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International Journal of... 2018Two male participants with chronic (> 2 years), non-fluent aphasia and their family members participated in script training using videoconferencing. Functional scripts...
Two male participants with chronic (> 2 years), non-fluent aphasia and their family members participated in script training using videoconferencing. Functional scripts were developed by people with aphasia (PWA) and their family members. Accuracy of scripts was measured by total target words produced per turn. Participant 1 with Broca's aphasia produced scripts with 0% accuracy pre-treatment and 87.5% accuracy post-treatment. Participant 2 with Transcortical Motor aphasia produced scripts with 20.2% accuracy pre-treatment and 63.5% accuracy post-treatment. Pre- and post-questionnaires for communication effectiveness and the use of telepractice for speech therapy indicated improvements in answering yes/no questions, participating in conversations with strangers, and increasing confidence and satisfaction with technology delivered treatment. The use of videoconferencing to deliver script training appears beneficial for individuals with chronic aphasia.
PubMed: 30588280
DOI: 10.5195/ijt.2018.6259 -
The Permanente Journal 2020Broca aphasia presents with impaired expression of spoken and/or written language and is often caused by infarction in the Broca area in the frontal lobe. We present a... (Comparative Study)
Comparative Study
INTRODUCTION
Broca aphasia presents with impaired expression of spoken and/or written language and is often caused by infarction in the Broca area in the frontal lobe. We present a case of Broca aphasia that was initially interpreted as confusion.
CASE PRESENTATION
A 76-year-old woman was brought to the Emergency Department because of confusion and slurred speech that began in the morning. The patient had an extensive history of alcohol abuse, hyperlipidemia, and hypertension and had recently quit drinking 5 days earlier. The patient appeared confused, answering questions with "I don't know," but had no signs of agitation. Magnetic resonance imaging of the brain confirmed a recent infarct involving the left frontal and occipital lobes, coinciding with the Broca area. The patient was able to communicate via writing and eventually made an uneventful recovery of speech.
DISCUSSION
This case demonstrates a patient without the display of stereotypical signs of stroke, yet that was the underlying condition leading to her aphasia. It is important for clinicians to be aware that a stroke can present with isolated findings such as language deficit or confusion.
Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Aphasia, Broca; Aspirin; Confusion; Diagnosis, Differential; Female; Frontal Lobe; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Magnetic Resonance Imaging; Stroke
PubMed: 31852049
DOI: 10.7812/TPP/19-061 -
Frontiers in Human Neuroscience 2014A critical examination of speech motor control depends on an in-depth understanding of network connectivity associated with Brodmann areas 44 and 45 and surrounding...
A critical examination of speech motor control depends on an in-depth understanding of network connectivity associated with Brodmann areas 44 and 45 and surrounding cortices. Damage to these areas has been associated with two conditions-the speech motor programming disorder apraxia of speech (AOS) and the linguistic/grammatical disorder of Broca's aphasia. Here we focus on AOS, which is most commonly associated with damage to posterior Broca's area (BA) and adjacent cortex. We provide an overview of our own studies into the nature of AOS, including behavioral and neuroimaging methods, to explore components of the speech motor network that are associated with normal and disordered speech motor programming in AOS. Behavioral, neuroimaging, and computational modeling studies are indicating that AOS is associated with impairment in learning feedforward models and/or implementing feedback mechanisms and with the functional contribution of BA6. While functional connectivity methods are not yet routinely applied to the study of AOS, we highlight the need for focusing on the functional impact of localized lesions throughout the speech network, as well as larger scale comparative studies to distinguish the unique behavioral and neurological signature of AOS. By coupling these methods with neural network models, we have a powerful set of tools to improve our understanding of the neural mechanisms that underlie AOS, and speech production generally.
PubMed: 25404911
DOI: 10.3389/fnhum.2014.00892 -
Neurorehabilitation and Neural Repair Jan 2015Previous findings suggest that language disorders may occur in severely brain-injured patients and could interfere with behavioral assessments of consciousness. However,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Previous findings suggest that language disorders may occur in severely brain-injured patients and could interfere with behavioral assessments of consciousness. However, no study investigated to what extent language impairment could affect patients' behavioral responses. Objective. To estimate the impact of receptive and/or productive language impairments on consciousness assessment.
