Are there prototypical associations between time frames and aspectual values? Evidence from Greek aphasia and healthy ageing

Time reference, which has been found to be selectively impaired in agrammatic aphasia, is often interwoven with grammatical aspect. A recent study on Russian aphasia found that time reference and aspect interact: Past reference was less impaired when tested within a perfective aspect context (compared to when tested within an imperfective aspect context), and reference to the non-past was less impaired when tested within an imperfective aspect context (compared to when tested within a perfective aspect context). To explain this pattern, the authors argued that there are prototypical associations between time frames and aspectual values. The present study explores the relationship between time reference and aspect focusing on Greek aphasia and healthy ageing and using a sentence completion task that crosses time reference and aspect. The findings do not support prototypical matches between different time frames and aspectual values. Building on relevant studies, we propose that patterns of performance of healthy or language-impaired speakers on constrained tasks tapping different combinations of time frames with aspectual values should reflect the relative frequency of these combinations in a given language. The analysis of the results at the individual level revealed a double dissociation, which indicates that a given time frame-aspectual value combination may be relatively easy to process for some persons with aphasia but demanding for some others.

From individual to global: Human rights and aphasia

This commentary marks the 70th anniversary of the Universal Declaration of Human Rights by examining Article 19 and its application to people with aphasia. This group of people still face lack of access, stigmatisation, exclusion, disadvantage and social withdrawal as well as poor public awareness of aphasia and inadequate prioritisation of support and resources. Nevertheless, a range of creative initiatives at individual, healthcare, local community, national and global levels have helped to connect and empower people with aphasia. Such initiatives include provision of accessible information in a range of media, inclusion of people with aphasia in decision-making and as research partners, awareness raising campaigns to counter attitudinal barriers, organisation of community aphasia groups, development of guidelines for best practice, national aphasia associations and international collaborations such as Aphasia United. While ongoing work and resourcing is needed to expand these efforts further, they have helped people with aphasia to be heard and to protect their sense of dignity which underlies human rights. A human rights approach can unite, politicise and refocus these efforts, and highlight the essential role of communication in fostering a better quality of life.

Longer-term needs of stroke survivors with communication difficulties living in the community: a systematic review and thematic synthesis of qualitative studies

OBJECTIVE

To review and synthesise qualitative literature relating to the longer-term needs of community dwelling stroke survivors with communication difficulties including aphasia, dysarthria and apraxia of speech.

DESIGN

Systematic review and thematic synthesis.

METHOD

We included studies employing qualitative methodology which focused on the perceived or expressed needs, views or experiences of stroke survivors with communication difficulties in relation to the day-to-day management of their condition following hospital discharge. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, The Cochrane Library, International Bibliography of the Social Sciences and AMED and undertook grey literature searches. Studies were assessed for methodological quality by two researchers independently and the findings were combined using thematic synthesis.

RESULTS

Thirty-two studies were included in the thematic synthesis. The synthesis reveals the ongoing difficulties stroke survivors can experience in coming to terms with the loss of communication and in adapting to life with a communication difficulty. While some were able to adjust, others struggled to maintain their social networks and to participate in activities which were meaningful to them. The challenges experienced by stroke survivors with communication difficulties persisted for many years poststroke. Four themes relating to longer-term need were developed: managing communication outside of the home, creating a meaningful role, creating or maintaining a support network and taking control and actively moving forward with life.

CONCLUSIONS

Understanding the experiences of stroke survivors with communication difficulties is vital for ensuring that longer-term care is designed according to their needs. Wider psychosocial factors must be considered in the rehabilitation of people with poststroke communication difficulties. Self-management interventions may be appropriate to help this subgroup of stroke survivors manage their condition in the longer-term; however, such approaches must be designed to help survivors to manage the unique psychosocial consequences of poststroke communication difficulties.

