Boston Diagnostic Aphasia Examination Research Articles

Language impairment in sporadic and familial (type 8) amyotrophic lateral sclerosis: A comparative study.

Language is frequently affected in patients with sporadic amyotrophic lateral sclerosis (sALS), with reduced performance in naming, syntactic comprehension, grammatical expression, and orthographic processing. However, the language profile of patients with familial type 8 ALS (ALS8), linked to p.P56S VAPB mutation, remains unclear. We investigated language in patients with ALS8 by examining their auditory comprehension and verbal production. We included three groups of participants: (1) patients with sALS (n = 20), (2) patients with familial ALS8 (n = 22), and (3) healthy controls (n = 21). The groups were matched for age, sex, and education level. All participants underwent a comprehensive language battery, including the Boston Diagnostic Aphasia Examination, the reduced Token test, letter fluency, categorical fluency (animals), word definition from the Cambridge Semantic Memory Research Battery, and a narrative discourse analysis. Participants also were evaluated using Addenbrooke's Cognitive Exam-Revised Version, the Hospital Anxiety and Depression Scale, and the ALS Functional Rating Scale-Revised. Compared to controls, sALS and ALS8 patients had impaired performance on oral (syntactic and phonological processing) comprehension and inappropriate discourse cohesion. sALS and ALS8 did not differ in any language measure. There was no correlation between language scores and functional and psychiatric scales. ALS8 patients exhibit language deficits that are independent of motor features. These findings are consistent with the current evidence suggesting that ALS8 has prominent non-motor features.

Efficacy and safety of mirror therapy for post-stroke aphasia: A systematic review and meta-analysis protocol.

Aphasia is one of the most common complications of stroke. Mirror therapy (MT) is promising rehabilitation measure for the treatment of post-stroke aphasia. Although some studies suggested that MT is effective and safe for aphasia, the effects and safety remain uncertain due to lacking strong evidence, such as the relevant systematic review and meta- analysis. This study will search PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network (CNKI), WANFANG, China Biomedical Literature Database (CBM), from inception to 1th May 2023 to identify any eligible study. No language or date of publication shall be limited. We will only include randomised controlled trials of MT in the Treatment of poststroke aphasia. Two investigators will work separately on the study selection, data extraction, and study quality assessment. The western aphasia battery (WAB) and aphasia quotient (AQ) will be included as the main outcomes. Boston diagnostic aphasia examination method (BDAE), Chinese standard aphasia examination (CRRCAE) will be included as the secondary outcomes. The statistical analysis will be conducted by RevMan V.5.4 software. The risk of bias of included studies will be assessed by the Cochrane 'Risk of bias' tool. The quality of proof of the results will be evaluated by using the Grading of Recommendations Assessment, Development and Evaluation guidelines. The finding will be presented in a journal or related conferences. This study will provide a basis for whether mirror therapy (MT) is effective and safe in the treatment of post-stroke aphasia. Systematic review registration INPLASY registration number: INPLASY 202340054.

Secondary language impairment in posterior cortical atrophy: insights from sentence repetition.

Posterior cortical atrophy (PCA) is a neurodegenerative syndrome characterized by progressive impairment in visuospatial and perceptual function linked to atrophy of the occipito-parietal cortex. Besides the salient visual impairment, several studies have documented subtle changes in language may also be present. Sentence repetition is a highly constrained linguistic task involving multiple linguistic and cognitive processes and have been shown to be impaired in other AD spectrum disorders, with little consensus on its relevance in PCA. This aim of this study was to further delineate the linguistic and cognitive features of impaired language in PCA using a sentence repetition task. Seven PCA patients and 16 healthy controls verbally repeated 16 sentences from the Boston Diagnostic Aphasia Examination. Responses were transcribed orthographically and coded for accuracy (percentage accuracy; percentage Correct Information Units; Levenshtein Distance) and for temporal characteristics (preparation duration (ms); utterance duration (ms); silent pause duration (ms); speech duration (ms); dysfluency duration (ms)). The potential modulating effects of attentional control and working memory capacity were explored. PCA patients showed lower overall accuracy with retained semantic content of the sentences, and lower phonological accuracy. Temporal measures revealed longer preparation and utterance duration for PCA patients compared to controls, alongside longer speech duration but comparable dysfluency duration. PCA patients also showed comparable silent pause duration to controls. Attentional control, measured using the Hayling sentence completion task, predicted accuracy of sentence repetition. The findings suggest that sentence repetition is impaired in PCA and is characterized by phonological, response planning and execution difficulties, underpinned in part by attentional control mechanisms. The emerging profile of language impairment in PCA suggests vulnerability of similar cognitive systems to other Alzheimer's syndromes, with subtle differences in clinical presentation.

