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American Journal of Speech-language... Apr 2024Adults with aphasia gesture more than adults without aphasia. However, less is known about the role of gesture in different discourse contexts for individuals with...
PURPOSE
Adults with aphasia gesture more than adults without aphasia. However, less is known about the role of gesture in different discourse contexts for individuals with different types of aphasia. In this study, we asked whether patterns of speech and gesture production of individuals with aphasia vary by aphasia and discourse type and also differ from the speech and gestures produced by adults without aphasia.
METHOD
We compared the amount, diversity, and complexity of speech and gesture production in adults with anomic or Broca's aphasia and adults with no aphasia ( = 20/group) in their first- versus third-person narratives.
RESULTS
Adults with Broca's aphasia showed the lowest performance in their amount, diversity, and complexity of speech production, followed by adults with anomic aphasia and adults without aphasia. This pattern was reversed for gesture production. Speech and gesture production also varied by discourse context. Adults with either type of aphasia used a lower amount of and less diverse speech in third-person than in first-person narratives; this pattern was also reversed for gesture production.
CONCLUSIONS
Overall, our results provide evidence for a compensatory role of gesture in aphasia communication. Adults with Broca's aphasia, who showed the greatest speech production difficulties, also relied most on gesture, and this pattern was particularly pronounced in the third-person narrative context.
PubMed: 38625101
DOI: 10.1044/2024_AJSLP-23-00046 -
Journal of Neuroscience Methods Jun 2024Traditional therapist-based rehabilitation training for patients with movement impairment is laborious and expensive. In order to reduce the cost and improve the...
BACKGROUND
Traditional therapist-based rehabilitation training for patients with movement impairment is laborious and expensive. In order to reduce the cost and improve the treatment effect of rehabilitation, many methods based on human-computer interaction (HCI) technology have been proposed, such as robot-assisted therapy and functional electrical stimulation (FES). However, due to the lack of active participation of brain, these methods have limited effects on the promotion of damaged nerve remodeling.
NEW METHOD
Based on the neurofeedback training provided by the combination of brain-computer interface (BCI) and exoskeleton, this paper proposes a multimodal brain-controlled active rehabilitation system to help improve limb function. The joint control mode of steady-state visual evoked potential (SSVEP) and motor imagery (MI) is adopted to achieve self-paced control and thus maximize the degree of brain involvement, and a requirement selection function based on SSVEP design is added to facilitate communication with aphasia patients.
COMPARISON WITH EXISTING METHODS
In addition, the Transformer is introduced as the MI decoder in the asynchronous online BCI to improve the global perception of electroencephalogram (EEG) signals and maintain the sensitivity and efficiency of the system.
RESULTS
In two multi-task online experiments for left hand, right hand, foot and idle states, subject achieves 91.25% and 92.50% best accuracy, respectively.
CONCLUSION
Compared with previous studies, this paper aims to establish a high-performance and low-latency brain-controlled rehabilitation system, and provide an independent and autonomous control mode of the brain, so as to improve the effect of neural remodeling. The performance of the proposed method is evaluated through offline and online experiments.
Topics: Humans; Brain-Computer Interfaces; Electroencephalography; Exoskeleton Device; Male; Neurofeedback; Evoked Potentials, Visual; Adult; Brain; Female; Young Adult; Imagination; Imagery, Psychotherapy
PubMed: 38604523
DOI: 10.1016/j.jneumeth.2024.110132 -
Brain Communications 2024Language comprehension is often affected in individuals with post-stroke aphasia. However, deficits in auditory comprehension are not fully correlated with deficits in...
Language comprehension is often affected in individuals with post-stroke aphasia. However, deficits in auditory comprehension are not fully correlated with deficits in reading comprehension and the mechanisms underlying this dissociation remain unclear. This distinction is important for understanding language mechanisms, predicting long-term impairments and future development of treatment interventions. Using comprehensive auditory and reading measures from a large cohort of individuals with aphasia, we evaluated the relationship between aphasia type and reading comprehension impairments, the relationship between auditory versus reading comprehension deficits and the crucial neuroanatomy supporting the dissociation between post-stroke reading and auditory deficits. Scores from the Western Aphasia Battery-Revised from 70 participants with aphasia after a left-hemisphere stroke were utilized to evaluate both reading and auditory comprehension of linguistically equivalent stimuli. Repeated-measures and univariate ANOVA were used to assess the relationship between auditory comprehension and aphasia types and correlations were employed to test the relationship between reading and auditory comprehension deficits. Lesion-symptom mapping was used to determine the dissociation of crucial brain structures supporting reading comprehension deficits controlling for auditory deficits and vice versa. Participants with Broca's or global aphasia had the worst performance on reading comprehension. Auditory comprehension explained 26% of the variance in reading comprehension for sentence completion and 44% for following sequential commands. Controlling for auditory comprehension, worse reading comprehension performance was independently associated with damage to the inferior temporal gyrus, fusiform gyrus, posterior inferior temporal gyrus, inferior occipital gyrus, lingual gyrus and posterior thalamic radiation. Auditory and reading comprehension are only partly correlated in aphasia. Reading is an integral part of daily life and directly associated with quality of life and functional outcomes. This study demonstrated that reading performance is directly related to lesioned areas in the boundaries between visual association regions and ventral stream language areas. This behavioural and neuroanatomical dissociation provides information about the neurobiology of language and mechanisms for potential future treatment interventions.
