Cases reported "Language Disorders"

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11/20. Rule invention in the acquisition of morphology by a language-impaired child.

    This paper presents a case study of a language-impaired child who invented a unique morphophonologic rule for signaling the distinction between English singular and plural nouns. Conventional linguistic-phonetic analysis indicated that the child was producing the distinction suprasegmentally rather than segmentally. Acoustic-phonetic analysis of matched singular-plural noun pairs was performed in order to determine quantitatively which suprasegmental acoustic cues he used to signal the distinction. Results of a multivariate analysis of variance revealed that singular and plural productions were significantly different from one another on various fundamental frequency, duration, and intensity parameters. This example of a child's linguistic creativity is offered as further evidence in support of a model of language acquisition that emphasizes the cognitive aspects underlying linguistic regularities in child language. Clinical implications are also discussed.
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12/20. Development dysphasia and electroencephalographic abnormalities.

    Seven patients, six boys and one girl, ranging in age from 2 years 7 months to 5 years 6 months at first contact, presented with severe language delay and dysphasic errors. They were found to have markedly abnormal EEGs despite the fact that only two of the children had had febrile seizures. The EEG abnormalities consisted to spike-wave or sharp wave discharges in focal or bilateral synchronous fashion, and were not affected by anticonvulsants. The children had normal motor development and no dysmorphic features. Results of neurological examinations were normal. CT and isotope scans were unrevealing. intelligence, measured by a non-verbal scale, was normal. The authors suggest that an electrophysiological disturbance was the underlying cause of both the language deficits and the EEG abnormalities. The remarkably frequent occurrence of postmaturity (five of the seven cases) suggests that perinatal events may be an etiological factor.
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13/20. The semantics of verbs in the dissolution and development of language.

    Evidence of the dissolution (DL) of verbs was examined in the written logs kept daily for 4 1/2 years by a woman (Mrs. W) who suffered from cerebral atrophy of unknown origin. Results were compared with similar analyses of written samples obtained from elementary school children (CWL), from normal adults (AWL) and from the literature on early oral language development (COL). The major finding of this study was that the sequence of the dissolution of verbs, in terms of the meanings expressed, mirrored the sequence of early acquisition. In the DL data reported here, Mrs. W continued to write about dynamic events after she ceased writing about stative events; in COL, children talk about dynamic events before stative events. Based on the AWL and CWL data, frequency of use is rejected as an explanation for the dominance and stability of dynamic relations in DL. Rather, it is suggested that the expression of dynamic relations may be less complex than the expression of stative relations due to possible differences in imagery and implication, but particularly due to the linguistic contexts in which each can be expressed.
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14/20. Primary progressive aphasia. An uncommon masquerader of psychiatric disorders.

    Primary progressive aphasia is a recently described, uncommon language disorder with unclear etiological and clinical boundaries. The infrequency and ambiguity of the syndrome may prompt psychiatric consultation. The authors review the pertinent features of one such referral, including a brief literature review of the salient aspects of the differential diagnosis, and note the implications for appropriate treatment.
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15/20. Differential recovery from impairment to the phonological lexicon.

    Word production was examined in four aphasics diagnosed acutely with neologistic jargon and who displayed impairment to the lexical stage of phonological production (Kohn & Smith, 1993, 1994a). To investigate the major source of their nonword errors (i.e., neologisms, phonemic paraphasias), single word production was tested at three different times over the first 6 months postonset, with one subject receiving additional testing at 14 months postonset. Two subjects showed signs of recovery to the phonological output system with respect to: (1) improved word production scores, (2) increased frequency of phonemic paraphasias versus neologisms, and (3) increased production of target phonemes. These subjects also displayed above-chance production of target phonemes and no significant tendency to perseverate phonemes across picture-naming trials. It was argued that this pattern reflects a resolving disturbance in retrieving entries from the phonological lexicon. The other two subjects showed no improvement in word production. They also consistently produced target phonemes at chance levels and had a tendency to perseverate phonemes across picture-naming trials. This static pattern of performance was considered to reflect loss of information from the phonological lexicon. The neuroanatomical damage sustained by each case was consistent with these two recovery patterns.
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16/20. Lexical-semantic deficits in two patients with dominant thalamic infarction.

    Two patients with dominant thalamic infarction, one in the tuberothalamic artery territory, the other in the paramedian artery territory, demonstrated language impairment limited to word retrieval difficulties in spontaneous language and structured naming tasks. Using a cognitive neuropsychological model of lexical processing developed in the study of patients with cortical lesions. We carried out a detailed investigation of their lexical abilities. Both patients demonstrated impairment restricted to oral and written picture naming and oral naming to definition and spared performance on tasks of lexical comprehension, oral word reading, and writing to dictation, as well as syntactic comprehension and production. Naming impairment disproportionately affected lower frequency words, and word substitutions often corresponded to objects that were semantically-related to target words. We propose that our patients' word retrieval impairments reflect a failure of thalamic input to effectively engage the cortical networks subserving lexical semantic processing, leading to degraded levels of activation as the semantic system interfaces with subsequent stages of lexical processing.
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17/20. Semantic memory impairment does not impact on phonological and orthographic processing in a case of developmental hyperlexia.

