Fluent Aphasia Research Articles

Processing of semantic and grammatical gender in Spanish speakers with aphasia

ABSTRACT Background: Previous studies have argued that there are two types of linguistic gender: grammatical gender, which is arbitrarily assigned to nouns, and semantic gender, which depends on the gender of the referent. Aim: We explore the hypothesis that these two types of gender entail distinct cognitive processes by investigating the performance of people with aphasia at the level of sentence processing. Methods and Procedure: Nine people with aphasia (seven with fluent aphasia) and a control group of thirteen age-matched healthy participants took part in a constrained completion choice task. The participants had to complete sentences in a way that made the last word gender congruent. The subjects of the sentences had either Semantic gender (enfermera, nurse; indicating the gender of the referent), Grammatical gender (silla, chair), or Opaque-Grammatical gender (tomate, tomato). Results: People with aphasia performed more poorly in all gender conditions than healthy controls. They also were less accurate in both the Grammatical and Opaque-Grammatical conditions than in the Semantic gender condition. Conclusion: We propose that because semantic gender provides more salient information, it is processed faster than grammatical gender.

Transcortical Sensory Aphasia Sonnet

A sonnet about transcortical sensory aphasia, a disorder in which comprehension remains intact, but language production is primarily constrained to repetition. Much like the mythical Echo, this sonnet is a reflection upon personal expression when one's words are not one's own.

Mitochondrial Diabetes: The Clinical Spectrum of MIDD and MELAS in Association With the A3243G Mutation

Abstract Introduction: Maternally inherited diabetes and deafness (MIDD) is a multisystem disorder characterized by insulinopenia and sensorineural hearing loss. This rare form of monogenic diabetes is most commonly associated with the A3243G mutation of mitochondrial DNA (mtDNA). The same mutation is seen in 80 percent of patients with MELAS (Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes). MIDD and MELAS have overlapping features suggesting a continuum of expression for the A3243G mutation. Clinical Case: A 41-year-old male was referred for genetic testing and counseling by his ophthalmologist following detection of bilateral punched-out retinal pigment epithelium (RPE) lesions on routine exam. His medical history was significant for type 1 diabetes mellitus (T1DM) diagnosed at the age of 21 and bilateral sensorineural hearing loss diagnosed at the age of 38. The referral was triggered by patient reported family history of MELAS in two of his brothers who were both diagnosed at the age of 10 and died at the ages of 20 and 27. Whether the patient was previously tested during early childhood remains unclear. His medical history was negative for stroke-like episodes or seizures. Neurologic evaluation revealed mild fluent aphasia with paraphasic errors and some comprehension difficulties. MRI of the brain without contrast showed no focus of restricted diffusion. Mitochondrial DNA sequence analysis was performed. A pathogenic variant (m.3243 A>G) was detected in the MT-TL1 gene at approximately 25% heteroplasmy. The patient was advised to avoid metformin given increased risk for lactic acidosis. He was also instructed against use of statins. At the age of 45, the patient presented to the emergency department (ED) with a complaint of headache, vertigo and incoordination. Physical examination revealed left homonymous hemianopsia, right horizontal nystagmus and bilateral upper extremity dysmetria. MRI of the brain without contrast showed a large area of predominantly cortical restricted diffusion involving the right temporal and occipital region with associated T2/FLAIR hyper-intensity. Cross over between the PCA and MCA territories was suggestive of a stroke-like episode related to MELAS. The patient received a bolus of IV arginine at 0.5 g/kg followed by an IV infusion of 0.5 g/kg/day for 3 days. He was later transitioned to oral arginine 5g three times daily and was discharged to a rehab facility. Clinical Lesson: This case demonstrates the evolution of MIDD to MELAS, supporting the concept that both syndromes represent a spectrum of the same disease. A few case reports describe the progression of MIDD to MELAS. Why some patients develop MELAS and others develop MIDD is unclear but may be related to heteroplasmy. Early identification of MIDD and MELAS is crucial given associated comorbidities and unique management issues.

