Showing papers on "Aphasia published in 2023"

Dissociation of Broca’s area from Broca’s aphasia in patients undergoing neurosurgical resections

Abstract: OBJECTIVE Broca’s aphasia is a syndrome of impaired fluency with retained comprehension. The authors used an unbiased algorithm to examine which neuroanatomical areas are most likely to result in Broca’s aphasia following surgical lesions. METHODS Patients were prospectively evaluated with standardized language batteries before and after surgery. Broca’s area was defined anatomically as the pars opercularis and triangularis of the inferior frontal gyrus. Broca’s aphasia was defined by the Western Aphasia Battery language assessment. Resections were outlined from MRI scans to construct 3D volumes of interest. These were aligned using a nonlinear transformation to Montreal Neurological Institute brain space. A voxel-based lesion-symptom mapping (VLSM) algorithm was used to test for areas statistically associated with Broca’s aphasia when incorporated into a resection, as well as areas associated with deficits in fluency independent of Western Aphasia Battery classification. Postoperative MRI scans were reviewed in blinded fashion to estimate the percentage resection of Broca’s area compared to areas identified using the VLSM algorithm. RESULTS A total of 289 patients had early language evaluations, of whom 19 had postoperative Broca’s aphasia. VLSM analysis revealed an area that was highly correlated (p < 0.001) with Broca’s aphasia, spanning ventral sensorimotor cortex and supramarginal gyri, as well as extending into subcortical white matter tracts. Reduced fluency scores were significantly associated with an overlapping region of interest. The fluency score was negatively correlated with fraction of resected precentral, postcentral, and supramarginal components of the VLSM area. CONCLUSIONS Broca’s aphasia does not typically arise from neurosurgical resections in Broca’s area. When Broca’s aphasia does occur after surgery, it is typically in the early postoperative period, improves by 1 month, and is associated with resections of ventral sensorimotor cortex and supramarginal gyri.

The Apraxia of Speech Rating Scale: Reliability, Validity, and Utility

Abstract: The purpose of this study was to examine the interrater reliability and validity of the Apraxia of Speech Rating Scale (ASRS-3.5) as an index of the presence and severity of apraxia of speech (AOS) and the prominence of several of its important features.Interrater reliability was assessed for 27 participants. Validity was examined in a cohort of 308 participants (120 with and 188 without progressive AOS) through item analysis; item-Total score correlations; correlations among ASRS Total score and component subscores and independent clinical ratings of AOS, dysarthria and aphasia severity, intelligibility, and articulatory errors, as well as years postonset and age; and regression models assessing item and Total score prediction of AOS presence.Interrater reliability was good or excellent for most items and excellent for the Total score. Item and Total score analyses revealed good separation of participants with versus without AOS. Inter-item and item-Total score correlations were generally moderately high as were correlations between the ASRS Total score and independent ratings of AOS severity, intelligibility, and articulatory errors. The Total score was not meaningfully correlated with ratings of aphasia and dysarthria severity, years postonset, or age. Total scores below 7 and above 10 revealed excellent diagnostic sensitivity and specificity for AOS. The presence of eight or more abnormal features was also highly predictive of AOS presence.The ASRS-3.5 is a reliable and valid scale for identifying the presence and severity of AOS and its predominant features. It has excellent sensitivity to AOS presence and excellent specificity relative to aphasia and dysarthria in patients with neurodegenerative disease.https://doi.org/10.23641/asha.21817584.

Caregiving and Friendship

Abstract: Friendship is an essential component of quality of life. The ongoing lifestyle changes and strain typically experienced by care partners of people with aphasia (PWA) can impact their social network, with friendships being particularly vulnerable to change. This study aimed to understand the impact of caregiving on care partners' friendships over time from the perspective of care partners of PWA. An online survey addressing care partners' demographics, care recipients' demographics, and care partners' perceptions of their friendships over time (before caregiving and during the acute and chronic stages of caregiving) was codesigned with three care partner stakeholders and then distributed to other individuals who care for a person with aphasia. Survey responses from 35 care partners of PWA who completed the survey were analyzed using quantitative and qualitative methods. Most participants reported their friendships were different in both the acute and chronic stages of caregiving compared with before caregiving. Overall, perceived friendship satisfaction and support decreased over time. Qualitative analysis revealed five main factors that could either facilitate or hinder care partner friendships, including role changes, personal characteristics, friendship initiation, friendship interactions, and outside influences. This work highlights that caring for a loved one with aphasia negatively impacts friendships for many care partners, and these friendship changes are often long-lasting. More resources for managing the impact of aphasia on care partners' social lives are needed, which, in turn, might improve the friendships and well-being of both the care partner and their loved one with aphasia.

