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Radiology Case Reports Sep 2023Mechanical thrombectomy is the gold standard in treating acute ischemic stroke complicated by large vessel occlusion. However, there are limited studies on repeated...
Mechanical thrombectomy is the gold standard in treating acute ischemic stroke complicated by large vessel occlusion. However, there are limited studies on repeated mechanical thrombectomy in acute ischemic stroke. In this case, we report a 68-year-old male with atrial fibrillation who developed sudden left limb weakness and motor aphasia for 6 hours, and his National Institutes of Health Stroke Scale (NIHSS) score was 10. Computed tomography angiography (CTA) showed occlusion of the right internal carotid artery, and mechanical thrombectomy was performed immediately. The patient's neurologic disability was utterly relieved, and the NIHSS score returned to 0. At 30 hours postoperatively, he again developed left limb weakness with motor aphasia. The NHISS Score was 11, and the CTA showed that the right internal carotid artery was re-occluded. After computed tomography perfusion evaluation, the patient underwent mechanical thrombectomy again, and the etiological examination confirmed Cardioembolism. Anticoagulation therapy was commenced 1 week post-thrombectomy. The prognosis of the patients was good.
PubMed: 37441454
DOI: 10.1016/j.radcr.2023.06.026 -
Frontiers in Human Neuroscience 2023Language production is a finely regulated process, with many aspects which still elude comprehension. From a motor perspective, speech involves over a hundred different...
INTRODUCTION
Language production is a finely regulated process, with many aspects which still elude comprehension. From a motor perspective, speech involves over a hundred different muscles functioning in coordination. As science and technology evolve, new approaches are used to study speech production and treat its disorders, and there is growing interest in the use of non-invasive modulation by means of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS).
METHODS
Here we analyzed data obtained from Scopus (Elsevier) using VOSViewer to provide an overview of bibliographic mapping of citation, co-occurrence of keywords, co-citation and bibliographic coupling of non-invasive brain stimulation (NIBS) use in speech research.
RESULTS
In total, 253 documents were found, being 55% from only three countries (USA, Germany and Italy), with emerging economies such as Brazil and China becoming relevant in this topic recently. Most documents were published in this last decade, with 2022 being the most productive yet, showing brain stimulation has untapped potential for the speech research field.
DISCUSSION
Keyword analysis indicates a move away from basic research on the motor control in healthy speech, toward clinical applications such as stuttering and aphasia treatment. We also observe a recent trend in cerebellar modulation for clinical treatment. Finally, we discuss how NIBS have established over the years and gained prominence as tools in speech therapy and research, and highlight potential methodological possibilities for future research.
PubMed: 37425291
DOI: 10.3389/fnhum.2023.1164890 -
Frontiers in Neuroscience 2023Globally, more than 10 million new stroke cases occur annually, of which aphasia accounts for about one-third. Aphasia has become an independent predictor of functional...
BACKGROUND
Globally, more than 10 million new stroke cases occur annually, of which aphasia accounts for about one-third. Aphasia has become an independent predictor of functional dependence and death for the stroke population. The closed-loop rehabilitation of combining behavioral therapy with central nerve stimulation seems to be the research trend of post-stroke aphasia (PSA) due to its advantages in improving linguistic deficits.
OBJECTIVE
To verify the clinical efficacy of a closed-loop rehabilitation program combining melodic intonation therapy (MIT) with transcranial direct current stimulation (tDCS) for PSA.
METHODS
This was a single-center, assessor-blinded, randomized controlled clinical trial, which screened 179 patients and included 39 PSA subjects, with the registration number ChiCTR2200056393 in China. Demographic and clinical data were documented. The primary outcome was the Western Aphasia Battery (WAB) used to assess language function, and the secondary outcomes included Montreal Cognitive Assessment (MoCA), Fugl-Meyer Assessment (FMA), and Barthel Index (BI) for evaluating cognition, motor, and activities of daily living, respectively. With the computer-generated randomization sequence, subjects were randomly divided into the conventional group (CG), MIT combined with sham stimulation group (SG), and MIT combined with tDCS group (TG). After the three-week intervention, the functional changes in each group were analyzed by the paired sample -test, and the functional difference between the three groups was analyzed by ANOVA.
