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To analyze speech and linguistic features in children with articulation disorder characterized by consonant and vowel phonological errors.
Between February 2007 and June 2015, 117 children who showed articulation disorder were selected for the study. Based on comprehensive speech and language assessments, the subjects were classified into articulation dysfunction (AD), or AD overlapping with language delay. Detailed information of articulation, including percentage of consonants correct (PCC) and normal percentage of variable consonants derived from the Assessment of Phonology and Articulation for Children test, were compared between the two groups.
Totally, 55 children were diagnosed as AD and 62 as AD with language delay. Mean PCC was not significantly different between the two groups. In both groups, the acquisition order of consonants followed the universal developmental sequence. However, differences were observed in the nasal & plosive consonants abnormality between the two groups. When adjusted to their delayed language level in AD with language delay group, 53% of children had appropriate articulation function for their expressive language level.
Speech and linguistic characteristics in children with articulation disorder were variable. Therefore, comprehensive assessment is required in children with inaccurate pronunciation, and a proper treatment plan based on the results of assessment should be followed.
To evaluate the types and severity of subcortical aphasia after stroke and to determine the predictors of the degree of aphasic impairment.
Medical records of 38 patients with post-stroke subcortical aphasia (19 males; mean age, 61.7±13.8 years) were reviewed retrospectively with respect to the following tests: the Korean version of the Western Aphasia Battery (K-WAB), the Korean version of the Modified Barthel Index (K-MBI), and the Fugl-Meyer Index (FMI). The severity of aphasia was evaluated by the aphasia quotient (AQ) and the language quotient (LQ).
Anomic aphasia was the most frequent type of aphasia (n=15, 39.5%), and the lesion most frequently observed in subcortical aphasia was located in the basal ganglia (n=19, 50.0%). Patients with lesions in the basal ganglia exhibited the lowest scores on the FMI for the upper extremities (p=0.04). Severity of aphasia was significantly correlated with the K-MBI (Pearson correlation coefficient: γ=0.45, p=0.01 for AQ and γ=0.53, p=0.01 for LQ) and FMI scores for the lower extremities (γ=0.43, p=0.03 for AQ and γ=0.49, p=0.05 for LQ). In a multivariate logistic regression analysis, K-MBI remained the only explanatory variable closely associated with aphasia severity.
This study showed the general characteristics of post-stroke subcortical aphasia, and it revealed that K-MBI was an associated and explanatory factor for aphasia severity.
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To investigate the usefulness of the communication domain in the Korean version of Ages and Stages Questionnaire (K-ASQ), and short form of the Korean version of MacArthur-Bates Communicative Development Inventories (M-B CDI-K), as screening tests for language developmental delay.
Data was collected between April 2010 and December 2013, from children who visited either the Department of Physical Medicine and Rehabilitation or the Developmental Delay Clinic, presenting with language development delay as their chief complaint. All the children took the short form of M-B CDI-K and K-ASQ as screening tests, and received diagnostic language assessments including Sequenced Language Scale for Infants (SELSI) or Preschool Receptive-Expressive Language Scale (PRES).
A total of 206 children, mean age 29.7 months, were enrolled. The final diagnoses were developmental language disorder, global developmental delay, autism spectrum disorder, cerebral palsy, etc. The M-B CDI-K short form and the communication domain of the K-ASQ had 95.9% and 76.7% sensitivity, and 82.4% and 85.3% specificity, with regards to diagnostic language assessments. The M-B CDI-K short form showed higher negative predictive value and better accuracy than the communication domain of the K-ASQ.
The screening ability of K-ASQ was not sufficient for children with language development delay, and the M-B CDI-K short form should be implemented for additional screening.
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To assess the clinical usefulness of the relatively short instrument, the Korean version of the Mini-Mental State Examination (MMSE-K), for testing the association between cognition and language function in subacute post-stroke aphasia patients.
Medical charts of 111 post-stroke patients (65 men; age 69.6±10.0 years; 124.6±80.6 days post-onset) were reviewed retrospectively. All patients were assessed longitudinally for aphasia using the validated Korean version of the Western Aphasia Battery (K-WAB) and for cognition using the MMSE-K. Patients were categorized and analyzed according to 3 aphasia-severity clusters.
All subscales of the K-WAB showed significant improvement in follow-up assessments in all groups (p<0.05 or p<0.01). Only the scores of orientation, language function, and total score of MMSE-K showed significant improvement in all groups (p<0.01). The more severely impaired group showed stronger Pearson correlation coefficients between cognition and language function. Additionally, comparisons between correlation coefficients showed that the association of improvement in orientation with that of fluency and AQ% (aphasia quotient %) was significant in the more severely impaired group.
