Perceptuella röstanalyser är en viktig del i logopedens arbete med röstpatienter. Syftet med föreliggande studie var att med hjälp av lyssnarbedömningar undersöka skillnader i röstkvalitet mellan spontantal och instruerat tal hos femåriga barn och vuxna kvinnor. Även inter- och intrabedömarreliabilitet undersöktes för fyra logopeder vilka utgjorde bedömningsgruppen. Resultatet visade signifikanta skillnader i röstkvalitet mellan spontantal och instruerat tal för kvinnorna gällande parametrarna heshet, hyperfunktion och skrovel. Hos barnen kunde starka tendenser till skillnad mellan spontantal och instruerat tal ses för parametrarna hyperfunktion och röstläge. Interbedömarreliabiliteten var högst vid bedömning av heshet hos barn och tendensen var att interbedömarreliabiliteten överlag var högre vid bedömning av barnrösterna än vid bedömning av kvinnorösterna. Värdena för intrabedömarreliabilitet visade starka tendenser till att vara högre vid bedömning av kvinnornas röster jämfört med barnens röster.

Till följd av att allt fler barn sondmatas har även svårigheterna vid övergång till oralt ätande ökat. Omhändertagandet av dessa barn görs lämpligast i team med exempelvis logoped, dietist, sjuksköterska och läkare. Syftet med föreliggande studie var att undersöka hur omhändertagande av barn med ätsvårigheter ser ut med fokus på sondmatning. Datainsamling skedde genom en fokusgruppintervju med vårdpersonal som arbetar med barn med ätsvårigheter. Transkriptionen analyserades, baserad på Grounded Theory, genom meningskodning. Analysen resulterade i åtta kategorier som beskriver omhändertagandet av barn med ätsvårigheter: Faktorer på organisationsnivå, Samarbete mellan yrken, Utredning, Arbete i samband med sondning, Arbete vid ätövergång, Resultat och uppföljning, Föräldrarnas roll i omhändertagandet och Näringens roll i omhändertagandet. Studien visar att det finns en medvetenhet om ätproblematik och ett intresse att lära sig mer om detta hos den intervjuade personalen. I omhändertagandet förekommer handledning av föräldrar och oralsensorisk stimulering. Dock saknas struktur och djupare kunskaper, vilket ett team med personal med specialistkompetens skulle kunna tillföra.

A Quick Test (AQT) Färg och Form är ett test av snabb automatiserad benämning avsett att detektera kognitiva störningar. Det består av tre delar som var och en utgörs av 40 visuella stimuli som skall benämnas så snabbt som möjligt. Tidigare studier har indikerat att AQT skiljer personer med Alzheimers sjukdom från friska kontroller med högre precision än det ofta använda Mini-Mental-Testet (MMT). I denna studie undersöktes för första gången om AQT-resultat kunde predicera diagnosen hos en konsekutiv serie patienter vid en minnesklinik samt relationen mellan AQT-resultat och biomarkörer (likvorproteiner) för neurodegenerativ sjukdom. 492 svarsblanketter från AQT Färg och Form analyserades och diagnostisk prediktion samt korrelation med nivån av likvorproteiner fastställdes för de 374 första patienterna i serien. Resultaten tyder på att AQT Färg och Form kan vara känsligt för vissa lindriga kognitiva sviktsymptom som förekommer hos personer remitterade för minnesbesvär men inte alltid känsligt för lindriga grader av demens. AQT-data korrelerade måttligt med nivån av patologiska likvorproteiner, troligen avspeglande förhöjda nivåer i Alzheimergruppen. Ytterligare forskning på konsekutiva fallserier behövs för att fastställa testets diagnostiska diskriminationsförmåga i klinisk praxis. / A Quick Test (AQT) Color-Form is a test that uses rapid automatized naming in order to identify cognitive impairment. It is divided into three parts, each of which consists of 40 stimuli that are to be named as quickly as possible. Previous studies have indicated that AQT separates patients with Alzheimer’s disease from normal controls with higher accuracy than the commonly used Mini-Mental State Examination (MMSE). The purpose of this study was to investigate, for the first time, whether AQT results collected from a consecutive series of patients at a Memory Clinic would be able to predict the diagnosis. Another aim was to study the possible relation between AQT results and Cerebrospinal Fluid (CSF) biomarkers for neurodegenerative diseases. 492 forms from AQT Color-Form tests were analyzed and diagnostic prediction and correlation with level of CSF biomarkers were determined for the first 374 patients. The results imply that AQT Color-Form may be sensitive to some symptoms of benign memory impairment that is found in patients admitted to a Memory Clinic, but that it is not always sensitive to mild degrees of dementia. Further research consecutive series of patients is needed in order to determine the diagnostic abilities of discrimination in clinical practice.

