Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)
description
Transcript of Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)
![Page 1: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/1.jpg)
Functional Neuroanatomy of
Lexical processing in children with cleft lip
and palate(CCLP)
Becker et al., 2007
![Page 2: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/2.jpg)
Background
Males are affected more often than females.
Incidence in:• Asian population = 1 in 500 births.• Caucasian and Hispanic populations
= 1 in 1000 births.• African American population = 1 in
2000 births.(Altemus & Ferguson, 1965; Chung et al., 1986;
Natsume & Kawai, 1986; Vanderas, 1987)
![Page 3: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/3.jpg)
Cleft Lip & PalateCleft lip may occur in
isolation or together with cleft palate and vice versa.
Incidence of cleft lip alone (15-20%) is lower than the incidence of cleft palate only (30-35%) and cleft lip and palate (50%).
(Coccia et al., 1969; Woolf et al.,
1963)
![Page 4: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/4.jpg)
Cleft Lip & Palate
• Occurrence of cleft lip and palate together is more common in males.
• Cleft palate only is more common in females
(Calzolari et al., 1988; Womersley & Stone, 1987)
![Page 5: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/5.jpg)
Types of CleftsCommon • Unilateral (9x as
common as bilateral and occurs more often on the left side)
• Bilateral
Often involve deformity of the nose
Unilateral
Bilateral
![Page 6: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/6.jpg)
Types of Clefts
Rare• Median • Facial(DeMyer, 1971;
Tessier, 1976)
![Page 7: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/7.jpg)
When do they form?
Between fourth to eight week of embryonic development.
Earlier malformations are more severe than later ones
![Page 8: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/8.jpg)
CausesGenetic Increased incidence
in children with a parent or sibling who are similarly affected ⇒ 1 in 131 (Melnick, 1986).
Note: Individuals with cleft palate only have higher percentage of siblings that have other types of malformations than individuals with cleft lip only or cleft lip and palate (Meskin & Pruzansky, 1969. (Malformations can occur in the orbital cleft, facial asymmetry, middle ear defects, sternum).
Orbital cleft
![Page 9: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/9.jpg)
Causes
Environmental
• Antiepileptic drug, phenytoin = 10-fold increase in the incidence of clefts.
• Smoking during pregnancy = 50% to 70% increase in clefting compared to those born to nonsmoking mothers.
• Certain viruses (rubella and influenza) increase risk of clefting.
![Page 10: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/10.jpg)
Associated AnomaliesClefting occurs in
about 250 syndromes including Van der Woude, Stickler syndrome, microcephaly, etc.
Van der Woude
microencephalyStickler
![Page 11: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/11.jpg)
Associated problems
1) Feeding2) Ear infection-
hearing loss3) Speech and
language disorders
4) Dental problems
![Page 12: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/12.jpg)
TreatmentSurgery NAM – Nasal
alveolar molding
![Page 13: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/13.jpg)
Anatomical differences
Adult males with cleft palate display:1) smaller cerebellum 2) smaller temporal lobe3) smaller occipital lobes4) larger frontal lobes
* Proportional gray and white matter(Nopoulos et al., 2000)
![Page 14: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/14.jpg)
Language Development• Early deficits in cognitive development
(Fox et al., 1978; Snyder & Scherer, 2004; Speltz et al., 2000).
• Problems with syntax, short length of utterance and delays in expressive language (Horn, 1972; Morris, 1962;
Withcomb et al., 1976). • Articulation disorders, sometimes
even after the cleft is repaired (Jones et al., 2003; O’Gara & logemann, 1988).
![Page 15: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/15.jpg)
Method
Participants
![Page 16: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/16.jpg)
Experimental design
Lexical task
Auditory Visual
Rhyme generation
Verb generation
Opposite generation
Rhyme generation
Verbgeneration
Opposite generation
e.g. “cake”– “eat
e.g. “white” – “black”
e.g. “mud” –”flood”
* Presentation was jittered – stimulus was presented every 2nd, 3rd, 4th MR frame in pseudorandom fashion.
