Nature and onset of communication disorder in pediatrics with HIV

American Speech-Language Association (ASHA) and the International Association of Physicians in AIDS Care (IAPAC) reported that speech-language and hearing disorders that occur as a direct or indirect consequence of HIV-infection are so common. However there has been little research into the nature and onset of such communication disorders in children living with HIV. Therefore the purpose of the study is to understand about the nature and onset of audiological and speech-language disorders of a group of children with HIV for the better management. In methodology 67 children (4-16 years, mean: 11.06) with HIV infection took part in the study. Otoscopic examination, Pure-tone and Impedance audiometry, REELS, SECS, PAT, FDA and BUFFALO-III was used to assess. In result, 22/67 individuals had hearing loss, 17/67 had swallowing disorder, 21/67 individuals had voice problems. Language development was delayed in 21/67 of the individuals at the pragmatic and syntactic level and 7/67 had the deviant language. There was negative correlation (r=-0.932) between the duration of HIV infection and degree of severity of communication disorders in the participants.     

Public health research at the CDC: implications for communication sciences and disorders

The following paper provides an overview of public health research at the Centers for Disease Control and Prevention (CDC), with emphasis on research involving speech, language and hearing disorders. Public health research involves a sequence of activities from disease tracking to disease prevention. Public health focuses on populations and works to identify changes in programs and policies that can positively impact population health. This paper uses three recent studies conducted by CDC investigators to illustrate different types of research along the public health prevention continuum, with emphasis on activities involving speech, language, and hearing endpoints. The three examples are: a study of cochlear implants and the subsequent risk of meningitis (illustrative of a public health response); a study examining the prevalence of autism in several U.S. populations (an example of a surveillance or monitoring activity); and a study examining the role of in utero cigarette exposure in the etiology of oral facial clefts (illustrative of a epidemiologic risk factor study). The public health continuum provides an important vehicle for advancing our knowledge of the causes and effective prevention of communication disorders. LEARNING OUTCOMES: The reader will become familiar with the public health sequence and the manners in which public health research relates to speech, language, and hearing disorders. The reader will be able to identify and discriminate among the components of public health research using the examples provided.     

The incidence of communication disorders in dysphagic patients

A retrospective study investigated the incidence and types of communication problems in 115 patients referred for swallowing difficulties. Each patient had a bedside swallowing evaluation completed as well as a screening of communication abilities. A formal speech-language evaluation was done when warranted and possible. Of the 115 patients, 93 had suspected swallowing problems based on the bedside evaluation done by the speech-language pathologist. Videofluoroscopy was performed on 85 of these patients. A significant positive correlation was found between communication impairments and both suspected and videofluoroscopically confirmed dysphagia. Cognitive problems were the most frequent communication impairment with dysarthria being second. Neurological diseases were the most common medical diagnoses in patients with swallowing difficulties. The case is presented for the speech-language pathologist to be the primary diagnostician and manager of both communication and oral-pharyngeal swallowing disorders whether they co-occur or not.     

350例人类免疫缺陷病毒感染者的听力表现

目的:观察人类免疫缺陷病毒(HIV)感染者的听力表现及与疾病的关系。方法:选择350例经酶联免疫吸附实验(ELISA)法及放射免疫沉淀实验(KIP)确诊HIV阳性患者以GSI-16测听仪进行纯音测听。结果:350例HIV阳性患者中,听力损失者达159例,占45.4%,比同组健康对照组的69例(19.7%)高。159例HIV阳性听力损失者中,包括感音神经性聋56例,传导性聋34例及混合性聋69例。轻度听力损失49例,平均听阈(30±5)dBHL;中度听力损失69例,平均听阈(54±7)dBHL;重度听力损失41例,平均听阈(84±9)dBHL。听力曲线呈上升型44例,下降型37例,岛状或平坦型78例。HIV阳性患者的听力损失以高频听力损失为主[(37±78)∶44,P<0.05],但其严重程度与疾病本身严重程度无关(P>0.05)。结论:HIV感染者多有听力损失且以高频听力损失为主,但其严重程度与疾病本身严重程度无关。     

Clinical course of hearing and language development in GJB2 and non-GJB2 deafness following habilitation with hearing aids

Mutations in the GJB2 gene (connexin 26) are the most common cause of nonsyndromic autosomal recessive sensorineural hearing loss. Genetic testing of GJB2 may offer opportunities to predict the features of hearing loss and prognostication of speech-language development in children with hearing loss. The present study assessed the clinical features of hearing and some aspects of language development in congenital deafness due either to GJB2 mutations or to other factors in Japanese patients who had been habilitated with hearing aids. Thirty-five unrelated subjects with nonsyndromic, congenital, bilateral sensorineural hearing loss were enrolled in the study. Among them, 16 had biallelic GJB2 mutations related to hearing loss and 17 lacked such mutations. As has been reported in populations of European ancestry, the present Japanese subjects with GJB2 mutations had a relatively high incidence of the flat pattern audiogram and nonprogressive pure tone thresholds compared with subjects without GJB2 mutations. Subjects with GJB2 mutations and those without GJB2 mutations both showed a similar tendency in speech perception, some aspects of language development, and communication methods. In both groups, development of reading ability tended to be normal, but vocabulary development tended to be delayed. The present results establish the basis for future studies to aid in the evaluation and follow-up of patients with congenital hearing loss associated with GJB2 mutations who are habilitated with hearing aids.     

