Severe Aphasia Research Articles

Correct Information Unit Analysis in Different Discourse Tasks Among Persons With Anomic Aphasia Based on Mandarin AphasiaBank.

This study aimed to explore how well persons with anomic aphasia communicate information during discourse regarding quantity, quality, and efficiency compared to neurotypical controls, to investigate the influence of discourse tasks on informativeness and efficiency and to examine impact factors like aphasia severity and cognitive ability. Language samples of four discourse tasks from 31 persons with anomic aphasia and 31 neurotypical controls were collected from Mandarin AphasiaBank. Correct information unit (CIU) analysis measures including the total number of CIUs, percentage of CIUs, CIUs per minute, and words per minute were calculated. Group differences and the effects of discourse tasks on informativeness and efficiency were investigated. Correlations of CIU analysis measures with aphasia severity and cognitive ability were examined. Persons with anomic aphasia showed lower efficiency in conveying information than controls. They underperformed controls on all CIU analysis measures when executing story narrative tasks. Discourse tasks influenced the informativeness and efficiency of both groups. Neurotypical controls delivered the greatest quantity of information most efficiently when narrating stories. Persons with anomic aphasia exhibited reduced quantity of information during procedural discourse and displayed superior information quality in sequential-picture descriptions. Discourse information may be impacted by aphasia severity and cognitive ability, with varying effects depending on the task. Persons with anomic aphasia are inefficient in communicating discourse messages and perform poorly on all measures in story narratives. When measuring discourse information, the effects of discourse tasks and factors like aphasia severity and cognitive ability should be considered.

Self-efficacy and resilience in severe aphasia – an exploratory cross-sectional study of two psychosocial factors and their relation to functional communication

Purpose Self-efficacy and resilience are important for various aspects of rehabilitation outcome after stroke. However, little is known about how these factors are affected and related to communication outcome in stroke survivors with aphasia. The purpose was to investigate self-efficacy and resilience, and associations to language and functional communication, in people with severe post-stroke aphasia. Materials and methods 37 participants with severe aphasia rated their self-efficacy and resilience, using adapted versions of the existing instruments DLSES and CD-RISC. In addition, linguistic ability, executive function and functional communication were assessed. Results Participants rated their self-efficacy and resilience as expected based on reports in the literature; somewhat lower than general populations and at similar levels as clinical populations. There were no association between self-efficacy, resilience and linguistic ability. In the sample as a whole, there were no associations between self-efficacy, resilience and functional communication. However, when results were stratified by executive function, associations emerged in the group with stronger executive function. Conclusions People with severe aphasia have decreased self-efficacy and resilience compared to general populations, but not necessarily in proportion to their language impairment. Among participants with relatively spared executive functions there were indications of an association between self-efficacy, resilience and functional communication.

10119-ACT-9 LONG-TERM USAGE OF TUMOR-TREATING FIELDS THERAPY FOR TREATMENT OF MALIGNANT GLIOMA

Abstract OBJECTIVE Tumor-Treating Fields therapy has been the standard therapy for newly diagnosed glioblastoma since 2018 in Japan. The patients are recommended to use the system for 18 or more hours per day. In practice, some patients could not use it long-term and dropped out from this therapy. We examined factors related to interruption of NovoTTF use. METHODS We reviewed the clinical course of NovoTTF-100A system (NovoTTF) in cases at our hospital from April 2018 to May 2023. We compared the group that continued to use NovoTTF or used it until the disease progressed (Group A) with the group that discontinued it for their own reasons (Group B). RESULTS There were 22 patients, 14 in group A and 8 in group B. The mean preoperative tumor volume was 25.3 cm3 in group A and 38.7 cm3 in group B (p=0.27). The mean number of days of NovoTTF use was 437 in Group A and 27 in Group B (p<0.05). The mean usage rate was 70% in group A and 22% in group B (p<0.05). Tumors were located in 6 frontal lobes, 3 temporal lobes, 3 parietal lobes, 1 basal ganglia, and 1 thalamus in group A, while 1 frontal lobe, 6 temporal lobes, and 1 parietal lobe in group B. Among six temporal lobe cases in group B, five revealed temporal lesions in the dominant hemisphere, causing moderate or severe aphasia before surgery. CONCLUSION The group that continued NovoTTF maintained its usage rate as well as the number of days of use, while the group of cases that discontinued for their own reasons had a low use rate. Five of the eight discontinued cases had temporal lobe lesions in the dominant hemisphere and had aphasia symptoms. Difficulties in understanding the need for NovoTTF may have contributed to the discontinuation.

