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Seminars in Speech and Language Feb 2017This article reviews existing research on the interactions between verbal short-term memory and language processing impairments in aphasia. Theoretical models of... (Review)
Review
This article reviews existing research on the interactions between verbal short-term memory and language processing impairments in aphasia. Theoretical models of short-term memory are reviewed, starting with a model assuming a separation between short-term memory and language, and progressing to models that view verbal short-term memory as a cognitive requirement of language processing. The review highlights a verbal short-term memory model derived from an interactive activation model of word retrieval. This model holds that verbal short-term memory encompasses the temporary activation of linguistic knowledge (e.g., semantic, lexical, and phonological features) during language production and comprehension tasks. Empirical evidence supporting this model, which views short-term memory in the context of the processes it subserves, is outlined. Studies that use a classic measure of verbal short-term memory (i.e., number of words/digits correctly recalled in immediate serial recall) as well as those that use more intricate measures (e.g., serial position effects in immediate serial recall) are discussed. Treatment research that uses verbal short-term memory tasks in an attempt to improve language processing is then summarized, with a particular focus on word retrieval. A discussion of the limitations of current research and possible future directions concludes the review.
Topics: Aphasia; Comprehension; Humans; Language; Linguistics; Memory, Short-Term; Psychological Theory; Serial Learning; Verbal Learning
PubMed: 28201834
DOI: 10.1055/s-0036-1597261 -
Archives of Physical Medicine and... May 2023The effect of treatment dose on recovery of post-stroke aphasia is not well understood. Inconsistent conceptualization, measurement, and reporting of the multiple... (Review)
Review
The effect of treatment dose on recovery of post-stroke aphasia is not well understood. Inconsistent conceptualization, measurement, and reporting of the multiple dimensions of dose hinders efforts to evaluate dose-response relations in aphasia rehabilitation research. We review the state of dose conceptualization in aphasia rehabilitation and compare the applicability of 3 existing dose frameworks to aphasia rehabilitation research-the Frequency, Intensity, Time, and Type (FITT) principle, the Cumulative Intervention Intensity (CII) framework, and the Multidimensional Dose Articulation Framework (MDAF). The MDAF specifies dose in greater detail than the CII framework and the FITT principle. On this basis, we selected the MDAF to be applied to 3 diverse examples of aphasia rehabilitation research. We next critically examined applicability of the MDAF to aphasia rehabilitation research and identified the next steps needed to systematically conceptualize, measure, and report the multiple dimensions of dose, which together can progress understanding of the effect of treatment dose on outcomes for people with aphasia after stroke. Further consideration is required to enable application of this framework to aphasia interventions that focus on participation, personal, and environmental interventions and to understand how the construct of episode difficulty applies across therapeutic activities used in aphasia interventions.
Topics: Humans; Stroke Rehabilitation; Rehabilitation Research; Aphasia; Stroke
PubMed: 36572201
DOI: 10.1016/j.apmr.2022.12.002 -
Journal of Neurology, Neurosurgery, and... Jul 2017
Topics: Aphasia; Aphasia, Wernicke; Comprehension; Humans
PubMed: 28416563
DOI: 10.1136/jnnp-2017-315842 -
Journal of Speech, Language, and... Apr 2022Aphasia fluency is multiply determined by underlying impairments in lexical retrieval, grammatical formulation, and speech production. This poses challenges for...
PURPOSE
Aphasia fluency is multiply determined by underlying impairments in lexical retrieval, grammatical formulation, and speech production. This poses challenges for establishing a reliable and feasible tool to measure fluency in the clinic. We examine the reliability and validity of perceptual ratings and clinical perspectives on the utility and relevance of methods used to assess fluency.
METHOD
In an online survey, 112 speech-language pathologists rated spontaneous speech samples from 181 people with aphasia (PwA) on eight perceptual rating scales (overall fluency, speech rate, pausing, effort, melody, phrase length, grammaticality, and lexical retrieval) and answered questions about their current practices for assessing fluency in the clinic.
