Fluent Aphasia Research Articles

Watch Out! It Is Not Delirium—It Is Wernicke's Aphasia!

Purpose: This case report aims to raise awareness among health care professionals and students that acute onset Wernicke's aphasia could be misinterpreted as delirium. In such a context, a patient's psychological/emotional reactions (e.g., agitation, anger) to aphasia associated communication breakdowns can be mismanaged as primary psychiatric concerns. Conclusion: Preliminary suggestions for relevant clinical practice are offered.

CNSC-06. NAVIGATING BRAIN CANCER: PATIENT STORIES AND MEDICAL BREAKTHROUGH

Abstract The complex interplay of genetic mutation, dys regulated signalling pathways, Epigenetic modifications and Interaction with tumor microenvironment are the major aggravating factors for Brain Tumors. Neurological complications involve Increased Intracranial pressure, Seizures, Motor and Sensory deficits, Aphasia, Hydrocephaly, Behavioral and personality changes, Cerebellar Symptoms. It is diagnosed in a sequential steps. Collecting good history from patient in primary then examining the patient all through and making some investigations to come to a final diagnosis. On asking history to a patient he complains of recurrent convulsions, Personality changes and some motor activity deficit and loss of few senses. On examination we can reveal defect in cranial nerve functions, Motor or sensory deficits, loss of reflexes and coordination. Then Investigations being the next step for diagnosis, We ask the patient to undergo for a test for Blood Biomarkers and CSF analysis in case of suspection of metastatic Brain tumors. Biopsy to obtain for Histopathological Examination. Histopathological examination is done for analysis of genetic mutations and molecular markers. The other imaging techniques like MRI, MRS, CT, PET, EEG are done. This gives a clear picture of what actually caused tumor and shows a way for treatment. Now the treatment involves both Medical and Surgical treatment. Medical treatment includes Chemotherapy along with radiation therapy where the drugs given are Temozolomide and targeted therapy included EGFR BRAF inhibitors for glioblastoma and low grade gliomas respectively. Tumor treating fields- Optune is given. Surgical treatment involves Craniotomy for removal of primary Brain tumors, Neuro Endoscopy if tumor is present in ventricles or base of Brain, Laser interstitial Thermal therapy for deap seated and recurrent brain tumors. This is all about the treatment and now the patient management is very important for further clinical help. Physical, occupational and speech therapy helps patients recover. Symptomatic approach for inoperable tumors Provide comprehensive support for patients nearing end of life, Emphasise confidence and Quality of life.

INNV-09. DISTANT PARENCHYMAL RECURRENCE DURING LONG-TERM USE OF TTFIELDS TREATMENT FOR GLIOBLASTOMA

Abstract BACKGROUND Tumor treating fields (TTFields) treatment has been an important option for the treatment of glioblastoma. The introduction of novel treatment options may lead to distinct recurrence patterns compared to those observed with conventional therapies; however, the specific recurrence pattern during TTFields treatment has not been elucidated. METHODS AND RESULTS Here, we analyzed 39 cases of glioblastoma treated with TTFields. Although a usage rate of more than 75% is recommended, among 39 cases, 18 discontinued TTFields treatment owing to requests by patients with lower usage rates. In these discontinued cases, patients exhibiting sensory aphasia were more frequently included compared to those who continued TTFields (44.4%, p<0.001). Among 21 cases involving patients who continued TTFields, tumor recurrence was observed in 15 of those cases. Five out of 15 cases (33.3%) exhibited recurrence in distant parenchyma from the primary lesion. A higher usage rate and relatively longer use of TTFields were observed in these five cases, along with more favorable progression-free survival than those in the other 10 cases (p=0.019, p=0.040, and p=0.024, respectively). In one case, recurrent tumors with lower-grade glioma histology but molecular markers characteristic for glioblastoma, IDH-wildtype were identified. This tumor arose in an area that received a lower local minimum power density of TTFields compared to the primary lesion, following long-term TTFields therapy CONCLUSIONS Long-term use of TTFields might be correlated with a high frequency of distant parenchymal recurrence in cases with favorable response.

M-MAT Meta: Treatment of Self-Awareness and Language for Individuals With Severe Wernicke's Aphasia.

