A 61-year-old man presented to the emergency department with acute fluent but nonsensical speech and intact comprehension. Imaging showed a contrast-enhancing lesion near Wernicke's area, suspect for an intracranial neoplasm, without signs of ischemia or hemorrhage. Suspecting focal epilepsy with conduction aphasia, symptoms resolved after anti-convulsive therapy.

Objective. Nearly one-third of stroke patients develop aphasia. Although the function of classical language areas (e.g. Broca's area, Wernicke's area) has been widely characterized, the network reorganization mechanisms behind specific language dysfunctions induced by different aphasia subtypes and the biomarkers for a rapid and objective classification remain to be clarified. Additionally, the rapid classification of aphasia subtypes continues to be a clinical challenge.Approach. To address these gaps, we developed a diagnostic framework analyzing topological changes in resting-state fMRI-derived functional brain networks. A transparent feature selection pipeline is designed through combining the topological features, the ReliefF algorithm, the elbow method, and cross-validation to alleviate the limitation of available aphasia datasets.Main results. Using a cubic SVM classifier, the proposed model achieved 88.70% ± 1.37% accuracy and a 92.92% ± 0.78% F1 score in distinguishing post-stroke aphasia patients (PWA) from non-aphasic stroke patients patients without aphasia (PWOA) on a public dataset. Further validation on an in-house dataset (13 patients with PWA and 25 normal post-stroke patients) showed similar performance (88.1% accuracy, 92.76% F1 score), demonstrating robustness. Further functional connectivity analysis revealed PWA exhibit higher global/local network efficiency, increased clustering, and shorter path lengths than PWOA. Subtype analysis for Anomic, Broca, Conduction, and Global aphasia identified distinct neural patterns via one-way ANOVA, suggesting divergent pathophysiology.Significance. The proposed framework not only improves classification accuracy but also enhances interpretability and reproducibility. Thus, it could form the basis of a new objective diagnostic approach for aphasia.

ABSTRACT Background Cognitive models of verbal short-term memory differ considerably with one popular model assuming independent short-term buffers, including the phonological loop, and others conceiving of short-term memory as activated long-term memory. Data from individuals with neuropsychological impairments, particularly phonemic deficits in the context of aphasia, are an important source of evidence to evaluate these different cognitive models. Aims The study used experimental results from an individual with conduction aphasia to evaluate cognitive models of short-term memory. Immediate serial recall tasks involved acoustic, phonological, lexical, and semantic information to varying degrees. Methods The experimental tasks involved oral recall of series of long and short tones, series of digits or words, series of the digits “1” and “0”, as well as the semantic categories of words (animals versus digits) in the correct order. Thirteen age-matched neurotypical control participants provided normative data with which the participant’s results were compared. Outcome The participant was impaired in the serial recall of lists of digits and lists of words. He was, however, unimpaired recalling series of long and short tones, series of “0” and “1”, as well as the semantic categories of words presented in lists. This is incompatible with the phonological loop model which does not distinguish between different verbal information and the varying degrees of phonological and semantic information. In addition, it is argued that within the larger family of psycholinguistic models of verbal short-term memory, one model accounts for the results better than others.

We investigated the ability of 40 left-hemisphere brain-lesioned individuals with various diagnoses of aphasia to temporally synchronize the audio of a spoken word to its congruent video using a maximum-likelihood adaptive psychophysical procedure. We found a statistically significant effect of aphasia type, not explained by lesion volume, on measures of audiovisual (AV) synchrony. Brain-lesioned individuals with no symptoms of aphasia, and those with conduction aphasia performed on the synchrony task more similarly to age-matched neurotypical controls, whereas those with anomic aphasia performed the poorest. In addition, we examined the correlation between this ability and AV integration (fusion) and observed a significant correlation between measures of AV synchrony and fusion. An ROI analysis of stroke lesion maps showed that damage to the left posterior temporal regions adversely affected AV processing, although whole-brain univariate lesion-symptom mapping analyses did not yield any significant results. These findings contribute to a better understanding of the functional relationship between different AV processes in multimodal integration and their underlying cortical networks in the human brain.