Standardized tests are generally based on the norms of the majority population who share the same culture, language and above all, similar prior learning experiences. Because of this, it is problematic for clinicians to use standardized tests when assessing children from culturally and linguistically diverse (CLD) backgrounds. Dynamic assessment (DA) is an alternative assessment method that can circumvent the dilemma of biased testing of children from CLD populations. By looking at the child‟s modifiability instead of static performance DA aims to target the child‟s true language ability. In this study the researchers investigated the difference between narratives produced before and after a dynamic assessment procedure called a test-teach-retest method. 16 South African preschool children were assessed in one session with a wordless picture sequence and then the test-teach-retest format was implemented. Each child was asked to tell the story in the pictures, followed by a dynamic assessment phase (focused questions), and finally a second elicitation of the narrative. No time elapsed between the tests and the teaching phase. Significant differences were found between the narratives elicited before and after the focused questions, but not for all measures. The use of mental state terms (what characters feel and think) increased from the first to the second narrative as well as some of the microstructural elements (linguistic structures) and macrostructural elements (global organization of the story). These results indicate that the use of narrative language in the field of DA has the potential of reducing bias when assessing children‟s narrative ability in culturally and linguistically diverse populations. / Standardiserade test är främst baserade på normer som hämtats från studier av majoritetsbe-folkningen i ett land. En befolkning delar ofta samma kultur och de är ofta enspråkiga, men framförallt delar de liknande upplevelser. På grund av detta är det mycket svårt för kliniker att använda standardiserade test på barn med flerspråkig bakgrund. Dynamic assessment (DA) är en alternativ och dynamisk bedömningsmetod som kan förhindra att språklig testning av mångkulturella barn blir partisk. DA är ett tillvägagångssätt som fokuserar på barns sätt att ta sig an språk medan traditionella mått främst används för att statiskt kvantifiera prestation. Den här uppsatsen syftar till att undersöka om det finns en skillnad i barns sätt att berätta en saga före och efter intervention med dynamisk bedömningsmetod. 16 sydafrikanska förskole-barn testades, varje barn fick vid ett tillfälle berätta två historier till samma bildsekvens. Mel-lan de två berättelserna ställde forskarna riktade frågor om innehållet, dessa riktade frågor motsvarar det dynamiska inslaget i bedömningen. Signifikanta resultat hittades, men inte för alla mätvärden. Signifikant var den ökade användningen av mental state terms (vad karaktä-rerna i en berättelse känner och tänker), samt ökningen av vissa mått på mikro- (lingvistisk struktur) och makrostruktur (övergripande organisering av berättelsen). Detta resultat tyder på att användningen av en dynamisk bedömningsmetod kan ge kliniker ett instrument som är opartiskt vid bedömning av mångkulturella barns berättarförmåga.

