Mild Aphasia Research Articles

Conflict Adaptation in Aphasia: Upregulating Cognitive Control for Improved Sentence Comprehension.

This study investigated conflict adaptation in aphasia, specifically whether upregulating cognitive control improves sentence comprehension. Four individuals with mild aphasia completed four eye tracking sessions with interleaved auditory Stroop and sentence-to-picture matching trials (critical and filler sentences). Auditory Stroop congruency (congruent/incongruent across a male/female voice saying "boy"/"girl") was crossed with sentence congruency (syntactically correct sentences that are semantically plausible/implausible), resulting in four experimental conditions (congruent auditory Stroop followed by incongruent sentence [CI], incongruent auditory Stroop followed by incongruent sentence [II], congruent auditory Stroop followed by congruent sentence [CC], and incongruent auditory Stroop followed by congruent sentence [IC]). Critical sentences were always preceded by auditory Stroop trials. At the end of each session, a five-item questionnaire was administered to assess overall well-being and fatigue. We conducted individual-level mixed-effects regressions on reaction times and growth curve analyses on the proportion of eye fixations to target pictures during incongruent sentences. One participant showed conflict adaptation indicated by faster reaction times on active sentences and more rapid growth in fixations to target pictures on passive sentences in the II condition compared to the CI condition. Incongruent auditory Stroop also modulated active-sentence processing in an additional participant, as indicated by eye movements. This is the first study to observe conflict adaptation in sentence comprehension in people with aphasia. The extent of adaptation varied across individuals. Eye tracking revealed subtler effects than overt behavioral measures. The results extend the study of conflict adaptation beyond neurotypical adults and suggest that upregulating cognitive control may be a potential treatment avenue for some individuals with aphasia. https://doi.org/10.23641/asha.27056149.

Treatment of Symptomatic Carotid Webs

The present study aims to describe the clinical characteristics and treatment outcomes of patients with symptomatic carotid web treated at a single institution in South America. Retrospective study of a single-center experience of patients with carotid webs surgically treated from September 2019 to September 2023. 10 patients had carotid webs, six (60%) were females. Median age was 54.5 years (range: 35-77 years). All patients were symptomatic. Diagnosis was made in 90% (n=9) of the patients with either computed tomography angiography or magnetic resonance alone. One (10%) patient underwent angiography for definite diagnosis. The median interval from the first neurological event to intervention was 90 months (range: 3 days- 108 months). Four (40%) patients underwent surgical treatment within one month from symptom onset and carotid web diagnosis, with a median of 3.5 days (range: 3-9 days). Six (60%) patients underwent delayed surgical treatment since the cause of the neurological event was uncertain, with a median of 54 months (range: 6 - 108 months). These six patients had recurrent neurological events. Three (30%) patients underwent carotid endarterectomies with polyurethane patch and three (30%) by eversion technique. Three (30%) patients underwent segmental resection and reanastomosis of the internal carotid artery. One underwent internal carotid artery plasty with saphenous vein. At a median follow-up of 30 months (range: 6-46 months), one patient persists with mild aphasia, another patient has severe aphasia and right hemiparesis, both as sequalae of their initial strokes, and another patient has suffered 3 non-ischemic episodes of brief transient right hemiparesis attributed to epileptic seizures. The other seven patients remain without new neurological events. Neurological events of carotid distribution deserve accurate imaging work up, keeping in mind the diagnosis of carotid web. Surgical treatment for carotid web seems effective for preventing recurrences; nevertheless, further studies are warranted to define the best management for these patients.

Identifying and Addressing Functional Communication Challenges in Patients With Behavioral Variant Frontotemporal Dementia.

