ASSIGNMENT

ON

Course code: PMSLP 5201

Subject: Technology and Methods of Investigation Pathological Language Data
Topic: The necessity of using neurophysiological methods for diagnosing
communication disorders.

Submitted to

TAWHIDA JAHAN
(Assistant Professor & Chairperson)
Department of Communication Disorders
Faculty of social science
The University of Dhaka

Submitted by

Md. Rasel Uddin

Roll No : 012
PMSLP 5th batch
Department of Communication Disorders
Faculty of social science
The University of Dhaka
The necessity of using neurophysiological methods for
diagnosing communication disorders.

A communication disorder is an impairment in the ability to receive, send, process, and

comprehend concepts or verbal, nonverbal and graphic symbol systems. It may be evident in the
processes of hearing, language, and speech. A communication disorder may range in severity
from mild to profound. It may be developmental or acquired. Individuals may demonstrate one
or any combination of communication disorders.
By American Speech-Language-Hearing Association (ASHA)

Types
1.A speech disorder is an impairment of the articulation of speech sounds, fluency and/or voice.
 An articulation disorder is the atypical production of speech sounds characterized by
substitutions, omissions, additions or distortions that may interfere with intelligibility.
 A fluency disorder is an interruption in the flow of speaking characterized by atypical
rate, rhythm, and repetitions in sounds, syllables, words, and phrases. This may be
accompanied by excessive tension, struggle behavior, and secondary mannerisms.
 A voice disorder is characterized by the abnormal production and/or absences of vocal
quality, pitch, loudness, resonance, and/or duration, which is inappropriate for an
individual's age and/or sex.
2. A language disorder is impaired comprehension and/or use of spoken, written and/or other
symbol systems. The disorder may involve (1) the form of language (phonology, morphology,
syntax), (2) the content of language (semantics), and/or (3) the function of language in
communication (pragmatics) in any combination.
 Phonology is the sound system of a language and the rules that govern the sound
combinations.
 Morphology is the system that governs the structure of words and the construction of
word forms.
 Syntax is the system governing the order and combination of words to form sentences,
and the relationships among the elements within a sentence.
 Semantics is the system that governs the meanings of words and sentences.
 Pragmatics is the system that combines the above language components in functional
and socially appropriate communication.
3. Hearing disorder
 Deaf
  Hard of hearing
4. Central auditory processing disorders

The Ad Hoc Committee developed a guideline called “Communication Disorders and Variations,”
[Asha, November 1982, pages 949–95O].

The general importance of using neurophysiological methods for

diagnosing communication disorders:
1. In the early 1800s people used phrenology to measure scalps to learn about underlying
mental dispositions. But by then scientists had developed several neurophysiological testing
methods so that speech pathologists could see live images of the brain and accurately identify the
defect.
2. Using modern neurophysiological testing methods, we can see blood flow in the brain
where it was impossible a few decades ago.
3. Modern neurophysiological testing methods help us to analyze and see the progression
of the disease.
4. Modern neurophysiological testing methods started a new era in diagnosis and most
studies.
5. We can see blood flow associated with neural activity using modern
neurophysiological testing methods. These arrangements are a boon to mankind.
6. Using modern neurophysiological testing methods, we can take several functional
brain images at a time which is revolutionary for the speech and language pathology sector as
well as medical science.
7. Using modern neurophysiological testing methods, we can see moving brain images
so we can understand defects more specifically.
8. With modern neurophysiological testing methods, we can look at the vocal sound
signal strength or "loudness" of a signal over time at different frequencies present in a particular
waveform.
9. These modern neurophysiological testing methods help not only in diagnosis but also
in planning and implementing specific treatment methods.
10. Although few of these modern neurophysiological testing methods have radioactive
hassles and are costly too, however, for the betterment of finding the specific problem and
appropriate measures, we can use those modern technologies.
11. I believe for the emotional satisfaction of health care professionals, speech and
language pathologists, patients, and their attendants, using modern neurophysiological testing
methods is a perfect decision in the context of evaluating and providing treatment.
The specific necessity of using neurophysiological methods for diagnosing
communication disorders:
There are various neurophysiological testing methods used in the evaluation, diagnosis, and
treatment of specific speech and language disorders as well as communication disorders which
are as follows:

Franz Joseph Gall

Franz Joseph Gall (1758–1828) was a pioneer in the study of brain anatomy. He made significant
contributions to the understanding of brain physiology and was an early advocate for localization
of function. He argued that the relative size of brain areas reflected specific abilities and
determined the external shape of the skull. His theories were adapted and further popularized by
his assistant, Johann Gasper Spurzhiem (1776–1832), who used the term phrenology to describe
the practice of personality assessment through analysis of skull shape.