Among subacute post-stroke aphasic patients, patients with more severe aphasia showed greater impairments to cognitive function; in addition, recovery of orientation may be related to recovery of language function.
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To compare and analyze the clinical characteristics of children with delayed language acquisition due to two different diagnoses, which were specific language impairment (SLI, a primarily delayed language development) and global developmental delay (GDD, a language delay related to cognitive impairment).
Among 1,598 children who had visited the developmental delay clinic from March 2005 to February 2011, 467 children who were diagnosed with GDD and 183 children who were diagnosed with SLI were included in this study. All children were questioned about past, family, and developmental history, and their language competences and cognitive function were assessed. Some children got electroencephalography (EEG), in case of need.
The presence of the perinatal risk factors showed no difference in two groups. In the children with GDD, they had more delayed acquisition of independent walking and more frequent EEG abnormalities compared with the children with SLI (p<0.01). The positive family history of delayed language development was more prevalent in children with SLI (p<0.01). In areas of language ability, the quotient of receptive language and expressive language did not show any meaningful statistical differences between the two groups. Analyzing in each group, the receptive language quotient was higher than expressive language quotient in both group (p<0.01). In the GDD group, the Bayley Scales of Infant Development II (BSID-II) showed a marked low mental and motor quotient while the Wechsler Intelligence Scale showed low verbal and nonverbal IQ. In the SLI group, the BSID-II and Wechsler Intelligence Scale showed low scores in mental area and verbal IQ but sparing motor area and nonverbal IQ.
The linguistic profiles of children with language delay could not differentiate between SLI and GDD. The clinicians needed to be aware of these developmental issues, and history taking and clinical evaluation, including cognitive assessment, could be helpful to diagnose adequately and set the treatment plan for each child.
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To investigate the usefulness of MacArthur-Bates Communicative Development Inventories-Korean (M-B CDI-K) short form as a screening test in children with language developmental delay.
From April 2010 to May 2012, a total of 87 patients visited the department of physical medicine and rehabilitation of National Health Insurance Service Ilsan Hospital with the complaint of language developmental delay and were enrolled in this study. All patients took M-B CDI-K short form and Sequenced Language Scale for Infants (SELSI) or Preschool Receptive-Expressive Language Scale (PRES) according to their age.
The study group consisted of 58 male patients and 29 female patients and the mean age was 25.9 months. The diagnosis are global developmental delay in 26 patients, selective language impairment in 31 patients, articulation disorder in 7 patients, cerebral palsy in 8 patients, autism spectrum disorder in 4 patients, motor developmental delay in 4 patients, and others in 7 patients. Seventy-one patients are diagnosed with language developmental delay in SELSI or PRES and of them showed 69 patients a high risk in the M-B CDI-K short form. Sixteen patients are normal in SELSI or PRES and of them showed 14 patients non-high risk in the M-B CDI-K short form. The M-B CDI-K short form has 97.2% sensitivity, 87.5% specificity, a positive predictive value of 0.97, and a negative predictive value of 0.88.
The M-B CDI-K short form has a high sensitivity and specificity so it is considered as an useful screening tool in children with language developmental delay. Additional researches targeting normal children will be continued to supply the specificity of the M-B CDI-K short form.
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To investigate the effects of transcranial direct current stimulation (tDCS) applied over the prefrontal cortex on the improvement of verbal, visuospatial working memory and naming in healthy adults.
Thirty two healthy adults (15 males and 17 females, mean age 37.3±13.0 years) were enrolled in this study. The subjects were divided into four groups randomly. They underwent sham or anodal tDCS over the left or right prefrontal cortex, for 20 minutes at a direct current of 1 mA. Before and immediately after tDCS, the subjects performed the Korean version of the mini-mental state exam (K-MMSE) and stroop test (color/word/interference) for the screening of cognitive function. For working memory and language evaluation, the digit span test (forward/backward), the visuospatial attention test in computer assisted cognitive program (CogPack®) and the Korean-Boston Naming Test (K-BNT) were assessed before tDCS, immediately after tDCS, and 2 weeks after tDCS.
The stroop test (word/interference), backward digit span test and K-BNT were improved in the left prefrontal tDCS group compared with that of the sham group (p<0.05). The stroop test (interference) and visuospatial attention test were in the right prefrontal tDCS group compared with that of the sham group (p<0.05). Their improvement lasted for 2 weeks after stimulation.
tDCS can induce verbal working memory improvement and naming facilitation by stimulating the left prefrontal cortex. It can also improve the visuospatial working memory by stimulating the right prefrontal cortex. Further studies which are lesion and symptom specific tDCS treatment for rehabilitation of stroke can be carried out.
