History Of Aphasia Research Articles

Case Report: Comprehensive management of Bulbar Motor Neuron disease in an elderly male: A Multidisciplinary case report approaching the treatment

Abstract* Bulbar Motor Neuron Disease (MND), a specific form of amyotrophic lateral sclerosis (ALS) primarily affecting the upper and lower motor neurons in the brainstem’s bulbar region, presents a significant challenge in clinical management. This case report delves into the clinical presentation and management of an 85-year-old male patient with typical symptoms, such as left-sided weakness, dysphagia, and dysarthria, along with a history of aphasia and hypertension, underlining the complexities associated with diagnosing and managing this condition. Methods: The patient underwent a thorough clinical examination, diagnostic investigations, and imaging, leading to a confirmed diagnosis of bulbar MND. Multidisciplinary interventions were employed to addressed the diverse symptoms, including compensation therapy, swallowing function training, physiotherapy, bolus modification, behavioral adjustments, oromotor exercises, postural corrections, and sensory and neurophysiologic stimulation to enhance swallowing safety and comfort. Additionally, interventions for dysarthria and left-sided weakness encompassed speech rate control, strength training, and the use of augmentative communication aids. Results: Over a 30-day follow-up period, the patient showed improvements in dysphagia, dysarthria, and activities of daily living. The treatment strategies effectively addressed the specific challenges associated with bulbar MND, focusing on enhancing the patient’s quality of life and functional abilities. Conclusions: This case report underscores the need for a comprehensive, multidisciplinary approach to manage bulbar MND. It highlights the complexities of diagnosing and addressing the diverse symptoms and difficulties that patients with this condition encounter, emphasizing the importance of a holistic and individualized therapeutic strategy.

Case report: a special case of cryptococcal infection-related inflammatory syndrome in a non-HIV infected and non-transplant patient

BackgroundCryptococcal meningoencephalitis (CM) is a severe infection of central nervous system with high mortality and morbidity. Infection-related inflammatory syndrome is a rare complication of CM. Herein, we report a case of CM complicated by infection-related inflammatory syndrome.Case presentationA 42-year-old man with chronic hepatitis B presented with a 3-day history of aphasia and left hemiparesis at an outside medical facility. The brain magnetic resonance imaging (MRI) showed symmetric and confluent hyperintense signal abnormalities mainly located in the basal ganglia, internal capsule, external capsule, periventricular, corona radiata, frontal and temporal lobes. Cerebrospinal fluid (CSF) examinations revealed elevated leukocyte and protein. India ink staining was positive for Cryptococcus. CSF culture and metagenomic next-generation sequencing (mNGS) confirmed Cryptococcus neoformans. Initial response was observed with intravenous fluconazole (400 mg per day). However, 11 days later, he developed impaired consciousness and incontinence of urine and feces. A repeat brain MRI showed the lesions were progressive and enlarged. The patient was referred to our department at this point of time. Repeat CSF analysis (India ink staining, culture and mNGS) re-confirmed Cryptococcus. However, clinical worsening after initial improvement, laboratory examinations and brain MRI findings suggested a diagnosis of infection-related inflammatory syndrome. Therefore, a combination of corticosteroids and antifungal therapy was initiated. At follow-up, a complete neurological recovery without any relapse was documented. The repeat brain MRI showed complete resolution of the previous lesions.ConclusionsThis case demonstrated that cryptococcal inflammatory syndromes must be suspected in cases of CM if an otherwise unexplained clinical deterioration is observed after initial recovery. The same can happen even before the primary infection is controlled. Thus, timely identification and prompt treatment is vital to reduce the mortality and disability of CM. The administration of corticosteroids in combination with antifungal therapy is an effective strategy in such cases.Graphical abstractClinical course and treatment process of the patient. Hemiparalysis and aphasia improved after the initiation of antifungal treatment. However, the patient developed impaired consciousness companied by deterioration of brain MRI findings. He was treated with adjunctive glucocorticoid taper therapy consisting of dexamethasone (20 mg/day, intravenously) for 1 week followed by oral prednisone 1 mg/kg/day, tapered based on clinical and radiological response, along with amphotericin B (0.6 mg/kg/day, intravenously), voriconazole (400 mg/day in 2 divided doses, intravenously), and 5-flucytosine (100 mg/kg/day in 4 divided doses, orally). Two weeks later, his symptoms improved significantly. After discharge, he began oral voriconazole for consolidation and maintenance therapy for 8 weeks and 9 months respectively. He recovered without any neurological sequelae at 6-month follow-up. Note: MRI = magnetic resonance imaging.