Transcranial Direct-Current Stimulation in Subacute Aphasia: A Randomized Controlled Trial

Abstract: Transcranial direct-current stimulation (tDCS) is a promising adjunct to therapy for chronic aphasia.This single-center, randomized, double-blind, sham-controlled efficacy trial tested the hypothesis that anodal tDCS augments language therapy in subacute aphasia. Secondarily, we compared the effect of tDCS on discourse measures and quality of life and compared the effects on naming to previous findings in chronic stroke. Right-handed English speakers with aphasia <3 months after left hemisphere ischemic stroke were included, unless they had prior neurological or psychiatric disease or injury or were taking certain medications (34 excluded; final sample, 58). Participants were randomized 1:1, controlling for age, aphasia type, and severity, to receive 20 minutes of tDCS (1 mA) or sham-tDCS in addition to fifteen 45-minute sessions of naming treatment (plus standard care). The primary outcome variable was change in naming accuracy of untrained pictures pretreatment to 1-week posttreatment.Baseline characteristics were similar between the tDCS (N=30) and sham (N=28) groups: patients were 65 years old, 53% male, and 2 months from stroke onset on average. In intent-to-treat analysis, the adjusted mean change from baseline to 1-week posttreatment in picture naming was 22.3 (95% CI, 13.5-31.2) for tDCS and 18.5 (9.6-27.4) for sham and was not significantly different. Content and efficiency of picture description improved more with tDCS than sham. Groups did not differ in quality of life improvement. No patients were withdrawn due to adverse events.tDCS did not improve recovery of picture naming but did improve recovery of discourse. Discourse skills are critical to participation. Future research should examine tDCS in a larger sample with richer functional outcomes.URL: https://www.gov; Unique identifier: NCT02674490.

The Resilience of the Phonological Network May Have Implications for Developmental and Acquired Disorders

Abstract: A central tenet of network science states that the structure of the network influences processing. In this study of a phonological network of English words we asked: how does damage alter the network structure (Study 1)? How does the damaged structure influence lexical processing (Study 2)? How does the structure of the intact network "protect" processing with a less efficient algorithm (Study 3)? In Study 1, connections in the network were randomly removed to increasingly damage the network. Various measures showed the network remained well-connected (i.e., it is resilient to damage) until ~90% of the connections were removed. In Study 2, computer simulations examined the retrieval of a set of words. The performance of the model was positively correlated with naming accuracy by people with aphasia (PWA) on the Philadelphia Naming Test (PNT) across four types of aphasia. In Study 3, we demonstrated another way to model developmental or acquired disorders by manipulating how efficiently activation spread through the network. We found that the structure of the network "protects" word retrieval despite decreases in processing efficiency; words that are relatively easy to retrieve with efficient transmission of priming remain relatively easy to retrieve with less efficient transmission of priming. Cognitive network science and computer simulations may provide insight to a wide range of speech, language, hearing, and cognitive disorders.

Lesion-symptom mapping of language impairments in people with brain tumours: The influence of linguistic stimuli.

Abstract: People with tumours in specific brain sites might face difficulties in tasks with different linguistic material. Previous lesion-symptom mapping studies (VLSM) demonstrated that people with tumours in posterior temporal regions have more severe linguistic impairments. However, to the best of our knowledge, preoperative performance and lesion location on tasks with different linguistic stimuli have not been examined. In the present study, we performed VLSM on 52 people with left gliomas to examine whether tumour distribution differs depending on the tasks of the Aachen Aphasia Test. The VLSM analysis revealed that single-word production (e.g. object naming) was associated with the inferior parietal lobe and that compound and sentence production were additionally associated with posterior temporal gyri. Word repetition was affected in people with tumours in inferior parietal areas, whereas sentence repetition was the only task to be associated with frontal regions. Subcortically, word and sentence production were found to be affected in people with tumours reaching the arcuate fasciculus, and compound production was primarily associated with tumours affecting the inferior longitudinal and inferior fronto-occipital fasciculus. Our work shows that tasks with linguistic stimuli other than single-word naming (e.g. compound and sentence production) relate to additional cortical and subcortical brain areas. At a clinical level, we show that tasks that target the same processes (e.g. repetition) can have different neural correlates depending on the linguistic stimuli used. Also, we highlight the importance of left temporoparietal areas.

Combining Stakeholder-Engaged Research and the Life Participation Approach to Aphasia

Abstract: Stakeholder-engaged research (SER) is common in many health-related fields and is gaining momentum in aphasiology. Stakeholder-engaged research shares many of the same goals and values as the Life Participation Approach to Aphasia (LPAA). The aim of this article is to identify how these two frameworks complement each other and can be applied to aphasia research. This is accomplished by first defining SER and highlighting associated benefits and challenges and then exploring the ways that SER and LPAA's core values support each other. The authors' SER project is discussed to illustrate the synergy between SER and LPAA and highlight the potential research and clinical impacts of expanding the use of SER in aphasiology.

