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ACQ
Volume 13, Number 1 2011
ACQ
uiring knowledge in speech, language and hearing
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.
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.