We describe the communication challenges of four patients with a neurodegenerative disorder consistent with behavioral variant frontotemporal dementia (bvFTD), characterized by early behavioral and personality changes. By describing their clinical profiles, we identify common barriers to functional communication in this population and provide recommendations for how speech-language pathologists (SLPs) might contribute to minimizing them. Four patients with bvFTD were selected from a cohort of patients with progressive communication impairments. Three of them returned for at least one follow-up visit. Case histories are presented along with the results of comprehensive speech and language, neuropsychological, and neurological testing. At the time of initial evaluation, patients were between the ages of 54 and 66 years and had been experiencing symptoms for 1.5-6 years. Consistent with their bvFTD diagnoses, all patients had prominent behavioral and personality changes that impacted communication. Patients 1 and 2 also had mild aphasia at enrollment, primarily characterized by anomia and loss of word meaning. Patients 3 and 4 both had apraxia of speech and moderate-to-severe aphasia at enrollment with prominent anomia and agrammatism. All four patients had impaired executive functioning and relative sparing of visuospatial skills; episodic memory was also impaired for Patients 2 and 4. Even though functional communication was progressively limited for all patients, none of them received regular support from an SLP. This case series adds to a scant, but growing, literature demonstrating that patients with bvFTD have communication impairments. SLPs are uniquely positioned to identify barriers to functional communication and to provide tailored strategy training to the patients and their care partners over the course of their disease. Systematic evaluation of the efficacy of treatment in this population would be valuable. https://doi.org/10.23641/asha.25933762.

Using Discourse Structure Analysis to Understand Communication Profiles of Members With Severe and Mild Aphasia in Facilitated Conversation Groups

Using Discourse Structure Analysis to Understand Communication Profiles of Members With Severe and Mild Aphasia in Facilitated Conversation Groups

QUESTION PRODUCTION IN ITALIAN-SPEAKING PWAGR

This paper presents the results of an elicitation task run with Italian-speaking people with agrammatic aphasia (PWAgr). Linguistic theories of aphasia have analysed the production of PWAgr as stemming either from a deterioration of grammatical knowledge or a limitation of extra-linguistic capacities which affect language. Among the former, the Tree Pruning Hypothesis (Friedmann and Grodzinsky, 1997) relates the height of the projections involved in the production of a structure with the chances of it being produced: the stronger the impairment in the speaker, the less likely they are to produce a structure involving higher nodes. Alternatively, syntactic knowledge may be preserved but its use is compromised by Working Memory (WM) limitations (e.g., Miyake et al., 1994; Jakubowicz, 2005). The two approaches make different predictions with respect to question production in Italian: according to the TPH, the production rates of yes/no-questions and who-questions should be comparable in moderate and mild aphasia. Why-questions involve a higher node and should thus not be available. Under a WM-limitation approach, the production rates of why-questions and yes/no-questions should be comparable and higher than those of who-questions. To determine which, if any, of the two approaches makes the correct predictions, three adult Italian speakers diagnosed with Broca’s aphasia and one with anomia performed an elicitation task targeting these three types of structures. Overall, yes/no-questions were the most frequent structures to be produced. The lack of who-questions, as opposed to the production of yes/no-questions, can be accounted for only if derivational complexity is taken into account, but the scarcity of why-questions suggests that the height of the nodes involved may play a role as well.

Structural Neuroplasticity Effects of Singing in Chronic Aphasia.

Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine the structural neuroplasticity changes underpinning group-based singing-induced treatment effects in chronic aphasia. Twenty-eight patients with at least mild nonfluent poststroke aphasia were randomized into two groups that received a 4-month multicomponent singing intervention (singing group) or standard care (control group). High-resolution T1 images and multishell diffusion-weighted MRI data were collected in two time points (baseline/5 months). Structural gray matter (GM) and white matter (WM) neuroplasticity changes were assessed using language network region of interest-based voxel-based morphometry (VBM) and quantitative anisotropy-based connectometry, and their associations to improved language outcomes (Western Aphasia Battery Naming and Repetition) were evaluated. Connectometry analyses showed that the singing group enhanced structural WM connectivity in the left arcuate fasciculus (AF) and corpus callosum as well as in the frontal aslant tract (FAT), superior longitudinal fasciculus, and corticostriatal tract bilaterally compared with the control group. Moreover, in VBM, the singing group showed GM volume increase in the left inferior frontal cortex (Brodmann area 44) compared with the control group. The neuroplasticity effects in the left BA44, AF, and FAT correlated with improved naming abilities after the intervention. These findings suggest that in the poststroke aphasia group, singing can bring about structural neuroplasticity changes in left frontal language areas and in bilateral language pathways, which underpin treatment-induced improvement in speech production.