A frontotemporal dementia-like case after high-altitude climbing

Abstract: Abstract Background We report a case who developed long-term neuropsychiatric sequelae similar to frontotemporal dementia after suffering a "high altitude sickness" while climbing a high mountain without taking precautions against acute hypoxia. Case presentation The 57-year-old patient showed symptoms of acute mountain sickness after climbing 3500 m. A few months after descending the mountain, he developed symptoms such as loss of empathy, decreased speech, perseveration, echolalia, and increased interest in sugary foods. The patient's MRI and PET/CT results were consistent with frontotemporal neurodegeneration. After the start of donepezil, persecution delusions developed, and the clinical picture worsened. In the process, he developed visual agnosia and anomic aphasia. Although there was no significant change in personality traits at the beginning, the patient developed apathy, loss of inhibition, lack of empathy, progressive aphasia, and problems perceiving and expressing emotions. A significant loss of function occurred within 4 years. The patient met the criteria for "probable behavioral variant frontotemporal dementia", but was defined as a frontotemporal dementia-like case due to possible relevance to a medical condition affecting the brain. Conclusions This case suggests that clinicians should be more careful about the chronic consequences of high-altitude diseases and avoid cholinesterase inhibitors such as donepezil, as it can worsen behavioral symptoms of frontotemporal dementia-like symptomatology.

Cognitive Deficits After Stroke.

Abstract: Cognition is a central feature of human existence and brain function. Cognitive deficits are common after stroke and may strongly impact functional outcome. Recent years have seen substantial advances in our understanding of cognitive functions in the healthy state, and this new body of knowledge promises to open new avenues for understanding and treating poststroke impairments, including cognitive deficits. The 5 reviews in this Focused Update from an international cast of experts provide excellent updates on cognitive syndromes that commonly contribute to poststroke disability: neglect, aphasia, apraxia, loss of executive function, and memory disorders. Cognitive impairment remains a major source of morbidity after stroke; these reviews approach this problem by considering clinical presentations, pathophysiology, measurement tools, and treatment approaches. In doing so, they highlight a number of key questions and critical gaps. A number of issues emerge as common across cognitive domains poststroke and are summarized herein. There is a need for improved methods to measure cognitive impairments, as well as for improved insights into pathophysiology of symptom onset and mechanisms of recovery after stroke, including validated biomarkers. These 5 state of the art summaries are sure to prove useful toward these goals.

Aphasic mild cognitive impairment in prodromal dementia with Lewy bodies

Abstract: Introduction This study aimed to determine the characteristics of aphasic mild cognitive impairment (aphasic MCI), which is characterized by a progressive and relatively prominent language impairment compared with other cognitive impairments, in the prodromal phase of dementia with Lewy bodies (DLB). Methods Of the 26 consecutive patients with aphasic MCI who had been prospectively recruited at our hospital, 8 patients were diagnosed with prodromal DLB and underwent language, neurological, neuropsychological, and neuroimaging (N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography; IMP-SPECT) testing. Three of these patients also underwent cholinesterase inhibitor therapy with donepezil. Results In our aphasic MCI cohort, the clinical diagnosis of probable prodromal DLB accounted for more than 30% of cases; therefore, the presence of language impairment in prodromal DLB was not very uncommon. Five patients were diagnosed with progressive anomic aphasia and three with logopenic progressive aphasia. Anomic aphasia was characterized by apparent anomia but relatively preserved repetition and comprehension ability and logopenic progressive aphasia by anomia, phonemic paraphasia, and impaired repetition. IMP-SPECT revealed hypoperfusion of the temporal and parietal lobes in the left hemisphere in all but one patient. All patients who underwent cholinesterase inhibitor therapy with donepezil showed improvement in general cognitive function, including language function. Discussion The clinical and imaging features of aphasic MCI in prodromal DLB are similar to those observed in Alzheimer's disease. Progressive fluent aphasia, such as progressive anomic aphasia and logopenic progressive aphasia, is one of the clinical presentations in prodromal state of DLB. Our findings provide further insight into the clinical spectrum of prodromal DLB and may contribute to the development of medication for progressive aphasia caused by cholinergic insufficiency.

Eye movement in reading and linguistic processing among bilingualism in oculomotor apraxia in patients with aphasia

Abstract: The present study compared linguistic processes and eye movement among individuals diagnosed with oculomotor apraxia (OMA) and the influence of bilingualism on OMA. Four patients consisting of one male and three females were diagnosed with OMA, and a group of four healthy individuals, comprising two males and two females who were all right-hand dominant. Also, a group of four stroke patients without ocular apraxia. Findings show that pointing skills in both the first (L1) and second language (L2) have increased, demonstrating statistical significance ( P-value < .001 and P-value = .02, respectively). Also, simple commands over time have increased in L1 and L2, showing statistical significance ( P-value < .01 and P-value < .01, respectively). Naming skills in L1 have increased over time, demonstrating statistical insignificance ( P-value < .01). However, in L2, no statistically significant change was observed ( P-value = .08). This skill in L1 in patients with OMA was significantly reduced compared to the healthy control group ( P-value = .03). Still, patients with OMA showed no statistically significant difference from their healthy counterparts ( P-value = .15). The orthographic ability of patients in L1 during the study period did not statistically change significantly ( P-value = .11). This skill level in L1 between patients with OMA and the healthy control group did not show a statistically significant difference ( P-value = .06). Still, there was a statistically significant change in the healthy control group in L2 ( P-value < .01). These findings suggest that the bilingual does not reflect a general executive in attentional guidance but could reflect more efficient guidance only under specific tasks.

