Showing papers on "Aphasia published in 2004"
TL;DR: It is proposed that "language" disorders, such as specific language impairment and non-fluent and fluent aphasia, may be profitably viewed as impairments primarily affecting one or the other brain system, and suggested a new neurocognitive framework for the study of lexicon and grammar.
1,493 citations
TL;DR: Cognitive, genetic, and anatomical features indicate that different PPA clinical variants may correspond to different underlying pathological processes.
Abstract: We performed a comprehensive cognitive, neuroimaging, and genetic study of 31 patients with primary progressive aphasia (PPA), a decline in language functions that remains isolated for at least 2 years. Detailed speech and language evaluation was used to identify three different clinical variants: nonfluent progressive aphasia (NFPA; n = 11), semantic dementia (SD; n = 10), and a third variant termed logopenic progressive aphasia (LPA; n = 10). Voxel-based morphometry (VBM) on MRIs showed that, when all 31 PPA patients were analyzed together, the left perisylvian region and the anterior temporal lobes were atrophied. However, when each clinical variant was considered separately, distinctive patterns emerged: (1) NFPA, characterized by apraxia of speech and deficits in processing complex syntax, was associated with left inferior frontal and insular atrophy; (2) SD, characterized by fluent speech and semantic memory deficits, was associated with anterior temporal damage; and (3) LPA, characterized by slow speech and impaired syntactic comprehension and naming, showed atrophy in the left posterior temporal cortex and inferior parietal lobule. Apolipoprotein E e4 haplotype frequency was 20% in NFPA, 0% in SD, and 67% in LPA. Cognitive, genetic, and anatomical features indicate that different PPA clinical variants may correspond to different underlying pathological processes.
1,342 citations
TL;DR: The outcome for language function was predicted by initial severity of the aphasia and by the initial stroke severity (assessed by the Scandinavian Stroke Scale), but not by age, sex or type of aphasIA.
Abstract: Aim: To determine the types, severity and evolution of aphasia in unselected, acute stroke patients and evaluate potential predictors for language outcome 1 year after stroke. Methods: 270 acute stroke patients with aphasia (203 with first-ever strokes) were included consecutively and prospectively from three hospitals in Copenhagen, Denmark, and assessed with the Western Aphasia Battery. The assessment was repeated 1 year after stroke. Results: The frequencies of the different types of aphasia in acute first-ever stroke were: global 32%, Broca’s 12%, isolation 2%, transcortical motor 2%, Wernicke’s 16%, transcortical sensory 7%, conduction 5% and anomic 25%. These figures are not substantially different from what has been found in previous studies of more or less selected populations. The type of aphasia always changed to a less severe form during the first year. Nonfluent aphasia could evolve into fluent aphasia (e.g., global to Wernicke’s and Broca’s to anomic), whereas a fluent aphasia never evolved into a nonfluent aphasia. One year after stroke, the following frequencies were found: global 7%, Broca’s 13%, isolation 0%, transcortical motor 1%, Wernicke’s 5%, transcortical sensory 0%, conduction 6% and anomic 29%. The distribution of aphasia types in acute and chronic aphasia is, thus, quite different. The outcome for language function was predicted by initial severity of the aphasia and by the initial stroke severity (assessed by the Scandinavian Stroke Scale), but not by age, sex or type of aphasia. Thus, a scoring of general stroke severity helps to improve the accuracy of the prognosis for the language function. One year after stroke, fluent aphasics were older than nonfluent aphasics, whereas such a difference was not found in the acute phase.
516 citations
TL;DR: In patients with and without insular lesions, apraxia of speech was associated with structural damage or low blood flow in left posterior inferior frontal gyrus, and this results illustrate a potential limitation of lesion overlap studies, and illustrate an alternative method for identifying brain-behaviour relationships.