Predictors of Cognitive Functions After Stroke Assessed Using the Wechsler Adult Intelligence Scale: A Retrospective Study.

The mechanism(s) of cognitive impairment remains complex, making it difficult to confirm the factors influencing poststroke cognitive impairment (PSCI). This study quantitatively investigated the degree of influence and interactions of clinical indicators of PSCI. Information from 270 patients with PSCI and their Wechsler Adult Intelligence Scale (WAIS-RC) scores, totaling 18 indicators, were retrospectively collected. Correlations between the indicators and WAIS scores were calculated. Multiple linear regression model(MLR), genetic algorithm modified Back-Propagation neural network(GA-BP), logistic regression model (LR), XGBoost model (XGB), and structural equation model were used to analyze the degree of influence of factors on the WAIS and their mediating effects. Seven indicators were significantly correlated with the WAIS scores: education, lesion side, aphasia, frontal lobe, temporal lobe, diffuse lesions, and disease course. The MLR showed significant effect of education, lesion side, aphasia, diffuse lesions, and frontal lobe on the WAIS. The GA-BP included five factors: education, aphasia, frontal lobe, temporal lobe, and diffuse lesions. LR predicted that the lesion side contributed more to mild cognitive impairment, while education, lesion side, aphasia, and course of the disease contributed more to severe cognitive impairment. XGB showed that education, side of the lesion, aphasia, and diffuse lesions contributed the most to PSCI. Aphasia plays a significant mediating role in patients with severe PSCI. Education, lesion side, aphasia, frontal lobe, and diffuse lesions significantly affected PSCI. Aphasia is a mediating variable between clinical information and the WAIS in patients with severe PSCI.

Cerebellar-Induced Aphasia After Stroke: Evidence for the “Linguistic Cerebellum”

The cerebellum is traditionally known to subserve motor functions. However, for several decades, the concept of the “cerebellar cognitive affective syndrome” has evolved. Studies in healthy participants and patients have confirmed the cerebellar role in language. The exact involvement of the cerebellum regarding cerebellar aphasia remains uncertain. We included 43 cerebellar stroke patients who were tested at 3 months post-onset with the Boston Naming Test (BNT), the Token Test (TT), and the Diagnostic Instrument for Mild Aphasia (DIMA). Lesion side (left/right) and volume (cm3) were investigated. Patients significantly deviated on the following: BNT (p<0.001), TT (p<0.05), DIMA subtests: sentences repetition (p=0.001), semantic odd-picture-out (p<0.05), sentence completion (p<0.05) without an effect of lesion location (left/right) or volume (cm3) (p>0.05). Our clinical study confirms a non-lateralized cerebellar aphasia post-stroke, characterized by impairments in word retrieval, phonology, semantics, and syntax resembling cerebral-induced aphasia. The integral cerebellum appears to interact with eloquent cortico-subcortical language areas.

Written discourse in diagnosis for acquired neurogenic communication disorders: current evidence and future directions.

We aimed to perform the first review of research focusing on written discourse performance in people with acquired neurogenic communication disorders. In studies from 2000 onward, we specifically sought to determine: (1) the differences between patient populations and control groups, (2) the differences between different patient populations, (3) longitudinal differences between patient populations, and (4) modality differences between spoken and written discourse performance. We completed a thorough search on MEDLINE, Embase, Cochrane, APAPsycinfo, Web of Science, and Scopus databases. We identified studies that focus on written discourse performance in people with aphasia, primary progressive aphasia, mild cognitive impairment, and Alzheimer's disease. Nineteen studies were identified from the review of literature, some of which addressed more than one of our review questions. Fifteen studies included a comparison between clinical populations and controls. Six studies compared different characteristics of patient populations. Three studies reported changes over time in progressive disorders. Six studies targeted different modalities of discourse. Differences in linguistic features by patient populations are not yet clear due to the limited number of studies and different measures and tasks used across the studies. Nevertheless, there is substantial evidence of numerous linguistic features in acquired neurogenic communication disorders that depart from those of healthy controls. Compared to the controls, people with aphasia tend to produce fewer words, and syntactically simpler utterances compared to the controls. People with Alzheimer's disease produce less information content, and this feature increases over time, as reported in longitudinal studies. Our review imparts additional information that written and spoken discourse provide unique insights into the cognitive and linguistic deficits experienced by people with aphasia, Alzheimer's disease, mild cognitive impairment and primary progressive aphasia and provide targets for treatment to improve written communication in these groups.