Preschool teachers' perceptions and reactions to challenging classroom behavior: implications for speech-language pathologists

Awareness of issues of social competence and challenging behavior related to childhood language an communication disorders has been increasing. The purpose of this clinical exchange is to provide speech-language pathologists with basic information on communication disorders and challenging behaviors, as well as with insights into ways to support both students and classroom teachers. To provide effective services to children with language impairments and optimally support classroom staff, speech-language pathologists need to recognize (a) the interdependence of language, communication, social competence, and challenging behaviors; (b) the significance that challenging behaviors can have on evaluations of academic competency; and (c) how teachers in early childhood classrooms perceive and react to challenging behaviors. This clinical exchange provides an overview of the relationship between language, communication, and social competence, and presents preliminary survey research data investigating teachers' perceptions and reactions to challenging behaviors. Clinical implications are discussed, including considerations for intervention with children who may exhibit challenging behaviors in combination with language disabilities, and the speech-language pathologist's instrumental role in educating and supporting classroom staff to use communication strategies when managing challenging classroom behaviors.     

Language-learning disorders and youth incarceration

Many speech-language pathologists are serving delinquent boys with language-learning disorders who are both current and former residents of correctional institutions. These youngsters demonstrate personal maladjustments that have a negative impact on school performance and socialization. Those boys within chaotic families are at risk of poverty, institutionalization, and substance abuse. Boys with language-learning disorders, who have encountered the law, need to be provided with services through collaborative and individualized efforts toward improving language skills, learning, and re-incorporating them into society. Further investigations are needed in order to clarify how the elements of personal, family, neighborhood, school and service conditions serve as either protective or risk factors for a life of incarceration in these individuals. LEARNING OUTCOMES: As a result of this presentation, the reader will understand the complex relationship among language-learning disorders, poverty, poor school performance, and delinquency in boys. The reader will become aware of the elements that should be present in school and correctional services in order to prevent recidivism in boys with language-learning disorders who have had problems with the law.     

Pediatricians' opinions about otitis media and speech-language-hearing development

Twenty-five pediatricians responded to a confidential survey about their opinions on the relationship between otitis media and children's speech-language-hearing status. Results found that pediatricians did not necessarily agree that otitis media has an impact on speech-language-hearing development. Pediatricians reported that an early otitis media onset (birth to age 2) affects speech-language development, but they also reported that parents and daycare environments could mitigate any otitis media effect. Pediatricians reported a possible otitis media impact on hearing status, but they did not necessarily agree that an otitis media history required referral for audiological testing. Clinical implications are discussed for collaboration among pediatricians, speech-language pathologists, and audiologists. LEARNING OUTCOMES: (1) The reader will become familiar with pediatricians' opinions about the impact of otitis media on speech-language development. (2) The reader will become familiar with strategies to support interdisciplinary collaboration between pediatricians, speech-language pathologists, and audiologists.     

Assessing deaf and hearing children's communication in Brazil

In Brazil there are no specific tests for either signed or spoken language for deaf children. A protocol evaluating communicative abilities independent of modality of communication (sign language or spoken language), and comprising assessments of (a) pragmatic profile; (b) modality of communication and linguistic level; (c) complexity of communication; and (d) style and efficacy of communication between parent and child was administered to 127 deaf and hearing children. The children, aged 3-6 years old, were distributed in three groups: 20 with severe hearing loss, 40 with profound hearing loss and 67 normally hearing. Deaf children were found to be delayed, independent of their linguistic level and preferred modality of communication. The protocol in this study proved to be an useful instrument for gathering relevant information about the three groups of preschool children's communicative abilities, and particularly suitable for use in countries where standardized assessments are not available. Learning outcomes: The reader will be introduced to the use of an assessment protocol comprising its development, application and data analysis. The reader will be informed about assessment of deaf children's preferred modality of communication, by the participation of a bilingual (sign language user) professional. Communication abilities can be assessed independently of the linguistic modality. In developing countries in general, where simple and easy to administer assessments tools are scarce, such a protocol is of specific value.     

