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Stuttering is a common speech disorder that interrupts speech fluency and tends to cluster in families. Typically, stuttering is characterized by speech sounds, words or syllables which may be repeated or prolonged and speech that may be further interrupted by hesitations or 'blocks'. Rare variants in a small number of genes encoding lysosomal pathway proteins have been linked to stuttering. We studied a large four-generation family in which persistent stuttering was inherited in an autosomal dominant manner with disruption of the cortico-basal-ganglia-thalamo-cortical network found on imaging. Exome sequencing of three affected family members revealed the PPID c.808C>T (p.Pro270Ser) variant that segregated with stuttering in the family. We generated a Ppid p.Pro270Ser knock-in mouse model and performed ex vivo imaging to assess for brain changes. Diffusion-weighted MRI in the mouse revealed significant microstructural changes in the left corticospinal tract, as previously implicated in stuttering. Quantitative susceptibility mapping also detected changes in cortico-striatal-thalamo-cortical loop tissue composition, consistent with findings in affected family members. This is the first report to implicate a chaperone protein in the pathogenesis of stuttering. The humanized Ppid murine model recapitulates network findings observed in affected family members. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsInterpretation\nIMPLICATIONS FOR REHABILITATIONThis scoping review aimed to inform future research priorities by collating evidence on neural correlates of speech and language recovery following childhood stroke.Neuroimaging, motor speech, or language outcomes following childhood stroke (28 days to 18 years age) in the subacute to chronic community stages (care occurring after acute medical management, including inpatient and outpatient rehabilitation, and community-based programs) were identified and extracted from Medline, Embase, PsycInfo, and Clinical databases.Of the 3990 studies screened, 11 met the inclusion criteria. Of the included articles, no papers formally assessed speech outcomes, 11 articles reported language outcomes through standardized testing, 11 utilized structural imaging (CT, MRI), and four reported functional neuroimaging outcomes (fMRI).This review revealed a rudimentary accounting of speech and language profiles in children post-stroke; limited by the use of varied and incomplete speech and language assessment batteries, inconsistent reporting of lesion locations associated with speech and language outcomes, a dearth of functional neuroimaging studies, and lack of information about speech and language function throughout the rehabilitation period, a time when the brain is most plastic and receptive to therapy. Future research should provide complete and accurate accounts of speech and language function and their neural correlates throughout rehabilitation and recovery to inform care, education, and employment planning.Although stroke is a top 10 cause of mortality in children, the current literature contains a rudimentary accounting of the speech and language profiles, and their neural correlates, following stroke in children.For rehabilitation professionals, our review demonstrates the need for comprehensive speech and language assessment in the subacute stage of recovery from childhood stroke.A complete and accurate account of speech and language functions, and their neural correlates, spanning recovery from childhood stroke is needed to inform clinical care.Although stroke is a top 10 cause of mortality in children, the current literature contains a rudimentary accounting of the speech and language profiles, and their neural correlates, following stroke in children.For rehabilitation professionals, our review demonstrates the need for comprehensive speech and language assessment in the subacute stage of recovery from childhood stroke.A complete and accurate account of speech and language functions, and their neural correlates, spanning recovery from childhood stroke is needed to inform clinical care. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to (1) quantify attention and executive functioning in children with developmental coordination disorder (DCD), (2) assess whether some children with DCD are more likely to show attention difficulties, and (3) characterize brain correlates of motor and attention deficits. Method: Fifty‐three children (36 with DCD and 17 without) aged 8 to 10 years underwent T1‐weighted and diffusion‐weighted magnetic resonance imaging, and standardized attention and motor assessments. Parents completed questionnaires of executive functioning and symptoms of inattention and hyperactivity. We assessed regional cortical thickness and surface area, and cerebellar, callosal, and primary motor tract structure. Results: Analyses of covariance and one‐sample t‐tests identified impaired attention, non‐motor processing speed, and executive functioning in children with DCD, yet partial Spearman's rank correlation coefficients revealed these were unrelated to one another or the type or severity of the motor deficit. Robust regression analyses revealed that cortical morphology in the posterior cingulate was associated with both gross motor skills and inattentive symptoms in children with DCD, while gross motor skills were also associated with left corticospinal tract (CST) morphology. Interpretation: Children with DCD may benefit from routine attention and hyperactivity assessments. Alterations in the posterior cingulate and CST may be linked to impaired forward modelling during movements in children with DCD. Overall, alterations in these regions may explain the high rate of non‐motor impairments in children with DCD. What this paper adds: Children with developmental coordination disorder have difficulties in attention, processing speed, and executive functioning.Non‐motor impairments were not interrelated or correlated with the type or severity of motor deficit.Posterior cingulate morphology was associated with gross motor skills and inattention.Gross motor skills were also associated with left corticospinal tract morphology. [ABSTRACT FROM AUTHOR]

Childhood apraxia of speech (CAS) is a rare disorder of childhood that can leave a watermark of the impacts throughout the lifetime. Since being first described in the 1950s, aetiological insights have been limited. At a neurobiological level, clinical MRI scans fail to reveal overt neural anomalies in individual cases with CAS, although quantitative MRI methods have revealed subtle brain anomalies at a group level. Dramatic insights, however, occurred in the past decade from the discovery of genetic pathways underlying the phenotype. Several single genes and copy number-variant conditions are now associated with CAS either in relative isolation, as in the case of FOXP2 variants, or most typically in association with other neurodevelopmental conditions, such as epilepsy, intellectual disability, motor impairment and autism. CAS requires careful differential diagnosis from other childhood speech disorders, but when a severe and persistent diagnosis is confirmed, a genetic aetiology should increasingly be pursued. [ABSTRACT FROM AUTHOR]

An editorial is presented that explores a randomised comparative effectiveness study that assesses the importance of music therapy on the neurodevelopment of infants who are confined in hospitals. It cites the risks of adverse neurodevelopmental outcomes to infants with history of prolonged and early hospitalisation. Also noted are the findings of the study that laid a foundation in evaluating the neuroprotective significance of music therapy and other sensory and linguistic enrichments.

