A consistent white-matter lesion is associated with network-level structural and functional disconnection in chronic Broca's aphasia.

ABSTRACT Introduction AAC interventions are designed to support the social, emotional, and everyday communication needs of individuals, including those with chronic aphasia. Research indicates that AAC interventions not only help meet communication needs but also have the potential to improve verb naming abilities in people with aphasia (PWA). However, there remains a gap in the literature regarding integrating evidence-based AAC interventions to enhance verb naming for PWA. Objective This study aimed to investigate the potential benefits of a novel Personalized AAC Verb Enhancement (PAVE) intervention to support verb use and communication efficiency in an individual with chronic Broca’s aphasia. Methods A single-participant clinical case study using a multiple-probe design across three topics was conducted to evaluate the effectiveness of PAVE, a person-centered AAC intervention combined with Verb Network Strengthening Treatment (VNeST) strategies, for an individual with chronic Broca’s aphasia. Visual analysis and the non-overlap of all pairs (NAP) method were employed to assess improvements in spoken verb naming (VN) and AAC verb identification (AVI). Social validity was measured using a questionnaire administered to both the client and their spouse before and after the intervention. Results The client demonstrated robust and sustained treatment effects in VN and AVI. Both client and spouse reported positive impressions of the PAVE intervention and noted improvements in verb production and communication accuracy. Conclusion The PAVE intervention shows potential as a clinically valuable approach to increase verb naming outcomes for PWA.

Broca's aphasia, a condition characterized by nonfluent speech and difficulty with language production, results from focal brain damage and is most often caused by stroke. Although traditionally linked to lesions in Broca's area (Brodmann areas 44 and 45 in the left inferior frontal gyrus), recent evidence suggests that the neuroanatomy of Broca's aphasia is far more complex, implicating a broader network of cortical and subcortical regions. This study aimed to delineate the specific cortical and white matter features that, when damaged, lead to persistent Broca's aphasia. 39 chronic cases of Broca's aphasia and 41 cases of stroke survivors whose language functions returned to within normal limits (WNL) were included. Lesion analyses and disconnection mapping were conducted using the Brainnetome Atlas and the Lesion Quantification Toolkit (LQT). Results highlighted the critical role of the left insula, particularly its hypergranular and dorsal granular regions, which showed 99.2% and 93.6% lesion overlap, respectively, in Broca's aphasia cases. These regions, along with portions of the motor cortex and the parietal and temporal lobes, contribute to speech production and language processing. Importantly, the traditionally defined Broca's area showed minimal overlap, challenging the conventional understanding of its role in chronic Broca's aphasia. In addition to cortical regions, white matter tract analysis revealed complete disconnection of key pathways, including the arcuate fasciculus, extreme capsule, and middle longitudinal fasciculus. The corticospinal tract and inferior fronto-occipital fasciculus (IFOF) were also heavily disrupted, suggesting that damage to both cortical areas and their structural connections contributes to the hallmark symptoms of Broca's aphasia. These findings emphasize the distributed nature of the neural network underlying Broca's aphasia, extending beyond traditional Broca's area to include multiple cortical regions and their associated white matter tracts. The study provides new insights into the structural basis of language impairment, offering a more nuanced understanding of Broca's aphasia.

ABSTRACT Background The use of pictographic images to elicit spoken language productions is common in aphasia therapy. However, investigations on the treatment effects of using video stimuli are limited. People with aphasia are likely to want to be able to communicate better about content depicted in video-clip segments, especially with the growing popularity of video sharing between friends and family on social media. Aims The aim of this study was to examine the effects of utilising video-clip segments in the provision of Response Elaboration Training (RET; Kearns, 1985) in the Persian language. Specifically, the study addressed four questions: (1) Will the provision of RET with video-clips as the treatment stimuli increase the number of correct information units (CIUs; Nicholas and Brookshire, 1993) Persian speakers with aphasia produce in response to trained stimuli? (2) Will there be an increase in the number of CIUs participants produce in response to untrained stimuli? (3) Will treatment gains be maintained over time? (4) Will the participants exhibit improved scores on the Persian Western Aphasia Battery (Nilipour et al., 2014) from pre- to posttreatment? Methods & Procedures Two participants with moderately severe chronic Broca’s aphasia due to a left-hemisphere stroke received treatment three times a week. A single-case multiple-probe design consisting of two consecutive treatment phases, periodic generalisation probes, and three posttreatment follow-up probes (one-week, three-weeks, and six-weeks) was used. Treatment sessions consisted of two rounds of RET applied to 10 video-clip stimuli. Outcomes & Results Participant 1 reached the treatment termination criteria after six therapy sessions in the first phase of treatment and after seven treatment sessions in the second phase. Participant 2 reached the termination criteria for the first and second treatment phases after 12 and eight treatment sessions, respectively. Large positive treatment effects were found for the participants for trained items. Treatment effects were maintained above baseline performance for trained items on all follow-up measures. Generalisation to untrained items was limited. Both participants exhibited an Aphasia Quotient increase posttreatment on the Persian Western Aphasia Battery, with the largest improvement identified on the spontaneous speech subtest. Conclusion Although preliminary, this study provides support for the use of video stimuli in the provision of RET in the Persian language to individuals with chronic Broca’s aphasia. The study encourages further exploration on the topic and discusses clinical implications of the research.

