Language Function In Patients Research Articles

Long-Term Effects of Transcranial Direct-Current Stimulation in Chronic Post-Stroke Aphasia: A Pilot Study

Transcranial direct-current stimulation (tDCS) has been suggested to improve language function in patients with post-stroke aphasia. Most studies on aphasic patients, however, were conducted with a very limited follow-up period, if any. In this pilot, single-blind study on chronic post-stroke aphasic patients, we aimed to verify whether or not tDCS is able to extend its beneficial effects for a longer period of time (21 weeks after the end of stimulation). Three aphasic patients underwent anodal tDCS (A-tDCS, 20 min, 1.5 mA) and sham stimulation (S-tDCS) over the left frontal (perilesional) region, coupled with a simultaneous naming training (on-line tDCS). Ten consecutive sessions (5 days per week for 2 weeks) were implemented. In the first five sessions, we used a list of 40 figures, while in the subsequent five sessions we utilized a second set of 40 figures differing in word difficulty. At the end of the stimulation period, we found a significant beneficial effect of A-tDCS (as compared to baseline and S-tDCS) in all our subjects, regardless of word difficulty, although with some inter-individual differences. In the follow-up period, the percentage of correct responses persisted significantly better until the 16th week, when an initial decline in naming performance was observed. Up to the 21st week, the number of correct responses, though no longer significant, was still above the baseline level. These results in a small group of aphasic patients suggest a long-term beneficial effect of on-line A-tDCS.

Neurocognitive and Seizure Outcomes of Selective Amygdalohippocampectomy versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy.

Objective. To report our institutional seizure and neuropsychological outcomes for a series of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH) between 2004 and 2011. Methods. A retrospective study of patients with mTLE was conducted. Seizure outcome was reported using time-to-event analysis. Cognitive outcome was reported using the change principal in component factor scores, one each, for intellectual abilities, visuospatial memory, and verbal memory. The Boston Naming Test was used for naming assessment. Language dominant and nondominant resections were compared separately. Student's t-test was used to assess statistical significance. Results. Ninety-six patients (75 ATL, 21 SelAH) were included; fifty-four had complete neuropsychological follow-up. Median follow-up was 40.5 months. There was no statistically significant difference in seizure freedom or any of the neuropsychological outcomes, although there was a trend toward greater postoperative decline in naming in the dominant hemisphere group following ATL. Conclusion. Seizure and neuropsychological outcomes did not differ for the two surgical approaches which is similar to most prior studies. Given the theoretical possibility of SelAH sparing language function in patients with epilepsy secondary to mesial temporal sclerosis and the limited high-quality evidence creating equipoise, a multicenter randomized clinical trial is warranted.

O5.02 * CORTICAL AND SUBCORTICAL LANGUAGE MAPPING WITH HIGHFREQUENCY (HF) STIMULATION: FEASIBILITY AND CLINICAL RESULTS

Resection of language pathways tumors requires intraoperative identification of cortical and subcortical language essential sites. Language mapping is traditionally performed with LowFrequency(60Hz) stimulation. In patients with previous treatment or long history of seizures, the use of LF may be problematic and results in inadequate mapping. HighFrequency(HF)(To5) stimulation represents an alternative strategy. We present our experience with HF stimulation for language mapping in patients with gliomas involving language pathways. Efficacy of mapping was compared with LF, and clinical impact (percentage of immediate and permanent deficits) and Extent-of-Resection(EOR)) was also reported. 80 patients were included (49 were frontal, 21 temporal). HF (repetition rate of 3Hz) identified language sites in all patients. In patients with long history of seizures, high doses of antiepileptic drugs (AEDs), previous treatments, in whom LF induced seizures and was inadequate for mapping, HF efficiently identified language sites at cortical and subcortical level. In patients (30 cases) in whom LF and HF were compared, HF induced positive language responses in the same sites as LF, in frontal and temporal lobes. Intraoperative seizures were 24% with LF, 2% with HF, also in patients with previous history of seizures, high doses of AEDs. Percentage of immediate and permanent deficits were 78% and 2%, also in patients in whom only HF was used. EOR was total in 82%. HF(To5, repetition rate of 3Hz) represents an efficient alternative stimulation strategy for language mapping, particularly in patients with long history of seizures and high AEDs, associated with a low risk of intraoperative seizures.