Recovery of language function and brain metabolism in a patient with crossed aphasia: 2-year follow-up of brain FDG PET images

ABSTRACTBackground: Crossed aphasia, a language disturbance in right-handed individuals secondary to a right hemisphere lesion, is rare, occurring in only l-2% of brain-lesioned patients. The precise neurological mechanisms of crossed aphasia are still unknown, and follow-up studies in the long term of language function are sparse.Aims: We describe a detailed follow-up evaluation of language function and resting brain glucose metabolism in a well-defined crossed aphasia patient after right middle cerebral artery (MCA) infarction.Methods & Procedures: A 49-year-old man was referred for the treatment of 3-week history of aphasia after right MCA infarction. He indicated a strong right-handed preference confirmed by the Edinburgh Handedness Questionnaire, and his family members are all right handed. There was no history of developmental delay or learning disability in childhood or previous neurological disease. Formal language evaluation was carried out in the subacute phase (3 weeks after onset) and the late phase (5 and 24 months after onset) with the Korean version of Western Aphasia Battery. He received 40-min sessions of conventional speech and language therapy by a qualified therapist of comparable experience, three times a week. The serial F-18 fluorodeoxyglucose positron emission tomography (FDG PET) scan was performed on 3 weeks and 24 months after onset, respectively. Subtraction PET imaging between baseline and follow-up evaluation was conducted with coregistration with the patient’s magnetic resonance imaging.Outcomes & Results: In the initial evaluation, his aphasia was categorized as Broca’s aphasia [aphasia quotients (AQs) 50.4, language quotients (LQs) 49.8]. Four months after the initial evaluation, the function of spontaneous speech, repetition, naming, and reading significantly improved, with a relatively moderate progress of comprehension (AQ 83.5, LQ 78.1). At 2-year follow-up, the function of spontaneous speech, repetition, naming, reading, and writing improved, but the comprehension revealed impairment with minimal improvement (AQ 88.9, LQ 86.8). The result revealed that the 20% increased area of F-18 FDG uptake in the subtraction PET image corresponded to the right basal ganglia, the right medial temporal lobe, both occipital lobes, and the left cerebellum.Conclusions: Our case showed long-term recovery of brain glucose metabolism and language function in a patient with mirror image crossed aphasia. The restoration of perilesional brain function and diaschisis possibly contributed to the recovery of the crossed aphasia.

Afasia hizkuntzaren antolaketarako erakusleiho

Afasiaren azterketak hizkuntzaren antolaketarako ebidentzia enpirikoa eskaintzen du, horregatik da ekarpen garrantzitsua eredu neurolinguistiko eta psikolinguistikoak garatzeko. Lan honetan, afasiologiarako sarrera labur gisa, burmuineko lesioen ikerketak hizkuntzaren eta hizkuntza osagaien antolaketaz zer erakutsi duen berrikusten da. Horretarako, aurkezten dira, batetik, afasiologiaren historian hizkuntzaren irudikapenaren inguruan izandako ikuspegi nagusiak eta, bestetik, zer-nolako datuak eskaintzen dituen afasiak hizkuntz osagaien antolaketa funtzionalerako eta hizkuntzalaritza teoriarako.

Assessing functional communication: validation of the Italian versions of the Communication Outcome after Stroke (COAST) scales for speakers and caregivers