RESULTS
There was no statistical difference on the baseline. After the intervention, the WAB's aphasia quotient (WAB-AQ), MoCA, FMA, and BI were statistically different in SG and TG, including all the sub-items in WAB and FMA, while only listening comprehension, FMA, and BI were statistically different in CG. The differences of WAB-AQ, MoCA, and FMA were statistically different among the three groups, but BI was not. The test results revealed that the changes of WAB-AQ and MoCA in TG were more significant than the others.
CONCLUSION
MIT combined with tDCS can augment the positive effect on language and cognitive recovery in PSA.
PubMed: 37397451
DOI: 10.3389/fnins.2023.1088218 -
Neurology International May 2023Patients with age-related white matter changes (ARWMC) frequently present a gait disorder, depression and cognitive impairment. Our aims are to define which alterations...
Spatial and Temporal Gait Characteristics in Patients Admitted to a Neuro-Rehabilitation Department with Age-Related White Matter Changes: A Gait Analysis and Clinical Study.
BACKGROUND
Patients with age-related white matter changes (ARWMC) frequently present a gait disorder, depression and cognitive impairment. Our aims are to define which alterations in the gait parameters are associated with motor or neuro-psychological impairment and to assess the role of motor, mood or cognitive dysfunction in explaining the variance of the gait parameters.
METHODS
Patients with gait disorders admitted to a Neuro-rehabilitation Department, affected by vascular leukoencephalopathy who had ARWMC confirmed by a brain MRI, were consecutively enrolled, classified by a neuroradiological scale (Fazekas 1987) and compared to healthy controls. We excluded subjects unable to walk independently, subjects with hydrocephalus or severe aphasia, with orthopaedic and other neurological pathologies conditioning the walking pattern. Patients and controls were assessed by clinical and functional scales (Mini Mental State Examination, Geriatric Depression Scale, Nevitt Motor Performance Scale, Berg Balance Scale, Functional Independence Measure), and computerised gait analysis was performed to assess the spatial and temporal gait parameters in a cross-sectional study.
RESULTS
We recruited 76 patients (48 males, aged 78.3 ± 6.2 years) and 14 controls (6 males, aged 75.8 ± 5 years). In the multiple regression analysis, the gait parameter with overall best model summary values, associated with the ARWMC severity, was the stride length even after correction for age, sex, weight and height (R = 0.327). The motor performances justified at least in part of the gait disorder (R change = 0.220), but the mood state accounted independently for gait alterations (R change = 0.039). The increase in ARWMC severity, the reduction of motor performance and a depressed mood state were associated with a reduction of stride length (R = 0.766, R = 0.587), reduction of gait speed (R = 0.573) and an increase in double support time (R = 0.421).
CONCLUSION
The gait disorders in patients with ARWMC are related to motor impairment, but the presence of depression is an independent factor for determining gait alterations and functional status. These data pave the way for longitudinal studies, including gait parameters, to quantitatively assess gait changes after treatment or to monitor the natural progression of the gait disorders.
PubMed: 37368328
DOI: 10.3390/neurolint15020044 -
NeuroImage. Clinical 2023Aphasia is an acquired disorder caused by damage, most commonly due to stroke, to brain regions involved in speech and language. While language impairment is the...