Introduction: Confusion has surrounded the description of post-operative mutism and associated morbidity in pediatric patients with cerebellar tumors for years. The heterogeneity of definitions and diagnostic features has hampered research progress within the field, and to date, no international guidelines exist on diagnosis, prevention, treatment, or follow-up of this debilitating condition. An international group of clinicians and researchers from multiple relevant disciplines recently formed a cohesive panel to formulate a new working definition and agree upon standardized methods for diagnosis and follow-up. Methods: Consensus was obtained using the modified nominal group technique, involving four rounds of online Delphi questionnaires interspersed with a structured consensus conference with lectures, group work, and open discussion sessions. Results: A new, proposed definition of 'post-operative pediatric CMS' was formed, preliminary recommendations for diagnostic and follow-up procedures were created, two working groups on a new scoring scale and risk prediction and prevention were established, and areas were identified where further information is needed. Discussion: The consensus process was motivated by desire to further research and improve quality of life for pediatric brain tumor patients. The Delphi rounds identified relevant topics and established basic agreement, while face-to-face engagement helped resolve matters of conflict and refine terminology. The new definition is intended to provide a more solid foundation for future clinical and research work. It is thought as a consensus for moving forward and hopefully paves the way to developing a standard approach to this challenging problem with the advent of better scoring methods and ultimate goal of reducing the risk of CMS. [ABSTRACT FROM AUTHOR]

Aim The epidemiology of preschool speech sound disorder is poorly understood. Our aims were to determine: the prevalence of idiopathic speech sound disorder; the comorbidity of speech sound disorder with language and pre-literacy difficulties; and the factors contributing to speech outcome at 4 years. Method One thousand four hundred and ninety-four participants from an Australian longitudinal cohort completed speech, language, and pre-literacy assessments at 4 years. Prevalence of speech sound disorder ( SSD) was defined by standard score performance of ≤79 on a speech assessment. Logistic regression examined predictors of SSD within four domains: child and family; parent-reported speech; cognitive-linguistic; and parent-reported motor skills. Results At 4 years the prevalence of speech disorder in an Australian cohort was 3.4%. Comorbidity with SSD was 40.8% for language disorder and 20.8% for poor pre-literacy skills. Sex, maternal vocabulary, socio-economic status, and family history of speech and language difficulties predicted SSD, as did 2-year speech, language, and motor skills. Together these variables provided good discrimination of SSD (area under the curve=0.78). Interpretation This is the first epidemiological study to demonstrate prevalence of SSD at 4 years of age that was consistent with previous clinical studies. Early detection of SSD at 4 years should focus on family variables and speech, language, and motor skills measured at 2 years. [ABSTRACT FROM AUTHOR]

Severe and persistent speech disorder, dysarthria, may be present for life after brain injury in childhood, yet the neural correlates of this chronic disorder remain elusive. Although abundant literature is available on language reorganization after lesions in childhood, little is known about the capacity of motor speech networks to reorganize after injury. Here, we examine the structural and functional neural correlates associated with chronic dysarthria after childhood-onset traumatic brain injury. Forty-nine participants aged 12 years 3 months to 24 years 11 months were recruited to the study: (i) a group with chronic dysarthria (n = 17); matched for age and sex with two control groups of (ii) healthy control subjects (n = 17); and (iii) individuals without dysarthria after traumatic brain injury (n = 15). A high-resolution 3D T1-weighted whole-brain data set was acquired for voxel-based morphometry analyses of group differences in grey matter. Functional magnetic resonance imaging was used to localize activation associated with speaking single words (baseline: listening to words). Group differences on voxel-based morphometry revealed widespread grey matter reductions in the dysarthric group compared with healthy control subjects, including in numerous speech motor regions bilaterally, such as the cerebellum, the basal ganglia and primary motor cortex representation of the articulators. Relative to the non-dysarthric traumatic brain injury group, individuals with dysarthria showed reduced grey matter bilaterally in the ventral sensorimotor cortex, but this reduction was concomitant with increased functional activation only in the left-hemisphere cluster during speech. Finally, increased recruitment of Broca’s area (Brodmann area 45, pars triangularis) but not its right homologue, correlated with better speech outcome, suggesting that this ‘higher-level’ area may be more critically involved with production when associated motor speech regions are damaged. We suggest that the bilateral morphological abnormalities within cortical speech networks in childhood prevented reorganization of speech function from the left- to right-hemisphere. Rather, functional reorganization involved over-recruitment of left-hemisphere motor regions, a reorganization method that was only partly relatively effective, given the presence of persisting yet mild speech deficits. The bilateral structural abnormalities found to limit functional reorganization here, may also be critical to poor speech prognosis for populations with congenital, degenerative or acquired neurological disorders throughout the lifespan. [ABSTRACT FROM AUTHOR]

The article presents information on strategies that nurses can use to retain clinical credibility after being promoted to senior nursing positions including nurse educators and nurse managers. Debates within the nursing profession over what the exact roles of nurses in senior positions should be are discussed. In the article the author offers her opinions on clinical credibility among nurses in senior nursing positions.