Cross-linguistic adaptations of The Comprehensive Aphasia Test: Challenges and solutions

Comparative research on aphasia and aphasia rehabilitation is challenged by the lack of comparable assessment tools across different languages. In English, a large array of tools is available, while in most other languages, the selection is more limited. Importantly, assessment tools are often simple translations and do not take into consideration specific linguistic and psycholinguistic parameters of the target languages. As a first step in meeting the needs for comparable assessment tools, the Comprehensive Aphasia Test is currently being adapted into a number of languages spoken in Europe. In this article, some key challenges encountered in the adaptation process and the solutions to ensure that the resulting assessment tools are linguistically and culturally equivalent, are proposed. Specifically, we focus on challenges and solutions related to the use of imageability, frequency, word length, spelling-to-sound regularity and sentence length and complexity as underlying properties in the selection of the testing material.

Engaging People with Aphasia in Design of Rehabilitation Through Participatory Design: A Way to Learn what They Really Want

Research literature on participatory design in relation to people with communicative and cognitive disabilities often focuses on the challenges of communication among the participants. This paper presents a case study involving people suffering from communication disabilities after a brain injury (aphasia) early in a design process of an avatar-mediated virtual learning environment for rehabilitation. The example demonstrates how providing time and space and supporting the communication with well-suited tools and artefact opens for firth-hand domain knowledge of living with aphasia. The results demonstrate that participatory design methods might result in much more than just being a step in the design process. In this specific case, it turns out to be a tool to engage, involve, and empower people with communication disabilities to interact and communicate. The paper argues, that participatory design is a way for designers to gain insights into what people with aphasia really want and, consequently, might also be a key to redesign rehabilitation for people with communication disabilities.

Assessment Fidelity in Aphasia Research

PURPOSE

In aphasia treatment literature, scarce attention is paid to factors that may reduce a study's validity, including adherence to assessment and treatment procedures (i.e., fidelity). Although guidelines have been established for evaluating and reporting treatment fidelity, none exist for assessment fidelity.

METHOD

We reviewed treatment fidelity guidelines and related literature to identify assessment fidelity components. We then examined 88 aphasia treatment studies published between 2010 and 2015 and report the frequency with which researchers provide information regarding the following assessment fidelity components: assessment instruments, assessor qualifications, assessor or rater training, assessment delivery, assessor or rater reliability, and assessor blinding.

RESULTS

We found that 4.5% of studies reported information regarding assessment instruments, 35.2% reported information regarding assessor qualifications, 6.85% reported information regarding assessor or rater training, 37.5% reported information regarding assessor or rater reliability, 27.3% reported on assessor blinding, and no studies reported information regarding assessment delivery.

CONCLUSIONS

There is a paucity of assessment fidelity information reported in aphasia treatment research. The authors propose a set of guidelines to ensure readers will be able to evaluate assessment fidelity, and thus study validity.

Cross-Linguistic Differences in a Picture-Description Task Between Korean- and English-Speaking Individuals With Aphasia

PURPOSE

The purpose of the study was to examine cross-linguistic differences in a picture-description task between Korean- and English-speaking individuals with Broca's and anomic aphasia to determine whether a variation exists in the use of verbs and nouns across the language and aphasia groups.

METHOD

Forty-eight individuals (male = 29; female = 19) participated in the study (n = 28 for aphasic group and n = 20 healthy controls). Data for English speakers were obtained from the Aphasia Bank Project. We used the picture-description task to obtain connected speech samples and analyzed noun- and verb-related linguistic variables.

RESULTS

Korean speakers with aphasia produced more verbs per utterance and a lower noun-to-verb ratio than English speakers with aphasia, whereas English speakers produced more nouns than Korean speakers. The Korean anomic group produced more verbs than Korean speakers with Broca's aphasia, whereas no effects were significant for English speakers with aphasia depending on the type of aphasia.

CONCLUSIONS

Aphasia symptoms vary as a function of linguistic features of languages that individuals with aphasia used premorbidly. Furthermore, the linguistic characteristics of the individual's language influenced aphasia symptoms more strongly than the type of aphasia. It is theoretically and clinically important that this cross-linguistic study provides different perspectives, and that noun-verb deficits may vary depending on linguistic features.

