Aphasia Severity Rating Scale Research Articles

Protocol for the development of the international population registry for aphasia after stroke (I-PRAISE)

ABSTRACT Background We require high-quality information on the current burden, the types of therapy and resources available, methods of delivery, care pathways and long-term outcomes for people with aphasia. Aim To document and inform international delivery of post-stroke aphasia treatment, to optimise recovery and reintegration of people with aphasia. Methods & Procedures Multi-centre, prospective, non-randomised, open study, employing blinded outcome assessment, where appropriate, including people with post-stroke aphasia, able to attend for 30 minutes during the initial language assessment, at first contact with a speech and language therapist for assessment of aphasia at participating sites. There is no study-mandated intervention. Assessments will occur at baseline (first contact with a speech and language therapist for aphasia assessment), discharge from Speech and Language Therapy (SLT), 6 and 12-months post-stroke. Our primary outcome is changed from baseline in the Amsterdam Nijmegen Everyday Language Test (ANELT/Scenario Test for participants with severe verbal impairments) at 12-months post-stroke. Secondary outcomes at 6 and 12 months include the Therapy Outcome Measure (TOMS), Subjective Index of Physical and Social Outcome (SIPSO), Aphasia Severity Rating Scale (ASRS), Western Aphasia Battery Aphasia Quotient (WAB-AQ), stroke and aphasia quality of life scale (SAQoL-39), European Quality of Life Scale (EQ-5D), lesion description, General Health Questionnaire (GHQ-12), resource use, and satisfaction with therapy provision and success. We will collect demography, clinical data, and therapy content. Routine neuroimaging and medication administration records will be accessed where possible; imaging will be pseudonymised and transferred to a central reading centre. Data will be collected in a central registry. We will describe demography, stroke and aphasia profiles and therapies available. International individual participant data (IPD) meta-analyses will examine treatment responder rates based on minimal detectable change & clinically important changes from baseline for primary and secondary outcomes at 6 and 12 months. Multivariable meta-analyses will examine associations between demography, therapy, medication use and outcomes, considering service characteristics. Where feasible, costs associated with treatment will be reported. Where available, we will detail brain lesion size and site, and examine correlations with SLT and language outcome at 12 months. Conclusion International differences in care, resource utilisation and outcomes will highlight avenues for further aphasia research, promote knowledge sharing and optimise aphasia rehabilitation delivery. IPD meta-analyses will enhance and expand understanding, identifying cost-effective and promising approaches to optimise rehabilitation to benefit people with aphasia.

Effect of High Frequency Transcranial Magnetic Stimulation on Recovery of Chronic Post-Stroke Aphasia

BackgroundBoth hemispheres have role in post-stroke aphasia recovery but better recovery is expected with the restoration of function by the left hemisphere. Transcranial stimulation has been used to favor recruitment of left-hemispheric language networks and increase activity of the left hemisphere, thus helps aphasia recovery . ObjectiveThe aim of this study is to evaluate the effect of excitatory repetitive transcranial magnetic stimulation (rTMS) on recovery of post stroke aphasic patients . Materials and methodsTwenty patients with post stroke chronic aphasia were enrolled in the study. Aphasia severity was assessed using Aphasia Severity Rating Scale (ASRS). Linguistic deficits were assessed using Kasr Al-Aini Arabic Aphasia test (KAAT). Real rTMS was applied three for 10 sessions of 10-Hz stimulation, positioned over the left Broca's area of the affected hemisphere. All patients were evaluated before, after the end of treatment sessions and one month later . ResultsThere was a significant improvement in the mean total score and mean scores of components of KAAT scale before, immediately after and after one month of rTMS (P< 0.05). Moreover, there was a significant improvement in mean scores of ASRS before, immediately after and after one month of rTMS (P= 0.000). There was a significant difference in mean scores of ASRS and KAAT before, immediately after the last session and after one month between small, medium and large brain infarcts. (P< 0.05). ConclusionExcitatory rTMS is a beneficial adjuvant therapy that improves language skills in patients with chronic post-stroke non-fluent aphasia in short and long term.The protocol of this observational study was registered in clinical trial registration: www.ClinicalTrials.gov, identifier: NCT04708197

Effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) on aphasia in cerebrovascular accident patients: Protocol of a systematic review and meta-analysis.

Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation approach, might be a promising technique in the management of aphasia after cerebrovascular accidents (CVA). This protocol of systematic review (SR) aims to investigate the effectiveness and safety of rTMS in patients with aphasia after CVA. The following databases will be searched: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge infrastructure (CNKI), Technology Periodical Database (VIP), WanFang Data, and China Biology Medicine (CBM) from inception to August 2019. Randomized controlled trials (RCTs) investigating the effectiveness and safety of rTMS for aphasia patients after CVA will be included. Primary outcome will include Boston Diagnostic Aphasia Examination (BDAE). Secondary outcomes will include Aphasia Battery of Chinese (ABC), Aachen Aphasia Test (AAT), Aphasia Quotient (AQ), the Western Aphasia Battery (WAB), Standard Language Test of Aphasia (SLTA), Aphasia Severity Rating Scale (ASRS), Concise China Aphasia Test Scale (CCAT), Amsterdam-Nijmegen Everyday Language Test (ANELT), or other related outcomes. Adverse events such as headache, tinnitus, anxiety, fatigue, or epileptic seizure will be considered as safety measurement. Studies screening, data extraction, and methodological quality assessment will be performed independently by two reviewers. Meta-analysis will be conducted with Review Manager 5.3 software and R software 3.6.1. This study will provide a high-quality synthesis of RCTs on the effectiveness and safety of rTMS as an adjuvant therapy in the treatment of aphasia. The conclusion of this study will help clinicians and patients with aphasia after CVA to make decision. No privacy health information will be collected, thus formal ethics approval is not required. The findings of this SR will be submitted to a peer-reviewed journal. CRD42019144587.

Validation of a prediction model for long-term outcome of aphasia after stroke

BackgroundAbout 30% of stroke patients suffer from aphasia. As aphasia strongly affects daily life, most patients request a prediction of outcome of their language function. Prognostic models provide predictions of outcome, but external validation is essential before models can be used in clinical practice. We aim to externally validate the prognostic model from the Sequential Prognostic Evaluation of Aphasia after stroKe (SPEAK-model) for predicting the long-term outcome of aphasia caused by stroke.MethodsWe used data from the Rotterdam Aphasia Therapy Study – 3 (RATS-3), a multicenter RCT with inclusion criteria similar to SPEAK, an observational prospective study. Baseline assessment in SPEAK was four days after stroke and in RATS-3 eight days. Outcome of the SPEAK-model was the Aphasia Severity Rating Scale (ASRS) at 1 year, dichotomized into good (ASRS-score of 4 or 5) and poor outcome (ASRS-score < 4). In RATS-3, ASRS-scores at one year were not available, but we could use six month ASRS-scores as outcome. Model performance was assessed with calibration and discrimination.ResultsWe included 131 stroke patients with first-ever aphasia. At six months, 86 of 124 (68%) had a good outcome, whereas the model predicted 88%. Discrimination of the model was good with an area under the receiver operation characteristic curve of 0.87 (95%CI: 0.81–0.94), but calibration was unsatisfactory. The model overestimated the probability of good outcome (calibration-in-the-large α = − 1.98) and the effect of the predictors was weaker in the validation data than in the derivation data (calibration slope β = 0.88). We therefore recalibrated the model to predict good outcome at six months.ConclusionThe original model, renamed SPEAK-12, has good discriminative properties, but needs further external validation. After additional external validation, the updated SPEAK-model, SPEAK-6, may be used in daily practice to discriminate between patients with good and patients with poor outcome of aphasia at six months after stroke.Trial registrationRATS-3 was registered on January 13th 2012 in the Netherlands Trial Register: NTR3271. SPEAK was not listed in a trial registry.

