Type Of Aphasia Research Articles

Exploring Communicative Gestures in Czech Persons with Diagnosed Aphasia

In my investigation, I worked with 6 persons with diagnosed aphasia. I introduce some possible perspectives on the exploration of the extent of speech damage in persons with aphasia and the various ways in which they substitute for language deficiency with the aid of gestures.
 From the viewpoint of data processing methods, on the one hand, I explore the parameters of spoken language, such as the quantity of words, and, on the other hand, the parameters of gestures, such as the quantity of gestures, diversity of gestures, etc. In aphasic persons speaking Czech, I verify the following assumption established by Jakob et al. (2011): the more speech-limited an aphasic person is, the more gestures he/she produces during the interpretation of a story.
 It was found that the number of words produced by aphasic persons varies, partially dependent on the specific type of aphasia. This is particularly true on both ends of the scale – people with large speech distortion use the highest quantity of gestures, people with low speech distortion use gestures to a lesser extent. Within the classification of semantic gestures, I focus particularly on iconic and deictic gestures. In addition, I presume that symbolic gestures (i.e. emblems) do not occur in aphasic persons’ speech, because aphasic persons prefer gestures that display the plot in the most concrete way.
 My data correlate with other studies dealing with this topic – aphasic persons do use gestures intentionally to substitute for their verbal deficiency. At the same time, they mostly use very concrete (iconic) gestures, which enable them to transmit a large volume of information.

Cue responsiveness as a measure of emerging language ability in aphasia

ABSTRACT Background Prior research suggests that initial aphasia severity, lesion size, and lesion location are the most salient factors in predicting recovery outcomes. While these factors provide important prognostic information, information that is individualized and readily available to clinicians is limited. Deficits in naming are common to all aphasia types and are routinely targeted in aphasia assessment and treatment, with cues provided to facilitate lexical retrieval. Objectives In this study, we examine aphasia recovery factors that are readily available to clinicians, examining whether a person’s ability to improve naming with cues, indicating “stimulability,” will be predictive of future word retrieval. Methods Ten participants with aphasia following a left-hemisphere stroke participated in initial assessment, seven of whom met criteria for longitudinal assessment. Stroke and early clinical recovery data were collected for all participants. At four timepoints over one year we evaluated longitudinal participants’ naming ability and measured the proportion of successful lexical retrieval with the presentation of phonemic, feature, and sentence cues. Results For all participants, multiple descriptive factors regarding recovery, including lesion information, information from the acute inpatient timeframe, and communication opportunities, were examined. For individuals followed longitudinally, naming stimulability did not consistently predict naming accuracy at the subsequent assessment timepoint. Individuals’ attempts at naming emerged as a metric related to future naming performance warranting further evaluation. Conclusions Multiple factors related to recovery must be considered when providing prognostic information. Naming stimulability and attempts at naming provide some information regarding future performance, but are not consistently reliable across timepoints.

A Brief Executive Language Screen for Frontal Aphasia.

Aphasia assessment tools have primarily focused on classical aphasia type and severity, with minimal incorporation of recent findings that suggest a significant role of executive control operations in language generation. Assessment of the interface between language and executive functions is needed to improve detection of spontaneous speech difficulties. In this study we develop a new Brief Executive Language Screen (BELS), a brief tool specifically designed to assess core language and executive functions shown to be involved in spontaneous generation of language. Similar to other measures of aphasia, the BELS assesses articulation and core language skills (repetition, naming and comprehension). Unique additions to the BELS include assessments of spontaneous connected speech, word fluency (phonemic/semantic) and sentence completion (verbal initiation, inhibition and selection). One-hundred and eight healthy controls and 136 stroke patients were recruited. Confirmatory factor analysis was used to determine construct validity and logistic regression was used to evaluate the discriminative validity, informing the final version of the BELS. The results showed that the BELS is sensitive for articulation and nominal language deficits, and it measures executive aspects of spontaneous language generation, which is a hallmark of frontal dynamic aphasia. The results have encouraging theoretical and practical implications.

