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Neuropsychologia Sep 2021Anosognosia, or lack of self-awareness, is often present following neurological injury and can result in poor functional outcomes. The specific phenomenon of...
Anosognosia, or lack of self-awareness, is often present following neurological injury and can result in poor functional outcomes. The specific phenomenon of intellectual awareness, the knowledge that a function is impaired in oneself, has not been widely studied in post-stroke aphasia. We aim to identify behavioral and neural correlates of intellectual awareness by comparing stroke survivors' self-reports of anomia to objective naming performance and examining lesion sites. Fifty-three participants with chronic aphasia without severe comprehension deficits rated their naming ability and completed a battery of behavioral tests. We calculated the reliability and accuracy of participant self-ratings, then examined the relationship of poor intellectual awareness to speech, language, and cognitive measures. We used support vector regression lesion-symptom mapping (SVR-LSM) to determine lesion locations associated with impaired and preserved intellectual awareness. Reliability and accuracy of self-ratings varied across the participants. Poor intellectual awareness was associated with reduced performance on tasks that rely on semantics. Our SVR-LSM results demonstrated that anterior inferior frontal lesions were associated with poor awareness, while mid-superior temporal lesions were associated with preserved awareness. An anterior-posterior gradient was evident in the unthresholded lesion-symptom maps. While many people with chronic aphasia and relatively intact comprehension can accurately and reliably report the severity of their anomia, others overestimate, underestimate, or inconsistently estimate their naming abilities. Clinicians should consider this when administering self-rating scales, particularly when semantic deficits or anterior inferior frontal lesions are present. Administering self-ratings on multiple days may be useful to check the reliability of patient perceptions.
Topics: Aphasia; Brain Mapping; Humans; Magnetic Resonance Imaging; Reproducibility of Results; Semantics; Stroke
PubMed: 34274379
DOI: 10.1016/j.neuropsychologia.2021.107961 -
Neuroscience and Biobehavioral Reviews Oct 2022People with aphasia (PWA) present with language deficits including word retrieval difficulties after brain damage. Language learning is an essential life-long human... (Review)
Review
People with aphasia (PWA) present with language deficits including word retrieval difficulties after brain damage. Language learning is an essential life-long human capacity that may support treatment-induced language recovery after brain insult. This prospect has motivated a growing interest in the study of language learning in PWA during the last few decades. Here, we critically review the current literature on language learning ability in aphasia. The existing studies in this area indicate that (i) language learning can remain functional in some PWA, (ii) inter-individual variability in learning performance is large in PWA, (iii) language processing, short-term memory and lesion site are associated with learning ability, (iv) preliminary evidence suggests a relationship between learning ability and treatment outcomes in this population. Based on the reviewed evidence, we propose a potential account for the interplay between language and memory/learning systems to explain spared/impaired language learning and its relationship to language therapy in PWA. Finally, we indicate potential avenues for future research that may promote more cross-talk between cognitive neuroscience and aphasia rehabilitation.
Topics: Aphasia; Humans; Language; Language Development; Language Therapy; Memory, Short-Term
PubMed: 35963544
DOI: 10.1016/j.neubiorev.2022.104825 -
Brain Sciences Dec 2023Naming decline is one of the most common symptoms of primary progressive aphasia (PPA). Most studies on anomia in PPA are performed without taking into account PPA...
Naming decline is one of the most common symptoms of primary progressive aphasia (PPA). Most studies on anomia in PPA are performed without taking into account PPA variants, especially for action naming. Only limited data are available for the neuroanatomical basis of anomia considering differences in the pathogenesis of PPAs. The aim of our study is to investigate the associations between anomia severity for both noun and verb naming and gray matter (GM) atrophy, as well as accompanying functional connectivity (FC) changes in three PPA variants. A total of 17 patients with non-fluent (nfvPPA), 11 with semantic (svPPA), and 9 with logopenic (lvPPA) PPA variants were included in the study and underwent cognitive/naming assessments and brain MRIs. Voxel-based morphometry was performed to evaluate GM volume. A resting-state functional MRI was applied to investigate FC changes in the identified GM areas. The study shows that different brain regions are involved in naming decline in each PPA variant with a predominantly temporal lobe involvement in svPPA, parietal lobe involvement in lvPPA, and frontal lobe involvement in nfvPPA. Separate data for object and action naming in PPA variants are provided. The obtained results mainly correspond to the current understanding of language processing and indicate that the evaluation of language impairments is preferable for each PPA variant separately. A further analysis of larger cohorts of patients is necessary to confirm these preliminary results.
