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Relationship between discourse and Western Aphasia Battery performance in African Americans with aphasia
Microsoft Academic Search
Background: There is a need for discourse research with African Americans who have aphasia, highlighted by ethnic group differences in stroke prevalence, and potential ethnic group differences in dialect. Identification of ethnic dialect is critical to differentiate communication changes associated with pathology from normal communicative differences associated with ethnicity. Also, preliminary research on adults with aphasia indicates an uncertain relationship
Hanna Ulatowska; Gloria Streit Olness; Robert Wertz; Agnes Samson; Molly Keebler; Karen Goins
Aphasia after Stroke: Type, Severity and Prognosis
Aim: To determine the types, severity and evolution of aphasia in unselected, acute stroke patients and evaluate potential predictors for language outcome 1 year after stroke. Methods: 270 acute stroke patients with aphasia (203 with first-ever strokes) were included consecutively and prospectively from three hospitals in Copenhagen, Denmark, and assessed with the Western Aphasia Battery. The assessment was repeated 1
Palle Møller Pedersen; Kirsten Vinter; Tom Skyhøj Olsen
Preliminary psychometric evaluation of an acute aphasia screening protocol
Results of preliminary psychometric evaluations of the Acute Aphasia Screening Protocol are presented. This protocol demonstrates good concurrent validity with the Western Aphasia Battery and good content and construct validity when compared to existing aphasia batteries. Test-retest reliability is high, indicating temporal stability of the procedure. Preliminary interjudge reliability is high within and across patients. These results indicate that the
Michael A. Crary; Nancy J. Haak; Anne E. Malinsky
The rate and extent of improvement with therapy from the different types of aphasia in the first year after stroke
Objective: To examine the rate and extent of improvement from the different types of aphasia in the first year after stroke.Design: A prospective longitudinal study.Setting: A specialist stroke unit.Participants: Seventy-five aphasic patients with first-ever stroke.Intervention: The type of aphasia was classified according to the criteria of the Western Aphasia Battery. The Western Aphasia Battery aphasia quotient was used to measure
A. M. O. Bakheit; S. Shaw; S. Carrington; S. Griffiths
A New Test Battery to Assess Aphasic Disturbances and Associated Cognitive Dysfunctions — German Normative Data on the Aphasia Check List
Aphasia, defined as an acquired impairment of linguistic abilities, can be accompanied by a diversity of neuropsychological dysfunction. Accordingly, the necessity to include cognitive testing in the diagnosis of aphasia is increasingly recognized (Helm-Estabrooks, 2002). Here we present the Aphasia Check List (ACL), a new test battery for the assessment of aphasic and associated cognitive disorders. The language part of
Elke Kalbe; Nadine Reinhold; Matthias Brand; Hans J. Markowitsch; Josef Kessler
Progressive Non-Fluent Aphasia in Malayalam: A Case Study
ERIC Educational Resources Information Center
Primary Progressive Aphasia (PPA) is a degenerative condition characterized by deterioration in language for at least two years without deterioration in other cognitive domains. This report highlights the language profile in a 79-year-old male with progressive nonfluent aphasia (PNFA) who was assessed using the Western Aphasia Battery and the…
George, Annamma; Mathuranath, P. S.
Ideomotor apraxia in agrammatic and logopenic variants of primary progressive aphasia.
There are few studies examining praxis in subjects with primary progressive aphasia. The aim of this study was to examine the pattern and severity of ideomotor apraxia in subjects with logopenic and agrammatic variants of primary progressive aphasia and to determine if the presence of ideomotor apraxia correlated with specific neuroanatomical structural abnormalities. Subjects with primary progressive aphasia were prospectively recruited and classified according to published criteria. Using the apraxia subtest of the Western Aphasia Battery, pattern and severity of ideomotor apraxia was examined in all subjects diagnosed with agrammatic and logopenic variants of primary progressive aphasia. The study included 47 subjects, 21 diagnosed with agrammatic variant of primary progressive aphasia and 26 with logopenic variant primary progressive aphasia. Subjects with agrammatic aphasia were older at onset than the logopenic variant (67.2 vs. 61.7 years, p = 0.02), but there was no difference in illness duration prior to evaluation. Those with logopenic aphasia showed more cognitive impairment on the Mini-Mental Status Examination (agrammatic = 26.7/30, logopenic = 22/30, p = 0.002), and a trend for more severe language impairment as measured by the Western Aphasia Battery-Aphasia Quotient (agrammatic = 82.3, logopenic = 75.2, p = 0.11). Strong correlations were found between Western Aphasia Battery-Aphasia Quotient and total apraxia, instrumental apraxia, and complex apraxia, while average to modest correlations were seen with upper limb apraxia and facial apraxia. After adjusting for age, mental status performance, and Western Aphasia Battery-Aphasia Quotient score, those with agrammatic aphasia had a higher degree of total apraxia (p = 0.004), facial apraxia (p = 0.03), instrumental apraxia (p = 0.0006), and complex apraxia (p = 0.0006) than those with logopenic aphasia. The agrammatic variant of primary progressive aphasia was associated with greater praxis deficits but less cognitive impairment than the logopenic variant. The presence of ideomotor apraxia was associated with grey matter loss in the left lateral premotor cortex with extension into the motor cortex. These findings suggest that although some affected areas in the agrammatic and logopenic variants of primary progressive aphasia overlap, there exists an area that is more affected in the agrammatic variant than the logopenic variant that accounts for the greater association of agrammatic aphasia with ideomotor apraxia. PMID:23358624
Adeli, Anahita; Whitwell, Jennifer L; Duffy, Joseph R; Strand, Edyth A; Josephs, Keith A
Ideomotor Apraxia in Agrammatic and Logopenic Variants of Primary Progressive Aphasia
PubMed Central
There are few studies examining praxis in subjects with primary progressive aphasia. The aim of this study was to examine the pattern and severity of ideomotor apraxia in subjects with logopenic and agrammatic variants of primary progressive aphasia and to determine if the presence of ideomotor apraxia correlated with specific neuroanatomical structural abnormalities. Subjects with primary progressive aphasia were prospectively recruited and classified according to published criteria. Using the apraxia subtest of the Western Aphasia Battery, pattern and severity of ideomotor apraxia was examined in all subjects diagnosed with agrammatic and logopenic variants of primary progressive aphasia. The study included 47 subjects, 21 diagnosed with agrammatic variant of primary progressive aphasia and 26 with logopenic variant primary progressive aphasia. Subjects with agrammatic aphasia were older at onset than the logopenic variant (67.2 versus 61.7 years, p=0.02), but there was no difference in illness duration prior to evaluation. Those with logopenic aphasia showed more cognitive impairment on the Mini-Mental Status Examination (agrammatic=26.7/30, logopenic=22/30, p=0.002), and a trend for more severe language impairment as measured by Western Aphasia Battery-Aphasia Quotient (agrammatic=82.3, logopenic=75.2, p=0.11). Strong correlations were found between Western Aphasia Battery-Aphasia Quotient and total apraxia, instrumental apraxia, and complex apraxia, while average correlation were seen with upper limb apraxia and modest correlation with facial apraxia. After adjusting for age, mental status performance, and Western Aphasia Battery-Aphasia Quotient score, those with agrammatic aphasia had a higher degree of total apraxia (p=0.004), facial apraxia (p=0.03), instrumental apraxia (p=0.0006), and complex apraxia (p=0.0006) than those with logopenic aphasia. The agrammatic variant of primary progressive aphasia was associated with greater praxis deficits but less cognitive impairment than the logopenic variant. The presence of ideomotor apraxia was associated with grey matter loss in the left lateral premotor cortex with extension into the motor cortex. These findings suggest that although some affected areas in the agrammatic and logopenic variants of primary progressive aphasia overlap, there exists an area that is more affected in the agrammatic variant than the logopenic variant that accounts for the greater association of agrammatic aphasia with apraxia.
Adeli, Anahita; Whitwell, Jennifer L.; Duffy, Joseph R.; Strand, Edyth A.; Josephs, Keith A.
A Comparison of the BAT and BDAE-SF Batteries in Determining the Linguistic Ability in Greek-Speaking Patients with Broca's Aphasia
The aim of this study is to test the validity and reliability of the Bilingual Aphasia Test as a measure of language impairment in a Greek-speaking Broca's aphasic population and to investigate relationships with the same aphasic group's performance on the Greek version of the short form of the Boston Diagnostic Aphasia Examination battery, mainly…
Peristeri, Eleni; Tsapkini, Kyrana
A comparison of the BAT and BDAE-SF batteries in determining the linguistic ability in Greek-speaking patients with Broca's aphasia.
The aim of this study is to test the validity and reliability of the Bilingual Aphasia Test as a measure of language impairment in a Greek-speaking Broca's aphasic population and to investigate relationships with the same aphasic group's performance on the Greek version of the short form of the Boston Diagnostic Aphasia Examination battery, mainly focusing on a series of subtests which are shared by the two batteries, yet occasionally differ in content. Correlation analyses showed that the two instruments yielded highly comparable results with respect to the measurement of reading and listening comprehension, as well as in the performance-based measurement of the automated sequence capacity of the patients. Nevertheless, the Bilingual Aphasia Test, as a more extensive battery, proved to be more sensitive and objective in characterizing the patients' language abilities in a number of individual language functions, including commands, sentence repetition, naming, verbal fluency and syntactic comprehension. PMID:21453043
Distinct regional anatomic and functional correlates of neurodegenerative apraxia of speech and aphasia: an MRI and FDG-PET study.
Progressive apraxia of speech (AOS) can result from neurodegenerative disease and can occur in isolation or in the presence of agrammatic aphasia. We aimed to determine the neuroanatomical and metabolic correlates of progressive AOS and aphasia. Thirty-six prospectively recruited subjects with progressive AOS or agrammatic aphasia, or both, underwent the Western Aphasia Battery (WAB) and Token Test to assess aphasia, an AOS rating scale (ASRS), 3T MRI and 18-F fluorodeoxyglucose (FDG) PET. Correlations between clinical measures and imaging were assessed. The only region that correlated to ASRS was left superior premotor volume. In contrast, WAB and Token Test correlated with hypometabolism and volume of a network of left hemisphere regions, including pars triangularis, pars opercularis, pars orbitalis, middle frontal gyrus, superior temporal gyrus, precentral gyrus and inferior parietal lobe. Progressive agrammatic aphasia and AOS have non-overlapping regional correlations, suggesting that these are dissociable clinical features that have different neuroanatomical underpinnings. PMID:23542727
Whitwell, Jennifer L; Duffy, Joseph R; Strand, Edythe A; Xia, Rong; Mandrekar, Jay; Machulda, Mary M; Senjem, Matthew L; Lowe, Val J; Jack, Clifford R; Josephs, Keith A
Letting the CAT out of the bag: A review of the Comprehensive Aphasia Test. Commentary on Howard, Swinburn, and Porter, "Putting the CAT out: What the Comprehensive Aphasia Test has to offer"
Background: For many years, aphasia batteries have been widely used to assess language difficulties associated with aphasia. Although many clinicians use aphasia batteries in their clinical evaluation, a gradual shift away from these tests has occurred in the last 10 years. Concerns about whether established aphasia batteries fulfil the purposes of assessment have resulted in the development and use of
Carolyn Bruce; Anne Edmundson
Western Europe: Battery forecast report - status 1995 and outlook. Summary
SciTech Connect
This presentation will cover the following main topics: (1) The market situation and the market players; (2) The Western European starter battery market in 1995 and outlook and 3. New European starter battery coding system: European Type Number (ETN). The current situation in the Western Europe lead battery market has the following features: (a) Market globalization; (b) a dramatic erosion of prices; (c) the acceleration of technological change; (d) {open_quotes}time to market{close_quotes} as a new competitive dimension and, (e) a strong German currency in the foreseeable future.
Kellinghusen, G. [VARTA, Hannover (Germany)
National Aphasia Association
... Aphasia Aphasia Quiz Communication Tips Aphasia in Other Languages Related Disorders I Have Aphasia What is Aphasia? I Need ... WHAT IS APHASIA? Aphasia is an acquired communication disorder that impairs a person's ability to process language, but does not affect intelligence . Aphasia impairs the ...
Short form of the Bilingual Aphasia Test in Russian: Psychometric data of persons with aphasia
Background: There is currently a lack of standardised aphasia batteries available in the Russian language. The psychometric properties of a short form of the Russian version of the Bilingual Aphasia Test (BAT) (Paradis, 1987) were examined. The BAT (Paradis & Zeiber, 1987) is one of the few published tests in Russian.Aims: The primary aims were: (1) to describe the psychometric
Maria V. Ivanova; Brooke Hallowell
Drug treatment of poststroke aphasia.
Impairment of language function (aphasia) is one of the most common neurological symptoms after stroke. Approximately one in every three patients who have an acute stroke will suffer from aphasia. The estimated incidence and prevalence of stroke in Western Europe is 140 and 800 per 100,000 of the population. Aphasia often results in significant disability and handicap. It is a major obstacle for patients to live independently in the community. When recovery from aphasia occurs, it is usually incomplete and patients are rarely able to return to full employment and other social activities. Currently, the main treatment for aphasia is conventional speech and language therapy. However, the effectiveness of this intervention has not been conclusively demonstrated and empirical observations suggest that spontaneous biological recovery may explain most of the improvement in language function that occurs in aphasics. The generally poor prognosis of the severe forms of poststroke language impairment (Broca, Wernicke and global aphasia), coupled with the limited effectiveness of conventional speech and language therapy has stimulated the search for other treatments that may be used in conjunction with speech and language therapy, including the use of various drugs. Dopamine agonists, piracetam (Nootropil), amphetamines, and more recently donepezil (Aricept), have been used in the treatment of aphasia in both the acute and chronic phase. The justification for the use of drugs in the treatment of aphasia is based on two types of evidence. Some drugs, such as dextroamphetamine (Dexedrine), improve attention span and enhance learning and memory. Learning is an essential mechanism for the acquisition of new motor and cognitive skills, and hence, for recovery from aphasia. Second, laboratory and clinical data suggest that drug treatment may partially restore the metabolic function in the ischemic zone that surrounds the brain lesion and also has a neuroprotective effect following acute brain damage. An example of this is the nootropic agent piracetam. Extensive animal studies have demonstrated the beneficial effects of this and other drugs on neural plasticity, but data on humans are still sparse. This review provides a critical analysis of the current evidence of the effectiveness of these drugs in the treatment of acute and chronic aphasia. PMID:15853562
Bakheit, A M O
Aphasia(s) in Alzheimer.
Language disorders of degenerative origin are frequently tied to Alzheimer disease (AD) the different variants of which can result in primary and secondary aphasia syndromes. More specifically, Alzheimer pathology can primarily erode frontal, temporal or parietal language cortices resulting in three genuine AD language variants which account for about 30% of primary degenerative aphasias. Likewise, it can spread from non-language to language cortices leading to secondary language disorders like in typical amnesic AD and in several atypical AD variants. This paper reviews the whole set of AD variants by characterising their impact on the neural language system and on linguistic functioning. It also provides cues for diagnostic strategies which are essential for linguistic, syndromic and nosological patient classification, for adequate clinical follow-up and for guiding language rehabilitation. Such diagnostic approaches, founded on detailed linguistic phenotyping while integrating anatomical and neuropathological findings, also represent a crucial issue for future drug trials targeting the physio-pathological processes in degenerative aphasias. PMID:24035593
Teichmann, M; Ferrieux, S
Putting the CAT out: What the Comprehensive Aphasia Test has to offer
Background: The Comprehensive Aphasia Test (CAT; Swinburn, Porter, & Howard, 2005) was published in 2005, the first new aphasia battery in English for 20 years.Aims: We aim to describe the motivations driving design decisions in the development of the CAT, summarise data on its properties (reliability and validity), and consider reasons why it might be a suitable assessment for clinical
David Howard; Kate Swinburn; Gillian Porter
Verb and sentence production and comprehension in aphasia: Northwestern Assessment of Verbs and Sentences (NAVS)
Background: Verbs and sentences are often impaired in individuals with aphasia, and differential impairment patterns are associated with different types of aphasia. With currently available test batteries, however, it is challenging to provide a comprehensive profile of aphasic language impairments because they do not examine syntactically important properties of verbs and sentences.Aims: This study presents data derived from the Northwestern
Soojin Cho-Reyes; Cynthia K. Thompson
Anatomical predictors of aphasia recovery: a tractography study of bilateral perisylvian language networks.
Stroke-induced aphasia is associated with adverse effects on quality of life and the ability to return to work. For patients and clinicians the possibility of relying on valid predictors of recovery is an important asset in the clinical management of stroke-related impairment. Age, level of education, type and severity of initial symptoms are established predictors of recovery. However, anatomical predictors are still poorly understood. In this prospective longitudinal study, we intended to assess anatomical predictors of recovery derived from diffusion tractography of the perisylvian language networks. Our study focused on the arcuate fasciculus, a language pathway composed of three segments connecting Wernicke's to Broca's region (i.e. long segment), Wernicke's to Geschwind's region (i.e. posterior segment) and Broca's to Geschwind's region (i.e. anterior segment). In our study we were particularly interested in understanding how lateralization of the arcuate fasciculus impacts on severity of symptoms and their recovery. Sixteen patients (10 males; mean age 60 ± 17 years, range 28-87 years) underwent post stroke language assessment with the Revised Western Aphasia Battery and neuroimaging scanning within a fortnight from symptoms onset. Language assessment was repeated at 6 months. Backward elimination analysis identified a subset of predictor variables (age, sex, lesion size) to be introduced to further regression analyses. A hierarchical regression was conducted with the longitudinal aphasia severity as the dependent variable. The first model included the subset of variables as previously defined. The second model additionally introduced the left and right arcuate fasciculus (separate analysis for each segment). Lesion size was identified as the only independent predictor of longitudinal aphasia severity in the left hemisphere [beta = -0.630, t(-3.129), P = 0.011]. For the right hemisphere, age [beta = -0.678, t(-3.087), P = 0.010] and volume of the long segment of the arcuate fasciculus [beta = 0.730, t(2.732), P = 0.020] were predictors of longitudinal aphasia severity. Adding the volume of the right long segment to the first-level model increased the overall predictive power of the model from 28% to 57% [F(1,11) = 7.46, P = 0.02]. These findings suggest that different predictors of recovery are at play in the left and right hemisphere. The right hemisphere language network seems to be important in aphasia recovery after left hemispheric stroke. PMID:24951631
Forkel, Stephanie J; Thiebaut de Schotten, Michel; Dell'Acqua, Flavio; Kalra, Lalit; Murphy, Declan G M; Williams, Steven C R; Catani, Marco
Family Adjustment to Aphasia
Family Adjustment to Aphasia Richard S. was a senior manager at a small company and next in line ... It also presents a great challenge to the family. There may be tension among family members and ...
Aphasia vs. Apraxia
... Apraxia Dysarthria & Apraxia - How Stroke Affects Speech Auditory Overload Reading, Writing and Math Reading Rehab Putting Words ... 2013. American Speech-Language Hearing Association For more information on aphasia, or to find an ASHA-certified ...
Types of Aphasia
... Stroke Affects Speech (opens in new window) Auditory Overload Reading, Writing and Math Reading Rehab (PDF) Putting ... skills. American Speech-Language Hearing Association For more information on aphasia, or to find an ASHA-certified ...
Rehabilitation of aphasia.
Aphasia is one of the most striking cognitive sequels of strokes and other cerebral lesions, and attempts to rehabilitate aphasic patients have been undertaken for many years. Following a brief overview of the epidemiology and the clinical characteristics of aphasia, the chapter presents the major traditional approaches to rehabilitation. They include the stimulation approach (also called classic), the behavior modification approach, Luria's approach (functional reorganization), the pragmatic approach, as well as the neurolinguistic approach. The next section illustrates some of the current approaches to aphasia rehabilitation, specifically the syndromic approach (also called neoassociationist), the cognitive neuropsychological approach, and the social approach. The chapter then provides examples of specific methods. While all intervention strategies may be classified, more or less correctly, into one or another of the above categories, it is not possible to mention the hundreds of specific interventions to be found in the literature, some of which have been described only briefly and in reference to a single case. The chapter concludes with a review of efficacy studies on aphasia therapy. Despite some opinions to the contrary, the current consensus is that sufficient experimental evidence of efficacy exists to recommend treatment of aphasia. PMID:23312652
Basso, Anna; Forbes, Margaret; Boller, François
Neuroplasticity: Evidence from Aphasia.
This article presents data showing that two of the four forms of neuroplasticity, homologous area adaptation and map extension, are relevant to recovery from aphasia. It discusses factors related to neuroplastic activity during language recovery, including neurophysiological, subject, and environmental treatment variables. (Contains references.)…
Thompson, Cynthia K.
A Behavioral Conceptualization of Aphasia
Aphasia is an acquired language impairment that affects over 1 million individuals, the majority of whom are over age 65 (Groher, 1989). This disorder has typically been conceptualized within a cognitive neuroscience framework, but a behavioral interpretation of aphasia is also possible. Skinner's (1957) analysis of verbal behavior proposes a framework of verbal operants that can be integrated with the work of Sidman (1971) and Haughton (1980) to describe the language difficulties individuals with aphasia experience. Using this synthesis of models, we propose a new taxonomy of aphasia based on the observed deficit relations. Assessment and treatment implications are also discussed.
Baker, Jonathan C; LeBlanc, Linda A; Raetz, Paige B
Let's Talk about Stroke and Aphasia
... talk about Stroke and Aphasia Aphasia is a language disorder that affects the ability to communicate. It's most often caused by strokes that occur in areas of the brain that control speech and language. What are the effects of aphasia? Aphasia does ...
Dopaminergic therapy in aphasia
Background The dopaminergic system is involved in a wide range of cognitive functions including motor control, reward, memory, attention, problem-solving and learning. This has stimulated interest in investigating the potential of dopaminergic drugs as cognitive enhancers in aphasic patients. Aim To discuss the evidence for the use of dopaminergic agents in patients with aphasia. Levodopa (L-dopa) and the dopamine agonist bromocriptine are the two drugs that have been trialled to date. We discuss, in some detail, the 15 studies that have been published on this topic from the first case report in 1988 to the present (2012), and assess the evidence from each. Main contribution In addition to summarising the effectiveness of the drugs that have been tried, we examine the possible cognitive mechanisms by which dopaminergic drugs may act on language function and aphasia recovery. Given the wide range of dopaminergic drugs, it is surprising that such a narrow range has been trialled in aphasic patients. Important lessons are to be learned from published studies and we discuss optimal trial designs to help guide future work. Conclusions The evidence for the efficacy of dopaminergic agents in aphasia therapy is mixed. Further trials with better tolerated agents are required. Optimal trial designs with appropriate control groups or blocks should be used. The mechanism of action is unclear, but at the cognitive level the evidence points towards either (re)learning of word-forms or their improved retrieval.
Gill, Sumanjit K.
[Hearing disorders in aphasia].
Aphasia is an acquired communication disorder that often involves receptive language abilities. After clinical assessment it is often not clear if this is partially due to a hearing loss, which can be compensated by hearing aids facilitating the rehabilitative process.In the present study the hearing ability of 88 male and female patients with aphasia after stroke, all of whom suffered from a left-hemispheric ischemia was assessed in the rehabilitative setting.We found that a majority of patients (72, 82%) was able to perform pure tone audiometry. 15 aphasic patients (21%) showed a hearing loss and were not fitted with hearing aids.Patients with aphasia are due to their central speech disorders in their communication skills limited, so that the therapeutic success is further reduced by an existing hearing loss. Due to the demographic development of our people and with the age increasing prevalence of hearing impairment hearing screening in the post-acute phase in aphasic patients is justified by pure tone audiometry. PMID:23900924
Läßig, A K; Kreter, S; Nospes, S; Keilmann, A
Primary progressive aphasia
Primary progressive aphasia (PPA) is a clinical syndrome diagnosed when three core criteria are met. First, there should be a language impairment (i.e., aphasia) that interferes with the usage or comprehension of words. Second, the neurological work-up should determine that the disease is neurodegenerative, and therefore progressive. Third, the aphasia should arise in relative isolation, without equivalent deficits of comportment or episodic memory. The language impairment can be fluent or non-fluent and may or may not interfere with word comprehension. Memory for recent events is preserved although memory scores obtained in verbally mediated tests may be abnormal. Minor changes in personality and behavior may be present but are not the leading factors that bring the patient to medical attention or that limit daily living activities. This distinctive clinical pattern is most conspicuous in the initial stages of the disease, and reflects a relatively selective atrophy of the language network, usually located in the left hemisphere. There are different clinical variants of PPA, each with a characteristic pattern of atrophy. The underlying neuropathological diseases are heterogeneous and can include Alzheimer's disease as well as frontotemporal lobar degeneration. The clinician's task is to recognize PPA and differentiate it from other neurodegenerative phenotypes, use biomarkers to surmise the nature of the underlying neuropathology, and institute the most fitting multimodal interventions.
Mesulam, Marsel
Aphasia is an acquired language impairment that affects over 1 million individuals, the majority of whom are over age 65 (Groher, 1989). This disorder has typically been conceptualized within a cognitive neuroscience framework, but a behavioral interpretation of aphasia is also possible. Skinner's (1957) analysis of verbal behavior proposes a…
Baker, Jonathan C.; LeBlanc, Linda A.; Raetz, Paige B.
Agnosia for accents in primary progressive aphasia?
As an example of complex auditory signal processing, the analysis of accented speech is potentially vulnerable in the progressive aphasias. However, the brain basis of accent processing and the effects of neurodegenerative disease on this processing are not well understood. Here we undertook a detailed neuropsychological study of a patient, AA with progressive nonfluent aphasia, in whom agnosia for accents was a prominent clinical feature. We designed a battery to assess AA's ability to process accents in relation to other complex auditory signals. AA's performance was compared with a cohort of 12 healthy age and gender matched control participants and with a second patient, PA, who had semantic dementia with phonagnosia and prosopagnosia but no reported difficulties with accent processing. Relative to healthy controls, the patients showed distinct profiles of accent agnosia. AA showed markedly impaired ability to distinguish change in an individual's accent despite being able to discriminate phonemes and voices (apperceptive accent agnosia); and in addition, a severe deficit of accent identification. In contrast, PA was able to perceive changes in accents, phonemes and voices normally, but showed a relatively mild deficit of accent identification (associative accent agnosia). Both patients showed deficits of voice and environmental sound identification, however PA showed an additional deficit of face identification whereas AA was able to identify (though not name) faces normally. These profiles suggest that AA has conjoint (or interacting) deficits involving both apperceptive and semantic processing of accents, while PA has a primary semantic (associative) deficit affecting accents along with other kinds of auditory objects and extending beyond the auditory modality. Brain MRI revealed left peri-Sylvian atrophy in case AA and relatively focal asymmetric (predominantly right sided) temporal lobe atrophy in case PA. These cases provide further evidence for the fractionation of brain mechanisms for complex sound analysis, and for the stratification of progressive aphasia syndromes according to the signature of nonverbal auditory deficits they produce.
Fletcher, Phillip D.; Downey, Laura E.; Agustus, Jennifer L.; Hailstone, Julia C.; Tyndall, Marina H.; Cifelli, Alberto; Schott, Jonathan M.; Warrington, Elizabeth K.; Warren, Jason D.
Agnosia for accents in primary progressive aphasia.
As an example of complex auditory signal processing, the analysis of accented speech is potentially vulnerable in the progressive aphasias. However, the brain basis of accent processing and the effects of neurodegenerative disease on this processing are not well understood. Here we undertook a detailed neuropsychological study of a patient, AA with progressive nonfluent aphasia, in whom agnosia for accents was a prominent clinical feature. We designed a battery to assess AA's ability to process accents in relation to other complex auditory signals. AA's performance was compared with a cohort of 12 healthy age and gender matched control participants and with a second patient, PA, who had semantic dementia with phonagnosia and prosopagnosia but no reported difficulties with accent processing. Relative to healthy controls, the patients showed distinct profiles of accent agnosia. AA showed markedly impaired ability to distinguish change in an individual's accent despite being able to discriminate phonemes and voices (apperceptive accent agnosia); and in addition, a severe deficit of accent identification. In contrast, PA was able to perceive changes in accents, phonemes and voices normally, but showed a relatively mild deficit of accent identification (associative accent agnosia). Both patients showed deficits of voice and environmental sound identification, however PA showed an additional deficit of face identification whereas AA was able to identify (though not name) faces normally. These profiles suggest that AA has conjoint (or interacting) deficits involving both apperceptive and semantic processing of accents, while PA has a primary semantic (associative) deficit affecting accents along with other kinds of auditory objects and extending beyond the auditory modality. Brain MRI revealed left peri-Sylvian atrophy in case AA and relatively focal asymmetric (predominantly right sided) temporal lobe atrophy in case PA. These cases provide further evidence for the fractionation of brain mechanisms for complex sound analysis, and for the stratification of progressive aphasia syndromes according to the signature of nonverbal auditory deficits they produce. PMID:23721780
Fletcher, Phillip D; Downey, Laura E; Agustus, Jennifer L; Hailstone, Julia C; Tyndall, Marina H; Cifelli, Alberto; Schott, Jonathan M; Warrington, Elizabeth K; Warren, Jason D
Decision making cognition in primary progressive aphasia.
We sought to investigate the decision making profile of Primary Progressive Aphasia (PPA) by assessing patients diagnosed with this disease (n = 10), patients diagnosed with behavioral variant frontotemporal dementia (bvFTD, n = 35), and matched controls (n = 14) using the Iowa Gambling Task, a widely used test that mimics real-life decision making. Participants were also evaluated with a complete neuropsychological battery. Patients with PPA were unable to adopt an advantageous strategy on the IGT, which resulted in a flat performance, different to that exhibited by both controls (who showed advantageous decision making) and bvFTD patients (who showed risk-appetitive behavior). The decision making profile of PPA patients was not associated with performance on language tasks and did not differ between sub-variants of the disease (namely, semantic dementia and progressive nonfluent aphasia). Investigating decision making in PPA is crucial both from a theoretical perspective, as it can shed light about the way in which language interacts with other cognitive functions, as well as a clinical standpoint, as it could lead to a more objective detection of impairments of decision making deficits in this condition. PMID:22207422
Gleichgerrcht, Ezequiel; Torralva, Teresa; Roca, María; Szenkman, Daniela; Ibanez, Agustin; Richly, Pablo; Pose, Mariángeles; Manes, Facundo
... alkaline and carbon zinc (9-volt, D, C, AA, AAA), mercuric-oxide (button, some cylindrical and rectangular), ... zinc-air (button), and lithium (9-volt, C, AA, coin, button, rechargeable). Alkaline and Zinc-Carbon Batteries ...
Acalculia, Aphasia and Spatial Disorders in Left and Right Brain-Damaged Patients
The paper reports the performance of 50 left- and 26 vascular right-brain-damaged (LBD, RBD) patients in the EC301 Calculation Battery, which explores different aspects of number and calculation processing. All patients underwent a comprehensive neuropsychological testing that also included evaluation for the presence and type of aphasia in LBD patients, and of spatial disorders in RBD patients. LBD were subdivided
Anna Basso; Francesca Burgio; Alessandra Caporali
Grammaticality judgment in aphasia: deficits are not specific to syntactic structures, aphasic syndromes, or lesion sites.
We examined the abilities of aphasic patients to make grammaticality judgments on English sentences instantiating a variety of syntactic structures. Previous studies employing this metalinguistic task have suggested that aphasic patients typically perform better on grammaticality judgment tasks than they do on sentence comprehension tasks, a finding that has informed the current view that grammatical knowledge is relatively preserved in agrammatic aphasia. However, not all syntactic structures are judged equally accurately, and several researchers have attempted to provide explanatory principles to predict which structures will pose problems to agrammatic patients. One such proposal is Grodzinsky and Finkel's (1998) claim that agrammatic aphasics are selectively impaired in their ability to process structures involving traces of maximal projections. In this study, we tested this claim by presenting patients with sentences with or without such traces, but also varying the level of difficulty of both kinds of structures, assessed with reference to the performance of age-matched and young controls. We found no evidence that agrammatic aphasics, or any other subgroup, are selectively impaired on structures involving traces: Some judgments involving traces were made quite accurately, whereas other judgments not involving traces were made very poorly. Subgroup analyses revealed that patient groups and age-matched controls had remarkably similar profiles of performance across sentence types, regardless of whether the patients were grouped based on Western Aphasia Battery classification, an independent screening test for agrammatic comprehension, or lesion site. This implies that the pattern of performance across sentence types does not result from any particular component of the grammar, or any particular brain region, being selectively compromised. Lesion analysis revealed that posterior temporal areas were more reliably implicated in poor grammaticality judgment performance than anterior areas, but poor performance was also observed with some anterior lesions, suggesting that areas important for syntactic processing are distributed throughout the left peri-sylvian region. PMID:15068594
Wilson, Stephen M; Saygin, Ay?e Pinar
Language as a stressor in aphasia
Background: Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians, and researchers would agree that language might be a stressor for persons with aphasia, systematic empirical studies of stress and\\/or anxiety in aphasia remain scarce.Aim: The aim of this paper is to review the existing literature discussing language as a stressor in
Dalia Cahana-Amitay; Martin L. Albert; Sung-Bom Pyun; Andrew Westwood; Theodore Jenkins; Sarah Wolford; Mallory Finley
Outcome assessment in aphasia: a survey
There has been a marked increase in attention to the measurement of "outcomes" after speech-language intervention for adult aphasia. Consumers, speech-language pathologists (SLPs), and funding sources desire evidence of therapy outcomes that improve communication and enhance the quality of life for people with aphasia. While many assessment tools are available to measure outcomes after aphasia therapy, there is little information
Nina Simmons-Mackie; Aura Kagan
Developing a Clinician-Friendly Aphasia Test
Purpose: The Kentucky Aphasia Test (KAT) is an objective measure of language functioning for persons with aphasia. This article describes materials, administration, and scoring of the KAT; presents the rationale for development of test items; reports information from a pilot study; and discusses the role of the KAT in aphasia assessment. Method:…
Marshall, Robert C.; Wright, Heather Harris
Differentiating psychosis versus fluent aphasia.
Following a stroke, a patient may present with varying degrees of neurological impairment, depending on the area of the brain which is damaged. Specifically, damage to the left cortical hemisphere may result in aphasia. The characteristic speech in a patient with an aphasia caused by a stroke can be similar to the speech in some patients with schizophrenia or other psychotic disorders. In a new patient without a reliable history who presents with suspected aphasia, it is important to include psychotic disorders as part of the differential diagnosis. Failure to differentiate psychotic disorders from aphasia could result in either a lack of treatment that would improve the patient's thought process, thought content, or language, or in a delayed treatment for a stroke, respectively. While a number of psychotic disorders exist and must be differentiated from one another in accordance with DSM-IV guidelines, speech abnormalities in patients with schizophrenia are well described in the literature. For this reason, schizophrenia is the psychotic disorder of focus in this paper. This case report illustrates a clinical situation where a patient required both a psychiatric and neurological consultation in order to determine the etiology of his language disorder. The purpose of this paper is to emphasize the need to consider both psychiatric disorders and aphasia in patients with unknown histories who present with language abnormalities, and to help the clinician critically examine the patient's speech so that, in conjunction with other clinical data, the correct diagnosis can be made and appropriate treatment initiated. PMID:21177243
Lane, Zac Paul; Singer, Adam; Roffwarg, David Elliot; Messias, Erick
Verbal Comprehension Ability in Aphasia: Demographic and Lexical Knowledge Effects
Background. Assessment of sentence-level auditory comprehension can be performed with a variety of tests varying in response requirements. A brief and easy to administer measure, not requiring an overt verbal or a complex motor response, is essential in any test battery for aphasia. Objective. The present study examines the clinical utility of receptive language indices for individuals with aphasia based on the Comprehension of Instructions in Greek (CIG), a variant of the Token Test, and the Greek version of PPVT-R. Methods. Normative data from a large community sample of Greek adults aged 46–80 years was available on both measures. A word-level-independent measure of auditory comprehension was computed as the standard score difference between the two tests and used to compare patients with and without comprehension deficits as indicated by their Boston Diagnostic Aphasia Examination profile. Results and Conclusions. Indices of internal consistency and test-retest reliability were very good. Education and age effects on performance were significant, with the former being stronger. The potential clinical utility of differential ability indices (contrasting sentence- and word-level auditory comprehension tests) is discussed.
Simos, Panagiotis G.; Kasselimis, Dimitrios; Potagas, Constantin; Evdokimidis, Ioannis
Patterns of Breakdown in Spelling in Primary Progressive Aphasia
Introduction The objective of this study is to determine which cognitive processes underlying spelling are most affected in the three variants of Primary Progressive Aphasia (PPA): Logopenic variant primary progressive aphasia (lvPPA), Semantic variant primary progressive aphasia (svPPA), and Nonfluent variant primary progressive aphasia (nfvPPA). Methods 23 PPA patients were administered The Johns Hopkins Dysgraphia Battery to assess spelling. Subtests evaluate for effects of word frequency, concreteness, word length, grammatical word class, lexicality (words vs. pseudowords), and "regularity" by controlling for the other variables. Significant effects of each variable were identified with chi square tests. Responses on all spelling to dictation tests were scored by error type. 16 of the 23 subjects also had a high resolution MRI brain scan to identify areas of atrophy. Results We identified 4 patterns of spelling that could be explained by damage to one or more cognitive processes underlying spelling. Nine patients (3 unclassifiable, 4 with lvPPA, 2 with svPPA) had dysgraphia explicable by impaired access to lexical representations, with reliance on sublexical phonology-to-orthography conversion (POC). Two patients (with nfvPPA) showed dysgraphia explicable by impaired access to lexical representations and complete disruption of sublexical POC. Seven patients (4 with lvPPA, 1 with svPPA, 2 unclassifiable) showed dysgraphia explicable by impaired access to lexical-semantic representations and/or lexical representations with partially spared sublexical POC mechanisms. Five patients (1 with nfvPPA, 2 with svPPA, 1 with lvPPA, and 1 unclassifiable) showed dysgraphia explicable by impairment of the graphemic buffer. Conclusions Any cognitive process underlying spelling can be affected in PPA. Predominance of phonologically plausible errors, more accurate spelling of regular words than irregular words, and more accurate spelling of pseudowords than words (indicating spared POC mechanisms) may indicate a low probability of progression to nfvPPA.
Sepelyak, Kathryn; Crinion, Jennifer; Molitoris, John; Epstein-Peterson, Zachary; Bann, Maralyssa; Davis, Cameron; Newhart, Melissa; Heidler-Gary, Jennifer; Tsapkini, Kyrana; Hillis, Argye E.
Novel Ways to Study Aphasia
Summarized are several nonverbal assessment techniques for aphasics. Two experiments concern speech perception (the scaling of speech and the relationship between aphasic's performance and level of auditory impairment) and one concerns the impact of aphasia on one's affective or attitudinal response to a symbol (connotative meaning). (KW)
Mostofsky, David; And Others
Naming and inhibition in aphasia
Lexical retrieval models illustrate both activation and inhibition between concepts, words, and phonemes. When semantic activation spreads from one concept to its related concepts, inhibition is recruited so that competition between related concepts can be overcome and a target production achieved. Persons with aphasia often exhibit difficulty with producing the desired response, which could be the result of inadequate inhibitory
Lori R Bartels-Tobin
Clinical utility of the Neuropsychological Assessment Battery (NAB) after unilateral stroke.
The NAB is a comprehensive battery assessing five cognitive domains (Attention, Language, Memory, Spatial, Executive Function). Despite the advantage of co-normative domain data, its clinical utility is not well established because few studies have reported full-battery findings. The aim of this study was to determine if the NAB was sensitive to well documented hemispheric differences in language and spatial skills after unilateral stroke. We compared demographically matched control participants (n = 52) and individuals after left (LHD, n = 36) or right (RHD, n = 33) hemisphere damage due to stroke on the NAB, parts of the Western Aphasia Battery, and traditional visuospatial tasks. Both stroke groups showed impaired NAB Attention, Spatial, and Executive Functions relative to controls, while the LHD group was more impaired than control and RHD groups on Language and Memory modules. LHD patients with aphasia on traditional measures performed worse than control and non-aphasic LHD patients on all NAB domains. RHD patients with spatial impairment on traditional measures performed worse than controls, but not RHD patients without spatial impairment, on the NAB Spatial domain. Findings suggest the NAB is generally comparable to traditional language and visuospatial measures, and it sufficiently detects attention and executive deficits. PMID:23682731
Pulsipher, Dalin T; Stricker, Nikki H; Sadek, Joseph R; Haaland, Kathleen Y
Rotterdam Aphasia Therapy Study (RATS) - 3: "The efficacy of intensive cognitive-linguistic therapy in the acute stage of aphasia"; design of a randomised controlled trial
Background Aphasia is a severely disabling condition occurring in 20 to 25% of stroke patients. Most patients with aphasia due to stroke receive speech and language therapy. Methodologically sound randomised controlled trials investigating the effect of specific interventions for patients with aphasia following stroke are scarce. The currently available evidence suggests that intensive speech and language therapy is beneficial for restoration of communication, but the optimal timing of treatment is as yet unclear. In the Rotterdam Aphasia Therapy Study-3 we aim to test the hypothesis that patients with aphasia due to stroke benefit more from early intensive cognitive-linguistic therapy than from deferred regular language therapy. Methods/design In a single blinded, multicentre, randomised controlled trial, 150 patients with first ever aphasia due to stroke will be randomised within two weeks after stroke to either early intensive cognitive-linguistic therapy (Group A) or deferred regular therapy (Group B). Group A will start as soon as possible, at the latest two weeks after stroke, with a four week period of one hour a day treatment with cognitive-linguistic therapy. In Group B professional speech and language therapy is deferred for four weeks. After this period, patients will follow the conventional procedure of speech and language therapy. Participants will be tested with an extensive linguistic test battery at four weeks, three months and six months after inclusion. Primary outcome measure is the difference in score between the two treatment groups on the Amsterdam-Nijmegen Everyday Language Test, a measure of everyday verbal communication, four weeks after randomisation. Trial registration This trial is registered in the Dutch Trial Register (http://www.trialregister.nl), NTR3271.
An Aphasia Mentoring Program: Perspectives of Speech-Language Pathology Students and of Mentors with Aphasia
Purpose: In contrast to clinician-as-expert models, social models of clinical practice typically acknowledge people with aphasia as equal partners in intervention. Given this, there may be a place within speech-language pathology education for programs situating people with aphasia as experts. This paper describes an aphasia mentoring program that…
Purves, Barbara A.; Petersen, Jill; Puurveen, Gloria
Aphasia severity, semantics, and depression predict functional communication in acquired aphasia
Background: The functional communication deficits that result from aphasia are well known, although contributing factors have not been systematically studied. Although overall aphasia severity is directly related to communication ability, the contribution of cognitive and mood factors is less understood.Aims: This study attempted to identify predictors of functional communication in patients with acquired aphasia at various points post?unilateral left hemisphere
Robert Fucetola; Lisa Tabor Connor; Jacquelyn Perry; Peter Leo; Frances M. Tucker; Maurizio Corbetta
[Various aspects of personality change in aphasia].
An experimental study of self-estimation of patients with aphasia carried out by the polar profile method in the course of restorative training is described. It is shown that the aphasia causes substantial changes in the patients' self-estimation that manifest themselves in a disparity of the latter during and before the disease. A comparison with a control group of neurological patients without aphasia showed a specificity of the revealed changes for aphasia and their connection with the communication disruption. As the general and verbal communication restore, a positive course of the patients' self-estimation, and approach of the latter to the premorbid level are noted. A relation between the self-estimation shift and the aphasia form was discovered. A conclusion on diagnostic and prognostic importance of personality examination in aphasia is drawn. PMID:6187143
Glozman, Zh M; Tsyganok, A A
The Main Concept Analysis in Cantonese Aphasic Oral Discourse: External Validation and Monitoring Chronic Aphasia
Purpose: The 1st aim of this study was to further establish the external validity of the main concept (MC) analysis by examining its relationship with the Cantonese Linguistic Communication Measure (CLCM; Kong, 2006; Kong & Law, 2004)--an established quantitative system for narrative production--and the Cantonese version of the Western Aphasia…
Kong, Anthony Pak-Hin
The Aphasia Rapid Test: an NIHSS-like aphasia test.