Problems of patients with aphasia in a psychosocial context

Aphasia is an acquired speech disorder resulting from a brain damage. It affects language both in its expression and reception. Disturbances in the language communication process lead to serious disorders in the psychosocial functioning of a person. Language is the most important tool for establishing verbal interactions and attaining your intentions in communication. Consequently, aphasia can lead to social isolation and loss of social roles. The article deals with the problems of psychosocial functioning of patients with aphasia. The first part outlines issues related to aphasia. We define types of aphasia, its symptoms and causes. The rest of the article is devoted to the presentation of psychosocial situation of people with aphasia. Then, attention is paid to the role of social support in better adaptation of patients to life in the new social and family situation, and includes guidelines to facilitate communication with a person suffering from aphasia.

Development of a categorical naming test in Korean: Standardization and clinical application for patients with stroke

PurposeThe purpose of this study was to develop and standardize a new categorical naming test, titled the Categorical Naming Test (CNT), for stroke patients, and to investigate its validity and clinical usefulness for patients with stroke.Materials and methodsThe CNT was developed based on semantic category, imageability, and psycholinguistic factors such as word frequency and word length. The test materials included two main semantic categories (living objects and artificial objects) comprising 60 items. We standardized the CNT on 221 healthy adults and administered the CNT to 112 stroke patients.ResultsInternal consistency and concurrent validity of the test were high. The mean total CNT scores varied significantly according to participants’ age, sex, and education. Among healthy controls, the scores for naming living objects were significantly higher than those for artificial objects. The analysis of stroke patients showed that the total CNT score revealed a statistically significant difference based on the patients’ lesion laterality and presence of aphasia, after controlling for age, sex, and education. However, the categorical scores achieved by comparing the naming scores for living and artificial objects showed no significant differences according to lesion laterality, stroke type, and presence of aphasia.ConclusionThe CNT is a newly developed version of an overt naming task with high internal consistency validity for stroke patients in Korea. The newly developed CNT can prove useful in evaluating naming ability in stroke patients.

Sentence Recall in Latent and Anomic Aphasia: An Exploratory Study of Semantics and Syntax.

We investigated whether semantic plausibility and syntactic complexity affect immediate sentence recall in people with latent and anomic aphasia. To date, these factors have not been explored in these types of aphasia. As with previous studies of sentence recall, we measured accuracy of verbatim recall and uniquely real-time speech measures. The results showed that accuracy did not distinguish performance between latent aphasia and neurotypical controls. However, some of the real-time speech measures distinguished performance between people with latent aphasia and neurotypical controls. There was some evidence, though not pervasive, that semantic plausibility and syntactic complexity influenced recall performance. There were no interactions between semantic plausibility and syntactic complexity. The speed of preparation of responses was slower in latent aphasia than controls; it was also slower in anomic aphasia than both latent and control groups. It appears that processing speed as indexed by temporal speech measures may be differentially compromised in latent and anomic aphasia. However, semantic plausibility and syntactic complexity did not show clear patterns of performance among the groups. Notwithstanding the absence of interactions, we advance an explanation based on conceptual short-term memory as to why semantically implausible sentences are typically more erroneous and possibly also slower in recall.

Grammar in the brain: Two grammar subsystems and two agrammatic types of aphasia

Grammar includes not only the ability to use verbs but also the ability to express and understand the relationships existing among the words in a sentence. Since the initial description of agrammatism (Kussmaul, 1877) it was proposed that there are two different types of agrammatism: Aktaphasie and Agrammatismus . The first one has been extensively studied, while the second one has been mostly overlooked. To analyze the brain areas involved in understanding the relationships existing among the words in a sentence. Its disturbances would correspond to the second type of agrammatism. Prepositions, adverbs, and grammatical cases are used to indicate the relationships among sentence words. This is a quasi-spatial ability supported by the left posterior parietal lobe. Almost one century ago a type of aphasia referred to as “semantic aphasia”, associated with left posterior parietal damage and characterized by the inability to use and understand the relationships among the language words, was described. Excepting a few papers, this type of aphasia has been usually ignored in the contemporary neuroscience literature. From the historical perspective, it has been proposed that grammar evolved in two steps: (1) proto-grammar, consisting of flat verb-noun compounds, and (2) hierarchical syntax or complex grammar. The first one is associated with the ability to use and understand verbs. The second one can be related to the ability to use verbally mediate spatial concepts. Some recently published cases of semantic aphasia corroborate its clinical manifestations and the locus of pathology. Functional studies support the participation of the left posterior parietal lobe in grammar. It is concluded that evidence suggests that semantic aphasia is a real type of aphasia and indeed there are two grammatical subsystems in the brain and two agrammatic types of aphasia. • Grammar contains the use of action and function words to express the relationship of elements in a sentence. • Action words (verbs) are supported by the Broca's area, while function words by the left posterior parietal lobe. • Left parietal lobe is specialized in understanding and using verbally mediated spatial information. • Damage in the left posterior parietal lobe results in so-called semantic aphasia. • Several pathways interconnect both grammatical subsystems.

