Prognosis Of Aphasia Research Articles

Aphasia outcome: the role of diffusion tensor tractography in patients with acute ischemic stroke

BackgroundsRecovery for poststroke aphasia has a decelerating trajectory, with the greatest improvement is within weeks and the slope of change decreasing over time. Therefore, it is essential to predict the prognosis of aphasia at an early stage as it could provide useful data in specific plans for management strategies. The aim of this work was to assess the arcuate fasciculus in stroke patients with aphasia and its impact on predicting the outcome. A prospective study was performed including 25 patients with acute ischemic stroke and aphasia and 10 healthy control subjects with no history of neurologic or psychiatric disease. All patients underwent language assessment using an Arabic version of the Comprehensive Aphasia Test (Arabic CAT), with the resultant mean T-score aphasia quotient (AQ). Early assessment of stroke and delayed assessment at three months. All patients had diffusion-weighted magnetic resonance imaging (DWI-MRI) of the brain to localize the lesion and 3D diffusion tensor imaging (DTI) of the arcuate fasciculus (AF) within 30 days of stroke.ResultsPatients in whom the AF could not be reconstructed had a poor score in early and late AQ and a poor prognosis compared to those in whom the AF could be reconstructed. Preservation of the left AF on DTI could mean the potential recovery of aphasia after stroke.ConclusionThe prognosis of aphasia in patients whose left AF could be reconstructed was better than those whose left AF could not be reconstructed, irrespective of the AF's integrity. That is why, we can assume that evaluation of the DTI of the left AF at early stages of stroke can help in predicting outcome of aphasia.

The Relationship Between Visuoconstructive Abilities and Language Performance in Patients With Aphasia After Stroke.

This study aimed to investigate the visuoconstructive abilities and the relationship between visuoconstructive function and language performance in aphasic patients. Right-handed 24 aphasic patients (males 14, females 10) with at least 3 months post-stroke and 32 age-matched healthy controls participated in this study. Visuoconstructive function was assessed by 3 levels of task difficulty: simple (drawing objects), intermediate (clock drawing), and complex (copy subtest of Rey complex figure test and block construction). Aphasic patients were divided into 3 sub-groups (mild, moderate to severe, and very severe group) according to severity of aphasia and compared with the control group, respectively. We analyzed the relation all levels of visuoconstructive tasks to aphasia quotient (AQ) and sub-domain scores of K-WAB. Moderate to severe aphasia group demonstrated no significant differences in scores of simple drawing objects compared to controls, but clock drawing, Rey complex figure copy and block design showed significantly decreased scores. Very severe group showed significantly lower scores in all levels of visuoconstructive tasks than the control. Correlation between all levels of visuoconstructive tasks except drawing objects and AQ were found to be statistically significant. Among the tasks, the clock drawing test revealed the highest correlation with language performance. Visuoconstructive abilities varied according to the severity of aphasia and the level of visuoconstructive tasks. Therefore, a thorough individual assessment of visuoconstructive function is needed to plan and predict the treatment and prognosis of aphasia and the clock drawing test may be a useful screening tool to evaluate this function.

Factors predicting long-term recovery from post-stroke aphasia

ABSTRACT Background It remains widely accepted that spontaneous recovery from aphasia is largely limited to the first related factors. This has direct implications for acute and chronic interventions for aphasia. few months following stroke. A few recent studies challenge this view, revealing that some individuals’ language abilities improve even during the chronic stage. Aims To identify prognostic indicators of long-term aphasia recovery. Methods & Procedures Eighteen people with aphasia initially evaluated in the chronic stage were retested at least one year later. The Western Aphasia Battery-Revised (WAB-R) Aphasia Quotient (AQ) was used to quantify changes in language impairment. Prognostic factors included those related to the patient (demographic, psychosocial), stroke (lesion volume and location), and treatment (medical, rehabilitative). Outcomes & Results Twelve participants improved and 6 remained stable or declined. Linear regression analysis revealed that lesion volume predicted long-term language gains, with smaller lesions yielding greater improvements. Individuals who did not improve were more likely to have lesions encompassing critical frontal and temporoparietal cortical regions and interconnecting white matter pathways. Exploratory regression analysis of psychosocial and treatment-related factors revealed a positive relationship between improvement and satisfaction with life participation, and a negative relationship between improvement and perceived impairment severity. Critically, psychosocial and treatment-related factors significantly improved model fit over lesion volume, suggesting that these factors add predictive value to determining long-term aphasia prognosis. Conclusions Long-term aphasia recovery is multidetermined by a combination of stroke-, psychosocial-, and treatment-related factors. This has direct implications for acute and chronic interventions for aphasia.

Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation.

Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21–40% of stroke patients sustain permanent aphasia, which progressively worsens one’s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.

An Innovative Therapeutic Program for Aphasia Patients and Their Relatives

Eleven aphasia patients and seven family members participated in a five-day residential course led by a speech pathologist, a psychologist and a neurologist. The aim of the course was to give the aphasics and their relatives information on the etiology, treatment possibilities and prognosis of aphasia; work on personal and interpersonal problems through psychological counseling; improve language function through comprehensive and intensive stimulation; examine the psychological, linguistic and neurological effects of the intensive course. The course participants met again one year after the course and were found to have changed positively both psychologically and interpersonally but, as expected, only to a minor degree linguistically and neurologically. Through this intensive course it was possible to assess the problems of the families more easily than in the hospital. The patients and their relatives reported that they had learnt how to identify and to deal with their psychological problems in a more constructive way. They also felt that they had support from the other families and were able to share their experiences. We found that this type of intervention had many positive effects on the ability of the participants to cope with the chronic disability.

Prognostication in post-stroke aphasia: How do speech pathologists formulate and deliver information about recovery?

Prognostication is a complex clinical task that involves forming a prediction about recovery and communicating prognostic information to patients and families. In aphasia, recovery is difficult to predict and evidence-based guidance on prognosis delivery is lacking. Questions about aphasia prognosis commonly arise, but it is unknown how speech pathologists formulate and deliver information about expected recovery. An understanding of current practice in prognostication is needed to develop evidence-based guidelines for this process, and is necessary in order to ensure successful future implementation of recommended practice regarding prognosis delivery. To identify the factors speech pathologists consider important when responding to questions about aphasia prognosis; to examine how they respond in different scenarios; and to evaluate their current attitudes towards aphasia prognostication. A total of 54 speech pathologists participated in an online survey featuring hypothetical aphasia prognosis delivery scenarios, short-response questions and ratings. Open responses were analysed thematically. Multiple-choice responses were analysed using descriptive statistics and non-parametric tests. Speech pathologists regarded factors relating to the nature and severity of post-stroke deficits, an individual's level of motivation and the availability of social support as most important for forming an aphasia prognosis. When delivering prognostic information, considerations of the recipient's emotional well-being, hope and expectations, and comprehension of information were regarded as most important. Speech pathologists' prognosis responses varied in content and manner of communication. The content of the responses included predictions of recovery and information about various attributes and activities contributing to recovery. Prognostic information was most frequently communicated through qualitative probability expressions, general statements and uncertainty-based expressions. A need for more professional support in aphasia prognostication was indicated. There is variation in the way speech pathologists respond to questions about aphasia prognosis, and it is unknown how these conversations affect people with aphasia and their significant others. Further research to understand speech pathologists' clinical reasoning and professional support needs, and the perspectives of people living with aphasia, may help to develop an evidence-based approach to prognostication in aphasia. What this paper adds What is already known on this subject Questions about aphasia prognosis are difficult to answer. Current methods for predicting aphasia recovery are yet to demonstrate the reliability and individual specificity required for clinical application. At present, there is no evidence-based guidance or support for prognosis delivery in aphasia. What this study adds to existing knowledge There is variation in the way speech pathologists predict aphasia recovery, the prognostic information they deliver and the manner in which they communicate prognoses. Current approaches to aphasia prognostication are reliant on experience and professional judgement, and speech pathologists desire more support for undertaking this task. What are the potential or actual clinical implications of this work? Speech pathologists lack a consistent approach to aphasia prognostication and desire more support in this task. The present findings offer insight into clinician attitudes and practice, and provide a direction for future research to establish best-practice guidelines for this complex and demanding area of aphasia management.

