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Aphasiology 2023Speech of individuals with non-fluent, including Broca's, aphasia is often characterized as "agrammatic" because their output mostly consists of nouns and, to a lesser...
BACKGROUND
Speech of individuals with non-fluent, including Broca's, aphasia is often characterized as "agrammatic" because their output mostly consists of nouns and, to a lesser extent, verbs and lacks function words, like articles and prepositions, and correct morphological endings. Among the earliest accounts of agrammatic output in the early 1900s was the "economy of effort" idea whereby agrammatic output is construed as a way of coping with increases in the cost of language production. This idea resurfaced in the 1980s, but in general, the field of language research has largely focused on accounts of agrammatism that postulated core deficits in syntactic knowledge.
AIMS
We here revisit the economy of effort hypothesis in light of increasing emphasis in cognitive science on rational and efficient behavior.
MAIN CONTRIBUTION
The critical idea is as follows: there is a cost per unit of linguistic output, and this cost is greater for patients with non-fluent aphasia. For a rational agent, this increase leads to shorter messages. Critically, the informative parts of the message should be preserved and the redundant ones (like the function words and inflectional markers) should be omitted. Although economy of effort is unlikely to provide a unifying account of agrammatic output in all patients-the relevant population is too heterogeneous and the empirical landscape too complex for any single-factor explanation-we argue that the idea of agrammatic output as a rational behavior was dismissed prematurely and appears to provide a plausible explanation for a large subset of the reported cases of expressive aphasia.
CONCLUSIONS
The rational account of expressive agrammatism should be evaluated more carefully and systematically. On the basic research side, pursuing this hypothesis may reveal how the human mind and brain optimize communicative efficiency in the presence of production difficulties. And on the applied side, this construal of expressive agrammatism emphasizes the strengths of some patients to flexibly adapt utterances in order to communicate in spite of grammatical difficulties; and focusing on these strengths may be more effective than trying to "fix" their grammar.
PubMed: 38213953
DOI: 10.1080/02687038.2022.2143233 -
Journal of Traditional Chinese Medicine... Feb 2024Stroke is the main cause of disability in the middle and old age. Hemiplegia, especially lower limb paralysis, often leads to the loss of self-care ability and a series...
Stroke is the main cause of disability in the middle and old age. Hemiplegia, especially lower limb paralysis, often leads to the loss of self-care ability and a series of secondary injuries. The main method to improve hemiplegic limb movement is exercise therapy, but there are still many patients with disabilities after rehabilitation treatment. As one of the non-pharmacological therapies for stroke, acupuncture has been recognized to improve motor function in patients. Here, we propose a new method, anterior sciatic nerve acupuncture, which can stimulate both the femoral nerve and the sciatic nerve. We designed this study to determine the effect of this method on lower limb motor function. Sixty participants recruited with hemiplegia after cerebral infarction will be randomly assigned to the test group or control group in a 1:1 ratio. The control group will receive Xingnao Kaiqiao acupuncture, and the test group will receive anterior sciatic nerve acupuncture on this basis. All participants will get acupuncture treatment once a day, 6 times a week for 2 weeks. The primary outcome is Fugl-Meyer Assessment of Lower Extremity and the secondary outcomes are Modified Ashworth Scale and Modified Barthel Index. Data will be collected before treatment, 1 week after treatment, and 2 weeks after treatment, and then statistical analysis will be performed. This study can preliminarily verify the effect of anterior sciatic nerve acupuncture on improving lower limb motor function in patients with cerebral infarction, which may provide an alternative approach for clinical treatment of hemiplegia.
Topics: Humans; Hemiplegia; Treatment Outcome; Stroke; Cerebral Infarction; Acupuncture Therapy; Randomized Controlled Trials as Topic
PubMed: 38213256
DOI: 10.19852/j.cnki.jtcm.2024.01.001 -
Applied Neuropsychology. Adult Jan 2024Production of verb morphology, especially tense inflection, is usually impaired in individuals with agrammatism. There have been relatively few studies on treatment of...