ABSTRACTBackground: There is an increasing need of assessing functional communication in daily activities and the impact on the quality of life from the perspective of the major protagonists of life situations following aphasia. Several instruments are available for English. One of the most recent is the Communication Outcome after Stroke scale for patients (COAST) and caregivers (Carer COAST). These scales are comprised of two components, interactive communication skills and their impact on quality of life, assessed through 20 question items, from the point of view of patient and carer. In contrast, the number of tools available in Italian is very limited.Aims: (i) To validate the COAST and Carer COAST scales for the Italian-speaking population; (ii) to explore the applicability of the COAST scales to a wider range of people with communication problems, not limited to moderate aphasia; (iii) to explore the agreement between patient’s and carer’s perspective on communication difficulties, and the effect of severity.Methods & Procedures: The scales were translated into Italian and adapted for the sociocultural context, preserving the accessible presentation and response format. Thirty people with a history of aphasia (from mild to severe) and 28 caregivers provided usable data. The scales’ psychometric properties were measured, along with exploratory analyses on the agreement between patients and carers.Outcomes & Results: The Italian versions of the COAST scales, i.e., COAST-IT and Carer COAST-IT, showed excellent internal consistency (α = 0.94 and 0.94–0.95, respectively), good test–retest reliability (ICC = 0.85 and 0.88, respectively), and indicative evidence of construct validity as judged by the correlations with measures derived from background and current Aachener Aphasia Test (AAT) scores (r ranging from 0.32 to 0.41 and from 0.47 to 0.70, respectively). The patient and caregiver scales were strongly correlated along the score range (r = 0.70–0.72) and agreement was not influenced by aphasia severity.Conclusions: The COAST-IT and Carer COAST-IT scales are practical and reliable patient- and carer-centred measures of functional communication and its impact on the quality of life, applicable to people with communication problems of different severity. These scales fill an important gap of effectiveness indicators for speech–language assessment and therapy in Italy. More generally, the results strengthen the need of complementing traditional language assessment with functional outcome measures, and considering the perspective both of people with communication difficulties and their carers. This adaptation could pave the way for cross-national sharing of functional communication assessment instruments and comparative studies.

SYPHILITIC AORTITIS PRESENTING WITH ACUTE ISCHEMIC STROKE AND LARGE ASCENDING AORTIC THROMBUS

Comprehensive evaluation including imaging for a cardioembolic etiology is indicated in the workup of acute ischemic stroke. A 57 year old male presented with a 2 day history of aphasia and right hemiparesis. He underwent transthoracic echocardiogram, which was normal except for a mildly dilated

Right hemisphere grey matter structure and language outcomes in chronic left hemisphere stroke.

The neural mechanisms underlying recovery of language after left hemisphere stroke remain elusive. Although older evidence suggested that right hemisphere language homologues compensate for damage in left hemisphere language areas, the current prevailing theory suggests that right hemisphere engagement is ineffective or even maladaptive. Using a novel combination of support vector regression-based lesion-symptom mapping and voxel-based morphometry, we aimed to determine whether local grey matter volume in the right hemisphere independently contributes to aphasia outcomes after chronic left hemisphere stroke. Thirty-two left hemisphere stroke survivors with aphasia underwent language assessment with the Western Aphasia Battery-Revised and tests of other cognitive domains. High-resolution T1-weighted images were obtained in aphasia patients and 30 demographically matched healthy controls. Support vector regression-based multivariate lesion-symptom mapping was used to identify critical language areas in the left hemisphere and then to quantify each stroke survivor's lesion burden in these areas. After controlling for these direct effects of the stroke on language, voxel-based morphometry was then used to determine whether local grey matter volumes in the right hemisphere explained additional variance in language outcomes. In brain areas in which grey matter volumes related to language outcomes, we then compared grey matter volumes in patients and healthy controls to assess post-stroke plasticity. Lesion-symptom mapping showed that specific left hemisphere regions related to different language abilities. After controlling for lesion burden in these areas, lesion size, and demographic factors, grey matter volumes in parts of the right temporoparietal cortex positively related to spontaneous speech, naming, and repetition scores. Examining whether domain general cognitive functions might explain these relationships, partial correlations demonstrated that grey matter volumes in these clusters related to verbal working memory capacity, but not other cognitive functions. Further, grey matter volumes in these areas were greater in stroke survivors than healthy control subjects. To confirm this result, 10 chronic left hemisphere stroke survivors with no history of aphasia were identified. Grey matter volumes in right temporoparietal clusters were greater in stroke survivors with aphasia compared to those without history of aphasia. These findings suggest that the grey matter structure of right hemisphere posterior dorsal stream language homologues independently contributes to language production abilities in chronic left hemisphere stroke, and that these areas may undergo hypertrophy after a stroke causing aphasia.

