Severe Aphasia Research Articles

Delayed cyst formation after radiosurgery for arteriovenous malformation: A case report and critical review

Background: Stereotactic radiosurgery (SRS) is a validated treatment option for cerebral arteriovenous malformations (AVMs), even if a greater knowledge of its potential delayed complications is still being acquired. Case Description: A 49-year-old man suffered multiple episodes of cerebral hemorrhage in an approximate 10-year follow-up interval in the context of a left central core AVM with deep venous drainage into the internal cerebral veins (Spetzler Martin Grade 4) despite being treated with gamma knife radiosurgery at two separate timepoints, and with an almost complete obliteration confirmed. Approximately 10 years after the first radiosurgery treatment, he developed severe motor aphasia, Grade 3 right hemiparesis, progressive confusion, and memory deficits. Cerebral imaging revealed cystic degeneration in the AVM’s periphery. Cyst fenestration and cystoperitoneal shunt were attempted. The treatments were temporarily effective, but a progressive cyst enlargement recurred with clinical deterioration. The patient was therefore proposed for surgical mass and cyst excision through an interhemispheric transcallosal approach. The postoperative magnetic resonance imaging showed complete removal of the lesion, and an uneventful post-operative course ensued. At the 6-month follow-up, our patient experienced a noticeable improvement in his speech, power, dexterity and was able to walk autonomously. Conclusion: Cystic degeneration of AVMs is a possible long-term complication after SRS. Long-term follow-up and data on such patients remain crucial, even with evidence of complete nidal obliteration.

What Impacts What: Clinicians' Perspectives of Causality in Aphasia Rehabilitation.

Determining the prognosis of aphasia recovery is an important task for clinicians in the rehabilitation of persons with aphasia. Although there are many variables identified as impactful to aphasia recovery, it is less clear (a) how clinicians perceive causality in aphasia rehabilitation and (b) how prognostic variables interact with each other. This study aimed to understand causal relations between prognostic variables from the clinician perspective. Ratings of perceived causality were obtained from 11 clinicians serving people with aphasia. Participants were presented with 255 directed causal relations (e.g., depression → aphasia severity), representing a total of 18 demographic, diagnostic, and psychosocial variables. Participants rated the perceived causality on a Likert scale from 0 (no causal effect) to 10 (strong causal effect). We also obtained ratings about frequency of access to information about each of the 18 variables. A perceived causal network showed differences among variables in their perceived causality. There were many causal relations identified, particularly between diagnostic and psychosocial variables. The variables with the strongest perceived causality were predominantly psychosocial variables, including depression, social support, and participation. However, these psychosocial variables were also the variables that clinicians had the least frequent access to information about. There were also notable differences between participants in their perceived causal networks. Clinicians hold valuable information about aphasia rehabilitation, including what variables are important to aphasia recovery. Understanding the complexity of interaction among prognostic variables and obtaining data from clinicians about prognostic variables and causality will advance the rehabilitation of aphasia. https://doi.org/10.23641/asha.27105865.

The Flu-ID: A New Evidence-Based Method of Assessing Fluency in Aphasia.

Assessing fluency in aphasia is diagnostically important for determining aphasia type and severity and therapeutically important for determining appropriate treatment targets. However, wide variability in the measures and criteria used to assess fluency, as revealed by a recent survey of clinicians (Gordon & Clough, 2022), results in poor reliability. Furthermore, poor specificity in many fluency measures makes it difficult to identify the underlying impairments. Here, we introduce the Flu-ID Aphasia, an evidence-based tool that provides a more informative method of assessing fluency by capturing the range of behaviors that can affect the flow of speech in aphasia. The development of the Flu-ID was based on prior evidence about factors underlying fluency (Clough & Gordon, 2020; Gordon & Clough, 2020) and clinical perceptions about the measurement of fluency (Gordon & Clough, 2022). Clinical utility is maximized by automated counting of fluency behaviors in an Excel template. Reliability is maximized by outlining thorough guidelines for transcription and coding. Eighteen narrative samples representing a range of fluency were coded independently by the authors to examine the Flu-ID's utility, reliability, and validity. Overall reliability was very good, with point-to-point agreement of 86% between coders. Ten of the 12 dimensions showed good to excellent reliability. Validity analyses indicated that Flu-ID scores were similar to clinician ratings on some dimensions, but differed on others. Possible reasons and implications of the discrepancies are discussed, along with opportunities for improvement. The Flu-ID assesses fluency in aphasia using a consistent and comprehensive set of measures and semi-automated procedures to generate individual fluency profiles. The profiles generated in the current study illustrate how similar ratings of fluency can arise from different underlying impairments. Supplemental materials include an analysis template, extensive guidelines for transcription and coding, a completed sample, and a quick reference guide. https://doi.org/10.23641/asha.27078199.

