Word-finding Research Articles

Neural correlates of spontaneous language production in two patients with right hemispheric language dominance

ABSTRACT Background It is not conclusively explored what kind of reorganisation processes are set off after a stroke with resulting aphasia. Since the development of functional Magnetic Resonance Imaging (fMRI), linguistic processes and their neural representation have been researched, especially in aphasic patients after left hemispheric insult. The situation differs in aphasic patients with crossed aphasia or aphasia after a right hemispheric lesion, for which only few studies have been carried out. In order to close this gap, the present study deals with the localisation of language functions in the brain of patients with crossed aphasia and right hemispheric language dominance. Aim The objective of the current study was to provide insights into the neural correlates of continuous aphasic language production of patients with right hemispheric language dominance. Based on the current state of research, a mirror image representation was expected. Methods & Procedures Two patients with fluent aphasia due to right hemisphere lesions, one presenting with crossed aphasia, described complex pictures. The continuous language output was transcribed and categorised into events. Lexical search (i.e. the difference between unimpaired speaking and word-finding difficulties) was analysed using fMRI. The neural activation clusters were compared with the corresponding areas of a control group consisting of 12 patients with left hemispheric aphasia. Outcomes & Results The analysis of the behavioural data revealed word-finding difficulties as one of the most limiting factors in the spontaneous language output of the patients. The neural correlates of lexical search (unimpaired minus impaired) were observed in four activation clusters both patients had in common. Each cluster was predominantly localised in the contra-lesional hemisphere. Compared to the corresponding areas of the control group, in general, a mirrored image representation could be confirmed. Conclusions The combination of detailed linguistic analysis and fMRI confirmed the assumption of mirrored language organisation for anomia in continuous language production. Moreover, the study might add to a more general understanding of the contribution of the contra-lesional hemisphere to language recovery in aphasia after left or right hemisphere damage.

Prevalence of Verb and Sentence Impairment in Aphasia as Demonstrated by Cluster Analysis

ABSTRACT Background: Verb and sentence processing impairments are frequently observed in people with aphasia (PWA). However, patterns of impairment (i.e. combinations of deficits that are revealed by arrays of tasks) are usually investigated at the group level, by selecting groups of patients with specific aphasia types (e.g., non-fluent variants with signs of agrammatism), or in case-series with relatively small samples. Aims: We aimed to explore patterns of impairment in verb and sentence processing in a large (N = 54) group of PWA with various aphasia types, using methods that do not require a priori aphasia-type information. Methods & Procedures: To assess verb and sentence processing impairments in production and comprehension, we used the Verb and Sentence Test (VAST) adapted to Russian (VAST-Ru). As our main method, we used k-means cluster analysis to group individuals based on their scores on different tasks of the VAST-Ru. We then compared cluster allocations to aphasia types (according to Alexander Luria’s classification) established by a standard clinical evaluation procedure. As a follow up, we investigated performance of each person with aphasia on each task by comparing their individual scores to the control group. Outcomes & Results: The k-means analysis grouped the PWA into two clusters. The main difference between the clusters was the severity of impairment across most of the tasks, both at the single verb and at the sentence level, both in production and in comprehension. All participants with efferent motor aphasia (roughly corresponding to Broca’s aphasia) and most of the participants with acoustic-mnestic aphasia (roughly corresponding to anomic aphasia) were in the less-impaired cluster. Complex aphasia types (complex motor and complex temporal aphasia) pertained to the more-impaired cluster, while other aphasia types (dynamic aphasia, corresponding to transcortical motor, and sensory, corresponding to Wernicke’s aphasia) were more or less evenly distributed over two clusters. Individual-level analysis revealed heterogeneous patterns of impairment in both clusters and across different aphasia types. Conclusions: These results demonstrate that verb and sentence impairments are prevalent in aphasia, irrespective of the aphasia type. They also indicate that aphasia severity mediates verb and sentence impairment in aphasia. We could not find a clear correspondence between individual patterns of impairment and aphasia type at this stage. The clinical implications are discussed.

Quantifying the Interplay of Semantics and Phonology During Failures of Word Retrieval by People With Aphasia Using a Multiplex Lexical Network.