Leukoaraiosis is not predictive of aphasia recovery

Stroke-related aphasia affects 20% to 40% stroke patients and early prediction of aphasia recovery remains extremely difficult to predict. Leukoaraiosis LA is recognised as one of the neuroimaging features of cerebral small vessel disease and is associated with brain disturbances. LA is known to be associated with long term cognitive decline, mood disorders, gait disability and has a negative impact of post-stroke functional outcome. The aim of this study was to determine whether the extent of LA could contribute to the prediction of recovery from post-stroke aphasia. Hundred and ten right handed aphasic patients with analyzable MRI sequences were included and assessed as soon as possible within fourteen days after a first left hemispheric stroke. The severity of aphasia was assessed using the Aphasia Severity Rating Scale (ASRS) at baseline and 6month (M6) after the stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. Good recovery at M6 was defined as an ASRS = 4–5. In a first step, axial diffusion-weighted images, or T2*-weighted images for intra-cerebral haemorrhage, and Flair images were imported. Lesions were drawn manually in order to measure the lesion size, as well as the volume of LA in Flair sequences. Good recovery from aphasia was significantly associated with lower severity of aphasia initially ( P < 0.001) and smaller lesions ( P < 0.001). No significant association was found between the volume of LA and recovery from aphasia, even adjusted to the lesion size or age in a multi variable model. The extent of leukoaraiosis is not a predictor of aphasia recovery, even adjusted to the lesion size or age. Hence, aphasia recovery seems to be poorly influenced by diffuse lesions of sub-cortical white matter, strengthening the idea of crucial and localised brain areas and networks involved in recovery.

Motor evoked potentials of upper-limbs predict aphasia recovery

Recovery from aphasia remains difficult to predict. Among the language features predicting recovery from aphasia, production scores such as repetition or phonology seem to be more relevant predictors than only severity. As motor cortex is strongly involved in language processes, both production and perception, the present study aimed to determine whether the integration of an electrophysiological measure of the motor networks using motor-evoked potentials MEP in the acute phase of stroke can improve the prediction of recovery from post-stroke aphasia. Hundred and twelve patients with aphasia within 14 days after a first ischemic or haemorrhagic stroke completed the study. The severity of aphasia was assessed using the Aphasia Severity Rating Scale (ASRS) at baseline and 6 month (M6) after the stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. MEPs were recorded from the abductor pollicis brevis muscle and orbicularis oris. The resting motor threshold (rMT) was defined for each muscle and a ratio between left and right rMT (rMTr) was calculated for upper-limbs and for lips. A first-level model, including only clinical variables (i.e. initial severity) predicted severity at six months for severe patients. When the rMTr of upper limbs was added in a second-level model, the predictive power significantly increased from 41 to 51%, as well as adding in a third-level model rMTr of upper-limbs and initial fibres number ratio of the corticospinal tracts (41 to 55%). With the changes of severity as the dependent variable, the same factors made a significant contribution and the predictive power of a second-level model increased from 4 to 20% to the same extent as in a third-level model (4% to 27%). Added with usual clinical factors, MEPs of upper-limbs and lips contribute to the prediction of aphasia recovery, particularly for patients with severe aphasia initially.