Time reference in French-speaking people with fluent and non-fluent aphasia (part II): a cluster analysis

ABSTRACT Background Tense production is often impaired in people with aphasia (PWA). Interestingly, the literature suggests that not all tenses are affected in the same way, although the pattern of dissociation is still debated in the literature. The heterogeneity of tense production deficits in PWA might partly explain this lack of consensus in the literature. While this heterogeneity has been demonstrated by descriptive statistics or double dissociations in several studies, no study has used cluster analyses to highlight the main patterns of tense dissociation. Furthermore, the factors underlying this heterogeneity have been little explored. Aims Our study aimed to use cluster analyses on tense production performance to (1) identify the main patterns of dissociation between tenses in PWA and (2) explore the clinical (aphasia type and severity) and cognitive (executive disorders and temporality) factors that may underlie these patterns. Methods & procedures Twenty-one French-speaking participants with fluent and non-fluent aphasia completed a verb inflection production task, as well as language and cognitive tests. Cluster analyses were performed on the differences in performance between the tenses on the verb inflection production task. Generalized linear mixed models and nonparametric statistics were used to analyze the effect of tense and its interaction with the clusters, and to compare the clusters on the clinical and cognitive variables. Outcomes & results Cluster analyses revealed two main clusters, one with worse performances in the past and future than in the present (PWA_1 – 70% of the PWA), and the other with worse performances in the past and present than in the future (PWA_2 – 30%). The type and severity of aphasia, and cognitive test performance did not differ between the two clusters. On the other hand, the PWA_2 cluster had a longer time post-onset than the PWA_1 cluster. Conclusions Our results confirm the heterogeneity of verb inflection deficits in PWA. They suggest that most PWA would have difficulties with past and future tenses, questioning the presence of discourse linking in these two tenses. However, a minority of PWA, who are clinically and cognitively indistinguishable from the others, do not follow this pattern. Adopting the strategy of producing a morphologically simple tense in French – future – could explain the high performance in the future tense and the errors in substituting other tenses with the future in this subgroup. Finally, the clinical and research implications of this heterogeneity, in relation to therapies and the lack of consensus in the literature, are discussed.

Treatment of Symptomatic Carotid Webs

The present study aims to describe the clinical characteristics and treatment outcomes of patients with symptomatic carotid web treated at a single institution in South America. Retrospective study of a single-center experience of patients with carotid webs surgically treated from September 2019 to September 2023. 10 patients had carotid webs, six (60%) were females. Median age was 54.5 years (range: 35-77 years). All patients were symptomatic. Diagnosis was made in 90% (n=9) of the patients with either computed tomography angiography or magnetic resonance alone. One (10%) patient underwent angiography for definite diagnosis. The median interval from the first neurological event to intervention was 90 months (range: 3 days- 108 months). Four (40%) patients underwent surgical treatment within one month from symptom onset and carotid web diagnosis, with a median of 3.5 days (range: 3-9 days). Six (60%) patients underwent delayed surgical treatment since the cause of the neurological event was uncertain, with a median of 54 months (range: 6 - 108 months). These six patients had recurrent neurological events. Three (30%) patients underwent carotid endarterectomies with polyurethane patch and three (30%) by eversion technique. Three (30%) patients underwent segmental resection and reanastomosis of the internal carotid artery. One underwent internal carotid artery plasty with saphenous vein. At a median follow-up of 30 months (range: 6-46 months), one patient persists with mild aphasia, another patient has severe aphasia and right hemiparesis, both as sequalae of their initial strokes, and another patient has suffered 3 non-ischemic episodes of brief transient right hemiparesis attributed to epileptic seizures. The other seven patients remain without new neurological events. Neurological events of carotid distribution deserve accurate imaging work up, keeping in mind the diagnosis of carotid web. Surgical treatment for carotid web seems effective for preventing recurrences; nevertheless, further studies are warranted to define the best management for these patients.