The Aphasia Rapid Test (ART) is a 26-point scale developed as a bedside assessment to rate aphasia severity in acute stroke patients in <3 min. We tested its inter-rater reproducibility, its sensitivity to detect changes from Day 1 to Day 8, and the predictive value of D8 ART scores on the 3-month aphasia outcome assessed with the Aphasia Handicap Score (AHS), a 0-5 "Rankin-like" score for aphasic disability. The reproducibility was tested in 91 aphasic patients within one week of stroke onset. The inter-rater concordance coefficient was 0.99 and the weighted Kappa value (?w) was 0.93. The sensitivity was tested in 70 aphasic patients by measuring changes in ART values between D1 and D8. Improvement occurred in 46 patients (66 %) and aggravation in three patients (4 %). In these patients, a logistic regression analysis showed that D8 ART was the only significant predictor of good (AHS 0-2) or poor (AHS 4-5) outcome. The ROC curves analyzes showed areas under the curve above 0.9 for good and poor outcome and revealed D8 ART best cut-off values of <12 for good and >21 for poor outcome, with more than 90 % sensitivity and 80 % specificity. The ART is a simple, rapid and reproducible language task, useful in monitoring early aphasic changes in acute stroke patients and highly predictive of the 3-month verbal communication outcome. It should be easy to adapt to other languages. PMID:23673997
Azuar, C; Leger, A; Arbizu, C; Henry-Amar, F; Chomel-Guillaume, S; Samson, Y
Treatment for lexical retrieval in progressive aphasia
Background Treatment for lexical retrieval impairment has been shown to yield positive outcomes in individuals with aphasia due to focal lesions, but there has been little research regarding the treatment of such impairments in individuals with progressive aphasia. Aims The purpose of this study was to examine the therapeutic effects of a semantic treatment for anomia in progressive aphasia relative to the outcome in an individual with stroke-induced aphasia. Methods & Procedures Two individuals with progressive aphasia and one with aphasia resulting from stroke participated in the study. Each participant presented with fluent, anomic aphasia; however, one of the patients with progressive aphasia demonstrated characteristics indicating a likely progression towards non-fluency. Each participant received a brief, intensive treatment intended to improve lexical retrieval in the context of generative naming for selected semantic categories. Treatment tasks included guided lexical retrieval prompted by the identification and elaboration of items within semantic subcategories, as well as other semantic tasks. Treatment outcomes were quantified using standard effects sizes as well as nonparametric tests comparing pre- versus post-treatment performance. Outcomes & Results One of the individuals with progressive aphasia showed large treatment effects for lexical retrieval of items from targeted semantic categories. The other progressive aphasia patient showed very small effects overall for treated categories. The individual with the focal lesion due to stroke showed medium-sized effects for trained categories as well as significant improvement on a standardised measure of naming. Conclusions Findings indicate that intensive, semantically based treatment for lexical retrieval can result in positive outcomes in individuals with progressive as well as stroke-induced aphasia. Examination of individual differences suggests that the status of semantic and episodic memory may provide predictive information regarding responsiveness to treatment.
Henry, Maya L.; Beeson, Pelagie M.; Rapcsak, Steven Z.
Herein, we review the basic mechanisms neural regeneration and repair and attempt to correlate the findings from animal models of stroke recovery to clinical trials for aphasia. Several randomized, controlled clinical trials that have involved manipulation of different neurotransmitter systems, including noradrenergic, dopaminergic, cholinergic and glutamatergic systems, have shown signals of efficacy. Biological approaches such as anti-Nogo and cell-replacement therapy have shown efficacy in preclinical models, but have yet to reach proof of concept in the clinic. Finally, noninvasive cortical stimulation techniques have been used in a few small trials, and have shown promising results. It appears that the efficacy of all of these platforms can be potentiated through coupling with speech-language therapy. Given this array of potential mechanisms that exist to augment and/or stimulate neural reorganization after stroke, we are optimistic that approaches to aphasia therapy will transition from compensatory models to models where brain reorganization is the goal.
Small, Steven L.; Llano, Daniel A.
Therapy efficacy in chronic aphasia.
There is good evidence that aphasia therapy is effective if sufficiently prolonged or intensive and that chronic aphasic individuals can also benefit from therapy, but data on chronic aphasia are scanty. The aim of this retrospective study was to investigate whether chronic aphasia benefits from a very intensive therapeutic regimen. We revised the files (January 2000 to December 2008) of the chronic subjects whom we suggested have periodic sessions in our Unit (generally once a week) and 2-3 hours daily of homework with the help of a family member, supervised and controlled by the speech-therapist. Treatment would go on as long as amelioration is evident. Results for 23 chronic aphasic subjects are reported. All subjects had undergone previous therapy and 10 had been dismissed because no further recovery was expected. Recovery was significant in oral and written nouns and actions naming, oral and written sentence production and Token Test scores. Only 4 subjects did not improve. Severity of the disorder did not predict success or failure. We conclude that recovery was due to the intense work done. Further, we believe such a regimen could be successful in a number of patients for whom a less intensive regimen would not be effective. PMID:22063820
Basso, Anna; Macis, Margherita
Fluent aphasia after closed head injury.
A case of post-traumatic, contre-coup Wernicke's aphasia resulting from left posterior temporal hemorrhagic contusion localized by angiography and CAT scan is reported. Categorization of aphasia is reviewed, emphasizing that a fluent language disorder can be elusive to laymen and non-neurologically oriented physicians. PMID:622678
Stone, J L; Lopes, J R; Moody, R A
On One Type of Agrammatism in Aphasia
This investigation examines in aphasics the loss of the ability to relate words to their grammatical categories. It finds that recognition of grammatical categories is lost in all forms of aphasia studied, but that the loss is manifested differently for different types of aphasia quantitatively and qualitatively. (SCC)
Tsvetkova, L. S.; Glozman, J. M.
SMARTER goal setting in aphasia rehabilitation
Background: There have been numerous calls for rehabilitation professionals to involve patients or clients in decisions about the goals of therapy. And yet collaborative goal setting in rehabilitation remains uncommon and is particularly difficult to achieve for people with aphasia.Aims: This discussion paper describes a new framework for conceptualising and structuring collaborative goal setting in aphasia rehabilitation. The framework has
Deborah Hersh; Linda Worrall; Tami Howe; Sue Sherratt; Bronwyn Davidson
Resumption of driving with aphasia following stroke
Background: Fitness to drive may be compromised by a variety of medical conditions, including stroke. Driving may legally be resumed 1 month after stroke if clinical recovery is deemed satisfactory. Advice available for patients and medical practitioners is unclear and inconsistent as to whether return to driving is influenced by aphasia. Information on the opinions of medical practitioners and aphasia
Catherine Mackenzie; Gillian Paton
Outcome Assessment in Aphasia: A Survey
There has been a marked increase in attention to the measurement of ''outcomes'' after speech-language intervention for adult aphasia. Consumers, speech-language pathologists (SLPs), and funding sources desire evidence of therapy outcomes that improve communication and enhance the quality of life for people with aphasia. While many assessment…
Simmons-Mackie, Nina; Threats, Travis T.; Kagan, Aura
Pharmacotherapy of Aphasia: Myth or Reality?
Pharmacotherapy of aphasia had been discussed for the last twenty years with first bromocriptine and amphetamine and then serotoninergic, GABAergic and cholinergic agents. Here, we reviewed the MEDLINE available reports of drug therapy for aphasia. So far, proofs of efficiency were found indubitable for none of the studied molecules. However, some…
de Boissezon, Xavier; Peran, Patrice; de Boysson, Chloe; Demonet, Jean-Francois
Primary progressive aphasia and apraxia of speech.
Primary progressive aphasia is a neurodegenerative syndrome characterized by progressive language dysfunction. The majority of primary progressive aphasia cases can be classified into three subtypes: nonfluent/agrammatic, semantic, and logopenic variants. Each variant presents with unique clinical features, and is associated with distinctive underlying pathology and neuroimaging findings. Unlike primary progressive aphasia, apraxia of speech is a disorder that involves inaccurate production of sounds secondary to impaired planning or programming of speech movements. Primary progressive apraxia of speech is a neurodegenerative form of apraxia of speech, and it should be distinguished from primary progressive aphasia given its discrete clinicopathological presentation. Recently, there have been substantial advances in our understanding of these speech and language disorders. The clinical, neuroimaging, and histopathological features of primary progressive aphasia and apraxia of speech are reviewed in this article. The distinctions among these disorders for accurate diagnosis are increasingly important from a prognostic and therapeutic standpoint. PMID:24234355
Jung, Youngsin; Duffy, Joseph R; Josephs, Keith A
Dynamic aphasia following low-grade glioma surgery near the supplementary motor area: A selective spontaneous speech deficit.
We describe a patient (KO) with reduced spontaneous speech, resembling dynamic aphasia, after awake glioma surgery in the proximity of the supplementary motor area. Naming, repetition, and comprehension were intact. He was tested with an extensive neuropsychological test-battery and a protocol for dynamic aphasia at 1 year. He presented with postoperative reduced spontaneous speech and selective executive function deficits. Most language recovery took place at 3 months postoperatively, whereas the executive functions improved between 3 months and 1 year. Results suggest that resection near the supplementary motor area could increase the risk of cognitive disturbances at long term, especially language. PMID:24098945
Satoer, Djaina; Kloet, Alfred; Vincent, Arnaud; Dirven, Clemens; Visch-Brink, Evy
Ambient Experience in Restitutive Treatment of Aphasia
One of the greatest challenges to language rehabilitation is reconciling the fact that the same therapeutic intervention, provided to different individuals with similar types of stroke-induced aphasia, may result in divergent outcomes. In this paper, the authors reviewed existing literature to identify relevant ambient factors – those outside the control of the clinician – that may potentially influence functional language recovery in aphasia and response to treatment. The goal was to develop a clinical history-taking tool to assist clinicians in gathering information germane to each individual's unique circumstances and environment, elements that may have previously been underestimated, to provide a complete inventory of potentially potent prognostic factors. First, two of the authors, speech–language pathologists experienced in aphasia rehabilitation, identified and categorized factors that seemed likely to influence aphasia outcomes. Then, a wide range of literature was reviewed in an effort to identify factors empirically found to be potent influences on aphasia recovery. Where studies relating these factors to aphasia were not found, relevant research from allied fields that examined recovery from brain injury is reported. Moreover, some factors thought to be potentially potent have yet to be examined. Finally, the ambient factors supported by evidence were categorized as facilitators or barriers to functional improvement, and the Ambient Influences on Outcome Checklist (AOC) was developed, including only those factors shown to be potent in the recovery process. It is hoped that this checklist can be used to more broadly assess potential prognostic influences in aphasia restitution, as well as spawn further research.
McClung, Jill S.; Rothi, Leslie J. Gonzalez; Nadeau, Stephen E.
Clinical note: acquired pragmatic impairments and aphasia.
Recent advances in the field of communication sciences have led to the description of acquired communication disorders affecting pragmatic skills in patients with brain damage. The present article discusses the impact of such findings on the clinical concept of aphasia. Through reference to a number of articles contained in this Special Issue, it must be reiterated that pragmatic and other linguistic components of communication abilites are two sides of a same coin-that of language-and intimately interrelated. It is also argued that the difference between traditional (e.g., syntax) and pragmatic components of language cannot be explained in simple terms such as the former being subserved only by linguistic processes and the latter by other cognitive processes. Pragmatic components are thus to be considered as part of language. The evolution of the concept of language has a direct impact on the clinical concept of aphasia. Indeed, if aphasia corresponds to an acquired impairment of language, then pragmatic impairments must be considered part of aphasia. The inclusion of pragmatic impairments in the concept of aphasia does not hold only when they occur within the frame of classic types of aphasia, but also when they occur in isolation. Consequently, a new type of aphasia-pragmatic aphasia-should be considered and defined in order to describe the clinical condition of those individuals suffering from acquired pragmatic disorders as those reported among right-hemisphere-damaged right-handers. It is concluded that the recent evolution around the concept of language should be followed by an evolution of the concept of aphasia per se. PMID:10441192
Joanette, Y; Ansaldo, A I
Isotope localization of infarcts in aphasia.
Radionucleide localization of infarcts producing aphasia was undertaken in 65 patients with a scan-test and onset-test interval of one months or less. The scans were traced on anatomical templates without knowledge of the aphasias. A phasics were classified by their test scores according to taxonomic criteria, independently from localization. Scans belonging to each clinically distinct group were overlapped "blindly". The results showed distinct areas for Broca's conduction and Wernicke's aphasics along the parasylvian axis of the lateral templates. Lesions of global aphasics covered all these areas, while transcorticals were outside of them. Lesion size and severity of aphasia showed significant correlation. It is concluded that a brief systematic survey of aphasia like ours is useful in predicting the anteroposterior location and often the depth and extent of lesions. PMID:907530
Kertesz, A; Lesk, D; McCabe, P
Transcranial magnetic stimulation and aphasia rehabilitation.
Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve naming in chronic stroke patients with nonfluent aphasia since 2005. In part 1, we review the rationale for applying slow, 1-Hz, rTMS to the undamaged right hemisphere in chronic nonfluent aphasia patients after a left hemisphere stroke; and we present a transcranial magnetic stimulation (TMS) protocol used with these patients that is associated with long-term, improved naming post-TMS. In part 2, we present results from a case study with chronic nonfluent aphasia where TMS treatments were followed immediately by speech therapy (constraint-induced language therapy). In part 3, some possible mechanisms associated with improvement after a series of TMS treatments in stroke patients with aphasia are discussed. PMID:22202188
Naeser, Margaret A; Martin, Paula I; Ho, Michael; Treglia, Ethan; Kaplan, Elina; Bashir, Shahid; Pascual-Leone, Alvaro
Transcranial Magnetic Stimulation and Aphasia Rehabilitation
Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve naming in chronic stroke patients with nonfluent aphasia since 2005. In Part 1, we review the rationale for applying slow, 1 Hz, rTMS to the undamaged right hemisphere in chronic nonfluent aphasia patients following a left hemisphere stroke; and present a TMS protocol used with these patients that is associated with long-term, improved naming post- TMS. In Part, 2 we present results from a case study with chronic nonfluent aphasia where TMS treatments were followed immediately by speech therapy (constraint-induced language therapy). In Part 3, some possible mechanisms associated with improvement following a series of TMS treatments in stroke patients with aphasia are discussed.
Naeser, Margaret A.; Martin, Paula I; Ho, Michael; Treglia, Ethan; Kaplan, Elina; Bhashir, Shahid; Pascual-Leone, Alvaro
Primary Progressive Aphasia in a Bilingual Woman
Multilingual aphasias are common because most people in the world know more than one language, but little is known of these syndromes except in patients who have had a stroke. We present a 76-year-old right-handed woman, fluent in English and Chinese, who developed anomia at age 70 and then progressed to aphasia. Functional neuroimaging disclosed mild left temporoparietal hypometabolism. Neurolinguistic
Christopher M. Filley; Gail Ramsberger; Lise Menn; Jiang Wu; Bessie Y. Reid; Allan L. Reid
AphasiaBank: Methods for Studying Discourse
Background AphasiaBank is a computerized database of interviews between persons with aphasia (PWAs) and clinicians. By February 2011, the database had grown to include 145 PWAs and 126 controls from 12 sites across the United States. The data and related analysis programs are available free over the web. Aims The overall goal of AphasiaBank is the construction of a system for accumulating and sharing data on language usage by PWAs. To achieve this goal, we have developed a standard elicitation protocol and systematic automatic and manual methods for transcription, coding, and analysis. Methods & Procedures We present sample analyses of transcripts from the retelling of the Cinderella story. These analyses illustrate the application of our methods for the study of phonological, lexical, semantic, morphological, syntactic, temporal, prosodic, gestural, and discourse features. Main Contribution AphasiaBank will allow researchers access to a large, shared database that can facilitate hypothesis testing and increase methodological replicability, precision, and transparency. Conclusions AphasiaBank will provide researchers with an important new tool in the study of aphasia.
MacWhinney, Brian; Fromm, Davida; Forbes, Margaret; Holland, Audrey
Neuroscience insights improve neurorehabilitation of poststroke aphasia.
The treatment of aphasias-acquired language disorders-caused by stroke and other neurological conditions has benefitted from insights from neuroscience and neuropsychology. Hebbian mechanisms suggest that massed practice and exploitation of residual neurological capacities can aid neurorehabilitation of patients with poststroke aphasia, and progress in basic neuroscience research indicates that the language system of the human brain is functionally interwoven with perceptual and motor systems. Intensive speech and language therapies, including constraint-induced aphasia therapy, that activate both the linguistic and concordant motor circuits utilize the knowledge gained from these advances in neuroscience research and can lead to surprisingly rapid improvements in language performance, even in patients with chronic aphasia. Drug-based therapies alone and in conjunction with behavioral language therapies also increase language performance in patients with aphasia. Furthermore, noninvasive transcranial magnetic stimulation and electrical stimulation techniques that target neuronal activity within perilesional areas might help patients with aphasia to regain lost language functions. Intensive language-action therapies that lead to rapid improvements in language skills might provide a new opportunity for investigating fast plastic neuronal changes in the areas of the brain associated with language processing. Here, we review progress in basic neuroscience research and its translational impact on the neurorehabilitation of language disorders after stroke. PMID:21297651
Berthier, Marcelo L; Pulvermüller, Friedemann
Fluent Aphasia in Telugu: A Case Comparison Study of Semantic Dementia and Stroke Aphasia
This study presents two cases with fluent aphasia in Telugu with semantic dementia and post-stroke fluent aphasia. Comparable scores were obtained on the conventional neuropsychological and language tests that were administered on the two cases. Both cases demonstrated fluent, grammatical and well-articulated speech with little content, impaired…
Alladi, Suvarna; Mridula, Rukmini; Mekala, Shailaja; Rupela, Vani; Kaul, Subhash
Social networks after the onset of aphasia: The impact of aphasia group attendance
Background: Social networks are the context for communication and life participation and are associated with adults' health, well-being, and longevity. Compared to other populations, persons with aphasia have not been included in social network research in the US.Aims: The study aimed to measure and compare 40 participants' social networks and frequency of contact within networks before and after aphasia. It
Candace P. Vickers
Excitatory repetitive transcranial magnetic stimulation induces improvements in chronic post-stroke aphasia
Summary Background Aphasia affects 1/3 of stroke patients with improvements noted only in some of them. The goal of this exploratory study was to provide preliminary evidence regarding safety and efficacy of fMRI-guided excitatory repetitive transcranial magnetic stimulation (rTMS) applied to the residual left-hemispheric Broca's area for chronic aphasia treatment. Material/Methods We enrolled 8 patients with moderate or severe aphasia >1 year after LMCA stroke. Linguistic battery was administered pre-/post-rTMS; a semantic decision/tone decision (SDTD) fMRI task was used to localize left-hemispheric Broca's area. RTMS protocol consisted of 10 daily treatments of 200 seconds each using an excitatory stimulation protocol called intermittent theta burst stimulation (iTBS). Coil placement was targeted individually to the left Broca's. Results 6/8 patients showed significant pre-/post-rTMS improvements in semantic fluency (p=0.028); they were able to generate more appropriate words when prompted with a semantic category. Pre-/post-rTMS fMRI maps showed increases in left fronto-temporo-parietal language networks with a significant left-hemispheric shift in the left frontal (p=0.025), left temporo-parietal (p=0.038) regions and global language LI (p=0.018). Patients tended to report subjective improvement on Communicative Activities Log (mini-CAL; p=0.075). None of the subjects reported ill effects of rTMS. Conclusions FMRI-guided, excitatory rTMS applied to the affected Broca's area improved language skills in patients with chronic post-stroke aphasia; these improvements correlated with increased language lateralization to the left hemisphere. This rTMS protocol appears to be safe and should be further tested in blinded studies assessing its short- and long-term safety/efficacy for post-stroke aphasia rehabilitation.
Szaflarski, Jerzy P.; Vannest, Jennifer; Wu, Steve W.; DiFrancesco, Mark W.; Banks, Christi; Gilbert, Donald L.
Effects of language proficiency and language of the environment on aphasia therapy in a multilingual
We examined the relative proficiency of four languages (Spanish, German, French, English) of a multilingual speaker with aphasia, JM. JM's self-rated proficiency was consistent with his naming accuracy for nouns and verbs (The Object and Action Naming Battery, Druks & Masterson, 2000) and with his performance on selected subtests of the Bilingual Aphasia Test (Paradis & Libben, 1987). Within and between-language changes were measured following two periods of language treatment, one in a highly-proficient language (Spanish) and one in a less-proficient language (English). The various outcome measures differed in their sensitivity to treatment-associated changes. Cross-language treatment effects were linked to the language of the environment at the time of testing and to relative language proficiency.
Goral, Mira; Rosas, Jason; Conner, Peggy S.; Maul, Kristen K.; Obler, Loraine K.
Effects of language proficiency and language of the environment on aphasia therapy in a multilingual.
We examined the relative proficiency of four languages (Spanish, German, French, English) of a multilingual speaker with aphasia, JM. JM's self-rated proficiency was consistent with his naming accuracy for nouns and verbs (The Object and Action Naming Battery, Druks & Masterson, 2000) and with his performance on selected subtests of the Bilingual Aphasia Test (Paradis & Libben, 1987). Within and between-language changes were measured following two periods of language treatment, one in a highly-proficient language (Spanish) and one in a less-proficient language (English). The various outcome measures differed in their sensitivity to treatment-associated changes. Cross-language treatment effects were linked to the language of the environment at the time of testing and to relative language proficiency. PMID:23185107
Goral, Mira; Rosas, Jason; Conner, Peggy S; Maul, Kristen K; Obler, Loraine K
Psycholinguistic assessments of language processing in aphasia (PALPA): An introduction
PALPA is designed to be a resource for speech and language therapists and cognitive and clinical neuropsychologists who wish to assess language processing skills in people with aphasia. We believe that PALPA can make a substantial contribution to the investigator\\/therapist's resources for examining people with aphasia. The comments made by a large number of aphasia therapists throughout the UK, other
Janice Kay; Ruth Lesser; Max Coltheart
Phonological Therapy in Jargon Aphasia: Effects on Naming and Neologisms
Background: Jargon aphasia is one of the most intractable forms of aphasia with limited recommendation on amelioration of associated naming difficulties and neologisms. The few naming therapy studies that exist in jargon aphasia have utilized either semantic or phonological approaches, but the results have been equivocal. Moreover, the effect of…
Bose, Arpita
The Role of the Arcuate Fasciculus in Conduction Aphasia
In aphasia literature, it has been considered that a speech repetition defect represents the main constituent of conduction aphasia. Conduction aphasia has frequently been interpreted as a language impairment due to lesions of the arcuate fasciculus (AF) that disconnect receptive language areas from expressive ones. Modern neuroradiological…
Bernal, Byron; Ardila, Alfredo
Lesion correlates of patholinguistic profiles in chronic aphasia: comparisons of syndrome-, modality- and symptom-level assessment.
One way to investigate the neuronal underpinnings of language competence is to correlate patholinguistic profiles of aphasic patients to corresponding lesion sites. Constituting the beginnings of aphasiology and neurolinguistics over a century ago, this approach has been revived and refined in the past decade by statistical approaches mapping continuous variables (providing metrics that are not simply categorical) on voxel-wise lesion information (voxel-based lesion-symptom mapping). Here we investigate whether and how voxel-based lesion-symptom mapping allows us to delineate specific lesion patterns for differentially fine-grained clinical classifications. The latter encompass 'classical' syndrome-based approaches (e.g. Broca's aphasia), more symptom-oriented descriptions (e.g. agrammatism) and further refinement to linguistic sub-functions (e.g. lexico-semantic deficits for inanimate versus animate items). From a large database of patients treated for aphasia of different aetiologies (n = 1167) a carefully selected group of 102 first ever ischaemic stroke patients with chronic aphasia (? 12 months) were included in a VLSM analysis. Specifically, we investigated how performance in the Aachen Aphasia Test-the standard clinical test battery for chronic aphasia in German-relates to distinct brain lesions. The Aachen Aphasia Test evaluates aphasia on different levels: a non-parametric discriminant procedure yields probabilities for the allocation to one of the four 'standard' syndromes (Broca, Wernicke, global and amnestic aphasia), whereas standardized subtests target linguistic modalities (e.g. repetition), or even more specific symptoms (e.g. phoneme repetition). Because some subtests of the Aachen Aphasia Test (e.g. for the linguistic level of lexico-semantics) rely on rather coarse and heterogeneous test items we complemented the analysis with a number of more detailed clinically used tests in selected mostly mildly affected subgroups of patients. Our results indicate that: (i) Aachen Aphasia Test-based syndrome allocation allows for an unexpectedly concise differentiation between 'Broca's' and 'Wernicke's' aphasia corresponding to non-overlapping anterior and posterior lesion sites; whereas (ii) analyses for modalities and specific symptoms yielded more circumscribed but partially overlapping lesion foci, often cutting across the above syndrome territories; and (iii) especially for lexico-semantic capacities more specialized clinical test-batteries are required to delineate precise lesion patterns at this linguistic level. In sum this is the first report on a successful lesion-delineation of syndrome-based aphasia classification highlighting the relevance of vascular distribution for the syndrome level while confirming and extending a number of more linguistically motivated differentiations, based on clinically used tests. We consider such a comprehensive view reaching from the syndrome to a fine-grained symptom-oriented assessment mandatory to converge neurolinguistic, patholinguistic and clinical-therapeutic knowledge on language-competence and impairment. PMID:24525451
Henseler, Ilona; Regenbrecht, Frank; Obrig, Hellmuth
... the brain. Many times, the cause of the brain injury is a stroke. A stroke occurs when blood ... carries oxygen and important nutrients. Other causes of brain injury are severe blows to the head, brain tumors, ...
The Changing "Face" of Aphasia Therapy.
A growing literature suggests that with intensive treatment, individuals with chronic aphasia continue to demonstrate language recovery for years post stroke. For example, Bhogal and colleagues conducted a literature review which suggests that intensive speech language therapy delivered over a short period of time (average of 8.8 hours per week for 11.2 weeks) resulted in significant improvements, while lower-intensity therapy provided over a longer period of time (average of 2 hours per week over 22.9 weeks) did not result in positive change (Bhogal, Teasell, Speechley, & Albert, 2003). Similarly, the constraint induced aphasia therapy data emphasize the importance of massed-practice in the improvement of language skills of individuals with chronic aphasia (Pulvermuller et al., 2001; Maher et al., 2006). However, providing intensive treatment to individuals with chronic aphasia can be costly, and the current healthcare environment in the United States is one which does not recognize its value. As a result, clinicians and researchers in the field are left searching for cost effective ways to deliver aphasia treatment. One method of providing less costly but intensive treatment is via the computer. PMID:20617109
Lee, Jaime B; Cherney, Leora R
The Changing "Face" of Aphasia Therapy
A growing literature suggests that with intensive treatment, individuals with chronic aphasia continue to demonstrate language recovery for years post stroke. For example, Bhogal and colleagues conducted a literature review which suggests that intensive speech language therapy delivered over a short period of time (average of 8.8 hours per week for 11.2 weeks) resulted in significant improvements, while lower-intensity therapy provided over a longer period of time (average of 2 hours per week over 22.9 weeks) did not result in positive change (Bhogal, Teasell, Speechley, & Albert, 2003). Similarly, the constraint induced aphasia therapy data emphasize the importance of massed-practice in the improvement of language skills of individuals with chronic aphasia (Pulvermuller et al., 2001; Maher et al., 2006). However, providing intensive treatment to individuals with chronic aphasia can be costly, and the current healthcare environment in the United States is one which does not recognize its value. As a result, clinicians and researchers in the field are left searching for cost effective ways to deliver aphasia treatment. One method of providing less costly but intensive treatment is via the computer.
Lee, Jaime B.; Cherney, Leora R.
Aphasia therapy on a neuroscience basis.
BACKGROUND: Brain research has documented that the cortical mechanisms for language and action are tightly interwoven and, concurrently, new approaches to language therapy in neurological patients are being developed that implement language training in the context of relevant linguistic and non-linguistic actions, therefore taking advantage of the mutual connections of language and action systems in the brain. A further well-known neuroscience principle is that learning at the neuronal level is driven by correlation; consequently, new approaches to language therapy emphasise massed practice in a short time, thus maximising therapy quantity and frequency and, therefore, correlation at the behavioural and neuronal levels. Learned non-use of unsuccessful actions plays a major role in the chronification of neurological deficits, and behavioural approaches to therapy have therefore employed shaping and other learning techniques to counteract such non-use. AIMS: Advances in theoretical and experimental neuroscience have important implications for clinical practice. We exemplify this in the domain of aphasia rehabilitation. MAIN CONTRIBUTION: Whereas classical wisdom had been that aphasia cannot be significantly improved at a chronic stage, we here review evidence that one type of intensive language-action therapy (ILAT)-constraint-induced aphasia therapy-led to significant improvement of language performance in patients with chronic aphasia. We discuss perspectives for further improving speech-language therapy, including drug treatment that may be particularly fruitful when applied in conjunction with behavioural treatment. In a final section we highlight intensive and rapid therapy studies in chronic aphasia as a unique tool for exploring the cortical reorganisation of language. CONCLUSIONS: We conclude that intensive language action therapy is an efficient tool for improving language functions even at chronic stages of aphasia. Therapy studies using this technique can open new perspectives for research into the plasticity of human language circuits. PMID:18923644
Pulvermüller, Friedemann; Berthier, Marcelo L
Aphasia therapy on a neuroscience basis
Background Brain research has documented that the cortical mechanisms for language and action are tightly interwoven and, concurrently, new approaches to language therapy in neurological patients are being developed that implement language training in the context of relevant linguistic and non-linguistic actions, therefore taking advantage of the mutual connections of language and action systems in the brain. A further well-known neuroscience principle is that learning at the neuronal level is driven by correlation; consequently, new approaches to language therapy emphasise massed practice in a short time, thus maximising therapy quantity and frequency and, therefore, correlation at the behavioural and neuronal levels. Learned non-use of unsuccessful actions plays a major role in the chronification of neurological deficits, and behavioural approaches to therapy have therefore employed shaping and other learning techniques to counteract such non-use. Aims Advances in theoretical and experimental neuroscience have important implications for clinical practice. We exemplify this in the domain of aphasia rehabilitation. Main Contribution Whereas classical wisdom had been that aphasia cannot be significantly improved at a chronic stage, we here review evidence that one type of intensive language-action therapy (ILAT)—constraint-induced aphasia therapy—led to significant improvement of language performance in patients with chronic aphasia. We discuss perspectives for further improving speech-language therapy, including drug treatment that may be particularly fruitful when applied in conjunction with behavioural treatment. In a final section we highlight intensive and rapid therapy studies in chronic aphasia as a unique tool for exploring the cortical reorganisation of language. Conclusions We conclude that intensive language action therapy is an efficient tool for improving language functions even at chronic stages of aphasia. Therapy studies using this technique can open new perspectives for research into the plasticity of human language circuits.
Pulvermuller, Friedemann; Berthier, Marcelo L.
Aphasia assessment and functional outcome prediction in patients with aphasia after stroke
Available studies did not clarify whether a language examination may predict functional and motor outcome in patients with\\u000a aphasia undergoing rehabilitation. This was the aim of the current study. Language examination considered in this study was\\u000a the Aachen Aphasia Test (AAT). One hundred fifty-six patients with a primary diagnosis of acute cerebrovascular accident of\\u000a left hemisphere were included: 105 with
Bernardo Gialanella
Examining language functions: a reassessment of Bastian's contribution to aphasia assessment.
Henry Charlton Bastian (1837-1915) developed his network model of language processing, modality deficits and correlated lesion localizations in the 1860s and was a leading clinical authority for over four decades. Although his ideas are little referenced today, having been overshadowed by his more eminent Queen Square colleague John Hughlings Jackson, his work on aphasia and paralysis was highly regarded by contemporaries. This paper traces Bastian's lasting but largely unattributed contribution to the development of standardized clinical assessment of language disorders. From 1867 onwards, Bastian trained generations of medical students in neurology. In his 1875 book On Paralysis there is evidence in his case descriptions that Bastian had already implemented a detailed set of procedures for examining aphasic patients. In 1886, Bastian published a 'Schema for the Examination of Aphasic and Amnesic Persons'. Bastian insisted on the utility of this battery for diagnosis, classification and lesion localization; he argued that its consistent use would allow the development of a patient corpus and the comparison of cases from other hospitals. In 1898 his Treatise on Aphasia included a list of 34 questions that were to be used to examine all patients to provide detailed and systematic evidence of spared and impaired abilities in all receptive and expressive modalities. Bastian's contribution to the development of standardized clinical aphasia assessment is reassessed through detailed analysis of his publications and those of his contemporaries as well as new material from archives and casebooks. This evidence demonstrates that his approach to diagnosis of language and other cognitive impairments has propagated through the decades. His legacy can be seen in the approach to standardized aphasia testing developed in the latter 20th century through to today. PMID:23803303
Lorch, Marjorie P
Can Herpes Simplex Virus Encephalitis Cause Aphasia?
Aphasia implies the loss or impairment of language caused by brain damage. The key to understanding the nature of aphasic symptoms is the neuro-anatomical site of brain damage, and not the causative agent. However, because "Herpes simplex" virus (HSV) encephalitis infection usually affects the frontal and temporal lobes, subcortical structures and…
Naude, H.; Pretorius, E.
Further Evidence of Auditory Extinction in Aphasia
Purpose: Preliminary research ( Shisler, 2005) suggests that auditory extinction in individuals with aphasia (IWA) may be connected to binding and attention. In this study, the authors expanded on previous findings on auditory extinction to determine the source of extinction deficits in IWA. Method: Seventeen IWA (M[subscript age] = 53.19 years)…
Marshall, Rebecca Shisler; Basilakos, Alexandra; Love-Myers, Kim
Semantic Weight and Verb Retrieval in Aphasia
Individuals with agrammatic aphasia may have difficulty with verb production in comparison to nouns. Additionally, they may have greater difficulty producing verbs that have fewer semantic components (i.e., are semantically "light") compared to verbs that have greater semantic weight. A connectionist verb-production model proposed by Gordon and…
Barde, Laura H. F.; Schwartz, Myrna F.; Boronat, Consuelo B.
A Computational Account of Bilingual Aphasia Rehabilitation
Current research on bilingual aphasia highlights the paucity in recommendations for optimal rehabilitation for bilingual aphasic patients (Edmonds & Kiran, 2006; Roberts & Kiran, 2007). In this paper, we have developed a computational model to simulate an English-Spanish bilingual language system in which language representations can vary by age…
Kiran, Swathi; Grasemann, Uli; Sandberg, Chaleece; Miikkulainen, Risto
Measuring Working Memory Deficits in Aphasia
Purpose: Many adults with aphasia demonstrate concomitant deficits in working memory (WM), but such deficits are difficult to quantify because of a lack of validated measures as well as the complex interdependence between language and WM. We examined the feasibility, reliability, and internal consistency of an "n"-back task for evaluating WM in…
Mayer, Jamie F.; Murray, Laura L.
Epidural cortical stimulation and aphasia therapy
Background: There are several methods of delivering cortical brain stimulation to modulate cortical excitability, and interest in their application as an adjuvant strategy in aphasia rehabilitation after stroke is growing. Epidural cortical stimulation, although more invasive than other methods, permits high-frequency stimulation of high spatial specificity to targeted neuronal populations.Aims: First we review evidence supporting the use of epidural cortical
Leora R. Cherney; Richard L. Harvey; Edna M. Babbitt; Rosalind Hurwitz; Rosalind C. Kaye; Jaime B. Lee; Steven L. Small
Algebra in a Man with Severe Aphasia
We report a dissociation between higher order mathematical ability and language in the case of a man (SO) with severe aphasia. Despite severely impaired abilities in the language domain and difficulties with processing both phonological and orthographic number words, he was able to judge the equivalence of and to transform and simplify…
Klessinger, Nicolai; Szczerbinski, Marcin; Varley, Rosemary
Treatment of Aphasia: A Process Approach.
The recommended treatment approach for aphasia involves increasing the efficiency of language processing by manipulating the patient's processing of stimuli. Discussed are assessment, identification of the point of processing breakdown, identification of facilitory stimulus parameters, and treatment through stimulus manipulation. Two case studies…
Hagen, Chris
Writing Treatment for Severe Aphasia: Who Benefits?
Writing treatment that involved repeated copying and recall of target words was implemented with 8 individuals with severe aphasia in order to discern the best candidates for the treatment. Four of the 8 participants had strong positive responses to the copy and recall treatment (CART), relearning spellings for 15 targeted words during 10 to 12…
Beeson, Pelagie M.; Rising, Kindle; Volk, Jennifer
Comprehension of Passives in Broca's Aphasia
Drai and Grodzinsky have statistically analyzed a large corpus of data on the comprehension of passives by patients with Broca's aphasia. The data come, according to Drai and Grodzinsky, from binary choice tasks. Among the languages that are analyzed are Dutch and German. Drai and Grodzinsky argue that Dutch and German speaking Broca patients…
Bastiaanse, Roelien; van Zonneveld, Ron
Accent Identification by Adults with Aphasia
The UK is a diverse society where individuals regularly interact with speakers with different accents. Whilst there is a growing body of research on the impact of speaker accent on comprehension in people with aphasia, there is none which explores their ability to identify accents. This study investigated the ability of this group to identify the…
Newton, Caroline; Burns, Rebecca; Bruce, Carolyn
Temporal Processing Capabilities in Repetition Conduction Aphasia
This study investigates the temporal resolution capacities of the central-auditory system in a subject (NP) suffering from repetition conduction aphasia. More specifically, the patient was asked to detect brief gaps between two stretches of broadband noise (gap detection task) and to evaluate the duration of two biphasic (WN-3) continuous noise…
Sidiropoulos, Kyriakos; Ackermann, Hermann; Wannke, Michael; Hertrich, Ingo
Adaptation to Aphasia: Grammar, Prosody and Interaction
This paper investigates recurrent use of the phrase "very good" by a speaker with non-fluent agrammatic aphasia. Informal observation of the speaker's interaction reveals that she appears to be an effective conversational partner despite very severe word retrieval difficulties that result in extensive reliance on variants of the phrase "very…
Rhys, Catrin S.; Ulbrich, Christiane; Ordin, Mikhail
Inhibition and auditory comprehension in Wernicke's aphasia
Background: While research findings support the presence of inefficiencies in allocation of attention in individuals with aphasia, the cognitive mechanisms behind these inefficiencies remain unclear. One mechanism that would affect resource allocation for selective processing is an impaired inhibitory mechanism which, when normally functioning, would actively suppress distracting information. Aims: The purpose of this study was to investigate the cognitive
Debra Wiener; Lisa Tabor Connor; Loraine Obler
[Various approaches to restoration of visual memory in aphasia].
The techniques of restitution of visual memory in aphasia patients are described. A specially designed testing procedure proved their efficiency. Analyzed is the dependence of visual memory restitution on the form and severity of aphasia, age and educational level of the patients. Verbal mediation of the memorized visual information is uneffective in aphasia. The results are treated in terms of psychological and neuropsychological concepts of memory. PMID:2481913
Glozman, Zh M; Pylaeva, N M; Si'lvestre, K
Implementation of Computer-Based Language Therapy in Aphasia
A first step in evaluating the use of computers in language therapy for individuals with aphasia is to establish the treatment as active in small groups prior to large-scale clinical trials. The present study evaluated a comprehensive computer-based language therapy program in a group of eight individuals with chronic in aphasia varying broadly in age, time post onset and aphasia type. Results revealed an overall therapeutic benefit in auditory comprehension, as well as positive trends in functional communication. Findings suggest that comprehensive therapy programs may be beneficial for many individuals with aphasia, and computer-based therapy may be one feasible avenue of providing this intervention.
Orange, Joseph B.; Jamieson, Donald J.
MAAS (Multi-axial Aphasia System): realistic goal setting in aphasia rehabilitation.
Treatment success in aphasia is influenced by various factors. Clinical decisions, including patient selection and decisions on frequency and content, are often guided by a clinician's implicit opinions. The Multi-axial Aphasia System (MAAS) was developed to structure linguistic, somatic, neuropsychological, psychosocial and socio-economic information on five separate axes, enabling an explicit and interdisciplinary process of clinical decision-making. The objectives of this study were to investigate the potentialities of MAAS in predicting the outcome of cognitive-linguistic treatment. A group of 58 aphasic patients were investigated prospectively. All received cognitive-linguistic treatment during a randomized, controlled study on the efficacy of lexical semantic treatment. An interdisciplinary aphasia team rated the pretreatment MAAS profiles of all patients. The team was blinded for treatment allocation and outcome. A multiple linear regression analysis was performed with the posttreatment verbal communication score as the variable to be predicted and the overall MAAS rating, age and type of treatment as predictor variables. In a second multiple regression analysis, the ratings for each of the five MAAS axes were used as candidate predictors. The team's overall rating contributed significantly to the prediction of verbal communicative ability after linguistic treatment. Of the five MAAS axes, the neuropsychological axis contributed to the prediction. An interdisciplinary approach to aphasia assessment may contribute to realistic goal setting in aphasia rehabilitation. The results of this study stress the importance of neuropsychological assessment of aphasic patients before treatment. PMID:19008680
van de Sandt-Koenderman, Wilhelmina M E; van Harskamp, Frans; Duivenvoorden, Hugo J; Remerie, Sylvia C; van der Voort-Klees, Yvonne A; Wielaert, Sandra M; Ribbers, Gerard M; Visch-Brink, Evy G
Aphasia Therapy in the Age of Globalization: Cross-Linguistic Therapy Effects in Bilingual Aphasia
Introduction. Globalization imposes challenges to the field of behavioural neurology, among which is an increase in the prevalence of bilingual aphasia. Thus, aphasiologists have increasingly focused on bilingual aphasia therapy and, more recently, on the identification of the most efficient procedures for triggering language recovery in bilinguals with aphasia. Therapy in both languages is often not available, and, thus, researchers have focused on the transfer of therapy effects from the treated language to the untreated one. Aim. This paper discusses the literature on bilingual aphasia therapy, with a focus on cross-linguistic therapy effects from the language in which therapy is provided to the untreated language. Methods. Fifteen articles including two systematic reviews, providing details on pre- and posttherapy in the adult bilingual population with poststroke aphasia and anomia are discussed with regard to variables that can influence the presence or absence of cross-linguistic transfer of therapy effects. Results and Discussion. The potential for CLT of therapy effects from the treated to the untreated language depends on the word type, the degree of structural overlap between languages, the type of therapy approach, the pre- and postmorbid language proficiency profiles, and the status of the cognitive control circuit.
Ansaldo, Ana Ines; Saidi, Ladan Ghazi
Constraint-induced aphasia therapy stimulates language recovery in patients with chronic aphasia after ischemic stroke
Background Constraint-induced aphasia therapy (CIAT) offers potential benefits to individuals with history of aphasia-producing ischemic stroke. The goals of this pilot study were to implement the original German CIAT protocol, refine the treatment program, and confirm its efficacy in patients with chronic aphasia. Material/Methods We translated and modified the original CIAT protocol to include a hierarchy of individual skill levels for semantic, syntactic, and phonological language production, while constraining non-use behaviors. Three male participants with moderate to severe post-stroke aphasia received CIAT 3-4 hours/day for 5 consecutive days. Pre and post-testing included formal language evaluation, linguistic analysis of story retell, and mini-Communication Activity Log (mini-CAL). Results Substantial improvements in comprehension and verbal skills were noted in 2 patients with an increase in the total number of words (31% and 95%) and in number of utterances for story-retell task (57% and 75%). All participants demonstrated an improvement on at least one linguistic measure. No subjective improvements on mini-CAL were noted by any of the participants. Conclusions Given that the duration of treatment was only 1 week, these linguistic improvements in post stroke aphasia participants were remarkable. The results indicate that the CIAT protocol used in this study may be a useful tool in language restoration after stroke. These initial findings should be confirmed in a larger, randomized study.
Ball, Angel L.; Grether, Sandra; Al-fwaress, Firas; Griffith, Nathan M.; Neils-Strunjas, Jean; Newmeyer, Amy; Reichhardt, Robert
Decoding Speech for Understanding and Treating Aphasia
Aphasia is an acquired language disorder with a diverse set of symptoms that can affect virtually any linguistic modality across both the comprehension and production of spoken language. Partial recovery of language function after injury is common but typically incomplete. Rehabilitation strategies focus on behavioral training to induce plasticity in underlying neural circuits to maximize linguistic recovery. Understanding the different neural circuits underlying diverse language functions is a key to developing more effective treatment strategies. This chapter discusses a systems identification analytic approach to the study of linguistic neural representation. The focus of this framework is a quantitative, model-based characterization of speech and language neural representations that can be used to decode, or predict, speech representations from measured brain activity. Recent results of this approach are discussed in the context of applications to understanding the neural basis of aphasia symptoms and the potential to optimize plasticity during the rehabilitation process.
