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Revista de Neurologia Jun 2015Stroke is one of the main causes of death and disability and has a high economic cost. Anger after stroke is common and worsens functionality and quality of life. The... (Review)
Review
INTRODUCTION
Stroke is one of the main causes of death and disability and has a high economic cost. Anger after stroke is common and worsens functionality and quality of life. The study of this comorbidity has been hampered by the lack of standardization in anger's evaluation.
AIM
To show the current evidence of anger's prevalence and anger's associated factors after stroke.
MATERIALS AND METHODS
Medline systematic review of original papers studying prevalence and associated factors of anger after stroke.
RESULTS
Post-stroke anger has a high prevalence (15-57.2%). Most studies have found a lack of association between irritability and sex, age, type, size, laterality and severity of the stroke and functionality. Occasionally anger has been associated with frontal infarcts and aphasia. Data regarding the association between anger and motor deficits and cognitive impairment has been inconclusive while the association between anger and psychiatric history, post stroke emotional incontinence and post stroke depression has been widely replicated. Environmental factors have been difficult to study but may be relevant.
CONCLUSION
There is a high prevalence of anger post stroke. Psychiatric factors have been associated to it, while other associations are less conclusive. To improve anger knowledge and management, it would be necessary to improve its definition and assessment.
Topics: Anger; Humans; Prevalence; Stroke
PubMed: 26005071
DOI: No ID Found -
International Journal of... Aug 2013This paper examines the evidence for community and outpatient aphasia groups using the International Classification of Functioning, Disability and Health (ICF)... (Review)
Review
This paper examines the evidence for community and outpatient aphasia groups using the International Classification of Functioning, Disability and Health (ICF) framework. A systematic search of the literature using eight electronic databases was completed; 29 studies met inclusion and exclusion criteria. Level of evidence and methodological quality was assessed and effect sizes calculated where possible. Evidence favouring community and outpatient groups centred on four level ii and level iii-i studies that examined the efficacy of highly structured group activities for improving specific linguistic processes with five medium-large effect sizes calculated. Medium and large effect sizes were also calculated on a level iii-i study examining number of friendships and community access. No effect sizes were available for level ii or level iii studies examining communication activity and participation. Overall, the results indicate that community and outpatient group participation can improve specific linguistic processes. There is also some evidence that group participation can benefit social networks and community access. However, there is limited evidence demonstrating improvement in functional communication as a consequence of group participation. The current evidence is not comprehensive. Further well-designed studies, particularly examining activity and participation, and contextual factors are required to advance community and outpatient aphasia group practice and participation.
Topics: Ambulatory Care; Aphasia; Communication; Community Health Services; Disability Evaluation; Humans; Linguistics; Patient Participation; Psychotherapy, Group; Quality of Life; Social Support; Treatment Outcome
PubMed: 23336826
DOI: 10.3109/17549507.2012.752865 -
Disability and Rehabilitation Sep 2022To investigate the effectiveness of non-drug interventions for people with aphasia in the prevention and/or treatment of anxiety post-stroke as either a primary or...
PURPOSE
To investigate the effectiveness of non-drug interventions for people with aphasia in the prevention and/or treatment of anxiety post-stroke as either a primary or secondary outcome.
MATERIALS AND METHODS
A systematic search of Medline, CINAHL, PsycINFO and Cochrane Library up to March 2021 was carried out. Studies of stroke populations were included if people with aphasia represented 25% or more of the enrolled participants. Quality of the evidence was assessed. A narrative synthesis of results is presented. The PROSPERO record ID for this study is 106451.
RESULTS
Ten studies were included: five randomised controlled trials (RCTs), a single case experimental design, and four pre-post studies. The quality of the RCT trials was at least adequate but none demonstrated a benefit to anxiety outcomes. Those studies that reported benefit were of lower-level evidence with respect to National Health and Medical Research Classifications. No studies were found that evaluated the prevention of anxiety after stroke for people with aphasia.
