A consistent white-matter lesion is associated with network-level structural and functional disconnection in chronic Broca's aphasia.

Despite being perhaps the most studied form of aphasia, the critical lesion location for Broca's aphasia has long been debated, and in chronic patients, cortical damage often extends far beyond Broca's area. In a group of 70 patients, we examined brain damage associated with Broca's aphasia using voxel-wise lesion-symptom mapping (VLSM). We found that damage to the posterior portion of Broca's area, the pars opercularis, is associated with Broca's aphasia. However, several individuals with other aphasic patterns had considerable damage to pars opercularis, suggesting that involvement of this region is not sufficient to cause Broca's aphasia. When examining only individuals with pars opercularis damage, we found that patients with Broca's aphasia had greater damage in the left superior temporal gyrus (STG; roughly Wernicke's area) than those with other aphasia types. Using discriminant function analysis and logistic regression, based on proportional damage to the pars opercularis and Wernicke's area, to predict whether individuals had Broca's or another types of aphasia, over 95% were classified correctly. Our findings suggest that persons with Broca's aphasia have damage to both Broca's and Wernicke's areas, a conclusion that is incongruent with classical neuropsychology, which has rarely considered the effects of damage to both areas.

Individuals with severe speech and language impairment as a result of chronic severe Broca's aphasia may rely on non‐speech communication aids to augment or replace speech. These aids include speech‐generating devices and graphic symbol software programs that produce synthetic speech upon activation. Previous research has indicated that individuals with chronic severe Broca's aphasia are able to identify, manipulate, and combine graphic symbols to produce simple phrases and sentences. The primary aim of this study is to evaluate the ability of three individuals with chronic severe Broca's aphasia to produce graphic symbol sentences of varying levels of complexity using a speech generating device. A single‐subject multiple‐baseline design across behaviours replicated across three participants was used to assess the effect of AAC intervention on the production of sentences using graphic symbols. Findings indicated that individuals with chronic severe Broca's aphasia were able to combine graphic symbols to produce sentences of varying levels of complexity. The results of this study suggest that technologically‐based AAC intervention approaches can be effective in facilitating communication for individuals with chronic severe Broca's aphasia. The overall findings are discussed in terms of clinical and public policy implications.

Aphasia is a linguistic problem that occurs after brain damage. It's a broad term that encompasses everything from modest word retrieval challenges to a complete inability to produce and interpret language. Fluent and non-fluent aphasia are two types of aphasia. Non-fluent aphasia is characterized by sluggish, effortful speaking and is caused by a stroke in the left frontotemporal areas. These patients' language production is mainly limited to one- or two-word utterances. Non-fluent aphasic patients can sing fluently despite their significant language production handicap, which has led to the use of singing and music in aphasia rehabilitation. Objective: To examine the effectiveness of Melodic Intonation Therapy (MIT) in patients with chronic Broca's aphasia. Methods: A descriptive study was conducted from March 1 to September 30, 2021, at NUR International University to investigate the efficacy of MIT in patients with persistent Broca's aphasia. For this purpose data was collected from almost 50 speech therapists working with chronic Broca's aphasic patients through a self-designed questionnaire. The questionnaire was used as a data collecting instrument that was designed by expert opinion and literature review. Results: Results indicated that MIT is effective in patients with chronic Broca's aphasia. On asking the respondent about the efficacy of MIT almost 88% responded that MIT is effective, 8% were not sure about the efficacy of MIT and 4% responded MIT is not effective in chronic aphasic patients. On asking the respondent about the development of expressive language 64 % responded that expressive Language is improved while 36 % were not sure about the development of expressive language development. On asking the respondent whether MIT reduces psychological stress on individuals regarding the necessity to speak correctly, 88 % responded with yes while 12 % responded with No that MIT reduces psychological stress. Conclusions: It is concluded from this study that MIT is effective in patients with chronic Broca’s aphasia.