The interictal language profile in adult epilepsy.

The purpose of this study was to systematically review the literature on the interictal language profile in adult patients with epilepsy. An extensive literature search was performed using MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, PASCAL, and PSYNDEXplus databases. Key aspects of inclusion criteria were adult patients with epilepsy, patient number >10, and in-depth qualitative investigations of a specific language modality or administration of tests of at least two different language modalities, including comprehension, naming, repetition, reading, writing, and spontaneous speech. Our search strategy yielded 933 articles on epilepsy and language. Of these, 31 met final eligibility criteria. Most included articles focused on temporal lobe epilepsy; only three studies were interested in the language profile of patients with idiopathic generalized epilepsies, and one study on frontal lobe epilepsy met inclusion criteria. Study results showed a pronounced heterogeneity of language abilities in patients with epilepsy, varying from intact language profiles to impairment in several language functions. However, at least 17% of patients displayed deficits in more than one language function, with naming, reading comprehension, spontaneous speech, and discourse production being most often affected. This review underscores the need to evaluate different language functions-including spontaneous speech, discourse abilities, naming, auditory and reading comprehension, reading, writing, and repetition-individually in order to obtain a reliable profile of language functioning in patients with epilepsy. Moreover, our findings show that in contrast to the huge scientific interest of memory functions in epilepsy, the examination of language functions so far played a minor role in epilepsy research, emphasizing the need for future research activities in this field.

Atypical cortical language organization in epilepsy patients: evidence for divergent hemispheric dominance for receptive and expressive language function.

The central goal of presurgical language mapping is to identify brain regions that subserve cortical language function to minimize postsurgical language deficits. Presurgical language mapping in patients with epilepsy presents a key challenge because of the atypical pattern of hemispheric language dominance found in this population, with higher incidences of bilateral and right-biased language dominance than typical. In this prospective study, we combine magnetoencephalography with a panel of tasks designed to separately assess receptive and expressive function to provide a sensitive measure of language function in 15 candidates for resective surgery. We report the following: 4 of 15 patients (27%) showed left hemisphere dominance across all tasks, 4 of 15 patients (27%) showed right hemisphere dominance across all tasks, and 7 of 15 (46%) showed discordant language dominance, with right-dominant receptive and left-dominant expressive language. All patients with discordant language dominance showed this right-receptive and left-expressive pattern. Results provide further evidence supporting the importance of using a panel of tasks to assess separable aspects of language function. The clinical relevance of the findings is discussed, especially about current clinical operative measures for assessing language dominance, which use single hemisphere procedure (intracarotid amobarbital procedure and awake intraoperative stimulation) for determining language laterality.

A clinical randomized case-control study of donepezil in the treatment of aphasia after stroke

Objective To explore the efficacy and safety of the donepezil hydrochloride in the treatment of post-stroke aphasia. Methods 60 patients with post-stroke aphasia were divided randomly into donepezil hydrochloride group (30 cases) and control group (30 cases). Trail group patients were received 5 mg per time, and once a day for oral administration of 2 weeks.From the third week they were received 10 mg per time, once a day, for continuous 10 weeks, and finally implemented four weeks washout period. The control group patients were received conventional treatment of neurology. The language function of patients were assessed with the Western Aphasia Battery (WAB) and the adverse reactions after treatment were evaluated by Treatment Emergent Symptom Scale (TESS). Assessments were implemented at the three time points, the start of trail, 12 weeks, a washout period of 4 weeks. Results After 12 weeks of treatment, the AQ, PQ, CQ scores of WAB in the experimental group were (91.35±8.14), (32.74±8.12), (91.53±7.89). After 4-week washout period, they were (94.69±5.21), (33.70±4.94), (93.33±5.59) respectively. After the trail for 12 and 16 weeks, the score of each WAB item in the trail group was significantly higher than that before treatment. Compared with the control group, there was significant difference between the two groups(P<0.01). The trail group had no significant adverse reactions. Conclusion Donepezil hydrochloride in the early treatment of post-stroke aphasia is safe, effective and the therapeutic effect is stable. Key words: Donepezil hydrochloride; Stroke; Aphasia

