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JPMA. the Journal of the Pakistan... Jan 2022Aphasia, an acquired language disorder, commonly results from a stroke affecting network of cortical and subcortical structures. Aphasia lacks effective standardised... (Review)
Review
Aphasia, an acquired language disorder, commonly results from a stroke affecting network of cortical and subcortical structures. Aphasia lacks effective standardised treatment. Neuroimaging and behavioural research indicate that some interventions promote neuroplasticity changes in aphasia. Research has suggested that non-invasive brain stimulation may be effective, causing functional reorganisation of language areas between the two hemispheres. This reorganisation evolves from different researches exploring novel procedures, including transcranial magnetic stimulation and intracranial direct current stimulation, which may modulate cortical activity in aphasia. The current narrative review was planned to assess these techniques while examining the casual role of specific regions of brain and the understanding of the underlying mechanism for treatment effects of brain stimulation. Literature was explored on search engines and databases, like Medline, Web of Science and bibliography of published studies. The key words used for the search were 'non-invasive brain stimulation', 'post-stroke aphasia', 'transcranial magnetic stimulation' and 'transcranial direct current stimulation'. Of the 175 publications downloaded, 40(23%) full-text English publications were reviewed.
Topics: Aphasia; Brain; Humans; Stroke; Transcranial Direct Current Stimulation; Transcranial Magnetic Stimulation
PubMed: 35099450
DOI: 10.47391/JPMA.2277 -
Brain : a Journal of Neurology Dec 2021Language and its associated disorders have puzzled humanity since the dawn of civilization. The first descriptions of aphasia go back to classical antiquity. The...
Language and its associated disorders have puzzled humanity since the dawn of civilization. The first descriptions of aphasia go back to classical antiquity. The Egyptians and Babylonians believed speech was a divine gift to mortals, and their descriptions of aphasia attributed these events to their Gods' anger and disfavour. The Edwin Smith Surgical Papyrus and the Hippocratic Corpus report several aphasia cases, relating this phenomenology to apoplexy, epilepsy, and other illnesses.
Topics: Aphasia; Brain; History, 19th Century; History, 20th Century; Neurology
PubMed: 34672327
DOI: 10.1093/brain/awab400 -
American Journal of Speech-language... Sep 2021Purpose Aphasia intervention research aims to improve communication and quality of life outcomes for people with aphasia. However, few studies have evaluated the... (Review)
Review
Purpose Aphasia intervention research aims to improve communication and quality of life outcomes for people with aphasia. However, few studies have evaluated the translation and implementation of evidence-based aphasia interventions to clinical practice. Treatment dosage may be difficult to translate to clinical settings, and a mismatch between dosage in research and clinical practice threatens to attenuate intervention effectiveness. The purpose of this study is to quantify a potential research-practice dosage gap in outpatient aphasia rehabilitation. Method This study utilized a two-part approach. First, we estimated clinical treatment dosage in an episode of care (i.e., treatment provided from outpatient assessment to discharge) via utilization in a regional provider in the United States. Second, we undertook a scoping review of aphasia interventions published from 2009 to 2019 to estimate the typical dosage used in the current aphasia literature. Results Outpatient clinical episodes of care included a median of 10 treatment sessions and a mean of 14.8 sessions (interquartile range: 5-20 sessions). Sessions occurred 1-2 times a week over 4-14 weeks. The median total hours of treatment was 7.5 hr (interquartile range: 3.75-15 hr). In contrast, published interventions administered a greater treatment dosage, consisting of a median of 20 hr of treatment (interquartile range: 12-30 hr) over the course of 15 sessions (interquartile range: 10-24 sessions) approximately 3 times per week. Conclusions Results demonstrate a meaningful research-practice dosage gap, particularly in total treatment hours and weekly treatment intensity. This gap highlights the potential for attenuation of effectiveness from research to outpatient settings. Future translational research should consider clinical dosage constraints and take steps to facilitate intervention implementation, particularly with regard to dosage. Conversely, health care advocacy and continued development of alternative delivery methods are necessary for the successful implementation of treatments with dosage that is incompatible with current clinical contexts. Pragmatic, implementation-focused trials are recommended to evaluate and optimize treatment effectiveness in outpatient clinical settings. Supplemental Material https://doi.org/10.23641/asha.15161568.
