Showing papers on "Aphasia published in 2006"
TL;DR: The data suggest that brain reorganization during language recovery proceeds in three phases: a strongly reduced activation of remaining left language areas in the acute phase is followed by an upregulation with recruitment of homologue language zones, which correlates with language improvement.
Abstract: Previous functional imaging studies of chronic stroke patients with aphasia suggest that recovery of language occurs in a pre-existing, bilateral network with an upregulation of undamaged areas and a recruitment of perilesional tissue and homologue right language areas. The present study aimed at identifying the dynamics of reorganization in the language system by repeated functional MRI (fMRI) examinations with parallel language testing from the acute to the chronic stage. We examined 14 patients with aphasia due to an infarction of the left middle cerebral artery territory and an age-matched control group with an auditory comprehension task in an event-related design. Control subjects were scanned once, whereas patients were scanned repeatedly at three consecutive dates. All patients recovered clinically as shown by a set of aphasia tests. In the acute phase [mean: 1.8 days post-stroke (dps)], patients' group analysis showed little early activation of non-infarcted left-hemispheric language structures, while in the subacute phase (mean: 12.1 dps) a large increase of activation in the bilateral language network with peak activation in the right Broca-homologue (BHo) was observed. A direct comparison of both examinations revealed the strongest increase of activation in the right BHo and supplementary motor area (SMA). These upregulated areas also showed the strongest correlation between improved language function and increased activation (r(BHo) = 0.88, r(SMA) = 0.92). In the chronic phase (mean: 321 dps), a normalization of activation with a re-shift of peak activation to left-hemispheric language areas was observed, associated with further language improvement. The data suggest that brain reorganization during language recovery proceeds in three phases: a strongly reduced activation of remaining left language areas in the acute phase is followed by an upregulation with recruitment of homologue language zones, which correlates with language improvement. Thereafter, a normalization of activation is observed, possibly reflecting consolidation in the language system.
908 citations
TL;DR: It is proposed that semantic cognition is supported by two interacting principal components: a set of amodal representations that progressively degrade in SD and executive processes that help to direct and control semantic activation in a task-appropriate fashion (which are dysfunctional in comprehension-impaired stroke aphasic patients).
Abstract: Different neuropsychological populations implicate diverse cortical regions in semantic memory: semantic dementia (SD) is characterized by atrophy of the anterior temporal lobes whilst poor comprehension in stroke aphasia is associated with prefrontal or temporal–parietal infarcts. This study employed a case-series design to compare SD and comprehension-impaired stroke aphasic patients directly on the same battery of semantic tests. Although the two groups obtained broadly equivalent scores, they showed qualitatively different semantic deficits. The SD group showed strong correlations between different semantic tasks—regardless of input/output modality—and substantial consistency when a set of items was assessed several times. They were also highly sensitive to frequency/familiarity and made coordinate and superordinate semantic errors in picture naming. These findings support the notion that amodal semantic representations degrade in SD. The stroke aphasia group also showed multimodal deficits and consistency across different input modalities, but inconsistent performance on tasks requiring different types of semantic processing. They were insensitive to familiarity/frequency—instead, tests of semantic association were influenced by the ease with which relevant semantic relationships could be identified and distractors rejected. In addition, the aphasic patients made associative semantic errors in picture naming that SD patients did not make. The aphasic patients' picture naming performance improved considerably with phonemic cues suggesting that these patients retained knowledge that could not be accessed without contextual support. We propose that semantic cognition is supported by two interacting principal components: (i) a set of amodal representations (which progressively degrade in SD) and (ii) executive processes that help to direct and control semantic activation in a task-appropriate fashion (which are dysfunctional in comprehension-impaired stroke aphasic patients).
702 citations
TL;DR: Refining the classification of the degenerative aphasias and AOS may be necessary to improve the understanding of the relationships among behavioural, pathological and imaging correlations.