Pasley, Brian N.; Knight, Robert T.
Therapy-induced neuroplasticity in chronic aphasia.
Research on the neural substrate of aphasia recovery has consistently increased since the advent of functional neuroimaging. The evidence from therapy-induced aphasia recovery studies shows that better recovery results from the reactivation of left hemisphere function; still, the specific left hemisphere key areas that sign successful outcome with a specific therapy approach remain to be identified. Nine participants suffering from aphasia received brief and intensive therapy with Semantic Feature Analysis (SFA). Behavioural and neuroimaging data during overt picture naming were obtained prior to and after therapy. This paper reports on a group of participants having benefited from SFA, and two distinct patterns of improvement. Correlational analysis showed that differences in outcome were not related to lesion size, but were negatively correlated with damage to Broca's area (BA45). Moreover, a group analysis showed that therapy-induced recovery following SFA was characterized by (a) a significant correlation between improvement and activation in the left precentral gyrus (BA4/6) before therapy, and (b) the recruitment of the left inferior parietal lobule, an area known for its role in semantic integration, following therapy with SFA. Individual fMRI analyses showed that although adaptive brain plasticity appeared to operate differently in each patient, best responders to SFA therapy recruited less areas after training compared to participants having shown less recovery who showed a larger number of activated areas sustaining recovery. The results of the present study suggest that a significant activation of BA4/6 could indicate the use of SFA to achieve successful outcome. Also our results suggest that greater SFA improvement in chronic aphasia is associated with recruitment of areas in the left hemisphere. PMID:22564481
Marcotte, Karine; Adrover-Roig, Daniel; Damien, Brigitte; de Préaumont, Mathilde; Généreux, Suzanne; Hubert, Michelyne; Ansaldo, Ana Inés
Receptive prosody in nonfluent primary progressive aphasias
Introduction Prosody has been little studied in the primary progressive aphasias (PPAs), a group of neurodegenerative disorders presenting with progressive language impairment. Methods Here we conducted a systematic investigation of different dimensions of prosody processing (acoustic, linguistic and emotional) in a cohort of 19 patients with nonfluent PPA syndromes (11 with progressive nonfluent aphasia, PNFA; five with progressive logopenic/phonological aphasia, LPA; three with progranulin-associated aphasia, GRN-PPA) compared with a group of healthy older controls. Voxel-based morphometry (VBM) was used to identify neuroanatomical associations of prosodic functions. Results Broadly comparable receptive prosodic deficits were exhibited by the PNFA, LPA and GRN-PPA subgroups, for acoustic, linguistic and affective dimensions of prosodic analysis. Discrimination of prosodic contours was significantly more impaired than discrimination of simple acoustic cues, and discrimination of intonation was significantly more impaired than discrimination of stress at phrasal level. Recognition of vocal emotions was more impaired than recognition of facial expressions for the PPA cohort, and recognition of certain emotions (in particular, disgust and fear) was relatively more impaired than others (sadness, surprise). VBM revealed atrophy associated with acoustic and linguistic prosody impairments in a distributed cortical network including areas likely to be involved in perceptual analysis of vocalisations (posterior temporal and inferior parietal cortices) and working memory (fronto-parietal circuitry). Grey matter associations of emotional prosody processing were identified for negative emotions (disgust, fear, sadness) in a broadly overlapping network of frontal, temporal, limbic and parietal areas. Conclusions Taken together, the findings show that receptive prosody is impaired in nonfluent PPA syndromes, and suggest a generic early perceptual deficit of prosodic signal analysis with additional relatively specific deficits (recognition of particular vocal emotions).
Rohrer, Jonathan D.; Sauter, Disa; Scott, Sophie; Rossor, Martin N.; Warren, Jason D.
Quantitative Template for Subtyping Primary Progressive Aphasia
Background: The syndrome of primary progressive aphasia(PPA)isdiagnosedwhenagradualfailureofword usage or comprehension emerges as the principal fea- ture of a neurodegenerative disease. Objective: To provide a quantitative algorithm for clas- sifyingPPAintoagrammatic(PPA-G),semantic(PPA-S), and logopenic (PPA-L) variants, each of which is known to have a different probability of association with Alzhei- mer disease vs frontotemporal lobar degeneration. Design: Prospective study. Setting: University medical center.
Marsel Mesulam; Christina Wieneke; Emily Rogalski; Derin Cobia; Cynthia Thompson; Sandra Weintraub
Having the Courage To Be Competent: Persons and Families Living with Aphasia.
This article provides examples and illustrations of how people with aphasia can and do demonstrate their competence in managing their lives despite chronic aphasia. It discusses a number of ways in which persons with aphasia and their families can learn to live fully despite the intrusion of aphasia. (Contains references.) (Author/CR)
Marshall, Robert C.
Snapshots of success: An insider perspective on living successfully with aphasia
Background:?While the negative impact of aphasia has been the focus of much research, few studies have investigated more positive examples of people living with aphasia. Exploring the concept of living successfully with aphasia from an insider perspective can enhance current research by providing positively framed data that balance this negative skew. Collectively, the perspectives of people with aphasia on themes
Kyla Brown; Linda Worrall; Bronwyn Davidson; Tami Howe
You don't say: dynamic aphasia, another variant of primary progressive aphasia?
Primary progressive aphasia (PPA) is a language predominant neurodegenerative disorder that has three recognized variants: nonfluent/agrammatic, semantic, and logopenic. This report describes a 60-year-old man who presented with a progressive decline in verbal output that does not fit the currently accepted PPA subtypes. The patient exhibited a paucity of verbal output and impaired phonemic fluency with minimal associated language, cognitive, or behavioral deficits. Focal cortical thinning/hypometabolism of the left superior frontal region and a cerebrospinal fluid profile not consistent with Alzheimer's disease pathology were identified. This case of isolated progressive dynamic aphasia extends the current boundaries of PPA diagnostic variants. PMID:23168447
Perez, David L; Dickerson, Bradford C; McGinnis, Scott M; Sapolsky, Daisy; Johnson, Keith; Searl, Meghan; Daffner, Kirk R
You Don't Say: Dynamic Aphasia, Another Variant of Primary Progressive Aphasia?
Primary progressive aphasia (PPA) is a language predominant neurodegenerative disorder that has three recognized variants: nonfluent/agrammatic, semantic, and logopenic. This report describes a 60-year-old man who presented with a progressive decline in verbal output that does not fit the currently accepted PPA subtypes. The patient exhibited a paucity of verbal output and impaired phonemic fluency with minimal associated language, cognitive, or behavioral deficits. Focal cortical thinning/hypometabolism of the left superior frontal region and a cerebrospinal fluid profile not consistent with Alzheimer's disease pathology were identified. This case of isolated progressive dynamic aphasia extends the current boundaries of PPA diagnostic variants.
Perez, David L.; Dickerson, Bradford C.; McGinnis, Scott M.; Sapolsky, Daisy; Johnson, Keith; Searl, Meghan; Daffner, Kirk R.
Alzheimer's pathology in primary progressive aphasia
Primary progressive aphasia (PPA) is a neurodegenerative disorder with language impairment as the primary feature. Different subtypes have been described and the 3 best characterized are progressive nonfluent aphasia (PNFA), semantic dementia (SD) and logopenic/phonological aphasia (LPA). Of these subtypes, LPA is most commonly associated with Alzheimer's disease (AD) pathology. However, the features of PPA associated with AD have not been fully defined. Here we retrospectively identified 14 patients with PPA and either pathologically confirmed AD or cerebrospinal fluid (CSF) biomarkers consistent with AD. Analysis of neurological and neuropsychological features revealed that all patients had a syndrome of LPA with relatively nonfluent spontaneous speech, phonemic errors, and reduced digit span; most patients also had impaired verbal episodic memory. Analysis of the pattern of cortical thinning in these patients revealed left posterior superior temporal, inferior parietal, medial temporal, and posterior cingulate involvement and in patients with more severe disease, increasing involvement of left anterior temporal and frontal cortices and right hemisphere areas in the temporo-parietal junction, posterior cingulate, and medial temporal lobe. We propose that LPA may be a "unihemispheric" presentation of AD, and discuss this concept in relation to accumulating evidence concerning language dysfunction in AD.
Rohrer, Jonathan D.; Rossor, Martin N.; Warren, Jason D.
Binding in agrammatic aphasia: Processing to comprehension
Background Theories of comprehension deficits in Broca's aphasia have largely been based on the pattern of deficit found with movement constructions. However, some studies have found comprehension deficits with binding constructions, which do not involve movement. Aims This study investigates online processing and offline comprehension of binding constructions, such as reflexive (e.g., himself) and pronoun (e.g., him) constructions in unimpaired and aphasic individuals in an attempt to evaluate theories of agrammatic comprehension. Methods & Procedures Participants were eight individuals with agrammatic Broca's aphasia and eight age-matched unimpaired individuals. We used eyetracking to examine online processing of binding constructions while participants listened to stories. Offline comprehension was also tested. Outcomes & Results The eye movement data showed that individuals with Broca's aphasia were able to automatically process the correct antecedent of reflexives and pronouns. In addition, their syntactic processing of binding was not delayed compared to normal controls. Nevertheless, offline comprehension of both pronouns and reflexives was significantly impaired compared to the control participants. This comprehension failure was reflected in the aphasic participants' eye movements at sentence end, where fixations to the competitor increased. Conclusions These data suggest that comprehension difficulties with binding constructions seen in agrammatic aphasic patients are not due to a deficit in automatic syntactic processing or delayed processing. Rather, they point to a possible deficit in lexical integration.
Janet Choy, Jungwon; Thompson, Cynthia K.
Aphasia friendly written health information: content and design characteristics.
People with aphasia need communicatively accessible written health information. Healthcare providers require knowledge of how to develop printed education materials (PEMs) in formats that people with aphasia prefer and can read. This study aimed to explore formatting characteristics considered to be barriers and facilitators to reading PEMs. Semi-structured in-depth interviews were conducted with 40 adults with aphasia who were selected using maximum variation sampling across aphasia severity, reading ability, and time post-stroke. Participants were shown stroke and aphasia PEMs obtained from the recruiting stroke services, asked to rank them from most liked to least liked, and comment on factors that made the PEMs easier and harder to read. The majority of participants ranked the aphasia friendly stroke (56.4%, n = 22) and aphasia (87.2%, n = 34) PEMs as most liked. Forty-five facilitator and 46 barrier codes were identified using qualitative content analysis and grouped into two categories; (1) content characteristics and (2) design characteristics. Findings support many of the recommendations found within the literature for developing best practice PEMs and accessible information for other patient groups. Routine consideration of the facilitators and barriers identified will contribute to making written information more accessible to people with aphasia. PMID:21682542
Rose, Tanya A; Worrall, Linda E; Hickson, Louise M; Hoffmann, Tammy C
Paraphasias in Multilingual Conduction Aphasia: A Single Case Study
Conduction aphasia is a type of fluent aphasia, which is caused due to the damage to the supramarginal gyrus and arcuate fasciculus resulting in repetition disturbance. It has been speculated that linguistic system in bilingual aphasics can breakdown in different ways across languages. There is a lack of detailed linguistic studies in specific…
Hegde, Medha; Bhat, Sapna
Measuring and Inducing Brain Plasticity in Chronic Aphasia
Brain plasticity associated with anomia recovery in aphasia is poorly understood. Here, I review four recent studies from my lab that focused on brain modulation associated with long-term anomia outcome, its behavioral treatment, and the use of transcranial brain stimulation to enhance anomia treatment success in individuals with chronic aphasia…
Fridriksson, Julius
Global aphasia without hemiparesis: language profiles and lesion distribution
OBJECTIVES—Global aphasia without hemiparesis (GAWH) is an uncommon stroke syndrome involving receptive and expressive language impairment, without the hemiparesis typically manifested by patients with global aphasia after large left perisylvian lesions. A few cases of GAWH have been reported with conflicting conclusions regarding pathogenesis, lesion localisation, and recovery. The current study was conducted to attempt to clarify these issues.?METHODS—Ten cases of GAWH were prospectively studied with language profiles and lesion analysis; five patients had multiple lesions, four patients had a single lesion, and one had a subarachnoid haemorrhage. Eight patients met criteria for cardioembolic ischaemic stroke.?RESULTS—Cluster analysis based on acute language profiles disclosed three subtypes of patients with GAWH; these clusters persisted on follow up language assessment. Each cluster evolved into a different aphasia subtype: persistent GAWH, Wernicke's aphasia, or transcortical motor aphasia (TCM). Composite lesion analysis showed that persistent GAWH was related to lesioning of the left superior temporal gyrus. Patients with acute GAWH who evolved into TCM type aphasia had common lesioning of the left inferior frontal gyrus and adjacent subcortical white matter. Patients with acute GAWH who evolved into Wernicke's type aphasia were characterised by lesioning of the left precentral and postcentral gyri. Recovery of language was poor in all but one patient.?CONCLUSIONS—Although patients with acute GAWH are similar on neurological examination, they are heterogeneous with respect to early aphasia profile, language recovery, and lesion profile.??
Hanlon, R.; Lux, W.; Dromerick, A.
Aphasia websites: An examination of their quality and communicative accessibility
Background : Studies have examined Internet use as a source of information by various populations, however no study has examined the quality and accessibility of websites for people with aphasia, or their use of such sites. Aims : This study aimed to describe the quality, communicative accessibility, and readability of a sample of aphasia websites and to determine whether sites
Carlye Ghidella; Stephen Murray; Melanie Smart; Kryss McKenna; Linda Worrall
A Comparison between Written and Spoken Narratives in Aphasia
The aim of the present study was to explore how a personal narrative told by a group of eight persons with aphasia differed between written and spoken language, and to compare this with findings from 10 participants in a reference group. The stories were analysed through holistic assessments made by 60 participants without experience of aphasia…
Behrns, Ingrid; Wengelin, Asa; Broberg, Malin; Hartelius, Lena
Personal narratives in aphasia: Coherence in the context of use
Background: Discourse functionality is a primary goal of aphasia assessment and intervention. People who have aphasia often display a paradoxical functionality in their production of discourse, despite their aphasic impairment. A variety of linguistic and non-linguistic resources are orchestrated to produce coherent discourse. One discourse genre, the personal story, is ubiquitous and fills important intrapersonal and interpersonal functions.Aims: The primary
Gloria Streit Olness; Hanna K. Ulatowska
The assessment for living with aphasia: reliability and construct validity.
The Assessment for Living with Aphasia (ALA) is a pictographic, self-report measure of aphasia-related quality-of-life. Research was undertaken to assess test-re-test reliability, construct validity, and the ability to discriminate aphasia severity. The ALA was administered to 101 participants with aphasia on two occasions. Test-re-test reliability was evaluated using intra-class correlations and internal consistency using Cronbach's alpha. Three reference measures were administered to assess construct validity. A focus group reported on ease of administration and face validity. Analysis identified 15 out of 52 rated items for elimination. For the remaining items, test-re-test reliability was excellent for the total score (ICC = .86) and moderate-to-strong for a priori domains adapted from the WHO ICF (.68-.83). Internal consistency was acceptable-to-high. Significant correlations were observed between the ALA and reference tests (SAQOL-39, .72; p < .001; VASES, .62, p = .03; BOSS CAPD, -.69; p = .008). The language impairment domain discriminated between all aphasia severity groups, while mild aphasia was different from moderate and severe aphasia in participation and total scores. The ALA was reportedly easy to administer and captured key aspects of the experience of living with aphasia. Results suggest acceptable test-re-test reliability, internal consistency and construct validity of the ALA. PMID:24160320
Simmons-Mackie, Nina; Kagan, Aura; Victor, J Charles; Carling-Rowland, Alex; Mok, Ada; Hoch, Jeffrey S; Huijbregts, Maria; Streiner, David L
Mild Aphasia: Is This the Place for an Argument?
Purpose: Individuals with mild aphasia often report significant disruption to their communication despite seemingly minor impairment. This study explored this phenomenon through examining conversations of a person with mild aphasia engaging in argumentation--a skill she felt had significantly deteriorated after her stroke. Method: A person with…
Armstrong, Elizabeth; Fox, Sarah; Wilkinson, Ray
Aphasia and Topic Initiation in Conversation: A Case Study
Background: Aphasiologists often research, assess and treat linguistic impairment and its consequences for daily life separately. Studies that link the language used by people with aphasia to routine communicative activities may expand the linguistic forms treated as relevant for successful communication by people with aphasia. Previous research…
Barnes, Scott E.; Candlin, Christopher N.; Ferguson, Alison
Principles Underlying the Bilingual Aphasia Test (BAT) and Its Uses
The Bilingual Aphasia Test (BAT) is designed to be objective (so it can be administered by a lay native speaker of the language) and equivalent across languages (to allow for a comparison between the languages of a given patient as well as across patients from different institutions). It has been used not only with aphasia but also with any…
Paradis, Michel
Many patients with progressive fluent aphasia present with poor verbal comprehension and profound word-finding difficulties in the context of much better picture comprehension and object use. The Japanese term Gogi (literally ?word-meaning?) aphasia matches this behavioural pattern. The alternative label of semantic dementia is most often used for these patients and this term emphasises a generalised degradation of conceptual knowledge
Matthew A. Lambon Ralph; David Howard
What People Living with Aphasia Think about the Availability of Aphasia Resources
Purpose: Obtaining health information and resources can influence an individual's (a) access to services, (b) interactions with health care providers, and (c) ability to manage one's own health needs. The purpose of this study was to gather the perceptions of consumers living with aphasia about resource availability and information needs. Method:…
Hinckley, Jacqueline J.; Hasselkus, Amy; Ganzfried, Ellayne
The anterior temporal lobes support residual comprehension in Wernicke's aphasia.
Wernicke's aphasia occurs after a stroke to classical language comprehension regions in the left temporoparietal cortex. Consequently, auditory-verbal comprehension is significantly impaired in Wernicke's aphasia but the capacity to comprehend visually presented materials (written words and pictures) is partially spared. This study used functional magnetic resonance imaging to investigate the neural basis of written word and picture semantic processing in Wernicke's aphasia, with the wider aim of examining how the semantic system is altered after damage to the classical comprehension regions. Twelve participants with chronic Wernicke's aphasia and 12 control participants performed semantic animate-inanimate judgements and a visual height judgement baseline task. Whole brain and region of interest analysis in Wernicke's aphasia and control participants found that semantic judgements were underpinned by activation in the ventral and anterior temporal lobes bilaterally. The Wernicke's aphasia group displayed an 'over-activation' in comparison with control participants, indicating that anterior temporal lobe regions become increasingly influential following reduction in posterior semantic resources. Semantic processing of written words in Wernicke's aphasia was additionally supported by recruitment of the right anterior superior temporal lobe, a region previously associated with recovery from auditory-verbal comprehension impairments. Overall, the results provide support for models in which the anterior temporal lobes are crucial for multimodal semantic processing and that these regions may be accessed without support from classic posterior comprehension regions. PMID:24519979
Robson, Holly; Zahn, Roland; Keidel, James L; Binney, Richard J; Sage, Karen; Lambon Ralph, Matthew A
The anterior temporal lobes support residual comprehension in Wernicke's aphasia
Wernicke's aphasia occurs after a stroke to classical language comprehension regions in the left temporoparietal cortex. Consequently, auditory–verbal comprehension is significantly impaired in Wernicke's aphasia but the capacity to comprehend visually presented materials (written words and pictures) is partially spared. This study used functional magnetic resonance imaging to investigate the neural basis of written word and picture semantic processing in Wernicke's aphasia, with the wider aim of examining how the semantic system is altered after damage to the classical comprehension regions. Twelve participants with chronic Wernicke's aphasia and 12 control participants performed semantic animate–inanimate judgements and a visual height judgement baseline task. Whole brain and region of interest analysis in Wernicke's aphasia and control participants found that semantic judgements were underpinned by activation in the ventral and anterior temporal lobes bilaterally. The Wernicke's aphasia group displayed an 'over-activation' in comparison with control participants, indicating that anterior temporal lobe regions become increasingly influential following reduction in posterior semantic resources. Semantic processing of written words in Wernicke's aphasia was additionally supported by recruitment of the right anterior superior temporal lobe, a region previously associated with recovery from auditory-verbal comprehension impairments. Overall, the results provide support for models in which the anterior temporal lobes are crucial for multimodal semantic processing and that these regions may be accessed without support from classic posterior comprehension regions.
Robson, Holly; Zahn, Roland; Keidel, James L.; Binney, Richard J.; Sage, Karen; Lambon Ralph, Matthew A.
Left Hemisphere Plasticity and Aphasia Recovery
A recent study by our group revealed a strong relationship between functional brain changes in the left hemisphere and anomia treatment outcome in chronic stroke patients (N=26) with aphasia (Fridriksson, 2010). The current research represents a continuation of this work in which we have refined our methods and added data from four more patients (for a total sample size of 30) to assess where in the left hemisphere treatment-related brain changes occur. Unlike Fridriksson (2010) which only focused on changes in correct naming as a marker of treatment outcome, the current study examined the relationship between changes in left hemisphere activity and changes in correct naming, semantic paraphasias, and phonemic paraphasias following treatment. We also expanded on the work by Fridriksson by examining whether neurophysiological measures taken at baseline (defined henceforth as the time-point before the start of anomia treatment) predict treatment outcome. Our analyses revealed that changes in activation in perilesional areas predicted treatment-related increases in correct naming in individuals with chronic aphasia. This relationship was most easily observed in the left frontal lobe. Decrease in the number of semantic and phonemic paraphasias was predicted by activation change in the temporal lobe involving cortical areas that were shown to be active during picture naming in 14 normal subjects. In contrast, a far less certain relationship was found between baseline neurophysiological measures and anomia treatment outcome. Our findings suggest that improved naming associated with behavioral anomia treatment in aphasia is associated with modulation of the left frontal lobe whereas reduction in naming errors is mediated by left posterior regions that classically are thought to be involved in language processing.
Fridriksson, Julius; Richardson, Jessica D.; Fillmore, Paul; Cai, Bo
Pathology in primary progressive aphasia syndromes.
'Primary progressive aphasia' (PPA) refers to core linguistic disorders caused by neurodegenerative disease. Three main PPA variants are recognized: nonfluent/agrammatic, semantic and logopenic. Correctly classifying patients during life according to the underlying histopathology will become increasingly important as cause-specific treatments become available. This article reviews clinical and histopathological studies of PPA, with particular reference to updated PPA classifications. Currently, one-to-one relationships do not exist within PPA subtypes. The semantic variant has the best correspondence between the clinical syndrome and the underlying pathological cause and the logopenic variant the worst correspondence. The use of future biomarkers should facilitate accurate clinicopathological correlation of patients during life. PMID:24952480
Harris, Jennifer M; Jones, Matthew
Neuroimaging and Recovery of Language in Aphasia
The use of functional neuroimaging techniques has advanced what is known about the neural mechanisms used to support language processing in aphasia resulting from brain damage. This paper highlights recent findings derived from neuroimaging studies focused on neuroplasticity of language networks, the role of the left and right hemispheres in this process, and studies examining how treatment affects the neurobiology of recovery. We point out variability across studies as well as factors related to this variability, and we emphasize challenges that remain for research.
Thompson, Cynthia K.; den Ouden, Dirk-Bart
Notes and Discussion Educational level, socioeconomic status and aphasia research: A comment on Connor et al. (2001)—Effect of socioeconomic status on aphasia severity and recovery
Is there a relation between socioeconomic factors and aphasia severity and recovery? Connor, Obler, Tocco, Fitzpatrick, and Albert (2001) describe correlations between the educational level and socioeconomic status of aphasic subjects with aphasia severity and subsequent recovery. As stated in the introduction by Connor et al. (2001), studies of the influence of educational level and literacy (or illiteracy) on aphasia
Alexandra Reis; Karl Magnus Petersson; F. C. Donders
Educational level, socioeconomic status and aphasia research: A comment on Connor et al. (2001)—Effect of socioeconomic status on aphasia severity and recovery
Alexandra Reis; Karl Magnus Petersson
Parallel Recovery in a Trilingual Speaker: The Use of the Bilingual Aphasia Test as a Diagnostic Complement to the Comprehensive Aphasia Test
We illustrate the value of the Bilingual Aphasia Test in the diagnostic assessment of a trilingual speaker post-stroke living in England for whom English was a non-native language. The Comprehensive Aphasia Test is routinely used to assess patients in English, but only in combination with the Bilingual Aphasia Test is it possible and practical to…
Green, David W.; Ruffle, Louise; Grogan, Alice; Ali, Nilufa; Ramsden, Sue; Schofield, Tom; Leff, Alex P.; Crinion, Jenny; Price, Cathy J.
Writing treatment for severe aphasia: who benefits?
Writing treatment that involved repeated copying and recall of target words was implemented with 8 individuals with severe aphasia in order to discern the best candidates for the treatment. Four of the 8 participants had strong positive responses to the copy and recall treatment (CART), relearning spellings for 15 targeted words during 10 to 12 weeks of treatment and up to 5 additional words during a month-long homework-based program. Of the 4 other participants, 3 learned the spellings of some target words but failed to reach criterion, and 1 had a poor treatment outcome. Insights regarding possible factors that limited success were gained by examination of individual responses to treatment as well as performance on the pretreatment assessments of semantic, phonological, and orthographic processes. Among the factors associated with success were (a) consistent, accurate completion of daily homework, (b) a relatively preserved semantic system, (c) the ability to discern words from nonwords, and (d) adequately preserved nonverbal visual problem-solving skills. Aphasia severity and minimal pretreatment spelling abilities did not necessarily limit the response to treatment. Participants with positive treatment outcomes demonstrated improved spelling of target words following repeated copying within a single treatment session, and accurately completed daily writing homework. Thus, pretreatment assessment and stimulability within initial treatment sessions provided indications of likely outcome. PMID:14575342
Beeson, Pélagie M; Rising, Kindle; Volk, Jennifer
Writing Treatment for Aphasia: A Texting Approach
Purpose Treatment studies have documented the therapeutic and functional value of lexical writing treatment for individuals with severe aphasia. The purpose of this study was to determine whether such retraining could be accomplished using the typing feature of a cellular telephone, with the ultimate goal of using text messaging for communication. Method A 31-year-old man with persistent Broca's aphasia, severe apraxia of speech, global dysgraphia, and right hemiparesis participated in this study. Using a multiple baseline design, relearning and maintenance of single-word spellings (and oral naming) of targeted items were examined in response to traditional Copy and Recall Treatment (CART) for handwriting and a new paradigm using 1-handed typing on a cell phone keyboard (i.e., a texting version of CART referred to as T-CART). Results Marked improvements were documented in spelling and spoken naming trained in either modality, with stronger maintenance for handwriting than cell phone typing. Training resulted in functional use of texting that continued for 2 years after treatment. Conclusions These results suggest that orthographic retraining using a cell phone keyboard has the potential to improve spelling knowledge and provide a means to improve functional communication skills. Combined training with both handwriting and cell phone typing should be considered in order to maximize the durability of treatment effects.
Beeson, Pelagie M.; Higginson, Kristina; Rising, Kindle
Cognitive Deficits and Reduced Insight in Primary Progressive Aphasia
Primary progressive aphasia (PPA) is a form of dementia caused by frontotemporal lobar degeneration. Unlike aphasia due to stroke, in which the association between particular aphasia profiles and insight has been well characterized, this relationship has not been investigated in PPA. Reduced insight is seen in other neurological conditions, but tends to involve right hemisphere damage, whereas PPA is predominantly a left hemisphere disorder. The aim of the current study was to examine whether fluent aphasia with less meaningful speech output, associated with diminished insight in stroke, is also characteristic of PPA patients with reduced insight. Fourteen PPA patients were studied. Results indicated that reduced information content in speech and poor performance on a nonlanguage test, the Pyramids and Palm Trees test, predicted reduced insight. This study has implications for the anatomical network involved in insight and clinical implications in terms of selecting interventions appropriate for individual patients with PPA.
Banks, Sarah Jane; Weintraub, Sandra
Implicit and explicit learning in individuals with agrammatic aphasia.
Implicit learning is a process of acquiring knowledge that occurs without conscious awareness of learning, whereas explicit learning involves the use of overt strategies. To date, research related to implicit learning following stroke has been largely restricted to the motor domain and has rarely addressed implications for language. The present study investigated implicit and explicit learning of an auditory word sequence in 10 individuals with stroke-induced agrammatic aphasia and 18 healthy age-matched participants using an adaptation of the Serial Reaction Time task. Individuals with aphasia showed significant learning under implicit, but not explicit, conditions, whereas age-matched participants learned under both conditions. These results suggest significant implicit learning ability in agrammatic aphasia. Furthermore, results of an auditory sentence span task indicated working memory deficits in individuals with agrammatic aphasia, which are discussed in relation to explicit and implicit learning processes. PMID:23532578
Schuchard, Julia; Thompson, Cynthia K
Nutritional profile of aphasia patients assessed in a phonoaudiology clinic
Cardiovascular diseases are the main causes of death in Brazil, and the cerebrovascular disease is the most prevalent. This study aimed to assess the nutritional status of aphasia patients and to identify the connection between the dietary consumption and
Kátia Cristina; Portero McLellan; Carolina de Sousa Donato; Maíra Adabo; Ivone Panhoca
Internal Consistency of Three Tests from the Halstead-Reitan Neuropsychological Battery for Older Children.
Examined the internal consistency of three tests from the Halstead-Reitan Neuropsychological Battery (R. Reitan and D. Wolfson, 1992) with a sample of 334 children, 9 to 14 years of age. Gives reliability coefficients for the Seashore Rhythm Test, two forms of the Speech Sounds Perception Test, and the Aphasia Screening Test. (SLD)
Livingston, Ronald B.; Gray, Robert M.; Haak, Ruth A.
A case of crossed aphasia with apraxia of speech
Apraxia of speech (AOS) is a rare, but well-defined motor speech disorder. It is characterized by irregular articulatory errors, attempts of self-correction and persistent prosodic abnormalities. Similar to aphasia, AOS is also localized to the dominant cerebral hemisphere. We report a case of Crossed Aphasia with AOS in a 48-year-old right-handed man due to an ischemic infarct in right cerebral hemisphere.
Patidar, Yogesh; Gupta, Meena; Khwaja, Geeta A; Chowdhury, Debashish; Batra, Amit; Dasgupta, Abhijit
Measuring the lexical semantics of picture description in aphasia
Background: Individuals with non?fluent aphasia have difficulty producing syntactically laden words, such as function words, whereas individuals with fluent aphasia often have difficulty producing semantically specific words. It is hypothesised that such dissociations arise, at least in part, from a trade?off between syntactic and semantic sources of input to lexical retrieval.Aims: The aims of this study were (a) to identify
Jean K. Gordon
Aphasia and auditory extinction: Preliminary evidence of binding
Background: McNeil, Odell, and Tseng (1991), and Murray and colleagues (Murray, 2000; Murray, Holland, & Beeson, 1997a, 1997b) have suggested that variability of performance in patients with aphasia may be due to nonlinguistic cognitive variables, such as attention (i.e., resources, capacity, effort), which affect language comprehension and production. Given the research that has supported the relationship between aphasia and attention
Rebecca Shisler
Research with rTMS in the treatment of aphasia.
This review of our research with rTMS to treat aphasia contains four parts: Part 1 reviews functional brain imaging studies related to recovery of language in aphasia with emphasis on nonfluent aphasia. Part 2 presents the rationale for using rTMS to treat nonfluent aphasia patients (based on results from functional imaging studies). Part 2 also reviews our current rTMS treatment protocol used with nonfluent aphasia patients, and our functional imaging results from overt naming fMRI scans, obtained pre- and post- a series of rTMS treatments. Part 3 presents results from a pilot study where rTMS treatments were followed immediately by constraint-induced language therapy (CILT). Part 4 reviews our diffusion tensor imaging (DTI) study that examined white matter connections between the horizontal, midportion of the arcuate fasciculus (hAF) to different parts within Broca's area (pars triangularis, PTr; pars opercularis, POp), and the ventral premotor cortex (vPMC) in the RH and in the LH. Part 4 also addresses some of the possible mechanisms involved with improved naming and speech, following rTMS with nonfluent aphasia patients. PMID:20714075
Naeser, Margaret A; Martin, Paula I; Treglia, Ethan; Ho, Michael; Kaplan, Elina; Bashir, Shahid; Hamilton, Roy; Coslett, H Branch; Pascual-Leone, Alvaro
The Nature of Lexical-Semantic Access in Bilingual Aphasia
Background. Despite a growing clinical need, there are no clear guidelines on assessment of lexical access in the two languages in individuals with bilingual aphasia. Objective. In this study, we examined the influence of language proficiency on three tasks requiring lexical access in English and Spanish bilingual normal controls and in bilingual individuals with aphasia. Methods. 12 neurologically healthy Spanish-English bilinguals and 10 Spanish-English bilinguals with aphasia participated in the study. All participants completed three lexical retrieval tasks: two picture-naming tasks (BNT, BPNT) and a category generation (CG) task. Results. This study found that across all tasks, the greatest predictors for performance were the effect of group and language ability rating (LAR). Bilingual controls had a greater score or produced more correct responses than participants with bilingual aphasia across all tasks. The results of our study also indicate that normal controls and bilinguals with aphasia make similar types of errors in both English and Spanish and develop similar clustering strategies despite significant performance differences between the groups. Conclusions. Differences between bilingual patients and controls demonstrate a fundamental lexical retrieval deficit in bilingual individuals with aphasia, but one that is further influenced by language proficiency in the two languages.
Kiran, Swathi; Balachandran, Isabel; Lucas, Jason
Research with rTMS in the treatment of aphasia
This review of our research with rTMS to treat aphasia contains four parts: Part 1 reviews functional brain imaging studies related to recovery of language in aphasia with emphasis on nonfluent aphasia. Part 2 presents the rationale for using rTMS to treat nonfluent aphasia patients (based on results from functional imaging studies). Part 2 also reviews our current rTMS treatment protocol used with nonfluent aphasia patients, and our functional imaging results from overt naming fMRI scans, obtained pre- and post- a series of rTMS treatments. Part 3 presents results from a pilot study where rTMS treatments were followed immediately by constraint-induced language therapy (CILT). Part 4 reviews our diffusion tensor imaging (DTI) study that examined white matter connections between the horizontal, midportion of the arcuate fasciculus (hAF) to different parts within Broca's area (pars triangularis, PTr; pars opercularis, POp), and the ventral premotor cortex (vPMC) in the RH and in the LH. Part 4 also addresses some of the possible mechanisms involved with improved naming and speech, following rTMS with nonfluent aphasia patients.
Naeser, Margaret A.; Martin, Paula I; Treglia, Ethan; Ho, Michael; Kaplan, Elina; Bashir, Shahid; Hamilton, Roy; Coslett, H. Branch; Pascual-Leone, Alvaro
Aphasia Severity and Salivary Cortisol over Time
The current study explored the complicated interplay between aphasia and the stress biomarker, cortisol, in left hemisphere (LH) and right hemisphere (RH) stroke patients. Nineteen LH patients and 12 RH patients began the study between one to six months post-stroke and were followed for three months. During this time, language skills were assessed monthly while afternoon salivary cortisol samples were collected biweekly. The LH and RH groups showed improvements in language test scores over the course of three months; however, only naming skills in the RH group appeared to be associated with afternoon salivary cortisol levels. Furthermore, contradicting previous reports regarding laterality and cortisol regulation in humans, the current study found that both LH patients and RH patients exhibited similar afternoon salivary cortisol levels across all time points.
Laures-Gore, Jacqueline S.
The interactional organization of aphasia naming testing.
In this article, Conversation Analysis (CA) is used to investigate the nature of aphasia naming tests in terms of their properties as a specialized form of social interaction. The basic test-item sequence which occurs in these tests is shown to be made up of a three-part sequential structure consisting of (1) a testing prompt, (2) a proffered answer by the testee, and (3) an acceptance or declining of that proffered answer by the tester. A declining prompts a further answer to be proffered, and this cycle continues until either an answer is accepted by the tester or until the participants treat the testee as being unable to produce the relevant picture name. It is suggested that the results of the analysis have implications for understanding naming tests as instruments which generate theoretical and clinical findings through particular talk-in-interaction practices. PMID:24073858
Wilkinson, Ray
Adult crossed aphasia in dextrals revisited.
The clinical study of crossed aphasia in dextrals (CAD) may shed light on the discreteness and modularity of several cognitive functions, such as language, gestures and visual spatial abilities, with respect to hemispheric lateralisation. Since 1975 over 180 cases have been described, employing, however, different criteria of assessment and classification. The purpose of this paper is to review them and to propose a set of diagnostic criteria that may be useful to single out a series of reliable CAD cases on which research can be safely carried out. A detailed analysis of such series is dealt with in terms of a number of characteristics concerning both the language disorder and the associated nonverbal cognitive impairments. PMID:15070002
Mariën, Peter; Paghera, Barbara; De Deyn, Peter P; Vignolo, Luigi A
Asymmetric inhibitory treatment effects in multilingual aphasia.
Findings from recent psycholinguistic studies of bilingual processing support the hypothesis that both languages of a bilingual are always active and that bilinguals continually engage in processes of language selection. This view aligns with the convergence hypothesis of bilingual language representation. Furthermore, it is hypothesized that when bilinguals perform a task in one language they need to inhibit their other, nontarget language(s) and that stronger inhibition is required when the task is performed in the weaker language than in the stronger one. The study of multilingual individuals who acquire aphasia resulting from a focal brain lesion offers a unique opportunity to test the convergence hypothesis and the inhibition asymmetry. We report on a trilingual person with chronic nonfluent aphasia who at the time of testing demonstrated greater impairment in her first acquired language (Persian) than in her third, later learned language (English). She received treatment in English followed by treatment in Persian. An examination of her connected language production revealed improvement in her grammatical skills in each language following intervention in that language, but decreased grammatical accuracy in English following treatment in Persian. The increased error rate was evident in structures that are used differently in the two languages (e.g., auxiliary verbs). The results support the prediction that greater inhibition is applied to the stronger language than to the weaker language, regardless of their age of acquisition. We interpret the findings as consistent with convergence theories that posit overlapping neuronal representation and simultaneous activation of multiple languages and with proficiency-dependent asymmetric inhibition in multilinguals. PMID:24499302
Goral, Mira; Naghibolhosseini, Maryam; Conner, Peggy S
Therapy for naming deficits in two variants of primary progressive aphasia
Background: Primary progressive aphasia (PPA) refers to a progressive and selective decline in language due to neurodegenerative disease. There are three variants of PPA, progressive nonfluent aphasia (PNFA), semantic dementia (SD), and logopaenic progressive aphasia (LPA). All variants include impaired object naming, but distinct underlying deficits might interfere with naming. Therefore, individuals with different types of PPA may respond differently
Melissa Newhart; Cameron Davis; Vijay Kannan; Lauren Cloutman; Argye E. Hillis
A Neurolinguistic Analysis of Expressive Agrammatism in Different Forms of Aphasia
Agrammatism, the disruption of the grammatical structure of speech, is studied in its accompaniment to aphasia. Since it occurs with all studied forms of aphasia, it is considered here a symptom typical to aphasia. It is also examined in relation to different kinds of aphasics. (SCC)
The psychometric properties of the English language version of the Aachen Aphasia Test (EAAT)
This article reports results of a standardization study of the English language version of the Aachen aphasia test (EAAT). The EAAT was administered to 135 speakers with and 93 without aphasia. Aphasic speakers were divided into four groups (n =30) representing EAAT standard syndrome groups (global, amnestic, Broca's and Wernicke's aphasia), and 15 speakers who could not be classified into
N. Miller; K. Willmes; R. De Bleser
What functional assessment can contribute to setting goals for aphasia therapy
The rehabilitation of communicative effectiveness has developed into one of the main concerns in aphasia treatment. Development of effective intervention programmes is dependent on rehabilitation evaluation. Standard assessment of neurolinguistic deficits does not account for communicative effectiveness. Improved scores on standard aphasia tests therefore have limited relevance to improved functional communication. Assessment of functional impairments can contribute to aphasia therapy
L. Blomert
Computer-Based Script Training for Aphasia: Emerging Themes from Post-Treatment Interviews
This study presents results of post-treatment interviews following computer-based script training for persons with chronic aphasia. Each of the 23 participants received 9 weeks of AphasiaScripts training. Post-treatment interviews were conducted with the person with aphasia and/or a significant other person. The 23 interviews yielded 584 coded…
Cherney, Leora R.; Halper, Anita S.; Kaye, Rosalind C.
Conceptualizing and Measuring Working Memory and its Relationship to Aphasia
Background General agreement exists in the literature that individuals with aphasia can exhibit a working memory deficit that contributes to their language processing impairments. Though conceptualized within different working memory frameworks, researchers have suggested that individuals with aphasia have limited working memory capacity, impaired attention-control processes as well as impaired inhibitory mechanisms. However, across studies investigating working memory ability in individuals with aphasia, different measures have been used to quantify their working memory ability and identify the relationship between working memory and language performance. Aims The primary objectives of this article are to (1) review current working memory theoretical frameworks, (2) review tasks used to measure working memory, and (3) discuss findings from studies that have investigated working memory as they relate to language processing in aphasia. Main Contribution Though findings have been consistent across studies investigating working memory ability in individuals with aphasia, discussion of how working memory is conceptualized and defined is often missing, as is discussion of results within a theoretical framework. This is critical, as working memory is conceptualized differently across the different theoretical frameworks. They differ in explaining what limits capacity and the source of individual differences as well as how information is encoded, maintained, and retrieved. When test methods are considered within a theoretical framework, specific hypotheses can be tested and stronger conclusions that are less susceptible to different interpretations can be made. Conclusions Working memory ability has been investigated in numerous studies with individuals with aphasia. To better understand the underlying cognitive constructs that contribute to the language deficits exhibited by individuals with aphasia, future investigations should operationally define the cognitive constructs of interest and discuss findings within theoretical frameworks.
Wright, Heather Harris; Fergadiotis, Gerasimos
Quality of life measurement and outcome in aphasia
Background Quality of life (QL) can be defined as the individual's perception of their own well-being. Aphasia is the most important potential consequence of stroke and has a profound effect on a patient's life, causing emotional distress, depression, and social isolation, due to loss of language functions. Aims To draw up a QL questionnaire for aphasics (QLQA) focusing particularly on difficulties in interpersonal relationships and on the loss of independence as a result of language disorders. We reported the results of a psychometric evaluation of this measure. Moreover, we experimentally focused on the differences in QLQA between patients affected only by neurological motor impairment and hemiparetic patients with aphasia (PWA) in order to verify the specific role of aphasia on QL. We also explored if the QLQA is sensitive to the severity of aphasia and to the time elapsing from the stroke. Methods A total of 146 consecutive PWA and 37 control subjects were enrolled to evaluate the reliability (internal consistency and test–retest reliability) and validity of the QLQA, using standard psychometric methods. Patients were divided into acute (within 3 months since stroke) and chronic (beyond 3 months) groups, and into mild and severe according to the severity of aphasia. The experimental group of only acute PWA was compared to control subjects, with right hemispherical lesion and without aphasia in QLQA total and partial scores. Results The QLQA had good internal consistency and test–retest reliability. Acute and chronic PWA and mild and severe ones differed in QLQA total, communication, and autonomy subscales. No differences were found in psychological condition. Between aphasic and control patients, significant differences were found in all QLQA subscales. Conclusion The QLQA is a valid measure of QL in PWA, contributing to a better distinction between severe and mild aphasia, and it is sensitive also to the variations in QL depending on the time interval from stroke.
Spaccavento, Simona; Craca, Angela; Del Prete, Marina; Falcone, Rosanna; Colucci, Antonia; Di Palma, Angela; Loverre, Anna
Exclusion and Inclusion Criteria for People with Aphasia in Studies of Depression after Stroke: A Systematic Review and Future Recommendations
Background\\/Aims: A third of individuals are depressed following stroke. A similar proportion have aphasia. The extent of their inclusion in depression following stroke studies affects the generalizability of findings. Methods: We systematically reviewed published studies (to December 2005) that diagnosed depression following stroke. We identified aphasia screening methods, aphasia exclusion and inclusion criteria and respective numbers of individuals with aphasia.
