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Archives of Physical Medicine and... Jul 2022To explore the effect of complexity and feedback on script training outcomes in aphasia DESIGN: Randomized balanced single-blind 2 × 2 factorial design. (Clinical Trial)
Clinical Trial
OBJECTIVE
To explore the effect of complexity and feedback on script training outcomes in aphasia DESIGN: Randomized balanced single-blind 2 × 2 factorial design.
SETTING
Freestanding urban rehabilitation hospital.
PARTICIPANTS
Adults with fluent and nonfluent aphasia (at least 6 months post onset).
INTERVENTIONS
Experimental treatment was AphasiaScripts, a computer-based script training program. Scripts were 10-turns long and developed at different complexity levels to allow for comparison of high vs low complexity. The program was modified to contrast high vs low feedback conditions during sentence practice. Participants were instructed to practice three 30-minute sessions per day, 6 days per week for 3 weeks.
MAIN OUTCOME MEASURES
Gains achieved from baseline in accuracy and rate of production of trained and untrained script sentences at post treatment and at 3-, 6-, and 12-weeks after the end of treatment.
RESULTS
Sixteen participants completed the intervention. On the trained script, gains were statistically significant for both accuracy and words per minute at post treatment and 3-, 6-, and 12-week maintenance. Gains on the untrained script were smaller than on the trained script; they were statistically significant only for accuracy at post treatment and 3-week maintenance. Complexity had an influence on accuracy at post-treatment (F=4.8391, P=.0501) and at maintenance (F=5.3391, P=.0413). Practicing scripts with high complexity increased accuracy by 11.33% at post treatment and by 9.90% at maintenance compared with scripts with low complexity. Participants with nonfluent aphasia made greater gains than those with fluent aphasia. There was no significant effect of feedback.
CONCLUSIONS
This study reinforces script training as a treatment option for aphasia. Results highlight the use of more complex scripts to better promote acquisition and maintenance of script production skills. There is a need for further investigation of these variables with larger samples and with other types of aphasia treatments.
Topics: Adult; Aphasia, Broca; Feasibility Studies; Feedback; Humans; Single-Blind Method
PubMed: 35304120
DOI: 10.1016/j.apmr.2022.03.002 -
Frontiers in Neurology 2022Exploring the brain reorganization patterns associated with language recovery would promote the treatment of global aphasia. While functional near-infrared spectroscopy...
BACKGROUND
Exploring the brain reorganization patterns associated with language recovery would promote the treatment of global aphasia. While functional near-infrared spectroscopy (fNIRS) has been widely used in the study of speech and language impairment, its application in the field of global aphasia is still limited.
AIMS
We aimed to identify cortical activation patterns of patients with global aphasia during naming and repetition tasks.
METHODS AND PROCEDURES
We recruited patients with post-stroke aphasia from the Department of Rehabilitation Medicine at Huashan Hospital. These individuals were diagnosed with global aphasia without cognitive impairments, as assessed by speech-language pathology evaluations. Age- and sex-matched healthy controls were recruited from the greater Shanghai area. During fNIRS measurement, patients and healthy controls completed the picture-naming and phrase repetition task. Cortical activation patterns on each of these language tasks were then compared between groups.
OUTCOMES AND RESULTS
A total of nine patients with global aphasia and 14 healthy controls were included in this study. Compared with the healthy subjects, patients with global aphasia showed increased activation in the left Broca's area, middle temporal gyrus (MTG), superior temporal gyrus (STG), and pre-motor and supplementary motor cortex (SMA) ( < 0.05) in the picture-naming task. Furthermore, the latency of the oxyhemoglobin (HbO) concentration in the left supramarginal gyrus (SMG) region had a strong negative correlation with their score of the naming task ( < 0.01). In the phrase repetition task, decreased activation was detected in the left SMA and SMG ( < 0.05) of patients relative to controls.
CONCLUSION
The left SMG plays a critical role in the language function of patients with global aphasia, especially in their abilities to name and repeat. fNIRS is a promising approach to revealing the changes in brain activities in patients with aphasia, and we believe it will contribute to a deeper understanding of the neurological mechanisms and the establishment of a novel treatment approach for global aphasia.
