Fluent Aphasia Research Articles

Praćenje oporavka tokom rehabilitacije senzomotorne afazije - studija slučaja

Introduction: Rehabilitation of aphasia depends on the localization, severity and extent of brain damage, length and intensity of rehabilitation, patient age, motivation, family support and environment, material conditions and other factors. Aim: Aim of the paper was to determine the outcomes of speech-language rehabilitation of patient N.N. with sensory aphasia resulting from brain injury caused by a fall down the stairs. The methodology was based on follow up of theoutcomes of speech rehabilitation for more than four months. We used the Boston Aphasia Diagnostic Test (BDAE). Case reaport: During patient's rehabilitation, we relied mainly on partially preserved reading ability, which is not specific to this type of aphasia. The first assessment of speech and language skills is not fully credible due to the poor general condition of the patient, the blurring of consciousness and other circumstances that cause the rehabilitation to be interrupted. After improving the general condition, the patient was readmitted, and the speech therapist performed an assessment and the patient was found to have sensory aphasia, with specificities in the form of partially preserved reading ability, which was used during rehabilitation. The assessment was performed four times over a 4-month period. After the patient's re-arrival, a speech therapy was performed at the hospital for a month, and after discharge from the institution, treatment continued in the family, occasionally following the instructions of the speech therapist. At the beginning of rehabilitation in the BDAE speech subtest, the patient achieved minimal results, while at the end of rehabilitation he achieved significantly more successful results in all segments of auditory comprehension. Conclusion: Good assessment of language status, planning of rehabilitation, follow-up of course of rehabilitation, encouragement, patient motivation, and family involvement in rehabilitation lead to good results in rehabilitation of aphasia.

Recurrent Cerebral Hemorrhage Associated with Ulcerative Colitis

Ulcerative colitis (UC) is a rare cause of stroke. Most such cases result from cerebral venous thrombosis, and cerebral vasculitis is one cause of venous thrombus formation. Here, we report a patient with UC who experienced recurrent cerebral hemorrhage. A 53-year-old Japanese woman with UC presented with sudden onset of disorientation and sensory aphasia. Brain computed tomography revealed cerebral hemorrhage in the left temporal lobe. She had a history of UC for two decades but had discontinued her medication. On the fifth hospital day, another cerebral hemorrhage occurred in the right occipital lobe. After steroid therapy, these abnormal findings on MRI improved within a short time, and she was discharged from hospital with no sequelae. Physicians should be alert to cerebral hemorrhage in patients with UC, consider cerebral vasculitis as an etiology, and treat with steroid therapy for a good outcome.

Grammatical Morphology in Aphasia: Evidence from Cantonese Classifiers

Grammatical Morphology in Aphasia: Evidence from Cantonese Classifiers

Piloting a cognitive-linguistic treatment for fluent aphasia in the outpatient medical setting: A clinical case

Piloting a cognitive-linguistic treatment for fluent aphasia in the outpatient medical setting: A clinical case

The Effects of Semantic Feature Analysis Treatment on Anomia in Two Japanese-Speaking Persons with Chronic Fluent Aphasia

The Effects of Semantic Feature Analysis Treatment on Anomia in Two Japanese-Speaking Persons with Chronic Fluent Aphasia

Phonological Errors on Impaired Language Modality Produced by Individuals with Broca’s Aphasia

Nearly all of Broca's aphasic patients have the tendency to produce phonological errors in their non-fluent speech output. The grade of errors may vary depending on the severity of brain pathology, affected language area, and the scope of impaired sounds. Any types of the phonological process might be found in their weakening language modalities. So, the present study investigates the severity of the aphasics’ language modality, phonemic and phonetic errors of the impaired speech. This descriptive study analyzes Balinese speech produced by three individuals who suffer from Broca’s aphasia. To find out, they were requested to repeat words, name pictures, answer questions and read short text orally. As the result, their language modalities were categorized severe. The listeners required some hard efforts to conclude, question and predict what the informants said and further communication was impossible on more complex words. They produce not only distortions as phonetic errors but also substitutions, deletions, insertions, and metatheses as phonemic errors. Sound substitutions mostly appeared in a greater percentage for every phonological task given. By analyzing the errors with generative phonology, the findings suggest that the PND can lead a better phonetic realization, one of which is by substituting the target sounds in terms of their phonological features similarity. Though phonemic processing is more common in fluent aphasia, non-fluent aphasics also produced sonority substitutions. Furthermore, there was not synchronous coordination between the underlying form in the posterior region and phonetic representation in the anterior region due to the loss of the linguistic message.