Independent contribution of individual white matter pathways to language function in pediatric epilepsy patients

Background and purposePatients with epilepsy and malformations of cortical development (MCDs) are at high risk for language and other cognitive impairment. Specific impairments, however, are not well correlated with the extent and locale of dysplastic cortex; such findings highlight the relevance of aberrant cortico-cortical interactions, or connectivity, to the clinical phenotype. The goal of this study was to determine the independent contribution of well-described white matter pathways to language function in a cohort of pediatric patients with epilepsy.Materials and methodsPatients were retrospectively identified from an existing database of pediatric epilepsy patients with the following inclusion criteria: 1. diagnosis of MCDs, 2. DTI performed at 3 T, and 3. language characterized by a pediatric neurologist. Diffusion Toolkit and Trackvis (http://www.trackvis.org) were used for segmentation and analysis of the following tracts: corpus callosum, corticospinal tracts, inferior longitudinal fasciculi (ILFs), inferior fronto-occipital fasciculi (IFOFs), uncinate fasciculi (UFs), and arcuate fasciculi (AFs). Mean diffusivity (MD) and fractional anisotropy (FA) were calculated for each tract. Wilcoxon rank sum test (corrected for multiple comparisons) was used to assess potential differences in tract parameters between language-impaired and language-intact patients. In a separate analysis, a machine learning algorithm (random forest approach) was applied to measure the independent contribution of the measured diffusion parameters for each tract to the clinical phenotype (language impairment). In other words, the importance of each tract parameter was measured after adjusting for the contribution of all other tracts.ResultsThirty-three MCD patients were included (age range: 3–18 years). Twenty-one patients had intact language, twelve had language impairment. All tracts were identified bilaterally in all patients except for the AF, which was not identified on the right in 10 subjects and not identified on the left in 11 subjects. MD and/or FA within the left AF, UF, ILF, and IFOF differed between language-intact and language-impaired groups. However, only parameters related to the left uncinate, inferior fronto-occipital, and arcuate fasciculi were independently associated with the clinical phenotype.ConclusionsScalar metrics derived from the left uncinate, inferior fronto-occipital, and arcuate fasciculi were independently associated with language function. These results support the importance of these pathways in human language function in patients with MCDs.

Asymmetry of planum temporale constrains interhemispheric language plasticity in children with focal epilepsy

Reorganization of eloquent cortex enables rescue of language functions in patients who sustain brain injury. Individuals with left-sided, early-onset focal epilepsy often show atypical (i.e. bilateral or right-sided) language dominance. Surprisingly, many patients fail to show such interhemispheric shift of language despite having major epileptogenic lesions in close proximity to eloquent cortex. Although a number of epilepsy-related factors may promote interhemispheric plasticity, it has remained unexplored if neuroanatomical asymmetries linked to human language dominance modify the likelihood of atypical lateralization. Here we examined the asymmetry of the planum temporale, one of the most striking asymmetries in the human brain, in relation to language lateralization in children with left-sided focal epilepsy. Language functional magnetic resonance imaging was performed in 51 children with focal epilepsy and left-sided lesions and 36 healthy control subjects. We examined the association of language laterality with a range of potential clinical predictors and the asymmetry of the length of the planum temporale. Using voxel-based methods, we sought to determine the effect of lesion location (in the affected left hemisphere) and grey matter density (in the unaffected right hemisphere) on language laterality. Atypical language lateralization was observed in 19 patients (38%) and in four controls (11%). Language laterality was increasingly right-sided in patients who showed atypical handedness, a left perisylvian ictal electroencephalographic focus, and a lesion in left anterior superior temporal or inferior frontal regions. Most striking was the relationship between rightward asymmetry of the planum temporale and atypical language (R = 0.70, P < 0.0001); patients with a longer planum temporale in the right (unaffected) hemisphere were more likely to have atypical language dominance. Voxel-based regression analysis confirmed that increased grey matter density in the right temporo-parietal junction was correlated with right hemisphere lateralization of language. The length of the planum temporale in the right hemisphere was the main predictor of language lateralization in the epilepsy group, accounting for 48% of variance, with handedness accounting for only a further 5%. There was no correlation between language lateralization and planum temporale asymmetry in the control group. We conclude that asymmetry of the planum temporale may be unrelated to language lateralization in healthy individuals, but the size of the right, contra-lesional planum temporale region may reflect a ‘reserve capacity’ for interhemispheric language reorganization in the presence of a seizure focus and lesions within left perisylvian regions.

Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia(1). In this experiment, we demonstrate the administration of low-frequency repetitive TMS (rTMS) to an optimal stimulation site in the right hemisphere in patients with chronic non-fluent aphasia. A battery of standardized language measures is administered in order to assess baseline performance. Patients are subsequently randomized to either receive real rTMS or initial sham stimulation. Patients in the real stimulation undergo a site-finding phase, comprised of a series of six rTMS sessions administered over five days; stimulation is delivered to a different site in the right frontal lobe during each of these sessions. Each site-finding session consists of 600 pulses of 1 Hz rTMS, preceded and followed by a picture-naming task. By comparing the degree of transient change in naming ability elicited by stimulation of candidate sites, we are able to locate the area of optimal response for each individual patient. We then administer rTMS to this site during the treatment phase. During treatment, patients undergo a total of ten days of stimulation over the span of two weeks; each session is comprised of 20 min of 1 Hz rTMS delivered at 90% resting motor threshold. Stimulation is paired with an fMRI-naming task on the first and last days of treatment. After the treatment phase is complete, the language battery obtained at baseline is repeated two and six months following stimulation in order to identify rTMS-induced changes in performance. The fMRI-naming task is also repeated two and six months following treatment. Patients who are randomized to the sham arm of the study undergo sham site-finding, sham treatment, fMRI-naming studies, and repeat language testing two months after completing sham treatment. Sham patients then cross over into the real stimulation arm, completing real site-finding, real treatment, fMRI, and two- and six-month post-stimulation language testing.

Noninvasive Language Mapping in Patients With Epilepsy or Brain Tumors

Functional magnetic resonance imaging (fMRI) has become part of routine brain mapping in patients with epilepsy or tumor undergoing resective surgery. However, robust localization of crucial functional areas is required. To establish a simple, short fMRI task that reliably localizes crucial language areas in individual patients who undergo respective surgery. fMRI was measured during an 8-minute auditory semantic decision task in 28 healthy controls and 35 consecutive patients who had focal epilepsy or a brain tumor. Nineteen underwent resective surgery. Group and individual analyses were performed. Results in patients were compared with postsurgical language outcome and electrocortical stimulation when available. fMRI activations concordant with the anterior and posterior language areas were found in 96% and 89% of the controls, respectively. The anterior and posterior language areas were both activated in 93% of the patients. These results were concordant with electrocortical stimulation results in 5 patients. Transient postsurgical language deficits were found in 2 patients in whom surgery was performed in the vicinity of the fMRI activations or who had postsurgical complications implicating areas of fMRI activations. The proposed fast fMRI language protocol reliably localized the most relevant language areas in individual subjects. It appears to be a valuable complementary tool for surgical planning of epileptogenic foci and of brain tumors.