RESULTS
Interrater reliability for the eight perceptual rating scales ranged from fair to good. The most reliable scales were speech rate, pausing, and phrase length. Similarly, clinicians' perceived fluency ratings were most strongly correlated to objective measures of speech rate and utterance length but were also related to grammatical complexity, lexical diversity, and phonological errors. Clinicians' ratings reflected expected aphasia subtype patterns: Individuals with Broca's and transcortical motor aphasia were rated below average on fluency, whereas those with anomic, conduction, and Wernicke's aphasia were rated above average. Most respondents reported using multiple methods in the clinic to measure fluency but relying most frequently on subjective judgments.
CONCLUSIONS
This study lends support for the use of perceptual rating scales as valid assessments of speech-language production but highlights the need for a more reliable method for clinical use. We describe next steps for developing such a tool that is clinically feasible and helps to identify the underlying deficits disrupting fluency to inform treatment targets.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.19326419.
Topics: Aphasia; Aphasia, Broca; Aphasia, Wernicke; Humans; Linguistics; Reproducibility of Results; Speech
PubMed: 35271379
DOI: 10.1044/2021_JSLHR-21-00484 -
CNS Spectrums Dec 2014Since currently available antipsychotic medications predominantly treat hallucinations, delusions, disorganized thoughts and behavior, and related agitation/aggression,... (Review)
Review
Since currently available antipsychotic medications predominantly treat hallucinations, delusions, disorganized thoughts and behavior, and related agitation/aggression, attention has traditionally been focused on managing positive symptoms. However, prominent negative symptoms and clinically relevant cognitive impairment affect approximately 40% and 80% of people with schizophrenia, respectively. Moreover, negative and cognitive symptoms are closely related to functional outcomes, and contribute substantially to the overall illness burden. Therefore, approaches to describe, measure, and manage these symptom domains are relevant. This article summarizes the phenomenology, prevalence, assessment, and treatment of negative and cognitive symptoms in patients with schizophrenia, including pharmacologic and nonpharmacologic management strategies that can be used in clinical care now, as well as pharmacologic approaches that are being tested. Currently, no approved treatments targeting negative or cognitive symptomatology in schizophrenia are available. It is hoped that progress in the understanding of the neurobiology of these important symptom domains of schizophrenia will help develop effective treatment strategies in the future. However, until this goal is achieved, clinicians should avoid therapeutic nihilism. Rather, the severity and impact of negative and cognitive symptoms should be determined, quantified, and monitored. Further, psychosocial treatments have shown therapeutic benefits. Thus, cognitive behavioral therapy, cognitive remediation, social skills training, and computer-assisted training programs should be offered in conjunction with antipsychotic treatment. Several non-antipsychotic augmentation strategies can be tried off-label. Treatment plans that incorporate currently available management options for negative and cognitive symptomatology in patients with schizophrenia should be adapted over time and based on the individual's needs, with the aim to enhance overall outcomes.
Topics: Anhedonia; Antipsychotic Agents; Aphasia; Cognition Disorders; Cognitive Behavioral Therapy; Humans; Schizophrenia; Schizophrenic Psychology
PubMed: 25403863
DOI: 10.1017/S1092852914000601 -
Handbook of Clinical Neurology 2022Language is one of the most complex and specialized higher cognitive processes. Brain damage to the distributed, primarily left-lateralized language network can result... (Review)
Review
Language is one of the most complex and specialized higher cognitive processes. Brain damage to the distributed, primarily left-lateralized language network can result in aphasia, a neurologic disorder characterized by receptive and/or expressive deficits in spoken and/or written language. Most often, aphasia is the consequence of stroke-termed poststroke aphasia (PSA)-yet, aphasia can also manifest due to neurodegenerative disease, specifically, a disorder called primary progressive aphasia (PPA). In recent years, functional connectivity neuroimaging studies have provided emerging evidence supporting theories regarding the relationships between language impairments, structural brain damage, and functional network properties in these two disorders. This chapter reviews the current evidence for the "network phenotype of stroke injury" hypothesis (Siegel et al., 2016) as it pertains to PSA and the "network degeneration hypothesis" (Seeley et al., 2009) as it pertains to PPA. Methodologic considerations for functional connectivity studies, limitations of the current functional connectivity literature in aphasia, and future directions are also discussed.