Lesion locations associated with outcomes for post-stroke aphasia

Several studies identified age, gender, handedness, lesion size, stroke subtype, aphasia/stroke initial severity as prognostic factors for recovery from aphasia. However, prediction of recovery still remains difficult to establish initially for patients with initial severe aphasia. The aim of this study was to identify the lesion location associated with poor recovery. One hunderd aphasic patients were included within fourteen days after a first ischemic or haemorrhagic stroke of the left hemisphere and had analysable MRI sequences. The severity of aphasia was determined using the Aphasia Severity Rating Scale in the acute phase and six months post-stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. Good recovery at M6 was defined as an ASRS = 4–5. In a first step, axial diffusion-weighted images, or T2*-weighted images for intra-cerebral haemorrhage, were imported. Lesions were drawn manually as regions of interest blinded to clinical data. Images were normalized to a standard brain template. The resulting normalized lesion maps were analysed in a VLSM approach, which applies the graded information at the behavioural level to voxel-wise binary lesion information. The resulting maps were corrected for multiple comparisons. Regarding all patients, a better outcome was significantly associated ( P < 0.01) with lesion excluding the following areas of the left hemisphere: Putamen, transverse temporal gyrus (Heschl gyrus), Insula, Rolandic Operculum. Regarding patients with severe aphasia initially, a poor recovery (i.e. ASRS at M6 < 4) was significantly associated ( P < 0.05) with lesion in the Putamen and transverse temporal gyrus (Heschl gyrus). The present study identified critical areas associated with poor outcomes for aphasia, particularly lesions of the superior temporal gyrus for patients with severe aphasia initially. These findings are in line with previous results in the literature.

Language features in the acute phase of poststroke severe aphasia could predict the outcome.

Aphasia recovery remains difficult to predict initially in particular for the most severe cases. The features of impaired verbal communication which are the basis for cognitive-linguistic diagnosis and treatment could be part of prediction of recovery from aphasia. This study investigated whether some components of language screening in the acute phase of stroke are reliable prognostic factors for language recovery in the post-acute phase. Monocentric prospective study. University hospital stroke unit. Eighty-six patients aged between 21 and 92 years (mean=67.4, SD=15.3) were admitted after a first left hemisphere stroke with aphasia and were consecutively included. Language assessment was performed in the acute phase and 3 months post-stroke with the LAnguage Screening Test (LAST) and the Aphasia Severity Rating Scale (ASRS) of the Boston Diagnostic Aphasia Examination (BDAE). Severe aphasia was defined as ASRS<3. Good recovery was defined as an ASRS≥4. Language scores and other potential predictors of recovery were analysed by comparing groups of patients with good versus poor recovery and as predictors of change with multiple regression approaches. LAST Total score as well as all the individual items of LAST, NIHSS and ASRS measured in the acute phase significantly differentiated good and poor recovery from aphasia at three months for all aphasic patients and for the most severe cases. In multivariable analyses the repetition score of LAST at the acute phase was significantly associated with the delta of ASRS between the acute phase and 3 months after the stroke reflecting changes in symptom severity. For patients with initial severe aphasia, word repetition from a language screening task seems to be a more relevant predictor of recovery than initial severity to enrich the prognosis of poststroke aphasia recovery three month after a stroke. These findings show the importance of phonological perception and production as well as speech motor components in the recovery of language. These linguistic aspects of the assessment seem more relevant than severity for prediction in the acute phase. These findings could improve aphasia management pathway for people with severe aphasia and their families and minimize the evidence-practice gap for speech pathologists.

Language screening test in the acute phase of post-stroke aphasia associated with clinical outcome

The individual prognosis of aphasia recovery remains difficult to establish initially. The aim of this study was to determine whether some components of language evaluated in the acute phase of stroke could be prognosis factors for aphasia recovery, and if these components could predict the clinical pattern of aphasia in the chronic phase. Were included all consecutive right-handed patients with aphasia, after a first stroke, confirmed by imagery, left hemisphere injured, without dementia. Assessment was performed at the acute phase: Language Screening Test (LAST) and Aphasia Severity Rating Scale (ASRS) of the Boston Diagnostic Aphasia Examination (BDAE). Three months after: LAST, ASRS and BDAE and good recovery from aphasia was defined as an ASRS score of 4 or 5. Twenty-eight patients (30–89 years) were included from November 2013 to February 2014. LAST total, LAST receptive and expression index, item order execution and naming and ASRS were significantly associated with good recovery at 3 months (Mann-Whitney; P < 0.05). Expression index was significantly associated with good recovery (OR = 2.2; CI95%: 1.2–3.8; P < 0.001) in a multi-variable analysis including receptive index and expression index, and also including expression index and ASRS in the acute phase. Naming, order execution, picture recognition, word repetition and automatic speech items of LAST (acute phase) and BDAE (3 months after) were correlated (Spearman and Mann-Whitney; P < 0,05). These results underline the importance of tests in the acute phase of stroke, both in terms of the prediction of recovery, better than severity in the acute phase, and the clinical evolution of aphasia.

