Assessment Of Aphasia Research Articles

Assessment Of Afasia in Stroke Patients: Case Study

Introduction: Aphasia is understood as difficulty in understanding or producing language caused by disorders involving the brain hemispheres. Early assessment of aphasia is very important to prevent the emergence of telegraphic speech styles, improve welfare, independence, social participation, quality of life, reduce length of stay and care costs, but there is little literature on this subject, especially in stroke patients. Purpose: This study is to provide an overview of the assessment of aphasia in stroke patients. Methods: The design of a case study involving 6 participants and data collection was carried out by conducting an assessment using the Language Aphasia Screening Test (LAST) instrument which was monitored for 3 days, including monitoring errors for naming images, monitoring mismatches repeating words and sentences, monitoring spontaneous pronunciation, monitoring image comprehension, monitoring comprehension of verbal instructions.Results: A total of 6 ischemic stroke patients were found wrong in repeating words and sentences. Conclusion: In aphasic stroke patients all language modalities are impaired, ranging from spontaneous speech, repetition, naming, language comprehension, reading and writing

Interpreter-mediated aphasia assessments

A setting which presents special challenges for interpreter-mediated communication is the speech pathology clinic, particularly when the encounter involves the assessment of aphasia. Drawing on a corpus of five interpreter-mediated assessments of aphasia in speakers of a range of languages (Cantonese, Greek, Tagalog and Vietnamese), this paper presents the findings of an interactive framing analysis of the corpus, focusing on illustrative extracts from two of the encounters. Analysis reveals that while the interpreters are frequently oriented towards issues of ‘meaning’ or ‘content’, the speech pathologists are generally oriented to issues of ‘form’. This is evident from the fact that the speech pathologists frequently question the interpreters about the ways in which the speaker’s language is abnormal. The interpreters, however, tend to respond to such questions with reference to their impressions of the person’s intended meaning. It is argued that these differences in orientation can be explained by the different professional knowledge schemata of speech pathologists and interpreters and the fundamentally ‘uninterpretable’ nature of many of the speakers’ utterances. This lack of shared understanding makes the interaction inefficient, and frequently results in a situation where the person with aphasia is put ‘on hold’. The paper concludes with a discussion of some practical implications for the conduct of interpretermediated aphasia assessments.

Associations between lesion size, lesion location and aphasia in acute stroke

ABSTRACT Background: The localization and organization of language has been an ongoing research interest ever since the early findings of Paul Broca. The emergence of neuroimaging the past 20 years has given us new insights on the anatomical and structural organization of the brain. Lesion studies on patients with aphasia can provide knowledge on where and how specific language functions are organized in the brain.Aims: The primary objective of the study was to investigate the relationships between aphasia severity, aphasic symptoms, lesion location and lesion volume in patients with left hemispheric stroke in the acute phase (within one week post-stroke). Using a voxel-based lesion-symptom mapping method (VLSM), we hypothesized that lesions associated with speech comprehension deficits mainly would involve regions within the posterior superior and middle temporal lobe, and lesions associated with speech production deficits would mainly be associated to the inferior frontal areas of the left hemisphere.Methods & procedures: Findings from diffusion-weighted magnetic resonance imaging (DWI-MRI) and patients’ scores from the Norwegian Basic Aphasia Assessment (NBAA) were used to investigate our research questions. We did a whole group analysis of descriptive statistics, lesion localization and lesion volume. We thereafter divided the patients into two groups based on their median scores on the NBAA, one high comprehension group and one low comprehension group. We used VLSM to investigate the associations between the patients’ lesions and the results from the NBAA.Outcomes & Results:Lesion volume was significantly associated with all subtest from the NBAA. Our initial analysis of the whole group showed that difficulties in naming was associated with lesions within the rolandic operculum. We also found that difficulties in repetition was associated with lesions within the rolandic operculum, and in addition, the superior temporal gyrus. In the group of patients with high comprehension scores lesions within Broca’s area, insula, the superior temporal gyrus (STG) and Heschl’s gyrus were found to be associated with difficulties with overall aphasia severity, repetition, naming, and reading out loud from the NBAA. Conclusions: Lesion volume is strongly associated with aphasia severity in the acute stages of stroke. Further, lesions within Broca’s area, the insula, the STG and Heschl’s gyrus were found to be crucial areas in language comprehension and production. This confirms current views that speech and language processes depend on the integrity of the entire network comprising both cortical structures and their interconnected fibre tracts.

