Clinicians have a wide-variety of therapy materials, activities, techniques, and procedures available for treatment of children with morphosyntax deficits. This clinically-focused article describes strategies that highlight the critical features of morphosyntactic targets, reviews, techniques, and procedures available to clinicians for their mindful use, and advocates for the addition of distributed learning in daily contexts by involving caregivers in language facilitation. It concludes with a proposal for a holistic approach that encompasses three levels of language intervention. At the first level, the clinician overtly primes the child's system; at the second level, the clinician sets up multiple opportunities to use the target in context; at the third level, the clinician engages caregivers as agents of intervention for distributed learning and sends the child out into a language-facilitating environment.

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Adults with hearing loss who report difficulty understanding speech with and without hearing aids often also report increased mental or listening effort. Although speech recognition measures are well known and have been in use for decades, measures of listening effort are relatively new and include objective measures such as working memory tasks, pupillometry, heart rate, skin conductance, and brain imaging. This purpose of this study is to evaluate an electroencephalogram (EEG)-based method to assess cognitive states associated with high frequency alpha (10-13 Hz) and theta (4-8 Hz) during effortful listening. Changes in high frequency alpha have been associated with semantic memory and cognitive demands. In addition, changes in theta have been associated with encoding information and increased listening effort. Correlations between EEG frequency recordings, self-report, and behavioral measures in speech recognition and auditory working memory tasks will be described. Results will be presented demonstrating the extent to which high frequency alpha predicts word recognition in noise performance and self-reported listening effort.

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At any given time, 3-9% of the general population experiences a voice problem. The incidence of voice disorders in children can vary anywhere between 6 and 23%, yet, only 2-4% of the population are seen by speech-language pathologists for further assessment and treatment. Voice disorders have negative effects on the social, emotional, and physical functioning of the child. Unfortunately, there is little known about the appropriate management of children with voice disorders. Depending on the nature of the voice disorder, different approaches, including behavioral voice therapy, vocal hygiene management, or medical intervention, are available. However, a concern with behavioral voice therapy is the ability of the child to transfer skills learned in clinic to an outside setting - limiting generalization and adaptation of the new behavioral approach. Biofeedback has been successfully used in adults with voice disorders to help generalize new vocal behaviors. Such data is lacking in the treatment of voice problems in the pediatric population. The current case study aimed to understand the use of biofeedback in an eight-year-old male who was diagnosed with a unilateral vocal fold lesion, who exhibited difficulty maintaining and generalizing his new vocal behaviors. It was hypothesized that the child would benefit from biofeedback and would maintain new vocal behaviors including the use of a safe and efficient voice pattern outside the clinic setting. Longitudinal data on vocal parameters including the pitch, loudness, and vocal fold vibration were obtained over a period of five weeks using an ambulation phonation monitor (APM). The APM uses an accelerometer attached to the sternal notch and measures pitch, loudness, and vocal fold vibration, which helps determine an individual’s daily voice use pattern and thereby determines the appropriate biofeedback setting. The five week period included (a) a week of pretesting, (b) two weeks of biofeedback, (c) a week of post-testing immediately following the week of biofeedback, and (d) a generalization testing two months post-study. During the five-week period, vocal parameters were monitored for an average of 7- 10 hours for 2-3 days each week. On weeks two and three, the child was provided with biofeedback on loudness levels based on his data from the pretesting week. Results indicated change in vocal parameters including loudness and vocal fold vibration patterns during the weeks of biofeedback. However, such generalization was not observed neither during immediate post feedback monitoring nor two months following the study protocol. Such data provide immediate effects from biofeedback on vocal behavior, however, motor learning principles, dose, and frequency of biofeedback will be discussed to further understand the long-term effects of biofeedback in children with voice problems.