Manual classification of production errors and the allocation of speech/spelling scores are time-consuming, laborious and error-prone tasks, even when conducted by clinicians and specialized researchers. Here we present sunflower, an R package developed to improve the analysis of language production quality for Spanish data. The package offers various functions, including (1) managing dataframes containing single responses and multiple-attempt responses, (2) conducting formal similarity analyses on words as well as positional accuracy data analyses within words, and (3) the classification of errors by considering lexicality, formal similarity and semantic similarity indexes, which are obtained by means of different algorithms and artificial intelligence techniques such as word2vec. The applications of sunflower, which is the first open-source package of its kind, include assessing whether production quality improves over the course of multiple attempts, and identifying which aspects of an individual's productions are most impacted by their impairments. Other potential applications include the analysis of whether improvements arise in a patient's production quality after a given treatment, distinguishing between cases of apraxia of speech and conduction aphasia, as well as simply using the package to improve and speed up the classification of speech/spelling errors with large datasets through automation.

Bimodal aphasia and dysgraphia: Phonological output buffer aphasia and orthographic output buffer dysgraphia in spoken and sign language

Phonemic paraphasia, a common characteristic of conduction aphasia, has traditionally been attributed to phonological representation dysfunction. An alternative hypothesis posits that phonemic paraphasia arises from difficulty converting phonemes into their corresponding articulatory maneuvers. However, detailed case studies supporting this theory have been lacking. In this report, we present the case of a 61-year-old right-handed man with right temporo-parietal infarction who exhibited crossed aphasia characterized by typical conduction aphasia symptoms (eg, relatively fluent speech with intact comprehension, frequent phonemic paraphasia, and pronounced difficulties in oral repetition) in the absence of distorted articulation, syllable segmentation, and prosody impairment. Despite the frequent occurrence of phonemic paraphasia and articulatory challenges, our patient's phonological representations remained relatively intact. His phonemic paraphasia was often self-corrected to produce correct responses, a feature known as conduit d'approche. During the oral repetition of individual mora (ie, the smallest unit of speech in Japanese), we observed that the patient consistently traced the corresponding Hiragana phonetic symbol accurately, despite his difficulties in articulation. We substantiated this phenomenon through objective assessment and posit that it resulted from an unusual separation of language functions in crossed aphasia-specifically, a disconnection between phonological representations in the right temporo-parietal cortex and speech articulation engrams in the left hemisphere. In this case of conduction aphasia, articulatory-based phonemic paraphasia may be viewed as an inability to convert phonemes into the appropriate articulatory maneuvers rather than as phonological representation dysfunction or apraxia of speech.

This study explored the use of an automated language analysis tool, FLUCALC, for measuring fluency in aphasia. The purpose was to determine whether CLAN's FLUCALC command could produce efficient, objective outcome measures for salient aspects of fluency in aphasia. The FLUCALC command was used on CHAT transcripts of Cinderella stories from people with aphasia (PWA; n = 281) and controls (n = 257) in the AphasiaBank database. PWA produced significantly fewer total words, fewer words per minute, more pausing, more repetitions, more revisions, and more phonological fragments than controls, with only one exception: The Wernicke's group was similar to the control group in percentage of filled pauses. Individuals with Broca's aphasia had significantly longer inter-utterance pauses and fewer total words than all other aphasia groups. Both the Broca's and conduction aphasia groups had higher percentages of phrase repetitions than the NABW (NotAphasicByWAB) group. The conduction aphasia group also had a higher percentage of phrase revisions than the NABW and the anomic aphasia groups. Principal components analysis revealed two principal components that accounted for around 60% of the variance and related to quantity of output, rate of speech, and quality of output. The Gaussian mixture models showed that the participants clustered in three groups, which corresponded predominantly to the controls, the nonfluent aphasia group, and the remaining aphasia groups (all classically fluent aphasia types). FLUCALC is an efficient way to measure objective fluency behaviors in language samples in aphasia. Automated analyses of objective fluency behaviors on large samples of adults with and without aphasia can produce measures that can be used by researchers and clinicians to better understand and track salient aspects of fluency in aphasia. https://doi.org/10.23641/asha.25979863.