Speech-language evaluation and rehabilitation treatment in Floating-Harbor syndrome: A case study

Floating-Harbor syndrome is a rare congenital disorder characterized by specific facial features, short stature associated with significantly delayed bone age and language impairment. Although language delay is a cardinal manifestation of this syndrome, few reports describe the specific language difficulties of these patients, particularly the development of language abilities in the long run. This paper reports on an Italian boy with Floating-Harbor syndrome and discusses his language evaluation at presentation (age 48 months) and development and progress of his language abilities after 4 years of rehabilitation treatment. At presentation he exhibited borderline mental retardation, with verbal abilities lower than performance abilities. He showed significant impairment of both expressive and receptive language, and also exhibited phonologic and articulations problems that lowered speech intelligibility. Neuropsychological assessment revealed cognitive problems. After speech-language rehabilitation treatment, he achieved significant improvement in language function.Learning outcomesThe reader will learn about (1) the distinctive clinical characteristics and (2) the speech-language abilities and their development after speech-language therapy in Floating-Harbor syndrome.     

Redefining the Survival of the Fittest: Communication Disorders in the 21st Century

Objectives: To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lost or degraded employment opportunities for people with such disorders, including disorders of hearing, voice, speech, and language. Study Design: Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language. Method: Analysis of epidemiological and economic data for industrialized countries, North America, and the United States. Results: Communication disorders are estimated to have a prevalence of 5% to 10%. People with communication disorders may be more economically disadvantaged than those with less severe disabilities. The data suggest that people with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilities. Communication disorders may cost the United States from $154 billion to $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product. Conclusions: Communication disorders reduce the economic output of the United States, whose economy has become dependent on communication‐based employment. This trend will increase during the next century. The economic cost and the prevalence rates of communication disorders in the United States indicate that they will be a major public health challenge for the 21st century.     

Valedictory--why pediatric otorhinolaryngology is important

The importance of the care given by the pediatric otolaryngologist to the individual child encompasses the traditional purposes of medicine. This field has its special focus on interventions that preserve, restore and/or otherwise improve hearing, speech, voice, gustation, olfaction, deglutition, respiration, appearances, etc. The value-added dimension of pediatric otolaryngology is of essential importance because it enhances communication-language--through the vehicles of hearing, voice, and speech. This critical role is manifest in two ways. The first relates to the economic bases of society. Comparison of the consequences of communications disorders in three different countries ranging, currently, from one very highly dependent upon communication skills (The Netherlands), to one highly dependent upon communication skills (the United States), to a developing nation less dependent upon communication skills (the Philippines) is presented. All three nations are adversely affected economically and socially by communication disorders. It is estimated that the United States loses between 2.5 and 3% of its gross domestic product from the economic sequel of communication disorders. It also appears that communication disorders contribute to crime, since the prevalence of communication disorders is many times greater in populations of juvenile delinquents than in the general population. Communication disorders may act synergistically with diminished economic and social resources and other factors in the causes of violent behavior and crime.     

Hearing loss in speech-language delayed children

An infant begins to communicate with his/her environment from the first months of life. However, true words do not appear until the age of 12-15 months, following a rather predictable sequence. Delay or failure of normal language development is not a rare situation in childhood and may be due to a variety of reasons. Among these, hearing undoubtedly plays a leading part in the language acquisition process. The purpose of this study was to assess the percentage of hearing-impaired children in a group of phenotypically healthy children presenting with speech-language delay. Between March 1993 and March 1999, 726 speech-language delayed children were examined in our department. In 72 of them, various diseases or syndromes had already been diagnosed and so they were excluded from the study. The remaining 654 apparently healthy children entered the study and underwent a thorough audiological assessment for determination of their hearing thresholds. Eighty-seven children (13.3%) showed various degrees of hearing loss. Most of them (55 children, 8.4%) suffered from sensorineural hearing impairment, while in 32 children (4.9%) a conductive hearing loss was discovered. The increased prevalence of hearing impairment found in our population mandates a thorough hearing evaluation for every case of speech-language delay, even for those children who show no evidence of other handicaps. This will help in the early diagnosis of hearing loss, allowing proper management to be instituted as early as possible.     

Communication disorders and emotional/behavioral disorders in children and adolescents

Recent research in child psychiatry has demonstrated a high prevalence of speech, language, and communication disorders in children referred to psychiatric and mental health settings for emotional and behavioral problems. Conversely, children referred to speech and language clinics for communication disorders have been found to have a high rate of diagnosable psychiatric disorders. Most of the emerging knowledge regarding relationships between communication disorders and psychiatric disorders has been presented in the child psychiatric literature. Speech-language pathologists and audiologists also need to be familiar with this information; an understanding of the complex interrelationship between communication disorders and emotional and behavioral disorders is important for diagnosis, assessment, and treatment. The purpose of this article is to review recent research and discuss clinical implications for professionals in speech-language pathology and audiology working with children and adolescents who have, or who are at risk for, developing emotional and behavioral disorders. Issues to be addressed include differential diagnosis, prevention, intervention, and the role of speech-language pathologists serving these children and adolescents.     

