[Study on brain mechanism of rehabilitation training of articulation disorder in cleft lip and palate patients based on functional magnetic resonance imaging].

The cleft lip and palate (CLP) is one of the most common craniofacial malformations in humans. We collected functional magnetic resonance data of 23 CLP patients before rehabilitation training (Bclp) and 23 CLP patients after rehabilitation training (Aclp), who were performing Chinese character pronunciation tasks, and performed brain activation analysis to explore the changes of brain mechanism in CLP patients after articulation disorder rehabilitation training. The study found that Aclp group had significant activation in the motor cortex, Broca area, Wernicke area and cerebellum. While the Bclp group had weak activation in the motor cortex with a small activation range. By comparing the differences and co-activated brain regions between the two groups, we found that rehabilitation training increased the activity level of negatively activated brain areas (cerebellum, left motor area, Wernicke area, etc.) to a positive level. At the same time, the activity level of weakly activated brain areas (right motor area, Broca area, etc.) was also increased. Rehabilitation training promoted the activity level of articulation-related brain regions. So that the activation intensity of articulation-related brain regions can be used as a quantifiable objective evaluation index to evaluate the effect of rehabilitation training, which is of great significance for the formulation of rehabilitation training programs.

Ultrasonic Imaging Investigation of Tongue Movement Patterns of Cleft-Related Lateralized and Palatalized Misarticulation.

OBJECTIVES: To explore the tongue movement patterns on Mandarin speaking children with repaired cleft palate with lateralized and palatalized misarticulation (LPM) using ultrasound imaging technique. METHODS: A group of 20 subjects who were diagnosed with speech sound disorder after cleft palate repairment, and another group of 18 children with LPM were recruited. A group of 20 typical children were recruited as the control group. The ultrasonography was used to collect the articulation pattern of the 8 single vowels that are /a/, /o/, / ɘ/, /i/, /u/, /y/, /ɨ/, /ʉ/ in Mandarin Chinese. Various ultrasonic tongue parameters were analyzed from both sagittal and coronal planes. RESULTS: Compared with the control group, coronal height of peak point, coronal tongue dorsum constraint index, sagittal peak point offset distance, sagittal distance between tongue tip and peak point, and sagittal tongue dorsum constraint index of /ɘ/,/i/, /y/ and /ɨ/ were significantly smaller in the cleft-related lateralized and palatalized group (CLP) and noncleft-related lateralized and palatalized group (NLP) ( P   <  0.05). Compared with the noncleft-related later- alized and palatalized group and control group, sagittal peak point offset distance of the vowels /ɘ/ and /i/ was significant smaller in the cleft-related lateralized and palatalized group group ( P  < 0.05). CONCLUSIONS: The ultrasound images on the children with cleft palate showed a midline elevation of the tongue and a significant apical constriction. The children with LPM showed a midline elevation at the coronal plane and anterior movement of the tongue high point at the sagittal plane. The apical vowels were more informative and accurate in indicating the features of LPM than other vowels.

Topological properties of the resting-state functional network in nonsyndromic cleft lip and palate children after speech rehabilitation.

Speech therapy has been widely used as an essential therapy for compensatory articulation errors in nonsyndromic cleft lip and palate patients. We sought to identify potential biomarkers of nonsyndromic cleft lip and palate children after speech rehabilitation based on resting-state fMRI and graph theory techniques. We scanned 28 nonsyndromic cleft lip and palate and 28 typically developing children for resting-state fMRI on a 3T MRI scanner. Functional networks were constructed, and their topological properties were obtained for assessing between-group differences (two-sample t-tests). Also, language clear degree scale scores were obtained for correlation analysis with the topological features in nonsyndromic cleft lip and palate patients. Significant between-group differences of local properties were detected in brain regions involved in higher-order language and social cognition. There were no significant correlations between topological feature differences and language clear degree scale scores in nonsyndromic cleft lip and palate patients. Graph theory provided valuable insight into the neurobiological mechanisms of speech rehabilitation in nonsyndromic cleft lip and palate patients. The global network features, small-world index, nodal clustering coefficient, and nodal shortest path length may represent potential imaging biomarkers for the estimation of effective speech rehabilitation.

The Impact of Real-Time Articulatory Information on Phonetic Transcription: Ultrasound-Aided Transcription in Cleft Lip and Palate Speech.