I denna studie undersöktes effekten av förstärkt hörselåterkoppling (enhanced auditoryfeedback, EAF) på observerbar stamning och upplevd känsla av talflyt hos vuxna personer som stammar. Så vitt vi vet finns inga tidigare studier av effekten av förstärkt hörselåterkoppling vid stamning. Mycket forskning finns dock på andra typer av hörselåterkoppling, som exempelvis frekvensförändrad hörselåterkoppling (frequencyaltered feedback, FAF), där man sett positiv effekt på talflytet hos personer som stammar. Deltagargruppen bestod av 14 personer i åldrarna 20-43 år, som stammade. Deltagarna fick läsa högt under olika förhållanden av hörselåterkoppling, de olika förhållandena som testades var förstärkt hörselåterkoppling och FAF mot normal hörselåterkoppling. Testtillfällena spelades in och procent stammade stavelser (%SS) räknades för en objektiv bedömning av talflytet. Deltagarna fick också skatta hur de upplevde talflytet under de olika förhållandena. Såväl observerbar stamning som skattning av upplevt talflyt visade en positiv tendens vid både förstärkt hörselåterkoppling och FAF. Förändringen var statistiskt signifikant för observerbar stamning vid FAF (p = 0,002), och för skattningen av upplevt talflyt vid både förstärkthörselåterkoppling (p = 0,0053) och FAF (p = 0,021). Att förändringen i observerbarstamning vid förstärkt hörselåterkoppling inte var statistiskt signifikant (p = 0,117) kanbero på relativt låg power hos studien, särskilt som två deltagare inte uppvisade någon stamning alls i testsituationen. De positiva resultaten gällande skattningen samt de positiva tendenserna i observerbar stamning (%SS) i denna studie motiverar fortsatt forskning om förstärkt hörselåterkoppling vid stamning. / This study examined the effects of enhanced auditory feedback (EAF) on observable stuttering and perceived sense of speech fluency in adults who stutter. To our knowledge there are no previous studies on the effects of EAF on stuttering. There are numerous studies on other types of altered auditory feedback, such as frequency altered feedback (FAF), in which a positive effect on speech fluency in people who stutter has been shown. The group of participants consisted of 14 people aged from 20-43 years, who stuttered. Participants were asked to read aloud during different conditions of auditory feedback, the different conditions tested were EAF and FAF compared to normal auditory feedback. The testing was recorded and the percentage of syllables stuttered (% SS) was calculated for an objective assessment of speech fluency. Participants were also asked to estimate how they perceived their speech fluency during the various conditions. Both observable stuttering and the ratings of experienced speech fluency showed a positive trend in both EAF and FAF. The change was statistically significant for observable stuttering in FAF (p = 0.002), and for the estimation of experienced speech fluency in both EAF (p = 0.0053) and FAF (p = 0.021). The lack of statistical significance for the change in observable stuttering during EAF (p = 0.117) may be due to relatively low power of the study, particularly as two participants showed no stuttering at all during the test conditions. The positive results regarding the estimation and the positive trends of observable stuttering (% SS) in this study motivates for further research on the effects of enhanced auditory feedback on stuttering.

Phonological awareness is a set of language manipulation skills such as blending, rhyme, alliteration production and detection. There are disagreements among researchers how phonological awareness is connected to literacy learning and also how and if children with Down syndrome acquire phonological awareness. The specific phenotype of Down syndrome shows deficits in both short term memory and language development. It is therefore of great concern to investigate how children with Down syndrome acquire phonological awareness and later on literacy. The PhonicStick is a joystick that generates speech sounds. In this study, the PhonicStick was used in phonological awareness intervention in children with Down syndrome. It was compared to intervention with Praxis cards – an already existing picture material in Swedish speech and language therapy. The aim of the study was to investigate if children with Down syndrome can improve phonological awareness during a six week period, and if this was the case, was there a difference in effectiveness between the materials. Six children with Down syndrome participated in this cross-over study. The results indicated that some children can acquire phonological awareness during a six week period. However, it was not possible to address the effectiveness to a certain material. The preference among the children to play with PhonicStick, showed that this is a material that motivates the children to participate in intervention. If the PhonicStick is adapted to this population of children with Down syndrome, this material can be used for phonological awareness intervention in children with Down syndrome.

