Speech Therapy - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

SPEECH THERAPY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Speech Therapy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84632-4 1. Speech Therapy-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on speech therapy. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON SPEECH THERAPY ..................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Speech Therapy ............................................................................. 5 The National Library of Medicine: PubMed ................................................................................ 34 CHAPTER 2. ALTERNATIVE MEDICINE AND SPEECH THERAPY ..................................................... 57 Overview...................................................................................................................................... 57 National Center for Complementary and Alternative Medicine.................................................. 57 Additional Web Resources ........................................................................................................... 58 General References ....................................................................................................................... 59 CHAPTER 3. DISSERTATIONS ON SPEECH THERAPY ....................................................................... 61 Overview...................................................................................................................................... 61 Dissertations on Speech Therapy ................................................................................................. 61 Keeping Current .......................................................................................................................... 61 CHAPTER 4. PATENTS ON SPEECH THERAPY .................................................................................. 63 Overview...................................................................................................................................... 63 Patents on Speech Therapy .......................................................................................................... 63 Patent Applications on Speech Therapy....................................................................................... 76 Keeping Current .......................................................................................................................... 78 CHAPTER 5. BOOKS ON SPEECH THERAPY...................................................................................... 79 Overview...................................................................................................................................... 79 Book Summaries: Federal Agencies.............................................................................................. 79 Book Summaries: Online Booksellers........................................................................................... 82 Chapters on Speech Therapy ........................................................................................................ 83 CHAPTER 6. MULTIMEDIA ON SPEECH THERAPY ........................................................................... 89 Overview...................................................................................................................................... 89 Video Recordings ......................................................................................................................... 89 CHAPTER 7. PERIODICALS AND NEWS ON SPEECH THERAPY ........................................................ 91 Overview...................................................................................................................................... 91 News Services and Press Releases................................................................................................ 91 Academic Periodicals covering Speech Therapy........................................................................... 93 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 97 Overview...................................................................................................................................... 97 NIH Guidelines............................................................................................................................ 97 NIH Databases............................................................................................................................. 99 Other Commercial Databases..................................................................................................... 101 APPENDIX B. PATIENT RESOURCES ............................................................................................... 103 Overview.................................................................................................................................... 103 Patient Guideline Sources.......................................................................................................... 103 Finding Associations.................................................................................................................. 111 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 113 Overview.................................................................................................................................... 113 Preparation................................................................................................................................. 113 Finding a Local Medical Library................................................................................................ 113 Medical Libraries in the U.S. and Canada ................................................................................. 113 ONLINE GLOSSARIES................................................................................................................ 119 Online Dictionary Directories ................................................................................................... 119 SPEECH THERAPY DICTIONARY ........................................................................................... 121

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INDEX .............................................................................................................................................. 151

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with speech therapy is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about speech therapy, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to speech therapy, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on speech therapy. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to speech therapy, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on speech therapy. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON SPEECH THERAPY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on speech therapy.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and speech therapy, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “speech therapy” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Stuttering: A Brief Review Source: American Family Physician. 57(9): 2175-2178. May 1, 1998. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This article provides an update of the diagnosis of and therapy for stuttering, a common disorder that usually resolves by adulthood. The authors begin with a discussion of the etiology of stuttering, noting that this is an area of controversy. The prevailing theories point to measurable neurophysical dysfunctions that disrupt the precise timing required to produce speech. Almost 80 percent of children who stutter recover fluency by the age of 16 years. Mild stuttering is self-limited, but more severe stuttering requires speech therapy, which is the mainstay of treatment. Delayed

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auditory feedback and computer-assisted training are currently used to help slow down speech and control other speech mechanisms. Pharmacologic therapy is seldom used, although haloperidol has been somewhat effective. The article concludes with the toll free telephone number of the Stuttering Foundation of America (800-992-9392). 2 tables. 16 references. (AA). •

Techniques for Reconstruction of the Pharynx and Voice Restoration Source: ADVANCE for Speech-Language Pathologists and Audiologists. 8(45): 7-9. November 9, 1998. Contact: Available from Merion Publications, Inc. 650 Park Avenue, Box 61556, King of Prussia, PA 19406-0956. (800) 355-5627, ext. 279. E-mail: [email protected]. Website: www.advanceweb.com. Summary: This article, from a professional newsletter for speech language pathologists and audiologists, outlines the several options available for reconstruction of postlaryngopharyngectomy defects. These surgical options fall into two major groups: those involving myocutaneous flaps that are tubed upon themselves to form a conduit and those using the alimentary tract, usually the jejunum or stomach. The author describes the advantages and disadvantages of each option, particularly when it comes to facilitating voice restoration. Research techniques used to evaluate speech following pharyngeal reconstruction include acoustic analysis to get an objective measure of speech characteristics, such as pitch and loudness. Most patients undergo the voice restoration procedure with tracheoesophageal puncture and a voice prosthesis. Speech therapy is geared toward teaching clients how to use and care for the voice prosthesis. The article concludes with a brief discussion of the risk factors for laryngeal cancer (the primary reason for laryngectomy), which include drinking alcohol and smoking. The article concludes with the contact information for the clinician interviewed. 3 figures.

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Amyotrophic Lateral Sclerosis: Lou Gehrig's Disease Source: American Family Physician. 59(6): 1489-1496. March 15, 1999. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on the pathology, epidemiology, etiology, clinical features, diagnosis, and management of amyotrophic lateral sclerosis (ALS). This progressive neuromuscular disease, commonly called Lou Gehrig's disease in memory of the famous baseball player who died of ALS in 1941, is characterized by weakness, muscle wasting, fasciculations, and increased reflexes. Approximately 30,000 Americans currently have the disease. The annual incidence rate is 1 to 2 cases per 100,000 people. The disease is most commonly diagnosed in middle age and affects more men than women. The etiology of the disease in unknown. Current research is focused on abnormalities of neuronal cell metabolism involving glutamate and the role of potential neurotoxins and neurotrophic factors. ALS usually presents with problems in dexterity or gait resulting from muscle weakness. Difficulty in speaking or swallowing is the initial symptom in the bulbar form of the disease. Over a period of months or years, patients who have ALS develop severe, progressive muscular weakness and other symptoms caused by loss of function in both upper and lower motor neurons. Sphincter control, sensory function, intellectual abilities, and skin integrity are preserved. Patients become completely disabled, often requiring ventilatory support and gastrostomy. Death usually occurs within 5 years of

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diagnosis and is attributed to respiratory failure or cachexia. Diagnosis of ALS is clinical, and is based on the characteristic signs of progressive weakness, atrophy, fasciculations, and hyperreflexia affecting several regions of the body. The management of ALS is a complex and demanding team effort requiring individualized therapy and continual adaptation of medications and therapies. The only agent currently labeled for the treatment of ALS is riluzole. This drug is believed to decrease glutamate release. Various symptomatic treatments may also be helpful. Spasticity may be relieved by use of baclofen, diazepam, or dantrolene. Physical therapy can help relieve many of the painful symptoms of ALS. Nonsteroidal anti-inflammatory drugs and anticonvulsants may also be helpful. Mechanical suction devices are useful in preventing aspiration of excess saliva. Tricyclic antidepressants are widely used in the treatment of ALS because of their multiple effects. Supportive therapies, including physical, occupational, and speech therapy and nutritional support, also have a crucial role in the care of patients who have ALS. The article includes two illustrative cases. 2 tables and 26 references. (AA-M).

Federally Funded Research on Speech Therapy The U.S. Government supports a variety of research studies relating to speech therapy. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to speech therapy. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore speech therapy. The following is typical of the type of information found when searching the CRISP database for speech therapy: •

Project Title: A COMPARISON OF LANGUAGE INTERVENTION PROGRAMS Principal Investigator & Institution: Gillam, Ronald B.; Professor; Speech Communication; University of Texas Austin 101 E. 27Th/Po Box 7726 Austin, Tx 78712 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 31-AUG-2005 Summary: (from applicant?s abstract): Nearly 7% of elementary school children present difficulties learning and using language. Unfortunately, language impairments are often long lasting and may have serious social, academic, and vocational ramifications. More than 1 million children receive language intervention in the public schools each year, and many more are seen in hospitals and other clinical settings. Recently, a computerized intervention approach known as Fast ForWord has received a great deal of attention at scientific meetings and in the popular press. The creators of this program (Michael Merzenich, Paula Tallal, and their associates) claim that Fast ForWord trains children?s brains to process speech better by gradually reducing specialized acoustic

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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modifications of speech stimuli as children improve on the games. The creators of Fast ForWord have completed a large, one-group, pretest-postest national field trial of their program. Their results suggest that children make approximately 1 standard deviation of improvement on standardized tests after a 6-week intervention period. We propose a randomized clinical study to compare the language outcomes of Fast ForWord to two other interventions (computer assisted language intervention without acoustically modified speech and individual language intervention) and to the outcomes of a general stimulation (control) condition. Each year for 3 years, 24 children will be randomly assigned to each of the four conditions at three regional sites (Austin, Texas Dallas, Texas, and Lawrence, Kansas) for a total of 54 children in each condition at the end of the study. The treatments will be administered in special summer programs. The primary research question is which intervention results in the most improvement in the composite language score from the Oral and Written Language Scales. Secondary questions include which intervention results in the greatest gains in conversational language, which intervention results in the greatest gains 3 and 6 months after training, which intervention results in the greatest improvement in auditory perception, and which intervention is the most cost effective. Our results will have theoretical and practical value. Theoretically, our study tests the temporal processing hypothesis of language impairment. Practically, our study will describe and compare the language, communication, auditory processing and academic outcomes of three interventions. Our analyses will help clinicians and administrators choose the most effective and least expensive treatment for the children they serve. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: A POST DISCHARGE INTERVENTION TO IMPROVE STROKE OUTCOMES Principal Investigator & Institution: Allen, Kyle R.; Summa Health System Box 2090, 525 E Market St Akron, Oh 44304 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2005 Summary: A need exists for effective and cost-efficient approaches to the management of stroke survivors, not only to prevent recurrent stroke but also to prevent and manage other post-stroke complications. Currently, it is assumed that by the time of discharge from an acute care or rehabilitation setting the patient, family, primary care physician, physiatrist, and neurologist have negotiated a shared responsibility to assure compliance with prescribed treatments. Often, this assumption is not met, resulting in fragmented care and negative patient outcomes that could have been prevented. As has been shown to be effective for the management of other chronic diseases, effective postdischarge stroke care management must not only address the physical needs of the stroke survivor, but also psychosocial issues which are known to impact on stroke outcomes. Previous post-stroke care research has found little improvement in patient outcomes due, in part, to the lack of a truly comprehensive care model. Many studies have been narrowly focused on medical management of targeted stroke-related conditions, for example hypertension or diabetes, with little or no consideration of the effect of the interplay between psychosocial and other variables. Other studies focused more on psychosocial, rather than physical, interventions. No previous studies have measured the patient's global well being as a study outcome. We propose a randomized controlled trial of 380 post-discharge ischemic stroke patients. The primary aim of this study is to determine the effectiveness of an integrated post-discharge interdisciplinary stroke care model in improving stroke survivor's global well being (a composite of neuromotor function, severe complications, management of risk for common post-stroke

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complications, quality of life, and stroke knowledge) by six months as compared to stroke patients who receive usual post- discharge care. Our model, tested and refined in a pilot study at this community teaching hospital, overcomes many of the weaknesses of previous trials of post-stroke care management. The pilot results showed that this intervention had a significant positive overall impact on stroke survivors' well being. This study will advance the field's knowledge of the effectiveness of truly comprehensive post-discharge stroke care management. The standardized assessments and intervention protocols can be used as a template that is easily adapted to a variety of health care settings. Such information will allow more effective and efficient management of stroke survivors Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AAC PROCESSING SUPPORT FOR SPOKEN LANGUAGE IN APHASIA Principal Investigator & Institution: Schwartz, Myrna F.; Associate Director; Albert Einstein Healthcare Network 5501 Old York Rd Philadelphia, Pa 191413098 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): The PC-based Communication System (CS) was developed for adults with acquired aphasia. It acts as a "processing prosthesis" by taking spoken message creation off-line and minimizing demands for fast retrieval and working memory. Used as an AAC device, the CS has been shown to enhance aphasics' fluency and grammatical expression in narrative production tasks. Used as a therapy tool, it resulted in improved unaided production after independent practice in the home. This proposal will extend the functionality of the CS by making it possible for the user to transfer CS-generated messages appropriate to specific situations onto a hand-held computer, which can be deployed in situ to supplement or cue language production in real-world, real-time, communication. The intention is to create an AAC device that will not only enable the transfer of information appropriate to these situations, but also will allow the user to demonstrate his or her intellectual competence, which may be obscured by the language disability. An experiment is proposed to evaluate whether and how the enhanced system (CS plus handheld: CS-HH) benefits aphasics' communication of messages prepared in anticipation of simulated service encounters (e.g., a medical examination). The experiment will compare a group trained to use CSHH in these simulated encounters with a second, closely matched group, that is trained to use conventional verbal and nonverbal strategies to compensate for their spoken language deficits (the control group). Experimental and control groups will be compared on a total of five service encounters: three that subjects train for in therapistled sessions, and two that they prepare for without therapist involvement (the generalization test). The prediction is that the experimental group will use the CS-HH to communicate more effectively both in the encounters they train for and in those they prepare themselves. A second study will use qualitative techniques (focus groups, semistructured interviews) to explore patients' assessment of their communicative competence in service- and other encounters, and their attitudes toward communication aids, both technological and conventional (e.g., picture books, gestures). It is predicted that after using the CS-HH in simulated service encounters, patients will view themselves as more effective communicators than they did at the start and will be positively disposed to using this AAC device in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ACOUSTIC OF VOCAL TRACT SHAPES FOR LIQUIDS Principal Investigator & Institution: Boyce, Suzanne E.; None; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2002; Project Start 15-MAR-2002; Project End 28-FEB-2007 Summary: (provided by applicant): There are significant individual differences in the way people produce the phonemes of their language. Very different but systematic variations in vocal tract configuration may produce acoustic profiles that native speakers accept as categorically equivalent. The articulatorily complex American English liquids /r/ and /l/, in particular, show several distinct types of tongue configuration. Significantly, these phonemes are among the most troublesome for children and non-native speakers, but current models of vocal tract acoustics do not account for individual variations in ways that might be useful in biofeedback speech therapy. For instance, therapists cannot currently "read" spectral information to discover which of several constrictions in the vocal tract is causing a distorted /r/. Further, articulatory feedback via ultrasound or palatography shows only a portion of the vocal tract. Previous acoustic models were limited by the lack of 3-dimensional data. Using MRI, we propose to acquire a multispeaker database of vocal tract volume and shape. These volumetric data will be used to develop comprehensive acoustic models of interspeaker differences in vocal tract configuration. Our goal is to categorize vocal tract shapes in terms of acoustic strategies for producing /r/ or /1/. We will also acquire ultrasound data for a portion of the longitudinal profile of the tongue on the same set of speakers. We will then test the ability of ultrasound curve portions to constrain categorization of full-length MM midsagittal tongue profile shapes into previously defined configuration types. These data will aid our understanding of vocal tract acoustics and articulatory variation in speech. They may be used to improve speech recognition technologies and the implementation of articulatory and acoustic biofeedback therapy techniques. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ANALYSIS AND REMEDIATION OF LANGUAGE PRODUCTION Principal Investigator & Institution: Berndt-Sloan, Rita S.; Professor; Neurology; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2003; Project Start 02-MAY-2003; Project End 29-FEB-2008 Summary: (provided by applicant): Aphasia strikes approximately one in 250 Americans. The reduced ability to communicate with language represents, in most cases, a catastrophic loss of self-sufficiency and a source of profound social isolation. No treatment for aphasia reported to date has reliably brought about changes in language production that migrate from highly constrained laboratory tasks such as single picture description to more challenging and socially functional tasks such as the production of entire narratives. The current climate in health care limits access to speech therapy, and thus it is imperative to develop approaches to treatment which allow patients to supplement 1:1 clinical treatment with intensive independent home practice. We have developed two computer programs to address the need for effective aphasia treatments that can be used semi-independently. One is a communication system (CS), which allows aphasic users to record spoken sentences a single word or phrase at a time, to replay these words or phrases, and to build them into sentences and narratives by manipulating visual icons on a computer screen. The other program is a language therapy system (TS) incorporating speech recognition and natural language understanding technology, which allows the computer to 'understand' the patient's

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spoken sentence and to provide feedback about whether it correctly describes a picture on the screen. This allows independent home practice of spoken language. The goals of this project are: (1) to replicate pilot results showing measurably more structured language production by aphasic patients using the CS, and to link these effects to characteristics of subjects' language processing impairments (Exp. 1); (2) to assess the impact of enhancing the CS with word-finding support for more severely impaired patients (Exp. 2); (3) to replicate the positive outcomes in pilot studies which used the TS and CS to improve aphasic patients' spoken language production, and to use the TS to train subjects on grammatical structures that provide tests of specific hypotheses about the impact of impaired short term memory on aphasic production (Exp. 3); and (4) to use data automatically collected by the CS to investigate the nature of the underlying disruption and to motivate the most effective approaches to remediation (Exp. 4). Information obtained from these studies will provide a basis for the further development of novel, theoretically motivated approaches to aphasia treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AUGMENTED LANGUAGE INTERVENTION FOR TODDLERS Principal Investigator & Institution: Romski, Maryann; Associate Dean for Social & Behavioral s; Communication; Georgia State University University Plaza Atlanta, Ga 30303 Timing: Fiscal Year 2002; Project Start 01-MAR-2000; Project End 28-FEB-2005 Summary: The long-term objective of this research program is to characterize and to facilitate the language development of young children with a variety of established disabilities who encounter significant difficult acquiring speech. Sixty children will be assessed, randomly assigned to participate in one of three interventions, and followed at 6- and 12-months after the intervention. The specific aims are: 1) to develop a finegrained 18 month longitudinal description of the communication development of 24-36 month old children; 2) to compare the effects of three interventions: Augmented Communication Input (ACI) which focuses on comprehension, modeling, and augmented input, Augmentative Communication Output (ACO), which focuses on production and augmented output, or Non-Augmented Communication (NAC), which focuses on a well-established spoken communication intervention, on the comprehension and production of symbols and words, the transfer of skills to hormone, and parental perception of child communication; and 3) to determine the effects of the interventions on communication, adaptive behavior, and educational placement at 6and 12- months following the intervention. During Pre-Intervention, the 60 participants will complete an assessment battery that includes descriptive, cognitive, communication, and family measures and provides a baseline database on each child. In Intervention, the children will be randomly assigned to one of the three interventions to determine the effects of two augmented language interventions versus oral communication intervention. In each intervention, the child and parent will participate in two 30-minute sessions a week across a 12 week period. Generalization to home, words/symbols comprehended and produced by the child, and parent perception of the child's communication will be assessed. In Follow-Up, 6- and 12-months post intervention measures of communication, adaptive behavior, parent perception, and educational placement will be administered. Findings will advance knowledge about the role of augmented language systems early in life and facilitate the children's adaptive behavior, educational placement, and long-term integration into society. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BIOPHYSIOLOGICAL MECHANISMS OF 'HEIGHTENED SPEECH' Principal Investigator & Institution: Verdolini, Katherine; Associate Professor; Communication Sci & Disorders; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 31-MAY-2008 Summary: (provided by applicant): The broad objectives are to study the biomechanics of "loud" or "heightened" speech, and to study how it can be safely trained in individuals with phonotrauma, who need it for their work Loud speech traditionally has been viewed as an anathema for vocal health. In this application we hold an opposing view that specialized approaches to loud voice training not only may prevent injury; some approaches actually may have therapeutic value in the treatment of both acute and chronic injury. In these studies, we focus on teachers, who represent the most common occupation in the United States. Teachers experience near epidemic proportions of voice problems, traceable prolonged, loud speech on the job. Functional consequences of such problems include reduction and loss of work, and reduced cognitive functioning for students. Societal costs appear to range in the billions of dollars annually in the U.S. Thus, a study of safe--and even therapeutic loud speech in this population is both critical and timely. We initiate our studies by investigating biomechanical factors that influence vocal loudness operationalized as radiated voice output power. Specific Aim #1 assesses whether recent, non-linear simulation models of loud speech production apply to human subjects, by measuring variations in radiated output power as a function of epilaryngeal-to-glottal cross-sectional area ratios. We use Single-Shot Fast Spin Echo (SSFSE) Magnetic Resonance Imaging (MRI). We expect to replicate theoretical findings that impedance-matched vocalization conditions--in particular those involving neutral epilaryngeal and glottal areas found with "resonant voice"--will maximize output power, while at the same time limiting damaging vocal fold impact stress. Specific Aim #2 assesses the utility of "resonant voice" exercises for the reversal of acute phonotrauma. The primary dependent variable is concentration of inflammatory markers from laryngeal surface secretions, and secondarily, aerodynamic and perceptual measures. Finally, Specific Aim #3 examines the effect of "resonant voice" training for teachers with chronic phonotrauma, using a randomized, prospective clinical trial. We will deliver a standardized resonant voice therapy program and a control treatment to teachers with phonotrauma. The primary dependent variable is quality of life in relation to voice, measured with the Voice Handicap Index. Secondary variables are aerodynamic, laryngeal, and vocal quality measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COGNITIVELY BASED TREATMENTS OF ACQUIRED DYSLEXIAS Principal Investigator & Institution: Friedman, Rhonda B.; Professor; Neurology; Georgetown University Washington, Dc 20057 Timing: Fiscal Year 2002; Project Start 01-MAY-1997; Project End 31-JUL-2007 Summary: (provided by applicant): Acquired disorders of reading (acquired dyslexia) are common in patients with aphasia subsequent to left hemisphere stroke. Even when language functions recover sufficiently to enable the patient to return to work, an unrecovered dyslexia often interferes significantly with job performance. Patients who cannot return to work may be left with little to occupy their time; the ability to read for pleasure could make a significant difference in their quality of life. The purpose of this project is to test a set of therapy programs for the treatment of acquired dyslexia, based upon a cognitive neuropsychological model of reading. A comprehensive and detailed

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battery of reading and reading-related tests is used to determine the underlying impairment causing the reading deficit in each patient. This proposal focuses on three specific deficits: 1) impaired access to the visual word form from the visual modality (pure dyslexia); 2) impaired orthographic-phonologic connections (phonologic/deep dyslexia); 3) poor lector/affixed word reading in text (phonological text alexia)). A set of experimental treatment programs has been devised for each of these reading deficits. These therapy programs derive in part from cognitive models of reading, in part from differences in general approach to treatment, and in part from the results of previous treatment studies. A set of general external probe tests are administered to all subjects before and after treatment There are additional external probes for each of the three deficit types, consisting of a list of words targeted for improvement but never trained. Measures include both accuracy and speed of reading. Group studies will examine the efficacy of treatments that have been successful in prior single case studies, and in some instances will compare the efficacy of two treatments with each other. Single case studies will be implemented to explore new treatment protocols or variations on old treatment protocols. Treatment programs are evaluated for efficacy by comparing the accuracy and speed of reading the treatment-specific probe words pre- and posttreatment, and examining performance on the general external probes pre- and posttreatment. The results of this project will increase our understanding of reading and its breakdown, leading to more effective methods of teaching reading to both normal and developmentally dyslexic children, in addition to providing a scientific basis for the choice of effective intervention strategies for the treatment of acquired dyslexia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COMBINED MODALITY TREATMENT OF ADSD Principal Investigator & Institution: Pearson, Erin J.; Communication Sci & Disorders; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2003; Project Start 08-AUG-2003; Project End 07-AUG-2005 Summary: (provided by applicant): This phase 1 clinical trial involves a prospective, randomized, and placebo-controlled repeated measures parallel arm design to examine the effect of phonatory retraining ("behavioral voice therapy") following botulinum toxin type A (Botox m) injections for adductor-type spasmodic dysphonia (ADSD). Subjects will include individuals undergoing first-time injections for ADSD. Following the collection of baseline measures, and after Botox injection, subjects will be randomized to 1 of 3 experimental groups: Botox only, Botox plus behavioral voice therapy, or Botox plus sham voice therapy. The Botox plus behavioral therapy group will incorporate current and well-recognized techniques for phonatory retraining that are widely practiced by voice therapists in the management of ADSD. A Botox plus sham voice therapy group is included in the design in order to better examine nonspecific treatment effects which may emerge as a result of close patient-therapist interaction during behavioral voice therapy for ADSD. Dependent variables to be examined include voice-related Quality of Life, duration of benefit, as well as acoustic source measures (obtained from both connected speech and sustained phonation) of phonation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORTICAL PLASTICITY AND PROCESSING OF SPEECH SOUNDS Principal Investigator & Institution: Kilgard, Michael P.; Assistant Professor; Neuroscience; University of Texas Dallas Richardson, Tx 75080

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Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2007 Summary: (provided by applicant): Approximately one out of every fifteen children entering elementary school in the U.S. has a significant developmental language impairment of unknown origin. Detailed studies of speech acoustics have significantly improved understanding and treatment of language impairments. These studies also provide the foundation needed to investigate the neural representation of speech. While peripheral representations have been extensively studied, relatively little is known about the cortical mechanisms that contribute to speech processing. The objective of this proposal is to define the distributed response of mammalian auditory cortex neurons to human speech sounds and to determine what experience-dependent changes in the neural representation of speech are possible. The first aim of the project will be to precisely document the distributed response of auditory cortex neurons to speech sounds. Our preliminary results (from awake and anesthetized recordings in two distinct auditory fields) indicate that frequency bandwidth and forward masking time course appear to account for speech responses of most auditory cortex neurons. The second aim will be to document the distributed cortical response to exaggerated speech sounds that have been used to treat language-learning impairments in thousands of children. Our initial findings indicate that the cortical activity patterns generated by modified speech are more distinct than the patterns generated by natural speech sounds. The third aim will be to establish how cortical neurons are modified by exposure to natural and modified speech sounds. The results of the proposed studies will add to our understanding of neural mechanisms that could contribute to speech processing and learning in human auditory cortex. Insights derived from these studies will influence the use and development of behavioral and sensory rehabilitation of language impairments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT OF PHONETIC CATEGORIES Principal Investigator & Institution: Flege, James E.; Professor; Rehabilitation Sciences; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 01-JUL-1984; Project End 30-JUN-2005 Summary: The later immigrants arrive in North America and begin to learn English as a second language (L2), the less accurately they produce and perceive certain English vowels and consonants, the stronger their overall degree of foreign accent tends to be, and the more difficulty they may have recognizing English words. Such effects are usually attributed to the passing of a critical period. This research will evaluate an alternative account, that of the Speech Learning Model (SLM). The SLM proposes that age- related effects on L2 speech arise from the development of the L1 phonetic system, not a diminished ability to learn speech. More specifically, the SLM proposes that as L1 phonetic categories are refined, they become more likely to assimilate L2 sounds and thus to block formation of the phonetic categories needed for the accurate production and perception of speech sounds. The first proposed project will examine native Spanish adults who recently immigrated to the U.S. at 6-month intervals over 7 years. Among the hypotheses to be tested are that (1) Overall degree of foreign accent will decrease as the ability to produce particular English sounds improves; (2) Improvements in segmental production will be observed only if the ability to perceive certain English sounds has also improved; (3) Improvements in the perception of English sounds will be accompanied, or preceded by the detection of phonetic differences between sounds found in English and Spanish. Another project will examine 240 native Italian adults who are all highly experienced in English but who differ according to their age of first

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exposure to English (range: 10 to 30 years). The SLM predicts that the native Italian participants' degree of foreign accent will increase linearly to the end of adolescence, then level out. The model also predicts that a significant correlation will exist between degree of foreign accent and the scores obtained on two perceptual tests. The final project will examine four groups of native Italian speakers who differ according to their age of first exposure to English and self-reported native language (L1) use. Eight experiments will test for the formation of phonetic categories by examining the production and perception of English vowels, and the recognition of English words. By hypothesis, early bilinguals will outperform late bilinguals, and individuals who now use their L1 seldom will outperform those who continue to use their L1 frequently. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT OF PHONOLOGICAL CATEGORIES Principal Investigator & Institution: Gierut, Judith A.; Professor; Speech and Hearing Sciences; Indiana University Bloomington P.O. Box 1847 Bloomington, in 47402 Timing: Fiscal Year 2002; Project Start 01-AUG-1992; Project End 31-MAY-2003 Summary: The proposed research investigates the development of phonological categories by children with functional phonological disorders. The primary focus is on default categories of language, which are presumed to be the universal properties most basic to a sound system, and the building blocks from which all other phonological categories emerge. The fundamental hypothesis to be tested is that, when a child initiates the acquisition process with a default other than the universal, this will have repercussions for subsequent elaboration and restructuring of the sound system, so much so that it may actually impede learning and put the child at-risk for change. Two projects involving 60 children, aged 3;0 to 7;6, are planned to examine defaults at different levels of language structure associated with place of articulation in fricatives and with consonant clusters. In both projects, converging evidence will be brought to bear on the status of defaults in acquisition, and will include phonological descriptions, conceptual testing, learning patterns, and computational analyses. Theoretically, the results will address the universal versus child-specific nature of defaults, the convergence of defaults in representation and processing, and the similarity of defaults across hierarchical levels of linguistic structure. Clinically, the consequences of defaults for learning will be determined, and the efficacy of treatment in inducing change in defaults will be established. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEVELOPMENT OF VOICE NEURAL PROSTHESIS TECHNOLOGY Principal Investigator & Institution: Hillman, Robert E.; Director; Massachusetts Eye and Ear Infirmary 243 Charles St Boston, Ma 02114 Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2008 Summary: (provided by applicant): About half of the patients who undergo total laryngectomy to treat advanced laryngeal cancer rely on a handheld artificial electrolarynx (EL) for communication. Unfortunately, the need to use one hand to control an EL is physically limiting, and these devices produce speech that sounds nonhuman, has reduced intelligibility and loudness, and draws undesirable attention to the user. The primary aim of this project is to develop an improved artificial electrolarynx communication system that more closely approximates normal voice and speech production. This will be accomplished in laryngectomy patients by developing a neural interface to provide hands-free control of an improved EL sound source, i.e., a voice