Predictive role of subcomponents of the left arcuate fasciculus in prognosis of aphasia after stroke: A retrospective observational study.

The relationship between the left arcuate fasciculus (AF) and stroke-related aphasia is unclear. In this retrospective study, we aimed to investigate the role of subcomponents of the left AF in predicting prognosis of aphasia after stroke. Twenty stroke patients with aphasia were recruited and received language assessment as well as diffusion tensor tractography scanning at admission. According to injury of the left AF, the participants were classified into four groups: group A (4 cases), the AF preserved intactly; group B (6 cases), the anterior segment injured; group C (4 cases), the posterior segment injured; and group D (6 cases), completely injured. After a consecutive speech therapy, language assessment was performed again. Changes of language functions among the groups were compared and the relation between these changes with segments injury of the AF was analyzed. After therapy, relatively high increase score percentage changes in terms of all the subcategories of language assessment were observed both in group A and C; by contrast, only naming in group B, and spontaneous speech in group D. Although no statistical difference was demonstrated among the four groups. In addition, there was no significant correlation between improvement of language function with segments injury of the AF. The predictive role of subcomponents of the left AF in prognosis of aphasia is obscure in our study. Nevertheless, it indicates the importance of integrity of the left AF for recovery of aphasia, namely that preservation of the left AF on diffusion tensor tractography could mean recovery potential of aphasia after stroke.

A Comparison of Two Treatment Approaches for Agrammatic Broca's Aphasia: Script Therapy vs. Verb Network Strengthening Treatment

A Comparison of Two Treatment Approaches for Agrammatic Broca's Aphasia: Script Therapy vs. Verb Network Strengthening Treatment

Influence of Lexical versus Procedural Knowledge in Sentence Production in Response to Thematic Role Assignment Treatment

Influence of Lexical versus Procedural Knowledge in Sentence Production in Response to Thematic Role Assignment Treatment

Factors related to the quality of life in the context of communication in people with aphasia in southern Brazil

Background: Stroke is a major global health problem. Aphasia, as a complication of stroke, has an impact on the quality of life (QOL). Few studies exist on the factors associated with QOL of people with aphasia (PwA), especially in communication, in emerging countries.Aims: To evaluate factors associated with QOL in the domain of communication using Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) to assess PwA in the southern region of Brazil.Methods & Procedures: Medical files of participants diagnosed with ischaemic stroke admitted to a public hospital in Joinville, Brazil, from August 2010 to December 2011 were reviewed. QOL in PwA was assessed using SAQOL-39 scale. Some factors associated with prognosis of aphasia were assessed with respect to QOL with an emphasis on the communication domain.Outcomes & Results: Of 50 PwA evaluated, 60% were male. The mean age was 69.6 years and the average time after stroke was 11.7 months. Overall mean score on the SAQOL-39 scale was 3.09, standard deviation (SD) = 0.6, range = 1.67–4.62. The psycho-social domain demonstrated a statistical trend towards significance for the lowest score obtained (p = .09). The habit of reading pre- and post-onset of stroke, higher economic level, larger time post-onset of stroke and higher physical domain scores were significantly associated with higher scores in the communication domain. There was no association between the communication domain scores with age, gender, caregivers, number of inhabitants in the home and physical and social activity.Conclusion: In the communication domain, reading showed positive implications on QOL. Further studies are needed to evaluate the role of reading practices as a therapeutic option in PwA.

