How Do head and neck cancer patients prioritize treatment outcomes before initiating treatment?
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PURPOSE: To determine, pretreatment, how head and neck cancer (HNC) patients prioritize potential treatment effects in relationship to each other and to survival and to ascertain whether patients' preferences are related to demographic or disease characteristics, performance status, or quality of life (QOL). PATIENTS AND METHODS: One hundred thirty-one patients were assessed pretreatment using standardized measures of QOL (Functional Assessment of Cancer Therapy-Head and Neck) and performance (Performance Status Scale for Head and Neck Cancer). Patients were also asked to rank a series of 12 potential HNC treatment effects. RESULTS: Being cured was ranked top priority by 75% of patients; another 18% ranked it second or third. Living as long as possible and having no pain were placed in the top three by 56% and 35% of patients, respectively. Items that were ranked in the top three by 10% to 24% of patients included those related to energy, swallowing, voice, and appearance. Items related to chewing, being understood, tasting, and dry mouth were placed in the top three by less than 10% of patients. Excluding the top three rankings, there was considerable variability in ratings. Rankings were generally unrelated to patient or disease characteristics, with the exception that cure and living were of slightly lower priority and pain of higher priority to older patients compared with younger patients. CONCLUSION: The data suggest that, at least pretreatment, survival is of primary importance to patients, supporting the development of aggressive treatment strategies. In addition, results highlight individual variability and warn against making assumptions about patients' attitudes vis-a-vis potential outcomes. Whether patients' priorities will change as they experience late effects is currently under investigation. (+info)
Differential recruitment of the speech processing system in healthy subjects and rehabilitated cochlear implant patients.
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Differences in cerebral activation between control subjects and post-lingually deaf rehabilitated cochlear implant patients were identified with PET under various speech conditions of different linguistic complexity. Despite almost similar performance in patients and controls, different brain activation patterns were elicited. In patients, an attentional network including prefrontal and parietal modality-aspecific attentional regions and subcortical auditory regions was over-activated irrespective of the nature of the speech stimuli and during expectancy of speech stimuli. A left temporoparietal semantic region was responsive to meaningless stimuli (vowels). In response to meaningful stimuli (words, sentences, story), left middle and inferior temporal semantic regions and posterior superior temporal phonological regions were under-activated in patients, whereas anterior superior temporal phonological regions were over-activated. These differences in the recruitment of the speech comprehension system reflect the alternative neural strategies that permit speech comprehension after cochlear implantation. (+info)
Identification of a pathway for intelligible speech in the left temporal lobe.
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It has been proposed that the identification of sounds, including species-specific vocalizations, by primates depends on anterior projections from the primary auditory cortex, an auditory pathway analogous to the ventral route proposed for the visual identification of objects. We have identified a similar route in the human for understanding intelligible speech. Using PET imaging to identify separable neural subsystems within the human auditory cortex, we used a variety of speech and speech-like stimuli with equivalent acoustic complexity but varying intelligibility. We have demonstrated that the left superior temporal sulcus responds to the presence of phonetic information, but its anterior part only responds if the stimulus is also intelligible. This novel observation demonstrates a left anterior temporal pathway for speech comprehension. (+info)
Phonological and semantic fluencies are mediated by different regions of the prefrontal cortex.
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Verbal phonological and semantic fluencies were investigated in 24 patients with unilateral prefrontal lesions and 10 normal control subjects. Lesions were limited to small areas within either the dorsolateral (Brodmann's area 46/9) or ventromedial (posterior part of the gyrus rectus) cortices. In a phonological fluency task, patients with lesions to the left dorsolateral region were impaired. In semantic fluency, not only the left dorsolateral group but also the two right frontal damaged groups performed worse than the control group. In agreement with previous studies, our results show that the phonological fluency is mediated by the left dorsolateral prefrontal cortex. In contrast to this, performance on the semantic fluency task depends on a wider portion of the prefrontal cortex involving the left and right dorsolateral and the right ventromedial areas. (+info)
Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up.
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OBJECTIVES: To assess long term (24 months) effects of the Lee Silverman voice treatment (LSVT), a method designed to improve vocal function in patients with Parkinson's disease. METHODS: Thirty three patients with idiopathic Parkinson's disease were stratified and randomly assigned to two treatment groups. One group received the LSVT, which emphasises high phonatory-respiratory effort. The other group received respiratory therapy (RET), which emphasises high respiratory effort alone. Patients in both treatment groups sustained vowel phonation, read a passage, and produced a monologue under identical conditions before, immediately after, and 24 months after speech treatment. Change in vocal function was measured by means of acoustic analyses of voice loudness (measured as sound pressure level, or SPL) and inflection in voice fundamental frequency (measured in terms of semitone standard deviation, or STSD). RESULTS: The LSVT was significantly more effective than the RET in improving (increasing) SPL and STSD immediately post-treatment and maintaining those improvements at 2 year follow up. CONCLUSIONS: The findings provide evidence for the efficacy of the LSVT as well as the long term maintenance of these effects in the treatment of voice and speech disorders in patients with idiopathic Parkinson's disease. (+info)
Holes in hearing.