Abstract: A traditional method of localizing brain functions has been to identify shared areas of brain damage in individuals who have a particular deficit. The rationale of this 'lesion overlap' approach is straightforward: if the individuals can no longer perform the function, the area of brain damaged in most of these individuals must have been responsible for that function. However, the reciprocal association, i.e. the probability of the lesion causing the deficit, is often not evaluated. In this study, we illustrate potential weaknesses of this approach, by re-examining regions of the brain essential for orchestrating speech articulation. A particularly elegant and widely cited lesion overlap study identified the superior part of the precentral gyrus of the insula (in the anterior insula) as the shared area of damage in chronic stroke patients with 'apraxia of speech', a disorder of motor planning and programming of speech. Others have confirmed that patients with apraxia of speech commonly have damage to the anterior insula. However, this reliable association might reflect the vulnerability of the insula to damage following occlusion or narrowing of the middle cerebral artery (which can independently cause apraxia of speech and many other deficits). To evaluate this possibility, we examined the relationship between apraxia of speech and the insula in three unique ways: (i) we determined the probability of the lesion causing the deficit, as well as the deficit being associated with the lesion, by examining speech articulation and advanced MRIs in two consecutive series of patients with acute left hemisphere, non-lacunar stroke, 40 with and 40 without insular damage; (ii) we studied patients at stroke onset to identify the deficit before it resolved in cases of small stroke; and (iii) we identified regions of dysfunctional brain tissue, as well as structural damage. Using this approach, we found no association between apraxia of speech and lesions of the left insula, anterior insula or superior tip of the precentral gyrus of the insula. Instead, in patients with and without insular lesions, apraxia of speech was associated with structural damage or low blood flow in left posterior inferior frontal gyrus. These results illustrate a potential limitation of lesion overlap studies, and illustrate an alternative method for identifying brain-behaviour relationships.
363 citations
TL;DR: The concept of VCI could be more useful if it were to be limited to cases of vascular MCI without dementia, by analogy with the concept of amnestic MCI, currently considered the earliest clinically diagnosable stage of Alzheimer disease (AD).
261 citations
TL;DR: Findings support previous work regarding improved and generalized naming associated with SFA treatment and indicate a need to examine effects of improved confrontation naming on more natural speaking situations.
Abstract: The effect of semantic feature analysis (SFA) treatment on confrontation naming and discourse production was examined in 2 persons, 1 with anomic aphasia and 1 with Wernicke's aphasia. Results indicated that confrontation naming of treated nouns improved and generalized to untreated nouns for both participants, who appeared to have different lexical access impairments. Both participants demonstrated improvement in some aspects of discourse production associated with the confrontation naming SFA treatment. However, there was no change in most manifestations of lexical retrieval difficulty during discourse for either participant. These findings support previous work regarding improved and generalized naming associated with SFA treatment and indicate a need to examine effects of improved confrontation naming on more natural speaking situations.
226 citations
TL;DR: Preliminary results following rTMS application to R Broca's area (posterior, R pars triangularis) in four stroke patients with nonfluent aphasia (5-11 years after left hemisphere stroke) show significant improvement in naming pictures was observed.
Abstract: Functional brain imaging with nonfluent aphasia patients has shown increased cortical activation (perhaps ‘‘overactivation’’) in right (R) hemisphere language homologues. These areas of overactivation may represent a maladaptive strategy that interferes with, rather than promotes, aphasia recovery. Repetitive transcranial magnetic stimulation (rTMS) is a painless, noninvasive procedure that utilizes magnetic fields to create electric currents in discrete brain areas affecting about a 1-cm square area of cortex. Slow frequency, 1 Hz rTMS reduces cortical excitability. When rTMS is applied to an appropriate cortical region, it may suppress the possible overactivation and thus modulate a distributed neural network for language. We provide information on rTMS and report preliminary results following rTMS application to R Broca’s area (posterior, R pars triangularis) in four stroke patients with nonfluent aphasia (5‐11 years after left hemisphere stroke). Following 10 rTMS treatments, significant improvement in naming pictures was observed. This form of rTMS may provide a novel, complementary treatment for aphasia.
205 citations
TL;DR: It is indicated that separate regions of the brain are essential for access to oral and written word forms of verbs and nouns, and that these neural regions can be differentially damaged in separate forms of PPA.
Abstract: Disproportionate impairment of naming nouns versus verbs and the opposite pattern have been reported in cases of focal brain damage or degenerative disease, indicating that processing of nouns and verbs may rely on different brain regions. However, it has not been clear whether it is the spoken word forms or the meanings (or both) of nouns and verbs that depend on separate neural regions. We tested oral and written naming of nouns and verbs, matched in difficulty, in patients with nonfluent primary progressive aphasia (nonfluent PPA; n = 15), fluent primary progressive aphasia (fluent PPA; n = 7), and amyotrophic lateral sclerosis with frontotemporal dementia (ALS-FTD; n = 6). Patients with nonfluent PPA and ALS-FTD, both individually and as groups, were significantly more impaired on verb naming than on noun naming and significantly more impaired on oral naming than written naming. Patients with fluent PPA showed the opposite pattern for both word class and modality, significantly more impaired naming of nouns versus verbs and significantly more impaired written versus oral naming. Results indicate that separate regions of the brain are essential for access to oral and written word forms of verbs and nouns, and that these neural regions can be differentially damaged in separate forms of PPA.
