide more intensive treatment sessions at home. Methods: The study used an experimental single case across behaviours design and parent interviews to evaluate outcomes both quantitatively and qualitatively. The study included four parent- child dyads from a mixed socioeconomic rural community in Canada. Child participants ranged in age from 3 years to 8 years. Child treatment outcomes were measured using an improvement rate difference (IRD) calculation based on percentage of phonemes correct. Fidelity to the treatment protocol was measured using a fidelity score. Results: All parents reported challenges in carrying out the program due to social and behavioural challenges. Parents also reported benefits such as being able to spend more time with their child and learning some useful cueing techniques. Only one of the four participants had a moderate effect size for his target words (RD=57%). Conclusion: While training parents to deliver DTTC may be effective for some parent-child dyads, clinicians are advised that parent training may not be suitable for all families, and parents in rural and remote communities may face particular social circumstances that make following through with an intensive treatment program difficult

Environmental mastery and depression in older adults in residential care

This study investigated the association between environmental mastery and depression in a sample of 96 older adults (aged 64&ndash;98 years) in residential care. The participants completed a scale that assessed depression along with measures for risk factors for depression such as functional capacity, self-evaluated physical health, bereavement experiences and environmental mastery. The results showed that 49 per cent of the variance in participants&rsquo; scores in depression could be attributed to their self-reported level of environmental mastery. Given the complexity of depression and the likelihood of reduced environmental mastery among older adults in residential care, the construct was further assessed as a mediating variable between the risk factors and depression. With environmental mastery taken as such, the explained variance in depression increased to 56 per cent. It was concluded that environmental mastery may be one of the more important factors affecting the mental health of older adults living in residential care and that strategies for increasing the residents&rsquo; environmental mastery are important to their psychological wellbeing. The discussion notes that among the questions needing further investigation are whether older adults who experience high environmental mastery make the transition from community living to residential nursing home care more successfully than others, and whether perceived mastery diminishes over time or occurs at the point of transition from community independent living to dependent supported living.<br /

Evaporative Moisture Loss from Heterogeneous Stone: Material- Environment Interactions During Drying

The complexities of evaporation from structurally and mineralogically heterogeneous sandstone (Locharbriggs Sandstone) are investigated through a laboratory-based experiment in which a variety of environmental conditions are simulated. Data reported demonstrate the significance of material-environment interactions on the spatial and temporal variability of evaporative dynamics. Evaporation from porous stone is determined by the interplay between environmental, material and solution properties, which govern the rate and mode by which water is transmitted to, and subsequently removed from, an evaporating surface. Initially, when the stone is saturated, evaporation is characterized by high rates of moisture loss primarily controlled by external atmospheric conditions. However, as drying progresses, eventually the hydraulic continuity between the stone surface and subsurface is disrupted with recession of the drying front and a decrease in evaporation rates which become reliant on the ability of the material to transport water vapour to the block surface. Pore size distribution and connectivity, as well as other material properties, control the timing of each stage of evaporation and the nature of the transition. These experimental data highlight the complexity of evaporation, demonstrating that different regions of the same stone can exhibit varying moisture dynamics during drying and that the rate and nature of evaporative loss differs under different environmental conditions. The results identify the importance of material-environment interactions during drying and that stone micro-environmental conditions cannot be inferred from ambient data alone. These data have significance for understanding the spatial distribution of stone surface weathering-related morphologies in both the natural and built environments where mineralogical and/or structural heterogeneity creates differences in moisture flux and hence variable drying rates. Such differences may provide a clearer explanation for the initiation and subsequent development of complex weathering responses where areas of significant deterioration can be found alongside areas that exhibit little or no evidence of surface breakdown.Madrid’s Regional Government Geo-materials Programme (S2013/MIT-2914)Peer reviewe

The adult perceptual limen of syllable segregation in typically developing paediatric speech

Inappropriate gaps between syllables are one of the core diagnostic features of both childhood apraxia of speech and acquired apraxia of speech. However, little is known about how listeners perceive and identify inappropriate pauses between syllables (gap detection). Only one previous study has investigated the perception of inappropriate pauses between syllables in typical adult speakers and no investigations of gap detection in children's speech have been undertaken. The purpose of this research was to explore the boundaries of listener gap detection to determine at which gap length (duration) a listener can perceive that an inappropriate pause is present in child speech. Listener perception of between-syllable gaps was explored in an experimental design study using the online survey platform Qualtrics. Speech samples were collected from two typically developing children and digitally manipulated to insert gaps between syllables. Adult listeners (n = 84) were recruited and could accurately detect segregation on 80% of presentations at a duration between 100 and 125 ms and could accurately detect segregation on 90% of presentations at a duration between 125 and 150 ms. Listener musical training, gender and age were not correlated with accuracy of detection, but speech pathology training was, albeit weakly. Male speaker gender, and strong onset syllable stress were correlated with increased accuracy compared to female speaker gender and weak onset syllable stress in some gap conditions. The results contribute to our understanding of speech acceptability in CAS and other prosodic disorders and moves towards developing standardised criteria for rating syllable segregation. There may also be implications for computer and artificial intelligence understanding of child speech and automatic detection of disordered speech based on between syllable segregation

Enterobiasis of the Ovary in a Patient With Cervical Carcinoma In Situ

Background: Enterobiasis occurs throughout the female genital tract and may involve peritoneal surfaces. It is generally an incidental finding at surgery or at autopsy but occasionally is symptomatic. Most of the superficial lesions are composed of granulomas with variable fibrosis in which diagnostic eggs are found, often associated with degenerated adult worms. Multiple histologic sections may be required to establish the diagnosis in older lesions

An automated lexical stress classification tool for assessing dysprosody in childhood apraxia of speech

Childhood apraxia of speech (CAS) commonly affects the production of lexical stress contrast in polysyllabic words. Automated classification tools have the potential to increase reliability and efficiency in measuring lexical stress. Here, factors affecting the accuracy of a custom-built deep neural network (DNN)-based classification tool are evaluated. Sixteen children with typical development (TD) and 26 with CAS produced 50 polysyllabic words. Words with strong–weak (SW, e.g., dinosaur) or WS (e.g., banana) stress were fed to the classification tool, and the accuracy measured (a) against expert judgment, (b) for speaker group, and (c) with/without prior knowledge of phonemic errors in the sample. The influence of segmental features and participant factors on tool accuracy was analysed. Linear mixed modelling showed significant interaction between group and stress type, surviving adjustment for age and CAS severity. For TD, agreement for SW and WS words was >80%, but CAS speech was higher for SW (>80%) than WS (~60%). Prior knowledge of segmental errors conferred no clear advantage. Automatic lexical stress classification shows promise for identifying errors in children’s speech at diagnosis or with treatment-related change, but accuracy for WS words in apraxic speech needs improvement. Further training of algorithms using larger sets of labelled data containing impaired speech and WS words may increase accuracy