Effect of Acupuncture vs Sham Acupuncture on Patients With Poststroke Motor Aphasia

Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain. To investigate the effects of acupuncture on language function, neurological function, and quality of life in patients with poststroke motor aphasia. This multicenter, sham-controlled, randomized clinical trial was conducted in 3 tertiary hospitals in China from October 21, 2019, to November 13, 2021. Adult patients with poststroke motor aphasia were enrolled. Data analysis was performed from February to April 2023. Eligible participants were randomly allocated (1:1) to manual acupuncture (MA) or sham acupuncture (SA) groups. Both groups underwent language training and conventional treatments. The primary outcomes were the aphasia quotient (AQ) of the Western Aphasia Battery (WAB) and scores on the Chinese Functional Communication Profile (CFCP) at 6 weeks. Secondary outcomes included WAB subitems, Boston Diagnostic Aphasia Examination, National Institutes of Health Stroke Scale, Stroke-Specific Quality of Life Scale, Stroke and Aphasia Quality of Life Scale-39, and Health Scale of Traditional Chinese Medicine scores at 6 weeks and 6 months after onset. All statistical analyses were performed according to the intention-to-treat principle. Among 252 randomized patients (198 men [78.6%]; mean [SD] age, 60.7 [7.5] years), 231 were included in the modified intention-to-treat analysis (115 in the MA group and 116 in the SA group). Compared with the SA group, the MA group had significant increases in AQ (difference, 7.99 points; 95% CI, 3.42-12.55 points; P = .001) and CFCP (difference, 23.51 points; 95% CI, 11.10-35.93 points; P < .001) scores at week 6 and showed significant improvements in AQ (difference, 10.34; 95% CI, 5.75-14.93; P < .001) and CFCP (difference, 27.43; 95% CI, 14.75-40.10; P < .001) scores at the end of follow-up. In this randomized clinical trial, patients with poststroke motor aphasia who received 6 weeks of MA compared with those who received SA demonstrated statistically significant improvements in language function, quality of life, and neurological impairment from week 6 of treatment to the end of follow-up at 6 months after onset. Chinese Clinical Trial Registry: ChiCTR1900026740.

Effects of repetitive transcranial magnetic stimulation combined with music therapy in non-fluent aphasia after stroke: A randomised controlled study.

Although existing studies have shown that both repetitive transcranial magnetic stimulation (rTMS) and music therapy have advantages in the treatment of non-fluent aphasia, the efficacy of the combination of these two methods remains to be investigated. To investigate the clinical efficacy of low-frequency rTMS combined with music therapy on language function and depression in patients with non-fluent aphasia after stroke. A single-blind parallel randomised controlled trial was conducted. Sixty patients (mean duration = 93.78 days) with non-fluent aphasia after stroke were randomly divided into a traditional therapy group (n = 20), a music therapy group (n = 20) and a combined therapy group (n = 20, 1Hz). The language function and depression were evaluated before and 3 weeks after treatment with the Chinese version of the Western Aphasia Battery scale, Boston Diagnostic Aphasia Examination scale and Stroke Aphasic Depression Questionnaire Hospital Version scale. The combined therapy group was significantly better in all outcomes than the traditional therapy group and was significantly better in depression than the music therapy group. The music therapy group was significantly better in repetition and depression than the traditional therapy group. Language improvement was positively correlated with depression improvement. For adverse events, only two patients in the combined therapy group showed slight dizziness during rTMS treatment and their symptoms improved after rest. Our preliminary randomised controlled study indicates that low-frequency rTMS combined with music therapy is feasible and safe in improving language function and depression in non-fluent aphasia patients after stroke. What is already known on this subject Repetitive transcranial magnetic stimulation (rTMS) and music therapy respectively have advantages in the treatment of non-fluent aphasia after stroke, but whether the combination of the two methods is more effective is still unknown. What this paper adds to the existing knowledge This is one of the first randomised control trials to investigate whether the clinical efficacy of low-frequency rTMS combined music therapy for non-fluent aphasia is better. The findings show that low-frequency rTMS combined music therapy is superior to traditional therapy in spontaneous speech, auditory comprehension, repetition, naming, aphasia quotient, functional language level and depression, and superior to music therapy in depression, while music therapy is superior to traditional therapy in repetition and depression. What are the potential or actual clinical implications of this work? Low-frequency rTMS combined music therapy may be a better method for treatment of non-fluent aphasia.