Using Family Members or Close Friends as Informants About Participation Goals for Older Adults With and Without Aphasia

Client-centered care is a stated focus for many rehabilitation programs, but personalized goal-setting presents unique challenges for people with aphasia (PWA). A potential solution for clinicians is to enlist the help of family members or close friends to determine what life activities should be addressed. In this article, we review two main reasons this solution is not ideal. First, we discuss how negative effects on autonomy and motivation may be instigated unintentionally. Next, we consider to what extent accurate input can be assumed by proxy responders. We conclude by reporting the results of a small study showing that congruence about activity choices among family members or friends not affected by aphasia is similar to previously reported congruence in families with a history of aphasia. These results suggest that ability to predict life activity preferences in others is limited, regardless of the presence of aphasia. We contend that although the input and participation of significant others is often critical to positive rehabilitation outcomes, the value of this input lies in its relationship to the priorities identified by the individual with aphasia, not in the potential for replacing it.

Dissociating short-term memory and language impairment: The importance of item and serial order information

Background: Selective verbal short-term memory (STM) deficits are rare, and when they appear, they are often associated with a history of aphasia, raising doubts about the selectivity of these deficits. Recent models of STM consider that STM for item information depends on activation of the language system, and hence item STM deficits should be associated with language impairment. By contrast, STM for order information is considered to recruit a specific system, distinct from the language system: this system could be impaired in patients with language-independent STM deficits. Aims: We demonstrate here the power of the item–order distinction to separate STM and language impairments in two brain-damaged cases with STM impairment and a history of aphasia. Methods & Procedures: Recognition and recall STM tasks, maximising STM for either item or order information were administered to patients MB and CG. Outcomes & Results: Patient MB showed mild phonological impairment. As predicted, associated STM deficits were characterised by poor item STM but preserved order STM. On the other hand, patient CG showed no residual language deficits. His STM deficit was characterised by poor order STM but perfectly preserved item STM. Conclusions: This study presents the first double dissociation between item and order STM deficits, and demonstrates the necessity of this distinction for understanding and assessing STM impairment in patients with and without aphasia.

Juergen Tesak and Chris Code. Milestones in the History of Aphasia: Theories and Protagonists. Hove, NY: Psychology Press, 2008. 312 pp. $70.00 (hardback). ISBN‐13: 978‐1‐84169‐513‐6

Journal of the History of the Behavioral SciencesVolume 45, Issue 2 p. 167-169 Book Review Juergen Tesak and Chris Code. Milestones in the History of Aphasia: Theories and Protagonists. Hove, NY: Psychology Press, 2008. 312 pp. $70.00 (hardback). ISBN-13: 978-1-84169-513-6 Ynez Violé O'Neill, Ynez Violé O'Neill Professor Emeritus of Neurobiology, University of California, Los AngelesSearch for more papers by this author Ynez Violé O'Neill, Ynez Violé O'Neill Professor Emeritus of Neurobiology, University of California, Los AngelesSearch for more papers by this author First published: 09 April 2009 https://doi.org/10.1002/jhbs.20368AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume45, Issue2Spring 2009Pages 167-169 RelatedInformation

Right anterior superior temporal activation predicts auditory sentence comprehension following aphasic stroke

Previous studies have suggested that recovery of speech comprehension after left hemisphere infarction may depend on a mechanism in the right hemisphere. However, the role that distinct right hemisphere regions play in speech comprehension following left hemisphere stroke has not been established. Here, we used functional magnetic resonance imaging (fMRI) to investigate narrative speech activation in 18 neurologically normal subjects and 17 patients with left hemisphere stroke and a history of aphasia. Activation for listening to meaningful stories relative to meaningless reversed speech was identified in the normal subjects and in each patient. Second level analyses were then used to investigate how story activation changed with the patients' auditory sentence comprehension skills and surprise story recognition memory tests post-scanning. Irrespective of lesion site, performance on tests of auditory sentence comprehension was positively correlated with activation in the right lateral superior temporal region, anterior to primary auditory cortex. In addition, when the stroke spared the left temporal cortex, good performance on tests of auditory sentence comprehension was also correlated with the left posterior superior temporal cortex (Wernicke's area). In distinct contrast to this, good story recognition memory predicted left inferior frontal and right cerebellar activation. The implication of this double dissociation in the effects of auditory sentence comprehension and story recognition memory is that left frontal and left temporal activations are dissociable. Our findings strongly support the role of the right temporal lobe in processing narrative speech and, in particular, auditory sentence comprehension following left hemisphere aphasic stroke. In addition, they highlight the importance of the right anterior superior temporal cortex where the response was dissociated from that in the left posterior temporal lobe.