Aphasia is an acquired disorder caused by damage, most commonly due to stroke, to brain regions involved in speech and language. While language impairment is the defining symptom of aphasia, the co-occurrence of non-language cognitive deficits and their importance in predicting rehabilitation and recovery outcomes is well documented. However, people with aphasia (PWA) are rarely tested on higher-order cognitive functions, making it difficult for studies to associate these functions with a consistent lesion correlate. Broca's area is a particular brain region of interest that has long been implicated in speech and language production. Contrary to classic models of speech and language, cumulative evidence shows that Broca's area and surrounding regions in the left inferior frontal cortex (LIFC) are involved in, but not specific to, speech production. In this study we aimed to explore the brain-behaviour relationships between tests of cognitive skill and language abilities in thirty-six adults with long-term speech production deficits caused by post-stroke aphasia. Our findings suggest that non-linguistic cognitive functions, namely executive functions and verbal working memory, explain more of the behavioural variance in PWA than classical language models imply. Additionally, lesions to the LIFC, including Broca's area, were associated with non-linguistic executive (dys)function, suggesting that lesions to this area are associated with non-language-specific higher-order cognitive deficits in aphasia. Whether executive (dys)function - and its neural correlate in Broca's area - contributes directly to PWA's language production deficits or simply co-occurs with it, adding to communication difficulties, remains unclear. These findings support contemporary models of speech production that place language processing within the context of domain-general perception, action and conceptual knowledge. An understanding of the covariance between language and non-language deficits and their underlying neural correlates will inform better targeted aphasia treatment and outcomes.
Topics: Adult; Humans; Magnetic Resonance Imaging; Aphasia; Stroke; Cognition Disorders; Cognition
PubMed: 37321143
DOI: 10.1016/j.nicl.2023.103452 -
Journal of Alzheimer's Disease Reports 2023Apraxia of speech (AOS) is a core feature of nonfluent/agrammatic primary progressive aphasia (naPPA), but its precise characteristics and the prevalence of AOS features...
BACKGROUND
Apraxia of speech (AOS) is a core feature of nonfluent/agrammatic primary progressive aphasia (naPPA), but its precise characteristics and the prevalence of AOS features in spontaneous speech are debated.
OBJECTIVE
To assess the frequency of features of AOS in the spontaneous, connected speech of individuals with naPPA and to evaluate whether these features are associated with an underlying motor disorder such as corticobasal syndrome or progressive supranuclear palsy.
METHODS
We examined features of AOS in 30 patients with naPPA using a picture description task. We compared these patients to 22 individuals with behavioral variant frontotemporal dementia and 30 healthy controls. Each speech sample was evaluated perceptually for lengthened speech segments and quantitatively for speech sound distortions, pauses between and within words, and articulatory groping. We compared subgroups of naPPA with and without at least two features of AOS to assess the possible contribution of a motor impairment to speech production deficits.
RESULTS
naPPA patients produced both speech sound distortions and other speech sound errors. Speech segmentation was found in 27/30 (90%) of individuals. Distortions were identified in 8/30 (27%) of individuals, and other speech sound errors occurred in 18/30 (60%) of individuals. Frequent articulatory groping was observed in 6/30 (20%) of individuals. Lengthened segments were observed rarely. There were no differences in the frequencies of AOS features among naPPA subgroups as a function of extrapyramidal disease.
CONCLUSION
Features of AOS occur with varying frequency in the spontaneous speech of individuals with naPPA, independently of an underlying motor disorder.
PubMed: 37313492
DOI: 10.3233/ADR-220089 -
Journal of Clinical Medicine May 2023Only a few studies have focused on hemiplegic migraine (HM) in children despite its early age of onset. The aim of this review is to describe the peculiar... (Review)
Review
BACKGROUND
Only a few studies have focused on hemiplegic migraine (HM) in children despite its early age of onset. The aim of this review is to describe the peculiar characteristics of pediatric HM.
METHODS
This is a narrative review based on 14 studies on pediatric HM selected from 262 papers.
RESULTS
Different from HM in adults, pediatric HM affects both genders equally. Early transient neurological symptoms (prolonged aphasia during a febrile episode, isolated seizures, transient hemiparesis, and prolonged clumsiness after minor head trauma) can precede HM long before its onset. The prevalence of non-motor auras among children is lower than it is in adults. Pediatric sporadic HM patients have longer and more severe attacks compared to familial cases, especially during the initial years after disease onset, while familial HM cases tend to have the disease for longer. During follow-up, the frequency, intensity, and duration of HM attacks often decrease. The outcome is favorable in most patients; however, neurological conditions and comorbidities can be associated.