Abstract TP393: Standardization of Large Vessel Occlusion Assessment With Designated Stroke Zone Decreases Door in Door Out Times

Background and Purpose: Increased Door in door out (DIDO) times prompted a change in the “Code Stroke” process in three sister Primary Stroke Centers. It was observed that utilizing a NIHSS >6 was insufficient in recognizing potential large vessel occlusion (LVO) candidates and correlated with an increase in the DIDO times of patients presenting to the Emergency Department (ED) with large vessel symptoms. After a “pilot” of the Vision, Aphasia, and Neglect (VAN) assessment tool in 2017, all three facilities initiated changes to the “Code Stroke” process. These changes included the implementation of the VAN assessment and the designation of a “Stroke Zone”. Methods: Data was collected from 2016 through the second quarter of 2019 on all “Code Strokes” activated in the ED. This data was analyzed to determine the efficacy of implementing the VAN assessment and designation of a “Stroke Zone”. Nursing staff and ED providers were educated on the utilization of the VAN assessment tool and the inclusion of a Computed Tomography Angiography (CTA) on patients presenting with a positive VAN assessment and symptom onset less than 24 hours. The number of Mechanical Endovascular Reperfusion (MER) candidates and the average DIDO times per quarter were compared before and after the implementation of the changes. Results: Evaluation of data from the three facilities showed that implementing a standardized LVO assessment tool in conjunction with a designated “Stroke Zone” increased the identification of potential LVO candidates and decreased DIDO times. Conclusion: The standardization of an LVO screening tool and utilization of a dedicated “Stroke Zone” contributed to a decrease in DIDO times in all three facilities. Efficacy of the changes to the process will assist in supporting best practices while caring for patients in the Stroke population. In addition, the early recognition of LVO candidates will positively impact Door to Needle times.

The influence of emotional valence on word recognition in people with aphasia

ABSTRACT Although several studies have demonstrated that emotional valence facilitates lexical processing in neurotypical adults, there has been limited work involving people with aphasia. This study explored the effects of valence (valenced/neutral) and polarity (positive/negative) on single word processing. Twenty people with chronic aphasia and 20 neurotypical controls completed a written lexical decision task in which valence was manipulated. An effect of valence (i.e. better performance for valenced vs. neutral words) was found in both accuracy and response time in the aphasic group and in response time for controls. Both groups showed an effect of polarity, with aphasic participants generating fewer errors for positive (vs. negative and neutral) stimuli, and controls responding more quickly to positive (vs. neutral) stimuli. Additionally, performance with positive words was impacted less by aphasia severity than negative and neutral words. The results highlight the importance of valence as a psycholinguistic factor in aphasia assessment and intervention.

