Aphasia Treatment Research Articles (Page 1)

Intensive comprehensive aphasia programs (ICAPs) are a novel service delivery model incorporating best practice principles in aphasia rehabilitation. Despite increased evidence, adoption of this model into health care services remains limited. This study evaluated the feasibility and effectiveness of the comprehensive, high-dose aphasia treatment (CHAT) program, a modified-ICAP, when implemented by a public rehabilitation facility in Brisbane, Australia. A nonrandomized, Type II hybrid clinical implementation and effectiveness study design was employed. The CHAT program includes 50 hr of goal-directed aphasia rehabilitation, delivered over 8 weeks. Sixty-seven adults with poststroke aphasia consented to the study. Feasibility was evaluated using service statistics (i.e., referrals, adherence, dose) and analyzed using descriptive statistics. Effectiveness evaluated changes in participants' language impairment, communication activity and participation, and quality of life at posttherapy and 3-month follow-up. Group-level data were analyzed using linear mixed models and Cohen's d effect sizes. Minimal detectable change (MDC90) was used to determine changes at the individual participant level. Fourteen cohorts of CHAT were delivered from February 2021 to December 2023. Sixty-five participants completed CHAT, with an average dose of 46.6 hr of therapy. Group-level analyses revealed significant improvements in participants' language impairment, communication activity and participation, and quality of life (p < .05) at posttherapy and 3-month follow-up. Most participants (89%) demonstrated significant improvements on at least one outcome measure. The CHAT program was feasibly delivered within a public, health care context and resulted in positive and enduring changes in participants' language impairment, communication function, and quality of life. https://doi.org/10.23641/asha.30522767.

This study examined the effects of a multimodal verb-centered noun retrieval treatment in three individuals with logopenic variant primary progressive aphasia (lvPPA). The intervention aimed to improve naming accuracy for trained nouns and promote generalization to untrained nouns. Three individuals with lvPPA participated in a multiple-baseline design study. Treatment was based on thematic relationships between verbs and nouns, incorporated self-cueing strategies, and orthographic homework practice, adapted from the Copy and Recall Treatment. Naming accuracy for treated and untreated nouns was assessed pretreatment and posttreatment to evaluate gains on the treated items and generalization effects. All participants demonstrated statistically significant improvements in naming accuracy for treated nouns, with large effect sizes. Generalization to untrained nouns was also observed in all participants but varied across participants, with the greatest gains observed in the individual with milder baseline impairments. The intervention, centered on verbs and their thematic roles, appeared to support lexical access of nouns and homework practice reinforced retrieval. The treatment effects and generalization were most robust for the individual with less-affected phonological manipulation and semantic processing abilities of nouns and verbs. Findings support the efficacy of a structured lexical retrieval intervention in lvPPA that leverages verb-noun thematic relationships and self-cueing strategies. Individual differences in baseline cognitive-linguistic skills and performance on sematic association tasks may influence treatment responsiveness. Future research should explore predictors of treatment response and assess long-term maintenance of gains to refine intervention approaches for lvPPA. https://doi.org/10.23641/asha.30082309.

ABSTRACT Background Despite the importance of grammatical skills for participation in daily life, treatments for sentence–level abilities in aphasia are comparatively scarce. The psycholinguistic paradigm of syntactic priming has recently been advanced as a potential assessment and treatment for grammatical skills, and existing evidence on priming in aphasia is highly promising. Nevertheless, a comprehensive analysis of the strength of priming effects in aphasia, as well as treatment components which might amplify these effects, has not been reported. This meta–analysis synthesizes existing findings on syntactic priming in aphasia, aiming to provide a comprehensive picture of priming effects and their potential application for treatment. Method A comprehensive search of reported syntactic priming studies including persons with aphasia was conducted, yielding 27 experiments. Standardized mean differences (SMD) were computed from each experiment to account for inter –study heterogeneity. Studies were then weighted by participant numbers. An omnibus meta–analysis model was fitted to evaluate standardized differences associated with priming, followed by meta–regression analyses assessing possible treatment components. Results A large, robust effect of syntactic priming was discovered (SMD = 1.37). All but one reported studies found positive priming effects, though substantial heterogeneity was found between included experiments. Meta–regression analyses found no effects of lexical overlap between primes and targets (lexical boost), the presence of a confederate in experiments, or oral repetition of prime sentences. Conclusions This study strongly supports the development of syntactic priming as a sentence–level treatment in aphasia, and suggests high adaptability of priming to different formats and settings. Lexical overlap may not be effective in facilitating priming–induced gains. Future studies of priming in aphasia should include larger samples of participants and should investigate how lexical information interacts with syntactic priming.

