Token Test Scores Research Articles

Intonation Melody Therapy to Improve Language Production in Patients with Non Fluent Aphasia Disorder Post Stroke

Aims: This Evidance Based Nursing Practice (EBNP) is to increase language production in patients with non-fluent aphasia post stroke. Methods: This EBNP method uses pre and post to see an increase in language production by assessing token test scores. By calculating the number of samples G-Power version 3.1.9.7 as many as 7 respondents. Data processing using Jamovi. Results: The analysis obtained using the t-test showed that the token test score experienced a significant change before and after the administration of intonation melody therapy (pValue <0.001), while the outcome of an increase in language production showed a significant change after administration of intonation melody therapy (pValue 0.896) with an average mean change mean 11.4 (95% CI: 6.28 -16.6) and moderate effect size (Cohen's d: 0.205). Conclusion: provision of melodic intonation therapy is proven effective in increasing language production in patients with post stroke non fluent aphasia.

Extra-Linguistic Cognitive Functions Involved in the Token Test: Results from a Cohort of Non-Aphasic Stroke Patients with Right Hemisphere Lesion.

The Token Test (TT) is widely used to examine comprehension disorders in aphasic patients, but abilities other than language may affect a patient's performance. This study aims to explore the correlation between the TT subtest performances and the performances in extra-linguistic cognitive areas in a cohort of patients from the Intensive Rehabilitation Post-Stroke (RIPS) study with a first, right hemisphere stroke and without aphasia, prospectively enrolled at admission to intensive inpatient post-acute rehabilitation. The patients were administered the TT (50-item version), the forward and backward digit span (DST), and the Montreal Cognitive Assessment (MoCA). Spearman's partial correlations adjusted by age were used to evaluate the association between the number of errors in the TT and the other tests' corrected scores. Of the 37 patients enrolled in this study, 29.7% made 3-11 errors on the TT, 27.0% more than 11 errors, mostly in parts IV and V. The forward and backward digit span scores showed correlations with errors in part V of the TT (r = -0.408, p = 0.013; r = -0.307, p = 0.027). The errors in part IV of the TT presented a correlation with a forward digit span too (r = -0.394, p = 0.017). With respect to MoCA domains, executive functioning, and orientation were related to the TT part V errors (r = -0.468, p = 0.007; r = -0.499, p = 0.003). The orientation also correlated with the TT part III (r = -0.504, p = 0.002). Our findings show that the TT performances in patients with right hemisphere stroke and without aphasia are related to impairments in auditory-verbal span/auditory working memory mostly for TT scores on subpart V as measured by the DST and to executive function and orientation, as measured by the MoCA subtests.

Grey and white matter atrophy 1 year after stroke aphasia

Dynamic whole-brain changes occur following stroke, and not just in association with recovery. We tested the hypothesis that the presence of a specific behavioural deficit after stroke would be associated with structural decline (atrophy) in the brain regions supporting the affected function, by examining language deficits post-stroke. We quantified whole-brain structural volume changes longitudinally (3–12 months) in stroke participants with (N = 32) and without aphasia (N = 59) as assessed by the Token Test at 3 months post-stroke, compared with a healthy control group (N = 29). While no significant difference in language decline rates (change in Token Test scores from 3 to 12 months) was observed between groups and some participants in the aphasic group improved their scores, stroke participants with aphasia symptoms at 3 months showed significant atrophy (>2%, P = 0.0001) of the left inferior frontal gyrus not observed in either healthy control or non-aphasic groups over the 3–12 months period. We found significant group differences in the inferior frontal gyrus volume, accounting for age, sex, stroke severity at baseline, education and total intracranial volume (Bonferroni-corrected P = 0.0003). In a subset of participants (aphasic N = 14, non-aphasic N = 36, and healthy control N = 25) with available diffusion-weighted imaging data, we found significant atrophy in the corpus callosum and the left superior longitudinal fasciculus in the aphasic compared with the healthy control group. Language deficits at 3 months post-stroke are associated with accelerated structural decline specific to the left inferior frontal gyrus, highlighting that known functional brain reorganization underlying behavioural improvement may occur in parallel with atrophy of brain regions supporting the language function.