PubMed: 38585671
DOI: 10.1093/braincomms/fcae102 -
Journal of Neurology Apr 2024Nonfluent variant primary progressive aphasia (nfvPPA) and primary progressive apraxia of speech (PPAOS) can be precursors to corticobasal syndrome (CBS). Details on...
BACKGROUND AND OBJECTIVES
Nonfluent variant primary progressive aphasia (nfvPPA) and primary progressive apraxia of speech (PPAOS) can be precursors to corticobasal syndrome (CBS). Details on their progression remain unclear. We aimed to examine the clinical and neuroimaging evolution of nfvPPA and PPAOS into CBS.
METHODS
We conducted a retrospective longitudinal study in 140 nfvPPA or PPAOS patients and applied the consensus criteria for possible and probable CBS for every visit, evaluating limb rigidity, akinesia, limb dystonia, myoclonus, ideomotor apraxia, alien limb phenomenon, and nonverbal oral apraxia (NVOA). Given the association of NVOA with AOS, we also modified the CBS criteria by excluding NVOA and assigned every patient to either a progressors or non-progressors group. We evaluated the frequency of every CBS feature by year from disease onset, and assessed gray and white matter volume loss using SPM12.
RESULTS
Asymmetric akinesia, NVOA, and limb apraxia were the most common CBS features that developed; while limb dystonia, myoclonus, and alien limb were rare. Eighty-two patients progressed to possible CBS; only four to probable CBS. nfvPPA and PPAOS had a similar proportion of progressors, although nfvPPA progressed to CBS earlier (p-value = 0.046), driven by an early appearance of limb apraxia (p-value = 0.0041). The non-progressors and progressors both showed premotor/motor cortex involvement at baseline, with spread into prefrontal cortex over time.
DISCUSSION
An important proportion of patients with nfvPPA and PPAOS progress to possible CBS, while they rarely develop features of probable CBS even after long follow-up.
PubMed: 38583104
DOI: 10.1007/s00415-024-12344-x -
Brain Structure & Function Apr 2024Wernicke (Der aphasische Symptomencomplex: Eine psychologische Studie auf anatomischer Basis. Cohn und Weigert, Breslau. https://wellcomecollection.org/works/dwv5w9rw... (Review)
Review
Wernicke (Der aphasische Symptomencomplex: Eine psychologische Studie auf anatomischer Basis. Cohn und Weigert, Breslau. https://wellcomecollection.org/works/dwv5w9rw , 1874) proposed a model of the functional neuroanatomy of spoken word repetition, production, and comprehension. At the heart of this epoch-making model are psychological reflex arcs underpinned by fiber tracts connecting sensory to motor areas. Here, I evaluate the central assumption of psychological reflex arcs in light of what we have learned about language in the brain during the past 150 years. I first describe Wernicke's 1874 model and the evidence he presented for it. Next, I discuss his updates of the model published in 1886 and posthumously in 1906. Although the model had an enormous immediate impact, it lost influence after the First World War. Unresolved issues included the anatomical underpinnings of the psychological reflex arcs, the role of auditory images in word production, and the sufficiency of psychological reflex arcs, which was questioned by Wundt (Grundzüge der physiologischen Psychologie. Engelmann, Leipzig. http://vlp.mpiwg-berlin.mpg.de/references?id=lit46 , 1874; Grundzüge der physiologischen Psychologie (Vol. 1, 5th ed.). Engelmann, Leipzig. http://vlp.mpiwg-berlin.mpg.de/references?id=lit806 , 1902). After a long dormant period, Wernicke's model was revived by Geschwind (Science 170:940-944. https://doi.org/10.1126/science.170.3961.940 , 1970; Selected papers on language and the brain. Reidel, Dordrecht, 1974), who proposed a version of it that differed in several important respects from Wernicke's original. Finally, I describe how new evidence from modern research has led to a novel view on language in the brain, supplementing contemporary equivalents of psychological reflex arcs by other mechanisms such as attentional control and assuming different neuroanatomical underpinnings. In support of this novel view, I report new analyses of patient data and computer simulations using the WEAVER++/ARC model (Roelofs 2014, 2022) that incorporates attentional control and integrates the new evidence.