Production of verb morphology, especially tense inflection, is usually impaired in individuals with agrammatism. There have been relatively few studies on treatment of verb tense inflection in agrammatic aphasia. In this study we adapted ACTION (a linguistically motivated treatment) to Persian language, to treat the production of regular and irregular verbs separately in sentence context. A single-subject multiple-baseline across behaviors design was used to establish the treatment effect. Using a non-probable convenience sampling, four Persian agrammatic patients with Broca's aphasia resulting from cerebrovascular accident (CVA) were recruited for this study. Two participants received treatment first for regular verbs (Phase 1, 4 weeks), and then for irregular verbs (Phase 2, 4 weeks). The other two participants received treatment in reverse order. In the final phase of treatment (Phase 3, 4 weeks), all 4 participants underwent a sentence construction treatment. All participants showed improvement in the production of trained tenses. Treatment also generalized to production of untrained regular verbs while generalization to irregular verbs was modest. Furthermore, improvement was found on narrative scores (e.g. MLU) after treatment. These findings suggest that Persian individuals with agrammatism could be trained to correctly apply temporal information to verb inflection in elicited speech.
PubMed: 38190255
DOI: 10.1080/23279095.2023.2297085 -
Journal of Neuroengineering and... Jan 2024Analysis of tongue movement would benefit from a reference showcasing healthy tongue capability. We aimed to develop a reference of tongue capability and evaluated the...
BACKGROUND
Analysis of tongue movement would benefit from a reference showcasing healthy tongue capability. We aimed to develop a reference of tongue capability and evaluated the role of visual feedback on the expression of movement.
METHODS
Using a wireless tracking intraoral wearable device, we composed probability distributions of the tongue tip as subjects were asked to explore the entire sensing surface area. Half of the 32 subjects received live visual feedback of the location of the center of the tongue tip contact.
RESULTS
We observed that the visual feedback group was 51.0% more consistent with each other in the position domain, explored 21.5% more sensing surface area, and was 50.7% more uniformly distributed. We found less consistent results when we evaluated velocity and acceleration.
CONCLUSION
Visual feedback best established a healthy capability reference which can be used for designing new interfaces, quantifying tongue ability, developing new diagnostic and rehabilitation techniques, and studying underlying mechanisms of tongue motor control.
Topics: Humans; Feedback, Sensory; Tongue; Movement; Feedback
PubMed: 38166962
DOI: 10.1186/s12984-023-01293-7 -
Brain Structure & Function Dec 2023Aphasia is a speech-language impairment commonly caused by damage to the left hemisphere. The neural mechanisms that underpin different types of aphasia and their...
INTRODUCTION
Aphasia is a speech-language impairment commonly caused by damage to the left hemisphere. The neural mechanisms that underpin different types of aphasia and their symptoms are still not fully understood. This study aims to identify differences in resting-state functional connectivity between anomic and Broca's aphasia measured through resting-state functional magnetic resonance imaging (rs-fMRI).
METHODS
We used the network-based statistic (NBS) method, as well as voxel- and connectome-based lesion symptom mapping (V-, CLSM), to identify distinct neural correlates of the anomic and Broca's groups. To control for lesion effect, we included lesion volume as a covariate in both the NBS method and LSM.
RESULTS
NBS identified a subnetwork located in the dorsal language stream bilaterally, including supramarginal gyrus, primary sensory, motor, and auditory cortices, and insula. The connections in the subnetwork were weaker in the Broca's group than the anomic group. The properties of the subnetwork were examined through complex network measures, which indicated that regions in right inferior frontal sulcus, right paracentral lobule, and bilateral superior temporal gyrus exhibit intensive interaction. Left superior temporal gyrus, right postcentral gyrus, and left supramarginal gyrus play an important role in information flow and overall communication efficiency. Disruption of this network underlies the constellation of symptoms associated with Broca's aphasia. Whole-brain CLSM did not detect any significant connections, suggesting an advantage of NBS when thousands of connections are considered. However, CLSM identified connections that differentiated Broca's from anomic aphasia when analysis was restricted to a hypothesized network of interest.