METHODS
Twenty-four acute and subacute stroke patients with different types of aphasia (global, n = 11; Broca, n = 4; Wernicke, n = 3; anomic, n = 4; mixed, n = 2) were recruited in neurology and neurosurgery units as well as in rehabilitation centers. The Coma Recovery Scale-Revised (CRS-R) was administered.
RESULTS
We observed that 25% (6 out of 24) of stroke patients with a diagnosis of aphasia and 54% (6 out of 11) of patients with a diagnosis of global aphasia did not reach the maximal CRS-R total score of 23. An underestimation of the consciousness level was observed in 3 patients with global aphasia who could have been misdiagnosed as being in a minimally conscious state, even in the absence of any documented period of coma. More precisely, lower subscores were observed on the communication, motor, oromotor, and arousal subscales.
CONCLUSION
Consciousness assessment may be complicated by the co-occurrence of severe language deficits. This stresses the importance of developing new tools or identifying items in existing scales, which may allow the detection of language impairment in severely brain-injured patients.
Topics: Activities of Daily Living; Aged; Aphasia; Consciousness; Cross-Sectional Studies; Disability Evaluation; Female; Home Care Services; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Physical Therapy Modalities; Single-Blind Method; Statistics, Nonparametric; Stroke; Walking
PubMed: 24743226
DOI: 10.1177/1545968314528067 -
JNMA; Journal of the Nepal Medical... Mar 2023Amyotrophic lateral sclerosis is a rare, progressive, incurable neurodegenerative disorder that affects motor neurons leading to progressive muscle weakness, disability,...
UNLABELLED
Amyotrophic lateral sclerosis is a rare, progressive, incurable neurodegenerative disorder that affects motor neurons leading to progressive muscle weakness, disability, and eventually death. A 45-year-old male, initially presented with hoarseness, flickering of tongue, and intermittent aspirations. In course of three years, patient developed motor aphasia, frequent aspirations and an inability to hold his neck. Patient was diagnosed with a bulbar onset type of amyotrophic lateral sclerosis on the basis of neurodegenerative features with normal radiographic imaging. For the prevention of recurrent aspiration pneumonia, he was managed with a percutaneous endoscopic gastrostomy tube. As he started developing respiratory failure tracheostomy was performed and kept on a continuous bi-level positive airway pressure ventilator, in the meantime, two courses of injection Edaravone were given. Early evaluation, diagnosis and management of the condition is a cornerstone for better prognosis of disease and survival.
KEYWORDS
amyotrophic lateral sclerosis; aspiration pneumonia; case reports; edaravone.
Topics: Male; Humans; Middle Aged; Amyotrophic Lateral Sclerosis; Edaravone; Respiratory Insufficiency; Prognosis; Tracheostomy
PubMed: 37203937
DOI: 10.31729/jnma.8098 -
Journal of Speech, Language, and... Sep 2018The aims of the study were to assess and compare grammatical deficits in written and spoken language production in subjects with agrammatic primary progressive aphasia... (Comparative Study)
Comparative Study
PURPOSE
The aims of the study were to assess and compare grammatical deficits in written and spoken language production in subjects with agrammatic primary progressive aphasia (agPPA) and in subjects with agrammatism in the context of dominant apraxia of speech (DAOS) and to investigate neuroanatomical correlates.
METHOD
Eight agPPA and 21 DAOS subjects performed the picture description task of the Western Aphasia Battery (WAB) both in writing and orally. Responses were transcribed and coded for linguistic analysis. agPPA and DAOS were compared to 13 subjects with primary progressive apraxia of speech (PPAOS) who did not have agrammatism. Spearman correlations were performed between the written and spoken variables. Patterns of atrophy in each group were compared, and relationships between the different linguistic measures and integrity of Broca's area were assessed.
RESULTS
agPPA and DAOS both showed lower mean length of utterance, fewer grammatical utterances, more nonutterances, more syntactic and semantic errors, and fewer complex utterances than PPAOS in writing and speech, as well as fewer correct verbs and nouns in speech. Only verb ratio and proportion of grammatical utterances correlated between modalities. agPPA and DAOS both showed greater involvement of Broca's area than PPAOS, and atrophy of Broca's area correlated with proportion of grammatical and ungrammatical utterances and semantic errors in writing and speech.