Expanding the scope: multimodal dimensions in aphasia discourse analysis-preliminary findings.

Aphasia, resulting from acquired brain injury, disrupts language processing and usage, significantly impacting individuals' social communication and life participation. Given the limitations of traditional assessments in capturing the nuanced challenges faced by individuals with aphasia, this study seeks to explore the potential benefits of integrating multimodal communication elements into discourse analysis to better capture narrative proficiency in this population. This study examined how incorporating multimodal communication elements (e.g., physical gestures, writing, drawing) into discourse analysis may affect the narrative outcomes of persons with aphasia compared to those observed using methods that exclude multimodal considerations. Participants included individuals with chronic aphasia and age-and education-matched healthy controls who completed a storytelling task-the Bear and the Fly story. Macrolinguistic scores were obtained using verbal-only and multimodal scoring approaches. Additionally, the frequency and type of multimodal communication use during storytelling were examined in relation to aphasia characteristics. Statistical analyses included both within-group and between-group comparisons as well as correlational analyses. Individuals with aphasia scored significantly higher in terms of their macrolinguistic abilities when multimodal scoring was considered compared to verbal-only scoring. Within the aphasia group, there were prominent differences noted in macrolinguistic scores for both fluent and nonfluent aphasia. Specifically, both groups scored higher on Main Concepts when multimodal scoring was considered, with the nonfluent group demonstrating significantly higher Main Concept and total macrolinguistic rubric scores in multimodal scoring compared to verbal scoring on the storytelling task. Additionally, aphasia severity showed moderate positive correlations with total macrolinguistic scores, indicating that individuals with less severe aphasia tended to produce higher quality narratives. Lastly, although persons with aphasia used different types of nonverbal modalities (i.e., drawing, writing), the use of meaning-laden gestures was most predominant during storytelling, emphasizing the importance of multimodal elements in communication for individuals with aphasia. Our preliminary study findings underscore the importance of considering multimodal communication in assessing discourse performance among individuals with aphasia. Tailoring assessment approaches based on aphasia subtypes can provide valuable insights into linguistic abilities and inform targeted intervention strategies for improving communication outcomes.

Assessing Language Lateralization through Gray Matter Volume: Implications for Preoperative Planning in Brain Tumor Surgery.

Functional MRI (fMRI) is widely used to assess language lateralization, but its application in patients with brain tumors can be hindered by cognitive impairments, compensatory neuroplasticity, and artifacts due to patient movement or severe aphasia. Gray matter volume (GMV) analysis via voxel-based morphometry (VBM) in language-related brain regions may offer a stable complementary approach. This study investigates the relationship between GMV and fMRI-derived language lateralization in healthy individuals and patients with left-hemisphere brain tumors, aiming to enhance accuracy in complex cases. The MRI data from 22 healthy participants and 28 individuals with left-hemisphere brain tumors were analyzed. Structural T1-weighted and functional images were obtained during three language tasks. Language lateralization was assessed based on activation in predefined regions of interest (ROIs), categorized as typical (left) or atypical (right or bilateral). The GMV in these ROIs was measured using VBM. Linear regressions explored GMV-lateralization associations, and logistic regressions predicted the lateralization based on the GMV. In the healthy participants, typical left-hemispheric language dominance correlated with higher GMV in the left pars opercularis of the inferior frontal gyrus. The brain tumor participants with atypical lateralization showed increased GMV in six right-hemisphere ROIs. The GMV in the language ROIs predicted the fMRI language lateralization, with AUCs from 80.1% to 94.2% in the healthy participants and 78.3% to 92.6% in the tumor patients. GMV analysis in language-related ROIs effectively complements fMRI for assessing language dominance, particularly when fMRI is challenging. It correlates with language lateralization in both healthy individuals and brain tumor patients, highlighting its potential in preoperative language mapping. Further research with larger samples is needed to refine its clinical utility.