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

Non-primary progressive language impairment in neurodegenerative conditions: protocol for a scoping review

BackgroundProgressive language difficulties arise in many neurodegenerative conditions, causing significant impact upon patients and families. This occurs most obviously in primary progressive aphasia (PPA) but can also occur within other forms of progressive disease. In these cases, language decline may be significant, but as they are not the presenting or dominant symptom, may be overlooked in favour of more prominent cognitive, behaviour or motor deficits. To date, there has been no systematic investigation into non-primary progressive aphasia. This scoping review aims to describe the currently reported language impairments found in non-language-led dementias and identify their clinical relevance, defined as the impact on everyday living. It also seeks to identify the reported interventions for language impairment in this patient group to-date.MethodWe will conduct a scoping review of published studies that have assessed and/or treated aphasia in people diagnosed with a neurodegenerative condition other than primary progressive aphasia. The systematic search will include the electronic databases PubMed, MEDLINE, OVID-EMBASE, PsycINFO, and speechBITE, using search terms for specific non-language-led dementia subtypes. Findings will be mapped and described according to the type of language difficulties identified and rehabilitation approaches employed. Intervention studies will be evaluated for their methodological rigour using validated scales.DiscussionThis scoping review will provide an overview of the types of aphasia found in neurodegenerative conditions where language dysfunction is not the primary focus. Current treatment approaches (and gaps in the provision of treatment) will be identified.

Gesture, prosody and verbal content in non-fluent aphasic speech

Abstract Non-fluent aphasia is characterized by frequent word search and a much slower speech rate than non-aphasic speech. For patients with this type of aphasia, communication with those around them is therefore made difficult and is often severely impaired. One of the therapeutic proposals to improve the quality of life of these patients is to re-educate them with more multimodal alternatives. This of course assumes that gestures represent possible alternative means of communication for patients, and that their gestures are not affected in the same way as their speech. This article therefore proposes to study the gestures of 4 aphasic people and to compare them to the gestures performed by non-aphasic people, but also to establish correspondences between those gestures, intonation contours and the way people with aphasia develop their discourse. Results show that although gesture rate is not different in the two groups of participants, the gesture-to-speech ratio is higher for people with aphasia (PWA) than for non-aphasic people (NAP). Considering the fact that PWA also gesture more than NAP during silent pauses, which are longer but not more frequent than in NAP’s speech, and the fact that their gestures coincide less often with a lexical word, we believe that PWA use their gestures as compensation strategies for deficient speech. Yet, their speech impairment is also reflected in their gesturing: more gestures are prepared but abandoned before the stroke in this group and pre-stroke holds are longer, which means that PWA hold their gestures in the hope that they will better coincide with the word they are supposed to accompany and which takes more time to be uttered than in non-pathological speech. Their gestures are also less linked to each other than in the NAP group which goes hand in hand with the fact that they tend to utter independent syntactic phrases with no cohesive marker between them. This is also reflected in their less frequent use of flat and rising tones in intonation, which generally indicate that two sentence parts are dependent one upon the other, as well as their less frequent use of gestures showing discourse organization. In terms of gesture types, the PWA in this study perform many rhythmic beats and rely much on conventional gestures to compensate for their speech impairment rather than on their own creativity. Globally, this means that if multimodal therapies may benefit PWA to improve their communication with other people, speech therapists nevertheless need to be aware that life-long habits of gesture-speech alignment and synchronization may not be so easy to overcome for patients.