181 citations
TL;DR: These results emphasize the significance of perilesional areas in the rehabilitation of aphasia even years after the stroke, and might reflect reorganisation of the language network that provides the basis for improved language functions after intensive training.
Abstract: Focal clusters of slow wave activity in the delta frequency range (1–4 Hz), as measured by magnetencephalography (MEG), are usually located in the vicinity of structural damage in the brain. Such oscillations are usually considered pathological and indicative of areas incapable of normal functioning owing to deafferentation from relevant input sources. In the present study we investigated the change in Delta Dipole Density in 28 patients with chronic aphasia (>12 months post onset) following cerebrovascular stroke of the left hemisphere before and after intensive speech and language therapy (3 hours/day over 2 weeks). Neuropsychologically assessed language functions improved significantly after training. Perilesional delta activity decreased after therapy in 16 of the 28 patients, while an increase was evident in 12 patients. The magnitude of change of delta activity in these areas correlated with the amount of change in language functions as measured by standardized language tests. These results emphasize the significance of perilesional areas in the rehabilitation of aphasia even years after the stroke, and might reflect reorganisation of the language network that provides the basis for improved language functions after intensive training.
176 citations
TL;DR: It is concluded that there is sufficiently consistent and converging evidence from clinical and imaging studies to support the claim that PNFA and SD are distinct subgroups of PPA, but there does not appear to be sufficient evidence at this point to support further discrimination within these progressive aphasic subgroups.
Abstract: This review summarizes clinical and imaging features associated with primary progressive aphasia (PPA). We investigate the hypothesis that these patients can be divided into subgroups of progressive non-fluent aphasia (PNFA) and semantic dementia (SD), based on their linguistic profiles and related imaging studies, and examine whether each of these major subgroups can be further subdivided. We focus on several critical features within each progressive aphasic subgroup. In PNFA, we examine agrammatism, phonologic disorder, and impaired verb processing to determine whether this syndrome is related to a modality-specific impairment in word formation and articulation, or a conceptual deficit that interferes with grammatical processing. In SD, we examine impaired semantic memory, limited remote memory, and anomia to assess whether this syndrome is due to a modality-neutral interruption of semantic memory, or the degradation of various material-specific representations of object features and words. We conclude that there is sufficiently consistent and converging evidence from clinical and imaging studies to support the claim that PNFA and SD are distinct subgroups of PPA. However, there does not appear to be sufficient evidence at this point to support further discrimination within these progressive aphasic subgroups. Testing hypotheses about finer-grained syndromes such as progressive dysarthria or progressive anomia has important consequences for improving our understanding of language organization and the neural basis for language.
174 citations
TL;DR: It is demonstrated that language dysfunction is not only a pronounced and well documented symptom in some MND patients but also that the study of language in MND can address interesting theoretical questions about the representation of language and conceptual knowledge in the brain.
TL;DR: Results suggest that poor modulation, including possible over-activation of R sensorimotor mouth and other R perisylvian language homologues may underlie in part, the hesitant, poorly articulated, agrammatic speech associated with nonfluent aphasia.
TL;DR: 150 aphasiacs and 59 controls were examined with a scorable, comprehensive battery, designed to be used by the clinician and the research worker, and classified according to taxonomic principles into Global, Motor, Isolation, Sensory, Conduction and Anomic groups.
Abstract: 150 aphasiacs and 59 controls were examined with a scorable, comprehensive battery, designed to be used by the clinician and the research worker. The subtests of Fluency, Information, Comprehension, Repetition and Naming were added and compared to a hypothetical normal of 100 obtaining the "aphasia Quotient." This is a measurement of the severity of language impairment. On the basis of their performance on the subtests, the patients were classified according to taxonomic principles into Global, Motor (Broca's), Isolation, Sensory (Wernicke's), Transcortical Motor, Transcortical Sensory, Conduction and Anomic groups (in order of severity). This classification is considered a clinically valid baseline for research, diagnosis and prognosis.