Communication skills fifteen years after vascular aphasia

Aphasia is a common deficiency that profoundly impairs daily communication. The aim of this study was to describe the severity of aphasia and participation restrictions in daily life communication activities in daily life 10 years or more after a stroke. We included patients with aphasia following a stroke before January 2004 from the Archives of Physical Medicine and Rehabilitation department of Pitié-Salpêtrière hospital and from patient associations. Initial clinical and demographic data were collected retrospectively. The severity of aphasia was assessed by the Aphasia Severity Rating Scale (ASRS) and communication skills in daily life by a French communication scale (Échelle de Communication Verbale de Bordeaux). 20 patients have been included, mean age 44 years; acute phase aphasia was always severe. Assessment was conducted 10 to 25 years after the onset (mean 16.8 years), 55% of patients had mild aphasia (ASRS 4–5), 25% moderate aphasia (ASRS 3) and 20% severe aphasia (ASRS 1–2). The most impaired communication skills were reading and writing administrative documents, having a conversation on a complicated subject and conversing with a stranger. Long-term assessment of communication skills shows that 45% of aphasic patients keep significant language impairments. Communication ability, concurring the severity of aphasia, is disturbed at various levels. Personal life seems preserved but vocational integration remains rare.

Electrophysiological prognostic factors of aphasia recovery

Aphasia is the main cause of communication disorders following stroke. The individual prognosis of aphasia recovery remind difficult to establish in the acute phase. The aim of this study was to investigate whether the motor evoked potentials (MEP) of the hand and the orbicularis oris in the acute phase of stroke could predict aphasia recovery. This study is ongoing at the University Hospital of Bordeaux. All consecutive patients with aphasia, first left hemispheric stroke confirmed by imaging, right-handed, non-demented, have been proposed for inclusion. MEPs were collected after stimulation of M1 the abductor pollicis and the orbicularis oris, right and left. The assessment of language performed in the acute phase was composed of: Language Screening Test (LAST) and the aphasia severity rating scale (ASRS) of the Boston Diagnostic Aphasia Examination (BDAE). Three and six months later, the language assessment was composed by: LAST, ASRS and BDAE. Good recovery from aphasia was defined as a score of ASRS 4 or 5. The association between the presence of a MEP after stimulation and good recovery was studied by Fischer exact tests. In our interim analysis, 46 patients were followed at 3 months, and 23 at 6 months. The presence of MEP of the right hand (left cortical stimulation) was significantly associated with good recovery 3 months ( P = 0.003) and 6 months ( P = 0.003) after a stroke. The presence of MEP of the right orbicularis oris (left cortical stimulation) was significantly associated with good recovery 3 months ( P = 0.003) and 6 months ( P = 0.011). MEP of hand and lips predict recovery from aphasia. This results suggest the importance of production systems in the recovery of language, suggesting a new approach compared semantic core highlighted in the old classic models such as Lichtheim.

Nonlinguistic Cognitive Impairment in Poststroke Aphasia

Background and objectives. Information on cognitive impairment in aphasic patients is limited. Our aim was to investigate the prevalence and course of nonlinguistic cognitive impairments in the first year after stroke and their association with aphasia and functional outcome. Methods. We included 147 patients with acute aphasia. At 3 months and 1 year, we assessed cognition with a nonlinguistic cognitive examination including abstract reasoning, visual memory, visual perception and construction, and executive functioning. We assessed language with a verbal communication rating (Aphasia Severity Rating Scale), the ScreeLing (a linguistic-level screening test), and the Token Test. We evaluated functional outcome with the modified Rankin scale and registered the use of antidepressants. Results. In total, 107 (88%) patients had impairments in at least one nonlinguistic cognitive domain at 3 months and 91 (80%) at 1 year. The most frequently observed impairment concerned visual memory (83% at 3 months; 78% at 1 year) and the least frequent visual perception and construction (19% at 3 months; 14% at 1 year). There was improvement on all cognitive domains including language, except for abstract reasoning. Patients with persisting aphasia had lower cognitive domain scores, worse functional outcome, and were more often depressed than patients who had recovered from aphasia. Conclusions. Standard nonlinguistic cognitive examination is recommended in aphasic stroke patients. Nonlinguistic cognitive impairments are common and associated with poor functional outcome and depression, especially in patients with persisting aphasia.

