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Restorative Neurology and Neuroscience 2023Aphasia is a debilitating language impairment, affecting millions of people worldwide. About 40% of stroke survivors develop chronic aphasia, resulting in life-long... (Review)
Review
BACKGROUND
Aphasia is a debilitating language impairment, affecting millions of people worldwide. About 40% of stroke survivors develop chronic aphasia, resulting in life-long disability.
OBJECTIVE
This review examines extrinsic and intrinsic neuromodulation techniques, aimed at enhancing the effects of speech and language therapies in stroke survivors with aphasia.
METHODS
We discuss the available evidence supporting the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation, and functional MRI (fMRI) real-time neurofeedback in aphasia rehabilitation.
RESULTS
This review systematically evaluates studies focusing on efficacy and implementation of specialized methods for post-treatment outcome optimization and transfer to functional skills. It considers stimulation target determination and various targeting approaches. The translation of neuromodulation interventions to clinical practice is explored, emphasizing generalization and functional communication. The review also covers real-time fMRI neurofeedback, discussing current evidence for efficacy and essential implementation parameters. Finally, we address future directions for neuromodulation research in aphasia.
CONCLUSIONS
This comprehensive review aims to serve as a resource for a broad audience of researchers and clinicians interested in incorporating neuromodulation for advancing aphasia care.
Topics: Humans; Transcranial Direct Current Stimulation; Aphasia; Stroke; Transcranial Magnetic Stimulation; Neurological Rehabilitation
PubMed: 37980575
DOI: 10.3233/RNN-231344 -
Journal of Neurology, Neurosurgery, and... Jun 2018Recent evidence has fuelled the debate on the role of massed practice in the rehabilitation of chronic post-stroke aphasia. Here, we further determined the optimal daily... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Recent evidence has fuelled the debate on the role of massed practice in the rehabilitation of chronic post-stroke aphasia. Here, we further determined the optimal daily dosage and total duration of intensive speech-language therapy.
METHODS
Individuals with chronic aphasia more than 1 year post-stroke received Intensive Language-Action Therapy in a randomised, parallel-group, blinded-assessment, controlled trial. Participants were randomly assigned to one of two outpatient groups who engaged in either highly-intensive practice (Group I: 4 hours daily) or moderately-intensive practice (Group II: 2 hours daily). Both groups went through an initial waiting period and two successive training intervals. Each phase lasted 2 weeks. Co-primary endpoints were defined after each training interval.
RESULTS
Thirty patients-15 per group-completed the study. A primary outcome measure (Aachen Aphasia Test) revealed no gains in language performance after the waiting period, but indicated significant progress after each training interval (gradual 2-week -score change [CI]: 1.7 [±0.4]; 0.6 [±0.5]), independent of the intensity level applied (4-week change in Group I: 2.4 [±1.2]; in Group II: 2.2 [±0.8]). A secondary outcome measure (Action Communication Test) confirmed these findings in the waiting period and in the first training interval. In the second training interval, however, only patients with moderately-intensive practice continued to make progress (Time-by-Group interaction: =0.009, =0.13).
CONCLUSIONS
Our results suggest no added value from more than 2 hours of daily speech-language therapy within 4 weeks. Instead, these results demonstrate that even a small 2-week increase in treatment duration contributes substantially to recovery from chronic post-stroke aphasia.
Topics: Aged; Aphasia; Chronic Disease; Female; Humans; Language Therapy; Male; Middle Aged; Recovery of Function; Speech Therapy; Stroke; Time Factors; Treatment Outcome
PubMed: 29273692
DOI: 10.1136/jnnp-2017-315962 -
Current Neurology and Neuroscience... Aug 2015The sequelae of post-stroke aphasia are considerable, with implications at the societal and personal levels. An understanding of the mechanisms of recovery of cognitive... (Review)
Review
The sequelae of post-stroke aphasia are considerable, with implications at the societal and personal levels. An understanding of the mechanisms of recovery of cognitive and language processes after stroke and the factors associated with increased risk of post-stroke language and cognitive deficits is vital in providing optimal care of individuals with aphasia and in counseling to their families and caregivers. Advances in neuroimaging facilitate the identification of dysfunctional or damaged brain tissue responsible for these cognitive/language deficits and contribute insights regarding the functional neuroanatomy of language. Evidence-based person-centered behavioral therapy remains the mainstay for rehabilitation of aphasia, although emerging evidence shows that neuromodulation is a promising adjunct to traditional therapy. These topics are discussed in this review, illustrating with recent studies from the Stroke Cognitive Outcomes and REcovery (SCORE) lab.