Self-Judgments of Word Production Accuracy in Acquired Apraxia of Speech

PURPOSE

The ability to recognize one's own speech errors has long been considered a clinical feature of acquired apraxia of speech (AOS) despite limited empirical data supporting this notion. This study was designed to (a) investigate the ability of speakers with AOS to self-judge the accuracy of their own word productions and (b) examine the test-retest stability of a measure to quantify the self-judgments of speakers with AOS.

METHOD

Twenty-four speakers with AOS and aphasia repeated mono- and multisyllabic words. After each word, they indicated whether their production was correct or incorrect. This procedure was repeated 1 week later to examine performance stability.

RESULTS

Percentage of incorrect word productions was stable for the group across times. Accuracy of judgments ranged from 64% to 100% at Time 1 and from 56% to 100% at Time 2. Inaccurate judgments of error productions (false positives) occurred much more frequently than inaccurate judgments of correct productions (false negatives).

CONCLUSIONS

Error production was remarkably stable in our participants. As a group, the participants failed to detect almost one third of words produced erroneously. However, accuracy and stability of judgments over sampling times varied across participants. Findings suggest that error awareness might be a worthwhile target for treatment in some individuals with AOS.

The Use of One or Three Semantic Associative Primes in Treating Anomia in Aphasia

PURPOSE

The aims of the study were to investigate the use of semantic associative relationships as primes in treating naming deficits, or anomia, in aphasia and to determine if differential treatment effects would be found if 1 or 3 primes were presented.

METHOD

Ten individuals with varying degrees of anomia participated in the study. A single-subject, A-B treatment design with a cross-over component was used. A 1-PRIME condition (use of 1 prime) was compared with a 3-PRIMES condition (use of 3 primes) for each participant.

RESULTS

Visual analyses of treatment data revealed improvements in 8 of 10 participants. Meaningful effect sizes were obtained in at least 1 of the conditions for 6 of the 10 participants. Slightly more participants demonstrated meaningful effect sizes in the 3-PRIMES condition than in the 1-PRIME condition. Correlation analyses revealed a positive correlation between the number of teaching episodes and 3-PRIMES probe performance.

CONCLUSIONS

The results support a protocol that uses semantic associative primes to increase naming accuracy in aphasia. The 3-PRIMES condition was slightly more beneficial than the 1-PRIME condition in terms of improving naming abilities in these participants, but there was no overwhelming advantage in using one or the other condition.

The Use of Electropalatography in the Treatment of Acquired Apraxia of Speech

PURPOSE

This investigation was designed to examine the effects of an articulatory-kinematic treatment in conjunction with visual biofeedback (VBFB) via electropalatography (EPG) on the accuracy of articulation for acquired apraxia of speech (AOS).

METHOD

A multiple-baseline design across participants and behaviors was used with 4 individuals with chronic AOS and aphasia. Accuracy of target speech sounds in treated and untreated phrases in probe sessions served as the dependent variable. Participants received an articulatory-kinematic treatment in combination with VBFB, which was sequentially applied to 3 stimulus sets composed of 2-word phrases with a target speech sound for each set.

RESULTS

Positive changes in articulatory accuracy were observed for participants for the majority of treated speech sounds. Also, there was generalization to untreated phrases for most trained speech sounds. Two participants had better long-term maintenance of treated speech sounds in both trained and untrained stimuli.

CONCLUSIONS

Findings indicate EPG may be a potential treatment tool for AOS. It appears that individuals with AOS can benefit from VBFB via EPG in improving articulatory accuracy. However, further research is needed to determine if VBFB is more advantageous than behavioral treatments that have been proven effective in improving speech production for speakers with AOS.

Effect of Stimulus Variables on Verbal Perseveration of Dysphasic Subjects

Oral responses were received from 33 dysphasics to word stimuli counterbalanced according to abstraction level, part of speech, length, and frequency of occurrence, and presented through the visual, auditory, and visual-auditory modalities. The results indicated that: through the visual modality, words of high and medium abstraction level produced significantly more perseveration than low, while through the auditory and visual-auditory modalities no significant differences were found; regardless of modality no significant differences existed among nouns, verbs and adjectives; regardless of modality long words produced significantly more perseveration than short; regardless of modality no significant differences existed between words of frequent and infrequent occurrence in the language; regardless of abstraction level, part of speech, word length and frequency of occurrence, the visual modality produced significantly more perseveration than the auditory and visual-auditory modalities, except in the case of words of high abstraction level where the auditory mode produced significantly more perseverations than the visual-auditory modality.

