Browsing by Subject "logopedia"

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  • Lonka, Eila (Helsingin yliopisto, 2014)
    ABSTRACT Individuals with profound deafness have damages in the inner and outer hair cells in the cochlea. For this reason they make only little use of frequency information and thus have minimal capacities to perceive speech sound cues. Accordingly, speech perception without augmentative means is impossible for them. Profoundly deaf children have been deprived of sound from very early stages of their lives, which inevitably has an effect on linguistic development. Cochlear implants (CIs) have proved their advantage in compensating auditory deficiency both in adults and children with profound hearing loss. In Helsinki University Hospital cochlear implantations started in the early 1980s for 10 Finnish adults with profound deafness. Since that time, due to the fast development of speech processing strategies introduced to CIs, high frequencies and temporal features important to the discrimination of consonantal cues and understanding continuous speech are now often available. The up-to-date worldwide estimation of adults using CIs is 200 000, and the respective number of children is 80 000. In Finland the estimated number of children with CIs is approximately 300, and 500 adults, respectively. In Studies I and II we followed the development of MMN responses to vowel and frequency stimuli in postlingually deafened adults. Plasticity of auditory pitch discrimination driven by cochlear implant (CI) use during a 2.5-year follow-up was indicated both by an enhancement of the amplitude of mismatch negativity (MMN) event-related brain potential (ERP) to vowel contrasts as well as to pure tone frequency changes. The MMN was observed in all patients after 2.5 years of CI use. It was first seen for the larger vowel difference /e/-/o/ and later for the smaller one /e/-/ø/. A significant enhancement was observed for the MMN elicited by 3200 Hz deviant tones among 4000 Hz standards. Instead, no observable mean amplitude MMNs were seen in duration stimuli. The MMN results were compared to audiometric speech recognition scores (SRSs) which improved over time. Participants with the highest SRSs had the highest MMN amplitudes. Studies III (n = 92) and IV (n = 164) report auditory and spoken language development as well as educational settings for Finnish children with cochlear implants. The results of the 92 children show that after approximately three years of hearing experience (hearing age = HA) at the mean chronological age of seven years, children are achieving developed forms of spoken language. The favourable age of two to three for early cochlear implantation in respect to good spoken language skills development was observed in 55 children. For Study IV, two questionnaires were employed; the first, concerning day care and educational placement, was filled in by professionals for rehabilitation guidance, and the second, evaluating language development (categories of auditory performance, spoken language skills, and main modes of communication), by speech and language therapists in audiology departments. Categories of auditory performance and spoken language levels were observed to grow in relation to age at cochlear implantation (p less than 0.001) as well as in relation to proportional hearing age (p less than 0.001). The composite scores for language development moved to more diversified ones in relation to increasing age at cochlear implantation and proportional hearing age (p less than 0.001). Furthermore, the results also indicated that nearly half of the children were enrolled in normal kindergartens and 43% of school-aged children in mainstream schools. Children without additional disorders outperformed those with additional disorders. The results of Study IV indicate that the most favourable age for cochlear implantation could be about the age of two. Compared to other children, spoken language evaluation scores of those with additional disabilities were significantly lower; however, these children showed gradual improvements in their auditory perception and language scores. Taken together, the positive effects of cochlear implantation were observed in MMN responses in adults and in behavioral results for children with CIs.