CONCLUSION
Definitive conclusions about the effectiveness of non-drug interventions for the prevention and/or treatment of anxiety in people with aphasia post-stroke cannot be made. Interventions that may show promise for those with aphasia and symptoms of anxiety include mindfulness meditation, modified cognitive behaviour therapy, unilateral nostril breathing, and the "Enhance Psychological Coping after Stroke" programme. Further high-quality research with better reporting of the inclusion of participants with aphasia and their specific sub-group results are required.Implications for RehabilitationIt is important for rehabilitation professionals to consider prevention of anxiety post-stroke as well as treatment.Mindfulness meditation, modified cognitive behavioural therapy, unilateral nostril breathing, and the and the "Enhance Psychological Coping after Stroke" programme may be of benefit to people with aphasia post-stroke.Adapting intervention protocols to be more communicatively accessible and training health professionals in supported communication may help people with aphasia engage in psychological therapies.
Topics: Anxiety; Anxiety Disorders; Aphasia; Cognitive Behavioral Therapy; Humans; Stroke
PubMed: 34116603
DOI: 10.1080/09638288.2021.1925752 -
Archives of Physical Medicine and... Feb 2024To identify prognostic factors for return to work (RTW) after stroke. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To identify prognostic factors for return to work (RTW) after stroke.
DATA SOURCES
PubMed, MEDLINE, Cochrane, and Embase were systematically searched.
STUDY SELECTION
Studies had to include people of working age (<65 years old) at the time of stroke (ischemic, hemorrhagic, or subarachnoid hemorrhage). The evaluation of RTW and rate of RTW had to be mentioned. Study selection was done by 2 independent authors. In total, 1241 articles were screened, 39 met all inclusion criteria.
DATA EXTRACTION
Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or with a third author. Quality was assessed using the Scottish Intercollegiate Guidelines Network quality assessment tool.
DATA SYNTHESIS
Among the 39 studies, prognostic factors for RTW were hemorrhagic stroke (odds ratio 0.53 [95% confidence interval 0.45-0.60], n=18 studies), sex (men) (1.26 [1.14-1.40], n=31), aphasia (0.37 [0.20-0.69], n=7), occupation (white collar worker) (1.84 [1.64-2.06], n=17), independence in activities of daily living (3.99 [1.73-9.23], n=7), and stroke severity (NIHSS) (1.23 [1.08-1.39], n=6).
CONCLUSIONS
This meta-analysis highlighted positive and negative prognostic factors associated with RTW after stroke. Two categories were distinguished: modifiable and non-modifiable prognostic factors. This study provides information to help understand the issues, set appropriate objectives and implement appropriate strategies to guide people to RTW after stroke. Randomized controlled studies are needed to better evaluate work-place intervention programs as well as the effects of intravenous thrombolysis, and cognitive and neuropsychological rehabilitation on return-to-work rates after stroke.
Topics: Male; Humans; Aged; Return to Work; Activities of Daily Living; Stroke; Workplace; Stroke Rehabilitation
PubMed: 37797913
DOI: 10.1016/j.apmr.2023.08.027 -
International Journal of Language &... Mar 2023Factors influencing the implementation of communication partner training (CPT) with familiar partners of people with aphasia (PWA) have previously been documented using...
BACKGROUND
Factors influencing the implementation of communication partner training (CPT) with familiar partners of people with aphasia (PWA) have previously been documented using disparate approaches. To date there has been no synthesis of these factors using a common theoretical framework. Investigating CPT implementation factors using a common theoretical framework may further our understanding of universal barriers and guide future development of tailored, theoretically informed implementation strategies.
AIMS
(1) To determine the perceived and/or observed barriers and facilitators to implementing CPT with familiar partners of adults with aphasia; (2) to map extracted barriers and facilitators to a common theoretical framework; (3) to synthesize extracted barriers and facilitators; and (4) to identify potential implementation strategies to address the most frequently identified barriers and facilitators.
METHODS & PROCEDURES
A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, CINAHL, Web of Science) were systematically searched in April 2021. Empirical qualitative and/or quantitative research studies reporting barriers/facilitators to speech-language therapists (SLTs) implementing CPT with familiar partners of adults with aphasia were included. The search was limited to English or French articles with no date limit applied. Methodological quality of included studies was assessed using the Mixed-Methods Appraisal Tool (MMAT). A framework and content analysis was then conducted to extract and synthesize the implementation factors in alignment with the Theoretical Domains Framework (TDF), followed by a theoretically informed mapping exercise to identify potential implementation strategies.