"I Could Not Talk . . . She Did Everything . . . She's Now My Sister": People With Aphasia's Perspectives on Friends Who Stuck Around.

Aphasia may decrease the capacity to develop and maintain friendships. The aim of this study was to better understand the perspectives of people with aphasia on why some friendship bonds remain strong and some do not. Furthermore, we wanted to explore how age and aphasia severity shape views on friendship. We interviewed 27 people with aphasia about their experiences of friendship before and after the onset of aphasia. We then used framework analysis and reflexive thematic analysis to interpret the interview data. From the interviews, we created four major themes concerning how friend relationships had been impacted by aphasia: (a) Not all bonds have the same chance of surviving the onset of aphasia; (b) people with aphasia's closest friends took active steps to keep relationships strong; (c) if friends knew some basic information about aphasia, bonds would stay stronger; (d) positive affective aspects of friendship play an important role in keeping bonds strong. We also noted differences in friendship experiences that appeared to be influenced by age and aphasia severity of participants. Interview data provided actionable ideas including focusing on friends who are likely to be responsive to help with maintaining the friendship, providing them with strategies to keep the friendship active and communication meaningful, and acknowledging the positive impact that this will have on the friend recovering from aphasia. More research is needed to develop programs that empower people with aphasia to maintain their friendships. https://doi.org/10.23641/asha.24688671.

More than one way to improve a CAT: Outcomes and reflections on two iterations of the Queen Square Intensive Comprehensive Aphasia Programme

ABSTRACT Background The field of human expert performance teaches us that high quality, high-dose guided practice is required to make large gains in cognitively driven acts. The same also seems to be true for people with acquired brain injury, yet therapy services for people with aphasia (PWA) have traditionally not been designed with this in mind. Intensive Comprehensive Aphasia Programmes (ICAPs) are one way to address the chronic under-dosing of therapy that most PWA experience. Aims There are several ways to deliver an ICAP; here we describe two iterations of our Queen Square ICAP. There was a 20-month COVID-induced pause between the Year 1 (Y1) and Year 2 (Y2) ICAP groups. We analyse ICAP-induced changes in both groups of PWA on a series of key outcome measures that span the International Classification of Functioning, Disability and Health, covering language impairment and function as well as mood and social participation. Methods & Procedures Forty-six PWA took part in Y1 and 44 in Y2. The PWA were all in the chronic stage post stroke and varied in aphasia severity from mild to severe, with the Y2 group being more impaired than Y1. Quantitative data was collected before and after the ICAP. The Y2 therapy team provided independent reflections on their experiences of delivering an ICAP. Outcomes & Results ICAP-related changes in outcome measures (impairment, function and goal attainment) were generally comparable for the Y1 and Y2 groups, with both groups’ speech production abilities improving the most. Both groups made clinically and statistically significant gains on the main quality of life measure. Participation in the ICAP made a big difference to PWAs’ self-confidence ratings. Their mood ratings also improved significantly, although they were not, on average, in the depressed range at baseline (directly pre-ICAP). All improvements achieved in both groups were maintained at the 3-month follow-up, highlighting the lasting effects that ICAPs can provide. Conclusions Evidence continues to accrue that ICAPs are an efficient way of increasing the dose of expert coaching required for people with chronic aphasia to make clinically meaningful improvements in their communicative abilities and quality of life. The main challenge remaining is convincing health-care providers to invest in them.

Effect of a communication partner training intervention on the use of graphic elements and frustration in a couple in which one member has severe aphasia

Effect of a communication partner training intervention on the use of graphic elements and frustration in a couple in which one member has severe aphasia