Investigating instances where lexical selection fails can lead to deeper insights into the cognitive machinery and architecture supporting successful word retrieval and speech production. In this paper, we used a multiplex lexical network approach that combines semantic and phonological similarities among words to model the structure of the mental lexicon. Network measures at different levels of analysis (degree, network distance, and closeness centrality) were used to investigate the influence of network structure on picture naming accuracy and errors by people with Anomic, Broca's, Conduction, and Wernicke's aphasia. Our results reveal that word retrieval is influenced by the multiplex lexical network structure in at least two ways-(a) the accuracy of production and error type on incorrect productions were influenced by the degree and closeness centrality of the target word, and (b) error type also varied in terms of network distance between the target word and produced error word. Taken together, the analyses demonstrate that network science techniques, particularly the use of the multiplex lexical network to simultaneously represent semantic and phonological relationships among words, reveal how the structure of the mental lexicon influences language processes beyond traditionally examined psycholinguistic variables. We propose a framework for how the multiplex lexical network approach allows for understanding the influence of mental lexicon structure on word retrieval processes, with an eye toward a better understanding of the nature of clinical impairments, like aphasia.

Design Considerations for Clinical Trials in Aphasia.

The use of the randomised controlled trial (RCT) design to evaluate the effectiveness of new interventions in aphasia has increased in recent years in response to calls for high quality evidence of the effectiveness of interventions for this population. This view-point article highlights some of the important considerations when designing a trial for an aphasia intervention, illustrated with decisions made when designing the Big CACTUS RCT for self-managed computer-based word finding therapy in aphasia. Considerations outlined include whether an RCT is needed, readiness for conducting an RCT, choice of comparators, randomisation options, blinding/masking, selection of outcome measures, pragmatic versus explanatory approaches, and fidelity measurement.

Validity Study of the Cookie Theft Picture Test - Early Detection of Dementia Based on Linguistic Abnormalities

Previous studies have provided inconsistent results regarding discriminatory language variables between subjects with dementia and healthy controls. In this study, using the Cookie Theft Picture Test (CTP), selected language variables are tested for predicting actual diagnoses. 24 healthy subjects and 24 subjects with mild dementia were included in the present study. All language variables except repetitions, word finding difficulties and paraphasias showed significant differences between the groups. The variables pause length and clues increase significantly the likelihood of AD, while the variable sentence length decreases it. Due to the small sample size and insufficient standardization, the study can only be interpreted to a limited extent. Nevertheless, the results indicate that the CTP appears to be suitable for practical use.

명칭실어증 환자의 동음이의어 처리 특성

연구목적: 후천적 뇌손상을 겪은 실어증 환자들은 문맥에 적절한 의미를 활성화하고 불필요한 의미는 효율적으로 억제하는 것에 어려움을 보일 수 있다. 본 연구는 단어 인출 문제를 가진 명칭실어증 환자들을 대상으로 우세 및 열세의미 조건에 따른 동음이의어 처리 특성을 살펴보고자 하였다. 연구방법: 명칭실어증 환자 13명과 일반성인 13명이 연구에 참여하였다. 본 연구의 과제는 마지막 어절에 동음이의어가 포함된 관형구를 본 뒤 해당 동음이의어의 우세의미 또는 열세의미와 관련된 표적단어가 제시되었을 때 의미 관련성을 판단하는 것이었다. 연구결과: 명칭실어증 환자 집단은 일반성인 집단에 비해 정반응 수가 적고 반응시간이 늦은 것으로 나타났으며, 이 같은 차이는 통계적으로 유의미하였다. 또한 두 집단 모두 우세의미 조건보다 열세의미 조건에서 유의하게 적은 정반응 수와 느린 반응시간을 보였다. 결론: 명칭실어증 환자는 일반성인에 비해 동음이의어 의미 처리에 어려움이 있었으나, 사용빈도가 높고 친숙한 우세의미의 경우 상대적으로 정확하고 빠른 수행이 가능하였으며 열세의미의 처리에 더 많은 시간과 노력이 소요되는 경향을 보였다. 본 연구는 명칭실어증 환자의 단어 인출 문제와 의미 처리 과정을 이해함에 있어 경험적 자료를 제안하였다는데 의의가 있다.