RESULTS & MAIN CONTRIBUTION
The database searches yielded 2115 studies. Following screening, 17 studies were included in the review. Overall, the included studies had good methodological quality. Extracted implementation factors were classified as barriers, facilitators or mixed (i.e., both) and aligned with 13 of the 14 TDF domains, plus two additional domains: 'carer perspectives on the CPT intervention' and 'patient/carer characteristics'. Synthesized data revealed eight key theoretical domains: Environmental context and resources; Social influences; Beliefs about consequences; Skills; Memory, attention and decision-making; Knowledge; Beliefs about capabilities; and Reinforcement. Within each domain, the research team identified common categories and developed illustrative examples of theoretically informed implementation strategies.
CONCLUSIONS & IMPLICATIONS
This systematic review and theory-informed synthesis of previously reported CPT implementation factors enabled the identification of key barriers to SLTs delivering this best practice. This led to proposed implementation strategies that should be validated, refined and evaluated in future research involving stakeholders who have contextual understanding of implementing CPT.
WHAT THIS PAPER ADDS
What is already known on the subject CPT of familiar partners of PWA is an effective intervention that is inconsistently used in clinical settings. Factors influencing CPT implementation have previously been identified, but using disparate approaches and frameworks. A synthesis of these factors articulated around a common framework is currently not available. What this paper adds to existing knowledge This paper provides a theory-informed synthesis of previously reported barriers and facilitators to SLTs implementing CPT with familiar partners of PWA. It highlights key factors influencing the uptake of this best practice and includes suggestion of implementation strategies to address them. What are the potential or actual clinical implications of this work? The key influencing factors and proposed implementation strategies reported in this paper may support stakeholders in the future design of tailored and theoretically informed implementation strategies aiming to improve the delivery of familiar CPT in their setting.
Topics: Adult; Humans; Allied Health Personnel; Aphasia; Communication
PubMed: 36417196
DOI: 10.1111/1460-6984.12805 -
Neuropsychology Review Sep 2021While converging evidence suggests linguistic roles of white matter tracts, detailed associations between white matter alterations of dual pathways and language... (Meta-Analysis)
Meta-Analysis Review
While converging evidence suggests linguistic roles of white matter tracts, detailed associations between white matter alterations of dual pathways and language abilities remain unknown in aphasic patients. We aimed to verify language functions of dual-pathway tracts from specific domains and investigate the influence of moderators. PubMed, Web of Science, Embase, and CENTRAL were searched for studies published between January 1, 1985 and March 17, 2019. A meta-analysis of 46 studies including 1353 aphasic patients was performed by pooling correlation coefficients between linguistic domains and diffusion metrics of dual-pathway tracts. Among these tracts, the fractional anisotropy (FA) value of the left inferior fronto-occipital fasciculus predominated across most linguistic aspects, showing the strongest correlations with global severity, comprehension, naming and reading ability. The left uncinate fasciculus and inferior longitudinal fasciculus also showed significant FA - comprehension correlations. For syntactic processing, FA values of the left superior longitudinal fasciculus and arcuate fasciculus showed significant positive correlations. Meta-regression revealed no influence of etiology on FA - language correlations, while sex had a moderating effect on the FA - comprehension correlation of the arcuate fasciculus, and age influenced the FA - naming correlation in the superior longitudinal fasciculus. In conclusion, multifunctional characteristics of tracts were revealed in aphasic patients, including broad linguistic associations of the inferior fronto-occipital fasciculus, and repetition and syntactic involvement of the arcuate fasciculus. Language associations of the inferior longitudinal fasciculus and uncinate fasciculus were clarified regarding comprehension subdomains. The insignificant moderating effect of the etiology indicates damage of dual pathways is the common neural mechanism, while sex and age influence the correlation with comprehension and naming ability, respectively, in specific tracts.
Topics: Aphasia; Diffusion Tensor Imaging; Humans; Language Development Disorders; Neural Pathways; White Matter
PubMed: 33656701
DOI: 10.1007/s11065-021-09482-8 -
Neurological Sciences : Official... Aug 2022Aphasia-acquired loss of the ability to understand or express language-is a common and debilitating neurological consequence of stroke. Evidence suggests that... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Aphasia-acquired loss of the ability to understand or express language-is a common and debilitating neurological consequence of stroke. Evidence suggests that transcranial magnetic stimulation (TMS) can significantly improve language outcomes in patients with aphasia. Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve naming in chronic stroke patients with nonfluent aphasia since 2005.