What minimum level of language comprehension is required for reliable administration of the SAQOL-39NLg?

ABSTRACT Background . Quality of life (QOL) is an important outcome in health care, usually captured by self-reported questionnaires. The Stroke Aphasia Quality Of Life Scale (SAQOL-39; SAQOL-39g) was developed by Hilari and colleagues specifically for people with aphasia (PWA), who often struggle with the linguistic complexity of QOL scales. It has since been translated into many languages, including Dutch (SAQOL-39NLg). Some level of (language) comprehension ability is however still required to fill out the SAQOL-39g reliably. So far, little research has been done to evaluate the minimum level of language comprehension needed to fill in the SAQOL-39g. Aim . The aim of this project was to find the minimum level of comprehension needed for PWA to complete the Dutch version of the SAQOL-39g, the SAQOL-39NLg reliably. Methods & procedures . PWA in the chronic phase were asked to fill in the SAQOL-39NLg twice. SLT students supported the PWA during administration. We hypothesized that if PWA comprehend the questions, scores at T1 and T2 should be similar and thus Intraclass Correlation Coefficients would be high. Aphasia severity and language comprehension were assessed at T1 by means of the Token Test, the word and sentence comprehension part of the Comprehensive Aphasia Test- Dutch version (CAT-NL) and the Semantic Association Test (SAT). ICC, Standard Error of Measurement (SEM) and SEM% of the results of the two SAQOL-39NLg administrations were calculated for groups of PWA grouped and ranked based on the results of the language assessments. Outcomes & results . For this study, sixty PWA were included. All of them had some level of comprehension difficulties, the majority moderate to severe. No correlation was found between results on any of the language tests, and difference scores of the two administrations of the SAQOL-39NLg. The ICC between SAQOL-39NLg administrations was above 0.73 when clustered on SAT scores, and above 0.80 for groups clustered based on Token Test and CAT-NL scores. For all repeated measurements, SEM% was between 5% and 10%, and therefore acceptable. Conclusions . We conclude that it is possible for PWA to answer the SAQOL-39NLg reliably, when he or she is able to perform language tests. This finding strongly suggests that PWA should not be excluded from scientific research, when questionnaires are used.

Profile and Determinants of Neurocognitive Dysfunction in a Sample of Adult Nigerians With Heart Failure

Heart failure (HF) in Africans is peculiar because subjects are younger than whites and have lower socioeconomic and educational level in addition to the high prevalence of hypertension-related etiology and increased mortality. Whereas cognitive dysfunction have been demonstrated among whites with HF, the prevalence and pattern of cognitive dysfunction among sub-Saharan African patients with HF have not been evaluated against this background. The aim of this study is to determine the 1-year prevalence and the factors contributing to cognitive dysfunction in a cohort of Nigerian patients with HF. In this cross-sectional case-control study, cognitive performance was evaluated in 111 consecutive individuals (60 HF patients and 51 controls matched for age, gender, and level of education) using the Community Screening Interview for Dementia, Word List Learning Delayed Recall, Boston Naming Test, and Modified Token Test. Other clinical and disease-specific variables were collated and correlated with cognitive performance. The mean total Community Screening Interview for Dementia, Word List Learning Delayed Recall, Boston Naming Test, and Modified Token Test scores were significantly lower among HF patients (P = < .001). The prevalence of global cognitive dysfunction was 90.0% in HF and 5.9% among controls (odds ratio, 15.3; 95% confidence interval, 5.08-46.01). Elevated systolic blood pressure, increased comorbidity index, and wide pulse pressure were significantly associated with poorer performance on at least 1 neuropsychological test. Using a multivariate linear regression analysis, pulse pressure retained its significance (P = .029; 95% confidence interval, -0.117 to -0.007) as the most important predictor of cognitive dysfunction in the cohort of HF patients. Cognitive dysfunction is prevalent among this sample of Nigerians with HF. Regular cognitive screening is therefore advocated among this high-risk group. Controlling comorbidities as well as blood pressure may improve cognitive performance among patients with HF.