35 Pairwise Concurrence Rates Between Standalone and Embedded Performance Validity Tests

Objective:Determine the classification concordance between a standalone performance validity test (PVT) and embedded PVTs from multiple cognitive domains.Participants and Methods:Participants were 106 patients (49.1% female; 69% white) that underwent neuropsychological evaluation at an outpatient university doctoral clinical psychology training and research clinic (M/SD: age = 32.38/11.95; education = 13.7/2.75). A comprehensive neuropsychological battery included the Medical Symptom Validity Test (MSVT) and embedded PVTs from different cognitive domains: attention - Wechsler Adult Intelligence Scale - Fourth Edition Reliable Digit Span and Digit Span age-corrected scaled score (DS ACSS); memory - California Verbal Learning Test, 3rd Edition (CVLT-3) Forced-Choice Recognition (FCR), executive functions -Wisconsin Card Sorting Test (WCST) Failure to Maintain Set (FMS); visual-spatial/construction -Rey Complex Figure Test (RCFT) Copy raw score; language - Boston Diagnostic Aphasia Examination Complex Ideation Material (CIM); and motor functions - Finger Tapping Test (FTT). All participants were administered the MSVT but not all participants were administered all seven embedded PVTs. Credible/noncredible classification concordance rates and kappa correlations (i.e., percentage of agreement) were computed for each pairwise PVT combination.Results:Twenty-two percent (n = 23) of the sample failed at least one PVT, with 17.0% (n = 18) failing at least two. DS ACSS was the embedded PVT with the highest MSVT concordance rate at 92.4% and a fair kappa coefficient of .39; WCST FMS had the lowest concordance with MSVT at 82.9% and a slight kappa coefficient of .19. The highest concordance among embedded PVTs from different cognitive domains was CVLT-3 FCR and RCFT Copy raw score at 89.7% with a fair kappa coefficient of .35; the lowest agreement among embedded PVTs was WCST FMS and FTT at 74.0% with a kappa coefficient of -.02. More conservative kappa coefficients among all pair-wise embedded PVT combinations from different cognitive domains ranged from -.02 to .36. For all standalone and embedded PVT pairwise concordance rates, only two fell below the recommended minimum agreement of 80%: FCR vs. FMS = 79.3% and FMS vs. FTT = 74.0%.Conclusions:Embedded PVTs across various cognitive domains have high agreement with a standalone PVT to aid in classifying noncredible performance, in the 83-92% range. Embedded PVTs from different cognitive domains also have mostly high agreement classification rates amongst themselves in aiding to determine noncredible performance, in the 74-90% range, with the lowest agreement rate between executive function and motor tests at 74%. More conservative kappa-based agreements between PVT pair-wise combinations were fairly consistent with other studies, with most being in the fair range. Finally, these findings indicate about a 17% base rate of noncredible cognitive performance in an outpatient university-based clinic.

Automatically measuring speech fluency in people with aphasia: first achievements using read-speech data

ABSTRACT Background Speech and language pathologists (SLPs) often rely on judgements of speech fluency for diagnosing or monitoring patients with aphasia. However, such subjective methods have been criticised for their lack of reliability and their clinical cost in terms of time. Aims This study aims at assessing the relevance of a signal-processing algorithm, initially developed in the field of language acquisition, for the automatic measurement of speech fluency in people with aphasia (PWA). Methods & Procedures Twenty-nine PWA and five control participants were recruited via non-profit organizations and SLP networks. All participants were recorded while reading out loud a set of sentences taken from the French version of the Boston Diagnostic Aphasia Examination. Three trained SLPs assessed the fluency of each sentence on a five-point qualitative scale. A forward-backward divergence segmentation and a clustering algorithm were used to compute, for each sentence, four automatic predictors of speech fluency: pseudo-syllable rate, speech ratio, rate of silent breaks, and standard deviation of pseudo-syllable length. The four predictors were finally combined into multivariate regression models (a multiple linear regression — MLR, and two non-linear models) to predict the average SLP ratings of speech fluency, using a leave-one-speaker-out validation scheme. Outcomes & Results All models achieved accurate predictions of speech fluency ratings, with average root-mean-square errors as low as 0.5. The MLR yielded a correlation coefficient of 0.87 with reference ratings at the sentence level, and of 0.93 when aggregating the data for each participant. The inclusion of an additional predictor sensitive to repetitions improved further the predictions with a correlation coefficient of 0.91 at the sentence level, and of 0.96 at the participant level. Conclusions The algorithms used in this study can constitute a cost-effective and reliable tool for the assessment of the speech fluency of patients with aphasia in read-aloud tasks. Perspectives for the assessment of spontaneous speech are discussed.

