There's more to the picture than meets the ear - Gaze behavior during communication in children with hearing impairment

Many children and adolescents with hearing impairment struggle to meet school demands. The difficulties can be traced to the characteristics of the hearing impairment, and to adverse consequences on language development, often overlooked in diagnostics and intervention. This thesis investigates the communicative ability of children and adolescents with bilateral sensorineural hearing impairment by studying verbal and nonverbal interactions with normal hearing peers. The study uses a referential communication task requiring the speaker to make relevant descriptions, and the listener to use verbal and nonverbal means to resolve uncertainties. Analyses focus on verbal questions and answers (paper 1), nonverbal gaze behavior in relation to the verbal production (paper 2 and 3), and the cognitive and linguistic factors influencing the gaze behavior (paper 4). The results yielded that: - The structured and predictive conversational setting enables speakers to include unrequested information without compromising the partner’s understanding (paper 1). - Gaze behavior is related to the production of verbal utterances, as shown by a higher probability of gaze to the conversational partner’s face when asking questions than making statements (paper 2). - Participants with hearing impairment consistently exhibit higher probability of gaze-to-partner than peers with normal hearing (paper 3). - Participants with hearing impairment and reduced phonological short term memory capacity show a doubled probability of gaze-to-partner, compared to peers with normal hearing (paper 4). The findings express the multimodality of communication, and the need for multidisciplinary assessment and therapy. Implications include pedagogical adaptations to an increased use of nonverbal cues in children and adolescents with hearing impairment. The results highlight areas of phonology and conversational strategies to target for speech-language services, and call for an evaluation of nonword repetition as a clinical marker allowing earlier identification of children with hearing impairment at risk for persistent language impairment

Executive functions in mono- and bilingual children with language impairment - issues for speech-language pathology.

The clinical assessment of language impairment (LI) in bilingual children imposes challenges for speech-language pathology services. Assessment tools standardized for monolingual populations increase the risk of misinterpreting bilingualism as LI. This Perspective article summarizes recent studies on the assessment of bilingual LI and presents new results on including non-linguistic measures of executive functions in the diagnostic assessment. Executive functions shows clinical utility as less subjected to language use and exposure than linguistic measures. A possible bilingual advantage, and consequences for speech-language pathology practices and future research are discussed

ELAN Analysis Companion (EAC): A Software Tool for Time-course Analysis of ELAN-annotated Data

LAN is a widely used and free (in both senses) annotation software for behavioral or other events that unfold over time. We report on and release a stand-alone program that expands on ELAN's capabilities in two ways: 1) it allows the researcher to plot and export time-course analysis data directly from ELAN's native annotation files, allowing for hassle-free data extraction in the time domain, e.g. for visual-world paradigm studies; and 2) it allows the researcher to weight ELAN's built-in annotator reliability rating based on the duration of the coded events. This software is released under an open license

Working memory and referential communication-multimodal aspects of interaction between children with sensorineural hearing impairment and normal hearing peers.

Whereas the language development of children with sensorineural hearing impairment (SNHI) has repeatedly been shown to differ from that of peers with normal hearing (NH), few studies have used an experimental approach to investigate the consequences on everyday communicative interaction. This mini review gives an overview of a range of studies on children with SNHI and NH exploring intra- and inter-individual cognitive and linguistic systems during communication. Over the last decade, our research group has studied the conversational strategies of Swedish speaking children and adolescents with SNHI and NH using referential communication, an experimental analog to problem-solving in the classroom. We have established verbal and non-verbal control and validation mechanisms, related to working memory capacity and phonological short term memory. We present main findings and future directions relevant for the field of cognitive hearing science and for the clinical and school-based management of children and adolescents with SNHI

Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden

BackgroundBalanced transfusions, including platelets, are critical for bleeding patients to maintain hemostasis. Many rural hospitals have no or limited platelet inventory, with several hours of transport time from larger hospitals. This study aimed to evaluate the feasibility of using cryopreserved platelets that can be stored for years, in remote hospitals with no or limited platelet inventory.Material and methodsThree remote hospitals participated in a prospective study including adult bleeding patients where platelet transfusions were indicated. Cryopreserved platelets were prepared in a university hospital, concentrated in 10 ml, transported on dry ice, and stored at −80°C at the receiving hospital. At request, the concentrated platelet units were thawed and diluted in fresh frozen plasma. The indications, blood transfusion needs, and laboratory parameters pre- and post-transfusion, as well as logistics, such as time from request to transfusion and work efforts in preparing cryopreserved platelets, were evaluated.ResultsTwenty-three bleeding patients were included. Nine patients (39%) were treated for gastrointestinal bleeding, five (22%) for perioperative bleeding, and four (17%) for trauma bleeding. The transfusion needs were 4.9 ± 3.3 red blood cell units, 3.2 ± 2.3 plasma units, and 1.9 ± 2.2 platelet units, whereof cryopreserved were 1.5 ± 1.1 (mean ± SD). One patient had a mild allergic reaction. We could not show the difference in laboratory results between pre- and post-transfusion of the cryopreserved units in the bleeding patients. The mean time from the order of cryopreserved platelets to transfusion was 64 min, with a range from 25 to 180 min.ConclusionCryopreserved platelets in remote hospitals are logistically feasible in the treatment of bleeding. The ability to have platelets in stock reduces the time to platelet transfusion in bleeding patients where the alternative often is many hours delay. Clinical effectiveness and safety previously shown in other studies are supported in this small feasibility study