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neural prosthesis. We will carry out a prospective surgical protocol to preserve phonation-related signals from both normally innervated strap muscles and from strap muscles that have been reinnervated by the recurrent laryngeal nerve. The signals will be detected using surface EMG electrodes and will be processed by a DSP-based system that will control a linear, hands-free EL transducer to produce more human-sounding speech. Patients will be systematically followed post-laryngectomy using electrophysiological and imaging approaches to better understand how underlying anatomical and physiological factors influence the development of neural prosthetic voice. Laryngeal nerve morphology will be studied in surgical specimens to help interpret recovered EMG signals. A post-surgical training protocol will be employed to ensure development of maximum proficiency with the new system, and to formally assess the role of training in the use of a voice neural prosthesis. A main goal is to formally compare speech communication using the two different innervation sources and conventional manual control. In addition, an ongoing iterative development effort will also attempt to use more advanced signal processing approaches to further improve/optimize the degree to which system performance approximates normal speech production in individual patients. In the long-term, once the fundamental approaches have been established, we plan to utilize aspects of this new technology for a broader laryngectomy population, and as a foundation for future efforts to develop additional surgical-prosthetic/neuroprosthetic approaches to voice and speech rehabilitation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EARLY LANGUAGE INTERVENTION VIA THE INTERNET Principal Investigator & Institution: Wilson, Mary S.; President; Laureate Learning Systems, Inc. 110 E Spring St Winooski, Vt 05404 Timing: Fiscal Year 2003; Project Start 15-MAY-2000; Project End 14-AUG-2005 Summary: (provided by applicant): This proposal requests SBIR Phase II support to complete and field test an Internet-based language intervention system designed to promote language development in preschool children with language disorders. Language delays are pervasive among school-age children. Early intervention is crucial since the consequences of language delay can be serious and cumulative. Yet research shows that most children with language delays never receive language intervention services during their preschool years. We propose to complete an Internet-based early language intervention system designed specifically for the remediation of language disorders in 3-5 year old children with language function in the range of 24-42 months. The curricular design will be guided by contemporary linguistic research. Online delivery of the intervention curriculum will be individualized and controlled by an artificial intelligence system that tracks performance and adjusts instructional support. By combining easy access via the Internet with centralized data collection and curricular control, it will become possible to implement and easily manage coordinated school and home language intervention strategies, and to provide services to more children without further taxing limited professional resources. In Phase I we tested the feasibility and technical merit of this objective. A prototype program module was developed and tested with 23 students who were enrolled in an Early Essential Education program, including 19 preschoolers with language delays. Data were collected over the Internet while testing six of these children. In Phase II we plan to fully develop and field-test this Internet-based language intervention system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EARLY ONTOGENY OF ATTUNEMENT TO THE LANGUAGE ENVIRONMENT Principal Investigator & Institution: Best, Catherine T.; Professor; Psychology; Wesleyan University Middletown, Ct 064590241 Timing: Fiscal Year 2002; Project Start 01-APR-1987; Project End 31-MAR-2007 Summary: (provided by applicant): As infants acquire the ambient language, they become attuned to its articulatory properties and to how they are harnessed for phonological functions. This project's long-term goal is to understand the way in which native language experience comes to shape speech perception and production. How do infants, who can acquire any human language, become native speaker-listeners of the ambient adult language? Language-specific constraints on adults' speech perception and production, and their emergence in infants, provide a window on this process, which we examine in studies of language-specific effects in young children and adults. Our first specific aim is to examine how perceptual experience with the ambient language lays the foundation for language-specific phonological development. Previously, we developed a theoretical account of native phonological constraints on perception of nonnative phonetic information, referred to as the Perceptual Assimilation Model (PAM). PAM offers predictions of infants' and adults' discrimination of nonnative contrasts, which have been upheld for adults from several language environments, as well as for development of infants' perception of nonnative contrasts. In the next grant period, we test the hypothesis that perceptual assimilation of nonnative contrasts is predicted by articulatory factors, in studies comparing American English, Danish, French, Italian, and Korean listeners. We investigate the neural basis of languagespecific perceptual attunement with fMRI studies. Also, our research on early attunement is extended to test the perception of articulatory aspects of nonnative speech by preschoolers and infants. The second specific aim is to characterize development of language-specific tendencies in production specifically in the phonetic properties of infant vocalizations. We extend our investigation of phonetic differences in the babbling of English-, French-, and Mandarin-learning infants during the second half-year, testing hypotheses about the emergence of language-specific effects in infants' productions of consonants, vowels, and syllabic organization. We also examine the link between perception and production in studies on infant imitation of speech and nonspeech vocal articulatory gestures. Phonological development research has important implications for early intervention on developmental speech and language deficits. Phonological disorders constitute a large proportion of speech therapy caseloads. Also, research suggests impaired phonological awareness is a primary cause of reading deficits in children. Thus, knowledge about normal phonological development can provide insights into developmental reading disabilities. Finally, this research is relevant to understanding second language learning, an issue of fundamental importance in our increasingly multilingual and multicultural society. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFECTS OF AAC STRATEGIES ON DYSARTHRIC SPEECH Principal Investigator & Institution: Hustad, Katherine C.; Communication Disorders; Pennsylvania State University-Univ Park 110 Technology Center University Park, Pa 16802 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 30-JUN-2003 Summary: (provided by applicant): Intelligibility is a multifaceted construct that is influenced by a myriad of variables such as linguistic-contextual knowledge of the

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listener, as well as the acoustic signal produced by the speaker. However, there has been little systematic investigation of the differential effects of listener-related and speakerrelated variables on intelligibility or the extent to which these variables can be exploited to enhance intelligibility for speakers with chronic dysarthria. The long-term goal of this research is to understand the independent and interactive contributions of speakerrelated and listener-related variables to speech intelligibility in individuals with chronic dysarthria of varying severity. The intervention strategy, alphabet supplementation (AS), in which speakers with dysarthria point to the first letter of each word while simultaneously speaking, is of particular interest in the present research. Preliminary studies suggest that AS has the potential to significantly enhance intelligibility of dysarthric speech; however; the reasons why intelligibility is improved are unknown. It is hypothesized that both speaker-related production changes and linguistic knowledge provided to listeners play a role. Two related studies will investigate the effects of these variables. Study 1 will examine the effects of intrinsic and extrinsic listener knowledge on intelligibility of habitual dysarthric speech through manipulation of semantic predictability and experimentally imposed alphabet cues. Study 2 will examine the effects of speaker-related production changes associated with implementation of AS through analysis of spectral and temporal acoustic differences between habitual speech and speech produced while implementing AS. Across both studies, 16 individuals with dysarthria secondary to cerebral palsy will serve as speakers and 256 non-disabled individuals will serve as listeners. Listeners will orthographically transcribe videotapes of speakers using habitual speech and using alphabet supplementation. Intelligibility data and acoustic data will be subjected to analysis of variance to answer research questions. The proposed studies will gather clinically-relevant efficacy data regarding AS as an intervention strategy within a theoretical framework. Outcomes of these studies will provide critical clinical information as well as important theoretical information that will begin to quantify contributors to speech intelligibility in dysarthria. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF BROMOCRIPTINE ON APHASIA TREATMENT OUTCOME Principal Investigator & Institution: Cherney, Leora R.; Rehabilitation Institute of Chicago Chicago, Il 60645 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): The purpose of this planning grant is to develop the methods and protocols for clinical trials that will evaluate the effectiveness of the pharmacological agent, bromocriptine, on the language outcome of patients with nonfluent aphasia. There is preliminary evidence that bromocriptine (BRC), a dopaminergic agent, can improve specific deficits of aphasia following stroke. However, it has been studied mostly in the chronic phases, and results have been mixed. Furthermore, most studies have used bromocriptine as a monotherapy but there is evidence that BRC may be more effective if given in combination with aphasia language treatment. Carefully designed randomized clinical trials with adequate numbers of patients are needed to adequately explore the optimum timing and duration of BRC for both acute and chronic aphasia, and to assess whether the combination of BRC with speech-language treatment is more effective than either one of them given as a monotherapy. Accordingly, the specific aims of the proposed clinical trials are (1) to assess whether low dose bromocriptine in combination with speech-language treatment results in greater improvements in language performance than speech-language

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treatment plus placebo; (2) to assess whether the effectiveness of low dose bromocriptine differs depending on the intensity of the speech-and-language treatment with which it is combined; (3) to assess whether any resultant changes in language performance are maintained over time; and (4) to assess whether the maintenance of these language skills is dependent on continued use of bromocriptine. Two randomized double-blind placebo-controlled trials (one for acute and one for chronic aphasia) are proposed, each with the following four arms (1) BRC plus low intensity aphasia treatment; (2) BRC plus high intensity aphasia treatment; (3) BRC placebo plus low intensity aphasia treatment; and (4) BRC placebo plus high intensity aphasia treatment. The primary outcome measure for each comparison in the trials will be the change in the Aphasia Quotient (AQ) score on the Western Aphasia Battery (Kertesz, 1982) from pretreatment to post-treatment. Other language performance and cognitive measures will be collected pre- and post-treatment to provide a comprehensive assessment of the changes in language performance. Language performance will also be measured at three and six months after completion of treatment to answer the secondary questions regarding maintenance of language improvements. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF LSVT ON DYSPHAGIA IN PARKINSON'S DISEASE Principal Investigator & Institution: Logemann, Jerilyn A.; Professor; Communication Scis & Disorders; Northwestern University 633 Clark Street Evanston, Il 60208 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2004 Summary: (provided by applicant): Lee Silverman Voice Treatment (LSVT) has shown promise in improving swallow, as well as voice and speech. This project is designed to define the effects of LSVT on swallow in patients who exhibit VFG verified aspiration on any food volume or viscosity. Thirty patients with idiopathic Parkinson's disease, who aspirate (with or without cough response) on any food consistency, will serve as subjects in this study. When identified clinically as at-risk for aspiration, patients will receive a modified barium swallow on a standard protocol, followed by randomization to immediate LSVT treatment for 1-month (4 sessions per-week for 4-weeks) or delayed LSVT beginning 1-month after the first group's therapy is completed. Thus, the comparison of critical interest is therapy vs. no therapy. The delayed group will serve as the no therapy arm. Patients in both arms will receive instructions on diet and posture modification, as necessary, based on the results of VFG. Patients will receive no other swallowing therapy or voice or speech therapy during this 2-month period when both groups receive treatment. After completion of one-month of therapy, patients will receive a modified barium swallow assessment to document change. Medication schedules will remain unchanged throughout the study, and patients will receive their modified barium swallow studies at the same time of day relative to medication both pre- and post-LSVT treatment. The outcome measure will be the elimination of aspiration. We will also define, as secondary measures, the changes in bolus transit times, the observation of percentage residue in the mouth and pharynx, the frequency of swallowing motility disorders and the temporal measures of swallow. These will all serve as explanatory variables for changes in frequency of occurrence of aspiration. This application proposes to generate pilot data on the effects of LSVT on aspiration, a potentially dangerous and costly side effect of dysphagia in Parkinson's disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFECTS OF TRAINING ON ADULT COCHLEAR IMPLANT USERS Principal Investigator & Institution: Fu, Qian-Jie; House Ear Institute 2100 W 3Rd St Los Angeles, Ca 900571922 Timing: Fiscal Year 2002; Project Start 01-MAY-2001; Project End 30-APR-2006 Summary: (Adapted from applicant's abstract): The long-term goal of the proposed study is to develop assessment and training strategies that maximize speech recognition in adults and children fitted with a cochlear implant (Cl). This study will focus on adult Cl users with lower than average (poor) speech recognition skills. It will capitalize on the benefits of a combined behavioral and neurophysiological approach to characterize psychophysical and speech recognition skills and construct individualized training strategies. The specific aims are to (1) evaluate the benefit of intensive psychophysical training; (2) evaluate the benefit of intensive speech recognition training; and (3) evaluate the correlations between the neurophysiological and psychophysical responses, and speech recognition. The significance of the proposed experiments is the demonstration that in poor (i.e., below average speech recognition) adult Cl users, basic psychophysical and speech recognition skills can be improved significantly by intensive training. Previous attempts to improve the speech recognition abilities of poor to moderate implant users have shown, at best, only minimal success. However, these attempts have been extremely limited in the amount of training provided. More intensive training programs may result in larger, more consistent improvements in speech recognition. Clinically, neurophysiological responses such as auditory evoked potentials may provide important information that can be used to guide and monitor individualized training programs. Theoretically, these results will increase our understanding of central auditory system plasticity and the cortical processes and mechanisms involved in perceptual learning. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFICACY OF VOICE THERAPY FOR VOCAL FOLD NODULES Principal Investigator & Institution: Behrman, Alison; New York Eye and Ear Infirmary 310 E 14Th St New York, Ny 10003 Timing: Fiscal Year 2003; Project Start 07-FEB-2003; Project End 31-JAN-2006 Summary: (provided by applicant): Vocal fold nodules are common acquired benign mucosal lesions. Their etiology includes vocal behaviors that cause mucosal trauma and cofactors such as smoking and reflux. The voice disorders associated with nodules may result in significant handicaps. Treatment may include watchful waiting, voice therapy, medical management, and/or surgery. Voice therapy, a behavioral regimen, is the most common treatment modality for nodules. However, therapy efficacy data are scarce and insufficient to provide treatment guidelines. Therefore, the long-term objective of this research is to identify treatment protocols for vocal fold nodules that provide optimal and cost-effective outcomes. Voice therapy for patients with nodules is commonly a 6-12 week treatment regimen comprised of a vocal hygiene and a voice production component. Vocal hygiene is an informational program designed to reduce vocal demands and behaviors that can cause mucosal irritation. The voice production component trains new motor patterns to reduce mucosal trauma during speech. The relative efficacy of these two regimens is unclear. Therefore, the immediate goal of this application is to evaluate the relative efficacy of these voice therapy regimens in the treatment of vocal fold nodules in adults, using a 3-year, single-center randomized clinical trial design: i) vocal hygiene education (VH); ii) voice production (VP); and iii) watchful waiting control (WW). The VH and VP regimens will consist of six consecutive

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weekly 1/2 hour sessions. The primary outcome measures will be patient selfassessment and measured nodule size, and the secondary outcomes will be clinical assessment and acoustic data. All measures will be assessed on all subjects at baseline and at weeks 7 and 10. We hypothesize that VP therapy is more effective than VH therapy or WW. The specific aim will test the hypothesis by determining the relative efficacy of the treatments with regard to the primary and the secondary outcome measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ENGINEERING THE VOCAL FOLD EXTRACELLULAR MATRIX Principal Investigator & Institution: Davis, Kim R.; Professor; Surgery; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2003; Project Start 01-FEB-2000; Project End 31-JAN-2005 Summary: Vocal cord oscillation is governed by the biomechanical properties of the tissue. These biomechanical properties, such as viscosity and elasticity are inherent in the extracellular matrix (ECM) of the vocal fold lamina propria. The composition of the ECM is controlled mainly by the fibroblast. Current theories support factors, and forces felt by the fibroblast. Management of the ECM may be accomplished by manipulation of the factors that effect the fibroblast, or directly changing the CM with injectable or implantable agents or materials. This proposal investigates the effect of forces on the fibroblast and ECM, selects agents for injection into the ECM that optimally influence the biomechanics of the vocal fold, and lays the groundwork for creating implantable, artificial matrices with favorable ECM properties for vocal tissue oscillation. Vocal tissue engineering, in a broad sense, includes, many possible methods that ultimately lead to tissues that has been preticatble created or influenced for a designated functional purpose. This proposal investigates areas that will potentially lead to three future clinical treatments that may predictably manage the biomechanical properties of the vocal flood by changing the composition of the ECM or replacing the ECM. These eventual areas are: 1) specific speech therapy exercises designed to expose the fibroblast to forces that lead to a remodeling of the ECM; 2) infections to manipulate the fibroblast and/or ECM, and 4) combinations of these. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ERP INTERVENTION

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Principal Investigator & Institution: Yoder, Paul J.; Professor; Special Education; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 30-NOV-2008 Summary: (provided by applicant): Two studies are proposed. The first study will seek to clarify the extent to which preschoolers with specific language impairment (SLI) have speech processing deficits. The second study seeks to determine whether the relative superiority of two language interventions in children with SLI depends on pretreatment speech processing ability and its behavioral correlates. Sixty children with SLI in Brown's stage I - IV will be recruited in this project. Additionally, 60 typically developing children matched for age, gender, ethnicity, and SES will be used to address the questions for Study 1. At entry into the study, language and speech processing will be tested. Speech processing will be measured with event-related potential and behavioral measures. For study two, the SLI children will be randomly assigned to one of two treatment groups: Milieu Language Teaching (MLT) or Broad-Target Recast

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(BRT) treatment. These children will receive treatment in a 1:1 format for 30 minutes/session, 3/week for 6 months. Grammar will be tested again twice during the treatment phase, immediately after treatment, and at two follow-up periods. General measures of expressive and receptive language and speech processing will be repeated at the last period. Multiple regression, multivariate permutation tests, and growth curve analyses will be used to test the research questions. Five years of funding are requested. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC DETERMINANTS OF ISOLATED CLEFT PALATE IN MICE Principal Investigator & Institution: Everett, Eric T.; Assistant Professor; Oral Facial Development; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2002; Project Start 01-MAR-2001; Project End 28-FEB-2003 Summary: Development of the mammalian secondary palate is a complex and critical process then when perturbed can lead to cleft palate (CP). Clefts of the primary and/or secondary palate are consistently included among he more common congenital anomalies occurring in humans. Children born with a cleft frequently require several different types of services, e.g., surgery, dental/orthodontic care, and speech therapy, all of which need to be provided in a coordinated manner over a period of years in order to obtain successful rehabilitation. Feeding, hearing, and speech problems are common sequelae of CP making this a significant disability particularly for the very young. Even though the combination of cleft lip with/or without cleft palate (CL/P) is more often seen, CP accounts for approximately one-third of all clefting cases and carries an incidence of 3 to 9 per 10,000 live births/year. CP is considered to an etiologically heterogeneous trait with an important genetic contribution. CP can be associated with more than 370 characterized disord4ers, yet in more than 50%^ cases, CP occurs as an isolated trait (non-syndromic). Our long- term objectives focus on understanding the molecular processes that govern mammalian secondary palate formation and on identifying and characterizing those genetic determinants that contribute directly and/or indirectly to the occurrence of CP in humans. The identification of genes responsible for CP in mice will permit characterization of their temporospatial patterns of expression and function activities during normal palatogenesis; and facilitate investigation of any putative roles played by their human counterparts in familial and sporadic forms of CP. We have identified four lines of transgenic mice resulting from recessive insertional mutations that cause non-syndromic CP. FISH analysis revealed the chromosomal localization of the transgene integration sites in three of the lines. The mutant loci map to Chromosome 3 at bands B-C and F3, in lines of OVE270 and OVE1226B, respectively. The transgene complex in the OVE1328 line localizes to Chromosome 4 at band A2. As a prelude to positional cloning strategies that will lead to the identification and characterizing the gene(s) disrupted, we will focus initially on one transgenic line in order to accomplish following specific aims: (1) identify and map the genomic DNA flanking the transgene complex integration site and (2) determine the interval of genomic DNA that in wildtype mice exists between the DNA that flanks the transgene integration site characterized in aim 1. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GRAMMATICAL /INTELLIGIBILITY INTERVENTION--DOWN SYNDROME Principal Investigator & Institution: Camarata, Stephen M.; Professor of Hearing and Speech Sciences; Psychology & Human Development; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2004 Summary: (provided by applicant): Children with Down syndrome often display speech-intelligibility and grammatical deficits beyond what would be predicted based upon general cognitive levels. The purpose of the proposed study is two-fold. First, recast intervention techniques that have proven effective in other populations with speech-intelligibility and grammatical deficits will be piloted in children with Down syndrome. Second, mismatched negativity (MMN) and N1 will be measured using ERP techniques and oral motor functioning as potential predictors of growth during intervention. A total of 12 children will be included in a multiple baseline, multiple probe design during the two year project. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GRAMMATICAL MORPHOLOGY IN SPECIFIC LANGUAGE IMPAIRMENT Principal Investigator & Institution: Leonard, Laurence B.; Rachel E. Stark Distinguished Professor; Audiology and Speech Sciences; Purdue University West Lafayette West Lafayette, in 479072040 Timing: Fiscal Year 2002; Project Start 01-JUL-2000; Project End 30-JUN-2005 Summary: Many children with specific language impairment (SLI) show an especially serious limitation in the use of grammatical morphemes. The problematic morphemes include verb inflections such as -s (as in "She walks to work"), and function words such as auxiliary verbs (as in "Chris is talking on the phone"). The problem can be longstanding, often carrying into the school years. The purpose of this project is to explore the possible bases of these grammatical morpheme limitations. To accomplish this goal, an experimental treatment paradigm will be employed. Each of the alternative explanations of grammatical morpheme limitations in children with SLI provides a reasonable account of the grammatical morphemes commonly studied. However, these accounts differ in their predictions across a wider range of grammatical morphemes. By monitoring the children's production and comprehension of different sets of grammatical morphemes and providing the children with intensive treatment on one set, the pattern of gains seen on the untreated sets should reveal the nature of the relationship among the morphemes. Because no two accounts make the same predictions for all morphemes, the resulting pattern of data should lend support to some accounts and argue against others. The treatment design to be employed should also provide important benefits of a clinical nature. The large number of children with SLI participating and the wide range of grammatical morphemes to be studied should provide important information about both the efficacy of treatment and the generalization patterns that might be expected from this treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMAGING AND MODELING THERAPEUTIC MECHANISMS OF ACTION Principal Investigator & Institution: Fox, Peter T.; Director, Research Imaging Center; Research Imaging Center; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2002; Project Start 15-MAR-2002; Project End 28-FEB-2004 Summary: (provided by applicant): The long-range vision of the proposed research program is to develop imaging strategies to study mechanisms of action of therapeutic interventions in brain disorders. The immediate goal of this proposal is to study mechanisms of action of treatment in Idiopathic Parkinson's Disease (IPD). Mechanism of action is a fundamentally important research objective, as the rational development of new treatments demands an understanding of mechanisms of action. Mechanism of action is a timely direction for imaging research, because methods are emerging which can demonstrate changes in variables directly related to mechanism of action, namely: 1) task-performance strategy (measured as the set of brain functional areas recruited by the task); 2) information exchange (measured as inter-regional functional co-variance during performance); and 3) connectivity & synaptic weighting and plastic changes therein (measured as inter-regional functional covariance during rest). Further, Structural Equation Modeling (SEM) offers a modeling construct for merging these three types of measurement into a functional system model. Herein, we propose to study the mechanism of action of the Lee Silverman Voice Treatment (LSVT) for hypophonia in IPD. Image-data acquired will include: functional MRI at rest and during speech, H21 0 PET at rest, during speech and during image guided TMS to the SMA. Taskperformance strategy will be assessed by functional activity during overt speech (paragraph reading) imaged with both H2O PET and with fMRI. Information exchange (inter-regional covariance during task) will be computed from each functional data set. Anatomical connectivity (interregional covariance during rest) will be measured with TMS/PET and with resting-state MRI. Structural Equation Modeling will be applied to PET- and fMR1-derived measures of strategy, information exchange and connectivity, to model the speech-motor system pre- and post-LSVT. All measures will be performed before and after 4 weeks of LSVT in 10 hypophonic IPD patients selected for LSVT. Once established, these methods have the potential to provide tools for exploring mechanism of action and thereby providing a rationale basis for the development of new treatments in IPD, as well as in many neurological, psychiatric and developmental disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMPROVING SPEECH INTERVENTION FOR DEAF CHILDREN Principal Investigator & Institution: Higgins, Maureen B.; Coordinator; Father Flanagan's Boys' Home Boys Town, Ne 68010 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2005 Summary: IMPROVING SPEECH INTERVENTION FOR DEAF CHILDREN The longrange goal of this project is to develop intervention practices that will optimize speech production outcomes for prelingually deafened children, particularly those with cochlear implants (CIs). There is remarkably little scientific evidence to support the treatment approaches used in speech intervention with such children. Data are needed to guide clinicians in selecting the most appropriate treatment goals and most effective treatment procedures. Speech/voice physiologic data from children implanted after four years of age support the need for early and highly focused intervention directed at remediation of their deviant speech/voice characteristics. One aim of this application is

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to determine if there is a similar need for children who have had fewer years of auditory deprivation. Therefore, the frequency of occurrence of deviant speech/voice behaviors (i.e., negative intraoral air pressures, high fundamental frequencies) for children implanted before age three and after age four will be compared. A second aim is to compare the efficacy of two forms of speech intervention with children with CIs. One form of treatment will include auditory discrimination and speech production activities. The other will focus on speech production only. Speech production and perception outcomes with both forms of treatment will be compared. Other aims will address how the acoustic characteristics of speech production of children with hearing loss (HL) are affected by 1) simultaneous speaking and signing and signed models 2) instruction to speak more clearly and 3) different speech elicitation procedures. These findings will provide information about 1) the ways in which signing and signed input could be adapted to help deaf children learn the most normal speech production patterns possible during intervention 2) the successful and unsuccessful strategies used by children with HL to maximize their intelligibility and 3) the hierarchy of difficulty of tasks that are used during speech intervention with children with HL. The ultimate goal of this application is to contribute to the development of improved intervention procedures so that more deaf children can become intelligible speakers. Such an achievement would expand the social, educational, and vocational opportunities of deaf children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEDIALIZATION VS. REINNERVATION FOR VOCAL CORD PARALYSIS Principal Investigator & Institution: Paniello, Randal C.; Otolaryngology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): Unilateral vocal fold paralysis (UVFP) is caused by injury to the recurrent laryngeal nerve. Patients with UVFP may have significant impairment of vocal cord function, including a breathy paralytic dysphonia. There are several available approaches for the treatment of this condition. Vocal fold medialization is currently used by most otolaryngologists and is probably the standard of care for treating this condition. An alternative approach is laryngeal reinnervation, which has a number of potential advantages over medialization but which requires several months before a final result is achieved. The primary goal of this study is to determine which approach produces a better outcome, i.e. to determine whether the theoretical advantages of reinnervation are actually achieved, and whether they outweigh the disadvantage of having to wait for them. Previous studies comparing these approaches have been small and limited by significant non-randomized patient selection bias. The study design is a multicenter, prospective, randomized clinical trial. Patients with UVFP meeting all inclusion criteria and released from therapy by a speech-language pathologist will be invited to participate. Participants will be stratified by site of lesion, electromyographic findings and pretreatment voice severity, then randomized into either a medialization arm or a reinnervation arm. Patients will be recruited from 12 academic medical centers with participating surgeons; 149 patients are planned for each study arm. An intense data collection protocol including voice recordings, aerodynamic measurements, electroglottography, videolaryngostroboscopy, and a validated clinical outcomes instrument will be collected pre-treatment and at 6 and 12 months post-treatment. Subjective perceptual scores will be obtained by presenting pre- and postoperative voice samples to both naive and experienced listeners

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using a custom computerized algorithm. The objective measurements will undergo multivariate analysis with stepwise multiple regression. These data will be used to test the hypothesis that reinnervation gives better results than medialization in patients with UVFP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MINORITY PREDOCTORAL FELLOWSHIP PROGRAM Principal Investigator & Institution: Fossett, Tepanta R.; Communication Sci & Disorders; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2003 Summary: (provided by applicant): The overall objective of this research is to advance understanding of the cognitive, linguistic and motoric mechanisms involved in normal and pathologic speech production systems. The specific aim of this proposal is to examine the effects of speaking rate manipulations on phonologic encoding in normal and aphasic persons without dysarthria or apraxia of speech (AOS). Changes in speaking rate may affect phonologic encoding and/or motor level processes. Sound production errors frequently occur in aphasia and are often used as evidence to establish differential diagnosis among types of aphasia and other neurogenic communication disorders (e.g., AOS). The frequent co-occurrence of language and motor level deficits following stroke has caused confusion regarding what types of errors can serve as evidence for disruption of specific levels of the production system. Serial order errors, however, are generally assumed to result from disruption of phonologic encoding processes in some individuals with aphasia who are without concomitant deficits in the speech motor system. Based on a spreading-activation model, it is hypothesized that manipulating speaking rate will affect serial order errors in predictable patterns in individuals with aphasia and in unimpaired speakers. In this repeated measures design, subjects will produce sentences at three speaking rates, in response to auditorily presented tongue-twister stimuli. Phonological-level serial order error (anticipation, perseverative and exchange) ratios will serve as the primary dependent variable. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROMOTOR BASIS OF STUTTERING Principal Investigator & Institution: Mcclean, Michael D.; Speech Scientist; Surgery; Western Michigan University 1903 W Michigan Ave Kalamazoo, Mi 49008 Timing: Fiscal Year 2002; Project Start 01-MAY-1999; Project End 30-APR-2004 Summary: The general goals of the proposed research are an enhanced understanding of the neuromotor basis of stuttering and the development of improved forms of speech therapy for persons who stutter. The problem of stuttering can reasonably be viewed as a motor disorder. From this perspective, speech disfluency is likely to be the result of the interaction of several forms of neural input to pattern generating circuitry within the motor systems of the brain. Such input involves, for example, systems in the brain that mediate phonetic pattern selection (i.e. the particular sounds we produce), emotional response, and speech rate or how fast we speak. Given the complexity of this overall system, it is logical that we develop improved methods for evaluating speech pattern generating function while controlling for these different sources of input. This approach is taken in the present research through analyses of orofacial movements and voice acoustics. A central issue in the study of pattern generating function for speech concerns how different muscle systems (e.g., tongue and jaw) are controlled and coordinated.

