Nonfluent Aphasia Research Articles

Association of cortical morphology, white matter hyperintensity, and glymphatic function in frontotemporal dementia variants.

Frontotemporal dementia (FTD) can be phenotypically divided into behavioral variant FTD (bvFTD), nonfluent variant primary progressive aphasia (nfvPPA), and semantic variant PPA (svPPA). However, the neural underpinnings of this phenotypic heterogeneity remain elusive. Cortical morphology, white matter hyperintensities (WMH), diffusion tensor image analysis along the perivascular space (DTI-ALPS), and their interrelationships were assessed in subtypes of FTD. Neuroimaging-transcriptional analyses on the regional cortical morphological deviances among subtypes were also performed. Changes in cortical thickness, surface area, gyrification, WMH, and DTI-ALPS were subtype-specific in FTD. The three morphologic indices are related to whole-brain WMH volume and cognitive performance, while cortical thickness is related to DTI-ALPS. Neuroimaging-transcriptional analyses identified key biological pathways linked to the formation and/or spread of TDP-43/tau pathologies. We found subtype-specific changes in cortical morphology, WMH, and glymphatic function in FTD. Our findings have the potential to contribute to the development of personalized predictions and treatment strategies for this disorder. Cortical morphologic changes, white matter hyperintensities (WMH), and glymphatic dysfunction are subtype-specific. Cortical morphologic changes, WMH, and glymphatic dysfunction are inter-correlated. Cortical morphologic changes and WMH burden contribute to cognitive impairments.

Reversible cerebral vasoconstriction syndrome post-cardiac transplantation: a therapeutic dilemma: case report

BackgroundReversible cerebral vasoconstriction syndrome (RCVS) is characterized by diffuse, multifocal segmental narrowing of cerebral arteries and can result in ischaemic stroke. Causal factors, identified in 60% of cases, include immunosuppressant pharmacotherapy. The few reports following heart transplantation are almost all in Asian recipients. We report on a Caucasian Australian patient with immunotherapy induced RCVS post heart transplantation to highlight the state of knowledge of the condition and the treatment dilemma it poses.Case presentationA 51-year-old female underwent orthotopic heart transplantation at our institution. Induction immunotherapy comprised basiliximab, mycophenolate mofetil and methylprednisolone. On day 6 post-transplantation the patient was transitioned to oral prednisolone and tacrolimus. On day 7 the patient began to experience bilateral, severe, transient occipital and temporal headaches. On day 9 tacrolimus dose was up-titrated. A non-contrast computed tomography brain (CTB) was normal. Endomyocardial biopsy on day 12 demonstrated moderate Acute Cellular Rejection (ACR), which was treated with intravenous methylprednisolone. That evening the patient experienced a 15-minute episode of expressive dysphasia. The following morning she became confused, aphasic, and demonstrated right sided neglect and right hemianopia. A CT cerebral perfusion scan demonstrated hypoperfusion in the left middle cerebral artery (MCA) territory and cerebral angiography revealed widespread, focal multi-segmental narrowing of the anterior and posterior circulations. A diagnosis of RCVS was made, and nimodipine was commenced. As both steroids and tacrolimus are potential triggers of RCVS, cyclosporin replaced tacrolimus and methylprednisolone dose was reduced. A further CTB demonstrated a large left MCA territory infarct with left M2 MCA occlusion. The patient made steady neurological improvement. She was discharged 34 days post-transplantation with mild residual right lower limb weakness and persistent visual field defect on verapamil, cyclosporine, everolimus, mycophenolate mofetil and prednisolone.ConclusionReversible cerebral vasoconstriction syndrome is rare after orthotopic heart transplantation. Until now, RCVS has been almost exclusively described in Asian recipients, and is typically caused by immunotherapy. The condition may lead to permanent neurological deficits, and in the absence of definitive treatments, early recognition and imaging based diagnosis is essential to provide the opportunity to remove the causal agent(s). Co-existent ACR, can pose unique treatment difficulties.

