Aphasia Group Research Articles

Community Integration and Quality of Life in Aphasia after Stroke.

PurposeTo examine community integration and contributing factors in people with aphasia (PWA) following stroke and to investigate the relationship between community integration and quality of life (QOL).Materials and MethodsThirty PWA and 42 age-and education-matched control subjects were involved. Main variables were as follows: socioeconomic status, mobility, and activity of daily living (ADL) (Modified Barthel Index), language function [Frenchay Aphasia Screening Test (FAST)], depression [Geriatric Depression Scale (GDS)], Community Integration Questionnaire (CIQ) and Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39). Differences between aphasia and control groups and factors affecting community integration and QOL were analyzed.ResultsHome and social integration and productive activity were significantly decreased in the aphasia group compared to the control group; 8.5 and 18.3 points in total CIQ score, respectively. Amount of time spent outside the home and frequency of social contact were also significantly reduced in the aphasia group. Total mean score on the SAQOL-39 was 2.75±0.80 points and was significantly correlated with economic status, gait performance, ADL, depressive mood, and social domain score on the CIQ. Depression score measured by GDS was the single most important factor for the prediction of QOL, but the FAST score was significantly correlated only with the communication domain of the SAQOL-39.ConclusionCommunity activities of PWA were very limited, and depression was highly associated with decreased community integration and QOL. Enhancing social participation and reducing emotional distress should be emphasized for rehabilitation of PWA.

The Effects of Verb Argument Complexity on Verb Production in Persons with Aphasia: Evidence from a Subject-Object-Verb Language.

The purpose of the study was to investigate the effects of verb argument complexity on verb production in individuals with aphasia using a verb-final language. The verb-argument complexity was examined by the number of arguments (1-, 2-, and 3-place) and the types of arguments (unaccusative vs. unergative comparisons). Fifteen Korean-speaking individuals with aphasia and 16 normal controls participated in the study. A confrontation naming task was used to elicit verb production with a total of 36 items for each verb type (1-place unergative, 1-place unaccusative, 2-place, and 3-place verbs). Individuals with aphasia presented lower mean percentage correctness in 3-place than in 1-place verbs, and showed differentially greater difficulties with unaccusative constructions than with unergative verbs, compared to the control group. The effects of verb-argument complexity were clearly observed in Korean-speaking individuals with aphasia. The effects of the number of arguments were observed most clearly in Broca's and Wernicke's types of aphasia and individuals with lower overall aphasia severity. The effects of Korean unaccusativity manifested across aphasia groups. General patterns of verb-argument complexity in Korean were consistent with previous findings in English.

Communication Recovery Groups for Persons with Aphasia: A Replicable Program for Medical and University Settings

This article describes Communication Recovery Groups (CRG), an aphasia group program that is sponsored by a medical setting and more recently a university setting. CRG's history and approach and its model of service in light of current healthcare challenges are summarized. The article also provides a detailed discussion regarding the logistics of offering conversation groups to persons with aphasia which are sponsored by medical and/or university settings, the intake process for new group members, and the training of student volunteers to help lead conversation groups.

The effects of instrumentality and name relation on action naming in Russian speakers with aphasia

Background: A verb’s instrumentality and name relation to an associated instrument noun are among the factors influencing verb retrieval in speakers with aphasia. Previous data on the effects of these factors are equivocal, possibly due to language- and task-specific factors.Aims: The present study aimed to investigate the nature of the instrumentality and verb-noun name relation effects by retesting them in a large sample of Russian-speaking individuals with fluent and non-fluent aphasia.Methods & Procedures: Forty Russian-speaking individuals with aphasia (twenty with fluent and twenty with non-fluent aphasia) and twenty controls performed an action naming task. Overall accuracy scores and qualitative error types were analysed.Outcomes & Results: A positive effect of instrumentality was found in both groups of individuals with aphasia. A negative effect of verb-noun name relation was found in non-fluent aphasia and was larger for verbs with a smaller overlap with the instrument noun. In both aphasia groups, semantically related errors were more numerous for non-instrumental than instrumental verbs, whereas phonological errors were more numerous for name-related than non-name-related instrumental verbs.Conclusions: The positive effect of instrumentality on verb retrieval may be attributed to a facilitatory effect of richer conceptual representations of instrumental verbs. The negative effect of name relation on verb retrieval may be explained by interference of the phonological form of the instrument noun. These factors influence verb retrieval in aphasia and should be taken into account when developing testing/treatment materials and stimuli for experimental studies.