Aim Early sucking and swallowing problems may be potential markers of neonatal brain injury and assist in identifying those infants at increased risk of adverse outcomes, but the relation between early sucking and swallowing problems and neonatal brain injury has not been established. The aim of the review was, therefore, to investigate the relation between early measures of sucking and swallowing and neurodevelopmental outcomes in infants diagnosed with neonatal brain injury and in infants born very preterm (<32wks) with very low birthweight (<1500g), at risk of neonatal brain injury. Method We conducted a systematic review of English-language articles using CINAHL, EMBASE, and MEDLINE OVID (from 1980 to May 2011). Additional studies were identified through manual searches of key journals and the works of expert authors. Extraction of data informed an assessment of the level of evidence and risk of bias for each study using a predefined set of quality indicators. Results A total of 394 abstracts were generated by the search but only nine studies met the inclusion criterion. Early sucking and swallowing problems were present in a consistent proportion of infants and were predictive of neurodevelopmental outcome in infancy in five of the six studies reviewed. Limitations The methodological quality of studies was variable in terms of research design, level of evidence (National Health and Medical Research Council levels II, III, and IV), populations studied, assessments used and the nature and timing of neurodevelopmental follow-up. Conclusions Based upon the results of this review, there is currently insufficient evidence to clearly determine the relation between early sucking and swallowing problems and neonatal brain injury. Although early sucking and swallowing problems may be related to later neurodevelopmental outcomes, further research is required to delineate their value in predicting later motor outcomes and to establish reliable measures of early sucking and swallowing function. [ABSTRACT FROM AUTHOR]

Abstract: Current models of speech production in adults emphasize the crucial role played by the left perisylvian cortex, primary and pre-motor cortices, the basal ganglia, and the cerebellum for normal speech production. Whether similar brain–behaviour relationships and leftward cortical dominance are found in childhood remains unclear. Here we reviewed recent evidence linking motor speech disorders (apraxia of speech and dysarthria) and brain abnormalities in children and adolescents with developmental, progressive, or childhood-acquired conditions. We found no evidence that unilateral damage can result in apraxia of speech, or that left hemisphere lesions are more likely to result in dysarthria than lesion to the right. The few studies reporting on childhood apraxia of speech converged towards morphological, structural, metabolic or epileptic anomalies affecting the basal ganglia, perisylvian and rolandic cortices bilaterally. Persistent dysarthria, similarly, was commonly reported in individuals with syndromes and conditions affecting these same structures bilaterally. In conclusion, for the first time we provide evidence that longterm and severe childhood speech disorders result predominantly from bilateral disruption of the neural networks involved in speech production. [Copyright &y& Elsevier]

Purpose: Dysarthria and dysphagia are known complications following posterior fossa tumour (PFT) surgery. Outcome studies for these disorders, however, have focused on a select sub-group of children with mutism. Little is known regarding the incidence or features of these impairments in a consecutively admitted sample of children with PFT. This study describes the incidence and features of mutism, dysarthria and dysphagia during the acute post-surgical phase in a consecutive sample of children with PFT, unselected for the presence of mutism. Methods: A retrospective medical chart review of children aged 2 to 18 years consecutively admitted with PFT between January 2003 and January 2008 was conducted. Results: Twenty-seven children with PFT were identified. Post-surgical mutism, dysarthria and dysphagia were recorded in 9/27 (33%), 8/27 (30%) and 9/27 (33%) cases, respectively. Dysarthria most commonly involved deficits in articulation; however, impairments in respiration, phonation and prosody were also reported. Dysphagia involved all stages of swallowing (i.e., pre-oral anticipatory, oral preparatory, oral and pharyngeal). Eighty-nine percent of children (8/9) presented with dysphagia at hospital discharge. Conclusions: The incidence of acute presentation of mutism, dysarthria and dysphagia post-surgery was relatively high, affecting around one in three cases. This incidence rate, considered together with the fact that over half of all cases had co-morbid communication or swallowing impairments, suggests that health professionals should be aware of the likelihood of dysarthria and dysphagia presentation in the acute period and consider speech pathology referral where necessary. [ABSTRACT FROM AUTHOR]

Little is documented about contemporary management of speech and swallowing disorders associated with paediatric acquired brain injury (ABI). It is therefore challenging for clinicians in this field to benchmark their clinical management against current evidence or practices undertaken in other centres. To address this issue, we aimed to provide much-needed baseline data on speech and language pathology management of speech and swallowing disorders associated with childhood ABI. Key objectives were to: (i) determine whether clinicians use formalized referral criteria, clinical guidelines, protocols or care pathways; and (ii) to document the specific assessment and treatment approaches used. Speech and language pathology managers and clinicians at 31 major paediatric rehabilitation centres across Australia, New Zealand, the UK and Ireland were invited to participate in an online survey. Fifty-one speech and language pathologists responded representing 26 centres (84% response rate). Routine referrals of ABI patients to speech and language pathology occurred relatively infrequently in these centres (12%). Centres utilized assessment protocols (23%) and guidelines (35%) more frequently than treatment guidelines (8%). Multidisciplinary care pathways were applied by 31%. Most centres used adult-based motor speech assessments and informal ('in-house developed') swallowing assessment tools. The limited use of referral criteria, protocols, care pathways and guidelines invites the possibility of unequal care, and less than optimal outcomes. Reliance on adult-based or in-house assessments is inappropriate, yet frequently a necessity due to an absence of paediatric-specific tools in this field. Further research is required in parallel with the formation of consensus groups to support the development of: (i) paediatric-specific assessment tools and management approaches; and (ii) clinical protocols and guidelines. [ABSTRACT FROM AUTHOR]

Abstract: Hemispherectomy (disconnection or removal of an entire cerebral hemisphere) is a rare surgical procedure used for the relief of drug-resistant epilepsy in children. After hemispherectomy, contralateral hemiplegia persists whereas gross expressive and receptive language functions can be remarkably spared. Motor speech deficits have rarely been examined systematically, thus limiting the accuracy of postoperative prognosis. We describe the speech profiles of hemispherectomized participants characterizing their intelligibility, articulation, phonological speech errors, dysarthric features, and execution and sequencing of orofacial speech and non-speech movements. Thirteen participants who had undergone hemispherectomy (six left, seven right; nine with congenital, four with acquired hemiplegia; operated between four months and 13years) were investigated. Results showed that all participants were intelligible but showed a mild dysarthric profile characterized by neuromuscular asymmetry and reduced quality and coordination of movements, features that are characteristic of adult-onset unilateral upper motor neuron dysarthria, flaccid-ataxic variant. In addition, one left and four right hemispherectomy cases presented with impaired production of speech and non-speech sequences. No participant showed evidence of verbal or oral dyspraxia. It is concluded that mild dysarthria is persistent after left or right hemispherectomy, irrespective of age at onset of hemiplegia. These results indicate incomplete functional re-organization for the control of fine speech motor movements throughout childhood, and provide no evidence of hemispheric differences. [Copyright &y& Elsevier]