In this study, we evaluated the feasibility and efficacy of language plus goal management training program for individuals with aphasia. The intervention targeted expressive language, while concurrently integrating tasks designed to improve executive function and error awareness. A single-subject repeated-measures design was utilized to determine whether a combined treatment (Multi-Modal Aphasia Therapy PLUS Goal Management Training [M-MAT Meta]) would be efficacious for individuals with aphasia. This article reports on two participants with severe Wernicke's aphasia, who comprised one of the four dyads of the study. Treatment was administered in a small group setting (N = 2) for 2 hr per day, 3 days per week for 4 weeks. Individual video feedback sessions were conducted once a week. Analysis of outcomes included visual inspection and calculation of Tau-U effect sizes of probed treatment data as well as statistical analysis of standardized language and executive function assessments. Visual inspection indicated improvements in naming and discourse skills, which were maintained at the 1-month follow-up. Both participants' standardized scores indicated a significant decrease in aphasia severity, which was maintained 1 month posttreatment. Error awareness improved for one of the two participants, but this improvement was not maintained. Participants demonstrated increased inhibition of unwanted responses and took longer on the planning and problem-solving time required to complete the assessment, indicating a decrease in impulsivity. The results of this preliminary study suggest that M-MAT Meta may be an effective way to increase self-awareness and communication in individuals with severe Wernicke's aphasia.

Time reference in French-speaking people with fluent and non-fluent aphasia (part II): a cluster analysis

ABSTRACT Background Tense production is often impaired in people with aphasia (PWA). Interestingly, the literature suggests that not all tenses are affected in the same way, although the pattern of dissociation is still debated in the literature. The heterogeneity of tense production deficits in PWA might partly explain this lack of consensus in the literature. While this heterogeneity has been demonstrated by descriptive statistics or double dissociations in several studies, no study has used cluster analyses to highlight the main patterns of tense dissociation. Furthermore, the factors underlying this heterogeneity have been little explored. Aims Our study aimed to use cluster analyses on tense production performance to (1) identify the main patterns of dissociation between tenses in PWA and (2) explore the clinical (aphasia type and severity) and cognitive (executive disorders and temporality) factors that may underlie these patterns. Methods & procedures Twenty-one French-speaking participants with fluent and non-fluent aphasia completed a verb inflection production task, as well as language and cognitive tests. Cluster analyses were performed on the differences in performance between the tenses on the verb inflection production task. Generalized linear mixed models and nonparametric statistics were used to analyze the effect of tense and its interaction with the clusters, and to compare the clusters on the clinical and cognitive variables. Outcomes & results Cluster analyses revealed two main clusters, one with worse performances in the past and future than in the present (PWA_1 – 70% of the PWA), and the other with worse performances in the past and present than in the future (PWA_2 – 30%). The type and severity of aphasia, and cognitive test performance did not differ between the two clusters. On the other hand, the PWA_2 cluster had a longer time post-onset than the PWA_1 cluster. Conclusions Our results confirm the heterogeneity of verb inflection deficits in PWA. They suggest that most PWA would have difficulties with past and future tenses, questioning the presence of discourse linking in these two tenses. However, a minority of PWA, who are clinically and cognitively indistinguishable from the others, do not follow this pattern. Adopting the strategy of producing a morphologically simple tense in French – future – could explain the high performance in the future tense and the errors in substituting other tenses with the future in this subgroup. Finally, the clinical and research implications of this heterogeneity, in relation to therapies and the lack of consensus in the literature, are discussed.

Time reference in French-speaking people with fluent and non-fluent aphasia (part I): tense dissociations, task effects and cognitive predictors