Usefulness of automated tractography for outcome prediction in patients with recurrent stroke.

[Purpose] To examine the usefulness of automated tractography for predicting outcomes in patients with recurrent stroke. [Participants and Methods] Diffusion tensor imaging was performed in the second week after stroke, and fractional anisotropy was calculated using automated tractography. Three patients with recurrent strokes were included in this study. [Results] Initial computed tomography findings of a 62-year-old man with stuttering speech revealed a hemorrhage in the left thalamus. Fractional anisotropy indicated slight neural damage in the association fibers of both hemispheres. The patient returned to work with mild attention deficit and aphasia. Initial diffusion-weighted imaging of a 75-year-old man with right upper extremity paresis showed high-intensity areas in the left corona radiata. Fractional anisotropy indicated bilateral neural damage to the corticospinal tract. The patient was discharged with severe right upper extremity impairment and a modified gait. Initial diffusion-weighted imaging of a 60-year-old woman with moyamoya disease who experienced a sudden loss of consciousness showed high-intensity areas in the left anterior circulation territories. Fractional anisotropy indicated severe damage to the right hemisphere, the corticospinal tract, and the superior longitudinal fasciculus of the left hemisphere. She was transferred to a nursing home and remained bedridden. [Conclusion] The symptoms identified in this study agreed with automated tractography findings, which suggests that this methodology is useful for predicting recurrent stroke outcomes.

Adaptation and Validation of the World Health Organization Quality of Life – BREF (WHOQOL-BREF) for People with Aphasia

ABSTRACT Background It is essential to consider the well-being and quality of life (QoL) of the person as part of an effective intervention in health. To this end, the World Health Organization developed an instrument to assess the QoL, the World Health Organization Quality of Life – BREF (WHOQOL-BREF). However, it is not adapted to the comprehension and expression difficulties a person with aphasia must face. Aims To create and validate a version of the WHOQOL-BREF, Portuguese version, which is adapted to the needs of people with aphasia (PWA). Methods & Resources For the adaptation and validation phase, two participatory workshops were held with a group of five PWA and then, individual interviews were carried out with the same experts. For the validation phase (concurrent validity and assessing group differences), the study included a sample of 45 people (15 PWA and 30 neurologically healthy participants – NHP). To evaluate the test-retest (intra-rater) reliability, the t-test was used, and the Pearson correlation was calculated. To compare the two groups (PWA and NHP), the Chi-Square Test was used for categorical variables and the independent t test (or the Mann-Whitney test) for the numerical variables. Outcomes & Results The results obtained are in line with what is reported in the literature regarding the aphasia-friendly adaptions of health assessment instruments: It is relevant to provide graphic support and to highlight specific information. There were no differences between test-retest (moderate to strong correlations between the two testing points: 0.56-0.79). Contrary to expectations, PWA did not present significant differences in QoL when compared to NHP, except for the physical domain (p=0.01). During concurrent validation, the following correlation values were obtained in the specific domains of WHOQOL-BREF and SAQOL-39: WHOQOL-BREF Physical/ SAQOL-39 Physical (0.55) and WHOQOL-BREF Physical/ SAQOL-39 Communication (0.53). Conclusion The adaptations carried out to facilitate the understanding and expression of PWA and the aphasia-friendly support materials produced for WHOQOL-BREF were well received by a group with mild aphasia and may be useful for the broader population of PWA. The WHOQOL-BREF could be used without communicative support by PWA, facilitating the collection of clinically relevant data about this population.