Investigação da queixa de disfagia em pacientes afásicos

OBJETIVOS: verificar a presença e evolução da queixa de deglutição em pacientes afásicos pós- AVE e, a partir do relato dos familiares em relação à melhora das manifestações, analisar se a ocorrência da afasia interferiu no prognóstico da disfagia. MÉTODO: 30 pacientes afásicos pós-AVE na fase crônica foram entrevistados e, juntamente com seus familiares, responderam a um questionário sobre a presença e a permanência de queixas de deglutição pós-AVE e aspectos relacionados, bem como melhoras ocorridas em relação aos quadros de disfagia e afasia. Para verificar se a disfagia parece ter interferido no prognóstico da afasia, comparou-se as curvas de Kaplan-Meier dos pacientes que referiram queixas de disfagia com os que não referiram. RESULTADOS: 48% dos pacientes tiveram queixas de dificuldades de deglutição pós-AVE. Destes, 93% apresentaram mudanças positivas (melhora parcial ou total do quadro). O tempo médio para que o paciente apresentasse qualquer tipo de mudança (espontânea ou não) foi de 76 dias. 60% referiu melhora total da disfagia, sendo que 47% foram submetidos à terapia fonoaudiológica. Em relação à afasia, 87% dos pacientes referiram melhora, apesar de nenhum paciente ter referido melhora total. 57% haviam sido expostos à terapia fonoaudiológica para a afasia. O tempo médio referido para que o paciente apresentasse qualquer tipo de mudança positiva nas manifestações foi de 183 dias. Não houve diferença significante na melhora da afasia entre o grupo com e sem queixa de deglutição. CONCLUSÕES: dos pacientes afásicos avaliados neste estudo, 48% apresentou queixa de disfagia. Verificou-se, a partir do relato dos familiares, que a ocorrência da afasia parece não ter interferido no prognóstico da disfagia.

Long-term prognosis of aphasia after stroke

BackgroundThe long-term functional outcome of aphasia after stroke is uncertain, even though this information is needed as early as possible for adequate patient care and support. This observational prospective study...

Prognosis of aphasia in stroke patients early after iv thrombolysis

ObjectiveStroke patients with aphasia have a high long-term morbidity. Intravenous rt-PA (iv) thrombolysis is given more deliberately to these patients. Early outcome data is lacking. Aim of this study was to determine early benefit from rt-PA in patients with aphasia. MethodsData of stroke patients treated by iv thrombolysis was scrutinized for the presence of aphasia defined as ≥1 point for aphasia on the National Institute of Health Stroke Scale (NIHSS). Improvement was defined as a gain of ≥1 point within 24h. Cranial computed tomography (CT) scans were evaluated regarding early ischemic changes (EICs), infarct volume and localization. ResultsFifty patients with aphasia were included. 16 (32%) of patients improved (4 (36%) minor, 7 (41%) moderate, 5 (23%) major stroke patients), while 44 (62%) remained unchanged. Of 28 patients with EICs, 10 (36%) improved compared to 7 out of 22 (32%) patients without (p=0.773). Aphasia outcome was significantly associated with infarct volume at admission and at 24h (Kruskal–Wallis, p=0.033, p≤0.001, respectively). ConclusionEICs are not predictive of aphasia outcome and patients with improvement showed smaller infarct volumes. One third improved within 24h, while two thirds remained unchanged. This might justify a closer follow-up of aphasia in stroke patients at the acute stage.

Post‐stroke aphasia prognosis: a review of patient‐related and stroke‐related factors