PubMed: 38581582
DOI: 10.1007/s00429-024-02785-5 -
Journal of Tropical Pediatrics Apr 2024Familial hemiplegic migraine (FHM), an autosomal dominant subtype of hemiplegic migraine, is a channelopathy presenting with severe headache, visual field defect,...
Familial hemiplegic migraine (FHM), an autosomal dominant subtype of hemiplegic migraine, is a channelopathy presenting with severe headache, visual field defect, paresthesia, unilateral motor deficit, encephalopathy, seizures and aphasia. This cross-sectional study was conducted over 10 months in children aged 1-18 years suspected of hemiplegic migraine at a tertiary care pediatric hospital. Fourteen children were screened and five children with genetically confirmed FHM were included. The symptoms in the study population were paroxysmal hemiparesis (5/5), headache (5/5) and focal seizures (1/5). The hemiplegia episodes lasted from 4 h to 7 days. The mean age at the onset of neurological symptoms was 6.8 ± 0.7 years and the mean age at diagnosis was 12.8 ± 1.7 years, with a mean delay of 6.1 ± 1.9 years for the diagnosis. Neuroimaging during acute episodes revealed accentuated gray, white differentiation in the contralateral cerebral hemisphere with mild effacement of sulcal spaces in T2/fluid-attenuated inversion recovery (FLAIR) images. Genetic testing revealed ATP1A2 mutations (FHM2) in 4/5 and SCN1A (FHM3) in 1/5 patients. All of them (5/5) were initiated on oral topiramate and had favorable treatment responses with a mean follow-up duration of 7 ± 1.4 months. Diagnosis of FHM is mainly clinical and can be confirmed by genetic analysis. Perfusion and diffusion-weighted MRI should be considered during acute headache episodes, as it is mostly normal in symptom-free periods. Routine MRI sequences like T1 weighted, T2 weighted, FLAIR and contrast remain normal even during acute attacks.
Topics: Humans; Child; Adolescent; Migraine with Aura; Hemiplegia; Cross-Sectional Studies; Brain Diseases; Mutation; Headache; Seizures
PubMed: 38580379
DOI: 10.1093/tropej/fmae008 -
Cureus Mar 2024Melodic intonation therapy (MIT) is one of the rehabilitation methods for patients with non-fluent or dysfluent aphasia, mainly caused by stroke or brain injury....
Melodic intonation therapy (MIT) is one of the rehabilitation methods for patients with non-fluent or dysfluent aphasia, mainly caused by stroke or brain injury. Although MIT is conducted in various languages, reports on the Japanese version of MIT (MIT-J) are limited. In this report, we describe a case about the efficacy of MIT-J in the subacute phase after stroke on subcortical aphasia. Our case was a 60-year-old right-handed woman who suffered from left putaminal hemorrhage. She was treated with acute therapy, including medications and rehabilitation, but non-fluent aphasia was preserved. Regardless of general speech therapies, her aphasia was not improved. In the subacute phase, we started MIT-J (protocol: 20 minutes per day, five days per week for two weeks). The effect of MIT-J was remarkable and in particular, speech intelligibility was improved. It is required to accumulate more cases to reveal the effect of MIT-J.
PubMed: 38576684
DOI: 10.7759/cureus.55590 -
Journal of Clinical Neuroscience :... May 2024Aphasia is a language disorder acquired secondary to brain damage. This study aims to evaluate clinical and radiological profile of patients with post stroke aphasia and...
BACKGROUND
Aphasia is a language disorder acquired secondary to brain damage. This study aims to evaluate clinical and radiological profile of patients with post stroke aphasia and factors affecting its recovery.
METHODS
We conducted a prospective study of patients with first left Middle or Anterior Cerebral Artery infarct or Intracerebral Hemorrhage (ICH) with aphasia admitted within 14 days of stroke onset. Aphasia Quotient (AQ) was assessed at 2 weeks (AQ1) and 3 months (AQ2) using Western Aphasia Battery-Hindi version. Magnetic Resonance Imaging of brain with Diffusion Tensor Imaging (DTI) of bilateral Arcuate Fasciculus (AF) and Corticospinal Tract was done at admission, and stroke volume, Laterality Indices of Fractional Anisotropy (LI-FA), Mean Diffusivity (LI-MD), Radial Diffusivity (LI-RD), Axial Diffusivity (LI-AD) and Apparent Diffusion Coefficient (LI-ADC) were obtained.