Clinician perspectives on the assessment of short-term memory in aphasia

ABSTRACT Background: Verbal short-term memory (STM) and the related ability, working memory (WM), are widely understood to be integral components of language production and comprehension. However, assessment of these abilities in people with aphasia is hampered by a lack of valid, standardized measures that are clinically appropriate. Focusing primarily on verbal STM, we held a series of five focus groups with speech-language pathologists (SLPs) to understand better their current clinical practices and their beliefs and attitudes regarding assessment of verbal STM in aphasia. Aims: The purpose of this study was to explore the attitudes, beliefs and preferences of clinical SLPs to determine: (1) current practices related to verbal STM assessment; (2) the extent to which practices reflect current theories of aphasia and the role of verbal STM in language processing; and (3) practical considerations regarding aphasia assessment in clinical practice. Methods & Procedures: Five focus groups were conducted using a semi-structured interview protocol with a total of 44 SLPs. Grounded theory methodology was used to collect, code and analyse the data. Codes were reviewed to identify emerging themes. Themes were compared to explore meta-themes, connections and potential theoretical frameworks. Outcomes & Results: Five main themes were identified: (1) The theoretical understanding that clinical SLPs have regarding the role of verbal STM in aphasia is not always consistent with clinical practice; (2) Clinical SLPs highly value functionally relevant assessments; (3) The intense time constraints in clinical practice affect all aspects of assessment; (4) Clinical SLPs feel that there is a lack of appropriate tests for assessment of STM in aphasia; and (5) Clinical SLPs prefer tests that are comprehensive, easy to administer and psychometrically sound. Conclusions: Clinical SLPs report a lack of standardized measures to assess STM in individuals with aphasia. Researchers are met with several challenges in the development of these tests including effective communication with clinicians regarding the benefit of verbal STM assessments, especially as it relates to functional skills, and the creation of a test that is comprehensive yet simple, quick and easy to administer.

The effect of augmented speech-language therapy delivered by telerehabilitation on poststroke aphasia—a pilot randomized controlled trial

Objective: Pilot a definitive randomized controlled trial of speech-language telerehabilitation in poststroke aphasia in addition to usual care with regard to recruitment, drop-outs, and language effects. Design: Pilot single-blinded randomized controlled trial. Setting: Telerehabilitation delivered from tertiary rehabilitation center to participants at their home or admitted to secondary rehabilitation centers. Subjects: People with naming impairment due to aphasia following stroke. Intervention: Sixty-two participants randomly allocated to 5 hours of speech and language telerehabilitation by videoconference per week over four consecutive weeks together with usual care or usual care alone. The telerehabilitation targeted functional, expressive language. Main measures: Norwegian Basic Aphasia Assessment: naming (primary outcome), repetition, and auditory comprehension subtests; Verb and Sentence Test sentence production subtest and the Communicative Effectiveness Index at baseline, four weeks, and four months postrandomization. Data were analyzed by intention to treat. Results: No significant between-group differences were seen in naming or auditory comprehension in the Norwegian Basic Aphasia Assessment at four weeks and four months post randomization. The telerehabilitation group (n = 29) achieved a Norwegian Basic Aphasia Assessment repetition score of 8.9 points higher (P = 0.026) and a Verb and Sentence Test score 3 points higher (P = 0.002) than the control group (n = 27) four months postrandomization. Communicative Effectiveness Index was not significantly different between groups, but increased significantly within both groups. No adverse events were reported. Conclusion: Augmented telerehabilitation via videoconference may be a viable rehabilitation model for aphasia affecting language outcomes poststroke. A definitive trial with 230 participants is needed to confirm results.

EXAMINATION AND REHABILITATION OF SPEECH DISORDERS IN A PATIENT WITH SUBCORTICAL APHASIA

The article presents a case of clinical observation of subcortical aphasia. It analyzes the manifestations of speech disorders and disorders of higher mental functions in a patient with a stroke in the basin of the left middle cerebral artery and a hematoma of the left internal carotid artery. The main focus is on the use of diagnostic scales and tests that are adequate to the patient's age: assessment of the severity of speech disorders using the method of quantitative speech assessment in aphasia worked out by L. S. Tsvetkova (QSA), neuropsychological examination by the method of A. R. Luria, Montreal scale of assessment of cognitive functions (MoCA test), and hospital scale of anxiety and depression HADS. The study has revealed the presence of efferent motor aphasia of moderate severity and acoustic - mnestic aphasia of mild severity in the clinical picture of subcortical aphasia. Attention is drawn to the manifestation of symptoms and syndromes characteristic of disorders in the work of all three blocks of the brain, mainly the second one. The qualitative and quantitative analysis of the results of the diagnostic studies carried out by the authors made it possible to select optimal differentiated methods of rehabilitation work, increase the volume of auditory - speech memory and reduce the symptoms of kinesthetic apraxia in the patient. The data obtained on the effectiveness of rehabilitation classes indicate more pronounced dynamics of recovery in aphasia with a subcortical lesion and the need for comprehensive psychological and pedagogical work targeted at improving the quality of life of the patient.