P3‐388: Effect of donepezil 23 mg/day on language function in patients with moderate‐to‐severe Alzheimer's disease (AD): Subgroup analysis of United States (U.S.)‐based patients

P3‐388: Effect of donepezil 23 mg/day on language function in patients with moderate‐to‐severe Alzheimer's disease (AD): Subgroup analysis of United States (U.S.)‐based patients

Multimodality language mapping in patients with left-hemispheric language dominance on Wada test

ObjectiveWe determined the utility of electrocorticography (ECoG) and stimulation for detecting language-related sites in patients with left-hemispheric language-dominance on Wada test. MethodsWe studied 13 epileptic patients who underwent language mapping using event-related gamma-oscillations on ECoG and stimulation via subdural electrodes. Sites showing significant gamma-augmentation during an auditory-naming task were defined as language-related ECoG sites. Sites at which stimulation resulted in auditory perceptual changes, failure to verbalize a correct answer, or sensorimotor symptoms involving the mouth were defined as language-related stimulation sites. We determined how frequently these methods revealed language-related sites in the superior-temporal, inferior-frontal, dorsolateral-premotor, and inferior-Rolandic regions. ResultsLanguage-related sites in the superior-temporal and inferior-frontal gyri were detected by ECoG more frequently than stimulation (p<0.05), while those in the dorsolateral-premotor and inferior-Rolandic regions were detected by both methods equally. Stimulation of language-related ECoG sites, compared to the others, more frequently elicited language symptoms (p<0.00001). One patient developed dysphasia requiring in-patient speech therapy following resection of the dorsolateral-premotor and inferior-Rolandic regions containing language-related ECoG sites not otherwise detected by stimulation. ConclusionsLanguage-related gamma-oscillations may serve as an alternative biomarker of underlying language function in patients with left-hemispheric language-dominance. SignificanceMeasurement of language-related gamma-oscillations is warranted in presurgical evaluation of epileptic patients.

Abstract 3734: Presurgical fMRI and Morbidity Outcomes in Patients with Vascular Lesions

Background fMRI is being increasingly used as an adjunct imaging technique for preoperative planning for patients with various brain lesions. The proximity of the lesion to eloquent cortex is a major factor in guiding surgical planning. Our group has previously reported significant association between the distance between brain tumor periphery and area of fMRI activation (Lesion-Activation Distance; LAD) and morbidity and mortality outcomes. This study investigated the relationship between vascular lesion LAD and morbidity. Methods This study was a retrospective analysis of data from patients with vascular lesions [arteriovenous malformations (AVMs) (n=49), and cavernomas (n=57)], who had received fMRI as part of their preoperative planning. The preoperative fMRI included motor mapping (n=87) and/or language mapping (n=102). The fMRI paradigms were chosen based on observed preoperative weakness (aphasia, paresis) and anticipated functional areas of the brain that may be affected by treatment. Results Multiple logistic regression analyses showed that a model that combines Age and Language LAD was a significant predictor of postoperative deficits (p= 0.04). Broca’s LAD(1-2 cm) X Age was a significant predictor of postoperative deficits (change in odds ratio (OR) =0.82, CI:0.68-0.98). The relationship between Brocas’s LAD and postoperative aphasia and Broca’s LAD and pre and postoperative aphasia trended towards significance (p = .08 and p =.07 respectively). Wernicke’s LAD, independently or combined with Age, was not a significant predictor of postoperative deficits. Binary logistic regression analysis for SMC LAD and postop deficits did not reach significance (p =.10). There were no significant differences in postoperative language or motor deficits as a function of gender or handedness. Conclusions These results suggest that both age and the proximity of a vascular lesion to language LAD are factors that can help predict postoperative outcomes, especially for Broca’s LAD. The lack of similar results when investigating the relationship between Wernicke’s LAD and postoperative deficits suggests potential brain reorganization and/or robustness of this brain region. These results have implications for the potential use of fMRI as a presurgical tool for language mapping in patients with vascular lesions.

Linguistic development in Alzheimer's disease: 12 months language training including use of a personal computer system—A pilot study

Objective: To assess linguistic development in patients with mild and moderate Alzheimer's disease (AD) who underwent treatment with a drug and regularly performed language activities.Methods: For 12 months, five patients with mild-to-moderate AD participated in a Stimulation-Activation-Training programme (SAT) including pragmatic, semantic, writing, conversation and counting sessions. A computer with exercise programs and a keyboard with a printer were used as complements to ordinary stationery. The linguistic competence was assessed using a standardized assessment tool.Results: The assessment indicated preservation or slight changes of the patients’ linguistic competence over the period and greater confidence in the management of the language. The personal computer system was a well accepted novelty.Conclusion: The documented approach, SAT training interlaced with everyday life tasks, may be helpful in maintaining and improving remaining language functions in patients with mild or moderate AD.