Phrenology
Phrenology was both popular and controversial in Europe and the United States, and it was
largely discredited by the mid-nineteenth century. Phrenology is a process that involves
observing and/or feeling the skull to determine an individual's psychological attributes.
 Pneumoencephalography

Pneumoencephalography is an obsolete imaging technique that allowed evaluation of the

contours of the brain and ventricles by the deliberate introduction of air into the subarachnoid
space.

This was achieved initially by a needle passed directly into the ventricles (via the fontanelles or a
burr hole). Small amounts of CSF were withdrawn and replaced with room air. The process was
repeated over and over until no more CSF could be obtained.

Later, it was realized that air inserted into the lumbar theca (via puncture) could be maneuvered
into the desired subarachnoid spaces by careful position and tilting of the head.

In the 1950s and 60s, as air was often to be found rather lacking as a negative contrast agent,
there was a switch to using positive agents, known as contrast
encephalography. Iofendylate (Pantopaque/Myodil), a contrast agent similar to Lipiodol, was a
popular choice .

Complications

Pneumoencephalography was said to be an extremely unpleasant undertaking for patients who

commonly experienced severe headaches, nausea, diaphoresis, lassitude, and hypotension.

Early mortality rates of pneumoencephalography, quoted in one source as 1-3% were high,
considering it was a diagnostic, and not a therapeutic technique
 positron emission tomography(PET)
A positron emission tomography scan is an imaging test that helps to identify a patient’s tissues
and organs. PET scan uses a radioactive drug (tracer) to show this activity. This technique
measures physiological function by looking at blood flow, metabolism, neurotransmitters, and
radiolabeled drugs. PET offers quantitative analyses, allowing relative changes over time to be
monitored as a disease process evolves or in response to a specific stimulus. This technique has
more accuracy to diagnose a case like communication disorder and nowadays this is becoming
popular too.
How is PET performed?

PET scans can be done on an outpatient basis. It is also possible that some hospital inpatients
may undergo a PET examination for certain conditions.

Although each facility may have specific protocols in place, generally, a PET scan procedure
follows this process:

1. The patient will be asked to remove any clothing, jewelry, or other objects that may
interfere with the scan.
2. If asked to remove clothing, the patient will be given a gown to wear.
3. The patient will be asked to empty his or her bladder prior to the start of the procedure.
4. One or 2 IV lines will be started in the hand or arm for injection of the radionuclide.
5. Certain types of scans of the abdomen or pelvis may require that a urinary catheter be
inserted into the bladder to drain urine during the procedure.
6. In some cases, an initial scan may be performed prior to the injection of the radionuclide,
depending on the type of study being done. The patient will be positioned on a padded
table inside the scanner.
7. The radionuclide will be injected into the IV. The radionuclide will be allowed to
concentrate in the organ or tissue for about 30 to 60 minutes. The patient will remain in
the facility during this time. The patient will not be hazardous to other people, as the
radionuclide emits less radiation than a standard X-ray.
8. After the radionuclide has been absorbed for the appropriate length of time, the scan will
begin. The scanner will move slowly over the body part being studied.
 9. When the scan has been completed, the IV line will be removed. If a urinary catheter has
been inserted, it will be removed.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) is a medical imaging technique that uses a magnetic field
and computer-generated radio waves to create detailed images of the organs and tissues in your
body.

Most MRI machines are large, tube-shaped magnets. When you lie inside an MRI machine, the
magnetic field temporarily realigns water molecules in your body. Radio waves cause these
aligned atoms to produce faint signals, which are used to create cross-sectional MRI images —
like slices in a loaf of bread.