CONCLUSIONS
agPPA and DAOS subjects showed similar patterns of agrammatism, although subjects performed differently when speaking versus writing. Integrity of Broca's area correlates with agrammatism.
Topics: Aged; Aphasia, Broca; Aphasia, Primary Progressive; Apraxias; Female; Humans; Language Tests; Linguistics; Male; Middle Aged; Semantics; Speech; Statistics, Nonparametric; Writing
PubMed: 30098169
DOI: 10.1044/2018_JSLHR-L-17-0474 -
Brain and Language Oct 2009Two chronic, nonfluent aphasia patients participated in overt naming fMRI scans, pre- and post-a series of repetitive transcranial magnetic stimulation (rTMS) treatments...
Two chronic, nonfluent aphasia patients participated in overt naming fMRI scans, pre- and post-a series of repetitive transcranial magnetic stimulation (rTMS) treatments as part of a TMS study to improve naming. Each patient received 10, 1-Hz rTMS treatments to suppress a part of R pars triangularis. P1 was a 'good responder' with improved naming and phrase length; P2 was a 'poor responder' without improved naming. Pre-TMS (10 years poststroke), P1 had significant activation in R and L sensorimotor cortex, R IFG, and in both L and R SMA during overt naming fMRI (28% pictures named). At 3 mo. post-TMS (42% named), P1 showed continued activation in R and L sensorimotor cortex, R IFG, and in R and L SMA. At 16 mo. post-TMS (58% named), he also showed significant activation in R and L sensorimotor cortex mouth and R IFG. He now showed a significant increase in activation in the L SMA compared to pre-TMS and at 3 mo. post-TMS (p < .02; p < .05, respectively). At 16 mo. there was also greater activation in L than R SMA (p < .08). At 46 mo. post-TMS (42% named), this new LH pattern of activation continued. He improved on the Boston Naming Test from 11 pictures named pre-TMS, to scores ranging from 14 to 18 pictures, post-TMS (2-43 mo. post-TMS). His longest phrase length (Cookie Theft picture) improved from three words pre-TMS, to 5-6 words post-TMS. Pre-TMS (1.5 years poststroke), P2 had significant activation in R IFG (3% pictures named). At 3 and 6 mo. post-TMS, there was no longer significant activation in R IFG, but significant activation was present in R sensorimotor cortex. On all three fMRI scans, P2 had significant activation in both the L and R SMA. There was no new, lasting perilesional LH activation across sessions for this patient. Over time, there was little or no change in his activation. His naming remained only at 1-2 pictures during all three fMRI scans. His BNT score and longest phrase length remained at one word, post-TMS. Lesion site may play a role in each patient's fMRI activation pattern and response to TMS treatment. P2, the poor responder, had an atypical frontal lesion in the L motor and premotor cortex that extended high, near brain vertex, with deep white matter lesion near L SMA. P2 also had frontal lesion in the posterior middle frontal gyrus, an area important for naming (Duffau et al., 2003); P1 did not. Additionally, P2 had lesion inferior and posterior to Wernicke's area, in parts of BA 21 and 37, whereas P1 did not. The fMRI data of our patient who had good response following TMS support the notion that restoration of the LH language network is linked in part, to better recovery of naming and phrase length in nonfluent aphasia.
Topics: Aphasia, Broca; Brain; Brain Mapping; Electric Stimulation; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Pattern Recognition, Visual; Photic Stimulation; Speech Production Measurement; Stroke; Transcranial Magnetic Stimulation; Treatment Outcome; Verbal Behavior
PubMed: 19695692
DOI: 10.1016/j.bandl.2009.07.007 -
The South African Journal of... Jun 2015The spontaneous and narrative language of Kiswahili agrammatic aphasic and non-brain-damaged speakers was analysed. The bilingual participants were also tested in... (Comparative Study)
Comparative Study
BACKGROUND
The spontaneous and narrative language of Kiswahili agrammatic aphasic and non-brain-damaged speakers was analysed. The bilingual participants were also tested in English to enable comparisons of verb production in the two languages. The significance of this study was to characterise bilingual Kiswahili-English spontaneous agrammatic output. This was done by describing Kiswahili-English bilingual output data with a specific focus on the production of verbs. The description involves comparison of verb and argument production in Kiswahili and English.
