Prognosis Of Aphasia Research Articles

Aphasia in acute stroke: incidence, determinants, and recovery.

Knowledge of the frequency and remission of aphasia is essential for the rehabilitation of stroke patients and provides insight into the brain organization of language. We studied prospectively and consecutively an unselected and community-based sample of 881 patients with acute stroke. Assessment of aphasia was done at admission, weekly during the hospital stay, and at a 6-month follow-up using the aphasia score of the Scandinavian Stroke Scale. Thirty-eight percent had aphasia at the time of admission; at discharge 18% had aphasia. Sex was not a determinant of aphasia in stroke, and no sex difference in the anterior-posterior distribution of lesions was found. The remission curve was steep: Stationary language function in 95% was reached within 2 weeks in those with initial mild aphasia, within 6 weeks in those with moderate, and within 10 weeks in those with severe aphasia. A valid prognosis of aphasia could be made within 1 to 4 weeks after the stroke depending on the initial severity of aphasia. Initial severity of aphasia was the only clinically relevant predictor of aphasia outcome. Sex, handedness, and side of stroke lesion were not independent outcome predictors, and the influence of age was minimal.

Recovery of acquired aphasia in children

Abstract We report a longitudinal study of 32 children (younger than 15 years) with acquired aphasia secondary to unilateral focal brain lesions, and study the factors responsible for the prognosis of aphasia. Poor outcome was associated with infectious aetiology, lesion onset after age 7 years, fluent speech, poor auditory comprehension and damage to Wernicke's area. Conversely, vascular and traumatic aetiology and the presence of mutism or hemiparesis were associated with a better recovery. However, as some of these factors tended to cluster, we performed a multivariable regression analysis. This analysis showed that only three of the variables could predict the prognosis: infectious aetiology, poor verbal comprehension, and involvement of Wernicke's area were all associated with a poor outcome. Age at lesion onset, in contrast, did not account for aphasia recovery. These data suggest therefore that recovery from aphasia depends much more upon the integrity of certain brain areas (left posterior language areas) than upon an hypothetic age-related plasticity. Long-term consequences of aphasia on school achievement were, however, quite ominous, for most children subsequently failed at school, including those who had recovered completely.

Prognosis of Aphasia by Fitting Growth Curves

The recovery of word-emission ability by Japanese aphasics was examined quantitatively. The scores on a word-emission task were obtained in a series of language tests for aphasia. 17 aphasics were asked to utter names of animals, giving as many as possible within a minute. The task was repeated four times at intervals of 104.1 days on the average, ranging from 27 to 271 days. The score on the word-emission task was estimated by fitting a growth curve to scores on the former three tests. Modified exponential, logistic, and Gompertz curves were used for estimation. All estimated scores by three growth curves were larger than the observed scores. The modified exponential curve which does not have an inflection point produced the most remarkable error. Between two curves which have an inflection point the logistic curve produced less error than the Gompertz curve. The difference in error of estimation was due to the difference in the saturation level of the two curves.

Young adult stroke: neuropsychological dysfunction and recovery.

Etiology, neuropsychological deficits, aphasia type, and recovery were retrospectively studied in 254 young adults with stroke. Cardiac embolism was the most common cause of stroke in patients younger than 40, while atherosclerosis was the most frequent etiology among those aged 41-50 years. In 166 aphasic patients, Broca's aphasia was the most common while Wernicke's and transcortical aphasias were rare. Compared with an older aphasic population, young patients had significantly more nonfluent aphasias and fewer comprehension deficits. These differences were related to stroke localization: the majority of infarcts localized by computed tomography in 37 patients involved either the entire middle cerebral artery territory or its superior or deep branches, explaining the preponderance of nonfluent aphasia. Prognosis of aphasia in our patients was better than has been reported for non-age-selected aphasia populations. Roughly one third of our patients recovered completely, one third improved, and one third had an unresolved language deficit. Complete recovery and significant improvement were observed even greater than 6 months after stroke. In some patients, recovery was much better than might have been predicted from lesion site and size depicted on computed tomograms.