Background: Vestibular evoked myogenic potentials (VEMPs) have been recorded from the sternocleidomastoid muscle (cervical VEMP or cVEMP) and more recently from the eye muscles (ocular VEMP or oVEMP) in response to air conduction and bone conduction stimuli. Both cVEMPs and oVEMPs are mediated by the otoliths and thereby provide diagnostic information that is complementary to videonystagmography and rotational chair tests. In contrast to the air conduction cVEMP, which originates from the saccule/inferior vestibular nerve, recent evidence suggests the possibility that the air conduction oVEMP may be mediated by the utricle/superior vestibular nerve. The oVEMP, therefore, may provide complementary diagnostic information relative to the cVEMP. There are relatively few studies, however, that have quantified the effects of stimulus and recording parameters on the air conduction oVEMP, and there is a paucity of normative data. Purpose: To evaluate the effects of several stimulus and recording parameters on the air conduction oVEMP and to establish normative data for clinical use. Research Design: A prospective repeated measures design was utilized. Study Sample: Forty-seven young adults with no history of neurologic disease, hearing loss, middle ear pathology, open or closed head injury, cervical injury, or audiovestibular disorder participated in the study. Data Collection and Analysis: The effects of stimulus frequency, stimulus level, gaze elevation, and recording electrode location on the amplitude and latency of the oVEMP for monaural air conduction stimuli were assessed using repeated measures analyses of variance in an initial group of 17 participants. The optimal stimulus and recording parameters obtained in the initial group were used subsequently to obtain oVEMPs from 30 additional participants. Results: The effects of stimulus frequency, stimulus level, gaze elevation, and electrode location on the response prevalence, amplitude, and latency of the oVEMP for monaural air conduction stimuli were significant. The maximum N1-P1 amplitude and response prevalence were obtained for contralateral oVEMPs using a 500 Hz tone burst presented at 125 dB peak SPL during upward gaze at an elevation of 30°. Conclusions: The optimal stimulus and recording parameters quantified in this study were used to establish normative data that may be useful for the clinical application of the air conduction oVEMP.

Vestibular evoked myogenic potentials (VEMP) are short latency electromyograms (EMG) evoked by high-level acoustic stimuli and recorded from surface electrodes over the tonically contracted sternocleidomastoid (SCM) muscle and are presumed to originate in the saccule. The present experiments examined the effects of click and tone-burst level and stimulus frequency on the latency, amplitude, and threshold of the VEMP in subjects with normal hearing sensitivity and no history of vestibular disease. VEMPs were recorded in all subjects using 100 dB nHL click stimuli. Most subjects had VEMPs present at 500, 750, and 1000 Hz, and few subjects had VEMPs present at 2000 Hz. The response amplitude of the VEMP increased with click and tone-burst level, whereas VEMP latency was not influenced by the stimulus level. The largest tone-burst-evoked VEMPs and lowest thresholds were obtained at 500 and 750 Hz. VEMP latency was independent of stimulus frequency when tone-burst duration was held constant.

The otoliths are vestibular organs that act as gravito-inertial force sensors and contribute to the perception of spatial orientation (earth verticality). The subjective visual vertical (SVV) is a psychophysical measure of the angle between perceptual vertical and true (gravitational) vertical. The otoliths contribute to the estimation of the physical vertical orientation, and individuals with normal vestibular function align the SVV within 2 degrees of true vertical (0 degrees). Impaired SVV has been documented in patients with unilateral vestibular disorders. Most research has focused on measuring the static SVV (head upright and stationary); however, more recently, methods have been developed to measure the SVV during stimulation of the otolith organs using on-axis yaw rotation (bilateral centrifugation), off-axis eccentric rotation (unilateral centrifugation), or head tilt for tests of bilateral or unilateral otolith function. The SVV test may be a useful method to assess utricular function in patients complaining of dizziness and/or imbalance and identify stages of recovery for otolith involvement.

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Vestibular-evoked myogenic potentials (VEMPs) are proposed as a reliable test to supplement the current vestibular test battery by providing diagnostic information about saccular and/or inferior vestibular nerve function. VEMPs are short-latency electromyograms (EMGs) evoked by high-level acoustic stimuli and recorded from surface electrodes over the tonically contracted sternocleidomastoid muscle. VEMP amplitude is influenced by the EMG level, which must be controlled. This study examined the ability of subjects to achieve the EMG target levels over a range of target levels typically used during VEMP recordings. In addition, the influence of target EMG level on the latency and amplitude of the click- and tone-evoked VEMP was examined. The VEMP amplitude increased as a function of EMG target level, and the latency remained constant. EMG target levels ranging from 30 microV to 50 microV are suggested for clinical application of the VEMP.