The importance of thematic informativeness in narrative discourse recovery in acute post-stroke aphasia

ABSTRACTBackground: Discourse analysis allows the examination of functional and ecological language impairment in post-stroke aphasia. Given its complexity, various methods of analysis have been developed to measure the multiple components of discourse. Clinical assessment usually includes discourse analysis, but how clinicians should assess recovery of discourse, particularly in acute care settings, is still a matter of debate.Aims: This study aimed to measure improvements in discourse production in early post-stroke aphasia recovery.Methods & Procedure: Twenty-three persons with aphasia following a first left middle cerebral artery stroke were recruited in the stroke unit of Hôpital du Sacré-Coeur de Montréal (May 2015-July 2018). Patients treated with thrombolysis (n = 10) and untreated patients underwent two aphasia assessments (0 to 72 hours, 7 to 14 days post-onset). Discourse assessment consisted of the picture description task from the Western Aphasia Battery. Changes in microlinguistic and thematic informativeness measures between the two assessment periods were analyzed.Outcomes & Results: In-depth microlinguistic analyses showed no significant difference between the initial and follow-up assessments. Conversely, some thematic informativeness variables improved significantly during the same time period. Patients treated with thrombolysis produced more thematic units than untreated patients at both assessments, but the change between the two groups was not significant.Conclusions & Implications: This study suggests that thematic informativeness variables are sensitive to language improvement in early post-stroke aphasia recovery whereas no microlinguistic variables improved significantly in the same period. In contrast to previous evidence, the difference between patients treated with thrombolysis and untreated patients was not evident over time. The results suggest that thematic informativeness constitutes an interesting path to explore as a routine clinical assessment in acute-care settings because it is time-efficient, simple to conduct and reliable in assessing early changes in the discourse production of individuals with aphasia in the acute post-stroke phase.

A Tutorial on Core Lexicon: Development, Use, and Application.

Evidence suggests that discourse-level assessment in aphasia should be implemented within clinical settings. However, existing discourse measures that are time and labor intensive in process prevent speech-language pathologists from applying such measures to their clinical practices. This article provides an overview of a lexicon-based analysis (core lexicon measure) that recently was developed and investigated for clinical usability. A new approach to core lexicon measures provides a simple scoring method with short instructions, which may be practical and time efficient for assessment and management of persons with aphasia. The article concludes with suggestions for clinical application and implementation.

Verb argument structure effects in aphasia are different at single-word versus sentence level

ABSTRACTBackground: Many aphasia assessments and therapies select and/or sequence verbs based on linguistic complexity of their verb argument structure (VAS). However, further empirical testing is needed to fully understand whether and how VAS parameters affect the cognitive difficulty of verb processing in different tasks and contexts.Aims: The study investigated whether more linguistically complex VAS universally implies more cognitively difficult verb processing, as predicted by the Argument Structure Complexity Hypothesis. We hypothesized that this would only be the case at sentence level, whereas in single-word tasks more linguistically complex VAS would facilitate lexical access via lexico-semantic associations with potential arguments, contrary to the Argument Structure Complexity Hypothesis.Methods and Procedures: The effects of three VAS parameters (number of arguments, number of valency frames, canonicity of thematic role marking) were tested in two tasks (single-word naming and cued sentence production) in two aphasia types (fluent and non-fluent, 20 participants per group). We analyzed how VAS parameters affected accuracy and latency in naming and canonicity and well-formedness in sentence production.Outcomes and Results: As hypothesized, VAS effects were different at the sentence versus single-word level. In sentence production, one VAS parameter (the number of arguments) showed the expected negative effect of greater linguistic complexity on sentence canonicity. No other comparisons were significant, likely due to ceiling effects. In contrast, in single-word naming, VAS effects were mixed. The number of valency frames showed the predicted facilitatory effect of linguistic complexity. The number of arguments showed a non-significant statistical trend in the same direction. For canonicity of thematic role marking, greater complexity had a negative effect on naming, possibly because it does not affect the number of lexico-semantic associates of the verb. All findings pertained to both non-fluent and fluent aphasia.Conclusions: When accounting for VAS parameters in selection or sequencing of verbs for assessment or therapy, the cognitive difficulty of verb processing should be estimated for a particular task. In sentence-level grammatical processing, most cognitively difficult verbs are those with more linguistically complex VAS. In contrast, in single verb retrieval, verbs with more linguistically complex VAS may be cognitively simpler if their richer lexico-semantic associations with potential arguments provide extra routes of lexical access.