Feasibility of longitudinal automated cognitive assessment in the stroke pathway

AbstractBackgroundStroke, post‐stroke dementia and post‐stroke cognitive impairment prevalence is rising significantly, placing an increasing burden on healthcare systems. Standardised pen and paper tools for cognitive assessment require clinical time. There is increasing research into the use of automated cognitive assessment. CognoSpeak (https://cognospeak.github.io/website/) is a fully automated cognitive assessment tool based in language an interaction. A virtual clinician asking questions and listening to responses using automatic speech recognition and Machine Learning algorithms.MethodsPatients who passed the eligibility criteria of having recent acute stroke/TIA, and do not have pre‐existing dementia, severe aphasia, deafness, or too medically unwell were approached to consent to speak to CognoSpeak. Participants completed the CognoSpeak assessment on the ward or at home via a web‐version, as well as MOCA and GAD and PHQ9.ResultsRecruitment started December 2020 and we approached 950 people and recruited 114 participants, with 20 having 6 months follow‐up and 5 12 months follow‐up. The mean age was 61.77 (SD 15.07). Most participants were recruited from Sheffield 71 (68%).The majority had ischemic stroke (67%) & mild stroke according to the NHISS (63%). The most common risk factor was hypertension (19%), and the majority of participants had no symptoms of disability before their stroke (22%). GAD and PHQ9 scores were collected.ConclusionIt is feasible to complete automated cognitive assessment with the stroke population. There remains barriers in utilising technology within this acute and especially longitudinal cognitive assessment in stroke survivors, where rates of anxiety in hospital and at follow‐up appointments may reflect rapid discharge and changes in the stroke pathway during the initial covid pandemic.

P211: Quality of Life and participation in society of elderly people with aphasia

Objective:Aphasia is a communication disorder associated with impairments in spoken language, understanding, reading and writing that impacts upon daily activities, participation in society and the quality of life (QoL), and it is common in elderly patients in the context of vascular diseases. We aimed to investigate participation in society and the environmental factors and health-related QoL of elderly people with aphasia.Methods:People with aphasia whose age was above 65 were included in this study. QoL was assessed by the Japanese version of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) and Life stage Aphasia Quality Of Life scale-11 (LAQOL-11), and the participation in society and the environmental factors as barriers was assessed by the Japanese version of the Community Integration Questionnaire (CIQ) and the Japanese version 2 of the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively. We explored predictors such as aphasia severity, communication impairment, cognitive functions, motor paralysis, activities of daily living (ADL).Results:We included 58 individuals (43 men; mean age 73.2 [SD 5.7] years) with aphasia after the mean 48 (SD 64.9) months of onset (of stroke, cerebral hemorrhage, subarachnoid hemorrhage, brain tumor, traumatic brain injury). The median of the total score of SAQOL-39 and LAQOL-11 was 3.91 (Quartile Deviation 0.47) out of 5 and 85.0 (QD 12.5) out of 110. The QoL was not associated with aphasia severity assessed by the Standard Language Test of Aphasia (SLTA) which is the most frequently used comprehensive aphasia rating scale in Japan, but poor QoL was significantly associated (Spearman correlations) with increased severity of communication impairment assessed by Communication ADL Test (P = 0.01). Moreover, increased QoL was significantly associated with increased participation in society (P = 0.03) and decreased environmental factors (P = 0.01).Conclusion:Poor communication ADL may have a negative effect on QoL in elderly people with aphasia. Also, we show that QoL is associated with participation in society. For patients with aphasia after retirement, specific rehabilitation of communication ADL might be beneficial and should be explored in future studies.

Amyloid and Tau PET Positivity in Progressive Apraxia of Speech and Agrammatic Aphasia

AbstractBackgroundThe spectrum of what is referred to as nonfluent/agrammatic primary progressive aphasia includes patients with isolated apraxia of speech (PPAOS), progressive agrammatic aphasia (PAA), or a combination thereof (AOS‐PAA). When AOS is present, there is typically an underlying 4R tauopathy (corticobasal degeneration; progressive supranuclear palsy); isolated PAA is more often associated with a 3R tauopathy (Pick’s disease). While pathological studies confirm the clinical syndrome is the sequela of these proteinopathies, beta‐amyloid (Aβ) deposition has also been observed. Given the growing number of treatment options, it is important to better understand the incidence of Alzheimer’s disease (AD) in PPAOS‐PAA spectrum disorders.Methods65 patients recruited by the Neurodegenerative Research Group at Mayo Clinic underwent Aβ‐PET imaging using Pittsburgh Compound B (PiB) and tau‐PET imaging with [18F]flortaucipir at the same visit (PPAOS = 23; PAA = 6; AOS‐PAA = 36). A global PiB SUVR (standardized uptake value ratio)≥1.48 and temporal lobe tau meta‐ROI SUVR≥1.25 were deemed Aβ and tau positive, respectively. The incidence of Aβ and tau positivity and clinical‐demographic profiles were compared among groups.ResultsThere was no difference in age, sex, APOE status, tau/Aβ positivity or PET SUVRs across clinical groups (Table 1). Patients differed on indices of aphasia and AOS severity, in concordance with group membership; there was no difference on a memory measure. Eight patients (12%) were both Aβ and tau positive (indicative of the presence of AD), with an additional 20 patients (31%) positive on only one biomarker (Table 1). Of the eight Aβ and tau positive patients, seven had AOS (six prosodic predominant AOS). Aβ more than tau SUVRs increased with age and were related to each other (Figure 1).ConclusionsAβ and tau positivity is not uncommon in AOS and/or PAA patients, particularly in older patients. Enrollment criteria for Aβ or tau targeted pharmacological trials should consider concordance of biological variables and clinical presentations, rather than simply biological biomarkers. Alternatively, if such patients are enrolled, the outcome measures should reflect the clinical impairments, as it is not yet known if or how concomitant AD influences the clinical presentation.