Background: Children with traumatic brain injury (TBI) may develop swallowing impairment or dysphagia with possible deleterious consequences of compromised nutritional intake or aspiration with subsequent respiratory complications. Objective: To examine the evidence base for clinical management of dysphagia by reviewing empirical data on the epidemiology, assessment and diagnosis, and prognosis for dysphagia associated with childhood TBI. Methods: A systematic review of the literature on dysphagia in children with TBI was conducted. Non-data driven studies or studies including data on individuals 18 years and over were excluded. Results: Available data was sparse. Only nine studies met inclusion criterion. Current preliminary data revealed that acute dysphagia incidence is high (68–76%) for children with severe TBI. Children with severe injury (GCS ≤ 8) and a ventilation period of ≥1.5 days following motor vehicle accident are at increased risk for dysphagia. Resolution of dysphagia is typically achieved by 12 weeks in children with cortical injury. Conclusion: There is a clear need for multi-centre prospective research studies in this field, however preliminary evidence can be used to inform aspects of clinical practice. First, routine swallowing screening may be implemented for children meeting criterion for being ‘at risk’ for dysphagia. Systematic referral of targeted patients is lacking in paediatric rehabilitative care, but early screening of these cases would optimize early dysphagia identification and management. Secondly, the positive prognosis for most cases with cortical injury suggests that long-term feeding options (i.e. gastrostomy) may not be indicated until at least 3 months have passed with minimal change in function. [ABSTRACT FROM AUTHOR]

Background. Allied health professionals have provided services under Enhanced Primary Care (EPC) since 2004; however, the experiences and views of AHPs about the initiative and how it has been utilised have not been well explored. Objective. We examined speech pathologists' views and experiences under EPC. Methods. A survey of speech pathologists in private practice who provide services under EPC was undertaken. Results. Speech pathologists provide EPC services to a wide range of clients with communication and swallowing disorders. The five EPC sessions provide a 'starting point' for therapy for some clients, and supplement existing therapy for others. Speech pathologists expressed concern about the accessibility of the program, and its understanding and use in practice, but noted that the program can be valuable for clients who are able to negotiate the hurdles, and for themselves in terms of increased referrals and collaboration with general practitioners. Conclusions. Education around eligibility, access, and reporting requirements is needed for clients, GPs and allied health professionals in order to reduce the frustrating aspects of this program, and support its ongoing use. [ABSTRACT FROM AUTHOR]

Background. Allied health professionals have provided services under Enhanced Primary Care (EPC) since 2004; however, the experiences and views of AHPs about the initiative and how it has been utilised have not been well explored. Objective. We examined speech pathologists' views and experiences under EPC. Methods. A survey of speech pathologists in private practice who provide services under EPC was undertaken. Results. Speech pathologists provide EPC services to a wide range of clients with communication and swallowing disorders. The five EPC sessions provide a 'starting point' for therapy for some clients, and supplement existing therapy for others. Speech pathologists expressed concern about the accessibility of the program, and its understanding and use in practice, but noted that the program can be valuable for clients who are able to negotiate the hurdles, and for themselves in terms of increased referrals and collaboration with general practitioners. Conclusions. Education around eligibility, access, and reporting requirements is needed for clients, GPs and allied health professionals in order to reduce the frustrating aspects of this program, and support its ongoing use. [ABSTRACT FROM AUTHOR]

Background: The involvement of service users in healthcare education has followed an increasing focus on patient-centred services. CETL4HealthNE, regional healthcare education collaboration, undertook a literature review to inform involvement strategies. Objectives: To identify-approaches used to involve service users in healthcare education curricula; perceptions of key stakeholders; impact of involvement on students' knowledge and skills, and the quality of care delivered. Method: A structured search of the literature on service user involvement in Higher Education healthcare curricular activity was undertaken (July 2006-February 2007). Papers were screened and data extracted and synthesized according to the aspect of the curriculum enhanced by involvement and level of impact evaluation. Results: Thirty papers addressed interventions in pre- and 11 in post-registration education. Thirty studies reported on evaluation. Students and service users both benefited from service user involvement in health care programmes. There was limited evidence that involvement changed behaviour in practice or significantly benefited the recipient of care. Conclusions: Service user involvement in curricular developments for healthcare professionals is a policy imperative aimed at improving their experience of services. Despite a limited and weak traditional evidence base for impact on students' knowledge and practice, both students and service users identify benefits from engagement. Further development of evaluation methodologies is required. [ABSTRACT FROM AUTHOR]

Abstract: Expressions of activation markers have been described on the surface of T cells in the blood and the lung in both health and disease. We have studied the distribution of activation markers on human lung T cells and have found that only certain populations exist. Importantly, the presence or absence of some markers appears to predict those of others, in particular cells which express CD103 also express CD49a and CD69, whereas cells which do not express CD69 also do not express CD49a or CD103. In view of the paucity of activation marker expression in the peripheral blood, we have hypothesised that these CD69+, CD49a+, and CD103+ (triple positive) cells are retained in the lung, possess effector function (IFNγ secretion) and express particular chemokine receptors which allow them to be maintained in this environment. We have found that the ability of the triple negative cells to secrete IFNγ is significantly less than the triple positive cells, suggesting that the expression of activation markers can highlight a highly specialised effector cell. We have studied the expression of 14 chemokine receptors and have found that the most striking difference between the triple negative cells and the triple positive cells is the expression of CXCR6 with 12.8±9.8% of triple negative cells expressing CXCR6 compared to 89.5±5.5% of triple positive cells. We propose therefore that CXCR6 may play an important role in the retention of T cells within the lung. [Copyright &y& Elsevier]