OBJECTIVE: This study investigated whether adding an additional modality, namely ultrasound tongue imaging (UTI), to perception-based phonetic transcription impacted on the identification of compensatory articulations and on interrater reliability. PATIENTS AND METHODS: Thirty-nine English-speaking children aged 3-12 years with cleft lip and palate (CLP) were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio recording and probe-stabilized ultrasound (US). Three types of transcriptions were performed: (1) descriptive observations from the live US by the clinician recording the data, (2) US-aided transcription (UA) by two US-trained clinicians, and (3) traditional phonetic transcription by two CLP specialists from audio recording. We compared the number of consonants identified as in error by each transcriber and then classified errors into eight different subcategories. RESULTS: Both UA and traditional transcription yielded similar error detection rates; however, these were significantly higher than the observations recorded live in the clinic. Interrater reliability for the US transcribers was substantial (κ = 0.65) compared to moderate (κ = 0.47) for the traditional transcribers. US transcribers were more likely to identify covert errors such as double articulations and retroflexion than the audio-only transcribers. CONCLUSION: UTI is a useful complement to traditional phonetic transcription for CLP speech.

Three-dimensional ultrasound evaluation of tongue posture and its impact on articulation disorders in preschool children with anterior open bite.

Background Tongue posture plays an important role in the etiology of anterior open bite (AOB) and articulation disorders, and is crucial for AOB treatment planning and posttreatment stability. Clinical assessment of tongue posture in children is unreliable due to anatomical limitations. The aim of the study was to present functional diagnostics using three-dimensional ultrasound (3DUS) assessment of resting tongue posture in comparison to clinical assessment, and the associations between the improper tongue posture, otorhinolaryngological characteristics, and articulation disorders in preschool children with AOB. Patients and methods A cross-sectional study included 446 children, aged 3-7 years, 236 boys and 210 girls, examined by an orthodontist to detect the prevalence of AOB. The AOB was present in 32 children. The control group consisted of 43 children randomly selected from the participants with normocclusion. An orthodontist, an ear, nose and throat (ENT) specialist and a speech therapist assessed orofacial and ENT conditions, oral habits, and articulation disorders in the AOB group and control group. Tongue posture was also assessed by an experienced radiologist, using 3DUS. The 3DUS assessment of tongue posture was compared to the clinical assessment of orthodontist and ENT specialist. Results The prevalence of AOB was 7.2%. The AOB group and the control group significantly differed regarding improper tongue posture (p < 0.001), and articulation disorders (p < 0.001). In children without articulation disorders from both groups, the improper tongue posture occured less frequently than in children with articulation disorders (p < 0.001). After age adjustment, a statistical regression model showed that the children with the improper tongue posture had higher odds ratios for the presence of AOB (OR 14.63; p < 0.001) than the others. When articulation disorders were included in the model, these odds ratios for the AOB became insignificant (p = 0.177). There was a strong association between the improper tongue posture and articulation disorders (p = 0.002). The 3DUS detected the highest number of children with improper resting tongue posture, though there was no significant difference between the 3DUS and clinical assessments done by orthodontist and ENT specialist. Conclusions The 3DUS has proved to be an objective, non-invasive, radiation free method for the assessment of tongue posture and could become an important tool in functional diagnostics and early rehabilitation in preschool children with speech irregularities and irregular tongue posture and malocclusion in order to enable optimal conditions for articulation development.

Ultrasound analysis of tongue contour for the sound [j] in adults and children. / Análise quantitativa das curvas de língua na avaliação ultrassonográfica da fala para o som [j] em adultos e crianças.

PURPOSE: Analyze and compare the mean tongue contours and articulatory gestures in the production of the sound [j] in adults and children with typical and atypical speech development. The children with atypical development presented speech sound disorders. METHODS: The diagnosis was determined by speech assessments. The study sample was composed of 90 individuals divided into three groups: 30 adults with typical speech development aged 19-44 years (AT), 30 children with typical speech development (CT), and 30 children with speech sound disorders, named as atypical in this study, aged four years to eight years and eleven months (CA). Ultrasonography assessment of tongue movements was performed for all groups. Mean tongue contours were compared between three groups in different vocalic contexts following the sound [j]. The maximum elevation of the tongue tip was considered for delimitation of gestures using the Articulate Assistant Advanced (AAA) software and images in sagittal plane/Mode B. The points that intercepted the language curves were analyzed by the statistical tool R. The graphs of tongue contours were obtained adopting a 95% confidence interval. After that, the regions with significant statistical differences (p<0.05) between the CT and CA groups were obtained. RESULTS: The mean tongue contours demonstrated the gesture for the sound [j] in the comparison between typical and atypical children. For the semivowel [j], there is an articulatory gesture of tongue and dorsum towards the center of ​​the hard palate, with significant differences observed between the children. CONCLUSION: The results showed differences between the groups of children regarding the ability to refine articulatory gestures.