Cross-linguistic Generalizations in the Verb-Production Treatment of Bilingual Aphasic Speakers

Objectives: This study investigates cross- linguistic generalizations in the verb-production therapy for one bilingual speaker with non-fluent aphasia. Methods: Intensive sixty-hour treatment sessions over a period of 12 weeks was provided for an unbalanced bilingual speaker with mild to severe aphasia. A combination of semantically and phonologically cued verbs as well as communication-based treatment were administrated. The treatment was provided in the patient’s L1. The Bilingual Aphasia Test and action-naming pictures from The Newcastle University Aphasia Therapy Resources were used for the pre-and-post-therapy assessments for both languages. Results: A cross-language generalization was reported from L1 to L2. A significant generalization was found in one linguistic domain, i.e., semantics. A within-language generalization was found, i.e., the untrained verbs of L1 showed significant improvement. Nonetheless, inhibition of the semantic domain of the patient’s L1 was reported. Providing treatment for the stronger language of a bilingual aphasic individual could lead to cross-language transfer to the untreated weaker language. Conclusions: We suggest that the cross-language generalization is reported due to the structural overlap between the two languages.

CompreTAP: Feasibility and reliability of a new language comprehension mapping task via preoperative navigated transcranial magnetic stimulation

ObjectiveStimulation-based language mapping approaches that are used pre- and intraoperatively employ predominantly overt language tasks requiring sufficient language production abilities. Yet, these production-based setups are often not feasible in brain tumor patients with severe expressive aphasia. This pilot study evaluated the feasibility and reliability of a newly developed language comprehension task with preoperative navigated transcranial magnetic stimulation (nTMS). MethodsFifteen healthy subjects and six brain tumor patients with severe expressive aphasia unable to perform classic overt naming tasks underwent preoperative nTMS language mapping based on an auditory single-word Comprehension TAsk for Perioperative mapping (CompreTAP). Comprehension was probed by button-press responses to auditory stimuli, hence not requiring overt language responses. Positive comprehension areas were identified when stimulation elicited an incorrect or delayed button press. Error categories, case-wise cortical error rate distribution and inter-rater reliability between two experienced specialists were examined. ResultsOverall, the new setup showed to be feasible. Comprehension-disruptions induced by nTMS manifested in no responses, delayed or hesitant responses, searching behavior or selection of wrong target items across all patients and controls and could be performed even in patients with severe expressive aphasia. The analysis agreement between both specialists was substantial for classifying comprehension-positive and -negative sites. Extensive left-hemispheric individual cortical comprehension sites were identified for all patients. Apart from one case presenting with transient worsening of aphasic symptoms, pre-existing language deficits did not aggravate if results were used for subsequent surgical planning. ConclusionEmploying this new comprehension-based nTMS setup allowed to identify language relevant cortical sites in all healthy subjects and severely aphasic patients who were thus far precluded from classic production-based mapping. This pilot study, moreover, provides first indications that the CompreTAP mapping results may support the preservation of residual language function if used for subsequent surgical planning.

Cerebellar Atrophy and Language Processing in Chronic Left-Hemisphere Stroke.