Topic maintenance in non-fluent aphasia conversation

Background: Studies on communication partner training programs for persons with aphasia reveal improvements in the conversation partners’ communication skills. This article explores the strategies for topic maintenance developed by the conversational partners of three people with non-fluent aphasia before and after an intervention on conversational strategies. Method: We used conversation analysis to examine video-recorded samples of everyday conversations (pre- and post-treatment and follow-up) between three couples. The assessment for topic management was performed with Conversation Analysis Profile for People with Aphasia (CAPPA). The intervention was conducted over a period of five weeks. The partners were trained to use strategies for better topic maintenance (multiple-choice, multimodality, and message verification). At six weeks post-therapy, a third recording was made. Results: After the intervention, changes in topic maintenance were observed. The use of strategies is related to the pre-existing context and the presence of visual support. Discussion/Conclusion: Individuals with non-fluent aphasia and their conversation partners engage in multimodal conversations and benefit from the use of strategies to overcome barriers to understanding, leading them to maintain a conversational topic.

Cerebrospinal Fluid Total and Phosphorylated Tau Protein in Behavioral Variant Frontotemporal Dementia, Progressive Supranuclear Palsy, Corticobasal Syndrome and Non-Fluent Agrammatic Primary Progressive Aphasia: A Systematic Review and Meta-Analysis.

(1) Background: Frontotemporal lobar degeneration (FTLD) is a generic term which refers to multiple pathologies, including FTLD-tau. The most common FTLD-tau diseases are Pick's disease (PiD), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). These diseases share four major syndromes: behavioral variant frontotemporal dementia (bvFD), Richardson syndrome (RS), corticobasal syndrome (CBS) and non-fluent agrammatic primary progressive aphasia (nfa-PPA). The primary aim of this meta-analysis was to examine the diagnostic performance of CSF total (t-tau) and phosphorylated (p-tau) protein in bvFTD, RS, CBS, nfa-PPA and pathologically or genetically defined tauopathy. (2) Methods: A systematic review and meta-analysis was performed on all studies with >10 subjects in a bvFTD/RS/CBS/nfa-PPA group and control group and available data on CSF t-tau or p-tau (mean, SD). Cohen's d was used to quantify the effect size of each study (3) Results: The PSP/tauopathy patients exhibited decreased levels of CSF p-tau compared to the control subjects. The CBS/bvFTD/nfa-PPA cohorts exhibited an increase in t-tau compared to the control groups. (4) Conclusions: Tauopathies may exhibit an inherent decrease in CSF p-tau. The admixture of AD patients in FTD cohorts and high heterogeneity among studies on rare diseases are significant confounding factors in FTLD studies.

Picture Naming Properties of Turkish People with Fluent and Non-Fluent Aphasia

Objectives: People with aphasia (PWA) have naming problems. During naming activities, they produce paraphasias. However, there is no significant association between paraphasia and aphasia types. This study aimed to identify the relationship between paraphasia and aphasia type, as well as the effect of cueing on naming performance. Materials and Methods: The study comprised 37 Turkish PWA who were divided into two groups: fluent and non-fluent aphasia. Participants were presented with 40 pictures and asked to name them. Cues were given in case they did not answer correctly. The participants' answers, the types of paraphasias, and how they responded to the cues were all recorded. Results: Participants in both groups significantly increased their naming performance for all words when cues were given. A total of 181 paraphasias were observed in the fluent aphasia group: Phonemic paraphasias were the most common (41.4%), followed by semantic paraphasias with 32.1%. There were 270 paraphasias in the non-fluent aphasia group, with phonemic paraphasia being the most common (60.7%). Conclusion: Phonemic and neologistic paraphasias were significantly higher in the non-fluent group. Phonemic and neologistic paraphasia is more common in those with non-fluent aphasia. This study found that the cueing method had a favourable influence on PWAs' naming performance, which is consistent with prior research.

Can Lesions in the Right Basal Ganglia Cause Aphasia? Crossed Aphasia in a Right-Handed Patient.