The Use of Definite References Signals Declarative Memory

Language function in patients with impaired declarative memory presents a compelling opportunity to investigate the inter-dependence of memory and language in referential communication. We examined amnesic patients’ use of definite references during a referential communication task. Discursively, definite references can be used to mark a referent as situationally unique (e.g., “the game,” as in the case of a recently publicized game) or as shared information (e.g., “the game,” as in one discussed previously). We found that despite showing normal collaborative learning after repeated referring—as indexed by consistent and increasingly efficient descriptive labels for previously unfamiliar tangram figures—amnesic patients did not consistently use definite references in referring to those figures. The use of definite references seems to be critically dependent on declarative memory, and the engagement of such memory is signaled by language.

Clinical fMRI of language function in aphasic patients: Reading paradigm successful, while word generation paradigm fails

In fMRI examinations, it is very important to select appropriate paradigms assessing the brain function of interest. In addition, the patients' ability to perform the required cognitive tasks during fMRI must be taken into account. To evaluate two language paradigms, word generation and sentence reading for their usefulness in examinations of aphasic patients and to make suggestions for improvements of clinical fMRI. Five patients with aphasia after stroke or trauma sequelae were examined by fMRI. The patients' language ability was screened by neurolinguistic tests and elementary pre-fMRI language tests. The sentence-reading paradigm succeeded to elicit adequate language-related activation in perilesional areas whereas the word generation paradigm failed. These findings were consistent with results on the behavioral tests in that all patients showed very poor performance in phonemic fluency, but scored well above mean at a reading comprehension task. The sentence-reading paradigm is appropriate to assess language function in this patient group, while the word-generation paradigm seems to be inadequate. In addition, it is crucial to use elementary pre-fMRI language tests to guide the fMRI paradigm decision.

Functional Reorganization Associated with Semantic Language Processing in Temporal Lobe Epilepsy Patients after Anterior Temporal Lobectomy : A Longitudinal Functional Magnetic Resonance Image Study

The focus of this study is brain plasticity associated with semantic aspects of language function in patients with medial temporal lobe epilepsy (mTLE). Using longitudinal functional magnetic resonance imaging (fMRI), patterns of brain activation were observed in twelve left and seven right unilateral mTLE patients during a word-generation task relative to a pseudo-word reading task before and after anterior temporal section surgery. No differences were observed in precentral activations in patients relative to normal controls (n = 12), and surgery did not alter the phonological-associated activations. The two mTLE patient groups showed left inferior prefrontal activations associated with semantic processing (word-generation > pseudo-word reading), as did control subjects. The amount of semantic-associated activation in the left inferior prefrontal region was negatively correlated with epilepsy duration in both patient groups. Following temporal resection, semantic-specific activations in inferior prefrontal region became more bilateral in left mTLE patients, but more left-lateralized in right mTLE patients. The longer the duration of epilepsy in the patients, the larger the increase in the left inferior prefrontal semantic-associated activation after surgery in both patient groups. Semantic activation of the intact hippocampus, which had been negatively correlated with seizure frequency, normalized after the epileptic side was removed. These results indicate alternation of semantic language network related to recruitment of left inferior prefrontal cortex and functional recovery of the hippocampus contralateral to the epileptogenic side, suggesting an intra- and inter-hemispheric reorganization following surgery.