Aphasia is a linguistic problem that occurs after brain damage. It's a broad term that encompasses everything from modest word retrieval challenges to a complete inability to produce and interpret language. Fluent and non-fluent aphasia are two types of aphasia. Non-fluent aphasia is characterized by sluggish, effortful speaking and is caused by a stroke in the left frontotemporal areas. These patients' language production is mainly limited to one- or two-word utterances. Non-fluent aphasic patients can sing fluently despite their significant language production handicap, which has led to the use of singing and music in aphasia rehabilitation. Objective: To examine the effectiveness of Melodic Intonation Therapy (MIT) in patients with chronic Broca's aphasia. Methods: A descriptive study was conducted from March 1 to September 30, 2021, at NUR International University to investigate the efficacy of MIT in patients with persistent Broca's aphasia. For this purpose data was collected from almost 50 speech therapists working with chronic Broca's aphasic patients through a self-designed questionnaire. The questionnaire was used as a data collecting instrument that was designed by expert opinion and literature review. Results: Results indicated that MIT is effective in patients with chronic Broca's aphasia. On asking the respondent about the efficacy of MIT almost 88% responded that MIT is effective, 8% were not sure about the efficacy of MIT and 4% responded MIT is not effective in chronic aphasic patients. On asking the respondent about the development of expressive language 64 % responded that expressive Language is improved while 36 % were not sure about the development of expressive language development. On asking the respondent whether MIT reduces psychological stress on individuals regarding the necessity to speak correctly, 88 % responded with yes while 12 % responded with No that MIT reduces psychological stress. Conclusions: It is concluded from this study that MIT is effective in patients with chronic Broca’s aphasia.

Purpose: Stimulation approach is a therapy technique to improve language production using auditory and visual stimulation. Jellow app is a mobile app designed for compensating for impaired language skills and may be used in the intervention of persons with aphasia. The study aimed to determine the benefits of using the Jellow app as a facilitator of stimulus therapy to improve language and psychosocial domains in chronic Broca's Aphasia. Methods: Ten right-handed male adults with Broca's Aphasia were assessed on WAB and SIQOL39g tests. The control group (n = 5) was enrolled only for stimulation therapy. Pictures of objects were used for therapy with the help of auditory or auditory and visual cues. In the study group (n = 5), along with stimulus therapy, subjects were also trained on the use of icons in the Jellow app to facilitate functional communication needs. After six-months tests were readministered. Results: Post-therapy, on WAB, the improvement in spontaneous speech, repetition, and naming were found to be significantly more in the study group (4.6 ± 0.55, 4.89 ± 0.56, 5.74 ± 0.24 respectively) than the control group (2.6 ± 0.89, 3.22 ± 0.49, 3.97 ± 0.3 respectively) on 2-sample t-test. Similarly, significantly more improvement was seen in the communication domain of SAQOL39g in the study group (2.03 ± 0.17) compared to the control group (1.14 ± 0.45). Conclusion: Use of the Jellow app may be a beneficial adjunct to stimulation therapy for improving linguistic abilities and quality of life in persons with chronic Broca's aphasia. IMPLICATIONS FOR REHABILITATION Following are the implications of this study in the rehabilitation of persons with chronic Broca's Aphasia: • Multimodality in therapy approach in traditional stimulation therapy is beneficial. • AAC Apps like the Jellow app can be used as an adjunct to the traditional stimulation approach of language intervention which facilitates the language abilities like spontaneous speech, repetition, and naming. • Language improvement due to rehabilitation is beneficial in improving the quality of life in this population. • The caregivers must be involved in the therapy program as they act as communication partners and can repeat the therapy tasks at home. • Similar type of study is warranted in a larger population so that people with chronic Broca's aphasia may get the benefit of the latest technology which may be cheaper and easier to use.