Abstract: Apraxia of speech (AOS) is a motor speech disorder characterized by slow speaking rate, abnormal prosody and distorted sound substitutions, additions, repetitions and prolongations, sometimes accompanied by groping, and trial and error articulatory movements. Although AOS is frequently subsumed under the heading of aphasia, and indeed most often co-occurs with aphasia, it can be the predominant or even the sole manifestation of a degenerative neurological disease. In this study we determine whether the clinical classifications of aphasia and AOS correlated with pathological diagnoses and specific biochemical and anatomical structural abnormalities. Seventeen cases with initial diagnoses of a degenerative aphasia or AOS were re-classified independently by two speech-language pathologists--blinded to pathological and biochemical findings--into one of five operationally defined categories of aphasia and AOS. Pathological diagnoses in the 17 cases were progressive supranuclear palsy in 6, corticobasal degeneration in 5, frontotemporal lobar degeneration with ubiquitin-only-immunoreactive changes in 5 and Pick's disease in 1. Magnetic resonance imaging analysis using voxel-based morphometry (VBM), and single photon emission tomography were completed, blinded to the clinical diagnoses, and clinicoimaging and clinicopathological associations were then sought. Interjudge clinical classification reliability was 87% (kappa = 0.8) for all evaluations. Eleven cases had evidence of AOS, of which all (100%) had a pathological diagnosis characterized by underlying tau biochemistry, while five of the other six cases without AOS did not have tau biochemistry (P = 0.001). A majority of the 17 cases had more than one yearly evaluation, demonstrating the evolution of the speech and language syndromes, as well as motor signs. VBM revealed the premotor and supplemental motor cortices to be the main cortical regions associated with AOS, while the anterior peri-sylvian region was associated with non-fluent aphasia. Refining the classification of the degenerative aphasias and AOS may be necessary to improve our understanding of the relationships among behavioural, pathological and imaging correlations.
590 citations
TL;DR: Advancing age and cardioembolism were associated with an increased risk for aphasia, and aphasic patients sought medical help earlier than nonaphasic stroke patients and were more likely to receive thrombolysis.
Abstract: Background and Purpose— In a geographically defined population, we assessed incidence and determinants of aphasia attributable to first-ever ischemic stroke (FEIS). MethodsA 1-year prospective, population-based study among the permanent residents of the canton Basle City, Switzerland, was performed using multiple overlapping sources of information. Results— Among 188 015 inhabitants, 269 patients had FEIS, of whom 80 (30%; 95% CI, 24 to 36) had aphasia. The overall incidence rate of aphasia attributable to FEIS amounted to 43 per 100 000 inhabitants (95% CI, 33 to 52). Aphasic stroke patients were older than nonaphasic patients. The risk of aphasia attributable to FEIS increased by 4% (95% CI, 1% to 7%), and after controlling for atrial fibrillation, by 3% (95% CI, 1% to 7%) with each year of patients’ age. Gender had no effect on incidence, severity, or fluency of aphasia. Cardioembolism was more frequent in aphasic stroke patients than in nonaphasic ones (odds ratio [OR], 1.85; 95% CI, 1.07 to 3.20). Ap...
570 citations
TL;DR: It is revealed that neuronal responses within the left caudate are sensitive to changes in the language or the meaning of words, suggesting that the left Caudate plays a universal role in monitoring and controlling the language in use.
Abstract: How does the bilingual brain distinguish and control which language is in use? Previous functional imaging experiments have not been able to answer this question because proficient bilinguals activate the same brain regions irrespective of the language being tested. Here, we reveal that neuronal responses within the left caudate are sensitive to changes in the language or the meaning of words. By demonstrating this effect in populations of German-English and Japanese-English bilinguals, we suggest that the left caudate plays a universal role in monitoring and controlling the language in use.
472 citations
TL;DR: This study aimed to characterize a large group of progressive aphasic patients from a single center first clinically by case note review, and then pathologically.
Abstract: Objective
The clinical and neuropathological categorization of patients presenting with progressive aphasia is an area of controversy. This study aimed to characterize a large group of progressive aphasic patients from a single center (n = 38), first clinically by case note review, and then pathologically.
Methods
Hierarchical cluster analysis of the cases according to their clinical language deficits was used to establish an unbiased, data-driven classification.
Results
This analysis revealed two groups of cases corresponding to the syndromes of progressive nonfluent aphasia (n = 23) and semantic dementia (n = 15). Postmortem analysis showed a majority in both groups of pathologies from the spectrum of frontotemporal lobar degeneration: the most frequent were non–Alzheimer's disease (AD) tauopathy in the nonfluent cases (10 of 23) and frontotemporal lobar degeneration with ubiquitin-positive, tau-negative inclusions in the fluent cases (8 of 15). Despite rigorous exclusion of cases with clinically significant memory deficits or other cognitive impairments, the pathology of AD was present in approximately one third of each group (overall 12 of 38), although often with an atypical neuroanatomical distribution.