Sentence production is impaired in many persons with aphasia (PWA). However, few effective treatments for sentence production exist. Recent research has advanced structural priming as a promising treatment for aphasia, but the underlying mechanisms of priming remain unclear. This study examined contributions of abstract syntactic and lexically boosted priming to sentence production improvements in PWA and underlying memory mechanisms. Twenty-four PWA and 16 age-matched controls completed baseline testing, three to six sessions of sentence production priming training, and 1-day and 1-week posttesting. Trained structures were passives and double-object datives. Participants were trained with same-verb and different-verb priming to assess lexical boost and abstract syntactic priming effects on treatment outcomes. The serial reaction time, fragmented picture, and picture pointing span tests were administered to assess contributions of implicit and explicit memory in predicting treatment gains. PWA and controls showed lasting improvements to both trained and untrained sentences following training. Critically, controls improved more strongly following same-verb priming, while PWA showed stronger gains following different-verb priming. High implicit memory scores facilitated greater treatment effects in both PWA and controls. Only controls showed positive effects of explicit memory. These results support structural priming as an effective sentence production treatment for PWA, especially when verbs are not matched between primes and target. We suggest lexical differentiation supports priming in PWA by allowing more efficient access and learning of abstract syntactic representations, which appears crucial to successful sentence production.

White matter hyperintensities (WMHs), the neuroimaging markers of cerebral small vessel disease, have been associated with adverse neurological recovery after stroke. However, their role in poststroke aphasia, an acquired language disorder affecting approximately one-third of stroke survivors, remains unclear. This review synthesizes evidence on the relationship between WMHs and poststroke aphasia, focusing on severity and recovery across stroke phases, associations with cognitive outcomes, and the influence of hemispheric lateralization. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Literature search was performed across PubMed, Scopus, and Web of Science. Thirteen studies met eligibility criteria, examining the impact of WMH severity on language and cognitive deficits in patients with poststroke aphasia. Correlation and regression analyses were the predominant statistical approaches to evaluate associations and control for confounders. Greater WMH burden was significantly associated with more severe language impairments in the chronic (6 studies, n=443), subacute (3 studies, n=117), and mixed subacute-chronic phases (1 study, n=42), particularly in object naming, word fluency, and spoken comprehension. Preliminary evidence suggests periventricular WMHs may be more linked to aphasia severity than deep WMHs, whereas treatment-related findings remain inconclusive. In the acute phase, 2 studies (n=288) found no association between WMH burden and either aphasia severity or treatment response. In chronic aphasia (4 studies, n=392), WMHs were also linked to poorer cognitive performance, especially in nonverbal reasoning and executive functions. Hemispheric assessment varied, with some studies focusing on the contralesional side to reduce lesion-related confounding, while others used bilateral measures, limiting comparability. WMHs may represent neuroimaging biomarkers of language and cognitive dysfunction in chronic and subacute poststroke aphasia. Future studies with standardized imaging protocols and larger samples are needed to clarify their prognostic value and personalize rehabilitation strategies. URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42024582826.