10037-SPE-3 APPROACH TO SAFE AND RELIABLE BRAIN TUMOR SURGERY APPLYING INTRAOPERATIVE GAMMA OSCILLATION REGULARITY ANALYSIS

Abstract In primary brain tumors, the complexity of Electroencephalogram (EEG) has been reported to be higher compared to healthy individuals. In gliomas, a significant decrease in gamma oscillation regularity in the tumor-surrounding brain cortex has been demonstrated. It is considered acceptable to remove the areas with significantly decreased gamma oscillation regularity as non-functional regions with deteriorated normal brain function. This article introduces the practical application of safe and reliable brain tumor surgery using an approach from non-functional regions through intraoperative analysis of gamma oscillation regularity. The patient had undergone a partial resection surgery for a left temporal lobe tumor at another hospital and was diagnosed with a glioblastoma. Upon transfer to our hospital, the patient exhibited mild motor aphasia but had good comprehension. Language dominance was determined to be on the left side through the WADA test. Approximately 50% of the tumor, which was enhanced near the Broca's area and Wernicke's area, remained after the first surgery. We performed a non-awake extraction surgery for the residual tumor using intraoperative analysis of gamma oscillation regularity. By depicting a non-functional field during the operation, almost all of the tumors to be contrasted were removed without exacerbation of symptoms. Since the non-functional field can be depicted intraoperatively, surgery can be performed safely even in patients who cannot tolerate awake surgery. Brain tumor surgery using intraoperative analysis of gamma oscillation regularity is considered highly beneficial.

Abstract 109: Endonasal Endoscopic Approach Associated Cerebral Vasospasm and Management: A Case Report

Introduction Endoscopic endonasal approach(EEA) techniques have been increasingly utilized and have been associated with development of cerebrospinal fluid(CSF) leak, meningitis, diabetes insipidus post‐operatively. Cerebral vasospasm following EEA has rarely been described. Here, we describe the clinical course and management of a patient who underwent EEA for encephalocele repair whose course was complicated by postoperative subarachnoid hemorrhage(SAH) and cerebral vasospasm. Methods n/a Results Case Presentation: 40 year old female with past medical history significant for cerebral venous sinus stent on aspirin, CSF rhinorrhea secondary to right nasal encephalocele s/p endoscopic transnasal transethmoidal repair with nasoseptal flap reconstruction and lumbar drain placement eleven days prior presented with speech difficulties and right sided weakness. On exam, patient was noted to have mild right hemiparesis and expressive aphasia. MRI brain showed subacute infarcts in left greater than right frontal lobes, corpus collosum and right anterior perforated substance. MRA head demonstrated multifocal arterial stenosis. In light of postoperative CT head showing SAH in the basilar, perimesencephalic, prepontine cisterns, interhemispheric fissure and right frontal sulci as well as intraventricular hemorrhage in fourth ventricle, her presentation was thought to be secondary to cerebral vasospasm in the setting of postoperative SAH. She was treated with intravenous hydration, permissive hypertension with head of bed in flat position and transferred for further evaluation. On arrival, she continued have mild right hemiparesis and aphasia. Repeat CTA head/neck and CT perfusion showed severe stenosis of bilateral M1 segments and left greater than right A1 segments as well as ischemic penumbra in left ACA/MCA watershed territory. Diagnostic cerebral angiogram showed bilateral severe A1 stenosis and mild to moderate bilateral M1 and supraclinoid ICA stenosis which improved with intra‐arterial verapamil. She was started on nimodipine. Systolic blood pressure was augmented with vasopressors for goal of 150‐180mmHg. Daily TCDs were followed. She developed worsening right leg weakness following day, thus she was taken for repeat diagnostic cerebral angiogram during which time she was re‐administered intra‐arterial verapamil with improvement in vasospasm. After the second treatment, she had improvement in speech and motor strength. Systolic blood pressure goal was gradually normalized. She was noted to have incidental left internal jugular (IJ) vein thrombosis for which anticoagulation was held in the setting of recent neurosurgical procedure and SAH. Workup for vasculitis and hypercoagulability was unrevealing. Lumbar puncture demonstrated 13 WBC/cu mm with lymphocytic predominance(90%), 23 RBC/cu mm, glucose 89mg/dl, protein 30mg/dl. CSF cultures were negative. Pleocytosis in CSF was attributed to recent neurosurgical procedure. Her neurological exam improved to baseline on hospital day(HD) 9.On HD12, she was found to have left common femoral deep venous thrombus in addition to the left IJ thrombus. Anticoagulation with low dose heparin infusion was started which was transitioned to apixaban on discharge. She was discharged home on HD20. Conclusion We report a case of EEA associated with severe multifocal cerebral vasospasm secondary to postoperative SAH that was successfully treated with induced hypertension, oral nimodipine and intra‐arterial verapamil as an adjunct therapy with an excellent outcome.