Interpretation
Progressive aphasia is best seen as a composite of two conditions, on both clinical and pathological levels: progressive nonfluent aphasia and semantic dementia. Ann Neurol 2006;59:156–165
329 citations
TL;DR: A hierarchical organization of recovery of aphasia after stroke and of compensation of language defects due to brain tumours can be deduced, by which the reactivation of undamaged network areas of the ipsilateral hemisphere usually lead to better outcome than the involvement of homotopic contra-lateral regions.
319 citations
TL;DR: This article showed that the effect of semantic category repetition on aphasic nonaphasic speakers' latencies increases with repetition of the blocked sets and showed that errors arise from competition among increasingly activated items within the homogeneous set.
265 citations
TL;DR: These findings support a claim that the patients' deficits on both verbal and non-verbal tasks reflect progressive deterioration of an amodal integrative semantic memory system critically involving the rostral temporal lobes, rather than a combination of atrophy in the left language network and a separate bilateral ventrotemporal-fusiform network.
Abstract: Considerable controversy exists regarding the relationship between semantic dementia (SD) and progressive aphasia. SD patients present with anomia and impaired word comprehension. The widely used consensus criteria also include the need for patients to exhibit associative agnosia and/or prosopagnosia: many authors have used the label SD for patients with non-verbal, as well as verbal, semantic deficits on formal testing even if they recognize the objects and people encountered in everyday life; others interpret the criterion of agnosia to require pervasive recognition impairments affecting daily life. According to this latter view, SD patients have pathology that disrupts both a bilateral ventrotemporal-fusiform network (resulting in agnosia) and the left hemisphere language network (resulting in profound aphasia). These authors suggest that this profile is different to that seen in the fluent form of primary progressive aphasia (fPPA), a neurodegenerative disease primarily affecting language function. We present data on seven patients who met the diagnostic criteria for fPPA. All seven showed deficits relative to matched controls on both verbal and non-verbal measures of semantic memory, and these deficits were modulated by degree of anomia, concept familiarity and item typicality. Voxel-based morphometry revealed reduced grey matter density in the temporal lobes bilaterally (more widespread on the left), with the severity of atrophy in the left inferior temporal lobe being significantly related to performance on both the verbal and non-verbal measures. Together these findings suggest that patients who meet the diagnostic criteria for fPPA, can also meet the diagnostic criteria for early-stage SD provided that the impact of concept familiarity and typicality is taken into account. In addition, these findings support a claim that the patients' deficits on both verbal and non-verbal tasks reflect progressive deterioration of an amodal integrative semantic memory system critically involving the rostral temporal lobes, rather than a combination of atrophy in the left language network and a separate bilateral ventrotemporal-fusiform network.
227 citations
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25 May 2006
TL;DR: The role of Broca's area in the human and the non-human primate brain and the phonological development of child language and aphasia as a linguistic problem is studied.
Abstract: Introduction PART 1: MATTERS ANATOMICAL 1. The origin of Broca's area and its connections from an ancestral working-memory network 2. A multimodal analysis of structure and function in Broca's region 3. Broca's area in the human and the non-human primate brain PART 2: MATTERS LINGUISTIC 4. Weak syntax 5. Speech production in Broca's agrammatic aphasia: Syntactic tree pruning 6. A blueprint for a brain map of syntax 7. Evaluating deficit patterns of Broac aphasics in the presence of high inter subject variability 8. Treating language deficits in Broca's aphasia PART 3: MOTOR ASPECTS AND SIGN LANGUAGE 9. Broca's region: a speech area? 10. Broca's area in system perspective: language in the context of action-oriented perception 11. The role of Broca's area in sign language PART 4: PSYCHOLINGUISTIC INVESTIGATION 12. Broca's area and lexical-semantic processing 13. The neural basis of sentence processing: Inferior frontal and temporal contributions 14. Involvement of the left and right frontal operculum in speech and nonspeech perception and production 15. On Broca, brain and binding 16. A role for Broca's area beyond language processing: evidence from neuropsychology and fMRI 17. Discussion PART 5: HISTORICAL ARTICLES, INTRODUCTION 18. Comments regarding the seat of the faculty of spoken language 19. On Affections of Speech from Disease fo the Brain 20. On Aphasia 21. The division of the human cortex 22. The agrammatical language disturbance 23. The cytoarchitectonics of the fields constituting Broca's area 24. The phonological development of child language and aphasia as a linguistic problem 25. Grammatical complexity and aphasic speech 26. The organization of language and the brain 27. Broca's area and Broca's aphasia
227 citations
TL;DR: Semantic dementia is associated with significantly more behavioral dysfunction than other variants of primary progressive aphasia, specifically behavioral features typical of frontotemporal dementia.