RESULTS
36 patients [8 ICH and 28 Acute Ischemic Stroke (AIS)] were included. AQ1 and AQ2 were significantly higher in subcortical stroke than cortical. AQ2 and increase in AQ scores (including its subscores) were significantly higher in ICH than AIS. National Institutes of Health Stroke Scale score at admission and volume of stroke had significant negative correlation with AQ1 and AQ2. Laterality Index of Fractional Anisotropy of Arcuate Fasciculus [LI-FA (AF)] had significant positive correlation with AQ2 and naming score at 3 months. Laterality Index of Mean Diffusivity of Arcuate Fasciculus [LI-MD (AF)] had significant negative correlation with AQ1, AQ2 and all subcomponents of AQ2. Significant positive correlation was seen between improvements in Modified Rankin Scale score and AQ.
CONCLUSION
The study shows that DTI can be used to predict severity of aphasia at follow up and recovery in language and motor functions occur in parallel.
Topics: Humans; Male; Female; Middle Aged; Aphasia; Prospective Studies; India; Diffusion Tensor Imaging; Stroke; Aged; Follow-Up Studies; Adult; Brain; Recovery of Function
PubMed: 38574684
DOI: 10.1016/j.jocn.2024.03.002 -
ASSETS. Annual ACM Conference on... Oct 2023We describe a smartphone/smartwatch system to evaluate anomia in individuals with aphasia by using audio-recording-based ecological momentary assessments. The system...
We describe a smartphone/smartwatch system to evaluate anomia in individuals with aphasia by using audio-recording-based ecological momentary assessments. The system delivers object-naming assessments to a participant's smartwatch, whereby a prompt signals the availability of images of these objects on the watch screen. Participants attempt to speak the names of the images that appear on the watch display out loud and into the watch as they go about their lives. We conducted a three-week feasibility study with six participants with mild to moderate aphasia. Participants were assigned to either a nine-item (four prompts per day with nine images) or single-item (36 prompts per day with one image each) ecological momentary assessment protocol. Compliance in recording an audio response to a prompt was approximately 80% for both protocols. Qualitative analysis of the participants' interviews suggests that the participants felt capable of completing the protocol, but opinions about using a smartwatch were mixed. We review participant feedback and highlight the importance of considering a population's specific cognitive or motor impairments when designing technology and training protocols.
PubMed: 38549687
DOI: 10.1145/3597638.3608419 -
Cureus Feb 2024Meningitis is a rare but possible complication of sinusitis. We present a case of a 21-year-old woman with a history of fever, headache and nasal obstruction who...
Meningitis is a rare but possible complication of sinusitis. We present a case of a 21-year-old woman with a history of fever, headache and nasal obstruction who presented at the emergency department with psychomotor agitation. Orotracheal intubation and invasive mechanical ventilation were given to protect airway. Blood analysis showed leukocytosis and elevated C-reactive protein. Cerebral and maxillofacial computed tomography (CT) demonstrated pansinusitis with gas foci more prominent in the left frontal sinus with an area of bone rarefaction on the posterior wall with possible communication with the cranial cavity. Lumbar puncture was performed. Empirical antibiotic and corticosteroid therapy were started. Neurosurgery (NC) and Ear Nose and Throat (ENT) surgeons declined indication for urgent surgery and she was admitted at General ICU. On the fourth day of hospitalization, a brain magnetic resonance imaging (CE-MRI) was performed, revealing subdural empyema and cerebritis adjacent to the frontal sinus. She was transferred to the reference neurosurgical center for surgical interventions and was admitted post-operatively at the Neurocritical Care Unit (NCCU). Reevaluation MRI showed residual anterior frontal empyema and absence of focus control in peri-nasal sinusitis, requiring a new ENT surgery. A spp was isolated from the blood, from the pus collected from the sinuses, and the CSF was sterile. The patient completed 21 days of antibiotic therapy. She was extubated on the 19th day, with Broca's aphasia and right hemiparesis, and on the 23rd day transferred to the ENT Service and later to the Rehabilitation Service. We present a case of atypical central nervous system (CNS) infection by a rare agent, highlighting the importance of vigilance, focus control, and neurocritical care. In a severe and complex manifestation like this, the management typically involves medical and surgical interventions. Subdural empyema should be treated as a neurosurgical emergency due to the potential rapid deterioration in patient's neurological condition, attributed to secondary damage. In this case, brain multimodal monitoring, was very helpful in acute phase management. Neurocritical care teams should be involved early in patients with this presentation of CNS infection to provide optimal management, reducing complications and secondary brain lesions therefore improving patient outcomes.
PubMed: 38533169
DOI: 10.7759/cureus.54864