Aphasia rehabilitation is a learning process that unfolds over time. Previous group studies have examined aphasia treatment response using pre- to posttreatment comparison, largely ignoring the unfolding learning response that occurs session-to-session. We aimed to (a) characterize the shape of learning while individuals with aphasia received intensive anomia intervention and (b) identify the cognitive predictors of this learning response. Individuals (N = 39) with chronic poststroke aphasia received intensive semantic feature analysis (SFA). Naming accuracy for trained and semantically related, untrained words was probed daily. We used Bayesian generalized linear mixed-effects models to estimate the shape of learning during SFA treatment and to measure the influence of key cognitive functions on treatment response. Most treatment gains appeared early during treatment, after the first 4 hr of intervention. Verbal recognition and visuospatial memory were associated with the magnitude of those early treatment gains, favoring strong cognitive performers. Treatment generalization to untrained targets was present but modest, with some evidence suggesting that visuospatial recall performance may be associated with treatment generalization. Monitoring SFA treatment response early could help inform clinicians whether patients will respond optimally to intervention. Verbal recognition and visuospatial recall support learning during treatment, helping elucidate cognitive underpinnings of learning during aphasia rehabilitation. https://doi.org/10.23641/asha.30213520.

Efficacy of cerebellar cathodal transcranial direct current stimulation for post-stroke aphasia: A randomized controlled trial

To evaluate the feasibility of delivering 50 h of comprehensive, high-dose aphasia treatment via telerehabilitation (TeleCHAT) to people with aphasia and their support people. A non-randomised one-armed quasi-experimental pre-post feasibility study. TeleCHAT was delivered from dedicated tele-suites in university spaces within a tertiary hospital. Participants received therapy in their homes via telerehabilitation using a configured telerehabilitation system which used videoconferencing software Zoom®. Three cohorts of people with aphasia (n = 12), support people (n = 11), and speech-language pathologists (n = 2) participated. Participants completed technology training, goal setting, and clinical treatment planning prior to the intervention. The TeleCHAT intervention included 50 h of goal-directed aphasia therapy, delivered 3-5 days per week over 8 weeks. Mixed-methods data was collected on participant demographics, aphasia profiles, achievement of dose, comprehensiveness of therapy, and support people participation. A diverse group of people with aphasia completed TeleCHAT. Nine participants received the intended dose of 50 h, with the remaining three closely approaching dose. A high proportion of sessions were spent actively engaged in therapeutic tasks (94-100%). A comprehensive array of 42 therapy activities was delivered and tailored to goals across the International Classification of Functioning, Disability and Health Framework. All participants had a support person participate actively in at least one session. It was feasible to deliver the core components of the TeleCHAT programme via telerehabilitation. As intended, a heterogeneous group of people with aphasia received a high-dose of tailored, comprehensive aphasia therapy, with the active participation of support people.

BACKGROUND Aphasia is a common consequence of stroke and traumatic brain injury (TBI) that significantly impairs communication and quality of life. Transcranial direct current stimulation (tDCS) has emerged as a non-invasive technique potentially enhancing language rehabilitation. This study aimed to evaluate the efficacy of tDCS in combination with speech-language therapy (SLT) in improving language functions in patients with aphasia. MATERIAL AND METHODS A group of 90 patients diagnosed with TBI- or stroke-related aphasia were randomly assigned to 3 groups: tDCS alone (Group I), SLT alone (Group II), and tDCS combined with SLT (Group III). Treatment procedures spanned 5 months. tDCS sessions lasted 30-40 minutes each (1-1.5 mA), targeting the left dorsolateral (F3) and the right (F4) prefrontal cortex. Language function was assessed using the Frenchay Aphasia Screening Test (FAST), Aphasia Evaluation Scale (SODA), and Token Test (TT). Statistical analyses compared pre- and post-intervention outcomes within and between groups. RESULTS All groups demonstrated significant improvements in language function (p < 0.001). Group III showed the greatest gains in verbal expression, comprehension, and reading (32.6% improvement in FAST scores), significantly outperforming Group I (24.3%) and Group II (17.8%). tDCS alone was more effective than SLT alone (p = 0.04). Combining tDCS with SLT resulted in superior patient-reported improvements in daily communication and confidence in verbal expression compared to either treatment alone. CONCLUSIONS Patients who received combined tDCS and SLT had notable improvements across all measured parameters, including verbal expression, comprehension, reading, and writing, as assessed by the FAST, SODA, and TT tests.

