Necessity of Using Neurophysiology Methods for Diagnosis for

Communication Disorder

There are numerous types of research methods used when conducting neurological
research, all with the purpose of trying to view the activity that occurs within the brain
during a certain activity or behavior. The disciplines within which these methods are
used is quite broad, ranging from psychology to neuroscience to biomedical
engineering to sociology. The following is a list of neuroimaging methods:
Electroencephalography (EEG), Functional magnetic resonance imaging (fMRI),
Magnetoencephalography (MEG), Positron emission tomography (PET) etc. [1]

A communication disorder is any disorder that affects an individual's ability to

comprehend, detect, or apply language and speech to engage in dialogue effectively
with others.[2] The delays and disorders can range from simple sound substitution to
the inability to understand or use one's native language.[3]

Phrenology is a process that involves observing and/or feeling the skull to determine
an individual's psychological attributes. Franz Joseph Gall believed that the brain was
made up of 27 individual organs that determined personality, the first 19 of these
'organs' he believed to exist in other animal species. Phrenologists would run their
fingertips and palms over the skulls of their patients to feel for enlargements or
indentations. [4]

An Insight Of Communication Disorder

Communication disorders are an umbrella diagnosis that encompasses a wide array of

issues that relate to language, speech, and hearing. These issues fall into distinct
categories, including:

• Aphasia (having issues understanding language)

• Speech disorders (stuttering, having a lisp, and other spoken communication
issues)
• Learning disabilities (dyslexia, dysgraphia)
• Sensory impairments (blindness, deafness, etc.)

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Some of the issues that develop as a result of a communication disorder include:

• Social isolation
• Bullying by peers
• Self-esteem issues
• Learning struggles
• Poor grades
• Anxiety
• Depression [5]

Discussion On Neurophysiological Disorder for Diagnosis For

Communication Disorder

There are some popular and renowned neurophysiological methods such as MRI,
fMRI, EEG-ERP, MEG, PEG, PET etc.

MRI and fMRI

The brain requires a steady supply of oxygen to metabolize glucose to provide energy.
This oxygen is supplied by the component of the blood called hemoglobin. It was
shown that the magnetic properties of hemoglobin depended on the amount of oxygen
it carried. This dependency has given rise to the method for measuring activation
using MRI, commonly known as functional MRI (fMRI) [6].

MRI is a medical imaging technique used in radiology to form pictures of the

anatomy and the physiological processes of the body. Part of MRI Scanner: MRI
scanners use strong magnetic fields, magnetic field gradients, and radio waves to
generate images of the organs in the body.

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fMRI is used in diagnosis and follow‑up of individuals with language, speech, and
voice disorders, which is important for validating the findings and demonstrating the
remarkable consistency of the functional anatomy across the brain and its defects [7].

Language processing is a complex integral process of anatomical, neurological, and

physiological functions of different brain regions. Many language disorders were
identified with their negative impact on the affected individuals such as autism,
specific language impairment (SLI), hearing loss, attention deficit hyperactivity
disorder (ADHD), dysphasia, and learning disability.

(1) Autism spectrum disorders (ASDs):fMRIresearch in ASDs has focused on the

neurobiology of core social impairment in which face perception is one of the earliest
emerging social deficits. The study of autistic patients versus healthy controls in
response to a neutral face task found decreased activation in the fusiform face area,
occipital face area, and superior temporal sulcus [8]. In contrast to these findings,
Hadjikhani et al. [9] reported significant activation in the fusiform face area in adults
with ASDs and healthy controls Piggot et al. [10] used fMRI with emotional face task
to compare activation in adults with autism versus healthy controls. The autism group
did not activate a cortical ‘face area’ when explicitly assessing emotions or the left
amygdala and left cerebellum when implicitly processing facial emotions.