Validation of the abbreviated version of the Token Test in Latin American Spanish stroke patients.

The abbreviated version of the Token Test (aTT) is widely used to assess language comprehension deficits in stroke patients (SPs). However, aTT has not been validated for Latin American Spanish speakers, so clinicians tend to use cut-off scores for aTT validated in developed countries. To provide normative data for the Spanish aTT (Sp-aTT) in healthy Chilean Spanish-speaking and SP, determining the influence of sociodemographic variables such as gender, age and education on Sp-aTT performance. A total of 210 healthy volunteers (age range = 18-88 years) and 197 SPs (age range = 23-94 years), all native speakers of Chilean Spanish, were recruited. The association of age, gender and years of education on the Sp-aTT performance was analysed. Specificity and sensibility analyses of the Sp-aTT to diagnose language comprehension deficits were completed. Only age (p < 0.001) and years of education (p < 0.001) impacted the total score of Sp-aTT. Gender did not show an association with Sp-aTT performance (p = 0.181). For SPs, the Sp-aTT score showed a significant positive correlation (rho = 0.4, p < 0.001) with the aphasia severity rating scale (ASRS) score. For Sp-aTT, the area under the curve was 0.97, and the optimal cut-off score for the Sp-aTT was 30 (0.73 of sensitivity, 0.92 of specificity and a Youden index of 0.644). Age and years of education are two key factors to be controlled for when determining the optimal cut-off points for the Sp-aTT. Our results also highlight the need for language-specific norms in stroke and aphasia research. What is already known on the subject The aTT has been validated and adapted in several countries. Its properties in screening and detecting comprehensive deficits in SPs highlight its potential as a screening tool in clinical practice. Moreover, considering that stroke is the third largest cause of death worldwide, research and clinical practice have focused on how to improve early detection of deficits in these people, especially those related to cognition, language and functionality in SPs. Therefore, counting with validated and adapted tools is essential for clinicians because it could contribute to accurate intervention and classification of language disorders. What this paper adds to the existing knowledge The main contribution of this study is to provide normative data for the aTT in Latin American Spanish speakers. No previous studies have focused on validating this test and analysing the influence of three critical variables (age, gender and years of education) on its performance in SPs from Latin America. In addition, we propose a classification of the severity of comprehension deficits in SPs. Finally, we found comprehension deficits in patients with right and left hemisphere stroke, which would imply that these deficits would not be exclusive to left hemisphere stroke. What are the potential or actual clinical implications of this work? Contribute with validation of language comprehension tools, such as the aTT, could improve early diagnosis of patients with language disorders. This validation provides a test based on the sociodemographic characteristics of Latin American Speakers, which has yet to be established. Due to this, normative data considering the sociodemographic characteristics of the target population is crucial for accurately classifying comprehension deficits after brain damage.

A Preliminary Examination of a Novel Telepractice Screening Protocol for Poststroke Aphasia.