The Brief Evaluation of Receptive Aphasia test for the detection of language impairment in patients with severe brain injury

ABSTRACT Primary objective: The assessment of language in patients post-comatose patients is limited by their reduced behavioral repertoire. We developed the Brief Evaluation of Receptive Aphasia (BERA) tool for assessing phonological, semantic and morphosyntactic abilities in patients with severe brain injury based on visual fixation responses. Research design: Prospective cross-sectional study and case reports. Methods and procedure: The BERA and Language Screening Test were first administered to 52 conscious patients with aphasia on two consecutive days in order to determine the validity and reliability of the BERA. Four post-comatose patients were further examined with the BERA, the Coma Recovery Scale-Revised (CRS-R), positron emission tomography and structural magnetic resonance imaging. Main outcome and results: The BERA showed satisfactory intra- and inter-rater reliability, as well as internal and concurrent validity in patients with aphasia. The BERA scores indicated selective receptive difficulties for phonological, semantic and particularly morphosyntactic abilities in post-comatose patients. These results were in line with the cortical distribution of brain lesions. Conclusions: The BERA may complement the widely used CRS-R for assessing and diagnosing patients with disorders of consciousness by providing a systematic and detailed characterization of residual language abilities.

Writing Errors in Broca’s and Wernicke’s Aphasias as a Manifestation of Functional Strategies for Writing

The research is devoted to the study of functional rearrangements in the structure of agraphia syndrome, depending on the content of the written task. Aim: To identify the variability of writing disorders in sensory and motor efferent agraphia in the conditions of performing different types of writing in terms of functional orientation. Materials and methods. The study involved 51 participants with post stroke aphasia and agraphia (29 people with with Wernicke aphasia). The severity of speech syndromes ranged from mild to moderate. All patients were right-handed. The native language for all participants was Russian. The study was carried out on the basis of inpatient departments of the Center for Speech Pathology and Neurorehabilitation in Moscow. Experimental methods included specially designed tasks that actualize the communicative, mnestic and regulatory functions of written speech. The productivity of writing when performing these tasks was compared with the assessment of the performance of diagnostic tasks traditionally used in clinical practice. Written errors were assessed at the level of individual graphemes, words and sentences. Statistical error analysis was carried out by intraindividual comparison of errors using nonparametric Chi-square tests and Wilcoxon’s test with subsequent correction for multiple comparisons using the Holm-Bonferroni method. Results. It was shown that in the group of patients with sensory agraphia, changes in the error structure were leading due to the increased load on the operation of auditory-speech analysis. In the group of patients with efferent motor dissociation agraphia identified when comparing different kinds of syntax errors. A common pattern for both groups was the use of compensatory strategies that optimize the writing process. Patients of both groups resorted to elliptical (incomplete, abbreviated) writing, used phrases of simple syntactic constructions, trying to reduce the number of written errors. The patients also resorted to a high variability of the communicative task, choosing the vocabulary that was most solidified in the past experience, which made it possible to avoid writing errors. Conclusion. Writing errors due to aphatic syndromes can be not only a manifestation of structural disorders of the component structure of speech function, but also a manifestation of the action of functional strategies of written communication.

The perversion of language: Jules Baillarger on aphasia, the lateralization of speech, and the Baillarger-Jackson principle