Abstract: Objective: To compare the behavioral profiles in different variants of primary progressive aphasia (PPA). Methods: We classified 67 patients with PPA into three clinical variants: semantic dementia (SEMD), progressive nonfluent aphasia (PNFA), and logopenic progressive aphasia (LPA), and we compared the severity of behavioral dysfunction, as measured by the Neuropsychiatric Inventory, in these groups and patients with frontotemporal dementia (FTD) and Alzheimer disease (AD). Results: SEMD was associated with significantly more socioemotional behavioral dysfunction than the other two variants of PPA and than AD, specifically more disinhibition, aberrant motor behavior, and eating disorders—behaviors that are typical of FTD. In contrast, PNFA and LPA did not differ from each other or from AD in the type or severity of behavioral dysfunction. Behavioral abnormalities increased in severity with disease duration in SEMD, but this association was not detected in PNFA or LPA. Conclusions: Semantic dementia is associated with significantly more behavioral dysfunction than other variants of primary progressive aphasia, specifically behavioral features typical of frontotemporal dementia.
TL;DR: Impaired day-to-day communication in nonaphasic frontotemporal dementia patients with a disorder of social comportment and executive functioning is due in part to a striking deficit in discourse organization associated with right frontOTemporal disease.
Abstract: Objective: To assess discourse in patients with frontotemporal dementia (FTD). Methods: The authors asked patients with progressive nonfluent aphasia (PNFA), patients with semantic dementia (SemD), and nonaphasic patients with a disorder of social comportment and executive functioning (SOC/EXEC) to narrate the story of a wordless children9s picture book. Results: The authors found significant discourse impairments in all three groups of patients. Moreover, there were qualitatively important differences between the groups. Patients with PNFA had the sparsest output, producing narratives with the fewest words per minute. Patients with SemD had difficulty retrieving words needed to tell their narratives. Though not aphasic, patients with SOC/EXEC had profound difficulty organizing their narratives, and they could not effectively express the point of the story. This deficit correlated with poor performance on a measure of executive resources requiring an organized mental search. In addition, a correlation of narrative organization with cortical atrophy in patients with SOC/EXEC was significant in right frontal and anterior temporal brain regions. Conclusions: Impaired day-to-day communication in nonaphasic frontotemporal dementia patients with a disorder of social comportment and executive functioning is due in part to a striking deficit in discourse organization associated with right frontotemporal disease. Difficulty with discourse in progressive aphasia is due largely to the language impairments of these patients.
TL;DR: Findings indicate that action naming impairment is not a general feature of FTD, but rather is associated with conditions that affect the frontoparietal-subcortical circuits involved in action knowledge and action representation.
Abstract: Action naming has been reported to be disproportionately impaired in comparison to object naming in patients with frontotemporal dementia (FTD). This finding has been attributed to the crucial role of frontal cortex in action naming. The investigation of object and action naming in the different subtypes of FTD, as well as in the related conditions of progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD), may thus contribute to the elucidation of the cerebral correlates of the action-object discrepancy as well as provide clues to the underlying cognitive mechanisms. The results indicated that, with the exception of semantic dementia, action naming was more impaired than object naming in all patient groups. The discrepancy was similar in frontal variant of FTD and Alzheimer's disease patients, whereas patients with nonfluent primary progressive aphasia, PSP, and CBD were significantly more impaired in the oral production of actions than of objects. These findings indicate that action naming impairment is not a general feature of FTD, but rather is associated with conditions that affect the frontoparietal-subcortical circuits involved in action knowledge and action representation.
TL;DR: It can be concluded that time is the factor which determines successful integration of the right hemisphere into the language network for compensation of lost left hemisphere language function.