Dynamics of recovery of speech and cognitive impairment in different periods of ischemic stroke

The results of the dynamics of speech and other cognitive functions restoration in all periods of ischemic stroke have been established. In the study of speech functions, the motor form of aphasia was more often diagnosed (in 59,1% of cases). In the acute period of ischemic stroke in 80% of cases, speech disorders of severe severity were detected. It was statistically proved that the motor component of speech recovered faster than the touch one. For example, all patients, suffering from sensory aphasia the earlier rehabilitation period ischemic stroke, a volume of understanding speeches sufficiently limited. Parognosia was diagnosed with 50% of patients, in 25% of cases, a violation of phonemic hearing was reviled. At follow-up study there is a positive dynamic in the form of restoration of the impressive component of speech, 75% of patients relatively freely understand human speech. At an in the acute period of ischemic stroke spontaneous speech is changed (lateral and verbal paraphasia is diagnosed in all patients). Polyphasia phenomena had been diagnosed with 50% of patients. Repetitive and dialogue form of speech highly limited. In a late period, polyphasia had been diagnosed with 25% examined. Improvement in the form of a decrease in the number of literal and verbal paraphases was reviled with 75% of patients. 80% of patients were able to dialogue form of speech. In general dynamics of indicators of the degree of speech recovery in women is slightly higher than in men, and does not depend on the age of patients. It was revealed that the most effective speech was restored in the first year after the acute cerebrovascular accident. The restoration of the impressive component of speech was faster in all forms of aphasia. A high level of quality of life was noted in patients with baseline less impaired mobility (an index of Riverbed, Rs=0,68; p=0,01) and less dependent on others (Barthel index, Rs=0,43; p=0,003). Prognostically unfavourable facts for speech restoration include the area of ischemic focus more than 0,8 cm. When assessing cognitive functions in the residual period, 85% of patients were diagnosed with moderate disorders, 15% of patients were diagnosed with mild cognitive impairment. The obtained data substantiate the need to optimize speech therapy assistance in all periods of ischemic stroke.

Speech and Language Disorders in the Elderly

Cerebrovascular insults and neurodegenerative diseases are the main causes of acquired speech and language disorders. A massive increase in the prevalence of both is evident from the age of 65 years. By the age of 90 years, more than 10 % of the population would have experienced a stroke and 30 % would have suffered from neurodegenerative diseases. Common risk factors are adiposity, hypertension and diabetes. The term aphasia subsumes acquired language disorders that have to be further classified in order to optimize diagnostics and therapy. Also prognosis depends on whether the disease is progressive or not. The Primary Progressive Aphasia (PPA) is based on neurodegenerative cortical lesions. It causes speech and language disorders. The 3 variants of PPA complete the former classification of Broca- and Wernicke aphasias that are mainly caused by cerebrovascular insults.In cerebral diseases, disorders of articulation are often combined with dysphonia. Therefore, in addition to dysarthria, a "dysarthrophonia" is evident. The main reasons for this are cortical lesions due to cerebrovascular insults or neurodegenerative diseases. Degenerative extrapyramidal diseases also often affect articulation. Depending on the kind of basal ganglia disease, dysarthria or dysarthrophonia is seen in 70-100 % of patients which might be combined with dysphagia. Vascular insults and neurodegenerative diseases are also causes of brainstem and cerebellar disorders that affect motor speech. Therapeutic approaches to the speech and language disorders depend on the nature of the underlying disease, namely whether it is progressive or regressive.

Microsurgical Resection of a Large Intraventricular Trigonal Tumor: 3-Dimensional Operative Video.