Psycholinguistic norms for 92 action pictures and verbs in the Persian language in young- and middle-aged people

A verb as the fundamental part of a sentence is important and its retrieval consists of different cognitive stages. Additionally, verb retrieval difficulty is reported in some types of aphasia and other neurological diseases, and some psycholinguistic variables can influence the verb retrieval process. This study aimed to provide a normative database in the Persian language for 92 black and white action pictures and related verbs in two groups of young ages (20 to 40 years old) and middle ages (41 to 64 years old). A total of 150 volunteers participated in this study, and the groups had similar characteristics due to education. The pictures were normed for variables such as name agreement, familiarity, visual complexity, age of acquisition, and image agreement. Correlation coefficients were calculated values among these measures, and comparisons were made between the two age groups. The results of the comparisons between the two groups showed that name agreement and familiarities were age-dependent. The results revealed that all measures varied with age. Also, the present study provided a set of verbs and their pictures in the Persian language and normative data were obtained on the psycholinguistic variables such that it can be used for clinical practice and research in the areas of verb processing and their naming.

What are the barriers to participation in a neuromodulation pilot trial for aphasia after stroke?

Aphasia is a common and debilitating manifestation of stroke. Transcranial electrical stimulation uses low-intensity electric currents to induce changes in neuronal activity. Recent evidence suggests that noninvasive techniques can be a valuable rehabilitation tool for patients with aphasia. However, it is difficult to recruit patients with aphasia for trials, and the reasons for this are not well understood. This study aimed to elucidate the main difficulties involved in patient's recruitment and inclusion in a randomized clinical study of neuromodulation in aphasia. We evaluated the reasons for the exclusion of patients in a pilot, randomized, double-blinded clinical trial in which patients diagnosed with motor aphasia after stroke were recruited from March to November 2018. A descriptive statistical analysis was performed. Only 12.9% (4) of patients with ischemic stroke were included in the clinical trial. A total of 87.1% (27) of the 31 recruited patients were excluded for various reasons including: sensory aphasia (32.2%), dysarthria (25.8%), spontaneous clinical recovery (16.1%), previous stroke (6.4%), and death or mutism (3.2%). The presence of other types of aphasia, dysarthria, spontaneous recovery, deaths, and mutism were barriers to recruiting patients evidenced in this neuromodulation study.

Conduction aphasia in patients with glioma in the left hemisphere

Syndromic analysis of speech and writing disorders in patients with arcuate tract lesion using the method by A.R. Luria and their comparison with well-known types of aphasia. Clinical and neuropsychological survey was performed in 14 patients with gliomas who underwent surgical treatment at the Burdenko Neurosurgical Center (10 gliomas of the frontal lobe and 4 tumors of the temporal lobe). All patients underwent MRI, HARDI MRI tractography and A.R. Luria's neuropsychological examination prior to surgery and after 5-6 postoperative days. Thirteen patients underwent awake craniotomy, 3 of them were examined one year after surgery. In all patients, the tumor was localized near arcuate tract and its infiltration was noted. No intraoperative damage to the tract was ever noted according to speech monitoring data. However, postoperative edema followed by infiltration and dislocation of the tract (in all patients), as well as local ischemia in 4 patients were observed. After resection of prefrontal and premotor gliomas, aphasia included frontal (perseveration) and temporal components (disorders of naming, auditory-speech memory). Unusual verbal paraphrases were noted. We also observed severe violation of writing (temporal type) even if spontaneous speech and repetition were preserved. In case of resection of deep posterior temporal gliomas, speech disorders included signs of frontal lobe lesion (perseveration) and writing disorders. Similar motor abnormalities were identified in writing. Arcuate tract lesion can result speech and writing disorders as signs of damage to certain cortical speech zones (frontal and temporal lobe). Violations of repetition were not predominant in any case. At the same time, interruption of connection between motor and auditory image of the word could be revealed in writing.