Ellen Townend; Marian Brady; Kirsty McLaughlan
A hierarchical fuzzy rule-based approach to aphasia diagnosis.
Aphasia diagnosis is a particularly challenging medical diagnostic task due to the linguistic uncertainty and vagueness, inconsistencies in the definition of aphasic syndromes, large number of measurements with imprecision, natural diversity and subjectivity in test objects as well as in opinions of experts who diagnose the disease. To efficiently address this diagnostic process, a hierarchical fuzzy rule-based structure is proposed here that considers the effect of different features of aphasia by statistical analysis in its construction. This approach can be efficient for diagnosis of aphasia and possibly other medical diagnostic applications due to its fuzzy and hierarchical reasoning construction. Initially, the symptoms of the disease which each consists of different features are analyzed statistically. The measured statistical parameters from the training set are then used to define membership functions and the fuzzy rules. The resulting two-layered fuzzy rule-based system is then compared with a back propagating feed-forward neural network for diagnosis of four Aphasia types: Anomic, Broca, Global and Wernicke. In order to reduce the number of required inputs, the technique is applied and compared on both comprehensive and spontaneous speech tests. Statistical t-test analysis confirms that the proposed approach uses fewer Aphasia features while also presenting a significant improvement in terms of accuracy. PMID:17293167
Akbarzadeh-T, Mohammad-R; Moshtagh-Khorasani, Majid
The World Report on Disability as a blueprint for international, national, and local aphasia services.
This commentary aims to extend the debate of the lead article authors (Wylie, McAllister, Davidson, and Marshall, 2013) by translating the nine recommendations of the World Report on Disability into a plan of action for the aphasia community. Solutions for the advancement of aphasia science and services are presented at international (macro), national (meso), and local (micro) levels. Implications for speech-language pathologists and aphasia service delivery are discussed. An overarching call to action is the need for speech-language pathologists to support a strong and vibrant aphasia community at all levels, so that the voices of people with aphasia can be heard. PMID:23101515
Worrall, Linda E; Howe, Tami; O'Callaghan, Anna; Hill, Anne J; Rose, Miranda; Wallace, Sarah J; Rose, Tanya; Brown, Kyla; Power, Emma; O'Halloran, Robyn; Rohde, Alexia
Wernicke's Aphasia Reflects a Combination of Acoustic-Phonological and Semantic Control Deficits: A Case-Series Comparison of Wernicke's Aphasia, Semantic Dementia and Semantic Aphasia
Wernicke's aphasia (WA) is the classical neurological model of comprehension impairment and, as a result, the posterior temporal lobe is assumed to be critical to semantic cognition. This conclusion is potentially confused by (a) the existence of patient groups with semantic impairment following damage to other brain regions (semantic dementia and…
Robson, Holly; Sage, Karen; Lambon Ralph, Matthew A.
Parallel recovery in a trilingual speaker: the use of the Bilingual Aphasia Test as a diagnostic complement to the Comprehensive Aphasia Test
We illustrate the value of the Bilingual Aphasia Test in the diagnostic assessment of a trilingual speaker post-stroke living in England for whom English was a non-native language. The Comprehensive Aphasia Test is routinely used to assess patients in English but only in combination with the Bilingual Aphasia Test is it possible and practical to provide a fuller picture of the language impairment. We describe our test selection and the assessment it allows us to make.
Degenerative jargon aphasia: unusual progression of logopenic/phonological progressive aphasia?
Primary progressive aphasia (PPA) corresponds to the gradual degeneration of language which can occur as nonfluent/agrammatic PPA, semantic variant PPA or logopenic variant PPA. We describe the clinical evolution of a patient with PPA presenting jargon aphasia as a late feature. At the onset of the disease (ten years ago) the patient showed anomia and executive deficits, followed later on by phonemic paraphasias and neologisms, deficits in verbal short-term memory, naming, verbal and semantic fluency. At recent follow-up the patient developed an unintelligible jargon with both semantic and neologistic errors, as well as with severe deficit of comprehension which precluded any further neuropsychological assessment. Compared to healthy controls, FDG-PET showed a hypometabolism in the left angular and middle temporal gyri, precuneus, caudate, posterior cingulate, middle frontal gyrus, and bilaterally in the superior temporal and inferior frontal gyri. The clinical and neuroimaging profile seems to support the hypothesis that the patient developed a late feature of logopenic variant PPA characterized by jargonaphasia and associated with superior temporal and parietal dysfunction. PMID:22713376
Caffarra, Paolo; Gardini, Simona; Cappa, Stefano; Dieci, Francesca; Concari, Letizia; Barocco, Federica; Ghetti, Caterina; Ruffini, Livia; Prati, Guido Dalla Rosa
Can tDCS enhance treatment of aphasia after stroke?
Background Recent advances in the application of transcranial direct current stimulation (tDCS) in healthy populations have led to the exploration of the technique as an adjuvant method to traditional speech therapies in patients with post-stroke aphasia. Aims The purpose of the review is: (i) to review the features of tDCS that make it an attractive tool for research and potential future use in clinical contexts; (ii) to describe recent studies exploring the facilitation of language performance using tDCS in post-stroke aphasia; (iii) to explore methodological considerations of tDCS that may be key to understanding tDCS in treatment of aphasia post stroke; and (iv) to highlight several caveats and outstanding questions that need to be addressed in future work. Main Contribution This review aims to highlight our current understanding of the methodological and theoretical issues surrounding the use of tDCS as an adjuvant tool in the treatment of language difficulties after stroke. Conclusions Preliminary evidence shows that tDCS may be a useful tool to complement treatment of aphasia, particularly for speech production in chronic stroke patients. To build on this exciting work, further systematic research is needed to understand the mechanisms of tDCS-induced effects, its application to current models of aphasia recovery, and the complex interactions between different stimulation parameters and language rehabilitation techniques. The potential of tDCS is to optimise language rehabilitation techniques and promote long-term recovery of language. A stimulating future for aphasia rehabilitation!
Holland, Rachel; Crinion, Jenny
Rapid improvement in verbal fluency and aphasia following perispinal etanercept in Alzheimer's disease
Background Recent clinical studies point to rapid and sustained clinical, cognitive, and behavioral improvement in both Alzheimer's disease and primary progressive aphasia following weekly perispinal administration of etanercept, a TNF-alpha inhibitor that acts by blocking the binding of this cytokine to its receptors. This outcome is concordant with recent basic science studies suggesting that TNF-alpha functions in vivo as a gliotransmitter that regulates synaptic function in the brain. We hypothesized that perispinal etanercept had the potential to improve verbal function in Alzheimer's disease, so we included several standarized measures of verbal ability to evaluate language skills in a clinical trial of perispinal etanercept for Alzheimer's disease. Methods This was a prospective, single-center, open-label, pilot study, in which 12 patients with mild-to-severe Alzheimer's disease were administered etanercept, 25–50 mg, weekly by perispinal administration for six months. Two additional case studies are presented. Results Two-tailed, paired t-tests were conducted comparing baseline performance to 6-month performance on all neuropsychological measures. Test batteries included the California Verbal Learning Test-Second Edition, Adult Version; Logical Memory I and II(WMS-LM-II) from the Wechsler Memory Scale-Abbreviated; the Comprehensive Trail Making Test (TMT); Boston Naming Test; and letter(FAS) and category verbal fluency. All measures revealed a significant effect except for the Boston Naming Test and the TMT-4, with WMS-LM-II being marginally significant at p = .05. The FAS test for letter fluency was most highly significant with a p < 0.0007. In addition, rapid improvement in verbal fluency and aphasia in two patients with dementia, beginning minutes after perispinal etanercept administration, is documented. Conclusion In combination with the previously reported results of perispinal etanercept in Alzheimer's disease and primary progressive aphasia, these results further argue that larger scale studies of this therapeutic intervention, including Phase 3 trials, are warranted in dementias. In addition, these results may provide insight into the basic pathophysiologic mechanisms underlying Alzheimer's disease and related forms of dementia, and suggest the existence of novel, rapidly reversible, TNF-mediated pathophysiologic mechanisms in Alzheimer's disease which are worthy of further investigation.
Tobinick, Edward L; Gross, Hyman
Syntactic and morphosyntactic processing in stroke-induced and primary progressive aphasia.
The paper reports findings derived from three experiments examining syntactic and morphosyntactic processing in individuals with agrammatic and logopenic variants of primary progressive aphasia (PPA-G and PPA-L, respectively) and stroke-induced agrammatic and anomic aphasia (StrAg and StrAn, respectively). We examined comprehension and production of canonical and noncanonical sentence structures and production of tensed and nontensed verb forms using constrained tasks in experiments 1 and 2, using the Northwestern Assessment of Verbs and Sentences (NAVS [57]) and the Northwestern Assessment of Verb Inflection (NAVI, Thompson and Lee, experimental version) test batteries, respectively. Experiment 3 examined free narrative samples, focusing on syntactic and morphosyntactic measures, i.e. production of grammatical sentences, noun to verb ratio, open-class to closed-class word production ratio, and the production of correctly inflected verbs. Results indicate that the two agrammatic groups (i.e., PPA-G and StrAg) pattern alike on syntactic and morphosyntactic measures, showing more impaired noncanonical compared to canonical sentence comprehension and production and greater difficulties producing tensed compared to nontensed verb forms. Their spontaneous speech also contained significantly fewer grammatical sentences and correctly inflected verbs, and they produced a greater proportion of nouns compared to verbs, than healthy speakers. In contrast, PPA-L and StrAn individuals did not display these deficits, and performed significantly better than the agrammatic groups on these measures. The findings suggest that agrammatism, whether induced by degenerative disease or stroke, is associated with characteristic deficits in syntactic and morphosyntactic processing. We therefore recommend that linguistically sophisticated tests and narrative analysis procedures be used to systematically evaluate the linguistic ability of individuals with PPA, contributing to our understanding of the language impairments of different PPA variants. PMID:22713394
Thompson, Cynthia K; Meltzer-Asscher, Aya; Cho, Soojin; Lee, Jiyeon; Wieneke, Christina; Weintraub, Sandra; Mesulam, M-Marsel
The contribution of the right cerebral hemisphere to the recovery from aphasia: a single longitudinal case study.
We examined the role of the right cerebral hemisphere in the recovery from aphasia of HJ, a 50-year-old right-handed and unilingual man who suffered from severe aphasia caused by an extensive left hemisphere (LH) lesion. He was followed-up over 10 months at 4-month intervals, with a lateralized lexical decision task (LDT), an attentional task, and a language battery. Testing started when HJ was 2 months poststroke. In the LDT, words were presented to central vision or lateralized to the left or right visual hemifield. At each test period, we examined the effect of the degree of imageability (high vs. low), and the grammatical class (noun vs. verb) of the targets on HJ's response times and error rates, with left visual field, right visual field, and central vision presentations. The results of the experiment showed that the pattern obtained with the LDT could not be accounted for by fluctuations in attention. There was an interaction of grammatical class with degree of imageability with left visual field displays only. The right hemisphere (RH) was faster with high-imageability words than with low-imageability words, regardless of their grammatical class. There was also an overall RH advantage on response times at 2 and 6 months after onset. This RH predominance coincided with a major recovery of language comprehension and the observation of semantic paralexias, while no major change in language expression was observed at that point. Ten months after onset, the pattern of lateralization changed, and response times for the LDT with either presentation site were equivalent. This LH improvement coincided with some recovery of language expression at the single-word level. The results of this study suggest that, in cases of severe aphasia caused by extensive LH lesions, the RH may play an important role in the recovery process. Furthermore, these results show that the contribution of the two cerebral hemispheres to recovery may vary overtime and affect specific aspects of language. PMID:12096877
Ansaldo, Ana Inés; Arguin, Martin; Roch Lecours, André
Objective To provide a quantitative algorithm for classifying primary progressive aphasia (PPA) into agrammatic (PPA-G), semantic (PPA-S) and logopenic (PPA-L) variants, each of which is known to have a different probability of association with Alzheimer's disease (AD) versus frontotemporal lobar degeneration (FTLD). Design Prospectively and consecutively enrolled 16 PPA patients tested with neuropsychological instruments and magnetic resonance imaging (MRI). Setting University medical center. Participants PPA patients recruited nationally in the USA as part of a longitudinal study. Results A two-dimensional template, reflecting performance on tests of syntax (Northwestern Anagram Test) and lexical semantics (Peabody Picture Vocabulary Test), classified all 16 patients in concordance with a clinical diagnosis that had been made prior to the administration of the quantitative tests. All three subtypes had distinctly asymmetrical atrophy of the left perisylvian language network. Each subtype also had distinctive peak atrophy sites. Only PPA-G had peak atrophy in the IFG (Broca's area), only PPA-S had peak atrophy in the anterior temporal lobe, and only PPA-L had peak atrophy in area 37. Conclusions Once an accurate root diagnosis of PPA is made, subtyping can be quantitatively guided using a two-dimensional template based on orthogonal tasks of grammatical competence and word comprehension. Although the choice of tasks and precise cut-off levels may evolve in time, this set of 16 patients demonstrates the feasibility of using a simple algorithm for clinico-anatomical classification in PPA. Prospective studies will show whether this suptyping can improve the clinical prediction of underlying neuropathology.
Mesulam, Marsel; Wieneke, Christina; Rogalski, Emily; Cobia, Derin; Thompson, Cynthia; Weintraub, Sandra
ACES: aphasia emulation, realism, and the turing test
To an outsider it may appear as though an individual with aphasia has poor cognitive function. However, the problem resides in the individual's receptive and expressive language, and not in their ability to think. This misperception, paired with a lack of empathy, can have a direct impact on quality of life and medical care. Hailpern's 2011 paper on ACES demonstrated
Joshua Hailpern; Marina Danilevsky; Karrie Karahalios
Production of Modal and Negative Particles in Greek Aphasia
This study aims at investigating the production of the Greek modal and negative particles by non-fluent aphasic patients. These particles belong to the highest part of the verb periphrasis, so they are likely to be impaired in non-fluent aphasia, according to some hypotheses about agrammatic language. Moreover, there is an agreement relation…
Koukoulioti, Vasiliki
Executive function and conversational strategies in bilingual aphasia
Background: Deficits of executive function (EF) have been proposed as all or part of the underlying mechanisms of language impairment in at least some types of aphasia. Executive functions also play a role in the recovery process. There is evidence that bilingual persons have some executive functioning advantages compared to monolingual persons. In this paper we combine two lines of
Claire Penn; Tali Frankel; Jennifer Watermeyer; Nicole Russell
A Study of Syntactic Processing in Aphasia II: Neurological Aspects
This paper presents the results of a study of the effects of left hemisphere strokes on syntactically-based comprehension in aphasic patients. We studied 42 patients with aphasia secondary to left hemisphere strokes and 25 control subjects for the ability to assign and interpret three syntactic structures (passives, object extracted relative…
Caplan, David; Waters, Gloria; Kennedy, David; Alpert, Nathanial; Makris, Nikos; DeDe, Gayle; Michaud, Jennifer; Reddy, Amanda
Production Latencies of Morphologically Simple and Complex Verbs in Aphasia
There are several accounts of why some individuals with post-stroke aphasia experience difficulty in producing morphologically complex verbs. Although a majority of these individuals also produce syntactically flawed utterances, at least two accounts focus on word-level encoding operations. One account proposes a difficulty with rule-governed…
Faroqi-Shah, Yasmeen; Thompson, Cynthia K.
Research with transcranial magnetic stimulation in the treatment of aphasia.
Repetitive transcranial magnetic stimulation (rTMS) has been used to improve language behavior, including naming, in stroke patients with chronic, nonfluent aphasia. Part 1 of this article reviews functional imaging studies related to language recovery in aphasia. Part 2 reviews the rationale for using rTMS to treat nonfluent aphasia (based on functional imaging) and presents our current rTMS protocol. We present language results from our rTMS studies as well as imaging results from overt naming functional MRI scans obtained before and after a series of rTMS treatments. Part 3 presents results from a pilot study in which rTMS treatments were followed immediately by constraint-induced language therapy. Part 4 reviews our diffusion tensor imaging study examining the possible connectivity of the arcuate fasciculus to different parts of Broca's area (pars triangularis, pars opercularis) and to the ventral premotor cortex. The potential role of mirror neurons in the right pars opercularis and ventral premotor cortex in aphasia recovery is discussed. PMID:19818232
Martin, Paula I; Naeser, Margaret A; Ho, Michael; Treglia, Ethan; Kaplan, Elina; Baker, Errol H; Pascual-Leone, Alvaro
Measuring Lexical Diversity in Narrative Discourse of People with Aphasia
Purpose: A microlinguistic content analysis for assessing lexical semantics in people with aphasia (PWA) is lexical diversity (LD). Sophisticated techniques have been developed to measure LD. However, validity evidence for these methodologies when applied to the discourse of PWA is lacking. The purpose of this study was to evaluate four measures…
Fergadiotis, Gerasimos; Wright, Heather H.; West, Thomas M.
Effects of Mindfulness Meditation on Three Individuals with Aphasia
Background: There is evidence to suggest that people with aphasia (PWA) may have deficits in attention stemming from the inefficient allocation of resources. The inaccurate perception of task demand, or sense of effort, may underlie the misallocation of the available attention resources. Given the lack of treatment options for improving attention…
Orenstein, Ellen; Basilakos, Alexandra; Marshall, Rebecca Shisler
Short-term and working memory impairments in aphasia
The aim of the present study is to investigate short-term memory and working memory deficits in aphasics in relation to the severity of their language impairment. Fifty-eight aphasic patients participated in this study. Based on language assessment, an aphasia score was calculated for each patient. Memory was assessed in two modalities, verbal and spatial. Mean scores for all memory tasks
Constantin Potagas; Dimitrios Kasselimis; Ioannis Evdokimidis
Are there susceptibility factors for primary progressive aphasia?
The determinants of selective vulnerability in neurodegenerative diseases remain elusive. The asymmetric loss of neurons in primary progressive aphasia offers a unique setting for addressing this question. Although no factor can yet account for the selective vulnerability of the left hemisphere language network to degenerative diseases, a few themes are emerging as potential targets of further investigation. PMID:23489582
Rogalski, Emily; Weintraub, Sandra; Mesulam, M-Marsel
Speech Errors in Progressive Non-Fluent Aphasia
The nature and frequency of speech production errors in neurodegenerative disease have not previously been precisely quantified. In the present study, 16 patients with a progressive form of non-fluent aphasia (PNFA) were asked to tell a story from a wordless children's picture book. Errors in production were classified as either phonemic,…
Ash, Sharon; McMillan, Corey; Gunawardena, Delani; Avants, Brian; Morgan, Brianna; Khan, Alea; Moore, Peachie; Gee, James; Grossman, Murray
Aphasia rehabilitation and the strange neglect of speed
Timing data is infrequently reported in aphasiological literature and time taken is only a minor factor, where it is considered at all, in existing aphasia assessments. This is not surprising because reaction times are difficult to obtain manually, but it is a pity, because speed data should be indispensable in assessing the severity of language processing disorders and in evaluating
M. Alison Crerar
Processing proper nouns in aphasia: Evidence from assessment and therapy
Background: Dissociations between proper and common names following brain damage have frequently been reported (see Yasuda, Nakamura, & Beckman, 2000, for review) and suggest that these different word classes are processed by distinct mechanisms. The dissociations are often observed in people with relatively pure impairments, but might also be expected more generally in aphasia. There is the further possibility that
Jo Robson; Jane Marshall; Tim Pring; Ann Montagu; Shula Chiat
Aphasia assessment and therapy using hypertext-related tasks
This paper discusses the potential usefulness of hypertext tools in communication disorders, particularly in aphasia assessment and therapy. The assessment of language comprehension abilities can be enhanced by evaluating patient performance on information-retrieval tasks. Hypertext tools can be used to gather information about patients' planning abilities and their semantic understanding of the available information. The paper explores the use of
Sameer Singh; Brain Petheram
Identifying Behavioral Measures of Stress in Individuals with Aphasia
Purpose: To develop valid indicators of stress in individuals with aphasia (IWA) by examining the relationship between certain language variables (error frequency [EF] and word productivity [WP]) and cortisol reactivity. Method: Fourteen IWA and 10 controls participated in a speaking task. Salivary cortisol was collected pre- and posttask. WP and…
Laures-Gore, Jacqueline S.; DuBay, Michaela F.; Duff, Melissa C.; Buchanan, Tony W.
Gesturing by Speakers with Aphasia: How Does It Compare?
Purpose: To study the independence of gesture and verbal language production. The authors assessed whether gesture can be semantically compensatory in cases of verbal language impairment and whether speakers with aphasia and control participants use similar depiction techniques in gesture. Method: The informativeness of gesture was assessed in 3…
Mol, Lisette; Krahmer, Emiel; van de Sandt-Koenderman, Mieke
Pre-Lexical Disorders in Repetition Conduction Aphasia
At the level of clinical speech/language evaluation, the repetition type of conduction aphasia is characterized by repetition difficulties concomitant with reduced short-term memory capacities, in the presence of fluent spontaneous speech as well as unimpaired naming and reading abilities. It is still unsettled which dysfunctions of the…
Sidiropoulos, Kyriakos; de Bleser, Ria; Ackermann, Hermann; Preilowski, Bruno
Progressive aphasia presenting with deep dyslexia and dysgraphia.
Primary progressive aphasia is clinically heterogeneous. We report a patient, alias Don, with a novel form of progressive aphasia, characterised by deep dyslexia and dysgraphia and dissociated access to phonological and orthographic word forms. The hallmarks of deep dyslexia and dysgraphia were present early in the course and persisted over time. Writing was initially poorer than reading, but this reversed over time. There was a lack of concordance between reading and writing errors. Don benefited from a semantic mediation strategy to learn letter sounds, involving associating letters with a country name (e.g., A=Afghanistan). Remarkably, he continued to be able to generate those phonologically complex country names when no longer able to name or sound letters. Don's performance is compatible with a traditional dual-route account of deep dyslexia and dysgraphia. The findings have potential practical implications for speech and language therapy in progressive aphasia. Moreover, they illustrate both the remarkable specificity yet clinical diversity in presentation of progressive aphasia. PMID:22465163
Snowden, Julie S; Kindell, Jacqueline; Thompson, Jennifer C; Richardson, Anna M T; Neary, David
Research with Transcranial Magnetic Stimulation in the Treatment of Aphasia
Repetitive transcranial magnetic stimulation (rTMS) has been used to improve language behavior, including naming, in stroke patients with chronic, nonfluent aphasia. Part 1 of this paper reviews functional imaging studies related to language recovery in aphasia. Part 2 reviews the rationale for using rTMS to treat nonfluent aphasia (based on functional imaging); and presents our current rTMS protocol. We present language results from our rTMS studies, and imaging results from overt naming fMRI scans obtained pre- and post- a series of rTMS treatments. Part 3 presents results from a pilot study where rTMS treatments were followed immediately by constraint-induced language therapy. Part 4 reviews our diffusion tensor imaging study that examined possible connectivity of arcuate fasciculus to different parts of Broca's area (pars triangularis, PTr; pars opercularis, POp); and to ventral premotor cortex (vPMC). The potential role of mirror neurons in R POp and vPMC in aphasia recovery is discussed.
Martin, Paula I; Naeser, Margaret A.; Ho, Michael; Treglia, Ethan; Kaplan, Elina; Baker, Errol H.; Pascual-Leone, Alvaro
Patterns of dysgraphia in primary progressive aphasia compared to post-stroke aphasia.
We report patterns of dysgraphia in participants with primary progressive aphasia that can be explained by assuming disruption of one or more cognitive processes or representations in the complex process of spelling. These patterns are compared to those described in participants with focal lesions (stroke). Using structural imaging techniques, we found that damage to the left extrasylvian regions, including the uncinate, inferior fronto-occipital fasciculus, and sagittal stratum (including geniculostriate pathway and inferior longitudinal fasciculus), as well as other deep white and grey matter structures, was significantly associated with impairments in access to orthographic word forms and semantics (with reliance on phonology-to-orthography to produce a plausible spelling in the spelling to dictation task). These results contribute not only to our understanding of the patterns of dysgraphia following acquired brain damage but also the neural substrates underlying spelling. PMID:22713396
Faria, Andreia V; Crinion, Jenny; Tsapkini, Kyrana; Newhart, Melissa; Davis, Cameron; Cooley, Shannon; Mori, Susumu; Hillis, Argye E
Patterns of Dysgraphia in Primary Progressive Aphasia Compared to Post-Stroke Aphasia
We report patterns of dysgraphia in participants with primary progressive aphasia that can be explained by assuming disruption of one or more cognitive processes or representations in the complex process of spelling. These patterns are compared to those described in participants with focal lesions (stroke). Using structural imaging techniques, we found that damage to the left extrasylvian regions, including the uncinate, inferior fronto-occipital fasciculus, and sagittal stratum (including geniculostriate pathway and inferior longitudinal fasciculus), as well as other deep white and grey matter structures, was significantly associated with impairments in access to orthographic word forms and semantics (with reliance on phonology-to-orthography to produce a plausible spelling in the spelling to dictation task). These results contribute not only to our understanding of the patterns of dysgraphia following acquired brain damage but also the neural substrates underlying spelling.
Faria, Andreia V.; Crinion, Jenny; Tsapkini, Kyrana; Newhart, Melissa; Davis, Cameron; Cooley, Shannon; Mori, Susumu; Hillis, Argye E.
Evaluating the Effectiveness of Intervention in Long-Term Aphasia Post-Stroke: The Experience from CHANT (Communication Hub for Aphasia in North Tyneside)
Background: Despite recognition of the need for increased long-term support for people with aphasia following stroke, there remains limited evidence for effective service-level interventions. Aims: To evaluate the outcomes and experiences of people participating in the Communication Hub for Aphasia in North Tyneside (CHANT), a 2-year partnership…
Mumby, Katharyn; Whitworth, Anne
Crossed aphasia: An analysis of the symptoms, their frequency, and a comparison with left-hemisphere aphasia symptomatology
This study presents a thorough analysis of published crossed aphasia (CA) cases, including for the first time the cases published in Japanese. The frequency of specific symptoms was determined, and symptomatology differences based on gender, familial sinistrality, and CA subtype were investigated. Results suggested that the CA population is comparable to the left-hemisphere patient population. However, male were significantly more
Patrick Coppens; Suzanne Hungerford; Satoshi Yamaguchi; Atsushi Yamadori
[Disruption and recovery of grammatical speech in patients with acoustic-mnestic aphasia].
The clinical picture of acustico-mnestical aphasia, besides defects of understanding, naming and reiteration is characterized by disorders of a grammatical shaping of statements as well. Such disorders as yet have not been specially studied. The conducted study explored disorders and rehabilitation of speech grammar in 10 patients with acustico-mnestical aphasia with the aid of a neuro-linguistical analysis of spontaneous speech in patients and some special tests. The study made it possible to eliminate general types of agrammatism in different forms of aphasia and disorders, specific of acustico-mnestical aphasia. The suggested methods appeared to be adequate for a rehabilitation of speech grammar in this group of patients. Besides rehabilitative training may be used as a supplementary method for studying the character and structure of agrammatism in acustico-mnestical aphasia. The achieved results may be used for the diagnostics and rehabilitation of speech in this form of aphasia. PMID:1210963
Glozman, Zh M; Kalita, N G
Language assessment of a Farsi-Norwegian bilingual speaker with aphasia.
The increased occurrence of strokes combined with the high incidence of bilingualism in many regions of the world has led to an increasing number of bilingual adults with aphasia. The literature on bilingual aphasia shows the need for valid, comprehensive and reliable assessment tools for diagnostic and treatment purposes. In spite of a growing number of case studies of bilingual speakers with aphasia, there is still a need for more studies of speakers with different language combinations. This case study describes a Farsi-Norwegian bilingual speaker with aphasia. Data were collected using the Bilingual Aphasia Test in both languages. The aim of this study is to show how assessment of both languages of a bilingual speaker with aphasia may reveal differences in linguistic competence between the languages and to discuss the relevance of the assessment for clinical practice. PMID:21453037
Koumanidi Knoph, Monica I
Functional measures of naming in aphasia: Word retrieval in confrontation naming versus connected speech
Background: Word-finding difficulties are central to aphasia and as such have received a great deal of attention in aphasia research. Although treatment for lexical retrieval impairments can be effective, studies often use measurement of single-word performance (e.g., confrontation naming) to support such claims. In contrast, what matters most to patients with aphasia and their families is the ability to converse.
Jamie Mayer; Laura Murray
A Comparison of Picture Description Abilities in Individuals with Vascular Subcortical Lesions and Huntington's Disease
The lexical-semantic and syntactic abilities of a group of individuals with chronic nonthalamic subcortical (NS) lesions following stroke (n=6) were investigated using the Western Aphasia Battery (WAB) picture description task [Kertesz, A. (1982). "The Western aphasia battery." New York: Grune and Stratton] and compared with those of a group of…
Jensen, Angela M.; Chenery, Helen J.; Copland, David A.
Conversation Therapy for Agrammatism: Exploring the Therapeutic Process of Engagement and Learning by a Person with Aphasia
Background & Aims: A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment…
Beckley, Firle; Best, Wendy; Johnson, Fiona; Edwards, Susan; Maxim, Jane; Beeke, Suzanne
Validity of an eye-tracking method to index working memory in people with and without aphasia
Background: Working memory (WM) is essential to auditory comprehension; thus understanding of the nature of WM is vital to research and clinical practice to support people with aphasia. A key challenge in assessing WM in people with aphasia is related to the myriad deficits prevalent in aphasia, including deficits in attention, hearing, vision, speech, and motor control of the limbs.
Aphasia following Striatocapsular Infarction May Be Explained by Concomitant Small Cortical Infarct on Diffusion-Weighted Imaging
Background: The underlying mechanism of aphasia following striatocapsular infarction (SCI) remains controversial. We hypothesized that aphasia resulting from SCI might be associated with concomitant cortical lesions, which can be demonstrated by diffusion-weighted imaging (DWI). Methods: We analyzed 24 patients with left SCI who underwent DWI and MR angiography within 2 days after the onset. Aphasia was assessed by the modified
Moon-Ku Han; Dong-Wha Kang; Sang-Wuk Jeong; Jae-Kyu Roh
[Total aphasia and speech therapy: a case history (author's transl)].
The medical profession and therapists continue to believe that total aphasia is untreable. A case report is used to demonstrate the diagnostic features of aphasia and describe the course of the impairment from the complete loss of speech, via the learning of highly automated expressions to the aquisition of single words which the patient uses independently in the different contexts. This development involves all language functions equally. The therapy is based on conventional methods, deblocking stategies, speech therapeutic talks - principal item of the treatment - and dialogue exercises carried out under normal conditions. The problems relating to deblocking methods are discussed. A description is made of the methods which have been developed from a combined audiovisual, tactile and writing motoric speech activation programme. The article presents the linguistic signs of the syndrome in an advanced stage and demonstrates the development of the thinking structure and the psychic problems with the help of the tree drawings. PMID:866802
Birchmeier-Nussbaumer, A K
Analysis of VOT in Turkish speakers with aphasia.
Studies investigating voicing onset time (VOT) production by speakers with aphasia have shown that nonfluent aphasics show a deficit in the articulatory programming of speech sounds based on the range of VOT values produced by aphasic individuals. If the VOT value lies between the normal range of VOT for the voiced and voiceless categories, then it is a phonetic distortion, thus a phonetic/articulatory deficit. A number of studies in different languages (French, English, Thai, Taiwanese) have investigated VOT in aphasic subjects in which their VOT values have been compared to those of normal speakers. This study investigates the VOT productions of voiced and voiceless stops by Turkish speakers with aphasia. Six patients with different aetiologies but similar language characteristics participated in this study. The results suggest that although Turkish nonfluent aphasics exhibit unimodal distribution of VOT production, the VOT values and ranges show language-specific properties. PMID:21091206
Kopkalli-Yavuz, Handan; Mavis, Ilknur; Akyildiz, Didem
Frontotemporal dementia and primary progressive aphasia, a review
Frontotemporal dementias are neurodegenerative diseases in which symptoms of frontal and/or temporal lobe disease are the first signs of the illness, and as the diseases progress, they resemble a focal left hemisphere process such as stroke or traumatic brain injury, even more than a neurodegenerative disease. Over time, some patients develop a more generalized dementia. Four clinical subtypes characterize the predominant presentations of this illness: behavioral or frontal variant FTD, progressive nonfluent aphasia, semantic dementia, and logopenic primary progressive aphasia. These clinical variants correlate with regional patterns of atrophy on brain imaging studies such as MRI and PET scanning, as well as with biochemical and molecular genetic variants of the disorder. The treatment is as yet only symptomatic, but advances in molecular genetics promise new therapies.
Kirshner, Howard S
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Development of a Partial Balint's Syndrome in a Congenitally Deaf Patient Presenting as Pseudo-Aphasia
We present a 56 year-old, right-handed, congenitally deaf, female who exhibited a partial Balint's syndrome accompanied by positive visual phenomena restricted to her lower right visual quadrant (e.g., color band, transient unformed visual hallucinations). Balint's syndrome is characterized by a triad of visuo-ocular symptoms that typically occur following bilateral parieto-occipital lobe lesions. These symptoms include the inability to perceive simultaneous events in one's visual field (simultanagnosia), an inability to fixate and follow an object with one's eyes (optic apraxia), and an impairment of target pointing under visual guidance (optic ataxia). Our patient exhibited simultanagnosia, optic ataxia, left visual-field neglect, and impairment of all complex visual-spatial tasks, yet demonstrated normal visual acuity, intact visual-fields, and an otherwise normal neurocognitive profile. The patient's visuo-ocular symptoms were noticed while she was participating in rehabilitation for a small right pontine stroke. White matter changes involving both occipital lobes had been incidentally noted on the CT scan revealing the pontine infarction. As the patient relied upon sign language and reading ability for communication, these visuo-perceptual limitations hindered her ability to interact with others and gave the appearance of aphasia. We discuss the technical challenges of assessing a patient with significant barriers to communication (e.g., the need for a non-standardized approach, a lack of normative data for such special populations), while pointing out the substantial contributions that can be made by going beyond the standard neuropsychological test batteries.
Drane, Daniel L.; Lee, Gregory P.; Huthwaite, Justin S.; Tirschwell, David L.; Baudin, Brett C.; Jurado, Miguel; Ghodke, Basavaraj; Marchman, Holmes B.
Motor aphasia: A rare complication of scorpion sting
Scorpion sting is common in villages, and is an important public health problem in India. The clinical symptoms of envenomation by scorpion sting are by sympathetic and parasympathetic stimulation, causing a variety of symptoms. The leading causes of death are cardiac dysfunction and pulmonary edema. We present herein a case of scorpion sting in a 9-year-old boy who developed pulmonary edema and gradually developed cytotoxic cerebral edema with infarct leading to motor aphasia with upper motor neuron facial palsy.
Kshirsagar, Vinayak Y.; Ahmed, Minhajuddin; Colaco, Sylvia M.
Background: Recent advances in the application of transcranial direct current stimulation (tDCS) in healthy populations have led to the exploration of the technique as an adjuvant method to traditional speech therapies in patients with post-stroke aphasia.Aims: The purpose of the review is: (i) to review the features of tDCS that make it an attractive tool for research and potential future
Rachel Holland; Jenny Crinion
Background: Recent advances in the application of transcranial direct current stimulation (tDCS) in healthy populations have led to the exploration of the technique as an adjuvant method to traditional speech therapies in patients with post-stroke aphasia.Aims: The purpose of the review is: (i) to review the features of tDCS that make it an attractive tool for research and potential future use in
Pragmatic assessment in adult aphasia: A clinical review
A range of pragmatic assessment instruments available for use with adults with aphasia is reviewed in relation to a specified perspective of pragmatic meanings (Bates 1976). The reviewed assessment instruments are divided into five hroad categories. These categories are: (1) observational profiles, (2) communicative efficiency measures, (3) standardized testing in real and\\/or simulated life situations, (4) family\\/significant others questionnaires\\/analyses, and
Sriwimon Manochiopinig; Christine Sheard; Vicki A. Reed
Galantamine in Frontotemporal Dementia and Primary Progressive Aphasia
Background\\/Aims: The treatment of frontotemporal dementia (FTD) has been mainly symptomatic. Small randomized or open-label case control studies of neurotransmitters have been inconclusive. We tried galantamine in the 2 most common varieties of FTD. Method: Thirty-six behavioral variety FTD and primary progressive aphasia (PPA) patients were treated in an open-label period of 18 weeks and a randomized, placebo-controlled phase for
A. Kertesz; D. Morlog; M. Light; M. Blair; W. Davidson; S. Jesso; R. Brashear
Lateralization of Cognitive Functions in Aphasia after Right Brain Damage
Purpose The lateralization of cognitive functions in crossed aphasia in dextrals (CAD) has been explored and compared mainly with cases of aphasia with left hemisphere damage. However, comparing the neuropsychological aspects of CAD and aphasia after right brain damage in left-handers (ARL) could potentially provide more insights into the effect of a shift in the laterality of handedness or language on other cognitive organization. Thus, this case study compared two cases of CAD and one case of ARL. Materials and Methods The following neuropsychological measures were obtained from three aphasic patients with right brain damage (two cases of CAD and one case of ARL); language, oral and limb praxis, and nonverbal cognitive functions (visuospatial neglect and visuospatial construction). Results All three patients showed impaired visuoconstructional abilities, whereas each patient showed a different level of performances for oral and limb praxis, and visuospatial neglect. Conclusion Based on the analysis of these three aphasic patients' performances, we highlighted the lateralization of language, handedness, oral and limb praxis, visuospatial neglect and visuospatial constructive ability in aphasic patients with right brain damage.
Ha, Ji-Wan; Hwang, Yu Mi; Sim, Hyunsub
Systematic review of communication partner training in aphasia: methodological quality.
Twenty-three studies identified from a previous systematic review examining the effects of communication partner training on persons with aphasia and their communication partners were evaluated for methodological quality. Two reviewers rated the studies on defined methodological quality criteria relevant to each study design. There were 11 group studies, seven single-subject participant design studies, and five qualitative studies. Quality scores were derived for each study. The mean inter-rater reliability of scores for each study design ranged from 85-93%, with Cohen's Kappa indicating substantial agreement between raters. Methodological quality of research on communication partner training in aphasia was highly varied. Overall, group studies employed the least rigorous methodology as compared to single subject and qualitative research. Only two of 11 group studies complied with more than half of the quality criteria. No group studies reported therapist blinding and only one group study reported participant blinding. Across all types of studies, the criterion of treatment fidelity was most commonly omitted. Failure to explicitly report certain methodological quality criteria may account for low ratings. Using methodological rating scales specific to the type of study design may help improve the methodological quality of aphasia treatment studies, including those on communication partner training. PMID:23451832
Cherney, Leora R; Simmons-Mackie, Nina; Raymer, Anastasia; Armstrong, Elizabeth; Holland, Audrey
From singing to speaking: facilitating recovery from nonfluent aphasia.
It has been reported for more than 100 years that patients with severe nonfluent aphasia are better at singing lyrics than they are at speaking the same words. This observation led to the development of melodic intonation therapy (MIT). However, the efficacy of this therapy has yet to be substantiated in a randomized controlled trial. Furthermore, its underlying neural mechanisms remain unclear. The two unique components of MIT are the intonation of words and simple phrases using a melodic contour that follows the prosody of speech and the rhythmic tapping of the left hand that accompanies the production of each syllable and serves as a catalyst for fluency. Research has shown that both components are capable of engaging fronto-temporal regions in the right hemisphere, thereby making MIT particularly well suited for patients with large left hemisphere lesions who also suffer from nonfluent aphasia. Recovery from aphasia can happen in two ways: either through the recruitment of perilesional brain regions in the affected hemisphere, with variable recruitment of right-hemispheric regions if the lesion is small, or through the recruitment of homologous language and speech-motor regions in the unaffected hemisphere if the lesion of the affected hemisphere is extensive. Treatment-associated neural changes in patients undergoing MIT indicate that the unique engagement of right-hemispheric structures (e.g., the superior temporal lobe, primary sensorimotor, premotor and inferior frontal gyrus regions) and changes in the connections across these brain regions may be responsible for its therapeutic effect. PMID:21088709
Schlaug, Gottfried; Norton, Andrea; Marchina, Sarah; Zipse, Lauryn; Wan, Catherine Y
Using Semantic Feature Analysis to Improve Contextual Discourse in Adults with Aphasia
Purpose: Semantic feature analysis (SFA) was used to determine whether training contextually related words would improve the discourse of individuals with nonfluent aphasia in preselected contexts. Method: A modified multiple-probes-across-behaviors design was used to train target words using SFA in 3 adults with nonfluent aphasia. Pretreatment,…
Rider, Jill Davis; Wright, Heather Harris; Marshall, Robert C.; Page, Judith L.
Effects of Word Frequency and Modality on Sentence Comprehension Impairments in People with Aphasia
Purpose: It is well known that people with aphasia have sentence comprehension impairments. The present study investigated whether lexical factors contribute to sentence comprehension impairments in both the auditory and written modalities using online measures of sentence processing. Method: People with aphasia and non brain-damaged controls…
DeDe, Gayle
Having the courage to be competent: persons and families living with aphasia
This paper provides examples and illustrations of how aphasic people can and do demonstrate their competence in managing their lives despite chronic aphasia. It discusses a number of ways in which aphasic persons and their families can learn to live fully despite the intrusion of aphasia.Educational objectives: After reading this paper, participants should (1) have a more fully developed appreciation
Robert C. Marshall
Effects of working memory load on processing of sounds and meanings of words in aphasia
Background: Language performance in aphasia can vary depending on several variables such as stimulus characteristics and task demands. This study focuses on the degree of verbal working memory (WM) load inherent in the language task and how this variable affects language performance by individuals with aphasia.Aims: The first aim was to identify the effects of increased verbal WM load on
Nadine Martin; Francine Kohen; Michelene Kalinyak-Fliszar; Anna Soveri; Matti Laine
Interviewing people with aphasia: Insights into method adjustments from a pilot study
Background: An increasing number of researchers are using qualitative methods to study the impact of aphasia. However, there is a paucity of published research outlining if and how qualitative interview methods are altered with participants with aphasia, and how potential modifications impact on the rigour of such research.Aims: In a qualitative, pilot study we investigated (1) What services do males
Amy M. Luck; Miranda L. Rose
"You Needed to Rehab...Families as Well": Family Members' Own Goals for Aphasia Rehabilitation
Background: Aphasia affects family members in addition to the individuals with the communication disorder. In order to develop appropriate services for the relatives of people with aphasia post-stroke, their rehabilitation goals need to be identified. Aim: The aim of the current investigation was to identify the rehabilitation goals that family…
Howe, Tami; Davidson, Bronwyn; Worrall, Linda; Hersh, Deborah; Ferguson, Alison; Sherratt, Sue; Gilbert, Jocelyn
A MEG Investigation of Single-Word Auditory Comprehension in Aphasia
Purpose: To explore whether individuals with aphasia exhibit differences in the M350, an electrophysiological marker of lexical activation, compared with healthy controls. Method: Seven people with aphasia, 9 age-matched controls, and 10 younger controls completed an auditory lexical decision task while cortical activity was recorded with…
Zipse, Lauryn; Kearns, Kevin; Nicholas, Marjorie; Marantz, Alec
Support for Anterior Temporal Involvement in Semantic Error Production in Aphasia: New Evidence from VLSM
Semantic errors in aphasia (e.g., naming a horse as "dog") frequently arise from faulty mapping of concepts onto lexical items. A recent study by our group used voxel-based lesion-symptom mapping (VLSM) methods with 64 patients with chronic aphasia to identify voxels that carry an association with semantic errors. The strongest associations were…
Walker, Grant M.; Schwartz, Myrna F.; Kimberg, Daniel Y.; Faseyitan, Olufunsho; Brecher, Adelyn; Dell, Gary S.; Coslett, H. Branch
Default-Mode Network Functional Connectivity in Aphasia: Therapy-Induced Neuroplasticity
Previous research on participants with aphasia has mainly been based on standard functional neuroimaging analysis. Recent studies have shown that functional connectivity analysis can detect compensatory activity, not revealed by standard analysis. Little is known, however, about the default-mode network in aphasia. In the current study, we studied…
Marcotte, Karine; Perlbarg, Vincent; Marrelec, Guillaume; Benali, Habib; Ansaldo, Ana Ines
Development of a Short Form of the Boston Naming Test for Individuals with Aphasia
Purpose: The purpose of this study was to develop a short form of the Boston Naming Test (BNT; Kaplan, Goodglass, & Weintraub, 2001) for individuals with aphasia and compare it with 2 existing short forms originally analyzed with responses from people with dementia and neurologically healthy adults. Method: Development of the new BNT-Aphasia Short…
del Toro, Christina M.; Bislick, Lauren P.; Comer, Matthew; Velozo, Craig; Romero, Sergio; Rothi, Leslie J. Gonzalez; Kendall, Diane L.