ABSTRACT Background People with fluent and non-fluent aphasia frequently have time reference deficits, which could be more pronounced for the past than for the present and future tenses. However, this performance pattern (past < non-past) is not consensual and might depend on the type of task used. Furthermore, the influence of cognitive processes on time reference deficits remains little explored, as does the origin of these difficulties (e.g. pre-phonological, morpho-phonological). Aims The primary aims of the study were (1) to identify time reference deficits and (2) dissociations between tenses in French speakers with fluent and non-fluent aphasia and (3) to specify the effect of tasks on performance and tense dissociations. Secondly, our study also aimed to determine whether time reference deficits were (4) influenced by cognitive functions and (5) explained by pre-phonological or morpho-phonological deficits. Methods & procedures Twenty-one French-speaking participants with fluent and non-fluent aphasia and 21 matched control subjects performed three tasks assessing time reference (verb inflection production, verb inflection selection, and adverb selection) and five neuropsychological tests (verbal and non-verbal working memory, inhibition, flexibility, and temporality). Quantitative and qualitative analyses were conducted. Outcomes & results Participants with fluent and non-fluent aphasia had worse performances than controls on the three time-reference tasks. The performance of the participants with fluent and non-fluent aphasia was quantitatively similar but qualitatively different on the verb inflection production task (i.e. different error types). A main task effect was also found: the verb inflection production task was the only one to show worse performances in the past than in the present and future. Regarding cognitive predictors, verbal working memory and temporality were linked to the three tasks assessing time reference. In contrast, non-verbal working memory was associated only with the two selection tasks, possibly related to the mental timeline. Finally, task analysis suggested a pre-phonological (encoding of diacritic features deficit) rather than a morpho-phonological origin. Conclusions Our study is the first to replicate time reference deficit in French speakers with aphasia. It suggests that the type of task might influence the performance profiles observed and help to shed light on the origin of the difficulties. Cognitive functions that have rarely been investigated before may also influence performance. These results have important clinical implications by questioning the tasks used to assess time reference. They also underline the importance of identifying the origin of difficulties in proposing targeted treatment.

Sentence comprehension in Malay-speaking adults with aphasia: the role of affix integration

ABSTRACT Background One of the impairments in comprehension mostly reported for aphasia is that in reversible passive sentences, where a systematic asymmetry with reversible active sentences has been attested across languages. In several accounts, this selective impairment has been proposed to be the result of the specific syntax of passive sentences. However, some results particularly from flexible word order languages suggest that a pattern where both active and passive sentences are impaired also exists. Aims In this study, we examined the actives and passives in the comprehension of a flexible word order language, namely standard Malay, in people with aphasia (PWA), aiming to confirm that the predominant pattern in this language is one of generalised impairment across reversible sentences (active and passive), and not an asymmetrical one. The role of fluency in determining the pattern of impairment was also explored. Methods & procedures Fourteen healthy adults and 20 PWA, 14 with fluent aphasia and 6 with non-fluent aphasia, took part in a comprehension study in standard Malay. Standard Malay is a flexible word order language that relies on the parsing of the voice affix on the verb to correctly interpret both active and passive sentences. Participants were tested on a sentence-picture matching task on comprehension of active and passive reversible clauses. Outcomes and results The study revealed that PWA were overall less accurate than healthy speakers in comprehension of reversible active and passive sentences, and non-fluent PWA were less accurate than fluent PWA with no effect of sentence type (active/passive). While not predominant, an asymmetric pattern was present in some participants. We propose that an impairment in thematic role assignment leads to a generalised impairment in comprehension of reversible sentences, while preserved thematic role mapping and impaired syntax lead to an asymmetric impairment. Conclusions The study confirmed that speakers of Malay mostly show a generalised impairment in both active and passive sentences. Given the nature of the language, we propose that this suggests that impairment in Malay is predominantly shown on affix integration, first in mapping of thematic roles, and then in the full syntactic processing.

Expanding the scope: multimodal dimensions in aphasia discourse analysis-preliminary findings.