A-250 Evidence for Language and Memory Improvements Following Right Anterior Temporal Lobectomy in a Patient with Mixed Language Dominance

Abstract Objective Anterior temporal lobectomy (ATL) surgery for epilepsy is commonly associated with post-surgical impairments in memory and language abilities, specifically episodic memory and confrontational naming. Less is known regarding outcomes of patients with atypical language dominance. Method Casey is a 19 year-old, ambidextrous, male with a history of remote symptomatic medically intractable focal epilepsy secondary to right inferior temporal encephalomalacia. Casey underwent right anterior temporal lobectomy and resection of mesial structures including part of the hippocampus. Results Casey’s pre-surgical neuropsychological evaluation revealed overall intellectual functioning in the average range with relative strengths in perceptual reasoning skills and weaknesses in attention, executive control, confrontational naming, and verbal fluency. Casey’s pre-surgical cognitive profile and functional MRI were suggestive of bilateral language organization. At post-surgical evaluation, Casey demonstrated strong overall cognitive abilities, basic reading, visual–spatial skills, and visual memory, as well as notable improvements in his processing speed and visual-motor integration. He demonstrated significant improvement in verbal working memory, verbal fluency, and contextual verbal memory. Casey continued to show significant weaknesses in word finding, phonetic verbal fluency, and rote verbal learning and memory, and milder weaknesses in aspects of executive functioning. Casey continued to demonstrate mood difficulties. Conclusions The current case provides evidence of continued mild deficits in traditional dominant hemisphere skills including rote verbal memory and focal language abilities, in a patient with a history of mixed language dominance, following right hemisphere ATL surgery. This case further highlights the importance of pre-surgical neuropsychological evaluation and fMRI in patients undergoing right ATL surgery.

A-175 Logopenic Variant of Primary Progressive Aphasia in a 66-Year Old Female—A Case Study

Abstract Objective The semantic, logopenic, and nonfluent/aggramatic variants of primary progressive aphasia (PPA) have distinct clinical profiles. However, much overlap exists and many questions remain regarding the nature of language impairments in each variant. This case study seeks to contribute to our understanding of the neuropsychological profile, syntactic, and phonological processes involved in logopenic variant PPA (lvPPA). Method The current case study was of a 66-year old female who gradually developed symptoms consistent with lvPPA during the prior four-year period, with marked worsening in the last few months. A collateral informant indicated that she was independent for basic and advanced activities of daily living. Brain/head imaging had not been conducted; medical history was unremarkable. Results Speech was notable for frequent pauses due to word-finding difficulty, circumlocution, and impaired naming, repetition, and verbal abstraction; fluency and comprehension were intact. Test data revealed significant impairments in tasks mediated by language including verbal processing speed, semantic knowledge, phonemic and semantic fluency, verbal learning and memory, verbal set-shifting, and judgment. Comprehension, non-verbal attention and processing speed, recognition for visual information, and performance on tasks of non-verbal executive functioning were intact. Depression and anxiety were denied. Conclusions Findings were notable for prominent language deficits, with preserved articulation, basic comprehension, and no evidence of visual agnosia. Her progression of symptoms, medical history, and test data were not consistent with a typical Alzheimer’s or vascular process, but were most consistent with lvPPA. Neurology consultation, MRI brain with volumetric analysis, and speech therapy were recommended.

Therapeutic songwriting as a meaningful, relationship-oriented activity to establish authentic communicative opportunities during therapy for an individual with PPA

ABSTRACT Background Therapeutic songwriting (TSW) is an activity used with people who have neurological and psychological conditions. TSW can act as a tool for assisting people with primary progressive aphasia (PPA) struggling to regain coherence and meaning amidst the psychosocial sequelae that often accompanies this chronic, progressive medical condition. With help from a facilitating clinician, TSW addresses issues of building and maintaining interpersonal relationships in the face of considerable language challenges. Aim This study explored how two different forms of TSW were perceived by a participant with PPA in terms of the quality and meaningfulness of the activity, and as a modality for conducting communication therapy. Methods & Procedures The participant was a 64-year-old woman with the logopenic variant of PPA. She participated in 13 therapy sessions designed to increase her successful use of conversational repair strategies while engaged in TSW using two different techniques: Song Parody Technique (SPT) and modified song Collage Technique (SCT). The participant’s perceptions were measured using the Meaningfulness of Songwriting Scale and a Songwriting Satisfaction and Enjoyment scale. A modified version of the ASHA Quality of Communication Life (ASHA QCL) was administered (pre and post) to measure the extent the participant believed TSW impacted her quality of communication life. The use of spontaneous repair strategies (word finding and picture board) during TSW tasks was tallied from recorded sessions. Outcomes & Results The participant found both forms of TSW meaningful. She enjoyed the activity and indicated creating the two songs was satisfying. She preferred the SPT over the modified SCT. When compared to pre-ASHA QCL measures, the participant felt it “easier to communicate” and to “stay in touch with family/friends”. She rated herself higher in terms of feeling “included”, “seeing the funny things in life”, “trying when people didn’t understand her”, and was more “confident in her ability to communicate”. The use of conversation repair increased from 20% to 80% of the opportunities during TSW. Conclusions Given the risk for psychosocial sequelae that often accompanies PPA, TSW was identified as an authentic, meaningful activity that created connectedness, while working on communication repairs during therapy. Even in the face of declining linguistic and cognitive abilities, TSW provided an opportunity for enriched social interaction, self-expression, motivation, confidence, and enhanced quality of communication. TSW addressed the importance of maintaining relationships in a manner that supported individualized choice and dignity for the participant.