ABSTRACT Jules Baillarger was one of the foremost figures of nineteenth-century neurobiology. He is remembered today for his discovery that the human cerebral cortex is composed of six intercalated layers. Even today, two horizontal fiber bundles within cortical layers IV and V are referred to as the outer and inner bands of Baillarger. It is a measure of the importance of Baillarger’s discovery that his findings were elaborated upon with advances in microscopy and the development of methods for staining neurons and myelin by, notably, Theodor Meynert and Santiago Ramon y Cajal. Furthermore, Baillarger’s observation that there are variations in the thickness of one or another of the six cortical layers in different cortical regions, and the discovery of giant pyramidal motor neurons in layer V of the precentral gyrus, ultimately led to the cytoarchitectonic and myeloarchitectonic maps of Oscar Vogt and Cécile Vogt-Mugnier, and of their student Korbinian Brodmann (1908). Less well known are Baillarger’s contributions to the semiology of aphasia and the pivotal role he played in the recognition of the localization and lateralization of speech to the left hemisphere. Paul Broca’s localization of articulate language to the posterior aspect of the frontal lobes and Marc Dax’s discovery that speech is a function of the left hemisphere were vigorously challenged within French academic medicine until 1865, when Baillarger gave two addresses to the Royal Academy of Medicine. In the first address, he described a form of aphasia he called the perversion of language, which we now call fluent aphasia, and reported that aphasic patients can express words or parts of sentences when they are angry or excited, a phenomenon now known as the Baillarger-Jackson principle. In his second address, Baillarger supported the lateralization of speech to the left hemisphere of the brain and referred to this association as Dax’s “singular law,” and supported the localization of speech to the posterior aspect of the left inferior frontal gyrus. Baillarger’s description of the perversion of language and of the influence of emotions on speech presaged the discipline of aphasiology, and his support for the lateralization of speech to the left hemisphere marks the first instance of the unequivocal recognition of asymmetrical hemispheric functions by academic medicine. This article reviews these aspects of Baillargher’s career. Critical sections of his papers on cortical structure, aphasia, and functional hemispheric asymmetry are translated by the author.

57-Year-Old Woman With Weakness and Word-Finding Difficulties

57-Year-Old Woman With Weakness and Word-Finding Difficulties

Aphasia: Conversion/dissociation or organic etiology?

Aphasia: Conversion/dissociation or organic etiology?

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.

THE EXAMINATION OF SHORT HANDWRITTEN RECORDS EXECUTED BY PERSONS OF THE ELDERLY AND SENILE AGE

Nowadays, the objects of forensic handwriting analysis are often become short handwritten records of elderly people and senile. The study of such records is one of the most difficult when conducting handwriting examination. This is due to the nature of this object, which is often subjected to changes due to insufficient written practice, influence of age-related changes in the body or conditions common for the elderly people and senile, frequent execution of short handwritten records in unusual conditions, and sometimes with the help of other people, limitations in the studied graphic material. The article attempts to substantiate and systematize theoretical knowledge on the study of short handwritten records executed by elderly and senile people through analyzing the literature and forensic practice on the study of this type of objects, establishing individual patterns of handwriting, explaining the nature of diagnostic signs occurrence, determining the structure of the process for solving the mentioned tasks. Cases from practice and related problematic aspects of solving identification and diagnostic tasks are considered. The main characteristics of impaired ability (sensory, amnestic and motor aphasia) to write are given. Literature sources are analyzed, which consider the physiological mechanisms of the formation of writing skills and the features of their changes due to various conditions in elderly and senile people. Handwriting can undergo changes owing to aging of the body. Disorder of hand-eye coordination, conditions of the musculoskeletal system, nervous system, circulatory disorders, inherent for elderly and senile people, affect the stability of handwriting features. Testaments, contracts of sale and donation, bank documents are often signed by people of elderly and senile age shortly before death resulting from a serious long illness after experiencing such conditions as stroke or myocardial infarction. It is the aging of the body that is accompanied by deterioration in the state of health, impaired vision, muscle weakness, depletion of the nervous system, decreased mobility of the musculoskeletal system and impaired blood circulation. Features of writing motor skill functioning in the elderly and senile people lead to a slowdown in the tempo of movement, decrease in their amplitude and speed, decrease in the plasticity of movements. The correct ratio of such signs as proficiency and coordination of movements is of great importance. In addition, short handwritten records executed by the elderly and senile people contain a limited amount of graphic material. At the moment of executing a short recording, even under normal conditions, the performer needs a certain adaptation to a situation, which can not be performed while rare or occasional execution of a single short record. Therefore, the stability of a skill while executing short recording has an increased spread, and selective variability has low thresholds.