Constraint-induced aphasia therapy (CIAT) is becoming increasingly popular worldwide. It is based on the theory of CI therapy, which is supported by considerable evidence as being useful for rehabilitation after stroke. The CIAT-II protocol (Johnson et al., 2015) was modified to a Japanese version, consisting of intensive training using five expressive language exercises, with shaping and a transfer package for 3 hr/day for 15 consecutive weekdays. We assessed outcomes using the Standard Language Test of Aphasia (SLTA) and Verbal Activity Log (VAL) before and after therapy. We confirmed some improvements in language function using the SLTA and remarkable improvement in VAL amount-of-use scores. Language function and communication skills can be improved using CIAT in patients with chronic aphasia, based on their language function evaluation. The present findings suggest that CIAT might be effective as speech therapy for Japanese patients with chronic aphasia.

ABSTRACTOBJECTIVE: To develop the naming, reading and imitation skills management programme through mobile application of patients with severe Broca’s Aphasia.METHODS: A pilot study with eight patients was carried out. Purposive non-probability sampling technique was used to recruit the patients with severe Broca’s aphasia who received therapy through mobile application. It contains three domains: naming, reading and imitation. The programme was developed in Urdu language. Study was conducted in Yusra General Hospital, Islamabad and Railway Hospital, Rawalpindi, Pakistan. The inclusion criteria were patients above age of 40 and three months of stroke with diagnosis of chronic Broca’s Aphasias, while patients with severe cognitive impairment were excluded. The pre and post score of patients was recorded. Treatment protocol included 30-45 mints sessions, 4 days per week for total of 8 weeks. Data for each patient was analyzed based on their pre and post intervention scores.RESULTS: According to demographic variations 50.0% people lie in the age range 40-50 while 50.0% of people were 51-60 years. The mean age of sample was 49 years and 87% of participants were right handed. The pretest score on repetition was 16.25± 6.96 and post-test was 60.5±9.11 (p-value=0.000). The pretest score on naming was 49.75± 26.28 and post-test was 111.25±31.38 (p-value=0.000). The pretest reading score was 31.75±10.87 and post-test scores was 67.50±17.13 (p-value=0.000).CONCLUSION: It is concluded from the results that the naming, reading and imitation skills improved in patients with severe Broca’s aphasia through management applications.KEY WORDS: Aphasia (MeSH), Broca’s Aphasia (MeSH), Language Disorder (MeSH), Android management application (Non-MeSH)

Objective To explore the impact of constraint-induced aphasia therapy (CIAT) on language function and neural activity in patients with chronic Broca′s aphasia. Methods Two chronic aphasics whose use of language was recovering after standard language therapy were selected to receive 1.5 h of CIAT twice daily for two weeks (30 hours in total). Before and after the CIAT they were tested using a block-designed picture-naming task, fMRIs were taken and their use of language was examined. Results The language function assessments showed relatively large improvements in the subjects′ use of language after 4 weeks of conventional language training, but not much further change after 8 and 12 weeks. After the two weeks of CIAT, their language function improved further to a certain extent. fMRI showed increased activation in the left inferior frontal gyrus with or without enhanced activation in the left hemisphere, and reduced activation in the right inferior frontal gyrus. Conclusions Functional reorganization induced in the brain by CIAT was associated with up-regulation of the left inferior frontal gyrus or down-regulation of the right inferior frontal gyrus. Even the whole language network may have been modified. Key words: Stroke; Broca′s aphasia; Language training; Constraint-induced aphasia therapy; Brain reorganization; Functional magnetic resonance imaging