DISCUSSION
We identified novel signatures of resting-state brain network differences between groups of individuals with anomic and Broca's aphasia. We identified a subnetwork of connections that statistically differentiated the resting-state brain networks of the two groups, in comparison with standard CLSM results that yielded isolated connections. Network-level analyses are useful tools for the investigation of the neural correlates of language deficits post-stroke.
PubMed: 38160205
DOI: 10.1007/s00429-023-02738-4 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2023To identify the features of the clinical picture and evaluate the dynamics of regression of neurodynamic speech disorders in comparison with cortical aphasia in patients...
OBJECTIVE
To identify the features of the clinical picture and evaluate the dynamics of regression of neurodynamic speech disorders in comparison with cortical aphasia in patients with ischemic stroke (IS) in the carotid system.
MATERIAL AND METHODS
We examined 268 patients with a median age of 59 (54; 70) years in the acute period of IS in the dominant hemisphere with the presence of cortical aphasia or neurodynamic speech disorders. The degree of speech recovery was characterized by an increase in the score on the Speech Questionnaire (ΔSQ) from 1 to 21 days after the development of IS. The patients were divided into group 1 (=148) with a low level of recovery (ΔSQ≤6) and group 2 (=120) with a high level (ΔSQ >6).
RESULTS
Of the 268 patients, cortical aphasia was detected in 171 (63.8%) patients, and neurodynamic speech disorders characterized by significant variability of symptoms over the course of hours and days were detected in 97 (36.2%) patients. In patients with cortical aphasia, the majority of patients (63.2%) were classified into group 1, and among patients with neurodynamic speech disorders - into group 2 (58.8%), which showed the stability of the regression dynamics of speech disorders (=0.001). In patients with cortical lesions the impressive side of speech suffered more often - in this group patients with sensorimotor aphasia predominate. In the case of neurodynamic speech disorders, motor and sensorimotor disorders are observed with approximately the same frequency (=0.002).
CONCLUSION
In comparison with cortical aphasias, the sensory component of speech suffers to a lesser extent in neurodynamic speech disorders. Neurodynamic speech disorders generally recover faster and more fully.
Topics: Humans; Stroke; Ischemic Stroke; Aphasia; Speech Disorders; Speech
PubMed: 38148692
DOI: 10.17116/jnevro202312312212 -
Neuro Endocrinology Letters Dec 2023The paper deals with the possibilities of the development and the support of individuals with developmental dysphasia with regard to the legislative framework of the...
Combination therapy for patients with a developmental dysphasia: selected approaches based on special education, rehabilitation and psychology in a systematic case study.
OBJECTIVE
The paper deals with the possibilities of the development and the support of individuals with developmental dysphasia with regard to the legislative framework of the Czech Republic in the field of education and presents the results of a systematic case study of a child patient diagnosed with developmental dysphasia (according to ICD-10; F80.1 and F80.2).
CASE REPORT
The study aimed to determine the effect of combined therapy using long-term special educational, rehabilitation and psychological intervention, speech therapy and music therapy on the development of the patient's communication skills. The proband was selected by random, stratified sampling based on pre-determined relevant characteristics (age 6 years i.e., before entering primary school, diagnosed with developmental dysphasia). A 6-year-old child patient participated in the research with the consent of the legal representative. The therapy was focused on special educational care, speech therapy, music therapy and psychological intervention (including psychotherapy). During the hospitalization and post-hospitalization care, there was also the presence of a physiotherapist and an occupational therapist.
CONCLUSION
The results of the research point out the need for regular and close multidisciplinary cooperation of an occupational therapist, a physiotherapist, a special educator, a speech therapist, a music therapist and a psychologist when working with patients diagnosed with developmental dysphasia. These professions focus specifically on specific areas of support with a focus on cognitive, phatic and motor functions with the support of social adaptability.
Topics: Child; Humans; Education, Special; Aphasia; Czech Republic
PubMed: 38131175
DOI: No ID Found -
Alzheimer's Research & Therapy Dec 2023Clinical variants of primary progressive aphasia (PPA) are diagnosed based on characteristic patterns of language deficits, supported by corresponding neural changes on...