Expert Versus Proxy Rating of Verbal Communicative Ability of People with Aphasia after Stroke

In randomized clinical trials of aphasia treatment, a functional outcome measure like the Amsterdam-Nijmegen Everyday Language Test (ANELT), administered by speech-language therapists, is often used. However, the agreement between this expert rating and the judgment of the proxy about the quality of the daily life communication of the person with aphasia is largely unknown. We examined the association between ANELT scores by speech-language therapists and proxy judgments on the Partner Communication Questionnaire both at 3 and 6 months in 39 people with aphasia after stroke. We also determined which factors affected the level of agreement between expert and proxy judgment of the communicative ability at 6 months in 53 people with aphasia. We found moderate agreement (at 3 months r = .662; p = < .0001 and at 6 months r = .565; p = .0001), with proxies rating slightly higher than experts. Less severe aphasia, measured with the Aphasia Severity Rating Scale, was associated with better agreement. In conclusion, although proxies were slightly more positive than experts, we found moderate agreement between expert and proxy rating of verbal communicative ability of people with aphasia after stroke, especially in milder cases.

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...

Recovery of aphasia after stroke: a 1-year follow-up study

Semantics, phonology, and syntax are essential elements of aphasia diagnosis and treatment. Until now, these linguistic components have not been specifically addressed in follow-up studies of aphasia recovery after stroke. The aim of this observational prospective follow-up study was to investigate semantic, phonological, and syntactic recovery in aphasic stroke patients. In addition, we investigated the recovery of verbal communication and of aphasia severity. We assessed 147 aphasic patients at 1, 2, and 6 weeks, 3 and 6 months, and 1 year after stroke with the ScreeLing, a screening test for detecting deficits on the three main linguistic components, the aphasia severity rating scale (ASRS), a measure of verbal communication, and the Token test, a measure of aphasia severity. We investigated the differences in scores between the six time points with mixed models. Semantics and syntax improved up to 6 weeks (p < 0.001) after stroke, and phonology up to 3 months (p ≤ 0.001). ASRS improved up to 6 months (p < 0.05) and the Token test up to 3 months (p < 0.001). We conclude that in aphasia after stroke, various linguistic components have a different recovery pattern, with phonology showing the longest period of recovery that paralleled aphasia severity, as measured with the Token test. The improvement of verbal communication continues after the stabilization of the recovery of the linguistic components.

The ScreeLing: Occurrence of linguistic deficits in acute aphasia post-stroke

To investigate the occurrence of semantic, phonological and syntactic deficits in acute aphasia with the ScreeLing after the establishment of its psychometric properties. To examine the relationship between these deficits and: (i) overall aphasia severity; and (ii) quality of Spontaneous Speech. The reliability and validity of the ScreeLing was established by investigating 141 subjects with acute aphasia (2 weeks after stroke), 23 with chronic aphasia, and 138 healthy controls. In addition, the acute patients were assessed with the Token Test and a Spontaneous Speech rating (Aphasia Severity Rating Scale). The ScreeLing was found to be valid and reliable for assessing the presence and severity of aphasia and linguistic deficits at 12 days after stroke. In 22.4% of the patients deficits were found in only 1 of the 3 linguistic levels; phonology was most frequently disturbed (16.3%), compared with semantics (2.7%), and syntax (3.4%). The number of impaired linguistic levels was related to aphasia severity: patients with a 3-level disorder had the lowest Token Test scores; patients with a selective phonological disorder had the highest Spontaneous Speech ratings. Phonology alone explained 54.6% of the variance in the Spontaneous Speech rating. In the acute stage, linguistic-level deficits are already present independently of each other, with phonology affected most frequently.