PubMed: 38137151
DOI: 10.3390/brainsci13121703 -
Journal of Communication Disorders 2022Anomia affects numerous persons with aphasia. Treatment effects of anomia group therapy have been reported, but the evidence is not comprehensive. This study aimed to... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Anomia affects numerous persons with aphasia. Treatment effects of anomia group therapy have been reported, but the evidence is not comprehensive. This study aimed to explore treatment effects of a naming treatment compared with a non-naming treatment delivered in a group setting.
METHODS
In a randomized controlled trial, 17 participants with chronic poststroke aphasia underwent group therapy, 2 hours a session, 3 times per week, for a total of 20 hours. The treatment given in the naming group was modified semantic feature analysis (SFA). Treatment content in the non-naming group comprised auditory comprehension, copying text, and reading. The primary outcome measure was accuracy in confrontation naming of participant-selected trained nouns and verbs. Generalization effects were evaluated in single-word naming, connected speech, and everyday communication.
RESULTS
Participants in both groups significantly improved their naming of trained items. There were no differences between the groups. The treatment effect did not remain at follow-up 10 weeks after therapy. No other statistically significant changes occurred in either group.
CONCLUSIONS
Group intervention can improve naming ability in individuals with chronic aphasia. However, similar treatment effects can be achieved using a non-naming treatment as using a naming treatment, such as modified SFA. Further research is warranted to identify the most important elements of anomia group therapy.
Topics: Anomia; Aphasia; Humans; Language Therapy; Semantics; Treatment Outcome
PubMed: 35367876
DOI: 10.1016/j.jcomdis.2022.106215 -
Brain and Language Sep 2022While previous studies have found that white matter damage relates to impairment severity in individuals with aphasia, further study is required to understand the...
While previous studies have found that white matter damage relates to impairment severity in individuals with aphasia, further study is required to understand the relationship between white matter integrity and treatment response. In this study, 34 individuals with chronic post-stroke aphasia underwent behavioral testing and structural magnetic resonance imaging at two timepoints. Thirty participants within this sample completed typicality-based semantic feature treatment for anomia. Tractography of bi-hemispheric white matter tracts was completed via Automated Fiber Quantification. Associations between microstructural integrity metrics and behavioral measures were evaluated at the tract level and in nodes along the tract. Diffusion measures of the left inferior longitudinal, superior longitudinal, and arcuate fasciculi were related to aphasia severity and diffusion measures of the left inferior longitudinal fasciculus were related to naming and treatment response. This study also found preliminary evidence of left inferior longitudinal fasciculus microstructural changes following treatment.
Topics: Anomia; Aphasia; Diffusion Tensor Imaging; Humans; Nerve Net; White Matter
PubMed: 35921727
DOI: 10.1016/j.bandl.2022.105163 -
Journal of Speech, Language, and... Jan 2022Meaningful changes in picture naming responses may be obscured when measuring accuracy instead of quality. A statistic that incorporates information about the severity...
PURPOSE
Meaningful changes in picture naming responses may be obscured when measuring accuracy instead of quality. A statistic that incorporates information about the severity and nature of impairments may be more sensitive to the effects of treatment.