BACKGROUND
Clinical variants of primary progressive aphasia (PPA) are diagnosed based on characteristic patterns of language deficits, supported by corresponding neural changes on brain imaging. However, there is (i) considerable phenotypic variability within and between each diagnostic category with partially overlapping profiles of language performance between variants and (ii) accompanying non-linguistic cognitive impairments that may be independent of aphasia magnitude and disease severity. The neurobiological basis of this cognitive-linguistic heterogeneity remains unclear. Understanding the relationship between these variables would improve PPA clinical/research characterisation and strengthen clinical trial and symptomatic treatment design. We address these knowledge gaps using a data-driven transdiagnostic approach to chart cognitive-linguistic differences and their associations with grey/white matter degeneration across multiple PPA variants.
METHODS
Forty-seven patients (13 semantic, 15 non-fluent, and 19 logopenic variant PPA) underwent assessment of general cognition, errors on language performance, and structural and diffusion magnetic resonance imaging to index whole-brain grey and white matter changes. Behavioural data were entered into varimax-rotated principal component analyses to derive orthogonal dimensions explaining the majority of cognitive variance. To uncover neural correlates of cognitive heterogeneity, derived components were used as covariates in neuroimaging analyses of grey matter (voxel-based morphometry) and white matter (network-based statistics of structural connectomes).
RESULTS
Four behavioural components emerged: general cognition, semantic memory, working memory, and motor speech/phonology. Performance patterns on the latter three principal components were in keeping with each variant's characteristic profile, but with a spectrum rather than categorical distribution across the cohort. General cognitive changes were most marked in logopenic variant PPA. Regardless of clinical diagnosis, general cognitive impairment was associated with inferior/posterior parietal grey/white matter involvement, semantic memory deficits with bilateral anterior temporal grey/white matter changes, working memory impairment with temporoparietal and frontostriatal grey/white matter involvement, and motor speech/phonology deficits with inferior/middle frontal grey matter alterations.
CONCLUSIONS
Cognitive-linguistic heterogeneity in PPA closely relates to individual-level variations on multiple behavioural dimensions and grey/white matter degeneration of regions within and beyond the language network. We further show that employment of transdiagnostic approaches may help to understand clinical symptom boundaries and reveal clinical and neural profiles that are shared across categorically defined variants of PPA.
Topics: Humans; Aphasia, Primary Progressive; Magnetic Resonance Imaging; Brain; Cognition; Linguistics
PubMed: 38102724
DOI: 10.1186/s13195-023-01350-2 -
International Journal of Language &... 2024Although existing studies have shown that both repetitive transcranial magnetic stimulation (rTMS) and music therapy have advantages in the treatment of non-fluent... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Although existing studies have shown that both repetitive transcranial magnetic stimulation (rTMS) and music therapy have advantages in the treatment of non-fluent aphasia, the efficacy of the combination of these two methods remains to be investigated.
AIMS
To investigate the clinical efficacy of low-frequency rTMS combined with music therapy on language function and depression in patients with non-fluent aphasia after stroke.
METHODS & PROCEDURES
A single-blind parallel randomised controlled trial was conducted. Sixty patients (mean duration = 93.78 days) with non-fluent aphasia after stroke were randomly divided into a traditional therapy group (n = 20), a music therapy group (n = 20) and a combined therapy group (n = 20, 1 Hz). The language function and depression were evaluated before and 3 weeks after treatment with the Chinese version of the Western Aphasia Battery scale, Boston Diagnostic Aphasia Examination scale and Stroke Aphasic Depression Questionnaire Hospital Version scale.
OUTCOMES & RESULTS
The combined therapy group was significantly better in all outcomes than the traditional therapy group and was significantly better in depression than the music therapy group. The music therapy group was significantly better in repetition and depression than the traditional therapy group. Language improvement was positively correlated with depression improvement. For adverse events, only two patients in the combined therapy group showed slight dizziness during rTMS treatment and their symptoms improved after rest.