OBJETIVO: Analisar e comparar os contornos médios de língua e os gestos articulatórios na produção do [j] em adultos e crianças com desenvolvimento típico e crianças com desenvolvimento atípico de fala. As crianças com desenvolvimento atípico de fala apresentavam desordens nos sons da fala caracterizadas como desvio fonológico. MÉTODO: O diagnóstico foi determinado pelas avaliações fonoaudiológicas. Desse modo, a amostra foi constituída por três grupos: 30 adultos com desenvolvimento típico de fala (idades entre 19 e 44 anos), 30 crianças com desenvolvimento típico de fala e 30 crianças com desvio fonológico, denominadas neste estudo como atípicas (idades entre quatro anos e oito anos e onze meses). Para todos os grupos, foi realizada avaliação ultrassonográfica dos movimentos da língua. A pesquisa comparou os contornos médios de língua entre os três grupos em diferentes contextos vocálicos seguintes ao som [j]. Para a delimitação dos gestos, considerou-se a elevação máxima da ponta da língua, utilizando-se software Articulate Assistant Advanced (AAA) e imagens no plano sagital/Modo B. Os pontos que interceptaram as curvas de língua foram analisados pela ferramenta estatística R. Os gráficos dos contornos de língua foram obtidos através do cálculo de intervalo com 95% de confiança. Depois dessa etapa, foram obtidas as regiões com diferenças significativas (p-valor ≤ 0,05) entre os grupos de CT e CA. RESULTADOS: Os contornos médios de língua demonstraram o gesto para a semivogal [j] na comparação entre crianças típicas e atípicas. Para a semivogal [j], há um gesto de língua, de dorso, em direção à área central do palato duro, sendo observadas diferenças significativas entre as crianças. CONCLUSÃO: Os resultados permitiram concluir que existem diferenças entre os grupos de crianças quanto à capacidade de refinar os gestos articulatórios.

Neural evidence for phonologically based language production deficits in older adults: An fMRI investigation of age-related differences in picture-word interference.

INTRODUCTION: Older adults often show declines in phonological aspects of language production, particularly for low-frequency words, but maintain strong semantic systems. However, there are different theories about the mechanism that may underlie such age-related differences in language (e.g., age-related declines in transmission of activation or inhibition). METHODS: This study used fMRI to investigate whether age-related differences in language production are associated with transmission deficits or inhibition deficits. We used the picture-word interference paradigm to examine age-related differences in picture naming as a function of both target frequency and the relationship between the target picture and distractor word. RESULTS: We found that the presence of a categorically related distractor led to greater semantic elaboration by older adults compared to younger adults, as evidenced by older adults' increased recruitment of regions including the left middle frontal gyrus and bilateral precuneus. When presented with a phonologically related distractor, patterns of neural activation are consistent with previously observed age deficits in phonological processing, including age-related reductions in the recruitment of regions such as the left middle temporal gyrus and right supramarginal gyrus. Lastly, older, but not younger, adults show increased brain activation of the pre- and postcentral gyri as a function of decreasing target frequency when target pictures are paired with a phonological distractor, suggesting that cuing the phonology of the target disproportionately aids production of low-frequency items. CONCLUSIONS: Overall, this pattern of results is generally consistent with the transmission deficit hypothesis, illustrating that links within the phonological system, but not the semantic system, are weakened with age.

Análise quantitativa das curvas de língua na avaliação ultrassonográfica da fala para o som [j] em adultos e crianças / Ultrasound analysis of tongue contour for the sound [j] in adults and children