Visual feedback of finger writing in a patient with sensory aphasia: a case report and theoretical considerations

ABSTRACT Through cognitive task performance, we examined the functional role of finger writing (kūsho) in a Japanese patient with moderate sensory aphasia and reading difficulties. We hypothesized that the visual feedback of kūsho would improve visual language processing, which we tested with a “kanji construction task” using character subparts. Results showed a higher number of correct responses 1) when the patient used kūsho and 2) when visual feedback of finger movements was available. The results suggest that kūsho may not improve the retrieval of phonological information but does aid the visual processing necessary to assemble character subparts.

Interests and Strengths in Autism, Useful but Misunderstood: A Pragmatic Case-Study.

BackgroundStudies on autistic strengths are often focused on what they reveal about autistic intelligence and, in some cases, exceptional and atypical reasoning abilities. An emerging research trend has demonstrated how interests and strengths often evident in autism can be harnessed in interventions to promote the well-being, adaptive, academic and professional success of autistic people. However, abilities in certain domains may be accompanied by major limitations in others, as well as psychiatric and behavioral issues, which may challenge their inclusion in support programs.ObjectivesTo provide an in-depth, pragmatic, real-life example of the psychological and psychiatric management of interests and strengths in an autistic adolescent.MethodAn autistic teenager, C.A., with above-average calendar calculation and musical abilities, received psychiatric, neuropsychological, and language standardized and clinical assessments, combined with a measurement of his musical and calendar calculation abilities. C.A. and his parents then received psychiatric and psychological support over a 14-month period, targeting their perceptions of C.A.’s interests, strengths, and co-occurring difficulties.ResultsC.A. had a verbal IQ within the intellectual disability range and a non-verbal IQ in the low mean range. Modest calendar calculation, absolute pitch, and matrix abilities coexisted with severe receptive and expressive language disorder. The discrepancy between his abilities in areas of strengths and his limitations in other domains led to anxiety, frustration, and sometimes behavioral issues. Displacing the focus from academic performance to interests, as well as promoting the use of his strengths to develop new skills independently of their short-term adaptive benefits yielded positive effects on C.A.’s self-assessment, quality of life, and behavior at follow up.DiscussionThe appealing idea that abilities mostly found in autistic people, such as calendar calculation, can be directly harnessed into academic achievement and lead to paid employment may have detrimental effects, especially when such abilities are modest and associated with other limitations. These abilities should be primarily used to maximize well-being and quality of life, independently of their short-term adaptive function, which may or may not be positive.

Characteristics of Non-linguistic Cognitive Impairment in Post-stroke Aphasia Patients.