Introduction: According to the Yearbook of Accidents of Electrical Origin for the year 2022, 853 accidents due to electric shock were reported in Brazil, of which 592 died, a reduction of 12.2% in mortality compared to the previous year. Three conditions elucidate trauma switches caused by the passage of electric current, the regulatory alterations by the passage of electric current, the conversion of electrical energy into thermal, known as the Joule effect, and muscle damage by the electrical stimulus of exacerbated contractions. Case Report: A 51-year-old male patient was followed up on an outpatient basis due to a nervous breakdown caused by accident with a high-voltage electrical discharge 15 years ago. After the event, he evolved with conduction aphasia, homonymous hemianopia on the right, hypoesthesia on the right side of the body, dysmetria on the right upper limb, and epileptic seizures of focal onset, evolving into tonic-clonic seizures. For seizure control, carbamazepine 200 mg 3 times a day was administered, with complete seizure control since then. Conclusion: Therefore, it is important to emphasize that the damage caused by electrocution to the central nervous system (CNS) is varied. Still, due to the patient’s clinical presentation, his neuroimaging findings, and his history, this is epilepsy secondary to electrocution. Encephalomalacia demonstrates a large scar in the brain tissue, and its control of seizure episodes with the adopted pharmacotherapy also corroborates.

ObjectiveTo analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based guidance for the prevention and treatment of poststroke aphasia in clinical practice.Data sourcesEmbase, PubMed, Cochrane Library and Web of Science were searched from January 1, 2002, to December 1, 2023.Study selectionIncluding the total number of strokes, aphasia, the number of different sexes or the number of PSA corresponding to different sex.Data extractionStudies with missing data, aphasia caused by nonstroke and noncompliance with the requirements of literature types were excluded.Data synthesis36 papers were included, from 19 countries. The analysis of 168,259 patients with stroke and 31,058 patients with PSA showed that the risk of PSA was 1.23 times higher in female than in male (OR = 1.23, 95% CI = 1.19–1.29, P < 0.001), with a prevalence of PSA of 31% in men and 36% in women, and an overall prevalence of 34% (P < 0.001). Analysis of the risk of the different types of aphasia in 1,048 patients with PSA showed a high risk in females for global, broca and Wenicke aphasia, and a high risk in males for anomic, conductive and transcortical aphasia, which was not statistically significant by meta-analysis. The incidence of global aphasia (males vs. females, 29% vs. 32%) and broca aphasia (17% vs 19%) were higher in females, and anomic aphasia (19% vs 14%) was higher in males, which was statistically significant (P < 0.05).ConclusionsThere are gender differences in the incidence and types of PSA. The risk of PSA in female is higher than that in male.

Introduction. Patients with a fluent type of aphasia have semantically poor discourse, which is often uninformative for the interlocutor, having consequences for their daily life. One of the treatment methods used in clinical practice is the semantic feature analysis (SFA). The aim of this study was to determine the impact of this treatment method on the content of discourse in patients with fluent aphasia. Methods. The sample consisted of 30 subjects with fluent aphasia, namely: Wernicke's aphasia (9 subjects), conductive aphasia (6 subjects), transcortical sensory aphasia (8 subjects), and anomic aphasia (7 subjects). To assess the formation of narrative discourse, the picture subtest "Cake theft" from the Boston diagnostic test for aphasia was used. The content of the discourse was assessed by two experienced speech therapists - aphasiologists. Results. After the treatment using the semantic feature analysis, an increase in the number of content words was observed in all patients (H = 22.53, df = 3, p &lt; .001; H = 23.42, df = 3, p &lt; .001; H = 23.10, df = 3, p &lt; .001). Patients with Wernicke's and transcortical sensory aphasia had most impairment in the content/informativeness of discourse. Uninformative discourse was observed in 5 (33.33%) patients with Wernicke's and 4 (26.67%) patients with transcortical sensory aphasia. The type and severity of aphasia were shown to affect the informativeness of discourse. Conclusion. The semantic feature analysis treatment method leads to a significant improvement of narrative discourse in patients with milder forms of aphasia, such as anomic and conductive aphasia.