  • Koski, Katja (Helsingin yliopisto, 2014)
    Staff members' communication strategies determine how individuals with profound and multiple learning disabilities (PMLD) can more fully participate in their community. Such individuals often possess limited interaction skills and may never be able to use symbolic communication strategies. Since staff members are often the main communication partners for individuals with PMLD, achieving successful interaction situations requires that the staff members modify their interaction strategies to meet the different needs of the individuals. However, staff members often fail to do so. Thus, both observational studies and staff members themselves have concluded that communication skills are a professional competence requiring special training. Speech and language therapists (SLTs) working with individuals who have PMLD often provide their service via indirect therapy, which includes giving advice to staff members on how to improve the communication between them and their clients with PMLD. Yet despite such efforts, the staff members seldom change their communication habits. Thus, the aim of this thesis is to understand the process of indirect speech therapy. Specifically, which issues are important for staff members to learn during indirect therapy and which factors support staff members in maintaining the targeted skills. The theoretical background of this study is based on Bronfenbrenner's Ecological Systems Theory. This theory states that the entire surrounding ecological system affects human development. The interaction between staff members and individuals with PMLD is therefore defined at the level of different sub-systems of Bronfenbrenner's theory. In the microsystem, the communicative abilities of staff members and individuals with PMLD affects how the interaction succeeds. In the exosystem, the interaction is regarded at the organisational level; the values and practices of the organisations have an effect on the interactions between the individuals and staff members. Finally, in the macrosystem, the social values and practices surrounding organisations (eg. laws, structures, philosophy) influence how the organisations provide care to their clients with PMLD and thus shape the interaction between the staff members and their clients. This study tries to target both the microsystem and the exosystem. Therefore, the research interests are in the interactions between staff members and clients with PMLD and in the organisation which provides the framework of these interactions. The materials of this thesis were collected from a communication partner training programme OIVA, developed by the Communication and Technology Centre of the Finnish Association on Intellectual and Developmental Disabilities. OIVA training was aimed at staff members working with individuals who have PMLD. The data were drawn from a group situation where SLTs analysed the participating staff members' interaction skills and from semi-structured interviews directed at the participating staff members. The SLTs' analyses of the staff members interaction patterns were analysed both quantitatively and qualitatively. The staff members' interviews were analysed using qualitative methods. This study discovered that SLTs have contrasting views about which strategies staff members should use to achieve successful interactions with their clients. Even though there might not be one single way of being a successful interaction partner, this variable can be confusing to staff members if they work with several SLTs who offer different professional advice. The participating staff members stated that they had pondered several ethical questions relating to the individuals' sense of belonging in the community and concerning their right to be understood and to understand the communications presented to them. This resulted in staff members starting to ask individuals with PMLD for their opinions about daily life and to act according to the individuals wishes. Furthermore, the staff members in this study reported a need for more supervisory support to maintain the results of the training and to disseminate the new practices to non-trained staff. It seems that permanent change in staff members' behaviours comes depends on whether the organisation is willing to focus on the selected issues over a long period of time, perhaps for years, and whether the organisation has developed support systems to maintain the benefits of the training. This study emphasises that indirect speech and language therapy is a complex professional task. The SLTs providing this therapy need more knowledge about the interaction strategies and the thinking habits affecting the interaction between staff members and individuals with PMLD. They also require understanding of the organisational factors which promote the staff members opportunities to participate in indirect therapy and to use and maintain the newly learnt communication skills.
  • Stolt, Suvi (Helsingin yliopisto, 2009)
    The aim was to analyse the growth and compositional development of the receptive and expressive lexicons between the ages 0,9 and 2;0 in the full-term (FT) and the very-low-birth-weight (VLBW) children who are acquiring Finnish. The associations between the expressive lexicon and grammar at 1;6 and 2;0 in the FT children were also studied. In addition, the language skills of the VLBW children at 2;0 were analysed, as well as the predictive value of early lexicon to the later language performance. Four groups took part in the studies: the longitudinal (N = 35) and cross-sectional (N = 146) samples of the FT children, and the longitudinal (N = 32) and cross-sectional (N = 66) samples of VLBW children. The data was gathered by applying of the structured parental rating method (the Finnish version of the Communicative Development Inventory), through analysis of the children´s spontaneous speech and by administering a a formal test (Reynell Developmental Language Scales). The FT children acquired their receptive lexicons earlier, at a faster rate and with larger individual variation than their expressive lexicons. The acquisition rate of the expressive lexicon increased from slow to faster in most children (91%). Highly parallel developmental paths for lexical semantic categories were detected in the receptive and expressive lexicons of the Finnish children when they were analysed in relation to the growth of the lexicon size, as described in the literature for children acquiring other languages. The emergence of grammar was closely associated with expressive lexical growth. The VLBW children acquired their receptive lexicons at a slower rate and had weaker language skills at 2;0 than the full-term children. The compositional development of both lexicons happened at a slower rate in the VLBW children when compared to the FT controls. However, when the compositional development was analysed in relation to the growth of lexicon size, this development occurred qualitatively in a nearly parallel manner in the VLBW children as in the FT children. Early receptive and expressive lexicon sizes were significantly associated with later language skills in both groups. The effect of the background variables (gender, length of the mother s basic education, birth weight) on the language development in the FT and the VLBW children differed. The results provide new information of early language acquisition by the Finnish FT and VLBW children. The results support the view that the early acquisition of the semantic lexical categories is related to lexicon growth. The current findings also propose that the early grammatical acquisition is closely related to the growth of expressive vocabulary size. The language development of the VLBW children should be followed in clinical work.