Background: Non-linguistic cognitive training has been suggested to improve the communication skills of patients with post-stroke aphasia (PSA). However, the association between language and non-linguistic cognitive functions is not fully understood. In this study, we used the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) to evaluate the characteristics of non-linguistic cognitive impairments in Chinese PSA patients.Methods: A total of 86 stroke patients were recruited in this study. Language and non-linguistic cognitive impairments were evaluated by the Western Aphasia Battery (WAB) and LOTCA, respectively. The patients were divided into two groups (PSA and non-PSA), and the Chinese norm (the data came from 44 Chinese individuals without neurological disorders in a previous study) was used as the control group. The LOTCA scores were compared among the three groups. Patients in the PSA group were subdivided into the fluent aphasia group (FAG) and the non-FAG according to the Chinese aphasia fluency characteristic scale. The LOTCA scores were also compared between the PSA subdivisions. Potential confounders were adjusted in the analysis of covariance. Partial correlation analysis between the subscores of WAB and LOTCA was also performed.Results: The total LOTCA scores in the PSA group (75.11 ± 17.08) were significantly lower compared with scores in the non-PSA (96.80 ± 7.75, P < 0.001) and the control group (97.65 ± 16.24, P < 0.001). The PSA group also had lower orientation, visual perception (VP), spatial perception (SP), visuomotor organization, thinking operation, and attention scores. The total LOTCA, orientation, VP, SP, and MP scores were lower in the non-FAG (69.24 ± 18.06, 8.62 ± 5.09, 12.76 ± 2.47, 7.48 ± 3.01, and 9.62 ± 2.25, respectively) compared with the FAG (80.36 ± 14.07, 12.14 ± 3.99, 14.09 ± 1.93, 9.68 ± 3.01, 10.55 ± 1.63, respectively, P's < 0.05). The aphasia quotient was positively correlated with the total score of LOTCA and scores of orientation, VP, SP, and MP (r = 0.710, 0.744, 0.565, 0.597, and 0.616; P < 0.001).Conclusion: Compared with stroke patients without aphasia, patients with PSA often have more extensive and serious non-linguistic cognitive impairments. Patients with non-fluent aphasia often present with serious cognitive impairments than those with fluent aphasia, especially the impairments of orientation and SP. Non-linguistic cognitive impairments correlate with language impairments in aphasia.

Neural correlates of spontaneous language production in two patients with right hemispheric language dominance

ABSTRACT Background It is not conclusively explored what kind of reorganisation processes are set off after a stroke with resulting aphasia. Since the development of functional Magnetic Resonance Imaging (fMRI), linguistic processes and their neural representation have been researched, especially in aphasic patients after left hemispheric insult. The situation differs in aphasic patients with crossed aphasia or aphasia after a right hemispheric lesion, for which only few studies have been carried out. In order to close this gap, the present study deals with the localisation of language functions in the brain of patients with crossed aphasia and right hemispheric language dominance. Aim The objective of the current study was to provide insights into the neural correlates of continuous aphasic language production of patients with right hemispheric language dominance. Based on the current state of research, a mirror image representation was expected. Methods & Procedures Two patients with fluent aphasia due to right hemisphere lesions, one presenting with crossed aphasia, described complex pictures. The continuous language output was transcribed and categorised into events. Lexical search (i.e. the difference between unimpaired speaking and word-finding difficulties) was analysed using fMRI. The neural activation clusters were compared with the corresponding areas of a control group consisting of 12 patients with left hemispheric aphasia. Outcomes & Results The analysis of the behavioural data revealed word-finding difficulties as one of the most limiting factors in the spontaneous language output of the patients. The neural correlates of lexical search (unimpaired minus impaired) were observed in four activation clusters both patients had in common. Each cluster was predominantly localised in the contra-lesional hemisphere. Compared to the corresponding areas of the control group, in general, a mirrored image representation could be confirmed. Conclusions The combination of detailed linguistic analysis and fMRI confirmed the assumption of mirrored language organisation for anomia in continuous language production. Moreover, the study might add to a more general understanding of the contribution of the contra-lesional hemisphere to language recovery in aphasia after left or right hemisphere damage.

Development of a measure of function word use in narrative discourse: core lexicon analysis in aphasia.