Aphasia is a common neurocognitive disorder caused by impaired speech and language, with stroke being the most frequent cause. The neuroanatomical mechanism underlying this condition is not yet fully understood. This case describes a 74-year-old Caucasian woman admitted with a clinical picture of right total anterior circulation infarct (TACI) and aphasia, scoring 17 on the National Institutes of Health Stroke Scale. Neuroimaging showed a large cortico-subcortical frontotemporoparietal and insular infarct involving the basal ganglia of the right hemisphere and bilateral focal atherosclerotic stenosis on the M1 segment of the middle cerebral artery. There was no left hemispheric lesion or abnormal electric activity on the electroencephalogram. A formal evaluation was compatible with transcortical motor aphasia. The aetiological study revealed atrial fibrillation, and the case was admitted as an ischaemic stroke of undetermined aetiology with two possible causes - intracranial atherosclerotic stenosis or atrial fibrillation. Our patient fulfilled all the formal criteria for crossed aphasia in dextral (CAD): aphasia, a lesion in the right hemisphere coupled with the structural integrity of the left hemisphere, an established preference for right-hand use without a familial history of left-handedness individuals, and an absence of brain damage in childhood. Our patient's case adds to the evidence that deep structures - alone or in combination with cortical structures - are primarily affected in CAD. The diagnostic criteria for crossed aphasia in dextral (CAD) are derived from clinical case studies and include aphasia, a lesion in the right hemisphere, a strong preference for using the right hand, the structural integrity of the left hemisphere and no history of brain damage during childhood.The right lentiform nucleus was found to be the most frequent anatomical substrate involved in CAD patients, consistent with our case description.Our patient experienced transcortical motor aphasia due to a stroke in the right hemisphere, adding to the evidence that in CAD patients, deep structures are primarily affected. In contrast, in left hemispheric lesions, cortical structures seem to be the main culprits.

Explorating the Role of Caregiver Quality Of Life in the Recovery Pattern of Patients With Severe Non-Fluent Aphasia – Case Series

Explorating the Role of Caregiver Quality Of Life in the Recovery Pattern of Patients With Severe Non-Fluent Aphasia – Case Series

Palinacousis in amyloidosis: exploring the hallucinatory phenomenon in brain pathology—a case report

BackgroundHereditary transthyretin amyloidosis, caused by transthyretin gene mutations, progresses with systemic impact and often presents peripheral neuropathy. Recent research reveals central nervous system involvement, marked by leptomeningeal amyloid accumulation and transient focal neurological episodes displaying cortical dysfunction.Case presentationA 47-year-old Caucasian man with hereditary transthyretin amyloidosis presented with motor aphasia, right hemiparesis, fever, and an altered state of consciousness. Tests ruled out stroke or infection. While improving, the patient reported an ongoing auditory repetition phenomenon for 48 hours despite efforts to shift focus or introduce new stimuli.ConclusionThis represents the first known case report documenting palinacousis in hereditary transthyretin amyloidosis attributed to central nervous system involvement. This case highlights the complexities in assessment and management of patients when neurological and psychiatric symptoms overlap.

Deictic vs. anaphoric pronouns: a comparison of fluent and non-fluent aphasia in English and Tagalog

ABSTRACT Deictic pronouns refer directly to the extralinguistic world (as in Stop her!), while anaphoric pronouns refer to elements introduced in discourse (as in My best friend is Mary. John adores her.). The distinction is central to linguistic theory and may be central also for understanding aphasia. This paper compares the production of deictic and anaphoric pronouns in fluent aphasia and non-fluent aphasia. It does so both for English and for Tagalog, which allows extensive omission of pronominal arguments. For both languages, the results show a dissociation between deictic and anaphoric pronouns. Non-fluent aphasic speech displays a lower proportion of anaphoric pronouns to non-pronouns than non-brain-damaged speech, while the proportion of deictic pronouns to non-pronouns is either not different (Tagalog) or higher (English). In contrast, fluent aphasic speech displays a higher proportion of deictic pronouns to non-pronouns, while the proportion of anaphoric pronouns is either not different (Tagalog) or lower (English).

Automated Analysis of Fluency Behaviors in Aphasia.

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

The relationship between working memory and sentence processing in individuals with Broca's aphasia

The aim of this study was to investigate the relationship between working memory and sentence processing in individuals with Broca's aphasia. To this end, the study was conducted on a sample of twenty (20) purposively selected individuals diagnosed with Broca's aphasia. A descriptive approach was adopted and two tests were used for data collection: the Baddeley Working Memory Test and the Sentence Processing Test. After data collection and statistical analysis, the results indicated a relationship between working memory and sentence processing in individuals with Broca's aphasia.