Excessive nasal resonance in speech (hypernasality) is a disorder which may have negative communicative and social consequences for the speaker. Excessive nasal resonance is often associated with cleft lip and palate, velopharyngeal impairment, dysarthria or hearing impairment. Evaluation of hypernasality has proved to be a challenge in the clinic and in research. There are questions regarding the accuracy and reliability of auditory perceptual evaluations of nasal speech, and whether instrumental measures can be used to improve the reliability of clinical evaluation. There is also the question of whether clinical evaluation reflects the impact of hypernasality in a speaker’s everyday life. The purpose of this thesis was to evaluate the extent of reliability problems connected with auditory perceptual assessment of nasality in speech, to explore whether they might interfere with treatment decisions or have an impact in the everyday life of patients, and whether they can be effectively diminished by the use of nasometry. Speakers with cleft lip and palate or velopharyngeal impairment formed the basis of the clinical population used in this study. Speech samples from 52 of these speakers, along with samples from a reference population of 21 speakers who did not have cleft palate, velopharyngeal impairment or speech disorders were used in perceptual evaluation tasks. Fourteen speakers from the clinical population and 11 from the reference population also underwent nasometric evaluation. A further reference population of 220 children from three Swedish cities, whose ages were consistent with those used for clinical checks of children born with cleft palate were assessed with nasometry to establish normative data for the Nasometer™. Perceptual speech assessments were conducted on hyper- and hyponasality, as well as audible nasal air emission and/or nasal turbulence, using 5-point ordinal scales. Listeners were SLPs experienced in the evaluation of cleft palate speech, non-expert SLPs and untrained listeners. Listening assessments were performed from audio recorded speech samples assembled in random order. Nasometry measures were made on three speech passages each with specific phonetic content, using the Nasometer™, model II. Perceptual evaluation Results showed that for hypernasality assessment, 15% of hypernasality assessments had disagreements between expert SLPs that were potentially important for clinical decisions, as did 6% of assessments for audible nasal air emission and/or nasal turbulence. For nasality problems, a comparison of expert and untrained listeners showed that they generally agreed on which speakers were hypernasal and on the ranking of nasal speakers. All speakers that had been rated with moderate to severe hypernasality by expert listeners were considered by the untrained listeners as having a serious enough speech disorder to call for intervention. However, in the case of audible nasal air emission and/or nasal turbulence the expert listeners were more prone to notice this feature than the untrained listeners. Instrumental evaluation The development of normative values for the three Swedish passages for the NasometerTM (comparable to normative values in other languages) has provided a basis for use of instrumental measures in Swedish clinics, oral sentences mixed sentences nasal sentences. The measures showed no significant differences due to city, gender or age within an age range of 4-10 years. When nasometry measures were compared with perceptual evaluation of speech samples from the same speakers, all correlations were moderate to good for expert SLPs and non-expert SLPs. The difference between correlations was significantly higher for expert SLPs than for untrained listeners. Reliability figures for perceptual assessments for expert SLP listeners indicated that there were some cases where lack of reliability could affect clinical decision making. However, in the main, judgements of nasality problems made by clinicians had everyday validity. They reflected the impressions of the everyday listener, especially in regard to the need for intervention. The study also indicates that now that Swedish norms are available, the Nasometer™ might be useful as a complement to auditory perceptual clinical speech assessments in Swedish cleft palate clinics in order to improve reliability of clinical assessment.