Comparing connected language elicitation procedures in persons with aphasia: Concurrent validation of the Story Retell Procedure
Background: The Story Retell Procedure (SRP) (Doyle et al., 1998) is a well?described method for eliciting connected language samples in persons with aphasia (PWA). However, the stimuli and task demands of the SRP are fundamentally different from commonly employed picture description, narrative, and procedural description tasks reported in the aphasia literature. As such, the extent to which measures of linguistic
Malcolm R. McNeil; Jee Eun Sung; Dorothy Yang; Sheila R. Pratt; Tepanta R. D. Fossett; Patrick J. Doyle; Stacey Pavelko
Spared musical abilities in a conductor with global aphasia and ideomotor apraxia.
A conductor suddenly developed global aphasia and severe ideomotor apraxia as a result of an infarct in the territory of the left middle cerebral artery. Although aphasia and apraxia remained unchanged during the following six years, his musical capacities were largely spared and he was still able to conduct. This case provides some evidence in favour of right hemisphere dominance for music. Images
Basso, A; Capitani, E
Supervised Home Training of Dialogue Skills in Chronic Aphasia: A Randomized Parallel Group Study
Purpose: The aim of this study was to prove the efficacy of supervised self-training for individuals with aphasia. Linguistic and communicative performance in structured dialogues represented the main study parameters. Method: In a cross-over design for randomized matched pairs, 18 individuals with chronic aphasia were examined during 12 weeks of…
Nobis-Bosch, Ruth; Springer, Luise; Radermacher, Irmgard; Huber, Walter
Language Assessment of a Farsi-Norwegian Bilingual Speaker with Aphasia
The increased occurrence of strokes combined with the high incidence of bilingualism in many regions of the world has led to an increasing number of bilingual adults with aphasia. The literature on bilingual aphasia shows the need for valid, comprehensive and reliable assessment tools for diagnostic and treatment purposes. In spite of a growing…
Koumanidi Knoph, Monica I.
Autonomy and empowerment in aphasia assessment and therapy: Isn't it the road more travelled?
In the lead article, the author expresses her serious concerns regarding the state-of-the-art in the functional assessment and treatment of aphasia. She offers social models of literacy and disability, which are referred to as 'radical approaches', as a means of addressing this current dilemma in aphasia rehabilitation. In reading the lead article, one senses that clinical aphasiologists have been down
Monica Strauss Hough
Releasing the Constraints on Aphasia Therapy: The Positive Impact of Gesture and Multimodality Treatments
Purpose: There is a 40-year history of interest in the use of arm and hand gestures in treatments that target the reduction of aphasic linguistic impairment and compensatory methods of communication (Rose, 2006). Arguments for constraining aphasia treatment to the verbal modality have arisen from proponents of constraint-induced aphasia therapy…
Rose, Miranda L.
The Use of a Modified Semantic Features Analysis Approach in Aphasia
Several studies have reported improved naming using the semantic feature analysis (SFA) approach in individuals with aphasia. Whether the SFA can be modified and still produce naming improvements in aphasia is unknown. The present study was designed to address this question by using a modified version of the SFA approach. Three, rather than the…
Hashimoto, Naomi; Frome, Amber
Using Text-to-Speech Reading Support for an Adult with Mild Aphasia and Cognitive Impairment
This single case study served to examine text-to-speech (TTS) effects on reading rate and comprehension in an individual with mild aphasia and cognitive impairment. Findings showed faster reading, given TTS presented at a normal speaking rate, but no significant comprehension changes. TTS may support reading in people with aphasia when time…
Harvey, Judy; Hux, Karen; Snell, Jeffry
Communication Difficulties and the Use of Communication Strategies: From the Perspective of Individuals with Aphasia
Background: To enhance communicative ability and thereby the possibility of increased participation of persons with aphasia, the use of communication strategies has been proposed. However, little is known about how persons with aphasia experience having conversations and how they perceive their own and their conversation partner's use of…
Johansson, Monica Blom; Carlsson, Marianne; Sonnander, Karin
Gesture and Speech Integration: An Exploratory Study of a Man with Aphasia
Background: In order to comprehend fully a speaker's intention in everyday communication, information is integrated from multiple sources, including gesture and speech. There are no published studies that have explored the impact of aphasia on iconic co-speech gesture and speech integration. Aims: To explore the impact of aphasia on co-speech…
Cocks, Naomi; Sautin, Laetitia; Kita, Sotaro; Morgan, Gary; Zlotowitz, Sally
Group Effects of Instrumentality and Name Relation on Action Naming in Bilingual Anomic Aphasia
Verb production in sentences was investigated in two groups of late bilingual Greek-English speakers: individuals with anomic aphasia and a control group. Verb retrieval in sentences was significantly impaired in both languages for the individuals with anomic aphasia. Additional results revealed no effect of instrumentality on action naming in…
Kambanaros, Maria
A Comparison of Intention and Pantomime Gesture Treatment for Noun Retrieval in People with Aphasia
Purpose: The effects of intention gesture treatment (IGT) and pantomime gesture treatment (PGT) on word retrieval were compared in people with aphasia. Method: Four individuals with aphasia and word retrieval impairments subsequent to left-hemisphere stroke participated in a single-participant crossover treatment design. Each participant viewed…
Ferguson, Neina F.; Evans, Kelli; Raymer, Anastasia M.
Error Variability and the Differentiation between Apraxia of Speech and Aphasia with Phonemic Paraphasia
Purpose: This study was conducted to evaluate the clinical utility of error variability for differentiating between apraxia of speech (AOS) and aphasia with phonemic paraphasia. Method: Participants were 32 individuals with aphasia after left cerebral injury. Diagnostic groups were formed on the basis of operationalized measures of recognized…
Haley, Katarina L.; Jacks, Adam; Cunningham, Kevin T.
Changes in N400 Topography Following Intensive Speech Language Therapy for Individuals with Aphasia
Our goal was to characterize the effects of intensive aphasia therapy on the N400, an electrophysiological index of lexical-semantic processing. Immediately before and after 4 weeks of intensive speech-language therapy, people with aphasia performed a task in which they had to determine whether spoken words were a "match" or a "mismatch" to…
Wilson, K. Ryan; O'Rourke, Heather; Wozniak, Linda A.; Kostopoulos, Ellina; Marchand, Yannick; Newman, Aaron J.
Masked Priming Effects in Aphasia: Evidence of Altered Automatic Spreading Activation
Purpose: Previous research has suggested that impairments of automatic spreading activation may underlie some aphasic language deficits. The current study further investigated the status of automatic spreading activation in individuals with aphasia as compared with typical adults. Method: Participants were 21 individuals with aphasia (12 fluent, 9…
Silkes, JoAnn P.; Rogers, Margaret A.
Nonlinguistic Learning in Individuals with Aphasia: Effects of Training Method and Stimulus Characteristics
Purpose: The purpose of the current study was to explore nonlinguistic learning ability in individuals with aphasia, examining the impact of stimulus typicality and feedback on success with learning. Method: Eighteen individuals with aphasia and 8 nonaphasic controls participated in this study. All participants completed 4 computerized,…
Vallila-Rohter, Sofia; Kiran, Swathi
Using mobile technology with individuals with aphasia: native iPad features and everyday apps.
The use of mobile technology, including smartphones and tablet devices, is a growing trend among adults nationwide, and its potential use in aphasia rehabilitation has generated widespread interest. Despite this trend, adults living with disability are less likely than other adults to go online. Complicating things further, most adults living with aphasia come from a generation where computers and technology were not an integral part of their lives. Additionally, training adults with aphasia requires a different approach than training those in the same age bracket without a disability. This article describes the mobile technology program at the Adler Aphasia Center in Maywood, New Jersey. The goal of this program is to improve access to mobile technology for people with aphasia. The use of mobile devices is the focus of the article. Mobile technology concepts and skills needed to establish a strong foundation for successful iPad (Apple Inc., Cupertino, CA) use are suggested. We discuss how apps may be used to support aphasia therapy with a focus on apps that are native to the iPad and on other apps that were not specifically developed for aphasia rehabilitation. Challenges in implementing a mobile technology program for people with aphasia and individual member success stories are included. PMID:24449461
Szabo, Gretchen; Dittelman, Janice
Linguistic and Neuropsychological Deficits in Crossed Conduction Aphasia: Report of Three Cases
This study describes the linguistic and neuropsychological findings in three right-handed patients with crossed conduction aphasia. Despite the location of the lesion in the right hemisphere, all patients displayed a combination of linguistic deficits typically found in conduction aphasia following analogous damage to the left hemisphere.…
Bartha, Lisa; Marien, Peter; Poewe, Werner; Benke, Thomas
A comparison of client and therapist goals for people with aphasia: A qualitative exploratory study
Background: A considerable body of literature attests to the efficacy of client and therapist collaborative goal setting to achieving optimal rehabilitation outcomes. Collaborative goal setting and shared decision making relies on good communication, thus potentially disadvantaging people with aphasia.Aims: This study aims to identify the similarities and differences between client goals and therapist goals in rehabilitation for people with aphasia
Alexia Rohde; Kerry Townley-ONeill; Karine Trendall; Linda Worrall; Petrea Cornwell
Language therapy and bilingual aphasia: Clinical implications of psycholinguistic and neuroimaging research
Given the increasing number of bilinguals around the world, bilingual aphasia has become a hot topic in the field of clinical and theoretical research in communication sciences. The aim of this article is to provide data-driven cues for intervention with bilingual aphasia. First, the impact of a number of factors considered to influence second language processing will be discussed with
Ana Inés Ansaldo; Karine Marcotte; Lilian Scherer; Gaelle Raboyeau
C-Speak Aphasia Alternative Communication Program for People with Severe Aphasia: Importance of Executive Functioning and Semantic Knowledge
Learning how to use a computer-based communication system can be challenging for people with severe aphasia even if the system is not word-based. This study explored cognitive and linguistic factors relative to how they affected individual patients' ability to communicate expressively using C-Speak Aphasia, (CSA), an alternative communication computer program that is primarily picture-based. Ten individuals with severe non-fluent aphasia received at least six months of training with CSA. To assess carryover of training, untrained functional communication tasks (i.e., answering autobiographical questions, describing pictures, making telephone calls, describing a short video, and two writing tasks) were repeatedly probed in two conditions: 1) using CSA in addition to natural forms of communication, and 2) using only natural forms of communication, e.g., speaking, writing, gesturing, drawing. Four of the ten participants communicated more information on selected probe tasks using CSA than they did without the computer. Response to treatment also was examined in relation to baseline measures of non-linguistic executive function skills, pictorial semantic abilities, and auditory comprehension. Only nonlinguistic executive function skills were significantly correlated with treatment response.
Nicholas, Marjorie; Sinotte, Michele P.; Helm-Estabrooks, Nancy
Effects of Syntactic Complexity, Semantic Reversibility and Explicitness on Discourse Comprehension in Persons with Aphasia and in Healthy Controls
Purpose Prior studies of discourse comprehension have concluded that the deficits of persons with aphasia (PWA) in syntactically based comprehension of sentences in isolation are not predictive of deficits in comprehending sentences in discourse (Brookshire & Nicholas, 1984; Caplan & Evans, 1990). However, these studies used semantically constrained sentences in discourse, which do not require syntactic analysis to be understood. We developed a discourse task to assess the effect of syntactic complexity, among other factors, upon discourse comprehension. Method 38 PWA and 30 healthy control subjects were presented with passages that contained 2 – 3 semantically reversible sentences that were either syntactically simple or syntactically complex. The passages were presented auditorily and comprehension was assessed with the auditory and written presentation of four multiple-choice questions immediately following each passage. Results Passages with syntactically simple sentences were better understood than passages with syntactically complex sentences. Moreover, semantically constrained sentences were more likely to be accurately interpreted than semantically reversible sentences. Comprehension accuracy on our battery correlated positively with comprehension accuracy on an existing battery. Conclusions The results show that the presence of semantically reversible syntactically complex sentences in a passage affects comprehension of the passage in both PWA and neurologically healthy individuals.
Levy, Joshua; Hoover, Elizabeth; Waters, Gloria; Kiran, Swathi; Caplan, David; Berardino, Alex; Sandberg, Chaleece
"Better But No Cigar": Persons with Aphasia Speak about their Speech.
PURPOSE: This study examined responses of persons with aphasia (PWAs) to a general question about their speech. The goal was to describe their evaluative responses as positive, negative, or neutral/mixed and determine if responses differed, based on time post-onset, aphasia severity, and aphasia type. METHODS: 71 participants from the AphasiaBank project were included. As part of a larger protocol, investigators asked, "How do you think your speech is these days?" Responses were videotaped and transcribed using CLAN. Two authors coded the evaluative responses and categorized themes in the elaborative content provided by the participants. RESULTS: Positive responses accounted for 59% of all responses, followed by neutral/mixed (18%), and negative (17%). Participants also mentioned specific speech problems (35%), improvement (31%), and therapy (8%) in their responses. Time post-onset and aphasia type were not significantly associated with nature of response. Aphasia severity was significantly associated with nature of response, with higher AQ scores in the positive group and vice versa. CONCLUSIONS: The responses are discussed in the context of self-image and self-expression in PWA and social models in aphasia therapy. Results are also compared with those of others with chronic disabilities and research on resilience, positive affect, and optimism. PMID:22347765
Fromm, Davida; Holland, Audrey; Armstrong, Elizabeth; Forbes, Margaret; Macwhinney, Brian; Risko, Amy; Mattison, Nicole
A tutorial on aphasia test development in any language: Key substantive and psychometric considerations
Background There are a limited number of aphasia language tests in the majority of the world's commonly spoken languages. Furthermore, few aphasia tests in languages other than English have been standardized and normed, and few have supportive psychometric data pertaining to reliability and validity. The lack of standardized assessment tools across many of the world's languages poses serious challenges to clinical practice and research in aphasia. Aims The current review addresses this lack of assessment tools by providing conceptual and statistical guidance for the development of aphasia assessment tools and establishment of their psychometric properties. Main Contribution A list of aphasia tests in the 20 most widely spoken languages is included. The pitfalls of translating an existing test into a new language versus creating a new test are outlined. Factors to consider in determining test content are discussed. Further, a description of test items corresponding to different language functions is provided, with special emphasis on implementing important controls in test design. Next, a broad review of principal psychometric properties relevant to aphasia tests is presented, with specific statistical guidance for establishing psychometric properties of standardized assessment tools. Conclusions This article may be used to help guide future work on developing, standardizing and validating aphasia language tests. The considerations discussed are also applicable to the development of standardized tests of other cognitive functions.
Ivanova, Maria V.; Hallowell, Brooke
Non-linguistic learning and aphasia: Evidence from a paired associate and feedback-based task
Though aphasia is primarily characterized by impairments in the comprehension and/or expression of language, research has shown that patients with aphasia also show deficits in cognitive-linguistic domains such as attention, executive function, concept knowledge and memory (Helm-Estabrooks, 2002 for review). Research in aphasia suggests that cognitive impairments can impact the online construction of language, new verbal learning, and transactional success (Freedman & Martin, 2001; Hula & McNeil, 2008; Ramsberger, 2005). In our research, we extend this hypothesis to suggest that general cognitive deficits influence progress with therapy. The aim of our study is to explore learning, a cognitive process that is integral to relearning language, yet underexplored in the field of aphasia rehabilitation. We examine non-linguistic category learning in patients with aphasia (n=19) and in healthy controls (n=12), comparing feedback and non-feedback based instruction. Participants complete two computer-based learning tasks that require them to categorize novel animals based on the percentage of features shared with one of two prototypes. As hypothesized, healthy controls showed successful category learning following both methods of instruction. In contrast, only 60% of our patient population demonstrated successful non-linguistic category learning. Patient performance was not predictable by standardized measures of cognitive ability. Results suggest that general learning is affected in aphasia and is a unique, important factor to consider in the field of aphasia rehabilitation.
"Better But No Cigar": Persons with Aphasia Speak about their Speech
Purpose This study examined responses of persons with aphasia (PWAs) to a general question about their speech. The goal was to describe their evaluative responses as positive, negative, or neutral/mixed and determine if responses differed, based on time post-onset, aphasia severity, and aphasia type. Methods 71 participants from the AphasiaBank project were included. As part of a larger protocol, investigators asked, "How do you think your speech is these days?" Responses were videotaped and transcribed using CLAN. Two authors coded the evaluative responses and categorized themes in the elaborative content provided by the participants. Results Positive responses accounted for 59% of all responses, followed by neutral/mixed (18%), and negative (17%). Participants also mentioned specific speech problems (35%), improvement (31%), and therapy (8%) in their responses. Time post-onset and aphasia type were not significantly associated with nature of response. Aphasia severity was significantly associated with nature of response, with higher AQ scores in the positive group and vice versa. Conclusions The responses are discussed in the context of self-image and self-expression in PWA and social models in aphasia therapy. Results are also compared with those of others with chronic disabilities and research on resilience, positive affect, and optimism.
Fromm, Davida; Holland, Audrey; Armstrong, Elizabeth; Forbes, Margaret; MacWhinney, Brian; Risko, Amy; Mattison, Nicole
Progranulin-associated primary progressive aphasia: a distinct phenotype?
The neuropsychological features of the primary progressive aphasia (PPA) syndromes continue to be defined. Here we describe a detailed neuropsychological case study of a patient with a mutation in the progranulin (GRN) gene who presented with progressive word-finding difficulty. Key neuropsychological features in this case included gravely impoverished propositional speech with anomia and prolonged word-finding pauses, impaired speech repetition most marked for sentences, and severely impaired verbal (with preserved spatial) short-term memory. There was a dissociated profile of performance on semantic processing tasks: visual semantic processing was intact, while within the verbal domain, verb comprehension was impaired and processing of nouns was intact on tasks requiring direct semantic processing but impaired on tasks requiring associative or inferential processing. Brain MRI showed asymmetric left cerebral atrophy particularly affecting the temporo-parietal junction, supero-lateral temporal and inferior frontal lobes. This case most closely resembles the PPA syndrome known as the logopenic/phonological aphasia variant (LPA) however there were also deficits of grammar and speech repetition suggesting an overlap with the progressive non-fluent aphasia (agrammatic) variant (PNFA). Certain prominent features of this case (in particular, the profile of semantic impairment) have not been emphasised in previous descriptions of LPA or PNFA, suggesting that GRN may cause an overlapping PPA syndrome but with a distinctive cognitive profile. This neuropsychological evidence suggests that GRN-PPA may result from damage involving the temporo-parietal junction and its functional connections in both the dorsal and ventral language networks, with implications for our understanding of language network pathophysiology. PMID:19766663
Rohrer, Jonathan D; Crutch, Sebastian J; Warrington, Elizabeth K; Warren, Jason D
Global aphasia without hemiparesis caused by a dural arteriovenous fistula.
A 61-year-old Japanese woman with chronic renal failure suddenly became silent at the end of hemodialysis. On a neurological examination, she was unable to respond to one-step commands, state the names of objects, repeat single words, read words aloud or write her name. Because she exhibited no paralysis of the extremities, we diagnosed her as having global aphasia without hemiparesis (GAWH). Cerebral angiography showed a dural arteriovenous fistula (AVF) in the left isolated transverse sinus with leptomeningeal venous drainage (Borden type 3, Lalwani grade 4). This case highlights dural AVF as an etiology of GAWH. PMID:24429454
Togawa, Jumpei; Ohi, Takekazu; Kawarazaki, Satoru
Dissociations Between Fluency And Agrammatism In Primary Progressive Aphasia
Background Classical aphasiology, based on the study of stroke sequelae, fuses speech fluency and grammatical ability. Nonfluent (Broca's) aphasia often is accompanied by agrammatism; whereas in the fluent aphasias grammatical deficits are not typical. The assumption that a similar relationship exists in primary progressive aphasia (PPA) has led to the dichotomization of this syndrome into fluent and nonfluent subtypes. Aims This study compared elements of fluency and grammatical production in the narrative speech of individuals with PPA to determine if they can be dissociated from one another. Method Speech samples from 37 individuals with PPA, clinically assigned to agrammatic (N=11), logopenic (N=20) and semantic (N=6) subtypes, and 13 cognitively healthy control participants telling the "Cinderella Story" were analyzed for fluency (i.e., words per minute (WPM) and mean length of utterance in words (MLU-W)) and grammaticality (i.e., the proportion of grammatically correct sentences, open-to-closed-class word ratio, noun-to-verb ratio, and correct production of verb inflection, noun morphology, and verb argument structure.) Between group differences were analyzed for each variable. Correlational analyses examined the relation between WPM and each grammatical variable, and an off-line measure of sentence production. Outcomes And Results Agrammatic and logopenic groups both had lower scores on the fluency measures and produced significantly fewer grammatical sentences than did semantic and control groups. However, only the agrammatic group evinced significantly impaired production of verb inflection and verb argument structure. In addition, some semantic participants showed abnormal open-to-closed and noun-to-verb ratios in narrative speech. When the sample was divided on the basis of fluency, all the agrammatic participants fell in the nonfluent category. The logopenic participants varied in fluency but those with low fluency showed variable performance on measures of grammaticality. Correlational analyses and scatter plots comparing fluency and each grammatical variable revealed dissociations within PPA participants, with some nonfluent participants showing normal grammatical skill. Conclusions Grammatical production is a complex construct comprised of correct usage of several language components, each of which can be selectively affected by disease. This study demonstrates that individuals with PPA show dissociations between fluency and grammatical production in narrative speech. Grammatical ability, and its relationship to fluency, varies from individual to individual, and from one variant of PPA to another, and can even be found in individuals with semantic PPA in whom a fluent aphasia is usually thought to accompany preserved ability to produce grammatical utterances.
Thompson, Cynthia K.; Cho, Soojin; Hsu, Chien-Ju; Wieneke, Christina; Rademaker, Alfred; Weitner, Bing Bing; Mesulam, M-Marsel; Weintraub, Sandra
Aphasia with elation, hypermusia, musicophilia and compulsive whistling.
A musically naive patient with dominant fronto-temporal and anterior parietal infarct developed transcortical mixed aphasia. From early convalescence, he exhibited elated mood with hyperprosody and repetitive, spontaneous whistling and whistling in response to questions. He often spontaneously sang without error in pitch, melody, rhythm and lyrics, and spent long periods of time listening to music. His behaviour progressively improved in parallel with very good recovery of verbal skills. Musicality and singing are rarely tested at the bedside. Preservation of these abilities in aphasics might portend eventual recovery.
Jacome, D E
Dystypia in acute stroke not attributable to aphasia or neglect.
A 68-year-old right-handed man had a sudden onset of impaired typing ability due to an ischaemic stroke that recovered over 2 months. The typing impairment was grossly out of proportion to his transient handwriting disturbance. Diffusion MRI showed a recent acute left temporoparietal infarct. There was no evidence of aphasia, alexia, agraphia, visuospatial inattention, sensory loss, neglect or poor coordination that could account for his isolated typing impairment. This example of a stroke that disproportionately affected typing more than handwriting abilities has practical implications for what deficits to look for in patients with stroke when assessing their fitness for work and rehabilitation requirements. PMID:24045760
Cook, Fabian Alexander Blyth; Makin, Stephen D J; Wardlaw, Joanna; Dennis, Martin S
Agrammatic primary progressive aphasia in two dextral patients with right hemispheric involvement.
Agrammatic primary progressive aphasia (PPA-G) has been known to be associated with focal brain atrophy involving the left posterior frontal and anterior insular regions. However, aphasia can also rarely result from right hemispheric lesions in right-handed patients, so-called crossed aphasia in dextrals (CAD). We report two right-handed patients with PPA-G whose 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) showed hypometabolism predominantly in the right hemisphere, implicating "crossed PPA-G." PMID:23058062
Jeong, Eun Hye; Lee, Yong Joo; Kwon, Miseon; Kim, Jae Seung; Na, Duk L; Lee, Jae-Hong
Paintable Battery
If the components of a battery, including electrodes, separator, electrolyte and the current collectors can be designed as paints and applied sequentially to build a complete battery, on any arbitrary surface, it would have significant impact on the design, implementation and integration of energy storage devices. Here, we establish a paradigm change in battery assembly by fabricating rechargeable Li-ion batteries solely by multi-step spray painting of its components on a variety of materials such as metals, glass, glazed ceramics and flexible polymer substrates. We also demonstrate the possibility of interconnected modular spray painted battery units to be coupled to energy conversion devices such as solar cells, with possibilities of building standalone energy capture-storage hybrid devices in different configurations.
Singh, Neelam; Galande, Charudatta; Miranda, Andrea; Mathkar, Akshay; Gao, Wei; Reddy, Arava Leela Mohana; Vlad, Alexandru; Ajayan, Pulickel M.
Paintable battery.
If the components of a battery, including electrodes, separator, electrolyte and the current collectors can be designed as paints and applied sequentially to build a complete battery, on any arbitrary surface, it would have significant impact on the design, implementation and integration of energy storage devices. Here, we establish a paradigm change in battery assembly by fabricating rechargeable Li-ion batteries solely by multi-step spray painting of its components on a variety of materials such as metals, glass, glazed ceramics and flexible polymer substrates. We also demonstrate the possibility of interconnected modular spray painted battery units to be coupled to energy conversion devices such as solar cells, with possibilities of building standalone energy capture-storage hybrid devices in different configurations. PMID:22745900
Singh, Neelam; Galande, Charudatta; Miranda, Andrea; Mathkar, Akshay; Gao, Wei; Reddy, Arava Leela Mohana; Vlad, Alexandru; Ajayan, Pulickel M
NASA Astrophysics Data System (ADS)
Enhancement of naming in nonfluent aphasia through gesture.
In a number of studies that have examined the gestural disturbance in aphasia and the utility of gestural interventions in aphasia therapy, a variable degree of facilitation of verbalization during gestural activity has been reported. The present study examined the effect of different unilateral gestural movements on simultaneous oral-verbal expression, specifically naming to confrontation. It was hypothesized that activation of the phylogenetically older proximal motor system of the hemiplegic right arm in the execution of a communicative but nonrepresentational pointing gesture would have a facilitatory effect on naming ability. Twenty-four aphasic patients, representing five aphasic subtypes, including Broca's, Transcortical Motor, Anomic, Global, and Wernicke's aphasics were assessed under three gesture/naming conditions. The findings indicated that gestures produced through activation of the proximal (shoulder) musculature of the right paralytic limb differentially facilitated naming performance in the nonfluent subgroup, but not in the Wernicke's aphasics. These findings may be explained on the view that functional activation of the archaic proximal motor system of the hemiplegic limb, in the execution of a communicative gesture, permits access to preliminary stages in the formative process of the anterior action microgeny, which ultimately emerges in vocal articulation. PMID:2322814
Hanlon, R E; Brown, J W; Gerstman, L J
Anatomy of language impairments in primary progressive aphasia.
Primary progressive aphasia (PPA) is a clinical dementia syndrome characterized by progressive decline in language function but relative sparing of other cognitive domains. There are three recognized PPA variants: agrammatic, semantic, and logopenic. Although each PPA subtype is characterized by the nature of the principal deficit, individual patients frequently display subtle impairments in additional language domains. The present study investigated the distribution of atrophy related to performance in specific language domains (i.e., grammatical processing, semantic processing, fluency, and sentence repetition) across PPA variants to better understand the anatomical substrates of language. Results showed regionally specific relationships, primarily in the left hemisphere, between atrophy and impairments in language performance. Most notable was the neuroanatomical distinction between fluency and grammatical processing. Poor fluency was associated with regions dorsal to the traditional boundaries of Broca's area in the inferior frontal sulcus and the posterior middle frontal gyrus, whereas grammatical processing was associated with more widespread atrophy, including the inferior frontal gyrus and supramarginal gyrus. Repetition performance was correlated with atrophy in the posterior superior temporal gyrus. The correlation of atrophy with semantic processing impairment was localized to the anterior temporal poles. Atrophy patterns were more closely correlated with domain-specific performance than with subtype. These results show that PPA reflects a selective disruption of the language network as a whole, with no rigid boundaries between subtypes. Further, these atrophy patterns reveal anatomical correlates of language that could not have been surmised in patients with aphasia resulting from cerebrovascular lesions. PMID:21368046
Rogalski, Emily; Cobia, Derin; Harrison, Theresa M; Wieneke, Christina; Thompson, Cynthia K; Weintraub, Sandra; Mesulam, M-Marsel
Anatomy of Language Impairments in Primary Progressive Aphasia
Primary progressive aphasia (PPA) is a clinical dementia syndrome characterized by progressive decline in language function but relative sparing of other cognitive domains. There are three recognized PPA variants: agrammatic, semantic, and logopenic. Although each PPA subtype is characterized by the nature of the principal deficit, individual patients frequently display subtle impairments in additional language domains. The present study investigated the distribution of atrophy related to performance in specific language domains (i.e., grammatical processing, semantic processing, fluency, and sentence repetition) across PPA variants to better understand the anatomical substrates of language. Results showed regionally specific relationships, primarily in the left hemisphere, between atrophy and impairments in language performance. Most notable was the neuroanatomical distinction between fluency and grammatical processing. Poor fluency was associated with regions dorsal to the traditional boundaries of Broca's area in the inferior frontal sulcus and the posterior middle frontal gyrus, whereas grammatical processing was associated with more widespread atrophy, including the inferior frontal gyrus and supramarginal gyrus. Repetition performance was correlated with atrophy in the posterior superior temporal gyrus. The correlation of atrophy with semantic processing impairment was localized to the anterior temporal poles. Atrophy patterns were more closely correlated with domain-specific performance than with subtype. These results show that PPA reflects a selective disruption of the language network as a whole, with no rigid boundaries between subtypes. Further, these atrophy patterns reveal anatomical correlates of language that could not have been surmised in patients with aphasia resulting from cerebrovascular lesions.
Rogalski, Emily; Cobia, Derin; Harrison, Theresa M.; Wieneke, Christina; Thompson, Cynthia K; Weintraub, Sandra; Mesulam, M.-Marsel
Intensive language training enhances brain plasticity in chronic aphasia
Background Focal clusters of slow wave activity in the delta frequency range (1–4 Hz), as measured by magnetencephalography (MEG), are usually located in the vicinity of structural damage in the brain. Such oscillations are usually considered pathological and indicative of areas incapable of normal functioning owing to deafferentation from relevant input sources. In the present study we investigated the change in Delta Dipole Density in 28 patients with chronic aphasia (>12 months post onset) following cerebrovascular stroke of the left hemisphere before and after intensive speech and language therapy (3 hours/day over 2 weeks). Results Neuropsychologically assessed language functions improved significantly after training. Perilesional delta activity decreased after therapy in 16 of the 28 patients, while an increase was evident in 12 patients. The magnitude of change of delta activity in these areas correlated with the amount of change in language functions as measured by standardized language tests. Conclusions These results emphasize the significance of perilesional areas in the rehabilitation of aphasia even years after the stroke, and might reflect reorganisation of the language network that provides the basis for improved language functions after intensive training.
Meinzer, Marcus; Elbert, Thomas; Wienbruch, Christian; Djundja, Daniela; Barthel, Gabriela; Rockstroh, Brigitte
Utilizing repetitive transcranial magnetic stimulation to improve language function in stroke patients with chronic non-fluent aphasia.
Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia(1). In this experiment, we demonstrate the administration of low-frequency repetitive TMS (rTMS) to an optimal stimulation site in the right hemisphere in patients with chronic non-fluent aphasia. A battery of standardized language measures is administered in order to assess baseline performance. Patients are subsequently randomized to either receive real rTMS or initial sham stimulation. Patients in the real stimulation undergo a site-finding phase, comprised of a series of six rTMS sessions administered over five days; stimulation is delivered to a different site in the right frontal lobe during each of these sessions. Each site-finding session consists of 600 pulses of 1 Hz rTMS, preceded and followed by a picture-naming task. By comparing the degree of transient change in naming ability elicited by stimulation of candidate sites, we are able to locate the area of optimal response for each individual patient. We then administer rTMS to this site during the treatment phase. During treatment, patients undergo a total of ten days of stimulation over the span of two weeks; each session is comprised of 20 min of 1 Hz rTMS delivered at 90% resting motor threshold. Stimulation is paired with an fMRI-naming task on the first and last days of treatment. After the treatment phase is complete, the language battery obtained at baseline is repeated two and six months following stimulation in order to identify rTMS-induced changes in performance. The fMRI-naming task is also repeated two and six months following treatment. Patients who are randomized to the sham arm of the study undergo sham site-finding, sham treatment, fMRI-naming studies, and repeat language testing two months after completing sham treatment. Sham patients then cross over into the real stimulation arm, completing real site-finding, real treatment, fMRI, and two- and six-month post-stimulation language testing. PMID:23852365
Garcia, Gabriella; Norise, Catherine; Faseyitan, Olufunsho; Naeser, Margaret A; Hamilton, Roy H
TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia.
This study sought to discover if an optimum 1 cm(2) area in the non-damaged right hemisphere (RH) was present, which could temporarily improve naming in chronic, nonfluent aphasia patients when suppressed with repetitive transcranial magnetic stimulation (rTMS). Ten minutes of slow, 1Hz rTMS was applied to suppress different RH ROIs in eight aphasia cases. Picture naming and response time (RT) were examined before, and immediately after rTMS. In aphasia patients, suppression of right pars triangularis (PTr) led to significant increase in pictures named, and significant decrease in RT. Suppression of right pars opercularis (POp), however, led to significant increase in RT, but no change in number of pictures named. Eight normals named all pictures correctly; similar to aphasia patients, RT significantly decreased following rTMS to suppress right PTr, versus right POp. Differential effects following suppression of right PTr versus right POp suggest different functional roles for these regions. PMID:21864891
Naeser, Margaret A; Martin, Paula I; Theoret, Hugo; Kobayashi, Masahito; Fregni, Felipe; Nicholas, Marjorie; Tormos, Jose M; Steven, Megan S; Baker, Errol H; Pascual-Leone, Alvaro
TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia
This study sought to discover if an optimum 1 cm2 area in the non-damaged right hemisphere (RH) was present, which could temporarily improve naming in chronic, nonfluent aphasia patients when suppressed with repetitive transcranial magnetic stimulation (rTMS). Ten minutes of slow, 1 Hz rTMS was applied to suppress different RH ROIs in eight aphasia cases. Picture naming and response time (RT) were examined before, and immediately after rTMS. In aphasia patients, suppression of right pars triangularis (PTr) led to significant increase in pictures named, and significant decrease in RT. Suppression of right pars opercularis (POp), however, led to significant increase in RT, but no change in number of pictures named. Eight normals named all pictures correctly; similar to aphasia patients, RT significantly decreased following rTMS to suppress right PTr, versus right POp. Differential effects following suppression of right PTr versus right POp suggest different functional roles for these regions.
Naeser, Margaret A.; Martin, Paula I.; Theoret, Hugo; Kobayashi, Masahito; Fregni, Felipe; Nicholas, Marjorie; Tormos, Jose M.; Steven, Megan S.; Baker, Errol H.; Pascual-Leone, Alvaro
Intensive language training in the rehabilitation of chronic aphasia: efficient training by laypersons.
Intense language training has been found to be more efficient in the rehabilitation of chronic aphasia than treatment spread across time. Intense treatment, however, challenges personnel and financial resources of the health care system. The present study examined, whether laypersons can be trained to apply standardized language training for chronic aphasia with effects comparable to training by experts. Twenty individuals with chronic aphasia participated in the training, Constraint-Induced Aphasia Therapy (CIAT), which comprises communicative language games with increasing level of difficulty in a motivating context for 3 hr/day on 10 consecutive days. Following a random-control design, training was applied either by experienced therapists (n=10) or trained laypersons (n=10). Standardized language assessments revealed significant within-group improvements, however, between-group differences were not present. We conclude that a standardized training program, such as CIAT, can be efficiently accomplished by trained laypersons with results comparable to that of experienced therapists. PMID:17697416
Meinzer, Marcus; Streiftau, Silke; Rockstroh, Brigitte
Reading comprehension by people with chronic aphasia: A comparison of three levels of visuographic contextual support
Background: People with aphasia often have concomitant reading comprehension deficits that interfere with their full participation in leisure and social activities involving written text comprehension.Aims: The purpose of this investigation was to explore the impact of three levels of visuographic support—(a) high?context photographs, (b) low?context photographs, and (c) no photographs—on the reading comprehension of narratives by people with chronic aphasia.Methods
Aimee Dietz; Karen Hux; Miechelle L. McKelvey; David R. Beukelman; Kristy Weissling
Recovery from moderate aphasia in the first year poststroke: Effect of type of therapy
Carlomagno S, Pandolfi M, Labruna L, Colombo A, Razzano C. Recovery from moderate aphasia in the first year poststroke: effect of type of therapy. Arch Phys Med Rehabil 2001;82:1073-80. Objectives: (1) To determine whether 2 model-based remediation programs affect writing performance in unselected subjects with moderate aphasia and whether there is consequent improvement in everyday life, and (2) to interpret
Sergio Carlomagno; Maria Pandolfi; Ludovica Labruna; Anna Colombo; Carmelina Razzano
Imaging short- and long-term training success in chronic aphasia
BACKGROUND: To date, functional imaging studies of treatment-induced recovery from chronic aphasia only assessed short-term treatment effects after intensive language training. In the present study, we show with functional magnetic resonance imaging (fMRI), that different brain regions may be involved in immediate versus long-term success of intensive language training in chronic post-stroke aphasia patients. RESULTS: Eight patients were trained daily
Ricarda Menke; Marcus Meinzer; Harald Kugel; Michael Deppe; Annette Baumgärtner; Hagen Schiffbauer; Marion Thomas; Kira Kramer; Hubertus Lohmann; Agnes Flöel; Stefan Knecht; Caterina Breitenstein
Language intervention in French–English bilingual aphasia: Evidence of limited therapy transfer
This study investigated the effect of treatment in the second language (L2) for a previously proficient French-English bilingual with aphasia, at 5 years post-stroke. Assessment on the Bilingual Aphasia Test (BAT) enabled objective measurement of language skills in each language, and comparison across languages, before and after treatment in L2 (English). Previous therapy had been provided exclusively in L1 (French).
Amanda Miller Amberber
Considering a multi-level approach to understanding maintenance of global coherence in adults with aphasia.
BACKGROUND: Discourse is a naturally occurring, dynamic form of communication. Coherence is one aspect of discourse and is a reflection of the listener's ability to interpret the overall meaning conveyed by the speaker. Adults with aphasia may present with impaired maintenance of global coherence, which, in turn, may contribute to their difficulties in overall communicative competence. AIMS: The aim of the study was to determine if microlinguistic processes contribute to maintenance of global coherence in adults with and without aphasia. METHOD AND PROCEDURES: Participants included 15 adults with aphasia (PWA) and 15 healthy controls (HC). Study participants told stories conveyed in wordless picture books. The discourse samples were transcribed and then analyzed for percent of information units produced, lexical diversity, syntactic complexity, and maintenance of global coherence. OUTCOMES AND RESULTS: Several linear regression models were carried out to investigate the relationship among the microlinguistic and macrolinguistic measures. For the control group, percent of information units conveyed was a significant predictor of maintenance of global coherence for stories told. For the aphasia group, percent of information units conveyed and lexical diversity were significant predictors of maintenance of global coherence for stories told. CONCLUSIONS: Results indicated that microlinguistic processes contribute to the maintenance of global coherence in stories told by adults with aphasia. These findings have important clinical implications for using a multi-level discourse model for analyzing discourse ability in adults with aphasia and measuring individual response to treatment. PMID:22962509
Wright, Heather Harris; Capilouto, Gilson J
Considering a multi-level approach to understanding maintenance of global coherence in adults with aphasia
Background Discourse is a naturally occurring, dynamic form of communication. Coherence is one aspect of discourse and is a reflection of the listener's ability to interpret the overall meaning conveyed by the speaker. Adults with aphasia may present with impaired maintenance of global coherence, which, in turn, may contribute to their difficulties in overall communicative competence. Aims The aim of the study was to determine if microlinguistic processes contribute to maintenance of global coherence in adults with and without aphasia. Method and Procedures Participants included 15 adults with aphasia (PWA) and 15 healthy controls (HC). Study participants told stories conveyed in wordless picture books. The discourse samples were transcribed and then analyzed for percent of information units produced, lexical diversity, syntactic complexity, and maintenance of global coherence. Outcomes and Results Several linear regression models were carried out to investigate the relationship among the microlinguistic and macrolinguistic measures. For the control group, percent of information units conveyed was a significant predictor of maintenance of global coherence for stories told. For the aphasia group, percent of information units conveyed and lexical diversity were significant predictors of maintenance of global coherence for stories told. Conclusions Results indicated that microlinguistic processes contribute to the maintenance of global coherence in stories told by adults with aphasia. These findings have important clinical implications for using a multi-level discourse model for analyzing discourse ability in adults with aphasia and measuring individual response to treatment.
Wright, Heather Harris; Capilouto, Gilson J.
Quantifying the effort individuals with aphasia invest in working memory tasks through heart rate variability.
PURPOSE The objective of this study was to quantify cognitive effort that individuals with aphasia and neurologically intact participants dedicate to verbal compared with spatial working memory tasks by using a physiological measure of effort: heart rate variability (HRV). METHOD Participants included 8 individuals with aphasia and 19 neurologically intact adults. Participants completed 3 verbal and 3 spatial working memory tasks that varied in difficulty. Performance accuracy and effort allocated to tasks was recorded. Effort was quantified as the change in the 0.07-0.14 Hz band of HRV from baseline to task conditions. RESULTS Results indicated that individuals with aphasia and control participants allocated effort to verbal and spatial working memory tasks. Unlike the control participants, participants with aphasia did not differentially invest effort based on task difficulty. Neither group allocated effort differentially based on task type. CONCLUSIONS Results of the physiological data provide preliminary support for accounts indicating that individuals with aphasia do not properly allocate effort to cognitive-linguistic tasks. Analysis of the Group × Difficulty interaction indicated that the aphasia group did not allocate extra effort when it was required. The lack of a difference in HRV for spatial and verbal tasks suggests that this difference is not specific to verbal stimuli. PMID:24686583
Christensen, Stephanie C; Wright, Heather Harris
Extending the Constraint-Induced Movement Therapy (CIMT) approach to cognitive functions: Constraint-Induced Aphasia Therapy (CIAT) of chronic aphasia.
Constraint-Induced Movement Therapy (CIMT) is a powerful and well evaluated therapeutic tool for the treatment of post-stroke paresis. CIMT is based on an intensive training (massed practice) principle and a gradual rebuilding of movement functions (shaping principle). In this article we will review how CIMT principles can be adapted to treat post-stroke aphasia, thereby establishing a Constraint-Induced Aphasia Therapy (CIAT). First results of this new approach suggest success and feasibility for the treatment of chronic aphasia. The observation of reorganizational changes in brain activity following intensive language training add to previous evidence that CIMT-based therapy may lead to macroscopic remodelling of cortical network architecture. PMID:17971622
Meinzer, Marcus; Elbert, Thomas; Djundja, Daniela; Taub, Edward; Rockstroh, Brigitte
Battery separator
The separator described is especially useful in high-energy-density batteries with deep discharge cycles, such as Ag\\/Zn batteries. It consists of a rigid, porous inorganic material (e.g., ceramic) with a flexible coating or film consisting of potassium titanate in the form of short fibers and a curable organic polymer such as poly(phenylene oxide). The coating is cured to form a porous,
F. C. Arrance; A. G. Rosa
Bipolar battery
A bipolar battery having a plurality of cells. The bipolar battery includes: a negative electrode; a positive electrode and a separator element disposed between the negative electrode and the positive electrode, the separator element electrically insulating the electrodes from one another; an electrolyte disposed within at least one of the negative electrode, the positive electrode and the separator element; and an electrode containment structure including a cup-like electrode holder.