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Method: Total 139 children who visited the department of rehabilitation medicine for the evaluation of suspected speech-language delay. All children were evaluated for receptive and expressive language quotients, articulation accuracy, verbal, performance and full-scale intelligent quotients and social maturation assessment. Results: Approximately 70% of the children who had chief complaints of speech or language disorder were diagnosed as 'receptive and expressive language developmental delay'. Intelligent and social quotients of the children with receptive and expressive language developmental delay were significantly lower than those of the other groups (p＜0.05). Both receptive and expressive language quotients, but not dysarticulation, were significantly correlated with intelligent and social quotients (p＜0.05). Multiple regression analysis demonstrated that the language quotients could predict intelligent and social quotients as simple equations (p＜0.01). Conclusion: Primary result of receptive and expressive language quotients from screening test of language evaluation might be able to predict cognitive function and social maturity, which also showed high-degree positive correlation with intelligent and social quotients. This result could provide a useful guideline for further developmental studies in children with speech and language disorder who received primary speech evaluation. (J Korean Acad Rehab Med 2008; 32: 129-134)
Objective: To determine the characteristic pattern of information processing in the children with specific language impairment (SLI) using the Kaufman-Assessment Battery (K-ABC) for children.
Method: Thirty patients were responded to K-ABC. Twenty-three of them were diagnosed as SLI without any abnormalities in other developmental areas, visual or auditory system. Seven patients showed language delay with other developmental abnormalities. Mean chronological age of SLI patients was 61.0 months. Patterns of information processing was measured using K-ABC. Sequential processing, simultaneous processing, mental processing, and achievement scales were obtained and compared between two groups.
Results: In SLI patients, sequential processing, simultaneous processing, mental processing, and achievement scales were 32.9⁑34.2, 54.3⁑26.9, 42.5⁑31.1, and 33.8⁑28.7, respectively. The SLI patients showed significantly poor scales in sequential than in simultaneous processing (p＜0.01).
Conclusion: The patients with SLI exhibited significant deficits in sequential processing, whereas simultaneous processing was better than that of the other group in this study. This characteristics of SLI patients will be useful for understanding and establishing proper therapeutic strategies for these patients.
Objective: This study involves an experiment using functional magnetic resonance imaging (fMRI) to delineate neural network and laterality of language related brain activation for spoken and written Korean words in normal adults.
Method: Eight normal right-handed Korean males, aged 20∼33 years, were investigated. Language tasks consisted of auditory and visual verb generation tasks. In fMRI, twenty slices were obtained for each functional volume using single shot echoplanar image sequences. Data were motion corrected, coregistered, normalized, and statistically analyzed using SPM-96 software. The number of activated voxels were counted in each hemisphere to calculate the laterality index according to each language task.
Results: In auditory verb generation task, inferior frontal gyrus and superior temporal region were activated in the left side. Right temporal lobe was also activated in the superior and middle temporal areas. Other activated area included medial frontal lobe. Lateralization index of auditory verb generation task was 78.6⁑30.7. In visual verb generation task, inferior frontal gyrus was activated in the left side. Medial frontal lobe, both lateral occipital lobe, and left parietal lobe were also activated. The laterality index was 87.6⁑10.1.
Conclusion: We could delineate cortical regions subserved for spoken and written Korean language and laterality of language related brain activation using fMRI. These results can contribute to understand underlying mechanism of language disorders in brain injury patients and to investigate the pattern of reorganization of language network after rehabilitation.
Objective: To identify the incidence and characteristics of language disorders in patients with traumatic brain injury (TBI), and to understand the differences of language disorder according to the degree and lesion of brain damage and the outcomes after proper language training programs.
Method: The subjects were 24 adult TBI patients. Seventeen patients with language disorder were examined with language disorder screening test. The characteristics of the language disorders were evaluated according to the degree and lesion site of the brain injury. Prognosis of the language disorders was studied. The tests were performed at the initiation and termination of the language treatment program.
Results: The incidence of language disorders was 91.7%. At the initial evaluation, all items showed a low rate of correct response, but at the final evaluation, the statistically significant improvement was noted in all items. There was no difference between moderate and severe brain damages at final evaluation. Focal lesion group revealed higher rate of correct response than diffuse lesion group on comprehension, expression, reading, and calculation at final evaluation.
Conclusion: The TBI patients showed diffuse language dysfunction on fluency, comprehension, expression, reading, writing, and calculation. But the majority of these patients showed satisfactory recovery, especially the focal brain lesion showed the better outcome. These patients with focal lesion were needed precise language evaluation and more intensive language treatment program.
Objective: The purpose of this study is to determine clinical and phonological characteristics of the patients with specific language impairment (SLI).