METHOD
We analyzed data from repeated administrations of a naming test to 72 participants with stroke aphasia in a clinical trial for anomia therapy. Participants were divided into two groups for analysis to demonstrate replicability. We assessed reliability among response type scores from five raters. We then derived four summary statistics of naming ability and their changes over time for each participant: (a) the standard accuracy measure, (b) an accuracy measure adjusted for item difficulty, (c) an accuracy measure adjusted for item difficulty for specific response types, and (d) a distance measure adjusted for item difficulty for specific response types. While accuracy measures address the likelihood of a correct response, the distance measure reflects that different response types range in their similarity to the target. Model fit was assessed. The frequency of significant improvements and the average magnitude of improvements for each summary statistic were compared between treatment groups and a control group. Effect sizes for each model-based statistic were compared with the effect size for the standard accuracy measure.
RESULTS
Interrater and intrarater reliability were near perfect, on average, though compromised somewhat by phonological-level errors. The effects of treatment were more evident, in terms of both frequency and magnitude, when using the distance measure versus the other accuracy statistics.
CONCLUSIONS
Consideration of item difficulty and response types revealed additional effects of treatment on naming scores beyond those observed for the standard accuracy measure. The results support theories that assume naming ability is decomposable into subabilities rather than being monolithic, suggesting new opportunities for measuring treatment outcomes.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.17019515.
Topics: Anomia; Aphasia; Humans; Linguistics; Reproducibility of Results; Stroke
PubMed: 34818508
DOI: 10.1044/2021_JSLHR-20-00205 -
Frontiers in Rehabilitation Sciences 2022Persons with aphasia (PWA) often have deficits in cognitive domains such as working memory (WM), which are negatively correlated with recovery, and studies have targeted...
Persons with aphasia (PWA) often have deficits in cognitive domains such as working memory (WM), which are negatively correlated with recovery, and studies have targeted WM deficits in aphasia therapy. To our knowledge, however, no study has examined the efficacy of multi-modal training which includes both WM training and targeted language therapy. This pilot project examined the feasibility and preliminary efficacy of combining WM training and naming therapy to treat post-stroke PWA. Chronic PWA were randomly assigned to either the a) Phonological Components Analysis (PCA) and WM intervention (WMI) condition (i.e., a computerized adaptive dual n-back task), or b) PCA and active control condition (WMC). Participants received face-to-face PCA therapy 3 times/week for 5 weeks, and simultaneously engaged in WM training or the active control condition five times/week, independently at home. Six PWA were enrolled, 3 in each condition. Feasibility metrics were excellent for protocol compliance, retention rate and lack of adverse events. Recruitment was less successful, with insufficient participants for group analyses. Participants in the WMI (but not the WMC) condition demonstrated a clinically significant (i.e., > 5 points) improvement on the Western Aphasia Battery- Aphasia Quotient (WAB-R AQ) and Boston Naming Test after therapy. Given the small sample size, the performance of two individuals, matched on age, education, naming accuracy pre-treatment, WAB-R AQ and WM abilities was compared. Participant WMI-3 demonstrated a notable increase in WM training performance over the course of therapy; WMC-2 was the matched control. After therapy, WMI-3's naming accuracy for the treated words improved from 30 to 90% (compared to 30-50% for WMC-2) with a 7-point WAB-R AQ increase (compared to 3 for WMC-2). Improvements were also found for WMI-3 but not for WMC-2 on ratings of communicative effectiveness, confidence and some conversation parameters in discourse. This feasibility study demonstrated excellent results for most aspects of Co-TrEAT. Recruitment rate, hampered by limited resources, must be addressed in future trials; remotely delivered aphasia therapy may be a possible solution. Although no firm conclusions can be drawn, the case studies suggest that WM training has the potential to improve language and communication outcomes when combined with aphasia therapy.
PubMed: 36188983
DOI: 10.3389/fresc.2022.815780 -
Journal of Speech, Language, and... May 2023Item response theory (IRT) is a modern psychometric framework with several advantageous properties as compared with classical test theory. IRT has been successfully used...
PURPOSE
Item response theory (IRT) is a modern psychometric framework with several advantageous properties as compared with classical test theory. IRT has been successfully used to model performance on anomia tests in individuals with aphasia; however, all efforts to date have focused on noun production accuracy. The purpose of this study is to evaluate whether the Verb Naming Test (VNT), a prominent test of action naming, can be successfully modeled under IRT and evaluate its reliability.