Aphasia with recurring utterances: Old syndrome, new perspectives

Background: Little is known about the linguistic, structural and functional recovery on which the production of aphasic recurring utterances (RUs) is based.Methods & Procedures: Retrospective database analysis was performed to study the prevalence of RUs among aphasia patients. Language features and recovery were examined in patients with RUs, who were matched with aphasic controls with similar demographic and clinical characteristics.Outcomes & Results: Of the 147 aphasia patients admitted to a rehabilitation unit, between 2008 and 2012, 12.92% exhibited some form of RU. When we examined the prevalence among those with global aphasia, it increased to 24.6%. Each patient displayed the stereotypy, with some meaningful modulation or intonation with communicative intent. Although there was some recovery (particularly in comprehension), language of all patients remained severely impaired. Patients with RU scored considerably less than the control group in aphasia quotient (U = 209.00; p = .000), in naming task (U = 174.0; p = .002) and in word repetition (U = 196.0; p = .000). But there were no significant differences between the two groups on a comprehension task (t = −.75 (1,28); p = .261) and Token test scores (U = 321.1; p = .130).Conclusions: Our data support the notion that RUs do not represent an absence of language abilities. Language characteristics and recovery pattern were discussed in terms of cognitive processes and neuroplasticity. The social impact of RUs is also highlighted.

The ScreeLing: Occurrence of linguistic deficits in acute aphasia post-stroke

To investigate the occurrence of semantic, phonological and syntactic deficits in acute aphasia with the ScreeLing after the establishment of its psychometric properties. To examine the relationship between these deficits and: (i) overall aphasia severity; and (ii) quality of Spontaneous Speech. The reliability and validity of the ScreeLing was established by investigating 141 subjects with acute aphasia (2 weeks after stroke), 23 with chronic aphasia, and 138 healthy controls. In addition, the acute patients were assessed with the Token Test and a Spontaneous Speech rating (Aphasia Severity Rating Scale). The ScreeLing was found to be valid and reliable for assessing the presence and severity of aphasia and linguistic deficits at 12 days after stroke. In 22.4% of the patients deficits were found in only 1 of the 3 linguistic levels; phonology was most frequently disturbed (16.3%), compared with semantics (2.7%), and syntax (3.4%). The number of impaired linguistic levels was related to aphasia severity: patients with a 3-level disorder had the lowest Token Test scores; patients with a selective phonological disorder had the highest Spontaneous Speech ratings. Phonology alone explained 54.6% of the variance in the Spontaneous Speech rating. In the acute stage, linguistic-level deficits are already present independently of each other, with phonology affected most frequently.

Therapy efficacy in chronic aphasia.

There is good evidence that aphasia therapy is effective if sufficiently prolonged or intensive and that chronic aphasic individuals can also benefit from therapy, but data on chronic aphasia are scanty.The aim of this retrospective study was to investigate whether chronic aphasia benefits from a very intensive therapeutic regimen. We revised the files (January 2000 to December 2008) of the chronic subjects whom we suggested have periodic sessions in our Unit (generally once a week) and 2–3 hours daily of homework with the help of a family member, supervised and controlled by the speech-therapist. Treatment would go on as long as amelioration is evident. Results for 23 chronic aphasic subjects are reported. All subjects had undergone previous therapy and 10 had been dismissed because no further recovery was expected. Recovery was significant in oral and written nouns and actions naming, oral and written sentence production and Token Test scores. Only 4 subjects did not improve. Severity of the disorder did not predict success or failure. We conclude that recovery was due to the intense work done. Further, we believe such a regimen could be successful in a number of patients for whom a less intensive regimen would not be effective.