Abstract 028: Chronic Subdural Hematoma Treatment with Embolization Versus Surgery Study Protocol

Introduction Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diseases with a significant financial burden. Current management includes observation for mild or asymptomatic patients and surgical drainage for moderate and severe patients. However, surgical drainage is associated with a 15% reoperation rate and a mortality of up to 10%. Middle meningeal artery embolization (MMAE) is a promising minimally invasive alternative with an estimated surgical recurrence rate of 6.8% and 4.6% for standalone MMAE and combined MMAE and surgery respectively. However, randomized data is lacking for this emerging therapy. Methods CHESS is a NIH‐funded, prospective, multi‐center, randomized, open label clinical trial. Subjects with moderately symptomatic cSDH (de novo or recurrent) will be randomized in a 1:1 radio to standalone MMAE or conventional surgery. Moderately symptomatic patients are defined as patients with moderate weakness (4/5), gait ataxia and/or mild aphasia. Embosphere or PVA will be used for MMAE. Primary outcome is defined as the proportion of patients that require rescue surgery or die within 180 days. Safety outcomes include the proportion of subjects with ischemic strokes, serious/life threatening adverse events, worsening neurological status or development of new disabling neurological symptoms, seizures, and cranial neuropathies (blindness and facial paralysis) within 180 days of randomization. One interim analysis for overwhelming efficacy and futility will be performed assuming a group sequential design of O’Brien and Fleming boundary. Results Based on an effect size of 13% of the composite primary outcome, a two‐sided Type I and Type II error of 0.05 and 0.15, and a dropout rate of 10%, a sample size of 394 patients is estimated. Conclusion CHESS will be the first US randomized controlled trial to provide evidence on the safety and effectiveness of 1) standalone MMAE vs surgical drainage; 2) particles as the embolic agent, and 3) MMAE on recurrent, in addition to de novo, cSDHs.

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

The case is an 88-year-old, woman, formerly a successful surgeon for decades, with Wernicke's aphasia due to dominant insular stroke. Our evaluation explored her deficits in the context of the heterogeneous presentations of insular strokes and how speech rehabilitation has impacted her language abilities given her cognitive reserve prior to her stroke. The patient sustained a left MCA embolic stroke in 2020. Neurodiagnostics revealed an infarct in the insula, dominant temporal, frontal, and parietal lobes. Baseline language assessment was completed. Results included moderate-severe receptive language impairment; intact fluency; deficits in writing and repetition; and significant paraphasias. Neuropsychological assessment demonstrated prominent deficits in repetition with paraphasias and irritability. Auditory learning, attention, and working memory were invalid due to deficits in repetition. She was diagnosed with mild vascular neurocognitive disorder and conduction aphasia. Despite comprehension having improved, the patient's paraphasias resemble the presentation of Wernicke's aphasia. Interestingly, there were some consistencies in paraphasic errors, such as consistently swapping certain words or letters, demonstrating diminished but not absent volition of speech. Story memory was the most effective measure of auditory memory given repetition deficits. Despite repetition deficits commonly localizing to the supramarginal gyrus, her repetition difficulty is likely related to language network disruption due to her insular infarct. Rehabilitation for comprehension was successful despite age at time of injury. Consistent with previous research, results suggest despite cognitive reserve, repetition is resistant to rehabilitation; however, in this case, paraphasic errors were also resistant. Rehabilitation should include a behavioral component for insular stroke patients.