Topics: Aphasia; Communication; Delivery of Health Care; Humans; Quality of Life
PubMed: 34411485
DOI: 10.1044/2021_AJSLP-20-00257 -
Neurologia Sep 2022In the context of neurological disorders, language assessment is traditionally based on the use of the standard language of the community in which the assessment is... (Review)
Review
INTRODUCTION
In the context of neurological disorders, language assessment is traditionally based on the use of the standard language of the community in which the assessment is performed. Dialectal variables constitute a "forgotten" topic. This review aims to provide resources and working guidelines to overcome this limitation.
DEVELOPMENT
The study was conducted as follows: 1) review of basic concepts of dialectology (language, dialect, isogloss line, idiolect, register, "standard variant," bilingualism); 2) characterisation of Spanish and Catalan dialectologies and search for online resources for the development of neurological assessment tools; 3) ad hoc search on the PubMed database (keywords: "dialect," "aphasia," and "multilingual").
CONCLUSIONS
We provide online resources to promote adequate development of assessment tools in Spanish and Catalan, accounting for dialectal considerations. We propose a set of working guidelines for the introduction of dialectal variables in language tests to ensure their ultimate objective: to evaluate the real use of the language, and not cultural knowledge of the standard language.
Topics: Aphasia; Humans; Language; Multilingualism; Neurology
PubMed: 34509402
DOI: 10.1016/j.nrleng.2019.07.007 -
Neurologia Sep 2022In the context of neurological disorders, language assessment is traditionally based on the use of the standard language of the community in which the assessment is... (Review)
Review
INTRODUCTION
In the context of neurological disorders, language assessment is traditionally based on the use of the standard language of the community in which the assessment is performed. Dialectal variables constitute a 'forgotten' topic. This review aims to provide resources and working guidelines to overcome this limitation.
DEVELOPMENT
The study was conducted as follows: 1) review of basic concepts of dialectology (language, dialect, isogloss line, idiolect, register, 'standard variant', bilingualism); 2) characterisation of Spanish and Catalan dialectologies and search for online resources for the development of neurological assessment tools; 3) ad hoc search on the PubMed database (keywords 'dialect', 'aphasia' and 'multilingual').
CONCLUSIONS
We provide online resources to promote adequate development of assessment tools in Spanish and Catalan, accounting for Dialectal considerations. We propose a set of working guidelines for the introduction of Dialectal variables in language tests to ensure their ultimate objective: to evaluate the real use of the language, and not cultural knowledge of the standard language.
Topics: Humans; Language; Aphasia; Neurology
PubMed: 31780323
DOI: 10.1016/j.nrl.2019.07.002 -
Seminars in Speech and Language Feb 2017The cognitive domains of language and memory are intrinsically connected and work together during language processing. This relationship is especially apparent in the... (Review)
Review
The cognitive domains of language and memory are intrinsically connected and work together during language processing. This relationship is especially apparent in the area of semantics. Several disciplines have contributed to a rich store of data about semantic organization and processing, and several semantic treatments for aphasic word and sentence production impairments have been based on these data. This article reviews the relationships between semantics and memory as they relate to word and sentence production, describes the aphasic language impairments that result from deficits in these areas, and summarizes treatment approaches that capitalize on what we have learned about these domains and how they work together.
Topics: Aphasia; Humans; Language Therapy; Memory Disorders; Semantics; Speech Production Measurement
PubMed: 28201837
DOI: 10.1055/s-0036-1597256 -
American Journal of Speech-language... Oct 2022This scoping review examined studies reporting restorative treatments designed to improve auditory comprehension in people with aphasia. (Review)
Review
PURPOSE
This scoping review examined studies reporting restorative treatments designed to improve auditory comprehension in people with aphasia.
METHOD
We searched eight databases using keywords and for studies published between 1970 and 2020. Searches returned 170 records, and after applying exclusionary criteria, 28 articles remained. For each article, two authors independently extracted data on study design parameters, participant characteristics, treatment protocol, and treatment outcomes, including generalization.
RESULTS
Studies were categorized by treatment focus: direct auditory ( = 7), mixed auditory ( = 13), or indirect ( = 8). Study designs were group ( = 12), single-subject experimental design ( = 11), or case study ( = 5). Fifteen studies had a control condition and/or a control group. Thirteen studies included two to 10 participants. Aphasia severity and auditory comprehension severity were infrequently reported, and most participants were greater than 1-year poststroke. Treatment targets and tasks varied. Sessions ranged from 8 to 240 min, once or more per week, for eight to 60 total sessions over 2-20 weeks. Impairment-based outcome measures were typically used. Improvement and generalization were regularly reported; however, authors frequently did not report statistical significance.