Evaluating informative content and global coherence in fluent and non-fluent aphasia.

Discourse analysis is an important component of aphasia assessment because it can provide an insight into functional communication abilities. However, there are many unknowns regarding the levels of discourse breakdowns that occur across aphasia types. The purpose of the current study is to explore the possible differences in discourse-level communication in persons with fluent and non-fluent aphasia during picture description. To examine if persons with fluent and non-fluent aphasia differ on utterance-level discourse measures when evaluating informative content and global coherence. Additionally, to evaluate and compare the types of global coherence violations made by each group. Data from 31 people with aphasia was collected from AphasiaBank, which included 13 people with fluent aphasia and 18 people with non-fluent aphasia. Discourse samples from three picture descriptions were analysed. Discourse outcomes included utterances with new information (UNIs-relevant utterances containing new information) and global coherence (the extent to which each utterance maintained the overall discourse theme). Additionally, seven types of errors were identified to explore the nature of breakdowns in global coherence. People with fluent aphasia produced significantly higher proportions of UNIs and had significantly higher average global coherence ratings than those with non-fluent aphasia. Differences in global coherence violations were identified with people with fluent aphasia producing more non-specific, incorrect and off-topic utterances and people with non-fluent aphasia producing more incomplete utterances. One of the most common global coherence error types in both groups was commentary. Although people with fluent aphasia produced more types of global coherence errors, including incorrect, non-specific and off-topic utterances, the group was still rated significantly higher on utterance relevance and topic maintenance, indicating that the ability to produce a complete utterance plays an important role in some aspects of discourse production. Additionally, these findings provide an insight into potential targets for intervention.

The influence of prestroke proficiency on poststroke lexical-semantic performance in bilingual aphasia

ABSTRACT Background: Bilingual persons with aphasia (BWA) may present different degrees and patterns of impairment in their two languages. Previous research suggests that prestroke proficiency may be amongst the factors determining poststroke language impairment in BWA; however, this relationship is not well understood. Aims: The purpose of this study was to examine the relationship between prestroke proficiency and poststroke lexical-semantic performance in BWA and to identify common patterns of language impairment in this population. Methods and procedures: Twenty-seven Spanish-English BWA (14 female, age range = 29–88 years) were administered a language use questionnaire (LUQ) to measure several aspects of their bilingual language history that contribute to their prestroke proficiency in both languages. They also underwent standardized language assessments tapping lexical-semantic performance in each language. A principal component analysis was first conducted on the LUQ metrics to determine the factors that contributed to prestroke proficiency in each language. Next, regression analyses allowed assessing the relationships between prestroke proficiency and poststroke lexical-semantic performance in both languages. Differences in proficiency and language performance across languages were contrasted prior and after stroke to identify profiles of impairment. Outcomes and results: Prestroke proficiency in the native language was determined by daily use, educational history, lifetime exposure, and language ability rating. Prestroke proficiency in the second language was determined by age of acquisition, daily use, educational history, lifetime exposure, lifetime confidence, family proficiency, and language ability rating. Prestroke proficiency significantly predicted poststroke lexical-semantic performance in BWA in both languages. Twenty-two participants presented parallel impairment while only three presented differential impairment. Conclusions: Our results confirm that prestroke language proficiency is a key predictor of poststroke language impairment in BWA. These findings have important implications for the assessment and diagnosis of aphasia in bilingual individuals.