Aphasia, resulting from acquired brain injury, disrupts language processing and usage, significantly impacting individuals' social communication and life participation. Given the limitations of traditional assessments in capturing the nuanced challenges faced by individuals with aphasia, this study seeks to explore the potential benefits of integrating multimodal communication elements into discourse analysis to better capture narrative proficiency in this population. This study examined how incorporating multimodal communication elements (e.g., physical gestures, writing, drawing) into discourse analysis may affect the narrative outcomes of persons with aphasia compared to those observed using methods that exclude multimodal considerations. Participants included individuals with chronic aphasia and age-and education-matched healthy controls who completed a storytelling task-the Bear and the Fly story. Macrolinguistic scores were obtained using verbal-only and multimodal scoring approaches. Additionally, the frequency and type of multimodal communication use during storytelling were examined in relation to aphasia characteristics. Statistical analyses included both within-group and between-group comparisons as well as correlational analyses. Individuals with aphasia scored significantly higher in terms of their macrolinguistic abilities when multimodal scoring was considered compared to verbal-only scoring. Within the aphasia group, there were prominent differences noted in macrolinguistic scores for both fluent and nonfluent aphasia. Specifically, both groups scored higher on Main Concepts when multimodal scoring was considered, with the nonfluent group demonstrating significantly higher Main Concept and total macrolinguistic rubric scores in multimodal scoring compared to verbal scoring on the storytelling task. Additionally, aphasia severity showed moderate positive correlations with total macrolinguistic scores, indicating that individuals with less severe aphasia tended to produce higher quality narratives. Lastly, although persons with aphasia used different types of nonverbal modalities (i.e., drawing, writing), the use of meaning-laden gestures was most predominant during storytelling, emphasizing the importance of multimodal elements in communication for individuals with aphasia. Our preliminary study findings underscore the importance of considering multimodal communication in assessing discourse performance among individuals with aphasia. Tailoring assessment approaches based on aphasia subtypes can provide valuable insights into linguistic abilities and inform targeted intervention strategies for improving communication outcomes.

From Sound to Meaning: Navigating Wernicke's Area in Language Processing.

Wernicke's area, a critical brain region associated with language comprehension, was first identified by Carl Wernicke in the late 19th century. Situated in the left hemisphere's posterior superior temporal gyrus, this area is essential for processing auditory and visual language inputs. It integrates semantic and syntactic information, playing a key role in meaningful communication. The development of Wernicke's area during infancy and childhood is marked by rapid growth and refinement influenced by early language exposure and environmental stimuli. Neuroplasticity, the brain's ability to reorganize and adapt, is crucial for recovery from language impairments such as Wernicke's aphasia. This capacity for reorganization includes synaptic plasticity and axonal sprouting, which facilitate recovery through targeted rehabilitation and enriched environments. Recent research utilizing advanced neuroimaging and neuroanatomical tracing techniques has elucidated the connectivity of Wernicke's area with other language-related regions, such as Broca's area. Functional studies have revealed its specialized roles in processing different aspects of language, including phonological, semantic, and syntactic features. Moreover, investigations into language disorders and potential therapeutic interventions underscore the importance of harnessing neuroplasticity for effective treatment. Emerging technologies, such as non-invasive brain stimulation and multimodal imaging, offer promising avenues for further exploration of Wernicke's area and its role in language functions. These innovations hold the potential to enhance our understanding of language processing and improve therapeutic strategies for language impairments. In conclusion, Wernicke's area is central to language comprehension, and genetic and environmental factors influence its development. Understanding neuroplasticity and leveraging advanced research technologies can significantly advance our ability to address language-related disorders and enhance patient outcomes.

Impact of Aphasia on Brain Activation to Motor Commands in Patients with Acute Intracerebral Hemorrhage.

Brain activation to motor commands is seen in 15% of clinically unresponsive patients with acute brain injury. This state called cognitive motor dissociation (CMD) is detectable by electroencephalogram (EEG) or functional magnetic resonance imaging, predicts long-term recovery, and is recommended by recent guidelines to support prognostication. However, false negative CMD results are a particular concern, and occult aphasia in clinically unresponsive patients may be a major factor. This study aimed to quantify the impact of aphasia on CMD testing. We prospectively studied 61 intensive care unit patients admitted with acute primary intracerebral hemorrhage (ICH) who had behavioral evidence of command following or were able to mimic motor commands. All patients underwent an EEG-based motor command paradigm used to detect CMD and comprehensive aphasia assessments. Logistic regression was used to identify predictors of brain activation, including aphasia types and associations with recovery of independence (Glasgow Outcome Scale-Extended score ≥ 4). Of 61 patients, 50 completed aphasia and the EEG-based motor command paradigm. A total of 72% (n = 36) were diagnosed with aphasia. Patients with impaired comprehension (i.e., receptive or global aphasia) were less likely to show brain activation than those with intact comprehension (odds ratio [OR] 0.23 [95% confidence interval 0.05-0.89], p = 0.04). Brain activation was independently associated with Glasgow Outcome Scale-Extended ≥ 4 by 12months (OR 2.4 [95% confidence interval 1.2-5.0], p = 0.01) accounting for the Functional Outcome in Patients with Primary ICH score (OR1.3 [95% confidence interval 1.0-1.8], p = 0.01). Brain activation to motor commands is four times less likely for patients with primary ICH with impaired comprehension. False negative results due to occult receptive aphasia need to be considered when interpreting CMD testing. Early detection of brain activation may help predict long-term recovery in conscious patients with ICH.