Brazilian Portuguese Adaptation and Validation of the Language Screening Test for Poststroke Patients.

There is a lack of standardized assessment tools for poststroke aphasia in Brazil, particularly bedside screenings for early identification of patients with suspected language disorders. The Language Screening Test (LAST) is a valid and reliable method for screening hospitalized patients following a stroke. This tool was first developed in French and then translated and validated in other languages. This study aimed to translate, culturally adapt, and validate the LAST into Brazilian Portuguese. Following a systematic, multistep approach to translation and cultural adaptation of language instruments, this study developed the two parallel versions of the Brazilian Portuguese LAST (pLAST) Versions A and B. The final versions were applied to 70 healthy and 30 poststroke adults across age and educational levels. Subtests of the Boston Diagnostic Aphasia Examination (BDAE) were used to assess the external validity of the pLAST. Findings showed that the two versions (A and B) of the pLAST were equivalent (intraclass correlation coefficient = .91; p < .001). No floor or ceiling effects were observed, and internal validity was excellent (Cronbach's α = .85). Moreover, its external validity against the BDAE was moderate to strong. Test sensitivity and specificity were 0.88 and 1, respectively, and accuracy was 0.96. The Brazilian Portuguese version of the LAST is a valid, simple, easy, and rapid test to screen poststroke aphasia in hospital settings. https://doi.org/10.23641/asha.23548911.

Defining aphasia: Content analysis of six aphasia diagnostic batteries

Clear operational definitions of constructs are necessary to ensure that research findings are meaningful and interpretable. In the field of aphasiology, aphasia is often defined to the effect of “aphasia is an acquired language disorder often due to brain injury that affects expressive and receptive language.” To contribute to our understanding of the construct of aphasia, we conducted a content analysis of six diagnostic aphasia tests: the Minnesota Test for the Differential Diagnosis of Aphasia, the Porch Index of Communicative Ability, the Boston Diagnostic Aphasia Examination, the Western Aphasia Battery, the Comprehensive Aphasia Test, and the Quick Aphasia Battery. These chosen tests have historical prominence, with several in regular clinical and research use today. We hypothesized that the content of the aphasia tests should be very similar since they all purport to identify and characterize (if present) aphasia, with recognition that there may be some subtle differences in test content stemming in large part to epistemological differences in the test makers’ views of aphasia. Instead, we found predominantly weak Jaccard indices, a similarity correlation coefficient, between test targets. Only five test targets were found in all six aphasia tests: auditory comprehension of words and sentences, repetition of words, confrontation naming of nouns, and reading comprehension of words. The qualitative and quantitative results suggest that the content across aphasia tests may be more disparate than expected. We conclude by discussing the implication of our results for the field, including the importance of updating, if necessary, the operational definition of aphasia through conversation with a broad audience of interested and affected people.

Undetected language deficits in left or right hemisphere post-stroke patients

Previous studies have reported that widely used tests for aphasia identification are unable to detect the subtle language deficits of left hemisphere brain damaged (LHBD) individuals. Similarly, the language disorders of individuals with right hemisphere brain damage (RHBD) usually remain undetected, due to the lack of any specialized test for the evaluation of their language processing skills. The aim of the present study was to evaluate the language deficits of 80 individuals suffering from the effects of either a LHBD or RHBD stroke, who were diagnosed as having no aphasia or language deficits based on the application of Boston Diagnostic Aphasia Examination. Their language abilities were examined with the use of the Adults’ Language Abilities Test, which explores morpho-syntactic and semantic phenomena of the Greek language in both the comprehension and production modalities. Results revealed that both groups of stroke survivors performed significantly worse compared to the group of healthy participants. Thus, it appears that the latent aphasia of LHBD and the language deficits of RHBD patients are likely to remain undetected and that patients are at risk of not receiving appropriate treatment if their language abilities are not evaluated by an effective and efficient battery of language tests.

