-
International Journal of Language &... Apr 2024Primary progressive aphasia (PPA) is a neurodegenerative condition characterised by a prominent and progressive deterioration in language abilities, which significantly... (Review)
Review
BACKGROUND
Primary progressive aphasia (PPA) is a neurodegenerative condition characterised by a prominent and progressive deterioration in language abilities, which significantly impacts quality of life and interpersonal relationships. Speech and language therapy plays a crucial role in offering interventions. Group intervention is one mode of delivery that could benefit communication functioning and overall wellbeing of people with PPA (pwPPA) and their care partners. Group interventions are also more efficient than one-to-one intervention and may facilitate peer support.
AIMS
The aim of this review was to systematically evaluate the current evidence for the effectiveness of speech and language therapy groups for pwPPA and their care partners. Specifically, this paper considered three questions: 1.What evidence-based speech and language therapy groups for pwPPA and their care partners have been reported to date? 2.Are group communication interventions effective in improving quality of life and communication function for pwPPA and their care partners? 3.Are group communication interventions that are designed for people with communication difficulties of other aetiologies (such as stroke) effective for pwPPA? In addition, this review aimed to describe the structure and content of groups, including aims, disciplines involved, size and frequency of group meetings, and outcome measures.
METHODS
MEDLINE, CINAHL and PsycINFO were used to retrieve articles of interest. A total of 10 studies published between 2009 and 2022 met the eligibility criteria and therefore were included in this study. Data were extracted from the articles regarding the structure and content of groups.
MAIN CONTRIBUTION
Although evidence is currently limited, results suggest that speech and language therapy group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being. The importance of multidisciplinary input and care partners' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision and one-off group sessions may be feasible and can benefit psychosocial well-being. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses.
CONCLUSIONS
The literature on speech and language therapy group interventions for PPA shows promise of positive effects on communication function and psychosocial well-being of both pwPPA and their care partners. Speech and language therapists can consider these published interventions when designing and implementing similar groups, but more robust evidence is required to confirm the relative effectiveness of this approach.
WHAT THIS PAPER ADDS
What is already known on this subject Speech pathology led group intervention shows some promise in benefitting communication functioning and overall well-being of pwPPA and their carers, but there has been no systematic evaluation of all the evidence regarding the efficacy of speech and language therapy led groups. Establishing feasibility, acceptability and efficacy of speech and language therapy group interventions for pwPPA and their carers may present a valuable addition for managing this progressive language disability. What this paper adds to existing knowledge Although evidence is currently limited, results from this systematic review suggest that speech and language therapy led group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being for pwPPA and their carers. The importance of multidisciplinary input and carers' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision for carers may be feasible and can benefit psychosocial wellbeing. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. What are the potential or actual clinical implications of this work? A synthesis of the evidence base for speech and language therapy led PPA groups, as well as a description of the group components and formats, will be valuable for clinical service planning, and will guide future examination of group options for pwPPA and their carers. Speech and language therapists can also consider the research findings from this systematic review when designing and implementing similar groups in their local context.
PubMed: 38602276
DOI: 10.1111/1460-6984.13031 -
International Journal of... Apr 2024This study aimed to evaluate the effects of symbolic gestural training on enhancing recovery of spoken naming in people with aphasia (PWA) using a systematic review and... (Review)
Review
PURPOSE
This study aimed to evaluate the effects of symbolic gestural training on enhancing recovery of spoken naming in people with aphasia (PWA) using a systematic review and meta-analysis.
METHOD
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, article search was conducted from four databases: Web of Science Core Collection, Medline, PsycINFO, and EBSCO. A total of 45 participants from four studies investigating the symbolic gestural training effects on PWA and outcome measures of spoken naming were included.
RESULT
The meta-analysis showed a medium overall effect of symbolic gestural training on enhancing recovery of spoken naming in PWA. Subgroup analysis also revealed that the training effect was more remarkable in the gesture + verbal training paradigm than in the gesture-only training paradigm. However, the differences in the training effects between short and long duration, and training supplied with and without feedback, were nonsignificant.
CONCLUSION
This study illustrates the current state of the literature on symbolic gestural training in PWA, and serves as a reference for clinicians, patients, and health policy-makers regarding the application of symbolic gestural training in clinical or rehabilitation programs.
PubMed: 38563470
DOI: 10.1080/17549507.2024.2321939 -
Neurological Sciences : Official... Mar 2024Most stroke patients suffer from an imbalance in blood supply, which causes severe brain damage leading to functional deficits in motor, sensory, swallowing, cognitive,...