Chronic stroke results in significant downstream changes at connected cortical sites. However, less is known about the impact of cortical stroke on cerebellar structure. Here, we examined the relationship between chronic stroke, cerebellar volume, cerebellar symmetry, language impairment, and treatment trajectories in a large cohort (N = 249) of chronic left hemisphere (LH) stroke patients with aphasia, using a healthy aging cohort (N = 244) as control data. Cerebellar gray matter volume was significantly reduced in chronic LH stroke relative to healthy control brains. Within the chronic LH stroke group, we observed a robust relationship between cerebellar volume, lesion size, and days post-stroke. Notably, the extent of cerebellar atrophy in chronic LH patients, particularly in the contralesional (right) cerebellar gray matter, explained significant variability in post-stroke aphasia severity, as measured by the Western Aphasia Battery-Revised, above and beyond traditional considerations such as cortical lesion size, days post-stroke, and demographic measures (age, race, sex). In a subset of participants that took part in language treatment studies, greater cerebellar gray matter volume was associated with greater treatment gains. These data support the importance of considering both cerebellar volume and symmetry in models of post-stroke aphasia severity and recovery.

Feasibility of an abstract verb naming treatment for aphasia

ABSTRACT Purpose Verb production impairments in aphasia have important implications for sentence production and communication in general. Verbs with low concreteness may be especially important for certain functional uses, and yet limited data regarding their response to treatment are available. This study was designed to examine a novel behavioral treatment approach to improve low concreteness verb naming in persons with aphasia. Method Three persons with nonfluent aphasia participated in a single-subject experimental design research study examining the feasibility of the novel treatment. The treatment was based on approaches that target the verb as the central node of meaning during sentence construction. The primary outcome measure was a sentence completion probe. Effects on untreated stimuli and on general language and naming assessments were also examined. Results Results indicated some limited changes associated with the treatment for two of the participants. Treatment performance data suggested possible improvements in verb processing that were not reflected in the primary outcome measure. Modest decreases in aphasia severity were noted for two of the participants. Conclusions The findings provide further support for targeting verbal production of verbs with low concreteness in aphasia. Several lessons learned may benefit future researchers examining areas related to the topic.

TelePriming sentence production in aphasia.

The application of videoconferencing to the assessment and treatment of aphasia has been rapidly increasing; however, there is a need to develop treatments targeting sentence production in persons with aphasia (PWA) that can be delivered through videoconferencing. Structural priming has received recent attention as a potential training method for PWA. We investigated the feasibility and efficacy of a collaborative structural priming task delivered via the internet, TelePriming, in facilitating sentence production in PWA and healthy adults. In Study 1, young adults (YA), older adults (OA), and PWA participated in a collaborative dialogue-like priming task through videoconferencing, taking turns with an interlocutor (experimenter) to describe transitive action pictures with the goal of finding matching pictures. We measured whether participants produced more passive sentences to describe their picture after hearing their interlocutor produce passive compared to active sentences (primes). In Study 2, we compared the data from the OA and PWA of Study 1 (TelePriming) to different groups of OA and PWA, who completed the same priming task in person. All three groups showed robust priming effects in Study 1, producing more passive sentences to describe target pictures after hearing the experimenter produce passive versus active sentences. In Study 2, when controlling for demographic information (age, education) and aphasia severity, TelePriming resulted in larger priming effects for OA and PWA, compared to the in-person priming task. Survey results revealed that both OA and PWA experienced increased comfort and satisfaction with using technology following the task. Interactive message-structure alignment processes remain largely intact in PWA, and the positive effects of structural priming in a collaborative communicative task are not diminished by remote delivery. The findings demonstrate the feasibility and validity of TelePriming in OA and PWA, laying experimental groundwork for future use of TelePriming in the assessment and treatment of clinical populations with limited access to face-to-face sessions.

Altered functional connectivity in language and non-language brain networks in patients diagnosed with acute post-stroke aphasia

ObjectiveA resting-state functional magnetic resonance imaging (rs-fMRI) approach was used to explore functional connectivity (FC) in language and non-language brain networks in acute post-stroke aphasia (PSA) patients, with a specific focus on the relationship between these fMRI results and patient clinical presentation. MethodsIn total, 20 acute PSA patients and 30 age-, sex-, and education level-matched healthy control (HC) participants were recruited and subjected to rs-fMRI imaging. In addition, western aphasia battery analyses（WAB） were used to compute aphasia quotient (AQ) values for PSA patients. Granger causality was employed to examine connections among cognition-associated resting-state brain networks, and the right middle frontal gyrus (RMFG),the mirror brain regions of Broca’s area and the Wernicke’s area, the right superior temporal gyrus were selected as regions of interest (ROIs). The REST plus software was then used to perform FC analyses of these regions to analyze changes in FC related to PSA pathogenesis. ResultsRelative to HC individuals, PSA patients exhibited significantly higher levels of intra-network FC between the right middle frontal gyrus (RMFG) and the left middle occipital gyrus (LMOG), with such FC being positively correlated with the AQ scores (P = 0.018). Moreover, reduced FC was detected between the Broca’s area homolog and the left middle frontal gyrus (LMFG), while FC was enhanced between the Wernicke’s area homolog and cerebellar vermis, and this FC was similarly positively correlated with patient AQ scores (P = 0.0297). ConclusionThese results suggest that FC between the bilateral hemispheres of the brain is significantly disrupted in acute PSA patients, interfering with the normal non-specific language network. Aphasia severity was further found to correlate with FC among many of the analyzed regions of the brain.