Analysis of Melodic Intonation Therapy (MIT) on Speech Ability in Stroke Patients with Aphasia at Srondol Health Center

The Irreversible brain disorders that cause sequelae in the form of motor aphasia or speech disorders which are mostly clinical manifestations in post-stroke patients cause inability to move, speech problems, perspective, because there are problems with brain function. Melodic Intonation Therapy (MIT) is the development of music as a therapeutic medium to improve language skills that use musical elements (intonation and beats) as therapy to improve language skills for people with aphasia. The purpose of this study is to analyze Melodic Intonation Therapy (MIT) on Speech Ability in Stroke Patients With Aphasia with the research stage based on field research in the Srondol community who experienced Stroke with speech difficulties/Aphasia. This research method uses an experimental quasy with a pre-post test with control group design with a sample of 30 respondents with the results of speech development of aphasia patients, international publications, and guidelines for the management of Melodic Intonation Therapy (MIT) in Stroke Patients with Aphasia. Based on the results of the study, it was found that patients who experienced stroke of the families of stroke patients supported him because family support was very important to maintain and maximize physical and cognitive recovery.

Case Report: Callosal disconnection syndrome manifesting as mixed frontal-callosal-posterior alien hand syndrome following extensive corpus callosum infarct

Alien hand syndrome (AHS) is a rare neurological phenomenon first described by Van Vleuten over a century ago. The most widely recognized variants in literature are frontal, callosal, and posterior AHS. AHS due to the corpus callosum lesion can occur alone or as part of callosal disconnection syndrome (CDS). This report presents a unique CDS case manifesting clinical features from all three AHS variants, resulting from an extensive corpus callosum infarct. Our patient exhibited various clinical features from the three AHS variants, which include grasping, groping, and difficulty releasing objects from the hand (anterior); intermanual conflict (callosal); arm levitation, mild hemiparesis, and hemisensory loss (posterior). Additionally, the extensive disruption of the corpus callosal fibers produced neurological manifestations of CDS, such as cognitive impairment, ideomotor and constructional apraxia, behavioral disorder, and transcortical motor aphasia. We employed a range of rehabilitation interventions, such as mirror box therapy, limb restraint strategy, verbal cue training, cognitive behavioral therapy, bimanual hand training, speech and language therapy, and pharmacological treatment with clonazepam. The patient showed almost complete resolution of CDS and AHS features by nine months post-stroke Our case report highlights distinctive clinical variations of AHS and the challenging correlation between clinical manifestations and neuroanatomical substrates. Future studies are necessary to explore the intricate neural connections and the precise function of the corpus callosum. This can be achieved by combining comprehensive neuropsychological testing with diffusion tensor tractography studies. It is also essential to develop a validated tool to standardize AHS assessment. Finally, the scarcity of evidence in rehabilitation interventions necessitates further studies to address the wide knowledge gap in AHS and CDS management.

Appraising the Conceptual and Lexical Retrieval in Persons with Fluent and Nonfluent Aphasia

Abstract Objective Conceptual knowledge refers to understanding and interpreting concepts and their relationships. Lexical knowledge is the knowledge that can be expressed through words. It entails meaning of words and their relationships. Word retrieval impairments are the most radical deficits that restrict communicative functions for individuals with aphasia. The current study aimed to compare the conceptual and linguistic impairments associated with fluent and nonfluent persons with aphasia (PWAs). Materials and Methods A total of 15 PWAs were recruited for the study, out of which, 8 were fluent aphasia and 7 were nonfluent aphasia. One picture-based conceptual task (picture comparison judgments) and one verb-based linguistic task (word comparison judgments) were used as the experimental paradigm. Results and Conclusion The findings of the study showed no significant difference in the performance of conceptual and lexical retrieval abilities in both fluent and nonfluent aphasia. The current study highlights the fact that both conceptual and lexical retrieval impairments prevail in both fluent and nonfluent aphasia.