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ABSTRACTBackground: Previous research indicates that combining behavioural therapy with transcranial direct current stimulation (tDCS) may be more effective than therapy alone in increasing naming ability in stroke survivors with chronic anomia. Anodal (excitatory) stimulation targeting left perilesional areas and/or cathodal (inhibitory) stimulation targeting right contralesional areas may particularly benefit non-fluent patients with localised damage to the left frontal lobe. However, studies have yet to systematically compare the effects of varying the laterality and polarity of tDCS within individual patients in order to determine optimal stimulation parameters.Aims: The primary purpose of the current study was to determine which tDCS parameters would result in the greatest improvements in naming ability in an individual (JSc) with chronic Broca’s aphasia (9 years post-stroke) due to a left frontal lesion. A range of secondary outcome measures were also collected to explore the potential effects of therapy on JSc’s connected speech, emotional well-being, and communicative effectiveness.Methods & Procedures: Following baseline naming assessment, JSc completed six, 4-week long cycles of therapy, each involving a different stimulation condition: four active (perilesional anodal, perilesional cathodal, contralesional anodal, and contralesional cathodal) and two sham control conditions (perilesional and contralesional). In the first week of each cycle, he completed three, 20-min therapy sessions, during which he carried out a personalised picture name repetition therapy task at the same time as receiving tDCS. Naming ability was measured before, immediately after, 1 week after, and 3 weeks after each week of therapy. The secondary outcome measures were completed before, 1 week after, and 3 weeks after each week of therapy.Outcomes & Results: Naming accuracy immediately after stimulation increased significantly more following perilesional anodal stimulation than following perilesional sham stimulation, and this effect remained significant at 3 weeks post-therapy. Treatment effects on the secondary outcome measures were less consistent.Conclusions: The results agree with previous work demonstrating the importance of activation in left frontal perilesional regions for accurate picture naming in stroke survivors with non-fluent aphasia. We have shown that the effectiveness of a total of 1 h of behavioural anomia therapy can be significantly increased when combined with perilesional anodal tDCS and demonstrated the feasibility of a longitudinal, repeated measures design with multiple outcome measures. Greater understanding of the optimal tDCS parameters to enhance anomia therapy outcomes in individual patients with differing lesion and behavioural profiles may one day assist with the translation of therapy plus tDCS protocols into everyday clinical practice.

About a quarter of stroke patients worldwide suffer serious language disorders such as aphasias. Most common symptoms of Broca's aphasia are word naming disorders which highly impact verbal communication and the quality of life of aphasic patients. In order to recover disturbances in word retrieval, several cueing methods (i.e. phonemic and semantic) have been established to improve lexical access establishing effective language rehabilitation techniques. Based on recent evidence from action-perception theories, which postulate that neural circuits for speech perception and articulation are tightly coupled, in the present work, we propose and investigate an alternative type of cueing using silent articulation-related visual stimuli. We hypothesize that providing patients with primes in the form of silent videos showing lip motions representative of correct pronunciation of target words, will result in faster word retrieval than when no such cue is provided. To test our prediction, we realize a longitudinal clinical virtual reality-based trial with four post-stroke Broca's patients and compare the interaction times between the two conditions over the eight weeks of the therapy. Our results suggest that silent visuomotor cues indeed facilitate word retrieval and verbal execution, and might be beneficial in lexical relearning in chronic Broca's patients.

ABSTRACTBackground: People with aphasia are using technology-based augmentative and alternative communication (AAC) devices to support their communication. Typically, messages in AAC devices are organised using the following two interfaces: (a) grid displays that organise symbols into semantic categories (e.g., food) and (b) scene displays that organise photographs contextually. However, there is no published research comparing the influence of these displays across communicative outcome variables.Aims: The purpose of this study was to explore the effect of a grid display and a scene display across several communicative variables (e.g., conversational turns) during conversational interactions with a communication partner (CP). Additionally, we investigated generalisation to an untrained second conversation in one of the two participants.Methods & Procedures: Two experiments were conducted, and each included a different participant with chronic Broca’s aphasia. In Experiment 1, the participant watched an I Love Lucy episode and was trained to use the grid and scene displays for communicative purposes (e.g., formulating messages with the AAC device). After training, the participant engaged in conversations with a CP using either the grid display or the scene display. Experiment 2 followed the same procedures as Experiment 1; however, this participant watched a second I Love Lucy episode. She did not receive any grid display or scene display training for the second episode. The investigators examined (a) the total conversation time, (b) the number of conversational turns, instances of frustration, and navigational errors, (c) conceptual complexity of utterances, and (d) question response accuracy (measured as a percentage).Results: Descriptive analyses revealed that the participants’ communicative outcomes were superior in the scene display conditions. Specifically, a greater number of conversational turns were taken with fewer instances of frustration and navigational errors. The utterances in the scene display conditions were longer and more complex than utterances in the grid display conditions. Probe question response accuracy was greater in the scene display condition in comparison with grid display condition.Conclusion: The experiments represent a preliminary attempt to measure communicative competence in persons with aphasia (PWA) using different displays. The results suggest that scene displays facilitate a greater number of conversational turns for PWA than the grid displays. Additionally, utterance complexity was greater in the scene display condition. However, these results are limited to two individuals with aphasia, and systematic replication is warranted.