METHODS
We conducted a systematic review and meta-analyses of TMS treatment studies in patients with aphasia. Eight electronic databases (PubMed, Medline, Embase, Scopus, ScienceDirect, Cochrane Central Register of Controlled Trials, Journals@Ovid, and clinicaltrials.gov) were searched for articles. Relevant studies were further evaluated, and studies that met inclusion criteria were reviewed. The searches were limited to human studies written in English and published between January 1960 and January 2020. In keeping with the main objective of this review, we included all studies that carried out treatment using rTMS in stroke patients with aphasia, regardless of the trial (or experimental) design of the study. Studies that implemented between-subject or randomized controlled (RCT) design, cross-over trials, and within-subject or pre-post trials were all included. Standard mean difference (SMD) for changes in picture naming accuracy was estimated.
RESULTS
The literature search yielded 423 studies. Fifty articles were further evaluated to be included. Eleven met all inclusion criteria and were chosen for review. Eleven eligible studies involving 242 stroke patients were identified in this meta-analysis. Further analyses demonstrated prominent effects for the naming subtest (SMD = 1.26, 95% CI = 0.80 to 1.71, p = 0.01), with heterogeneity (I = 69.101%). The meta-analysis continued to show that there was a statistically significant effect of rTMS compared with sham rTMS on the severity of aphasia. None of the patients from the 11 included articles reported adverse effects from rTMS.
CONCLUSIONS
There are some strong studies evaluating the efficacy of rTMS in stroke patients but further research is required to fully establish the usefulness of this treatment. This meta-analysis indicates a clinically positive effect of rTMS with or without speech and language therapy (SLT) for patients with aphasia following stroke in overall language function and expressive language, including naming, repetition, writing, and comprehension. Low-frequency (1 Hz) rTMS over the unaffected hemisphere is effective and compatible with the concept of interhemispheric inhibition. Moreover, the treatment of 1 Hz rTMS for patients with aphasia after stroke was safe.
Topics: Aphasia; Humans; Speech Therapy; Stroke; Stroke Rehabilitation; Transcranial Magnetic Stimulation
PubMed: 35499630
DOI: 10.1007/s10072-022-06092-x -
The effect of sleep on novel word learning in healthy adults: A systematic review and meta-analysis.Psychonomic Bulletin & Review Dec 2021There is increasing evidence to indicate that sleep plays a role in language acquisition and consolidation; however, there has been substantial variability in... (Meta-Analysis)
Meta-Analysis Review
There is increasing evidence to indicate that sleep plays a role in language acquisition and consolidation; however, there has been substantial variability in methodological approaches used to examine this phenomenon. This systematic review and meta-analysis aimed to investigate the effect of sleep on novel word learning in adults, and explore whether these effects differed by retrieval domain (i.e., recall, recognition, and tests of lexical integration). Twenty-five unique studies met the inclusion criteria for the review, and 42 separate outcome measures were synthesized in the meta-analysis (k = 29 separate between-group comparisons, n = 1,396 participants). The results from the omnibus meta-analysis indicated that sleep was beneficial for novel word learning compared with wakefulness (g = 0.50). Effect sizes differed across the separate domain-specific meta-analyses, with moderate effects for recall (g = 0.57) and recognition memory (g = 0.52), and a small effect for tasks which measured lexical integration (g = 0.39). Overall, the results of this meta-analysis indicate that sleep generally benefits novel word acquisition and consolidation compared with wakefulness across differing retrieval domains. This systematic review highlights the potential for sleep to be used to improve second-language learning in healthy adults, and overall provides further insight into methods to facilitate language development.
Topics: Adult; Humans; Mental Recall; Recognition, Psychology; Sleep; Verbal Learning; Wakefulness
PubMed: 34549375
DOI: 10.3758/s13423-021-01980-3 -
CNS Drugs Jul 2016Aphasia is a common symptom in post-stroke patients. Piracetam is a commonly used nootropic agent that promises various benefits to brain function, including language... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Aphasia is a common symptom in post-stroke patients. Piracetam is a commonly used nootropic agent that promises various benefits to brain function, including language improvement.