Kaun, Thomas D. (New Lenox, IL) [New Lenox, IL
Zebra batteries
By using molten sodium chloroaluminate as secondary electrolyte, a series of solid transition metal chlorides can be used as positive electrodes in cells with sodium as the negative and beta-alumina as the solid electrlyte. Nickel chloride is preferred and Zebra batteries based on this cell reaction have been developed to the pilot-line production stage. The batteries have a number of features which make them attractive for electric-vehicle applications. Thus, the cells can be assebled in the discharged state eliminating the need to handle liquid sodium. By locating the positive electrode inside the beta-alumina tube, square cell cases can be used giving maximum packing efficiency in batteries. The absence of corrosion in the cell leads to a long life and high reliability. For electric-vehicle applications safety is very imporant, and crash testing has shown that even serious damage to the battery in a crash situation would not present a significant additional hazard to the driver or passengers. The remaining technical challenges are to increase the specific power of the battery towards the end of discharge and to demonstrate that the processes, which have been developed for cell and battery production, are capable of meeting the cost targets.
Sudworth, J. L.
Verb inflections in agrammatic aphasia: Encoding of tense features ?
Across most languages, verbs produced by agrammatic aphasic individuals are frequently marked by syntactically and semantically inappropriate inflectional affixes, such as Last night, I walking home. As per language production models, verb inflection errors in English agrammatism could arise from three potential sources: encoding the verbs' morphology based on temporal information at the conceptual level, accessing syntactic well-formedness constraints of verbal morphology, and encoding morphophonological form. We investigate these aspects of encoding verb inflections in agrammatic aphasia. Using three sentence completion experiments, it was demonstrated that production of verb inflections was impaired whenever temporal reference was involved; while morphological complexity and syntactic constraints were less likely to be the source of verb inflection errors in agrammatism. These findings are discussed in relation to current language production models.
Setting a research agenda to inform intensive comprehensive aphasia programs.
Research into intensive comprehensive aphasia programs (ICAPs) has yet to show that this service delivery model is efficacious, effective, has cost utility, or can be broadly implemented. This article describes a phased research approach to the study of ICAPs and sets out a research agenda that considers not only the specific issues surrounding ICAPs, but also the phase of the research. Current ICAP research is in the early phases, with dosing and outcome measurement as prime considerations as well as refinement of the best treatment protocol. Later phases of ICAP research are outlined, and the need for larger scale collaborative funded research is recognized. The need for more rapid translation into practice is also acknowledged, and the use of hybrid models of phased research is encouraged within the ICAP research agenda. PMID:24091283
Hula, William D; Cherney, Leora R; Worrall, Linda E
Tardive Seizure with Postictal Aphasia: A Case Report
Electroconvulsive therapy (ECT) is a highly effective treatment for certain psychiatric disorders with relatively few serious side effects or complications. Tardive seizures are one of these rare, but potentially fatal complications. Recognizing and treating tardive seizures is essential to prevent prolonged postictal confusion, progression to status epilepticus and associated soft tissue injury, anoxia, aspiration and death. Currently there is an unknown prevalence of their occurrence and an overall lack of clinical description of their phenomenology. We describe a case in which a patient develops a tardive seizure followed by a receptive and expressive aphasia, thought to be a variant of Todd's postictal paralysis. This case is further unique in that there was a lateralization of a motor seizure presumably to the hemisphere contralateral to the RUL electrode placement.
Felkel, W. Carson; Wagner, Gerhardt; Kimball, James; Rosenquist, Peter; McCall, W. Vaughn; Arias, Lorraine
Beyond the temporal pole: limbic memory circuit in the semantic variant of primary progressive aphasia.
Despite accruing evidence for relative preservation of episodic memory in the semantic variant of primary progressive aphasia (previously semantic dementia), the neural basis for this remains unclear, particularly in light of their well-established hippocampal involvement. We recently investigated the Papez network of memory structures across pathological subtypes of behavioural variant frontotemporal dementia and demonstrated severe degeneration of all relay nodes, with the anterior thalamus in particular emerging as crucial for intact episodic memory. The present study investigated the status of key components of Papez circuit (hippocampus, mammillary bodies, anterior thalamus, cingulate cortex) and anterior temporal cortex using volumetric and quantitative cell counting methods in pathologically-confirmed cases with semantic variant of primary progressive aphasia (n = 8; 61-83 years; three males), behavioural variant frontotemporal dementia with TDP pathology (n = 9; 53-82 years; six males) and healthy controls (n = 8, 50-86 years; four males). Behavioural variant frontotemporal dementia cases with TDP pathology were selected because of the association between the semantic variant of primary progressive aphasia and TDP pathology. Our findings revealed that the semantic variant of primary progressive aphasia and behavioural variant frontotemporal dementia show similar degrees of anterior thalamic atrophy. The mammillary bodies and hippocampal body and tail were preserved in the semantic variant of primary progressive aphasia but were significantly atrophic in behavioural variant frontotemporal dementia. Importantly, atrophy in the anterior thalamus and mild progressive atrophy in the body of the hippocampus emerged as the main memory circuit regions correlated with increasing dementia severity in the semantic variant of primary progressive aphasia. Quantitation of neuronal populations in the cingulate cortices confirmed the selective loss of anterior cingulate von Economo neurons in behavioural variant frontotemporal dementia. We also show that by end-stage these neurons selectively degenerate in the semantic variant of primary progressive aphasia with preservation of neurons in the posterior cingulate cortex. Overall, our findings demonstrate for the first time, severe atrophy, although not necessarily neuronal loss, across all relay nodes of Papez circuit with the exception of the mammillary bodies and hippocampal body and tail in the semantic variant of primary progressive aphasia. Despite the longer disease course in the semantic variant of primary progressive aphasia compared with behavioural variant frontotemporal dementia, we suggest here that the neural preservation of crucial memory relays (hippocampal?mammillary bodies and posterior cingulate?hippocampus) likely reflects the conservation of specific episodic memory components observed in most patients with semantic variant of primary progressive aphasia. PMID:24844729
Tan, Rachel H; Wong, Stephanie; Kril, Jillian J; Piguet, Olivier; Hornberger, Michael; Hodges, John R; Halliday, Glenda M
Lithium batteries
The physical principles and technology of commercial Li batteries operating at ambient temperatures are reviewed in chapters contributed by international specialists. An overview of Li battery systems is presented, and organic and inorganic electrolytes are characterized in terms of properties, structure, conductivity, Li stability, and film formation. Individual chapters are devoted to Li/CuO cells; cells with Pb, Bi, Pb/Bi, or Bi/Cu oxides; Li/FeS2, Li/CuS, Li/MnO2, Li/CF, Li/Ag2CrO4, Li/AgBi(CrO4)2, Li/V2O5, Li/SO2, and Li/oxyhalide cells, secondary Li cells, and solid-electrolyte Li cells. Graphs and tables of performance parameters and drawings and photographs of typical batteries are included. No individual items are abstracted in this volume
Gabano, J.-P.
Using the Multimodal Communication Screening Test for Persons with Aphasia (MCST?A) to guide the selection of alternative communication strategies for people with aphasia
Background: People with severe communication problems associated with aphasia and concomitant apraxia of speech are often unable to meet their daily communication needs through speech alone. For these people, augmentative and alternative communication (AAC) strategies may offer opportunities for improved communication effectiveness. However, it can be challenging to determine if individuals can learn to use alternative communication strategies independently or
Joanne P. Lasker; Kathryn L. Garrett
Profiling Performance in L1 and L2 Observed in Greek-English Bilingual Aphasia Using the Bilingual Aphasia Test: A Case Study from Cyprus
The Greek and the English versions of the Bilingual Aphasia Test (BAT) were used to assess the linguistic abilities of a premorbidly highly proficient late bilingual female after a haemorrhagic cerebrovascular accident involving the left temporo-parietal lobe. The BAT was administered in the two languages on separate occasions by the first author,…
Kambanaros, Maria; Grohmann, Kleanthes K.
Influences of Electromagnetic Articulography Sensors on Speech Produced by Healthy Adults and Individuals with Aphasia and Apraxia
Purpose: This study examined whether the intraoral transducers used in electromagnetic articulography (EMA) interfere with speech and whether there is an added risk of interference when EMA systems are used to study individuals with aphasia and apraxia. Method: Ten adult talkers (5 individuals with aphasia/apraxia, 5 controls) produced 12 American…
Katz, William F.; Bharadwaj, Sneha V.; Stettler, Monica P.
The Use of Main Concept Analysis to Measure Discourse Production in Cantonese-Speaking Persons with Aphasia: A Preliminary Report
Discourse produced by speakers with aphasia contains rich and valuable information for researchers to understand the manifestation of aphasia as well as for clinicians to plan specific treatment components for their clients. Various approaches to investigate aphasic discourse have been proposed in the English literature. However, this is not the…
Evaluation of communication, life participation and psychological well?being in chronic aphasia: The influence of group intervention
Background: The impact of change in communication, life participation, and psychological well?being in aphasia is recognised but still not fully explored. Further, considerable scope exists to address these factors within the context of intervention. Innovative practices and group intervention are advocated for people with chronic aphasia but detail and evidence remains limited.We are grateful to Leeds Health Authority, the Leeds
Alison Ross; Isabel Winslow; Paul Marchant; Shelagh Brumfitt
Using resource allocation theory and dual?task methods to increase the sensitivity of assessment in aphasia
Background: Quantifying the severity of language impairment and measuring change in language performance over time are two important objectives in the assessment of aphasia. The notion of cognitive effort as understood from a resource allocation perspective provides a potentially useful complement to traditional constructs employed in aphasia assessment. Aims: The series of experiments described in this paper used resource allocation
Malcolm McNeil; Patrick Doyle; William Hula; Hillel Rubinsky; Tepanta Fossett; Christine Matthews
Aphasia Rehabilitation in Asia and the Pacific Region: Japan, China, India, Australia and New Zealand. Monograph #45.
This monograph presents a "state of the art" overview of contemporary aphasia rehabilitation policies and resources in Asia and the Pacific region. Following Martha Taylor Sarno's introduction, Sumiko Sasanuma discusses the history and development of Japan's aphasia rehabilitation services, focusing on demography and data sources, assessment and…
Sarno, Martha Taylor, Ed.; Woods, Diane E., Ed.
Improved Vocabulary Production after Naming Therapy in Aphasia: Can Gains in Picture Naming Generalise to Connected Speech?
Background: Naming accuracy for nouns and verbs in aphasia can vary across different elicitation contexts, for example, simple picture naming, composite picture description, narratives, and conversation. For some people with aphasia, naming may be more accurate to simple pictures as opposed to naming in spontaneous, connected speech; for others,…
Conroy, Paul; Sage, Karen; Ralph, Matt Lambon
Functional Outcome after Stroke in Patients with Aphasia and Neglect: Assessment by the Motor and Cognitive Functional Independence Measure Instrument
Background: The role of neuropsychological deficits in predicting functional outcome in patients with aphasia and neglect at the end of rehabilitation after stroke has been poorly investigated. This was the aim of this prospective study evaluated using a Functional Independence Measure (FIM) instrument. Methods: Patients with a primary diagnosis of cerebrovascular accident [125 patients with aphasia, 45 with neglect and
Bernardo Gialanella; Cristina Ferlucci
Using Computers to Enable Self-Management of Aphasia Therapy Exercises for Word Finding: The Patient and Carer Perspective
Background: Speech and language therapy (SLT) for aphasia can be difficult to access in the later stages of stroke recovery, despite evidence of continued improvement with sufficient therapeutic intensity. Computerized aphasia therapy has been reported to be useful for independent language practice, providing new opportunities for continued…
Palmer, Rebecca; Enderby, Pam; Paterson, Gail
Dissociated disorders of speaking and writing in aphasia
Of 500 left brain-damaged patients with educational level above elementary school investigated with a standard quantitative battery for dissociation between oral and written expression, speech was found to be selectively impaired in seven (three with \\
A Basso; A Taborelli; L A Vignolo
The neural correlates of semantic feature analysis in chronic aphasia: discordant patterns according to the etiology.
This event-related functional magnetic resonance imaging (fMRI) study reports on the impact of semantic feature analysis (SFA) therapy on the neural substrate sustaining the recovery from severe anomia in two patients: one participant was diagnosed with primary progressive aphasia (PPA) 2 years before this study; the other participant acquired aphasia 8 years before this study. The participant with PPA showed severe progressive nonfluent aphasia (PNFA), the language profile being similar to a Broca's aphasia; the stroke patient presented with Broca's aphasia and a severe apraxia of speech (AOS). To examine the neural substrate allowing for recovery, both patients received brief and intensive therapy with SFA; behavioral and event-related (ER)-fMRI measures during oral picture naming were obtained pre- and post-therapy. Both patients benefitted from SFA to improve their naming performance. Functional MRI performances on trained and correct pretraining items were contrasted. Adaptive brain plasticity appeared to operate differently in each patient, despite the similarity of naming recovery profiles. PMID:20221954
Marcotte, Karine; Ansaldo, Ana Inés
Purpose It is well known that people with aphasia have sentence comprehension impairments. The present study investigated whether lexical factors contribute to sentence comprehension impairments in both the auditory and written modalities using on-line measures of sentence processing. Methods People with aphasia and non-brain-damaged controls participated in the experiment (n=8 per group). Twenty-one sentence pairs containing high and low frequency words were presented in self-paced listening and reading tasks. The sentences were syntactically simple and differed only in the critical words. The dependent variables were response times for critical segments of the sentence and accuracy on the comprehension questions. Results The results showed that word frequency influences performance on measures of sentence comprehension in people with aphasia. The accuracy data on the comprehension questions suggested that people with aphasia have more difficulty understanding sentences containing low frequency words in the written compared to auditory modality. Both group and single case analyses of the response time data also pointed to more difficulty with reading than listening. Conclusions The results show that sentence comprehension in people with aphasia is influenced by word frequency and presentation modality.
Drug therapy of post-stroke aphasia: a review of current evidence.
This review considers the role of drug therapy in the treatment of post-stroke aphasia, the evidence for efficacy of different agents, and the theory-based explanations of drug-related benefits for aphasia rehabilitation. Pharmacological interventions modulating stroke-induced disruption of diverse neurotransmitters may improve language and communication deficits in aphasic patients through facilitation of brain plasticity and long-term potentiation. However, benefits are not evident for all compounds and refinement in clinical trial designs is required. Some pharmacological trials have failed because drug treatment was not combined with speech-language therapy, while other trials combining drugs with intensive model-driven therapies also failed probably because of short-trial duration, inadequate sample selection, or lack of drug action. Preliminary data reveals that combining neuroscience-based intensive aphasia techniques (constraint-induced aphasia therapy) and drugs acting on cholinergic and glutamatergic neurotransmitter systems are associated with better outcomes than other strategies and long-term maintenance of benefits. Although further studies are needed, current state of the evidence suggests that drug therapy may play a key role in the treatment of post-stroke aphasia. PMID:21845354
Berthier, Marcelo L; Pulvermüller, Friedemann; Dávila, Guadalupe; Casares, Natalia García; Gutiérrez, Antonio
Battery separators
A novel, improved battery separator and process for making the separator. Essentially, the separator carries a plurality of polymeric ribs bonded to at least one surface and the ribs have alternating elevated segments of uniform maxiumum heights and depressed segments along the length of the ribs.
Le Bayon, R.; Faucon, R.; Legrix, J.
A description is given of a synthetic pulp separator for a lead acid battery, the separator having two or more plies and a ribbed profile the surface adapted to face the positive having a higher content of synthetic pulp than the other surface.
Clegg, G.A.; Pearson, E.J.
Thermal Battery.
National Technical Information Service (NTIS)
A research program is being conducted to define and eliminate those problems at the Cl2 electrode which prevent the Li-Cl2 battery from operating as a practical and reliable missile energy source. This application requires a high power density, high rate ...
E. H. Hietbrink D. A. J. Swinkels J. J. Petraits G. M. Craig
Battery assembly
The disclosure describes a battery assembly which comprises several gas depolarizable electrochemical cells, e.g., metal/air cells, stacked electrically in series along a first dimension. Each cell has first and second electrodes of opposite polarities. The battery assembly also comprises a housing for containing the stack of cells. The housing includes a structure for ventilating the interior of the housing and further includes first and second opposite end walls which lie perpendicular to the first dimension. The stack of cells is arranged within the housing with the first electrode of the initial cell of the stack facing the first wall and the second electrode of the final cell of the stack facing the second wall. The battery assembly further includes first and second electrically conductive connectors disposed within the housing. The first connector has a first end electrically coupled to the first electrode of the initial cell and a second end disposed adjacent the first wall. The second connector has a first end electrically coupled to the second electrode of the final cell and a second end also disposed adjacent the first wall. The battery assembly further comprises first and second terminals which are electrically coupled to the first and second connectors, respectively, and extend through the first wall to the exterior of the housing.
McArthur, W.J.; Kelm, R.W.
Digital batteries
The energy density in conventional capacitors is limited by sparking. We present nano-capacitor arrays, where - like in laser diodes and quantum wells [1] - quantization prevents dielectric breakthrough. We show that the energy density and the power\\/weight ratio are very high, possibly larger than in hydrogen [2]. Digital batteries are a potential clean energy source for cars, laptops, and
Alfred W. Hübler
Digital Batteries
The energy density in conventional capacitors is limited by sparking. We present nano-capacitor arrays, where - like in laser diodes and quantum wells [1] - quantization prevents dielectric breakthrough. We show that the energy density and the power/weight ratio are very high, possibly larger than in hydrogen [2]. Digital batteries are a potential clean energy source for cars, laptops, and mobile devices. The technology is related to flash drives. However, because of the high energy density, safety is a concern. Digital batteries can be easily and safely charged and discharged. In the discharged state they pose no danger. Even if a charged digital battery were to explode, it would produce no radioactive waste, no long-term radiation, and probably could be designed to produce no noxious chemicals. We discuss methodologies to prevent shorts and other measures to make digital batteries safe. [1] H. Higuraskh, A. Toriumi, F. Yamaguchi, K. Kawamura, A. Hubler, Correlation Tunnel Device, U. S. Patent No. 5,679,961 (1997) [2] Alfred Hubler, http://server10.how-why.com/blog/
Hubler, Alfred
Recovery from aphasia: a longitudinal study on language recovery, lateralization patterns, and attentional resources.
Despite the large body of evidence on the neural basis of the recovery from aphasia, the role of either cerebral hemisphere remains controversial. This paper reports the results of a longitudinal single-case study on the patterns of lateralization for lexical semantic processing during the recovery from aphasia. The experimental protocol included a lateralized lexical decision task (LDT), an attentional task and a language test. There was no presentation site effect on the LDT, and the performance was jointly influences by attentional and language factors. These findings suggest that the recovery of lexical semantic processing may be sustained by both cerebral hemispheres, and highlights the importance of experimental protocols that allow examining both language and attentional factors modulating factors modulating the recovery from aphasia. PMID:15370384
Ansaldo, Ana Inés; Arguin, Martin; Lecours, André Roch
Neuroimaging in aphasia treatment research: Consensus and practical guidelines for data analysis
Functional magnetic resonance imaging is the most widely used imaging technique to study treatment-induced recovery in post-stroke aphasia. The longitudinal design of such studies adds to the challenges researchers face when studying patient populations with brain damage in cross-sectional settings. The present review focuses on issues specifically relevant to neuroimaging data analysis in aphasia treatment research identified in discussions among international researchers at the Neuroimaging in Aphasia Treatment Research Workshop held at Northwestern University (Evanston, Illinois, USA). In particular, we aim to provide the reader with a critical review of unique problems related to the pre-processing, statistical modeling and interpretation of such data sets. Despite the fact that data analysis procedures critically depend on specific design features of a given study, we aim to discuss and communicate a basic set of practical guidelines that should be applicable to a wide range of studies and useful as a reference for researchers pursuing this line of research.
Meinzer, Marcus; Beeson, Pelagie M.; Cappa, Stefano; Crinion, Jenny; Kiran, Swathi; Saur, Dorothee; Parrish, Todd; Crosson, Bruce; Thompson, Cynthia K.
Why Is It Difficult to Predict Language Impairment and Outcome in Patients with Aphasia after Stroke?
One of the most devastating consequences of stroke is aphasia. Communication problems after stroke can severely impair the patient's quality of life and make even simple everyday tasks challenging. Despite intense research in the field of aphasiology, the type of language impairment has not yet been localized and correlated with brain damage, making it difficult to predict the language outcome for stroke patients with aphasia. Our primary objective is to present the available evidence that highlights the difficulties of predicting language impairment after stroke. The different levels of complexity involved in predicting the lesion site from language impairment and ultimately predicting the long-term outcome in stroke patients with aphasia were explored. Future directions and potential implications for research and clinical practice are highlighted.
Kasselimis, Dimitrios; Varkanitsa, Maria; Selai, Caroline; Potagas, Constantin; Evdokimidis, Ioannis
Lead-acid batteries
A method of producing a lead-acid battery capable of activation by the addition of electrolyte thereto, comprises the steps of: starting with a battery container accommodating at least one pack of battery plate grids having insulating separators interposed between adjacent grids, each of said grids carrying the lead-acid battery paste required to produce a positive or a negative battery plate
J. A. Bant; V. J. Raban
Batteries for Electric Vehicles
NASA Technical Reports Server (NTRS)
Report summarizes results of test on "near-term" electrochemical batteries - (batteries approaching commercial production). Nickel/iron, nickel/zinc, and advanced lead/acid batteries included in tests and compared with conventional lead/acid batteries. Batteries operated in electric vehicles at constant speed and repetitive schedule of accerlerating, coasting, and braking.
Conover, R. A.
Perception of visually masked stimuli by individuals with aphasia: A methodological assessment and preliminary theoretical implications
Background Studies of the automatic processes supporting language processing and dysfunction in aphasia often rely on priming paradigms. The ability to confidently interpret these studies in terms of understanding the relative contributions of automatic vs. controlled processing, however, depends on the ability to isolate only automatic processes. One way this may be accomplished is through the use of visual masking. The effective use of visual masking, however, depends on verification that there was no task-relevant information consciously available from the prime item. Aims The study reported here was designed to assess the visibility of visually masked stimuli, for both typical adults and adults with aphasia. Methods & Procedures This experiment involved 31 typical adults and 21 individuals with aphasia. Visual masking sequences were presented on a computer screen, with 11 different interstimulus intervals assessed. Participants made lexical decisions on the masked stimuli. The two participant groups were compared in terms of their ability to distinguish the word/non-word status of masked stimuli at the various intervals. Outcomes & Results Participants with aphasia showed an overall poorer ability to discriminate between visually masked words and non-words than typical adults. Conclusions The visual masking sequence effectively interfered with task-relevant conscious perception of some masked stimuli for typical adults and all masked stimuli for participants with aphasia. This finding, combined with preliminary data collected on a similar task that involved a simple presence/absence judgment on masked items, suggests that there may be differences in the ability of individuals with aphasia to process rapidly presented masked stimuli, even when there is minimal linguistic processing required.
Brain Regions Underlying Repetition and Auditory-Verbal Short-term Memory Deficits in Aphasia: Evidence from Voxel-based Lesion Symptom Mapping
Background A deficit in the ability to repeat auditory-verbal information is common among individuals with aphasia. The neural basis of this deficit has traditionally been attributed to the disconnection of left posterior and anterior language regions via damage to a white matter pathway, the arcuate fasciculus. However, a number of lesion and imaging studies have called this notion into question. Aims The goal of this study was to identify the neural correlates of repetition and a related process, auditory-verbal short-term memory (AVSTM). Both repetition and AVSTM involve common elements such as auditory and phonological analysis and translation to speech output processes. Based on previous studies, we predicted that both repetition and AVSTM would be most dependent on posterior language regions in left temporo-parietal cortex. Methods & Procedures We tested 84 individuals with left hemisphere lesions due to stroke on an experimental battery of repetition and AVSTM tasks. Participants were tested on word, pseudoword, and number-word repetition, as well as digit and word span tasks. Brain correlates of these processes were identified using a statistical, lesion analysis approach known as voxel-based lesion symptom mapping (VLSM). VLSM allows for a voxel-by-voxel analysis of brain areas most critical to performance on a given task, including both grey and white matter regions. Outcomes & Results The VLSM analyses showed that left posterior temporo-parietal cortex, not the arcuate fasciculus, was most critical for repetition as well as for AVSTM. The location of maximal foci, defined as the voxels with the highest t values, varied somewhat among measures: Word and pseudoword repetition had maximal foci in the left posterior superior temporal gyrus, on the border with inferior parietal cortex, while word and digit span, as well as number-word repetition, were centered on the border between the middle temporal and superior temporal gyri and the underlying white matter. Conclusions Findings from the current study show that 1) repetition is most critically mediated by cortical regions in left posterior temporo-parietal cortex; 2) repetition and AVSTM are mediated by partially overlapping networks; and 3) repetition and AVSTM deficits can be observed in different types of aphasia, depending on the site and extent of the brain injury. These data have implications for the prognosis of chronic repetition and AVSTM deficits in individuals with aphasia when lesions involve critical regions in left temporo-parietal cortex.
Baldo, Juliana V.; Katseff, Shira; Dronkers, Nina F.
Measuring Lexical Diversity in Narrative Discourse of People With Aphasia
Purpose A microlinguistic content analysis for assessing lexical semantics in people with aphasia (PWA) is lexical diversity (LD). Sophisticated techniques have been developed to measure LD. However, validity evidence for these methodologies when applied to the discourse of PWA is lacking. The purpose of this study was to evaluate four measures of LD to determine how effective they were at measuring LD in PWA. Method Four measures of LD were applied to short discourse samples produced by 101 PWA: (a) the Measure of Textual Lexical Diversity (MTLD; McCarthy, 2005), (b) the Moving-Average Type-Token Ratio (MATTR; Covington, 2007), (c) D (McKee, Malvern, & Richards, 2000), and (d) the Hypergeometric Distribution (HD-D; McCarthy & Jarvis, 2007). LD was estimated using each method, and the scores were subjected to a series of analyses (e.g., curve-fitting, analysis of variance, confirmatory factor analysis). Results Results from the confirmatory factor analysis suggested that MTLD and MATTR reflect LD and little of anything else. Further, two indices (HD-D and D) were found to be equivalent, suggesting that either one can be used when samples are >50 tokens. Conclusion MTLD and MATTR yielded the strongest evidence for producing unbiased LD scores, suggesting that they may be the best measures for capturing LD in PWA.
Classification of primary progressive aphasia and its variants
This article provides a classification of primary progressive aphasia (PPA) and its 3 main variants to improve the uniformity of case reporting and the reliability of research results. Criteria for the 3 variants of PPA—nonfluent/agrammatic, semantic, and logopenic—were developed by an international group of PPA investigators who convened on 3 occasions to operationalize earlier published clinical descriptions for PPA subtypes. Patients are first diagnosed with PPA and are then divided into clinical variants based on specific speech and language features characteristic of each subtype. Classification can then be further specified as "imaging-supported" if the expected pattern of atrophy is found and "with definite pathology" if pathologic or genetic data are available. The working recommendations are presented in lists of features, and suggested assessment tasks are also provided. These recommendations have been widely agreed upon by a large group of experts and should be used to ensure consistency of PPA classification in future studies. Future collaborations will collect prospective data to identify relationships between each of these syndromes and specific biomarkers for a more detailed understanding of clinicopathologic correlations.
Hillis, A.E.; Weintraub, S.; Kertesz, A.; Mendez, M.; Cappa, S.F.; Ogar, J.M.; Rohrer, J.D.; Black, S.; Boeve, B.F.; Manes, F.; Dronkers, N.F.; Vandenberghe, R.; Rascovsky, K.; Patterson, K.; Miller, B.L.; Knopman, D.S.; Hodges, J.R.; Mesulam, M.M.; Grossman, M.
Aphasia after hemispherectomy in an adult with early onset epilepsy and hemiplegia.
A 55 year old left handed man with left hemisphere subcortical encephalomalacia, seizures, language impairment, and right hemiparesis from a motor vehicle accident at age five was evaluated for epilepsy surgery. The patient continued to speak and followed commands during a left intracarotid amobarbital test (IAT). Left functional hemispherectomy resulted in expressive aphasia. Based on postoperative outcome, language was bilateral. The injury after primary development of language function, the predominantly subcortical lesion, and the late timing of surgical intervention well past development and plasticity may have been factors in the emergence of postoperative aphasia. PMID:14707328
Loddenkemper, T; Dinner, D S; Kubu, C; Prayson, R; Bingaman, W; Dagirmanjian, A; Wyllie, E
Hand Battery
NSDL National Science Digital Library
In this activity about chemistry and electricity, learners form a battery by placing their hands onto plates of different metals. Learners detect the current by reading a DC microammeter attached to the metal plates. Learners experiment with different metals to find out what combination produces the most current as well as testing what happens when they press harder on the plates or wet their hands. Learners also investigate what happens when they wire the plates to a voltmeter.
Exploratorium, The
Battery depletion monitor
A cmos inverter is used to compare pacemaker battery voltage to a referenced voltage. When the reference voltage exceeds the measured battery voltage, the inverter changes state to indicate battery depletion.
Electric storage batteries
Recombination lead acid electric storage battery of sealed or recombinant type in which the gas evolved during operation or charging is induced to recombine within the battery at the battery electrodes.
Culpin, B.; Peters, K.
Batteries: Overview of Battery Cathodes
The very high theoretical capacity of lithium (3829 mAh\\/g) provided a compelling rationale from the 1970's onward for development of rechargeable batteries employing the elemental metal as an anode. The realization that some transition metal compounds undergo reductive lithium intercalation reactions reversibly allowed use of these materials as cathodes in these devices, most notably, TiS. Another intercalation compound, LiCoO, was
Doeff; Marca M
Battery cell feedthrough apparatus
A compact, hermetic feedthrough apparatus comprising interfitting sleeve portions constructed of chemically-stable materials to permit unique battery designs and increase battery life and performance.
Kaun, Thomas D. (New Lenox, IL)
Profiling performance in L1 and L2 observed in Greek-English bilingual aphasia using the Bilingual Aphasia Test: a case study from Cyprus.
The Greek and the English versions of the Bilingual Aphasia Test (BAT) were used to assess the linguistic abilities of a premorbidly highly proficient late bilingual female after a haemorrhagic cerebrovascular accident involving the left temporo-parietal lobe. The BAT was administered in the two languages on separate occasions by the first author, a bilingual English-Greek speech pathologist. The results revealed a non-parallel recovery in the two languages. This information will be used not only to guide clinical intervention for the patient but also to provide the first report on the manifestations of aphasia in Greek. Moreover, the use of the (Standard Modern) Greek version of the BAT to investigate Greek Cypriot aphasics has implications for the use of the BAT on underspecified languages or dialects. Such studies may help with the development of assessment measures and therapy strategies that focus on specific characteristics of one or multiple languages. PMID:21453038
Kambanaros, Maria; Grohmann, Kleanthes K
Integrated training for aphasia: an application of part-whole learning to treat lexical retrieval, sentence production, and discourse-level communications in three cases of nonfluent aphasia.
PURPOSE The purpose of this study was to evaluate integrated training for aphasia (ITA), a multicomponent language-production treatment based on part-whole learning that systematically trains lexical retrieval, sentence production, and discourse-level communications. Specific research objectives were to evaluate acquisition of target structures, statistical parameters associated with learning variables, treatment generalization, and the efficacy of individual treatment components. METHOD ITA was administered to 3 individuals with nonfluent aphasia following a multiple-baseline, across-behaviors design. Effect size and correlational coefficients were computed to assess acquisition, generalization, and maintenance of target structures. Standardized tests and a treatment efficacy questionnaire were also completed. RESULTS A significant treatment effect was found in 2 of the 3 participants. In addition, as is seen in normal skill acquisition, practice time and error rate were significantly correlated. All participants demonstrated evidence of generalization on standardized language measures. Only 1 participant improved, however, on the communication measures. Results of the treatment component analysis revealed significant differences in the perceived efficacy of individual therapy tasks. CONCLUSIONS Findings add to the evidence supporting multicomponent aphasia treatments, provide preliminary support for ITA and the application of a part-whole learning approach, and suggest that specific treatment components may contribute differentially to outcomes and generalization effects. PMID:24686892
Milman, Lisa; Vega-Mendoza, Mariana; Clendenen, Deanna
Temporal Processing and Context Dependency of Phoneme Discrimination in Patients with Aphasia
Standard diagnostic procedures for assessing temporal-processing abilities of adult patients with aphasia have so far not been developed. In our study, temporal-order measurements were conducted using two different experimental procedures to identify a suitable measure for clinical studies. Additionally, phoneme-discrimination abilities were…
Fink, Martina; Churan, Jan; Wittmann, Marc
Lexical diversity for adults with and without aphasia across discourse elicitation tasks
Background: Differences in lexical diversity (LD) across different discourse elicitation tasks have been found in neurologically intact adults (NIA) (Fergadiotis, Wright, & Capilouto, 2010) but have not been investigated systematically in people with aphasia (PWA). Measuring lexical diversity in PWA may serve as a useful clinical tool for evaluating the impact of word retrieval difficulties at the discourse level. Aims: The
Gerasimos Fergadiotis; Heather Harris Wright
Sentence Comprehension in Agrammatic Aphasia: History and Variability to Clinical Implications
Individuals with Broca's aphasia often present with deficits in their ability to comprehend non-canonical sentences. This has been contrastingly characterized as a systematic loss of specific grammatical abilities or as individual variability in the dynamics between processing load and resource availability. The present study investigated sentence…
Johnson, Danielle; Cannizzaro, Michael S.
Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation.
Stroke victims tend to prioritize speaking, writing, and walking as the three most important rehabilitation goals. Of note is that two of these goals involve communication. This underscores the significance of developing successful approaches to aphasia treatment for the several hundred thousand new aphasia patients each year and over 1 million stroke survivors with chronic aphasia in the U.S. alone. After several years of growth as a research tool, non-invasive brain stimulation (NBS) is gradually entering the arena of clinical aphasiology. In this review, we first examine the current state of knowledge of post-stroke language recovery including the contributions from the dominant and non-dominant hemispheres. Next, we briefly discuss the methods and the physiologic basis of the use of inhibitory and excitatory repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) as research tools in patients who experience post-stroke aphasia. Finally, we provide a critical review of the most influential evidence behind the potential use of these two brain stimulation methods as clinical rehabilitative tools. PMID:24399952
Shah, Priyanka P; Szaflarski, Jerzy P; Allendorfer, Jane; Hamilton, Roy H
Non-linguistic learning in aphasia: Effects of training method and stimulus characteristics
Purpose The purpose of the current study was to explore non-linguistic learning ability in patients with aphasia, examining the impact of stimulus typicality and feedback on success with learning. Method Eighteen patients with aphasia and eight healthy controls participated in this study. All participants completed four computerized, non-linguistic category-learning tasks. We probed learning ability under two methods of instruction: feedback-based (FB) and paired-associate (PA). We also examined the impact of task complexity on learning ability, comparing two stimulus conditions: typical (Typ) and atypical (Atyp). Performance was compared between groups and across conditions. Results Results demonstrated that healthy controls were able to successfully learn categories under all conditions. For our patients with aphasia, two patterns of performance arose. One subgroup of patients was able to maintain learning across task manipulations and conditions. The other subgroup of patients demonstrated a sensitivity to task complexity, learning successfully only in the typical training conditions. Conclusions Results support the hypothesis that impairments of general learning are present in aphasia. Some patients demonstrated the ability to extract category information under complex training conditions, while others learned only under conditions that were simplified and emphasized salient category features. Overall, the typical training condition facilitated learning for all participants. Findings have implications for therapy, which are discussed.
Semantic Interference during Object Naming in Agrammatic and Logopenic Primary Progressive Aphasia (PPA)
This study examined the time course of object naming in 21 individuals with primary progressive aphasia (PPA) (8 agrammatic (PPA-G); 13 logopenic (PPA-L)) and healthy age-matched speakers (n=17) using a semantic interference paradigm with related and unrelated interfering stimuli presented at stimulus onset asynchronies (SOAs) of -1000, -500, -100…
Thompson, Cynthia K.; Cho, Soojin; Price, Charis; Wieneke, Christina; Bonakdarpour, Borna; Rogalski, Emily; Weintraub, Sandra; Mesulam, M-Marsel
Speech pathology services for primary progressive aphasia: Exploring an emerging area of practice
Background: Primary progressive aphasia (PPA) is a clinical dementia syndrome characterised by the gradual dissolution of language without impairment of other cognitive domains for at least the first 2 years of illness (Mesulam, 2001). In recent years the authors had observed an increase in the number of referrals of individuals with a queried diagnosis of PPA to their speech pathology
Cathleen Taylor; Rachel Miles Kingma; Karen Croot; Lyndsey Nickels
The Time Course of Neurolinguistic and Neuropsychological Symptoms in Three Cases of Logopenic Primary Progressive Aphasia
Primary progressive aphasia (PPA) is a rare clinical dementia syndrome affecting predominantly language abilities. Word-finding difficulties and comprehension deficits despite relatively preserved cognitive functions are characteristic symptoms during the first two years, and distinguish PPA from other dementia types like Alzheimer's disease.…
Etcheverry, Louise; Seidel, Barbara; Grande, Marion; Schulte, Stephanie; Pieperhoff, Peter; Sudmeyer, Martin; Minnerop, Martina; Binkofski, Ferdinand; Huber, Walter; Grodzinsky, Yosef; Amunts, Katrin; Heim, Stefan
Model Choice and Sample Size in Item Response Theory Analysis of Aphasia Tests
Purpose: The purpose of this study was to identify the most appropriate item response theory (IRT) measurement model for aphasia tests requiring 2-choice responses and to determine whether small samples are adequate for estimating such models. Method: Pyramids and Palm Trees (Howard & Patterson, 1992) test data that had been collected from…
Hula, William D.; Fergadiotis, Gerasimos; Martin, Nadine
Effect of Verb Network Strengthening Treatment in Moderate-to-Severe Aphasia
Purpose: This Phase II treatment study examined the effect of Verb Network Strengthening Treatment (VNeST) on individuals with moderate-to-severe aphasia. Research questions addressed (a) pre- to posttreatment changes and pretreatment to treatment phase changes on probe sentences containing trained verbs (e.g., "The carpenter is 'measuring' the…
Edmonds, Lisa A.; Babb, Michelle
Fluent Versus Nonfluent Primary Progressive Aphasia: A Comparison of Clinical and Functional Neuroimaging Features
To better characterize fluent and nonfluent variants of primary progressive aphasia (PPA). Although investigators have recognized both fluent and nonfluent patients with PPA (Mesulam, 2001), the clinical and neuroimaging features of these variants have not been fully defined. We present clinical and neuropsychological data on 47 PPA patients…
Clark, D.G.; Charuvastra, A.; Miller, B.L.; Shapira, J.S.; Mendez, M.F.
Should Pantomime and Gesticulation Be Assessed Separately for Their Comprehensibility in Aphasia? A Case Study
Background: Gesticulation (gestures accompanying speech) and pantomime (gestures in the absence of speech) can each be comprehensible. Little is known about the differences between these two gesture modes in people with aphasia. Aims: To discover whether there are differences in the communicative use of gesticulation and pantomime in QH, a person…
van Nispen, Karin; van de Sandt-Koenderman, Mieke; Mol, Lisette; Krahmer, Emiel
Perspectives on Public Awareness of Stroke and Aphasia among Turkish Patients in a Neurology Unit
Recent studies on awareness have drawn attention to the fact that aphasia is a little known disorder to the public, in spite of all the publicity about this frequently occurring neurogenic language disorder. Being a very new concept, studies of awareness are rare in Turkey. This survey study assessed the extent of public awareness of neurological…
Mavis, Ilknur
Visuomotor Tracking Abilities of Speakers with Apraxia of Speech or Conduction Aphasia
This investigation examined the visuomotor tracking abilities of persons with apraxia of speech (AOS) or conduction aphasia (CA). In addition, tracking performance was correlated with perceptual judgments of speech accuracy. Five individuals with AOS and four with CA served as participants, as well as an equal number of healthy controls matched by…
Robin, Donald A.; Jacks, Adam; Hageman, Carlin; Clark, Heather M.; Woodworth, George
The Effects of Modified Melodic Intonation Therapy on Nonfluent Aphasia: A Pilot Study
Objective: Positive results have been reported with melodic intonation therapy (MIT) in nonfluent aphasia patients with damage to their left-brain speech processes, using the patient's intact ability to sing to promote functional language. This pilot study sought to determine the immediate effects of introducing modified melodic intonation therapy…
Conklyn, Dwyer; Novak, Eric; Boissy, Adrienne; Bethoux, Francois; Chemali, Kamal
Tell Me Your Story: Analysis of Script Topics Selected by Persons with Aphasia
Purpose: This study examined the content of 100 short scripts, co-constructed by persons with aphasia (PWA) and a clinician. The PWA subsequently learned the scripts by interacting with a computerized virtual therapist. The goal was to provide clinicians with ideas regarding content for treatment that is meaningful to PWAs. Method: Thirty-three…
Holland, Audrey L.; Halper, Anita S.; Cherney, Leora R.
Psychosocial Well-Being in Persons with Aphasia Participating in a Nursing Intervention after Stroke
The psychosocial adjustment process after stroke is complicated and protracted. The language is the most important tool for making sense of experiences and for human interplay, making persons with aphasia especially prone to psychosocial problems. Persons with aphasia are systematically excluded from research projects due to methodological challenges. This study explored how seven persons with aphasia experienced participating in a complex nursing intervention aimed at supporting the psychosocial adjustment process and promoting psychosocial well-being. The intervention was organized as an individual, dialogue-based collaboration process based upon ideas from "Guided self-determination." The content addressed psychosocial issues as mood, social relationships, meaningful activities, identity, and body changes. Principles from "Supported conversation for adults with aphasia" were used to facilitate the conversations. The data were obtained by participant observation during the intervention, qualitative interviews 2 weeks, 6 months, and 12 months after the intervention and by standardized clinical instruments prior to the intervention and at 2 weeks and 12 months after the intervention. Assistance in narrating about themselves and their experiences with illness, psychological support and motivation to move on during the difficult adjustment process, and exchange of knowledge and information were experienced as beneficial and important by the participants in this study.
Bronken, Berit Arnesveen; Kirkevold, Marit; Martinsen, Randi; Wyller, Torgeir Bruun; Kvigne, Kari
Aphasia with left occipitotemporal hypometabolism: a novel presentation of posterior cortical atrophy?
Alzheimer's disease is a common neurodegenerative disease often characterized by initial episodic memory loss. Atypical focal cortical presentations have been described, including the logopenic variant of primary progressive aphasia (lvPPA) which presents with language impairment, and posterior cortical atrophy (PCA) which presents with prominent visuospatial deficits. Both lvPPA and PCA are characterized by specific patterns of hypometabolism: left temporoparietal in lvPPA and bilateral parietoccipital in PCA. However, not every patient fits neatly into these categories. We retrospectively identified two patients with progressive aphasia and visuospatial deficits from a speech and language based disorders study. The patients were further characterized by MRI, fluorodeoxyglucose F18 and Pittsburgh Compound B (PiB) positron emission tomography. Two women, aged 62 and 69, presented with a history of a few years of progressive aphasia characterized by fluent output with normal grammar and syntax, anomia without loss of word meaning, and relatively spared repetition. They demonstrated striking deficits in visuospatial function for which they were lacking insight. Prominent hypometabolism was noted in the left occipitotemporal region and diffuse retention of PiB was noted. Posterior cortical atrophy may present focally with left occipitotemporal metabolism characterized clinically with a progressive fluent aphasia and prominent ventral visuospatial deficits with loss of insight. PMID:23850398
Wicklund, Meredith R; Duffy, Joseph R; Strand, Edythe A; Whitwell, Jennifer L; Machulda, Mary M; Josephs, Keith A
Treating visual speech perception to improve speech production in non- fluent aphasia
Background and Purpose Several recent studies have revealed modulation of the left frontal lobe speech areas not only during speech production, but also for speech perception. Crucially, the frontal lobe areas highlighted in these studies are the same ones that are involved in non-fluent aphasia. Based on these findings, this study examined the utility of targeting visual speech perception to improve speech production in non-fluent aphasia. Methods Ten patients with chronic non-fluent aphasia underwent computerized language treatment utilizing picture-word matching. To examine the effect of visual peech perception upon picture naming, two treatment phases were compared – one which included matching pictures to heard words and another where pictures were matched to heard words accompanied by a video of the speaker's mouth presented on the computer screen. Results The results revealed significantly improved picture naming of both trained and untrained items following treatment when it included a visual speech component (i.e. seeing the speaker's mouth). In contrast, the treatment phase where pictures were only matched to heard words did not result in statistically significant improvement of picture naming. Conclusions The findings suggest that focusing on visual speech perception can significantly improve speech production in non-fluent aphasia and may provide an alternative approach to treat a disorder where speech production seldom improves much in the chronic phase of stroke.