A clinical-radiological framework of the right temporal variant of frontotemporal dementia.

The concept of the right temporal variant of frontotemporal dementia (rtvFTD) is still equivocal. The syndrome accompanying predominant right anterior temporal atrophy has previously been described as memory loss, prosopagnosia, getting lost and behavioural changes. Accurate detection is challenging, as the clinical syndrome might be confused with either behavioural variant FTD (bvFTD) or Alzheimer’s disease. Furthermore, based on neuroimaging features, the syndrome has been considered a right-sided variant of semantic variant primary progressive aphasia (svPPA). Therefore, we aimed to demarcate the clinical and neuropsychological characteristics of rtvFTD versus svPPA, bvFTD and Alzheimer’s disease. Moreover, we aimed to compare its neuroimaging profile against svPPA, which is associated with predominant left anterior temporal atrophy. Of 619 subjects with a clinical diagnosis of frontotemporal dementia or primary progressive aphasia, we included 70 subjects with a negative amyloid status in whom predominant right temporal lobar atrophy was identified based on blinded visual assessment of their initial brain MRI scans. Clinical symptoms were assessed retrospectively and compared with age- and sex-matched patients with svPPA (n = 70), bvFTD (n = 70) and Alzheimer’s disease (n = 70). Prosopagnosia, episodic memory impairment and behavioural changes such as disinhibition, apathy, compulsiveness and loss of empathy were the most common initial symptoms, whereas during the disease course, patients developed language problems such as word-finding difficulties and anomia. Distinctive symptoms of rtvFTD compared to the other groups included depression, somatic complaints, and motor/mental slowness. Aside from right temporal atrophy, the imaging pattern showed volume loss of the right ventral frontal area and the left temporal lobe, which represented a close mirror image of svPPA. Atrophy of the bilateral temporal poles and the fusiform gyrus were associated with prosopagnosia in rtvFTD. Our results highlight that rtvFTD has a unique clinical presentation. Since current diagnostic criteria do not cover specific symptoms of the rtvFTD, we propose a diagnostic tree to be used to define diagnostic criteria and call for an international validation.

Electroencephalographic characteristics of word finding during phonological and semantic verbal fluency tasks.

AimsVerbal Fluency is sensitive to brain damage and is employed to assess language abilities like the size of vocabulary and the semantic‐lexical networks’ integrity and executive functioning abilities particularly inhibition, working memory, and self‐monitoring. Various studies revealed oscillatory changes related to word retrieval during different tasks. However, there are not enough studies on electroencephalographic characteristics of word retrieval routes (phonological or semantic pathway) during free recall. The purpose of our study was to investigate electroencephalography power relationship with semantic and phonological word finding routes during verbal fluency.MethodsIn this within‐subject study, the electroencephalography of 20 healthy participants was recorded during written category and letter fluency tasks and compared with the rest state. Absolute power of the signals in delta (1‐3.5 Hz), theta (4‐7.5 Hz), alpha (8‐12 Hz), and beta (12.5‐30 Hz) was calculated in three lobes (frontal, parietal, and temporal).ResultsA repeated measures ANOVA showed significant interaction of condition × lobe × frequency × side (P < .001). Post hoc test for each lobe showed significant changes in the absolute power of delta, theta and beta for frontal, delta and theta for parietal, and theta and beta for temporal lobes (P‐values < .05).ConclusionSearching the words by phonological entries is associated with decreased beta and increased theta in left frontal lobe. These changes are not necessary for semantic word retrieval strategy.