Leveraging big data to understand the interaction of task and language during monologic spoken discourse in speakers with and without aphasia

ABSTRACT Monologic spoken discourse allows us to evaluate every day speech while retaining some experimental constraint. It also has clinical relevance, providing cognitive-linguistic information not measured on typical standardised tests. Here, we leverage big behavioural data (AphasiaBank) to understand how discourse genres (narrative, procedural, expositional), and unique tasks within those genres, influence microstructural elements of discourse. We compare task × microstructure interaction across speakers with and without aphasia and evaluate the influence of aphasia type and overall aphasia severity on this interaction. Using multivariate statistical methods, we find that, for both speaker groups, discourse microstructure is most similar for tasks within the same discourse genre and that microstructure is largely dissociable across discourse genres. The aphasia group had more speaker variance per task, which was partially explained by aphasia type and overall aphasia severity. Our results provide necessary information for usage and interpretation of monologic discourse in research and clinical contexts.

A child with aphasia – An outline of the problem

The article is a scientific paper on the issue of aphasia. The author carries out a review and critical analysis of terminology describing this unique speech and language disorder. She points to the lack of terminological coherence both among specialists and among parents of children with aphasia. She also lists different types of aphasia, describes them, and presents the origins of cortical disorders. The second part of the article presents procedures included in selected legislative acts on the organization of education for children with special educational needs, including children with aphasia. The author analyses the successive stages of the psychological and educational counseling procedures that parents go through in their child's assessment and treatment process.

Prevalence of Verb and Sentence Impairment in Aphasia as Demonstrated by Cluster Analysis

ABSTRACT Background: Verb and sentence processing impairments are frequently observed in people with aphasia (PWA). However, patterns of impairment (i.e. combinations of deficits that are revealed by arrays of tasks) are usually investigated at the group level, by selecting groups of patients with specific aphasia types (e.g., non-fluent variants with signs of agrammatism), or in case-series with relatively small samples. Aims: We aimed to explore patterns of impairment in verb and sentence processing in a large (N = 54) group of PWA with various aphasia types, using methods that do not require a priori aphasia-type information. Methods & Procedures: To assess verb and sentence processing impairments in production and comprehension, we used the Verb and Sentence Test (VAST) adapted to Russian (VAST-Ru). As our main method, we used k-means cluster analysis to group individuals based on their scores on different tasks of the VAST-Ru. We then compared cluster allocations to aphasia types (according to Alexander Luria’s classification) established by a standard clinical evaluation procedure. As a follow up, we investigated performance of each person with aphasia on each task by comparing their individual scores to the control group. Outcomes & Results: The k-means analysis grouped the PWA into two clusters. The main difference between the clusters was the severity of impairment across most of the tasks, both at the single verb and at the sentence level, both in production and in comprehension. All participants with efferent motor aphasia (roughly corresponding to Broca’s aphasia) and most of the participants with acoustic-mnestic aphasia (roughly corresponding to anomic aphasia) were in the less-impaired cluster. Complex aphasia types (complex motor and complex temporal aphasia) pertained to the more-impaired cluster, while other aphasia types (dynamic aphasia, corresponding to transcortical motor, and sensory, corresponding to Wernicke’s aphasia) were more or less evenly distributed over two clusters. Individual-level analysis revealed heterogeneous patterns of impairment in both clusters and across different aphasia types. Conclusions: These results demonstrate that verb and sentence impairments are prevalent in aphasia, irrespective of the aphasia type. They also indicate that aphasia severity mediates verb and sentence impairment in aphasia. We could not find a clear correspondence between individual patterns of impairment and aphasia type at this stage. The clinical implications are discussed.