Purpose: Stimulation approach is a therapy technique to improve language production using auditory and visual stimulation. Jellow app is a mobile app designed for compensating for impaired language skills and may be used in the intervention of persons with aphasia. The study aimed to determine the benefits of using the Jellow app as a facilitator of stimulus therapy to improve language and psychosocial domains in chronic Broca's Aphasia. Methods: Ten right-handed male adults with Broca's Aphasia were assessed on WAB and SIQOL39g tests. The control group (n = 5) was enrolled only for stimulation therapy. Pictures of objects were used for therapy with the help of auditory or auditory and visual cues. In the study group (n = 5), along with stimulus therapy, subjects were also trained on the use of icons in the Jellow app to facilitate functional communication needs. After six-months tests were readministered. Results: Post-therapy, on WAB, the improvement in spontaneous speech, repetition, and naming were found to be significantly more in the study group (4.6 ± 0.55, 4.89 ± 0.56, 5.74 ± 0.24 respectively) than the control group (2.6 ± 0.89, 3.22 ± 0.49, 3.97 ± 0.3 respectively) on 2-sample t-test. Similarly, significantly more improvement was seen in the communication domain of SAQOL39g in the study group (2.03 ± 0.17) compared to the control group (1.14 ± 0.45). Conclusion: Use of the Jellow app may be a beneficial adjunct to stimulation therapy for improving linguistic abilities and quality of life in persons with chronic Broca's aphasia. IMPLICATIONS FOR REHABILITATION Following are the implications of this study in the rehabilitation of persons with chronic Broca's Aphasia: • Multimodality in therapy approach in traditional stimulation therapy is beneficial. • AAC Apps like the Jellow app can be used as an adjunct to the traditional stimulation approach of language intervention which facilitates the language abilities like spontaneous speech, repetition, and naming. • Language improvement due to rehabilitation is beneficial in improving the quality of life in this population. • The caregivers must be involved in the therapy program as they act as communication partners and can repeat the therapy tasks at home. • Similar type of study is warranted in a larger population so that people with chronic Broca's aphasia may get the benefit of the latest technology which may be cheaper and easier to use.

Broca's aphasia, a condition characterized by nonfluent speech and difficulty with language production, results from focal brain damage and is most often caused by stroke. Although traditionally linked to lesions in Broca's area (Brodmann areas 44 and 45 in the left inferior frontal gyrus), recent evidence suggests that the neuroanatomy of Broca's aphasia is far more complex, implicating a broader network of cortical and subcortical regions. This study aimed to delineate the specific cortical and white matter features that, when damaged, lead to persistent Broca's aphasia. 39 chronic cases of Broca's aphasia and 41 cases of stroke survivors whose language functions returned to within normal limits (WNL) were included. Lesion analyses and disconnection mapping were conducted using the Brainnetome Atlas and the Lesion Quantification Toolkit (LQT). Results highlighted the critical role of the left insula, particularly its hypergranular and dorsal granular regions, which showed 99.2% and 93.6% lesion overlap, respectively, in Broca's aphasia cases. These regions, along with portions of the motor cortex and the parietal and temporal lobes, contribute to speech production and language processing. Importantly, the traditionally defined Broca's area showed minimal overlap, challenging the conventional understanding of its role in chronic Broca's aphasia. In addition to cortical regions, white matter tract analysis revealed complete disconnection of key pathways, including the arcuate fasciculus, extreme capsule, and middle longitudinal fasciculus. The corticospinal tract and inferior fronto-occipital fasciculus (IFOF) were also heavily disrupted, suggesting that damage to both cortical areas and their structural connections contributes to the hallmark symptoms of Broca's aphasia. These findings emphasize the distributed nature of the neural network underlying Broca's aphasia, extending beyond traditional Broca's area to include multiple cortical regions and their associated white matter tracts. The study provides new insights into the structural basis of language impairment, offering a more nuanced understanding of Broca's aphasia.