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This general issue will be studied through analysis of orofacial movements and voice acoustics in individuals with a history of stuttering and a group of normal speakers. An electromagnetic system will be used to record displacements of the upper lip, lower lip, jaw, and tongue while subjects repeat a limited set of speech utterances at varying rates and vocal intensities. A wide range of clinical-behavioral measures of speech performance will be obtained in stutterer subjects. A general hypothesis underlying much of the work is that there are subgroups of individuals whose pattern generating function for speech reflects different motor strategies, and these strategies have varying levels of inherent stability or propensity for disfluency. This and related hypotheses will be addressed in relation to investigations concerning (1) the association of orofacial and voice acoustic measures in normal speakers, (2) the association of speech motor output to clinical-behavioral measures of speech performance in persons who stutter, (3) the effects of speech therapy on speech motor output, (4) the existence of speech motor subgroups, and (5) the temporal-spatial characteristics of orofacial movements and voice acoustics during disfluency. Work on these various problems should lead to an improved basis for clinical categorization of persons who stutter, better understanding of the changes in motor performance associated with speech therapy, and a broad data base for computational modeling of speech motor control and simulation of the mechanisms of speech disfluency. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PDA-ENHANCED SPEECH TREATMENT FOR PARKINSON DISEASE Principal Investigator & Institution: Ramig, Lorraine O.; Professor; Commun Disorders & Speech Sci; University of Colorado at Boulder Boulder, Co 80309 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 29-FEB-2004 Summary: (provided by applicant): The aim of this project is to determine the efficacy of delivering a proven speech therapy treatment for PD via the new technology of PDA's. This application is represents a novel approach to meet the (growing) need to provide speech therapy services to a greater number of PD patients. In addition, the application seeks to determine whether PDA's could be used as remote data acquisition devices. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PERCUTANEOUS DYSFUNCTION

FES

ON

POST

STROKE

SHOULDER

Principal Investigator & Institution: Chae, John; Associate Professor and Director of Rese; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: Shoulder subluxation in hemiplegia is a common problem and can lead to shoulder pain, decreased range of motion, and poor motor and functional recovery. The purpose of this study is to assess the efficacy of percutaneous functional electrical stimulation of hemiplegic shoulder muscles in 1)decreasing shoulder subluxation, 2)preventing or minimizing shoulder pain and 3)enhancing neurologic motor and 4)functional (ADL) recovery of the impaired upper extremity. Subjects , who are within 3 weeks of their first anterior circulation nonhemorrhagic infarct with clinical evidence of shoulder subluxation will be enrolled and randomized to the electrical stimulation or control group. The stimulation group will be implanted with percutaneous electrodes in their hemiplegic posterior deltoid and supraspinatus muscles and receive 6 hrs/day of stimulation for 3 weeks. The control group will be treated with the Harris hemisling and

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a wheelchair arm support board. Both groups will receive standard physical, occupational, and speech therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT

PHONOLOGICAL

CHANGE:

STIMULABILITY

IN

CYCLES

Principal Investigator & Institution: Glaspey, Amy M.; Speech and Hearing Sciences; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2004; Project Start 16-MAR-2004; Project End 15-MAR-2006 Summary: (provided by applicant): The goal of phonological treatment is to improve the skills of children with phonological disorders of speech, yet data to support the efficacy of treatment is limited due to the slow nature of phonological development and the lack of adequate measures to assess small increments of change during therapy. The proposed investigation presents a new measure that offers potential for the assessment of incremental change, the Scaffolding Scale of Stimulability (SSS) (Glaspey, 2002). The SSS is a dynamic assessment that measures expressive phonology based on the types of cues and modeling a child needs to produce targets within increasingly complex linguistic environments. The aims of the proposed investigation include: (1) assessment of the validity and reliability of the SSS; (2) comparison of outcomes of the SSS with static assessment measures; and (3) documentation of treatment effects during six months of cycles treatment. Overall, the proposed investigation will provide insight into the nature of phonological change, which will allow for better measurement of treatment efficacy in future studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRESCHOOL MEASUREMENT/TREATMENT/RECOVERY

STUTTERING:

Principal Investigator & Institution: Cordes Bothe, Anne K.; School of Professional Studies; University of Georgia 617 Boyd, Gsrc Athens, Ga 306027411 Timing: Fiscal Year 2002; Project Start 20-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): Stuttering is a disorder of speech production that can interfere significantly with communication and therefore with social, educational, vocational, and most other life activities. It is widely acknowledged that children are more likely to recover from stuttering than adults, but whether their recovery should be attributed to the nature of the disorder, to naturally occurring environmental factors, or to parent- or clinician administered treatment remains a much more difficult question to answer. The studies to be completed under this grant, therefore, will focus on the relationships among measurement, judge training, treatment, and recovery for preschool children who stutter, under two specific aims: I. Measurement systems for the speech of children who stutter will be developed and validated; and II. The parameters and the effects of parent-administered consequences for young children's stuttering will be evaluated. Studies to be conducted under Specific Aim I will identify exemplars of preschool children's stuttered and nonstuttered speech, based on the repeated judgments of 10 internationally recognized, authoritative judges; adapt an existing computer-driven response-contingent judge-training program to use the obtained exemplars of children's speech, and determine whether the resulting Child Training program is necessary and sufficient for training judges to provide valid and reliable data about children's stuttering; and develop an internet-available version of the Training program to compare results from students, clinicians, and parents in multiple sites.

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Studies to be conducted under Specific Aim II will then make use of the measurement training program and the external measurement validation system, as developed under Specific Aim I, to determine whether children who appear to recover from their stuttering without formal treatment receive more speech-related consequences from their parents than do children who do not recover; to compare the effectiveness, effects, and efficiency of three parent-training, parent-administered treatment programs for young children's stuttering; and to determine whether maintenance results are similar for children who recover from their stuttering with and without clinician-directed intervention. Together, the studies to be conducted under this grant should have substantial impact both on the discipline's knowledge about stuttering and on the management options that can be recommended to parents as well-supported choices for their children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REHABILITATION FOR SELF-MANAGEMENT OF PARKINSONS DISEASE Principal Investigator & Institution: Wagenaar, Robert C.; Professor of Neurophysiology; Phsyical Therapy; Boston University Charles River Campus 881 Commonwealth Avenue Boston, Ma 02215 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2006 Summary: (provided by applicant): The overall goal of the proposed research is to determine whether rehabilitation that focuses on self-management of health helps to improve the day-to-day functioning and quality of life of community-living clients with Parkinson's disease (PD), beyond the effects of medical treatment alone. Typically for people with PD, medical treatment declines in effectiveness over a variable number of years, and these individuals face a relentless progression into disability and lowered quality of life that can end in a need for custodial care. If a rehabilitation program can ameliorate disability and support a high quality of life by positively influencing mobility, communication, and healthful daily living skills, it is possible that more intensive use of medication could be postponed. As a result, people with this disease might benefit longer from medication and be less quickly referred to costly inpatient rehabilitation and long term care facilities. The proposed research uses rigorous methodology, which is rare for studies of rehabilitation with this population, and builds on our previous research toward understanding the role of rehabilitation in promoting health in people with PD. In a randomized controlled design, people with PD will be assigned to one of three conditions for a duration of 6 weeks: (i) medication only, (ii)medication plus 2 outpatient group rehabilitation sessions and 1 social activity session per week, or (iii)medication plus 2 outpatient group rehabilitation sessions and 1 home/community rehabilitation session per week. Rehabilitation will occur through integrated physical, occupational, and speech therapy services specialized to the selfmanagement of health needs of people with PD. The first specific aim of the proposed study is to determine if increasing "doses" of self-management rehabilitation (from Conditions i to ii to iii) result in increasingly positive quality of life outcomes. The second aim is to document change in rehabilitation effects at 2 and 6 months postintervention. The third aim is to describe possible active ingredients in the rehabilitation by measuring neuromuscular and voice function outcomes. The fourth aim is to provide evidence for the validity of self-management outcome measures for use with PD. It is hypothesized that there will be beneficial and lasting effects of rehabilitation for quality of life outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SOUND CONTRASTS IN PHONOLOGY (SCIP) Principal Investigator & Institution: Mckinley, Nancy L.; Thinking Publications 424 Galloway St Eau Claire, Wi 54703 Timing: Fiscal Year 2003; Project Start 31-JAN-2003; Project End 31-JUL-2003 Summary: (provided by applicant): This project is designed to address the gap that exists between recent discoveries in phonological intervention and clinical application during intervention of severe speech disorders. A software program will be developed to help support practitioners' efficient implementation of these important clinical innovations. Specifically, in Phase I, a software tool, Sound Contrasts in Phonology (SCIP) and a user manual, will be developed to be used by speech-language pathologists (SLPs) in treating speech disorders in children. Feasibility testing of the product with SLPs will follow alpha and beta testing of the software. Phase II will examine the treatment efficacy of the tool. Three regional test sites will be incorporated to assess the feasibility of SCIP and the user manual. A counterbalanced design will be used in two experimental tasks with a mandatory quota of 8 SLPs in each of the three regional sites (N = 24). Feasibility data will be collected in terms of efficiency and accuracy in two experimental tasks that compare SCIP with traditional methods of developing treatment materials and reporting treatment progress. Specifically, quantitative data will be collected in the form of the amount of time it takes to develop treatment materials under two conditions (SCIP vs traditional) and the number of errors to complete each task (a measure of accuracy expressed as a percentage). Analysis of variance employing all the design features of counterbalancing, study participants, and study site, will be applied to each measurement. Qualitative data will also be collected in the form of a questionnaire. The project will potentially have important clinical significance. As proposed, the project will provide a "better, faster, cheaper" approach in the development of intervention materials to increase clinician access to recent innovations in phonological intervention, decrease clinicians' time and effort in developing individualized treatment materials, and potentially have a profound impact on the nature of phonological intervention with significant decreases in the length of time typically required by children with speech disabilities. The commercial potential of SCIP is expected to be high given that there are over 86,000 certified SLPs in the U.S., many of whom serve the 20% of children who exhibit phonological disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SPECIALIZED THERAPIES BY CHILDREN, CORRELATES OF USE Principal Investigator & Institution: Kuhlthau, Karen A.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2003; Project Start 06-AUG-2003; Project End 31-JUL-2004 Summary: (provided by applicant): This project describes patterns and correlates of use of specialized therapies (physical therapy, occupational therapy, speech therapy, language therapy, respiratory therapy, and home health) in children and in children with chronic conditions and injuries. The project has three objectives: 1) to describe patterns of use and expenditures for specialized therapies for children with and without chronic conditions, 2) to determine correlates of specialized therapy use among children including predisposing, enabling, and need characteristics, and, 3) to understand how use of providers affects use. The project will use data from four data sources, the National Health Interview Survey on Disability, the Medical Expenditure Panel Survey, the 5 percent sample of Medi-Cal eligibility and encounter data, California's fee-forservice Medicaid plan, and a cohort of children in Harvard Vanguard Health Associates.

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Descriptive analyses will include examining patterns of use among chronically and nonchronically ill children and understanding absolute and relative expenditures of therapies. The study will further examine the role of primary and specialty providers as predictors of specialized therapy use. This project will provide the first comprehensive and systematic description of the use, expenditures, and predictors of specialized therapies by children. Understanding the correlates of use and expenditures will provide information about children who have relatively rich versus relatively sparse use of services. This information will help health plans to better predict future use. It will help advocates who may seek to change policies that influence access for subpopulations. This study will provide useful information in discussions regarding care co-ordination and interagency systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SPEECH KINEMATICS IN PARKINSON'S DISEASE Principal Investigator & Institution: Huber, Jessica E.; Audiology and Speech Sciences; Purdue University West Lafayette West Lafayette, in 479072040 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): Major advances in speech therapy for patients with Parkinson's disease (PD) have been made in the last decade. Significantly improved therapy results have been reported using the Lee Silverman Voice Treatment (LSVT) program. A core feature of LSVT is to instruct the patient to speak more loudly, thereby increasing sound pressure level (SPL). The general goal of this project is to investigate the physiologic mechanisms underlying increased SPL in patients with PD. Individuals with PD demonstrate speech movements (kinematics) which differ from normal speakers. It has been hypothesized that, in individuals with PD, increasing SPL causes a scaling-up of motor output from all three speech subsystems - respiratory, laryngeal, and articulatory - resulting in more normal speech production. The first specific aim of this project is to examine respiratory and articulatory kinematics in individuals with PD while they increase SPL. Individuals with PD may have difficulty accurately perceiving their own vocal intensity. Due to this difficulty, the mechanisms individuals with PD use to increase SPL may depend on the amount of self-monitoring of vocal intensity required by the task. Thus, the second specific aim of this project is to examine the effect of different cues to increase SPL on the kinematic mechanisms utilized by individuals with PD. Studies of motor control of the limbs have indicated that individuals with PD may have difficulty with premotor planning. If increasing SPL results in global effects to the speech system, as has been hypothesized, premotor organization may be altered. Therefore, there is one exploratory aim in the present project: to examine premotor planning of the respiratory subsystem for speech by individuals with PD. Methods employed in this project will include the collection and analysis of chest wall, lip, and jaw kinematics to examine the mechanisms for increasing SPL in individuals with PD. An understanding of the effects of increasing SPL on speech kinematics and premotor planning and of how difficulties in perception of vocal intensity affect kinematics is likely to assist with the improvement of speech therapy for individuals with PD and to further the understanding of the effects of PD on speech motor control. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Speech Therapy

Project Title: TEACHING NONVERBAL CHILDREN WITH AUTISM USEFUL SPEECH Principal Investigator & Institution: Rogers, Sally J.; Professor of Psychiatry; Psychiatry; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 24-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): Autism has a devastating effect on language development. Fifty percent of persons with autism do not develop complex, communicative speech, and lack of speech is associated with very poor outcomes in autism. Yet there is evidence that specific treatments delivered early in life can increase the number of children with autism who can learn useful speech. Various early intervention projects have indicated that 75-95 percent of children receiving very intensive and carefully constructed early intervention programs develop some useful speech by age 5. However, we have very few manualized, empirically demonstrated treatments to guide practitioners in developing expressive speech in young children with autism. The mechanisms that underlie the language impairment in autism are not clear. Lack of social engagement and mental retardation are assumed to play pivotal roles and treatments have generally focused on increasing social engagement, imitation skills, and understanding of language in order to develop language. The approach used to teach speech and language in the Denver Model is built from such a conceptualization. However, in the past few years, empirical findings have begun to suggest that the presence of oral-motor dyspraxia in at least some children with autism may be an additional barrier to speech development. A promising treatment for oral motor dyspraxia solidly based in neuromotor aspects of speech production has been successfully used for the past 20 years: the PROMPT approach. While originally developed for other neurologically based speech impairments, it has begun to be used clinically successfully with young nonverbal children with autism after more traditional approaches to speech development have failed. The main objectives of the project are to complete standardization and refinement of these two treatments for expressive language in autism: PROMPT and the Denver Model, and to examine their effects on nonverbal preschoolers with autism by obtaining initial pilot data on efficacy of each for developing expressive speech. These activities are prerequisite for a full-scale experimental treatment study comparing these two treatments for developing speech in young nonverbal children with autism. (1) Treatment manuals both for therapists and for parents will be completed, tested, and refined. (2) Treatment fidelity measures will be developed and tested for both therapy and home components. (3) Pilot testing will be used to establish appropriate "dosages" of treatments to assure reasonable progress. (4) Finally, a short-term pilot study using random assignment of matched participants and single subject design will be conducted to examine efficacy of each approach. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THINK REHABILITATION

BIG,

FROM

VOICE

TO

LIMB

MOVEMENT

Principal Investigator & Institution: Koshland, Gail F.; Physiology; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JAN-2005 Summary: We will test the efficacy of an innovative treatment technique that could induce a radical paradigm shift in movement rehabilitation for people with Parkinson disease (PD). Based upon an extremely successful speech treatment for people with

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idiopathic PD (the Lee Silverman Voice Treatment (LSVT(R)), people with PD will undergo intensive practice of high effort/large amplitude arm movements and learn to transfer their "big effort" to everyday movements. Unlike other physical therapy approaches with unclear efficacy, the LSVT(R) approach has clearly demonstrated both short and long term efficacy up to two years. In addition, LSVT(R) is supported by hypotheses put forth to explain hypokinesia and bradykinesia in people with PD, therefore, it is easily applied to limb movements. Fifty subjects will be randomly assigned to one of two interventions with similar intensity regimens, think big therapy (novel) or traditional physical therapy (control). Speech studies have shown that a treatment with a simple focus (think loud) may generalize to affect motor output in other systems (e.g., articulation, speaking rate, swallowing, respiratory mechanics). Thus, we predict that learning to perform bigger arm movements will also improve arm speed, based upon the well described relationship between movement speed and amplitude. In addition, we will document the generalizability of this technique to improve arm and leg function. Although both groups may show improvements given the intense work schedule, we predict that improvements in the think big therapy will be greater than in the traditional physical therapy (control) group. Measurements will include physiological tests for assessing arm movement speed and amplitude using kinematic techniques. As "sense of effort" is the primary proposed mechanism underlying this treatment approach, we will measure sense of effort. Additional measurements will include tests of arm and leg function (strength, timed ADL tasks, gait, handwriting), a standardized clinical assessment (UPDRS), and a subjective rating scale. If successful, we plan to 1) further validate retention of treatment effects and generalizability of this technique (speech to limb; limb to speech) and 2) develop a standardized protocol that can be used for training physical therapists. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRANSCRANIAL MAGNETIC STIMULATION TO IMPROVE SPEECH Principal Investigator & Institution: Naeser, Margaret A.; Research Professor of Neurology; Neurology; Boston University Medical Campus 715 Albany St, 560 Boston, Ma 02118 Timing: Fiscal Year 2002; Project Start 05-JUL-2002; Project End 30-JUN-2005 Summary: (provided by applicant): The purpose of this research is to investigate whether repetitive transcranial magnetic stimulation (rTMS) can be used to improve speech in chronic stroke patients with nonfluent aphasia. rTMS allows non-invasive stimulation of human cortex. Slow (1 Hz) rTMS appears to decrease excitability in the targeted cortical region of interest (ROI) leading to measurable behavioral effects. A small 8-shaped coil (as will be used in the present study) affects primarily a cortical area of less than 2 x 2 cm. We have observed in fMRI studies that patients with nonfluent speech (slow, hesitant, poorly articulated, agranunatic speech) have excess blood flow (presumed abnormal increase in cortical excitability) in many right (R) perisylvian areas including R sensorimotor mouth, R Broca's homologue (BA 45) and R Wernicke's homologue(BA 22). Slow (1 Hz) rTMS will be used to suppress activation of specific ROls observed to have high blood flow (presumed overactivation) on fMRI. It is expected that suppression of activity in the directly targeted ROl will have an overall modulating effect on functionally connected elements of the distributed neural network for naming (and propositional speech) in chronic stroke patients with nonfluent aphasia, and will result in a behavioral improvement. Pilot data on four nonfluent aphasia patients support this claim and document the feasibility and safety of the study. Naming

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Ability (20 pictures of common objects) and reaction times are measured immediately pre- and immediately post- an rTMS treatment. There are two phases. Phase 1 includes aphasia patients (n=40) and age-matched normal controls (n=12). For normal controls, Phase 1 will provide information on the effect of slow rTMS on 7 language-related ROIs. For aphasia patients, Phase 1 will provide information regarding which of 5 ROIs is the most promising for more extensive rTMS treatment in Phase 2. Phase 2 (aphasia patients only) is a randomized, sham-controlled, incomplete crossover design. One group (n=20) receives 10 Real rTMS treatments over a two-week period; and one group (n=20), 10 Sham rTMS treatments over a two-week period. Only those who receive Sham treatments FIRST will be crossed over. It is hypothesized that 10 sessions of Real rTMS at 1 Hz given over a two week period to a specific ROl (e.g., R BA 45, supported from our pilot data) will significantly improve picture naming and propositional speech, when tested at 1-2 weeks and 2 months post- the last rTMS treatment, as compared to pre- Phase 2 testing. Sham rTMS to the same ROl is hypothesized to have no effect. This will be the first systematic rTMS study designed to improve speech in stroke patients with nonfluent aphasia. The implications could be far reaching regarding optimal treatment in aphasia with potential for combining current language therapies with rTMS to promote maximum recovery of language. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VARIABILITY IN PHONOLOGICAL/ARTICULATORY DISORDERS Principal Investigator & Institution: Forrest, Karen M.; Professor; Speech and Hearing Sciences; Indiana University Bloomington P.O. Box 1847 Bloomington, in 47402 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): It is estimated that approximately 20% of the preschool and school age population demonstrate speech acquisition disorders that are not attributable to an organic cause (NIDCD, 1994). Factors that influence the development of these are not known, but disorders of speech perception, oral-motor control, prosody, and cognitive dysfunction all have received attention as possible etiological determinants. The conclusion from these many research and clinical investigations is that PAD is not likely to have a unitary cause or profile; however, characteristics that differentiate subtypes remain elusive. The primary goal of this research is to provide a multidimensional approach to determining PAD subtypes. A dynamic systems model is being used to drive hypotheses about the factors that influence PAD development. Within this context, the impact of speech perception capabilities, including the ability of young children to extract linguistically relevant information from a variable signal, will be explored. Variations in speech production will be examined with acoustic analysis techniques with the aim of determining how variability and consistency influence speech acquisition and its disorder. Factors to be included in this analysis reflect both spectral and temporal control of articulation. Because this project also is motivated by clinical concerns, diagnostic tools that may help differentiate subtypes of PAD will be evaluated. Treatment protocols will be assessed to determine the relative efficacy of various procedures. The interaction between etiological factors, diagnostic markers and treatment efficacy will be examined, It is expected that this multifaceted approach will prove clinically useful, and at the same time, refine our theories of speech acquisition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VIRTUAL THERAPIST SPEECH TREATMENT FOR PARKINSON DISEASE Principal Investigator & Institution: Cole, Ronald A.; Institute of Cognitive Science; University of Colorado at Boulder Boulder, Co 80309 Timing: Fiscal Year 2004; Project Start 15-APR-2004; Project End 31-MAR-2006 Summary: (provided by applicant): Our previous studies have generated the first shortand long-term experimental efficacy data for speech treatment for individuals with Idiopathic Parkinson disease (IPD), documenting acoustic, aerodynamic and physiologic changes accompanying treatment. Despite these major steps in establishing the experimental efficacy of speech treatment for individuals with IPD, the "real world" treatment of speech remains an unmet need for the vast majority of these individuals. At least 89% of individuals with IPD have disordered speech, but only 3-4% receive speech treatment. This is a serious problem, as individuals with IPD who have received Lee Silverman Voice Treatment (LSVT) therapy benefit in many ways: they not only produce more intelligible and expressive speech, but they often report dramatic improvements in their self esteem and quality of life. We thus propose to conduct research to demonstrate the feasibility 6f a novel solution to make LSVT training more accessible to over one million individuals--the development and testing of a fully automated computer-based speech therapy system, in which voice training is conducted by a virtual speech therapist--and animated computer character that models the key perception and production behaviors of a human therapist. While development of the proposed system may seem futuristic and ambitious at first blush, perceptive animated agents are now a reality, and language training applications using these agents have produced significant gains in speech and language skills of profoundly deaf children. In addition, under a seed grant from the Coleman Foundation, we have developed an initial version of an LSVT therapist that models well the facial expressions, gestures and utterances of a human LSVT therapist. It is thus feasible to develop and assess the potential value of an automated training system that uses a perceptive animated agent to conduct voice training with individuals with IPD. The proposed work builds upon our well established foundation of experimental efficacy data and the successful application of perceptive animated agents in language training tasks to accomplish two specific aims: (1) design and test a fully automated voice training system in which a virtual therapist conducts LSVT sessions with individuals with IPD; and (2) explore the feasibility of using this system as either a substitute or adjunct to LSVT training with human clinicians. In addition to assessment procedures used in previous LSVT efficacy studies, the proposed work will provide new insights into LSVT treatment through sophisticated analyses of audio and video data collected during sessions and pre and post treatment, that employ computer vision and speech signal processing algorithms to analysis of facial movements, gestures and speech data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VISIBABBLE, A SYSTEM FOR EARLY SPEECH INTERVENTION Principal Investigator & Institution: Fell, Harriet J.; Speech Technology/Applied Research Corp. Research Corporation Lexington, Ma 02421 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2003 Summary: (provided by applicant): This project will develop sound recognition software to provide real-time visual reinforcement of vocalizations produced by infants or preschool children. This program is intended for children who are delayed in the frequency and variety of pre-speech vocalizations they produce and, hence, are at risk

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for being non-speaking. This will provide an automated training system to maintain and develop children?s motor plans necessary for continued vocal development and expand the child?s repertoire of voluntary communicative behaviors that can be interpreted by partners in functional and social interaction. The system will encourage infants to practice vocalizing and to explore a larger repertoire of phonetic patterns. Particularly, it will reinforce the production of syllabic utterances that are associated with later language and cognitive development. Phase I will develop software to respond in realtime to the frequency, amplitude, and acoustic landmarks in infant vocalizations. The system will be tested on two typically developing and three at-risk children. Phase II will extend both the acoustic repertoire and the reinforcement component of the software. Phase II will also include a longer-term study with more children. PROPOSED COMMERCIAL APPLICATION: VisiBabble targets pre-linguistic children. It might be uded by clinicians in hospitals and early intervention centers and by parents in the home. The system could be software used on the family PC, a stand-alone system that operates through the family TV, or a self-contained device about the size of a current notebook computer. It could be used for children delayed in pre-speech vocalization to encourage them to generate speech sounds that they otherwise produce infrequently. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with speech therapy, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “speech therapy” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for speech therapy (hyperlinks lead to article summaries): •

“White coat effect” induced by therapist's presence during speech therapy for stroke rehabilitation: a single case study. Author(s): Sakamoto H, Sakamaki T, Tani T, Sugai Y, Nakamura T, Ono Z, Kanda T, Kurabayashi M, Nagai R. Source: Archives of Physical Medicine and Rehabilitation. 1999 April; 80(4): 470-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10206614

3 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A foster home approach to speech therapy. Author(s): Hatten JT, Hatten PA. Source: J Speech Hear Disord. 1971 May; 36(2): 257-63. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5087664

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A review of speech therapy in Australia. Author(s): Eldridge M. Source: Br J Disord Commun. 1966 October; 1(2): 136-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5999079

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A review of speech therapy services in ten cerebral palsy schools in the Republic of South Africa. Author(s): Shavell A. Source: J S Afr Speech Hear Assoc. 1974 December; 21(1): 45-62. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4455911

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A solid state delayed auditory feedback system for speech therapy. Author(s): Pollock R, Gregory NL, Shaw A. Source: Biomed Eng. 1976 December; 11(12): 413-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1016678

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A therapeutic speech amplifier and its use in speech therapy. Author(s): Greene MC, Watson BW, Gay P, Townsend DB. Source: The Journal of Laryngology and Otology. 1972 June; 86(6): 595-605. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5041624

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Accessing children's knowledge of sociolinguistic rules for speech therapy lessons. Author(s): Ripich DN, Panagos JM. Source: J Speech Hear Disord. 1985 November; 50(4): 335-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4057975

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Active participation of mothers during speech therapy improved language development of children with cleft palate. Author(s): Pamplona MC, Ysunza A. Source: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery / Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi. 2000 September; 34(3): 231-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11020919

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An analysis of motivational techniques used in speech therapy. Author(s): Mowrer DE. Source: Asha. 1970 October; 12(10): 491-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5505512

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An experiment in applying linguistics to speech therapy. Author(s): Hutchison MK. Source: Br J Disord Commun. 1972 April; 7(1): 49-53. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5078400

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An intensive summer speech therapy program for children. Author(s): Ward JF, Godfrey CM, Jousse AT. Source: Canadian Journal of Public Health. Revue Canadienne De Sante Publique. 1968 February; 59(2): 54-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5645175

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An objective method for the evaluation of speech therapy in aphasia. Author(s): Sarno MT, Sands E. Source: Archives of Physical Medicine and Rehabilitation. 1970 January; 51(1): 49-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5412925

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Applications of orofacial myofunctional techniques to speech therapy. Author(s): Landis CF. Source: Int J Orofacial Myology. 1994 November; 20: 40-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9055663

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Articulatory disorders in speech among Finnish-speaking students according to age, sex, and speech therapy. Author(s): Laine T, Linnasalo AL, Jaroma M. Source: Journal of Communication Disorders. 1987 August; 20(4): 327-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3624528

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Behavior problems of children in regular classes and those diagnosed as requiring speech therapy. Author(s): Lindholm BW, Touliatos J. Source: Percept Mot Skills. 1979 October; 49(2): 459-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=514765

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Bromocriptine and speech therapy in non-fluent chronic aphasia after stroke. Author(s): Bragoni M, Altieri M, Di Piero V, Padovani A, Mostardini C, Lenzi GL. Source: Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2000 February; 21(1): 19-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10938198

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Certain select variables as predictors of goal achievement in speech therapy. Author(s): Oratio AR, Hood SB. Source: Journal of Communication Disorders. 1977 June; 10(4): 331-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=925195

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Change in velopharyngeal valving after speech therapy in cleft palate patients. A videonasopharyngoscopic and multi-view videofluoroscopic study. Author(s): Ysunza A, Pamplona C, Toledo E. Source: International Journal of Pediatric Otorhinolaryngology. 1992 July; 24(1): 45-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1399303

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Changing the delivery of speech therapy. Author(s): Humphreys JC. Source: Indian J Pediatr. 1992 March-April; 59(2): 187-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1398847

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Classification of child stuttering: Part II. Persistent late onset male stuttering, and treatment issues for persistent stutterers--psychotherapy or speech therapy, or both? Author(s): Gemelli RJ. Source: Child Psychiatry and Human Development. 1982 Fall; 13(1): 3-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7168960

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Clinical speech therapy in collaboration with the Westdeutsche Kieferklinik Duesseldorf. Author(s): Herrmann D. Source: Cleft Palate J. 1969 October; 6: 421-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5260748

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Communication abilities in hemiplegia: effect of speech therapy. Author(s): Hagen C. Source: Archives of Physical Medicine and Rehabilitation. 1973 October; 54(10): 454-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4743414

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Communication disorders: speech therapy in the home. Author(s): Harris PL. Source: Home Healthcare Nurse. 1987 May-June; 5(3): 51-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3647027