TL;DR: The results indicate that the major cause of aphasic impairments of syntactically based comprehension are intermittent reductions in the processing capacity available for syntactic, interpretive, and task-related operations.
TL;DR: Results suggest a spatiotemporal poststroke brain reorganization involving both hemispheres during the recovery course, with an early implication of a new contralateral functional neural network and a later implication of an ipsilateral one.
Abstract: Background and Purpose— The goal of this study was to develop a functional MRI (fMRI) paradigm robust and reproducible enough in healthy subjects to be adapted for a follow-up study aiming at evaluating the anatomical substratum of recovery in poststroke aphasia Methods— Ten right-handed subjects were studied longitudinally using fMRI (7 of them being scanned twice) and compared with a patient with conduction aphasia during the first year of stroke recovery Results— Controls exhibited reproducible activation patterns between subjects and between sessions during language tasks In contrast, the patient exhibited dynamic changes in brain activation pattern, particularly in the phonological task, during the 2 fMRI sessions At 1 month after stroke, language homotopic right areas were recruited, whereas large perilesional left involvement occurred later (12 months) Conclusions— We first demonstrate intersubject robustness and intrasubject reproducibility of our paradigm in 10 healthy subjects and thus its
TL;DR: Two consecutive treatments were conducted to investigate skill learning and generalization within and across cognitive-linguistic domains in a 62-year-old Spanish-English bilingual man with severe non-fluent aphasia, resulting in modest gains in both Spanish and English.
TL;DR: Lesion results for pantomime interpretation deficits demonstrate that lesions in the frontal component of the human analog of the "mirror neuron system" are associated with deficits in non-linguistic action understanding.
TL;DR: This case demonstrates the clinical overlap between FTLD and CBS and shows that the two can appear in the same patient at different stages of the disease in relation to the progression of anatomical damage.
Abstract: Recent clinical and pathological studies have suggested that frontotemporal lobar degeneration (FTLD) and corticobasal syndrome (CBS) show clinical and pathological overlap We present four years of longitudinal clinical, cognitive and anatomical data in the case of a 56-year-old woman, AS, whose clinical picture evolved from FTLD to CBS For the first three years, AS showed a progressive speech and language disorder compatible with a diagnosis of the nonfluent aphasia variant of FTLD At year four, 10 years after her first symptom, AS developed the classical clinical signs of CBS, including alien limb phenomenon and dystonia Voxel-based morphometry (VBM) applied to AS's four annual scans showed progression of atrophy from the inferior posterior frontal gyrus, to the left insula and finally to the medial frontal lobe This case demonstrates the clinical overlap between FTLD and CBS and shows that the two can appear in the same patient at different stages of the disease in relation to the progres
TL;DR: A critical review of the various methods that are currently used for the analysis of spontaneous speech ("discourse") of aphasic patients can be found in this article, where a distinction is made between semi-spontaneous speech (description of situational pictures or story telling) and real" spontaneous speech (conversations or interviews based on standardised questions).
Abstract: Background: Aphasia has very serious consequences for speech production and, hence, for communication in daily life. Nevertheless, in the standard diagnostic procedures and in clinical practice, analysis of speech production in daily life is usually ignored or is restricted to the scoring of one or more variables on rating scales. Many methods for describing and analysing discourse production have been developed during the last few decades, with different aims and focusing on different linguistic levels. Aims: The aim of this paper is to present a critical review of the various methods that are currently used for the analysis of spontaneous speech ("discourse") of aphasic patients. A distinction is made between semi-spontaneous speech (description of situational pictures or story telling) and "real" spontaneous speech (conversations or interviews based on standardised questions). Both types of connected speech can be analysed with two types of measuring instruments: rating scales and quantified linguistic variables. The advantages and disadvantages of the measuring instruments most frequently used for pragmatic, conversational, and linguistic analyses are discussed. Special attention is paid to the (ecological) validity and reliability of the methods. Main Contribution: The general outcome of the evaluation of procedures for analysing speech production and communicative abilities is that several methods do not fulfil the requirements for reliability and validity. Other methods are extremely time-consuming or give little information on the consequences of the outcomes for clinical practice. Conclusions: None of the discussed procedures is perfect, although some are better than others. Most methods do not give indications for treatment of speech production and communicative disorders in daily life and are not suitable for determining changes in the spontaneous speech of individual patients.