(2) SLI is deficit in the production or comprehension of language despite normal

cognitive development and educational opportunities that involves poor vocabulary,
syntactic, morphological deficits, impairment in language comprehension, and
phonological problems. fMRI study for SLI cases reported underactivation for
Broca’s area (BA 44/45), as well as in speech‑related cortical andsubcortical brain
regions, whereas overactivation was observed in the posterior middle temporal gyrus
and the left anterior insular (AI) cortex, Badcocket al.[11] assessed the relationship
between brain structure and function in 10 individuals with SLI; the left inferior
frontal cortex showed increased gray matter and decreased functional activation,
whereas the posterior temporal cortex showed both decreased gray matter and
functional activation. Vannest et al. [12] reported that the use of a single Language
paradigm with fMRI may not adequately reveal hemispheric and regional
organization of language, particularly in the developing brain.

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(3) ADHD is an age‑inappropriate problem with inattention, impulsivity, and
hyperactivity affecting school‑aged children. fMRI studies of ADHD response and
interference inhibition reported consistent underactivation relative to controls in the
right and left ventrolateral prefrontalcortex (VLPFC) and AI, supplementary
motorarea, and caudate while switching also elicitsreduced activation in bilateral
VLPFC/AI and basalganglia. Moreover, poor inhibition performance correlates with
decreased gray matter volumes in the VLPFC, AI, anterior cingulate cortex, striatal,
and temporoparietal regions. However, ADHD child will need sedation to do fMRI
properly that compromises the test and fMRI results [13] Castellanos et al. [14] found
that ADHD patients exhibited more significant resting‑state brain activities in basic
sensory and sensory‑related cortices, and that dorsal anterior cingulate cortex had
more significant resting‑state functional connectivity with several other brain regions
in the ADHD patients as compared with the controls

(4) Hearing loss is associated with delayed language disorder that could be corrected
if the offending cause is treated. Tan et al. [15] used fMRI study to investigate the
primary auditory cortex (A1) activation pre–post‑implant in relation to improvement
in hearing thresholds in young cochlear implant recipients. They found that multiple
brain regions were more active postimplant at the angular gyrus, the supramarginal
gyrus, the middle temporal gyrus, the cingulate gyrus, and regions in the prefrontal
cortex Unilateral sensory neural hearing loss cases showed robust activation in the
auditory cortex bilaterally on fMRI. There was unexpected activation in the inferior
frontal gyrus bilaterally and the cuneus. These results might represent a general
cortical reorganization strategy present in patients with unilateral sensory neural
hearing loss on either side [16]

(5) Developmental dyslexiais a specific disorder of reading development with

impairment in the acquisition of reading skills despite normal intelligence, motivation,
and adequate schooling. fMRI demonstrated changes in the reading networks
depending on reading skill level and an evidence of characteristic hypoactivation of
temporoparietal, as well as occipitotemporal brain areas in individuals with
developmental dyslexia, an increase in activation in left frontal and right lateralized
anterior brain areas. This hyperactivation has been suggested to reflect a
compensatory mechanism for the dysfunctional reading system [17] Evidence from

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many neuroimaging studies point toward a characteristic hypoactivation of
left‑hemispheric temporoparietal and occipitotemporal brain regions in children and
adults with developmental dyslexia compared with typical reading controls. In
developmental dyslexia, a hypoactivation of the left temporoparietal region of the
brain seems to reflect an inability to map the sounds of languages (phonemes) to its
written counterparts (letters/graphemes). After behavioral remediation, the children
with dyslexia improved significantly in language processing and readingability with
coinciding increased cortical activityon fMRI [18]

(6) Developmental dyscalculia: learning disability in mathematics. Mathematical

learning disabilities involves aberrations in multiple functional systems including
brain systems implicated in visual form judgement, symbol recognition anchored in
the ventral temporal–occipital cortex, quantity and magnitude processing anchored in
the intraparietal sulcus region of the parietal cortex, as well as attention and working
memory functions supported by a frontoparietal control network. Following
acquisition of a variety of arithmetic skills, increased expertise was correlated with
decreased frontal and increased parietal fMRI activation. The findings attributed to a
switch from calculation to retrieval of learned answers from cortical memory stores
[19]

(7) Aphasia is language limitations that include both expressive and receptive
modalities. It is commonly caused by stroke. Several fMRI studies investigated
patients of cerebral stroke with aphasia. Lukic et al. [20] on fMRI study showed that
patient with stroke showed a shift in activation to the prelesional (parietotemporal)
cortex during phonologic task performance.