Pilot Results for ECoLoGiC-Tx: A New Conversation-Level Intervention Improving Language in People With Moderate to Severe Aphasia.

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

Automating Intended Target Identification for Paraphasias in Discourse Using a Large Language Model.

To date, there are no automated tools for the identification and fine-grained classification of paraphasias within discourse, the production of which is the hallmark characteristic of most people with aphasia (PWA). In this work, we fine-tune a large language model (LLM) to automatically predict paraphasia targets in Cinderella story retellings. Data consisted of 332 Cinderella story retellings containing 2,489 paraphasias from PWA, for which research assistants identified their intended targets. We supplemented these training data with 256 sessions from control participants, to which we added 2,415 synthetic paraphasias. We conducted four experiments using different training data configurations to fine-tune the LLM to automatically "fill in the blank" of the paraphasia with a predicted target, given the context of the rest of the story retelling. We tested the experiments' predictions against our human-identified targets and stratified our results by ambiguity of the targets and clinical factors. The model trained on controls and PWA achieved 50.7% accuracy at exactly matching the human-identified target. Fine-tuning on PWA data, with or without controls, led to comparable performance. The model performed better on targets with less human ambiguity and on paraphasias from participants with fluent or less severe aphasia. We were able to automatically identify the intended target of paraphasias in discourse using just the surrounding language about half of the time. These findings take us a step closer to automatic aphasic discourse analysis. In future work, we will incorporate phonological information from the paraphasia to further improve predictive utility. https://doi.org/10.23641/asha.24463543.

Designing remote synchronous auditory comprehension assessment for severely impaired individuals with aphasia.

The use of telepractice in aphasia research and therapy is increasing in frequency. Teleassessment in aphasia has been demonstrated to be reliable. However, neuropsychological and clinical language comprehension assessments are not always readily translatable to an online environment and people with severe language comprehension or cognitive impairments have sometimes been considered to be unsuitable for teleassessment. This project aimed to produce a battery of language comprehension teleassessments at the single word, sentence and discourse level suitable for individuals with moderate-severe language comprehension impairments. Assessment development prioritised response consistency and clinical flexibility during testing. Teleassessments were delivered in PowerPoint over Zoom using screen sharing and remote control functions. The assessments were evaluated in 14 people with aphasia and 9 neurotypical control participants. Modifiable assessment templates are available here: https://osf.io/r6wfm/. People with aphasia were able to engage in language comprehension teleassessment with limited carer support. Only one assessment could not be completed for technical reasons. Statistical analysis revealed above chance performance in 141/151 completed assessments. People with aphasia, including people with moderate-severe comprehension impairments, are able to engage with teleassessment. Successful teleassessment can be supported by retaining clinical flexibility and maintaining consistent task demands. What is already known on the subject Teleassessment for aphasia is reliable but assessment of auditory comprehension is difficult to adapt to the online environment. There has been limited evaluation of the ability of people with severe aphasia to engage in auditory comprehension teleassessment. What this paper adds to existing knowledge Auditory comprehension assessment can be adapted for videoconferencing administration while maintaining clinical flexibility to support people with severe aphasia. What are the potential or actual clinical implications of this work? Teleassessment is time and cost effective and can be designed to support inclusion of severely impaired individuals.