Pharmacotherapy of Traumatic Childhood Aphasia: Beneficial Effects of Donepezil Alone and Combined With Intensive Naming Therapy.

At present, language therapy is the only available treatment for childhood aphasia (CA). Studying new interventions to augment and hasten the benefits provided by language therapy in children is strongly needed. CA frequently emerges as a consequence of traumatic brain injury and, as in the case of adults, it may be associated with dysfunctional activity of neurotransmitter systems. The use of cognitive-enhancing drugs, alone or combined with aphasia therapy, promotes improvement of language deficits in aphasic adults. In this study we report the case of a 9-year-old right-handed girl, subject P, who had chronic anomic aphasia associated with traumatic lesions in the left temporal-parietal cortex. We performed a single-subject, open-label study encompassing administration of the cholinergic agent donepezil (DP) alone during 12 weeks, followed by a combination of DP and intensive naming therapy (INT) for 2 weeks and thereafter by a continued treatment of DP alone during 12 weeks, a 4-week washout period, and another 2 weeks of INT. Four comprehensive language and neuropsychological evaluations were performed at different timepoints along the study, and multiple naming evaluations were performed after each INT in order to assess performance in treated and untreated words. Structural magnetic resonance imaging (MRI) was performed at baseline. MRI revealed two focal lesions in the left hemisphere, one large involving the posterior inferior and middle temporal gyri and another comprising the angular gyrus. Overall, baseline evaluation disclosed marked impairment in naming with mild-to-moderate compromise of spontaneous speech, repetition, and auditory comprehension. Executive and attention functions were also affected, but memory, visuoconstructive, and visuoperceptive functions were preserved. Treatment with DP alone significantly improved spontaneous speech, auditory comprehension, repetition, and picture naming, in addition to processing speed, selective, and sustained attention. Combined DP-INT further improved naming. After washout of both interventions, most of these beneficial changes remained. Importantly, DP produced no side effects and subject P attained the necessary level of language competence to return to regular schooling. In conclusion, the use of DP alone and in combination with INT improved language function and related cognitive posttraumatic deficits in a child with acquired aphasia. Further studies in larger samples are warranted.

When people living with dementia say 'no': Negotiating refusal in the acute hospital setting.

A quarter of UK acute hospital beds are occupied by people living with dementia (PLWD). Concerns have been raised by both policy makers and carers about the quality of communication between hospital staff and PLWD. PLWD may experience communication impairments such as word finding difficulties, limited ability to construct coherent narratives and difficulties understanding others. Since much healthcare delivery occurs through talk, healthcare professionals (HCPs) and PLWD are likely to experience increased communication barriers. Consistent with this, HCPs report stress and reduced job satisfaction associated with difficulty communicating with PLWD. HCPs face these challenges whilst striving to deliver person-centred care, respecting the autonomy and wishes of the patient before them. However, best practice recommendations in the field tend not to be based on actual interactional evidence. This paper investigates recurring interactional difficulties around HCP requests to carry out health and social care tasks and subsequent reluctance or refusal on the part of PLWD. Using conversation analysis, we examined 41 video recordings of HCP/PLWD interactions collected across three acute inpatient wards. We identify both the nature of the refusals, and any mitigation offered, and explore the requests preceding them in terms of entitlement and contingency. We also explore the nature of HCP requests which precede PLWD agreement with a course of action. We conclude that several features of requests can be seen to precede acceptance, principally the use of higher entitlement requests, and the lowering of contingencies. Our findings underline the importance of examining the contextual interactional detail involved in the negotiation of healthcare, which here leads to an understanding of how design of HCP requests can impact on an important healthcare activity being carried out. They also emphasise the power of conversation analytic methods to identify areas of frequent interactional trouble in dementia care which have not previously been articulated.

Dementia with Lewy bodies presenting as Logopenic variant primary progressive Aphasia

ABSTRACT We report a patient presenting with clinical features of logopenic variant primary progressive aphasia (lvPPA) who was later diagnosed with probable dementia with Lewy bodies. LvPPA is a neurodegenerative disease that is characterized by anomia, word-finding difficulty, impaired comprehension, and phonological errors. The most common underlying pathology for lvPPA is Alzheimer’s disease. However, our patient with clinical features of logopenic progressive aphasia was later diagnosed with probable dementia with Lewy bodies. This case demonstrates that lvPPA can also be an initial manifestation of a phenotype of dementia with Lewy bodies.