CONCLUSIONS
A variety of treatments have addressed auditory comprehension deficits in people with aphasia, with many reporting improvements in auditory comprehension for some people. However, the variability in treatment tasks and delivery and outcome measurements preclude confidently offering specific clinical recommendations for implementing auditory comprehension treatments. Gaps identified by the current study may guide the development and exploration of transparent, repeatable, patient-centered treatments.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.21291345.
Topics: Humans; Comprehension; Aphasia; Treatment Outcome
PubMed: 36252946
DOI: 10.1044/2022_AJSLP-21-00297 -
American Journal of Speech-language... Mar 2018Visuographic supports in the form of images are utilized during assessment and treatment for individuals with aphasia to supplement speech, language, and cognitive... (Review)
Review
PURPOSE
Visuographic supports in the form of images are utilized during assessment and treatment for individuals with aphasia to supplement speech, language, and cognitive losses limiting communication. Clinicians rely on prior experience and intuition to make decisions regarding image-based support design and selection (e.g., augmentative and alternative communication strategies). Researchers have begun to focus on the relationship between the images and the benefits they provide for adults with aphasia.
METHOD
The aim of this review-resulting from a roundtable discussion at the 2016 Clinical Aphasiology Conference-was to disseminate summaries of current and past researches regarding image use by individuals with aphasia and to highlight areas of need within research and practice.
RESULTS
Review of the literature illuminated 4 major themes: (a) image creation, capture, and sharing; (b) image characteristics; (c) image use across linguistic domains and contexts; and (d) implications for clinical and research practices.
CONCLUSIONS
Reviewing current knowledge and practice regarding the use of visual supports for individuals with aphasia is essential to advancing therapeutic practices and providing evidence-based protocols for creating, selecting, and implementing images within augmentative and alternative communication strategies. Several gaps in knowledge were identified as future research needs (e.g., caregiver training and enhanced image feature investigation).
Topics: Aphasia; Auditory Perception; Cognition; Comprehension; Humans; Language Tests; Language Therapy; Photic Stimulation; Predictive Value of Tests; Prognosis; Reading; Speech; Verbal Behavior; Visual Perception
PubMed: 29497760
DOI: 10.1044/2017_AJSLP-16-0190 -
Brain Stimulation 2023Aphasia affects approximately one-third of stroke patients and yet its rehabilitation outcomes are often unsatisfactory. More effective strategies are needed to promote... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Aphasia affects approximately one-third of stroke patients and yet its rehabilitation outcomes are often unsatisfactory. More effective strategies are needed to promote recovery.
OBJECTIVE
We aimed to examine the efficacy and safety of the theta-burst stimulation (TBS) on the language area in the superior frontal gyrus (SFG) localized by personalized functional imaging, in facilitating post-stroke aphasia recovery.
METHODS
This randomized sham-controlled trial uses a parallel design (intermittent TBS [iTBS] in ipsilesional hemisphere vs. continuous TBS [cTBS] in contralesional hemisphere vs. sham group). Participants had aphasia symptoms resulting from their first stroke in the left hemisphere at least one month prior. Participants received three-week speech-language therapy coupled with either active or sham stimulation applied to the left or right SFG. The primary outcome was the change in Western Aphasia Battery-Revised (WAB-R) aphasia quotient after the three-week treatment. The secondary outcome was WAB-R aphasia quotient improvement after one week of treatment.
RESULTS
Ninety-seven patients were screened between January 2021 and January 2022, 45 of whom were randomized and 44 received intervention (15 in each active group, 14 in sham). Both iTBS (estimated difference = 14.75, p < 0.001) and cTBS (estimated difference = 13.43, p < 0.001) groups showed significantly greater improvement than sham stimulation after the 3-week intervention and immediately after one week of treatment (p's < 0.001). The adverse events observed were similar across groups. A seizure was recorded three days after the termination of the treatment in the iTBS group.
CONCLUSION
The stimulation showed high efficacy and SFG is a promising stimulation target for post-stroke language recovery.
Topics: Humans; Transcranial Magnetic Stimulation; Aphasia; Stroke; Stroke Rehabilitation; Treatment Outcome; Prefrontal Cortex
PubMed: 37652135
DOI: 10.1016/j.brs.2023.08.023 -
Stroke Oct 2019
Review
Topics: Aphasia; Clinical Trials as Topic; Humans; Stroke
PubMed: 31510904
DOI: 10.1161/STROKEAHA.119.025290