BACKGROUND
Most stroke patients suffer from an imbalance in blood supply, which causes severe brain damage leading to functional deficits in motor, sensory, swallowing, cognitive, emotional, and speech functions. Repetitive transcranial magnetic stimulation (rTMS) is thought to restore functions impaired during the stroke process and improve the quality of life of stroke patients. However, the efficacy of rTMS in treating post-stroke function impairment varies significantly. Therefore, we conducted a meta-analysis of the number of patients with effective rTMS in treating post-stroke dysfunction.
METHODS
The PubMed, Embase, and Cochrane Library databases were searched. Screening and full-text review were performed by three investigators. Single-group rate meta-analysis was performed on the extracted data using a random variable model. Then subgroup analyses were performed at the levels of stroke acuity (acute, chronic, or subacute); post-stroke symptoms (including upper and lower limb motor function, dysphagia, depression, aphasia); rTMS stimulation site (affected side, unaffected side); and whether or not it was a combination therapy.
RESULTS
We obtained 8955 search records, and finally 33 studies (2682 patients) were included in the meta-analysis. The overall analysis found that effective strength (ES) of rTMS was 0.53. In addition, we found that the ES of rTMS from acute/subacute/chronic post-stroke was 0.69, 0.45, and 0.52. We also found that the ES of rTMS using high-frequency stimulation was 0.56, while the ES of rTMS using low-frequency stimulation was 0.53. From post-stroke symptoms, we found that the ES of rTMS in sensory aspects, upper limb functional aspects, swallowing function, and aphasia was 0.50, 0.52, 0.51, and 0.54. And from the site of rTMS stimulation, we found that the ES of rTMS applied to the affected side was 0.51, while the ES applied to the unaffected side was 0.54. What's more, we found that the ES of rTMS applied alone was 0.53, while the ES of rTMS applied in conjunction with other therapeutic modalities was 0.53.
CONCLUSIONS
By comparing the results of the data, we recommend rTMS as a treatment option for rehabilitation of functional impairment in patients after stroke. We also recommend that rehabilitation physicians or clinicians use combination therapy as one of the options for patients.
PubMed: 38512529
DOI: 10.1007/s10072-024-07455-2 -
BMC Geriatrics Mar 2024To analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based guidance for the prevention and treatment of poststroke aphasia in clinical practice.
DATA SOURCES
Embase, PubMed, Cochrane Library and Web of Science were searched from January 1, 2002, to December 1, 2023.
STUDY SELECTION
Including the total number of strokes, aphasia, the number of different sexes or the number of PSA corresponding to different sex.
DATA EXTRACTION
Studies with missing data, aphasia caused by nonstroke and noncompliance with the requirements of literature types were excluded.
DATA SYNTHESIS
36 papers were included, from 19 countries. The analysis of 168,259 patients with stroke and 31,058 patients with PSA showed that the risk of PSA was 1.23 times higher in female than in male (OR = 1.23, 95% CI = 1.19-1.29, P < 0.001), with a prevalence of PSA of 31% in men and 36% in women, and an overall prevalence of 34% (P < 0.001). Analysis of the risk of the different types of aphasia in 1,048 patients with PSA showed a high risk in females for global, broca and Wenicke aphasia, and a high risk in males for anomic, conductive and transcortical aphasia, which was not statistically significant by meta-analysis. The incidence of global aphasia (males vs. females, 29% vs. 32%) and broca aphasia (17% vs 19%) were higher in females, and anomic aphasia (19% vs 14%) was higher in males, which was statistically significant (P < 0.05).
CONCLUSIONS
There are gender differences in the incidence and types of PSA. The risk of PSA in female is higher than that in male.
Topics: Female; Humans; Male; Incidence; Aphasia; Stroke; Patient Compliance
PubMed: 38438862
DOI: 10.1186/s12877-024-04765-0 -
Frontiers in Psychology 2024Time reference is used to build the temporal framework of discourse and is essential in ensuring efficient communication. Several studies have reported time reference... (Review)
Review
Time reference is used to build the temporal framework of discourse and is essential in ensuring efficient communication. Several studies have reported time reference deficits in fluent and non-fluent aphasia and have shown that tenses (past, present, future) are not all impaired to the same extent. However, there is little consensus on the dissociations between tenses, and the question of the influence of the type of aphasia (fluent vs. non-fluent) on time reference remains open. Therefore, a systematic review and an individual participant data meta-analysis (or mega-analysis) were conducted to determine (1) whether one tense is more impaired than another in fluent and non-fluent aphasia and, if so, (2) which task and speaker-related factors moderate tense effects. The systematic review resulted in 35 studies reporting the performance in time reference of 392 participants. The mega-analysis was then performed on 23 studies for a total of 232 participants and showed an alteration of past tense compared to present and future tenses in both types of aphasia. The analysis also showed a task and an age effect on time reference but no gender effect, independently of tenses. These results add to our knowledge of time reference in aphasia and have implications for future therapies.