Quantifying the Effort Individuals With Aphasia Invest in Working Memory Tasks Through Heart Rate Variability

The objective of this study was to quantify cognitive effort that individuals with aphasia and neurologically intact participants dedicate to verbal compared with spatial working memory tasks by using a physiological measure of effort: heart rate variability (HRV). Participants included 8 individuals with aphasia and 19 neurologically intact adults. Participants completed 3 verbal and 3 spatial working memory tasks that varied in difficulty. Performance accuracy and effort allocated to tasks was recorded. Effort was quantified as the change in the 0.07-0.14 Hz band of HRV from baseline to task conditions. Results indicated that individuals with aphasia and control participants allocated effort to verbal and spatial working memory tasks. Unlike the control participants, participants with aphasia did not differentially invest effort based on task difficulty. Neither group allocated effort differentially based on task type. Results of the physiological data provide preliminary support for accounts indicating that individuals with aphasia do not properly allocate effort to cognitive-linguistic tasks. Analysis of the Group × Difficulty interaction indicated that the aphasia group did not allocate extra effort when it was required. The lack of a difference in HRV for spatial and verbal tasks suggests that this difference is not specific to verbal stimuli.

Activation of syntax in lexical production in healthy speakers and in aphasia

Theories of spoken word production agree that semantic and phonological representations are activated in spoken word production. There is less agreement concerning the role of syntax. In this study we investigated noun syntax activation in English bare noun naming, using mass and count nouns.Fourteen healthy controls and 13 speakers with aphasia took part. Participants named mass and count nouns, and completed a related noun syntax judgement task. We analysed speakers' noun syntax knowledge when naming accurately, and when making errors in production.Healthy speakers' noun syntax judgement was accurate for words they named correctly, but this did not correlate with naming accuracy. Speakers with aphasia varied in their noun syntax judgement, and this also did not correlate with naming accuracy. Healthy speakers' syntax for semantic errors was less accurate, as was that for speakers with aphasia. For phonological errors half the participants with aphasia could access syntax, half could not, indicating two types of phonological error. Individual differences were found in no responses. Finally, we found no effect of frequency for any of the above.The lack of a relationship between syntax and naming accuracy suggests that syntax is available, but access is not obligatory. This finding supports theories incorporating non-obligatory syntactic processing, which is independent of phonological access. The semantic error data are best explained within such a theory where there is damage to phonological access and hence to independent syntax. For the aphasia group we identify two types of phonological error, one implicating syntax and phonology, and one implicating phonology only, again supporting independent access to these systems. Overall the data support a model within which syntax is independent of phonology, and activation of syntax operates flexibly dependent on task demands and integrity of other processing routines.

Impairment and Functional Interventions for Aphasia: Having it All.

Aphasia, a cognitive-linguistic disorder secondary to stroke, is a frequent and often chronic consequence of stroke with detrimental effects on autonomy and health-related quality of life. Treatment of aphasia can be approached in a number of ways. Impairment-based approaches that focus on training a specific linguistic form can be implemented. Additionally, functionally oriented intervention such as supported conversation and aphasia groups are also frequently utilized when providing a treatment program for an individual with aphasia. Creating a treatment approach that includes both impairment and functional methodologies and considers how these relate to the three domains proposed by the International Classification of Functioning Disability and Health (ICF)-body functions and structure, activity, and participation-can provide an individual with aphasia an optimal treatment program that is person-centered and multi-faceted.