Abstract 205: Efficacy and Safety of Mechanical Thrombectomy for Primary MeVO with Disabling Deficit

Introduction We aimed to evaluate the efficacy and safety of mechanical thrombectomy (MT) for medium vessel occlusion (MeVO) with the disabling deficit. Methods The study period was from January 2011 to December 2022. Inclusion criteria were 1) within 24 hours of stroke onset, 2) prestroke mRS score ≤1, 3) NIHSS score ≥4 or disabling deficit (complete hemianopia (≥2 on NIHSS), severe aphasia (≥2 on NIHSS), visual sensory extinction (≥1 on NIHSS), significant weakness with NIHSS subscore of paralysis ≥2), 4) MeVO (MCA distal M2, M3, ACA A1, A2, A3, PCA P1, P2, and P3). Outcomes were compared between the MT and standard medical treatment (SMT) groups. Outcome was defined as the favorable outcome (mRS score 0‐2 at 90 days), death within 90 days, and symptomatic intracranial hemorrhage (SICH). Results Of all, 192 patients (72 women, median age 78 years, median NIHSS score 11 points) were enrolled, and 76.6% (n=147) had distal M2 occlusion. Compared to the SMT group (n=153), the MT group (n=39) had a significantly larger median Tmax>10 sec volume (median 25 mL vs. 5 mL, P<0.01) and Tmax> 6‐sec volume (61 mL vs. 44 mL, P<0.01), while median NIHSS score (13 vs. 11, P=0.69) and intravenous thrombus (51.6％ vs. 55.3%, P=0.72) were significantly lower in the MT group. There were significantly more patients in the MT group with a favorable outcome (73.7% vs. 54.1%, adjusted odds ratio 2.59 95% confidence interval 1.07‐6.24), death within 90 days (7.9% vs. 3.1%), SICH (5.3% vs. 4.4%) were not significantly different. In subgroup analysis, MT was independently associated with age (<80 years; 1.33, 1.21‐15.57, P=0.222) and neurological severity (NIHSS ≥10 points; 2.79, 1.07‐7.24, P=0.870) for a favorable outcome. Conclusion In MeVO with disabling deficits, MT was independently associated with more favorable outcomes than the SMT group.

Abstract 252: The outcomes and complications in patients undergoing subclavian‐carotid artery bypass surgery: A case series

Introduction Endovascular intervention has become the mainstay of treatment for acute ischemic stroke. However, in certain cases, open surgery is the only option to achieve revascularization. This study presented two patients with symptomatic common carotid artery occlusion (CCAO) who subsequently underwent subclavian‐carotid artery bypass surgery using the polytetrafluorethylene graft. The complications of the procedure and patient’s outcomes were discussed. Methods We identified two patients who were admitted to our medical center between January 2022 to December 2022 for subclavian‐carotid artery bypass procedure. Clinical data were reviewed retrospectively. Results Case 1. A 69‐year‐old woman with a history of lung cancer, hypertension, chronic tobacco use, atherosclerosis, and known calcified plaque at the left carotid bifurcation on dual antiplatelet therapy presented with acute onset of expressive aphasia and right hemiparesis due to acute left CCAO. Endovascular procedure was deferred due to difficult arterial access. An endarterectomy of CCA, eversion endarterectomy of external carotid artery, and subclavian‐carotid artery bypass surgery were performed. She developed neck hematoma post‐operatively, requiring evacuation. She was discharged to acute rehabilitation facility and eventually home. Six months after surgery, she still had severe expressive aphasia and spasticity of the right arm and leg (Figure A‐C). Case 2. A 79‐year‐old man with a strong family history of arterial dissection, hypertension, coronary artery disease, and obesity experienced intense chest pain and left hemiparesis secondary to Type A aortic dissection with extension from the innominate artery to the right carotid bifurcation. Endovascular intervention was deferred given the angulation of aortic arch after surgical repair. Decision was made to perform subclavian‐carotid artery bypass surgery. Post‐operatively, he had evacuation of neck hematoma. He also had tracheostomy and gastrostomy tube placement prior to discharge to skilled nursing facility. At 6‐month follow up, he could ambulate with a walker and oral diet was resumed (Figure D‐F). Conclusion CCAO is a rare condition, and there is no prospective randomized trial that compares various treatment strategies for symptomatic CCAO. Consistent with the findings of our study, bypass surgeries have been shown as an effective treatment to prevent further ischemic infarct in patients with symptomatic CCAO. Both patients in our study survived at 6‐month follow up with no recurrence of stroke. Additionally, no other surgical complications were noted except for neck hematoma. Bypass surgery was performed as a salvage procedure for both patients after they suffered from stroke. Early identification of CCAO and collaboration between vascular surgeon and endovascular interventionist would maximize the benefit of this life‐saving procedure to the appropriate candidates.