Fridriksson, Julius; Baker, Julie M.; Whiteside, Janet; Eoute, David; Moser, Dana; Vesselinov, Roumen; Rorden, Chris
People with aphasia: capacity to consent, research participation and intervention inequalities.
Of 14 randomized controlled trials included in the recent Cochrane review of the evidence relating to information provision after stroke, only one included people with aphasia with the remainder either excluding this patient sub-group (10/14 trials) or failing to report any exclusion criteria. A third of people that experience a stroke will also experience aphasia, affecting their speaking, understanding, reading, and writing. The pervasive supposition that people with aphasia lack the capacity to make decisions for themselves is flawed and has the potential to lead to inequalities in care. We highlight the degree to which people with aphasia have been excluded from full participation in some areas of stroke research and the potential clinical consequences of their systematic exclusion. We emphasize the clinical and ethical need for the provision of more accessible research information and consent processes, illustrate the feasibility of adopting such an approach, and consider the broader benefits to stroke research of inclusive and accessible research approaches. PMID:23130972
Brady, Marian C; Fredrick, Alex; Williams, Brian
Single Subject Controlled Experiments in Aphasia: The Science and the State of the Science
This paper discusses the use of single subject controlled experimental designs for investigating the effects of treatment for aphasia. A brief historical perspective is presented, followed by discussions of the advantages and disadvantages of single subject and group approaches, the basic requirements of single subject experimental research, and…
Single subject controlled experiments in aphasia: The science and the state of the science
This paper discusses the use of single subject controlled experimental designs for investigating the effects of treatment for aphasia. A brief historical perspective is presented, followed by discussions of the advantages and disadvantages of single subject and group approaches, the basic requirements of single subject experimental research, and crucial considerations in design selection. In the final sections, results of reviews
Cynthia K. Thompson
A Proposed Regional Hierarchy in Recovery of Post-Stroke Aphasia
Activation studies in patients with aphasia due to stroke or tumours in the dominant hemisphere have revealed effects of disinhibition in ipsilateral perilesional and in contralateral homotopic cortical regions, referred to as collateral and transcallosal disinhibition. These findings were supported by studies with selective disturbance of…
Heiss, W.-D.; Thiel, A.
Beginning to Teach the End: The Importance of Including Discharge from Aphasia Therapy in the Curriculum
Background: Discharging clients with long-term aphasia from therapy services constitutes a challenging dilemma for practising clinicians for a multitude of reasons. Although discharge was raised and discussed as a contentious issue in the field of aphasiology ten years ago, it remains an aspect of practice which is complex and underexplored. We…
Hersh, Deborah; Cruice, Madeline
Production and comprehension in aphasia: gains and pitfalls in using macrostructure tasks in Aesop's fables.
Macrostructures provide the global meaning of a text. Using Aesop's fables, the main goal of this study has been to identify the advantages and limitations in using the macrostructure tasks of retell, summary, lesson, and gist as clinical tools in understanding 16 patients with mild-to-moderate aphasia. Results suggest that all of the macrostructure tasks are important in determining the production skills of patients with aphasia. Comprehension, on the other hand, is best determined through the macrostructure tasks of retell and lesson. In addition to the language processing skills of patients with aphasia, macrostructures also provide a cognitive picture of how patients manipulate information from stories (i.e., reducing information, making inferences, and generalizing didactic information). Inherent limitations, however, are seen when interpreting possible reasons why patients with aphasia are unable to perform some of these tasks. Given that the potential gains of using macrostructure tasks outweigh the limitations, this study suggests that macrostructures may have clinical value as a diagnostic tool in understanding the cognitive-linguistic processes of patients with brain injury. PMID:23721371
Ulatowska, Hanna K; Reyes, Belinda; Olea Santos, Tricia; Garst, Diane; Mak, Kelly; Graham, Kelly
Bilingual Aphasia and Language Control: A Follow-Up fMRI and Intrinsic Connectivity Study
In a world that is becoming more multilingual, bilingual aphasia is a clinical problem with a major clinical impact. However, at present we lack causal explanations of the many features of recovery patterns and there is no consensus about the language in which the patient should receive speech therapy. Further advance requires an understanding of…
Abutalebi, Jubin; Della Rosa, Pasquale Anthony; Tettamanti, Marco; Green, David W.; Cappa, Stefano F.
Naming practice for people with aphasia as a mobile web application
Bangagears is a new version of Banga, a smart phone application that supports word finding practice, a form of therapy for people with aphasia [1]. While Banga was implemented as a native application, a program specific to a particular kind of phone, Bangagears uses the emerging HTML5 technology to operate, in principle, on many different kinds of phones and other
Skye Chandler; Jesse Harris; Alex Moncrief; Clayton Lewis
Poster: the development of a semantic feature analysis based mobile application for individuals with aphasia
We present a Semantic Feature Analysis based mobile application and paired web application, which have been developed in order to facilitate speech and language therapy with a Person with Aphasia (PWA). The goal of this research is to streamline current speech and language therapy practices, by enabling rapid data entry, aggregation and remote analysis. The mobile application has been developed
Conor Higgins; Áine Kearns; Sue Franklin
Transient aphasia and reversible major depression due to a giant sagittal sinus dural AV fistula.
A 61-year-old man presenting with transient global aphasia and chronic major depression was found to have a giant high flow dural arteriovenous fistula of the superior sagittal sinus. EEG and SPECT scan showed left frontoparietal dysfunction. This resolved after fistula embolization, as did the patient's neuropsychiatric complaints. PMID:12939439
Katz, Jeffrey M; Shetty, Teena; Gobin, Y Pierre; Segal, Alan Z
Variability in Subcortical Aphasia Is Due to Variable Sites of Cortical Hypoperfusion
A variety of fluent and nonfluent aphasias have been reported after left basal ganglia stroke. It has been speculated that this heterogeneity may reflect variations in cortical hypoperfusion resulting from large vessel stenosis. To test this hypothesis, a consecutive series of 24 patients with left caudate infarct identified with…
Hillis, Argye E.; Barker, Peter B.; Wityk, Robert J.; Aldrich, Eric M.; Restrepo, Lucas; Breese, Elisabeth L.; Work, Melissa
An evaluation of multiple?choice test images for comprehension assessment in aphasia
Background: Using images in multiple?choice formats for comprehension testing in aphasia is common. It is generally assumed that persons being assessed perceive the content of the images represented in such tasks. However, specific visual characteristics of individual images may influence visual attention, which may influence accuracy in the selection of a correct target image corresponding to a verbal stimulus. The
Sabine Heuer; Brooke Hallowell
Recovery of semantic word processing in global aphasia: a functional MRI study
One important issue concerning the recovery of higher cognitive functions—such as word comprehension in aphasia—is to what extent impairments can be compensated for by intact parts of the network of areas normally involved in a closely related function ("redundancy recovery"). In a previous functional MRI investigation, we were able to show that left hemispheric redundancy recovery within a distributed system
Roland Zahn; Eva Drews; Karsten Specht; Stefan Kemeny; Wolfgang Reith; Klaus Willmes; Michael Schwarz; Walter Huber
A short history of the Veterans Administration's influence on aphasia assessment tools
Background: The United States Veterans Administration (VA) has a long history of supporting medical developments, including those in the rehabilitation sciences. Its large patient population, numerous facilities, and funding of research, education, and training have resulted in many medical advances. Its positive influences also have extended to the profession of speech?language pathology, particularly regarding the assessment and treatment of aphasia.Aims:
Donald Freed
Primary Progressive Aphasia in a Bilingual Speaker: A Single-Case Study
We report on the case of an elderly bilingual woman presenting with a diagnosis of primary progressive aphasia. The participant's native language was Friulian (L1), a predominantly oral Romance language, and her second language was Italian (L2), formally learned at primary school in oral and written forms. We investigated her linguistic abilities…
Zanini, Sergio; Angeli, Valentina; Tavano, Alessandro
Health-Related Quality of Life in People with Severe Aphasia
Background: Health-related quality of life (HRQL) measures are increasingly used to help us understand the impact of disease or disability on a person's life and to measure the effectiveness of interventions. A small number of studies have looked at perceived HRQL in people with mild or moderate aphasia. They report that reduced HRQL is associated…
Hilari, Katerina; Byng, Sally
Background: Studies of the automatic processes supporting language processing and dysfunction in aphasia often rely on priming paradigms. However, the ability to confidently interpret these studies in terms of understanding the relative contributions of automatic vs controlled processing depends on the ability to isolate only automatic processes. One way this may be accomplished is through the use of visual masking.
JoAnn P. Silkes; Margaret A. Rogers
Longitudinal assessment of coherence in an adult with fluent aphasia: A follow-up study
Background: It has been suggested that individuals with fluent aphasia demonstrate microlinguistic impairments and relatively preserved macrolinguistic abilities (Glosser & Deser, 1990). However, results of a previous study in which measures of sentence production, intersentential cohesion, and story grammar were assessed longitudinally over a period of 12 months did not support this contention (Coelho, Liles, Duffy, Clarkson, & Elia, 1994).
Carl Coelho; Laura Flewellyn
Using a computer to communicate: Effect of executive function impairments in people with severe aphasia
Background : Some individuals with severe non-fluent aphasia do not respond in a functional way to any form of communication therapy. Others show improved ability to communicate with treatment focused on alternative communication modalities such as drawing, gesturing, or using a computer. An important difference between these two patient groups may lie in their nonverbal executive function abilities. Executive functions
Marjorie Nicholas; Michele Sinotte; Nancy Helm-Estabrooks
Strategic design of protocols to evaluate vision in research on aphasia and related disorders
Background: Most experimental and assessment tasks in studies of neurogenic language disorders rely on visual information processing. Given that many patients with such disorders have visual deficits, failure to describe and\\/or control for visual function may lead to invalid data collection and interpretation. A review of literature on participant description in aphasia research indicates a clear need for improvement in
Brooke Hallowell
Treating Verbs in Aphasia: Exploring the Impact of Therapy at the Single Word and Sentence Levels
Background: In recent years there has been significant interest in the differential processing of nouns and verbs in people with aphasia, but more limited consideration about whether the differences have implications for therapy. It remains unclear whether verbs can be treated in a similar way to nouns or should be treated using approaches that…
Webster, Janet; Whitworth, Anne
Comparison of clinician and spouse perceptions of the handicap of aphasia: Everybody understands 'understanding'
This study examines whether standard aphasia assessment procedures provide sufficient information for speech pathologists to make socially valid judgements about the extent of disability and handicap experienced by aphasic speakers in their daily lives. Fourteen speech pathologists and six spouses described their impressions of six aphasic speakers' communication problems and completed a 42-item questionnaire rating their perceptions of how language
Dorothea Oxenham; Christine Sheard; Rogeradams
A Comparison of Computerized and Paper-Based Language Tests with Adults with Aphasia
Purpose: This study investigated whether computers are a useful tool in the assessment of people with aphasia (PWA). Computerized and traditionally administered versions of tasks were compared to determine whether (a) the scores were equivalent, (b) the administration was comparable, (c) variables such as age affected performance, and (d) the…
Newton, Caroline; Acres, Kadia; Bruce, Carolyn
Comparison of Alternatives to Multidimensional Scoring in the Assessment of Language Comprehension in Aphasia
Purpose: Multidimensional scoring methods yield valuable information about communication abilities. However, issues of training demands for valid and reliable scoring, especially in current service delivery contexts, may preclude common usage. Alternatives to multidimensional scoring were investigated in a sample of adults with aphasia. Method:…
Odekar, Anshula; Hallowell, Brooke
Do picture?naming tests provide a valid assessment of lexical retrieval in conversation in aphasia?
Background: Word?finding problems commonly occur in aphasia and can significantly affect communication. Assessment of this deficit typically involves naming pictures. However, this method has been criticised as lacking ecological validity. Alternative methods include the measurement of lexical retrieval in narration or conversation, although few published studies have quantified word finding in the latter.Aims: We aimed to identify a reliable and
Ruth Herbert; Julie Hickin; David Howard; Felicity Osborne; Wendy Best
The effects of aphasia severity on the ability to assess language disorders via telerehabilitation
Background: Telerehabilitation is the remote delivery of rehabilitation services via information technology and telecommunication systems. There have been a number of recent studies that have used video conferencing to assess language skills in people with aphasia. These studies have highlighted the possibility that severity of impairment and aetiology may have an effect on the administration of telerehabilitation language assessment protocols.
Anne J. Hill; Deborah G. Theodoros; Trevor G. Russell; Elizabeth C. Ward; Richard Wootton
Evolution of Phonemic Word Fluency Performance in Post-Stroke Aphasia
In this longitudinal study, quantitative and qualitative changes in responses of people with aphasia were examined on a phonemic fluency task. Eighteen patients were tested at 3-month intervals on the letters F-A-S while they received comprehensive, intensive treatment from 3 to 12 months post-stroke. They returned for a follow-up evaluation at an…
Sarno, Martha Taylor; Postman, Whitney Anne; Cho, Young Susan; Norman, Robert G.
The Potential of Virtual Reality to Assess Functional Communication in Aphasia
Speech-language pathologists (SLPs) who work with adults with cognitive-linguistic impairments, including aphasia, have long needed an assessment tool that predicts ability to function in the real world. In this article, it is argued that virtual reality (VR)-supported approaches can address this need. Using models of disability such as the…
Garcia, Linda J.; Rebolledo, Mercedes; Metthe, Lynn; Lefebvre, Renee
Adapting the Bilingual Aphasia Test to Rarotongan (Cook Islands Maori): Linguistic and Clinical Considerations
This article describes the adaptation of the Bilingual Aphasia Test (BAT) to the Rarotongan dialect of Cook Islands Maori, a Polynesian language spoken in the Cook Islands and expatriate communities. A brief linguistic sketch of Rarotongan is presented. As Rarotongan is characterised by a complex pronominal system, "a" versus "o" possession and…
Amberber, Amanda Miller
Aphasia and Cognitive Sciences: Problems of Appraisal Tests in Indian Context.
Discusses the urgency of therapeutic appraisal tests for various types of aphasia in India, where the clinical population comes from multilingual, multiethnic, and multicultural backgrounds; has a low literacy level; and hails from various geographical regions. The need for good diagnostic tests is imperative for a detailed evaluation of language…
Gupta, Santosh
Drawing: Its value as a communication aid for adults with aphasia
Drawings by adults with aphasia are clinically relevant. Their value to clinicians and clinical researchers is derived from their usefulness in diverse applications. First, drawings may help specify location and severity of brain damage. Second, they may aid in determining semantic\\/conceptual integrity of thought following brain damage. Third, they may serve as an alternative or augmentative mode of expression. When
Jon G. Lyon
The Time-Course of Lexical Activation during Sentence Comprehension in People with Aphasia
Purpose: To investigate the time-course of processing of lexical items in auditorily presented canonical (subject-verb-object) constructions in young, neurologically unimpaired control participants and participants with left-hemisphere damage and agrammatic aphasia. Method: A cross modal picture priming (CMPP) paradigm was used to test 114 control…
Ferrill, Michelle; Love, Tracy; Walenski, Matthew; Shapiro, Lewis P.
Role of Importance and Distinctiveness of Semantic Features in People with Aphasia: A Replication Study
Previous studies suggest that people with aphasia have incomplete lexical-semantic representations with decreased low-importance distinctive (LID) feature knowledge. In addition, decreased LID feature knowledge correlates with ability to discriminate among semantically related words. The current study seeks to replicate and extend previous…
Mason-Baughman, Mary Beth; Wallace, Sarah E.
Reconciling the Perspective of Practitioner and Service User: Findings from The Aphasia in Scotland Study
Background: It is widely accepted that service users should be actively involved in new service developments, but there remain issues about how best to consult with them and how to reconcile their views with those of service providers. Aims: This paper uses data from The Aphasia in Scotland study, set up by NHS Quality Improvement Scotland to…
Law, James; Huby, Guro; Irving, Anne-Marie; Pringle, Ann-Marie; Conochie, Douglas; Haworth, Catherine; Burston, Amanda
Gesture and Naming Therapy for People with Severe Aphasia: A Group Study
Purpose: In this study, the authors (a) investigated whether a group of people with severe aphasia could learn a vocabulary of pantomime gestures through therapy and (b) compared their learning of gestures with their learning of words. The authors also examined whether gesture therapy cued word production and whether naming therapy cued gestures.…
Marshall, Jane; Best, Wendy; Cocks, Naomi; Cruice, Madeline; Pring, Tim; Bulcock, Gemma; Creek, Gemma; Eales, Nancy; Mummery, Alice Lockhart; Matthews, Niina; Caute, Anna
Access to Knowledge from Pictures but not Words n a Patient with Progressive Fluent Aphasia.
Presents data from a patient with a progressive fluent aphasia, who exhibited a severe verbal impairment but a relatively preserved access to knowledge from pictures. Argues for a distributed, multi-modality system for semantic memory in which information is stored in different brain regions and in different representational formats. (Author/VWL)
Saffran, Eleanor M.; Coslett, H. Branch; Martin, Nadine; Boronat, Consuelo B.
Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation
Stroke victims tend to prioritize speaking, writing, and walking as the three most important rehabilitation goals. Of note is that two of these goals involve communication. This underscores the significance of developing successful approaches to aphasia treatment for the several hundred thousand new aphasia patients each year and over 1 million stroke survivors with chronic aphasia in the U.S. alone. After several years of growth as a research tool, non-invasive brain stimulation (NBS) is gradually entering the arena of clinical aphasiology. In this review, we first examine the current state of knowledge of post-stroke language recovery including the contributions from the dominant and non-dominant hemispheres. Next, we briefly discuss the methods and the physiologic basis of the use of inhibitory and excitatory repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) as research tools in patients who experience post-stroke aphasia. Finally, we provide a critical review of the most influential evidence behind the potential use of these two brain stimulation methods as clinical rehabilitative tools.
Shah, Priyanka P.; Szaflarski, Jerzy P.; Allendorfer, Jane; Hamilton, Roy H.
Cognitive and Cognate-Based Treatments for Bilingual Aphasia: A Case Study
Two consecutive treatments were conducted to investigate skill learning and generalization within and across cognitive-linguistic domains in a 62-year-old Spanish-English bilingual man with severe non-fluent aphasia. Treatment 1 was a cognitive-based treatment that emphasized non-linguistic skills, such as visual scanning, categorization, and…
Kohnert, Kathryn
Neuroimaging in aphasia treatment research: Issues of experimental design for relating cognitive to neural changes
The design of functional neuroimaging studies investigating the neural changes that support treatment-based recovery of targeted language functions in acquired aphasia faces a number of challenges. In this paper, we discuss these challenges and focus on experimental tasks and experimental designs that can be used to address the challenges, facilitate the interpretation of results and promote integration of findings across studies.
Rapp, Brenda; Caplan, David; Edwards, Susan; Visch-Brink, Evy; Thompson, Cynthia K.
The Merest L"ogomachy": The 1868 Norwich Discussion of Aphasia by Hughlings Jackson and Broca
This article reconsiders the events that took place at the 1868 meeting of the British Association for the Advancement of Science (BA) in Norwich. Paul Broca and John Hughlings Jackson were invited to speak on the new and controversial subject of aphasia. Over the ensuing decades, there have been repeated references made to a debate between Broca…
Lorch, Marjorie Perlman
Model?driven intervention in bilingual aphasia: Evidence from a case of pathological language mixing
Background: Speech?language pathologists are meeting an increasing number of bilingual clients. This poses a special challenge to clinical practice, given that bilingualism adds to the complexity of aphasia patterns and clinical decisions must be made accordingly. One question that has come to the attention of clinical aphasiologists is that of the language in which therapy should be administered. This issue
Ana Inés Ansaldo; Ladan Ghazi Saidi; Adelaida Ruiz
Piezonuclear battery
A piezonuclear battery generates output power arising from the piezoelectric voltage produced from radioactive decay particles interacting with a piezoelectric medium. Radioactive particle energy may directly create an acoustic wave in the piezoelectric medium or a moderator may be used to generate collision particles for interacting with the medium. In one embodiment a radioactive material (.sup.252 Cf) with an output of about 1 microwatt produced a 12 nanowatt output (1.2% conversion efficiency) from a piezoelectric copolymer of vinylidene fluoride/trifluorethylene.
Bongianni, Wayne L. (Los Alamos, NM)
Transient aphasia: a rare complication of head-up tilt test.
Head-up tilt test (HUT) is widely used as a diagnostic tool. It reproduces vasovagal attacks in many susceptible patients. Although it is known to be safe and well tolerated, it is a procedure with potential neurologic complications. We observed that it could cause transient aphasia in some patients. To explore clinical characteristics and possible pathogenesis of aphasia induced by HUT, we reviewed the data of patients undergoing HUT in our hospital. 13 patients experienced transient aphasia in 3,488 cases. According to the hemodynamic changes, the incidence in vasodepressor, mixed, cardioinhibition and the negative response were 6.67, 5.52, 0 and 1.14 ‰ orderly, and not significantly different among the groups. It had significant difference between the positive response and the negative response and between vasodepressor and the negative response (both p < 0.05). The incidence in adults was significantly higher than that in children (<18 years) (p < 0.01), but not different between female and male. The average onset time was 11.33 ± 6.66 min (range 4-17 min) during baseline HUT or 4.90 ± 2.69 min (range 2-10 min) during sublingual nitroglycerin-provocated HUT. The duration was 3-60 min, except for one who was completely relieved of the disorder 4 h later. In conclusions, there is a risk of provoking transient aphasia during HUT. It reminds that performer should alert the possibility of transient aphasia during the test, especially when the patient is an adult and has a positive response. PMID:24514919
Chu, Weihong; Wang, Cheng; Lin, Ping; Li, Fang; Wu, Lijia; Xie, Zhenwu
Group training in communication skills for carers of adults with aphasia.
This study describes a communication skills group programme for four carers of adults with aphasia that ran once a week for 6 consecutive weeks. The content of the group was based on an approach previously not described in the literature in any detail. Conversation analysis (CA) was used to guide individualized advice that was incorporated into the group by the use of written advice sheets. Intervention was motivated by the results of a newly developed assessment tool--the Conversation Analysis Profile for People with Aphasia (CAPPA)--and a quantitative and qualitative analysis of collaborative repair. The CAPPA utilizes the methodology of conversation analysis (CA) as a means of both characterizing and comparing the relationship between the carers' perception of the aphasia and what is occurring in natural conversation. During the group, accurate perceptions and strategies that minimized the disruption to the conversation were reinforced, while inaccurate perceptions and strategies that appeared to impede interaction were discouraged. The use of the CAPPA results and a quantitative/qualitative analysis of repair management to measure change pre- and post-group was explored. The post-intervention analyses examined three questions in particular: (1) did the carers demonstrate more accurate perceptions of their relatives' aphasia?; (2) did the carers report a decrease in the problem severity of the aphasia?; and (3) was there a change in the time taken to repair a trouble source and was this attributable to a change in the management of repair by the carer? The study was essentially an investigation of whether this type of approach was beneficial to the carers involved. The results suggested that focusing on individualized advice and targeting conversation management in the group setting was a useful way of providing advice to carers. Furthermore, the CAPPA and a quantitative/qualitative analysis of repair management seem to have the potential for motivating the individualized advice and measuring the effectiveness of an intervention. PMID:10884903
Booth, S; Swabey, D
[Detection of endpoint for segmentation between consonants and vowels in aphasia rehabilitation software based on artificial intelligence scheduling].
For the purpose of improving the efficiency of aphasia rehabilitation training, artificial intelligence-scheduling function is added in the aphasia rehabilitation software, and the software's performance is improved. With the characteristics of aphasia patient's voice as well as with the need of artificial intelligence-scheduling functions under consideration, the present authors have designed a set of endpoint detection algorithm. It determines the reference endpoints, then extracts every word and ensures the reasonable segmentation points between consonants and vowels, using the reference endpoints. The results of experiments show that the algorithm is able to attain the objects of detection at a higher accuracy rate. Therefore, it is applicable to the detection of endpoint on aphasia-patient's voice. PMID:19813633
Deng, Xingjuan; Chen, Ji; Shuai, Jie
Features of aphasic gesturing--an exploratory study of features in gestures produced by persons with and without aphasia.
The purpose of this study was to see how features of gestures produced by persons with aphasia (PWA) are affected and to relate the findings to possible underlying factors. Spontaneous gestures were studied in two contexts: (i) associated with the production of nouns and verbs and (ii) in relation to word finding or production difficulties. The method involved assembling two datasets of co-speech gestures, produced by PWA and by persons without aphasia and to code the gestures for a number of features of expression and content. Features that were affected in the Aphasia dataset were gaze, head movements, hand use and semantic features. The results point to possibly converging explanations, such as generally lower semantic complexity as a direct effect of the aphasia, more cognitive effort and/or a greater dependence on one-hand gestures leading more indirectly to increased gaze aversion, more head shakes and lower complexity in gestures in PWA. PMID:23889213
Ahlsén, Elisabeth; Schwarz, Anneli
Aqueous Electrolyte Batteries
Despite the growing interest in advanced lithium batteries, the overwhelming majority of batteries manufactured today are still based on aqueous electrolytes, mostly sulphuric acid or potassium hydroxide solution. The ubiquitous lead-acid battery is, after 150 years, still being improved as regards its design and materials of construction. Rechargeable batteries based on potassium hydroxide electrolyte have nickel oxide or silver oxide
R. M. dell
Industrial battery technologies and markets
Industrial battery market segments generally fall into two major categories--traction batteries, also called motive power batteries; and stationary batteries, also referred to as standby power batteries. The major industrial battery subcategories are discussed. Industrial trucks and rail and mine vehicles represent two major subcategories of motive power batteries. Industrial trucks include forklifts, automated guided vehicles (AGVs), various types of towing
C. W. Seitz
Lithium Ion Batteries
Lithium ion batteries, which use a new battery chemistry, are being developed under cooperative agreements between Lockheed Martin, Ultralife Battery, and the NASA Lewis Research Center. The unit cells are made in flat (prismatic) shapes that can be connected in series and parallel to achieve desired voltages and capacities. These batteries will soon be marketed to commercial original-equipment manufacturers and thereafter will be available for military and space use. Current NiCd batteries offer about 35 W-hr/kg compared with 110 W-hr/kg for current lithium ion batteries. Our ultimate target for these batteries is 200 W-hr/kg.
Crossed Aphasia in a Dextral: A Test of the Alexander–Annett Theory of Anomalous Organization of Brain Function
A case of crossed aphasia is presented in a strongly right-handed 77-year-old white female without history of familial sinistrality or prior neurological illness. She developed a right middle cerebral artery infarction documented by CT and accompanied by obvious clinical signs of a conduction aphasia with some resolution but continuing obvious language defect after 9 weeks in rehabilitation. Comprehensive neuropsychological and
D. C. Osmon; J. Panos; P. Kautz; B. Gandhavadi
SHORT REPORT The relationship between the severity of post?stroke aphasia and state self?esteem
Background: The study of self?esteem after stroke may provide valuable prognostic information of the potential for functional recovery and may also inform the approach to treatment. Hitherto, research into the effect of post?stroke aphasia on self?esteem has received little attention. The purpose of the present study is to examine the relationship between aphasia and self?esteem and to establish whether the
A. M. O. Bakheit; L. Barrett; J. Wood
Metal-Air Batteries
Metal-air batteries have much higher specific energies than most currently available primary and rechargeable batteries. Recent advances in electrode materials and electrolytes, as well as new designs on metal-air batteries, have attracted intensive effort in recent years, especially in the development of lithium-air batteries. The general principle in metal-air batteries will be reviewed in this chapter. The materials, preparation methods,
Jiguang Zhang; Peter G. Bruce; Gregory Zhang
Pediatric Environmental Neurobehavioral Test Battery.
Contents: How to Use This Book; Rational for Pediatric Neurobehavioral Testing; Selection of Basic Pediatric Test Battery; Test Battery Implementation; (Preparation, Test Battery Administration, Data Management); Resources.
M. Gibertini R. W. Amler
Deciphering logopenic primary progressive aphasia: a clinical, imaging and biomarker investigation.
Within primary progressive aphasia the logopenic variant remains less understood than the two other main variants, namely semantic and non-fluent progressive aphasia. This may be because of the relatively small number of explored patients and because of the lack of investigations with a comprehensive three-level characterization of cognitive, brain localization and biological aspects. The aim of the present study was to decipher the logopenic variant through a multimodal approach with a large cohort of 19 patients (age 66.5 ± 8.7 years, symptom duration 3.2 ± 0.6 years) using detailed cognitive and linguistic assessments, magnetic resonance imaging and perfusion single-photon emission computed tomography as well as cerebrospinal fluid biomarkers screening for Alzheimer pathology. The linguistic assessment unveiled that language dysfunction is not limited to the typical feature of word finding and verbal working memory impairments but that it extends into the language system affecting to some degree syntactic production, phonological encoding and semantic representations. Perfusion tomography revealed damage of the temporal-parietal junction with a peak of significance in the superior temporal gyrus (Brodmann area 42), and of some less significant prefrontal areas (Brodmann areas 8, 9 and 46), whereas hippocampal cortices were unaffected. Magnetic resonance imaging, which was visually assessed in a larger group of 54 patients with logopenic, non-fluent, semantic variants as well as with posterior cortical atrophy, confirmed that the logopenic variant demonstrates predominant atrophy of left temporal-parietal junction, but that this atrophy pattern has a relatively poor sensitivity and specificity for clinical diagnosis. Finally, the biomarker study revealed that two-thirds of the logopenic patients demonstrated a profile indicative of Alzheimer pathology whereas one-third had a non-Alzheimer profile. Splitting the two groups showed that logopenic aphasia due to probable Alzheimer pathology is a more aggressive variant characterized by more extensive language/cognitive disorders affecting, in addition to lexical processes and verbal working memory, also phoneme sequencing, semantic processing and ideomotor praxis. Concordantly, logopenic aphasia due to probable Alzheimer pathology demonstrated more extensive brain hypoperfusion involving larger regions throughout the inferior parietal, the posterior-superior and the middle temporal cortex. These findings allow for unfolding logopenic aphasia into two subvariants differing by disease severity, lesion nature and lesion distribution, which has important implications for diagnosis, patient management and for potential future trials with anti-Alzheimer drugs. The present data therefore provide novel insight into the cognition and brain damage of logopenic patients while unveiling the existence of distinct diseases constituting a 'logopenic aphasia complex'. PMID:24108322
Teichmann, Marc; Kas, Aurélie; Boutet, Claire; Ferrieux, Sophie; Nogues, Marie; Samri, Dalila; Rogan, Christina; Dormont, Didier; Dubois, Bruno; Migliaccio, Raffaella
From primary progressive aphasia to corticobasal syndrome: two clinical and rCBF functional reports.
We describe two cases, both presenting with a 2-year history of isolated language disorders, one compatible with logopenic variant and the other with non-fluent variant of primary progressive aphasia (PPA). Afterwards, each developed a corticobasal syndrome (CBS) with alien limb phenomenon and a multi-domain cognitive impairment. Regional cerebral perfusion (rCBF) study using 99mTc-ECD single photon emission computed tomography (SPECT) revealed hypoperfusion patterns consistent with these aphasia types and with the presence of limb apraxia. We report two cases of PPA variants associated with CBS and we suggest that SPECT rCBF correlates can be useful in making a differential diagnosis within the PPA spectrum. PMID:22512772
Caso, F; Onofrio, F; Falautano, M; Todeschini, P; Migliaccio, R; Comi, G; Perani, D; Magnani, G
Singing therapy can be effective for a patient with severe nonfluent aphasia.
Patients with severe aphasia are rarely treated using speech therapy. We used music therapy to continue to treat a 79-year-old patient with chronic severe aphasia. Interventions 1, 2, and 3 were to practice singing a song that the patient knew, to practice singing a song with a therapist, and to practice saying a greeting using a song with lyrics, respectively. In addition, practice of uttering names of body parts was initiated using touch and rhythm. After intervention 1, the patient could sing spontaneously and repeat lyrics. After intervention 2, she could sing with the therapist, and sing spontaneously and repeat lyrics. After intervention 3, she could memorize words with meaning, say the words in context, and use them. The patient could utter the names of two body parts after therapy with touch and rhythm. These suggest that rehabilitation therapy can still be used in patients with severe cognitive impairment. PMID:22274592
Yamaguchi, Satoshi; Akanuma, Kyoko; Hatayama, Yuka; Otera, Masako; Meguro, Kenichi
A Randomized Controlled Trial on Very Early Speech and Language Therapy in Acute Stroke Patients with Aphasia
Background Aphasia affects one third of acute stroke patients. There is a considerable spontaneous recovery in aphasia, but impaired communication ability remains a great problem. Communication difficulties are an impediment to rehabilitation. Early treatment of the language deficits leading to increased communication ability would improve rehabilitation. The aim of this study is to elucidate the efficacy of very early speech and language therapy (SLT) in acute stroke patients with aphasia. Methods A prospective, open, randomized, controlled trial was carried out with blinded endpoint evaluation of SLT, starting within 2 days of stroke onset and lasting for 21 days. 123 consecutive patients with acute, first-ever ischemic stroke and aphasia were randomized. The SLT treatment was Language Enrichment Therapy, and the aphasia tests used were the Norsk grunntest for afasi (NGA) and the Amsterdam-Nijmegen everyday language test (ANELT), both performed by speech pathologists, blinded for randomization. Results The primary outcome, as measured by ANELT at day 21, was 1.3 in the actively treated patient group and 1.2 among controls. NGA led to similar results in both groups. Patients with a higher level of education (>12 years) improved more on ANELT by day 21 than those with <12 years of education (3.4 vs. 1.0, respectively). In 34 patients in the treatment group and 19 in the control group improvement was ?1 on ANELT (p < 0.05). There was no difference in the degree of aphasia at baseline except for fluency, which was higher in the group responding to treatment. Conclusions Very early intensive SLT with the Language Enrichment Therapy program over 21 days had no effect on the degree of aphasia in unselected acute aphasic stroke patients. In aphasic patients with more fluency, SLT resulted in a significant improvement as compared to controls. A higher educational level of >12 years was beneficial.
Laska, A.C.; Kahan, T.; Hellblom, A.; Murray, V.; von Arbin, M.
"Pre-semantic" cognition revisited: critical differences between semantic aphasia and semantic dementia.
Patients with semantic dementia show a specific pattern of impairment on both verbal and non-verbal "pre-semantic" tasks, e.g., reading aloud, past tense generation, spelling to dictation, lexical decision, object decision, colour decision and delayed picture copying. All seven tasks are characterised by poorer performance for items that are atypical of the domain and "regularization errors" (irregular/atypical items are produced as if they were domain-typical). The emergence of this pattern across diverse tasks in the same patients indicates that semantic memory plays a key role in all of these types of "pre-semantic" processing. However, this claim remains controversial because semantically impaired patients sometimes fail to show an influence of regularity. This study demonstrates that (a) the location of brain damage and (b) the underlying nature of the semantic deficit affect the likelihood of observing the expected relationship between poor comprehension and regularity effects. We compared the effect of multimodal semantic impairment in the context of semantic dementia and stroke aphasia on the seven "pre-semantic" tasks listed above. In all of these tasks, the semantic aphasia patients were less sensitive to typicality than the semantic dementia patients, even though the two groups obtained comparable scores on semantic tests. The semantic aphasia group also made fewer regularization errors and many more unrelated and perseverative responses. We propose that these group differences reflect the different locus for the semantic impairment in the two conditions: patients with semantic dementia have degraded semantic representations, whereas semantic aphasia patients show deregulated semantic cognition with concomitant executive deficits. These findings suggest a reinterpretation of single-case studies of comprehension-impaired aphasic patients who fail to show the expected effect of regularity on "pre-semantic" tasks. Consequently, such cases do not demonstrate the independence of these tasks from semantic memory. PMID:19766662
Jefferies, Elizabeth; Rogers, Timothy T; Hopper, Samantha; Ralph, Matthew A Lambon
Designing a Free Style, Indirect, and Interactive Storytelling Application for People with Aphasia
In this paper, we describe the iterative design and evaluation of a storytelling application for individuals with expressive\\u000a aphasia. Our user studies show that besides basic requirements for medical care and training, there is an unmet need of aphasics\\u000a to share their daily experiences and activities, anecdotes and feelings with their significant others. Thus, the goal of the\\u000a proposed design
Elke Daemen; Pavan Dadlani; Jia Du; Ying Li; Pinar Erik-paker; Jean-bernard Martens; Boris E. R. De Ruyter
Temporal processing and context dependency of phoneme discrimination in patients with aphasia
Standard diagnostic procedures for assessing temporal-processing abilities of adult patients with aphasia have so far not been developed. In our study, temporal-order measurements were conducted using two different experimental procedures to identify a suitable measure for clinical studies. Additionally, phoneme-discrimination abilities were tested on the word, as well as on the sentence level, as a relationship between temporal processing and
Martina Fink; Jan Churan; Marc Wittmann
Making sense of progressive non-fluent aphasia: an analysis of conversational speech.
The speech of patients with progressive non-fluent aphasia (PNFA) has often been described clinically, but these descriptions lack support from quantitative data. The clinical classification of the progressive aphasic syndromes is also debated. This study selected 15 patients with progressive aphasia on broad criteria, excluding only those with clear semantic dementia. It aimed to provide a detailed quantitative description of their conversational speech, along with cognitive testing and visual rating of structural brain imaging, and to examine which, if any features were consistently present throughout the group; as well as looking for sub-syndromic associations between these features. A consistent increase in grammatical and speech sound errors and a simplification of spoken syntax relative to age-matched controls were observed, though telegraphic speech was rare; slow speech was common but not universal. Almost all patients showed impairments in picture naming, syntactic comprehension and executive function. The degree to which speech was affected was independent of the severity of the other cognitive deficits. A partial dissociation was also observed between slow speech with simplified grammar on the one hand, and grammatical and speech sound errors on the other. Overlap between these sets of impairments was however, the rule rather than the exception, producing continuous variation within a single consistent syndrome. The distribution of atrophy was remarkably variable, with frontal, temporal and medial temporal areas affected, either symmetrically or asymmetrically. The study suggests that PNFA is a coherent, well-defined syndrome and that varieties such as logopaenic progressive aphasia and progressive apraxia of speech may be seen as points in a space of continuous variation within progressive non-fluent aphasia. PMID:19696033
Knibb, Jonathan A; Woollams, Anna M; Hodges, John R; Patterson, Karalyn
Making sense of progressive non-fluent aphasia: an analysis of conversational speech
The speech of patients with progressive non-fluent aphasia (PNFA) has often been described clinically, but these descriptions lack support from quantitative data. The clinical classification of the progressive aphasic syndromes is also debated. This study selected 15 patients with progressive aphasia on broad criteria, excluding only those with clear semantic dementia. It aimed to provide a detailed quantitative description of their conversational speech, along with cognitive testing and visual rating of structural brain imaging, and to examine which, if any features were consistently present throughout the group; as well as looking for sub-syndromic associations between these features. A consistent increase in grammatical and speech sound errors and a simplification of spoken syntax relative to age-matched controls were observed, though telegraphic speech was rare; slow speech was common but not universal. Almost all patients showed impairments in picture naming, syntactic comprehension and executive function. The degree to which speech was affected was independent of the severity of the other cognitive deficits. A partial dissociation was also observed between slow speech with simplified grammar on the one hand, and grammatical and speech sound errors on the other. Overlap between these sets of impairments was however, the rule rather than the exception, producing continuous variation within a single consistent syndrome. The distribution of atrophy was remarkably variable, with frontal, temporal and medial temporal areas affected, either symmetrically or asymmetrically. The study suggests that PNFA is a coherent, well-defined syndrome and that varieties such as logopaenic progressive aphasia and progressive apraxia of speech may be seen as points in a space of continuous variation within progressive non-fluent aphasia.
Woollams, Anna M.; Hodges, John R.; Patterson, Karalyn
Evaluating Single-Subject Treatment Research: Lessons Learned from the Aphasia Literature
The mandate for evidence-based practice has prompted careful consideration of the weight of the scientific evidence regarding\\u000a the therapeutic value of various clinical treatments. In the field of aphasia, a large number of single-subject research studies\\u000a have been conducted, providing clinical outcome data that are potentially useful for clinicians and researchers; however,\\u000a it has been difficult to discern the relative
Pélagie M. Beeson; Randall R. Robey
Proverb interpretation in fluent aphasia and Alzheimer's disease: Implications beyond abstract thinking
This study compared proverb processing across three groups, i.e. patients with fluent aphasia (APH), patients with Alzheimer's Disease (AD), and normal control subjects (NC). Proverb stimuli were used to examine the effects of group membership and proverb familiarity in two presentation formats (i.e. spontaneous versus multiple-choice) on performance. The sensitivity of linguistic and cognitive measures as predictors of ability to
S. B. Chapman; H. K. Ulatowska; L. R. Franklin; A. E. Shobe; J. L. Thompson; D. D. McIntire
Naming practice for people with aphasia in a mobile web application: early user experience
Bangaten is a new version of Banga [2,3], a smart phone application that supports word finding practice, a form of therapy for people with aphasia. Early user experience shows that Bangaten offers useful cross-platform operation, on both Android and iPhone devices, including remote management of a client's device. Bangaten demonstrates the growing usefulness of emerging HTML5 technology for implementing assistive
Khalyle Hagood; Terrance Moore; Tiffany Pierre; Paula Messamer; Gail Ramsberger; Clayton Lewis
A process for translating evidence-based aphasia treatment into clinical practice
Background: Increased attention in the field of speech-language pathology is directed towards evidence-based treatment, particularly with regard to neurogenic communication disorders.Aims: The paper describes the development of an evidence-based aphasia clinic. Core principles of the clinic are the use of language treatment techniques that have support in efficacy data, and the objective measurement of treatment effectiveness.Main Contribution: Care paths for
Robert Fucetola; Fran Tucker; Karen Blank; Maurizio Corbetta
Western Samoa.
This discussion of Western Samoa, which lies 2575 km northeast of Auckland, New Zealand, focuses on the following: geography; the people; history; government; political conditions; the economy; foreign relations; and relations the US. The population of Western Samoa, as of 1985, totals 163,000 with an annual growth rate of 0.9%. The infant mortality rate is 13/1000; life expectancy is 65 years. The main islands are formed ranges of extinct volcanoes. Volcanic activity last occurred in 1911. More than 2000 years age, waves of Polynesians migrated from Southeast Asia to the Samoan Islands. Samoans are the 2nd largest Polynesian group, after the Maoris of New Zealand, and speak a Polynesian dialect. Samoans have tended to retain their traditional ways despite exposure to European influence for more than 150 years. Most Samoans live within the traditional social system based on an extended family group, headed by a chief. Western Samoans are Christian. Education is free but not compulsory. In 1967, 95% of the children of primary school age attended school. From 1947 to 1961, a series of constitutional advances, assisted by visits from UN missions, brought Western Samoa from dependent status to self-government and finally to independence. The 1960 constitution is based on the British pattern of parliamentary democracy, modified to take Samoan customs into account. The present head of state holds his position for life. Future heads of state will be elected by the Legislative Assembly for 5-year terms. The Parliament consists of the Legislative Assembly and the head of state. The Supreme Court is the superior court of record and has full jurisdiction in civil, criminal, and constitutional matters. The "matai" of chief system still dominates the politics of Western Samoa, although several political parties have been formed and seem to be taking root. The "matai" system is a predominantly conservative force but does provide for change. Western Samoa is predominantly agricultural, and the village communities maintain an economy based on farming and fishing. Stagnating or declining agricultural production has resulted in an increasing dependence on imports. The islands have few resources and no deposits of commercially valuable minerals. Western Samoa suffers from a persistent current accounts deficit. The government's primary goal is to improve agricultural production. Western Samoa has particularly close relations with its Pacific island neighbors and New Zealand. The US has taken a special interest in Western Samoa's economic development. PMID:12178131
Iconic gesture in normal language and word searching conditions: a case of conduction aphasia.