Background: Non-eosinophilic asthma is a potentially important clinicopathological phenotype since there is evidence that it responds poorly to inhaled corticosteroid therapy. However, little is known about the underlying airway immunopathology and there are no data from placebo-controlled studies examining the effect of inhaled corticosteroids. Methods: Airway immunopathology was investigated using induced sputum, bronchial biopsies, bronchial wash and bronchoalveolar lavage in 12 patients with symptomatic eosinophilic asthma, 11 patients with non-eosinophilic asthma and 10 healthy controls. The patients with non-eosinophilic asthma and 6 different patients with eosinophilic asthma entered a randomised, double-blind, placebo-controlled crossover study in which the effects of inhaled mometasone 400 μg once daily for 8 weeks on airway responsiveness and asthma quality of life were investigated. Results: Patients with non-eosinophilic asthma had absence of eosinophils in the mucosa (median 4.4 cells/ mm2 vs 23 cells/mm2 in eosinophilic asthma and 0 cells/mm2 in normal controls; p =0.03) and normal subepithelial layer thickness (5.8 μm vs 10.3 μm in eosinophilic asthma and 5.1 μm in controls, p=0.002). Non-eosinophilic and eosinophilic asthma groups had increased mast cell numbers in the airway smooth muscle compared with normal controls (9 vs 8 vs 0 cells/mm2, p=0.016). Compared with placebo, 8 weeks of treatment with inhaled mometasone led to less improvement in methacholine PC20 (0.5 vs 5.5 doubling concentrations, 95% Cl of difference 1.1 to 9.1; p = 0.018) and asthma quality of life (0.2 vs 1.0 points, 95% Cl of difference 0.27 to 1.43; p=0.008). Conclusions: Non-eosinophilic asthma represents a pathologically distinct disease phenotype which is characterised by the absence of airway eosinophilia, normal subepithelial layer thickness and a poor short- term response to treatment with inhaled corticosteroids. [ABSTRACT FROM AUTHOR]

This research paper shows the ways in which survivors of domestic abuse can move on with their lives and take action to prevent their re-victimisation by returning to education. The primary aim was to explore the role of education as an agent of change, effecting positive and empowering changes to survivors' lives, thereby enhancing their life chances and preventing future re-victimisation. A qualitative approach was adopted in which in-depth life-history interviews were conducted with the target population and semi-structured interviews conducted with key workers from domestic abuse support agencies and educational service providers. A measure of social capital was used to assess the level of social support available to participants at two points in time. Findings suggest a relationship between social support networks and a need for long-term one-to-one support in achieving personal and educational development - a primary motivation to living abuse-free lives. [ABSTRACT FROM AUTHOR]

A placement at the National Institute of Conductive Education (NICE) in Birmingham for children with motor disorders is strongly preferred over mainstream or special schools by some parents, but it has been noted that this is usually refused following the current statementing process. Although funding constraints have been articulated, Angela Morgan, a Research Fellow at the Wolverhampton University Policy Research Institute, and Kevin Hogan, also at the University of Wolverhampton, contend in this article that other explanations are possible, as variability remains in placement decisions. The experiences of education administrators working within the special educational needs departments of local education authorities who make the ultimate decision regarding school placement have hitherto been unexplored. This study offers findings from an exploratory qualitative study, which suggests that administrators are working from disparate understandings of conductive education within an arena fraught with conflict. Recommendations derived from the study include further in-service training for education administrators and prior training for individuals seeking a career in education administration to enhance collaborative working partnerships between administrators and parents. [ABSTRACT FROM AUTHOR]

This article provides an understanding of childhood welfare from a radical perspective, showing how power within the special education system affects the discourse of `choice' for parents. The analysis unmasks the disciplinary power operating within the special education system and explores the manner in which such power affects choice for parents. In turn, the analysis suggests that although disciplinary power offers little sites for resistance, the actions of some parents in the exercise of choice are seen as a growing challenge to that power. It remains to be seen just how resistant the system will become in the face of such opposition. [ABSTRACT FROM AUTHOR]

Objectives : To provide a preliminary clinical profile of the resolution and outcomes of oral-motor impairment and swallowing function in a group of paediatric dysphagia patients post-traumatic brain injury (TBI). To document the level of cognitive impairment parallel to the return to oral intake, and to investigate the correlation between the resolution of impaired swallow function versus the resolution of oral-motor impairment and cognitive impairment. Participants : Thirteen children admitted to an acute care setting for TBI. Main outcome measures : A series of oral-motor (Verbal Motor Production Assessment for Children, Frenchay Dysarthria Assessment, Schedule for Oral Motor Assessment) and swallowing (Paramatta Hospital's Assessment for Dysphagia) assessments, an outcome measure for swallowing (Royal Brisbane Hospital's Outcome Measure for Swallowing), and a cognitive rating scale (Rancho Level of Cognitive Functioning Scale). Results : Across the patient group, oral-motor deficits resolved to normal status between 3 and 11 weeks post-referral (and at an average of 12 weeks post-injury) and swallowing function and resolution to normal diet status were achieved by 3-11 weeks post-referral (and at an average of 12 weeks post-injury). The resolution of dysphagia and the resolution of oral-motor impairment and cognitive impairment were all highly correlated. Conclusion : The provision of a preliminary profile of oral-motor functioning and dysphagia resolution, and data on the linear relationship between swallowing impairment and cognition, will provide baseline information on the course of rehabilitation of dysphagia in the paediatric population post-TBI. Such data will contribute to more informed service provision and rehabilitation planning for paediatric patients post-TBI. [ABSTRACT FROM AUTHOR]

