Executive function in the classroom: Cognitive flexibility supports reading fluency for typical readers and teacher-identified low-achieving readers.

BACKGROUND: Dominant explanations of reading fluency indicate automatic phonological decoding frees mental resources for processing meaning. However, decoding automaticity does not guarantee attention to meaning. Recent neurocognitive work suggests executive functioning (EF) may contribute to fluency beyond decoding automaticity. AIMS: Two studies examined contributions of an understudied EF, cognitive flexibility, to fluent reading and tested a teacher-administered EF intervention to improve fluency in teacher-identified low-achieving (LA) readers. METHODS AND PROCEDURES: Study 1 assessed word reading fluency, automatic decoding, reading comprehension, verbal and nonverbal ability, and reading-specific and domain-general cognitive flexibility in 50 1st and 2nd grade typically-developing (TD) readers. Study 2 compared TD and LA readers' cognitive flexibility and examined effectiveness of cognitive flexibility intervention for improving fluency in 33 LA 2nd and 3rd graders. OUTCOMES AND RESULTS: Reading-specific flexibility contributed to fluency beyond automatic decoding and all other control variables in TD readers who had significantly higher cognitive flexibility than LA readers. Teacher-administered EF intervention improved reading fluency for LA readers. CONCLUSIONS AND IMPLICATIONS: These findings expand understanding of the neurocognitive basis of reading fluency and add to the growing body of evidence that EF underlies learning differences and serves as a useful target of intervention for LA students.

Effect of surface neuromuscular electrical stimulation on labial and lingual muscles in healthy volunteers.

Neuromuscular electrical stimulation (NMES) may have potential as a treatment for muscle weakness as it may improve strength when applied to the orofacial muscles. However, before incorporating this procedure into clinical practice, research is needed to investigate its effects on lingual and facial muscles of speech and mastication. The aim of this study was to determine what effect(s) submental and labial NMES would have on lingual and labial muscle strength in healthy participants. Fourteen healthy adults (27-49 years old) were assigned to two groups (treatment and control). A pretreatment and post-treatment test using the Iowa Oral Performance Instrument was used to measure the strength of labial and lingual muscles in both groups. Participants in the treatment group received labial and submental NMES while performing a structured labial, buccal, and lingual exercise program. In contrast, participants in the control group completed the same oral motor exercise program without stimulation. RESULTS: On comparing the total change in labial and lingual strength between the two groups, an increase in total labial strength was found in the treatment group compared with the control group. However, the control group showed an increase in total lingual strength compared with the treatment group. Results for all measurements were not statistically significant. This study concluded that NMES may be a promising modality to combine with labial and buccal exercises for improvement of muscle strength.

A REVIEW OF ELECTRICAL STIMULATION AND ITS EFFECT ON LINGUAL, LABIAL AND BUCCAL MUSCLE STRENGTH.

BACKGROUND: Lingual, labial and buccal weakness (LLBW) is a widespread consequence of several neurological insults. LLBW impact on oral motor functions such as speech production and swallowing is well documented in the literature. Therefore, it is important for the speech-language pathologists to have access to evidence-based approaches for treatment. Thus, it is imperative that the speech-language pathology field search for effective treatment approaches and explore new treatment modalities that can improve therapy outcomes. One relatively new modality in this field is neuromuscular electrical stimulation (NMES). AIMS: The purpose of this paper is fivefold: (a) to provide an overview of the general effects of NMES on skeletal muscles; (b) to review the effect of NMES on orofacial musculature evaluating the potential appropriateness of NMES for use in strengthening lingual, labial and buccal muscles; (c) to identify future directions for research with consideration of its potential role in improving speech intelligibility and the oral preparatory phase of swallowing in patients with oral motor weakness; (d) to provide a brief anatomic and physiologic bases of LLBW; (e) to provide background information for orofacial myologists who may encounter individuals with LLBW. MAIN CONTRIBUTION: NMES is a modality that is commonly used in physical therapy and occupational therapy fields that assists in treating several motor and sensory muscular disorders including muscular weakness. The literature reviewed demonstrate that very limited data related to the use of NMES on orofacial muscles exist despite the fact that these muscles can be easily accessed by electrical stimulation from the surface. CONCLUSIONS: This review of the research using electrical stimulation of muscles highlights the need for experimental treatment studies that investigate the effect of NMES on orofacial weakness.

The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing.

Surface electrical stimulation is currently used in therapy for swallowing problems, although little is known about its physiological effects on neck muscles or swallowing. Previously, when one surface electrode placement was used in dysphagic patients at rest, it lowered the hyolaryngeal complex. Here we examined the effects of nine other placements in normal volunteers to determine 1) whether movements induced by surface stimulation using other placements differ, and 2) whether lowering the hyolaryngeal complex by surface electrical stimulation interfered with swallowing in healthy adults. Ten bipolar surface electrode placements overlying the submental and laryngeal regions were tested. Maximum tolerated stimulation levels were applied at rest while participants held their mouths closed. Videofluoroscopic recordings were used to measure hyoid bone and subglottic air column (laryngeal) movements from resting position and while swallowing 5 ml of liquid barium, with and without stimulation. Videofluoroscopic recordings of swallows were rated blind to condition using the National Institutes of Health-Swallowing Safety Scale. Significant (P < 0.0001) laryngeal and hyoid descent occurred with stimulation at rest. During swallowing, significant (P