Investigations of the impact of altered auditory feedback in-the-ear devices on the speech of people who stutter: One-year follow-up

Purpose.?This study examined objective and subjective measures of the effect of a self-contained ear-level device delivering altered auditory feedback (AAF) for those who stutter 12 months following initial fitting with and without the device.

Method.?Nine individuals with developmental stuttering participated. In Experiment 1, the proportion of stuttering was examined during reading and monologue. A self-report inventory inquiring about behaviour related to struggle, avoidance and expectancy associated with stuttering was examined in Experiment 2. In Experiment 3, naïve listeners rated the speech naturalness of speech produced by the participants during reading and monologue.

Results.?The proportions of stuttering events were significantly ( p < 0.05) reduced at initial fitting and remained so 12 months post follow-up. After using the device for 12 months, self-reported perception of struggle, avoidance and expectancy were significantly (p < 0.05) reduced relative to pre-fitting. Naïve listeners rated the speech samples produced by those who stutter while wearing the device significantly more natural sounding than those produced without the device for both reading and monologue (p < 0.0001).

Conclusions.?These findings support the notion that a device delivering AAF is a viable therapeutic alternative in the treatment of stuttering.     

A phase II trial of the Westmead Program: Syllable-timed speech treatment for pre-school children who stutter

This report presents a Phase II clinical trial of a syllable-timed speech treatment for early stuttering known as The Westmead Program. Of 17 children recruited, eight children aged between 3–4.5 years (mean 3 years 8 months) completed the treatment. The primary outcome measure was percentage syllables stuttered (%SS) measured from independent, blinded speech assessments of beyond-clinic audio recordings. Secondary outcomes were measures of treatment time, speech quality, and parent severity ratings. Dropouts occurred, but at a similar rate to other clinical trials of this nature. For the eight children who completed the treatment, mean pre-treatment stuttering was 6.0%SS and at 12-months post-Stage 2 entry stuttering had decreased to 0.2%SS, representing a mean stuttering reduction of 96%. A large effect size was obtained with a mean of 8.0 clinical hours required for these children to reach Stage 2. Independent listeners judged the everyday speech of all children to be not unnatural in any way. Stuttering reductions were attained with clinical efficiency and simplicity compared to other early stuttering interventions. Further clinical trials development of the treatment is warranted.     

Contralateral white noise attenuates 40-Hz auditory steady-state fields but not N100m in auditory evoked fields

The different response characteristics of the different auditory cortical responses under conventional central masking conditions were examined by comparing the effects of contralateral white noise on the cortical component of 40-Hz auditory steady state fields (ASSFs) and the N100m component in auditory evoked fields (AEFs) for tone bursts using a helmet-shaped magnetoencephalography system in 8 healthy volunteers (7 males, mean age 32.6 years). The ASSFs were elicited by monaural 1000 Hz amplitude modulation tones at 80 dB SPL, with the amplitude modulated at 39 Hz. The AEFs were elicited by monaural 1000 Hz tone bursts of 60 ms duration (rise and fall times of 10 ms, plateau time of 40 ms) at 80 dB SPL. The results indicated that continuous white noise at 70 dB SPL presented to the contralateral ear did not suppress the N100m response in either hemisphere, but significantly reduced the amplitude of the 40-Hz ASSF in both hemispheres with asymmetry in that suppression of the 40-Hz ASSF was greater in the right hemisphere. Different effects of contralateral white noise on these two responses may reflect different functional auditory processes in the cortices.     

静息态功能磁共振成像观察正常人听觉皮层功能

目的 探讨正常人听觉皮层与全脑的正相关及负相关的功能连接.方法 采用静息态下平面回波成像技术采集44名健康受试者fMRI数据,分别以左侧及右侧AⅠ区为种子点,用功能连接的方法观察左、右大脑初级听觉皮层与全脑的正相关及负相关功能连接脑图.结果 分别以双侧AⅠ区为种子点时,正激活的脑网络主要包含双侧AⅠ、AⅡ、岛叶、辅助运动区及扣带回,以同侧为主;与右侧AⅠ区相关的正激活脑区还包括同侧背侧丘脑.与双侧AⅠ区相关的负激活脑网络与脑默认网络大体一致,主要包括双侧后扣带回/楔前叶、额叶内侧回、顶下小叶,双侧小脑半球可见明显激活.结论 静息态磁共振功能连接可满意显示听觉皮层的连接脑图.正相关功能连接主要局限在听觉系统内,负相关功能连接类似于默认网络.     