Background: Identifying language disorders earlier can help children receive the support needed to improve developmental outcomes and quality of life. Despite the prevalence and impacts of persistent language disorder, there are surprisingly no robust predictor tools available. This makes it difficult for researchers to recruit young children into early intervention trials, which in turn impedes advances in providing effective early interventions to children who need it. Aims: To validate externally a predictor set of six variables previously identified to be predictive of language at 11 years of age, using data from the Longitudinal Study of Australian Children (LSAC) birth cohort. Also, to examine whether additional LSAC variables arose as predictive of language outcome. Methods & Procedures: A total of 5107 children were recruited to LSAC with developmental measures collected from 0 to 3 years. At 11–12 years, children completed the Clinical Evaluation of Language Fundamentals, 4th Edition, Recalling Sentences subtest. We used SuperLearner to estimate the accuracy of six previously identified parent‐reported variables from ages 2–3 years in predicting low language (sentence recall score ≥ 1.5 SD below the mean) at 11–12 years. Random forests were used to identify any additional variables predictive of language outcome. Outcomes & Results: Complete data were available for 523 participants (52.20% girls), 27 (5.16%) of whom had a low language score. The six predictors yielded fair accuracy: 78% sensitivity (95% confidence interval (CI) = [58, 91]) and 71% specificity (95% CI = [67, 75]). These predictors relate to sentence complexity, vocabulary and behaviour. The random forests analysis identified similar predictors. Conclusions & Implications: We identified an ultra‐short set of variables that predicts 11–12‐year language outcome with 'fair' accuracy. In one of few replication studies of this scale in the field, these methods have now been conducted across two population‐based cohorts, with consistent results. An imminent practical implication of these findings is using these predictors to aid recruitment into early language intervention studies. Future research can continue to refine the accuracy of early predictors to work towards earlier identification in a clinical context. WHAT THIS PAPER ADDS: What is already known on the subject: There are no robust predictor sets of child language disorder despite its prevalence and far‐reaching impacts. A previous study identified six variables collected at age 2–3 years that predicted 11–12‐year language with 75% sensitivity and 81% specificity, which warranted replication in a separate cohort. What this study adds to the existing knowledge: We used machine learning methods to identify a set of six questions asked at age 2–3 years with ≥ 71% sensitivity and specificity for predicting low language outcome at 11–12 years, now showing consistent results across two large‐scale population‐based cohort studies. What are the potential or clinical implications of this work?: This predictor set is more accurate than existing feasible methods and can be translated into a low‐resource and time‐efficient recruitment tool for early language intervention studies, leading to improved clinical service provision for young children likely to have persisting language difficulties. [ABSTRACT FROM AUTHOR]

This doctoral study examined the function of baby massage in supporting early infant-carer attachment relationships among families facing stressful life experiences. It was designed in response to Bennett, Underdown and Barlow's [Bennett, C., A. Underdown, and J. Barlow. 2013. “Massage for Promoting Mental and Physical Health in Typically Developing Infants Under the Age of Six Months [Online].” Cochrane Database of Systematic Reviews (4): 1–162] meta-analysis of studies examining the effects of baby massage on infant health, and their recommendation that further research focused on the outcomes for families they described as ‘higher risk’. Analysis of the available literature also identified a lack of fine-grained research foregrounding families’ experiences of infant massage. This qualitative project was located in the constructivist paradigm, using a praxeological case study methodology. Innovative techniques and participatory methods were used including an information video and film as a data source and reflective stimulus; approaches which engaged babies and carers as co-inquirers in the research. It also required a robust ethical framework; a ‘matrix’ of approaches to informed consent [Rouse, E. J. 2018. “How Infant Massage Enhances Pedagogical Attachment in Families Facing Challenging Circumstances.” PhD diss., University of Wolverhampton] . This paper positions video as a method that supports detailed observations of young babies and foregrounds their ‘voices’ in the research. It contributes a detailed account of the benefits, challenges and ethical considerations around using video, and argues that it can support adults who care for and work with young children to have a deepened understanding of infant communication. [ABSTRACT FROM AUTHOR]

Purpose: To our knowledge, there are no data examining the agreement between self-reported and clinician-rated stuttering severity. In the era of big data, self-reported ratings have great potential utility for large-scale data collection, where cost and time preclude in-depth assessment by a clinician. Equally, there is increasing emphasis on the need to recognize an individual's experience of their own condition. Here, we examined the agreement between selfreported stuttering severity compared to clinician ratings during a speech assessment. As a secondary objective, we determined whether self-reported stuttering severity correlated with an individual's subjective impact of stuttering. Method: Speech-language pathologists conducted face-to-face speech assessments with 195 participants (137 males) aged 5-84 years, recruited from a cohort of people with self-reported stuttering. Stuttering severity was rated on a 10-point scale by the participant and by two speech-language pathologists. Participants also completed the Overall Assessment of the Subjective Experience of Stuttering (OASES). Clinician and participant ratings were compared. The association between stuttering severity and the OASES scores was examined. Results: There was a strong positive correlation between speech-language pathologist and participant-reported ratings of stuttering severity. Participantreported stuttering severity correlated weakly with the four OASES domains and with the OASES overall impact score. Conclusions: Participants were able to accurately rate their stuttering severity during a speech assessment using a simple one-item question. This finding indicates that self-report stuttering severity is a suitable method for large-scale data collection. Findings also support the collection of self-report subjective experience data using questionnaires, such as the OASES, which add vital information about the participants' experience of stuttering that is not captured by overt speech severity ratings alone. [ABSTRACT FROM AUTHOR]

