Maturation of the mismatch response in pre-school children: Systematic literature review and meta-analysis

Event-related potentials (ERPs), specifically the Mismatch Response (MMR), holds promise for investigating auditory maturation in children. It has the potential to predict language development and distinguish between language-impaired and typically developing groups. However, summarizing the MMR's developmental trajectory in typically developing children remains challenging despite numerous studies. This pioneering meta-analysis outlines changes in MMR amplitude among typically developing children, while offering methodological best-practices. Our search identified 51 articles for methodology analysis and 21 for meta-analysis, involving 0-8-year-old participants from 2000 to 2022. Risk of Bias assessment and methodology analysis revealed shortcomings in control condition usage and reporting of study confounders. The meta-analysis results were inconsistent, indicating large effect sizes in some conditions and no effect sizes in others. Subgroup analysis revealed the main effects of age and brain region, as well as an interaction of age and time-window of the MMR. Future research requires a specific protocol, larger samples, and replication studies to deepen the understanding of the auditory discrimination maturation process in children.

Pilot study: Correlation between nasalance scores and cephalometric parameters in Estonian cleft palate children

BACKGROUND AND OBJECTIVE

According to Klassen et al. (2012), the overall quality of life of CL/P children is most affected by appearance and quality of speech, as these differences are most noticeable to others. To what extent changes in craniofacial growth have an impact on speech quality has yet to be clarified. Therefore, we aimed to determine which cephalometric parameters differed between healthy and cleft palate groups.

MATERIAL AND METHODS

17 healthy and 11 children born with CL/P were included. We conducted a cross-sectional and comparative study. A combination of objective and subjective assessment methods was performed: nasalance scores were calculated, and lateral cephalograms were evaluated by indirect digitization using Dolphin Imaging Software.

RESULTS

The analysis showed differences in the length of the hard (PNS-A) and soft palate (PNS-P), and in the width of the lower oropharyngeal airway (AW5-AW6). The mean length of the hard palate was 3.7 mm and the soft palate 3.0 mm shorter in the CL/P group compared to the healthy group. Hypernasal resonance was related to (1) the length of the hard palate, (2) the distance between the hyoid bone from the third cervical vertebra, and (3) the angle formed by the NA line and the NB line (ANB). Only 11 CL/P children met the inclusion criteria. Thus, the results may have been affected by the small sample size. The Control group consisted of children who visited ENT doctors or orthodontists.

CONCLUSION

The results showed differences in cephalometric parameters in the two groups. Still, we continue to collect data and plan to conduct the analysis on larger and more homogenous sample size.

The effect of velopharyngeal insufficiency on voice quality in Estonian Children with Cleft Palate

Most children born with cleft palate (CP) or cleft lip and palate (CL/P) have velopharyngeal insufficiency (VPI), some degree of hypernasal resonance, articulation disorders and laryngeal dysphonia. Combination of different CL/P specific problems may mask laryngeal dysphonia and therefore, it may remain undiagnosed and untreated by clinicians. The research aimed to study the effect of VPI on voice quality in Estonian CL/P children. We included 18 CL/P and 79 healthy children. Combination of objective (Multi-Dimensional Voice Program (MDVP)) and subjective (Pediatric Voice Handicap Index (pVHI), GRBAS scale, video-nasoendoscopy (VNE), video-laryngostroboscopy (VLS)) assessment methods were assisted and performed by our multidisciplinary cleft teams. We found that (1) overall quality of life is greatly affected by voice, resonance and articulation disorders in CL/P group, (2) more than half of the CL/P children had morphological changes of the vocal folds, (3) the severity of VPI did not result in worse outcomes of acoustic parameters of voice.

Adaption and validation of the Mississippi Aphasia Screening Test to Estonian speakers with aphasia

OBJECTIVES

The Mississippi Aphasia Screening Test (MAST) is a brief screening tool for assessing the expressive and receptive language abilities of patients with aphasia. The goal of this study was to adapt and validate the MAST into the Estonian language. The discriminant validity and internal consistency of the test were examined, as well as its sensitivity and specificity.

METHODS

The MASTest was administered in 50 left hemisphere stroke patients with aphasia (LHA+ group) in the acute phase after the stroke and 126 healthy volunteers in a control group (CG), stratified by age and level of education. Nonparametric tests were used to get normative values, compare the values of the MASTest scores between the LHA+ group and the CG, and to assess the discriminant validity, internal consistency, sensitivity, and specificity of the MASTest.

RESULTS

The summary scores: total score (MASTest-T), expressive score (MASTest-E), and receptive score (MASTest-R) correlated with age and educational level, and the normative values were adjusted accordingly. The LHA+ group showed more impairment than the CG in all subtests and summary scores. The internal reliability of the MASTest was high for the whole sample and LHA+ group. The sensitivity and specificity of the MASTest using the 5th percentile were 74% and 94%, respectively, but using receiver operating characteristic (ROC) analysis, it was 89% and 80%.

CONCLUSION

The MASTest is a valid screening tool for evaluating expressive and receptive language abilities in Estonian patients with aphasia in early stroke. The MASTest is the first validated aphasia screening test for Estonian-speaking people, who number less than one million worldwide.

Normative nasalance scores for Estonian children

Normative nasalance scores are essential for the treatment and assessment purposes for clinicians. Till date, no studies have been done on nasalance in Estonia. This research was conducted to develop Estonia-specific optimized speech stimuli for Nasometer II and establish the normative nasalance scores. Ninety-two randomly selected healthy and 14 cleft palate Estonian monolingual children, aged four to seven years, were included as participants. Estonian language-specific test material was developed. The Estonian test material consisted of 24 speech stimuli. Based on the phoneme content, the stimuli were divided into three groups: (1) sentences that included oral and nasal phonemes and targeted the same phoneme distribution as in spontaneous speech, (2) sentences that included only oral phonemes and (3) sentences that were loaded with nasal phonemes. Nasometer II software was used to calculate the nasalance scores for each child and each sentence. Results indicated that there were significant differences in nasalance scores for oronasal and oral stimuli scores, and no significant differences were found in nasal stimuli scores between the study and control group. The threshold for oronasal stimuli was 42.1-18.9, oral stimuli was 27.9-3.9 and nasal stimuli was 69.4-46.2. In conclusion, Estonia-specific optimized speech stimuli were developed and normative nasalance scores were established. These normative scores can be used for the diagnosis and follow-up treatment of patients with resonance disorders, especially for patients with cleft palate.

Comprehension and production of noun compounds by Estonian children with specific language impairment

The authors examined how 12 Estonian-speaking children with specific language impairment (SLI) and 60 children with normal speech development (ND) comprehended compound nouns with differing sequence of the components (first task) and how they produced compound nouns to label genuine and accidental categories by using analogy (second task) and sentence transformation (third task). The results demonstrated that children with SLI were capable of producing compound nouns for genuine categories, but avoided production of compounds to label objects in temporary juxtapositions. However, by comparison with the control group, SLI children differed statistically significantly in terms of both the number of correct answers and the pattern of mistakes. In the cases when compound nouns were expected to be produced by transforming sentences, the results of SLI children were considerably lower than those of their peers. The results of this study support the idea that children with SLI experience difficulties related to processing linguistic information.