CONCLUSIONS & IMPLICATIONS
Our preliminary randomised controlled study indicates that low-frequency rTMS combined with music therapy is feasible and safe in improving language function and depression in non-fluent aphasia patients after stroke.
WHAT THIS PAPER ADDS
What is already known on this subject Repetitive transcranial magnetic stimulation (rTMS) and music therapy respectively have advantages in the treatment of non-fluent aphasia after stroke, but whether the combination of the two methods is more effective is still unknown. What this paper adds to the existing knowledge This is one of the first randomised control trials to investigate whether the clinical efficacy of low-frequency rTMS combined music therapy for non-fluent aphasia is better. The findings show that low-frequency rTMS combined music therapy is superior to traditional therapy in spontaneous speech, auditory comprehension, repetition, naming, aphasia quotient, functional language level and depression, and superior to music therapy in depression, while music therapy is superior to traditional therapy in repetition and depression. What are the potential or actual clinical implications of this work? Low-frequency rTMS combined music therapy may be a better method for treatment of non-fluent aphasia.
Topics: Humans; Music Therapy; Transcranial Magnetic Stimulation; Female; Male; Middle Aged; Stroke; Single-Blind Method; Aged; Treatment Outcome; Combined Modality Therapy; Stroke Rehabilitation; Adult; Aphasia; Aphasia, Broca; Depression
PubMed: 38088533
DOI: 10.1111/1460-6984.12991 -
BMC Geriatrics Dec 2023Corticobasal syndrome (CBS) is a neurodegenerative disease diagnosed based on clinical manifestations such as asymmetrical parkinsonism, limb apraxia, and speech and...
BACKGROUND
Corticobasal syndrome (CBS) is a neurodegenerative disease diagnosed based on clinical manifestations such as asymmetrical parkinsonism, limb apraxia, and speech and language impairment. The background pathology of CBS is commonly a variety of proteinopathies, but association with cerebrovascular disease has also been reported. Foix-Chavany-Marie syndrome (FCMS) is a rare neurological disorder characterized by facio-pharyngo-glossal diplegia with automatic-voluntary movement dissociation presenting with bilateral paresis of the facial, lingual, pharyngeal and masticatory muscles. FCMS is commonly attributable to stroke. Transactive response DNA binding protein of 43 kD (TDP-43) proteinopathy is also known as the pathological background of FCMS, while the pathological background of the majority of CBS cases consists of diverse tauopathies instead of TDP-43 proteinopathy. In this report, we describe a case mimicking FCMS that was finally diagnosed as CBS with suggested 4-repeat tauopathy.
CASE PRESENTATION
A 68-year-old female started experiencing difficulty speaking followed by difficulty writing, and especially texting, several years before her visit. Her impairment had been gradually worsening, and she came to our hospital. On neurological examination, she demonstrated the facial apraxia, frontal lobe dysfunction, and upper motor neuron signs. She presented some characteristics suggestive of FCMS. Her symptoms exhibited rapid progression and myoclonus, parkinsonism, and left-side dominant cortical sensory deficit occurred, resulting in the fulfillment of diagnostic criteria for CBS after 9 months. Tau PET imaging displayed notable ligand uptake in the brainstem, subthalamic nuclei, basal ganglia, and bilateral subcortical frontal lobe, suggesting that her pathological background was 4-repeat tauopathy. As a result of her progressive dysphagia, she became unable to eat and passed away after 12 months.
CONCLUSION
We hereby present an atypical case of CBS showing clinical features mimicking FCMS at first presentation. TDP-43 proteinopathy was suspected based on the clinical symptoms in the early stages of the disease; however, the clinical course and imaging findings including tau PET suggested that her pathological background was 4-repeat tauopathy.
Topics: Female; Humans; Aged; Deglutition Disorders; Corticobasal Degeneration; Neurodegenerative Diseases; Syndrome; Apraxias; Parkinsonian Disorders; TDP-43 Proteinopathies
PubMed: 38087192
DOI: 10.1186/s12877-023-04564-z