Although discourse-level assessments contribute to predicting real-world performance in persons with aphasia (PWA), the use of discourse measures is uncommon in clinical settings due to resource-heavy procedures. Moreover, assessing function word use in discourse requires the arduous procedure of defining grammatical categories for each word in language transcripts. The purpose of this exploratory study was twofold: (1) to develop core function word lists as a clinician-friendly means of evaluating function word use in discourse; and (2) to examine the ability of the core function word measure to differentiate PWA from cognitively healthy adults and persons with fluent aphasia from non-fluent aphasia. The 25 most commonly used function words (core function words) were extracted from narrative language samples from 470 cognitively healthy adults, which were divided into seven age groups (20s, 30s, 40s, 50s, 60s, 70s and 80s). The percent agreement of core function words for 11 PWA (fluent aphasia = 5; non-fluent aphasia = 6) and 11 age- and education-matched controls were then calculated. Percent agreement for the core function words produced was compared between the controls and the PWA group, and between participants with fluent aphasia and non-fluent aphasia. The results indicated that PWA produced fewer core function words from the lists than the control group, and that core function word use was strongly correlated with aphasia severity. Persons with non-fluent aphasia produced fewer core function words than those with fluent aphasia, although this could be a confound of aphasia classification from the use of the Western Aphasia Battery (WAB)-Revised. Core function word lists consisting of a limited number of items for quantifying function word use in discourse remain in a nascent stage of development. However, the findings are consistent with previous studies analysing the total production of function words in language samples produced by PWA. Therefore, core function words may potentially serve as a clinician-friendly manner of quantifying function words produced in discourse. What this paper adds What is already known on the subject Function word analysis in discourse requires arduous processes of identifying the error production and grammatical category of function words in discourse. Previous studies have demonstrated that core lexicon measures are an efficient, simple means of quantifying discourse in PWA. However, function words have never been considered for generating an independent core lexicon list. What this paper adds to existing knowledge As an exploratory study, we focused primarily on developing a clinician-friendly measure to evaluate function word production in discourse, motivated by the idea of an adaptation strategy within the core lexicon framework. Our findings demonstrated that by using a simple scoring system that the core lexicon measure provides, we differentiated the control group from the PWA group, and persons with fluent aphasia from persons with non-fluent aphasia. Additionally, we found significant correlations between function word production and aphasia severity determined by WAB Aphasia Quotient (AQ). What are the potential or actual clinical implications of this work? The results add empirical evidence for the utility of core function word lists for quantifying function word usage in discourse in PWA. Counting the presence and absence of function words in discourse will allow clinicians to avoid labour-intensive preparatory work, and to obtain useful diagnostic information in a less time-consuming way.

Quantifying the Interplay of Semantics and Phonology During Failures of Word Retrieval by People With Aphasia Using a Multiplex Lexical Network.

Investigating instances where lexical selection fails can lead to deeper insights into the cognitive machinery and architecture supporting successful word retrieval and speech production. In this paper, we used a multiplex lexical network approach that combines semantic and phonological similarities among words to model the structure of the mental lexicon. Network measures at different levels of analysis (degree, network distance, and closeness centrality) were used to investigate the influence of network structure on picture naming accuracy and errors by people with Anomic, Broca's, Conduction, and Wernicke's aphasia. Our results reveal that word retrieval is influenced by the multiplex lexical network structure in at least two ways-(a) the accuracy of production and error type on incorrect productions were influenced by the degree and closeness centrality of the target word, and (b) error type also varied in terms of network distance between the target word and produced error word. Taken together, the analyses demonstrate that network science techniques, particularly the use of the multiplex lexical network to simultaneously represent semantic and phonological relationships among words, reveal how the structure of the mental lexicon influences language processes beyond traditionally examined psycholinguistic variables. We propose a framework for how the multiplex lexical network approach allows for understanding the influence of mental lexicon structure on word retrieval processes, with an eye toward a better understanding of the nature of clinical impairments, like aphasia.

Intensive aphasia therapy improves low mood in fluent post-stroke aphasia: Evidence from a case-controlled study

ABSTRACT Introduction: Depressive symptoms are a major drawback of aphasia, negatively impacting on functional outcomes. In a previous study, Intensive Language-Action Therapy (ILAT) was effective in improving depression and low mood in persons with chronic non-fluent aphasia. We present a proof-of-concept case–control study that evaluates language and mood outcomes amongst persons with fluent post-stroke aphasia. Participants: Thirteen Spanish speaking persons with fluent aphasia due to chronic stroke lesions in the left hemisphere participated in the study. Intervention: Five participants (intervention group) received ILAT for 3 h/day during two consecutive weeks, for an overall of 30 h, and 8 participants (control group) entered a waiting-list no-treatment arm. Results: The main finding was that participants receiving active treatment showed significant improvements on depression and aphasia severity scores, whereas no significant changes were found in the control group. Conclusions: The implementation of ILAT was efficient in improving clinical language deficits in people with fluent aphasia and contributes to improvement in mood after therapy. Trial registration: EUDRACT (2008-008481-12)