METHOD
We used responses on the VNT from 107 individuals with chronic aphasia from AphasiaBank. Unidimensionality and local independence, two assumptions prerequisite to IRT modeling, were evaluated using factor analysis and Yen's statistic (Yen, 1984), respectively. The assumption of equal discrimination among test items was evaluated statistically via nested model comparisons and practically by using correlations of resulting IRT-derived scores. Finally, internal consistency, marginal and empirical reliability, and conditional reliability were evaluated.
RESULTS
The VNT was found to be sufficiently unidimensional with the majority of item pairs demonstrating adequate local independence. An IRT model in which item discriminations are constrained to be equal demonstrated fit equivalent to a model in which unique discrimination parameters were estimated for each item. All forms of reliability were strong across the majority of IRT ability estimates.
CONCLUSIONS
Modeling the VNT using IRT is feasible, yielding ability estimates that are both informative and reliable. Future efforts are needed to quantify the validity of the VNT under IRT and determine the extent to which it measures the same construct as other anomia tests.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.22329235.
Topics: Humans; Anomia; Reproducibility of Results; Factor Analysis, Statistical; Psychometrics
PubMed: 37000934
DOI: 10.1044/2023_JSLHR-22-00458 -
Neuropsychological Rehabilitation Oct 2019This study examined the maintenance of anomia treatment effects in primary progressive aphasia (PPA). Following baseline testing, a phonological treatment and an...
This study examined the maintenance of anomia treatment effects in primary progressive aphasia (PPA). Following baseline testing, a phonological treatment and an orthographic treatment were administered over the course of six months. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (Prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (Remediation items). Naming accuracy was measured at baseline, and it was measured at 1 month, 8 months, and 15 months post-treatment. The change in naming accuracy from baseline to each post-treatment evaluation was calculated within each treatment condition, and within a matched untrained condition. The change in naming accuracy was then compared between the three conditions. The results of these analyses indicate that phonological and orthographic treatments are both effective in the Prophylaxis and Remediation of anomia in all three variants of PPA. For Prophylaxis items, some of the effects of each treatment can persist for as long as 15 months post-treatment. These long-term treatment effects were more robust in the orthographic treatment condition and for participants with the semantic variant of PPA.
Topics: Adult; Aged; Anomia; Aphasia, Primary Progressive; Female; Follow-Up Studies; Humans; Language Therapy; Male; Middle Aged; Neurological Rehabilitation; Treatment Outcome
PubMed: 29380657
DOI: 10.1080/09602011.2018.1425146 -
Dementia & Neuropsychologia Dec 2020Complaints about naming difficulties may be common in the elderly. In dementia, anomia is the most frequent symptom of language disorders. Naming training can improve...
UNLABELLED
Complaints about naming difficulties may be common in the elderly. In dementia, anomia is the most frequent symptom of language disorders. Naming training can improve lexical access and promote better quality of communication for elderly with or without dementia.
OBJECTIVE
To analyze naming scores, response time and the generalization of responses for naming of neurotypical and demented low-educated older adults before and after receiving a naming training program, with and without oral comprehension stimulation.
METHOD
Twenty elderly participants, 10 with dementia and 10 neurotypical, were included after interview, screening for cognition and functionality. The naming training was based on retrieval practice and carried out in 5 sessions. Half of the group underwent exclusive naming training, while the other half received naming training associated with oral comprehension stimulation.
RESULTS
Elderly people with dementia performed better after training for scores on oral naming and comprehension of oral words, except for object manipulation. The response time for naming trained and untrained stimuli was also better for elderly people with dementia. After the intervention, neurotypical individuals performed statistically better in comprehension time and in the score in oral naming, comprehension of oral words and object manipulation, for trained and untrained words.
CONCLUSION
Naming training, exclusive or associated with oral comprehension, using the recovery technique benefits the language performance of neurotypical and demented elderly, and provides improvements even for untrained stimuli.
PubMed: 33354294
DOI: 10.1590/1980-57642020dn14-040011