TL;DR: This review will examine artistic production in individuals with a variety of syndromes including achromatopsia, neglect, visual agnosia, aphasia, epilepsy, migraine, dementia and autism, finding that artists are not spared visual-motor deficits despite their special graphic abilities.
TL;DR: Two complementary measures designed to capture elements of conversation between adults with aphasia and their speaking conversation partners have been developed.
Abstract: Conversation partners of individuals with aphasia, including health care professionals, families, and others, play a role that is as important for communication as the language disorder suffered by individuals with aphasia. Two complementary measures designed to capture elements of conversation between adults with aphasia and their speaking conversation partners have been developed. The first measure provides an index of the conversation partner’s skill in providing conversational support. The second provides an index of the level of participation in conversation by the person with aphasia. This article describes the development of the measures, including preliminary psychometric data, and discusses applications.
TL;DR: The study aimed to describe the properties of the Korean version of the Western Aphasia Battery (hereinafter K-WAB) and to present the normative data of normal individuals and patients to optimally differentiate between the normal and the aphasic individuals.
Abstract: The study aimed to describe the properties of the Korean version of the Western Aphasia Battery (hereinafter K-WAB) and to present the normative data of normal individuals and patients. The K-WAB contains the same test contents and structure as the original WAB and the general test administration method was maintained. We administered the K-WAB to 224 normal adults in seven age groups (15–24, 25–34, 35–44, 45–54, 55–64, 65–74, and 75 years or older), in five educational levels (0, 1–6, 7–9, 10–12, and 13 years or more) and by gender. The age and educational levels were influential to the K-WAB performance. Accordingly, we formed six subgroups of the normal: two age groups (15–74, and 75 years or older groups) by three educational groups (0, 1–6, and 7 years or more). Two hundred thirty-eight patients were also evaluated using the K-WAB. The highest aphasia quotient (AQ), language quotient (LQ), and cortical quotient (CQ) were achieved by 15–74 age group with 7 or more years of education (M=97.11,...
TL;DR: Rec rehabilitation increased the speed of word-finding processes and TTP analysis was sensitive to this functional change and can be used to represent improvement in behavior, and it is important to monitor the behavioral performance that might correlate with the temporal pattern of the hemodynamic response.
Abstract: Background and Purpose— Comparing the temporal characteristics of hemodynamic responses in activated cortical regions of aphasic patients before and after therapy would provide insight into the relationship between improved task performance and changes in blood oxygenation level–dependent (BOLD) functional MRI (fMRI) signal. This study investigated differences in the time to peak (TTP) of hemodynamic responses in activated regions of interest (ROIs), before and after therapy, and related them to changes in task performance. Methods— Three aphasic patients and 3 controls overtly generated a single exemplar in response to a category. For the patients, TTP of hemodynamic responses in selected ROIs was compared before and after language therapy. The timing differences between auditory cues and verbal responses were compared with TTP differences between auditory and motor cortices. Results— The selected ROIs were significantly activated in both aphasic patients and controls during overt word generation. In the...
TL;DR: In patients with acute left caudate infarct, the presence and type of aphasia reflected regions of hypoperfusion, and generally followed predictions based on chronic lesion studies, regarding anatomical lesions associated with classic aphasic types.
TL;DR: This paper examined non-propositional speech with respect to linguistic descriptions, psycholinguistic experiments, sociolinguistic studies, child language development, clinical language disorders, and neurological studies, and suggested that generation of novel sentences and management of prefabricated expressions represent two legitimate and separable processes in language behaviour.
Abstract: Although interest in the language sciences was previously focused on newly created sentences, more recently much attention has turned to the importance of formulaic expressions in normal and disordered communication. Also referred to as formulaic expressions and made up of speech formulas, idioms, expletives, serial and memorized speech, slang, sayings, cliches, and conventional expressions, non-propositional language forms a large proportion of every speaker's competence, and may be differentially disturbed in neurological disorders. This review aims to examine non-propositional speech with respect to linguistic descriptions, psycholinguistic experiments, sociolinguistic studies, child language development, clinical language disorders, and neurological studies. Evidence from numerous sources reveals differentiated and specialized roles for novel and formulaic verbal functions, and suggests that generation of novel sentences and management of prefabricated expressions represent two legitimate and separable processes in language behaviour. A preliminary model of language behaviour that encompasses unitary and compositional properties and their integration in everyday language use is proposed. Integration and synchronizing of two disparate processes in language behaviour, formulaic and novel, characterizes normal communicative function and contributes to creativity in language. This dichotomy is supported by studies arising from other disciplines in neurology and psychology. Further studies are necessary to determine in what ways the various categories of formulaic expressions are related, and how these categories are processed by the brain. Better understanding of how non-propositional categories of speech are stored and processed in the brain can lead to better informed treatment strategies in language disorders.