Topics: Aphasia; Aphasia, Primary Progressive; Brain; Humans; Magnetic Resonance Imaging; Neurodegenerative Diseases
PubMed: 35078613
DOI: 10.1016/B978-0-12-823384-9.00005-0 -
International Journal of Language &... Jul 2020Communication is at the heart of relationships, especially for couples. When language is altered, as it is in aphasia, communication in couples can be affected.
BACKGROUND
Communication is at the heart of relationships, especially for couples. When language is altered, as it is in aphasia, communication in couples can be affected.
AIMS
To explore how members of a couple perceive the impact of aphasia on their communication.
METHODS & PROCEDURES
Nine French-speaking couples participated in the study. One member of each couple had chronic stroke-related aphasia, which varied in type and severity. The 18 participants took part in individual semi-structured interviews to understand their perspective on communication within their couple. The interviews were recorded, transcribed and analysed with a qualitative thematic analysis.
OUTCOMES & RESULTS
Three main themes emerged: (1) experiencing limitations in conversation; (2) assuming changed speaking and listening roles; and (3) experiencing new emotions, feelings and reactions in communication. Couples experienced diminished frequency and duration of conversations as well as restrained topics after the onset of aphasia. Ten participants reported that each member's communication role of listener versus speaker had changed, and that the person with aphasia became a less active participant. Communication was described as 'positive' before aphasia and 'fine' to 'difficult' following aphasia. Persons with aphasia and spouses expressed experiencing difficulties managing emotions related to communication. Frustration and caution towards the other member of the couple had been associated with aphasia. In addition, five spouses reported that they refrained from initiating discussions on specific topics in order to maintain a positive relationship with the person with aphasia.
CONCLUSION & IMPLICATIONS
The results describe some of the consequences of aphasia on communication in couples. Clinicians could use interviews to understand the impact of aphasia on a couple's communication. This may help to design communication partner training (CPT) that better aligns with the particular needs of couples living with aphasia, acknowledging the importance of emotional dimensions of relationships. What this paper adds What is already known on the subject The general psychosocial impacts of aphasia on persons with aphasia and spouses are known. Their conversations have been described and used as a focus for CPT. However, CPT may be difficult to implement in clinical settings. What this paper adds to the existing knowledge This paper provides in-depth descriptions of perceived changes in relational or transactional communication by the PWA and their spouse. The frequency, duration and topics of conversations changed and emotions such as frustration and caution appeared. Participants assumed changed speaking and listening roles. What are the potential or actual clinical implications of this work? The participants' description of communication could be used by speech-language pathologists when conducting CPT to illustrate how aphasia affects communication in couples. Emotions emerging as a result of changes in communication following aphasia should be assessed before CPT and could be a starting point to work on communication. This could support clients' commitment in CPT.
Topics: Aged; Aged, 80 and over; Aphasia; Female; Humans; Interpersonal Relations; Male; Middle Aged; Qualitative Research; Speech-Language Pathology; Spouses; Stroke
PubMed: 32400928
DOI: 10.1111/1460-6984.12537 -
Archives of Disease in Childhood Mar 2016Many children who present with these acquired impairments of communication have a clear preceding event such as an acquired brain injury from a road traffic accident.... (Review)
Review
Many children who present with these acquired impairments of communication have a clear preceding event such as an acquired brain injury from a road traffic accident. Children often respond differently in this situation to adult presentations. They may have a period of mutism when the prognosis might look poor and yet they subsequently make rapid progress and recover speech. They have greater potential for neural plasticity and language recovery, although they often have persisting difficulties in oral and written language. Alternatively, there may be a presentation with a paroxysmal event such as a seizure or a period of depressed consciousness, and the unusual behaviour that may accompany dysphasia and dysarthria may be misinterpreted in the child, whereas for the adult with the more common 'stroke-like' presentation, it would be immediately considered. Rarely the aphasia/dysphasia may itself be the paroxysmal event where actually recognising that the child's disrupted communication is the basis of any observed behaviours can be the greater challenge.