The delivery of telepractice interventions for people with poststroke aphasia has been found effective and feasible compared to traditional, in-person interventions; however, telepractice assessments, particularly screening protocols, which may foster convenient access to aphasia diagnostic services, have received limited examination within the aphasia literature. Therefore, the purpose of this study was to examine a novel telepractice screening protocol for people with poststroke aphasia that assesses both language and extralinguistic cognitive abilities via both performance-based and patient-reported measures. Twenty-one participants with previously diagnosed poststroke aphasia completed the telepractice administration of the Frenchay Aphasia Screening Test (FAST), the Aphasia Impact Questionnaire-21 (AIQ-21), the Oxford Cognitive Screen (OCS), and the Cognitive-Communication Checklist for Acquired Brain Injury (CCCABI). Care partners of the participants completed the Communicative Effectiveness Index (CETI). After the telepractice session, each participant completed a feasibility questionnaire to rate their overall experience. All participants screened as having aphasia. Pearson correlation analyses yielded a strong positive relationship between OCS and FAST scores (r = .74), a strong relationship between OCS and CCCABI scores (r = -.71), and a moderate relationship between FAST and AIQ-21 scores (r = -.35). Moderate relationships were noted between the performance-based measures and the CETI (r = .30). The overall feasibility of telepractice administration was rated positively by each participant. No significant relationships were found between the feasibility responses and participant characteristics. Overall, the telepractice screening protocol yielded an effective and feasible way to identify poststroke aphasia. Similar to in-person administration of screening measures, it was more difficult to identify milder levels of aphasia severity. Future research should examine whether this telescreening protocol can identify poststroke aphasia within the broader stroke population.

Prediction models of the aphasia severity after stroke by lesion load of cortical language areas and white matter tracts: An atlas-based study

ObjectiveTo construct relatively objective, atlas-based multivariate models for predicting early aphasia severity after stroke, using structural magnetic resonance imaging. MethodsWe analyzed the clinical and imaging data of 46 patients with post-stroke aphasia. The aphasia severity was identified with a Western Aphasia Battery Aphasia Quotient. The assessments of stroke lesions were indicated by the lesion load of both the cortical language areas (Areas-LL) and four white matter tracts (i.e., the superior longitudinal fasciculus, SLF-LL; the inferior frontal occipital fasciculi, IFOF-LL; the inferior longitudinal, ILF-LL; and the uncinate fasciculi, UF-LL) extracted from human brain atlas. Correlation analyses and multiple linear regression analyses were conducted to evaluate the correlations between demographic, stroke- and lesion-related variables and aphasia severity. The predictive models were then established according to the identified significant variables. Finally, the receiver operating characteristic (ROC) curve was utilized to assess the accuracy of the predictive models. ResultsThe variables including Areas-LL, the SLF-LL, and the IFOF-LL were significantly negatively associated with aphasia severity (p < 0.05). In multiple linear regression analyses, these variables accounted for 59.4 % of the variance (p < 0.05). The ROC curve analyses yielded the validated area under the curve (AUC) 0.84 both for Areas-LL and SLF-LL and 0.76 for IFOF-LL, indicating good predictive performance (p < 0.01). Adding the combination of SLF-LL and IFOF-LL to this model increased the explained variance to 62.6 % and the AUC to 0.92. ConclusionsThe application of atlas-based multimodal lesion assessment may help predict the aphasia severity after stroke, which needs to be further validated and generalized for the prediction of more outcome measures in populations with various brain injuries.

Typing Versus Handwriting: A Preliminary Investigation of Modality Effects in the Writing Output of People With Aphasia.

Handwriting and typing have different cognitive and motor demands; however, questions remain as to whether performance in people with aphasia varies based on modality. This study compares written discourse production across handwritten and onscreen typed modalities for a large sample of people with aphasia. We also aimed to explore potential variables that predict the number of written words generated by participants and determine if modality differences emerge when these variables are included as predictors. Writing samples, via handwriting and onscreen typing, elicited in a picture description task were collected from 52 participants with chronic aphasia and coded for number of words. Generalized linear mixed-effects models were used to model the data. Aphasia type, severity of aphasia, writing severity, and use of nondominant hand for writing or onscreen typing were included as predictor variables. There were no significant differences between the number of words generated in the typed modality versus handwritten modality for the sample. Of the predictor variables examined, Western Aphasia Battery-Revised writing scores significantly predicted the number of words produced (p < .001). However, the interaction of writing severity with modality was not significant. This preliminary study suggests that there was no effect of modality on one measure of written production, number of words. Future research is needed to evaluate if there are meaningful differences between modalities when additional measures, such as writing informativeness, are considered. https://doi.org/10.23641/asha.26506144.