失語症の改善と予後 予後に関わる因子の検討

失語症の改善と予後 予後に関わる因子の検討

構文能力の回復と失語症の予後

構文能力の回復と失語症の予後

PROGNOSIS OF HEMIPARESIS AND APHASIA DUE TO CEREBROVASCULAR DISEASES IN RELATION TO THE FINDINGS ON COMPUTERIZED TOMOGRAPHY

Computerized tomography (CT) of the brain allows the clinical diagnosis of intracerebral hemorrhage or cerebral infarction with a precision heretofore unattainable. The size, location and extension of lesion are acurately portrayed. At Mihara Memorial Hospital in the past two years, prognosis of 101 cases with cerebral infarction and 80 cases with cerebral hemorrhage has been studied in relation to the findings on computerized tomography.1) The hemiplegia (complete palsy) was not found in patients with localized thalamic hemorrhage by CT scan, but was found in most of the patients who had hemorrhagic extension into the ventricle. The prognosis of hemiplegia was determined by the size of hematoma. The larger the lesion, the poorer the prognosis of hemiplegia was.2) All of the patients with putaminal hemorrhage extended into the ventricular system had complete hemiplegia. The prognosis of hemiplegia in patients with the hemorrhage taking place in the anterior putamen, is more favorable than in those with the posterior putaminal hemorrhage.3) Aphasia was not found in the patients who had extension of the hematoma within less than 24mm. Most of the patients with the hematoma larger than 25mm showed total or motor aphasia. The prognosis of aphasia is unfavorable in patients with hematoma larger than 35mm.All of the patients with thalamic hemorrhage showed no aphasia.4) Only 3.3% of the patients with small basal ganglia infarction demonstrated complete hemiplegia as compared with 36.6% of the patients with major artery occlusion.Sixty-five per cent of the patients with small infarction of the basal ganglia made good recovery compared with 17% of the patients with major artery occlusion. Motor deficit were mild in patients with lesion in the anterior limb or genu of the internal capsule, whereas patients who sustained small infarction in the posterior two-third of the posterior limb generally had much more marked motor involvement, especially in the most posterior one-third of the posterior limb.Ninety-two per cent of the patients with lesion less than 10mm had a good recovery whereas there was little or no improvement in 40% of the patients with 10-15mm diameter lesions.The lesion due to major artery occlusion involved the watershed sparing internal capsule at the level including pineal body by CT scan. The hemiparesis and its improvement were unfavorable in the patients with major artery occlusion.Prognosis of aphasia of the patients without obvious low density area on cortex or subcortex was more excellent than those of the patients with above low density area by CT scan.

Extent of the Lesion According to CT Findings and Prognosis of Aphasia

The extent of the lesions of aphasia patients was determined by CT-Scan, and the findings were compared with the degree of recovery from aphaia. The following results were seen:1) The lesions were classified into three groups according to the extent of the lesion.2) Recovery can be well expected when the extent of the leasion is less than 10% (Group I) .3) In many cases of motor aphasia, recovery can be expected when the extent of lesion is 10-30% (Group II) .4) In cases with the extent of lesion being more than 30%, the expectancy of recovery is low.5) The earlier the training was started, the better was the recovery.6) It can be considered that the extent of the lesion is closely related to the prognosis of aphasia.

10 Years Observation and Rehabilitation of Stroke Disability

In the I State Home for Incurables in Lodz (Poland) 195 hemiplegia cases were observed over ten years. 140 women and 55 men. This comprised 8.2% and 17.8% of all ill females and males respectively. Causes of the lesion were vascular 187, trauma 4, neoplasm 4. Hemiparesis was in females most frequent between 60 and 80 years, in males between 50 and 80 years. Communication was absent or difficult in 126 cases (in 22 the cause was aphasia, in 104 dementia). Incontinence was noted in 77 cases, inability to walk (on admission) in 129. During the ten years under survey 135 died, 15 were discharged home, 26 females and 18 males were rehabilitated. Very good improvement in motor activity was obtained in 14 females (3 without kinesitherapy) and 7 males, indicating adequate walking and independence in activities of daily living after prolonged bedfastness. (average 2.5 years in males and 2.7 years in females). Altogether 88 patients improved from the locomotor angle. In cases with dementia, incontinence and severe aphasia prognosis in rehabilitation was found to be poor.