Although there is a substantive body of research about the language used by individuals with aphasia, relatively little is known about their spontaneous iconic gesture. A single case study of LT, an individual with conduction aphasia indicated qualitative differences between the spontaneous iconic gestures produced alongside fluent speech and in tip of the tongue states. The current study examined the iconic gestures produced by another individual with conduction aphasia, WT, and a group of 11 control participants. Comparisons were made between iconic gestures produced alongside normal language and those produced alongside word-searching behaviour. Participants recounted the Tweety and Sylvester cartoon Canary Row. All gesture produced was analysed qualitatively and quantitatively. WT produced more iconic gestures than controls accompanying word searching behaviour, whereas he produced a similar frequency of iconic gestures to control participants alongside normal language. The iconic gestures produced in the two language contexts also differed qualitatively. Frequency of iconic gesture production was not affected by limb apraxia. This study suggests that there are differences between iconic gestures that are produced alongside normal language and those produced alongside word-searching behaviour. Theoretical and clinical implications of these findings are discussed. PMID:23534389
Pritchard, Madeleine; Cocks, Naomi; Dipper, Lucy
Dynamic aphasia in progressive supranuclear palsy: a deficit in generating a fluent sequence of novel thought.
We report a patient (KAS) who presented with pure dynamic aphasia in the context of progressive supranuclear palsy (PSP). KAS had the hallmark propositional language impairment in the context of preserved naming, reading, repetition and comprehension skills. The severity of KAS's propositional language deficit was demonstrated to be comparable to other dynamic aphasic patients. Remarkably, despite virtually abolished propositional speech, KAS was unimpaired on word and sentence level generation tasks that required a single response. This dissociation was further investigated on two discourse level generation tasks that required the generation of multiple connected sentences. Quantitative production analysis and novelty measures demonstrated that her performance was extremely reduced and characterised by a lack of novel words and sentences and a tendency to perseverate. This pattern of performance suggests that there may be two subtypes of dynamic aphasia. Patients with the more documented first subtype have language-specific deficits, fail word and sentence level generation tests and have left inferior frontal gyrus lesions. Patients with the second subtype, like KAS, pass word and sentence level generation tests and fail discourse level generation tests. They have a verbal and non-verbal generation deficit and bilateral frontal and subcortical damage. Our findings are discussed with reference to executive functioning accounts of dynamic aphasia and models of speech production. We interpret our patients' impairment as being underpinned by a deficit in one set of mechanisms involved in discourse generation; namely the generation of a fluent sequence of novel thought. PMID:16504225
Robinson, Gail; Shallice, Tim; Cipolotti, Lisa
Feasibility and cost analysis of implementing high intensity aphasia clinics within a sub-acute setting.
Abstract The current study explored the clinical feasibility and costs of embedding three different intensive service delivery models for aphasia treatment (computer, group therapy, and therapy with a speech pathology therapy assistant) within three sub-acute facilities. The study employed a two cohort comparison design, with the first cohort (n = 22) receiving the standard service of treatment currently offered. This treatment was delivered by a speech-language pathologist and involved on average 3 hours of treatment/week over 8 weeks. Participants in the second cohort (n = 31) received one of the three intensive treatment models providing up to 9 hours of therapy/week for 11 weeks. Organizational data was collected throughout treatment, with participant, caregiver, and clinician satisfaction with the intensive models also being measured. Participants completed the spoken language production sub-tests and the Disability Questionnaire of the Comprehensive Aphasia Test (CAT) pre- and post-treatment. All intensive models yielded high participant attendance, satisfaction, and significant improvements to the CAT sub-tests. The pro-rata cost of providing treatment per hour per client for the computer and group therapy models was found to be ˜ 30% cheaper compared to the standard service. The outcomes support the potential feasibility of embedding the different models into sub-acute facilities to enhance client access to intensive treatment for aphasia. PMID:24597463
Wenke, Rachel; Lawrie, Melissa; Hobson, Tania; Comben, Wendy; Romano, Michelle; Ward, Elizabeth; Cardell, Elizabeth
Neuroimaging in aphasia treatment research: consensus and practical guidelines for data analysis.
Functional magnetic resonance imaging is the most widely used imaging technique to study treatment-induced recovery in post-stroke aphasia. The longitudinal design of such studies adds to the challenges researchers face when studying patient populations with brain damage in cross-sectional settings. The present review focuses on issues specifically relevant to neuroimaging data analysis in aphasia treatment research identified in discussions among international researchers at the Neuroimaging in Aphasia Treatment Research Workshop held at Northwestern University (Evanston, Illinois, USA). In particular, we aim to provide the reader with a critical review of unique problems related to the pre-processing, statistical modeling and interpretation of such data sets. Despite the fact that data analysis procedures critically depend on specific design features of a given study, we aim to discuss and communicate a basic set of practical guidelines that should be applicable to a wide range of studies and useful as a reference for researchers pursuing this line of research. PMID:22387474
Meinzer, Marcus; Beeson, Pélagie M; Cappa, Stefano; Crinion, Jenny; Kiran, Swathi; Saur, Dorothee; Parrish, Todd; Crosson, Bruce; Thompson, Cynthia K
Electrophysiological responses to argument structure violations in healthy adults and individuals with agrammatic aphasia
Sentence comprehension requires processing of argument structure information associated with verbs, i.e. the number and type of arguments that they select. Many individuals with agrammatic aphasia show impaired production of verbs with greater argument structure density. The extent to which these participants also show argument structure deficits during comprehension, however, is unclear. Some studies find normal access to verb arguments, whereas others report impaired ability. The present study investigated verb argument structure processing in agrammatic aphasia by examining event-related potentials associated with argument structure violations in healthy young and older adults as well as aphasic individuals. A semantic violation condition was included to investigate possible differences in sensitivity to semantic and argument structure information during sentence processing. Results for the healthy control participants showed a negativity followed by a positive shift (N400-P600) in the argument structure violation condition, as found in previous ERP studies (Friederici & Frisch, 2000; Frisch, Hahne, & Friederici, 2004). In contrast, individuals with agrammatic aphasia showed a P600, but no N400, response to argument structure mismatches. Additionally, compared to the control groups, the agrammatic participants showed an attenuated, but relatively preserved, N400 response to semantic violations. These data show that agrammatic individuals do not demonstrate normal real-time sensitivity to verb argument structure requirements during sentence processing.
Kielar, Aneta; Meltzer-Asscher, Aya; Thompson, Cynthia
Perspectives on public awareness of stroke and aphasia among Turkish patients in a neurology unit.
Recent studies on awareness have drawn attention to the fact that aphasia is a little known disorder to the public, in spite of all the publicity about this frequently occurring neurogenic language disorder. Being a very new concept, studies of awareness are rare in Turkey. This survey study assessed the extent of public awareness of neurological disorders, including aphasia, and information sources to answer questions about such disorders. A survey questionnaire consisting of 22 brief questions divided into three sections of awareness was administered to a convenience sample of 196 adults at a University Hospital in 2004. The results indicated that epilepsy and dementia are "the most well-known", and Multiple Sclerosis (MS) is "the least-known" among the surveyed diseases/disorders. Aphasia awareness was also low. The respondents preferred doctors as the most reliable information source. Speech and language therapists were found to be one of the information sources in advocating publicity as well. Most respondents expected to receive information from the doctors; who, in Turkey, are totally occupied with the physical aspects of health care provision. Neurologists, in collaboration with speech and language therapists, should be in a position to develop educational programmes to increase public awareness. PMID:17364617
Mavi?, Ilknur
This paper discusses the use of single subject controlled experimental designs for investigating the effect of treatment for aphasia. A brief historical perspective is presented, followed by discussions of the advantages and disadvantages of single subject and group approaches, the basic requirements of single subject experimental research, and crucial considerations in design selection. In the final sections, results of reviews of published single subject controlled experiments are discussed, with emphasis on internal validity issues, the number of participants enrolled in published studies, operational specification of the dependent and independent variables, and reliability of measurement. Learning outcomes As a result of reading this paper, the participant will: (1) understand the mechanisms required for demonstration of internal and external validity using single subject controlled experimental designs, (2) become familiar with the basic requirements of single subject controlled experimental research, (3) understand the types of single subject controlled experimental designs that are the most appropriate for studying the effects of treatment for aphasia, and (4) become familiar with trends in the published aphasia treatment literature in which single subject controlled experimental designs have been used.
Crossed aphasia with left spatial neglect and visual imperception: a case report.
A 64-year-old right-handed woman with no left-handers in the family developed aphasia associated with moderate left hemiparesis and dense left homonymous hemianopia following rupture of a right middle cerebral artery aneurysm and subsequent selective surgery confined to the right hemisphere. Severe left spatial neglect and constructional apraxia were also present. The patient was an achondroplasic dwarf whose previous medical and neurological history was otherwise unremarkable. Computed tomography of the brain showed a large right temporo-insulofrontoparietal lesion. Language and nonverbal cognitive functions were assessed after 2 and 6 months, and then four years later. A reportedly overall language disruption in the acute period evolved into Wernicke's aphasia and then into a mild form of conduction aphasia. The associated left spatial neglect eventually shrank to a minimum. The patient never had clinically detectable visual agnosia, but on specific tests of visual recognition and perception some impairment was found four years after onset. The left hemiparesis disappeared in time while the left hemianopia persisted. This case is a convincing example of an entirely righthanded person in whom both linguistic and visuospatial functions are represented in the right hemisphere. PMID:12624720
Paghera, B; Mariën, P; Vignolo, L A
[The significance of the study of aphasia, apraxia and agnosia at present time].
Neuropsychology initiated by the study of aphasia, apraxia and agnosia had been regarded as one division of psychiatry. This is one of the reasons why neuropsychology is minor territory in neurology. Some people say that neuropsychology seems difficult to understand, not scientific, not useful and is rather a man's taste than a medicine. I try to respond in this paper to these critics by way of analyzing our own cases while insisting on the today's importance of the study of aphasia, apraxia and agnosia. Our personal cases consist of the following three categories. 1) Primary progressive apraxia: proposal of the symptomatic concept suggested by the investigation of our own eight cases and those in the literature. 2) Musical alexia with agraphia in a trombone player: study of the cerebral localization in a person with special ability. 3) Disturbance of reaching proposal of intracerebral pathways in kinesthesia. Therefore it is highly possible that the significance of the study of aphasia, apraxia and agnosia should become enlarged now and after; and it seems urgent to answer its need that younger neurologists participate in this area. PMID:10791080
Kawamura, M
Recent developments in functional and structural imaging of aphasia recovery after stroke
Background Functional and structural neuroimaging techniques can increase our knowledge about the neural processes underlying recovery from post-stroke language impairments (aphasia). Aims In the present review we highlight recent developments in neuroimaging research of aphasia recovery. Main Contribution We review (a) cross-sectional findings in aphasia with regard to local brain functions and functional connectivity, (b) structural and functional imaging findings using longitudinal (intervention) paradigms, (c) new adjunct treatments that are guided by functional imaging techniques (e.g., electrical brain stimulation) and (d) studies related to the prognosis of language recovery and treatment responsiveness after stroke. Conclusions More recent developments in data acquisition and analysis foster better understanding and more realistic modelling of the neural substrates of language recovery after stroke. Moreover, the combination of different neuroimaging protocols can provide converging evidence for neuroplastic brain remodelling during spontaneous and treatment-induced recovery. Researchers are also beginning to use sophisticated imaging analyses to improve accuracy of prognosis, which may eventually improve patient care by allowing for more efficient treatment planning. Brain stimulation techniques offer a new and exciting way to improve the recovery potential after stroke.
Meinzer, Marcus; Harnish, Stacy; Conway, Tim; Crosson, Bruce
Background The use of constraint-induced treatment in aphasia therapy has yielded promising but mixed results. Aims We conducted a treatment study with an individual with chronic non-fluent aphasia. The goal of the treatment was to improve verb production in sentence- and narrative- contexts. Methods & Procedures We administered a modified constraint-induced aphasia treatment in a single-subject design. Treatment emphasized the production of verbs within informative exchanges. Verb production in narratives was assessed before and after the treatment. Outcomes & Results Results demonstrated a significant increase in the number of verbs produced during narrative generation following treatment. Moreover, a positive change was perceived by naïve listeners who rated the social-communicative impact of the participant's narratives. Conclusions The increase in verb production seen in the post-treatment measures is attributed to a combination of the constraints imposed on sentence production during the treatment sessions, the informative nature of the treatment exchanges, and the relative intensity of the treatment schedule.
Goral, Mira; Kempler, Daniel
Improved Language in a Chronic Nonfluent Aphasia Patient Following Treatment with CPAP and TMS
Objective To present pre- and post-treatment language data for a nonfluent aphasia patient who received two treatment modalities: 1) Continuous Positive Airway Pressure (CPAP) for his sleep apnea, starting 1 year poststroke; and 2) repetitive transcranial magnetic brain stimulation (rTMS), starting 2 years poststroke. Background Language data were acquired beyond the spontaneous recovery period of 3–6 months poststroke onset (MPO). CPAP restores adequate oxygen flow throughout all stages of sleep, and may improve cognition. A series of slow, 1 Hz rTMS treatments to suppress a posterior portion of right pars triangularis has been shown to improve phrase length and naming in chronic nonfluent aphasia. Method The BDAE and Boston Naming Test (BNT) were administered pre- CPAP, and after 2–5 months of CPAP. These same tests were administered pre-TMS, and at 3 and 6 months post-TMS, and again 2.4 years later. Results Post-CPAP testing showed increased phrase length, auditory comprehension, and naming animals and tools/implements (BDAE). Testing at 3 and 6 months post-TMS showed significant increase in phrase length, auditory comprehension and BNT, compared to pre-TMS. These gains were retained at 2.4 years post-TMS. CPAP use continued throughout. Conclusions Physiological treatment interventions may promote language recovery in chronic aphasia.
Naeser, Margaret A.; Martin, Paula I.; Lundgren, Kristine; Klein, Reva; Kaplan, Jerome; Treglia, Ethan; Ho, Michael; Nicholas, Marjorie; Alonso, Miguel; Pascual-Leone, Alvaro
Association between therapy outcome and right-hemispheric activation in chronic aphasia.
The role of the right hemisphere for language processing and successful therapeutic interventions in aphasic patients is a matter of debate. This study explored brain activation in right-hemispheric areas and left-hemispheric perilesional areas in response to language tasks in chronic non-fluent aphasic patients before and after constraint-induced aphasia therapy (CIAT). In particular, we analysed the relation between brain responses and therapy outcome. Using functional magnetic resonance imaging (fMRI), brain activation was measured during word-reading (REA) and word-stem completion (COM) in 16 chronic non-fluent aphasic and 8 healthy subjects. Before therapy, activation in right inferior frontal gyrus/insula (IFG/IC) was stronger in aphasics compared to controls during REA and in precentral gyrus (PCG) during COM. Therapeutic intervention per se did not change brain activation for either task across all aphasic subjects. However, therapeutic success correlated with a relative decrease of activation in right-hemispheric areas, including the IFG/IC. Most importantly, initial activation in right IFG/IC and other right-hemispheric areas correlated positively with subsequent therapy success. Thus, right-hemispheric activation prior to aphasia therapy strongly predicts therapeutic success, suggesting that brain activation in chronic aphasia indicates the patients' potential for further language improvement. PMID:18349055
Richter, Maria; Miltner, Wolfgang H R; Straube, Thomas
Aluminum Permanganate Battery.
A battery is provided comprising an aluminum anode, an aqueous solution of permanganate as the cathodic species and a second electrode capable of reducing permanganate. Such a battery system is characterized by its high energy density and low polarization...
C. Marsh S. L. Licht
A compact, hermetic feedthrough apparatus is described comprising interfitting sleeve portions constructed of chemically-stable materials to permit unique battery designs and increase battery life and performance. 8 figs.
Kaun, T.D.
Improved Thermal Battery Performance.
A thermal battery was developed which demonstrated an energy density in excess of 17 watt-hours per pound. This advancement of approximately three times the energy density of thermal batteries was accomplished with the lithium aluminum iron disulfide syst...
J. A. DeGruson
Navy Lithium Battery Safety.
Lithium batteries are electrochemical reactors that transform chemical energy into electrical energy on demand. Lithium metal batteries were first marketed in early 1970, primarily for military use. They have a very high gravimetric and volumetric energy ...
C. Batchelor J. Dow
Grid alloys for automobile batteries in the new millennium
By 2000, most lead-acid, starting/lightening/ignition (SLI) batteries produced in the Western world had made the transition from traditional lead-antimony alloy grids to lead-calcium-based alloys. The automobile requirements for high cranking performance and maintenance-free batteries have accelerated the trend. Cost reductions as well as high numbers of grids-per-battery have led to automated, continuous grid-manufacturing processes which require lead-calcium-based alloys. Higher under-hood temperatures have lead to the introduction of higher tin content and silver additions to lead-calcium alloys to improve battery life. Lead-antimony alloys are still used as grid alloys in SLI batteries around the world. With higher performance requirements in vehicles and newer batteries in the next decade, however, the use of lead-antimony alloys for automobile batteries may decline significantly. This paper describes the operating conditions of automobile batteries in the new millennium and how the grid-production processes and grid alloys have changed to meet the requirements of these batteries.
Siegmund, Andreas; Prengaman, R. David
Battery Review Board
The topics covered are presented in viewgraph form: NASA Battery Review Board Charter; membership, board chronology; background; statement of problem; summary of problems with 50 AH standard Ni-Cd; activities for near term programs utilizing conventional Ni-Cd; present projects scheduled to use NASA standard Ni-Cd; other near-term NASA programs requiring secondary batteries; recommended direction for future programs; future cell/battery procurement strategy; and the NASA Battery Program.
Vaughn, Chester
Primary and secondary ambient temperature lithium batteries
These proceedings collect papers on the subject of batteries. Topics include: lithium-oxygen batteries, lithium-sulphur batteries, metal-metal oxide batteries, metal-nonmetal batteries, spacecraft power supplies, electrochemistry, and battery containment materials.
J. P. Gabano; Z. Takehara; P. Bro
Auditory and Linguistic Interaction in Developmental Aphasia: Evidence from Two Studies of Auditory Processing. Papers and Reports on Child Language Development, No. 4.
This paper describes the results of two studies of auditory processing in child aphasia, and their implication for understanding deviant language development. The term "aphasia" is discussed as it is used to describe adult and child language disorders. A first experiment on the auditory functioning in aphasic and nonaphasic children suggests that…
Rosenthal, William S.
Evidence-Based Systematic Review: Effects of Intensity of Treatment and Constraint-Induced Language Therapy for Individuals with Stroke-Induced Aphasia
Purpose: This systematic review summarizes evidence for intensity of treatment and constraint-induced language therapy (CILT) on measures of language impairment and communication activity/participation in individuals with stroke-induced aphasia. Method: A systematic search of the aphasia literature using 15 electronic databases (e.g., PubMed,…
Cherney, Leora R.; Patterson, Janet P.; Raymer, Anastasia; Frymark, Tobi; Schooling, Tracy
Can impairment-focused therapy change the everyday conversations of people with aphasia? A review of the literature and future directions
Background: The ultimate goal in any programme of aphasia rehabilitation is that behaviours targeted in therapy will generalise to everyday use for people with aphasia (PWA). The pervasiveness of conversation in everyday life has undoubtedly contributed to the recent interest in aphasiology regarding how we facilitate, and capture evidence of, change in conversation following therapy. Given the rich nature of
Marcella Carragher; Paul Conroy; Karen Sage; Ray Wilkinson
Constrained versus Unconstrained Intensive Language Therapy in Two Individuals with Chronic, Moderate-to-Severe Aphasia and Apraxia of Speech: Behavioral and fMRI Outcomes
Purpose: This Phase I study investigated behavioral and functional MRI (fMRI) outcomes of 2 intensive treatment programs to improve naming in 2 participants with chronic moderate-to-severe aphasia with comorbid apraxia of speech (AOS). Constraint-induced aphasia therapy (CIAT; Pulvermuller et al., 2001) has demonstrated positive outcomes in some…
Kurland, Jacquie; Pulvermuller, Friedemann; Silva, Nicole; Burke, Katherine; Andrianopoulos, Mary
The evaluation of a learner?centred training programme for spouses of adults with chronic aphasia using qualitative case study methodology
Background: Family education, training, and counselling programmes have been cited as one way to complement traditional interventions for the individual with aphasia. However, the literature still represents the speech?language pathologist as the expert in a directive role. Aims: This article describes the second phase of a research study aimed at addressing the psychosocial sequelae of aphasia by developing and studying
Magnesium battery disposal characteristics
This study assesses the disposal characteristics of U.S. Army procured military magnesium batteries under current Resource Conservation and Recovery Act (RCRA) hazardous waste identification regulations administered by the U.S. Environmental Protection Agency. Magnesium batteries were tested at 100, 50, 10 and 0 percent remaining state of charge. Present findings indicate that magnesium batteries with less than 50 percent remaining charge
Louis Soffer; Terrill Atwater
Biomedical applications of batteries
An overview is presented of the many ways in which batteries and battery materials are used in medicine and in biomedical studies. These include the use of batteries as power sources for motorised wheelchairs, surgical tools, cardiac pacemakers and defibrillators, dynamic prostheses, sensors and monitors for physiological parameters, neurostimulators, devices for pain relief, and iontophoretic, electroporative and related devices for
Roger Linford; Walkiria Schlindwein
Lithium battery thermal models
Thermal characteristics and thermal behavior of lithium batteries are important both for the batteries meeting operating life requirements and for safety considerations. Sandia National Laboratories has a broad-based program that includes analysis, engineering and model development. We have determined thermal properties of lithium batteries using a variety of calorimetric methods for many years. We developed the capability to model temperature
Daniel H Doughty; Paul C Butler; Rudolph G Jungst; E. Peter Roth
Battery energy storage technologies
Battery energy storage systems, comprising lead-acid batteries, power conversion systems, and control systems, are used by three main groups: power generating utilities, power distributing utilities, and major power consumers (such as electric furnace foundries). The principal advantages of battery energy storage systems to generating utilities include load leveling, frequency control, spinning reserve, modular construction, convenient siting, no emissions, and investment
Max D. Anderson; Dodd S. Carr
Commercialization of advanced batteries
Mader & Associates has been working as a contractor for the South Coast Air Quality Management District (District) as well as domestic and off-shore battery developers for the past several years. During this period, it has performed various assessments of advanced battery technology as well as established the Advanced Battery Task Force. The following paper is Mader's view of the
J. Mader
Battery energy storage systems, comprising lead-acid batteries, power conversion systems, and control systems, are discussed. They are used by power generating utilities power distributing utilities, and major power consumers (such as electric furnace foundries). The principal advantages that battery energy storage systems offer generating utilities are described, including load leveling, frequency control, spinning reserve, modular construction, convenient siting, absence of
Adaptation and validation of standardized aphasia tests in different languages: Lessons from the Boston Diagnostic Aphasia Examination - Short Form in Greek.
The aim of the current study was to adapt the Boston Diagnostic Aphasia Examination - Short Form (BDAE-SF) [1] to the Greek language and culture, determine the influence of demographic variables on performance and in particular the effects of age and education, develop normative data, and examine the discriminative validity of the test for acute stroke patients. A sample of 129 community healthy adults participated in the study (66 women), covering a broad range of ages and education levels so as to maximize representation of the Greek population and be able to examine the effects of age and education in language performance. Regression models showed that, overall, younger and more educated individuals presented higher performance on several subtests. Normative data for the Greek population are presented in percentile tables. Neurological patients' performance was compared to that of the neurologically intact population using Wilcoxon's rank sum test and for the most part was found to be significantly inferior, indicating good discriminant validity of the test. Qualitative errors of patients diagnosed with aphasia on the test are presented, and limitations and generalizable strengths of this adaptation are discussed. PMID:20595743
Tsapkini, Kyrana; Vlahou, Christina Helen; Potagas, Costantin
White matter damage in primary progressive aphasias: a diffusion tensor tractography study
Primary progressive aphasia is a clinical syndrome that encompasses three major phenotypes: non-fluent/agrammatic, semantic and logopenic. These clinical entities have been associated with characteristic patterns of focal grey matter atrophy in left posterior frontoinsular, anterior temporal and left temporoparietal regions, respectively. Recently, network-level dysfunction has been hypothesized but research to date has focused largely on studying grey matter damage. The aim of this study was to assess the integrity of white matter tracts in the different primary progressive aphasia subtypes. We used diffusion tensor imaging in 48 individuals: nine non-fluent, nine semantic, nine logopenic and 21 age-matched controls. Probabilistic tractography was used to identify bilateral inferior longitudinal (anterior, middle, posterior) and uncinate fasciculi (referred to as the ventral pathway); and the superior longitudinal fasciculus segmented into its frontosupramarginal, frontoangular, frontotemporal and temporoparietal components, (referred to as the dorsal pathway). We compared the tracts' mean fractional anisotropy, axial, radial and mean diffusivities for each tract in the different diagnostic categories. The most prominent white matter changes were found in the dorsal pathways in non-fluent patients, in the two ventral pathways and the temporal components of the dorsal pathways in semantic variant, and in the temporoparietal component of the dorsal bundles in logopenic patients. Each of the primary progressive aphasia variants showed different patterns of diffusion tensor metrics alterations: non-fluent patients showed the greatest changes in fractional anisotropy and radial and mean diffusivities; semantic variant patients had severe changes in all metrics; and logopenic patients had the least white matter damage, mainly involving diffusivity, with fractional anisotropy altered only in the temporoparietal component of the dorsal pathway. This study demonstrates that both careful dissection of the main language tracts and consideration of all diffusion tensor metrics are necessary to characterize the white matter changes that occur in the variants of primary progressive aphasia. These results highlight the potential value of diffusion tensor imaging as a new tool in the multimodal diagnostic evaluation of primary progressive aphasia.
Galantucci, Sebastiano; Tartaglia, Maria Carmela; Wilson, Stephen M.; Henry, Maya L.; Filippi, Massimo; Agosta, Federica; Dronkers, Nina F.; Henry, Roland G.; Ogar, Jennifer M.; Miller, Bruce L.
Chemically rechargeable battery
Batteries (50) containing oxidized, discharged metal electrodes such as an iron-air battery are charged by removing and storing electrolyte in a reservoir (98), pumping fluid reductant such as formalin (aqueous formaldehyde) from a storage tank (106) into the battery in contact with the surfaces of the electrodes. After sufficient iron hydroxide has been reduced to iron, the spent reductant is drained, the electrodes rinsed with water from rinse tank (102) and then the electrolyte in the reservoir (106) is returned to the battery. The battery can be slowly electrically charged when in overnight storage but can be quickly charged in about 10 minutes by the chemical procedure of the invention.
Graf, James E. (Inventor); Rowlette, John J. (Inventor)
Batteries and energy systems
A historical review of the galvanic concept and a brief description of the theory of operation of batteries are followed by chapters on specific types of batteries and energy systems. Chapters contain a section on basic theory, performance and applications. Secondary cells discussed are: SLI batteries, lead-acid storage batteries, lead secondary cells, alkaline secondary cells, nickel and silver-cadmium systems and solid electrolyte systems. Other chapters discuss battery charging, regenerative electrochemical systems, solar cells, fuel cells, electric vehicles and windmills. (KAW)
Mantell, C.L.
Silicon Carbide Radioisotope Batteries
The substantial radiation resistance and large bandgap of SiC semiconductor materials makes them an attractive candidate for application in a high efficiency, long life radioisotope battery. To evaluate their potential in this application, simulated batteries were constructed using SiC diodes and the alpha particle emitter Americium Am-241 or the beta particle emitter Promethium Pm-147. The Am-241 based battery showed high initial power output and an initial conversion efficiency of approximately 16%, but the power output decayed 52% in 500 hours due to radiation damage. In contrast the Pm-147 based battery showed a similar power output level and an initial conversion efficiency of approximately 0.6%, but no degradation was observed in 500 hours. However, the Pm-147 battery required approximately 1000 times the particle fluence as the Am-242 battery to achieve a similar power output. The advantages and disadvantages of each type of battery and suggestions for future improvements will be discussed.
Rybicki, George C.
Neural mechanisms underlying the facilitation of naming in aphasia using a semantic task: an fMRI study
Background Previous attempts to investigate the effects of semantic tasks on picture naming in both healthy controls and people with aphasia have typically been confounded by inclusion of the phonological word form of the target item. As a result, it is difficult to isolate any facilitatory effects of a semantically-focused task to either lexical-semantic or phonological processing. This functional magnetic resonance imaging (fMRI) study examined the neurological mechanisms underlying short-term (within minutes) and long-term (within days) facilitation of naming from a semantic task that did not include the phonological word form, in both participants with aphasia and age-matched controls. Results Behavioral results showed that a semantic task that did not include the phonological word form can successfully facilitate subsequent picture naming in both healthy controls and individuals with aphasia. The whole brain neuroimaging results for control participants identified a repetition enhancement effect in the short-term, with modulation of activity found in regions that have not traditionally been associated with semantic processing, such as the right lingual gyrus (extending to the precuneus) and the left inferior occipital gyrus (extending to the fusiform gyrus). In contrast, the participants with aphasia showed significant differences in activation over both the short- and the long-term for facilitated items, predominantly within either left hemisphere regions linked to semantic processing or their right hemisphere homologues. Conclusions For control participants in this study, the short-lived facilitation effects of a prior semantic task that did not include the phonological word form were primarily driven by object priming and episodic memory mechanisms. However, facilitation effects appeared to engage a predominantly semantic network in participants with aphasia over both the short- and the long-term. The findings of the present study also suggest that right hemisphere involvement may be supportive rather than maladaptive, and that a large distributed perisylvian network in both cerebral hemispheres supports the facilitation of naming in individuals with aphasia.
A Single-subject Study to Examine the Effects of Constrained-induced Aphasia Therapy on Naming Deficit
Aphasia is prevalent in people following stroke, which can have a significant impact on the quality of life of the patients with stroke. One of the new methods for treatment of patients with aphasia is constraint-induced aphasia therapy (CIAT). The aim of this study was to investigate the efficacy of CIAT on naming deficits in individuals with chronic aphasia. This study had a prospective, single-subject study with A-B-A design. The CIAT was administered to two patients with chronic aphasia. Participants were a 57-year-old male and a 45-year-old female and had a stroke 60 and 36 months ago, respectively. In this study, the naming test was used as the outcome measure. The naming test was administered in three baseline sessions with 1 week interval between tests (phase A). Patients received CIAT for four consecutive weeks (3 days/week). Four measurements were taken during the treatment phase (phase B). In follow-up phase (phase A) two other measurements were performed. Visual analysis consisting of level, regression line, and variability were used to determine the effects of CIAT on naming. Both participants increased scores on naming test after phase A and B. The mean of the naming score improved from the baseline to the intervention phase in both participants. There was a positive trend in naming scores during the treatment phase compared with the trend in the baseline demonstrated by both participants. The results of this study showed that the CIAT can be effective in improving the naming deficit in patients with chronic post-stroke aphasia.
Kavian, Shohre; Khatoonabadi, Ahmad Reza; Ansari, Noureddin Nakhostin; Saadati, Mahsa; shaygannejad, Vahid
1992 five year battery forecast
Five-year trends for automotive and industrial batteries are projected. Topic covered include: SLI shipments; lead consumption; automotive batteries (5-year annual growth rates); industrial batteries (standby power and motive power); estimated average battery life by area/country for 1989; US motor vehicle registrations; replacement battery shipments; potential lead consumption in electric vehicles; BCI recycling rates for lead-acid batteries; US average car/light truck battery life; channels of distribution; replacement battery inventory end July; 2nd US battery shipment forecast.
Amistadi, D.
Study about lithium battery's characteristics
To make certain the lithium battery's terminal limited discharge voltage and internal resistance in different load, four 3.2 V\\/60Ah lithium batteries are put in series to form battery pack in tests. The lithium battery pack terminal voltage, current and overall internal resistance were recorded with the discharge time. By analyze datas from the tests with MATLAB, the lithium battery pack
Ding Zuowu; Wang Shulin; Zhao Weijun; Qu Min
Batteries for Vehicular Applications
This paper will describe battery technology as it relates to use in vehicular applications, including hybrid-electric vehicles (HEV), electric vehicles (EV), and plug-in-hybrid-electric vehicles (PHEV). The present status of rechargeable batteries, the requirements for each application, and the scientific stumbling blocks that stop batteries from being commercialized for these applications will be discussed. Focus will be on the class of batteries referred to as lithium batteries and the various chemistries that are the most promising for these applications. While Li-ion is expected in HEVs in the very near future, use in PHEVs are expected to be more gradual and dependent on solving the life, safety, and cost challenges. Finally, batteries for EVs remain problematic because of the range and charging-time issues.
Srinivasan, Venkat
Lexical learning in mild aphasia: gesture benefit depends on patholinguistic profile and lesion pattern.
Gestures accompany speech and enrich human communication. When aphasia interferes with verbal abilities, gestures become even more relevant, compensating for and/or facilitating verbal communication. However, small-scale clinical studies yielded diverging results with regard to a therapeutic gesture benefit for lexical retrieval. Based on recent functional neuroimaging results, delineating a speech-gesture integration network for lexical learning in healthy adults, we hypothesized that the commonly observed variability may stem from differential patholinguistic profiles in turn depending on lesion pattern. Therefore we used a controlled novel word learning paradigm to probe the impact of gestures on lexical learning, in the lesioned language network. Fourteen patients with chronic left hemispheric lesions and mild residual aphasia learned 30 novel words for manipulable objects over four days. Half of the words were trained with gestures while the other half were trained purely verbally. For the gesture condition, rootwords were visually presented (e.g., Klavier, [piano]), followed by videos of the corresponding gestures and the auditory presentation of the novel words (e.g., /krulo/). Participants had to repeat pseudowords and simultaneously reproduce gestures. In the verbal condition no gesture-video was shown and participants only repeated pseudowords orally. Correlational analyses confirmed that gesture benefit depends on the patholinguistic profile: lesser lexico-semantic impairment correlated with better gesture-enhanced learning. Conversely largely preserved segmental-phonological capabilities correlated with better purely verbal learning. Moreover, structural MRI-analysis disclosed differential lesion patterns, most interestingly suggesting that integrity of the left anterior temporal pole predicted gesture benefit. Thus largely preserved semantic capabilities and relative integrity of a semantic integration network are prerequisites for successful use of the multimodal learning strategy, in which gestures may cause a deeper semantic rooting of the novel word-form. The results tap into theoretical accounts of gestures in lexical learning and suggest an explanation for the diverging effect in therapeutical studies advocating gestures in aphasia rehabilitation. PMID:24001598
Kroenke, Klaus-Martin; Kraft, Indra; Regenbrecht, Frank; Obrig, Hellmuth
IMITATE: An intensive computer-based treatment for aphasia based on action observation and imitation
Background Neurophysiological evidence from primates has demonstrated the presence of mirror neurons, with visual and motor properties, that discharge both when an action is performed and during observation of the same action. A similar system for observation-execution matching may also exist in humans. We postulate that behavioral stimulation of this parietal-frontal system may play an important role in motor learning for speech and thereby aid language recovery after stroke. Aims The purpose of this article is to describe the development of IMITATE, a computer-assisted system for aphasia therapy based on action observation and imitation. We also describe briefly the randomized controlled clinical trial that is currently underway to evaluate its efficacy and mechanism of action. Methods and Procedures IMITATE therapy consists of silent observation of audio-visually presented words and phrases spoken aloud by six different speakers, followed by a period during which the participant orally repeats the stimuli. We describe the rationale for the therapeutic features, stimulus selection, and delineation of treatment levels. The clinical trial is a randomized single blind controlled trial in which participants receive two pre-treatment baseline assessments, six weeks apart, followed by either IMITATE or a control therapy. Both treatments are provided intensively (90 minutes per day). Treatment is followed by a post-treatment assessment, and a six-week follow-up assessment. Outcomes & Results Thus far, five participants have completed IMITATE. We expect the results of the randomized controlled trial to be available by late 2010. Conclusions IMITATE is a novel computer-assisted treatment for aphasia that is supported by theoretical rationales and previous human and primate data from neurobiology. The treatment is feasible, and preliminary behavioral data are emerging. However, the results will not be known until the clinical trial data are available to evaluate fully the efficacy of IMITATE and to inform theoretically about the mechanism of action and the role of a human mirror system in aphasia treatment.
Lee, Jaime; Fowler, Robert; Rodney, Daniel; Cherney, Leora; Small, Steven L.
Elevated occipital ?-amyloid deposition is associated with widespread cognitive impairment in logopenic progressive aphasia
Background Most subjects with logopenic primary progressive aphasia (lvPPA) have beta-amyloid (A?) deposition on Pittsburgh Compound B PET (PiB-PET), usually affecting prefrontal and temporoparietal cortices, with less occipital involvement. Objectives To assess clinical and imaging features in lvPPA subjects with unusual topographic patterns of A? deposition with highest uptake in occipital lobe. Methods Thirty-three lvPPA subjects with A? deposition on PiB-PET were included in this case-control study. Line-plots of regional PiB uptake were created, including frontal, temporal, parietal and occipital regions, for each subject. Subjects in which the line sloped downwards in occipital lobe (lvPPA-low), representing low uptake, were separated from those where the line sloped upwards in occipital lobe (lvPPA-high), representing unusually high occipital uptake compared to other regions. Clinical variables, atrophy on MRI, hypometabolism on F18-fluorodeoxyglucose PET, and presence and distribution of microbleeds and white matter hyperintensities (WMH) were assessed. Results Seventeen subjects (52%) were classified as lvPPA-high. Mean occipital PiB uptake in lvPPA-high was higher than all other regions, and higher than all regions in lvPPA-low. The lvPPA-high subjects performed more poorly on cognitive testing, including executive and visuospatial testing, but the two groups did not differ in aphasia severity. Proportion of microbleeds and WMH was higher in lvPPA-high than lvPPA-low. Parietal hypometabolism was greater in lvPPA-high than lvPPA-low. Conclusions Unusually high occipital A? deposition is associated with widespread cognitive impairment and different imaging findings in lvPPA. These findings help explain clinical heterogeneity in lvPPA, and suggest that A? influences severity of overall cognitive impairment but not aphasia.
Whitwell, Jennifer L.; Lowe, Val J.; Duffy, Joseph R.; Strand, Edythe A.; Machulda, Mary M.; Kantarci, Kejal; Wille, Samantha M.; Senjem, Matthew L.; Murphy, Matthew C.; Gunter, Jeffrey L.; Jack, Clifford R.; Josephs, Keith A.
Extended turn construction and test question sequences in the conversations of three speakers with agrammatic aphasia.
The application of Conversation Analysis (CA) to the investigation of agrammatic aphasia reveals that utterances produced by speakers with agrammatism engaged in everyday conversation differ significantly from utterances produced in response to decontextualised assessment and therapy tasks. Early studies have demonstrated that speakers with agrammatism construct turns from sequences of nouns, adjectives, discourse markers and conjunctions, packaged by a distinct pattern of prosody. This article presents examples of turn construction methods deployed by three people with agrammatism as they take an extended turn, in order to recount a past event, initiate a discussion or have a disagreement. This is followed by examples of sequences occurring in the talk of two of these speakers that result in different, and more limited, turn construction opportunities, namely "test" questions asked in order to initiate a new topic of talk, despite the conversation partner knowing the answer. The contrast between extended turns and test question sequences illustrates the effect of interactional context on aphasic turn construction practices, and the potential of less than optimal sequences to mask turn construction skills. It is suggested that the interactional motivation for test question sequences in these data are to invite people with aphasia to contribute to conversation, rather than to practise saying words in an attempt to improve language skills. The idea that test question sequences may have their origins in early attempts to deal with acute aphasia, and the potential for conversation partnerships to become "stuck" in such interactional patterns after they may have outlived their usefulness, are discussed with a view to clinical implications. PMID:23848370
Beeke, Suzanne; Beckley, Firle; Best, Wendy; Johnson, Fiona; Edwards, Susan; Maxim, Jane
Neurology of anomia in the semantic variant of primary progressive aphasia
The semantic variant of primary progressive aphasia (PPA) is characterized by the combination of word comprehension deficits, fluent aphasia and a particularly severe anomia. In this study, two novel tasks were used to explore the factors contributing to the anomia. The single most common factor was a blurring of distinctions among members of a semantic category, leading to errors of overgeneralization in word–object matching tasks as well as in word definitions and object descriptions. This factor was more pronounced for natural kinds than artifacts. In patients with the more severe anomias, conceptual maps were more extensively disrupted so that inter-category distinctions were as impaired as intra-category distinctions. Many objects that could not be named aloud could be matched to the correct word in patients with mild but not severe anomia, reflecting a gradual intensification of the semantic factor as the naming disorder becomes more severe. Accurate object descriptions were more frequent than accurate word definitions and all patients experienced prominent word comprehension deficits that interfered with everyday activities but no consequential impairment of object usage or face recognition. Magnetic resonance imaging revealed three characteristics: greater atrophy of the left hemisphere; atrophy of anterior components of the perisylvian language network in the superior and middle temporal gyri; and atrophy of anterior components of the face and object recognition network in the inferior and medial temporal lobes. The left sided asymmetry and perisylvian extension of the atrophy explains the more profound impairment of word than object usage and provides the anatomical basis for distinguishing the semantic variant of primary progressive aphasia from the partially overlapping group of patients that fulfil the widely accepted diagnostic criteria for semantic dementia.
Rogalski, Emily; Wieneke, Christina; Cobia, Derin; Rademaker, Alfred; Thompson, Cynthia; Weintraub, Sandra
Neurology of anomia in the semantic variant of primary progressive aphasia.
The semantic variant of primary progressive aphasia (PPA) is characterized by the combination of word comprehension deficits, fluent aphasia and a particularly severe anomia. In this study, two novel tasks were used to explore the factors contributing to the anomia. The single most common factor was a blurring of distinctions among members of a semantic category, leading to errors of overgeneralization in word-object matching tasks as well as in word definitions and object descriptions. This factor was more pronounced for natural kinds than artifacts. In patients with the more severe anomias, conceptual maps were more extensively disrupted so that inter-category distinctions were as impaired as intra-category distinctions. Many objects that could not be named aloud could be matched to the correct word in patients with mild but not severe anomia, reflecting a gradual intensification of the semantic factor as the naming disorder becomes more severe. Accurate object descriptions were more frequent than accurate word definitions and all patients experienced prominent word comprehension deficits that interfered with everyday activities but no consequential impairment of object usage or face recognition. Magnetic resonance imaging revealed three characteristics: greater atrophy of the left hemisphere; atrophy of anterior components of the perisylvian language network in the superior and middle temporal gyri; and atrophy of anterior components of the face and object recognition network in the inferior and medial temporal lobes. The left sided asymmetry and perisylvian extension of the atrophy explains the more profound impairment of word than object usage and provides the anatomical basis for distinguishing the semantic variant of primary progressive aphasia from the partially overlapping group of patients that fulfil the widely accepted diagnostic criteria for semantic dementia. PMID:19506067
Mesulam, Marsel; Rogalski, Emily; Wieneke, Christina; Cobia, Derin; Rademaker, Alfred; Thompson, Cynthia; Weintraub, Sandra
IMITATE: An intensive computer-based treatment for aphasia based on action observation and imitation.
BACKGROUND: Neurophysiological evidence from primates has demonstrated the presence of mirror neurons, with visual and motor properties, that discharge both when an action is performed and during observation of the same action. A similar system for observation-execution matching may also exist in humans. We postulate that behavioral stimulation of this parietal-frontal system may play an important role in motor learning for speech and thereby aid language recovery after stroke. AIMS: The purpose of this article is to describe the development of IMITATE, a computer-assisted system for aphasia therapy based on action observation and imitation. We also describe briefly the randomized controlled clinical trial that is currently underway to evaluate its efficacy and mechanism of action. METHODS AND PROCEDURES: IMITATE therapy consists of silent observation of audio-visually presented words and phrases spoken aloud by six different speakers, followed by a period during which the participant orally repeats the stimuli. We describe the rationale for the therapeutic features, stimulus selection, and delineation of treatment levels. The clinical trial is a randomized single blind controlled trial in which participants receive two pre-treatment baseline assessments, six weeks apart, followed by either IMITATE or a control therapy. Both treatments are provided intensively (90 minutes per day). Treatment is followed by a post-treatment assessment, and a six-week follow-up assessment. OUTCOMES #ENTITYSTARTX00026; RESULTS: Thus far, five participants have completed IMITATE. We expect the results of the randomized controlled trial to be available by late 2010. CONCLUSIONS: IMITATE is a novel computer-assisted treatment for aphasia that is supported by theoretical rationales and previous human and primate data from neurobiology. The treatment is feasible, and preliminary behavioral data are emerging. However, the results will not be known until the clinical trial data are available to evaluate fully the efficacy of IMITATE and to inform theoretically about the mechanism of action and the role of a human mirror system in aphasia treatment. PMID:20543997
Lee, Jaime; Fowler, Robert; Rodney, Daniel; Cherney, Leora; Small, Steven L