Explorating the Role of Caregiver Quality Of Life in the Recovery Pattern of Patients With Severe Non-Fluent Aphasia – Case Series

Explorating the Role of Caregiver Quality Of Life in the Recovery Pattern of Patients With Severe Non-Fluent Aphasia – Case Series

The coproduction of a multilevel personal narrative intervention for people with aphasia in a community communication support group—A pilot study

IntroductionPeople with aphasia (PWA) face challenges in sharing personal stories due to communication difficulties. Discourse treatment in aphasia focusing on personal narrative macrostructure has yet to receive the attention this warrants of researchers and clinicians. Emerging person-centered approaches involve coproduction and codesign with PWA for meaningful discourse treatments. Few studies explore discourse treatment's impact on functional communication. This pilot study aims to explore whether the use of the coproduction approach in the development of a multilevel personal narrative intervention at the group level increased the production of macrostructure elements in trained and untrained narrative discourse contexts, improved aphasia severity and functional communication skills, and advanced quality of life of the participants with aphasia.MethodsAn ABA design was followed featuring a pre-treatment baseline assessment phase, a treatment phase, and a post-treatment assessment phase immediately after treatment was completed. Three people with chronic stroke-induced aphasia, three communication partners, and a moderator took part in the study. All participants were members of a university-led community aphasia communication group. The research protocol consisted of eleven, two-hour, weekly sessions over an 11-week block. Nine treatment sessions were carried out following codesign and coproduction methods that focused on participants with aphasia producing words, sentences, and total communication strategies to express macrostructure elements in their personal stories. Assessment measures were collected at baseline and post-treatment to evaluate improvements in trained and untrained narrative abilities, aphasia severity, functional communication, and the impact of aphasia on quality of life.ResultsMultilevel personal narrative therapy improved the narrative skills of the participants with aphasia at the macrostructural level of narrative discourse. Improvements were also observed in functional communication and quality of life post-treatment.DiscussionThe involvement of participants with aphasia in the codesign and coproduction of the treatment content for the group intervention facilitated improvement in narrative skills, functional communication, and overall quality of life with aphasia. It is recommended that researchers and clinicians consider using content from the personal narratives of clients with aphasia to build discourse treatment and adopt codesign and coproduction approaches, when designing interventions for people with chronic aphasia, to improve communication outcomes in everyday life.

The validation of aphasia united best practice recommendations with people with aphasia and their caregivers in Vietnam: a nominal group technique study

ABSTRACT Background Speech and language therapy is a relatively new profession in Vietnam and to date, 79 individuals have graduated from Master and Bachelor programs. For the few therapists working with adult populations, clinical guidance tailored to the Vietnamese context is limited. The Aphasia United Best Practice Recommendations were developed to provide multi-national guidance for the management of post-stroke aphasia and have been translated into 29 languages, including Vietnamese. To date however, their applicability to low-middle income countries with emerging speech and language services such as Vietnam has not been explored. Aims To determine the relevance, comprehensibility, and comprehensiveness of the Aphasia United Best Practice Recommendations to people with aphasia and caregivers in Vietnam. Methods and Procedures People with aphasia and their caregivers participated in focus groups, utilising the nominal group technique. Participants were recruited from four hospitals in Ho Chi Minh City. Participants with aphasia were sampled for severity of aphasia, age, sex, time-post onset, geographic location, employment status, and relationship. Participants reviewed the recommendations, rated relevance and comprehensibility (clarity), and made suggestions for improvement. Participants assessed the comprehensiveness of the recommendations and additional items were generated and prioritised. Data were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results People with aphasia (n = 11) and caregivers (n = 17) participated in one of nine focus groups. People with aphasia rated all recommendations as relevant. Levels of agreement varied for caregivers and fell < 85% for one recommendation only (Recommendation 4 – relating to the need for all people with aphasia to have some means of communication prior to discharge). Both participant groups suggested changes to content and wording to reflect the context and culture of Vietnam. Three common themes within the newly proposed recommendations were identified across both participants with aphasia and caregiver groups: (1) easier access to speech and language therapy services and information about aphasia, (2) the need for psychological and social support for people with aphasia and (3) the need for increased community awareness and supports for people with aphasia and their caregivers. Conclusions and Implications The Aphasia United Best Practice Recommendations were perceived to be relevant, however new recommendations reflecting the unique cultural, economic and healthcare environment of Vietnam were identified. Recommendations relating to access to services and community-based rehabilitation were prioritised, supporting the need for continued growth and advocacy for the speech and language therapy profession in Vietnam.