Correlation study of Token Test and Loewenstein Occupational Therapy Cognitive Assessment in Chinese aphasia after stroke

Objective To study the correlation of Token Test and Loewenstein Occupational Therapy Cognitive Assessment in Chinese aphasia, and to offer objective basis for clinical application in China. Methods A total of 54 patients with aphasia after stroke were selected. Japanese revised Token Test was used to assess their language functions and Loewenstein Occupational Therapy Cognitive Assessment to assess their cognition functions. The associations between Token Test scores and every subentry scores, total scores on Leewenstein Occupational Therapy Cognitive Assessment were analyzed by using correlations analysis and multiple stepwise regression analysis. Results Correlations of Token Test scores and every subentry scores, total scores in LOTCA were significant (all P < 0.05) by using Pearson correlations analysis and partial correlations analysis. Multiple stepwise regression analysis showed that the main factor which affected the scores of Token Test was Visual and Spatial Perception. Conclusions The cognition function can promote the improvement of language functions of patients with aphasia after stroke, which may be related mostly to the perception of cognition function. Key words: Cerebrovascular accident; Aphasia; Cognition; Loewenstein Occupational Therapy Cognitive Assessment; Token Test

Brain Lesions in Conduction Aphasia

Objective: To investigate the neuroanatomical correlation of conduction aphasia by analyzing neuroimage data of patients who were diagnosed as conduction aphasia after stroke. Method: Nine patients with conduction aphasia after stroke were retrospectively reviewed with their medical records. Language functions of patients were assessed by Korean-version Western Aphasia Battery (K-WAB). Stroke lesions were assessed by brain computed tomography or magnetic resonance images taken within 1 month after onset of stroke. Results: The stroke subtypes were cerebral infarction in 5 patients and intracranial hemorrhage in 4 patients. The lesions were located in left hemisphere in 8 subjects and right hemisphere in 1 subject. The left hemispheric lesion were located in the insula and superior temporal lobe in 3, the inferior parietal lobe in 2, the corona radiate in 1, the basal ganglia in 1 patient and both corona radiata and basal ganglia in 1. The right hemispheric lesion was located in the inferior parietal and superior temporal lobe. Conclusion: 6 of 9 patients with conduction aphasia had brain lesions in the path of arcuate fasciculus in the left hemisphere, however, 3 of 9 patients showed other brain lesions. These findings suggested that conduction aphasia could be caused by heterogeneous brain lesions. The characteristic features of conduction aphasia according to diverse brain lesions may need further investigation. (Brain & NeuroRehabilitation 2009; 2: 85-90)

Intensive language therapy in chronic aphasia: Which aspects contribute most?

Background: Recent research suggests the effectiveness of short‐term highly intensive treatment approaches in the chronic stage of aphasia. However, the effective elements of such treatment need to be determined. This study was supported by the Deutsche Forschungsgemeinschaft (DFG, Grant RO 805/11‐4) and the Kuratorium Zentrales Nervensystem (Kuratorium ZNS, Grant 2001013). The study was carried out in cooperation with the Kliniken Schmieder (Konstanz and Allensbach) and the Hegau Jugendwerk (Gailingen). Aims: The present study's aim was to evaluate which factors attribute to the success of aphasia therapy. An intensive (3 hours/day, 10 consecutive days) model‐orientated aphasia therapy (MOAT), which considers patients' individual symptoms, was evaluated and therapy effects were compared to those of a similarly intensive training focusing on active speaking elements (constraint‐induced aphasia therapy, CIAT) in order to identify the effective elements. Methods & Procedures: 12 patients with chronic aphasia received 30 hours of MOAT over 10 days. Language functions were assessed with a standardised language test (Aachen Aphasia Test) and a naming task prior to therapy, after therapy, and at a 6‐month follow‐up. In addition, the amount and quality of communication were assessed with questionnaires as an indication of transfer to everyday communication. Results of this treatment group were compared to those of 27 patients who were treated according to principles of CIAT. Outcomes & Results: Language functions improved significantly following treatment relative to the pre‐treatment scores, and the improvements remained stable across the follow‐up period. Effects were comparable to those of CIAT for most variables, except for written language and perception of everyday communication which improved more after MOAT than after CIAT. The naming task disclosed generalisation to untreated items for MOAT. Conclusions: Results confirm that an intense training focused on individual deficits leads to substantial and durable improvements in language functions in patients with chronic aphasia. The comparison across treatments suggests consideration of the functional deficit, written language, and everyday communication as effective elements in the rehabilitation of chronic aphasia.