    Recent evidence from patients with progressive language disorders and dementia has been used to suggest that phonological and orthographic processing depend on intact semantic memory. These claims challenge the traditional view that there are functionally separate modules in the language system. The effect of a severe, but nonprogressive, semantic impairment on phonological and orthographic processing was evaluated in LA, a mentally retarded child with hyperlexia. knowledge of a word's meaning did not affect LA's word repetition, a measure of phonological processing, or his acquisition and retention of orthographic patterns for writing to dictation low-frequency words with exceptional spellings. These findings support the assertion that both orthographic and phonological whole-word representations can be acquired, stored, and retrieved in the absence of a functional link to semantic memory.
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18/20. telemedicine and the diagnosis of speech and language disorders.

    OBJECTIVE: To summarize results of telemedicine evaluations of speech and language disorders in patients in a small, rural hospital and in large multidisciplinary medical practices. MATERIALS AND methods: Eight patients underwent assessment as part of experiments with the National Aeronautics and Space Administration-launched Advanced Communications technology Satellite. A second clinician was on-site with patients to assess the reliability of satellite observations. Twenty-four previously videotaped samples of speech disorders were also transmitted to assess agreement with original face-to-face clinical diagnoses. In addition, results of 150 telemedicine evaluations among Mayo Clinic practices in minnesota, arizona, and florida were examined retrospectively. RESULTS: Evaluations were reliable, and patient satisfaction was good. Diagnoses were consistent with lesion localization and medical diagnosis when they were known, and they frequently had implications for lesion localization and medical diagnosis and management when they were previously unknown. The frequency of uncertain diagnosis (13%) for evaluation among the Mayo practices was only slightly higher than that encountered in face-to-face practice. face-to-face evaluations were considered necessary for only 6 of the 150 patients (4%). CONCLUSION: telemedicine evaluations can be reliable, beneficial, and acceptable to patients with a variety of acquired speech and language disorders, both in rural settings and within large multidisciplinary medical settings.
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19/20. Antiepileptic drugs and atypical evolution of idiopathic partial epilepsy.

    Six patients with classic benign epilepsy of childhood with centrotemporal spikes, treated with carbamazepine (four patients) or sodium valproate (two patients) evolved atypically because the epileptic disorder, diffusion of the electroencephalographic (EEG) discharges during wakefulness, and continuous spike-and-wave during slow sleep associated with severe neuropsychologic abnormalities worsened. These features appeared after a seizure-free interval varying for 2 weeks to 1 year 6 months after initiating therapy and remitted when the previous anticonvulsant drug was discontinued and either substituted with another drug or the patient was left without any treatment. Once the initial antiepileptic drug was discontinued and after a period roughly proportional to the duration of the clinical-EEG complication, the evolution of the patients' seizures was not unusual for this type of epilepsy, with patients eventually becoming free of both seizures and medication and reaching normal school achievement. The clinical complications cannot be attributed solely to the drugs. It must also be related to the underlying substract (i.e., the specific epileptic syndrome involved) that in some patients becomes susceptible to atypical evolution when either product is administered.
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20/20. Autism and autistic epileptiform regression with occipital spikes.

    The electroencephalographic abnormalities seen in landau-kleffner syndrome (LKS) (language deterioration) are non-specific, and consist of a variety of epileptiform discharge patterns including continuous slow spike-wave discharges during sleep, focal sharp waves with spikes, and centrotemporal (rolandic) spikes. Similarly, the EEG abnormalities seen in autistic epileptiform regression (language and social/behavioral deterioration) are non-specific and overlap with those seen in LKS. By contrast, distinct epilepsy syndromes in otherwise normal children occur in the EEG-defined benign focal epilepsies of childhood. Occipital spikes or spike-wave present either in the older child with visual symptoms and headache or in the younger child with autonomic symptoms followed by brief or prolonged partial motor seizures. Seven young children (five from a consecutive series of 42) presenting clinically with autism or autistic regression and possible or definite seizures, whose EEGs revealed occipital spikes or spike-wave characteristic of the benign epilepsies, are reported. Although occipital spikes are commonly seen in young children as an age-dependent EEG-defined benign focal epilepsy, their high frequency in this population with cognitive difficulties suggests a possible causal relation. The effects of the epileptiform discharge on cognitive functioning presumably reflect extension into temporal and parietal lobes, rather than occipital disturbances per se.
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