Topics: Adolescent; Aphasia; Brain Injuries; Child; Humans; Language Disorders; Speech; Speech Disorders
PubMed: 25990500
DOI: 10.1136/archdischild-2014-306153 -
Brain and Nerve = Shinkei Kenkyu No... Nov 2014In this paper, I review some of the writings of Macdonald Critchley with an accompanying biographical sketch. The contents of his first book, "Mirror-Writing" (1928) as...
In this paper, I review some of the writings of Macdonald Critchley with an accompanying biographical sketch. The contents of his first book, "Mirror-Writing" (1928) as well as those of "Aphasiology and other aspects of language" (1970), and his views on aphasia are presented. The book "Mirror-Writing" consists of a major review of mirror writing and related reversal phenomena. This monograph provides great insight on these symptoms, which are rare today. The ideas of Critchley on cerebral function and dysfunction (evolution and dissolution) substantially succeeded those of John Hughlings Jackson. Critchley's holistic view of aphasia is also briefly reviewed in this paper. The principal of Critchley's thoughts on neurological symptomatology is an interest in the origins of the brain, behavior, and language.
Topics: Aphasia; Books; Brain; England; Functional Laterality; History, 19th Century; History, 20th Century; Humans; Neurology
PubMed: 25407065
DOI: 10.11477/mf.1416200033 -
Neuroepidemiology 2022A decrease in ischemic stroke (IS) incidence has been observed in high income countries during the last decades. Whether this has influenced the occurrence of aphasia in...
INTRODUCTION
A decrease in ischemic stroke (IS) incidence has been observed in high income countries during the last decades. Whether this has influenced the occurrence of aphasia in IS is uncertain. We therefore examined the incidence rate and potentially related determinants of aphasia in IS.
METHODS
We prospectively examined consecutive patients admitted to hospital with first-ever acute IS between March 1, 2017, and February 28, 2018, as part of the Lund Stroke Register (LSR) Study, comprising patients from the uptake area of Skåne University Hospital, Lund, Sweden. Patients were assessed with National Institutes of Health Stroke Scale (NIHSS) at stroke onset. Presence of aphasia was evaluated with NIHSS item 9 (language). We registered IS subtypes and risk factors. To investigate possible temporal changes in aphasia incidence, we made comparisons with corresponding LSR data from 2005 to 2006. Incidence rates were calculated and adjusted to the European Standard Population (ESP) and to the Swedish population.
RESULTS
Among 308 included IS patients, 30% presented with aphasia (n = 91; 95% CI: 25-35), a proportion of aphasia in IS that was similar to 2005-2006. The incidence rate of aphasia was 31 per 100,000 person-years adjusted to the ESP (95% CI: 25-38 per 100,000 person-years) corresponding to a significant decrease of 30% between 2005-2006 and 2017-2018. The decrease was significantly more pronounced in men. The initial severity of aphasia remained unchanged, with the majority of patients having severe to global aphasia. No significant differences between vascular stroke risk factors were noted among stroke patients with or without aphasia.
CONCLUSION
Even though the overall IS incidence rate has decreased during the first decades of the 21st century, the proportion of IS patients with aphasia at stroke onset remains stable at 30%. Aphasia continues to be an important symptom that needs to be considered in stroke care and rehabilitation.
Topics: Aphasia; Humans; Incidence; Ischemic Stroke; Male; Risk Factors; Stroke
PubMed: 35320798
DOI: 10.1159/000524206