Topics: Animals; Aphasia; Behavior Therapy; Caregivers; Humans; Neuroimaging; Stroke; Treatment Outcome
PubMed: 26077130
DOI: 10.1007/s11910-015-0573-x -
Current Opinion in Neurology Feb 2017Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will... (Review)
Review
PURPOSE OF REVIEW
Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions.
RECENT FINDINGS
Trials in this early time window are few. Although the seminal AVERT trial suggests that a cautious approach is necessary immediately (<24 h) after stroke, early mobility training and mobilization appear well tolerated, with few reasons to delay initiating some rehabilitation within the first week. The results of large clinical trials of early aphasia therapy are on the horizon, and examples of targeted upper limb treatments with better patient selection are emerging.
SUMMARY
Early rehabilitation trials are complex, particularly those that intervene across acute and rehabilitation care settings, but these trials are important if we are to optimize recovery potential in the critical window for repair. Concerted efforts to standardize 'early' recruitment, appropriately stratify participants and implement longer term follow-up is needed. Trial standards are improving. New recommendations from a recent Stroke Recovery and Rehabilitation Roundtable will help drive new research.
Topics: Aphasia; Humans; Patient Selection; Stroke; Stroke Rehabilitation; Time-to-Treatment
PubMed: 27845945
DOI: 10.1097/WCO.0000000000000404 -
Seminars in Speech and Language Feb 2016AphasiaBank has used a standardized protocol to collect narrative, procedural, personal, and descriptive discourse from 290 persons with aphasia, as well as 190 control... (Review)
Review
AphasiaBank has used a standardized protocol to collect narrative, procedural, personal, and descriptive discourse from 290 persons with aphasia, as well as 190 control participants. These data have been transcribed in the Codes for the Human Analysis of Transcripts (CHAT) format for analysis by the Computerized Language Analysis (CLAN) programs. Here, we review results from 45 studies based on these data that investigate aphasic productions in terms of these eight areas: discourse, grammar, lexicon, gesture, fluency, syndrome classification, social factors, and treatment effects. For each area, we also indicate how use of the CLAN programs has facilitated the analysis. We conclude with an examination of ways in which the size of the database could be increased through on-site recordings and data from teletherapy.
Topics: Adult; Aphasia; Databases, Factual; Female; Gestures; Humans; Language; Linguistics; Male; Middle Aged; Young Adult
PubMed: 26882361
DOI: 10.1055/s-0036-1571357 -
JPMA. the Journal of the Pakistan... Jan 2022Aphasia, an acquired language disorder, commonly results from a stroke affecting network of cortical and subcortical structures. Aphasia lacks effective standardised... (Review)
Review
Aphasia, an acquired language disorder, commonly results from a stroke affecting network of cortical and subcortical structures. Aphasia lacks effective standardised treatment. Neuroimaging and behavioural research indicate that some interventions promote neuroplasticity changes in aphasia. Research has suggested that non-invasive brain stimulation may be effective, causing functional reorganisation of language areas between the two hemispheres. This reorganisation evolves from different researches exploring novel procedures, including transcranial magnetic stimulation and intracranial direct current stimulation, which may modulate cortical activity in aphasia. The current narrative review was planned to assess these techniques while examining the casual role of specific regions of brain and the understanding of the underlying mechanism for treatment effects of brain stimulation. Literature was explored on search engines and databases, like Medline, Web of Science and bibliography of published studies. The key words used for the search were 'non-invasive brain stimulation', 'post-stroke aphasia', 'transcranial magnetic stimulation' and 'transcranial direct current stimulation'. Of the 175 publications downloaded, 40(23%) full-text English publications were reviewed.