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Comparison of cross-language generalisation following speech therapy. Author(s): Holm A, Dodd B. Source: Folia Phoniatrica Et Logopaedica : Official Organ of the International Association of Logopedics and Phoniatrics (Ialp). 2001 May-June; 53(3): 166-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11316943

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Contingencies and consequences in speech therapy. Author(s): McReynolds LV. Source: J Speech Hear Disord. 1970 February; 35(1): 12-24. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5438826

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Contraindications for speech therapy for cleft palate speakers. Author(s): Smith JK. Source: Cleft Palate J. 1969 July; 6: 202-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5261866

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Controlled trial of speech therapy versus oxprenolol for stammering. Author(s): Rustin L, Kuhr A, Cook PJ, James IM. Source: British Medical Journal (Clinical Research Ed.). 1981 August 22; 283(6290): 517-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6790048

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Developing the speech therapy service in day nurseries: a progress report. Author(s): Bath D. Source: Br J Disord Commun. 1981 December; 16(3): 159-73. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7337788

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Do 'minority' groups have special needs? Speech therapy and the Chasidic Jewish community in north London. Author(s): Law J, Wallfish T. Source: Child: Care, Health and Development. 1991 September-October; 17(5): 319-29. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1934320

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Education reform and speech therapy. Author(s): Evesham M. Source: Midwife Health Visit Community Nurse. 1989 January-February; 25(1-2): 8-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2921958

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Effectiveness of speech therapy for aphasic stroke patients. A randomised controlled trial. Author(s): Lincoln NB, McGuirk E, Mulley GP, Lendrem W, Jones AC, Mitchell JR. Source: Lancet. 1984 June 2; 1(8388): 1197-200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6202993

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Effectiveness of speech therapy for second grade children with misarticulations-predictive factors. Author(s): Irwin RB, West JF, Trombetta MA. Source: Except Child. 1966 March; 32(7): 471-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5904623

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Effects of speech therapy and pharmacologic and surgical treatments on voice and speech in Parkinson's disease: a review of the literature. Author(s): Schulz GM, Grant MK. Source: Journal of Communication Disorders. 2000 January-February; 33(1): 59-88. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10665513

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Effects of speech therapy on aphasics' responses to Functional Communication Profile. Author(s): Levita E. Source: Percept Mot Skills. 1978 August; 47(1): 151-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=704242

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Effects of speech therapy with poetry on heart rate rhythmicity and cardiorespiratory coordination. Author(s): Bettermann H, von Bonin D, Fruhwirth M, Cysarz D, Moser M. Source: International Journal of Cardiology. 2002 July; 84(1): 77-88. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12104068

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Effects of varying latencies in the stimulus-response paradigm of speech therapy. Author(s): Irwin RB, Nickles A, Hulit LM. Source: Percept Mot Skills. 1973 December; 37(3): 707-13. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4764496

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Efficacy of speech therapy in children with language disorders: specific language impairment compared with language impairment in comorbidity with cognitive delay. Author(s): Goorhuis-Brouwer SM, Knijff WA. Source: International Journal of Pediatric Otorhinolaryngology. 2002 April 25; 63(2): 12936. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11955604

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Electronic spelling aid for use in speech therapy. Author(s): Gibbs AT, McCarthy JP, Whelpton D. Source: Med Biol Eng. 1975 September; 13(5): 742-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1186340

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Emerging issues in speech therapy in Iran. Author(s): Nilipour R. Source: Folia Phoniatrica Et Logopaedica : Official Organ of the International Association of Logopedics and Phoniatrics (Ialp). 2002 March-April; 54(2): 65-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12037418

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Evaluating speech therapy through precision recording. Author(s): Mowrer DE. Source: J Speech Hear Disord. 1969 August; 34(3): 239-44. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5821126

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Evaluating the effects of speech therapy for aphasics: developing the single case methodology. Author(s): Pring TR. Source: Br J Disord Commun. 1986 April; 21(1): 103-15. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3524649

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Factors affecting language recovery in aphasic stroke patients receiving speech therapy. Author(s): Lendrem W, McGuirk E, Lincoln NB. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1988 August; 51(8): 1103-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2464045

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Fonetix: building virtual speech therapy practicum over the Internet. Author(s): Morawej A, Jackson AT, McLeod RD. Source: Stud Health Technol Inform. 1999; 64: 253-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10747546

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Form equivalence of the PPVT on children in speech therapy. Author(s): Coyle FA Jr, Dans C, Cork E. Source: Psychological Reports. 1968 December; 23(3): 1002. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5717410

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Functional phonetics and speech therapy. Author(s): Haas W. Source: Br J Disord Commun. 1968 April; 3(1): 20-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5665919

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Generalization in operant speech therapy for misarticulation. Author(s): Griffiths H, Craighead WE. Source: J Speech Hear Disord. 1972 November; 37(4): 485-94. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4648938

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Group and individual speech therapy for the pre-school child with delayed language. Author(s): Stewart TM. Source: Health Visit. 1988 July; 61(7): 210-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3410725

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How does speech therapy work? Author(s): Enderby P. Source: The Practitioner. 1979 December; 223(1338): 796-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=542449

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Hypnosis and speech therapy as a combined therapeutic approach to the problem of stammering. A study of thirty patients. Author(s): Lockhart MS, Robertson AW. Source: Br J Disord Commun. 1977 October; 12(2): 97-108. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=588438

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Improvement of voicing in patients with Parkinson's disease by speech therapy. Author(s): Liotti M, Ramig L. Source: Neurology. 2003 November 11; 61(9): 1316; Author Reply 1316-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14610158

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Improvement of voicing in patients with Parkinson's disease by speech therapy. Author(s): de Swart BJ, Willemse SC, Maassen BA, Horstink MW. Source: Neurology. 2003 February 11; 60(3): 498-500. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12578936

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Individual speech therapy in motion. Author(s): Vry S. Source: J Speech Hear Disord. 1968 May; 33(2): 199-200. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5648175

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Innovation in speech therapy: a cost effective program. Author(s): Alvord DJ. Source: Except Child. 1977 May; 43(8): 520-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=404153

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Intensive speech therapy for cleft palate children. Author(s): Albery L, Enderby P. Source: Br J Disord Commun. 1984 September; 19(2): 115-24. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6477818

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Introduction to the present state of medical speech pathology and speech therapy in Holland. Author(s): Damste PH. Source: Pract Otorhinolaryngol (Basel). 1971; 33(5): 344. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5159313

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Japanese speech therapy (logopedics) education after the presentation of the education guidelines in the 1995 IALP general assembly. Author(s): Iitaka K. Source: Folia Phoniatrica Et Logopaedica : Official Organ of the International Association of Logopedics and Phoniatrics (Ialp). 2002 March-April; 54(2): 75-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12037421

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John Thelwall and the origins of British speech therapy. Author(s): Rockey D. Source: Medical History. 1979 April; 23(2): 156-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=381813

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Knowledge and opinions of speech therapy in teachers, doctors and nurses. Author(s): Lesser R, Hassip S. Source: Child: Care, Health and Development. 1986 July-August; 12(4): 235-49. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3742736

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Language disorders in young children: when is speech therapy recommended? Author(s): Goorhuis-Brouwer SM, Knijff WA. Source: International Journal of Pediatric Otorhinolaryngology. 2003 May; 67(5): 525-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12697355

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Linguistic interaction: the active role of parents in speech therapy for cleft palate patients. Author(s): Pamplona MC, Ysunza A, Uriostegui C. Source: International Journal of Pediatric Otorhinolaryngology. 1996 September; 37(1): 17-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8884403

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Linguistics and speech therapy. Author(s): Corder SP. Source: Br J Disord Commun. 1966 October; 1(2): 119-30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5999077

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Linguistics and speech therapy--a case study. Author(s): Connor P, Stork FC. Source: Br J Disord Commun. 1972 April; 7(1): 44-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5078399

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Microcomputer speech therapy for dysphasic adults: a comparison with two conventionally administered tasks. Author(s): Kinsey C. Source: Br J Disord Commun. 1986 April; 21(1): 125-33. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3524650

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Modern trends in plastic surgery. Congenital deformities. 3. Speech and speech therapy in cleft palate. Author(s): Morley ME. Source: Mod Trends Plast Surg. 1966; 2: 255-67. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5334608

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My personal experience with speech therapy for stuttering at the Stuttering Center of Western Pennsylvania. Author(s): Nakao A, Tanaka N, Coleman C. Source: Acta Medica Okayama. 2001 June; 55(3): 193-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11434432

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Myofunctional therapy. Orthodontics--tongue thrusting--speech therapy. Author(s): Cottingham LL. Source: Am J Orthod. 1976 June; 69(6): 679-87. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=775999

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Otolaryngology and speech therapy. Author(s): Fomon S, Bell JW, Lubart J, Schattner A, Syracuse VR. Source: Eye Ear Nose Throat Mon. 1966 June; 45(6): 71-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5930874

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Outcome measures in speech therapy: impairment, disability, handicap and distress. Author(s): Enderby P. Source: Health Trends. 1992; 24(2): 61-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10171254

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Palatal lift and speech therapy for velopharyngeal incompetence. Author(s): Kerman PC, Singer LS, Davidoff A. Source: Archives of Physical Medicine and Rehabilitation. 1973 June; 54(6): 271-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4575170

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Parent education in a public school program of speech therapy. Author(s): mcCroskey RL, Baird VG. Source: J Speech Hear Disord. 1971 November; 36(4): 499-505. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5125803

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Physical therapy, occupational therapy, and speech therapy. Author(s): Egland GO. Source: Physical Therapy. 1966 October; 46(10): 1116-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5977205

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Post laryngectomy rehabilitation the case for planned early speech therapy. Author(s): Subbarao PB, Shenoy AM, Nanjundappa, Anantha N. Source: Indian Journal of Cancer. 1991 December; 28(4): 218-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1818023

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Progress report on an evaluation of speech therapy for aphasia. Author(s): David RM, Enderby P, Bainton D. Source: Br J Disord Commun. 1979 September; 14(2): 85-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=93486

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Proposed evaluation of speech therapy for acquired aphasia. Author(s): Enderby P, David RM. Source: Br J Disord Commun. 1976 October; 11(2): 144-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=974010

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Psychogenic voice disorder unresponsive to speech therapy: psychological characteristics and cognitive-behaviour therapy. Author(s): Butcher P, Elias A, Raven R, Yeatman J, Littlejohns D. Source: Br J Disord Commun. 1987 April; 22(1): 81-92. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3676079

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Psychological effects of speech therapy. Author(s): Lincoln NB, Jones AC, Mulley GP. Source: Journal of Psychosomatic Research. 1985; 29(5): 467-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4067888

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Recent advances in speech therapy. Author(s): Bergendal BI. Source: Public Health Rev. 1979 July-September; 8(3): 279-320. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=552105

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Reliability of the assessment of impairments, disabilities and handicaps in survey research on speech therapy. Author(s): Raaijmakers MF, Dekker J, Dejonckere PH, van der Zee J. Source: Folia Phoniatrica Et Logopaedica : Official Organ of the International Association of Logopedics and Phoniatrics (Ialp). 1995; 47(4): 199-209. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7670553

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Role of speech therapy and sign language prior to cochlear implantation. Author(s): Deggouj N, Phillips C, Gersdorff M. Source: Acta Otorhinolaryngol Belg. 1998; 52(4): 275-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9914799

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Selection of aphasic stroke patients for intensive speech therapy. Author(s): Legh-Smith JA, Denis R, Enderby PM, Wade DT, Langton-Hewer R. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1987 November; 50(11): 1488-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3694208

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Sensory integrative therapy and speech therapy for improving the perceptual motor skills and speech articulation of a dyspractic boy. Author(s): Jaroma M, Danner P, Koivuniemi E. Source: Folia Phoniatr (Basel). 1984; 36(6): 261-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6519607

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Some indications for speech therapy. Author(s): Greene MC. Source: The Practitioner. 1973 December; 211(266): 745-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4787962

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Speech and speech therapy in cleft palate. Author(s): Morley ME. Source: Mod Trends Plast Surg. 1966; 2: 255-67. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6003945

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Speech therapy after total laryngectomy and esophageal replacement in a preschool patient: a case study. Author(s): Jacobs AH, Abramson AL. Source: International Journal of Pediatric Otorhinolaryngology. 1980 April; 2(1): 21-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7188051

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Speech therapy and dysphonia. Author(s): Carding PN, Murty GE. Source: Clinical Otolaryngology and Allied Sciences. 1990 December; 15(6): 493-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2073756

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Speech therapy and elderly people: a study of therapists' attitudes. Author(s): Bebbington D. Source: Health Trends. 1991; 23(1): 9-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10113886

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Speech therapy and language recovery in severe aphasia. Author(s): Sarno MT, Silverman M, Sands E. Source: Journal of Speech and Hearing Research. 1970 September; 13(3): 607-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5507117

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Speech therapy and Parkinson's disease: a review and further data. Author(s): Johnson JA, Pring TR. Source: Br J Disord Commun. 1990 August; 25(2): 183-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2206966

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Speech therapy and teaching English to speakers of other languages. Author(s): Gandour J. Source: J Speech Hear Disord. 1980 February; 45(1): 133-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6986508

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Speech therapy and the treatment of cerebrovascular disorders. Author(s): Leche P. Source: Proc R Soc Med. 1972 January; 65(1): 85-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4111412

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Speech therapy by interactive television. Author(s): Sanborn CJ, Seibert DJ, Sanborn DE 3rd, Pyke HF, Ferland SF, Welsh GW. Source: Community Health (Bristol). 1974 November-December; 6(3): 134-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4459019

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Speech therapy for benign and pre-malignant lesions of the larynx. Author(s): Prinz M. Source: Trans Pa Acad Ophthalmol Otolaryngol. 1976 Spring; 29(1): 79-86. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=960195

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Speech therapy for Parkinson's disease. Author(s): Scott S, Caird FI. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1983 February; 46(2): 1404. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6842217

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Speech therapy for patients with Parkinson's disease. Author(s): Scott S, Caird FI. Source: British Medical Journal (Clinical Research Ed.). 1981 October 24; 283(6299): 1088. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6794774

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Speech therapy for psychogenic voice disorder: a survey of current practice and training. Author(s): Elias A, Raven R, Butcher P, Littlejohns DW. Source: Br J Disord Commun. 1989 April; 24(1): 61-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2638190

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Speech therapy for stroke patients. Author(s): Pickersgill MJ. Source: Lancet. 1984 September 15; 2(8403): 644-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6147683

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Speech therapy for the hemiplegic patient. Author(s): Ellams J. Source: Nurs Mirror Midwives J. 1974 August 9; 139(6): 66-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4496627

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Speech therapy for the laryngectomy patient. Author(s): Struthers C. Source: J R Coll Gen Pract. 1970 October; 20(99): 248-50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5532332

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Speech therapy for the mildly dysphasic patient: when is it indicated? Author(s): Huret JS, Betts HB. Source: Imj Ill Med J. 1974 June; 145(6): 512-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4152501

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Speech therapy for the partially deaf child. Author(s): Fawcus R. Source: Developmental Medicine and Child Neurology. 1972 February; 14(1): 78-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5023573

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Speech therapy for your computer. Author(s): Tsotsos S. Source: Int J Comput Dent. 2000 May; 3(2): 133-42. English, German. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11351552

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Speech therapy in a home care setting. Three case studies. Author(s): Skrine R, Sanders SM, Wilburn DC, Cantrell E. Source: Caring. 2003 January; 22(1): 32-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12557463

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Speech therapy in New Zealand. Author(s): Gane GM, Makgill B. Source: Br J Disord Commun. 1968 October; 3(2): 196-200. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5701740

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Speech therapy in Parkinson's disease: a study of the efficacy ad long term effects of intensive treatment. Author(s): Robertson SJ, Thomson F. Source: Br J Disord Commun. 1984 December; 19(3): 213-24. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6508992

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Speech therapy in the management of carcinoma of the larynx. Author(s): Gannon R. Source: Appl Ther. 1968 March; 10(3): 187-91. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5645683

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Speech therapy in the management of male-to-female transsexuals. Author(s): de Bruin MD, Coerts MJ, Greven AJ. Source: Folia Phoniatrica Et Logopaedica : Official Organ of the International Association of Logopedics and Phoniatrics (Ialp). 2000 September-October; 52(5): 220-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10965175

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Speech therapy management following laryngectomy. Author(s): Gordon MT. Source: Br J Disord Commun. 1971 April; 6(1): 52-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5576630

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Speech therapy program at a general hospital helps aphasic children. Author(s): Breen PO, Allen WP. Source: Hospitals. 1968 March 16; 42(6): 49-50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5639292

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Speech therapy with adult brain-damaged patients. Author(s): Leche P. Source: Nurs Times. 1969 November 20; 65(47): 1485-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5352907

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Speech therapy with cochlear implant wearers. Author(s): Waters T. Source: British Journal of Audiology. 1986 February; 20(1): 35-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3754166

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Speech therapy with selected patients with congenital velopharyngeal inadequacy. Author(s): Goda S. Source: Cleft Palate J. 1966 July; 3: 268-74. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5220835

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Speech therapy with the profoundly deaf in the USA. Author(s): Wirz SL. Source: Br J Disord Commun. 1978 October; 13(2): 153-60. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=728366

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Speech therapy, a developing profession. Author(s): Musgrave C. Source: Cent Afr J Med. 1983 June; 29(6): 129-31. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6627374

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Speech therapy. Author(s): Furlong M. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1999 February 17-23; 13(22): 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10326438

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Speech therapy. Author(s): White S. Source: Br Dent Surg Assist. 1976 November-December; 35(6): 100-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1076046

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Speech therapy. Author(s): Hudson-Smith S. Source: Dist Nurs. 1969 January; 11(10): 206-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5191533

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Stroke: speech therapy. Author(s): Law D. Source: Community Outlook. 1978 November 9; : 333-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=251122

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Structural linguistics as a basis of logopedics and speech therapy. Author(s): Bloch V. Source: Folia Phoniatr (Basel). 1974; 26(1): 68-81. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4407216

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Structuring speech therapy contingencies with an oral apraxic child. Author(s): Daly DA, Cantrell RP, Cantrell ML, Aman LA. Source: J Speech Hear Disord. 1972 February; 37(1): 22-32. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5053941

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Success and failure in speech therapy. Author(s): Van Riper C. Source: J Speech Hear Disord. 1966 August; 31(3): 276-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5916173

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Swallowing and speech therapy after definitive treatment for laryngeal cancer. Author(s): Samlan RA, Webster KT. Source: Otolaryngologic Clinics of North America. 2002 October; 35(5): 1115-33. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12587251

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The bilingual child in the speech therapy clinic. Author(s): Miller N. Source: Br J Disord Commun. 1978 April; 13(1): 17-30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=718791

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The combination of learning principles and speech therapy techniques in the treatment of non-communicating children. Author(s): Nelson RO, Evans IM. Source: Journal of Child Psychology and Psychiatry, and Allied Disciplines. 1968 November; 9(2): 111-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5716578

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The costs of using trained and supervised volunteers as part of a speech therapy service for dysphasic patients. Author(s): Quinteros B, Williams DR, White CA, Pickering M. Source: Br J Disord Commun. 1984 December; 19(3): 205-12. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6508991

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The counterpart system in speech therapy in Singapore. Author(s): McCafferty MA. Source: J Singapore Paediatr Soc. 1975 October; 17(2): 84-95. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1207083

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The effectiveness of an intensive group speech therapy programme for adult stammerers. Author(s): Helps R, Dalton P. Source: Br J Disord Commun. 1979 April; 14(1): 17-30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=540092

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The effects of speech therapy and pharmacological treatments on voice and speech in Parkinson s disease: a review of the literature. Author(s): Schulz GM. Source: Current Medicinal Chemistry. 2002 July; 9(14): 1359-66. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12132992

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The evaluation of home based speech therapy for language delayed pre-school children in an inner city area. Author(s): Stevenson P, Bax M, Stevenson J. Source: Br J Disord Commun. 1982 December; 17(3): 141-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6763876

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The implications for speech therapy of a study of the “verbal regulation of behaviour” in multiply handicapped children. Author(s): Burland R. Source: Br J Disord Commun. 1971 October; 6(2): 120-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4255571

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The inter-relationship of speech therapy and physiotherapy in children with neurodevelopmental disorders. Author(s): Levitt S, Miller C. Source: Developmental Medicine and Child Neurology. 1973 April; 15(2): 188-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4697753

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The interrelationship of speech therapy and prostheses for the handicapped child. Author(s): Landis P, Fleming J. Source: Dent Clin North Am. 1974 July; 18(3): 723-34. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4278324

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The origins and status of speech therapy in the schools. Author(s): Black ME. Source: Asha. 1966 November; 8(11): 419-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4859810

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The response of a disabled elderly population to speech therapy. Author(s): Walker SA, Williams BO. Source: Br J Disord Commun. 1980 May; 15(1): 19-29. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7387867

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The response of the apparent receptive speech disorder of Parkinsonism to speech therapy. Author(s): Hartman DE, Abbs JH. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1985 June; 48(6): 606. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4009199

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The response of the apparent receptive speech disorder of Parkinson's disease to speech therapy. Author(s): Scott S, Caird FI. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1984 March; 47(3): 302-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6707678

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The role of physical, occupational, and speech therapy in hospice: patient empowerment. Author(s): Frost M. Source: Am J Hosp Palliat Care. 2001 November-December; 18(6): 397-402. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11712721

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The role of speech therapy in stroke rehabilitation. Author(s): Gresham GE, Weiss CJ. Source: Heart Dis Stroke. 1993 January-February; 2(1): 49-52. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8149088

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The role of speech therapy in the head and neck service. Author(s): Dinner MI. Source: J S Afr Speech Hear Assoc. 1975 December; 22: 43-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1236596

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The use of a manual vibrator in the speech therapy program of four school-age mentally retarded children. Author(s): Grant L. Source: Journal of Communication Disorders. 1982 September; 15(5): 375-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7130441

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The use of hypnosis in speech therapy: a questionnaire study. Author(s): Macfarlane FK, Duckworth M. Source: Br J Disord Commun. 1990 August; 25(2): 227-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2206967

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The use of speech therapy in the treatment of globus pharyngeus patients. A randomised controlled trial. Author(s): Khalil HS, Bridger MW, Hilton-Pierce M, Vincent J. Source: Rev Laryngol Otol Rhinol (Bord). 2003; 124(3): 187-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14725135

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The use of video in the self-evaluation of speech therapy students. Author(s): McGovern MA. Source: Br J Disord Commun. 1985 December; 20(3): 297-300. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4084440

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Training assistants in cleft palate speech therapy in the developing world: a report. Author(s): Wirt A, Wyatt R, Sell DA, Grunwell P, Mars M. Source: Cleft Palate J. 1990 April; 27(2): 169-74; Discussion 174-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2340637

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Training counterparts in cleft palate speech therapy in the less developed world: an extended report. Author(s): Wirt A, Wyatt R, Sell D, Mars M, Grunwell P, Lamabadusuriya S. Source: Br J Disord Commun. 1990 December; 25(3): 355-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2095840

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Trial of intensive compared with weekly speech therapy in preschool children. Author(s): Barratt J, Littlejohns P, Thompson J. Source: Archives of Disease in Childhood. 1992 January; 67(1): 106-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1739321

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Trials and tribulations in speech therapy. Author(s): Allen CM. Source: Bmj (Clinical Research Ed.). 1990 August 11; 301(6747): 302-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1697487

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Use of a storage oscilloscope in speech therapy. Author(s): Schwartz MF. Source: J Speech Hear Disord. 1969 May; 34(2): 111-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5782398

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Uses of the Sheehan sentence completion test in speech therapy for stuttering. Author(s): Griffith FA. Source: J Speech Hear Disord. 1969 November; 34(4): 342-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5349140

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Waiting for speech therapy: a group to help the under-3s. Author(s): Lee A. Source: Prof Care Mother Child. 1996; 6(4): 105-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8852124

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Which three year olds need speech therapy? Uses of the Levett-Muir language screening test. Author(s): Levett L, Muir J. Source: Health Visit. 1983 December; 56(12): 454-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6559779

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White-coat effect induced by therapist's presence during speech therapy: study of post-stroke aphasic Japanese patients. Author(s): Sakamoto H, Sakamaki T, Tani T, Sugai Y, Kurabayashi M. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 December; 81(12): 929-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12447092

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Who needs speech therapy? Author(s): Williams BO, Walker SA, Dall JL. Source: Age and Ageing. 1977 May; 6(2): 96-103. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=888751

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CHAPTER 2. ALTERNATIVE MEDICINE AND SPEECH THERAPY Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to speech therapy. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to speech therapy and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “speech therapy” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to speech therapy: •

Accessing children's knowledge of sociolinguistic rules for speech therapy lessons. Author(s): Ripich DN, Panagos JM. Source: J Speech Hear Disord. 1985 November; 50(4): 335-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4057975

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Effects of speech therapy with poetry on heart rate rhythmicity and cardiorespiratory coordination. Author(s): Bettermann H, von Bonin D, Fruhwirth M, Cysarz D, Moser M. Source: International Journal of Cardiology. 2002 July; 84(1): 77-88. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12104068

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Effects of varying latencies in the stimulus-response paradigm of speech therapy. Author(s): Irwin RB, Nickles A, Hulit LM.

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Source: Percept Mot Skills. 1973 December; 37(3): 707-13. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4764496 •

Hypnosis and speech therapy as a combined therapeutic approach to the problem of stammering. A study of thirty patients. Author(s): Lockhart MS, Robertson AW. Source: Br J Disord Commun. 1977 October; 12(2): 97-108. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=588438

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Stroke: speech therapy. Author(s): Law D. Source: Community Outlook. 1978 November 9; : 333-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=251122

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The role of varied therapies in the rehabilitation of the retarded child; occupational therapy, music therapy, speech therapy and remedial reading. Author(s): KNIGHT D, LUDWIG AJ, POPE L, STRAZZULLA M. Source: Am J Ment Defic. 1957 January; 61(3): 508-15. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13381761

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The use of hypnosis in speech therapy: a questionnaire study. Author(s): Macfarlane FK, Duckworth M. Source: Br J Disord Commun. 1990 August; 25(2): 227-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2206967

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Waiting for speech therapy: a group to help the under-3s. Author(s): Lee A. Source: Prof Care Mother Child. 1996; 6(4): 105-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8852124

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to speech therapy; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Parkinson's Disease Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 3. DISSERTATIONS ON SPEECH THERAPY Overview In this chapter, we will give you a bibliography on recent dissertations relating to speech therapy. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “speech therapy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on speech therapy, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Speech Therapy ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to speech therapy. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

THE EFFECT OF SPEECH THERAPY ON BEHAVIOR AND ACADEMIC ACHIEVEMENT OF HIGH IQ CHILDREN by NEWBURGER, DORIS, PHD from New York University, 1967, 197 pages http://wwwlib.umi.com/dissertations/fullcit/6804788

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 4. PATENTS ON SPEECH THERAPY Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.4 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “speech therapy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on speech therapy, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Speech Therapy By performing a patent search focusing on speech therapy, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 4Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on speech therapy: •

Aid for speech therapy and a method of making same Inventor(s): Mills; Michael (Pointe Claire, CA) Assignee(s): M.b.a. Therapeutic Language Systems Inc. (westmount, Ca) Patent Number: 4,460,342 Date filed: June 15, 1982 Abstract: An aid for speech therapy comprising a chart having a series of time frames of equal time intervals. Each of the time frames has an illustration of the human mouth to pictorially display the lips, tongue and jaw positions of the mouth in making a sound, word or phrase alphabetically displayed in the time frames. A sound reproducing device may also be provided to audibly reproduce the sound, word or phrase which is alphabetically displayed. Excerpt(s): The present invention relates to an improved speech therapy teaching aid wherein a chart is provided having a series of time frames of equal time intervals on which is illustrated a pictorial display of a human mouth and an alphabetical display of the sound coinciding with the illustrated movements of the mouth. Several systems have been heretofore provided to teach speech. However, these systems are extremely complex and costly and a great many have proven unsatisfactory. Further, such known systems have limited applications and cannot teach speech or lip reading to the deaf. For example, U.S. Pat. No. 4,218,836 teaches a speech therapy system comprising a series of complex mouth, tongue and lip positions as well as a code to represent nasality, inspirations, aspirations, etc. Such system is complex and does not, like other known systems, provide a time base associated with mouth movement to pronounce a sound to teach points of emphasis in a sound, length of syllables, pacing, pauses and timing. It is a feature of the present invention to provide a speech therapy teaching aid which overcomes the disadvantages of the prior art. Web site: http://www.delphion.com/details?pn=US04460342__

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Air flow measuring instrument for speech therapy Inventor(s): Jentges; Helen C. (W. 2211 Holyoke, Spokane, WA 99208) Assignee(s): None Reported Patent Number: 4,579,124 Date filed: August 29, 1984 Abstract: A small, portable instrument to measure oral or nasal air flow during speech for both diagnostic and therapeutic purposes. The instrument provides a receptor at one end communicating by an elongate air passageway to a vertical measuring cylinder carrying a sphere vertically movable therein responsive to air flowing therethrough. The vertical position of the sphere in the measuring cylinder indicates amount of air flow and its change in vertical position indicates change in outflow through the receptor at any particular time. Parameters of the instrument may be varied to maintain measurements within the height limitation of the measuring cylinder, and the cylinder may be calibrated for absolute measuration.