Highlights: 1. To author’s knowledge, this study is the first study done in National Brain Center Hospital In Jakarta2. No similar studies have been done during the pandemic era3. This study can add additional data to further studies about aphasia in comparison with post pandemic era Abstract Global aphasia, sensory transcortical aphasia, motor transcortical aphasia, motor aphasia, sensory aphasia, conduction aphasia and anomic aphasia can occur in ischemic stroke. There are different locations of lesions in each type of aphasia. There has been an increase in incidence and mortality of stroke patients during the COVID-19 pandemic. Before the pandemic, global aphasia was the most common type of aphasia. This study was conducted to determine the type of aphasia, clinical and radiological features, and also management of aphasia in ischemic stroke during the pandemic. This research is a descriptive study with a cross sectional approach. Sampling was done by total sampling technique. The research sample was ischemic stroke subjects with aphasia diagnosed from January 1, 2021 - December 31, 2021 at the National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono Jakarta. Statistical analysis was done using IBM SPSS Statistics for Mac, Version 25.0 (IBM Corp., Armonk, N.Y., USA). There were 162 aphasic subjects with ischemic stroke. Age range was 34 – 87 years. Most subjects were male (59.9%), aged 55-65 years (37.0%). Hypertension (90.1%), diabetes mellitus (50.0%), and dyslipidemia (75.9%) were the dominant risk factors. The most common type of aphasia is global aphasia (43.8%) and motoric aphasia. (33,3%). The parietal lobe was the dominant location of global aphasia (38 subjects) and motoric aphasia (47 subjects). The therapy given to aphasic subjects with a history of ischemic stroke includes speech therapy (85.2%), antiplatelet therapy (98.1%), anticoagulants (19.1%), rTPA (1.2%), and neuroprotectors (3.0 %). In conclusion, in ischemic stroke subjects with aphasia at the National Brain Center Hospital during the pandemic, global aphasia was found to be the most common with the dominant global aphasia lesion location in the parietal lobe.

This study reports pilot data for a novel intervention, ECoLoGiC-Tx, delivered to four people with moderate to severe aphasia. ECoLoGiC-Tx addresses language and communication in unstructured, participant-led conversation. The speech-language pathologist (SLP) uses a framework to choose turns that facilitate a social interaction. When communication breakdown occurs, the SLP implements a least-to-most hierarchy to maximize the people with aphasia's (PWA's) independence in self-repair. ECoLoGiC-Tx draws its theoretical underpinnings from conversation analysis and theories of rehabilitation, including principles of complexity, neuroplasticity, and learning. Four PWA attended 60-min sessions twice weekly for 10 weeks. Assessment occurred at pretreatment, posttreatment, and 6-week maintenance. Outcomes included established discourse measures for conversation and monologue, tests of language and functional communication, and patient-/family-reported outcome measures (P/FROMs). Discourse samples were collected three times per assessment. Interrater reliability and fidelity for assessment and treatment procedures are reported. Participants presented with Broca's aphasia (one moderate, one severe) or conduction aphasia (one moderate, one severe). Each demonstrated improvements in discourse, test batteries, and P/FROMs. They all demonstrated reduced aphasia severity measured by the Western Aphasia Battery-Revised at posttreatment or maintenance. Change in conversation and monologue was robust for three participants, but was mixed for one person (P1: moderate Broca's aphasia). P/FROMs indicated improvement at posttreatment and maintenance for all participants. Most treatment gains were maintained at 6-week follow-up. This study provides promising results for ECoLoGiC-Tx to improve language function of people with chronic moderate to severe aphasia. Generalization occurred to tests, functional communication, spontaneous conversation, and structured monologue tasks.