PubMed: 36686505
DOI: 10.3389/fneur.2022.1025384 -
Journal of Physical Therapy Science Feb 2023[Purpose] To assess the clinical applicability of a novel automated tractography tool named XTRACT during acute stroke rehabilitation. [Participants and Methods] Three...
[Purpose] To assess the clinical applicability of a novel automated tractography tool named XTRACT during acute stroke rehabilitation. [Participants and Methods] Three patients with left hemisphere stroke were sampled. Diffusion tensor images were acquired on the second week, and automated tractography was then applied. Tractography images and fractional anisotropy (FA) values in the corticospinal tract (CST) and arcuate fasciculus (AF) were assessed in relation to hemiparesis and aphasia. [Results] Patient 1 was nearly asymptomatic; FA in the left CST was 0.610 and that in the AF was 0.509. Patient 2 had severe hemiparesis and mild motor aphasia. Tractography images of the CST and AF were blurred; FA in the left CST was 0.295 and that in the AF was 0.304. Patient 3 showed no hemiparesis or aphasia at initial assessment. Tractography image of the CST was intact but that of the AF was less clear; FA in the left CST was 0.586 and that in the AF was 0.338. Considering the less clear images of the AF and lower FA value in Patients 2 and 3, further examinations for aphasia were performed, which revealed agraphia. [Conclusion] Visualization and quantification of neural fibers using automated tractography promoted planning acute care rehabilitative treatment in patients with stroke.
PubMed: 36744203
DOI: 10.1589/jpts.35.156 -
Contrast Media & Molecular Imaging 2022A total of 35 patients with aphasia after cerebral infarct were included. Among them, 15 conjunctures were sensory (Wernicke's) aphasia and 20 cases were motor (Broca)...
A total of 35 patients with aphasia after cerebral infarct were included. Among them, 15 conjunctures were sensory (Wernicke's) aphasia and 20 cases were motor (Broca) aphasia. Perfusion Weighted Imaging (PWI) and Magnetic Resonance Spectroscopy (MRS) were performed on the attached hard area to measure the local cerebral blood flow (rCBF) and sectional cerebral blood compass (rCBV), mean conveyance tense (MTT), point delay (TTP), and -acetylaspartate (NAA), choline (Cho), creatine (Cr)), and lactic acidic (lactate, Lac) and generally a relative analysis. . Among the patients with contaminative aphasia, rCBF was way diminished in the contralateral mirror extent. MTT and TTP were significantly longer than the contralateral mirror range, NAA and Cho were sullenness than the contralateral side, and the Lac peak appeared. The distinction was statistically taken ( < 0.05). Compared with the contralateral mirror circumference, motor aphasia was significantly reduced in rCBF and rCBV, and MTT and TTP were way prolonged. NAA and Cho were reduced compared with the contralateral side, and the Lac peak appeared. The dispute was statistically momentous ( < 0.05). . After cerebral infarction, the language cosine extent of patients with aphasia bestows a rank of hypoperfusion and light metabolism, suggesting that it may be the pathogeny of aphasia.
Topics: Aphasia; Choline; Creatine; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy
PubMed: 35360264
DOI: 10.1155/2022/5885860 -
Cortex; a Journal Devoted To the Study... Mar 1986We developed a battery of tests to evaluate the relationship of perseveration to aphasia, and tested 44 subjects (18 with aphasia, 13 with right hemispheric lesions, 13...
We developed a battery of tests to evaluate the relationship of perseveration to aphasia, and tested 44 subjects (18 with aphasia, 13 with right hemispheric lesions, 13 normal controls). Several major findings emerged: left hemispheric, posteriorly located, aphasia producing lesions also produced abundant perseverations, both verbal and non-verbal, which were primarily recurrent in type; right hemispheric lesions produced few perseverations, and these were primarily of the continuous type; more than half of the verbal recurrent perseverations of aphasia on a naming task were semantic in nature. We conclude that recurrent perseveration has a special, perhaps integral, link to language disorders of aphasia, particularly fluent aphasia associated with posterior lesions.