Recovery of language function in individuals with post-stroke aphasia is associated with a variety of patient and stroke-related indices. Amidst a complex interaction of a multitude of variables, clinicians are faced with the arduous challenge of predicting aphasia recovery patterns and subsequently, long-term outcomes in these individuals. Unfortunately, predictive factors are highly variable making prognosis of aphasia recovery difficult. Therefore, the objective of this review was to assess the influence of patient-related and stroke-related factors on language recovery in individuals with post-stroke aphasia. We completed a literature review to assess and identify evidence-based patient and stroke-related variables shown to be influential in aphasia recovery. A range of patient-related (gender, handedness, age, education, socio-economic status and intelligence) and stroke-related indices (initial severity, lesion site and lesion size) were identified as potential influential factors to post-stroke aphasia recovery. Initial severity of aphasia emerged as the factor most predictive of long-term aphasia recovery. Other influential factors of post-stroke language recovery included lesion site and size. Stroke-related factors, including aphasia severity, lesion site and lesion size, appear most critical to post-stroke aphasia recovery. The findings presented in this review offer clinicians an evidenced-based framework to assist in prediction of post-stroke aphasia recovery patterns and subsequent long-term functional communication outcomes.

An electrophysiological contribution to the study of language lateralization and prognosis of aphasia

The study is aimed at identifying hemispheric language dominance in both the right-handed and left-handed participants. Eighteen right-handed and 18 left-handed young volunteers were invited to listen for 80 times to a 720 ms duration Italian word. Signals from 16 electrodes were averaged and displayed both as traces and maps. When the word was delivered to the participant, a positive component at 340 ms was recorded, following the N100-P200 complex. The potential was significantly lateralized to the left hemisphere in 50% of the right-handers. The left-handed group was less homogeneous. Six out of 18 participants (33%) had a right lateralization, six participants (33%) had the positive potential shifted to the left hemisphere. Finally, the remaining participants had a bilateral representation. The maps show that there are no two participants alike, independently of either sex or handedness. A 300 Hz tone of the same duration failed to evoke the P340. Results indicate the utility of event-related potentials in studying the language processing. The possibility to identify cortical localization permits a better prognosis of acquired aphasia. The method is relatively cheap and noninvasive. Application is suggested in those participants who are at risk of stroke or in patients to be submitted to a neurosurgical intervention nearby possible language areas.

Assessment of arcuate fasciculus with diffusion-tensor tractography may predict the prognosis of aphasia in patients with left middle cerebral artery infarcts

It is often clinically difficult to assess the severity of aphasia in the earliest stage of cerebral infarction. A method enabling objective assessment of verbal function is needed for this purpose. We examined whether diffusion tensor (DT) tractography is of clinical value in assessing aphasia. Thirteen right-handed patients with left middle cerebral artery infarcts who were scanned within 2 days after stroke onset were enrolled in this study. Magnetic resonance data of ten control subjects were also examined by DT tractography. Based on the severity of aphasia at discharge, patients were divided into two groups: six patients in the aphasic group and seven in the nonaphasic group. Fractional anisotropy (FA) and number of arcuate fasciculus fibers were evaluated. Asymmetry index was calculated for both FA and number of fibers. FA values for the arcuate fasciculus fibers did not differ between hemispheres in either the patient groups or the controls. Number of arcuate fasciculus fibers exhibited a significant leftward asymmetry in the controls and the nonaphasic group but not in the aphasic group. Asymmetry index of number of fibers was significantly lower (rightward) in the aphasic group than in the nonaphasic (P = 0.015) and control (P = 0.005) groups. Loss of leftward asymmetry in number of AF fibers predicted aphasia at discharge with a sensitivity of 0.83 and specificity of 0.86. Asymmetry of arcuate fasciculus fibers by DT tractography may deserve to be assessed in acute infarction for predicting the fate of vascular aphasia.

Aphasia following left putaminal hemorrhage. Statistical analysis of factors affecting prognosis

Multivariate and single variable analyses were employed to investigate the recovery mode of aphasia in right-handed patients with putaminal hemorrhage on the left side. Speech disturbance was evaluated using the standard language test for aphasia (SLTA) at intervals of 1, 3 and 6 months after the ictus. Recovery was assessed in relation to age, gender, volume and location of hematoma, and treatment modalities. Extension of the hematoma into the corona radiata was the factor that dominated the prognosis of aphasia at all intervals during the follow-up period. Good recovery was documented in patients with less than 2 cm2 of the hematoma volume located in the corona radiata. Recovery was poor, however, in patients with more than 12 cm2 of the hematoma in the corona radiata. While aphasia continued to improve over 6 months after the ictus, recovery was more prominent in the first 3 months. Our study precisely demonstrated that the extension into the corona radiata independently and strongly influenced the outcome of aphasia in patients with left putaminal hemorrhage.