Event Abstract Back to Event Agrammatic Aphasia following Right versus Left Basal Ganglia Lesions: case reports and review of the literature VENUGOPAL BALASUBRAMANIAN1*, Maureen Costello1, Maha Aldera1 and Judith Koebli1 1 Seton Hall University, United States Introduction. The controversies surrounding the clinical entity of agrammatic Broca’s aphasia can be traced to the multiple perspectives on its cognitive, linguistic and neurological bases (Baastianse & Thompson, 2012; D’Esposito & Alexander, 1998; Lieberman, 2002). A currently brewing issue is about Broca’s aphasia’s alleged causal connections with the subcortical basal ganglia (BG). Early clinical studies have argued that permanent Broca’s aphasia does not occur without subcortical lesions (Dronkers et al, 1992; Stuss & Benson, 1986). In this context, the objectives of the current study include the following: to present data from two chronic Broca’s aphasics, to provide a comprehensive review of the literature on the left versus right BG lesions to discuss the agrammatic characteristics of our subjects, and to discuss the implications for subcortical models of language. Method. Subjects. LK, a 45-year-old male high school teacher suffered a stroke and consequently developed right hemiplegia and moderate non-fluent aphasia. A CT scan evaluation revealed infarcts involving the left temporal region extending up to a portion of the frontal lobe and BG of the left hemisphere (Figure 1). Clinical language evaluation indicated the presence of agrammatic Broca’s aphasia. He received language therapy for five years post-stroke. SE, a 69-year-old right-handed female with a stroke-induced lesion to the right frontal lobe under the anterior horn of the lateral ventricle, the head of caudate and putamen of the right hemisphere (Figure 1). Periodic assessment over a duration of eleven years since onset had yielded a persistent profile of agrammatic Broca’s aphasia, apraxia of speech, and left hemiplegia. Procedure. A large array of data was gathered from LK and SE using Boston Diagnostic Aphasia Examination, Token Test (only LK) Discourse Analyses (Conversation & narrative), Discourse Comprehension Test, Psycholinguistic Assessment of Language Performance in Aphasia (PALPA), Reversible Sentence Comprehension Test (SE only), Linguistic Ambiguity Comprehension Test, and Grammaticality & Semantic acceptability assessment. Results and Discussion LK and SE evidenced deficits in both language production and comprehension. LK had problems in inflectional morphology as well as sentence constructions. SE’s language comprehension was moderately impaired as her performance on Reversible Sentence Comprehension Test revealed. Story recall task brought out features of agrammatic and apraxic speech. Test results of both SE and LK are summarized in a series of figures. The involvement of BG lesions in both LK and SE support the clinical observation that permanent Broca’s aphasia does not occur without subcortical lesions. According to the circuit models, BG forms part of cortical-striatal-cortical circuit that sub-serves complex systems such as grammars (Liebermann, 2002; Mesulam, 1990), hence agrammatism following BG lesions in these two cases. An alternative explanation is that the BG structures are involved in a sequential cognitive process that underlies behaviors including language (Chan, Ryan, & Bever, 2013). Hence agrammatic aphasia occurs following BG lesions. SE’s lesion in the right BG can be explained on the basis of the observation that language lateralization is less striking at the subcortical level (Galaburda & Eidelberg, 1982). Figure 1 References Bastiaanse, R., & Thompson, C. (2012). Perspectives on agrammatism. New York: Psychology Press. Chan, S., Ryan, L., & Bever, T. (2013). Role of the striatum in language: Syntactic and conceptual sequencing. Brain & Language, 