Topics: Anomia; Aphasia; Aphasia, Broca; Aphasia, Wernicke; Brain Damage, Chronic; Dominance, Cerebral; Humans; Middle Aged; Neuropsychological Tests; Psychomotor Performance; Stereotyped Behavior; Verbal Behavior
PubMed: 2423294
DOI: 10.1016/s0010-9452(86)80035-1 -
The Journal of Dermatology Jun 2018Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs.... (Review)
Review
Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gastrointestinal or central nervous system involvement, may predispose the patients to poorer or even fatal outcomes. We present a 30-year-old female patient with systemic manifestation of MAP 10 days after delivery of a full-term pregnancy who subsequently developed motor aphasia and intestinal perforation. The patient was administrated empirical treatment with an antiplatelet, anticoagulant, methylprednisolone sodium succinate and alprostadil. Antibiotics were administrated due to intestinal perforation and secondary sepsis. Despite all treatment, the patient died a week later. We summarized all the previous reports of MAP based on thorough review of previous published work. Overall, this is the first patient with MAP combined with motor aphasia and intestinal perforation and may provide insights for future studies on the treatment of this disease.
Topics: Adult; Alprostadil; Anti-Bacterial Agents; Anticoagulants; Aphasia, Broca; Fatal Outcome; Female; Humans; Intestinal Perforation; Magnetic Resonance Angiography; Malignant Atrophic Papulosis; Neuroprotective Agents; Platelet Aggregation Inhibitors; Sepsis; Skin
PubMed: 29516548
DOI: 10.1111/1346-8138.14280 -
Annals of Indian Academy of Neurology 2015With advances in neuroimaging, traditional views regarding the clinicoanatomic correlation in stroke patients with aphasia are being challenged and it has been observed...
CONTEXT
With advances in neuroimaging, traditional views regarding the clinicoanatomic correlation in stroke patients with aphasia are being challenged and it has been observed that lesions at a given cortical or subcortical site may manifest with different aphasia profiles.
AIMS
To study as to whether there is a strict clinicoanatomical correlation between the type of aphasia and lesion site in patients with first ever stroke.
SETTINGS AND DESIGN
Observational study, based in a tertiary care center.
MATERIALS AND METHODS
Stroke patient's ≥18 years of age were screened and those with first ever stroke and aphasia were subjected to a detailed stroke workup and language assessment using the Hindi version of Western Aphasia Battery (WAB). Statistical analysis was done with χ(2) test with Yates correction and Kruskal-Wallis test. The level of significance was set at P < 0.05.
RESULTS
Overall aphasia was detected in 27.9% of the 260 screened cases with stroke. Amongst 60 cases with first ever stroke and aphasia, the aphasia type was: Global (33.33%), Broca's (28.3%), transcortical motor (13.33%), transcortical sensory (10%), Wernicke's (8.33%), anomic (5%), and conduction (1.67%) aphasia. A definite correlation between the lesion site and the type of aphasia as per the traditional classification was observed in 35% cases only.
CONCLUSIONS
No absolute correlation exists between the lesion site and the type of clinical aphasia syndrome in majority of the patients with cortical and subcortical stroke.
PubMed: 26713015
DOI: 10.4103/0972-2327.165469 -
BMJ Case Reports Jan 2016Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) consists of recurrent headaches with focal neurological signs, which... (Review)
Review
Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) consists of recurrent headaches with focal neurological signs, which can include motor, sensory and aphasic symptoms. Although considered rare, it is becoming increasingly recognised in clinical practice due to the accumulation of case reports. The pathophysiology remains unclear although changes in the neurovascular resemble those found in migraine, which are thought to be triggered by an infectious process. HaNDL can mimic various serious, including life-threatening, diseases, such as stroke and meningoencephalitis, which is why vigorous tests should be sought before this diagnosis of exclusion can be reached. Treatment is symptomatic and the prognosis is excellent. A literature review of the topic is discussed. We report an adolescent girl who presented with recurrent expressive dysphasia and right-sided hypoaesthesia and moderate occipital headaches who was diagnosed with HaNDL syndrome.
Topics: Acetazolamide; Adolescent; Aphasia, Broca; Carbonic Anhydrase Inhibitors; Diagnosis, Differential; Female; Headache; Humans; Hypesthesia; Lymphocytosis; Nervous System Diseases; Syndrome
PubMed: 26768705
DOI: 10.1136/bcr-2015-213018 -
Nature Mar 2014Historically, the study of speech processing has emphasized a strong link between auditory perceptual input and motor production output. A kind of 'parity' is essential,...