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Excerpt(s): There are no applications related hereto heretofore filed in this or any foreign country. My invention relates generally to measuring and testing instruments and more particularly to an air flow meter for use in speech therapy to measure air flow from nasal or oral cavities during speech. The production of speech is a complex interreaction of physical, physiological and psychological phenomena wherein a speaker's respiration moves a stream of air through the larynx, which impresses it with acoustic energy by a process known as phonation, and subsequently through the oral and nasal cavities where it is resonated and restructured by a process known as articulation to produce an aurally perceivable, comprehensible, energy that we call speech. The process is sufficiently complex that until the recent past, at least, it has been dealt with, understood and analyzed largely subjectively by its audio results rather than by means of any objective scientific measuration. The instant invention seeks to provide an instrument that objectively measures some forms of speech quality and particularly one which measures, either absolutely or comparatively, the flow of air from either nasal or oral passages for use principally in speech therapy, either as a diagnostic or remedial tool. Web site: http://www.delphion.com/details?pn=US04579124__ •

Amplifier filter system for speech therapy Inventor(s): Asp; Carl W. (3815 Dellwood Dr., Knoxville, TN 37919), Silverstein; Bernard (7808 Sheffield Dr., Knoxville, TN 37919) Assignee(s): None Reported Patent Number: 4,802,228 Date filed: October 24, 1986 Abstract: Am amplifier filter system for speech therapy applications. This apparatus combines a direct channel amplifier and two band pass filter amplifiers such that selected phonemes (speech sounds) of the spoken word can be enhanced so that a speaker can be taught corrections for various articulation deficiencies. Through the choice of optimum center frequencies in one-octave bandpass filters for various phonemes of a given language, a selected portion of the acoustic spectrum within the language can be enhanced to achieve this result. The apparatus is highly portable, light weight and is affordable. It provides for inputs from microphones and/or tape recorders, and outputs to earphones, loudspeakers, vibrators, and/or tape recorders. Because of the unique design of this unit, it is "user friendly" thus making it useful in both the presence of a clinician and by a client during his or her own therapy. A particular response at each of the center frequencies is selected to have a 12-14 dB slope which has been found to provide the optimum enhancements of the acoustic spectra of the various phonemes. Excerpt(s): This invention relates generally to amplifiers for speech sounds of any language, and more particularly to an amplifier system for selectively amplifying the acoustic spectra of various sounds present in the speech of individuals. In the course of speaking an individual utilizes a wide variety of phonemes (speech sounds) which make up the words and phrases of the particular language. When a phoneme is heard with its normal acoustic spectrum, a "normal" listener can perceive it as a sound of the language, and is able to perceive differences between it and misarticulations such as substitutions, distortions, omissions or additions. However, a person who speaks with defective articulation is used to hearing the defective phonemes and perceives his or her speech as "normal" rather than as defective. Thus, a person with defective speech is resistive to change. Such problems exist with people having a physical or learned speech

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impairment, sometimes associated with auditory perceptual difficulties, and also with pesons having foreign or social dialects. Various attempts have been made to provide systems for the training (i.e., therapy) of persons having speech and hearing impairment. One such device is described in U.S. Pat. No. 3,920,903, issued to I. Bellier on Nov. 18, 1975. The application resulting in this patent had priority from an application filed in France in 1972. Web site: http://www.delphion.com/details?pn=US04802228__ •

Apparatus for speech pattern derivation Inventor(s): Fourcin; Adrian J. (Hemel Hempstead, GB2) Assignee(s): Larynogograph Limited (hertfordshire, Gb2) Patent Number: 4,139,732 Date filed: January 4, 1978 Abstract: The invention relates to the monitoring, recording and display of a speaker's larynx waveform, for the purposes of education, speech therapy and speech analysis. A pair of electrodes are applied externally to the larynx region of the speaker's neck. Each electrode has two concentric surfaces (the outer surface is called a guard ring). One electrode feeds a carrier voltage to the speaker's neck. The other electrode receives the resultant larynx amplitude-modulated current. Detection techniques are used to derive the larynx waveform. A preferred detection technique is "slicing" which is herein defined as a demodulation which follows the changes in envelope of an amplitudemodulated carrier and retains only the small rapid larynx modulation filtering out the slower neck-movement modulation. The important feature of speech called intonation, which is made up of rhythm and pitch patterns, is directly correlated with larynx frequency. The present larynx waveform provides a simple and reliable basis both for the representation of intonation in speech and for the analysis of the frequencies defining other speech pattern features. Any combination of these patterns is displayed, on a domestic television receiver, for instance, and, or plotted or recorded. Excerpt(s): The present invention relates to apparatus for use in the art of speech pattern derivation, and thus for instance may further relate to speech therapy, education and stress detection as in so-called "lie-detection". The following comments are offered by way of background information to the art with which the invention is concerned. In the perception of speech we rely primarily on the analysis provided by the hearing mechanism to transform the complex variability of the acoustic signal into coherent slowly varying comprehensible patterns. A child's ability to perceive these patterns determines his progress in the acquisition of speech skills and an adult's ability to perceive new speech pattern forms determines the rapidity with which he acquires the speech forms of another language. It is of advantage in teaching to provide for the immediate extraction of such pattern information from a speaker and his speech, the storage of such patterns and the instantaneous display thereof by visual, tactile or vibratile means to provide correcting or reinforcing feedback. Web site: http://www.delphion.com/details?pn=US04139732__

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•

Demonstrative puppet for phonetic training of persons having speech and/or hearing disorders Inventor(s): Miles; Janet A. (3 Windflower, Coto De Caza, CA 92679) Assignee(s): None Reported Patent Number: 5,662,477 Date filed: July 17, 1995 Abstract: A puppet for demonstrating the preferred positioning of oral anatomical structures (e.g., mouth, tongue, hard palate, incisor teeth) when making various audible phonetic sounds. Generally, the puppet comprises a puppet body having an upper jaw, a lower jaw, an oral cavity, a tongue, and at least one tooth extending downwardly from the upper jaw. A hand insertion passageway is formed in the puppet body and leads into a plurality of digit-receiving spaces or pouches formed in the upper jaw, tongue and lower jaw. Thus, the user's hand may be inserted into the puppet such that selected digits of the user's hand become positioned within selected ones of the digit-receiving spaces. Thereafter the digits of the user's hand may be moved or manipulated to cause the desired movement and relative positioning of the oral anatomical structures. In this regard, the invention is usable to demonstrate proper formation of certain phonetic sounds, thereby facilitating the administration of speech therapy or training to persons who are affected with speech and/or hearing disorders. Excerpt(s): The present invention relates to demonstrative aids utilized in training or education, and more particularly to a demonstrative hand puppet which may be utilized to demonstrate proper positioning of the mouth and tongue relative to the front teeth when articulating various phonetic sounds. Speech and/or language disorders have been known to affect human beings of all ages. Such disorders may result from various causes including, but not limited to, learning disabilities, mental retardation, brain injury, minimal brain disfunction, hearing impairment, stroke, habitual mispronunciation, or physical causes (e.g., cleft lip). In some individuals, language or speech disorders can not be linked to any discernable physical or non-physical cause. Irrespective of the cause or etiology of an individual's language or speech disorder, such disorders may typically be improved or remedied if appropriate speech and/or language therapy is provided to the affected individual by a qualified speech pathologist. Web site: http://www.delphion.com/details?pn=US05662477__

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Hollow tubular device to assist patients during speech therapy Inventor(s): Knopf; Jonathan D. (8064 East Cloud, Salina, KS 67401) Assignee(s): None Reported Patent Number: 5,507,648 Date filed: August 3, 1994 Abstract: A hollow tubular device to assist patients during speech therapy a main body portion of a tubular configuration having a hollow interior with an interior surface and having an exterior surface, the main body portion being formed of a plastic material; a pair of parallel end caps at each end of the main body portion, the end caps being circular in shape with a thickness essentially the same thickness as the side wall; and an centrally disposed aperture extending through each end cap.

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Excerpt(s): The use of devices of various designs and configurations for use during speech therapy is known in the prior art. More specifically, devices of various designs and configurations for use during speech therapy heretofore devised and utilized for the purpose of assisting patients with speech impediments and impairments of a wide variety of designs and configurations are known to consist basically of familiar, expected, and obvious structural configurations, notwithstanding the myriad of designs encompassed by the crowded prior art which has been developed for the fulfillment of countless objectives and requirements. By way of example, the prior art discloses in U.S. Pat. No. 5,123,922 to Berg a speaking tube. U.S. Pat. No. 4,773,412 to Blom discloses a speaking tracheostomy tube. Web site: http://www.delphion.com/details?pn=US05507648__ •

Human mouth model for speech therapy Inventor(s): Angelotti; Norma (24 Trumbull Ave., Haverhill, MA 01830) Assignee(s): None Reported Patent Number: 4,073,071 Date filed: December 30, 1976 Abstract: A human mouth model for speech therapy instruction including a transparent upper jaw portion including a hard palate portion, soft palate portion, gums, and a set of upper teeth; a transparent lower jaw portion including a mouth floor, gums, and a set of lower teeth; an opening formed by the rearward ends of the jaw portions in the area of the oral part of the pharynx; and hinge means interconnecting the rearward ends of the jaw portions. Excerpt(s): This invention relates to a human mouth model for speech therapy instruction, and more particularly to such a model possessing anatomical structure necessary for demonstrating tongue positions to form desired sounds. Generally, speech therapists teach their patients with charts, diagrams, written exercises, or recorded sounds which attempt to convey to the patient the proper formation of the tongue and lips to make a particular sound. These methods are often transformed into interesting and workable exercises, stories, and games to be practiced by the patient as a means of correcting speech impediments. This is a long and difficult procedure, partly because of the difficulty of the patients in understanding exectly how the tongue is to be placed and how it is to be manipulated in order to prevent an old habit and to reinforce a new habit which will result in the elimination of a speech impediment. This is an especially difficult area because traditionally the speech therapist can only use words to try and describe the necessary positions, manipulations, and desired results. It is even more difficult for the extremely young, the deaf, the blind and the retarded than it is for those with normal faculties to understand how to position and manipulate their tongue pursuant to verbal directions. The therapist can indicate correct position of the tongue in her mouth or in the patient's mouth only with the mouth fully open so that the tongue can be viewed, in which case the full understanding of where the tongue must be and of how it must move during the formation and delivery of the sound cannot be conveyed. In addition, a complete viewing of the tongue is impossible, since the human demonstrator's mouth can be opened only to a limited extent and can be viewed from only one direction. Attempts to use certain other model mouths, such as those used in taxidermy and dental work, have met with indifferent success, for they are basically designed only to show teeth and teeth positions, and are not concerned with the subtelties of sound formation and speech. Such models are unsatisfactory, as are the

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mouths of human demonstrators, because it is impossible to see the position of the tongue from the back, from the top, and from the sides. This limits the ability of the therapist to convey to the patient the identity and function of the different parts of the mouth which cooperate with the tongue in its various positions to make desired sounds. Web site: http://www.delphion.com/details?pn=US04073071__ •

Method and stuttering therapy apparatus Inventor(s): Webster; Ronald L. (P.O. Box 9737, Hollins College, VA 24020) Assignee(s): None Reported Patent Number: 4,020,567 Date filed: October 16, 1974 Abstract: A method and apparatus is utilized in the detection of certain characteristics in the speech of stutterers as they participate in a program which reconstructs the basic properties of speed sounds. The method of speech therapy for stutterers includes transducing a patient's speech into an electrical signal and comparing the transduced signal to a reference signal representative of the desired speech target behavior. The comparison is initiated when the amplitude of the transduced speech signal exceeds a threshold related to minimal sound level. When the amplitude of the transduced speech signal exceeds that of the reference signal, the subject is visually advised of an error in his speech. When the amplitude of the transduced speech signal remains above the trigger threshold and below the reference signal, the subject is visually advised that a correct speech response has been made. In a second embodiment, the rate of change of the amplitude of the subject's speech signal is compared with a reference related to the desired target behavior. Excerpt(s): This invention relates to a method and apparatus for use in the treatment of stuttering and more particularly to a method of detecting and indicating speech onset errors in stutterers who are participating in a program of therapy that reconstructs the form of the detailed gestures from which speech originates. Children and adults who stutter have substantial difficulty in overcoming the handicap because of limitations in detecting certain aberrant characteristics of their own speech. Normally, the therapist must try to explain the various detailed characteristics of correct and incorrect sounds. Because in the reconstruction of speech the stutterer must modify minute aspects of speech behavior, it is difficult to cause the subject to attend to the details of his speech in a correct and efficient manner. While the reasons for stuttering are not clearly known, it has been demonstrated that the handicap may be reduced or eliminated by the systematic reconstruction of the stutterer's speech behaviors. However, certain difficulties exist in causing stutterers to attend adequately to the detailed characteristics of their own speech. Specifically, within each syllable the amplitude rise time of the voiced component must fall beneath a certain value if stuttering is to be avoided. Therefore, it may be seen that it is difficult for the therapist to either make rapid, reliable judgments about the subject's behavior or to provide adequate feedback to the subject about the adequacy of his speech responses. Web site: http://www.delphion.com/details?pn=US04020567__

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Speech therapy Inventor(s): Acres; Penelope A. (53 Dorothy Rd., Norwood, Johannesburg, Transvaal Province, ZA) Assignee(s): None Reported Patent Number: 4,218,836 Date filed: February 28, 1979 Abstract: This invention relates to speech therapy wherein a speech teaching aid is provided comprising at least one two dimensional frontal outline of human face, the outline including a representation of vocal apparatus corresponding to the configuration of the vocal apparatus of a person when a particular phonetic sound is being made. The aid may be applied to a mirrored surface so that a comparison can be made by the patient of his facial expression with that of the aid. Excerpt(s): This invention relates to a method of speech therapy and a teaching aid therefor. More particularly the invention is concerned with articulatory disabilities in patients. There are several communication channels which are used in speech therapy and these include the auditory, tactile, kinesthetic and visual channels. The visual channel involves sight and perception and methods employing the visual channel concentrate on teaching the patient to pick out visual clues and to use these clues as a basis for vocal improvement. Most of these visual methods are, however, complicated and of limited application because they do not show the patient how to produce sounds, but rather demonstrate what happens when a sound is made. An object of this invention is to provide a teaching aid for use in speech therapy and a visual method of speech therapy utilizing the aid. Web site: http://www.delphion.com/details?pn=US04218836__

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Speech therapy appliance Inventor(s): Blakeley; Robert W. (248 NW. Seblar Ct., Portland, OR 97210) Assignee(s): None Reported Patent Number: 5,257,930 Date filed: November 21, 1991 Abstract: A method and device that facilitates production of r sounds in humans who have difficulty pronouncing them. An appliance is placed adjacent the posterior edge of the hard palate that lowers the effective roof of the palatal vault. The appliance preferably extends between the last erupted posterior maxillary teeth on each side of the dental arch, and lowers the palatal vault of the occlusal plane of the teeth between which the appliance extends. The position of the appliance in a subject's mouth can be manipulated by a handle, or the appliance can be fixed in a subject's mouth using dental clasps. Excerpt(s): This invention concerns a prosthetic device for helping overcome speech problems, particularly difficulties pronouncing r sounds. The phoneme /r/ is one of the five most used English consonants. Its frequency of occurrence in spoken English consonants is approximately 9%. There are several sound variations, called allophones, within the phoneme /r/. The phoneme is considered a consonant when it initiates a syllable (as in the word "red") or when it occurs in a consonant blend (e.g. "dr" as in dress). It is considered vocalic or vowelized when it occurs within a syllable (e.g. bird)

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or in a postvocalic position (as in water). The symbol for the vowel r is 3. Difficulty pronouncing r sounds is one of the residual errors most often found in school age children. The persistence of this error may be related to the difficulty of correcting misarticulation of this phoneme. The tongue shape and position when articulating r are not easily visible, which makes it a difficult sound to teach and learn by imitation. Traditional speech therapy, however, has relied almost exclusively on instructional, auditory techniques to teach the phoneme /r/ and other troublesome speech sounds. For example, a clinician will teach a subject auditory discrimination by clarifying the differences between sounds, then may give verbal instruction for reproducing the sound by showing the subject how his mouth and tongue can be used to produce it. The patient will in turn learn to listen carefully to his sound production, and learn to produce the desired sound by imitating the auditory sample, and sometimes the mouth movements, prescribed by the therapist. Teaching r sounds has proven particularly difficult using these methods, particularly after habituation of the error has occurred. Web site: http://www.delphion.com/details?pn=US05257930__ •

Speech therapy device providing direct visual feedback Inventor(s): Jones; Cynthia L. (430 Silver Valley Blvd., Munroe Falls, OH 44262), Lorman; Janis S. (1738 Gorge Pk Blvd., Stow, OH 44224) Assignee(s): None Reported Patent Number: 5,169,316 Date filed: July 9, 1991 Abstract: A speech therapy device for providing a means for the treatment of speech and swallowing problems and disorders comprising a sheet having first and second surfaces with a centrally-affixed means for providing direct visual feedback, as well as instructions, guidelines and indicia placed strategically therearound for practicing basic oral exercise drills. The preferred visual feedback means is a mirror, particularly one comprised of an acrylic material. The sheet may be either a single flat sheet or folio prepared from a folded single sheet or multiple sheets. Excerpt(s): The present invention relates to a device for improving speech/language problems and disorders by combining teaching and/or instructional indicia with a direct visual feedback means, particularly a mirror centrally mounted on a sheet of stock material surrounded by such teaching and/or instructional indicia. Experts in the profession of speech pathology work with children and adults whose speech or language skills interfere with communication, calls attention to itself and frustrates both speaker and listener. These specialists, called speech-language pathologists ("SLPs"), evaluate and correct defective speech and language and teach new speech and language skills. The field of speech therapy is often called speech pathology and SLPs are sometimes known as speech therapists or speech clinicians. The present invention will help these experts in the rehabilitation of patients. Speech-language pathologists divide speech and language defects into five main types: 1) articulation problems such as the inability to produce certain sounds; 2) stuttering, cluttering (rapid, slurred speech), and other fluency problems; 3) voice disorders including problems of pitch, voice quality and volume; 4) delayed speech characterized by a child's slow language development; and 5) aphasia, the partial or total loss of the ability to speak or understand language. Speech/language pathologists also treat disorders of swallowing as part of their current scope of practice.

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Web site: http://www.delphion.com/details?pn=US05169316__ •

Speech therapy system Inventor(s): Fetterman; Eliezer (Atniel, IL), Friedman; Arye (Atniel, IL), Zeitlin; Vladimir (Jerusalem, IL) Assignee(s): Speech Therapy Systems Ltd. (kiryat Arba, Il) Patent Number: 5,765,135 Date filed: July 7, 1997 Abstract: The invention provides a speech therapy system, comprising a first channel including a microphone, and a first analog-to-digital (A/D) transducer for transducing voice signals from the microphone into digital form, a second channel including at least one respiration sensor attachable to a user's body for detecting breathing motion, and a second A/D transducer connected to the sensor for transducing breathing motion signals into digital form. The system further includes a processing, video display and voice output unit, to which the first and second channels are connected, for the simultaneous display of voice and breathing motion patterns while effecting the sounding of the voice signals. Excerpt(s): The present invention relates to a speech therapy system, and more particularly to a system for training and improving proper coordination between respiration and voice production. Known speech therapy apparatus includes trainers for treating stuttering by improving abdominal respiration, or, alternatively, for correcting incorrect sounds characteristics as compared to correct reference sounds. It has been found that many of the problems surrounding smooth and correct speech originate in the lack of coordination between respiration and voice production, thus causing speech defects. It is therefore a broad object of the present invention to provide a system to ameliorate the above-described problem, and to improve coordination between respiration and voice. Web site: http://www.delphion.com/details?pn=US05765135__

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Speech therapy variable code learning translator Inventor(s): Simmons; William F. (541 March St., Shillington, PA 19607) Assignee(s): None Reported Patent Number: 4,769,846 Date filed: September 9, 1985 Abstract: The Speech Therapy Translator converts minimal manipulations to aural conversation using basic words and statements necessary for rehabilitating patients who are speech handicapped. The system is also used for language and minor utterance translation. Applications in the fields of animal sound and language translation, Linguistic Anthropology, and aids to the permanently speech-handicapped are evident. The main feature of the system is that the sight sense is not needed for fluent conversation. There are three primary modes of operation.The first mode is DC switch excitation. The switches are attached to the fingers, eyelids or convenient movable positions on the body. The second mode of operation utilizes audio microphone inputs. The microphones, with sufficient amplification, are sensitive to touch excitation. The

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microphones are also activated by various pulse-type sounds. These sounds are in the nature of clicks, whistles, or cricket sounds. The basic system contains two active coding channels and the sounds for this mode must be made directional. If the patient is incapable of any minor utterances, this mode could not be used. The third mode uses selective filters, external to the basic system. Preselected sounds such as (e) and (uh) excite the two channels of the system. The coding arrangement sets up the translation process from the step incrementing channel operation to the selected word in the voice synthesizer. This third mode may also contain phase time delay coding detection which is coded into the translation process. The third mode may be used for animal sound verses action response translation and applications in Linguistic Anthropology. Excerpt(s): The Speech Therapy Translator is an immediate translator. Initial speeds are adjustable and will vary with improvement during the code-learning process. When used in speech therapy, the variable code-learning translator allows the patient to speak at rates conducive to the response capability of the patient and with external adjustments will increase speaking rates as the patient improves. A patient incapable of speaking may speak with normal conversation by manipulating touch switches, tapping, or uttering almost inaudible grunts or clicks into a throat microphone. The system is basic and will translate animal gibberish to English or any other language. Bird whistles and ultra sound detection reveal interesting code to language translations. Word capacity is increased by adding another channel to the system or by increasing the number of steps to the existing two channels. The voice synthesizer may be a commercial speak and spell unit converted for the translator by arrangement. The synthesizer may also be a programmed chip from Texas Instruments or National Semiconductor Corporation. Special programmed synthesizers are necessary for larger word capacity. Word capacity is increased by adding another channel to the system or by increasing the number of steps in the existing two channels, or both. An experimental model uses Magnecraft W102MX-2, 200 ohm 6-volt DC Relays. With larger word capacities, solid state relays are used to conserve space. Web site: http://www.delphion.com/details?pn=US04769846__ •

Teaching apparatus Inventor(s): Deyo; Charles R. (Fort Worth, TX), Hunnicutt; Jack B. (Fort Worth, TX), Journot; Vida M. (5913 Quality Hill, Smithfield, TX 76080) Assignee(s): Jounot; Said Vida M. (tx) Patent Number: 4,012,852 Date filed: March 25, 1975 Abstract: An electronic speech therapy teaching apparatus for use by a speech therapist includes a silent timer with an associated electronic digital display, an adjustable aural speech rate device, an automatic calculator for computing a student's percentage of correct responses, an electronic display of the accumulation of total and correct responses, and controls to select and operate the various features of the apparatus. The silent timer selectively counts up or down, informing the operator when counting down, through an audio/visual alarm, when a predetermined time period has expired. The adjustable aural speech rate device produces tones at a rate appropriate for the speech student. Manually controlled switches enable the operator to register and display the number of correct and total responses during the evaluation procedure. An automatic computer calculates the percentage of a student's correct responses as they are registered by the operator.

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Excerpt(s): This invention relates to equipment for use by speech therapists and the like in testing, evaluating and modifying the speech habits of those persons who are considered to have a speech handicap. Among those extraordinary people who have frequently been neglected in times past have been those people who exhibited what is commonly called a speech handicap. This neglect has not always been intentional, because certainly there have been relatives and close friends, as well as professional people such as speech pathologists, etc., who have been very concerned about the welfare of such handicapped persons. But mere "concern" or "sympathy" by others usually has not been enough to make much difference in the speech habits of most persons; what has been needed has been hardware, instruments, programs and other tangible "tools" with which the handicapped can be helped. In particular, there has long been a dearth of equipment with which to evaluate a person's handicap with sufficient accuracy (and speed) so that a therapist could promptly begin constructive work with the person--without spending a lot of time in unfruitful exploration. For example, if a child has a handicap such that he continually stutters, it usually doesn't take an observer very long to discern this fact. And if that child who once stuttered has been helped to full speech fluency, it shouldn't take an observer too long to conclude that the problem has been solved. But, regrettably, there has not really existed any equipment with which to accurately evaluate performance somewhere between these two extremes, i.e., equipment which would permit a clinician to quickly say with assurance that a child is performing 10% or 15% better this week than he did last week. Neither has it been possible to demonstrate with empirical data that a given therapy program is more cost effective than another program because the first program repeatedly provides more improvement at a lower cost. Hence, it is believed that the absence of any specialized equipment for measuring speech abnormalities in a scientific manner has contributed to the prolongation of some rather laborious trial-and-error techniques in speech therapy that should have been abandoned (or at least drastically modified) long ago. Too, in order to determine if a person with a speech handicap is being helped by a particular program of therapy, it is fairly obvious that tests should first be performed to find out what is the person's beginning level of speech capability. This initial testing of the degree of a person's specific speech errors is commonly referred to as establishing a baseline for the specified speech behavior of the client or "subject". Although it is so logical that a baseline or beginning point should be established at the inception of any program of therapy, until recently there were no widely accepted or standardized procedures which could be used by various clinicians throughout the country in order to evaluate the degrees of a person's speech errors. While each so-called expert in speech therapy usually had his or her preferred test routines and training techniques, there were essentially no empirical data for hundreds or thousands of different handicapped persons which might be useful in discovering which tests or training techniques seemed to be more reliable than others, or which therapy techniques seemed to be more beneficial than others and to which students. Hence, the lack of standardized instrumentation for monitoring the performance of different persons has tended to inhibit major progress in dealing with many difficulties in human speech. Web site: http://www.delphion.com/details?pn=US04012852__

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Tone analysis system with visual display Inventor(s): Humphrey; John H. (Los Angeles, CA), Humphrey; Thomas D. (Silverado, CA) Assignee(s): Murli Advani (villa Park, Ca) Patent Number: 4,024,789 Date filed: December 9, 1974 Abstract: An audible tone identifier comprises a transducer and amplifier for responding to audible tones, such as generated by a human voice speaking or singing, or a musical instrument, and a plurality of filters sharply tuned to the notes of one or more octaves or fractions thereof of the equal tempered chromatic musical scale or to other patterns of sounds that are to be individually identified. The outputs of the filters are connected to lamp driver circuits which in turn are connected through transposing plug-and-jack connectors and sharp-and-flat insertion switches to lamps on a display board, whereby any musical tone within the range of the device, received by the transducer, will be identified visually on the display board by the lighting of a lamp. The tone identifier may be a component of a teaching or speech therapy system including a source of recorded instructions and sounds to be produced by a trainee, such as a tape player and pre-recorded tape, and headphones through which the trainee hears instructions as well as the sounds produced by him. Excerpt(s): Aids to the teaching of music, whether vocal or instrumental, and for the tuning of instruments have, in the past generally employed one or the other of two concepts. In accordance with one of these concepts the tone identifying device is comprised of a plurality of tone generators each of which may be individually activated to generate a tone of known frequency. A tone originating in a musical instrument or in the vocal cords of a voice trainee is fed into the device through a microphone and amplifier and is applied to comparison circuitry, such as a cathode ray tube, along with the tone that is being generated as selected within the device. Identification of the tone that is being generated externally and applied to the device is then accomplished through a comparison and matching technique which is at best an indirect method providing no useful output until a match has been accomplished and therefore not giving a direct indication of tone identity nor lending itself readily to the identification of two or more tones simultaneously sounded nor the possibility of a steady and lasting indication of the externally generated tone when the production of that tone has ceased. The other concept involves the employment in the tone identifying device of a plurality of tuned vibratory elements such as reeds or tuning forks. These are tuned to the frequencies of the notes of the musical scale and are arranged to be set in sympathetic vibration either accoustically or electrically, in response to an externally generated tone that is to be identified and that is introduced into the device through a microphone or other type of transducer. Petroff U.S. Pat. No. 2,779,920, granted Jan. 29, 1957, is an example of an audio-frequency meter employing tuned reeds. A laminated iron core is arranged to influence all of the tuned reeds magnetically and the core carries a winding upon which are impressed the tone signals that are to be identified. In one embodiment the reeds are arranged to serve as light shutters and in another embodiment they are arranged to complete, in their vibratory excursions, the circuits of lamps. The tone display device employing tuning forks is disclosed in Balamuth U.S. Pat. No. 3,204,513, granted Sept. 7, 1965. In this disclosure tones to be individually identified by the lighting of lamps are applied to a plurality of windings each associated with one of a set of tuning forks to set the tuning fork in vibration at its natural frequency through an iron core associated with the winding. Each tuning fork also has associated with it a pickup

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coil to be energized at the frequency at which the tuning fork is vibrating. Each of the pickup coils controls a circuit closure device for completing a circuit of a lamp individual to the pickup coil and therefore representing the tuning fork that has been set in vibration. Web site: http://www.delphion.com/details?pn=US04024789__

Patent Applications on Speech Therapy As of December 2000, U.S. patent applications are open to public viewing.5 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to speech therapy: •

Method for utilizing oral movement and related events Inventor(s): Fletcher, Samuel G.; (Springville, UT) Correspondence: Karl R Cannon; PO Box 1909; Sandy; UT; 84091; US Patent Application Number: 20020087322 Date filed: November 14, 2001 Abstract: A method for utilizing oral movements is used in speech assessment, speech therapy, language development, and controlling external devices. A device is used which includes a sensor plate having sensors to detect contact of the tongue with the sensor plate. One aspect of the invention allows viewing representations of contact of the tongue and palate during speech and comparing the representations with model representations displayed in a split screen fashion. The model representations may be generated by another speaker utilizing a sensor plate or by computer generated representations which have been electronically stored. The representations may be analyzed to assess speech proficiency and the model may be mimicked for speech enhancement. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/249,148, filed Nov. 15, 2000. Not Applicable. 1. The Field of the Invention. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Portable speech therapy device Inventor(s): Evangelisti, Fred C.; (Sacramento, CA) Correspondence: Bever Hoffman & Harms, Llp; 2099 Gateway Place; Suite 320; San Jose; CA; 951101017 Patent Application Number: 20030036041 Date filed: August 16, 2001 Abstract: A portable speech therapy device that enables postoperative cancer patients to practice voice exercises without direct supervision by activating a series of colored indicator lights in predetermined patterns associated with push-button actuation switches. The patient is initially taught to make a certain sound when an associated

5

This has been a common practice outside the United States prior to December 2000.