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Previous experiments have demonstrated that the correct tonotopic representation of spectral information is important for speech recognition. However, in prosthetic devices, such as hearing aids and cochlear implants, there may be a frequency/place mismatch due in part to the signal processing of the device and in part to the pathology that caused the hearing loss. Local regions of damaged neurons may create a "hole" in the tonotopic representation of spectral information, further distorting the frequency-to-place mapping. The present experiment was performed to quantitatively assess the impact of spectral holes on speech recognition. Speech was processed by a 20-band processor: SPEAK for cochlear implant (CI) listeners, and a 20-band noise processor for normal-hearing (NH) listeners. Holes in the tonotopic representation (from 1.5 to 6 mm in extent) were created by eliminating electrodes or noise carrier bands in the basal, middle, or apical regions of the cochlea. Vowel, consonant, and sentence recognition were measured as a function of the location and size of the hole. In addition, the spectral information that would normally be represented in the hole region was either: (1) dropped, (2) assigned to the apical side of the hole, (3) assigned to the basal side of the hole, or (4) split evenly to both sides of the hole. In general, speech features that are highly dependent on spectral cues (consonant place, vowel identity) were more affected by the presence of tonotopic holes than temporal features (consonant voicing and manner). Holes in the apical region were more damaging than holes in the basal or middle regions. A similar pattern of performance was observed for NH and CI listeners, suggesting that the loss of spectral information was the primary cause of the effects. The Speech Intelligibility Index was able to account for both NH and CI listeners' results. No significant differences were observed among the four conditions that redistributed the spectral information around the hole, suggesting that rerouting spectral information around a hole was no better than simply dropping it. (+info)
The effects of familiarization on intelligibility and lexical segmentation in hypokinetic and ataxic dysarthria.
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This study is the third in a series that has explored the source of intelligibility decrement in dysarthria by jointly considering signal characteristics and the cognitive-perceptual processes employed by listeners. A paradigm of lexical boundary error analysis was used to examine this interface by manipulating listener constraints with a brief familiarization procedure. If familiarization allows listeners to extract relevant segmental and suprasegmental information from dysarthric speech, they should obtain higher intelligibility scores than nonfamiliarized listeners, and their lexical boundary error patterns should approximate those obtained in misperceptions of normal speech. Listeners transcribed phrases produced by speakers with either hypokinetic or ataxic dysarthria after being familiarized with other phrases produced by these speakers. Data were compared to those of nonfamiliarized listeners [Liss et al., J. Acoust. Soc. Am. 107, 3415-3424 (2000)]. The familiarized groups obtained higher intelligibility scores than nonfamiliarized groups, and the effects were greater when the dysarthria type of the familiarization procedure matched the dysarthria type of the transcription task. Remarkably, no differences in lexical boundary error patterns were discovered between the familiarized and nonfamiliarized groups. Transcribers of the ataxic speech appeared to have difficulty distinguishing strong and weak syllables in spite of the familiarization. Results suggest that intelligibility decrements arise from the perceptual challenges posed by the degraded segmental and suprasegmental aspects of the signal, but that this type of familiarization process may differentially facilitate mapping segmental information onto existing phonological categories. (+info)
Imitation of nonwords by hearing impaired children with cochlear implants: suprasegmental analyses.
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In this study, we examined two prosodic characteristics of speech production in 8-10-year-old experienced cochlear implant (CI) users who completed a nonword repetition task. We looked at how often they correctly reproduced syllable number and primary stress location in their responses. Although only 5% of all nonword imitations were produced correctly without errors, 64% of the imitations contained the correct syllable number and 61% had the correct placement of primary stress. Moreover, these target prosodic properties were correctly preserved significantly more often for targets with fewer syllables and targets with primary stress on the initial syllable. Syllable and stress scores were significantly correlated with measures of speech perception, intelligibility, perceived accuracy, and working memory. These findings suggest that paediatric CI users encode the overall prosodic envelope of nonword patterns, despite the loss of more detailed segmental properties. This phonological knowledge is also reflected in other language and memory skills. (+info)