Purpose: Advancements in genetic testing and analysis have allowed improved identification of the genetic basis of childhood apraxia of speech, a rare speech presentation. This study aimed to understand speech-language pathologists' (SLPs') consideration of incorporation of genetics in clinical practice using a theory-informed qualitative approach. Method: Semistructured interviews were conducted with 12 pediatric SLPs using a behavior change theory (Theoretical Domains Framework [TDF]) within a case study describing a child with complex co-occurring features, including childhood apraxia of speech. Interviews focused on three stages of the patient journey (prereferral, referral, and postreferral). Interviews were analyzed to identify barriers and enablers to considering incorporation of genetics in current clinical practice. Barriers and enablers were grouped and mapped onto a contextually relevant TDF-coded analysis framework. Results: Barriers were identified across several TDF domains, through all stages of the patient journey. Lack of confidence, relevance, and level of experience were most common prereferral, and connection to and awareness of genetics services and contextual factors were barriers in the referral stage. Perception of professional role, knowledge, and beliefs about effects on families were barriers postreferral. Associated enablers were also identified, including seeing value in genetic diagnosis, support from other health care professionals, supervision, and relationships with genetics services. Conclusions: Results of this qualitative study highlight barriers and enablers to incorporating genetics into speech-language pathology clinical practice. These findings will assist in the development of theory-informed implementation strategies to support SLPs into the future. [ABSTRACT FROM AUTHOR]

This article introduces the Journal of Speech, Language, and Hearing Research Special Issue: Selected Papers From the 2022 Apraxia Kids Research Symposium. The field of childhood apraxia of speech (CAS) has developed significantly in the past 15 years, with key improvements in understanding of basic biology including genetics, neuroscience, and computational modelling; development of diagnostic tools and methods; diversity of evidence-based interventions with increasingly rigorous experimental designs; and understanding of impacts beyond impairment-level measures. Papers in this special issue not only review and synthesize the some of the substantial progress to date but also present novel findings addressing critical research gaps and adding to the overall body of knowledge. A second aim of this prologue is to report the current research needs in CAS, which arose from symposium discussions involving researchers, clinicians, and Apraxia Kids community members (including parents of children with CAS). Four primary areas of need emerged from discussions at the symposium. These were: (a) What questions should we ask? (b) Who should be in the research? (c) How do we conduct the research? and (d) How do we move from research to practice? Across themes, symposium attendees emphasized the need for CAS research to better account for the diversity of people with CAS and improve the timeliness of implementation of high-level evidence-based practice across the lifespan. It is our goal that the articles and prologue discussion in this special issue provide an appreciation of advancements in CAS research and an updated view of the most pressing needs for future research. [ABSTRACT FROM AUTHOR]

Urban densification continues to present a unique set of economic and environmental challenges. A growing shortage of green space and infrastructure is intrinsically linked with urban growth and development. With this comes the loss of ecosystem services such as urban heat island effects, reduction of air quality and biodiversity loss. Vertical greenery systems (VGS) offer an adaptive solution to space-constrained areas that are characteristic of dense urban areas, and can potentially improve the sustainability of cities. However, in order to promote VGS uptake, methods are required to enable systematic appraisal of whether existing walls can be retrofitted with VGS. Further, feasibility studies that quantify the potential for retrofit suitability of VGS across entire urban areas are lacking. This study established an evaluation tool for green wall constructability in urban areas and validated the assessment tool by determining the quantity of walls in five major Australian cities that could potentially have VGS incorporated into the existing infrastructure. Each wall was analysed using an exclusionary set of criteria that evaluated and ranked a wall based on its suitability to VGS implementation. Sydney and Brisbane recorded the greatest proportional length of walls suitable for VGS, with 33.74% and 34.12% respectively. Conversely, Perth's urban centre was the least feasible site in which to incorporate VGS, with over 97% of surveyed walls excluded, mainly due to the prevalence of <1 m high fence lines and glazed shopfronts. This study aimed to evaluate feasibility assessments of green wall retrofitability in highly urbanised areas with the intention of creating an analytical method that is accessible to all. This method, coupled with the promising number of feasible walls found in this study, emphasises the need for more government policy and incentives encouraging green wall uptake and could play a pivotal role in the expansion of green infrastructure and urban forestry. • Vertical greenery presents is a potential solution to revegetate and regreen cities. • Methods and evaluation tools are needed to promote vertical greenery uptake. • A feasibility rating tool for green wall retrofitability was assessed in this study. • This tool demonstrated the different levels of retrofitability in urban areas of Australia. • The tool could be used by green stakeholders to increase urban greenspace and regreen cities. [ABSTRACT FROM AUTHOR]

Summary: Most patients with GNB1 encephalopathy have developmental delay and/or intellectual disability, brain anomalies and seizures. Recently, two cases with GNB1 encephalopathy caused by haploinsufficiency have been reported that also show a Prader–Willi‐like phenotype of childhood hypotonia and severe obesity. Here we present three new cases from our expert centre for genetic obesity in which GNB1 truncating and splice variants, probably leading to haploinsufficiency, were identified. They all have obesity, hyperphagia and intellectual deficit. The clinical cases and their weight courses are presented, together with a review of all 68 published cases with GNB1 encephalopathy. Information on weight was not mentioned in most of these articles, so we contacted authors for additional clinical information on weight status and hyperphagia. Of the 42 patients whose weight status we could determine, obesity was present in 8 patients (19%). Obesity is significantly over‐represented in the group with truncating and splicing variants. In this group, we see an obesity prevalence of 75%. Since GNB1 has been linked to several key genes in the hypothalamic leptin‐melanocortin pathway, which regulates satiety and energy expenditure, our data support the potential association between GNB1 haploinsufficiency and genetic obesity. We also suggest GNB1 is a candidate gene for the known obesity phenotype of the 1p36 microdeletion syndrome given this chromosomal region includes the GNB1 gene. Knowledge of an additional obesity phenotype is important for prognosis, early interventions against obesity and awareness when prescribing weight‐inducing medication. [ABSTRACT FROM AUTHOR]