Background: Anomia is a debilitating symptom of aphasia, which impacts significantly on patient quality of life. There is strong evidence in the literature to indicate that treatments for anomia are successful for individuals with aphasia, including those in the chronic stage. However, numerous limitations exist within the methodologies of relevant studies. It remains unclear which treatments provide optimal benefits for varying types and severities of aphasia. Aims: The primary aim of this study was to compare the effectiveness of two treatments, Constraint-Induced Aphasia Therapy-Plus (CIATplus) and Multi-modality Aphasia Therapy (M-MAT) for noun retrieval in individuals with severe chronic Broca's aphasia. The secondary aim was to investigate whether the use of verbal constraint is an essential element of therapy. We hypothesised that M-MAT and CIATplus would lead to equally improved naming scores for treated stimuli. Methods & Procedures: Two females with chronic Broca's aphasia (CH and MT) participated in the study. We utilised two single-participant, alternating treatment designs with multiple probes. For each treatment participants received 3.25-hour treatment sessions along with 45 minutes social interaction 4 days a week, for 2 weeks (32 hours total). Treatment involved naming items in the context of turn-taking card games and home transfer request tasks. Naming probes and assessments were conducted at baseline, following each treatment, and at 6 weeks and 3 months post treatment. Outcomes & Results: Both participants differed in their responses to the treatments. However, M-MAT proved equally efficacious as CIATplus for naming of treated items. Overall, generalisation was not observed for any of the measures. CH reported enjoying both treatments, while MT preferred M-MAT. Conclusions: As expected, a number of variables are likely to have contributed to differences in participant responses to treatment. Replication with larger, well-stratified samples is required to better ascertain the effects of CIATplus and M-MAT on anomia in different types and severities of aphasia. This information would contribute to the more effective application of client-tailored treatment practices.

OPINION article Front. Hum. Neurosci., 01 June 2016Sec. Speech and Language Volume 10 - 2016 | https://doi.org/10.3389/fnhum.2016.00249

Previous research suggests that the noradrenergic system modulates flexibility of access to the lexical-semantic network, with propranolol benefiting normal subjects in lexical-semantic problem solving tasks. Patients with Broca's aphasia with anomia have impaired ability to access appropriate verbal output for a given visual stimulus in a naming task. Therefore, we tested naming in a pilot study of chronic Broca's aphasia patients with anomia after propranolol and after placebo in a double-blinded crossover manner. Naming was better after propranolol than after placebo, suggesting a potential benefit from propranolol in chronic Broca's aphasia with anomia. Larger follow-up studies are necessary to further investigate this effect.

Background : The present study describes a treatment approach that was applied to improve word retrieval for an individual with chronic Broca's aphasia. The procedure combined elements of loose training with aspects of structured treatment. Treatment involved presentation of semantic cues according to semantic feature analysis [SFA] (Boyle & Coelho, 1995), as well as a forward chaining technique as in response elaboration training [RET] (Kearns, 1985). The technique was intended to elicit the targeted response by activating a semantic network without inhibiting related or creative responses. Aims : The purpose was to investigate whether the combined SFA-RET treatment approach would improve naming accuracy of object noun pictures. This study also focused on an issue related to degradation in word retrieval, but instead of frequency of occurrence the focus was familiarity. Familiarity was based on to how often the individual with aphasia encountered the object nouns in her everyday life. Methods & Procedures : The individual studied, LP, was a 57-year-old, right-handed female who was 8 years post-onset of a left cerebrovascular accident and demonstrated a moderate to severe Broca's aphasia. LP's naming scores were consistent with a severe impairment and the majority of her paraphasic errors were semantic in nature. Treatment materials consisted of 30 photographs of object nouns, of which 15 represented “high-familiarity” objects and 15 represented “low-familiarity”. The 30 pictures were divided into three sets of 10 pictures. Each set consisted of five high- and five low-familiarity objects. Two sets of pictures were designated as treatment stimuli and the third as the control set. The treatment programme was carried out in an ABA single subject design. After the baseline phase the individual with aphasia was treated for 3 hours per week for 6 weeks and was seen for three follow-up sessions 6 weeks later. Outcomes & Results : Results indicated that the combined SFA-RET treatment resulted in improved naming of the treatment pictures as well as the untreated control pictures. In addition, during the treatment phase naming accuracy and consistency were greater for the high-familiarity than the low-familiarity objects. During the follow-up phase it was noted that the treatment effect was maintained at a higher level for the treatment pictures than for the control pictures. A similar trend was observed for the high- versus the low-familiarity words. Conclusions : These findings indicate that the combined treatment approach described was effective in improving this individual's word retrieval of object nouns. However, it is unclear whether the combined approach was necessary or what the individual contributions of each approach were to the final outcome. Finally, it appeared that LP was able to generate semantic features associated with the high-familiarity words and name the stimulus pictures more easily than the low-familiarity words, perhaps because of her regular contact with those objects in her daily life. This finding supports the contention that personalising treatment stimuli can be an important adjunct to any treatment task.