Interplay of Semantic Plausibility and Word Order Canonicity in Sentence Processing of People With Aphasia Using a Verb-Final Language.

The Western Aphasia Battery is widely used to assess people with aphasia (PWA). Sequential Commands (SC) is one of the most challenging subtests for PWA. However, test items confound linguistic factors that make sentences difficult for PWA. The current study systematically manipulated semantic plausibility and word order in sentences like those in SC to examine how these factors affect comprehension deficits in aphasia. Fifty Korean speakers (25 PWA and 25 controls) completed a sentence-picture matching task that manipulated word order (canonical vs. noncanonical) and semantic plausibility (plausible vs. less plausible). Analyses focused on accuracy and aimed to identify sentence types that best discriminate the groups. Additionally, we explored which sentence type serves as the best predictor of aphasia severity. PWA demonstrated greater difficulties in processing less plausible sentences than plausible ones compared to the controls. Across the groups, noncanonical and less plausible sentences elicited lower accuracy than canonical and plausible sentences. Notably, the accuracy of PWA and control groups differed in noncanonical and less plausible sentences. Additionally, aphasia severity significantly correlated with less plausible sentences. Even in languages with flexible word order, PWA find it challenging to process sentences with noncanonical syntactic structures and less plausible semantic roles.

Using Discourse Structure Analysis to Understand Communication Profiles of Members With Severe and Mild Aphasia in Facilitated Conversation Groups

Using Discourse Structure Analysis to Understand Communication Profiles of Members With Severe and Mild Aphasia in Facilitated Conversation Groups

A Fatal Case of Powassan Virus Encephalitis

The Powassan virus (POWV) is part of the Flaviviridae family. It is mainly transmitted via tickbite but can rarely be spread person-to-person through blood transfusions. Initial symptoms include fever, headache, and vomiting. It can cause severe symptoms, including confusion, aphasia, and seizures. Approximately 1 out of 10 people with severe disease die. From 2010 to 2020, 194 Powassan virus cases have been reported to the Center for Disease Control (CDC), with 22 of them resulting in death. In this case report, we discuss a 39-year-old female who presented with fever, myalgia, and confusion. During her hospitalization, she developed tonic-clonic seizures, which required sedation and intubation. A central venous catheter was inserted due to poor intravenous access, and in the process of placing it, the provider sustained a needle stick injury. The patient was eventually diagnosed with POWV encephalitis and transferred to a higher level of care, where a brain perfusion study showed an absence of brain flow consistent with brain death. After a discussion with the family, the decision was made to extubate the patient terminally. The provider who sustained the needle stick injury reported no concerning symptoms two years after the event.

Distinct brain morphometry patterns revealed by deep learning improve prediction of post-stroke aphasia severity