Premature Thoughts on Writing Disorders

Three papers appeared in the 19th century describing the dissociation between speech and writing: Marcé (1856), Ogle (1867) and Pitres (1884). An account of the convincing evidence of dissociations put forward in these papers is presented. Three explanations are proposed as to the reason why the observations reported by these authors were overlooked or rejected by their contemporaries, namely: (a) in the first half of the century it seems that very little knowledge of the processes underlying writing (as opposed to speech) was available, (b) the debates focussed on the independence of speech versus motor control and language versus the intellect, (c) parallelisms between phylogeny, ontogeny and aphasia impeded the application of the principle of double dissociations, including the dissociations between speech and writing. It is argued that this phenomenon in the history of aphasia is best captured by the concept of prematurity in scientific discovery proposed by Stent (1972, 2003).

Reader in the History of Aphasia

Reader in the History of Aphasia

Reader in the History of Aphasia

Reader in the History of Aphasia

Reader in the History of Aphasia: From Franz Gall to Norman Geschwind. Edited by Paul Eling

<i>Reader in the History of Aphasia: From Franz Gall to Norman Geschwind</i>. Edited by Paul Eling

Selective attention and aphasia in adults: Preliminary findings

Thirteen patients with left-hemisphere stroke and history of aphasia and 13 normal controls were administered the covert orientation of visual attention task (COVAT). This task presents targets to the right or left of a central fixation point after a cue (84% of trials) or with no cue (16% of trials). Left-hemisphere damaged patients also received tests of language function at the time of the study. For targets presented 100 msec after cue onset, normal controls demonstrated equivalent responding for targets to the left and to the right of a central fixation point. Patients with left-hemisphere damage showed slower reaction times when responding to targets on the right as opposed to the left side of space when attention was first cued to the opposite side of space (invalid trials) or when attention was focused on a central fixation point (uncued trials), but they did not show slower reaction times on the right side when attention was first cued to the right (valid trials). For left-sided targets, no differences between valid, invalid, and uncued trials existed. Slower responding to right-as opposed to left-sided targets on invalid and uncued trials was correlated with impaired performance on six of seven language measures for patients with left-hemisphere damage. Implications for the relationship between language and selective attention systems in the left hemisphere are discussed.

Phrenological studies of aphasia before Broca: Broca's aphasia or Gall's aphasia?

The history of aphasia is usually taken to begin with Broca's (1861a,b) discovery of the correlation of aphemia with damage to the posterior inferior portion of the frontal lobes and the subsequent relation to left hemisphere. That there were prior, even biblical, references to aphasia is not in dispute, nor that, according to Benton and Joynt (1960), almost all the clinical forms of aphasia had been described prior to 1800. The significance of Broca's case studies, therefore, lies in the association of motor aphasia with focal pathology in the frontal lobe. This paper examines the status of aphasia localization prior to Broca, and, specifically, the extent to which Broca's discovery may have been anticipated by the phrenologists.

Pathologies et philosophies du langage

ABSTRACT : This paper is devoted to the resumption of the debate over the pathological disorders that affect language between the end of the 17th century and the middle of the 19th century. The first part deals with the history of the rehabilitation of the deaf and dumb according to the two most influent therapeutic schools : the advocates of sign language and the advocates of oral re-training. The second part bears on the history of aphasia and on the theories of the localize» and of the Unitarians in clinical practice. The aim of this work is to lay the foundations of a reconstructive analysis of the history of linguistics based on the relationship between linguistics, the neurosciences and the science of simulation (both mechanical and non mechanical). The reconstruction will then be used to examine the field of theorical debates in 20th century linguistics, where a comparison with the pioneering cognitivist sciences is growing more and more necessary.

Paul Broca and the history of aphasia

Paul Broca and the history of aphasia

Paul Broca and the history of aphasia.

Paul Broca and the history of aphasia.