ACQ Vol 13 No1 2011

Distortions and syntactic errors were less frequent than in the PNFA group and lexical retrieval was better than in the SD group. Neuroanatomical correlates revealed that motor speech and syntactic structures and complexity were localised to frontal regions, with lexical retrieval associated with anterior and inferior temporal regions, and phonological errors as well as other measures of impaired fluency associated with posterior temporal regions. Speech rate was non-localisable with atrophy present in both anterior and posterior language regions. This study demonstrates that it is an oversimplification to refer to the language symptoms of the investigated dementia types as non-fluent or fluent. The authors have provided a detailed account of the linguistic and motor speech differences between these three variants of primary progressive aphasia, which will assist in the diagnostic process. Risk factors in severely neglected children with language delay Sylvestre, A., & Merette, C. (2010) Language delay in severely neglected children: A cumulative specific effect of risk factors? Child Abuse & Neglect , 34 , 414–428. Nikki Worthington Children who have experienced neglect and in particular, severe neglect, are at an increased risk of developing communication problems. This study investigated whether language delay in severely neglected children under 3 years of age was influenced by specific risk factors or whether it was the cumulative effect of risk factors that resulted in the language delay. A total of 48 risk factors were evaluated including those of a biological (e.g., inherited), psychological (e.g., cognitive development) and environmental (e.g., maternal characteristics) nature. The participants were 68 French-speaking children living in Canada. The children were registered for Youth Protection Services and had experienced severe neglect by their families. Data regarding risk factors and the child’s communication abilities were collected in the form of two 90-minute interviews from 68 mothers whose children ranged in age from 2 to 36 months (average 16.7 months). Two scales of the Rossetti Infant-Toddler Language Scale (ITLS) were used to evaluate the communication skills of each child (i.e., language comprehension and language expression). Results from the ITLS demonstrated that over 35% of the children in the study presented with a language delay, which is significantly greater than the incidence in the general population, and that this delay was evident from a very early age (< 9 months). When the authors analysed the biological and psychological risk factors associated with children identified with language delay results pointed to one specific risk factor – cognitive development. Despite the obvious link between language and cognition, this result was surprising as previous research had established a cumulative risk model. Although environmental risk factors did not have a cumulative effect on language development, a number of those factors were more closely associated to language delay than others. These included maternal mental health, the mother’s own history of childhood neglect and abuse, and the mother’s low acceptability level towards her child. These factors may lead to a reduction in the quantity and quality of interactions between carer and child.

Findings from the study may help determine the type of intervention programs most suitable for neglected children with language delay. Current interventions that focus on improving mother–child attachments however fail to address the mother’s own abuse history. The authors conclude that intervention should be targeted at providing a supporting, nurturing environment not only for the child but also for the mother if there is any hope of breaking the intergenerational neglect cycle. This would suggest that speech pathologists working with vulnerable children and their families need to collaborate closely with other professionals to ensure that both caregiver and child can benefit from intervention. Recovery of global aphasia Smania, N., Gandolfi, M., Aglioti, S.M., Girardi, P., Fiaschi, A., & Girardi, F. (2010). How long is the recovery of global aphasia? Twenty-five years of follow-up in a patient with left hemisphere stroke. Neurorehabilitation and Neural Repair , 24 (9), 871–875. doi: 10.1177/1545968310368962 Emma McLaughlin Speech pathologists working with adults with aphasia are faced with many challenges, questions and doubts. As a clinician who has worked with such clients for 18 years, I have sometimes questioned the degree to which I helped my clients, and often wondered what their lives were like years after I was no longer a part of it. The paper by Smania et al. (2010) offers some insight into both of these questions, and provides us with valuable information from long term longitudinal research. In this single case study set in Italy, a 37-year-old man with global aphasia after a large ischemic stroke was assessed 9 times between 3 weeks and 25 years post-stroke using several language, cognitive and speech tests. He had received “language rehabilitation” (but the qualifications of the health professional who provided the rehabilitation were not stated in the paper) for 2 years, 5 times per week in the first 6 months and then 3 times per week until the end of the second year. The participant was subsequently re-tested over 25 years, using several assessments including the Milan Language Examination, the Token Test, the Raven Test, and tests for oral, ideational, and ideomotor apraxia at 3 weeks, 2 and 6 months, and 1, 2, 3, 10, 21, and 25 years post stroke. An additional examination performed 3 years after his stroke suggested that spatial memory and selective attention were unimpaired. Verbal memory could not be assessed. Statistical analyses were conducted to determine trends of improvement over time, and the relationship between differing measures of linguistic function. Results suggested improvement in all language functions over time, but with differing patterns of recovery that continued for many years after the stroke. Three broad periods of recovery were identified. The first year after the stroke saw most recovery in verbal comprehension and word repetition. In 1–3 years after the stroke, naming and reading began to emerge. The third and final period of recovery (3–25 years) was characterised by progressive improvement of previously improved modalities, as well as the development of limited but appropriate spontaneous speech (first evident at 10 years post-stroke). The authors speculate that several factors may have contributed to the participant’s long-term continuing recovery, including an initial period of rehabilitation, young age, and high levels of motivation and social participation.

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ACQ Volume 13, Number 1 2011

ACQ uiring knowledge in speech, language and hearing