BackgroundEmerging evidence suggests that post-stroke aphasia severity depends on the integrity of the brain beyond the lesion. While measures of lesion anatomy and brain integrity combine synergistically to explain aphasic symptoms, substantial interindividual variability remains unaccounted. One explanatory factor may be the spatial distribution of morphometry beyond the lesion (e.g., atrophy), including not just specific brain areas, but distinct three-dimensional patterns.MethodsHere, we test whether deep learning with Convolutional Neural Networks (CNNs) on whole brain morphometry (i.e., segmented tissue volumes) and lesion anatomy better predicts chronic stroke individuals with severe aphasia (N = 231) than classical machine learning (Support Vector Machines; SVMs), evaluating whether encoding spatial dependencies identifies uniquely predictive patterns.ResultsCNNs achieve higher balanced accuracy and F1 scores, even when SVMs are nonlinear or integrate linear or nonlinear dimensionality reduction. Parity only occurs when SVMs access features learned by CNNs. Saliency maps demonstrate that CNNs leverage distributed morphometry patterns, whereas SVMs focus on the area around the lesion. Ensemble clustering of CNN saliencies reveals distinct morphometry patterns unrelated to lesion size, consistent across individuals, and which implicate unique networks associated with different cognitive processes as measured by the wider neuroimaging literature. Individualized predictions depend on both ipsilateral and contralateral features outside the lesion.ConclusionsThree-dimensional network distributions of morphometry are directly associated with aphasia severity, underscoring the potential for CNNs to improve outcome prognostication from neuroimaging data, and highlighting the prospective benefits of interrogating spatial dependence at different scales in multivariate feature space.

Regional brain aging: premature aging of the domain general system predicts aphasia severity

Premature brain aging is associated with poorer cognitive reserve and lower resilience to injury. When there are focal brain lesions, brain regions may age at different rates within the same individual. Therefore, we hypothesize that reduced gray matter volume within specific brain systems commonly associated with language recovery may be important for long-term aphasia severity. Here we show that individuals with stroke aphasia have a premature brain aging in intact regions of the lesioned hemisphere. In left domain-general regions, premature brain aging, gray matter volume, lesion volume and age were all significant predictors of aphasia severity. Increased brain age following a stroke is driven by the lesioned hemisphere. The relationship between brain age in left domain-general regions and aphasia severity suggests that degradation is possible to specific brain regions and isolated aging matters for behavior.

Validity and satisfaction in telehealth aphasia assessment: videoconference administration of the Comprehensive Aphasia Test-Hungarian

ABSTRACT Background The demand for telehealth aphasia assessment is increasing, yet only a limited number of instruments’ validity and feasibility in telehealth have been evaluated. The Comprehensive Aphasia Test (CAT) is a widely available language test with established psychometric properties in several languages, including Hungarian. Aims The current study aimed to evaluate the validity of administering the Hungarian version of the CAT (CAT-H) via videoconference and explore the satisfaction of people with aphasia (PWA) with videoconference assessment compared to in-person assessment. Methods & Procedures Twelve PWA with left hemisphere stroke (mean age = 50.83 years, mean post-onset = 19 months), exhibiting mild-to-moderate aphasia, completed both in-person and videoconference assessments using the CAT-H Language Battery. The study used a comparison design, incorporating elements of counterbalancing and blinding. The assessments were conducted by speech-language pathologists (SLPs), with one person leading the in-person assessment and another leading the videoconference assessment for each participant. The order of administration (in-person or videoconference) was counterbalanced across participants. SLPs leading the second assessments were blind to the results of the first assessments. One key adjustment for the videoconference assessment was the utilisation of the screen sharing and/or control sharing features within the videoconferencing software. Participants also filled out a satisfaction questionnaire after each assessment and expressed their preference between the two assessment methods at the end of the study. Intraclass correlation coefficients (ICCs) were calculated to compare the CAT-H modality summary scores and the CAT-H language battery score between in-person and videoconference assessments. Outcomes & Results There was good-to-excellent agreement between in-person and videoconference assessments, with ICCs ranging from 0.80 to 0.96 (p < 0.001) for the CAT-H modalities and an ICC of 0.97 for the CAT-H language battery score. At the individual level, minor inconsistencies were observed in the language battery score between the two assessments. Participants reported high satisfaction with both assessment methods, with satisfaction levels for the videoconference assessment being comparable to those for the in-person assessment. While the majority of participants did not exhibit a preference between the two methods in terms of understanding the clinician, approximately half of them favoured the in-person assessment for expressing themselves and comfort. Conclusions Obtained results suggest that the CAT-H can be effectively administered via videoconference, offering a viable alternative to in-person assessment when necessary. Future studies should replicate these findings with a larger and more diverse study sample, involving participants with moderately severe and severe aphasia.