TL;DR: Compared treatment that required forced use of the language modality, Constraint Induced Language Therapy, to treatment allowing all modes of communication, CILT showed more consistent improvement on standard aphasia measures and clinician judgments of narrative discourse.
Abstract: This investigation reports the results of a pilot study concerning the application of principles of use-dependent learning developed in the motor rehabilitation literature as Constraint Induced Therapy to language rehabilitation in a group of individuals with chronic aphasia. We compared treatment that required forced use of the language modality, Constraint Induced Language Therapy, (CILT) to treatment allowing all modes of communication. Both treatments were administrated intensively in a massed practice paradigm, using the same therapeutic stimuli and tasks. Results suggest that whereas both interventions yielded positive outcomes, CILT participants showed more consistent improvement on standard aphasia measures and clinician judgments of narrative discourse. These findings suggest that CILT intervention may be a viable approach to aphasia rehabilitation. (JINS, 2006, 12, 843–852.)
TL;DR: Older people with chronic aphasia had significantly fewer social contacts and social activities than their peers, and speech and language therapists may direct their rehabilitation efforts towards two areas: (1) conversational partner programmes training friends to maintain these relationships; and (2) encouraging and supporting aphasic clients in leisure activities of their choice.
Abstract: Background: Developing the knowledge base on the impact of aphasia on people's social lives has become increasingly important in recent times to further our understanding of the broad consequences of communication disability and thus provide appropriate services. Past research clearly indicates that relationships and social activities with family members and others undergo change with the onset of aphasia in an individual, however more evidence of a quantitative nature would be beneficial. Aims: The current research furthers our knowledge by quantifying chronically aphasic older people's regular social contacts and social activities, and places them in context by comparing them with healthy older people of similar age and education. Methods & Procedures: A total of 30 aphasic participants aged 57 to 88 years, and 71 non‐aphasic controls aged 62 to 98 years were interviewed by a speech and language therapist using self‐report measures of Social Network Analysis (Antonucci & Akiyama, 1987) and Social Activi...
TL;DR: The relationship between social support and quality of life was examined, exploring which aspects of social support (social network versus perceived social support) were most associated with health-relatedquality of life (HRQL).
Abstract: Background & Aims : Stroke and aphasia can have a profound impact on people's social activities, and family and social relationships. This study looked at patterns of social support in people with chronic aphasia following stroke. It examined the relationship between social support and quality of life, exploring which aspects of social support (social network versus perceived social support) were most associated with health-related quality of life (HRQL). Methods & Procedures : A cross-sectional interview-based survey study was conducted. A cluster-sampling framework was used to recruit participants with chronic aphasia following stroke (> 1 year) from three different sites in the south-east of England. Measures included the Stroke and Aphasia Quality of Life Scale-39 item version (SAQOL-39), the MOS Social Support Survey (SSS), and a social network questionnaire. Descriptive statistics, correlation, t -tests, and ANOVAs were used as appropriate. Outcomes & Results : The results of those able to self-r...
TL;DR: Although PNFA, fvFTD, and PCA groups had abnormal scores (relative to controls) on most semantic measures, their differing patterns across measures indicate that the apparent semantic impairment in these conditions is largely secondary to other factors.
Abstract: Using semantic dementia (SD) as a reference point, the authors assessed semantic memory in four other neurodegenerative disorders: progressive nonfluent aphasia (PNFA), frontal variant frontotemporal dementia (fvFTD), Alzheimer's disease (AD), and posterior cortical atrophy (PCA). Individuals with SD were more impaired than other groups on semantic measures and showed a characteristic pattern across tasks: category fluency (CF) worse than letter fluency (LF), naming worse than comprehension, and visual and verbal comprehension equally affected, suggesting disruption to an amodal semantic system. Individuals with AD demonstrated a similar pattern to a milder degree. Although PNFA, fvFTD, and PCA groups had abnormal scores (relative to controls) on most semantic measures, their differing patterns across measures indicate that the apparent semantic impairment in these conditions is largely secondary to other factors.
TL;DR: It is claimed that language functional magnetic resonance imaging can identify language lateralization in patients with temporal lobe epilepsy and that fMRI‐based findings are highly concordant with the conventional assessment procedure of speech dominance, the intracarotid amobarbital test (IAT).