Anatomical MRI staging of frontotemporal dementia variants: For the Frontotemporal Lobar Degeneration Neuroimaging Initiative and the National Alzheimer's Coordinating Center cohort: For the Frontotemporal Lobar Degeneration Neuroimaging Initiative and the National Alzheimer's Coordinating Center co

Abstract: INTRODUCTION The three clinical variants of frontotemporal dementia (behavioral variant [bvFTD], semantic dementia, and progressive non-fluent aphasia [PNFA]) are likely to develop over decades, from the preclinical stage to death. METHODS To describe the long-term chronological anatomical progression of FTD variants, we built lifespan brain charts of normal aging and FTD variants by combining 8022 quality-controlled MRIs from multiple large-scale data-bases, including 107 bvFTD, 44 semantic dementia, and 38 PNFA. RESULTS We report in this manuscript the anatomical MRI staging schemes of the three FTD variants by describing the sequential divergence of volumetric trajectories between normal aging and FTD variants. Subcortical atrophy precedes focal cortical atrophy in specific behavioral and/or language networks, with a "radiological" prodromal phase lasting 8-10 years (time elapsed between the first structural alteration and canonical cortical atrophy). DISCUSSION Amygdalar and striatal atrophy can be candidate biomarkers for future preclinical/prodromal FTD variants definitions. HIGHLIGHTS We describe the chronological MRI staging of the most affected structures in the three frontotemporal dementia (FTD) syndromic variants. In behavioral variant of FTD (bvFTD): bilateral amygdalar, striatal, and insular atrophy precedes fronto-temporal atrophy. In semantic dementia: bilateral amygdalar atrophy precedes left temporal and hippocampal atrophy. In progressive non-fluent aphasia (PNFA): left striatal, insular, and thalamic atrophy precedes opercular atrophy.

Photobiomodulation with Super-Pulsed Laser Shows Efficacy for Stroke and Aphasia: Case Studies

Abstract: Background: Brain disorders have become more and more common today, due to both the aging population and the ever-expanding sports community. However, a new therapeutic technology called photobiomodulation (PBM) is giving hope to thousands of individuals in need. Traumatic brain injury (TBI), dementia, post traumatic stress (PTSD) and attention deficit (ADD) disorders are in many cases quickly and safely improved by PBM. PBM employs red or near-infrared (NIR) light (600 - 1100 nm) to stimulate healing, protect tissue from dying, increase mitochondrial function, improve blood flow, and tissue oxygenation. PBM can also act to reduce edema, increase antioxidants, decrease inflammation, protect against apoptosis, and modulate the microglial activation state. All these effects can occur when light is delivered to the head, and can be beneficial in both acute and chronic brain conditions. Methods: In this case series, we used a high power, FDA-approved superpulsed laser system applied to the head to treat four chronic stroke patients. Patients received as few as three 6 - 9 minute treatments over a one-week period. The follow up time varied, but in one case was two years. Results: Patients showed significant improvement in their speech and verbal skills. Improvements were also noticed in walking ability, limb movement, less numbness, and better vision. Conclusion: The use of PBM in stroke rehabilitation deserves to be tested in controlled clinical trials, because this common condition has no approved pharmaceutical treatment at present.

Rehabilitation Therapy Doses Are Low After Stroke and Predicted by Clinical Factors

Abstract: Stroke is a leading cause of long-term disability. Greater rehabilitation therapy after stroke is known to improve functional outcomes. This study examined therapy doses during the first year of stroke recovery and identified factors that predict rehabilitation therapy dose.Adults with new radiologically confirmed stroke were enrolled 2 to 10 days after stroke onset at 28 acute care hospitals across the United States. Following an initial assessment during acute hospitalization, the number of physical therapy, occupational therapy, and speech therapy sessions were determined at visits occurring 3, 6, and 12 months following stroke. Negative binomial regression examined whether clinical and demographic factors were associated with therapy counts. False discovery rate was used to correct for multiple comparisons.Of 763 patients enrolled during acute stroke admission, 510 were available for follow-up. Therapy counts were low overall, with most therapy delivered within the first 3 months; 35.0% of patients received no physical therapy; 48.8%, no occupational therapy, and 61.7%, no speech therapy. Discharge destination was significantly related to cumulative therapy; the percentage of patients discharged to an inpatient rehabilitation facility varied across sites, from 0% to 71%. Most demographic factors did not predict therapy dose, although Hispanic patients received a lower cumulative amount of physical therapy and occupational therapy. Acutely, the severity of clinical factors (grip strength and National Institutes of Health Stroke Scale score, as well as National Institutes of Health Stroke Scale subscores for aphasia and neglect) predicted higher subsequent therapy doses. Measures of impairment and function (Fugl-Meyer, modified Rankin Scale, and Stroke Impact Scale Activities of Daily Living) assessed 3 months after stroke also predicted subsequent cumulative therapy doses.Rehabilitative therapy doses during the first year poststroke are low in the United States. This is the first US-wide study to demonstrate that behavioral deficits predict therapy dose, with patients having more severe deficits receiving higher doses. Findings suggest directions for identifying groups at risk of receiving disproportionately low rehabilitation doses.