Therapy Efficacy in Chronic Aphasia

There is good evidence that aphasia therapy is effective if sufficiently prolonged or intensive and that chronic aphasic individuals can also benefit from therapy, but data on chronic aphasia are scanty.The aim of this retrospective study was to investigate whether chronic aphasia benefits from a very intensive therapeutic regimen. We revised the files (January 2000 to December 2008) of the chronic subjects whom we suggested have periodic sessions in our Unit (generally once a week) and 2–3 hours daily of homework with the help of a family member, supervised and controlled by the speech-therapist. Treatment would go on as long as amelioration is evident. Results for 23 chronic aphasic subjects are reported. All subjects had undergone previous therapy and 10 had been dismissed because no further recovery was expected. Recovery was significant in oral and written nouns and actions naming, oral and written sentence production and Token Test scores. Only 4 subjects did not improve. Severity of the disorder did not predict success or failure. We conclude that recovery was due to the intense work done. Further, we believe such a regimen could be successful in a number of patients for whom a less intensive regimen would not be effective.

Estudo Normativo do Token Test versão reduzida: dados preliminares para uma população de idosos brasileiros

INTRODUCAO: A preservacao das habilidades de compreensao da fala nos idosos esta correlacionada com a preservacao das funcoes cognitivas. Essa habilidade e caracteristica fundamental para a comunicacao e sua avaliacao possibilita a identificacao de deficits cognitivos mais especificos, alem de facilitar o desenvolvimento de estrategias de intervencao mais precoces e eficientes. OBJETIVO: Disponibilizar normas contemporâneas para a utilizacao de um instrumento de avaliacao da compreensao verbal, o Token Test, para idosos brasileiros saudaveis. METODO: Uma amostra com 120 idosos (76 mulheres), com medias de 71,1 anos para idade e de 6,9 anos de educacao formal para escolaridade, foi avaliada utilizando o Miniexame do Estado Mental, para identificacao da existencia de comprometimento cognitivo, e o Token Test, para avaliacao da compreensao da fala. RESULTADOS: Foram encontradas correlacoes significativas (p < 0,01) entre o escore do Token Test e a educacao formal e a idade, os quais corresponderam respectivamente a 5% e 21% da variância compartilhada. Tais variaveis foram consideradas nas tabelas normativas. CONCLUSAO:Nossos dados indicam que as normas disponibilizadas aqui sao suficientemente representativas. Este trabalho abre caminho para estudos futuros de comparacao entre o desempenho no Token Test de idosos saudaveis e daqueles em processos de declinio cognitivo.

Oral language comprehension assessment among elderly: A population based study in Brazil

Background Determinants of oral language comprehension, a complex skill, are not clearly established, but may include age, schooling, health condition, depression and quality of life. Objective To assess oral comprehension skill among Brazilian elderly and identify factors explaining elderly variability in the Token test performance. Methods A population-based random sample of 373 elderly (≥ 60 years) in Belo Horizonte, 2007, answered standardized questionnaire including socio-demographic and health-related questions and performed the Token Test short version (SVTT), Snellen Test, Mini Mental State Examination, General Health Questionnaire, and Health Survey Short Form (SF12). Results Token Test scores ranged from 8 to 35 points; 50% of participants scored ≤ 24 points with no sex variation. Age, schooling, literacy, cognitive status, hypertension, self-rated conversational understanding and SF12 mental component explained 62% of SVTT variability. Conclusions Language comprehension disorder was quite common and test performance was highly influenced by education and cognitive status. Association between test performance and self-rated conversational comprehension indicated that elderly were aware of their difficulty.