Examining the Writing Processes in Scenario‐Based Assessment Using Regression Trees

Scenario‐based writing assessment has two salient characteristics by design: a lead‐in/essay scaffolding structure and a unified scenario/topic throughout. In this study, we examine whether the scenario‐based assessment design would impact students' essay scores compared to its alternative conditions, which intentionally broke the scaffolding effect and/or topic effect. Furthermore, with the availability of rich keystroke log data, we used tree‐based methods to investigate which writing process features had greater influence in predicting students' essay scores under different assessment conditions. The results revealed significantly lower essay scores when the unified topic effect was removed and no significant essay score change when neither scaffolding nor topic effects existed compared to the original scenario‐based assessment condition. The findings also suggested that different assessment conditions call on different configurations of writing process features. The rate of typo correction in the writing process was consistently among the highest ranking features that predicted the essay scores well, regardless of the presence of scaffolding and/or topic effects. The broken topic effect might affect the extent of word finding and retrieval as well as editing across multiple words by the students during writing. Topics for future study and limitations are also discussed.

As dificuldades de encontrar palavras: entre o som e o significado

A sensação de ausência ou inacessibilidade de uma palavra que desejamos encontrar é referida na literatura científica pela sigla WFD (Word Finding Difficulties), fenômeno presente tanto na normalidade quanto em algumas patologias que impactam o funcionamento da linguagem. O objetivo deste artigo é discutir criticamente a autonomia dos níveis linguísticos a partir de dados emergentes no campo das afasias. A metodologia utilizada compreende a análise microgenética de enunciados produzidos por uma senhora afásica, em contextos dialógicos. Tomando como base a Neurolinguística de orientação enunciativo-discursiva, a reflexão integra três campos de investigação científica, dentre os quais tem especial relevância a Linguística desenvolvida por Jakobson. Baseamo-nos também na Neuropsicologia Luriana e na Filosofia da Linguagem desenvolvida pelo Círculo de Bakhtin. Os dados apresentados e analisados deixam entrever, a partir do conceito de indissociabilidade entre som e sentido, a interdependência dos níveis linguísticos e, indo além, da multidimensionalidade presente na rede de enlaces que está subjacente a cada palavra.

Evaluating Change in the Conversation of a Person With Mild Aphasia After Attentive Reading With Constrained Summarization-Written Treatment.

Purpose The purpose of this project was to evaluate the effect of a discourse-level treatment, Attentive Reading with Constrained Summarization-Written (ARCS-W), on conversational discourse. ARCS-W aims to improve spoken and written output by addressing the cognitive-linguistic requirements of discourse production through constrained summarization of novel material. Method This is an experimentally controlled case study with a single participant, Bill. Three conversation samples were collected at pretreatment, and a single conversation was collected 1 month after treatment. The participant completed 24 ARCS-W treatment sessions, and each session included reading and then summarizing a novel current event article following specific constraints (use lexically precise words, stay on topic, use complete sentences) in speaking and writing. Conversation outcomes evaluated the success of each utterance (1-4 scale), grammaticality, and the proportion of utterances with relevant content (relevant utterances). Additionally, behavioral manifestations of word-finding difficulty were evaluated in conversation. Results Bill improved communicative success at the utterance level based on the minimal detectable change. He also demonstrated reductions in behavioral manifestations of lexical retrieval difficulty based on decreases in the percentage of false starts (e.g., t*, t*), mazes (e.g., uh, s*, um), and abandoned utterances. Bill did not increase the proportion of relevant utterances or grammatical utterances in conversation. Conclusions This case study provides preliminary evidence of the potential impact of ARCS-W treatment in conversation. Additionally, the measures implemented to evaluate conversation represent a promising adaptation of a novel methodology to capture change in conversation. Supplemental Material https://doi.org/10.23641/asha.12375053.

Unusual cortical symptoms of dural arteriovenous fistula mimicking transient ischemic attack

ABSTRACT The clinical presentation of dural arteriovenous fistula (DAVF) can vary. A 47-year-old man complained of transient difficulty playing badminton and speech disturbance for 10 minutes. His symptoms were suspected to be visuomotor coordination deficit similar to optic ataxia and anomic aphasia. Magnetic resonance imaging and angiography revealed vasogenic edema and perfusion delay in the left temporo-occipital area and an abnormal connection between the left occipital artery and transverse sinus. Transverse sinus DAVF was diagnosed by conventional cerebral angiography. We believe that this is the unique case of DAVF manifested as visuomotor coordination deficit suspected optic ataxia and anomic aphasia.