The Relationship Between Memory, Type, and Severity of Aphasia With Confrontation Naming in Post-stroke Patients With Chronic Aphasia

Abstract: Objectives: The brain’s widespread neural functions lead to aphasia in which the patients experience difficulties in cognitive and language functions. Memory, type, and severity of aphasia are associated with language and the naming process. In the current study, we investigated the relationship between memory, type, and severity of aphasia using the confrontation naming test in post-stroke patients with chronic aphasia. Methods: This research was a descriptive-analytic cross-sectional study. We selected 45 chronic aphasia patients aged 35-70 years. The participants with a mild to moderate score in Mini-Mental State Examination (MMSE) were assessed with the Persian naming test, Wechsler Memory Scale, and Persian Western Aphasia Battery. Results: There was a significant difference between memory with correct answers without a cue, correct answers with a semantic cue, and the total correct answers from confrontation naming (P<0.001, r=0.62; P=0.01, r=0.37; and P<0.001, r=0.71; respectively). Furthermore, the results indicated a significant difference between the type of aphasia with subtests of confrontation naming involving correct answers with semantic cues and total correct answers (P=0.02). Also, the results showed a significant difference between the severity of aphasia with correct answers without a cue, correct answers with a semantic cue, and the total correct answers from confrontation naming (P<0.001, r=0.77; P=0.03, r=0.31; and P<0.001, r=0.67; respectively). In comparing semantic and phonetic cues, memory, type, and severity of aphasia indicated significant association only with semantic cues. Discussion: There is an association between memory, type, and severity of aphasia with confrontation naming in patients with aphasia. The data have highlighted the importance of factors that need to be considered to formulate a comprehensive treatment plan to achieve further improvement in naming skills.

Errorless, Errorful, and Retrieval Practice for Naming Treatment in Aphasia: A Scoping Review of Learning Mechanisms and Treatment Ingredients

Abstract: Purpose: Increasingly, mechanisms of learning are being considered during aphasia rehabilitation. Well-characterized learning mechanisms can inform “how” interventions should be administered to maximize the acquisition and retention of treatment gains. This systematic scoping review mapped hypothesized mechanisms of action (MoAs) and treatment ingredients in three learning-based approaches targeting naming in aphasia: errorless learning (ELess), errorful learning (EFul), and retrieval practice (RP). The rehabilitation treatment specification system was leveraged to describe available literature and identify knowledge gaps within a unified framework. Method: PubMed and CINHAL were searched for studies that compared ELess, EFul, and/or RP for naming in aphasia. Independent reviewers extracted data on proposed MoAs, treatment ingredients, and outcomes. Results: Twelve studies compared ELess and EFul, six studies compared ELess and RP, and one study compared RP and EFul. Hebbian learning, gated Hebbian learning, effortful retrieval, and models of incremental learning via lexical access were proposed as MoAs. To maximize treatment outcomes within theorized MoAs, researchers manipulated study ingredients including cues, scheduling, and feedback. Outcomes in comparative effectiveness studies were examined to identify ingredients that may influence learning. Individual-level variables, such as cognitive and linguistic abilities, may affect treatment response; however, findings were inconsistent across studies. Conclusions: Significant knowledge gaps were identified and include (a) which MoAs operate during ELess, EFul, and RP; (b) which ingredients are active and engage specific MoAs; and (c) how individual-level variables may drive treatment administration. Theory-driven research can support or refute MoAs and active ingredients enabling clinicians to modify treatments within theoretical frameworks.

Advanced Brain Age and Chronic Poststroke Aphasia Severity

Abstract: Chronic poststroke language impairment is typically worse in older individuals or those with large stroke lesions. However, there is unexplained variance that likely depends on intact tissue beyond the lesion. Brain age is an emerging concept, which is partially independent from chronologic age. Advanced brain age is associated with cognitive decline in healthy older adults; therefore, we aimed to investigate the relationship with stroke aphasia. We hypothesized that advanced brain age is a significant factor associated with chronic poststroke language impairments, above and beyond chronologic age, and lesion characteristics.This cohort study retrospectively evaluated participants from the Predicting Outcomes of Language Rehabilitation in Aphasia clinical trial (NCT03416738), recruited through local advertisement in South Carolina (US). Primary inclusion criteria were left hemisphere stroke and chronic aphasia (≥12 months after stroke). Participants completed baseline behavioral testing including the Western Aphasia Battery-Revised (WAB-R), Philadelphia Naming Test (PNT), Pyramids and Palm Trees Test (PPTT), and Wechsler Adult Intelligence Scale Matrices subtest, before completing 6 weeks of language therapy. The PNT was repeated 1 month after therapy. We leveraged modern neuroimaging techniques to estimate brain age and computed a proportional difference between chronologic age and estimated brain age. Multiple linear regression models were used to evaluate the relationship between proportional brain age difference (PBAD) and behavior.Participants (N = 93, 58 males and 35 females, average age = 61 years) had estimated brain ages ranging from 14 years younger to 23 years older than chronologic age. Advanced brain age predicted performance on semantic tasks (PPTT) and language tasks (WAB-R). For participants with advanced brain aging (n = 47), treatment gains (improvement on the PNT) were independently predicted by PBAD (T = -2.0474, p = 0.0468, 9% of variance explained).Through the application of modern neuroimaging techniques, advanced brain aging was associated with aphasia severity and performance on semantic tasks. Notably, therapy outcome scores were also associated with PBAD, albeit only among participants with advanced brain aging. These findings corroborate the importance of brain age as a determinant of poststroke recovery and underscore the importance of personalized health factors in determining recovery trajectories, which should be considered during the planning or implementation of therapeutic interventions.