Historically, the study of speech processing has emphasized a strong link between auditory perceptual input and motor production output. A kind of 'parity' is essential, as both perception- and production-based representations must form a unified interface to facilitate access to higher-order language processes such as syntax and semantics, believed to be computed in the dominant, typically left hemisphere. Although various theories have been proposed to unite perception and production, the underlying neural mechanisms are unclear. Early models of speech and language processing proposed that perceptual processing occurred in the left posterior superior temporal gyrus (Wernicke's area) and motor production processes occurred in the left inferior frontal gyrus (Broca's area). Sensory activity was proposed to link to production activity through connecting fibre tracts, forming the left lateralized speech sensory-motor system. Although recent evidence indicates that speech perception occurs bilaterally, prevailing models maintain that the speech sensory-motor system is left lateralized and facilitates the transformation from sensory-based auditory representations to motor-based production representations. However, evidence for the lateralized computation of sensory-motor speech transformations is indirect and primarily comes from stroke patients that have speech repetition deficits (conduction aphasia) and studies using covert speech and haemodynamic functional imaging. Whether the speech sensory-motor system is lateralized, like higher-order language processes, or bilateral, like speech perception, is controversial. Here we use direct neural recordings in subjects performing sensory-motor tasks involving overt speech production to show that sensory-motor transformations occur bilaterally. We demonstrate that electrodes over bilateral inferior frontal, inferior parietal, superior temporal, premotor and somatosensory cortices exhibit robust sensory-motor neural responses during both perception and production in an overt word-repetition task. Using a non-word transformation task, we show that bilateral sensory-motor responses can perform transformations between speech-perception- and speech-production-based representations. These results establish a bilateral sublexical speech sensory-motor system.
Topics: Brain; Brain Mapping; Female; Frontal Lobe; Functional Laterality; Hearing; Humans; Language; Male; Models, Neurological; Psychomotor Performance; Speech; Speech Perception; Temporal Lobe
PubMed: 24429520
DOI: 10.1038/nature12935 -
Neurorehabilitation and Neural Repair Feb 2022Speech entrainment (SE), the online mimicking of an audio-visual speech model, has been shown to increase speech fluency in individuals with non-fluent aphasia. One...
BACKGROUND
Speech entrainment (SE), the online mimicking of an audio-visual speech model, has been shown to increase speech fluency in individuals with non-fluent aphasia. One theory that may explain why SE improves speech output is that it synchronizes functional connectivity between anterior and posterior language regions to be more similar to that of neurotypical speakers.
OBJECTIVES
The present study tested this by measuring functional connectivity between 2 regions shown to be necessary for speech production, and their right hemisphere homologues, in 24 persons with aphasia compared to 20 controls during both free (spontaneous) speech and SE.
METHODS
Regional functional connectivity in participants with aphasia were normalized to the control data. Two analyses were then carried out: (1) normalized functional connectivity was compared between persons with aphasia and controls during free speech and SE and (2) stepwise linear models with leave-one-out cross-validation including normed functional connectivity during both tasks and proportion damage to the left hemisphere as independent variables were created for each language score.
RESULTS
Left anterior-posterior functional connectivity and left posterior to right anterior functional connectivity were significantly more similar to connectivity of the control group during SE compared to free speech. Additionally, connectivity during free speech was more associated with language measures than connectivity during SE.
CONCLUSIONS
Overall, these results suggest that SE promotes normalization of functional connectivity (i.e., return to patterns observed in neurotypical controls), which may explain why individuals with non-fluent aphasia produce more fluent speech during SE compared to spontaneous speech.
Topics: Adult; Aged; Aphasia, Broca; Chronic Disease; Connectome; Female; Humans; Imitative Behavior; Magnetic Resonance Imaging; Male; Middle Aged; Mouth; Outcome Assessment, Health Care; Speech Perception; Speech Therapy; Stroke Rehabilitation; Visual Perception
PubMed: 34968159
DOI: 10.1177/15459683211064264