METHODS AND PROCEDURES
The participants recruited for this study were drawn from two groups of participants (six non-fluent aphasic/agrammatic speakers and six non-brain-damaged). From each participant, a sample of spontaneous output was tape-recorded in English and Kiswahili based on the description and narration of the Flood rescue picture' and the 'Cookie theft picture'. The data elicited were compared for each subject and between the participants and relevant verb parameters have been analysed. The variables that were studied included mean length of utterance (MLU), inflectional errors, verb tokens and types, copulas and auxiliaries. Further, all verbs produced were classified as per their argument structure.
RESULTS
The results from English data supported previous findings on agrammatic output. The agrammatic participants produced utterances with shorter MLU and simpler sentence structure. However, Kiswahili data surprisingly showed reversed results, with agrammatic speakers producing longer utterances than non-brain-damaged (NBD) controls. The results also revealed selective impairment in some agrammatic speakers who made inflectional errors. The verb argument structure showed contrasting results, with agrammatic speakers preferring transitive verbs whilst the NBD speakers used more intransitive verbs.
CONCLUSIONS
The study attempts for the first time to characterise English-Kiswahili bilingual spontaneous and narrative output. A quantitative analysis of verb and argument production is conducted. The results of the English data are consistent with those in the literature; agrammatic speakers produce utterances with shorter MLU and simpler sentence structure. However, Kiswahili data reveals a surprisingly reversed pattern most notably with respect to MLU with agrammatics producing longer utterances than NBD controls. Argument structure analysis revealed that agrammatics used more transitive verbs than intransitives.
Topics: Aphasia, Broca; Humans; Kenya; Language Tests; Linguistics; Multilingualism; Narration; Phonetics; Speech Acoustics; Speech Production Measurement; Stroke
PubMed: 26304215
DOI: 10.4102/sajcd.v62i1.89 -
Journal of Neuropathology and... Mar 2020Four right-handed patients who presented with an isolated impairment of speech or language had transactive response DNA-binding protein of 43 kDa (TDP-43) type B...
Four right-handed patients who presented with an isolated impairment of speech or language had transactive response DNA-binding protein of 43 kDa (TDP-43) type B pathology. Comportment and pyramidal motor function were preserved at presentation. Three of the cases developed axial rigidity and oculomotor findings late in their course with no additional pyramidal or lower motor neuron impairments. However, in all 4 cases, postmortem examination disclosed some degree of upper and lower motor neuron disease (MND) pathology in motor cortex, brainstem, and spinal cord. Although TDP-43 type B pathology is commonly associated with MND and behavioral variant frontotemporal dementia, it is less recognized as a pathologic correlate of primary progressive aphasia and/or apraxia of speech as the presenting syndrome. These cases, taken together, contribute to the growing heterogeneity in clinical presentations associated with TDP pathology. Additionally, 2 cases demonstrated left anterior temporal lobe atrophy but without word comprehension impairments, shedding light on the relevance of the left temporal tip for single-word comprehension.
Topics: Anomia; Aphasia, Broca; Apraxias; Brain; DNA-Binding Proteins; Frontotemporal Lobar Degeneration; Humans; Inclusion Bodies; Male; Middle Aged; TDP-43 Proteinopathies
PubMed: 31995205
DOI: 10.1093/jnen/nlz132 -
Behavioural Neurology 1995The present study investigated the relationship between verbal short-term memory and motor speech processes in healthy control subjects and five patients suffering from...
The present study investigated the relationship between verbal short-term memory and motor speech processes in healthy control subjects and five patients suffering from Broca's aphasia. Control subjects showed a phonological similarity effect, a word length effect and an articulatory suppression effect, supporting the hypothesis of a phonological store and an articulatory loop component of short-term memory. A similar effect of phonological similarity was observed in the aphasic patients, while the effects of word length and articulatory suppression were reduced. In control subjects, measures of short-term memory were correlated to measures of motor speech rate only if speech rate was assessed in more complex conditions (such as sentence rather than syllable repetition). There was also evidence of an association of speech impairment and short-term memory deficits in the aphasic patients.
PubMed: 24487425
DOI: 10.3233/BEN-1995-8203