A 62-yr-old woman presented with incidentally detected left trigonal mass by magnetic resonance imaging (MRI) performed during workup for left-sided hearing loss and vertigo of 5-yr duration. Due to persistent dizziness, headache, and progressive enlargement of the tumor in follow-up scans, operation was planned. Because the tumor extended superiorly, a superior parietal lobule approach was selected.She underwent a left parietal craniotomy. A strip electrode was used to localize the motor and sensory regions, and neuronavigation was used to confirm the entry site. A small transsulcal corticotomy was performed posterior to a large cortical vein. The tumor was pinkish in color with a well-defined capsule. It was centrally debulked by using curettes, pituitary forceps, and the ultrasonic aspirator. Tumoral blood supply from the choroid plexus and the posterior choroidal vessels were cauterized and divided. Additional blood supply coming from the anterior choroidal vessels was also found and cauterized. After circumferential dissection of the tumor capsule, the tumor was removed completely. The pathology indicated WHO Grade I meningioma. The patient had mild expressive and receptive aphasia postoperatively, but improved progressively. The postoperative MRI showed total resection with no evidence of brain injury. At 3-mo follow-up, the speech was normal; she was independent for all daily activities, but had not yet returned to work (Karnofsky score 80).This 3-D video shows the technical nuances of microsurgical resection of an intraventricular tumor through a narrow brain corridor.Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

Measuring word retrieval in narrative discourse: core lexicon in aphasia.

Discourse analysis procedures are time consuming and impractical in a clinical setting. Critical to clinicians are simple and informative discourse measures that require minimal time and labour to complete. Many studies, however, have overlooked difficulties that clinicians face. We recently developed core lexicon lists for nouns, verbs, adjectives and adverbs for two narrative discourse tasks with healthy control groups. Core lexicon lists consist of important lexical items required to produce coherently meaningful discourse in response to discourse tasks. Measuring core lexicon is useful for quantifying word retrieval impairments at the discourse level in clinical populations. To apply an age-based core lexicon list for nouns, verbs, adjectives and adverbs for the wordless picture books Good Dog Carl (1985) and Picnic (1984) and to determine how well the lists measured linguistic impairments in persons with aphasia (PWA). Lemma forms were extracted from 470 control participants who were divided into seven age groups. Twenty-five core lexicons were identified for four word classes (nouns, verbs, adjectives and adverbs) among the seven age groups. The nouns, verbs, adjectives and adverbs for each PWA (N = 11) were then compared with the core lexicon for their respective age group. Per cent agreement was computed by comparing the number of total items within each list to the number of items that PWA produced. A Spearman's correlation coefficient was computed between the WAB-R AQ and the per cent agreement for each word type for PWA. The percentage of agreement for each word type among the age cohorts ranged between 56% and 96%. Of the four word types, core verbs significantly correlated with the WAB AQs for both discourse tasks. A post-hoc analysis found significant differences between fluent and non-fluent aphasia for core verbs. Core lexicon analysis appears to be a practical way to capture impairments in word retrieval at the discourse level. Core verbs may be a better indicator to understand holistic language performances for PWA. Use of the core lexicon checklist can serve as an option to reconcile ecological validity with clinical usability.

To what extent does typicality boost semantic priming effects between members of their categories?

ABSTRACTAtypical items of their semantic category yield more generalisation than their typical members when relearning in connectionist networks (Plaut, D. C. (1996). Relearning after damage in connectionist networks: toward a theory of rehabilitation. Brain and Language, 52(1), 25–82) and in empirical studies (Kiran, S., & Thompson, C. K. (2003). The role of semantic complexity in treatment of naming deficits: Training semantic categories in fluent aphasia by controlling exemplar typicality. Journal of Speech, Language, and Hearing Research, 46(4), 773–787). It seems therefore that atypical words provide more information about the overall structure of the semantic category due to their specific and shared features. In this view, atypical primes could strongly facilitate the processing of targets compared to typical primes, because typical primes contain little information about the variation between members within a category. In contrast, three semantic priming experiments in visual word recognition showed an advantage with the typical context, but not with the atypical one. These findings were observed in a variety of tasks, including lexical decision, categorisation and semantic judgment. Our results do not support the findings about generalisation in relearning and suggest that typicality effects in semantic priming mostly come from the activation of representative features of categories.