RESUMO Objetivo Analisar e comparar os contornos médios de língua e os gestos articulatórios na produção do [j] em adultos e crianças com desenvolvimento típico e crianças com desenvolvimento atípico de fala. As crianças com desenvolvimento atípico de fala apresentavam desordens nos sons da fala caracterizadas como desvio fonológico. Método O diagnóstico foi determinado pelas avaliações fonoaudiológicas. Desse modo, a amostra foi constituída por três grupos: 30 adultos com desenvolvimento típico de fala (idades entre 19 e 44 anos), 30 crianças com desenvolvimento típico de fala e 30 crianças com desvio fonológico, denominadas neste estudo como atípicas (idades entre quatro anos e oito anos e onze meses). Para todos os grupos, foi realizada avaliação ultrassonográfica dos movimentos da língua. A pesquisa comparou os contornos médios de língua entre os três grupos em diferentes contextos vocálicos seguintes ao som [j]. Para a delimitação dos gestos, considerou-se a elevação máxima da ponta da língua, utilizando-se software Articulate Assistant Advanced (AAA) e imagens no plano sagital/Modo B. Os pontos que interceptaram as curvas de língua foram analisados pela ferramenta estatística R. Os gráficos dos contornos de língua foram obtidos através do cálculo de intervalo com 95% de confiança. Depois dessa etapa, foram obtidas as regiões com diferenças significativas (p-valor ≤ 0,05) entre os grupos de CT e CA. Resultados Os contornos médios de língua demonstraram o gesto para a semivogal [j] na comparação entre crianças típicas e atípicas. Para a semivogal [j], há um gesto de língua, de dorso, em direção à área central do palato duro, sendo observadas diferenças significativas entre as crianças. Conclusão Os resultados permitiram concluir que existem diferenças entre os grupos de crianças quanto à capacidade de refinar os gestos articulatórios.

ABSTRACT Purpose Analyze and compare the mean tongue contours and articulatory gestures in the production of the sound [j] in adults and children with typical and atypical speech development. The children with atypical development presented speech sound disorders. Methods The diagnosis was determined by speech assessments. The study sample was composed of 90 individuals divided into three groups: 30 adults with typical speech development aged 19-44 years (AT), 30 children with typical speech development (CT), and 30 children with speech sound disorders, named as atypical in this study, aged four years to eight years and eleven months (CA). Ultrasonography assessment of tongue movements was performed for all groups. Mean tongue contours were compared between three groups in different vocalic contexts following the sound [j]. The maximum elevation of the tongue tip was considered for delimitation of gestures using the Articulate Assistant Advanced (AAA) software and images in sagittal plane/Mode B. The points that intercepted the language curves were analyzed by the statistical tool R. The graphs of tongue contours were obtained adopting a 95% confidence interval. After that, the regions with significant statistical differences (p<0.05) between the CT and CA groups were obtained. Results The mean tongue contours demonstrated the gesture for the sound [j] in the comparison between typical and atypical children. For the semivowel [j], there is an articulatory gesture of tongue and dorsum towards the center of ​​the hard palate, with significant differences observed between the children. Conclusion The results showed differences between the groups of children regarding the ability to refine articulatory gestures.

Multiple phonetically trained-listener comparisons of speech before and after articulatory intervention in two children with repaired submucous cleft palate.

Cleft Palate (CP) assessments based on phonetic transcription are the "gold standard" therapy outcome measure, despite reliability difficulties. Here we propose a novel perceptual evaluation, applied to ultrasound-visual biofeedback (U-VBF) therapy and therapy using visual articulatory models (VAMs) for two children with repaired submucous CP. Three comparisons were made: post VAM, post U-VBF and overall pre- and post-therapy. Twenty-two phonetically-trained listeners were asked to determine whether pre- or post-therapy recordings sounded "closer to the English target", using their own implicit phonological knowledge (prompted via orthographic representation). Results are compared with segment-oriented percent target consonant correct (PTCC) derived from phonetic transcriptions. Listener judgements and PTCC suggest that both children made improvements using both VAM and U-VBF. Statistical analysis showed listener agreement in each comparison, though agreement was weak. However, perceptual evaluation offers a straightforward method of evaluating the effectiveness of interventions and can be used by phonetically trained or lay listeners.

Using ultrasound visual feedback to remediate velar fronting in preschool children: A pilot study.

Anecdotally, velar fronting can be difficult to remediate in some children. This pilot study examined the use of ultrasound visual feedback in remediating velar fronting in typically developing children. A single-case, multiple-baseline across-subjects experimental design was used to examine acquisition, retention and generalisation of velar treatment targets. Two otherwise typically developing children (P1, aged 4;0; P3, aged 4;11) completed the study. The productions of /k/ and /É¡/ at syllable level were targeted during treatment. P1 improved her productions of /k/ and /É¡/ at syllable level during the treatment period and achieved correct production at word level during follow-up. P3 made no improvements in his productions of velar targets. This study suggests that ultrasound visual feedback may be an option for remediating velar fronting in some preschoolers. Further study is required.

Covert contrast in velar fronting: An acoustic and ultrasound study.