Een sensitieve snelle benoemtest voor woordvindproblemen bij patiënten met een laaggradig glioom

Patiënten met een laaggradig glioom (langzaam groeiende hersentumor) rapporteren vaak woordvindproblemen, terwijl deze met de huidig gebruikte benoemtests in de praktijk vaak niet geobjectiveerd worden. In deze studie worden de resultaten van een sensitieve snelle benoemtest (SBT) voor objecten besproken, toegepast bij deze patiëntengroep.&#x0D; Via deze nieuwe test werden reactietijden verzameld van 18 patiënten met een vermeend laaggradig glioom en van 20 gezonde participanten. Om uit te sluiten dat bij glioompatiënten tragere reactietijden worden gevonden als gevolg van algehele cognitieve traagheid, zijn de resultaten van een test voor cognitieve snelheid (Trail Making Test-A, TMT-A) meegenomen in het onderzoek. De resultaten op de SBT zijn vergeleken met de resultaten op de klinisch veel gehanteerde Boston Naming Test (BNT) om zo de toegevoegde waarde van de SBT te kunnen evalueren. Tevens is het effect van woordfrequentie en Age of Acquisition (AoA) op de benoemtijden onderzocht. Glioompatiënten waren significant langzamer in het benoemen van de objecten dan de gezonde participanten. De tragere reactietijdenwerden niet verklaard door een algeheel tragere verwerkingssnelheid. Ook de BNT-scores konden de lagere reactietijden op de SBT niet verklaren. Een kwalitatieve vergelijking tussen de resultaten van de BNT en de SBT duidde op een hogere sensitiviteit van de SBT voor woordvindproblemen. In de groep gezonde participanten wordt een effect gevonden van woordfrequentie en AoA op de benoemsnelheden, in de patiëntengroep is echter geen effect van deze variabelen waar te nemen.&#x0D; De resultaten laten een duidelijk verschil in benoemsnelheid zien tussen laaggradige glioompatiënten en gezonde participanten, terwijl patiënten zelden een afwijkende score behaalden op de BNT. Het lijkt zinvol om de SBT te gebruiken in de klinische praktijk, waarbij reactietijden als een belangrijk component meegenomen worden voor het diagnosticeren van woordvindproblemen bij glioompatiënten.

Naming gains and within-intervention progression following semantic feature analysis (SFA) and phonological components analysis (PCA) in adults with chronic post-stroke aphasia

ABSTRACT Background: Up to 60% of people with aphasia experience persistent word-finding difficulties into the chronic stage, starting six months after the stroke. Semantic Feature Analysis (SFA) and Phonological Components Analysis (PCA) are two common word-finding interventions that use the generation of semantic features for SFA (e.g. category) and phonological features for PCA (e.g. first sound) to improve naming. Despite inconsistent support for the generalization to untreated items, studies have shown improvements on probe word naming for treated items. However, research concerning within-intervention effects and generalization to alternative contexts has been limited. Aim: This study investigated the effect of treatment for SFA and PCA probe word naming as well as their within-intervention effects in four individuals with chronic post-stroke aphasia. Methods & Procedures: Baseline and follow-up measures included standardized assessments and image naming tasks. The image naming task was used to generate three lists: an SFA treated list, a PCA treated list, and an untreated list. One SFA session and one PCA session per week were then provided concurrently to each participant for a period of six weeks. Outcomes & Results: While only one participant experienced significant gains on treated probe word naming, these gains were maintained four weeks after the intervention. Exploratory results suggested that effects could transfer to two types of generalization items: different pictures of the same items and pictures of items shown in a natural context. Furthermore, while generalization to untreated items did not reach significance for any participant, some generalization of gains to standardized assessments was observed. Although rarely equivalent for SFA and PCA interventions, all participants also experienced some degree of within-intervention improvement over the progression of sessions. These improvements included a reduction in the number of forced choices required for feature generation and/or a reduction in the number of words never named during intervention sessions. Conclusion: The results support additional avenues of investigation for SFA and PCA therapies for individuals with post-stroke aphasia, namely within intervention effects and the potential for generalization to different contexts.