Journal Article•
TL;DR: The outcome of the study demonstrates that the FBI is sensitive to changes in behavior and personality in both variants of FTD.
Abstract: Objective: To evaluate the construct validity of the Frontal Behavioral Inventory (FBI) and to describe the evolution of the behavioral abnormalities of the behavioral and aphasic presentations of frontotemporal dementia (FTD) by means of a 3-year longitudinal study. Background: The FBI is a standardized behavioral questionnaire useful in the diagnosis and quantification of the personality and behavior disorder FTD. Method: Patients who had three consecutive yearly assessments with the FBI were selected, 12 with the behavioral variant of FTD (FTD-bv) and 14 with Primary Progressive Aphasia (PPA). Results: FBI scores rose as the disease progressed in both the FTD-bv and PPA groups over the 3 years of testing. Initial mean FBI scores of the FTD-bv group were above the cutoff for FTD as established for this diagnosis with previous standardization. By the third year, the mean FBI score of PPA patients was also above the established cutoff for FTD. Conclusions: The outcome of the study demonstrates that the FBI is sensitive to changes in behavior and personality in both variants of FTD. The FBI can be used to describe the evolution of symptoms and the course of the illness of Pick complex patients who present initially with FTD-bv or who present with PPA and subsequently develop the behavioral disorder.
TL;DR: The discussion focuses on how the similarities and differences across languages and across aphasic types may be interpreted with respect to the underlying deficit in Broca's and Wernicke's aphasia.
TL;DR: This paper is the first to attempt to dissociate the effects of number of phonemes, number of syllables or the complexity of the syllable structure on word production in a case series of nine English‐speaking aphasic individuals.
Abstract: Many people with aphasia show effects of word length on the accuracy of their word production. However, it is unclear from previous research whether this is an effect of number of phonemes, number of syllables or the complexity of the syllable structure (number of consonant clusters), as these factors are usually confounded. This paper is the first to attempt to dissociate the effects of these three factors on word production in a case series of nine English-speaking aphasic individuals. Using carefully controlled stimuli and analysis using logistic regression, the effects of these highly intercorrelated variables can be distinguished. Significant effects of number of phonemes were found on word production accuracy in English but there was no evidence for independent effects of number of syllables, number of clusters (syllabic complexity), or syllable frequency (once the intercorrelations between these variables had been controlled). It is argued that these data are consistent with any theory of spoken word production that incorporates a level of processing where phonemes are represented and that level is a potential source of error.
TL;DR: A 52-year-old right-handed woman, who had a stroke that affected her left insula, putamen, and superior temporal gyrus, was prescribed zolpidem, and ingestion of the first dose was followed by a dramatic improvement in her speech, which persisted for three years.
Abstract: To the Editor: There is currently no effective pharmacologic treatment for chronic aphasia, a frequent and incapacitating consequence of hemispheric stroke. We report the case of a 52-year-old right-handed woman, who had a stroke that affected her left insula, putamen, and superior temporal gyrus. Three years later, her speech was still restricted to stereotyped syllables, with not a single identifiable word. Language comprehension was better preserved. Because of occasional insomnia, zolpidem (10 mg) was prescribed. To the amazement of the patient and her family, ingestion of the first dose was followed by a dramatic improvement in her speech, which persisted . . .
TL;DR: In this article, identity as it relates to aphasia and the resulting impact on life participation is discussed and the relationships among social identity, language, and social interaction are considered from a sociocultural perspective.
Abstract: This article discusses identity as it relates to aphasia and the resulting impact on life participation. The relationships among social identity, language, and social interaction are considered from the sociocultural perspective. Core social identity concepts are identified and used to examine the broad classifications of aphasia intervention. Examples are provided to illustrate how one long-standing stroke support group has promoted renegotiation of identity. A rationale is provided for speech-language pathologist's involvement in stroke support groups that promote healthy renegotiation of identity. Additional clinical recommendations for facilitating identity are offered.