Purpose: Stuttering is a speech condition that can have a major impact on a person’s quality of life. This descriptive study aimed to identify subgroups of people who stutter (PWS) based on stuttering burden and to investigate differences between these subgroups on psychosocial aspects of life. Method: The study included 618 adult participants who stutter. They completed a detailed survey examining stuttering symptomatology, impact of stuttering on anxiety, education and employment, experience of stuttering, and levels of depression, anxiety, and stress. A two-step cluster analytic procedure was performed to identify subgroups of PWS, based on self-report of stuttering frequency, severity, affect, and anxiety, four measures that together inform about stuttering burden. Results: We identified a high- (n = 230) and a low-burden subgroup (n = 372). The high-burden subgroup reported a significantly higher impact of stuttering on education and employment, and higher levels of general depression, anxiety, stress, and overall impact of stuttering. These participants also reported that they trialed more different stuttering therapies than those with lower burden. Conclusions: Our results emphasize the need to be attentive to the diverse experiences and needs of PWS, rather than treating them as a homogeneous group. Our findings also stress the importance of personalized therapeutic strategies for individuals with stuttering, considering all aspects that could influence their stuttering burden. People with high-burden stuttering might, for example, have a higher need for psychological therapy to reduce stuttering-related anxiety. People with less emotional reactions but severe speech distortions may also have a moderate to high burden, but they may have a higher need for speech techniques to communicate with more ease. Future research should give more insights into the therapeutic needs of people highly burdened by their stuttering. [ABSTRACT FROM AUTHOR]

The number of words children produce (expressive vocabulary) and understand (receptive vocabulary) changes rapidly during early development, partially due to genetic factors. Here, we performed a meta–genome-wide association study of vocabulary acquisition and investigated polygenic overlap with literacy, cognition, developmental phenotypes, and neurodevelopmental conditions, including attention-deficit/hyperactivity disorder (ADHD). We studied 37,913 parent-reported vocabulary size measures (English, Dutch, Danish) for 17,298 children of European descent. Meta-analyses were performed for early-phase expressive (infancy, 15–18 months), late-phase expressive (toddlerhood, 24–38 months), and late-phase receptive (toddlerhood, 24–38 months) vocabulary. Subsequently, we estimated single nucleotide polymorphism–based heritability (SNP- h 2 ) and genetic correlations (r g) and modeled underlying factor structures with multivariate models. Early-life vocabulary size was modestly heritable (SNP- h 2 = 0.08–0.24). Genetic overlap between infant expressive and toddler receptive vocabulary was negligible (r g = 0.07), although each measure was moderately related to toddler expressive vocabulary (r g = 0.69 and r g = 0.67, respectively), suggesting a multifactorial genetic architecture. Both infant and toddler expressive vocabulary were genetically linked to literacy (e.g., spelling: r g = 0.58 and r g = 0.79, respectively), underlining genetic similarity. However, a genetic association of early-life vocabulary with educational attainment and intelligence emerged only during toddlerhood (e.g., receptive vocabulary and intelligence: r g = 0.36). Increased ADHD risk was genetically associated with larger infant expressive vocabulary (r g = 0.23). Multivariate genetic models in the ALSPAC (Avon Longitudinal Study of Parents and Children) cohort confirmed this finding for ADHD symptoms (e.g., at age 13; r g = 0.54) but showed that the association effect reversed for toddler receptive vocabulary (r g = −0.74), highlighting developmental heterogeneity. The genetic architecture of early-life vocabulary changes during development, shaping polygenic association patterns with later-life ADHD, literacy, and cognition-related traits. [ABSTRACT FROM AUTHOR]

Purpose: Understanding what limits speech development in minimally verbal (MV) children with autism spectrum disorder (ASD) is important for providing highly effective targeted therapies. This preliminary investigation explores the extent to which developmental speech deficits predicted by Directions Into Velocities of Articulators (DIVA), a computational model of speech production, exemplify real phenotypes. Method: Implementing a motor speech disorder in DIVA predicted that speech would become highly variable within and between tokens, while implementing a motor speech plus an auditory processing disorder predicted that DIVA's speech would become highly centralized (schwa-like). Acoustic analyses of DIVA's output predicted that acoustically measured phoneme distortion would be similar between the two cases, but that in the former case, speech would show more within- and between-token variability than in the latter case. We tested these predictions quantitatively on the speech of children with MV ASD. In Study 1, we tested the qualitative predictions using perceptual analysis methods. Speech pathologists blinded to the purpose of the study tallied the signs of childhood apraxia of speech that appeared in the speech of 38 MV children with ASD. K-means clustering was used to create two clusters from the group of 38, and analysis of variance was used to determine whether the clusters differed according to perceptual features corresponding to within- and between-token variability. In Study 2, we employed acoustic analyses on the speech of the child from each cluster who produced the largest number of analyzable tokens to test the predictions of differences in within-token variability, betweentoken variability, and vowel space area. Results: Clusters produced by k-means analysis differed by perceptual features that corresponded to within-token variability. Nonsignificant differences between clusters were found for features corresponding to between-token variability. Subsequent acoustic analyses of the selected cases revealed that the speech of the child from the highvariability cluster showed significantly more quantitative within- and between-token variability than the speech of the child from the low-variability cluster. The vowel space of the child from the low-variability cluster was more centralized than that of typical children and that of the child from the high-variability cluster. Conclusions: Results provide preliminary evidence that subphenotypes of children with MV ASD may exist, characterized by (a) comorbid motor speech disorder and (b) comorbid motor speech plus auditory processing disorder. The results motivate testable predictions about how these comorbidities affect speech. [ABSTRACT FROM AUTHOR]

The article discusses research on the use of music in health interventions for newborn infants in relation to neurodevelopmental effects and problems with sensory deprivation for preterm infants.

The author discusses diagnosis and medical care of pulmonary nodules identified in patients with lung cancer. It cites data related to the nodules sizing more than five millimeter, having lower risks of malignancy and mentions that diagnosis tools foe radiologists like positron emission tomography and semi-automated volumetric. It notes concerns associated with biopsy tests for diagnosis of the nodules and collection of data regarding lung cancer by National Health Service of Great Britain.

This commentary is on the original article by Geytenbeek et al. on pages 294–300 of this issue. [ABSTRACT FROM AUTHOR]