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indicator light is turned on, and then allowed to practice with the device at home. The sequences associated with each actuation switch are made progressively more challenging as the patient masters the sequences associated with each switch (e.g., progressively shorter time periods allowed response, progressively greater number of prompts, or different patterns in which the colored indicators are turned on). The device is field programmable to allow the doctor to tailor sequences to correspond with a patient's recovery progress. Excerpt(s): The present invention is directed to speech therapy methods, and in particular to speech therapy methods for postoperative vocal organ cancer patients. Experts in the profession of speech pathology work with patients whose speech or language skills are defective in one way or another. These specialists, called speechlanguage pathologists ("SLPs"), evaluate and correct defective speech and language and teach new speech and language skills. The field of speech therapy is often called speech pathology and SLPs are sometimes known as speech therapists, speech clinicians, or speech technicians. Speech and language difficulties arise from a variety of physical problems, including cancer of the tongue or other vocal organs. Treatment in such instances typically involves surgery to remove cancerous growth from the affected vocal organs and post-operative chemotherapy treatment. Speech therapy is started as soon as possible after the operation to rehabilitate the affected vocal organs, and often takes place while a patient is undergoing chemotherapy. The method of speech therapy varies, but usually involves one-on-one sessions in which an SLP visually prompts a patient to make (utter) selected sounds that exercise the affected vocal organs. In many instances, the SPL develops practice drills during which the patient makes a series of such sounds in a predetermined or random pattern. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Speech therapy system and method Inventor(s): Parmer, Pam; (San Antonio, TX), Spiser-Albert, Valarie; (San Antonio, TX), Waryas, Carol; (San Antonio, TX) Correspondence: Jacqueline E. Hartt, PH.D.; Allen, Dyer, Doppelt, Milbrath & Gilchrist, P.A.; 255 South Orange Avenue, Suite 1401; P.O. Box 3791; Orlando; FL; 32802-3791; US Patent Application Number: 20020099554 Date filed: January 25, 2001 Abstract: A method for providing speech therapy includes the steps of selecting a problem speech sound and searching a database that houses a plurality of records. Each record contains a picture and a word associated with the word. Next a set of records is automatically generated from the plurality of records. Each record contains a word specific to the problem speech's sound. At least a portion of each record in the set of records is next automatically presented to a user sequentially on a display device, and the user is prompted to pronounce the displayed word. Finally, the pronunciation of each word is scored. The system includes hardware for carrying out the method, including a processor, display device, input device, and software resident on the processor adapted to access a database of records, present records to the user, and receive a score entered into the input device. Excerpt(s): The present invention relates to systems and methods for analyzing and remediating speech pathologies, and, more particularly, to such systems and methods that are computer-based. Articulation and phonology disorders are the most common of

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the speech and language disorders. The prevalence of this disorder is, at the time of writing, approximately 10% of the school-age population. In addressing a perceived articulation issue in a student, speech/language pathologists have in the past used an initial test based upon a series of cards. Each card contains a picture and a word, and the student is asked to pronounce the word associated with the card. The pathologist then determines whether the student's pronunciation is "right" or "wrong." It may be recognized that such a system can be cumbersome, owing to the cards' having to be placed in a desired order and sorted manually. An intervention system designed to automate this process, Picture Gallery I, was presented by the owner of the current application. In this system pictures and/or words stored in a database could be sorted using a desired criterion such as a particular phoneme and presented to the student under software control for facilitating the acquisition or remediation of speech or language skills. No analysis or scoring is performed; rather, the product is intended for use by one or more students, either alone or in concert with a pathologist/teacher. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with speech therapy, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “speech therapy” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on speech therapy. You can also use this procedure to view pending patent applications concerning speech therapy. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON SPEECH THERAPY Overview This chapter provides bibliographic book references relating to speech therapy. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on speech therapy include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “speech therapy” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on speech therapy: •

Therapy Techniques for Cleft Palate Speech and Related Disorders Source: San Diego, CA: Singular Publishing Group. 2001. 175 p. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 076930169X. Summary: This book describes speech therapy for individuals with cleft palate, velopharyngeal insufficiency (VPI), and their sequelae. The purpose of the book is to provide information that will be useful to clinicians and parents of children with 'cleft palate speech.' The author provides a developmental approach, written in response to requests for information from speech language pathologists (SLPs) being asked to offer therapeutic services to individuals with cleft palate at various stages of development. The author describes the types of interventions that may be provided by speech

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specialists treating children with cleft palate and related disorders, including feeding, early intervention, prevention, and treatment, along with recommendations about when treatment should be applied. The author focuses on how SLPs can guide parents through the therapy process, not just to understand it, but to participate in that process. Ten chapters cover speech production, working with infants and toddlers with cleft palate, models of service delivery from preschool through adolescence, techniques for the elimination of abnormal compensatory errors, moving from sounds to conversation, procedures and materials, evaluation and therapy techniques to avoid, and velocardiofacial syndrome and other special groups. The book is illustrated with black and white photographs of SLPs and children in the therapeutic setting. The book concludes with a references list, an appendix of selected resources, and a subject index. 78 references. •

Living with Aphasia: Psychosocial Issues Source: San Diego, CA: Singular Publishing Group, Inc. 1992. 305 p. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $47.50 plus shipping and handling. ISBN: 1565930673. Summary: This book explores the psychosocial issues of living with aphasia. Sixteen chapters are presented in five sections: introspection; the person with aphasia; the person with aphasia and treatment; the family; and the person with aphasia and society. Specific topics covered include self-awareness of the problem of aphasia; the physical experience of the person with aphasia; the psychological effects of aphasia; aphasia and artistic creation; the dynamics of speech therapy; typical behavior of persons with aphasia and their families; the bilingual person with aphasia; workplace considerations; legal issues; ethical-moral dilemmas in aphasia rehabilitation; and associations for persons with aphasia. The book includes extensive quotations from people with aphasia, as well as numerous case examples.

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Stuttering: Treatment of the Young Stutterer in the School Source: Memphis, TN: Stuttering Foundation of America. 1995. 64 p. Contact: Available from Stuttering Foundation of America. P.O. Box 11749, Memphis, TN 38111-0749. (800) 992-9392. PRICE: $2.00 plus shipping and handling. Publication number 4. Summary: This booklet is a reprint of the original report of a conference held in 1963. It is written for public school clinicians who have to wrestle with the baffling problem of stuttering. A group of speech pathologists were asked what specific problems they had encountered in working with elementary school children who stutter, and what questions they wanted answered in relation to their work. The editor of this 1995 edition of the report notes that the information is still relevant and has been reprinted because of numerous requests for it. After a representative letter from a public school clinician, the booklet poses and answers commonly asked questions. These questions cover the needs and intention of the booklet; how stuttering in children differs from that in adults; how therapy for stuttering in children differs from that for adults; the basic qualifications of the therapist; how to recognize children for whom stuttering is a problem; prevention considerations; how to tell whether or not to work with parents, and how to keep parents apprised of ongoing therapy; how regular classroom teachers can cooperate effectively with the speech therapy program; how to motivate children to

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participate in therapy and to continue working toward stated goals; how to establish the goals of therapy; how to structure the first meeting; ongoing strategies of therapeutic interaction; the emotions that may be associated with therapy, including fear, selfconfidence, and self-esteem; indications of improvement; the termination of therapy; and group therapy with children who stutter. The booklet concludes with a list of strategies for parents. The names and affiliations of the original conference participants are also provided. The booklet is illustrated with black and white photographs of children. •

Looking Forward: A Guidebook for the Laryngectomee. 3rd ed Source: New York, NY: Thieme Medical Publishers, Inc. 1995. 96 p. Contact: Available from Thieme Medical Publishers, Inc. 381 Park Avenue South, Suite 501, New York, NY 10157-0208. (800) 782-3488. PRICE: $9.95 for single copy plus shipping and handling; bulk rates available. Summary: This patient education handbook for people undergoing laryngectomy was written to familiarize patients with experiences that they may have before or after surgery. In addition, the author provides practical hints for dealing with difficulties that may arise as a result of the removal of the larynx. Seven chapters discuss the diagnosis, including diagnostic tests and preoperative procedures; the operation itself, including the surgical technique, radiation therapy, risks, and chance of cure; immediate postoperative care; speech therapy, including the voice rehabilitation options available; tracheostomy tube care; stoma care; and returning to activities of daily living, including working, outdoor activities, and sexual intimacy. The handbook includes extensive appendices, including a detailed glossary, making a crocheted stoma cover, nutritional considerations, feeding tubes and their care, suggestions for restaurant dining, care of the stoma button, family support guidelines, recommended exercises, and the addresses of manufacturers and suppliers of related materials and equipment. The book is written for an educated lay reader.

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Communicative Disorders Related to Cleft Lip and Palate. 4th ed Source: Austin, TX: PRO-ED, Inc. 1997. 570 p. Contact: Available from PRO-ED, Inc. 8700 Shoal Creek Boulevard, Austin, TX 787576897. (512) 451-3246. Fax (800) 397-7633. PRICE: $56.70 plus shipping and handling. ISBN: 0890797013. Summary: This textbook explores in great detail cleft lip and cleft palate and the communicative disorders that can result from these conditions. After an introductory chapter, 22 chapters cover topics including the anatomy and physiology of normal and disordered velpharyngeal function for speech; basic genetic concepts in craniofacial anomalies; social and psychological perspectives on cleft lip and palate; primary surgical correction of cleft palate; secondary surgical procedures to correct postoperative velopharyngeal incompetencies found after primary palatoplasties; and prosthodontic management of the individual with cleft lip and palate for speech habilitation needs. The authors also discuss health supervision and the coordination of the craniofacial team; etiological factors related to managing cleft palate speech disorders; congenital and acquired velopharyngeal inadequacy; audiological management of patients with cleft palate and related disorders; the clinical assessment, evaluation, and management of 11 categorical aspects of cleft palate speech disorders; the diagnosis of specific cleft palate speech error patterns for planning therapy or physical management needs; the use of nasometry in the assessment and remediation of velopharyngeal inadequacy; the

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radiographic assessment of velopharyngeal function for speech; nasopharyngoscopy; and aerodynamic assessments and procedures used to determine the extent of velopharyngeal inadequacy. Topics related to therapy include the rationale, methods, and techniques of cleft palate speech therapy; counseling and early management of feeding and language skills development for infants and toddlers with cleft palate; therapy considerations for preschool children with cleft palate; speech and voice therapy techniques for school age and adult patients with remaining cleft palate speech disorders; considerations for the behavioral treatment of velopharyngeal closure for speech; and behavioral treatments of velopharyngeal impairment. Each chapter includes black and white photographs or illustrations and extensive references; a subject index concludes the textbook.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “speech therapy” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “speech therapy” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “speech therapy” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Dictionary of Speech Therapy by Morris; ISBN: 1870332512; http://www.amazon.com/exec/obidos/ASIN/1870332512/icongroupinterna

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Marvelous Mouth Music: Songs for Speech Therapy and Beyond [ABRIDGED] by Aubrey Lande, et al; ISBN: 1893601056; http://www.amazon.com/exec/obidos/ASIN/1893601056/icongroupinterna

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Neurospeech Therapy for the Cerebral Palsied: A Neuroevolutional Approach by Edward Damien, Mysak; ISBN: 0807726125; http://www.amazon.com/exec/obidos/ASIN/0807726125/icongroupinterna

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School speech therapy; a source book by Martha E. Black; ISBN: 0870768522; http://www.amazon.com/exec/obidos/ASIN/0870768522/icongroupinterna

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Speech Therapy and the Bobath Approach to Cerebral Palsy by Marie Crickmay; ISBN: 0398003629; http://www.amazon.com/exec/obidos/ASIN/0398003629/icongroupinterna

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Speech Therapy in the Public Schools by Martha E. Black; ISBN: 0672612879; http://www.amazon.com/exec/obidos/ASIN/0672612879/icongroupinterna

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Speech Therapy: A Clinical Companion: Notes on Clinical Practice for Students by Jennifer Warner, et al; ISBN: 0719009936; http://www.amazon.com/exec/obidos/ASIN/0719009936/icongroupinterna

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The Clinician's Guide to Alaryngeal Speech Therapy by Minnie S. Graham; ISBN: 0750698624; http://www.amazon.com/exec/obidos/ASIN/0750698624/icongroupinterna

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Working With the Classroom Curriculum: A Guide for Analysis and Use in Speech Therapy by Patricia A. Prelock, et al; ISBN: 0761678832; http://www.amazon.com/exec/obidos/ASIN/0761678832/icongroupinterna

Chapters on Speech Therapy In order to find chapters that specifically relate to speech therapy, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and speech therapy using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “speech therapy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on speech therapy: •

How Speech Is Produced and What Goes Wrong Source: in Golding-Kushner, K.J. Therapy Techniques for Cleft Palate Speech and Related Disorders. San Diego, CA: Singular Publishing Group. 2001. p. 13-34. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 076930169X. Summary: Children born with cleft palate may exhibit speech problems related to a variety of anatomic and medical problems, such as malocclusions and hearing loss. They may also develop the same phonological and developmental articulation disorders exhibited by children without cleft palate. This chapter on speech production is from a book that describes speech therapy for individuals with cleft palate, velopharyngeal insufficiency (VPI), and their sequelae. The purpose of the book is to provide information that will be useful to clinicians and parents of children with 'cleft palate speech.' The author notes that, by far, the speech problems in these children that seem to cause the greatest difficulty are those related to velopharyngeal insufficiency (VPI) and palatal fistulae. In order to understand these errors, the author reviews the mechanics of normal speech production and what may go wrong when there is a cleft palate. Topics include developmental articulation errors, phonological errors, so called 'cleft palate speech', obligatory articulation errors, compensatory errors, compensatory adaptations, visual distortions, unusual orofacial anomalies, clinical speech analysis, and VPI and hypernasality. 11 figures.

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Techniques for the Elimination of Abnormal Compensatory Errors Source: in Golding-Kushner, K.J. Therapy Techniques for Cleft Palate Speech and Related Disorders. San Diego, CA: Singular Publishing Group. 2001. p. 68-92. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 076930169X. Summary: Speech therapy to eliminate abnormal compensatory errors can be simple and quick. This chapter is from a book that describes speech therapy for individuals with cleft palate, velopharyngeal insufficiency (VPI), and their sequelae. The purpose of the book is to provide information that will be useful to clinicians and parents of children with 'cleft palate speech.' In this chapter, the author offers a guide to techniques

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for the elimination of abnormal compensatory errors in this population. The first step in planning treatment is administration of an articulation test and analysis of speech sound production in words, sentences, and conversational speech. Results of these tests should be analyzed in terms of place, manner, and voicing of the sound. Errors should also be categorized as developmental, compensatory, or obligatory in order to facilitate decisions about the timing of therapy and the selection of appropriate targets in therapy. The author also offers specific techniques for the elicitation of specific sounds, guidelines for the use of articulatory contacts, and a discussion of using technology in treatment. •

After the Sound: Selection and Sequencing of Target Sounds and from Sounds to Conversation Source: in Golding-Kushner, K.J. Therapy Techniques for Cleft Palate Speech and Related Disorders. San Diego, CA: Singular Publishing Group. 2001. p. 93-112. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 076930169X. Summary: The ultimate goal of speech therapy is to transfer or generalize correct production of speech sounds to conversational speech automatically. This chapter is from a book that describes speech therapy for individuals with cleft palate, velopharyngeal insufficiency (VPI), and their sequelae. The purpose of the book is to provide information that will be useful to clinicians and parents of children with 'cleft palate speech.' In this chapter, the author offers a guide to techniques for selection and sequencing of target sounds and from sounds to conversation. Several parameters of treatment are considered, including the sequence of target sounds, when to introduce additional sounds, phonetic complexity of target words, how to move up and across levels of therapy from syllables through conversation, linguistic complexity of the therapy task, and the therapeutic awareness of the individual's conversational partner. 7 figures.

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Promoting Function: Communication and Feeding Source: in Dormans, J.P. and Pellegrino, L., eds. Caring for Children with Cerebral Palsy: A Team Approach. Baltimore, MD: Paul H. Brookes Publishing Company. 1998. p. 347370. Contact: Available from Paul H. Brookes Publishing Company. P.O. Box 10624, Baltimore, MD 21285-0624. (800) 638-3775. Fax (410) 337-8539. E-mail: [email protected]. Website: www.brookespublishing.com. PRICE: $38.95 plus shipping and handling. ISBN: 155766322X. Summary: The use of speech and language for communicating, learning, and regulating behavior is a critical developmental task and forms the basis for all social interactions. Children with cerebral palsy have significant neuromotor impairments that frequently affect their oral motor system and, as a result, also affect their development of speech, language, and feeding skills. In this chapter, from a book on the team approach to caring for children with cerebral palsy, basic aspects of assessment and treatment of communication and feeding problems are reviewed and an illustrative case example is provided. Speech, language, and communication topics covered include drooling (sialorrhea), dysarthria (movement disorders of neurological origin that can affect speech production), respiration, phonation (the generation of sound), resonation, articulation, speech therapy, language assessment, and language therapy. Because each

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child with cerebral palsy presents a unique profile of motor, cognitive, socioemotional, linguistic, and familial characteristics, comprehensive evaluation of the child must occur (and should be ongoing during treatment phases) before goals are established. For some children, conventional forms of communication and traditional forms of therapy will suffice to produce satisfactory outcomes; for other children, alternative methods of feeding and communication must be employed. 1 table. 33 references. •

Parents' Most Frequently Asked Questions Source: in Flexer, C.; Richards, C. We CAN Hear and Speak!: The Power of AuditoryVerbal Communication for Children Who Are Deaf or Hard of Hearing. Washington, DC: Alexander Graham Bell Association for the Deaf, Inc. 1998. p. 101-119. Contact: Available from Alexander Graham Bell Association for the Deaf, Inc. 3417 Volta Place, N.W., Washington, DC 20007-2778. Voice/TTY (202) 337-5220. Fax (202) 337-8314. E-mail: [email protected]. Website: www.agbell.org. PRICE: $24.95 plus shipping and handling. ISBN: 0882002090. Summary: This chapter is from a book is written for families of children who are deaf or hard of hearing. The authors emphasize that hearing is the most effective modality for teaching spoken language, reading, and cognitive skills. Additionally, auditory verbal communication and intervention is the most effective way to integrate amplified hearing into the child's total personality. This chapter lists 36 frequently asked questions, categorized into four areas: initial diagnosis and getting started, auditory-verbal therapy, school issues (preschool through college), and funding for technology and therapy. The parents who authored this book share their experiences, discuss how their children with severe and profound hearing losses were provided access to sound, and explain how their children learned to use amplified sound as their primary window to the world. Specific topics addressed include ABRs, early intervention, hearing aids, listening skills, family support systems, measuring progress with auditory verbal therapy, financial aid, school social situations, self esteem, special education, mainstreaming, working with educators, speech therapy, IEPs, and field trips. 1 figure.

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Articulation Issues Source: in Martin, K.L. Does My Child Have a Speech Problem? Chicago, IL: Chicago Review Press. 1997. p. 17-35. Contact: Available from Chicago Review Press. 814 North Franklin Street, Chicago, IL 60610. (312) 337-0747; Fax (312) 337-5985. PRICE: $16.95 plus shipping and handling. ISBN: 1556523157. Summary: This chapter on articulation issues is from a guide that helps parents and teachers identify normal speech development and potential speech and language problems in children. Articulation is defined as the ability to speak clearly and intelligibly. Articulation is considered a motor act, which means the muscle movement is involved. If a child has difficulty in controlling or coordinating the organs of speech to produce the sounds of her native language, she is said to have an articulation problem or disorder. The chapter is written in a question-and-answer format, covering topics including identifying articulation problems, the age at which mastery of certain speech sounds should be achieved, consonant production and placement, when speech therapy is warranted for articulation problems, the causes of articulation problems, normal articulation errors, the relationship between articulation development and middle ear infections, the relationship between dentition and articulation errors, modeling or imitating speech problems of other children, and the relationship between articulation

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skills and a sensorineural hearing loss. After each section, the author offers related strategies for the parents to employ. •

Anomalies of the External Ear Source: in Mencher, G.T.; Gerber, S.E.; McCombe, A. Audiology and Auditory Dysfunction. Needham Heights, MA: Allyn and Bacon. 1997. p. 73-88. Contact: Available from Allyn and Bacon. 160 Gould Street, Needham Heights, MA 02194-2310. (800) 278-3525; Fax (617) 455-7024; E-mail: [email protected]; http://www.abacon.com. PRICE: $46.95 plus shipping and handling. ISBN: 0205161014. Summary: This chapter on congenital anomalies of the external ear is from a textbook on auditory dysfunction. The author begins with a detailed discussion of embryology, including ontogenetic development, auditory system development, irregularities of the external ear, microtia and atresia, facial anomalies, and additional terminology. This section includes a description of the complex craniofacial anomalies associated with Treacher Collins syndrome (mandibulofacial dysostosis), Crouzon syndrome, and other craniofacial disorders. The chapter concludes with a discussion of the surgical and audiological approaches to treatment for complex craniofacial disorders. The author emphasizes that the majority of people with craniofacial anomalies have normal intelligence and normal emotions and should be treated as such. However, poor use of muscle structure, abnormal dentition (teeth), poor vision and hearing, and a host of other factors often result in speech and language delays and serious articulatory disorders that require treatment. Cosmetic surgery, hearing aids, and speech therapy may allow such persons to take their proper places in the community. 10 figures. 1 table.

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Getting an Early Start: Infants and Toddlers with Cleft Palate Source: in Golding-Kushner, K.J. Therapy Techniques for Cleft Palate Speech and Related Disorders. San Diego, CA: Singular Publishing Group. 2001. p. 35-60. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 076930169X. Summary: This chapter on infants and toddlers with cleft palate is from a book that describes speech therapy for individuals with cleft palate, velopharyngeal insufficiency (VPI), and their sequelae. The purpose of the book is to provide information that will be useful to clinicians and parents of children with 'cleft palate speech.' In this chapter, the author notes that the first contact between speech language pathologists (SLPs) and the family of a baby with cleft palate often occurs in the newborn period because of feeding concerns. In most cases, minor adjustments in positioning of the baby and the nipple are successful in establishing a normal feeding routine. The author also discusses early intervention, home programs, and the prevention of compensatory errors. Specific topics include feeding and oral motor skills, speech therapy for babies, language development, models of service delivery, prevention of speech and language disorders, home programs for early intervention, eliciting oral sound production in very young children, the nasal escape of air and hypernasality, recognizing first word attempts, prevention of glottal stop errors, when to ignore speech and when to start direct therapy. Parents should be reminded to follow up with medical care, especially because of the high frequency of middle ear disease among children with cleft palate. 5 figures. 4 tables.

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Beyond Early Intervention: Models of Service Delivery from Preschool Through Adolescence Source: in Golding-Kushner, K.J. Therapy Techniques for Cleft Palate Speech and Related Disorders. San Diego, CA: Singular Publishing Group. 2001. p. 61-67. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 076930169X. Summary: This chapter on models of service delivery from preschool through adolescence is from a book that describes speech therapy for individuals with cleft palate, velopharyngeal insufficiency (VPI), and their sequelae. The purpose of the book is to provide information that will be useful to clinicians and parents of children with 'cleft palate speech.' In addition to discussing different cycles in which speech language pathologists (SLPs) may be involved in the care of a patient with cleft palate or VPI, the author considers models of service delivery and aspects of treatment such as venue and scheduling. The chapter concludes with a discussion of funding for speech therapy services, including the issue of qualifying for receiving services through government funded programs.

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Communication Disorders in Velo-Cardio-Facial Syndrome and Other Special Groups Source: in Golding-Kushner, K.J. Therapy Techniques for Cleft Palate Speech and Related Disorders. San Diego, CA: Singular Publishing Group. 2001. p. 139-157. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 076930169X. Summary: Velo cardio facial syndrome (VCFS) is one of the most common syndromes associated with cleft palate. There are over 180 features associated with VCFS and severe speech and language problems and learning disabilities are among the most common. Therefore, knowledge of the patterns of communication impairment in children with VCFS and effective, efficient intervention procedures is of great importance to speech language pathologists (SLPs). This chapter on communication disorders in VCFS syndrome and other special groups is from a book that describes speech therapy for individuals with cleft palate, velopharyngeal insufficiency (VPI), and their sequelae. The purpose of the book is to provide information that will be useful to clinicians and parents of children with 'cleft palate speech.' In this chapter, the author discusses the common findings in VCFS, feeding concerns in infants with VCFS, school services for children with VCFS, learning disabilities associated with VCFS, and other syndromes, including Stickler syndrome, and Treacher Collins syndrome. The author concludes the chapter with a case history of a child born with an unusual pattern of severe oral anomalies; this case history is used as an example of the importance of distinguishing between obligatory and compensatory speech errors. 2 figures. 2 tables.

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CHAPTER 6. MULTIMEDIA ON SPEECH THERAPY Overview In this chapter, we show you how to keep current on multimedia sources of information on speech therapy. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on speech therapy is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “speech therapy” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “speech therapy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on speech therapy: •

Hearing Loss in Young Children Source: Milwaukee, WI: Maxishare. 1993. (videocassette). Contact: Available from Maxishare. P.O. Box 2041, Milwaukee, WI 53201. (800) 444-7747 or (414) 266-3428; Fax (414) 266-3443; E-mail: [email protected]. PRICE: $89.00 each. Item Number 201001. Summary: This videotape program addresses several basic issues that parents of children newly diagnosed with hearing loss may encounter. The program begins with scenes depicting common household sounds and a voice narration discussing how most people take everyday sounds for granted. The program then describes the emotions that parents may go through upon learning that their child has been diagnosed with a hearing loss. Other topics briefly mentioned include how proper evaluation and testing help determine the degree of hearing loss, the use of video reinforcement audiology, the audiogram, how loudness is measured, the four degrees of hearing loss (mild, moderate, severe, profound), the anatomy of the ear, the impact of ear infection on hearing loss, the

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degree of hearing loss and how it impacts language and speech development, the types of hearing aids used in children, what to expect when a child begins using a hearing aid, problems with hearing aids and otitis externa (outer ear infection), the methods of communication available (manual, oral, total), and the role of the speech pathologist and speech therapy in the child's language and speech development. The video depicts a number of families and children in household settings and in speech therapy. Parents are encouraged to seek support from other parents and health care professionals and to become educated partners in advocating for their child's health care and education. •

Being Understood Source: Chicago, IL: Craniofacial Center, University of Illinois at Chicago. 199X. (videocassette). Contact: Available from Craniofacial Center. MC 588, University of Illinois at Chicago, 808 South Wood Street, Room 476, Chicago, IL 60612-7308. (312) 996-0178. PRICE: $95.00 plus shipping and handling; $30.00 for 10-day rental, applicable toward purchase. Summary: This videotape program explores the use of speech therapy for toddlers and older children with cleft palate. The program shows a speech language therapist's office and work with a child who has a corrected cleft palate and lip. Topics covered include the parts of the body that produce speech sounds (the articulators); how the articulators work during three different types of sounds; problems with articulation in children with clefts; and adaptive substitutions that children with clefts use in speech production. The video also shows an older (pre-adolescent) child as well as a toddler in speech therapy with a speech language therapist and, in the case of the toddler, with the parents. The videotape is designed for parents, speech and language professionals, and associated health professionals and students who deal with lip/palate. (AA-M).

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Voices to Remember Source: Belleair Bluffs, FL: Suncoast Media, Inc. 1992. (Videocassette). Contact: Available from Suncoast Media, Inc. 2938 West Bay Drive, Suite B, Belleair Bluffs, FL 34640. Voice (800) 899-1008; Fax (813) 587-7942. PRICE: $89.00 for public performance rights; $39.00 for home use and support groups only; $4.00 shipping and handling. Item Number 5202. Also available from Communication Skill Builders. 3830 East Bellevue, P.O. Box, 42050-3C, Tuscon, AZ 85733. (602) 323-7500; Fax (602) 325-0306. PRICE: $89.00 plus shipping and handling. Item Number 7197-3C. Summary: This videotape program tells the stories of four adults who stutter, as seen through the eyes of 11-year-old Alyssa. The inspirational portrayals of Frank, an onion farmer, Sue the nurse, Jock, a former scientist, and children's dentist Marvin, along with Alyssa's own story reach out to all people who stutter and address the challenges they face. Topics covered include dealing with teasing by classmates and peers, dating and socializing in high school, coping with the telephone, choosing a career that focuses on speaking, communicating in the workplace, being open and honest about stuttering, deciding on long-term speech therapy, and developing a sense of humor in living with stuttering. (AA-M).

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CHAPTER 7. PERIODICALS AND NEWS ON SPEECH THERAPY Overview In this chapter, we suggest a number of news sources and present various periodicals that cover speech therapy.

News Services and Press Releases One of the simplest ways of tracking press releases on speech therapy is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “speech therapy” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to speech therapy. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “speech therapy” (or synonyms). The following was recently listed in this archive for speech therapy: •

Speech therapy may not help preschoolers Source: Reuters Health eLine Date: October 13, 2000

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Drug boosts speech therapy after stroke Source: Reuters Health eLine Date: August 31, 2000

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Speech therapy helps Parkinson's patients Source: Reuters Health eLine Date: July 28, 1999 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “speech therapy” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “speech therapy” (or synonyms). If you know the name of a company that is relevant to speech therapy, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.

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BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “speech therapy” (or synonyms).