AGR - 1 A Case Study of Cognitive Reserve and Wernicke's Aphasia Status-Post Insular Stroke.

ABSTRACT Background Language sample analysis is a common tool for inventorying an individual’s linguistic strengths and weaknesses. Although most research has focused on quantifying propositional or novel language production, studies suggest that individuals with aphasia, specifically nonfluent aphasia, produce high percentages of formulaic language relative to healthy controls. To date, little is known about how individuals with fluent aphasia subtypes use formulaic language and how the elicitation task influences their production. Aims The purpose of this research was to comprehensively describe patterns of formulaic language use in various discourse tasks in language samples of individuals with fluent aphasia. Methods & Procedures The retrospective analysis included discourse samples from Aphasiabank from 142 individuals with anomic, conduction, and Wernicke’s aphasia across four monologic discourse tasks. After identifying and classifying formulaic items into nine types, percentages of formulaic language were calculated for each participant and discourse task. Non-parametric statistics and Pearson’s correlations were used to compare production patterns and explore relationships between language severity and formulaic item types. Outcomes & Results Unique patterns of formulaic language were observed across groups including lower proportions of fillers in individuals with Wernicke’s aphasia and higher proportions of yes/no variants and speech formulas in individuals with conduction aphasia. Production patterns were most influenced by discourse task in individuals with anomic aphasia. Formulaic language use did not correlate with aphasia severity as measured by aphasia quotient. Conclusions Findings add to the evidence base describing formulaic language usage in individuals with post-stroke aphasia, which serves as a necessary foundation for eventual clinical application.

Intersectional sociodemographic and neurological relationships in the naming ability of persons with post-stroke aphasia

ABSTRACT Introduction Roughly 30% of stroke survivors suffer from aphasia—a communication disorder that affects the ability to communicate effectively—but little is known about their healthcare expenditure or how it varies between aphasia subtypes. This study evaluates the relative differential in healthcare expenditure of anomic, Broca’s, Wernicke’s and Conduction aphasia and assesses expenditure between demographic cohorts Methods Individual level data from the 2010 Moss Aphasia Psycholinguistic Project Database was matched with the 2010 Medical Expenditure Panel Survey using a propensity score algorithm based on functional, health, and demographic characteristics. Multilevel, generalized, nonlinear regression models were applied to the resulting data set to assess the correlation between annual healthcare expenditure, time post onset (tpo), sex, race, family size, marital status, income, education, aphasia type, and region of residence. Results were used to predict expenditure by aphasia subtype, race, and sex. Multiple distributional specifications tested the sensitivity and ensured the robustness of estimates. Results Regression results indicate that individuals with Broca’s aphasia had statistically higher healthcare expenditures paying an average of $10,896.45 annually when compared to anomic ($7,927.60), Wernicke’s ($7,096.22), and Conduction ($9,447.19) aphasias. Additionally, healthcare expenditure increased with each year of age (β=0.004, SE=0.005), but decreased with each year after stroke (β=-0.002, SE=0.001). Females (β=0.358, SE=0.131) and Blacks (β=0.103, SE=0.200) paid significantly more annually compared to males and Whites, respectively. Neither region of residence, income, nor level of education were significantly correlated with healthcare expenditure. Conclusion This study showed that, while individuals with Broca’s aphasia had higher average healthcare expenditure than other subtypes, the differential was not statistically significant. Sex and race cohorts did, however, show statistically significant differences in healthcare expenditures. While causality is outside the scope of this analysis, additional work is needed to determine the best strategy to mitigate these disparities.