Language deficits are cardinal manifestations of some frontotemporal dementia (FTD) phenotypes and also increasingly recognized in sporadic and familial amyotrophic lateral sclerosis (ALS). They have considerable social and quality-of-life implications, and adaptive strategies are challenging to implement. While the neuropsychological profiles of ALS-FTD phenotypes are well characterized, the neuronal underpinnings of language deficits are less well studied. A multiparametric, quantitative neuroimaging study was conducted to characterize the involvement of language-associated networks, tracts, and cortical regions with a panel of structural, diffusivity, and functional magnetic resonance imaging (MRI) metrics. Seven study groups were evaluated along the ALS-FTD spectrum: healthy controls (HC), individuals with ALS without cognitive impairment (ALSnci), C9orf72-negative ALS-FTD, C9orf72-positive ALS-FTD, behavioral-variant FTD (bvFTD), nonfluent variant primary progressive aphasia (nfvPPA), and semantic variant PPA (svPPA). The integrity of the Broca's area, Wernicke's area, frontal aslant tract (FAT), arcuate fascicle (AF), inferior occipitofrontal fascicle (IFO), inferior longitudinal fascicle (ILF), superior longitudinal fascicle (SLF), and uncinate fascicle (UF) was quantitatively evaluated. The functional connectivity (FC) between Broca's and Wernicke' areas and FC along the FAT was also specifically assessed. Patients with nfvPPA and svPPA exhibit distinctive patterns of gray and white matter degeneration in language-associated brain regions. Individuals with bvFTD exhibit Broca's area, right FAT, right IFO, and UF degeneration. The ALSnci group exhibits Broca's area atrophy and decreased FC along the FAT. Both ALS-FTD cohorts, irrespective of C9orf72 status, show bilateral FAT, AF, and IFO pathology. Interestingly, only C9orf72-negative ALS-FTD patients exhibit bilateral uncinate and right ILF involvement, while C9orf72-positive ALS-FTD patients do not. Language-associated tracts and networks are not only affected in language-variant FTD phenotypes but also in ALS and bvFTD. Language domains should be routinely assessed in ALS irrespective of the genotype.

Two patients with chronic Broca's aphasia participated in an oral reading treatment program. A multiple baseline design across responses was used. Materials consisted of 90 sentences randomly divided into three groups. Baseline performance was established; then each group of sentences was trained sequentially for 10 sessions. At the end of each session, oral reading performance was probed. For both patients, results indicated increases in accuracy of oral reading of treated materials, with maintenance of performance following termination of treatment. However, generalization to oral reading of untreated material as well as generalization to other oral language tasks were evident only for the aphasic patient with a severe apraxia of speech.

Background: Melodic Intonation Therapy (MIT) is a therapeutic approach used to increase verbal output in adults with aphasia through combination of melodic intoning and rhythmic tapping with simple phrase production. Although MIT was developed in the 1970s, few studies have been conducted relative to determining the programme's overall effectiveness as well as examining ability to generalise skills to other communicative contexts. Aims: The purpose of the current investigation was to examine the effectiveness of MIT as a means of increasing verbal output in a gentleman with chronic Broca's aphasia. Methods & Procedures: A modified version of MIT without the tapping component was implemented with BR, 69-year-old male with chronic Broca's aphasia of 4 years' duration. BR had tried MIT previously with little success: he had difficulty with the tapping element and the packaged phrases lacked functionality, adversely affecting his motivation. A set of automatic and self-generated phrases were developed and implemented with a multiple baseline design across phrase type with an established criterion of 75% accuracy over two consecutive sessions for both stimulus sets. Generalisation stimuli were presented at the last weekly session. BR attended three hour-long weekly sessions, for 8 weeks. Follow-up probing with all stimuli occurred at 2 and 4 weeks post-treatment. A set of standardised tests and social validation measures were administered pre- and post-treatment. Outcomes & Results: BR reached 75% accuracy on automatic phrases at 4 weeks into the treatment programme, which was retained throughout the maintenance phase and both follow-up sessions. Performance on self-generated phrases was 55% at 8 weeks -post-treatment, which was maintained at both follow-up sessions. Separate Welch two s-ample t-tests used to analyse the automatic and self-generated phrase data, yielded highly significant treatment effects for both data sets, with non-significant findings for autocorrelation. Improved performance on standardised tests was observed most no-tably for auditory comprehension and reading and writing skills, with some improvement in spontaneous speech and naming. Increased perception of communicative effectiveness was reported independently by both BR and his spouse. Conclusions: Overall, BR significantly increased his ability to produce short phrases using MIT without tapping. Thus MIT appears to be a viable option for enhancing verbal output for some individuals with non-fluent aphasia, regardless of time post-stroke. Additional investigations are needed to examine generalisation effects to other linguistic contexts. Efficiency issues (treatment length, intensity) require further exploration relative to MIT efficacy and effectiveness and its variations.