A 3-year evolution of linguistic disorders in aphasia after stroke

Aphasia recovery after stroke has been the subject of several studies, but in none the deficits on the various linguistic levels were examined, even though in the diagnosis and treatment of aphasia the emphasis lays more and more on these linguistic level disorders. In this observational prospective follow-up study, we explored whether it is meaningful to investigate the recovery of semantics, phonology, and syntax separately. Fifteen patients with aphasia poststroke were assessed at 3 and 10 days, 7 weeks, 4 and 7 months, and 3 years postonset with the ScreeLing, a linguistic level test, the Aphasia Severity Rating Scale (spontaneous speech) and the Token Test. Group results showed improvement for the overall ScreeLing (P<0.01) and its subparts semantics (P<0.01) and syntax (P<0.01) up to 7 weeks, just as the Token Test (P<0.01). Phonology improved up to 4 months (P<0.05) and spontaneous speech up to 7 months (P<0.05). The recovery pattern of the three linguistic levels did not follow a parallel course, with a great deal of variability in linguistic recovery curves between and within patients. These results suggest that it is meaningful to assess the recovery of the linguistic levels separately, starting from the acute stage poststroke.

Information processing in patients with intracranial tumours: a preliminary evaluation of the clinical utility of inspection time

Psychomotor slowing is a common feature in many patients with intracranial tumours. We therefore performed a preliminary study to determine if inspection time, a measure of the efficiency of the brain's information processing, was impaired in patients with intracranial tumours. Inspection time, and some other neuropsycholgical and functional tests, were compared in 23 people with intracranial tumours and 24 spinal surgery controls prior to surgery. Groups were matched for sex, age and education. Inspection time scores were poorer in the brain tumour group (p < 0.003) and the effect size was moderate (η2 = 0.197). The brain tumour group also had lower scores on the Boston Aphasia Severity Rating Scale, more anxiety on the Hospital Anxiety Depression Scales, but better Karnovsky Performance scores. Other cognitive and functional tests showed no significant differences between the groups, although group sizes were small. There were no significant changes in inspection time after spinal surgery; however, after intracranial tumour surgery, approximately 30% of patients showed no change, 30% deteriorated and 40% improved. This preliminary study suggests that recording inspection time, in a neuro-oncological setting, may prove informative and practically useful in assessing non-motor processing speed in people with brain tumours.

Medical Instruction at Fever and Small-Pox Hospitals

<h3>Background</h3> The 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 was aimed at predicting functional outcome at 1 year after stroke. <h3>Methods</h3> We examined linguistic components (ScreeLing) and functional verbal communication (Aphasia Severity Rating Scale, ASRS) in 147 aphasic patients. The ScreeLing was administered at 1, 2 and 6 weeks after stroke; the ASRS at 1 week and 1 year. The relationships between linguistic, demographic and stroke characteristics, and good functional outcome at 1 year (ASRS 4 or 5) were examined with logistic regression analyses. <h3>Results</h3> The baseline linguistic components (ie, semantics, phonology and syntax) were significant predictors (p&lt;0.001) for 1-year outcome in univariable analyses. In multivariable analysis, these variables explained 46.5% of the variance, with phonology being the only significant predictor (p=0.003). Age, Barthel Index score, educational level and haemorrhagic stroke were identified as other significant predictors of outcome. A prognostic model of these five baseline predictors explained 55.7% of the variance. The internally validated area under the receiver operating characteristic curve (AUC) was 0.89, indicating good predictive performance. Adding the degree of phonological recovery between 1 and 6 weeks after stroke to this model increased the explained variance to 65% and the AUC to 0.91. <h3>Conclusions</h3> The outcome of aphasia at 1 year after stroke can be predicted in the first week by the phonology score, the Barthel Index score, age, educational level and stroke subtype, with phonology being the strongest predictor.