CONCLUSION
Further studies are needed to better define the clinical phenotype and the natural history of pediatric HM and to refine genotype-phenotype correlations in order to improve the knowledge on HM physiopathology, diagnosis, and outcome.
PubMed: 37297978
DOI: 10.3390/jcm12113783 -
Alternative Therapies in Health and... Sep 2023It is estimated that 25% of the patients in Pakistan experience stroke resulting in problems with language. Among many of the conditions, problem with verbal expressive... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
It is estimated that 25% of the patients in Pakistan experience stroke resulting in problems with language. Among many of the conditions, problem with verbal expressive production (Broca's Aphasia) is one of the main problem faced by people having stoke. Many traditional therapies are incorporated to treat symptoms of Aphasia including fluent and non- fluent Aphasia.
OBJECTIVES
The primary objective of the current study was to determine the effectiveness of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with convention speech therapy, Melodic Intonation therapy (MIT) in enhancing the verbal expressive skills in patients with severe Broca's Aphasia. Another objective of this study was to compare the efficacy of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with traditional therapy, as well as the quality of life of patients with severe Broca's Aphasia.
METHODS
A randomized control trial (NCT03699605, clinicaltrials.gov) was conducted from November 2018 - June 2019 in Pakistan railway Hospital (PRH). Patients having a three-month history of severe Broca's Aphasia, aged between 40-60 years, bilingual (Urdu and English language) and having the ability to use a smart phone were included in the study. Patients with cognitive impairments were excluded. Total of 77 patients were evaluated for eligibility criteria according to the G Power software for sample size. Out of 77, 54 individuals fulfilled the inclusion criteria. The participants were divided into 2 groups (27 each) through sealed envelope method. Patients of both groups were assessed pre and post intervention using the Boston Diagnostic Aphasia Examination (BADE) battery (Primary outcome measure). Experimental group n = 25 received VESMP-U therapy and control group n = 25 (2 drop out in each group) received MIT for 16 weeks i.e. 4 days per week having 64 sessions altogether. Each intervention session lasted up to 30-45 minutes for both groups.
RESULTS
Within and between group analysis after intervention showed that the VESMP-U group had significantly improved BDAE scores (P = .001; 95% CI) than the MIT group for all variables (articulatory intelligibility, phrase length, grammatical form, prosody/intonation, spontaneous speech, word finding, repetition, and auditory comprehension). The BDAE scores of participants in experimental group having VESMP-U therapy pre- and post-intervention were statistically significant (P = .001; 95% CI), which indicates that participant's communication skills were enhanced by use of VESMP-U.
CONCLUSION
Android based application VESMP-U has been found to be effective in improving expression and quality of life of patients with severe Broca's aphasia.
Topics: Adult; Humans; Middle Aged; Aphasia, Broca; Asian People; Pakistan; Quality of Life; Stroke
PubMed: 37295011
DOI: No ID Found -
Frontiers in Neurology 2023Stroke is a group of cerebrovascular diseases with high prevalence and mortality rate. Stroke can induce many impairments, including motor and cognitive dysfunction,... (Review)
Review
Stroke is a group of cerebrovascular diseases with high prevalence and mortality rate. Stroke can induce many impairments, including motor and cognitive dysfunction, aphasia/dysarthria, dysphagia, and mood disorders, which may reduce the quality of life among the patients. Constraint-induced therapy has been proven to be an effective treatment method for stroke rehabilitation. It has been widely used in the recovery of limb motor dysfunction, aphasia, and other impairment like unilateral neglect after stroke. In recent years, constraint-induced therapy can also combine with telehealth and home rehabilitation. In addition, constraint-induced therapy produces significant neuroplastic changes in the central nervous system. Functional magnetic resonance imaging, diffusion tensor imaging, and other imaging/electrophysiology methods have been used to clarify the mechanism and neuroplasticity. However, constraint-induced therapy has some limitations. It can only be used under certain conditions, and the treatment time and effectiveness are controversial. Further research is needed to clarify the mechanism and effectiveness of CI therapy.
PubMed: 37273704
DOI: 10.3389/fneur.2023.1170420