Abstract: Summary: Purpose: Recent studies have claimed that language functional magnetic resonance imaging (f MRI) can identify language lateralization in patients with temporal lobe epilepsy (TLE) and that f MRI-based findings are highly concordant with the conventional assessment procedure of speech dominance, the intracarotid amobarbital test (IAT). Methods: To establish the power of language f MRI to detect language lateralization during presurgical assessment, we compared the findings of a semantic decision paradigm with the results of a standard IAT in 68 patients with chronic intractable right and left temporal lobe epilepsy (rTLE, n = 28; lTLE, n = 40) who consecutively underwent a presurgical evaluation program. The patient group also included 14 (20.6%) subjects with atypical (bilateral or right hemisphere) speech. Four raters used a visual analysis procedure to determine the laterality of speech-related activation individually for each patient. Results: Overall congruence between f MRI-based laterality and the laterality quotient of the IAT was 89.3% in rTLE and 72.5% in lTLE patients. Concordance was best in rTLE patients with left speech. In lTLE patients, language f MRI identified atypical, right hemisphere speech dominance in every case, but missed left hemisphere speech dominance in 17.2%. Frontal activations had higher concordance with the IAT than did activations in temporoparietal or combined regions of interest (ROIs). Because of methodologic problems, recognition of bilateral speech was difficult. Conclusions: These data provide evidence that language f MRI as used in the present study has limited correlation with the IAT, especially in patients with lTLE and with mixed speech dominance. Further refinements regarding the paradigms and analysis procedures will be needed to improve the contribution of language f MRI for presurgical assessment. Key Words: Language f MRI—Temporal lobe epilepsy—Language lateralization—Intracarotid amobarbital test.
TL;DR: Results indicated that patients with AOS made the most errors on tasks requiring the coordination of complex, but not simple, articulatory movements, whereas patients without apraxia of speech did not.
TL;DR: In this paper, the effect of semantic naming treatment on crosslinguistic generalization was investigated in 3 participants with English-Spanish bilingual aphasia, using a single-subject experimental setup.
Abstract: Purpose The effect of semantic naming treatment on crosslinguistic generalization was investigated in 3 participants with English–Spanish bilingual aphasia. Method A single-subject experimental des...
TL;DR: Examining the available literature, it becomes evident that there is a need for long-term, large scale follow-up studies, evaluating likely long- term neuropsychological outcomes of stroke and their prognostic utility.
Abstract: This review examines the available literature on neuropsychological outcomes of stroke and the literature on the ability of specific areas of neuropsychological deficit to predict functional stroke outcome. The literature reviewed indicates that post-stroke deficits in executive function, memory, language, and speed of processing are common, with those identified as having progressive ‘post-stroke dementia’ presenting with a similar, though more impaired profile, with increased impairments particularly noted in the area of memory. It is clear that some aspects of neuropsychological functioning (e.g., presence of neglect, aphasia, anosognosia; and verbal memory and attention deficits) show promise as a means of predicting post-stroke functional outcomes. Examining the available literature, it becomes evident that there is a need for long-term, large scale (i.e., population based) follow-up studies, evaluating likely long-term neuropsychological outcomes of stroke and their prognostic utility.
TL;DR: It appears that decreased executive functioning ability may coincide with decreased functional communication ability in persons with aphasia.
Abstract: The purpose of this exploratory study was to investigate the relationship between functional communication and executive function ability in aphasia. Twenty-five participants with aphasia underwent examination with an extensive test battery including measures of functional communication, executive function ability, and language impairment. Compared to published norms, most participants did not perform within normal limits on the executive function tests. As expected, the correlation between severity of language impairment and functional communication ratings exceeded that among the executive functioning and functional communication measures. Eight of ten correlation coefficients for the relationship between executive functioning and functional communication reached statistical significance suggesting a clear relationship between scores on the executive functioning measures and functional communication ability. Based on these results, it appears that decreased executive functioning ability may coincide with decreased functional communication ability in persons with aphasia.
TL;DR: Donepezil (10 mg/day) improved aphasia severity at endpoint (week 16) relative to placebo compared to placebo (p = 0.037) in a randomized, placebo-controlled, double-blind parallel trial to evaluate the efficacy and safety of donepezil in chronic poststroke aphasIA.