Academic Periodicals covering Speech Therapy Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to speech therapy. In addition to these sources, you can search for articles covering speech therapy that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute6: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

6

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.7 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:8 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

7

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 8 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway9 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.10 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “speech therapy” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 4059 552 590 18 36 5255

HSTAT11 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.12 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.13 Simply search by “speech therapy” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

9

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

10

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 11 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 12 13

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists14 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.15 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.16 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

14 Adapted 15

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 16 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on speech therapy can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to speech therapy. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to speech therapy. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “speech therapy”:

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Other guides Cleft Lip and Palate http://www.nlm.nih.gov/medlineplus/cleftlipandpalate.html Head and Neck Cancer http://www.nlm.nih.gov/medlineplus/headandneckcancer.html Speech and Communication Disorders http://www.nlm.nih.gov/medlineplus/speechandcommunicationdisorders.html Stuttering http://www.nlm.nih.gov/medlineplus/stuttering.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on speech therapy. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Cleft Palate and Cleft Lip Source: Danbury, CT: National Organization for Rare Disorders, Inc. (NORD). 2002. 6 p. Contact: Available from National Organization for Rare Disorders, Inc. (NORD). 55 Kenosia Avenue, P.O. Box 1968, Danbury, CT 06813-1968. (203) 744-0100. Fax: (203) 7982291. TDD: (203) 797-9590. Email: [email protected]. Website: www.rarediseases.org. PRICE: Full-text available online for $7.50. Summary: Cleft lip and palate are common malformations that are noticeable at birth (congenital). A cleft is an incomplete closure of the palate or lip or both. These are genetic disorders that occur in the first trimester of pregnancy and may be barely noticeable or may be severe enough to require surgical and dental are, as well as speech therapy. This fact sheet reviews this condition, covering synonyms, a general introduction, the symptoms, causes (etiology), affected population, related disorders, and standard therapies. The fact sheet concludes with a list of resources for more information and a list of references. The fact sheet includes the contact addresses for the National Organization for Rare Disorders. 20 references.

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Cued Speech Source: Rochester, NY: National Technical Assistance Center (NETAC), National Technical Institute for the Deaf, Rochester Institute of Technology. 1999. [2 p.]. Contact: Available from National Technical Assistance Center. Rochester Institute of Technology, National Technical Institute for the Deaf, 52 Lomb Memorial Drive, Rochester, NY 14623-5604. Voice/TTY (716) 475-6433. Fax (716) 475-7660. E-mail: [email protected]. PRICE: Single copy free. Also available for free at www.netac.rit.edu/publication. Summary: Cued Speech (CS) is a tool to make spoken languages visible. CS is a phonemically based system that uses eight handshapes in four locations near the face to supplement the information available on the lips during speech. This fact sheet describes CS and its use in the classroom. Topics covered include the use of CS to support literacy development, the use of CS in the family setting and in the classroom, the role of CS as part of speech therapy (to work on pronunciation, accent, duration, and rhythm), and the results of CS use in the areas of language skills, speechreading, audition, foreign language. The fact sheet reprints the CS consonant handshapes and vowel placements, and includes the contact information for the National Cued Speech Association's Information Center (800-459-3529). 1 figure.

•

When Cancer Affects the Way You Look. Facing the Future: Managing the Change in Your Appearance Source: London, England: Changing Faces. 1997. 25 p. Contact: Available from Changing Faces. 1 and 2 Junction Mews, London W2 1PN United Kingdom. Telephone 0171-706-4232; Fax 0171-706-4234; E-mail: [email protected]. PRICE: $5.00 each. Order Number S01. Summary: This booklet is written for patients whose cancer has resulted or is likely to result in a change in their appearance, particularly their facial appearance. The booklet helps readers understand the problem of adjusting to looking different. The author provides examples of the types of things that may be difficult and some strategies for dealing with them. Throughout the booklet, the author emphasizes that readers must play an active part in the management of their own condition. Topics include preparing for treatment; types of cancer that may alter one's facial appearance; communicating with one's health care providers, including some useful questions to ask the health care provider about treatment, rehabilitation, speech therapy, dietary concerns, and support services; talking to other people, in family settings, friends, support groups, and counseling; managing the immediate effects of treatment, including issues of food and nutrition, pain, and appearance; use of prostheses and make up; managing socially after treatment, including strategies to use in social settings with friends, acquaintances, and strangers; problems with speech and strategies to use to communicate more effectively; and positive thinking and its role. The booklet then shares the experiences of a number of patients as they go through the process of adapting to a facial appearance change due to cancer or its treatment. The booklet concludes with a section that helps readers concentrate on the activities they can undertake at present and focus on changes they want to make for their own future. Specific strategies to try are offered in each section. The booklet lists support organizations and groups in England.

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Camp About Face Source: Indianapolis, IN: Craniofacial Program Office, James Whitcomb Riley Hospital for Children. 199x. 4 p. Contact: Available from Craniofacial Program Office. James Whitcomb Riley Hospital for Children. Room 2514, 702 Barnhill Drive, Indianapolis, IN 46202. (317) 274-2489. PRICE: Single copy free. Summary: This brochure describes Camp About Face, a summer camping experience for children with cleft lip and palate and other cranial or facial anomalies. Camp About Face is designed to provide opportunities for challenge, social interaction, and personal growth that are often missing in the lives of children with cranial or facial anomalies. Both group and individual education sessions are integrated into the camp program and include speech therapy, dental hygiene, psychosocial interactions, and cosmetic counseling. Recreational activities are designed to challenge children to reach their full potential and include canoeing, swimming, hiking, and arts and crafts. Social interaction provides opportunities for children to meet other children with similar social and medical experiences. The brochure is illustrated with full-color photographs of children experiencing Camp About Face.

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Elderly Adult Day Care: A Choice Source: Oklahoma City, OK: Division of Services for the Aging. Contact: Available from Support Services Unit. State Office, P.O. Box 25352, Oklahoma City, OK 73125. (405) 521-4214. (TDD 405-424-4311 ext. 2851). Summary: This brochure describes geriatric day care programs available in the state of Oklahoma. It lists benefits such as individual and family counseling, recreation, reality orientation, physical and speech therapy, and respite for caregivers.

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Spasmodic Dystonia Source: Chicago, IL: Dystonia Medical Research Foundation. 1995. [2 p.]. Contact: Available from Dystonia Medical Research Foundation. One East Wacker Drive, Suite 2430, Chicago, IL 60601-1905. (312) 755-0198. Fax (312) 803-0138. E-mail: [email protected]. Website: www.dystonia-foundation.org. PRICE: $0.20. Summary: This brochure describes spasmodic dysphonia, a neurological condition affecting the vocal muscles of the larynx. Written in a question-and-answer format, the brochure covers the symptoms of spasmodic dysphonia; the different types of spasmodic dysphonia (adductor type and abductor type); the causes of the condition; diagnostic tests used to confirm spasmodic dysphonia; the epidemiology of the condition; current forms of therapy, including physical therapy, speech therapy, and the use of local injections of botulinum toxin (Botox); and the possibility that spasmodic dysphonia is genetic. The brochure includes the address and telephone number of the Dystonia Medical Research Foundation.

•

Adult Day Health Care. Alzheimer's Day Care Resource Center Source: Eureka, CA: Humboldt Senior Resource Center. 1993. [5 p.]. Contact: Humboldt Senior Resource Center. 1910 California Street, Eureka, CA 95501. (707) 443-9747. PRICE: Free.

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Summary: This brochure describes the Adult Day Health Care program and the Alzheimer's Day Care Resource Center of the Humboldt Senior Resource Center in Eureka, California. The Adult Day Health Care program serves people with physical disabilities, people who are lonely or depressed, and people with confusion or memory loss. A variety of services including social work, nursing, personal care, and physical, occupational, and speech therapy are available to help participants reach and maintain an optimum level of health and to assist families with ongoing care. Program fees are based on a sliding scale and are Medi-Cal reimbursable. The Alzheimer's Day Care Resource Center offers information, support, and caregiving assistance to families of people with Alzheimer's disease. The Center offers a free Alzheimer's Cooperative Newsletter (see AZJA04438), educational workshops, access to print and audiovisual materials from the resource library, assistance in connecting with community services, adult day care services, support groups for caregivers, and advice about behavioral changes, coping strategies, and creating a safe home environment. •

Dysarthria: Understanding This Speech Problem Source: San Bruno, CA: Krames Communications. 1997. [4 p.]. Contact: Available from Krames Communications. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032; Fax (415) 244-4512. PRICE: Single copy free; $20.00 per pack of 50 brochures. Item Number 9433-LNZL. Summary: This brochure explains dysarthria, a speech problem caused by a lack of control over muscles in the face and mouth. This problem may occur when the brain is damaged by injury or illness. A person who has dysarthria knows which words to use, but may not be able to make the right sounds. The brochure lists the common signs of dysarthria and describes the role of speech language therapy in the rehabilitation work of persons with dysarthria. The brochure includes a sidebar offering strategies for family members or caregivers who wish to help the person with dysarthria practice his or her communication skills. The brochure is illustrated with full-color drawings of patients in speech therapy settings. One section briefly describes the related problems of aphasia (trouble using language) and dysphagia (swallowing difficulty).

•

Freeman-Sheldon Syndrome Source: Salt Lake City, UT: Freeman-Sheldon Parent Support Group. 199x. 2 p. Contact: Available from Freeman-Sheldon Parent Support Group. 509 East Northmont Way, Salt Lake City, UT 84103. (801) 364-7060. PRICE: Single copy free. Summary: This brochure familiarizes readers with Freeman-Sheldon syndrome, a rare genetic condition which characteristically includes a small 'whistling' mouth, a flat mask-like face, club feet, joint contractures usually involving the fingers and hands, and under-development of the cartilage of the nose. The brochure describes the features of Freeman-Sheldon syndrome; its inheritance pattern; and treatment options including orthopedic surgery, plastic surgery, craniofacial surgery, physical therapy, and speech therapy. The brochure includes photographs of children with Freeman-Sheldon syndrome, before and after corrective surgery. The members of the physician advisory panel of the Freeman-Sheldon Parent Support Group are also noted.

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Why Adult Day Care? Source: Washington, DC: National Council on the Aging, Inc. 1989. 8 p.

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Contact: Available from National Council on the Aging, Inc. 600 Maryland Avenue, SW, West Wing 100, Washington, DC 20024. (202) 479-1200. PRICE: $15.00 per 50 copies. Summary: This brochure for families of disabled adults, such as those with Alzheimer's disease, describes the benefits of adult day care using a community-based service. Services may include recreation, personal care, health care, occupational therapy, transportation, meals, and speech therapy. The brochure also lists the goals of adult day care and describes the purpose of the National Institute on Adult Daycare. National Council on the Aging publications about daycare are listed. •

Child who Stutters at School: Notes to the Teacher Source: Memphis, TN: Stuttering Foundation of America. 2000. [2 p.]. Contact: Stuttering Foundation of America. P.O. Box 11749, Memphis, TN 38111-0749. (800) 992-9392 or (901) 452-7343. Fax (901) 452-3931. E-mail: [email protected]; http://www.stutterSFA.org. PRICE: $0.10 each; bulk prices available plus shipping and handling. Item Number SFA NT 95-5. Summary: This brochure for preschool and elementary school teachers provides suggestions on how to treat a child who stutters in the classroom. The brochure covers issues such as answering questions and reading aloud in class, teasing by other children, and speech therapy. It goes on to provide general information about stuttering and gives tips for talking with children who stutter. The brochure is available in English and Spanish.

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Cleft Lip and Palate Program Source: New York, NY: New York University Medical Center. Contact: Available from Variety Center for Craniofacial Rehabilitation. Institute of Reconstructive Plastic Surgery, New York University Medical Center, 550 First Avenue, New York, NY 10016. (212) 263-5834. PRICE: Single copy free. Summary: This brochure is designed to provide information to the parents of children born with cleft lip and/or cleft palate. Written in a question-and-answer format, the brochure includes a definition of a cleft, their epidemiology, the causes of cleft lip and palate, how to feed a child with cleft lip and/or palate, the importance of parent support groups, the best time to surgically repair a cleft, the treatment provided prior to surgery, the first surgical procedure, when and how the cleft palate is repaired, indications for speech therapy, other problems arising from cleft palate, orthodontic therapy for children with cleft palate, and indications for future surgery. The brochure includes before-and-after photographs of children with cleft lip and/or palate.

•

Beginnings for Parents of Hearing Impaired Children, Inc.: A Family Guide to Communication Options Source: Raleigh, NC: BEGINNINGS for Parents of Children Who Are Deaf or Hard of Hearing, Inc. 199x. [4 p.]. Contact: Available from BEGINNINGS for Parents of Children Who Are Deaf or Hard of Hearing, Inc. P.O. Box 17646, Raleigh, NC 27619. Voice/TTY (919) 850-2746. Fax (919) 850-2804. PRICE: Single copy free. Summary: This brochure summarizes the variety of communication options for children who are deaf or hard of hearing. The brochure emphasizes the need for parents to have balanced and objective information about each option, in order to make appropriate

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choices for their child and family. The brochure includes a glossary of related terms, defining language, speech, signs, amplification, speechreading, FM system, speech therapy, aural rehabilitation, and English-based sign system. The brochure unfolds to a chart that lists the communication options of American Sign Language (with English as a Second Language), the auditory-verbal method, cued speech, the auditory-oral method, and total communication. For each option, the chart provides a definition and then summarizes primary goals, receptive language development, expressive language, hearing, family responsibility, and parent training needs. •

Landau-Kleffner Syndrome Source: Bethesda, MD: National Institute of Neurological Disorders and Stroke. 1998. [1 p.]. Contact: Available from National Institute of Neurological Disorders and Stroke. Office of Scientific and Health Reports, P.O. Box 5801, Bethesda, MD 20824. (800) 352-9424 or (301) 496-5751. PRICE: Single copy free. Summary: This fact sheet from the National Institute of Neurological Disorders and Stroke describes Landau-Kleffner syndrome (LKS), also called acquired epileptiform aphasia, a rare, childhood neurological disorder. The disorder is characterized by the sudden or gradual development of aphasia (loss of language) and an abnormal electroencephalogram (EEG). LKS affects the parts of the brain that control speech and comprehension. The disorder usually occurs in normally developing children between the ages of 3 and 7. The fact sheet describes the syndrome, treatment options, prognosis, and present research efforts on the disorder. The prognosis for children with LKS varies. Some affected children may have a permanent severe language disorder, while others may regain much of their language abilities (although it may take months or years). In some cases, remissions and relapse may occur. The prognosis is improved when the onset of the disorder is after age 6 and when speech therapy is started early. The fact sheet concludes with the telephone numbers and addresses for two organizations through which readers can obtain more information. 6 references.

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Communicating with Aphasic Patients Source: in Mosby-Year Book, Inc. Mosby's Patient Teaching Guides. St. Louis, MO: Mosby-Year Book, Inc. 1995. p. 84. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. PRICE: $52.95. ISBN: 0815158629. Summary: This fact sheet outlines strategies for communicating with people with aphasia. The person with aphasia may have difficulty understanding spoken or written language or may have trouble expressing herself in spoken or written language. Aphasia usually results from damage in the communication centers of the brain. The fact sheet first briefly describes seven types of aphasia: nonfluent, fluent, anomic, conduction, global, receptive (Wernicke's), and expressive (Broca's). The fact sheet emphasizes that, when aphasia occurs, it is very important that speech therapy is begun very quickly. Being unable to communicate is very frustrating and it is important to keep encouraging and helping the person to regain speech. The fact sheet then offers ten strategies for better communication with people with aphasia. These strategies cover topics including the setting, discerning the reliability of information provided, the need for patience, the use of nonverbal expression, the use of cue cards, managing fatigue, and the need to treat the person with aphasia as an intelligent adult, regardless of the communication breakdown.

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Aphasia: Fact Sheet Source: New York, NY: National Aphasia Association. 2001. 4 p. Contact: Available from National Aphasia Association (NAA). Response Center, 351 Butternut Ct., Millersville, MD 21108. (800) 922-4622; Fax (410) 729-5724. Website: http://www.aphasia.org. PRICE: $.50 each. Summary: This fact sheet provides basic information about aphasia, a disorder caused by brain damage which affects a person's ability to communicate. The primary symptom of aphasia is an impairment in the ability to express oneself when speaking. The understanding of speech, reading, and writing are also often impaired. The fact sheet answers common questions about aphasia, including a definition of aphasia, the causes of aphasia, the different types of aphasia (nonfluent and fluent), the incidence of aphasia, and the purpose of speech therapy to help patients with aphasia. The fact sheet includes the contact information, including the toll free telephone number (800-9224NAA) of the National Aphasia Association.

•

Med Facts: Vocal Cord Dysfunction Source: Denver, CO: National Jewish Center for Immunology and Respiratory Medicine. April 1995. 3 p. Contact: Available from National Jewish Center for Immunology and Respiratory Medicine. 1400 Jackson Street, Denver, CO 80206. (800) 222-5864 or (303) 388-4461. PRICE: Single copy free. Summary: This fact sheet provides information about vocal cord dysfunction (VCD), an abnormal closing of the vocal cords that causes asthma-like symptoms of difficult breathing or wheezing. Topics covered include the symptoms of VCD; how the vocal cords function normally; problems with the diagnosis of VCD; diagnostic tests for VCD; potential triggers of VCD; treatment options, including speech therapy; and the research and clinical work being done in this area at the National Jewish Center for Immunology and Respiratory Medicine.

•

How Children Use Language to Satisfy Needs Source: in Schrader, M., ed. Parent Articles 1: Enhance Parent Involvement in Language Learning. San Antonio, TX: Communication Skill Builders. 1988. p. 57-58. Contact: Available from Communication Skill Builders. Customer Service, 555 Academic Court, San Antonio, TX 78204-2498. (800) 211-8378; TTY (800) 723-1318; Fax (800) 2321223. PRICE: $52.00 plus shipping and handling. Order Number 076-1674-39X-MS799. Summary: This fact sheet provides parents with information on how children use language to satisfy needs. Topics covered include the use of indirect requests, using polite forms of language, giving the listener adequate information, and suggestions for parents to help their child learn language at home. The fact sheet is one of a series of instructional materials designed to enhance parent involvement in language learning. The fact sheets share information on speech therapy and speech/language disorders targeted to parents of children 1 to 7 years old. The fact sheets also answer frequentlyasked questions and suggest related activities to enhance children's speech and language skills.

•

Cleft lip and palate: The school-aged child Source: Chapel Hill, NC: Cleft Palate Foundation. 1996. 32 pp.

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Contact: Available from Cleft Palate Foundation, 1829 East Franklin Street, Suite 1022, Chapel Hill, NC919 27514. Telephone: (919) 933- 9044 or (800) 243-5338 / e-mail: [email protected] / Web site: http://www.cleft.com. $2.00; shipping and handling for 1however2 items $1.75, shipping and handling for 3however5 items $2.25. Summary: This pamphlet provides information on how to achieve the best possible appearance and speech for school-age children with cleft lip or cleft palate. Information on surgery, speech therapy, and orthodontia is presented, together with suggestions for helping to create a good school experience for children with cleft lip or cleft palate. This section covers the importance of protecting a childs hearing (especially for children with cleft palate, who are at greater risk for hearing problems), dealing with learning problems, and handling teasing. Advice for teachers of children with cleft lip or cleft palate is included. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to speech therapy. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to speech therapy. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with speech therapy.

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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about speech therapy. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “speech therapy” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “speech therapy”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “speech therapy” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “speech therapy” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.17

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

17

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)18: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

18

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

119

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

121

SPEECH THERAPY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 3-dimensional: 3-D. A graphic display of depth, width, and height. Three-dimensional radiation therapy uses computers to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing the normal tissue as much as possible. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abductor: A muscle that draws a part away from the median line. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Academic Medical Centers: Medical complexes consisting of medical school, hospitals, clinics, libraries, administrative facilities, etc. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adductor: A muscle that draws a part toward the median line. [NIH] Adjunctive Therapy: Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosols: Colloids with a gaseous dispersing phase and either liquid (fog) or solid (smoke) dispersed phase; used in fumigation or in inhalation therapy; may contain propellent agents. [NIH]

Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and

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stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Air Pressure: The force per unit area that the air exerts on any surface in contact with it. Primarily used for articles pertaining to air pressure within a closed environment. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Alexia: The inability to recognize or comprehend written or printed words. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analysis of Variance: A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Anomalies: Birth defects; abnormalities. [NIH]

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Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Aphasia: A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. [NIH] Apraxia: Loss of ability to perform purposeful movements, in the absence of paralysis or sensory disturbance, caused by lesions in the cortex. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articulation: The relationship of two bodies by means of a moveable joint. [NIH] Articulation Disorders: Disorders of the quality of speech characterized by the substitution, omission, distortion, and addition of phonemes. [NIH] Artificial Intelligence: The study and implementation of techniques and methods for designing computer systems to perform functions normally associated with human intelligence, such as understanding language, learning, reasoning, problem solving, etc. [NIH]

Aspirate: Fluid withdrawn from a lump, often a cyst, or a nipple. [NIH] Aspiration: The act of inhaling. [NIH] Atresia: Lack of a normal opening from the esophagus, intestines, or anus. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition,

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or hormonal changes. [NIH] Audiology: The study of hearing and hearing impairment. [NIH] Audition: The sense of hearing. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Auditory Cortex: Area of the temporal lobe concerned with hearing. [NIH] Auditory Perception: The process whereby auditory stimuli are selected, organized and interpreted by the organism; includes speech discrimination. [NIH] Aural: Pertaining to or perceived by the ear, as an aural stimulus. [EU] Autonomic: Self-controlling; functionally independent. [EU] Baclofen: A GABA derivative that is a specific agonist at GABA-B receptors. It is used in the treatment of spasticity, especially that due to spinal cord damage. Its therapeutic effects result from actions at spinal and supraspinal sites, generally the reduction of excitatory transmission. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Barium swallow: A series of x-rays of the esophagus. The x-ray pictures are taken after the person drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. Also called an esophagram. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and

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clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blast phase: The phase of chronic myelogenous leukemia in which the number of immature, abnormal white blood cells in the bone marrow and blood is extremely high. Also called blast crisis. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinesia: Abnormal slowness of movement; sluggishness of physical and mental responses. [EU] Brain Ischemia: Localized reduction of blood flow to brain tissue due to arterial obtruction or systemic hypoperfusion. This frequently occurs in conjuction with brain hypoxia. Prolonged ischemia is associated with brain infarction. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bromocriptine: A semisynthetic ergot alkaloid that is a dopamine D2 agonist. It suppresses prolactin secretion and is used to treat amenorrhea, galactorrhea, and female infertility, and has been proposed for Parkinson disease. [NIH] Bronchopulmonary: Pertaining to the lungs and their air passages; both bronchial and pulmonary. [EU] Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Cachexia: General ill health, malnutrition, and weight loss, usually associated with chronic

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disease. [NIH] Camping: Living outdoors as a recreational activity. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrovascular Disorders: A broad category of disorders characterized by impairment of blood flow in the arteries and veins which supply the brain. These include cerebral infarction; brain ischemia; hypoxia, brain; intracranial embolism and thrombosis; intracranial arteriovenous malformations; and vasculitis, central nervous system. In common usage, the term cerebrovascular disorders is not limited to conditions that affect the cerebrum, but refers to vascular disorders of the entire brain including the diencephalon; brain stem; and cerebellum. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also

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controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic lymphocytic leukemia: A slowly progressing disease in which too many white blood cells (called lymphocytes) are found in the body. [NIH] Chronic myelogenous leukemia: CML. A slowly progressing disease in which too many white blood cells are made in the bone marrow. Also called chronic myeloid leukemia or chronic granulocytic leukemia. [NIH] Chronic phase: Refers to the early stages of chronic myelogenous leukemia or chronic lymphocytic leukemia. The number of mature and immature abnormal white blood cells in the bone marrow and blood is higher than normal, but lower than in the accelerated or blast phase. [NIH] Cleft Lip: Congenital defect in the upper lip where the maxillary prominence fails to merge with the merged medial nasal prominences. It is thought to be caused by faulty migration of the mesoderm in the head region. [NIH] Cleft Palate: Congenital fissure of the soft and/or hard palate, due to faulty fusion. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Implantation: Surgical insertion of an electronic device implanted beneath the skin with electrodes to the cochlear nerve to create sound sensation in persons with sensorineural deafness. [NIH]

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Cochlear Implants: Electronic devices implanted beneath the skin with electrodes to the cochlear nerve to create sound sensation in persons with sensorineural deafness. [NIH] Cochlear Nerve: The cochlear part of the 8th cranial nerve (vestibulocochlear nerve). The cochlear nerve fibers originate from neurons of the spiral ganglion and project peripherally to cochlear hair cells and centrally to the cochlear nuclei (cochlear nucleus) of the brain stem. They mediate the sense of hearing. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Coloboma: Congenital anomaly in which some of the structures of the eye are absent due to incomplete fusion of the fetal intraocular fissure during gestation. [NIH] Communication Disorders: Disorders of verbal and nonverbal communication caused by receptive or expressive language disorders, cognitive dysfunction (e.g., mental retardation), psychiatric conditions, and hearing disorders. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the

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standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computer Systems: Systems composed of a computer or computers, peripheral equipment, such as disks, printers, and terminals, and telecommunications capabilities. [NIH] Concentric: Having a common center of curvature or symmetry. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Constriction: The act of constricting. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortices: The outer layer of an organ; used especially of the cerebrum and cerebellum. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Criterion: A standard by which something may be judged. [EU] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Custodial Care: Board, room, and other personal assistance services generally provided on a long term basis. It excludes regular medical care. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Dantrolene: Skeletal muscle relaxant that acts by interfering with excitation-contraction coupling in the muscle fiber. It is used in spasticity and other neuromuscular abnormalities. Although the mechanism of action is probably not central, dantrolene is usually grouped with the central muscle relaxants. [NIH]

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Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Day Care: Institutional health care of patients during the day. The patients return home at night. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dental Clasps: Metal devices for fastening together two or more parts of dental prostheses for stabilizing or retaining them by attachment to abutment teeth. For a precision attachment for a partial denture, denture precision attachment is available. [NIH] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Denture Precision Attachment: Comprising a vulcanized rubber, artificial plastic or metal plate to which the false teeth are fitted. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dexterity: Ability to move the hands easily and skillfully. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dilatation: The act of dilating. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is

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receiving. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysarthria: Imperfect articulation of speech due to disturbances of muscular control which result from damage to the central or peripheral nervous system. [EU] Dyskinesias: Abnormal involuntary movements which primarily affect the extremities, trunk, or jaw that occur as a manifestation of an underlying disease process. Conditions which feature recurrent or persistent episodes of dyskinesia as a primary manifestation of disease may be referred to as dyskinesia syndromes (movement disorders). Dyskinesias are also a relatively common manifestation of basal ganglia diseases. [NIH] Dyslexia: Partial alexia in which letters but not words may be read, or in which words may be read but not understood. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysphonia: Difficulty or pain in speaking; impairment of the voice. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolarynx: A battery-operated instrument that makes a humming sound. An electrolarynx is used to help people whose voice boxes (larynxes) have been removed. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Ergot: Cataract due to ergot poisoning caused by eating of rye cereals contaminated by a

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fungus. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal speech: Speech produced by trapping air in the esophagus and forcing it out again. It is used by people whose voice boxes (larynxes) have been removed. [NIH] Esophagram: A series of x-rays of the esophagus. The x-ray pictures are taken after the person drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. Also called a barium swallow. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Evoked Potentials: The electric response evoked in the central nervous system by stimulation of sensory receptors or some point on the sensory pathway leading from the receptor to the cortex. The evoked stimulus can be auditory, somatosensory, or visual, although other modalities have been reported. Event-related potentials is sometimes used synonymously with evoked potentials but is often associated with the execution of a motor, cognitive, or psychophysiological task, as well as with the response to a stimulus. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Facial Expression: Observable changes of expression in the face in response to emotional stimuli. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical,

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characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fluid Therapy: Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to water-electrolyte balance. Fluids may be administered intravenously, orally, by intermittent gavage, or by hypodermoclysis. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Gestures: Movement of a part of the body for the purpose of communication. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to

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replace diseased or injured tissue removed from another part of the body. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Habituation: Decline in response of an organism to environmental or other stimuli with repeated or maintained exposure. [NIH] Handicap: A handicap occurs as a result of disability, but disability does not always constitute a handicap. A handicap may be said to exist when a disability causes a substantial and continuing reduction in a person's capacity to function socially and vocationally. [NIH] Hearing aid: A miniature, portable sound amplifier for persons with impaired hearing, consisting of a microphone, audio amplifier, earphone, and battery. [NIH] Hearing Disorders: Conditions that impair the transmission or perception of auditory impulses and information from the level of the ear to the temporal cortices, including the sensorineural pathways. [NIH] Hemiparesis: The weakness or paralysis affecting one side of the body. [NIH] Hemiplegia: Severe or complete loss of motor function on one side of the body. This condition is usually caused by BRAIN DISEASES that are localized to the cerebral hemisphere opposite to the side of weakness. Less frequently, BRAIN STEM lesions; cervical spinal cord diseases; peripheral nervous system diseases; and other conditions may manifest as hemiplegia. The term hemiparesis (see paresis) refers to mild to moderate weakness involving one side of the body. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hyperreflexia: Exaggeration of reflexes. [EU] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypokinesia: Slow or diminished movement of body musculature. It may be associated with basal ganglia diseases; mental disorders; prolonged inactivity due to illness;

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experimental protocols used to evaluate the physiologic effects of immobility; and other conditions. [NIH] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileum: The lower end of the small intestine. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] Incision: A cut made in the body during surgery. [NIH] Incisor: Anything adapted for cutting; any one of the four front teeth in each jaw. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Insertional: A technique in which foreign DNA is cloned into a restriction site which occupies a position within the coding sequence of a gene in the cloning vector molecule. Insertion interrupts the gene's sequence such that its original function is no longer

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expressed. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intracranial Embolism: The sudden obstruction of a blood vessel by an embolus. [NIH] Intracranial Embolism and Thrombosis: Embolism or thrombosis involving blood vessels which supply intracranial structures. Emboli may originate from extracranial or intracranial sources. Thrombosis may occur in arterial or venous structures. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Introspection: Examination by a person of his own feelings, thoughts, and mental state. [NIH]

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Language Development: The gradual expansion in complexity and meaning of symbols and sounds as perceived and interpreted by the individual through a maturational and learning process. Stages in development include babbling, cooing, word imitation with cognition, and use of short sentences. [NIH] Language Development Disorders: Conditions characterized by language abilities (comprehension and expression of speech and writing) that are below the expected level for a given age, generally in the absence of an intellectual impairment. These conditions may be associated with deafness; brain diseases; mental disorders; or environmental factors. [NIH] Language Disorders: Conditions characterized by deficiencies of comprehension or