The anterior temporal lobes support residual comprehension in Wernicke’s aphasia

Wernicke's aphasia occurs after a stroke to classical language comprehension regions in the left temporoparietal cortex. Consequently, auditory-verbal comprehension is significantly impaired in Wernicke's aphasia but the capacity to comprehend visually presented materials (written words and pictures) is partially spared. This study used functional magnetic resonance imaging to investigate the neural basis of written word and picture semantic processing in Wernicke's aphasia, with the wider aim of examining how the semantic system is altered after damage to the classical comprehension regions. Twelve participants with chronic Wernicke's aphasia and 12 control participants performed semantic animate-inanimate judgements and a visual height judgement baseline task. Whole brain and region of interest analysis in Wernicke's aphasia and control participants found that semantic judgements were underpinned by activation in the ventral and anterior temporal lobes bilaterally. The Wernicke's aphasia group displayed an 'over-activation' in comparison with control participants, indicating that anterior temporal lobe regions become increasingly influential following reduction in posterior semantic resources. Semantic processing of written words in Wernicke's aphasia was additionally supported by recruitment of the right anterior superior temporal lobe, a region previously associated with recovery from auditory-verbal comprehension impairments. Overall, the results provide support for models in which the anterior temporal lobes are crucial for multimodal semantic processing and that these regions may be accessed without support from classic posterior comprehension regions.

Measuring the coherence of healthy and aphasic discourse production in Chinese using Rhetorical Structure Theory (RST)

Measuring the coherence of healthy and aphasic discourse production in Chinese using Rhetorical Structure Theory (RST)

Exploring the Benefits of Unilateral Nostril Breathing Practice Post-Stroke: Attention, Language, Spatial Abilities, Depression, and Anxiety

Unilateral nostril breathing (UNB) is a yogic pranayama technique that has been shown to improve verbal and spatial cognition in neurologically intact individuals. Early study of UNB in healthy individuals has shown benefits for attention and memory. This preliminary study explored whether UNB influenced various measures of attention, language, spatial abilities, depression, and anxiety in post-stroke individuals, both with and without aphasia. A within-subjects repeated-measures design was used to determine whether UNB improved cognitive, linguistic, and affect variables in post-stroke individuals. Within-subjects comparisons determined UNB's effects over time, and between-subjects comparison was used to determine whether changes in these variables differed between post-stroke individuals with and without aphasia. Athens and Atlanta, Georgia. Eleven post-stroke individuals participated in a 10-week UNB program. Five individuals had stroke-induced left hemisphere damage with no diagnosis of aphasia (left hemisphere damage control group; LHD), and six individuals experienced left hemisphere damage with a diagnosis of aphasia (individuals with aphasia group; IWA). Individuals were assessed on measures of attention, language, spatial abilities, depression, and anxiety before, during, and after UNB treatment. UNB significantly decreased levels of anxiety for individuals in both groups. Performance on language measures increased for the individuals with aphasia. Significant findings for language and affect measures indicate that further investigation regarding duration of UNB treatment and use of UNB treatment alongside traditional speech-language therapy in post-stroke individuals is warranted.

A correlativity study of amplitude of low frequency fluctuation change of resting·state brain activity and a·- phasia quotient in aphasia patients after stroke

Objective To study a correlativity of amplitude of low frequency fluctuation change of resting-state brain activity and aphasia quotient in aphasia patients after stroke and investigate recovery and mechanism of the aphasia. Methods Adopting amplitude of low-frequency fluctuation (ALFF) in blood oxygenation level dependent functional MRI(BOLD-fMRI) and Siemens version 3.0T MR Scanner was used to obtain 12 aphasia patients and 20 normal volunteers of fMRI data.The fMRI data were processed with the software of DPARSF and analyzed by ALFF, and group analysis was performed with two sample t-test by REST software to obtain increased and decreased ALFF map.Brain regions, in which, ALFF of aphasia group was lower than that of normal control group, were done correlation analysis with aphasia quotient. Results As compared with those in normal subjects, the regions showing decreased ALFF in aphasia patients were distributed in left middle temporal gyrus, left medial prefrontal gyrus, right cerebellum, which were positively correlated with aphasia quotient(rRoi1=0.48, rRoi2=0.36, rRoi3=0.28, respectively); while the regions showing increased ALFF covered left occipital lobe, precentral gyrus, insula, right precuneus. Conclusion As compared with those in normal subjects, the regions positively correlated with aphasia quotient show decreased ALFF in aphasia patients, which are one of the mechanisms of aphasia.The regions increased ALFF in aphasia patients may participate in language function of recovery. Key words: Aphasia; Resting state; Amplitude of low frequency fluctuation; Correlation analysis