Method: Subjects were 24 SLI patients without known mental retardation, cerebral palsy, epilepsy, hearing loss or structural brain lesion and 23 normal children. Developmental history, oropharyngeal abnormality, and brainstem auditory evoked potentials were obtained in SLI patients. Receptive language age and quotient were assessed by Peabody picture vocabulary test. Phonetic characteristics of subjects were analysed using Visi-PitchⰒ and computerized speech laboratory.
Results: In perceptual evaluation, 32.3% of SLI patients showed incomplete articulation pattern. The patterns of incomplete articulation were substitution, distortion, nasalization, and addition. The receptive language of SLI patients (0.89⁑0.28) was significantly lower than control group (1.16⁑0.18). In Visi-PitchⰒ analysis, diadochokinetic rate and maximal phonation time were decreased in SLI patients. The total duration of three syllables in SLI patients were significantly prolonged, especially for bilabial heavily asperated and glottalized consonants and alveolar and velar slightly asperated, heavily asperated, and glottalized consonants.
Conclusion: The patients with SLI showed characteristic defect in articulation as well as expressive and receptive language delayment. This articulatory defect may be resulted from disturbance of central programming and coordination of articulation. The objective and quantitative analysis of Phonological characteristics using computerized speech system in SLI patients can contribute to diagnose and evaluate the treatment outcome for the patients.
Objectives: To report the results of functional magnetic resonance imaging (fMRI) experiment to delineate brain network for auditory language tasks in normal Korean adults.
Method: Five normal right-handed Korean males, aged 20∼33 years, were investigated using fMRI technique. Language tasks consisted of auditory listening and verb generation tasks. In fMRI, twenty slices were obtained for each functional volume using single shot echoplanar image sequences. Eighty-four volumes were obtained for each functional run. Data were motion corrected, coregistered, normalized, and statistically analyzed using SPM-96 software (Wellcom Department of Cognitive Neurology, Oxford, UK).
Results: Functional activation were detected in superior temporal region (coordinates: x=64, y=42, z=2) in the left side and superior to middle temporal lobe (coordinates: x=50, y=20, z=2) in the right side for auditory listening task. Auditory verb generation task activated inferior frontal gyrus (coordinates: x=56, y=16, z=14), superior temporal region, and medial frontal region in the left side. Right temporal lobe was also activated in the superior to middle temporal areas. Activation was more extensive in the left side for both language tasks.
Conclusion: Our results can remarkably delineate cortical and subcortical regions subserved for auditory language processing. These results can be contributing to understand the underlying mechanism of language disorders in brain-injured patients and to investigate the pattern of reorganization of language network after rehabilitation.
Objective: To evaluate the characteristics of speech-language development and to find out the relationship between them and radiological findings, and mental/motor developmental quotient in the children with cerebral palsy and other delayed development.
Method: Fifty-eight children with cerebral palsy or delayed development were evaluated with Bayley scales of infant development, brain magnetic resonance imaging (MRI), and single photon emission computerized tomography (SPECT). At the same time, the speech-language development using several evaluation batteries was assessed.
Results: Most of the children with cerebral palsy or delayed development showed delay in speech-language development. There was no relationship between speech-language development and presence of the lesion on brain MRI or SPECT, and mental/motor developmental quotient.
Conclusion: Speech-language development was delayed in most of the children with cerebral palsy or other delayed development. Therefore, early interventions for speech-language development and comprehensive speech therapy are required for improving functional outcome in these children.
Objective: To evaluate the pattern of developmental delay of language and to correlate the language with other developmental areas in cerebral palsy children.
Method: Sequenced Inventory of Communication Development (SICD) was studied in 31 children with cerebral palsy of age ranging from 11 months to 48 months. Korean Denver Developmental Screening Test (DDST) was also performed in 18 children simultaneously.
Results: On SICD, 10 children (32.3%) showed the receptive language delay and 13 children (41.9%) showed the expressive language delay. Among 15 spastic quadriplegic children, 40% showed the delay of receptive language development, 53.3% showed the delay in expressive language development. Among 10 spastic diplegic children, 30% showed the delay of both receptive and expressive language development. One spastic right hemiplegic child showed a delay of expressive language development, but 4 left hemiplegic children showed the normal language development. One hypotonic cerebral palsy child showed a delay of both receptive and expressive language development.
The expressive language was delayed more than the receptive language.
SICD correlated highly with the language sector of DDST. And both SICD and DDST language sectors correlated with the other sectors of DDST (personal-social, fine motor-adaptive, gross motor), especially with the fine motor sector (r=0.912, 0.918, 0.976, p＜0.001).
Conclusion: There is a considerably high incidence of developmental delay of language in cerebral palsy children, especially among spastic quadriplegic children.
The early evaluation and treatment for the developmental delay of language need to be included in a general rehabilitation program for the cerebral palsy children.
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