Spontaneous Ruptured Brain Arteriovenous Malformation In Adolescent Patient: Case Report

Introduction: Brain arteriovenous malformations (bAVMs) are one of the most common causes of intracranial hemorrhage in the adolescent. AVMs are relatively rare as congenital intracranial abnormalities but these lesions are becoming frequently reported. AVMs generally has no any symptoms and only recognized after intracranial or subarachnoid hemorrhage occurs. This disease usually gives symptoms of headaches and seizures without cause. However, along with the development of medical technology, arteriovenous malformation lesions are common. Case report: This 24 year old woman in unconscious with right hemiparesis and atypical chronic progressive headache with vas 8-9, without aura. Previously the patient had a seizure with a duration of 5 minutes, rigid all over body. The patient had no prior history of trauma, infection, hypertension, diabetes or stroke. GCS E2M5Vaphasia with motoric aphasia, motoric and sensory deficits in the form of right hemiparesis, paresis of N. VII, increased physiological reflexes, and positive Babinsky reflex. CT-Scan Angiography imaging of the head showed intraparenchymal bleeding in the left temporoparietal lobe with perifocal edema, AVM in the left temporalis region with a nidus with a feeding artery from the left MCA and a draining vein from the left transverse sinus. The patient was referred for further vascular intervention. Discuss: AVMs was previously considered a congenital malformation with risk of bleeding in anomalous tissue or nidus occurring within the brain parenchyma. Rupture of the artery and discharge into the subarachnoid space causes a sudden increase in ICP, cerebral vascular vasospasm resulting in global and focal brain dysfunction. In addition, with the increasing use of non-invasive intracranial imaging, AVMs can be detected directly.

Structural network topology associated with naming improvements following intensive aphasia therapy in post-stroke aphasia

A stroke can disrupt the finely tuned language network resulting in aphasia, a language impairment. Though many stroke survivors with aphasia recover within the first 6 months, a significant proportion have lasting deficits. The factors contributing to optimal treatment response remain unclear. Some evidence suggests that increased modularity or fragmentation of brain networks may underlie post-stroke aphasia severity and the extent of recovery. We examined associations between network organization and aphasia recovery in sixteen chronic stroke survivors with non-fluent aphasia following 35 h of Multi-Modality Aphasia Therapy over 10 days and 20 healthy controls who underwent imaging at a single timepoint. Using diffusion-weighted scans obtained before and after treatment, we constructed whole-brain structural connectomes representing the number of probabilistic streamlines between brain regions. Graph theory metrics were quantified for each connectome using the Brain Connectivity Toolbox. Correlations were examined between graph metrics and speech performance measured using the Boston Naming Test (BNT) at pre-, post- and 3-months post-intervention. Compared to controls, participants with stroke demonstrated higher whole-brain modularity at pre-treatment. Modularity did not differ between pre- and post-treatment. In individuals who responded to therapy, higher pre-treatment modularity was associated with worse performance on the BNT. Moreover, higher pre-treatment participation coefficients (i.e., how well a region is connected outside its own module) for the left IFG, planum temporale, and posterior temporal gyri were associated with greater improvements at post-treatment. These results suggest that pre-treatment network topology may impact therapeutic gains, highlighting the influence of network organization on post-stroke aphasia recovery.

Neurologic music therapy for non-fluent aphasia: a systematic review and meta-analysis of randomized controlled trials

IntroductionThe efficacy of neurologic music therapy (NMT) techniques for the treatment of non-fluent aphasia has been widely accepted by the rehabilitation medical community. However, consensus on which dimensions of speech function can be improved by NMT techniques and standardized intervention dosage remains elusive. This study aimed to provide evidence regarding the efficacy of NMT in improving speech function and explore the optimal intervention dose. A systematic review and meta-analysis were conducted to search for randomized clinical trials and open-label trials that evaluated speech functions after NMT.MethodsWe searched all papers and reviews published from database inception to July 2023, including PubMed, Cochrane Library, Web of Science, Embase, and CNKI. Statistical analyses were mainly carried out on RevManV5.4.1 and pooled using a random-effects model. The primary outcome was the standardized mean difference (SMD) in speech functions, determined by calculating the change in speech functions score from baseline to the primary endpoint in the NMT group versus the control arm.ResultsA total of 11 studies with 329 patients were included. NMT had a positive effect on repetition ability (SMD = 0.37, 95%CI [0.12, 0.62], p < 0.05), but did not lead to significant differences in naming, comprehension, spontaneous speech, or communication. When the intervention time was >20 h, NMT exhibited a significant advantage at improving repetition ability (SMD = 0.43, 95%CI [0.06, 0.79], p < 0.05).DiscussionThis study provides evidence supporting the NMT enhancement of repetition ability in patients with non-fluent aphasia. Future large-sample studies are required to determine the optimal intervention dose of music therapy for different subtypes of non-fluent aphasia.Systematic review registrationPROSPERO, identifier CRD42023470313.