Barriers and Facilitators to Communication Accessibility as Perceived by People With Aphasia

Abstract: Purpose: Communication access is a human right, but many individuals with communication impairments face challenges accessing their environments. As part of a larger study investigating barriers and facilitators to communication access in the retail/service industry, the purpose of the present study was to investigate the experiences of people with aphasia (PWA) accessing goods and services in their communities. Methods: Nine PWA were interviewed about their experiences accessing retail businesses and services. Interviews were coded and thematically analyzed to identify key themes related to barriers and facilitators to communication during business interactions. Stakeholders on the research team included two PWA, who provided input throughout the research process. Results: Three main themes were found: supporting communication, aphasia awareness and education, and respect for PWA. Codes within each theme comprised facilitators that led to positive experiences and barriers that led to negative business interactions. Discussion/Conclusions: People with aphasia identified tangible ways that retail businesses can be made more communicatively accessible. Stakeholders with aphasia made meaningful contributions to the research process. Future work will investigate how these findings, integrated with business perspectives, can be used to support businesses in applying strategies to become more communicatively accessible.

Posttraumatic Growth in People Living With Aphasia

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Stakeholder-Engaged Research

Abstract: There is a need for intervention to support friendship for people living with aphasia. The purpose of this article is to describe a stakeholder engagement process that involved researchers, clinicians, people living with aphasia, and care partners to inform such intervention. Through reflection and firsthand accounts of non–university-based researchers, people not typically represented in the research process, we share details of two main lessons learned throughout the stakeholder engagement journey: (1) accessible engagement and (2) team correspondence. Finally, we describe experiences with use of the Social Convoy Model to support discussion and engagement about friendship and aphasia. We argue that this tool be a consideration in future intervention research in this area to support people with aphasia communicating their friendship priorities and goals. Although the richness of multistakeholder research teams has been documented, we hope that this article provides detail that is not commonly shared thus illuminating the process. We also hope to provide a transparent account of the cost and time required to ensure equity across stakeholder groups.

Network anatomy in logopenic variant of primary progressive aphasia

Abstract: The logopenic variant of primary progressive aphasia (lvPPA) is a neurodegenerative syndrome characterized linguistically by gradual loss of repetition and naming skills, resulting from left posterior temporal and inferior parietal atrophy. Here, we sought to identify which specific cortical loci are initially targeted by the disease (epicenters) and investigate whether atrophy spreads through pre-determined networks. First, we used cross-sectional structural MRI data from individuals with lvPPA to define putative disease epicenters using a surface-based approach paired with an anatomically-fine-grained parcellation of the cortical surface (i.e., HCP-MMP1.0 atlas). Second, we combined cross-sectional functional MRI data from healthy controls and longitudinal structural MRI data from individuals with lvPPA to derive the epicenter-seeded resting-state networks most relevant to lvPPA symptomatology and ascertain whether functional connectivity in these networks predicts longitudinal atrophy spread in lvPPA. Our results show that two partially distinct brain networks anchored to the left anterior angular and posterior superior temporal gyri epicenters were preferentially associated with sentence repetition and naming skills in lvPPA. Critically, the strength of connectivity within these two networks in the neurologically-intact brain significantly predicted longitudinal atrophy progression in lvPPA. Taken together, our findings indicate that atrophy progression in lvPPA, starting from inferior parietal and temporo-parietal junction regions, predominantly follows at least two partially non-overlapping pathways, which may influence the heterogeneity in clinical presentation and prognosis.

Increased Improvement in Speech-Language Skills After Transcranial Photobiomodulation Plus Speech-Language Therapy, Compared to Speech-Language Therapy Alone: Case Report with Aphasia.