Topics: Aphasia; Brain; Humans; Stroke; Transcranial Direct Current Stimulation; Transcranial Magnetic Stimulation
PubMed: 35099450
DOI: 10.47391/JPMA.2277 -
International Journal of... Jun 2022This paper reviews several studies whose aim was to understand the nature of language recovery in chronic aphasia and identify predictors of how people may recover... (Review)
Review
This paper reviews several studies whose aim was to understand the nature of language recovery in chronic aphasia and identify predictors of how people may recover their language functions after a brain injury. Several studies that mostly draw from data collected within the Centre for Neurobiology of Language Recovery were reviewed and categorised in four aspects of language impairment and recovery in aphasia: (a) neural markers for language impairment and recovery, (b) language and cognitive markers for language impairment and recovery, (c) effective treatments and (d) predictive modelling of treatment-induced rehabilitation. Language impairment and recovery in stroke-induced aphasia is multi-factorial, including patient-specific and treatment-specific factors. A combination of these factors may help us predict treatment responsiveness even before treatment begins. Continued work on this topic will lead to a better understanding of the mechanisms that underly language impairment and treatment-induced recovery in aphasia, and, consequently, use this information to predict each person's recovery profile trajectory and provide optimal prescriptions regarding the type and dosage of treatment.
Topics: Aphasia; Humans; Language; Language Development Disorders; Recovery of Function; Stroke
PubMed: 35603543
DOI: 10.1080/17549507.2022.2075036 -
American Journal of Speech-language... Nov 2022We present a 20-item naming test, the Severity-Calibrated Aphasia Naming Test (SCANT), that can serve as a proxy measure for an aphasia severity scale that is derived...
PURPOSE
We present a 20-item naming test, the Severity-Calibrated Aphasia Naming Test (SCANT), that can serve as a proxy measure for an aphasia severity scale that is derived from a thorough test battery of connected speech production, single-word production, speech repetition, and auditory verbal comprehension.
METHOD
We use lasso regression and cross-validation to identify an optimal subset from a set of 174 pictures to be named for prediction of aphasia severity, based on data from 200 participants with left-hemisphere stroke who were quasirandomly selected to represent the full impairment scale. Data from 20 healthy controls (i.e., participant caretakers/spouses) were also analyzed. We examine interrater reliability, test-retest reliability, sensitivity and specificity to the presence of aphasia, sensitivity to therapy gains, and external validity (i.e., correlation with aphasia severity measures) for the SCANT.
RESULTS
The SCANT has extremely high interrater reliability, and it is sensitive and specific to the presence of aphasia. We demonstrate the superiority of predictions based on the SCANT over those based on the full set of naming items. We estimate a 15% reduction in power when using the SCANT score versus the full test battery's aphasia severity score as an outcome measure; for example, to maintain the same power to detect a significant group average change in aphasia severity, a study with 25 participants using the full test battery to measure treatment effectiveness would require 30 participants if the SCANT were to be used as the testing instrument instead.
CONCLUSION
We provide a linear model to convert SCANT scores to aphasia severity scores, and we identify a change score cutoff of four SCANT items to obtain a high degree of confidence based on test-retest SCANT data and the modeled relation between SCANT and aphasia severity scores.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.21476871.