Abstract Background Deep brain stimulation (DBS) is a viable surgical treatment method for Parkinson’s disease (PD). It has positive effects on the classical motor symptoms, but effects on speech and voice are not equally beneficial. The speech disorder related to PD is hypokinetic dysarthria, with impaired articulatory precision as a prominent symptom. Studies have shown effects on different aspects of speech due to DBS of the subthalamic nucleus (STN) but the effects of stimulation of the caudal zona incerta (cZi) are less explored. Aims The aim of the current study was to investigate the effect of STN-DBS and cZi-DBS on perceptually measured articulatory precision in PD patients. Method Read speech productions were collected from 19 DBS-treated PD patients, ten STN and nine cZi. The recordings were made before surgery and 12 months postoperatively with stimulator on and off. Levodopa medication was always on. From the reading passage, three-syllable words were selected and isolated. Articulatory precision of the words was rated in two different assessments; an overall rating of articulatory precision and an identification of occurring misarticulations. Results The results from the perceptual assessment showed a decrease in articulatory precision after surgery for both groups. The decrease was significant for the cZi group, but not for the STN group. There was no significant difference between the groups. The frequency of observed misarticulations increased as an effect of DBS for both patient groups, with significant increase for the STN group but not for the cZi group. There was no significant difference between the groups. The most commonly observed misarticulation categories were stop-plosive reduced in quality, fricative realized as other fricative and stop-plosive realized as fricative . Conclusions The results obtained in the current study show that STN-DBS and cZi-DBS may have adverse effects on articulatory precision in PD patients. Keywords Articulatory precision, Parkinson’s disease, DBS, STN, cZi

<p>Since the brain is an important prerequisite for human language there is a great interest to gain more knowledge about healthy brain activity during language mediated communication. This study examines variations in high level language ability relating to demographic factors like gender and age and relates language ability to neural activity.</p><p>Eighteen individuals in ages between 22 and 64 were included and divided into groups in relation to gender and age. The material used to assess language ability was derived from <em>Testbatteri för Bedömning av Subtila Språkstörningar</em> (Laakso, Brunnegård, Hartelius & Ahlsén, 2000), Swedish Lexical Decision Test (Almkvist, Adveen, Henning & Tallberg, 2007) and a reading test (Högskoleprovet). The results were correlated with measured brain activity using functional Magnetic Resonance Imaging (fMRI) and language paradigms. ANOVA was applied to discover possible demographic variances in language ability as well as in brain activity.</p><p>The results showed no significant differences in language ability. On the other hand there was a tendency that younger individuals scored higher on language tests than older. Naming ability was inversely related to neural activity in Broca. Neural differences were also found regarding gender and age. Men showed generally more activation than women. Younger individuals, as well as the individuals with high wordgeneration ability, activated more subtle areas than others. This study also points to a relation between high language ability and high cognitive ability.</p> / <p>Då hjärnan är en viktig förutsättning för mänskligt språk finns stort intresse för att ökakunskapen om den friska hjärnans aktivitet vid språklig kommunikation. Föreliggande studieundersöker högre språkliga förmågors variation, avseende de demografiska faktorerna könoch ålder samt relaterar språklig förmåga till neural aktivitet.</p><p>Arton försökspersoner mellan 22 och 64 år inkluderades och delades in i grupper efter könoch ålder. Materialet som användes för kartläggning av språklig förmåga härstammade frånTestbatteri för Bedömning av Subtila Språkstörningar (Laakso, Brunnegård, Hartelius & Ahlsén, 2000) samt Swedish Lexical Decision Test (Almkvist, Adveen, Henning & Tallberg,2007) och Högskoleprovets lästest. Resultaten korrelerades med uppmätt hjärnaktivitet vidspråkliga paradigm i funktionell magnetkameraundersökning (fMRI). ANOVA användes föratt upptäcka eventuella variationer mellan grupperna, både i språklig förmåga och ihjärnaktivitet.</p><p>Resultaten visade inga signifikanta variationer i språkförmåga. Däremot kunde tendenserskönjas där yngre presterade bättre på språktesterna än äldre. Benämningsförmåga befannsomvänt relaterad till neural aktivitet i Broca. Neurala skillnader upptäcktes även avseende könoch ålder. Män uppvisade generellt högre grad av aktivering än kvinnor. Den yngreförsöksgruppen, liksom de med hög ordflödesförmåga, aktiverade fler och mer subtilaområden än övriga. Studien pekade även på att hög kognitiv förmåga var relaterad till högspråkförmåga.</p>