Abstract: Objective: This is a case report showing that transcranial photobiomodulation (tPBM) combined with traditional, speech-language therapy improved and accelerated the results from speech-language therapy, in a stroke person with aphasia (PWA). Background: tPBM is a safe, noninvasive technique using red and near-infrared light to improve the metabolism of cells. tPBM helps by promoting neuromodulation, while decreasing neuroinflammation and promoting vasodilation. Several studies have shown that tPBM can help individuals with stroke or traumatic brain injury achieve significant cognitive improvements. Methods: A 38-year-old female, who sustained an ischemic stroke on the left side of the brain, received two, 5-month series of treatments. The first series of treatments included traditional speech-language therapy, for the first 5 months poststroke. The second series of treatments included tPBM in combination with speech-language therapy, for the next 5 months. The tPBM treatments included application of red (630 and 660 nm) and near-infrared (850 nm) wavelengths of photons applied to left hemisphere scalp areas. The major cortical language areas were subjacent to the scalp placements along the line of the Sylvian fissure. At each session, first a light-emitting diode (LED) cluster head with red (630 and 660 nm) and near-infrared (850 nm) wavelengths, with an irradiance (power density) of 200 mW/cm2, a beam size of 4.9 cm2, and a fluence (energy density) of 12 J/cm2 per minute, was applied to the left side of the scalp/brain, along the Sylvian fissure for 60 sec at each at the following eight, language network target areas: frontal pole, prefrontal cortex, and inferior frontal gyrus (Broca's area); supramarginal gyrus and angular gyrus in the parietal lobe; inferior motor/sensory cortex (mouth area); and posterior superior temporal gyrus (Wernicke's area) and superior temporal sulcus in the temporal lobe, for a total of 8 min. Second, for the next 20 min (1200 sec), simultaneous with speech-language therapy, an LED PBM helmet was applied to the scalp/head. This helmet contained 256 separate LED lights, near-infrared (810 nm) wavelength, 60 mW power per LED light, total power, 15 W; energy, 72 Joules; fluence, 28.8 J/cm2; and irradiance, 24 mW/cm2. Results and Conclusion: During the initial, 5-month treatment series with traditional speech-language therapy only, there was little to no improvement in dysarthria and expressive language. During the second, 5-month treatment series, however, with tPBM applied first, to the left hemisphere only, and second, to both hemispheres during each session plus simultaneous speech-language therapy, there was marked improvement in the dysarthria and expressive language. After the first 5-month series, this PWA had utilized a slow rate of speech with a production of ∼25 to 30 words-per-minute during conversations and spontaneous speech. Utterance length was only 4-6 words with simple, grammatical structure. After the second, 5-month series of treatment combining tPBM plus speech-language therapy, the rate of speech increased to 80+ words-per-minute and utterance length was increased to 9-10 words, with more complex grammatical structure.

Acceptability, feasibility and preliminary efficacy of low-moderate intensity Constraint Induced Aphasia Therapy and Multi-Modality Aphasia Therapy in chronic aphasia after stroke.

Abstract: BACKGROUND High-intensity Constraint-Induced Aphasia Therapy Plus (CIAT-Plus) and Multi-Modality Aphasia Therapy (M-MAT) are effective interventions for chronic post-stroke aphasia but challenging to provide in clinical practice. Providing these interventions may be more feasible at lower intensities, but comparative evidence is lacking. We therefore explored feasibility, acceptability, and preliminary efficacy of the treatments at a lower intensity. METHODS A multisite, single-blinded, randomized Phase II trial was conducted within the Phase III COMPARE trial. Groups of participants with chronic aphasia from the usual care arm of the COMPARE trial were randomized to M-MAT or CIAT-Plus, delivered at the same dose as the COMPARE trial but at lower intensity (6 hours/week × 5 weeks rather than 15 hours/week × 2 weeks). Blinded assessors measured aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient), word retrieval, connected speech, multimodal communication, functional communication, and quality of life immediately post interventions and after 12 weeks. Feasibility and acceptability were explored. RESULTS Of 70 eligible participants, 77% consented to the trial; 78% of randomized participants completed intervention and 98% of assessment visits were conducted. Fatigue and distress ratings were low with no related withdrawals. Adverse events related to the trial (n = 4) were mild in severity. Statistically significant treatment effects were demonstrated on word retrieval and functional communication and both interventions were equally effective. CONCLUSIONS Low-moderateintensity CIAT-Plus and M-MAT were feasible and acceptable. Both interventions show preliminary efficacy at a low-moderate intensity. These results support a powered trial investigating these interventions at a low-moderate intensity.

Improvement of language function after C7 neurotomy at the intervertebral foramen in patients with chronic post-stroke aphasia: a phase I cohort study