OBJECTIVE
We performed a systematic review and meta-analysis to assess whether piracetam facilitates the rehabilitation of language performance in post-stroke patients.
METHODS
Randomized controlled trials (RCTs) of piracetam treatment in post-stroke patients published in any language were included, excluding those involving pre-existing cognitive disorders such as dementia and mood disturbances. We searched several databases including PubMed, EMBASE, Cochrane Central, CINAHL, Web of Science, and PsycINFO for RCTs published up to 31 December 2015. We conducted a meta-analysis using RevMan (version 5.3), with standardized mean differences (SMDs) and fixed-effect models, and used StataSE (version 13) for the detection of publication bias. This study has been submitted to PROSPERO, and its registration number is CRD42016034088.
RESULTS
We identified 1180 titles and abstracts, and finally included seven RCTs in this meta-analysis. The number of participants in each study ranged from 19 to 66, summing up to 261 patients overall. The dose of piracetam was consistent while the frequency and time of therapy varied. The assessment of the language at the end of trials showed no significant improvement in overall severity of aphasia [SMD 0.23, 95 % confidence interval (CI) -0.03 to 0.49, P = 0.08], but written language (SMD 0.35, 95 % CI 0.04 to 0.66, P = 0.03) showed pronounced improvement. Subgroup analyses indicated a dissociation of effectiveness between short- and long-term assessment in overall severity (P = 0.008, I (2) = 85.6 %) in terms of tests for subgroup differences, and a mild trend toward dissociation in written subtests (P = 0.30, I (2) = 5.1 %). Funnel plots and Egger's test identified no obvious publication bias in the primary variable.
CONCLUSIONS
Piracetam plays a limited role in the rehabilitation of overall language impairment and only benefits written language ability at the end of trials. Its effect on overall linguistic level and written language tends to emerge within a short period and declines thereafter.
Topics: Aphasia; Humans; Language Disorders; Piracetam; Randomized Controlled Trials as Topic; Stroke; Treatment Outcome
PubMed: 27236454
DOI: 10.1007/s40263-016-0348-1 -
Journal of Neurology Jan 2017Primary progressive aphasia (PPA) is considered a heterogeneous syndrome, with different clinical subtypes and neuropathological causes. Novel PET biomarkers may help to... (Review)
Review
Primary progressive aphasia (PPA) is considered a heterogeneous syndrome, with different clinical subtypes and neuropathological causes. Novel PET biomarkers may help to predict the underlying neuropathology, but many aspects remain unclear. We studied the relationship between amyloid PET and PPA variant in a clinical series of PPA patients. A systematic review of the literature was performed. Patients with PPA were assessed over a 2-year period and classified based on language testing and the International Consensus Criteria as non-fluent/agrammatic (nfvPPA), semantic (svPPA), logopenic variant (lvPPA) or as unclassifiable (ucPPA). All patients underwent a Florbetapir (18-F) PET scan and images were analysed by two nuclear medicine physicians, using a previously validated reading method. Relevant studies published between January 2004 and January 2016 were identified by searching Medline and Web of Science databases. Twenty-four PPA patients were included (13 women, mean age 68.8, SD 8.3 years; range 54-83). Overall, 13/24 were amyloid positive: 0/2 (0%) nfvPPA, 0/4 (0%) svPPA, 10/14 (71.4%) lvPPA and 3/4 (75%) ucPPA (p = 0.028). The systematic review identified seven relevant studies, six including all PPA variants and one only lvPPA. Pooling all studies together, amyloid PET positivity was 122/224 (54.5%) for PPA, 14/52 (26.9%) for nfvPPA, 6/47 (12.8%) for svPPA, 101/119 for lvPPA (84.9%) and 12/22 (54.5%) for ucPPA. Amyloid PET may help to identify the underlying neuropathology in PPA. It could be especially useful in ucPPA, because in these cases it is more difficult to predict pathology. ucPPA is frequently associated with amyloid pathology.
Topics: Aged; Amyloid; Aphasia, Primary Progressive; Brain; Female; Humans; Male; Middle Aged; Positron-Emission Tomography
PubMed: 27815682
DOI: 10.1007/s00415-016-8324-8