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

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

Normative data of 300 Dutch‐speaking children on the Token Test

Background: The Token Test (TT) was originally developed to detect—subtle—oral comprehension difficulties in aphasic adults. Subsequent studies underscored its power to discriminate aphasic from non‐aphasic brain‐damaged participants, and confirmed its clinical utility to such an extent that it was included in several aphasia assessment batteries. These attempts at standardising and clinically validating the TT in adult participants were paralleled by similar efforts in children. As a result, the TT was used as a reliable instrument to study different clinical childhood populations, to help determining receptive language ability in paediatric participant/patient groups, and to assess the validity of other childhood auditory receptive language tests. It was shown that the TT can be used to discriminate children with acquired aphasia from non‐aphasic brain‐injured children. Aims: (1) To introduce norms for children between 6 and 16 years of age, in order to improve the clinical use of the TT in the Dutch‐speaking paediatric group; and (2) to test the adequacy of the TT in a clinical paediatric population. Methods & Procedures: The 61‐item version of the TT was administered to 300 Dutch‐speaking normal schoolchildren whose ages ranged from 6 to 16 years. Medians, upper and lower quartiles, and the lower 5% limits were calculated per age group. Graphs were drawn up by using a least squares fit to normative data separately for boys and girls. To address the utility of the TT in a neuropaediatric setting, the scores of 38 Dutch‐speaking children with acquired aphasia were reviewed retrospectively and compared with the current norms. Outcomes & Results: Data analysis showed a highly significant positive correlation between age and TT score in the total norm group (r s = .57; p < .001), as well as in the female (r s = .69; p < .001) and male (r s = .50; p < .001) groups. Gender also plays a role in test performance, girls attaining significantly higher total TT scores (U = 9340; p = .01). A retrospective review of the TT scores of 38 aphasic children revealed that 65% of the boys and 80% of the girls scored on or below the lower 5% limit, whereas 91% of the boys and 100% of the girls performed on or below the lower quartile. Conclusions: The normative data collected in a large sample of healthy children suggest a faster language development in girls than in boys. The norms also discriminate children with aphasia from healthy children, which finding underlines the clinical utility of the TT in a neuropaediatric setting. A comparison of the aphasic children's performance with the present norms shows that series 5 is a valuable abbreviated TT alternative.

Comparison of Alternatives to Multidimensional Scoring in the Assessment of Language Comprehension in Aphasia

Multidimensional scoring methods yield valuable information about communication abilities. However, issues of training demands for valid and reliable scoring, especially in current service delivery contexts, may preclude common usage. Alternatives to multidimensional scoring were investigated in a sample of adults with aphasia. One alternative method involved modified multidimensional scoring; the others incorporated correct/incorrect scoring. The scores for the 3 alternative methods were derived from the scores obtained using the traditional multidimensional method. Revised Token Test scores obtained using the traditional multidimensional method were collected from 10 participants with aphasia. These scores were manipulated to yield 3 additional sets of scores corresponding to the alternative methods. There were no significant differences between the traditional multidimensional method and 1 of the correct/incorrect methods. Significant differences were found between traditional multidimensional scoring and each of the other 2 methods. The study findings suggest that simpler scoring systems might yield similar data to traditional multidimensional scoring. If simpler alternative methods yield similar results, using alternative scoring methods with published tests based on multidimensional scoring will help expand their use in everyday clinical practice.

Measures of Maternal Alcohol Use as Predictors of Development in Early Childhood

The effect of prenatal alcohol exposure on growth, dysmorphology, and cognitive development at 6 years was examined in children whose mothers had completed a self-administered questionnaire during pregnancy. Drinking patterns prior to pregnancy recognition and indications of problem drinking (IPD) were assessed. Heavier alcohol intake was associated with slower growth in height and head circumference and increased dysmorphology, as evidenced by facial features associated with fetal alcohol syndrome (FAS) and the prevalence of probable/possible fetal alcohol effects (FAE). Indications of problem drinking predicted facial features associated with FAS and cognitive deficits (i.e., lower WPPSI Verbal IQ scores and lower scores on a test of receptive language function, the Token Test). Effects of alcohol consumption on head circumference and of indications of problem drinking on Verbal IQ and Token Test scores remained significant, even after excluding children born to mothers having drinkers (over seven drinks a day) and children with probable/possible FAE. Verbal IQ was an average of 7.1 points (95% confidence interval = 0.01, 14.25) lower among children born to mothers having more than one indication of problem drinking than it was among those born to women having fewer indications; Token Test scores were 4.3 points lower (95% confidence interval = 1.38, 7.24). Although the confidence intervals for these estimates are broad in this small, heterogeneous sample, their magnitude, if confirmed, is significant given that the population standard deviation for Verbal IQ is 15, and that for the Token Test is 5.