Rehabilitation after ischemic stroke in the elderly

SUMMARY Introduction The article is an attempt to assess the effectiveness of various physiotherapeutic methods in people after ischemic stroke in the elderly, because rehabilitation has been shown to be an indispensable element of the treatment of these people. The range of methods used is a broadly understood concept, and this article will present the most effective reports from the world of physiotherapy on how to rehabilitate patients after a stroke. Aim The aim of the article is to characterize given methods as therapies, to indicate applications in rehabilitation and to assess their effectiveness. Methods and materials The most commonly used methods for patient improvement are NDT-Bobath, a Kabat proprioceptive pathway method (PNF). The basic therapy for the elderly after an ischemic stroke should be carried out with support for motor imagining. This article uses pilot and review works from 1986-2017. Results The presented methods of improving NDT Bobath, PNF and motor imagery are more effective in the treatment of people after ischemic stroke in the elderly than traditional methods of treatment. Research that was used for the purposes of this article conducted in the years 2009-2015 prove the effectiveness of these methods. Conclusions Based on the research carried out so far, the effectiveness of the given methods on the process of rehabilitation of a patient after a stroke can be confirmed. The use of both basic therapeutic and supportive methods at the same time gives beneficial results than using them alone. Key words: rehabilitation, stroke, neurorehabilitation INTRODUCTION A stroke is the under World Organization for a clinical syndrome characterized by a sudden onset of a focal, and sometimes also generalized brain dysfunction, the symptoms of which persist longer than 24 hours or until death and has no purpose. 80-85% of all ischemic strokes. Stroke third in time with full deaths in development after cardiovascular disease and cancer. Factors leading to pathological processes, while ischemic stroke is arterial or complete blockage of blood supply to the brain, the effects lead to hypoxia, the effects lead to damage to nerve cells [1,3]. The most important ischemic stroke is disability or weakness, sensory disturbance, involuntary movements, chorea movements, sensory and motor aphasia, maladjustment disorder [1,2].

Early discrimination of cognitive motor dissociation from disorders of consciousness: pitfalls and clues

Bedside assessment of consciousness and awareness after a severe brain injury might be hampered by confounding clinical factors (i.e., pitfalls) interfering with the production of behavioral or motor responses to external stimuli. Despite the use of validated clinical scales, a high misdiagnosis rate is indeed observed. We retrospectively analyzed a cohort of 49 patients with severe brain injury admitted to an acute neuro-rehabilitation program. Patients’ behavior was assessed using the Motor Behavior Tool and Coma Recovery Scale Revised. All patients underwent systematic assessment for pitfalls including polyneuropathy and/or myopathy and/or myelopathy, major cranial nerve palsies, non-convulsive status epilepticus, aphasia (expressive or comprehensive), cortical blindness, thalamic involvement and frontal akinetic syndrome. A high prevalence (75%) of pitfalls potentially interfering with sensory afference (polyneuropathy, myopathy, myelopathy, and sensory aphasia), motor efference (polyneuropathy, myopathy, motor aphasia, and frontal akinetic syndrome), and intrinsic brain activity (thalamic involvement and epilepsy) was found. Nonetheless, the motor behavior tool identified residual cognition (i.e. a cognitive motor dissociation condition) regardless of the presence of these pitfalls in 70% of the patients diagnosed as unresponsive using the Coma Recovery Scale Revised. On one hand, pitfalls might contribute to misdiagnosis. On the other, it could be argued that they are clues for diagnosing cognitive motor dissociation rather than true disorders of consciousness given their prominent effect on the sensory–motor input–output balance.

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.