Processing of emotional words after stroke: An electrophysiological study

ObjectiveAuditory evoked potentials (EP) were used to examine the neural processing of personal–emotional and neutral words, in a group of 14 people with post-stroke aphasia and an equal sized control group to determine whether the EP differed between groups and word types. MethodsEffects of the emotional value of the words and participant group were assessed on EP. Latencies and amplitudes of EP were analyzed for the two groups (aphasia and control) in response to word type (emotional and neutral). ResultsN1 amplitudes were smaller and P2 and P3 were delayed in the aphasia group, for both word types, indicating effects of stroke on processing of both neutral and emotional words. P3 amplitudes were larger for emotional words in both groups. These differences in late cortical responses between word types for both groups suggest distinct neural networks involved in the response to emotional and neutral words, even with post-stroke language impairment. ConclusionsThe neurophysiological processing of affective speech in aphasia has been revealed. This opens up the interpretation of these results to the critical assessment and therapeutic identification of emotional language in people with aphasia. SignificanceThis study has implications not just for aphasia but allows for further exploration of other neurological conditions.

The efficacy of outpatient and community-based aphasia group interventions: A systematic review

This paper examines the evidence for community and outpatient aphasia groups using the International Classification of Functioning, Disability and Health (ICF) framework. A systematic search of the literature using eight electronic databases was completed; 29 studies met inclusion and exclusion criteria. Level of evidence and methodological quality was assessed and effect sizes calculated where possible. Evidence favouring community and outpatient groups centred on four level ii and level iii-i studies that examined the efficacy of highly structured group activities for improving specific linguistic processes with five medium–large effect sizes calculated. Medium and large effect sizes were also calculated on a level iii-i study examining number of friendships and community access. No effect sizes were available for level ii or level iii studies examining communication activity and participation. Overall, the results indicate that community and outpatient group participation can improve specific linguistic processes. There is also some evidence that group participation can benefit social networks and community access. However, there is limited evidence demonstrating improvement in functional communication as a consequence of group participation. The current evidence is not comprehensive. Further well-designed studies, particularly examining activity and participation, and contextual factors are required to advance community and outpatient aphasia group practice and participation.

Identification of target tones and speech sounds studied with event-related potentials: Language-related changes in aphasia

Background: Although frequently observed in aphasia, the contribution of speech sound processing impairments to auditory comprehension deficits has not been clarified. Event-related brain potentials can be used to investigate the neural processes underlying speech sound processing in aphasia, thereby adding information to investigations exclusively based on behavioural assessments. Aims: Against the background of previous findings of reduced amplitudes in an aphasic group during a syllable identification task, three main research questions are pursued in this study: whether possible ERP alterations in the aphasia group (1) are specific for language processing or can also be observed in non-language processing, (2) are also found in brain-injured persons without aphasia, and (3) correlate with auditory comprehension deficits. Methods & Procedures: Here 10 aphasic participants were compared with 10 non-aphasic participants who had right hemisphere lesions and with 18 healthy controls. Event-related brain potentials (ERPs) were obtained during two oddball paradigms in which the participants had to identify: (i) target tones differing in pitch and (ii) target syllables differing in the initial consonant. Outcomes & Results: Overall the aphasic participants performed the task successfully, but responded correctly to fewer targets and had prolonged response times. When compared to healthy controls, N1 amplitude was reduced in both brain-damaged groups; in response to syllables, this attenuation was more pronounced in the aphasic participants. The aphasia group demonstrated significantly reduced N1 amplitude in response to standard and target tones and target syllables, while the right hemisphere group had significantly reduced N1 amplitudes in response to tones only (both standard and target). In both brain-injured groups, N1 amplitudes were larger over the contralesional hemisphere. This hemisphere difference was significantly larger for syllables than tones in the aphasic participants. Furthermore this group had delayed N2 and P3 latencies, whereas N2 amplitude reduction was found in the right hemisphere group. Conclusions: The present results indicate reduced early attentional processing and delayed subsequent processing in aphasia. In addition to disturbed non-linguistic auditory processing, the present results suggest impairments in speech sound related processing in aphasia occurring as early as at 100 ms post-stimulus. Topographical distribution patterns in the aphasia group suggest a larger right hemisphere involvement in the processing of syllables than for tones.