A Comparative Investigation of Automatic Speech Recognition Platforms for Aphasia Assessment Batteries.

The rehabilitation of aphasics is fundamentally based on the assessment of speech impairment. Developing methods for assessing speech impairment automatically is important due to the growing number of stroke cases each year. Traditionally, aphasia is assessed manually using one of the well-known assessment batteries, such as the Western Aphasia Battery (WAB), the Chinese Rehabilitation Research Center Aphasia Examination (CRRCAE), and the Boston Diagnostic Aphasia Examination (BDAE). In aphasia testing, a speech-language pathologist (SLP) administers multiple subtests to assess people with aphasia (PWA). The traditional assessment is a resource-intensive process that requires the presence of an SLP. Thus, automating the assessment of aphasia is essential. This paper evaluated and compared custom machine learning (ML) speech recognition algorithms against off-the-shelf platforms using healthy and aphasic speech datasets on the naming and repetition subtests of the aphasia battery. Convolutional neural networks (CNN) and linear discriminant analysis (LDA) are the customized ML algorithms, while Microsoft Azure and Google speech recognition are off-the-shelf platforms. The results of this study demonstrated that CNN-based speech recognition algorithms outperform LDA and off-the-shelf platforms. The ResNet-50 architecture of CNN yielded an accuracy of 99.64 ± 0.26% on the healthy dataset. Even though Microsoft Azure was not trained on the same healthy dataset, it still generated comparable results to the LDA and superior results to Google's speech recognition platform.

Picnic, Accident or Cookies? A Systematic Approach to Guide the Selection of the Picture Definition Tasks in Linguistic Assessment

Picture description tasks are used to elicit language samples in individuals with aphasia and other cognitive disorders. However, task selection may affect the type of language variables elicited. In this study, our goal is to compare the strengths and the weaknesses of the two internationally used picture description tasks with a novel picture description task developed specifically for Turkish-speaking individuals. In sum, 20 cognitively healthy individuals with a mean age of 52 ± 14/3 were included. Three different picture description tasks composed of single pictures were used: The Picnic Scene from the Western Aphasia Battery-Revised, the Cookie Theft picture from the Boston Diagnostic Aphasia Examination and the Accident Scene from the Turkish Language Assessment Test for Aphasia. All language samples were recorded using a digital voice recorder. Automated and semi-automated approaches were used for the systematic analysis of the language features that were classified into four levels: general language measures, the morphosyntactic level, the lexicosemantic level and the sentence level. Participants showed greater efficiency and produced the greatest number of subordinate clauses, derivational suffixes, passive voice suffixes and relative past tense construction during the Accident Scene description. On the lexicosemantic level, the Picnic Scene was particularly superior to the Cookie Theft Picture in eliciting nouns. Imperfective aspect use was less frequent in the Accident Scene description. All three tasks had limitations and advantages compared with each other. We recommend the development of novel picture description tasks that would be more effective in eliciting specific language features in Turkish-speaking individuals.

Empirically derived “discourse phenotypes” are associated with neuropsychological performance, cognitive status, and global atrophy: A latent profile analysis of connected speech measures