On the neurological status of speech automatisms and its significance for neurolinguistic models

Abstract Forty-five aphasic patients, who had suffered a left middle cerebral infarction involving more than 2% of forebrain volume at least 4 months previously, were investigated for the presence of speech automatisms and their accompanying neurological and neuropsychological symptoms. Fourteen patients were found to produce automatisms. The presence of this symptom was correlated, although not closely, with degree of bucco–facial apraxia, but not significantly with lesion size. The correlation with Token Test scores was insignificant when the effects of ideomotor apraxia had been partialized. We interpret our observations on the basis of a theory that speech automatisms are a symptom of primary or secondary severe dysfunction in the periphery of the language production apparatus in the vicinity of processes of speech motor planning and execution.

Recovery from ideomotor apraxia. A study on acute stroke patients.

In this study we investigated whether there are predictors for recovery from ideomotor apraxia (IMA) in patients with focal left hemisphere vascular lesions. Recovery was followed in 26 patients, first examined between 15 and 30 days postonset. They were apraxic at the first examination and had a second (and in some cases, a third) neuropsychological assessment after some months. Six patients with bilateral lesions were also studied to help to define the role of the right hemisphere in recovery from IMA. Other neuropsychological variables (Token Test, Progressive Matrices and Oral Apraxia scores) and site and size of the lesion were also determined. The main results are that improvement from IMA is related to the site of the lesion (anterior lesions faring better); the evolution of IMA is related more to the evolution of oral apraxia than to the evolution of other neuropsychological variables; and the presence of a second lesion in the right hemisphere did not have the negative influence on recovery that might have been expected.

Crossed Aphasia: One Or More Syndromes?

Seven strongly right-handed patients developed aphasia following a right hemisphere vascular lesion documented by computerized tomography. One patient had a severe unilateral neglect, indication of its presence were evident in three and absent in three patients. The Token Test scores were significantly higher than in matched controls. Two patients had Broca aphasia, four had Wernicke aphasia and one had agraphia. The correlation between type of aphasia and locus of lesion was not much different from that normally found in standard left hemisphere brain demaged aphasics.

Comprehension of Abstract and Concrete Commands by High and Low Level Aphasic Subjects: Effects of Presentation Mode

This study examined the effects of live voice (LV), tape recorded (TR) and videotape recorded (VTR) presentations on high and low level aphasic subjects' auditory comprehension of abstract and concrete token test commands. Subjects' understanding of Token Test commands was not influenced significantly by mode of presentation. The performances of high-comprehension and low-comprehension aphasic groups was not significantly different. Analysis of weighted token test scores, but not plus-minus scores, showed subjects to perform significantly better on concrete than abstract token test commands. Clinical implications emerging from the study are 1) that the Token Test should probably be delivered by tape recorder to standardize presentation and 2) that the use of recorded stimuli may provide a valuable adjunctive means of providing auditory comprehension training for some aphasic clients.

Comprehension of main ideas and details in coherent and noncoherent discourse by aphasic and nonaphasic listeners

Aphasic and nonaphasic listeners' comprehension of main ideas and details within coherent and noncoherent narrative discourse was examined. Coherent paragraphs contained one topic to which all sentences in the paragraph related. Noncoherent paragraphs contained a change in topic with every third or fourth sentence. Each paragraph contained four main ideas and one or more details that related to each main idea. Listeners' responses to yes/no questions following each paragraph yielded the following results: (1) Nonaphasic listeners comprehended the paragraphs better than aphasic listeners. (2) Both aphasic and nonaphasic listeners comprehended main ideas better than they comprehended details. (3) Coherence did not affect comprehension of main ideas for either group. (4) Coherence did not affect comprehension of details by nonaphasic subjects. (5) Coherence affected comprehension of details by aphasic subjects, and their comprehension of details in coherent paragraphs was worse than their comprehension of details in noncoherent paragraphs. There was no significant correlation between Token Test scores and measures of paragraph comprehension.