Abstract: We studied 26 patients in a randomized, placebo-controlled, double-blind parallel trial to evaluate the efficacy and safety of donepezil in chronic poststroke aphasia. Donepezil (10 mg/day) improved aphasia severity at endpoint (week 16) relative to placebo (p = 0.037).
TL;DR: How older people with aphasia consider the quality of their current lives is explored, as well as their husbands’ or daughter’s accounts of their lives.
Abstract: Understanding the client's perspective is essential for good practitioner care in rehabilitation after stroke, and nothing is more relevant than enquiring directly about our clients' quality of life to inform our management. Relatively little is known about how older people with aphasia consider the quality of their current lives, and this article seeks to explore this issue. Four women's accounts of their life quality are presented, as well as their husbands' or daughter's accounts of their lives. Their stories share some common elements. Who you love or share your life with; where you live; feeling independent and/or in control; and engaging in satisfying activities mattered to these women's life quality. The impact of aphasia varies across the cases, and the need to accept change for successful living is illustrated in all accounts.
TL;DR: This is the first study to employ multiple pre- and post-treatment fMRI sessions in the study of treatment-induced recovery from aphasia and has implications for future studies of brain plasticity in stroke.
22 Apr 2006
TL;DR: A hybrid desktop-handheld system developed to support individuals with aphasia allows its users to develop speech communication through images and sound on a desktop computer and download this speech to a mobile device that can then support communication outside the home.
Abstract: In this paper, we describe the design and preliminary evaluation of a hybrid desktop-handheld system developed to support individuals with aphasia, a disorder which impairs the ability to speak, read, write, or understand language. The system allows its users to develop speech communication through images and sound on a desktop computer and download this speech to a mobile device that can then support communication outside the home. Using a desktop computer for input addresses some of this population's difficulties interacting with handheld devices, while the mobile device addresses stigma and portability issues. A modified participatory design approach was used in which proxies, that is, speech-language pathologists who work with aphasic individuals, assumed the role normally filled by users. This was done because of the difficulties in communicating with the target population and the high variability in aphasic disorders. In addition, the paper presents a case study of the proxy-use participatory design process that illustrates how different interview techniques resulted in different user feedback.
TL;DR: The use of single subject controlled experimental designs for investigating the effects of treatment for aphasia is discussed, with emphasis on internal validity issues, the number of participants enrolled in published studies, operational specification of the dependent and independent variables, and reliability of measurement.
TL;DR: The notion that an intact RH supports use of some types of formulaic language is supported, as well as the identification of relatively preserved formulaic expressions in LH damage, to provide a basis for a more effective treatment plan.
Abstract: Background: The preservation of swearing, serial speech, and speech formulas is well documented in clinical descriptions of aphasia. Proper nouns and sentence stems have also been reported in the residual speech of severely aphasic subjects. The incidence of formulaic expressions in spontaneous speech of right‐hemisphere‐damaged subjects has not yet been well examined. Recent interest in formulaic expressions (FEs) in normal language use, combined with the converging evidence of a role for the right hemisphere in processing pragmatic elements of language, led to this study. Methods & Procedures: We undertook an examination of hypotheses about the hemispheric processing of FEs in the spontaneous speech of persons with left hemisphere (LH) and right hemisphere (RH) damage. Based on preserved use of formulaic expressions in clinically described aphasic speech, the hypothesis under examination in this study was that the intact RH has a role in the production of formulaic expressions. Further inquiries involve...
TL;DR: No significant differences existed between test results following traditional speech-language therapy versus AAT, and results of a client-satisfaction questionnaire indicated that each of the participants was more motivated, enjoyed the therapy sessions more, and felt that the atmosphere of the sessions was lighter and less stressed during AAT compared with traditional therapy.
Abstract: This study explored the effects and effectiveness of animal-assisted therapy (AAT) for persons with aphasia. Three men with aphasia from left-hemisphere strokes participated in this study. The men received one semester of traditional therapy followed by one semester of AAT. While both therapies were effective, in that each participant met his goals, no significant differences existed between test results following traditional speech-language therapy versus AAT. Results of a client-satisfaction questionnaire, however, indicated that each of the participants was more motivated, enjoyed the therapy sessions more, and felt that the atmosphere of the sessions was lighter and less stressed during AAT compared with traditional therapy.