•Total of 6 runs.•Each run consisted of 21 stimuli - one
discrete task and one modality.
![Page 17: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/17.jpg)
Movement analysisMotion in the scanner can be a problem. If more than 1.5 mm (RMS value) was
needed to realign head movement, the data was excluded.
Image analysisGeneral Linear Model for event related
data.Time = 7-level factor (BOLD measures
every 3.08 seconds).Removed outliers = time course that had
greater than 2% change in signal.
![Page 18: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/18.jpg)
Overlap analysisCompared with Brown et al. (2005) study.
Brown et al. 2005 (used the same tasks)• Age-related regions = regions that
showed increased or decreased activity with age.
• Performance-related regions = regions that were related to performance ability.
• Age-and performance-independent regions.
![Page 19: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/19.jpg)
Developmental analysisTo determine if age had an effect.Each CCLP was compared to an age-
matched cohort (group of 20 control individuals matched within 2 years).
Statistical analysisRepeated measures analysis – mixed
model.Between subject factor = condition or
group (with or without cleft lip and/or palate)
Within subject factor = time
![Page 20: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/20.jpg)
Results
Results were based only on correct responses.
**Reaction time (collapsed across task and modality)Experimental: 1813 msecControl: 1804 msec** not statistically different
![Page 21: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/21.jpg)
Main Effect of TimeTo determine how reliably each voxel was
activated by the tasks. Regions activated were similar to
previous study (Schlagger et al., 2002) looking at single word processing.
![Page 22: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/22.jpg)
Main effect: voxels reliably activated across all subjects and all tasks
![Page 23: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/23.jpg)
Group x time interactionThere were several regions that
displayed activation differences related to:
1) latency (CCLP > control)2) duration (CCLP >control)3) magnitude
![Page 24: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/24.jpg)
Higher magnitude in CCLP
Left superior medial frontal gyrus
Right parietal precuneusRight inferior frontal gyrus
![Page 25: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/25.jpg)
Lower magnitude in CCLP
Left inferior frontal gyrus* Right lateral prefrontal cortex – not shown
Right middle temporal gyrus
![Page 26: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/26.jpg)
Similar in CCLP and controls
Left cingulate gyrus
* left paracentral lobule, right superior temporal gyrus – not shown
![Page 27: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/27.jpg)
Not activated in CCLP
Right middle frontal gyrus
![Page 28: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/28.jpg)
Developmental Analysis
9 out of 12 CCLP showed regions that had differences in BOLD responses from their age-matched cohorts.
Older participants (>14.5 years) showed differences consistently in the right frontal cortex (n=2) and ACC (n=1) when compared to controls.
![Page 29: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/29.jpg)
Group x time: regions that were statistically different in BOLD response between groups
![Page 30: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/30.jpg)
Regions that corresponded to Brown et al., 2005 study.
![Page 31: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/31.jpg)
* Functional differences between CCLP and control increase with age.Average number of regions where the BOLD responses that differed from the controlsOlder (above 14.5 years) = 8.4Younger (below 14.5 years) = 2.6
![Page 32: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/32.jpg)
CCLP show substantial variability in activation regions when compared to
controls
lateral
medial
posteriorPink: CCLP ≠ control (Are there more blue than pink regions in the older
participant?)
Blue: CCLP = control
posterior
![Page 33: Functional Neuroanatomy of Lexical processing in children with cleft lip and palate (CCLP)](https://reader036.fdocuments.in/reader036/viewer/2022062309/56814f39550346895dbcd80e/html5/thumbnails/33.jpg)
DiscussionCCLP have similar but non-identical
functional neuroanatomy during language tasks at comparable levels of performance.
Regional differences in functional neuroanatomy are more apparent in age/performance related areas.
CCLP display increasing differences in age-related regions with increasing age.
CCLP display novel organization during language tasks