Abstract: ABSTRACT Background: Post-stroke aphasia is a common but intractable sequela which still needs new and more effective treatments. Evidence from follow-ups after contralateral seventh cervical nerve transfer surgery indicated that nerve transection leads to immediate language improvements in patients with right post stroke aphasia. Objective: Through a prospective cohort design, this study aims to prove that C7 neurotomy at the intervertebral foramen (NC7) combined with a 3-week intensive speech and language therapy (iSLT) can improve the language function in post-stroke aphasia patients. Methods: In this study, patients aged over 18 years old and had been diagnosed with post-stroke aphasia for 1 year or longer were included. Primary outcomes were the change in the ability to retrieve personally relevant words in Boston Naming Test (BNT) with follow-up assessment after three weeks' iSLT post operatively. As well as several secondary outcome measures including the Western Aphasia Battery (WAB), daily communication abilities (measured by the Communication Activities of Daily Living Third Edition [CADL 3]) and Fugl-Meyer of upper limb part (UEFM). Results: The average increase of BNT score was 11.2 points from baseline to 3 weeks post operatively (P=0.001, 95%CI: 8.1-14.1). The WAB and CADL-3 assessment showed 9.4, 10.4 points increasing in average (P<0.005, 95%CI: 4.6 to 14.1; P<0.001, 95%CI:6.7 to 14.1) from baseline to 4-week follow-up, respectively. The mean difference from baseline to 3 weeks post-operatively in UEFM score decreased 0.8 points (95% CI: -3.2 to 1.6; p<0.405). Conclusions: NC7 plus iSLT significantly improved the language function in patients with post-stroke aphasia, and did not significantly affect the motor function of the right limb. The mechanism of this surgery needs to be further explored.

The right uncinate fasciculus supports verbal short-term memory in aphasia

Abstract: Abstract Verbal short-term memory (STM) deficits are associated with language processing impairments in people with aphasia. Importantly, the integrity of STM can predict word learning ability and anomia therapy gains in aphasia. While the recruitment of perilesional and contralesional homologous brain regions has been proposed as a possible mechanism for aphasia recovery, little is known about the white-matter pathways that support verbal STM in post-stroke aphasia. Here, we investigated the relationships between the language-related white matter tracts and verbal STM ability in aphasia. Nineteen participants with post-stroke chronic aphasia completed a subset of verbal STM subtests of the TALSA battery including nonword repetition (phonological STM), pointing span (lexical-semantic STM without language output) and repetition span tasks (lexical-semantic STM with language output). Using a manual deterministic tractography approach, we investigated the micro- and macrostructural properties of the structural language network. Next, we assessed the relationships between individually extracted tract values and verbal STM scores. We found significant correlations between volume measures of the right Uncinate Fasciculus and all three verbal STM scores, with the association between the right UF volume and nonword repetition being the strongest one. These findings suggest that the integrity of the right UF is associated with phonological and lexical-semantic verbal STM ability in aphasia and highlight the potential compensatory role of right-sided ventral white matter language tracts in supporting verbal STM after aphasia-inducing left hemisphere insult.

How parents with aphasia deal with children's resistance to requests.

Abstract: Negotiating bedtime or table manners with children can be challenging, probably even more so for parents with aphasia. This study aims to explore how parents with aphasia deal with children's resistance to requests in everyday interactions. It examines the interactional practices of parents with aphasia and their consequences for deontic authority (the right to direct another person's future action). Using conversation analysis, I conducted a collection-based study of request sequences in 10 hours of video recordings involving three parents with aphasia (two with mild and one with severe aphasia). Two different types of child resistance following a parental request were analysed: passive resistance (indicated by the child's inaction) and active resistance (indicated by the child's attempt to bargain or give an account for not doing the requested action). It is shown that all three parents with aphasia respond to passive resistance with pursuits, such as 'hey' and other prompts. However, while the two parents with greater linguistic resources deal with active resistance by seeking compliance with counterarguments and by cautiously upgrading their deontic rights, such fine-tuning is not present when the parent with more limited linguistic resources deals with his child's resistance. This parent uses intrusive physical practices, gestures, increased volume and repetition. This analysis offers insights into practices that appear to affect the ability of these parents with aphasia to negotiate with their children and thus engage in parenting and participate in family life. In order to be able to offer support when engaging with children as desired by parents with aphasia, it is important to gain further insights into how aphasia can affect the organisation of everyday family life.

Right hemispheric structural connectivity and poststroke language recovery

Abstract: Poststroke aphasia typically results from brain damage to the left‐lateralized language network. The contribution of the right‐lateralized homologues in aphasia recovery remains equivocal. In this longitudinal observational study, we specifically investigated the role of right hemisphere structural connectome in aphasia recovery. Twenty‐two patients with aphasia after a left hemispheric stroke underwent comprehensive language assessment at the early subacute and chronic stages. A novel structural connectometry approach, using multi‐shell diffusion‐weighted MRI data collected at the early subacute stage, was used to evaluate the relationship between right hemisphere white matter connectome and language production and comprehension abilities at early subacute stage. Moreover, we evaluated the relationship between early subacute right hemisphere white matter connectome and longitudinal change in language production and comprehension abilities. All results were corrected for multiple comparisons. Connectometry analyses revealed negative associations between early subacute stage right hemisphere structural connectivity and language production, both cross‐sectionally and longitudinally (pFDR < .0125). In turn, only positive associations between right hemisphere structural connectivity and language comprehension were observed, both cross‐sectionally and longitudinally (pFDR < .0125). Interhemispheric connectivity was highly associated with comprehension scores. Our results shed light on the discordant interpretations of previous findings, by providing evidence that while some right hemisphere white matter pathways may make a maladaptive contribution to the recovery of language, other pathways support the recovery of language, especially comprehension abilities.