Background: Previous research has suggested that semantic plus gesture treatments are effective for aphasic noun retrieval deficits. However, there is a paucity of evidence concerning the efficacy of semantic or gesture treatments for aphasic verb retrieval deficits. As both verbs and arm/hand gestures represent movement concepts, gesture may well be a potent treatment for verb retrieval deficits. Aims: This study investigated the comparative effects of semantic, gesture, repetition, and combined semantic plus gesture treatments for verb retrieval deficits associated with chronic Broca's aphasia. Methods & Procedures: Three women with chronic Broca's aphasia and significant verb retrieval deficits participated in single‐subject multiple‐baseline across conditions designs. Two participants primarily evidenced a word‐form verb retrieval deficit and one a semantic deficit. A total of 100 verb pictures were balanced for relevant lexical factors and divided into five groups of 20 items. Following 10 baseline trials, 20 treatment sessions aimed at improving verb production were completed. Three treatment conditions were simultaneously compared. Treatment of incorrectly named items involved production of an associated noun and the movement and location characteristics of the target verb. Gesture conditions involved production of an iconic gesture. Outcomes & Results: The participant with semantic‐based verb retrieval deficit (MT) showed minimal response to any of the three treatments. Two participants with word‐form impairments (KC and MW) demonstrated significantly improved verb retrieval skills and large treatment effects following all three treatments. KC and MW correctly used treated items in picture description and conversation tasks, and there was a modest amount of generalisation to untreated items. Combined semantic plus gesture treatment was superior for MW, but all three treatments were equally efficacious for KC. Conclusions: The findings support the use of multi‐modal semantic treatments to improve verb retrieval in individuals with aphasic word‐form verb retrieval deficits. Replication is required to achieve a stronger evidence base. Baseline error patterns may be useful in predicting response to treatment.

Background: Verb production difficulties are well documented in individuals with aphasia. Yet there remains limited evidence regarding the efficacy of treatments for verb retrieval in these individuals. While previous studies have generally demonstrated positive treatment outcomes in improving single-verb production on confrontation naming tasks, few studies have attempted to examine therapy outcomes in more natural communicative contexts. Aims: This study aimed to evaluate and compare the effects of repetition, semantic, and combined semantic and gesture treatments for verb retrieval and use in individuals with chronic Broca's aphasia. Methods & Procedures: Two individuals with severe and moderate Broca's aphasia participated in this single-participant, multiple-baseline across conditions design. Participant GF presented with mixed levels of verb retrieval deficits and significant apraxia of speech. Participant PF evidenced verb retrieval impairment arising primarily from the output phonological level. A total of 100 action pictures drawn from various sources were balanced for relevant linguistic factors and individual error rates during baseline naming. Treatments were carried out sequentially. Each treatment condition lasted for ten sessions. Semantic treatments involved the production of various features that were semantically associated with the target verb, including associated nouns, and the movement and location characteristics of the target verb. Gesture treatments involved the production of hand and arm movements representative of the target verb. Outcomes & Results: Both participants differed in their response to treatments. GF exhibited increased verb-naming accuracy following repetition-orthographic and combined semantic and gesture treatments; while PF displayed significant increase in naming accuracy following repetition-only and semantic treatment conditions. For both participants, treatments that resulted in significant increase in naming accuracy were shown to be equally efficacious. Both GF and PF also demonstrated increased verb production in narrative and conversation tasks. PF further evidenced improvements in sentence production on a picture description task post-treatment. Conclusions: These findings highlighted the responsiveness to therapy in two individuals with severe and moderate aphasia in the chronic stages. However, there was no significant change in specific lexical, syntactical and morphological linguistic production in conversation. Future research could explore the incorporation of single verb therapy in sentences and/or more natural communicative environments, to further enhance changes at the discourse level.

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. 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. 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. 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.