Language development in children who stutter: A review of recent research

Abstract

Purpose: This article reviews recent studies that examined the controversial claim that children who stutter (CWS), as a group, have weaker language skills than children who do not stutter (CWNS). The article was an effort to address the conflicting conclusions of two previous reviews of the research in this area.

Method: Studies published in research journals during the past 7 years (2011–2018) were located through a systematic review of the literature. Each study was analysed to determine how well it supported the claim that CWS, as a group, have weaker language skills than CWNS.

Result: The evidence was not convincing to support this controversial claim. Rather, the review indicated that CWS performed as well as or better than CWNS on formal language tasks.

Conclusion: The claim that language weaknesses are linked to children’s stuttering is not well supported by recently published studies. Alternative interpretations of the literature are offered.     

大脑瘫痪对小儿听觉诱发脑干反应的影响

采用左、右耳分別和两耳同时施声刺激从头顶Cz点记录方法,观察了30例正常儿童(NC)和60例脑瘫儿童(CCP)的听觉诱发脑干反应(ABR)。与NC相比,CCP的ABR发生明显异常(93.33％)表现为电压降低、潜伏时延K、左右两侧反应不对称和反应丧失等7种类型。经统计,除自身的ABR在左、右耳间波Ⅰ～Ⅴ、Ⅳ电压不等(P<0.05),波Ⅰ～Ⅴ、Ⅶ潜伏时差异显著(P<0.05)外,患侧波Ⅰ～Ⅴ,双侧的Ⅰ～Ⅴ、Ⅶ,对侧的Ⅱ、Ⅳ电压较NC低(P<0.05);患侧波Ⅰ～Ⅴ、Ⅶ的潜伏时延长(P<0.05)。结果提示:(1)CCP的听觉通路和脑干普遍受到损伤,且部位不定;(2)CCP的脑干和听觉通路损伤具有不对称性。     

听觉功能MRI研究的实验设计

目的探讨听觉fMRI研究的有效数据采集方式。方法对13例健康年轻受试者分别采用纯音及调幅音两种听觉刺激条件，刺激分别采用组块和事件相关设计进行听觉呈现，以比较连续及稀疏两种采集方式下听觉皮层的fMRI响应，运用SPM2软件进行数据分析和脑功能区定位，并分析两种不同实验数据采集方式下听觉皮层激活的差异。结果调幅声较纯音更易激发听觉皮层的激活；两种刺激条件下，稀疏采集时听觉皮层的fMRI响应明显多于连续采集，比较听觉皮层各区，以初级听觉皮层fMRI响应为著。结论调幅音是听觉fMRI研究中的合适刺激；稀疏采集方式有助于克服环境噪声的负面影响，结合物理衰减方法，可实现听觉功能的fMRI研究。     

多发性硬化患者中枢听觉传导通路的扩散张量成像

目的 采用扩散张量成像（DTI）和纤维追踪技术探讨有听力损害的多发性硬化（MS）患者听觉中枢传导通路的纤维显微结构改变。方法 收集存在听力损害的MS患者15例（MS组）,其中单侧听力损害8例,双侧7例;另收集健康对照组15名。以MS组和对照组脑干内外侧丘系（LL）、中脑下丘（IC）分别为ROI₁、ROI₂进行DTI;再借助纤维追踪技术观察两侧颞横回（ROI₃）中枢听觉皮层的纤维走行,比较两组不同ROI神经纤维的FA、ADC值,并分析MS组单侧听力损害患者有差异的DTI参数值与临床扩展致残量表（EDSS）评分和病程的相关性。结果 MS组双侧听力损害患者的听觉传导通路ROI₁（P=0.016）、ROI₂（P=0.038）、ROI₃（P=0.007）的FA均低于对照组,ROI₁（P=0.016）、ROI₂（P=0.039）ADC值高于对照组,ROI₃的ADC值与对照组差异无统计学意义（P=0.108）。MS组单侧听力损伤患者的损伤侧仅ROI₁（P=0.022）、ROI₃（P=0.029）FA低于对照组。MS组单侧听力损害患者有差异的DTI参数值与EDSS评分、病程均无相关性。结论 MS患者中枢听觉传导通路DTI参数存在异常,可为临床听力损害提供直接证据。     