Perceptual Characteristics of Consonant Production in Apraxia of Speech and Aphasia.

Purpose This retrospective analysis examined group differences in error rate across 4 contextual variables (clusters vs. singletons, syllable position, number of syllables, and articulatory phonetic features) in adults with apraxia of speech (AOS) and adults with aphasia only. Group differences in the distribution of error type across contextual variables were also examined. Method Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia participated in this study. In the context of a 2-group experimental design, the influence of 4 contextual variables on error rate and error type distribution was examined via repetition of 29 multisyllabic words. Error rates were analyzed using Bayesian methods, whereas distribution of error type was examined via descriptive statistics. Results There were 4 findings of robust differences between the 2 groups. These differences were found for syllable position, number of syllables, manner of articulation, and voicing. Group differences were less robust for clusters versus singletons and place of articulation. Results of error type distribution show a high proportion of distortion and substitution errors in speakers with AOS and a high proportion of substitution and omission errors in speakers with aphasia. Conclusion Findings add to the continued effort to improve the understanding and assessment of AOS and aphasia. Several contextual variables more consistently influenced breakdown in participants with AOS compared to participants with aphasia and should be considered during the diagnostic process. Supplemental Material https://doi.org/10.23641/asha.9701690.

Language deficits following dominant hemisphere tumour resection are significantly underestimated by syndrome-based aphasia assessments

ABSTRACT Background: In assessing post-operative language impairment, clinical teams typically rely on “aphasia subtype” classifications, based on post-stroke patterns of impairment. However, this approach may significantly underestimate the prevalence of post-surgical language impairments due to the different pathophysiological mechanisms involved. There is a paucity of research in chronic post-surgical patients. Aims: We investigated post-surgical language performance in the chronic phase. Methods & Procedures: Using both the Western Aphasia battery Revised (WAB-R) and the Comprehensive Aphasia test (CAT), we assessed a range of language skills in 26 right-handed patients approximately 6–12 months after they underwent surgery to remove a primary tumour in their left cerebral hemisphere. Participants’ self-reports of their speech and language skills post-surgery were also collected. Outcomes and Results: Following surgery, 77% of patients scored below normal cut-off on one or more language subtests of the CAT battery. This contrasted with only 27% on the WAB AQ. The CAT findings were supported by subjective data, with 58% of patients self-reporting post-surgical communication difficulty. Conclusions: Our results show that current “aphasia subtype” testing is inadequate, and is likely to significantly underestimate chronic language deficits in this population. Alternative approaches to formal language assessment need to be used in this group of patients whose pattern of impairments is very different from that observed in post-stroke aphasia.

A Single Case Narrative of Spirituality Following Aphasia from Traumatic Brain Injury: Findings about Forgiveness and Freedom Using WELLHEAD and SHALOM

Rehabilitation has neglected the spirituality of people with aphasia, a neurogenic impairment of language for communication and thought processes. Aphasia reduces scope for adjustment processes where words are normal currency, such as forgiveness and reconciliation. A single case narrative was generated from a case series exploring the feasibility of spiritual health assessment in aphasia. The individual had traumatic brain injury, with the primary symptom of aphasia, giving the first detailed account of its kind. The WELLHEAD spirituality toolkit provided a structured interview approach, exploring spirituality in terms of ‘meaning and purpose’ within four dimensions, WIDE, LONG, HIGH and DEEP, incorporating patient-reported outcome measures and goal-setting, with feedback interviews. Spiritual Health and Life Orientation Measure (SHALOM) generated a comparator spiritual health assessment. The quantitative feedback measures and self-reported outcomes were complemented by detailed qualitative interview transcripts subject to systematic thematic analysis in NVivo. The findings were co-constructed and systematically verified. This non-religious narrative evidenced the accessibility, acceptability, and impact of the resources. Self-forgiveness was paramount for freedom to journey into the unknown beyond self with ‘Calm’, towards helping others and accepting help. Religion, Faith and Belief were reconceptualised. Forgiveness of self and others was integral and instrumental in recovery, offering avenues for further investigation and application.