  • Saalasti, Satu (Helsingin yliopisto, 2012)
    Asperger Syndrome (AS) belongs to autism spectrum disorders where both verbal and non-verbal communication difficulties are at the core of the impairment. Social communication requires a complex use of affective, linguistic-cognitive and perceptual processes. In the four studies included in the current thesis, some of the linguistic and perceptual factors that are important for face-to-face communication were studied using behavioural methods. In all four studies the results obtained from individuals with AS were compared with typically developed age, gender and IQ matched controls. First, the language skills of school-aged children were characterized in detail with standardized tests that measured different aspects of receptive and expressive language (Study I). The children with AS were found to be worse than the controls in following complex verbal instructions. Next, the visual perception of facial expressions of emotion with varying degrees of visual detail was examined (Study II). Adults with AS were found to have impaired recognition of facial expressions on the basis of very low spatial frequencies which are important for processing global information. Following that, multisensory perception was investigated by looking at audiovisual speech perception (Studies III and IV). Adults with AS were found to perceive audiovisual speech qualitatively differently from typically developed adults, although both groups were equally accurate in recognizing auditory and visual speech presented alone. Finally, the effect of attention on audiovisual speech perception was studied by registering eye gaze behaviour (Study III) and by studying the voluntary control of visual attention (Study IV). The groups did not differ in eye gaze behaviour or in the voluntary control of visual attention. The results of the study series demonstrate that many factors underpinning face-to-face social communication are atypical in AS. In contrast with previous assumptions about intact language abilities, the current results show that children with AS have difficulties in understanding complex verbal instructions. Furthermore, the study makes clear that deviations in the perception of global features in faces expressing emotions as well as in the multisensory perception of speech are likely to harm face-to-face social communication.
  • Saaristo-Helin, Katri (Helsingin yliopisto, 2011)
    The aim of this study was to examine the applicability of the Phonological Mean Length of Utterance (pMLU) method to the data of children acquiring Finnish, for both typically developing children and children with a Specific Language Impairment (SLI). Study I examined typically developing children at the end of the one-word stage (N=17, mean age 1;8), and Study II analysed children s (N=5) productions in a follow-up study with four assessment points (ages 2;0, 2;6, 3;0, 3;6). Study III was carried out in the form of a review article that examined recent research on the phonological development of children acquiring Finnish and compared the results with general trends and cross-linguistic findings in phonological development. Study IV included children with SLI (N=4, mean age 4;10) and age-matched peers. The analyses in Studies I, II and IV were made using the quantitative pMLU method. In the pMLU method, pMLU values are counted for both the words that the children targeted (so-called target words) and the words produced by the children. When the child s average pMLU value was divided with the average target word pMLU value, it is possible to examine that child s accuracy in producing the words with the Whole-Word Proximity (PWP) value. In addition, the number of entirely correctly produced words is counted to obtain the Whole-Word Correctness (PWC) value. Qualitative analyses were carried out in order to examine how the children s phoneme inventories and deficiencies in phonotactics would explain the observed pMLU, PWP and PWC values. The results showed that the pMLU values for children acquiring Finnish were relatively high already at the end of the one-word stage (Study I). The values were found to reflect the characteristics of the ambient language. Typological features that lead to cross-linguistic differences in pMLU values were also observed in the review article (Study III), which noted that in the course of phonological acquisition there are a large number of language-specific phenomena and processes. Study II indicated that overall the children s phonological development during the follow-up period was reflected in the pMLU, PWP and PWC values, although the method showed limitations in detecting