PubMed: 38406299
DOI: 10.3389/fpsyg.2024.1322539 -
BMC Neurology Feb 2024Various post-stroke dysfunctions often result in poor long-term outcomes for stroke survivors, but the effect of conventional treatments is limited. In recent years,...
Various post-stroke dysfunctions often result in poor long-term outcomes for stroke survivors, but the effect of conventional treatments is limited. In recent years, lots of studies have confirmed the effect of repetitive transcranial magnetic stimulation (rTMS) in stroke rehabilitation. As a new pattern of rTMS, theta burst stimulation (TBS) was proved recently to yield more pronounced and long-lasting after-effects than the conventional pattern at a shorter stimulation duration. To explore the role of TBS in stroke rehabilitation, this review summarizes the existing evidence from all the randomized controlled trials (RCTs) so far on the efficacy of TBS applied to different post-stroke dysfunctions, including cognitive impairment, visuospatial neglect, aphasia, dysphagia, spasticity, and motor dysfunction. Overall, TBS promotes the progress of stroke rehabilitation and may serve as a preferable alternative to traditional rTMS. However, it's hard to recommend a specific paradigm of TBS due to the limited number of current studies and their heterogeneity. Further high-quality clinical RCTs are needed to determine the optimal technical settings and intervention time in stroke survivors.
Topics: Humans; Stroke Rehabilitation; Transcranial Magnetic Stimulation; Stroke; Time Factors
PubMed: 38297193
DOI: 10.1186/s12883-023-03492-0 -
Frontiers in Bioscience (Landmark... Jan 2024Microtubule-associated protein tau () mutations are one of the main causes of genetic Frontotemporal dementia (FTD) and are characterised by high clinical heterogeneity....
BACKGROUND
Microtubule-associated protein tau () mutations are one of the main causes of genetic Frontotemporal dementia (FTD) and are characterised by high clinical heterogeneity. A behavioural variant of FTD is the principal phenotype, but other rarer phenotypes are described, mostly reported as single cases. In this review, we provide an overview of the clinical phenotypes associated with mutations in order to define their characteristics and explore genotype-phenotype correlations.
METHODS
We performed systematic bibliographic research on the Pubmed database, focusing on articles published between 1998 and 2022. We analysed the clinical phenotype of 177 patients carrying mutations, focusing on the rarest ones. We performed a narrative synthesis of the results.
RESULTS
Regarding language phenotypes, the most frequent were the non-fluent variant and the semantic variant of Primary Progressive Aphasia (nfvPPA, svPPA), approximately in the same proportion. Almost 20% of the whole group of patients present a clinical phenotype belonging to the corticobasal syndrome-progressive supranuclear palsy (CBS-PSP) spectrum. While no clear genotype-phenotype correlation could be identified, some mutations were associated with a specific phenotype, while others gave origin to multiple clinical pictures and mixed phenotypes.
CONCLUSIONS
A high clinical heterogeneity exists in FTD associated with mutations without a clear phenotype-genotype correlation in most cases. However, some characteristics can be helpful to drive genetic testing. Deep phenotyping of patients, together with functional studies of single mutations, particularly those associated with atypical phenotypes, are necessary to better understand the biological mechanisms underlying this clinical variability.
Topics: Humans; Frontotemporal Dementia; tau Proteins; Mutation; Genetic Association Studies; Phenotype
PubMed: 38287807
DOI: 10.31083/j.fbl2901012 -
Annals of Medicine and Surgery (2012) Jan 2024Snakebites, a major health concern in developing countries, affect rural farming communities. Venom, primarily neurotoxin, injected during a snake bite disrupts the... (Review)
Review
OBJECTIVE
Snakebites, a major health concern in developing countries, affect rural farming communities. Venom, primarily neurotoxin, injected during a snake bite disrupts the nervous system, causing symptoms like muscle weakness, paralysis, altered sensation, and coordination issues. This review focuses on evaluating neurological and neuro-ophthalmological manifestations associated with snakebites.
METHODS
A database search was conducted in EMBASE and PubMed for studies published from 2000 to 2023. The investigation centered on examining neurological and neuro-ophthalmological symptoms and signs, treatment approaches, treatment outcomes, and long-term complications of snake bites.
RESULTS
Neurological and neuro-ophthalmological symptoms were common in both neurotoxic and hemotoxic snake bites, especially in neurotoxic cases. Ptosis was a prevalent manifestation across various snake bites, along with respiratory paralysis, limb weakness, dysphasia, and visual disturbances in some instances. However, most patients improved without residual neurological symptoms after treatment.