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

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

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

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

Automated Analysis of Fluency Behaviors in Aphasia.

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

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

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

Association of aortic coarctation to a cerebral aneurysm in 53-year-old male with coronaropathy: What should be prioritized?

Coarctation of the aorta (CoA) is a common congenital defect, which although normally detected and surgically repaired in childhood. Rarely present in adults. Unless significant hypertension exists, adult patients are usually asymptomatic. We report a case of a 53-year-old Man with cardiovascular risk factors, presented with ccs class II angina and wernicke's aphasia. Further investigation of his aphasia was needed for the evaluation of his hemorrhagic risk under antithrombotic therapy and anticoagulant. These last revealed coarctation of the aorta (CoA) associated to cerebral aneurysm (CA). The patient underwent an angioplasty of his coronary artery disease, then he was presented to surgery for the CA and endovascular repair for the CoA. The issue raised by the case was whether to treat first the CoA or the CA. Although uncommon in adults, aortic coarctation should be included in the differential diagnosis of resistant high blood pressure, since it is associated with significant complications and mortality when untreated as aneurysms.

P028 Progressive multifocal leukoencephalopathy in a patient with systemic lupus erythematosus

Abstract Background/Aims Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease that develops following the reactivation of the John Cunningham virus (JCV) that in rare circumstances can occur in autoimmune disorders such as systemic lupus erythematosus (SLE). We present a 75-year-old female with SLE who had been treated with immunosuppressive therapy (mycophenylate and steroids) for one year. Methods A 75 year-old female presented with sub-acute deterioration of physical and cognitive function over the course of a few months including memory loss, ataxia, dysgraphia, word finding difficulty, confusion, low mood and reduced oral intake. Neurological examination revealed receptive and expressive aphasia, gaze fixation, unilateral weakness, brisk reflexes with positive plantar reflex and rigidity. A diagnosis of PML was made due to the detection of JC virus in the cerebrospinal fluid (234 copies/ml) and brain MRI findings consistent with the disease. Haematology results showed a profound lymphopenia (0.1x109 ). Mycophenolate was held and she was commenced on increasing doses of Mirtazapine up to 45mg. Clinical review at four months found marked improvement in her cognitive and physical abilities. Repeat CSF analysis found JC virus to be undetectable. Results PML has a 20-fold greater incidence in SLE when compared with the general population. Lymphopenia is a common finding in patients with SLE and has been found to correlate with both the risk and severity of opportunistic infections. The cause of this can be multifactorial and immunosuppressive drugs are often implicated however SLE in isolation can cause severe CD4+ lymphopenia leading to an increased risk of PML reactivation. This case demonstrates the importance of monitoring lymphocyte counts in SLE. Current guidance suggests adjusting regimes of immunosuppressive therapy if lymphocyte counts fall below 1x109 however further guidance on its management may be warranted. The heterogenous manifestation of SLE can make differentiating between the neurological syndromes associated with rheumatic disease and PML challenging. Given the management of PML is vastly different to that of SLE in regards to introduction or withdrawal of immunosuppressive therapies, there should be a high index of clinical suspicion in the early stages of investigation. In vitro studies have explored the possibility of mirtazapine (a 5-HT2A antagonist) providing a low-risk treatment option for those with SLE and this warrants further research into its efficacy in treating or preventing PML in this cohort. Our patient had improved symptomology after cessation of mycophenolate and the commencement of Mirtazapine. Conclusion PML is a rare complication of SLE but should be considered in patients admitted with neuropsychiatric presentations, the use of Mirtazapine may provide a low-risk treatment strategy. Disclosure D. Babla: None. Y. Suleman: None. A. Whittington: None. S. Hamdulay: None.

Visual Attention to Semantic and Orthographic Associations in Fluent Aphasia: Evidence from Eye-Tracking.