Predictions of Brain Damage from an Aphasia Screening Test; An Application of Discriminant Functions and a Comparison with a Non-Linear Method of Analysis

Under linear discriminant function analysis of four cerebral-damage criterion groups (including non-damage), arranged in seven two-way comparisons, the aphasia screening test gave over-all percentages of correct prediction of 262 Ss' actual brain-damage classifications, ranging between 77.5% and 93.4%. An earlier analysis of the same Ss' responses to the aphasia test, organized in terms of four mutually exclusive and exhaustive, non-linear rules for classifying each S to a single damage category (control, left, right, and diffuse or bilateral), produced percentages of correct prediction within virtually the same range as did the discriminant function analysis, but with a different pattern of accuracy of prediction. The results of the aphasia test discriminant function analysis were almost completely congruent with those obtained from the same kind of analysis applied to 23 entirely different test variables from the Wechsler, Halstead, and Trail Making tests. The implications of such methods as the discriminant function, for the production of new understanding of the effects of brain damage on human behavior, are discussed.

Global coherence during discourse production in adults: a review of the literature

BACKGROUND

Global coherence is a metric of expressive language performance that represents the speaker's ability to initiate, plan and maintain a topic of discussion. Studies indicate that disruptions of global coherence can occur during the ageing process and following neurological disease or injury. However, little is known about the specific impact that the ageing process, disease or injury has on global coherence during discourse production.

AIMS

To review the literature on global coherence in adult populations and assess the impact that age, disease or injury has on global coherence during expressive language tasks.

METHODS & PROCEDURES

We completed an in-depth search of Medline and PyschInfo (1990-2014) to identify studies of global coherence in adult populations. We identified studies that included a comparison group and utilized a measure of global coherence during expressive language production among adults.

OUTCOMES & RESULTS

Twenty studies comprised of 692 study participants who met inclusion criteria were identified for the review of the literature. Studies included participants without neurological impairments and individuals with aphasia, traumatic brain injury, dementia, generalized memory impairment and other neurological conditions. Study results indicated global coherence is an expressive language skill that is influenced by the ageing process and neurological disease or injury.

CONCLUSIONS & IMPLICATIONS

Although evidence indicated that global coherence is negatively influenced by ageing and neurological disease/injury, the heterogeneity of study populations, measurement tools and study designs were limiting factors in determining the exact nature by which these factors impact the skill of global coherence.

Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language

This article explores the relationship between automatic and involuntary language in the work of Samuel Beckett and late nineteenth-century neurological conceptions of language that emerged from aphasiology. Using the work of John Hughlings Jackson alongside contemporary neuroscientific research, we explore the significance of the lexical and affective symmetries between Beckett's compulsive and profoundly embodied language and aphasic speech automatisms. The interdisciplinary work in this article explores the paradox of how and why Beckett was able to search out a longed-for language of feeling that might disarticulate the classical bond between the language, intention, rationality and the human, in forms of expression that seem automatic and "readymade".

Linguistic analysis of discourse in aphasia: A review of the literature

This review examined previous research applications of linguistic discourse analysis to assess the language of adults with aphasia. A comprehensive literature search of seven databases identified 165 studies that applied linguistic measures to samples of discourse collected from people with aphasia. Analysis of methodological applications revealed an increase in published research using linguistic discourse analysis over the past 40 years, particularly to measure the generalisation of therapy outcomes to language in use. Narrative language samples were most frequently subject to analysis though all language genres were observed across included studies. A total of 536 different linguistic measures were applied to examine language behaviours. Growth in the research use of linguistic discourse analysis and suggestions that this growth may be reflected in clinical practice requires further investigation. Future research directions are discussed to investigate clinical use of discourse analysis and examine the differences that exist between research and clinical practice.