Sympsium on hearing loss--the otolaryngologist's responsibility. Habilitation and rehabilitation of patients with sensorineural hearing losses

A philosophy of the (re)habilitation of patients with sensorineural hearing losses from a communication point of view is presented. Pediatric and adult populations are discussed separately. Topics of consideration for pediatric patients include the appropriate use of amplification, team management of the hearing handicap, educational placement and the importance of parent counseling. The discussion of the management of adult patients reviews some problems in hearing aid fitting, patient counseling and appropriate case follow-up. The guiding principle behind these (re)habilitation processes is the integration of the hearing-impaired patient into a hearing world.     

Childhood autism: deficits of communication and symbolic development. I. Distinctions from language disorders

The present paper reviews, outlines, and explores the literature concerned with the speech-language disorder of childhood autism. The problems of communication of the autistic child are compared and contrasted with those of children with a variety of other language disorders (e.g. receptive developmental dysphasia). Based upon the review of normal preverbal communicatory and symbolic development, it is concluded that childhood autism involves a pervasive language disorder encompassing communication in general, as well as certain symbolic-representational abilities necessary for language. An overview of the attempts to teach speech to autistic children in then undertaken with special emphasis on the possible implications of developmental knowledge for these training pursuits. Finally, the role of neurologic substrates in the language and communication disorder of autism is presented.     

Hearing loss in people with HIV/AIDS and associated factors: an integrative review

The current scientific literature reports on the incidence of hearing impairments due to HIV/AIDS, and the hearing changes can occur due to damage to the outer, middle or inner ear. Thus, it is important to study how these changes occur, the hearing loss and their associations with the HIV/AIDS infection.ObjectiveTo identify the factors related to hearing loss in people with HIV/AIDS in the global scientific literature.MethodStudy carried out an Integrative Review of the Literature. The key words used were: hearing loss, hearing disorders and deafness, separately associated to the keyword HIV on PUBMED, ScIELO, LILACS and ISI databases. We used complete original papers, of free access, in English, Spanish, French and Portuguese. Thirteen quantitative studies from 1994-2010 were selected.ConclusionWe did not find any strong direct association between anti-retroviral therapy and hearing loss; however, there are indications of hearing loss in the population studied, and their associations and causes need to be better investigated.     

Speech and language outcomes of children with bronchopulmonary dysplasia

A prospective follow-up of very low birth weight infants (VLBW) with (n = 89) and without (n = 71) bronchopulmonary dysplasia (BPD) and Term control children (n = 93) was conducted at 8 years of age. Groups were compared on measures of articulation, receptive and expressive language, verbal and performance IQ, oral motor skills and gross and fine motor skills. The BPD group demonstrated reduced articulation, receptive language skills, performance IQ, and overall gross and fine motor skills when compared to VLBW and Term groups. The BPD and VLBW groups did not differ on expressive language, oral motor skills, or verbal IQ. The groups also differed in enrollment in special classes and speech-language therapy, with almost half (48%) of the BPD group enrolled in speech-language therapy compared to 21% of the VLBW group, and 9% of the Term group. These results suggest that BPD may have adverse effects on speech development as well as on performance IQ, motor skills, and receptive language over and above the effects of VLBW. LEARNING OUTCOMES: (1) As a result of this activity the reader will be able to describe what BPD is and how it impacts speech and language. (2) As a result of this activity the reader will be able to discuss how children with VLBW with BPD differ from children with VLBW without BPD in their developmental outcomes.     

Remote management of voice and swallowing disorders

Telehealth or telepractice can alleviate shortages of speech-language pathologists, particularly in rural and underserved areas, where specialists in voice and swallowing disorders may not be available. In addition to improving access to services, telehealth offers the opportunity for patients to receive care in their natural environment, as in the case of home health care where treatment can include family members and caregivers. This article presents an overview of telehealth applications in the remote management of voice and swallowing disorders including historical background, current issues, and a brief review of clinical effectiveness studies.     

Adolescent male-to-female transgender voice and communication therapy

Current research to describe and evaluate effectiveness of voice and communication therapy for male-to-female transgender people is limited to adults. This paper provides rationale, procedures, and outcomes from voice and communication therapy for a male-to-female transgender adolescent 15 years of age. Treatment addressed vocal hygiene, breath support, fundamental frequency, intonation, resonance and vocal quality, and rate. Positive acoustic, perceptual, and client self-report outcomes confirm treatment effectiveness for this adolescent. Learning outcomes: The reader will be able to recognize common aspects of transgender voice and communication therapy provided by a speech-language pathologist. The reader will also be able to explain the effectiveness of therapy provided to an adolescent speaker.