Pathophysiological aspects of Landau-Kleffner syndrome: From the active epileptic phase to recovery

In their original description of the syndrome of “acquired aphasia with convulsive disorder,” Landau and Kleffner (1957) suggested “that persistent convulsive discharges in brain tissue largely concerned with linguistic communication result in the functional ablation of these areas for normal linguistic behavior.” In further case studies, the observation of continuous epileptic discharges in electroencephalograms (EEGs) recorded during sleep agreed with this early suggestion. Although several group studies emphasized the almost parallel fluctuation of aphasic disorders and EEG abnormalities, the causal relationship between epileptiform EEG discharges and the language defect remains a matter of debate. Another subject of discussion concerns the outcome of aphasia after recovery of epilepsy that typically occurs at the beginning of adolescence. In the Landau-Kleffner syndrome (LKS), the prognosis of aphasia varies in a manner opposite that observed after structural lesions of the left hemisphere. To further elucidate the pathophysiological basis of aphasia and its poor outcome in LKS, this chapter reexamines five clinical studies of LKS with particular emphasis on electrophysiological and metabolic findings and their relationship to neuropsychological deficits. The data presented and discussed covers a follow-up period extending for each case from the active period to the late recovery phase of epilepsy lasting from 7 to 15 years. The chapter summarizes the clinical histories and neuropsychological findings gathered during the period when the children were aphasic and epileptic and after recovery and focuses on the experimental data supporting focal or regional cerebral dysfunction underlying this particular acquired childhood aphasia.

Benzodiazepine receptor imaging with iomazenil SPECT in aphasic patients with cerebral infarction.

To investigate the relationship between prognosis of aphasia and neuronal damage in the cerebral cortex, we evaluated the distribution of central-type benzodiazepine receptor (BZR) binding in post-stroke aphasics with [123I]iomazenil and SPECT. We performed iomazenil SPECT in six aphasic patients (aged from 45 to 75 years; all right-handed) with unilateral left cerebral infarction. Three patients showed signs of Broca's aphasia and the other three Wernicke's aphasia. Cerebral blood flow (CBF) imaging was performed with [123I]iodoamphetamine (IMP). The regions of interest (ROIs) on both images were set in the cerebral cortex, cerebellar cortex and language-relevant area in both hemispheres. Three patients were classified in the mild prognosis group and the other three in the moderate prognosis group. The left language-relevant area was more closely concerned with the difference in aphasic symptoms than the right one in both BZR and CBF distribution, but the ipsilateral to the contralateral ratio (I/C ratio) in the language-relevant areas in the BZR distribution was significantly lower in the moderate prognosis group than in the mild prognosis group, although no difference was seen for these values between the two groups in the CBF distribution. These results suggest that BZR imaging, which makes possible an increase in neuronal cell viability in the cerebral cortex, is useful not only for clarifying the aphasic symptoms but also for evaluating the prognosis of aphasia in patients with cerebral infarction.

Brain Plasticity in Poststroke Aphasia: What Is the Contribution of the Right Hemisphere?

The brain may use two strategies to recover from poststroke aphasia: the structural repair of primarily speech-relevant regions or the activation of compensatory areas. We studied the cortical metabolic recovery in aphasic stroke patients with positron emission tomography (PET) at rest and during word repetition. The left supplementary motor area (SMA) showed the most prominent compensatory activation in the subacute state of stroke. The restitution of the left superior temporal cortex determined the long-term prognosis of aphasia. The brain recruited right-hemispheric regions for speech processing, when the left-hemispheric centers were permanently impaired. This strategy, however, was significantly less effective than the repair of the original speech-relevant network.