Metalinguistic Awareness as Self-Management in People with Apraxia of Speech and Aphasia: Lived Experience from a Longitudinal Case Series

People with acquired apraxia of speech (AOS) and aphasia commonly experience long-term communication disability without support for their ongoing recovery or self-management. Little is known about their lived experience of metalinguistic abilities and capacity to harness them for self-management of speech production. The author, a speech and language therapist (SLT), revisited her previous qualitative study after her own more recent lived experience of recovering from mild aphasia. Participant perspectives were explored from a longitudinal case series (eleven people with confirmed AOS and aphasia discharged from SLT), with full ethical approval. The anonymized data comprised detailed transcripts from videoed semi-structured interviews, participant assessments, field notes and reflections, member checking, and reflexivity. The original systematic thematic analysis of these data in NVivo software was re-interrogated by the author, deriving three overarching themes: Metalinguistic awareness of spoken communication breakdown, Self-management, and Therapeutic assessment. The participants conveyed the nature, occurrence, context, mechanism, and purpose underlying errors in spoken communication (themes of What, When, Where, How and Why). They generated compensatory strategies, elucidated via subthemes with quotations, verified contemporaneously by an original participant volunteer. The findings support the value of metalinguistic co-construction during in-depth assessments of communication disability, offering fresh avenues for long-term self-management in aphasia and AOS.

Word Repetition Paired With Startling Stimuli Decreases Aphasia and Apraxia Severity in Severe-to-Moderate Stroke: A Stratified, Single-Blind, Randomized, Phase 1 Clinical Trial.

This prospective, single-blinded, parallel, stratified, randomized clinical trial via telehealth aimed to investigate the impact of Startle Adjuvant Rehabilitation Therapy (START) on aphasia, apraxia of speech (AOS), and quality of life in individuals with chronic stroke. The study hypothesized that START would have a greater effect on AOS-related measures and more severe individuals. Forty-two participants with poststroke aphasia, AOS, or both were randomly assigned to the START or control group. Both groups received 77-dB GET READY and GO cues during a word repetition task for three 1-hr sessions on consecutive days. The START group additionally received 105-dB white noise GO cues during one third of trials. The Western Aphasia Battery-Revised, Apraxia Battery for Adults, Stroke Impact Scale, and Communication Outcomes After Stroke scale were administered at Day 1, Day 5, and 1-month follow-up. START improved performance on some subtests of the Western Aphasia Battery (Comprehension, Repetition, Reading) and measures of AOS (Diadochokinetic Rate, Increasing Word Length) in individuals with moderate/severe aphasia, whereas moderate/severe controls saw no changes. Individuals with mild aphasia receiving START had improved Reading, whereas mild controls saw improved Comprehension. The START group had increased mood and perceived communication recovery by Day 5, whereas controls saw no changes in quality of life. This study is the first to evaluate the impact of training with startling acoustic stimuli on clinical measures of aphasia and AOS. Our findings suggest START can enhance both nontrained speech production and receptive speech tasks in moderate/severe aphasia, possibly by reducing poststroke cortical inhibition. Our findings should be considered carefully, as our limitations include small effect sizes, within-group variability, and low completion rates for quality-of-life assessments and follow-up visits. Future studies should explore a mechanism of action, conduct larger and longer Phase 2 clinical trials, and evaluate long-term retention. https://doi.org/10.23641/asha.24093519.

QUALITY OF LIFE OF A PATIENT AFTER ENDARTERECTOMY OF THE INTERNAL CAROTID ARTERY (ICA) FOLLOWINGAN ACUTE ISCHEMIC STROKE (AIS) DURING COVID-19

The aim of the study was to evaluate the quality of life of a patient af- terendarterectomy (CEA) of the Internal Carotid Artery (ICA) following an Acute ischemic stroke (AIS) during COVID-19.A right-handed, 51-year-old patient, a visual artist, single, in good health and no chronic illnesses to date, became infected with SARS-CoV-2 and contracted COVID-19. The presence of SARS-CoV-2 virus was confirmed by a RT PCR antigen test. The patient was hospitalized, and required mechanical ventilation at an Intensive Care Unit (ICU) before an acute ischemic stroke (AIS) onset. Except for untreated hypertension, her medical history was unremarkable. Her blood pressure was 180/100 mm Hg; her pulse was 76 beats per minute and was regular. AIS from the left middle cerebral artery (MCA) has resulted primarily in damage to the left hemisphere, and secondary effects on the right side resulting in body weakness and mild anomic aphasia. Magnetic resonance imaging (MRI) confirmed stroke and detected brain tissue damaged by an AIS. It revealed hyperintense foci in the T2 and FLAIR sequences, 21 mm in size in the left hemisphere of the brain. In search of the cause of AIS, CT angiography was performed. It revealed a large (90%) ICA occlusion. The patient was admitted to the emergency room at the Vascular Surgery Clinic with an Endovascular Subunit. The revascularization procedure (CEA) was performed under general endotracheal anesthesia with the use of the protocol and techniques (elaborated at the Department of Vascular Surgery and Endovascular Procedures, The John Paul II Hospital in Krakow). The CEA procedure improved her general health: she regained the ability to name objects and her HRQOL also improved in her perception. The improvement achieved was statistically significant. She returned to painting and functions well in society.The patient’s perception of HRQoL measured by the SF-36 domains was better after the CEA: a significant improvement in self-reported overall health has occured. The HRQoL outcome measures may be valuable in future clinical trials of comparing different methods of treatment offered after AIS.