Six Early Bilinguals (Raised In A Bilingual Household)

➢ 6 late bilinguals (exposed to L2 at 11)

• Had to generate sentences silently in both languages in MRI

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Electroencephalography (EEG) –Event Related Potential (ERP)

Brain needs to be involved in different activities to perform livelihood of

human beings. More specifically, when human beings execute numerous everyday
behaviors, they have to conduct cognitive processing done in the brain. For example,
to express and understand language, to identify parents and relatives from their
neighbors and thousands of unknown populations, and to categories different objects
which surround them, cognitive processing in the brain is a must. In fact, it is difficult
to manually measure how does human brain perform such cognitive activities.
So, there already developed a lot of brain measuring techniques like EEG (Electro
encephalography) to record such cognitive functions. At the same time, in EEG
(Event Related Potentials) recording, ERP (Event Related Potentials) is extensively
used toprocess and analyze the signals elicited from human cognitive
processing.

In the experiment Donchin et al. (1986) found that P300 is observed by the task which
involved working memory. More specifically, since P3b become larger during the
task of attention and it reflects the memorization processes, it is potential enough for
the task of object categorization. At the same time, by giving insight into the
underlying mechanism of the brain activity, we can take a look at the role of ERP
(P3b) in object categorization for ‘food’ and ‘no-food’ by measuring the electrode
location at Pz with the peak latency range 350-500ms(See Fig 1).[21]

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Event-related potential (ERP)reflections of phonologically unexpected words have
notbeen studied so far. Fortunately, we found that a Chinesepoem with a specific
language pattern might be an appropriate material which could provide a further
possibility forthe solution of this problem. Well-known poems represent“fossilized”
linguistic units, in which meaning, syntax, andphonology are highly expected. By
substituting a word inthat poem by a homophone, one gets a pure
semanticallyunexpected event, while substituting with a synonym, aphonologically
unexpected event occurs. It must beadmitted that at the same time, there is possibly
also anorthographically unexpected event, but it seems doubtfulthat persons, other
than those gifted with “eidetic imagery”,memorize poems as complex visual patterns
and thereforedevelop detailed visual expectations. [22]

This becomes particularly problematic when spatiotemporal componentoverlap

interacts with differential P600 modulations due to task demands. While the problem
of spatiotemporal component overlap is generally acknowledged, andoccasionally
invoked to account for within-study inconsistencies in the data, its implications
areoften overlooked in psycholinguistic theorizing that aims to integrate findings
across studies. Webelieve WCS-centric theorizing to be the single largest reason for
the lack of convergence regardingthe processes underlying the N400 and the P600,
thereby seriously hindering the advancement ofneurocognitive theories and models of
language processing.[23]

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Eventrelated potential (ERP) provides the idealresearch tools to examine the
automaticprocessing in cognitive system. N400 and P600are commonly used ERP
(event-related potential)index in the research of language cognition. [24]

P1/N1

➢ P1
• 50ms – auditory, 100ms – visual
• General attention/arousal
➢ N1
• Selective attention to stimulus characteristics
• Stimulus discrimination

P2/N2

➢ P2 – obligatory cortical potential

• Low individual variability and high reproducibility
• Stimulus classification
• Sensitive to pitch and loudness (auditory)
➢ N2
• Stimulus discrimination
• Deviation of stimulus from expectation

P300

➢ Stimulus classification and response preparation

• Varies with stimulus complexity
• Possibly associated with memory and attention
• P3a , P3b

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P600

➢ Memory and language

• Old-new response (greater for old information)
• Syntactic Positive Shift (Kutas and Hilliard, 1983)
• Syntactic processing load due to parsing failure
• Elicited with syntactic and morphosyntactic violations (agreement,
phrase structure, subcategorization, syntactic ambiguity).