ABSTRACT Background Primary progressive aphasia (PPA) affects the production of discourse. Despite this, only a few studies have explored discourse treatments for people with PPA. These studies, all from countries with native English-speaking populations, have yielded positive results. However, there is a need for more research on discourse treatment from non-native English-speaking populations. To address this, we conducted the first discourse treatment study in Norway. Aim We aimed to explore the feasibility of adapting a multilevel discourse treatment from English to Norwegian, and the acceptability and early effectiveness of this intervention in a participant with PPA, addressing the treatment’s impact on lexical retrieval informativeness, efficiency, macrostructure, and social and functional communication. Methods and Procedures In this single-case study, we applied a multiple baseline design with repeated measures. One person with mixed PPA with Alzheimer’s disease pathology was enrolled in the study. The participant received 20 sessions of the principle-based intervention, the Narrative and Discourse Intervention in Aphasia (NADIIA), delivered over six weeks. Discourse production was measured with the Curtin University Discourse Protocol, and social and functional communication with the Aphasia Impact Questionnaire-21 (AIQ-21) and the Communicative Effectiveness Index (CETI). We applied visual inspection of the data, and the statistical measures, the Non-overlap of All Pairs (NAP) and the within-case standardised mean difference (WC-SMD). Outcome and Results The participant showed improvement in lexical retrieval in discourse production, the macrostructure of the discourse and informativeness and efficiency, with the NAP ranging from weak to medium and the WC-SMD ranging from small to medium. The results were maintained at three-month follow-up. The participant improved on the AIQ-21, with scores improving from 24 points at the pretest to 12 points at three-month follow-up. The CETI scores were almost at ceiling ( > 90 points) at pretesting, and this was maintained at post-testing and follow-up. Conclusion It is possible to deliver the NADIIA in Norwegian without any major adaptations. The treatment had a positive impact on discourse production and social and functional communication, and the results were maintained at the three-month follow-up. This is a promising intervention that Norwegian speech and language therapists can add to their toolkit when working with people with PPA.

Effective neural connectivity deficits during speech auditory feedback processing in post-stroke aphasia: An fMRI study.

Effect of feedback type and self-selected practice schedule on speech fluency during aphasia script treatment.

ABSTRACT Postoperative aphasia is a significant complication following brain tumor resection, affecting both quality of life and prognosis. Currently, speech language therapy (SLT) is the primary approach for treating aphasia, with no alternative rehabilitation options available. However, rTMS has shown promise intreating stroke-related language impairments. In this case report, we applied bilateral rTMS to address aphasia following brain tumor resection. A 36-year-old man with a known diagnosis of an oligodendroglioma (WHO3°) at the temporo-parieto-occipital junction presented with initial mild aphasia. Preoperative diagnostics revealed language-relevant areas in the supramarginal gyrus and infiltration of the AF, ILF and IFOF, leading to the decision to perform an awake craniotomy fortumor resection. Following complete resection, ischemia medial to the resection cavity was observed, resulting in a worsening of aphasia (AAT scorepostop196/440). Over 7 days, continuous bilateral rTMS combined with SLT was administered without any severe side effects. The patient’s aphasia significantly improved post-treatment (AAT scoreDischarge291/440; AAT score1 Month343/440; AAT score3 Months 386/440). Given the encouraging results, a potential beneficial effect of the additional rTMS therapy may be suggested. However, larger cohorts and randomized controlled trials are necessary to confirm these preliminary results.

Approximately 44% of individuals with chronic aphasia also present with apraxia of speech, necessitating integrated treatment approaches to optimize recovery. This study examined the effects of a combined treatment protocol, leveraging Treatment of Underlying Forms (TUF) and a modified version of Sound Production Treatment (SPT), on language and speech outcomes in individuals with mild aphasia and apraxia. Three participants underwent treatment involving alternating and combined TUF and modified SPT. The pre- and posttreatment assessments included standardized and treatment-specific speech and language measures. The results indicated significant improvements in the production of both trained and untrained items with similar syntactic and articulatory complexities, whereas generalization to simpler targets varied among participants. Our findings suggest that combined TUF/modified SPT may enhance speech and language outcomes, warranting further investigation of individual variability in treatment responses and generalization patterns.