CONCLUSIONS
Understanding patterns of neurological manifestations contributes valuable insights for the comprehensive management of snakebite.
PubMed: 38222724
DOI: 10.1097/MS9.0000000000001523 -
Medicine Jan 2024Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with poststroke aphasia (PSA) requires further validation. Here, we aimed to explore the efficacy and safety of the NIBS technique combined with speech training in PSA by traditional Meta-analysis and to compare the intervention effects of the 2 NIBS techniques by Network meta-analysis.
METHODS
Randomized controlled trials of the NIBS technique combined with speech training for treating PSA in 9 databases, including Web of Science, PubMed, and CNKI, and 2 clinical trial registries were searched by computer. Literature screening was performed using EndNote X9 software, and data analysis and presentation of results were performed using RevMan 5.4.1 and Stata 17.0 software.
RESULTS
Screening yielded 17 studies with 1013 patients with PSA. Meta-analysis showed that aphasia quotient scores were higher in the intervention group than in the control group [standardized mean difference (SMD) = 1.06, 95% confidence interval (CI) (0.63, 1.49), Z = 4.80, P < .00001]; Western aphasia battery scores on all 4 subscales were higher than those of the control group, the spontaneous language score is [SMD = 0.62, 95% CI (0.46, 0.78), Z = 7.52, P < .00001], the listening comprehension score is [SMD = 0.46, 95% CI (0.30, 0.62), Z = 5.62, P < .00001], the repetition score is [SMD = 1.14, 95% CI (0.59, 1.70), Z = 4.04, P < .0001], the naming score is [SMD = 1.06, 95% CI (0.79, 1.32), Z = 7.85, P < .00001]; The effective rate of the intervention group was higher than that of the control group [odd ratio = 4.19, 95% CI (2.39, 7.37), Z = 4.99, P < .00001]. The results of the Network meta-analysis showed that the best probability ranking of the 2 NIBS techniques combined with speech training in improving aphasia quotient scores was repetitive transcranial magnetic stimulation group (92.2%) > transcranial direct current stimulation group (55.7%). Regarding safety, it was not found that the NIBS technique combined with speech training to treat PSA increases the risk of adverse reactions.
CONCLUSION
The NIBS technique combined with speech training can effectively improve the recovery of language function in PSA patients with minimal adverse effects, and the clinic can give priority to r TMS combined with speech training in treating PSA.
Topics: Humans; Aphasia; Brain; Speech; Stroke; Stroke Rehabilitation; Transcranial Direct Current Stimulation; Transcranial Magnetic Stimulation; Network Meta-Analysis
PubMed: 38215135
DOI: 10.1097/MD.0000000000036880 -
World Neurosurgery Mar 2024Stroke presentation secondary to a cardiac myxoma thromboembolism is rare in the pediatric population. Because of such rarity, the reported cases in the literature are...
BACKGROUND
Stroke presentation secondary to a cardiac myxoma thromboembolism is rare in the pediatric population. Because of such rarity, the reported cases in the literature are primarily case reports. Additionally, general pediatric stroke management lacks evidence-based guidelines because of its low incidence and lack of clinical trials. In pediatric strokes identified from a cardiac myxoma, the incidence favors boys with the classical presentation of unilateral weakness and aphasia. We present a pediatric patient who presented with strokelike symptoms secondary to an intracranial embolus from a previously undiagnosed cardiac myxoma.
METHODS
We performed a systematic review by searching PubMed, Google Scholar, Web of Science, and Embase databases for cases of pediatric myxoma causing stroke (n = 2431) and identified 19 reported uses of surgical management in treating pediatric patients who present with stroke symptoms secondary to a cardiac myxoma thromboembolism.
RESULTS
The most common imaging modality was magnetic resonance imaging in 42% of cases, computed tomography in 36.8%, followed by computed tomography angiography in 31.6% of cases. Of these 19 children treated with procedures, 36.8% of pediatric patients aged between 4 and 14 years underwent neurosurgery (n = 7).
CONCLUSIONS
We describe an urgent mechanical thrombectomy and share preoperative and postoperative images and pathology slides confirming a stroke from myxoma origin. We provide added insight in the safe use of mechanical thrombectomy as treatment for pediatric strokes secondary to a thromboembolism.
Topics: Male; Humans; Child; Child, Preschool; Adolescent; Stroke; Thrombectomy; Embolism; Myxoma; Thromboembolism; Heart Neoplasms
PubMed: 38211812
DOI: 10.1016/j.wneu.2024.01.024