125, 283-294. D’Esposito, M., & Alexander, M.P. (1995). Subcortical aphasia: distinct profiles following left putaminal hemorrhage. Neurology, 45, 38-41. Dronkers, N.F., Shapiro, J.K., Redfern, B., Knight, R.T. (1992). The role of Broca’s area in Broca’s aphasia. Journal of Clinical and Experimental Neuropsychology, 14, 198. Galaburda, A.M., & Eidelberg, D. (1982). Symmetry and asymmetry in the human posterior thalamus. Archives of Neurology, 39, 325-336. Lieberman, P. (2002). On the nature and evolution of the neural bases of human language. Am J Phys Anthropol., 35, 36-62. Mesulam, M.M. (1990). Large-scale neurocognitive networksand distributed processing for attention, language, and memory. Annals of Neurology, 28, 597-613. Stuss, D.T., & Benson, D.F. (1986). The frontal lobes. New York: Raven. Keywords: Subcortical aphasia, Basal Ganglia, agrammatic aphasia, cortical-striatal-cortical circuitry, Broca's Aphasia Conference: 54th Annual Academy of Aphasia Meeting, Llandudno, United Kingdom, 16 Oct - 18 Oct, 2016. Presentation Type: Poster Sessions Topic: Academy of Aphasia Citation: BALASUBRAMANIAN V, Costello M, Aldera M and Koebli J (2016). Agrammatic Aphasia following Right versus Left Basal Ganglia Lesions: case reports and review of the literature. Front. Psychol. Conference Abstract: 54th Annual Academy of Aphasia Meeting. doi: 10.3389/conf.fpsyg.2016.68.00103 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Apr 2016; Published Online: 15 Aug 2016. * Correspondence: Dr. VENUGOPAL BALASUBRAMANIAN, Seton Hall University, South Orange, NJ, United States, venugopal.balasubramanian@shu.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers VENUGOPAL BALASUBRAMANIAN Maureen Costello Maha Aldera Judith Koebli Google VENUGOPAL BALASUBRAMANIAN Maureen Costello Maha Aldera Judith Koebli Google Scholar VENUGOPAL BALASUBRAMANIAN Maureen Costello Maha Aldera Judith Koebli PubMed VENUGOPAL BALASUBRAMANIAN Maureen Costello Maha Aldera Judith Koebli Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Background: Melodic intonation therapy (MIT) is a treatment approach used to facilitate verbal production in adults with aphasia by combining melodic intoning and rhythmic tapping. Although MIT was developed in the early 1970s, there is limited empirical evidence documenting specific behavioural outcomes.Aims: Two individuals with chronic Broca’s aphasia and acquired apraxia of speech received MIT applied to wh-questions in the context of multiple baseline designs. Methods & Procedures: Linguistic principles were applied to the selection of items used for treatment and measurement of generalisation effects. The dependent variables were (a) production of wh-questions and (b) articulatory accuracy via percentage of consonants correct in the production of wh-questions.Results: For Participant 1, there was an increase in the production of wh-questions for only one wh-morpheme which was maintained at 6 weeks post-treatment. For Participant 2, there was an increase in production of wh-questions for two wh-morphemes; however, performance was variable and declined by 6 weeks post-treatment. For both participants, there were modest gains in percentage of consonants correct for treated and generalisation items at 6 weeks post-treatment.Conclusions: There were limited gains in the production of wh-questions for both participants with the application of MIT. However, there were modest gains in percentage of consonants correct. MIT as applied in this investigation to wh-questions utilising linguistic principles did not result in improvement in the formulation and production of wh-questions, but treatment did have positive effects on articulatory accuracy for treatment and generalisation items. Additional research is needed to further examine the efficacy of MIT for outcomes involving both language and speech production.