AbstractBackgroundEvidence suggests that “connected speech” (i.e., spoken language, as in discourse) is related to early cognitive decline and early Alzheimer’s disease and related dementias (ADRD), yet performance on speech tasks and cognitive performance in ADRD are notably heterogeneous. Here we examined whether unique spoken language phenotypes could be ascertained using latent profile analysis (LPA), and we examined the association of identified clusters to demographic, clinical and cognitive characteristics. In the subsets with amyloid PET and structural MR, we analyzed cluster associations with estimated amyloid DVR and/or global atrophy at or near the speech sample.Method1,039 participants from the Wisconsin Registry for Alzheimer’s Prevention (WRAP) completed comprehensive neuropsychological testing and provided a spoken language digital recording describing the Cookie Theft picture from the Boston Diagnostic Aphasia Examination. Cognitive status was determined by consensus conference. Five speech‐language metrics based on previous literature (Table 1) were automatically extracted from transcriptions of recordings utilizing Computerized Language Analysis (CLAN), including: semantic content, sentence length, speaking rate, and fluency. Baseline speech metric Z‐scores were included in the LPA; model fits were evaluated using BIC criteria. T‐tests, chi‐square tests, and ANCOVAs were used to the compare demographic, clinical, cognitive and imaging characteristics of the resulting discourse phenotypes (alpha = .05).ResultFit indices suggested a 3‐profile model: normal content‐normal fluency (n = 558), low content‐normal fluency (n = 224), and low content‐low fluency (n = 257) (Figure 1). The three phenotypes differed on gender and cognitive status, with more men and a higher proportion of MCI in the low content‐low fluency phenotype than the other groups; the phenotypes also differed on concurrent neuropsychological tests of language, memory and executive function. In the subset with imaging, the low content‐low fluency phenotype showed the most global atrophy. There were no differences in concurrent estimated amyloid accumulation (Table 2, Figure 2).ConclusionThree phenotypes of narrative discourse were identified and were associated with multiple neuropsychological tests, overall cognitive status and global brain atrophy. While connected speech metrics are generally viewed as a promising ADRD digital biomarker, the underlying taxonomy identified here suggests a more precision‐based approach is possible.

Predicting Post-Stroke Cognitive Impairment Using Lesion Location

<h3>Research Objectives</h3> To develop a model to predict specific cognitive impairments following stroke based on the lesion's white matter edge density and location with respect to the left posterior arcuate fasciculus. <h3>Design</h3> Retrospective observational cohort study. <h3>Setting</h3> University medical center, inpatient and outpatient. <h3>Participants</h3> 149 adults (> 18 years old at time of stroke) from the Iowa Lesion Patient Registry. Participants must have had a stroke, an MRI or CT with visible focal brain lesion, and a neuropsychological assessment completed at the medical center. The cohort was 50% female, predominantly White (83%), upper middle-aged (mean age of 59 years old), and had an average of 13 years of education. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Cognitive impairment was quantified using z-scores for the following neuropsychological assessments, selected based on completion by >50% of participants Trail Making Test B, five subtests of the Wechsler Adult Intelligence Scale-IV, Benton Visual Retention Test, Rey Auditory Verbal Learning Test, Complex Figure Test, and two subtests of the Boston Diagnostic Aphasia Examination. The proportion of impaired tests per participant was also calculated. Lesion overlap with the left posterior arcuate fasciculus (LPAF) and lesion edge density were determined by summation of voxels. <h3>Results</h3> There was a significant though small positive correlation between the proportion of impaired z-scores and lesion overlap with the LPAF (r = 0.33, p <.001), indicating that greater lesion overlap corresponds to impairment on a greater number of neuropsychological test scores. The correlation between edge density and proportion of impaired scores was small and borderline significant (r=0.17, p=0.05). For individual neuropsychological tests, participants with lesion overlap to the LPAF had significantly lower scores than non-overlap participants on the majority (10 of 16) of assessed scores, and edge density was significantly negatively correlated to 7 of the 16 test scores. <h3>Conclusions</h3> Lesion overlap with the left posterior arcuate fasciculus has the potential to be used as a predictive marker of cognitive impairment in a post-stroke cohort and may be a stronger measure of cognitive impairment than edge density. <h3>Author(s) Disclosures</h3> No disclosures.

Tongue Acupuncture for the Treatment of Poststroke Aphasia: A Systematic Review and Meta-Analysis.