<p>Language impairment affects the ability to communicate. Children with languageimpairment have difficulties in using language in interaction to various degrees, and the contributions of the conversational partner are of great importance. The use of languagein interaction can be analysed by means of conversation analysis. The purpose of thepresent study was to study interaction of a group of pre-school children with language impairment with four different conversational partners. These were a peer with languag eimpairment, a peer with typical language development, a pre-school teacher and a parent. This study also intended to analyze the conversations in terms of similarities and differences between the participation frameworks. In all, 12 conversations were analyzedby using conversation analysis. A number of phenomena of interest were identified. The frequency of occurence of some of these phenomena was calculated to complement the qualitative analysis. The results show a number of phenomena occurring where mutualunderstanding is present and when it is limited. These phenomena are sequencing in theform of initiative-response and question-answer, back-channelling, development of conversational topic, breakdown, non-sequencing, topic drift, repair, clarification requestand confirmation. The results also demonstrate differences in the conversations betweenthe participation frameworks with reference to the frequency and the distinction of thephenomena. The greatest differences are found between child-child and adult-childconversations. The pre-school teacher and the parents ask more questions and use more clarification requests and confirmations than the children with language impairment. The development of conversational topics is more distinct in child-adult conversations. The development of conversational topics also occurs to some extent in conversations between two children with language impaiment. In conversations between a child withlanguage impairment and a child with typical language development this phenomenon isgenerally indistinct. Utterances lacking topical coherence in relation to each other areonly distinctly occuring in conversations between two children with language impairment. The pre-school teacher and the parents all perform more distinct other repairsthan the children with language impairment.</p> / <p>En språkstörning påverkar den kommunikativa förmågan. Barn med språkstörning harolika grad av svårighet i språklig interaktion med andra människor och samtalspartnern spelar en betydande roll. Samtalsanalys är ett sätt att analysera den faktiskaspråkanvändningen. Syftet med föreliggande studie var att studera interaktion hos engrupp förskolebarn med språkstörning i fyra olika deltagarstrukturer. De olika deltagarstrukturerna var samtal med ett annat barn med språkstörning, ett barn medtypisk språkutveckling, en person ur förskolepersonalen samt en förälder. Vidare syftade studien till att analysera likheter och skillnader i samtalen mellan de olika deltagarstrukturerna. Totalt analyserades 12 samtal med samtalsanalys, conversationanalysis (CA). Under analysen valdes ett antal fenomen ut och kompletterandeberäkningar gjordes på några av de utvalda fenomenen i samtalen. Resultatet visar att detfinns ett antal fenomen som belyser samförståelse och begränsad samförståelse i samtalen. Dessa fenomen utgörs av sekvensering i form av initiativ-respons och frågasvar, återkoppling, utvecklande av samtalsämne, sammanbrott, icke-relevant svar, yttrande som inte ämnesmässigt koherent i förhållande till föregående yttrande, ämnesglidning, reparation, begäran om förtydligande samt bekräftande av föregående yttrande. I resultatet framkommer skillnader i samtalen mellan de olika deltagarstrukturerna med avseende på hur ofta dessa fenomen förekommer och hur tydliga de är. De största skillnaderna återfinns mellan barn-barn- och barnvuxensamtalen. Personalen och föräldrarna ställer fler frågor samt begär förtydligande och bekräftar föregående yttrande i större utsträckning än barnen med språkstörning. Utvecklande av samtalsämne är tydligast i barn-vuxensamtalen. Utvecklande av samtalsämne förekommer också i viss utsträckning i deltagarstrukturen barn med språkstörning-barn med språkstörning. I deltagarstrukturen barn med språkstörning-barn med typisk språkutveckling är detta fenomen generellt otydligt. Yttranden som saknar ämnesmässig koherens i förhållande till varandra är endast tydligt förekommande ideltagarstrukturen barn med språkstörning-barn med språkstörning. Personalen och föräldrarna utför tydligare annan reparationer än barnen med språkstörning.</p>