Voice and deglutition functions after the supracricoid and total laryngectomy procedures for advanced stage laryngeal carcinoma.

OBJECTIVES: This investigation compared speech and deglutition functions after alternative surgical treatments for advanced stage laryngeal carcinoma: the supracricoid laryngectomy (SCL) versus the total laryngectomy (TL). Study design and setting Cohort investigation at Wayne State University School of Medicine. METHODS: Quantitative studies of laryngeal biomechanics, acoustic and speech aerodynamic features, and deglutition skills of these individuals were coupled to listener and patient self-impressions of speech and voice characteristics for group comparative analyses. RESULTS: Results revealed that patients from each subgroup performed comparably relative to speech intelligibility and voice quality disturbances. Videostroboscopy of the neoglottal mechanisms in these two populations helped to explain these outcomes. Acoustic and speech aerodynamic testing demonstrated variably abnormal features in both surgical subgroups. Whereas the SCL patients eventually achieved full oral diets, they required many sessions of swallowing therapy to obtain this objective and eliminate tube feeding supplementation. The TL patients did not evidence protracted swallowing difficulties or the need for specific exercises in order to remove their feeding tubes postoperatively. References to organ preservation strategies in lieu of surgical management are included for completeness purposes. CONCLUSIONS: The SCL and TL surgical procedures for advanced stage laryngeal carcinoma resulted in equivalent speech and swallowing functional outcomes.

Laryngeal anesthetization for the treatment of acquired disfluency: a case study.

UNLABELLED: The subject of this case study is an adult who became severely disfluent after a motor vehicle accident in which he did not suffer significant injuries. His disfluency persisted for 4 months notwithstanding a short trial of speech therapy. Hyperfunctional phonation subsystem disturbances were identified on follow-up evaluations. Laryngeal anesthetization was achieved via a transcutaneous lidocaine injection. The patient improved dramatically within 15 min of the procedure. More than 18 months later, he has retained normal speech fluency without any additional post-injection intervention. Theoretical discussions are rendered to help interpret this treatment outcome. EDUCATIONAL OBJECTIVES: The reader will be able to describe (1) the laryngeal movements and adjustments commonly associated with stuttered speech; (2) the speech dysfunctions a patient evidenced following a motor vehicle accident; and (3) the author's treatment rationale for resolving the patient's speech disorder.

Communication effects of prenatal alcohol exposure.

This paper surveys the literature on prenatal alcohol exposure. The focus is on studies of speech, language, and communication skills evidenced by children diagnosed with fetal alcohol syndrome and fetal alcohol effects. Concomitant physical, behavioral, intellectual, and learning patterns are reviewed. Symptoms presented by alcohol-exposed children are compared to those seen in other developmentally delayed children. Future needs in areas of identification, assessment, and treatment are discussed.

Young children's idiom comprehension: trying to get the picture.

Young children (3.5-6.5 years of age) were tested for their comprehension of 10 common idioms in context and no-context conditions. Results revealed a significant linear trend for children to make more literal responses with increasing age. Children of this age did not find the story contexts helpful in interpreting the idioms. A range of comprehension scores was found among the individual idioms, but semantic transparency (as judged by adults) was not related to comprehension. Child-internal and methodologic variables influencing idiom comprehension are discussed.

Acquiring lexical contrast: the case of bring-take learning.

Production of the deictic verbs bring and take was evaluated among 88 normally functioning children (grades K-6). Theoretical approaches and assumptions concerning a working definition of word mastery were contrasted and found to influence (a) the evaluative scheme chosen to assess lexical knowledge and (b) conclusions concerning the development of lexical contrast. Results, which revealed a developmental order unlike that reported elsewhere, are related to the broad issue of interpretation of lexical overextension behavior. A model of antonym learning is proposed that assigns a prepotent role to the second-to-emerge term in a contrastive pair.

Apraxia of speech: the effectiveness of a treatment regimen.

This investigation describes a treatment program for an adult patient with apraxia of speech. The program was composed of a series of physiologic (nonspeech) and phonetic (articulatory) tasks that began with oroneuromotor control activities and progressed to consonant-vowel (CV) syllable, word, and sentence drills. All activities were paced by a metronome. Detailed descriptions are provided about the (a) nature of the specific treatment steps, (b) sequence of steps followed, (c) criteria used for progression within and between steps, (d) actual number of trials and time required to reach criteria for each step, and (e) steps that were especially easy or difficult to master. A multiple probe design employed to test program efficacy revealed that (a) all tasks in the treatment program were successfully acquired, (b) control of all treatment behaviors was maintained, and (c) carry-over from treated to nontreated behaviors did not occur. Results confirmed that the program positively affected the patient's performance. Suggestions are offered outlining possible modification of the treatment steps so as to yield similar results with greater clinical efficiency.

Clinical evaluation of children's classification behavior.

Classification skills among 88 unimpaired school children (22 each at grades k, 2, 4, and 6) were evaluated using the Iconic-Symbolic (IS) test of the Muma Assessment Program (Muma and Muma, 1979). IS stimuli are 18 test plates, each of which contains pictures of three objects. The child is required to select any two of these pictures. Evaluation of response patterns is intended to permit judgement of subject classification strategy and changes therein across the middle childhood years. In the current study, children, after exposure to standard IS test procedures, were interviewed in order to determine the rationale they used in forming their paired-object classes. Results revealed little isomorphism between the rationale that children, in fact, employed in the task and the classification criteria presumed, a priori, by the IS procedures. Minimal differences were found in the degree of response-rationale isomorphism across the child sample. Implications of these results are discussed as they relate to the evaluation of classification skills among unimpaired and clinical populations.

Object grouping strategies by adults: evaluating a class act.

Eighty unimpaired adult subjects were exposed to the iconic-symbolic (I-S) subtest (Muma & Muma, 1979), an instrument designed to provide evidence regarding object grouping processes in clinical populations. I-S instructions and a revised (REV) instruction were employed. Subjects were also asked to provide a rationale statement for each object grouping. The 2,880 rationale statements thus generated were analyzed on the isomorphism between the statements and the object grouping criteria presumed by the I-S test design. Significantly higher isomorphic levels occurred under REV instructions, although fewer than one-half of the REV subjects performed at the cognitive (i.e., symbolic) stage defined and predicted by the I-S protocols. Subjects demonstrated an overwhelming preference for the formation of taxonomic classes rather than for schematic-based object groupings as has been argued by some writers. Analysis of rationale statements strongly suggested that three major strategies were employed by individual subjects in the establishment of object classes: an intensional, an extensional, and a mixed intensional-extensional strategy. It was concluded that adult subjects show a range of classification strategies, those strategies are best described by using something other than an iconic-symbolic dichotomy, and classification tasks devoid of a rationale component may foster incomplete and potentially distorted conclusions concerning grouping abilities and underlying processes.

Procedural influences on auditory comprehension: a second look at the Revised Token Test.

The purpose of this report is to demonstrate how methodologic procedures used in the standardization of certain subtests of the Revised Token Test ( RTT ) ( McNeil and Prescott , 1978) may have affected the nature of the data collected and, subsequently the interpretation of auditory comprehension abilities shown by clinical populations tested with the RTT .