qualitative differences between the children. Correct vowels were not scored in the pMLU counts, which led to some misleadingly high pMLU and PWP results: vowel errors were only reflected in the PWC values. Typically developing children in Study II reached the highest possible pMLU results already around age 3;6. At the same time, the differences between the children with SLI and age-matched peers in the pMLU values were very prominent (Study IV). The values for the children with SLI were similar to the ones reported for two-year-old children. Qualitative analyses revealed that the phonologies of the children with SLI largely resembled the ones of younger, typically developing children. However, unusual errors were also witnessed (e.g., vowel errors, omissions of word-initial stops, consonants added to the initial position in words beginning with a vowel). This dissertation provides an application of a new tool for quantitative phonological assessment and analysis in children acquiring Finnish. The preliminary results suggest that, with some modifications, the pMLU method can be used to assess children s phonological development and that it has some advantages compared to the earlier, segment-oriented approaches. Qualitative analyses complemented the pMLU s observations on the children s phonologies. More research is needed in order to verify the levels of the pMLU, PWP and PWC values in children acquiring Finnish.
  • Sellman, Jaana (Helsingin yliopisto, 2008)
    This conversation analytical study analyses the interactional practices adopted by speech therapists and their clients during their training in voice therapy. This study also describes how learning takes place during the therapy process. In contrast to traditional voice therapy studies, change is examined here by using qualitative research methodology, namely conversation analysis. This study describes the structures of interaction in voice therapy, shows how the shortcomings in the client s performance are evaluated and corrected and finally, how the voice training sequence and the participation changes during therapy. The database consists of 51 videotaped voice therapy sessions from six clients with voice disorders. The analytic focus is on the practices in one voice training exercise of the trilled /r/. All the sequences of this exercise (in total 36) and all adjacency pairs within (N = 627) were transcribed and analysed in detail. This study shows that voice training consists of successive model imitation adjacency pairs. This adjacency pair works as a resource in voice training. Furthermore, the use of this particular adjacency pair is an institutional practice in all therapies in this study. The structure of interaction in voice training sequences resembles the practices found in aphasia therapy and in speech therapy of children, as well as the practices of educational and counselling interaction and physiotherapy. More than half of the adjacency pairs were expanded to three (or more) part structures as client s responses were typically followed by therapist s feedback. With their feedback turns, therapists: 1) maintain training practice, 2) evaluate the problem of client s performance, 3) deliver information, 4) activate the client to observe the performance and 5) assist her in correcting the performance. This study describes the four different ways that therapists help their clients to improve the performance after encountering a problem. The longitudinal data shows that learning in therapy is manifested in the changing participation. As clients learn to identify their voice features, they can participate in evaluating or correcting their performances by themselves. This study describes the recurrent professional practices of voice therapists and shows how the institutional commitments of voice therapy are managed in and through talk and interaction. The study also provides detailed description of the management of help in voice training. By describing the interaction in training sequences, this study expands the conception of voice rehabilitation and how it can be researched. The results demonstrate that the learning process and therapy outcomes can be assessed by analysing interaction in therapy. Moreover, this analysis lays the foundation for a novel understanding of the practices in speech therapy and for the development of speech therapy theory. By revealing the activities of interaction, it also makes it possible to discuss them explicitly with speech therapy students. Key words: voice therapy, conversation analysis, institutional interaction, learning, change in participation, feedback, evaluation, error correction, self-repair