Multisensory cueing facilitates naming in aphasia

BackgroundImpaired naming is a ubiquitous symptom in all types of aphasia, which often adversely impacts independence, quality of life, and recovery of affected individuals. Previous research has demonstrated that naming can be facilitated by phonological and semantic cueing strategies that are largely incorporated into the treatment of anomic disturbances. Beneficial effects of cueing, whereby naming becomes faster and more accurate, are often attributed to the priming mechanisms occurring within the distributed language network.ObjectiveWe proposed and explored two novel cueing techniques: (1) Silent Visuomotor Cues (SVC), which provided articulatory information of target words presented in the form of silent videos, and (2) Semantic Auditory Cues (SAC), which consisted of acoustic information semantically relevant to target words (ringing for “telephone”). Grounded in neurophysiological evidence, we hypothesized that both SVC and SAC might aid communicative effectiveness possibly by triggering activity in perceptual and semantic language regions, respectively.MethodsTen participants with chronic non-fluent aphasia were recruited for a longitudinal clinical intervention. Participants were split into dyads (i.e., five pairs of two participants) and required to engage in a turn-based peer-to-peer language game using the Rehabilitation Gaming System for aphasia (RGSa). The objective of the RGSa sessions was to practice communicative acts, such as making a request. We administered SVCs and SACs in a pseudorandomized manner at the moment when the active player selected the object to be requested from the interlocutor. For the analysis, we compared the times from selection to the reception of the desired object between cued and non-cued trials.ResultsNaming accuracy, as measured by a standard clinical scale, significantly improved for all stimuli at each evaluation point, including the follow-up. Moreover, the results yielded beneficial effects of both SVC and SAC cues on word naming, especially at the early intervention sessions when the exposure to the target lexicon was infrequent.ConclusionsThis study supports the efficacy of the proposed cueing strategies which could be integrated into the clinic or mobile technology to aid naming even at the chronic stages of aphasia. These findings are consistent with sensorimotor accounts of language processing, suggesting a coupling between language, motor, and semantic brain regions.Trial registrationNCT02928822. Registered 30 May 2016.

Comparing language samples of Bangla speakers using a colour photograph and a black-and-white line drawing.

A comprehensive aphasia assessment is necessary to diagnose the type and severity of aphasia differentially and guide appropriate interventions. One component of an aphasia assessment is the picture description task (PDT), designed to probe spontaneous speech fluency and information content. Most aphasia assessments use black-and-white line drawings (LD) to elicit spontaneous language samples from people with aphasia (PWA). However, recent studies reported two visuographic variables: (1) colour (over black and white) and (2) photograph (over LD), that tended to encourage easier and faster comprehension and increased overall naturalistic language production from neurologically healthy individuals as well as PWA. Additionally, a suitable stimulus for a PDT should always be culturally relevant to the target population. Therefore, we suggest that a new PDT must include a culturally appropriate colour photograph (CP). To investigate if a culturally appropriate CP elicits longer and more complex utterances than a culturally appropriate black-and-white LD from neurologically healthy native Bangla speakers. A total of 30 participants (mean age = 36.03 years) were recruited based on self-reports of no known impairments in cognition, language, vision and hearing. All were of middle socioeconomic status with at least 12 years of formal education. A culturally appropriate CP was selected showing multiple characters performing various functions. Later, an artist prepared the black-and-white LD of that CP. The elicited language samples using these two pictures were transcribed and coded following preset transcription and coding guidelines. The transcribed samples were further analysed using the Bangla adaptation of Systematic Analysis of Language Transcripts (SALT) software. To identify the differences in language production between these two picture types, investigators used four measurement variables: mean length of utterances (MLU), complexity index (CI), total number of words (TNW) and words per minute (WPM). Of the four measures, only MLU showed a statistically significant difference between the CP and the black-and-white LD. CI demonstrated a strong correlation with MLU for the CP, which indicates that the participants who produced higher MLU for the CP also produced a higher CI for the CP. There were no significant differences between the two picture types for CI, TNW and WPM. This study found that the grammatical complexity, as measured by MLU, of spontaneous language production of neurologically healthy adults was higher when a CP was used in a PDT. A CP may also be beneficial for PWA to produce complex language samples. What this paper adds What is already known on the subject There are studies on neurologically healthy individuals as well as on PWA that identified the impact of using different visuographic variables (colour and photograph) separately, which enhanced the picture comprehension and improved performances on associated language production tasks. To our knowledge, no studies have identified the combined impact of these two visuographic variables on spontaneous language production. Therefore, this initial study on neurologically healthy Bangla adults reports the impact of using a CP as a stimulus item for a PDT task to elicit spontaneous language samples. What this paper adds to existing knowledge This study reports that using a culturally appropriate CP for a PDT enhances the grammatical complexity of spontaneous language production of neurologically healthy adults. To our knowledge, this is the first study in Bangla that used the MLU as a measurement variable to analyse adults' spontaneous language production. What are the potential or actual clinical implications of this work? The development of future aphasia assessments should consider incorporating CPs as stimuli for PDTs, which may guide speech-language pathologists to provide accurate diagnoses for aphasia and related language disorders.