MRI定量分析正常儿童前后髋臼发育

目的 探讨以股骨头中心点至同侧髋臼最薄弱点之间连线为基线测量前后髋臼指数评价儿童髋关节前后髋臼的正常发育规律。方法 收集165名1个月~12岁正常儿童髋关节MRI资料,分别以股骨头中心点到同侧髋臼最薄弱点之间的连线为基线（方法1）和以双侧Y形软骨中点的连线为基线（方法2）,测量前/后骨性髋臼指数（A/PBAI）和前/后软骨性髋臼指数（A/PCAI）,观察2种方法、观察者间及观察者内测量上述指数的一致性,并分析以上指数与年龄的相关性。结果 2种方法测量ABAI（ICC=0.832）的一致性好,测量ACAI（ICC=0.535）、PBAI（ICC=0.565）、PCAI（ICC=0.472）的一致性均较好。观察者间及观察者内测量髋臼指数的一致性均好（ICC均> 0.75）。ABAI、ACAI及PBAI与年龄呈负相关（r=-0.762、-0.475、-0.368,P均< 0.001）,PCAI与年龄无明显相关（r=-0.190,P<0.005）;4岁前,ABAI随年龄增长逐渐减小,4岁后逐步趋于平稳;ACAI及PBAI随年龄增长稍有降低;PCAI随年龄变化不明显。结论 以股骨头中心点至髋臼最薄弱点连线为基线测量前后骨性或软骨性髋臼指数,可准确评价髋关节前后髋臼的正常发育情况。     

手语在聋人听觉皮层可塑性中的作用的磁共振成像研究

手语是一种动态的视觉-空间语言,是聋人的主要交流手段.听觉皮层在高级认知功能特别是语言加工中具有重要作用,聋人在听觉皮层发生了跨通道的可塑性变化,手语对这种可塑性的变化具有重要的影响,无创性磁共振成像技术为考察这种影响提供了极好手段.本文主要综述了手语者听觉皮层结构改变的研究,和手语使用及其习得时间对听觉皮层功能可塑性影响的相关研究进展.     

磁共振泌尿系水成像诊断儿童无功能肾病因

目的 探讨磁共振泌尿系水成像（MRU）诊断儿童无功能肾病因的价值。方法 回顾性分析38例经核素肾动态显像确诊为一侧肾脏无功能患儿的临床和MRU资料,其中18例患儿接受手术治疗。对MRU原始图像进行MIP重建以诊断病因。结果 7例MRU仅见一侧存在肾实质结构,诊断为孤立肾;16例MRU于一侧肾区未见正常肾实质,见多个大小不等、互不相通的类圆形高信号,诊断为多囊性发育不良肾;12例患侧肾皮质菲薄或无明显肾皮质,肾盂异常扩张,T2WI呈高信号,提示重度肾积水;3例于一侧盆腔见体积明显缩小的肾形结构,肾实质显示不清,肾盂扩张,T2WI呈高信号,伴扩张输尿管异位开口于阴道或尿道,诊断为异位发育不良肾。18例接受手术患儿术后诊断均与MRU相符。结论 MRU对于诊断无功能肾病因具有重要意义。     