There is growing evidence that speech sound acquisition is a gradual process, with instrumental measures frequently revealing covert contrast in errors perceived to involve phonemic substitution. Ultrasound imaging has the potential to expand our understanding of covert contrast by showing whether a child uses different tongue shapes while producing sounds that are perceived as neutralised. This study used an ultrasound measure (Dorsum Excursion Index) and acoustic measures (VOT and spectral moments of the burst) to investigate overt and covert contrast between velar and alveolar stops in child speech. Participants were two children who produced a perceptually overt velar-alveolar contrast and two children who neutralised the contrast via velar fronting. Both acoustic and ultrasound measures revealed significant differences between perceptually distinct velar and alveolar targets. One child with velar fronting demonstrated covert contrast in one acoustic and one ultrasound measure; the other showed no evidence of contrast. Clinical implications are discussed in this article.

Using ultrasound visual biofeedback to treat persistent primary speech sound disorders.

Growing evidence suggests that speech intervention using visual biofeedback may benefit people for whom visual skills are stronger than auditory skills (for example, the hearing-impaired population), especially when the target articulation is hard to describe or see. Diagnostic ultrasound can be used to image the tongue and has recently become more compact and affordable leading to renewed interest in it as a practical, non-invasive visual biofeedback tool. In this study, we evaluate its effectiveness in treating children with persistent speech sound disorders that have been unresponsive to traditional therapy approaches. A case series of seven different children (aged 6-11) with persistent speech sound disorders were evaluated. For each child, high-speed ultrasound (121 fps), audio and lip video recordings were made while probing each child's specific errors at five different time points (before, during and after intervention). After intervention, all the children made significant progress on targeted segments, evidenced by both perceptual measures and changes in tongue-shape.

Tongue contour for /s/ and /∫/ in children with speech sound disorder.

PURPOSE: To describe the tongue shape for /s/ and /∫/ sounds in three different groups of children with and without speech sound disorder. METHODS: The six participants were divided into three groups: Group 1--two typically developing children, Group 2--two children with speech sound disorder presenting any other phonological processes but not the ones involving the production of the /∫/ and Group 3--two children with speech sound disorder presenting any phonological processes associated to the presence of the phonological process of palatal fronting (these two children produced /∫/ as /s/) aged between 5 and 8 years old, all speakers of Brazilian Portuguese. The data were the words /'∫avi/ (key) and /'sapu/ (frog). Tongue contour was individually traced for the five productions of each target word. RESULTS: The analysis of the tongue contour pointed to evidences that both /s/ and /∫/ were produced using distinct tongue contours for G1 and G2. The production of these two groups was more stable than G3. The tongue contour for /s/ and /∫/ from the children in G3 was similar, indicating that their production was undifferentiated. CONCLUSION: The use of the ultrasound applied to the speech analysis was effective to confirm the perceptual analysis of the sound made ​​by the speech-language pathologist.

A multidimensional investigation of children's /r/ productions: perceptual, ultrasound, and acoustic measures.

PURPOSE: This study explored relationships among perceptual, ultrasound, and acoustic measurements of children's correct and misarticulated /r/ sounds. Longitudinal data documenting changes across these parameters were collected from 2 children who acquired /r/ over a period of intervention and were compared with data from children with typical speech. METHOD: Participants were 3 children with typical speech, recorded once, and 2 children with /r/ misarticulation, recorded over 7-8 months. The following data from /r/ produced in nonwords were collected: perceptually rated accuracy, ultrasound measures of tongue shape, and F3 - F2 distance. RESULTS: Regression models revealed significant associations among perceptual, ultrasound, and acoustic measures of /r/ accuracy. The inclusion of quantitative tongue-shape measurements improved the match between the ultrasound and perceptual/acoustic data. Perceptually incorrect /r/ productions were found to feature posteriorly located peaked tongue shapes. Of the children who were seen longitudinally, 1 developed a bunched /r/ and 1 demonstrated retroflexion. The children with typical speech also differed in their tongue shapes. CONCLUSION: Results support the validity of using qualitative and quantitative ultrasound measures to characterize the accuracy of children's /r/ sounds. Clinically, findings suggest that it is important to encourage pharyngeal constriction while allowing children to find the /r/ tongue shape that best fits their individual vocal tract.

A multi-modal approach to intervention for one adolescent's frontal lisp.