ABSTRACT Background Persons with aphasia (PWA) frequently experience difficulties in text-level reading comprehension. StraTexT is a strategy-based intervention to treat text comprehension in aphasia. Previous studies on StraTexT have analysed quantitative and qualitative data of an intervention study with 22 participants, providing estimates of the magnitude of treatment effects, insights into subjectively perceived improvements, and a comparison with a control condition. Individual-level quantitative analyses and interview data have not been integrated, and it is unclear for which individuals StraTexT may be particularly beneficial when considering both types of data. The rehabilitation treatment specification system (RTSS) provides a helpful framework to integrate the data. Aims (1) to describe different treatment response profiles to the targets improvement in text comprehension and transfer of reading strategies to everyday life based on self-perceived and performance-based measures, and (2) to explore similarities and differences within and across these response profiles in pre-treatment participant characteristics and patterns of change. Methods We integrated the self-perceived and performance-based outcomes on change in text comprehension, reading abilities and the transfer of reading strategies. Then, we identified different response profiles based on similarities in treatment response. We described participant characteristics for individuals at the extreme ends of the response continuum. Finally, based on the interview data, we described similarities and differences in perceived changes in reading functions, cognitive functions, and transfer within and across different response profiles to better understand applicable mechanisms of action. Outcomes and Results Regarding the selected targets, we identified seven response profiles. Subjective and objective improvement did not correlate. The descriptions of pre-treatment characteristics revealed that reading speed, discrepancies between subjective and objective measures, and several other factors differed in PWA with different response profiles. However, self-perceived change in reading functions, cognitive functions and strategy use was heterogeneous within and across response profiles. Conclusions StraTexT contributes to objective and subjective improvements in text comprehension, even in individuals who do not transfer the strategies to everyday reading. The interview data suggests that for each PWA, a different subset of StraTexT’s mechanisms of action may be at work. This likely reflects differences in underlying impairments. We propose potential indicators for candidacy decisions, including the reading speed and the discrepancy between subjective and objective measures, to be explored in future research, and emphasize the need for both performance-based and self-rated outcomes. Furthermore, our results support the use of multiple- rather than single strategy interventions.

This scoping review will identify multilevel language interventions that target spoken language production in aphasia following stroke and describe their characteristics, the theoretical predictions of the approaches, and what tools are used to measure outcomes. Multilevel aphasia interventions target more than one linguistic level in a sequential and/or simultaneous way. Recent research has shown that treating multiple levels of language processing in the same intervention can broaden treatment effectiveness and provide greater evidence of therapy gains transferring to untreated language skills and impacting broader participation and quality of life than focusing on language levels in isolation. Currently, there is no synthesis or analysis of multilevel aphasia interventions in the literature that might help understand the components that may contribute to these potential benefits. Conducting a scoping review will allow us to systematically explore the nature of these multilevel interventions, their proposed outcomes, and highlight directions for clinical practice and future research. This review will consider aphasia intervention studies that aim to improve spoken production through involving more than one linguistic level in the intervention. Studies will include people with post-stroke aphasia irrespective of aphasia type, severity, or time post-onset. This review will be conducted in accordance with JBI methodology for scoping reviews. CINAHL, MEDLINE, PsycINFO, and Scopus will be searched for published articles. Two reviewers will independently screen articles for relevance against the inclusion criteria. Data will be presented in tables, accompanied by a narrative summary. OSF https://osf.io/4y7me.