Behavioral disturbances differentiate frontotemporal lobar degeneration subtypes and Alzheimer's disease: evidence from the Frontal Behavioral Inventory

Behavioral assessment is useful for the diagnosis of frontotemporal lobar degeneration (FTLD). We explored the ability of the Frontal Behavioral Inventory (FBI) to discriminate between patients with distinct subtypes of FTLD and patients with Alzheimer's disease (AD), as well as the influence of demographic variables on FBI scores. The FBI was administered to the caregivers of 87 patients diagnosed with FTLD [64 behavioral variant FTLD, 19 aphasic variant FTLD (primary progressive aphasia), and 4 motor/extrapyramidal variant (corticobasal syndrome)] and 30 patients with AD. Patients with AD were older than patients with FTLD. The two groups did not differ with respect to duration of illness, level of education, or sex ratio. Age significantly predicted disinhibited positive behaviors, such as perseverations and irritability, whereas education did not contribute to FBI ratings. Classification accuracy for the discrimination of AD and mixed FTLD groups was 81%. Moreover, 88.3% and 83.7% accuracy was achieved for the discrimination of AD and behavioral variant FTLD, and AD and primary progressive aphasia groups, respectively. The Total Negative subscale of the FBI, which summarizes the presence of deficit (negative) behaviors, was the best discriminator. A cut-off score of 17 provided 83% sensitivity and 98% specificity in distinguishing between FTLD and AD patients. The FBI is a sensitive and specific tool for the differential diagnosis of FTLD from AD. The optimal cut-off point for the detection of FTLD patients was lower than that initially proposed.

Considering a multi-level approach to understanding maintenance of global coherence in adults with aphasia

Background: Discourse is a naturally occurring, dynamic form of communication. Coherence is one aspect of discourse and is a reflection of the listener's ability to interpret the overall meaning conveyed by the speaker. Adults with aphasia may present with impaired maintenance of global coherence, which in turn may contribute to their difficulties in overall communicative competence. Aims: The aim of the study was to determine if microlinguistic processes contribute to maintenance of global coherence in adults with and without aphasia. Method & Procedures: Participants included 15 adults with aphasia (PWA) and 15 healthy controls (HC). Study participants told stories conveyed in wordless picture books. The discourse samples were transcribed and then analysed for percent of information units produced, lexical diversity, syntactic complexity, and maintenance of global coherence. Outcomes & Results: Several linear regression models were carried out to investigate the relationship among the microlinguistic and macrolinguistic measures. For the control group, percent of information units conveyed was a significant predictor of maintenance of global coherence for stories told. For the aphasia group, percent of information units conveyed and lexical diversity were significant predictors of maintenance of global coherence for stories told. Conclusions: Results indicated that microlinguistic processes contribute to the maintenance of global coherence in stories told by adults with aphasia. These findings have important clinical implications for using a multi-level discourse model for analysing discourse ability in adults with aphasia and measuring individual response to treatment.