Frontotemporal dementia

Frontotemporal dementia is an umbrella clinical term that encompasses a group of neurodegenerative diseases characterised by progressive deficits in behaviour, executive function, or language. Frontotemporal dementia is a common type of dementia, particularly in patients younger than 65 years. The disease can mimic many psychiatric disorders because of the prominent behavioural features. Various underlying neuropathological entities lead to the frontotemporal dementia clinical phenotype, all of which are characterised by the selective degeneration of the frontal and temporal cortices. Genetics is an important risk factor for frontotemporal dementia. Advances in clinical, imaging, and molecular characterisation have increased the accuracy of frontotemporal dementia diagnosis, thus allowing for the accurate differentiation of these syndromes from psychiatric disorders. As the understanding of the molecular basis for frontotemporal dementia improves, rational therapies are beginning to emerge.

The complexity of the relationship between neuropsychological deficits and impairment in everyday tasks after stroke

BACKGROUND AND PURPOSE

A large body of research reports that stroke patients are debilitated in terms of daily independence after dismissal from the hospital unit. Patients struggle with the use of daily objects or performing complex actions. Differences between individual deficits of patients are often associated with the site of the brain damage. However, clinical studies suggest that patients exhibit varied constellations of action-associated difficulties and neuropsychological deficits. There is a lack of conclusive evidence indicating how different neuropsychological symptoms link to the impaired ability to perform activities of daily living (ADL).

MATERIALS AND METHODS

To further address this matter, in this study we compared the behavior of patients with left brain damage (LBD) and right brain damage (RBD) following stroke in two naturalistic task scenarios (tea making and document filing), and compared the committed action errors to the neuropsychological screening results.

RESULTS

We observed mild to severe impairments in both the LBD and RBD groups amounting to 37-55% of failure rate in attainment of action goal. Interestingly, the performance on both tasks was not correlated to each other, suggesting that the tasks involved a different set of higher cognitive functions. Despite similar behavioral manifestations, in the LBD group poor task performance was related to deficits in praxis performance and unilateral tactile and visual extinction. The presence of aphasia did not correlate with task performance, except for a link between low scores in Aachen aphasia test scales and misestimation error in the tea making task. In the RBD group, difficulties with performance were primarily linked to deficit in praxis and unilateral visual extinction.

CONCLUSIONS

Despite similar behavior, the underlying mechanisms of the deficits after stroke might be different (in patients with LBD and RBD) and reveal complex interlinks of cognitive networks involved in the ability to carry on everyday tasks.

A novel eye-tracking method to assess attention allocation in individuals with and without aphasia using a dual-task paradigm

Numerous authors report that people with aphasia have greater difficulty allocating attention than people without neurological disorders. Studying how attention deficits contribute to language deficits is important. However, existing methods for indexing attention allocation in people with aphasia pose serious methodological challenges. Eye-tracking methods have great potential to address such challenges. We developed and assessed the validity of a new dual-task method incorporating eye tracking to assess attention allocation. Twenty-six adults with aphasia and 33 control participants completed auditory sentence comprehension and visual search tasks. To test whether the new method validly indexes well-documented patterns in attention allocation, demands were manipulated by varying task complexity in single- and dual-task conditions. Differences in attention allocation were indexed via eye-tracking measures. For all participants significant increases in attention allocation demands were observed from single- to dual-task conditions and from simple to complex stimuli. Individuals with aphasia had greater difficulty allocating attention with greater task demands. Relationships between eye-tracking indices of comprehension during single and dual tasks and standardized testing were examined. Results support the validity of the novel eye-tracking method for assessing attention allocation in people with and without aphasia. Clinical and research implications are discussed.

LEARNING OUTCOMES

Readers will be able to: (1) summarize the nature of dual-task paradigms, (2) identify shortcomings of existing dual-task measures of attention allocation for application to people with aphasia, (3) describe how eye-tracking measures may be recorded and analyzed to reflect differences in attention allocation across conditions, and (4) summarize potential clinical applications for eye-tracking measures of attention allocation.