Introduction. Craniotomy in conscious patients is a possible tool for optimizing of tumor resection degree (Extent of Resection) while maintaining the quality of life. Traditionally, the main focus during these operations is on the cortical speech areas. At the same time, there is a shortage of studies on mapping of long associative tracts during the removal of gliomas of dominant speech hemisphere.Aim. To analyze the data of intraoperative mapping and the postoperative state of speech function in patients with temporal lobe gliomas of left hemisphere (including those involving arcuate bundle) operated by the use of method of craniotomy in consciousness.Materials and methods. Gliomas of temporal lobe of left hemisphere were removed in 27 patients aged 14 to 67 years (median age 43 years). In 10 patients, the tumor was localized in middle parts of temporal lobe (at the level of middle and upper temporal gyri), in 9 patients – in posterior parts of temporal lobe and exited into the supramarginal zone, in 8 it spread partially from temporal lobe to insular area. Gliomas of high degree of malignancy were detected in 21 patients, 6 had tumors of low degree of malignancy. Surgical intervention was performed with intraoperative “awakening”. All patients underwent cortical electrophysiological stimulation in order to control localization of cortical speech zones, subcortical stimulation was performed in 21 cases to identify terminals of arcuate bundle. Speech disorders before and after surgery (on day 4–6) were evaluated by neuropsychologist using the method proposed by A. R. Luria, an automated test with the naming of pictures was additionally used intraoperatively. The average current strength of direct electrical stimulation was 3 (1.9–6.5) mA. In 12 cases, magnetic resonance (MR) tractography with construction of arcuate tract was performed before and after the surgery.Results. Cortical temporal speech zones during intraoperative electrical stimulation were detected in 20 (74 %) of 27 patients. In 10 patients, the arcuate tract was mapped in form of appearance of mixed speech disorders in the depth of surgical wound. In 23 (85.2 %) of 27 patients in early postoperative period, an increase in speech disorders was noted of which 13 people had disorders of temporal type only and 10 people (surgery on deep posterior parts of temporal lobe) had a combination of temporal and frontal types of speech disorders (conduction aphasia). Postoperative MR‑tractography (performed in 12 patients) revealed direct intraoperative tract lesion in 5 cases and ischemia of the tract area passage in 2 cases. These 7 patients had combined speech disorders after surgery. Gross sensory aphasia after surgery was manifested in 4 patients, in 2 of them ischemia was revealed according to postoperative magnetic resonance imaging, and 2 more had hemorrhagic impregnation in the removed tumor bed.Conclusion. When removing tumors of temporal lobe in “awakening” conditions it is necessary to map speech zones not only in the cortical, but also in the subcortical area with terminals of arcuate bundle. Mapping of speech zones in these different localizations makes it possible to identify fundamentally different speech disorders.

ABSTRACT Anomic aphasia is characterized by good comprehension and non-word repetition but poor naming. Two sub-types of deficits might be hypothesized: faulty access to preserved phonological representations or preserved access to impaired representations. Phonological errors may occur only when representations are impaired or in post-lexical deficits (conduction aphasia). We analysed the incidence of phonological naming errors of 30 individuals, 25 with anomic aphasia based on poor naming but good repetition and comprehension, and five with conduction aphasia based on poor naming and poor repetition. Individuals with anomic aphasia produced very few phonological errors compared to individuals with conduction aphasia (0–19.1% versus 42–66%). However, six individuals with anomia produced more than 11% phonological errors, suggesting two patterns of deficit: either impaired lexical representations or impaired access to them. The lack of phonological errors in most individuals with anomic aphasia suggests that access to the phonological output lexicon is semantically, not phonologically driven.

Vascular events represent the third cause of death and are also one of the main causes of disability in adulthood. Among the most frequent cognitive sequelae are the aphasia. There is a need to carry out clinical interventions that allow the person with aphasia to rehabilitate language, have quality of life and return to their usual activities. The functional reorganization approach of A. R. Luria proposes that after brain injury cognitive abilities are disorganized, but that through a neuropsychological intervention they can be recovered, at least partially. It is essential to restructure the lost ability and make a change in the psychophysiological structure. We present the case of a 44-year-old man who, after a cerebral infarction, was diagnosed with mixed aphasia: Broca and conduction aphasia. A rehabilitation program based on the functional reorganization approach was started. After 60 sessions, an improvement in automatic language, repetition, naming, and spontaneous language was observed. Likewise, independence for daily activities, family and social interaction increased.