Expressing Opinions and Feelings in a Conversational Setting

This article examines the ways in which individuals with aphasia communicate opinions and feelings using evaluative language during conversation in an aphasia group. Evaluative language refers to semantic resources conveying emotions, judgments, and valuations and includes emotive adjectives, nouns, verbs, and adverbs as well as metaphor. Although individuals with aphasia are known to be able to use evaluative language in a monologic context, little is known about how people with aphasia use evaluative language in conversation, or about the role of co-construction in such usage. The data for this study were collected during a conversation group consisting of five participants with aphasia and a facilitator. The analysis used is based on Appraisal theory (Martin and White 2005) and examined the evaluation categories of Affect, Appreciation, Judgment, and Graduation. Regardless of severity, all aphasic speakers contributed an equal amount of evaluation to the interaction and demonstrated some usage of all types of evaluation. However, those with more severe aphasia relied heavily on their conversational partners to scaffold their opinions and used a range of resources including lexical items, such as exactly, and repetition (e.g., "yeah yeah yeah") to agree emphatically with opinions expressed. Lexical variety was notably less in the aphasic speakers than the non-brain-damaged group facilitator. The article discusses the patterns of skills observed together with the clinical implications for working with people with aphasia on emotional meanings.

Integration of diffusion tensor-based arcuate fasciculus fibre navigation and intraoperative MRI into glioma surgery

This study was designed to evaluate the feasibility and efficacy of diffusion tensor-based arcuate fasciculus (AF) fibre navigation in combination with 1.5-Tesla (1.5-T) intraoperative MRI (iMRI) for the resection of gliomas involving eloquent language fibre tracts (AF tracts). Twenty patients with AF tract-involved gliomas in the dominant hemisphere were prospectively enrolled. The patients were divided into two groups. The normal group included nine patients with preoperative intact language function, while the aphasia group consisted of 11 patients who presented with different levels of conduction aphasia. The AF tractography results were integrated into three-dimensional (3D) datasets used for neuronavigation, and their course was superimposed onto the surgical field during glioma resection. The iMRI was used to compensate for the effects of brain shift and to evaluate the extent of resection. Fibre tract visualisation provided a quick and intuitive overview of the displaced course of the AF in 3D space and the surgical field under a microscope. At a 3-month to 6-month follow-up, only two patients from the normal group suffered exacerbated language deficits due to tumour recurrence. Meanwhile, language function in all patients in the aphasia group had improved. Therefore, AF neuronavigation, combined with 1.5 T iMRI, is a feasible method of maximising resection and minimising language deficits when removing gliomas that involve the AF.

Verbal fluency in Alzheimer's disease and Aphasia

This study examined the impact of two neurological diseases on access to semantic knowledge and the status of semantic representations. Patients with Alzheimer's disease (AD) and Aphasia (APH) were compared with control groups using the supermarket fluency task. We measured several aspects: number of category names produced, number of categories sampled to produce the words, the number of words per category sampled, number of exemplars and kinds of errors recorded. Both AD and APH groups produced significantly fewer words on the fluency task than control groups. As compared with the APH and control groups, in the AD group verbal fluency was characterized by a tendency to generate more category names with fewer exemplars within a category. The findings are consistent with the view that a bottom-up disruption in semantic knowledge occurs in AD and a general semantic disruption occurs in Aphasia.

Teaching Nursing Assistant Students about Aphasia and Communication

Research indicates that communication between patients with communication disorders and their health care providers may be compromised, which leads to adverse outcomes and reduced participation in patients' own health care. Emerging studies demonstrate that effective communication education programs may decrease communication difficulties. This feasibility study of an education program that includes people with aphasia as educators aims to improve nursing assistant students' knowledge of aphasia and awareness of supported communication strategies while also examining the experiences of participants with aphasia. This preliminary study suggests that explicit aphasia and communication training delivered in this format has positive learning outcomes for nursing assistant students and potential psychosocial benefits to participants with aphasia. The format can be modified for a variety of health care audiences and lends itself to implementation by community aphasia groups and centers.