THE LONG-TIME EFFECTS OF GROUP THERAPY INTERVENTION ON MARRIAGE COMMUNICATION BETWEEN FLUENT AND NON-FLUENT APHASIC PATIENTS AND THEIR SPOUSES: WHO BENEFITS THE MOST?

Our study aims to assess the long-time effects of group therapy intervention on marriage communication between fluent and non-fluent aphasic patients and their spouses. From the initial cohort of 150 couples four experimental groups have been selected, each comprising 20 subjects: (1) patients with fluent aphasia (FAP) (2) patients with fluent aphasia spouses (FAPS) (3) patients with non-fluent aphasia (NFAP) (4) patients with non-fluent aphasia spouses (NFAPS). All aphasic patients had mild or moderate fluent or nonfluent aphasia, as confirmed by the Cracow Neuropsychological Battery for Aphasia Examination – CNBA (Pąchalska, 1999). To assess the 3 aspects of interactions between spouses: support, engagement and depreciation we use the Communication in Marriage Questionnaire – KKM scores (Kaźmierczak, Plopa, 2008). These patients attended the groups sessions administered according to Pąchalska’s Model of Aphasia Group Therapy (1991a; 1991b) . It was found that after the long-time group intervention the experimental and the control groups of aphasic patients as well as their spouses differ one from another. NFAP as well as FAP therapy patients had higher KKM scores in the support received from their spouses and their spouses engagement in communication and lower scores in depreciation in their spouses’ behavior than did the controls. Also NFAPS evaluated support and engagement expressed by their aphasic partner higher than the control group. However FAPS and the control group KKM scores were quite similar, except for the support expressed by their aphasic partner. Long-time group therapy for patients with aphasia with the presence of caregivers not only improves the communication with significant others but also it is associated with better marital interactions and communication after therapy as reflected in the KKM scores than in the case of the controls, and improves the patient’s and caregivers’ perception of quality of life.

What can repetition, reading and naming tell us about Jargon aphasia?

Jargon Aphasia is an acquired language disorder characterised by high proportions of nonword error production, rendering spoken language incomprehensible. There exist two major hypotheses relating to the source of nonword error; one implicates disruption to phonological processing and the other suggests both phonological and lexical contributions. The lexical sources are described as failure in lexical retrieval followed by surrogate phonological construction, or a lexical selection error further compounded by phonological breakdown. The current study analysed nonword error patterns of ten individuals with fluent Neologistic Jargon aphasia in word repetition, reading and picture naming to gain insights into the contributions of these different sources. It was predicted that, if lexical retrieval deficits contribute to nonword production, naming would produce a greater proportion and severity of nonword errors in comparison to repetition and reading, where phonology is present and additional sub-lexical processing can support production. Both group and case series analyses were implemented to determine whether quantity and quality of nonwords differed across the three production tasks. Nonword phoneme inventories were compared against the normative phoneme distribution to explore whether phonological production takes place within a typically organised, lexically constrained system. Results demonstrated fewer nonword errors in naming and a tendency for nonwords in naming to be characterised by lower phonological accuracy. However, nonwords were, for the most part, constructed with reference to target phonological information and, generally, nonword phonological production patterns adhered to the statistical properties of the learned phonological system. While a subset of the current group demonstrated very limited lexical processing capacity which manifested as nonword errors in naming being most disrupted, overall the results suggest that nonwords are largely underpinned by some degree of successful lexical retrieval and implicate phonological sources, which manifest more severely when production is accomplished via nonlexical processing routes.