Recovery of gestures for persons with severe non-fluent aphasia and limb apraxia: A long-term follow-up study

Persons with severe non-fluent aphasia would benefit from using gestures to substitute for their absent powers of speech. The use of gestures, however, is challenging for persons with aphasia and concomitant limb apraxia. Research on the long-term recovery of gestures is scant, and it is unclear whether gesture performance can show recovery over time. This study evaluated the recovery of emblems and tool use pantomimes of persons with severe non-fluent aphasia and limb apraxia after a left hemisphere stroke. The Florida Apraxia Screening Test-Revised (FAST-R) was used for measurements. The test includes 30 gestures to be performed (i) after an oral request, (ii) with the aid of a pictorial cue, or (iii) as an imitation. The gestures were rated on their degree of comprehensibility. The comprehensibility of gestures after an oral request improved significantly in five out of seven participants between the first (1–3 months after the stroke) and the last (3 years after) examination. Improvement continued for all five in the period between six months and three years. The imitation model did improve the comprehensibility of gestures for all participants, whereas the pictorial cue did so just slightly. The skill of producing gestures can improve even in the late phase post-stroke. Because of this potential, we suggest that gesture training should be systematically included in the rehabilitation of communication for persons with severe non-fluent aphasia.

Transfer effects of recursive self-feedback on connected speech production in patients with chronic nonfluent aphasia: Preliminary results

ABSTRACT Background Persons with nonfluent aphasia (PWNA) have deficits with online feedback for speech error detection and correction which have debilitating effects on language relearning in learned and novel contexts. Previous studies have shown that aphasia treatments that combine PWNA’s offline self-feedback and external feedback from speech-language pathologists (SLPs) improve language production in learned and novel contexts. However, it remains unclear whether PWNA can use their offline self-feedback alone during treatments that generalizes to improvement in connected speech production. Here, we examine generalization effects of recursive self-feedback on PWNA’s connected speech production. Recursive self-feedback utilizes offline self-feedback loops alone to help PWNA optimize their error monitoring and correction abilities for language production in learned and novel contexts. Method A crossover design was used to investigate generalization effects of two treatments on connected speech production in four PWNA. These treatments comprised script production with recursive self-feedback and script production with external feedback. Employing a mobile health approach, treatments were remotely administered to participants within the comfort of their homes. Practice of both treatment blocks occurred intensively over two hours per day, five days per week, spanning two to three weeks. Each treatment block featured pretreatment and posttreatment assessment phases, with the sequencing of treatment blocks evenly counterbalanced across all participants. Following the initial treatment block, a two-week period devoid of treatment preceded the commencement of the second treatment block. Untrained narrative elicitation tasks were utilized to prompt connected speech production samples from all participants during the assessment phases of each treatment block. Effect sizes per participant were computed using within-case standard mean difference analysis. Results PWNA exhibited variability in performance, showing improvement in microlinguistic measures of connected speech following both script production with recursive self-feedback and script production with external feedback. Particularly, script production with recursive self-feedback demonstrated marginally superior enhancement in connected speech measures compared to its counterpart. Conclusion The study provides preliminary evidence for generalization effects of recursive self-feedback training and external feedback training on PWNA’s connected speech production. Further research is required to corroborate the findings and to implement recursive self-feedback procedures optimized specifically for spontaneous speech.

The Clock is Ticking: Overcoming Time with Mechanical Thrombectomy for Middle Cerebral Artery Infarct

Coronary angiography is associated with several documented complications, and cardioembolic stroke following angiography is a rare occurrence. This letter presents a case involving thrombotic occlusion of the left middle cerebral artery (MCA) during coronary angiography. A 36-year-old female patient, presenting to the emergency department with chest pain, underwent coronary angiography due to non-ST-segment elevation myocardial infarction. While the responsible lesion underwent revascularization, the patient experienced new-onset motor deficits and aphasia. DSA imaging was conducted on the patient, whose diffusion magnetic resonance imaging and clinical findings were indicative of MCA infarction. Thrombectomy was performed on the patient with a left MCA infarction. Proficient management of neurological complications underscores the potential positive impact of interventional treatment strategies on mortality and morbidity. In this letter to the editor, the significance of early diagnosis, appropriate treatment, and multidisciplinary approach is emphasized.