Topics: Humans; Reproducibility of Results; Aphasia; Language Tests; Stroke; Speech
PubMed: 36332139
DOI: 10.1044/2022_AJSLP-22-00071 -
Journal of Speech, Language, and... Nov 2019Purpose Reorganization of language networks in aphasia takes advantage of the facts that (a) the brain is an organ of plasticity, with neuronal changes occurring... (Review)
Review
Purpose Reorganization of language networks in aphasia takes advantage of the facts that (a) the brain is an organ of plasticity, with neuronal changes occurring throughout the life span, including following brain damage; (b) plasticity is highly experience dependent; and (c) as with any learning system, language reorganization involves a synergistic interplay between organism-intrinsic (i.e., cognitive and brain) and organism-extrinsic (i.e., environmental) variables. A major goal for clinical treatment of aphasia is to be able to prescribe treatment and predict its outcome based on the neurocognitive deficit profiles of individual patients. This review article summarizes the results of research examining the neurocognitive effects of psycholinguistically based treatment (i.e., Treatment of Underlying Forms; Thompson & Shapiro, 2005) for sentence processing impairments in individuals with chronic agrammatic aphasia resulting from stroke and primary progressive aphasia and addresses both behavioral and brain variables related to successful treatment outcomes. The influences of lesion volume and location, perfusion (blood flow), and resting-state neural activity on language recovery are also discussed as related to recovery of agrammatism and other language impairments. Based on these and other data, principles for promoting neuroplasticity of language networks are presented. Conclusions Sentence processing treatment results in improved comprehension and production of complex syntactic structures in chronic agrammatism and generalization to less complex, linguistically related structures in chronic agrammatism. Patients also show treatment-induced shifts toward normal-like online sentence processing routines (based on eye movement data) and changes in neural recruitment patterns (based on functional neuroimaging), with posttreatment activation of regions overlapping with those within sentence processing and dorsal attention networks engaged by neurotypical adults performing the same task. These findings provide compelling evidence that treatment focused on principles of neuroplasticity promotes neurocognitive recovery in chronic agrammatic aphasia. Presentation Videohttps://doi.org/10.23641/asha.10257587.
Topics: Aphasia; Behavior; Brain; Humans; Language; Neurocognitive Disorders; Neuronal Plasticity; Recovery of Function; Recruitment, Neurophysiological
PubMed: 31756151
DOI: 10.1044/2019_JSLHR-L-RSNP-19-0219 -
American Journal of Speech-language... Sep 2021Purpose Aphasia intervention research aims to improve communication and quality of life outcomes for people with aphasia. However, few studies have evaluated the... (Review)
Review
Purpose Aphasia intervention research aims to improve communication and quality of life outcomes for people with aphasia. However, few studies have evaluated the translation and implementation of evidence-based aphasia interventions to clinical practice. Treatment dosage may be difficult to translate to clinical settings, and a mismatch between dosage in research and clinical practice threatens to attenuate intervention effectiveness. The purpose of this study is to quantify a potential research-practice dosage gap in outpatient aphasia rehabilitation. Method This study utilized a two-part approach. First, we estimated clinical treatment dosage in an episode of care (i.e., treatment provided from outpatient assessment to discharge) via utilization in a regional provider in the United States. Second, we undertook a scoping review of aphasia interventions published from 2009 to 2019 to estimate the typical dosage used in the current aphasia literature. Results Outpatient clinical episodes of care included a median of 10 treatment sessions and a mean of 14.8 sessions (interquartile range: 5-20 sessions). Sessions occurred 1-2 times a week over 4-14 weeks. The median total hours of treatment was 7.5 hr (interquartile range: 3.75-15 hr). In contrast, published interventions administered a greater treatment dosage, consisting of a median of 20 hr of treatment (interquartile range: 12-30 hr) over the course of 15 sessions (interquartile range: 10-24 sessions) approximately 3 times per week. Conclusions Results demonstrate a meaningful research-practice dosage gap, particularly in total treatment hours and weekly treatment intensity. This gap highlights the potential for attenuation of effectiveness from research to outpatient settings. Future translational research should consider clinical dosage constraints and take steps to facilitate intervention implementation, particularly with regard to dosage. Conversely, health care advocacy and continued development of alternative delivery methods are necessary for the successful implementation of treatments with dosage that is incompatible with current clinical contexts. Pragmatic, implementation-focused trials are recommended to evaluate and optimize treatment effectiveness in outpatient clinical settings. Supplemental Material https://doi.org/10.23641/asha.15161568.
Topics: Aphasia; Communication; Delivery of Health Care; Humans; Quality of Life
PubMed: 34411485
DOI: 10.1044/2021_AJSLP-20-00257