Biphasic Development of Focal Cerebral Hyperperfusion After Revascularization Surgery for Adult Moyamoya Disease Associated With Autosomal Dominant Polycystic Kidney Disease

BackgroundCerebral hyperperfusion (CHP) syndrome is a potential complication of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD), but its biphasic and delayed development is extremely rare. Case reportA 47-year-old woman with autosomal dominant kidney disease (ADPKD) presented with transient ischemic attacks due to MMD, and underwent left STA-MCA anastomosis. N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography (123IMP-SPECT) 1 day after surgery revealed asymptomatic CHP at the site of anastomosis. Strict blood pressure control and minocycline hydrochloride relieved CHP at postoperative day 7. However, 2 days later, the patient complained of sensory aphasia, and 123IMP-SPECT demonstrated significant focal CHP at the site of anastomosis accompanying high-intensity signal on magnetic resonance (MR) imaging of fluid attenuated inversion recovery (FLAIR) in her left temporal lobe near the site of anastomosis. We continued strict blood pressure control and additionally administered free radical scavenger (Edaravone) and antiepileptic agents, which gradually improved sensory aphasia. MR imaging and 123IMP-SPECT also confirmed the amelioration of the FLAIR-high lesion and focal CHP in her left temporal lobe. Two months later, the patient underwent right STA-MCA anastomosis without complications. ConclusionsAlthough the underlying mechanism is unknown, biphasic development of focal CHP after revascularization surgery in an MMD patient with ADPKD is unique. Due to the potential vulnerability of the systemic vessels in ADPKD, it is conceivable that intrinsic vascular wall fragility in MMD could be enhanced by ADPKD and have partly led to this rare complication.

Automated analysis of language production in aphasia and right-hemisphere damage: frequency and collocation strength

ABSTRACTBackground: Reliance on formulaic language, i.e., holistically processed multiword chunks, is claimed to distinguish speakers with aphasia, speakers with right-hemisphere damage (RHD), and neurotypical controls (NC). Frequency and collocation strength of word combinations are indicators of formulaic language.Aims: We aimed to determine frequency and collocation properties of spoken production, as indicators of formulaic language, in people with aphasia, speakers with RHD and NC.Methods and Procedures: We used computerized methods to investigate spontaneous language in 40 speakers: 10 with fluent aphasia (fA), 10 with non-fluent aphasia (nfA), 10 with RHD, and 10 NC. Our analysis not only focused on frequency and collocation strength of grammatical combinations as markers of formulaic language (using the British National Corpus as reference), but also looked at word frequency, language fluency, proportion of content words, and measures of lexical and combinatorial diversity.Outcomes and Results: Both groups with aphasia differed from neurotypical speakers with regard to lexical features and word combinations. Their language was less fluent, less diverse at the word level, and, in the non-fluent group, contained a higher proportion of content words. Each aphasic group also differed significantly from controls with increased values on at least one marker of formulaic language. Speakers with RHD produced less-frequent combinations, which were more weakly collocated; however, these effects did not reach statistical significance.Conclusions: Our results show that formulaic language use distinguishes aphasic from other speakers and that differences can be tracked with an automated, corpus-based script that uses frequency and collocation variables. We present our study in the context of usage-based frameworks of language.

Better conversations with aphasia: what are the interactional challenges of Wernicke’s aphasia and how do people deal with them?

Better conversations with aphasia: what are the interactional challenges of Wernicke’s aphasia and how do people deal with them?

Comprehension and production of different types of sentences in Turkish-speaking patients with nonfluent and fluent aphasia

Background: In aphasia treatment, one of the most important steps is to make an extensive assessment so that the language profile of the patient is identified to set realistic therapy goals. With c...

Transient Neurologic Deficit without Vascular Pathology Correlates with Reversible Focal Hypoperfusion on Arterial Spin Labeled Perfusion Imaging

AbstractWe present the case of a 16-year-old boy with altered mental status and magnetic resonance imaging demonstrating left hemispheric hypoperfusion without evidence of stroke, based on arterial spin labeling (ASL) and dynamic contrast-enhanced perfusion imaging. Vessel imaging on magnetic resonance angiography and computed tomography angiography, in addition to an echocardiogram, showed no evidence of an embolic source. Electroencephalography showed left posterior temporal slowing. Within 8 hours, he was awake and alert but with receptive aphasia, and within 24 hours his symptoms completely resolved. Repeat ASL perfusion imaging demonstrated complete resolution of the perfusion abnormality, and diffusion imaging revealed no areas of infarct. This report demonstrates the correlation between a transient neurologic deficit and reversible focal hypoperfusion measured by ASL cerebral perfusion.