The MRI machine can also produce 3D images that can be viewed from different angles.

MRI of the brain and spinal cord

MRI is the most frequently used imaging test of the brain and spinal cord. It's often performed to
help diagnose:

 Aneurysms of cerebral vessels

 Disorders of the eye and inner ear

 Multiple sclerosis

 Spinal cord disorders

 Stroke

 Tumors

 Brain injury from trauma

 fMRI-functional Magnetic Resonance Imaging

A special type of MRI is the functional MRI of the brain (fMRI). It produces images of
blood flow to certain areas of the brain. It can be used to examine the brain's anatomy and
determine which parts of the brain are handling critical functions.
 This helps identify important language and movement control areas in the brains of
people being considered for brain surgery. Functional MRI can also be used to assess
damage from a head injury or from disorders such as Alzheimer's disease.

Electroencephalogram (EEG)

An electroencephalogram (EEG) is a recording of brain activity. During this painless test,

small sensors are attached to the scalp to pick up the electrical signals produced by the brain.
These signals are recorded by a machine and are looked at by a doctor.

The EEG is used to evaluate several types of brain disorders. When epilepsy is present, seizure
activity will appear as rapid spiking waves on the EEG.

People with lesions of their brain, which can result from tumors or stroke, may have unusually
slow EEG waves, depending on the size and the location of the lesion.
The test can also be used to diagnose other disorders that influence brain activity, such as
Alzheimer's disease, certain psychoses, and a sleep disorder called narcolepsy.

The EEG may also be used to determine the overall electrical activity of the brain (for example,
to evaluate trauma, drug intoxication, or extent of brain damage in comatose patients). The EEG
may also be used to monitor blood flow in the brain during surgical procedures.

There may be other reasons for your healthcare provider to recommend an EEG.

Event-Related Potential

This is a more sophisticated method of extracting more specific sensory, cognitive, and motor
events using simple averaging techniques where we can measure real-time brain activity. ERPs
are measured by electroencephalography (EEG). The magnetoencephalography (MEG)
equivalent of ERP is the ERF or event-related field. Evoked potentials and evoked potentials are
subtypes of ERPs. Therefore, it is very important to use the most reliable neurophysiological
methods of this kind to diagnose communication disorders.

P1/N1

 P1
50ms –auditory,100ms –visual
General attention/arousal
 N1
Selective attention to stimulation characteristics
Stimulus discrimination
 P2
P2 obligatory cortical potential
Low individual variability and high reproducibility
Stimulus classification
Sensitive to pitch and loudness
 N2
Stimulus discrimination
Deviation of stimulus from expectation
  P300
Stimulus classification and response preparation
Possibly associated with memory and attention
P3a,P3b

 P600
Memory and language
Old new response
Syntactic positive
Syntactic processing load due to parsing failure
Elicited with syntactic and morphosyntactic

Magnetoencephalography (MEG)

Magnetoencephalography (MEG) is a non-invasive technique for investigating human

brain activity. It allows the measurement of ongoing brain activity on a millisecond-by-
millisecond basis, and it shows where in the brain activity is produced.

Advantages of MEG

MEG signals are obtained directly from neuronal electrical activity.

MEG signals are able to show absolute neuronal activity whereas the fMRI signals show relative
neuronal activity, meaning that the fMRI signal analysis always be compared to reference
neuronal activity. This means that MEG can be recorded in sleeping subjects.

MEG does not make any operational noise, unlike fMRI. While fMRI measurement requires the
complete absence of subject movement during recording, MEG measurement does not, so
children can move their heads within the MEG helmet.
Finally, and most importantly, MEG provides us with temporal characteristics about brain
activation with sub-millisecond precision, whereas fMRI measurement provides poor temporal
information.

MEG provides also more accurate spatial localization of neural activities than EEG, a
complementary method of recording brain activity. The I-LABS MEG Brain Imaging Center
system allows co-registration of EEG and MEG.

Reference:
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3. American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and
variations [Relevant Paper]. Available from www.asha.org/policy. doi:10.1044/policy.RP1993-00208.
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