MRI定量测量不同年龄正常儿童髋关节

目的 比较不同年龄正常儿童髋关节MRI的定量测量结果。方法 采用MRI三维快速扰相梯度回波序列(3DFSPGR)对0~12岁正常儿童髋关节进行测量,指标包括骨性髋臼指数(OAI)、软骨性髋臼指数(CAI)、盂唇角和软骨性髋臼覆盖率,取均值进行统计学分析。结果 6个月~4岁OAI值逐渐减小,之后缓慢减小并接近成人,至12岁为(13.25±1.90)°。CAI在2岁以内从(16.04±1.71)°降至(12.02±1.64)°,9岁后缓慢减低,至12岁为(7.14±1.83)°。盂唇角各年龄组间差异无统计学意义(P>0.05)。软骨性髋臼覆盖率在6个月为(78.94±3.11)%,1岁为(80.61±2.70)%,均低于2岁后各年龄组(P均<0.05),2岁后各年龄组间差异无统计意义(P均>0.05)。结论 OAI不能全面反应髋关节的发育过程。采用MRI 3DFSPGR序列对正常儿童髋关节进行测量,可反映髋关节软骨发育过程。     

儿童髓外硬膜下结核球的临床特点及其MRI诊断

目的 探讨儿童髓外硬膜下结核球(IET)的临床特点及MRI表现。方法 回顾性分析7例经手术及组织病理学证实IET患儿的临床资料和MRI表现。结果 7例患儿均有其他部位结核病史,临床主要表现为不同程度的进行性肢体瘫痪及感觉功能障碍、尿潴留或尿失禁等脊髓压迫症状。3例初发症状出现于抗结核治疗后3个月以内,1例出现于4~6个月,3例出现于7~9个月。MR平扫及增强扫描发现全部IET,病灶呈长梭形或扁豆状位于椎管内脊髓后方纵向走行,T1WI呈稍低信号或等信号,T2WI呈等信号或混杂高信号,增强后病灶呈均匀或不均匀明显强化。结论 IET可能是机体对抗结核药物治疗所发生的矛盾反应的结果,MR检查特别是增强扫描可清楚显示病变的范围、形态和信号特点,结合临床可及时、准确诊断IET。     

言语性幻听症状的多模态脑影像学研究现状及未来趋势

既往研究显示精神分裂症患者言语性幻听症状存在特异的脑结构网络损害、脑功能网络紊乱、脑血流和脑神经代谢物紊乱,这些研究在很大程度上增进了对言语性幻听症状神经病理机制的理解。然而,言语性幻听症状相关的特异性脑影像学表征是否随时间或病程进展而演变？脑影像学表征(脑网络、脑血流)的发展轨迹呈何特征？治疗结局不同的患者之间是否存在不同的基线特异性脑影像学表征,哪些特异的基线脑影像学表征能够预测疗效结局,为个体化精准治疗方案的制定提供客观依据？这些问题尚需通过进一步的深入研究来揭示。因此,采用多模态磁共振成像技术,从多角度纵向分析首发精神分裂症患者言语性幻听症状的脑影像学指标演变轨迹及其与疗效结局之间的关系,将有助于阐释上述问题。     

MRI诊断儿童下丘脑错构瘤

目的 总结儿童下丘脑错构瘤的典型与非典犁MRI表现,旨在提高对该病的诊断水平.方法 回顾性分析18例经临床病理证实的下丘脑错构瘤的临床及影像学表现.男12例,女6例,年龄1～15岁,平均5.6±3.8岁.14例临床表现为性早熟,7例表现为痴笑样癫痫.18例患儿均行MRI矢状面T1WI、T2WI和冠状面T1WI平扫,矢状...     