Alexia and agraphia in Spanish.

Every language has certain specific idiosyncrasies in its writing system. Cross-linguistic analyses of alexias and agraphias are fundamental to understand commonalities and differences in the brain organization of written language. Few reports of alexias and agraphias in the Spanish language are currently available. To analyse the clinical manifestations of alexias and agraphias in Spanish, and the effect of demographic variables. Spanish versions of the Western Aphasia Battery (WAB) and Boston Diagnostic Aphasia Examination (BDAE) were used for language assessment. Lesion localization was obtained by using computed axial tomography and magnetic resonance imaging. The final sample included 200 patients: 195 (97.5%) right-handed and five (2.5%) left-handed; 119 men and 81 women with a mean age of 57.37 years (SD = 15.56), education of 13.52 years (SD = 4.08), and mean time post-onset of 6.58 months (SD = 12.94). Using the WAB, four quotients were calculated: aphasia quotient (AQ), reading-writing quotient (RWQ), language quotient (LQ) and cortical quotient (CQ). The types of aphasia were: global = 11 patients (5.5%), Broca = 31 (15.5%), Wernicke = 30 (15.0%), conduction = 22 (11.0%), transcortical sensory = 17 (8.5%), transcortical motor = 3 (1.5%), amnesic or anomic = 54 (27.0%) and mixed non-fluent = 32 (16.0%). The degree of oral and written language impairment differed across the various aphasia types. Most severe reading and writing difficulties were found in global, mixed non-fluent and transcortical motor aphasia; fewer difficulties were observed in amnesic, Broca and conduction aphasia. The severity of the written language impairments paralleled the severity of the oral language disturbances. Age negatively, while schooling positively, correlated with the scores in reading and writing tests. No effect of sex and time since onset was found. In Spanish-speaking aphasia patients, difficulties in reading and writing are similar to oral language difficulties. This similarity of performance is mostly based on severity rather than the participants' patterns of errors. What this paper adds What is already known on the subject There is limited information about alexia and agraphia in Spanish. What this paper adds to existing knowledge An extensive study with a large sample of patients. What are the potential or actual clinical implications of this work? The study contributes to the clinical management of patients with reading and writing disturbances.

Relative Weight Analysis of the Western Aphasia Battery

ABSTRACT Background: The Western Aphasia Battery (WAB) is one of the most widely used batteries for assessing people with aphasia. Despite longstanding use, it is unclear how the individual components of the battery contribute to the aphasia quotient (AQ), which profiles aphasia severity. Objectives: The primary objective of this study was to explore the individual contributions of the four major components (Spontaneous Speech, Auditory Verbal Comprehension, Repetition, Naming) and the 10 subtests of the WAB to the WAB AQ using relative weight analysis (RWA). The second objective was to evaluate whether the contributions that these components and subtests make to the WAB AQ are influenced by aphasia type (fluent vs non-fluent). Methods & Procedures: Data for 288 persons with aphasia obtained from the AphasiaBank were analyzed in this study. RWA was performed with the R relaimpo package 2.2–3 using WAB AQ scores, scores from the major components, and scores from the10 subtests that are used to calculate the AQ. A second RWA was completed to examine whether the relative weights for these measures vary as a function of aphasia type (fluent vs non-fluent). Outcomes & Results: Results of RWA for the four major components of the AQ indicated that Spontaneous Speech contributes ~30%, Auditory Verbal Comprehension 20%, Repetition 25%, and Naming/Word Finding 25% to the AQ. RWA for the 10 WAB subtests revealed the major contributors to be Fluency (14.4%), Repetition (14.1%), Information Content (13.1%), and Object Naming (10.5%). In comparisons of the four major areas between individuals with fluent vs non-fluent aphasia, only the contribution of Spontaneous Speech differed between the two groups with this area contributing 31% to the AQ in those individuals with fluent aphasia and 28% in those with non-fluent aphasia. Conclusions: RWA demonstrated that the major components of the WAB do not contribute equally to the AQ but that the contribution of Spontaneous Speech is less than has been suggested previously. The strongest contributors to the AQ are primarily measures of expressive language. This greater influence of the expressive language measures on the AQ should be considered carefully when interpreting the AQ and aphasia severity.