An adolescent with a persistent frontal lisp participated in a two-part 11-session intervention case study. The first phase used ultrasound imagery and acoustic, phonetic and voice education to provide information about articulatory setting (AS) and general awareness of the speech production process. The second phase used traditional articulation therapy, online visual-acoustic biofeedback and fluency strategies to target the frontal lisp directly (specifically /s/, /z/, /ʃ/ and /ʧ/). Trained listener evaluations of pre-intervention, post-phase 1 and post-phase 2 assessments showed no improvement after phase 1, but notable improvement in all treatment targets immediately after phase 2. These improvements were substantially maintained at assessment 4 months post-intervention. The outcomes suggest that direct training was more effective than the AS approach; however, the client's ability to self-monitor in phase 2, rapid acquisition of the targets and maintenance at 4 months post-intervention possibly reflected the knowledge gained in phase 1 about AS.

An ultrasonographic investigation of cleft-type compensatory articulations of voiceless velar stops.

Ultrasound imaging was used to investigate the articulation of the voiceless velar stop [k] in five speakers with compensatory articulation related to cleft palate. The perceptual evaluation of the acoustic realization and the visual assessment of the tongue movement for the target sound were made by three examiners. The analysis revealed a variety of different compensatory strategies that included glottal stops, pharyngeal stops, midpalatal stops and glottal and velar co-productions. One patient produced palatal click sounds together with a midpalatal stop. The ultrasound imaging also revealed covert articulatory movements that would have been missed in a purely perceptual analysis. The analysis of the ultrasound images points to subphonemic aspects of cleft-type compensatory articulation that are important to understand for speech therapy.

Neural substrates of phonological and lexicosemantic representations in Alzheimer's disease.

The language profile of patients suffering from Alzheimer's disease (AD) is characterized not only by lexicosemantic impairments but also by phonological deficits, as shown by an increasing number of neuropsychological studies. This study explored the functional neural correlates underlying phonological and lexicosemantic processing in AD. Using H(215)O PET functional brain imaging, a group of mild to moderate AD patients and a group of age-matched controls were asked to repeat four types of verbal stimuli: words, wordlike nonwords (WL+), non-wordlike nonwords (WL-) and simple vowels. The comparison between the different conditions allowed us to determine brain activation preferentially associated with lexicosemantic or phonological levels of language representations. When repeating words, AD patients showed decreased activity in the left temporo-parietal and inferior frontal regions relative to controls, consistent with distorted lexicosemantic representations. Brain activity was abnormally increased in the right superior temporal area during word repetition, a region more commonly associated with perceptual-phonological processing. During repetition of WL+ and WL- nonwords, AD patients showed decreased activity in the middle part of the superior temporal gyrus, presumably associated with sublexical phonological information; at the same time, AD patients showed larger activation than controls in the inferior temporal gyrus, typically associated with lexicosemantic levels of representation. Overall, the results suggest that AD patients use altered pathways to process phonological and lexicosemantic information, possibly related to a progressive loss of specialization of phonological and lexicosemantic neural networks.

Case study using ultrasound to treat /r/.

BACKGROUND: Ultrasound has shown promise as visual feedback in remediation of /r/. AIMS: To compare treatment for /r/ with and without ultrasound. METHODS & PROCEDURES: A Canadian English-speaking adolescent participated in a case study with a no treatment baseline, alternating treatment blocks with and without ultrasound and a final no treatment period. OUTCOMES & RESULTS: Formant values and trained listener ratings of speech samples indicated improvement in /r/ production, particularly after the introduction of ultrasound. CONCLUSIONS: Ultrasound appeared to facilitate the acquisition of /r/ for the participant. Large-scale studies are needed to evaluate ultrasound further.

A case of cortical deafness and anarthria.

Generally, cortical deafness is not complicated by anarthria and cortical anarthria does not affect auditory perception. We report a case of simultaneous progressive cortical deafness and anarthria. At the age of 70 years, the patient, a woman, noticed hearing problems when using the telephone, which worsened rapidly over the next 2 years. She was then referred to our hospital for further examinations of her hearing problems. Auditory tests revealed threshold elevation in the low and middle frequencies on pure-tone audiometry, a maximum speech discrimination of 25% and normal otoacoustic emissions and auditory brainstem, middle- and long-latency responses. An articulation test revealed abnormal pronunciation. Because of these problems only written and not verbal communication was possible; her ability to read and write was unimpaired. She showed no other neurological problems. Brain MRI demonstrated atrophic changes of the auditory cortex and Wernicke's language center and PET suggested low uptake of (18F) 2-fluoro-2-deoxy-d-glucose around the Sylvian fissures in both hemispheres. Neurologically, the patient was suspected of having progressive aphasia or frontotemporal dementia. Her cortical deafness and anarthria are believed to be early signs of this entity.