儿童脑部磁共振灌注成像技术的初步研究

目的：研究磁共振灌注成像（MR PWI）技术应用于儿童脑部血流灌注分析的可行性及其方法。方法：使用GE 1.5T HDx echo speed plus MRI扫描仪,头线圈,PWI序列,双倍剂量MRI造影剂（马根维显,0.2mmol/kg）;实验组前瞻性研究儿童患者45例,根据患儿体重及MRI造影剂注射速度（2～4ml/s）分为4组、8个亚组;对照组搜集成人患者20例,MRI造影剂注射速度4ml/s。MR PWI图像资料处理得到负性增强积分（NEI）伪彩图并测量相应感兴趣区的NEI值与相对负性增强积分（rNEI）。结果：本研究表明体重＜20kg的患儿MRI造影剂注射速度须达到3ml/s以上时能形成良好的MR PWI信号-时间曲线;造影剂注射速度为2ml/s时,仅适用于体重＜10kg的患儿;体重＞20kg患儿必须使用＞3ml/s的造影剂注射速度,推荐速度为4ml/s。实验组患儿NEI值的偏差显著（标准差13.69～22.54）,与对照组的差异具有显著的统计学意义（P＜0.001）;而rNEI值的偏差不明显（标准差0.05～0.08）,与对照组的差异无显著的统计学意义（P＞0.001）。结论：在特定的条件下MR PWI能有效分析儿童脑部血流灌注情况,为MR PWI在儿科领域的应用研究迈出重要的一步。     

儿童巨输尿管症的磁共振尿路造影诊断

目的：探讨磁共振尿路造影（MRU）诊断儿童巨输尿管症的价值。方法：10例巨输尿管症患儿术前作IVU、BUS和MRU检查，MRU应用重T2加权脂肪抑制快速自旋回波序列。对照分析MRU影像与手术结果，比较MRU与IVU、BUS在巨输尿管症诊断中的作用。结果：MRU影像与手术结果完全一致，对巨输尿管症的诊断正确率100％。病变累及单侧的7例，双侧的3例，患侧输尿管全段迂曲，管腔显著扩张。结论：MRU是诊断儿童巨输尿管症的理想手段。     

正常小儿髋关节发育的磁共振成像定量分析

目的 应用磁共振T2W快速梯度回波(FFE)序列进行多参数定量测量,观察正常小儿髋关节发育过程的变化规律。方法 对163名6个月~12岁正常发育小儿髋关节进行MR扫描,测量反映股骨头覆盖率的指标,包括髋臼总覆盖角(TCA)、骨性髋臼覆盖角(ACA)、盂唇覆盖角(LCA),并测量反映髋臼窝宽度、深度和股骨头直径的指标,包括髋臼窝宽度(AW)、髋臼窝深度(AD)和股骨头直径(DFH),并分析以上指标与年龄的相关性。结果 ACA、LCA、AW、AD、DFH均与年龄呈明显相关。TCA在1岁以内与年龄有相关性,1岁以后与年龄无明显相关性。TCA与ACA及LCA均呈明显正相关,ACA与LCA呈明显负相关。结论 正常髋关节的发育是髋臼软骨增加、骨化比例增多、髋臼窝逐渐增大与加深、股骨头逐渐增大的过程。发育早期髋臼软骨及盂唇在维持髋关节承重及保持关节稳定性方面起重要作用。随年龄增大,骨性结构逐渐替代软骨结构的作用,髋臼与股骨头同步发育,髋关节结构始终保持相对稳定。     

磁源性影像在癫痫患者术前听觉性语言区定位中的应用

目的 探讨磁源性影像在癫痫患者术前语言区定位中的应用.方法 应用磁源性影像技术对24例癫痫患者手术前行癫痫灶定位及听觉性语言区定位,并确定癫痫灶与听觉性语言区的关系.结果 24例患者中,听觉性语言中枢位于左颞叶14例,右颞叶5例,双侧颞叶5例.癫痫灶位于左颞叶14例,左颞顶叶1例,右颞叶4例,右颞顶叶1例,左额颞叶1例,右额颞顶叶1例,双侧颞叶2例.10例癫痫灶与听觉性语言中枢重叠,10例癫痫灶与听觉性语言中枢所在位置不重叠,3例癫痫灶位于语言区前方,1例癫痫灶位于语言区后方.1例患者因左颞叶胚胎发育不良性神经上皮瘤与听觉性语言区重叠未能全部切除,术后出现短期语言功能障碍,术后随访仍偶有幻听,其余患者均无语言功能障碍发生.结论 磁源性影像可对癫痫患者进行癫痫灶定位及语言区定位,对减少手术后语言功能障碍具有重要意义.