Raising public awareness of aphasia in southern Ontario, Canada: A survey

PURPOSE

Despite the relatively high prevalence of aphasia, research indicates that, world-wide, public awareness of aphasia is lacking. Of the surveys that have been conducted internationally, none has studied the Canadian public's awareness of aphasia. The purpose of the present survey was to assess public awareness and basic knowledge of aphasia of individuals in southern Ontario, Canada.

METHOD

Using the same questionnaire that has been used in other countries, face-to-face surveys were conducted in public places (e.g. parks) at various locations in southern Ontario. Respondents were asked questions pertaining to their awareness and knowledge of aphasia. The number of surveys retained for analysis was 831. In addition to an evaluation of public awareness and knowledge of aphasia, the potential influences of age, gender, and occupation were analysed. For those who had heard of aphasia, questions were asked to determine how or where they had heard of aphasia.

RESULT

Consistent with the literature, overall public awareness and basic knowledge of aphasia in southern Ontario was found to be limited. The factors of age, gender and occupation were found to influence the results.

CONCLUSION

This investigation supports the need for better promotion of aphasia awareness to the public in southern Ontario and, by extension, in Canada.

Friends and foes in the lexicon: homophone naming in aphasia

The study of homophones--words with different meanings that sound the same--has great potential to inform models of language production. Of particular relevance is a phenomenon termed frequency inheritance, where a low-frequency word (e.g., deer) is produced more fluently than would be expected based on its frequency characteristics, presumably because of shared phonology with a high-frequency homophone counterpart (e.g., dear). However, prior studies have been inconsistent in showing frequency inheritance. To explain this inconsistency, we propose a dual nature account of homophony: a high-frequency counterpart exerts 2 counterposing effects on a low-frequency homophone target during the 2 main stages of naming: (a) a detrimental impact during semantically driven lexical retrieval; (b) a beneficial impact during phonological retrieval. In a study of naming in participants with chronic aphasia followed by computational investigations, we find strong evidence for the dual nature account of homophony.

A qualitative study of legal and social justice needs for people with aphasia

This paper presents an exploratory investigation of situations in which people with aphasia may be vulnerable to legal and access to justice issues. The study used a qualitative descriptive approach to analyse 167 de-identified transcriptions of previously collected interviews, with 50 participants with mild-to-severe aphasia following stroke, 48 family members, and their treating speech-language pathologists. Situations experienced by people with aphasia and their family members were coded using key-word searches based on the previously published framework developed by Ellison and colleagues to describe situations of vulnerability to legal and access to justice needs for older people. Health and financial and consumer situations were most frequently identified in the data. Additionally, there were a number of situations found specifically relating to people with aphasia involving their signatures and credit card use. Instances of discrimination and abuse were also identified, and, although infrequent, these issues point to the profound impact of aphasia on the ability to complain and, hence, to ensure rights to care are upheld. The findings of this study are consistent with previous research in suggesting that legal and access to justice needs are an important issue for people with aphasia and their families.

Initial evaluation of the Consent Support Tool: a structured procedure to facilitate the inclusion and engagement of people with aphasia in the informed consent process

This study evaluated the Consent Support Tool (CST), a procedure developed to identify the optimum format in which to present research information to people with different severities of aphasia, in order to support their understanding during the informed consent process. Participants were a convenience sample of 13 people with aphasia who had mixed comprehension ability. The CST was used to profile each participant's language ability and identify an information format that should maximize her/his understanding. Next, participants were shown information presented in three formats: standard text and two 'aphasia-friendly' versions providing different levels of support. Participants' understanding of the information was measured for each format. The format recommended by the CST was compared with the format observed to maximize understanding for each participant. The CST accurately predicted the optimum format for 11/13 participants and differentiated people who could understand fully with support from those who could not in 12/13 cases. All participants interviewed (10/10) found the adapted formats helpful and 9/10 preferred them to the standard version. These findings suggest that the CST could usefully support researchers to determine whether a person with aphasia is likely to be able to provide informed consent, and which information format will maximize that individual's understanding. The CST and different information formats are available as Supplementary Appendices to be found online at http://www.informahealthcare.com/doi/abs/10.3109/17549507.2013.795999 .