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This paper reports on the comprehension of movement-derived structures by a Spanish-Basque bilingual with chronic Broca's aphasia. The study reveals adifferential impairmentwhich affects mostly Basque and aselective impairmentin this language that affects only object questions and subject relatives. The impairment pattern observed is discussed in light of the predictions made by different representational and processing accounts for (monolingual as well as bilingual) Spanish and Basque agrammatism.The asymmetry observed between the two languages suggests that the patient resorts to language-specific morpho-syntactic cues, which cannot be transferred from one language to the other because of the typological distance between Spanish and Basque. The data confirm results from previous studies showing that (major) typological distance hinders cross-language effects from arising in bilingual aphasia.

Despite being perhaps the most studied form of aphasia, the critical lesion location for Broca's aphasia has long been debated, and in chronic patients, cortical damage often extends far beyond Broca's area. In a group of 70 patients, we examined brain damage associated with Broca's aphasia using voxel-wise lesion-symptom mapping (VLSM). We found that damage to the posterior portion of Broca's area, the pars opercularis, is associated with Broca's aphasia. However, several individuals with other aphasic patterns had considerable damage to pars opercularis, suggesting that involvement of this region is not sufficient to cause Broca's aphasia. When examining only individuals with pars opercularis damage, we found that patients with Broca's aphasia had greater damage in the left superior temporal gyrus (STG; roughly Wernicke's area) than those with other aphasia types. Using discriminant function analysis and logistic regression, based on proportional damage to the pars opercularis and Wernicke's area, to predict whether individuals had Broca's or another types of aphasia, over 95% were classified correctly. Our findings suggest that persons with Broca's aphasia have damage to both Broca's and Wernicke's areas, a conclusion that is incongruent with classical neuropsychology, which has rarely considered the effects of damage to both areas.

Background: Anomia is a debilitating symptom of aphasia, which impacts significantly on patient quality of life. There is strong evidence in the literature to indicate that treatments for anomia are successful for individuals with aphasia, including those in the chronic stage. However, numerous limitations exist within the methodologies of relevant studies. It remains unclear which treatments provide optimal benefits for varying types and severities of aphasia. Aims: The primary aim of this study was to compare the effectiveness of two treatments, Constraint-Induced Aphasia Therapy-Plus (CIATplus) and Multi-modality Aphasia Therapy (M-MAT) for noun retrieval in individuals with severe chronic Broca's aphasia. The secondary aim was to investigate whether the use of verbal constraint is an essential element of therapy. We hypothesised that M-MAT and CIATplus would lead to equally improved naming scores for treated stimuli. Methods & Procedures: Two females with chronic Broca's aphasia (CH and MT) participated in the study. We utilised two single-participant, alternating treatment designs with multiple probes. For each treatment participants received 3.25-hour treatment sessions along with 45 minutes social interaction 4 days a week, for 2 weeks (32 hours total). Treatment involved naming items in the context of turn-taking card games and home transfer request tasks. Naming probes and assessments were conducted at baseline, following each treatment, and at 6 weeks and 3 months post treatment. Outcomes & Results: Both participants differed in their responses to the treatments. However, M-MAT proved equally efficacious as CIATplus for naming of treated items. Overall, generalisation was not observed for any of the measures. CH reported enjoying both treatments, while MT preferred M-MAT. Conclusions: As expected, a number of variables are likely to have contributed to differences in participant responses to treatment. Replication with larger, well-stratified samples is required to better ascertain the effects of CIATplus and M-MAT on anomia in different types and severities of aphasia. This information would contribute to the more effective application of client-tailored treatment practices.

Background: Verb production difficulties are well documented in individuals with aphasia. Yet there remains limited evidence regarding the efficacy of treatments for verb retrieval in these individuals. While previous studies have generally demonstrated positive treatment outcomes in improving single-verb production on confrontation naming tasks, few studies have attempted to examine therapy outcomes in more natural communicative contexts. Aims: This study aimed to evaluate and compare the effects of repetition, semantic, and combined semantic and gesture treatments for verb retrieval and use in individuals with chronic Broca's aphasia. Methods & Procedures: Two individuals with severe and moderate Broca's aphasia participated in this single-participant, multiple-baseline across conditions design. Participant GF presented with mixed levels of verb retrieval deficits and significant apraxia of speech. Participant PF evidenced verb retrieval impairment arising primarily from the output phonological level. A total of 100 action pictures drawn from various sources were balanced for relevant linguistic factors and individual error rates during baseline naming. Treatments were carried out sequentially. Each treatment condition lasted for ten sessions. Semantic treatments involved the production of various features that were semantically associated with the target verb, including associated nouns, and the movement and location characteristics of the target verb. Gesture treatments involved the production of hand and arm movements representative of the target verb. Outcomes & Results: Both participants differed in their response to treatments. GF exhibited increased verb-naming accuracy following repetition-orthographic and combined semantic and gesture treatments; while PF displayed significant increase in naming accuracy following repetition-only and semantic treatment conditions. For both participants, treatments that resulted in significant increase in naming accuracy were shown to be equally efficacious. Both GF and PF also demonstrated increased verb production in narrative and conversation tasks. PF further evidenced improvements in sentence production on a picture description task post-treatment. Conclusions: These findings highlighted the responsiveness to therapy in two individuals with severe and moderate aphasia in the chronic stages. However, there was no significant change in specific lexical, syntactical and morphological linguistic production in conversation. Future research could explore the incorporation of single verb therapy in sentences and/or more natural communicative environments, to further enhance changes at the discourse level.