“Are we…providing them with an equal service?”: Speech-language pathologists’ perceptions of bilingual aphasia assessment of Samoan-English speakers

Purpose: Speech-language pathologists are more often providing services to clients from a different cultural and/or linguistic background from their own. It can be particularly challenging to conduct language assessments with individuals with bilingual aphasia, especially given the limited research in this area. This investigation explored speech-language pathologists’ perspectives on: the challenges that impede the assessment of language in Samoan-English speakers with bilingual aphasia; and the facilitators that support the assessment of language in Samoan-English speakers with bilingual aphasia. Methods: The study used a qualitative descriptive approach, underpinned by a constructivist paradigm. A focus group was conducted with four speech-language pathologists who had experience working with Samoan-English speakers with bilingual aphasia, including one clinician with extensive knowledge of the Samoan language. Results: The focus group yielded rich data relevant to the research questions. Analysis revealed 29 codes within eight categories of challenges related to: the Samoan language and culture; the SLP’s background; using interpreters; family involvement; the logistics of the assessment; determining which language(s) to assess; assessment tasks and resources; and obtaining an initial impression of and building rapport with the individual. The analysis also identified 14 codes within five categories of facilitators related to: the SLP’s background; using interpreters; family involvement; determining which language(s) to assess; and assessment tasks and resources. Conclusions: The investigation provides valuable insights into the experience of conducting language assessments with Samoan-English speakers with bilingual aphasia. The findings may also be useful for informing the delivery of speech-language pathology services to other individuals with bilingual aphasia.

Abstract 67: Contributions of the Unaffected Hemisphere to Outcome Predictions of Acute Aphasia

Making accurate predictions about a stroke patient’s language/speech-motor outcome and recovery potential is a challenge. We previously showed that a combined variable of lesion site and size, the Arcuate Fasciculus lesion load (AF-LL), correlated highly with measures of speech fluency in chronic aphasic patients. However, in bi-hemispherically organized systems (such as the speech-motor system), there might also be contributions from the unaffected hemisphere to outcome that have to be determined. Methods: Over a period of several years, ischemic stroke patients presenting with acute aphasia were evaluated using a bedside version of the Western Aphasia Battery complemented by picture naming tests, automatic speech measures, and a custom-made word/phrase spoken and sung test. A total of 110 acute patients were assessed acutely of which 60 followed up at 3 months for outcome assessments. Lesion maps drawn on diffusion-weighted images were used to calculate lesion loads of a probabilistic Arcuate Fasciculus (AF) tract. The homotop version of the AF of the right hemisphere was used to extract regional fractional anisotropy (FA) values. FA values serve as a measure of white matter fiber alignment and integrity. Several prediction models were constructed testing whether or not adding either lesion load measures, or right hemisphere structural measures (tract FA values) and right hemisphere functional measures (singing-speaking dissociation) to acute bedside aphasia assessments would improve outcome predictions. Results: The overall bedside WAB score in the acute stroke period was the best single predictor of overall WAB score outcome at 3 months explaining about 50% of the in-sample and 45% of the out-of-sample variance. This prediction was improved when a AF-lesion-load measures were added to the model (R2=0.62 for out-of-sample predictions). When right hemisphere structural (tract FA values) and functional information (singing-speaking difference) was added, out-of-sample prediction in language outcome at 3 months improved to 83%. Conclusion: A combination of a bedside aphasia test, lesion load of the left hemisphere, as well as structural and functional measures of the unaffected hemisphere predict language outcome.

The adaptation of the Language Battery of CAT-TR into Turkish: Results from a Pilot Study

The adaptation of the Language Battery of CAT-TR into Turkish: Results from a Pilot Study

Survey of Aphasia Assessment Measures Implemented in Clinical and Research Settings

Survey of Aphasia Assessment Measures Implemented in Clinical and Research Settings