After all, ERP is an associated method with EEG technique which investigates the
nature of brainactivity in a given task. It is used to measure the changes of EEG
signals during observing stimuli. At thesame time, it also investigates time duration of
a correct response o the stimuli. So, since ERP providesthe researcher a whole picture
of the different states of living human brain, it is genuinely called ‘analphabet of brain
language’[25]

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Magnetoencephalography (MEG)

MEG to recordauditory evoked neuromagnetic responses to simple sounds(sinusoidal

tones) in children with autism and in typicallydeveloping controls. MEG is well suited
for this investigation: it provides submillisecond temporal resoluton ofsynchronized
cortical neural responses and has beendemonstrated to be well tolerated by children
with autism. Favorable spatiotemporal features, MEGbased methods have contributed
to our understanding ofneurodevelopmental features of cognition in ASD. Some MEG
indiceshave been proposed as potential biomarkers for ASD that couldbe useful for
diagnostic accuracy and prognostic specificity. [26]

More recently, magnetoencephalography (MEG) studies have shown that the

responses from the auditorycortex to self-produced speech are attenuated in
themillisecond time scale, when compared with responsesfrom tape-recorded speech.
[27]

Pneumoencephalography (PEG)

Pneumoencephalography (sometimes abbreviated PEG; also referred to as an "air

study") was a common medical procedure in which most of the cerebrospinal fluid
(CSF) was drained from around the brain by means of a lumbar puncture and replaced
with air, oxygen, or helium to allow the structure of the brain to show up more clearly
on an X-ray image. It was derived from ventriculography, an earlier and more
primitive method where the air is injected through holes drilled in the skull.

Pneumoencephalography

Modern imaging techniques such as MRI and CT have rendered

pneumoencephalography obsolete. Widespread clinical use of diagnostic tools using
these newer technologies began in the mid-to-late 1970s. These revolutionized the

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field of neuroimaging by not only being able to non-invasively examine all parts of
the brain and its surrounding tissues, but also by doing so in much greater detail than
previously available with plain X-rays, therefore making it possible to directly
visualize and precisely localize soft-tissue abnormalities inside the skull. This led to
significantly improved patient outcomes while reducing discomfort.Today,
pneumoencephalography is limited to the research field and is used under rare
circumstances.[28]

Positron emission tomography (PET)

A positron emission tomography scan isan imaging test that helps to identifyyour
tissues and organs.A PET scan uses a radioactive drug(tracer) to show this activity.

A technique that measures physiologicalfunction by looking at blood flow,

metabolism,neurotransmitters, and radiolabeled drugs.PET offers quantitative
analyses, allowing relativechanges over time to be monitored as a diseaseprocess
evolves or in response to a specificstimulus.[29]

The new technological advances achieved during the last decade allowed the
scientific community to investigate and employ neurophysiological measures not only
for research purposes but also for the study of human behaviour in real and daily life
situations. The aim of this review is to understand how and whether neuroscientific
technologies can be effectively employed to better understand the human behaviour in
real decision-making contexts.[30]

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 REFFERENCE

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4. Parssinen 1974, p. 2.
5. https://www.insightpsychological.ca/counselling/communication-
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11. Humphreys K, Hasson U, Avidan G, Minshew N, Behrmann M. Cortical patterns of
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20. https://ojs.southfloridapublishing.com/ojs/index.php/jdev/article/view/133/144
21. https://link.springer.com/article/10.1007/s00221-011-2739-3
22. http://loop.frontiersin.org/people/9156/overview
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P600” effects in language comprehension. Brain research Reviews 2008; 59(1):55-73.
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Numminen, Salmelin, & Hari, 1999).
28. https://en.wikipedia.org/wiki/Pneumoencephalography
29. https://www.mayoclinic.org/tests-procedures/pet-scan/about/pac-20385078
30. https://www.researchgate.net/publication/335896896_Consumer_Behaviour_through
_the_Eyes_of_Neurophysiological_Measures_State-of-the-Art_and_Future_Trends

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