Objective This review evaluated the efficacy of tongue acupuncture for the clinical treatment of poststroke aphasia. Methods PubMed, Medline, Cochrane, Embase, CNKI, VIP, and Wanfang databases were searched from their inception to 1st June 2022. The dataset included randomized controlled trials (RCTs) with tongue acupuncture for the treatment of poststroke aphasia. Data aggregation and risk of bias evaluation were conducted on Review Manager Version 5.4.1 and Stata16.0. The main outcome measures included the Aphasia Battery of Chinese (ABC), the Chinese Functional Communication Profile (CFCP), the Boston Diagnostic Aphasia Examination (BDAE), and clinical efficiency. Then, comparing the effectiveness of tongue acupuncture, tongue acupuncture combined with conventional therapies, conventional therapies with head acupuncture, language training, body acupuncture, and Jie Yu Dan. Results A total of 20 studies with 1355 patients were included. Meta-analysis showed that compared with conventional treatments, tongue acupuncture has a significant improvement in clinical efficacy score (MD = 1.25, 95% CI (1.09, 1.43), P=0.001) and CFCP of poststroke aphasia (MD = 39.78, 95% CI (26.59, 52.97), P < 0.00001), but was not significant in improving ABC (MD = 5.95, 95% CI (2.85, 9.04), P=0.06). Compared to the conventional treatments, tongue acupuncture combined with conventional therapies promoted the ABC (MD = 11.48, 95% CI (2.20, 20.75), P < 0.00001), clinical efficacy score (MD = 1.22, 95% CI (1.14, 1.30), P < 0.00001), and CFCP score (MD = 29.80, 95% CI (19.08, 40.52), P < 0.00001) of poststroke aphasia. Conclusion This systematic review indicated that tongue acupuncture or tongue acupuncture combined with conventional treatments was an effective therapy for treating poststroke aphasia. However, stricter evaluation standards and rigorously designed RCTs are needed.

Adaptation of Melodic Intonation Therapy to a Tone Language: A Pilot Study of Tone-Rhythmic Therapy in Mandarin Chinese

Introduction: Although melodic intonation therapy (MIT) has proven effective in individuals with non-fluent aphasia in a variety of western languages, its application to Mandarin-speaking aphasic patients has not been thoroughly studied. The adaptation is complicated because Mandarin Chinese is a tone language with specific prosodic elements that differ from Indo-European languages. This study developed a Chinese-specific variant of MIT, i.e., tone-rhythmic therapy (TRT), and tested its efficacy in individuals with non-fluent aphasia. Methods: Six non-fluent aphasic patients were recruited; all of them were admitted to the study over 6 months after stroke and had received a standard program of language therapy. In the current research, tone and rhythmic practice were incorporated into the training procedures, and the adaptation was then examined in patients. The TRT treatment lasted 6 weeks, with five 50-min sessions per week. The Boston Diagnostic Aphasia Examination (BDAE) and the Functional Assessment of Communication Skills for Adults (FACS) tests were used to measure the change in the speech and language skills of patients. Results: The results showed that the patients had increased BDAE and FACS scores after intervention, and the treatment effect lasted for 6 months. Discussion: The modified MIT proved effective for Mandarin-speaking patients with non-fluent aphasia with lasting effects. Further studies evaluating its efficacy are needed for other types of aphasia and other tone languages.

Combined anodal transcranial direct current stimulation and behavioural naming treatment improves language performance in patients with post-stroke aphasia

ABSTRACT Primary objective During the last decade, studies using anodal transcranial Direct Current Stimulation (atDCS) have yielded promising results in patients with aphasia. The main aim of the present pilot study was to assess the effects of combined atDCS over the left posterior perisylvian region and behavioral naming training on the behavioral outcomes of language comprehension and production of patients with post-stroke aphasia. Research design A 2 × 2 quasi-experimental design was conducted, optimal to compare changes after treatment in experimental versus control group. Methods and Procedures Ten patients with post-stroke aphasia were enrolled in this study: half received atDCS on the left posterior perisylvian region while they underwent a 2-week behavioral naming training. The other half received sham stimulation. The outcomes were measured using the abbreviated form of the Boston Diagnostic Aphasia Examination and analyzed using ANOVAs. Main outcomes and Results Both groups improved their performance in Oral comprehension, Narrative writing and Language Competence Index, but only those that received anodal tDCS presented better results in the Naming category after the treatment. Conclusions AtDCS on the left posterior perisylvian area seems to be a promising tool for boosting the outcomes of behavioral naming therapy in patients with post-stroke aphasia.

Cerebellar Continuous Theta Burst Stimulation for Aphasia Rehabilitation: Study Protocol for a Randomized Controlled Trial.