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expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Language Therapy: Rehabilitation of persons with language disorders or training of children with language development disorders. [NIH] Laryngeal: Having to do with the larynx. [NIH] Laryngectomy: Total or partial excision of the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mandibulofacial Dysostosis: A rare congenital anomaly characterized by antimongoloid oblique palpebral fissures, coloboma of the lower eyelids, hypoplasia of the facial bones, malformations of the external ears and sometimes middle and inner ears, an abnormally large mouth. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Mechanoreceptors: Cells specialized to transduce mechanical stimuli and relay that information centrally in the nervous system. Mechanoreceptors include hair cells, which mediate hearing and balance, and the various somatosensory receptors, often with nonneural accessory structures. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by

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means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]

Mesoderm: The middle germ layer of the embryo. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motor Neurons: Neurons which activate muscle cells. [NIH] Motor Skills: Performance of complex motor acts. [NIH] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH]

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Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Music Therapy: The use of music as an adjunctive therapy in the treatment of neurological, mental, or behavioral disorders. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naive: Used to describe an individual who has never taken a certain drug or class of drugs (e. g., AZT-naive, antiretroviral-naive), or to refer to an undifferentiated immune system cell. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurologist: A doctor who specializes in the diagnosis and treatment of disorders of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotoxins: Toxic substances from microorganisms, plants or animals that interfere with the functions of the nervous system. Most venoms contain neurotoxic substances. Myotoxins are included in this concept. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light

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hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Nurseries: Facilities which provide care for infants. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Occupational Therapy: The field concerned with utilizing craft or work activities in the rehabilitation of patients. Occupational therapy can also refer to the activities themselves. [NIH]

Orofacial: Of or relating to the mouth and face. [EU] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Outer ear: The pinna and external meatus of the ear. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Oxprenolol: A beta-adrenergic antagonist used in the treatment of hypertension, angina pectoris, arrhythmias, and anxiety. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

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Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Periodicity: The tendency of a phenomenon to recur at regular intervals; in biological systems, the recurrence of certain activities (including hormonal, cellular, neural) may be annual, seasonal, monthly, daily, or more frequently (ultradian). [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phonation: The process of producing vocal sounds by means of vocal cords vibrating in an expiratory blast of air. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Pneumonia: Inflammation of the lungs. [NIH]

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Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Predictive factor: A situation or condition that may increase a person's risk of developing a certain disease or disorder. [NIH] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU]

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Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH]

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Reaction Time: The time from the onset of a stimulus until the organism responds. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recurrent Laryngeal Nerve: Branches of the vagus (tenth cranial) nerve. The recurrent laryngeal nerves originate more caudally than the superior laryngeal nerves and follow different paths on the right and left sides. They carry efferents to all muscles of the larynx except the cricothyroid and carry sensory and autonomic fibers to the laryngeal, pharyngeal, tracheal, and cardiac regions. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Respiratory Mechanics: The physical or mechanical action of the lungs, diaphragm, ribs, and chest wall during respiration. It includes airflow, lung volume, neural and reflex controls, mechanoreceptors, breathing patterns, etc. [NIH] Respiratory Therapy: Care of patients with deficiencies and abnormalities associated with the cardiopulmonary system. It includes the therapeutic use of medical gases and their administrative apparatus, environmental control systems, humidification, aerosols, ventilatory support, bronchopulmonary drainage and exercise, respiratory rehabilitation, assistance with cardiopulmonary resuscitation, and maintenance of natural, artificial, and mechanical airways. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Rhythmicity: Regular periodicity. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Riluzole: A glutamate antagonist that has reported anticonvulsant activity. It has been shown to prolong the survival of patients with amyotrophic lateral sclerosis and has been approved in the United States to treat patients with ALS. [NIH]

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Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Sialorrhea: Increased salivary flow. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sign Language: A system of hand gestures used for communication by the deaf or by people speaking different languages. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or

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cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Isolation: The separation of individuals or groups resulting in the lack of or minimizing of social contact and/or communication. This separation may be accomplished by physical separation, by social barriers and by psychological mechanisms. In the latter, there may be interaction but no real communication. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Speech Acoustics: The acoustic aspects of speech in terms of frequency, intensity, and time. [NIH]

Speech Disorders: Acquired or developmental conditions marked by an impaired ability to comprehend or generate spoken forms of language. [NIH] Speech Intelligibility: Ability to make speech sounds that are recognizable. [NIH] Speech pathologist: A specialist who evaluates and treats people with communication and swallowing problems. Also called a speech therapist. [NIH] Speech Perception: The process whereby an utterance is decoded into a representation in terms of linguistic units (sequences of phonetic segments which combine to form lexical and grammatical morphemes). [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces

Dictionary 147

surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Supraspinal: Above the spinal column or any spine. [NIH] Surgery, Plastic: The branch of surgery concerned with restoration, reconstruction, or improvement of defective, damaged, or missing structures. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the

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skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Tracheoesophageal puncture: A small opening made by a surgeon between the esophagus and the trachea. A valve keeps food out of the trachea but lets air into the esophagus for esophageal speech. [NIH]

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Tracheostomy: Surgical formation of an opening into the trachea through the neck, or the opening so created. [NIH] Tracheostomy tube: A 2-inch- to 3-inch-long curved metal or plastic tube placed in a surgically created opening (tracheostomy) in the windpipe to keep it open. Also called a trach ("trake") tube. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tungsten: A metallic element with the atomic symbol W, atomic number 74, and atomic weight 183.85. It is used in many manufacturing applications, including increasing the hardness, toughness, and tensile strength of steel; manufacture of filaments for incandescent light bulbs; and in contact points for automotive and electrical apparatus. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Velopharyngeal Insufficiency: Failure of the soft palate to reach the posterior pharyngeal wall. It may be caused by cleft palate surgery, palatal or pharyngeal abnormalities or injury, or neuromuscular dysfunction of the velopharyngeal sphincter. It causes hypernasality of speech. [NIH] Venoms: Poisonous animal secretions forming fluid mixtures of many different enzymes, toxins, and other substances. These substances are produced in specialized glands and secreted through specialized delivery systems (nematocysts, spines, fangs, etc.) for disabling prey or predator. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vocal cord: The vocal folds of the larynx. [NIH] Voice Disorders: Disorders of voice pitch, loudness, or quality. Dysphonia refers to

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impaired utterance of sounds by the vocal folds. [NIH] Voice Quality: Voice quality is that component of speech which gives the primary distinction to a given speaker's voice when pitch and loudness are excluded. It involves both phonatory and resonatory characteristics. Some of the descriptions of voice quality are harshness, breathiness and nasality. [NIH] Watchful waiting: Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called observation. [NIH] Wheezing: Breathing with a rasp or whistling sound; a sign of airway constriction or obstruction. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

151

INDEX 3 3-dimensional, 8, 121 A Abdomen, 121, 127, 137, 147 Abdominal, 72, 121, 130, 140 Abductor, 106, 121 Aberrant, 69, 121 Academic Medical Centers, 23, 121 Acoustic, 4, 5, 8, 11, 16, 19, 23, 25, 32, 33, 34, 65, 66, 121, 146 Activities of Daily Living, 81, 121 Adaptation, 5, 121, 141 Adductor, 11, 106, 121 Adjunctive Therapy, 121, 139 Adjustment, 121 Adolescence, 13, 80, 87, 121 Adrenergic, 121, 130, 140 Adverse Effect, 121, 145 Aerosols, 121, 144 Agonist, 121, 124, 125, 130 Air Pressure, 23, 122 Airway, 122, 150 Alexia, 11, 122, 131 Algorithms, 33, 122, 125 Alimentary, 4, 122, 136 Alkaline, 122, 124 Alkaloid, 122, 125 Alpha Particles, 122, 143 Alternative medicine, 92, 122 Alveoli, 122, 130 Amenorrhea, 122, 125 Amino acid, 122, 144, 149 Amplification, 72, 109, 122 Anal, 122, 139 Analog, 72, 122 Analysis of Variance, 16, 122 Anatomical, 14, 22, 67, 68, 122, 127, 135, 145 Angina, 122, 140 Angina Pectoris, 122, 140 Anomalies, 20, 81, 83, 86, 87, 106, 122 Antibacterial, 123, 146 Antibiotic, 123, 146 Antibody, 123, 128, 134, 135, 138, 143 Anticonvulsant, 123, 144 Antigen, 123, 128, 134, 135 Anti-inflammatory, 5, 123 Anus, 122, 123, 136

Anxiety, 123, 140 Aperture, 67, 123 Aphasia, 7, 8, 10, 16, 24, 31, 36, 37, 44, 46, 71, 80, 107, 109, 110, 123 Apraxia, 24, 123 Aqueous, 123, 124 Arterial, 123, 125, 126, 134, 136, 142, 147 Arteries, 123, 125, 126, 129, 136, 138 Arteriovenous, 123, 126 Artery, 123, 125, 126, 129, 136, 137, 143, 149 Articulation, 13, 31, 32, 45, 65, 71, 77, 83, 84, 85, 90, 123, 131 Articulation Disorders, 83, 123 Artificial Intelligence, 14, 123 Aspirate, 17, 123 Aspiration, 5, 17, 123 Atresia, 86, 123 Atrophy, 5, 123 Audiology, 21, 29, 49, 86, 89, 124 Audition, 105, 124 Auditory, 4, 6, 12, 18, 23, 35, 66, 70, 71, 85, 86, 109, 124, 132, 134, 137 Auditory Cortex, 12, 124 Auditory Perception, 6, 124 Aural, 72, 73, 109, 124 Autonomic, 124, 141, 144 B Baclofen, 5, 124 Bacteria, 123, 124, 138, 146, 148, 149 Bacterial Physiology, 121, 124 Barium, 17, 124, 132 Barium swallow, 17, 124, 132 Basal Ganglia, 124, 131, 134 Basal Ganglia Diseases, 124, 131, 134 Base, 25, 64, 124, 136, 147 Basement Membrane, 124, 132 Benign, 18, 47, 124, 143 Biomechanics, 10, 19, 124 Biopsy, 124, 141 Biotechnology, 34, 92, 99, 124 Bladder, 125, 129, 139 Blast phase, 125, 127 Blood pressure, 125, 134, 138 Blood vessel, 125, 126, 127, 136, 147, 148, 149 Body Fluids, 125, 133, 140 Bolus, 17, 125

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Bolus infusion, 125 Bone Marrow, 125, 127, 137 Brachytherapy, 125, 136, 143 Bradykinesia, 31, 125 Brain Ischemia, 125, 126 Brain Stem, 125, 126, 128 Branch, 117, 125, 131, 137, 140, 146, 147, 148 Breakdown, 11, 109, 125, 130, 133 Bromocriptine, 16, 37, 125 Bronchopulmonary, 125, 144 Bulbar, 4, 125 C Cachexia, 5, 125 Camping, 106, 126 Carbon Dioxide, 126, 133, 144 Carcinoma, 49, 126 Cardiac, 126, 131, 132, 139, 144 Cardiopulmonary, 126, 144 Cardiorespiratory, 39, 57, 126 Case report, 126, 127 Case series, 126, 127 Cathode, 75, 126 Caudal, 126, 130, 142 Cell, 4, 122, 123, 124, 126, 128, 130, 132, 133, 136, 137, 138, 139, 141, 142, 144, 150 Cell Respiration, 126, 144 Central Nervous System, 126, 132 Cerebellum, 126, 129 Cerebral, 16, 35, 82, 84, 124, 125, 126, 132, 133, 134, 148 Cerebral Infarction, 126 Cerebral Palsy, 16, 35, 82, 84, 126 Cerebrovascular, 47, 124, 126 Cerebrovascular Disorders, 47, 126 Cerebrum, 126, 129 Cervical, 127, 134 Character, 33, 122, 127, 130 Chemotherapy, 77, 127 Chest wall, 29, 127, 144 Chin, 127, 138 Chromosomal, 20, 122, 127 Chronic, 6, 10, 16, 28, 31, 37, 125, 127, 135, 147 Chronic Disease, 6, 126, 127 Chronic lymphocytic leukemia, 127 Chronic myelogenous leukemia, 125, 127 Chronic phase, 16, 127 Cleft Lip, 20, 67, 81, 104, 106, 108, 111, 127 Clinical study, 6, 127 Clinical trial, 5, 10, 11, 16, 99, 127, 129, 130, 141, 142, 143

Cloning, 20, 125, 127, 135 Cochlea, 127, 135 Cochlear, 18, 22, 45, 49, 127, 128, 148 Cochlear Implantation, 45, 127 Cochlear Implants, 22, 128 Cochlear Nerve, 127, 128 Cognition, 128, 136 Collapse, 125, 128 Coloboma, 128, 137 Communication Disorders, 15, 24, 36, 37, 39, 53, 87, 98, 104, 128 Comorbidity, 40, 128 Complement, 128, 133 Complementary and alternative medicine, 57, 59, 128 Complementary medicine, 57, 128 Compliance, 6, 129 Computational Biology, 99, 129 Computer Systems, 123, 129 Concentric, 66, 129 Concomitant, 24, 129 Conduction, 109, 129 Constriction, 129, 136, 150 Contraindications, ii, 38, 129 Control group, 7, 25, 129, 143 Coordination, 39, 57, 72, 81, 126, 129 Coronary, 122, 129, 138 Coronary Thrombosis, 129, 138 Cortex, 12, 31, 123, 129, 132, 133 Cortical, 12, 18, 31, 129, 132, 145 Cortices, 129, 134 Cranial, 106, 126, 128, 129, 141, 144 Criterion, 78, 129 Cues, 16, 26, 29, 129 Curative, 129, 148 Custodial Care, 27, 129 Cyst, 123, 129 D Dantrolene, 5, 129 Data Collection, 14, 23, 130, 133 Day Care, 106, 107, 108, 130 Degenerative, 130, 138 Dendrites, 130, 139 Dental Clasps, 70, 130 Dentition, 85, 86, 130 Denture Precision Attachment, 130 Deprivation, 23, 130 Dexterity, 4, 130 Diagnostic procedure, 63, 92, 130 Diaphragm, 130, 144 Diastolic, 130, 134 Diencephalon, 126, 130

Index

Digestion, 122, 130, 137, 147 Dilatation, 130, 142 Direct, iii, 65, 71, 75, 76, 86, 130, 144, 147 Discrimination, 15, 23, 71, 124, 130 Distal, 130, 131 Dopamine, 125, 130, 139 Dorsal, 130, 142 Double-blind, 17, 130 Drive, ii, vi, 20, 32, 90, 105, 106, 109, 131 Drug Interactions, 131 Duodenum, 131, 136, 147 Dysarthria, 16, 24, 84, 107, 131 Dyskinesias, 124, 131, 138 Dyslexia, 10, 131 Dysphagia, 17, 107, 131 Dysphonia, 11, 23, 46, 106, 131, 149 Dystonia, 106, 131 E Efficacy, 11, 13, 16, 18, 21, 23, 25, 26, 28, 30, 32, 33, 40, 48, 131 Elasticity, 19, 131 Electrode, 66, 126, 131 Electrolarynx, 13, 131 Electrolyte, 131, 133, 140 Electrophysiological, 14, 131 Embryology, 86, 131 Empirical, 30, 74, 131 Endemic, 131, 147 Environmental Health, 98, 100, 131 Epidemic, 10, 131, 147 Ergot, 125, 131 Esophageal, 46, 132, 148 Esophageal speech, 132, 148 Esophagram, 124, 132 Esophagus, 123, 124, 132, 141, 144, 147, 148 Evoke, 132, 147 Evoked Potentials, 18, 132 Excitability, 31, 132 Excitation, 72, 129, 132, 139 Excitatory, 124, 132, 133 Expiration, 132, 144 Expiratory, 132, 141 External-beam radiation, 132, 143 Extracellular, 19, 132 Extracellular Matrix, 19, 132 Extracellular Space, 132 Extraction, 66, 132 Extremity, 25, 132, 140 F Facial, 20, 33, 70, 86, 87, 105, 106, 132, 137 Facial Expression, 33, 70, 132

153

Family Planning, 99, 132 Fatigue, 109, 132 Fibrosis, 133, 145 Fissure, 127, 128, 133 Fluid Therapy, 133, 140 Focus Groups, 7, 133 Fold, 10, 18, 19, 21, 23, 133 G Gait, 4, 31, 133 Gallbladder, 121, 133 Gamma Rays, 133, 143 Gas, 126, 133, 134, 144, 147 Gas exchange, 133, 144 Gastrin, 133, 134 Gastrointestinal, 133 Gastrostomy, 4, 133 Gene, 20, 125, 133, 135, 141 Genetic Engineering, 125, 127, 133 Gestures, 7, 15, 33, 69, 133, 145 Gland, 133, 140, 145, 147 Glutamate, 4, 133, 144 Governing Board, 133, 142 Grade, 39, 133 Graft, 133, 134 Growth, 20, 21, 77, 106, 121, 123, 134, 137, 141 H Habitual, 16, 67, 127, 134 Habituation, 71, 134 Handicap, 10, 44, 69, 74, 134 Hearing aid, 85, 86, 90, 134 Hearing Disorders, 67, 128, 134 Hemiparesis, 134 Hemiplegia, 25, 37, 134 Hemorrhage, 134, 147 Hereditary, 134, 138 Heredity, 133, 134 Homologous, 134, 147 Hormonal, 124, 134, 141 Hormone, 9, 133, 134, 142 Hospice, 53, 134 Host, 86, 134 Hydrogen, 124, 134, 138, 140, 142 Hyperreflexia, 5, 134 Hypertension, 6, 134, 140, 148 Hypokinesia, 31, 134 Hypoplasia, 135, 137 Hypoxia, 125, 126, 135 I Id, 58, 111, 116, 118, 135 Idiopathic, 17, 22, 31, 33, 135 Ileum, 135, 136

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Immune system, 135, 139, 149, 150 Impairment, 6, 11, 12, 19, 21, 23, 30, 40, 44, 66, 67, 82, 87, 110, 124, 126, 131, 135, 136, 138 Implant radiation, 135, 136, 143 In situ, 7, 135 Incision, 135, 136 Incisor, 67, 135 Incompetence, 44, 135 Indicative, 82, 135, 140, 149 Infarction, 125, 126, 129, 135, 138 Infection, 89, 135, 137, 147, 150 Infertility, 125, 135 Inflammation, 123, 133, 135, 140, 141, 149 Inlay, 135, 144 Inner ear, 135, 137 Innervation, 14, 135 Insertional, 20, 135 Insight, 26, 136 Internal radiation, 136, 143 Intestines, 121, 123, 133, 136, 145 Intracellular, 135, 136 Intracranial Embolism, 126, 136 Intracranial Embolism and Thrombosis, 126, 136 Intrinsic, 16, 124, 136 Introspection, 80, 136 Invasive, 31, 136 Ions, 124, 131, 134, 136 Ischemia, 122, 123, 125, 136 Ischemic stroke, 6, 136 J Jejunum, 4, 136 Joint, 107, 123, 136 K Kb, 98, 136 L Language Development, 9, 14, 30, 35, 71, 76, 86, 109, 136, 137 Language Development Disorders, 136, 137 Language Disorders, 14, 40, 67, 78, 86, 110, 128, 136, 137 Language Therapy, 8, 28, 67, 84, 107, 137 Laryngeal, 4, 10, 13, 23, 29, 51, 137, 144 Laryngectomy, 4, 13, 44, 46, 48, 49, 81, 137 Larynx, 47, 49, 65, 66, 81, 106, 137, 144, 148, 149 Library Services, 116, 137 Lip, 25, 29, 64, 81, 90, 104, 108, 110, 111, 127, 137 Liver, 121, 133, 137

Localization, 20, 137 Localized, 125, 134, 135, 137, 141 Lymphatic, 135, 137 M Malignant, 47, 137, 143 Malnutrition, 123, 125, 137 Mandibulofacial Dysostosis, 86, 137 Manifest, 134, 137 Maxillary, 70, 127, 137 Meatus, 137, 140 Mechanoreceptors, 137, 144 Medial, 127, 137 Mediate, 24, 128, 130, 137 MEDLINE, 99, 137 Meiosis, 137, 147 Membrane, 128, 132, 137, 138 Memory, 4, 7, 9, 107, 138 Mental, iv, 5, 30, 67, 98, 100, 125, 127, 128, 132, 134, 135, 136, 138, 139, 142, 143 Mental Disorders, 134, 136, 138, 142 Mental Retardation, 30, 67, 128, 138 Mesoderm, 127, 138 MI, 53, 119, 138 Microbiology, 121, 138 Migration, 127, 138 Mobility, 27, 138 Modeling, 9, 22, 25, 26, 85, 138 Modification, 17, 122, 133, 138, 143 Molecular, 20, 99, 101, 125, 129, 138, 142, 148 Molecule, 123, 124, 128, 132, 135, 138, 143, 144, 149 Monitor, 18, 138 Monoclonal, 138, 143 Monotherapy, 16, 138 Morphology, 14, 138 Motility, 17, 138 Motor Neurons, 4, 138 Motor Skills, 45, 86, 138 Movement Disorders, 84, 131, 138 Mucins, 139, 145 Multivariate Analysis, 24, 139 Muscle relaxant, 129, 139 Musculature, 134, 139 Music Therapy, 58, 139 Myocardium, 122, 138, 139 N Naive, 23, 139 Need, 3, 6, 8, 10, 13, 20, 22, 25, 27, 28, 33, 54, 79, 83, 89, 108, 109, 112, 139 Nerve, 14, 121, 127, 128, 130, 135, 139, 141, 144, 145, 147, 148

Index

Nervous System, 126, 137, 139, 141 Neural, 12, 13, 15, 24, 31, 137, 139, 141, 144 Neurogenic, 24, 139 Neurologic, 25, 139 Neurologist, 6, 139 Neuromuscular, 4, 27, 129, 139, 149 Neuronal, 4, 139 Neurons, 12, 128, 130, 132, 138, 139, 147 Neurotoxic, 139 Neurotoxins, 4, 139 Neurotransmitter, 122, 130, 133, 139 Neutrons, 122, 139, 143 Nonverbal Communication, 128, 140, 143 Nurseries, 38, 140 Nutritional Support, 5, 133, 140 O Occupational Therapy, 28, 44, 58, 108, 140 Orofacial, 24, 36, 83, 140 Otitis, 90, 140 Outer ear, 90, 140 Outpatient, 27, 140 Oxprenolol, 38, 140 Oxygen Consumption, 140, 144 P Palate, 20, 35, 37, 38, 42, 43, 46, 49, 54, 67, 68, 70, 76, 79, 81, 83, 84, 86, 87, 90, 104, 106, 108, 110, 111, 127, 140, 149 Palliative, 140, 148 Palsy, 84, 140 Pancreas, 121, 140 Paralysis, 23, 123, 125, 134, 140 Paresis, 134, 140 Pathologic, 24, 124, 129, 140, 146 Pathologies, 77, 140 Pathologist, 23, 78, 140 Patient Education, 81, 104, 114, 116, 119, 140 Patient Selection, 23, 141 Perception, 9, 12, 15, 23, 29, 32, 33, 66, 70, 134, 141 Percutaneous, 25, 141 Perforation, 123, 141 Periodicity, 141, 144 Peripheral Nervous System, 131, 134, 139, 140, 141 Peripheral Nervous System Diseases, 134, 141 Pharmacologic, 4, 39, 141, 148 Pharynx, 4, 17, 68, 141 Phonation, 11, 14, 65, 84, 141 Physical Therapy, 28, 31, 44, 106, 107, 141 Physiologic, 22, 29, 33, 122, 135, 141, 144

155

Physiology, 30, 81, 131, 141 Pilot study, 7, 30, 141 Pitch, 4, 66, 71, 141, 149, 150 Plants, 122, 126, 138, 139, 141, 148 Plasticity, 18, 141 Pneumonia, 129, 141 Posterior, 25, 70, 122, 126, 130, 140, 142, 149 Postoperative, 23, 76, 77, 81, 142 Post-traumatic, 138, 142 Practice Guidelines, 100, 142 Predictive factor, 39, 142 Preoperative, 81, 142 Prevalence, 78, 142 Probe, 11, 21, 142 Problem Solving, 123, 142 Progression, 27, 142 Progressive, 4, 134, 142 Prolactin, 125, 142 Prophase, 142, 147 Prosthesis, 4, 7, 14, 142 Protein S, 125, 142, 144 Protocol, 14, 17, 23, 31, 142 Protons, 122, 134, 142, 143 Psychiatric, 22, 128, 138, 142 Psychiatry, 30, 37, 40, 45, 47, 51, 52, 53, 142 Psychic, 138, 142, 143, 145 Psychogenic, 45, 47, 143 Psychotherapy, 37, 143 Public Policy, 99, 143 Pulse, 73, 138, 143 Q Quality of Life, 7, 10, 11, 27, 33, 143 R Radiation, 81, 121, 122, 132, 133, 136, 143, 150 Radiation therapy, 81, 121, 132, 136, 143 Radioactive, 134, 135, 136, 143 Radiolabeled, 143 Radiological, 141, 143 Radiotherapy, 125, 143 Random Allocation, 143 Randomization, 17, 143 Randomized, 6, 10, 11, 16, 18, 23, 25, 27, 32, 131, 143 Randomized clinical trial, 16, 18, 23, 143 Reaction Time, 32, 144 Receptor, 64, 121, 123, 130, 132, 144 Recurrent Laryngeal Nerve, 14, 23, 144 Refer, 1, 128, 137, 139, 140, 144, 148 Reflex, 144 Reflux, 18, 144

156

Speech Therapy

Refraction, 144, 146 Regimen, 18, 131, 144 Relapse, 109, 144 Reliability, 26, 45, 109, 144 Respiration, 65, 72, 84, 126, 138, 144 Respiratory failure, 5, 144 Respiratory Mechanics, 31, 144 Respiratory Therapy, 28, 144 Restoration, 4, 141, 144, 147 Resuscitation, 144 Rhythmicity, 39, 57, 144 Ribosome, 144, 149 Riluzole, 5, 144 Risk factor, 4, 145 S Saliva, 5, 145 Salivary, 145 Salivary glands, 145 Sclerosis, 4, 144, 145 Screening, 54, 127, 145 Secretion, 125, 139, 145 Segmental, 12, 145 Segmentation, 145 Seizures, 145 Self Care, 121, 145 Semisynthetic, 125, 145 Sensor, 72, 76, 145 Sequencing, 84, 145 Sex Characteristics, 121, 145 Shock, 145, 149 Sialorrhea, 84, 145 Side effect, 17, 121, 145, 148 Sign Language, 45, 109, 145 Signs and Symptoms, 144, 145 Skeleton, 136, 145, 146 Skull, 146, 148 Small intestine, 131, 134, 135, 136, 146 Social Environment, 143, 146 Social Isolation, 8, 146 Social Work, 107, 146 Somatic, 121, 138, 141, 146 Sound wave, 129, 146 Spasm, 146 Spasmodic, 11, 106, 146 Spasticity, 5, 124, 129, 146 Specialist, 112, 146 Spectrum, 65, 146 Speech Acoustics, 12, 146 Speech Disorders, 28, 67, 81, 146 Speech Intelligibility, 16, 146 Speech pathologist, 67, 74, 80, 90, 146 Speech Perception, 15, 32, 146

Sphincter, 4, 137, 146, 149 Spinal cord, 124, 125, 126, 134, 139, 141, 144, 146 Spinal Cord Diseases, 134, 146 Sporadic, 20, 147 Stimulus, 39, 57, 124, 131, 132, 135, 144, 147, 148 Stoma, 81, 147 Stomach, 4, 121, 132, 133, 134, 136, 141, 144, 146, 147 Stress, 10, 66, 147 Stroke, 6, 10, 16, 24, 31, 34, 37, 39, 40, 45, 47, 50, 53, 55, 58, 67, 92, 98, 109, 136, 147 Subacute, 135, 147 Subclinical, 135, 145, 147 Suction, 5, 147 Supplementation, 16, 147 Support group, 90, 105, 107, 108, 147 Suppression, 31, 147 Supraspinal, 124, 147 Surgery, Plastic, 107, 147 Symptomatic, 5, 147 Symptomatic treatment, 5, 147 Synapse, 121, 147 Synapsis, 147 Synaptic, 22, 139, 147 Systemic, 125, 135, 143, 147 Systolic, 134, 147 T Temporal, 6, 16, 17, 25, 32, 124, 134, 137, 147, 148 Temporal Lobe, 124, 148 Therapeutics, 148 Threshold, 69, 132, 134, 148 Thrombosis, 136, 142, 147, 148 Thrombus, 129, 135, 136, 148 Tinnitus, 140, 148 Tissue, 19, 121, 123, 124, 125, 131, 133, 135, 137, 138, 139, 141, 144, 145, 148 Tone, 75, 146, 148 Tonicity, 131, 148 Tonus, 148 Tooth Preparation, 121, 148 Toxic, iv, 139, 148 Toxicity, 131, 148 Toxicology, 100, 148 Toxin, 11, 106, 148 Trachea, 137, 141, 148, 149 Tracheoesophageal puncture, 4, 148 Tracheostomy, 68, 81, 149 Tracheostomy tube, 68, 81, 149 Transfection, 125, 149

Index

Translation, 72, 122, 149 Trauma, 18, 124, 148, 149 Tungsten, 126, 149 U Unconscious, 135, 149 V Vaccine, 142, 149 Vascular, 126, 135, 147, 148, 149 Vasculitis, 126, 149 Vector, 135, 149 Veins, 125, 126, 137, 149 Velopharyngeal Insufficiency, 79, 83, 84, 86, 87, 149 Venoms, 139, 149

Ventricle, 143, 147, 149 Vertigo, 140, 149 Veterinary Medicine, 99, 149 Viscosity, 17, 19, 149 Vocal cord, 19, 23, 75, 110, 141, 149 Voice Disorders, 18, 71, 149 Voice Quality, 71, 150 W Watchful waiting, 18, 150 Wheezing, 110, 150 White blood cell, 123, 125, 127, 150 Windpipe, 141, 149, 150 X X-ray, 124, 126, 132, 133, 143, 150

157

158

Speech Therapy

Index

159

160

Speech Therapy