The Prevalence of Speech and Language Disorders in French-Speaking Preschool Children From Yaoundé (Cameroon).

The purpose of this study was to determine the prevalence of speech and language disorders in French-speaking preschool-age children in Yaoundé, the capital city of Cameroon. A total of 460 participants aged 3-5 years were recruited from the 7 communes of Yaoundé using a 2-stage cluster sampling method. Speech and language assessment was undertaken using a standardized speech and language test, the Evaluation du Langage Oral (Khomsi, 2001), which was purposefully renormed on the sample. A predetermined cutoff of 2 SDs below the normative mean was applied to identify articulation, expressive language, and receptive language disorders. Fluency and voice disorders were identified using clinical judgment by a speech-language pathologist. Overall prevalence was calculated as follows: speech disorders, 14.7%; language disorders, 4.3%; and speech and language disorders, 17.1%. In terms of disorders, prevalence findings were as follows: articulation disorders, 3.6%; expressive language disorders, 1.3%; receptive language disorders, 3%; fluency disorders, 8.4%; and voice disorders, 3.6%. Prevalence figures are higher than those reported for other countries and emphasize the urgent need to develop speech and language services for the Cameroonian population.

F121. Patterns of propagation in parietal lobe epilepsy

Parietal lobe epilepsy accounts for about 5% of all the focal epilepsies. Seizures of the parietal lobe origin can be difficult to diagnose because of the diverse ictal manifestations. Moreover, the ictal semiology may be related to the propagation from the epileptogenic zone (EZ) to other areas of the brain, such as the motor cortex or temporolimbic area. The scalp EEG often doesn’t accurately localize the EZ requiring the use of Stereo-EEG (SEEG).The parietal lobe resection is the least commonly performed resective surgery for drug-resistant epilepsy (DRE) with limited publications. We present a case of parietal lobe epilepsy in a patient with previous history of hemorrhagic stroke affecting the left parietal lobe secondary to a cerebral venous thrombosis who was admitted to our epilepsy monitor unit for scalp and SEEG. Patient was a 66 years old right-handed woman who experienced hemorrhagic stroke over the left parietal-posterior frontal area, while she was receiving chemotherapy for her acute lymphoblastic leukemia. She was 62 years old when she acutely presented with clonic movements of the right arm consistent with epilepsia partialis continua (EPC) recurred for several hours at a time and was followed by aphasia. She was treated with levetiracetam with good control of her seizures for two years. After that she had recurrent episodes of clonic movements in the right arm with/without prolonged aphasia. She tried lacosamide, clobazam, clonazepam, on top of the levetiracetam, which did not result in control of the seizures. Video-EEG telemetry showed interictal epileptic spikes (IEDs) in the left temporal region and one typical EPC followed by aphasia with diffuse onset over the left hemisphere. SEEG was required with depth electrodes into the left temporal, frontal, parietal, insular, cingulate cortex and 4 lines surrounding the hemorrhagic lesion in the left parietal lobe. IEDs were abundant in the lines posterior and lateral to the lesion followed by the cingulate and temporal neocortex. Many electrographic seizures were captured manifesting with low voltage fast activity (LVFA) in the lines lateral and posterior without clinical symptoms. One typical EPC that lasted for 3 h was captured. SEEG showed onset as LVFA in the electrodes lateral and posterior to the lesion without clinical symptoms. Then it spread to the electrodes anterior to the lesion (behind the central sulcus) that caused clonic jerking of the right arm and then aphasia when spread to the neocortical temporal. Low voltage stimulation of the electrodes anterior to the lesion produced prolonged afterdischarges and typical clonic movements of the right arm. Seizures of the parietal lobe origin can be a silent at onset, not expressing symptoms until they propagate to the other lobes. In this case, SEEG confirmed parietal lobe epilepsy with spread to the Rolandic cortex to cause clonic movements/EPC and to the posterior temporal neocortex to cause receptive aphasia.