We examined the allocation of visual attention in an association task by both neurotypical participants (n = 11) and adults with fluent aphasia (n = 12). Participants were presented with a picture (e.g., a basket) followed by a semantically related association (i.e., "strawberry") and an orthographically related association (i.e., "b," the first letter of "basket"). An eye tracker recorded their eye movements for three areas of interest (AOI): the picture, the semantic associate, and the orthographic associate, over 1396 observations. Results showed that both neurotypical participants and participants with aphasia looked longer at the semantic associate than at the picture, and this difference was more pronounced for neurotypicals than for people with aphasia (PWA). Neurotypicals also looked longer than the PWA group at the orthographic associate than at the prior picture. Regarding eye fixation counts, both participant groups looked more frequently at the semantic associate than at either the picture or the orthographic associate. Notably, this pattern was more pronounced among neurotypical participants than PWA. Our findings emphasize the importance of semantic associations in fluent aphasia and suggest a potential rehabilitative approach in speech and language therapy.

Developmental Language Disorder: Do Speech and Language Therapies Help to Address the Problem?

Developmental language disorder (DLD) is a common language disorder affecting children (Laasonen et al., 2018). A child suffers from the disorder when the child exhibits difficulty in learning, understanding, and using a language. The disorder thus affects various aspects of a child’s development process, particularly those relating to speaking, listening, reading, and writing. As a language disorder, DLD affects the ability of a child to communicate due to difficulty in expressing meaning or interpreting communication from others. DLD can either be receptive, expressive, or both. A child suffers from receptive language disorder if they find it difficult to understand the meaning of the words used by others. It is expressive if the child finds it difficult to find the right words to help him/her convey meaning through talking. Based on its nature, several indicators can help show that a child suffers from DLD (Laasonen et al., 2018). Some of the common indicators include delayed ability to put words together to construct sentences, difficulty in learning new words and engaging in a conversation with peers, and general difficulty in following instructions due to poor interpretive ability to communicate messages.

Targeted language training combined with transcranial direct current therapy for Wernicke aphasia in the sequelae stage: A case report

ObjectiveTo observe the effects of combining targeted language training with transcranial direct current stimulation (tDCS) on speech rehabilitation in senile stroke patients with Wernicke's aphasia in the sequelae stage. MethodsA patient with Wernicke's aphasia caused by stroke, 15 months prior, was successively treated with regimen A (targeted language training), regimen B (L-Wernicke area tDCS + targeted language training), and regimen C (R-Wernicke area tDCS + targeted language training) for a total of 3 weeks, with a 2-day washout period between each regimen. The accuracy of spontaneous speech, auditory word-picture matching, visual word-picture matching, retelling, graph-reading writing, and graph-reading naming items was evaluated and compared before treatment and 3 weeks after treatment with regimens A, B, and C. ResultsAfter 3 weeks of the regimen A treatment, there was no significant improvement in each evaluation item. After 3 weeks of treatment with regimen B, the patient's spontaneous speech slightly improved, but the expression remained meaningless. Visual word-graph matching was slightly improved, but auditory word-graph matching was not. After 3 weeks of treatment with regimen C, the spontaneous speech of the patient's increased significantly, and the correct rates of auditory word-graph matching, visual word-graph matching, retelling, and picture reading and writing were significantly improved compared with those before treatment and after 3 weeks of treatment with regimens A and B (P < 0.05). ConclusionsTargeted language training combined with tDCS stimulation of the non-dominant Wernicke's area can improve spontaneous speech, auditory word-picture matching, visual word-picture matching, retelling, and picture reading and writing ability in elderly patients with Wernicke's aphasia after stroke, thus promoting speech rehabilitation.

Expansion of the Genotypic and Phenotypic Spectrum of ASH1L-Related Syndromic Neurodevelopmental Disorder.

Pathogenic ASH1L variants have been reported in probands with broad phenotypic presentations, including intellectual disability, autism spectrum disorder, attention deficit hyperactivity disorder, seizures, congenital anomalies, and other skeletal, muscular, and sleep differences. Here, we review previously published individuals with pathogenic ASH1L variants and report three further probands with novel ASH1L variants and previously unreported phenotypic features, including mixed receptive language disorder and gait disturbances. These novel data from the Brain Gene Registry, an accessible repository of clinically derived genotypic and phenotypic data, have allowed for the expansion of the phenotypic and genotypic spectrum of this condition.