BackgroundLanguage recovery is limited in moderate to severe post-stroke aphasia patients. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising tool in improving language dysfunctions caused by post-stroke aphasia, but the treatment outcome is as yet mixed. Considerable evidence has demonstrated the essential involvement of the cerebellum in a variety of language functions, suggesting that it may be a potential stimulation target of TMS for the treatment of post-stroke aphasia. Theta burst stimulation (TBS) is a specific pattern of rTMS with shorter stimulation times and better therapeutic effects. The effect of continuous TBS (cTBS) on the cerebellum in patients with aphasia with chronic stroke needs further exploration.MethodsIn this randomized, sham-controlled clinical trial, patients (n = 40) with chronic post-stroke aphasia received 10 sessions of real cTBS (n = 20) or sham cTBS (n = 20) over the right cerebellar Crus I+ a 30-min speech-language therapy. The Western Aphasia Battery (WAB) serves as the primary measure of the treatment outcome. The secondary outcome measures include the Boston Diagnostic Aphasia Examination, Boston Naming Test and speech acoustic parameters. Resting-state fMRI data were also obtained to examine treatment-induced changes in functional connectivity of the cerebro-cerebellar network. These outcome measures are assessed before, immediately after, and 12 weeks after cerebellar cTBS intervention.DiscussionThis protocol holds promise that cerebellar cTBS is a potential strategy to improve language functions in chronic post-stroke aphasia. The resting-state fMRI may explore the neural mechanism underlying the aphasia rehabilitation with cerebellar cTBS.

Linguistic characteristics of different types of aphasia: A computer-assisted qualitative analysis using T-LAB

Aphasic disorders are observed in patients with both vascular and neurodegenerative pathology. Although spontaneous speech in the various forms of aphasia has some features that are identifiable on a purely linguistic level, diagnosing the type of aphasia critically relies on the support of clinical and neuroimaging data. To identify some core characteristics of different types of fluent aphasias (i.e., disorders of speech production due to lesions in the posterior regions of the left perisylvian areas not associated with articulatory deficits or apraxia of speech) in spontaneous speech using T-LAB computer-assisted qualitative analyses. This is a mixed-method software that allows exploring narratives by highlighting their key features using linguistic, statistical and graphical tools. We collected samples of spontaneous speech (narratives) from 34 fluent aphasic Italian speakers (i.e.,11 post-stroke aphasic patients, 17 with the logopenic variant of Primary Progressive Aphasia and 6 with the semantic variant) during the description of the Cookie Theft Picture of the Boston Diagnostic Aphasia Examination. Thirty-four healthy control subjects were asked to complete the same task. Analyses of the entire corpus (all of the narratives), specific metadata introduction and tagging were performed by two raters and any conflicts were resolved by a third rater. T-LAB analysis revealed statistically significant differences between both aphasic patients and healthy controls and between vascular and degenerative patients. Although the main distinction emerged between post-stroke and neurodegenerative aphasias, important differences also emerged between the individuals with the logopenic variant and the semantic variant. These findings underline the potential usefulness of a computer-assisted analysis of speech production to identify the core linguistic characteristics of different aphasic disorders, independently of any clinical support.

Linguistic profiles of variants of primary progressive aphasia

BackgroundSeveral subtypes of primary progressive aphasia (PPA) have been proposed. Most reports use small samples, and few have included Spanish-speaking participants. AimTo analyze the language profile and nonlinguistic deficits in a large sample of PPA Spanish monolingual participants. Method177 individuals were diagnosed with PPA in a sample consisting of 69 men and 108 women (Mage = 66.40 years, SD = 9.30). The participants were assessed using the Spanish versions of the Western Aphasia Battery Revised (SWAB-R) and the Boston Diagnostic Aphasia Examination (SBDAE). Non-verbal reasoning was evaluated with the Raven's Colored Progressive Matrices. Results41.8% of the sample met the criteria for the logopenic variant (lvPPA), while 28.2% met the criteria for semantic (svPPA), 15.3% for lexical (lxvPPA), and 14.7% for nonfluent/agrammatic (nfvPPA) variants. Language difficulties were similar in all variants except for lxvPPA. Scores on Spontaneous Language, Auditory Comprehension, Repetition, and Naming were significantly higher for the lxvPPA group. Raven's Colored Progressive Matrices scores were significantly lower in lvPPA. Years of education correlated with all test scores, while age was negatively associated with naming. When the PPA variants were classified according to the traditional aphasia classification, discrepancies were evident. Furthermore, the most frequent type of aphasia was Amnesic, while the least frequent was Wernicke's aphasia. ConclusionThe SWAB-R is useful in describing the clinical characteristics of aphasia for each variant of PPA, but quantitative scores from this battery are not capable of distinguishing between variants of PPA, with the exception of lxvPPA.