Main Concepts in the Spoken Discourse of Persons with Aphasia: Analysis on a Propositional and Linguistic Level

Individuals produce discourse for various purposes as part of their daily functioning. Therefore, the ability to form a discourse should be one of the main goals of functional speech-language therapy for persons with aphasia (PwA). In addition to assessing the language skills required to form a discourse, it is important to analyse how PwA form general ideas that need to be narrated. This study had two specific aims: (1) to investigate the ability of PwA, with special consideration to the stage of their recovery—the acute and the chronic phase—to form main concepts in a discourse, and (2) to examine the relationship between the number of main concepts and different types of language measures related to productivity, informativeness, and grammaticality in all tested groups. Participants included a total of 38 persons with mild and moderate aphasia (19 in the acute and 19 in the chronic phase of recovery) and 38 healthy speakers (HS) who were matched in age, gender, and level of education. In order to effectively compare the discourse produced by the groups, a single structured stimulus was used, whereby all participants were asked to orally describe a picture from the Croatian version of the Comprehensive Aphasia Test. Compared to the HS, the main concepts produced by PwA were different in number, as well as in terms of their accuracy and completeness. However, when analysing the success in the production of the main concepts with regard to the time post-stroke—acute and chronic—the difference was not confirmed, indicating great individual differences between PwA that undermine the differences on a group level. Linguistic measures of informativeness (CIUs and CIU/words) and only one measure of grammaticality (number of clauses) showed a significant correlation with the number of main concepts in PwA. When analysing correlations for PwA in the acute and chronic phases, only CIU showed a significant association with MC, confirming it as a robust measure of discourse production in PwA. PwA did not produce long and complex sentences, and they showed difficulties in the use of verbs and the marking of argument structures.

Effects of cognitive and social demands on linguistic production for people with moderate, mild, or no aphasia

ABSTRACT Background Most everyday communication occurs in situations where cognitive and social demands are present. These types of situations may compound language deficits for people with aphasia (PWA). An understanding of the language interference that may occur from cognitive and social demands is an important precursor for assessment and intervention that addresses everyday communication situations. Aims To determine how cognitively and socially demanding conditions affect micro- and macrolinguistic production for people with moderate, mild, or no aphasia during narrative discourse and to compare effects among groups. Method Thirty participants with mild (n = 9), moderate (n = 9), or no (n = 12) aphasia completed story-retell tasks in three separate conditions: baseline, unresponsive partner, and dual-task. The stories and conditions were pseudorandomly presented for each participant. A secondary analysis investigated lexical, morphosyntactic, and macrolinguistic production. Results As expected, when compared with baseline, the dual-task condition interfered more with language production than the unresponsive partner condition for all participant groups. Interference on distinct aspects of language production for each participant group, however, was not anticipated. This interference was characterized by significant dual-task costs on (a) macrolinguistic production for participants with moderate aphasia, (b) word productivity and lexical diversity for participants with mild aphasia, and (c) lexical-phonological errors for participants with no aphasia. When compared with baseline, the unresponsive partner led to numerical interference on the same measure and group combinations as the dual-task, but these changes were not statistically significant. Conclusions Cognitive and social demands have different effects on language depending on the presence and severity of aphasia with cognitive demands impacting discourse-level structures for participants with moderate aphasia, lexical-level structures for participants with mild aphasia, and lexical-phonological errors for participants with no aphasia. Future research should identify how these demands could be integrated with assessment and treatment for PWA to help improve everyday communication participation.