Betoningsorsakade durationsökningar för svenska inlärare av franska : en studie av två inlärargruppers vokaldurationer

I denna uppsats har jag velat undersöka om de prosodiska skillnaderna mellan svenskan och franskan kan förklara de avvikelser från den franska normen som återfinns hos nästan alla svenska inlärare av franska, i det närmaste oberoende av hur länge man har studerat språket. Jag ville studera om skillnaderna kunde härledas till olikheterna mellan de båda rytmiska språktyperna stress-timing och syllable-timing, där svenskan anses tillhöra den förra och franskan den senare. I hur stor utsträckning påverkar modersmålet inlärning och produktion av ett andraspråk? Den undersökning jag har gjort syftade till att se om de rytmiska olikheterna mellan svenskan och franskan har märkbara effekter på hur betoning realiseras. Förhoppningen var att skillnaderna skulle vara särskilt påtagliga vid just betoning beroende på de skiljande realiseringssätten i franskan och svenskan. Informanterna utgjordes av två grupper av svenska inlärare av franska där den ena uteslutande lärt sig franska i Sverige och den andra även lärt sig språket under vistelse i Frankrike eller annat franskspråkigt land. Informanternas resultat jämfördes med franska referenspersoners och visade ett klart mönster. Tydlig påverkan från det svenska modersmålet märktes för samtliga informanter och i synnerhet för den inlärargrupp som endast lärt sig franska här i landet

Changing labels for a concept in change. Commentaries to: Bishop, D.V.M. Ten questions about terminology for children with unexplained language problems

In this commentary we reflect on current labels and criteria for child language impairment from a Swedishperspective. We call for a new label highlighting the developmental, changeable and dynamic characteristics of theimpairment and discuss implications for diagnosis, assessment and research. Conceptual coherence will promotethe professional identity and status necessary for much needed communicability

'It depends on who I'm with' : How young people with developmental language disorder describe their experiences of language and communication in school

BACKGROUND: The risks of developmental language disorder (DLD) for both educational progress and socio-emotional development are well documented, but little is known about how children and young people with DLD experience and describe their language and communication. The need to complement experimental and quantitative studies with qualitative perspectives of the lived experience of individuals with DLD for speech and language therapists (SLT) practice has recently been foregrounded.AIMS: To understand further the experiences of young people with DLD focusing on language and communication in a school context, and thereby contribute to the improvement of the communicative situation in school for this group. The study is guided by the following research question: How do young people diagnosed with DLD describe their experiences of language and communication in school?METHODS & PROCEDURES: The study is based on data generated from qualitative semi-structured interviews with 23 participants diagnosed with DLD (age 13-19 years old) living in Sweden. All participants attended mainstream schools. To enable data to be collected during COVID-19 restrictions, all interviews were conducted using Zoom. Reflexive thematic analysis was used to analyse the data.OUTCOMES & RESULTS: Four main themes related to experiences of language and communication in school were constructed from the interviews: (1) feelings of inadequacy and comparisons with others; (2) feelings of being misjudged and misunderstood; (3) the importance of feeling safe and comfortable; and (4) the significance of the social and communicative context. The results bear witness of difficult and challenging aspects related to language and communication in school, including educational, social and emotional dimensions. An important outcome of this study is how young people diagnosed with DLD describe their language and communication functioning to be dependent on both individual characteristics and abilities, as well as situational, contextual and social factors.CONCLUSIONS & IMPLICATIONS: The results from this study show that young people with DLD can have persisting problems related to language and communication in school, including educational, social and emotional dimensions. SLT services may therefore be needed throughout the school years to ensure that students with DLD receive adequate support. In addition, support that goes beyond language abilities and targets social, contextual and emotional aspects should be considered.WHAT THIS PAPER ADDS: What is already known on this subject Children and young people have unique knowledge about their language and communication which is instrumental for designing interventions and support strategies. Qualitative analyses of interview data have been able to identify both risk factors and protective strategies in relation to the well-being of individuals with DLD. Despite this, children and young people with DLD are rarely heard in research or clinical discussions. What this paper adds to existing knowledge In this study we listen to the voices of young people with DLD as they describe their experiences of language and communication in school. The participants describe a condition that makes them struggle to keep up with peers and puts them at risk of being misjudged by teachers, but also give examples of situations where negative consequences are hardly felt. What are the potential or actual clinical implications of this work? DLD is a complex and dynamic disorder where contextual and social factors interact with individual abilities in creating the end result. The results of the study indicate that DLD can cause persisting problems related to language and communication in school, with impact on educational, social and emotional dimensions. To counteract these effects, SLT services may be needed throughout the school years, and support that goes beyond language abilities must be considered