Abstract Background Dementia with Lewy bodies (DLB) rarely manifests as prominent language impairment. Neurodegenerative nonfluent language deficits are typically recognised as a nonfluent/agrammatic variant of primary progressive aphasia (nfvPPA), which is most often associated with tau pathology and infrequently linked to Lewy body pathology. Herein, we present a rare case of a patient with probable DLB who exhibited marked nonfluent/agrammatic language symptoms and demonstrated language improvement after cholinesterase inhibitor (ChEI) therapy. Case report We describe a rare case of a 71-year-old woman who initially presented with language features suggestive of nfvPPA and was later diagnosed with probable DLB. We assessed her language symptom progression and response to treatment with a ChEI. The patient’s initial symptoms included 4 years of reduced speech output, agrammatic speech, and impaired sentence comprehension, while word comprehension and reading remained intact, consistent with the language profile of nfvPPA. Subsequently, she developed cognitive fluctuations and Parkinsonism. 123I-meta-iodobenzylguanidine myocardial scintigraphy revealed significantly reduced cardiac uptake, though episodes of visual hallucinations and REM sleep behaviour disorder could not be clearly identified. Based on these findings and the diagnostic criteria, the patient was diagnosed with probable DLB with nfvPPA-like language disorder. Treatment with donepezil titrated to 5 mg led to an improvement in language function. Conclusions This case underscores the importance of considering Lewy body disease in the differential diagnosis of neurodegenerative language disorders, even when nonfluent speech is predominant. Moreover, ChEIs may offer effective symptomatic treatment for primary progressive aphasia associated with Lewy body disease.

Timing of implicit processes in aphasia: An event-related potential investigation of masked priming effects.

Aphasia is a language network disorder caused by organic brain lesions, which severely affects patients' daily communication and interaction. The therapeutic effect of conventional rehabilitation training alone is limited. Currently, Theta Burst Stimulation (TBS) is a novel therapeutic modality of repetitive Transcranial Magnetic Stimulation (rTMS) and is a commonly used patterned rTMS. It appears in the form of burst waves and mimics the natural firing pattern of hippocampal neurons under Theta rhythm. Based on rTMS, TBS embeds a pattern in which three 50 Hz pulse bursts are inserted into a 5 Hz pulse train. This stimulation pattern can induce cortical plasticity in a shorter period of time and is gradually being applied in the treatment of aphasia. Auditory comprehension, as the initial component of language input, involves the reception and storage of linguistic signals, as well as the analysis and integration of lexical semantics. The recovery of this ability plays a prerequisite role in the functional improvement of patients with post-stroke aphasia (PSA). In recent years, research on aphasia has mainly focused on speaking, reading, and writing abilities, with relatively less attention paid to auditory comprehension. Therefore, this article reviews the research progress related to the use of TBS in treating auditory comprehension in aphasia, aiming to provide new ideas and references for the clinical selection of TBS stimulation protocols.

Purpose Intensive Comprehensive Aphasia Programs (ICAPs) deliver personalised treatment to improve outcomes for people with aphasia. Structured, collaborative clinical planning may address challenges associated with personalising therapy, facilitating implementation of these programs. This study aimed to (1) understand speech pathologists’ perspectives of barriers, facilitators, and strategies to implementing clinical planning for one modified ICAP, Comprehensive, High-dose Aphasia Treatment (CHAT), and its telerehabilitation-delivered counterpart (TeleCHAT); and (2) develop a theory-driven intervention to implement clinical planning. Methods Phase one: treating speech pathologists and speech pathology leaders involved in CHAT/TeleCHAT participated in focus groups/interviews. Reported barriers, facilitators, and strategies for implementation were analysed via mixed deductive-inductive content analysis and categorised using implementation frameworks. Phase two: findings from phase one were translated into an implementation intervention using determinant-strategy mapping tools. Results Three themes were identified: (1) overall experience; (2) learning a new way of practice; and (3) the implementation context. Clinical planning was highly regarded by participants. However, barriers relating to its fit within a clinical setting were reported. Adequate social support may leverage this barrier. An implementation intervention including six evidence-based strategies was developed. Conclusions Strategies to support implementation of clinical planning for CHAT/TeleCHAT have been identified, an important preliminary step for implementing ICAPs.