A theoretical account of lexical and semantic naming deficits in bilingual aphasia

PURPOSE

The purpose of this study was to examine premorbid language proficiency and lexical and semantic processing deficits in bilingual aphasia and develop a theoretical account of bilingual language processing.

METHOD

Nineteen Spanish-English patients with bilingual aphasia completed a language use questionnaire (LUQ) and were administered Spanish and English standardized language assessments. The authors analyzed the data to (a) identify patterns of lexical and semantic processing deficits and conceptualize a theoretical framework that accounts for language deficits, (b) determine LUQ measures that predict poststroke language deficits, and (c) evaluate the relationship between predictive LUQ measures and poststroke language deficits in order to identify impairment patterns.

RESULTS

On the basis of the results, the authors obtained significant correlations on several measures between language input and output. They identified prestroke language ability rating as the strongest predictor of poststroke outcomes. On the basis of these data, 2 distinct groups were identified: (a) patients who lost the same amount of language in Spanish and English and (b) patients who lost different amounts of Spanish and English.

CONCLUSIONS

These findings suggest that it is possible to identify relationships between language patterns and deficits in patients with bilingual aphasia and that these trends will be instrumental in clinical assessments of this understudied population.

[Buccofacial apraxia without limb apraxia or aphasia after right premotor area contusion: a case report]

Facial apraxia, as well as aphasia, has been associated with lesions in the cerebral hemisphere contralateral to the dominant hand. We describe a patient with severe facial apraxia caused by contusion in the right frontal operculum, premotor area and primary motor cortex ipsilateral to the dominant hand. The patient had no aphasia or limb apraxia. Magnetic resonance images of the brain reveal no abnormality of the hemisphere contralateral to the dominant hand. Thus, in some individuals, facial praxis is controlled by the hemisphere non-dominant for both handedness and language.

[Gogi (word-meaning) aphasia]

Gogi (word meaning) aphasia is an aphasic syndrome originally described by Tsuneo Imura in 1943. According to Imura, this syndrome is characterized by 4 symptoms: (1) difficulty in comprehending the meaning of a word despite perfect perception of the sound of the word; (2) presence of word amnesia and verbal paraphasia; (3) preservation of the ability to repeat spoken words; and (4) characteristic disturbances in reading and writing, in which Kana (Japanese syllabogram) can be correctly read and written, but Kanji (Japanese logogram) is read and transcribed in a peculiar way without comprehension, resulting in strange paragraphia. Gogi aphasia occupies a unique seat in the category of transcortical sensory aphasia. While the latter is grossly defined as fluent sensory aphasia with good repetition and without any specification about the linguistic level of deficit, the former is defined more specifically as fluent sensory aphasia with the deficit limited to the level of words. The characteristic Kana-Kanji dissociation aids in the diagnosis of this syndrome. Recently, it has been repeatedly confirmed that the temporal lobe type of Pick disease (known as semantic dementia in recent English literature) often presents the clinical picture of Gogi aphasia in its early course. Many Japanese physicians have contributed to the elucidation of this clinicopathological correlation. This is mainly because many neurologists and psychiatrists in Japan have long been familiar with the concept of Gogi aphasia and the nosology of Pick disease.

A database for investigating the logographeme as a basic unit of writing Chinese

Chinese script is non-alphabetic and a Chinese graph is basically syllabic which may consist of phonetic and semantic radicals with no representation of phonemes. The logographeme, a unit smaller than a radical, has been suggested to be the basic unit of Chinese writing based on data collected on people with aphasia. To better understand the role of logographemes in Chinese writing development, a data corpus of logographemes based on characters appearing in primary school textbooks is established. Logographemes are analysed in terms of features that are believed to influence writing development. A total of 249 logographemes were identified: 151 logographemes with no meaning and sound (NMS), 84 logographemes with both sound and meaning which could also stand alone to serve as a character (SA) and 14 logographemes with meaning only (MO). At each grade, the frequencies of NMS logographemes were relatively lower than those of SA and MO logographemes, and the frequencies of SA and MO logographemes were similar; 94% of logographemes were present in the characters taught to grade one students. Students learnt all the pronounceable logographemes by grade three, while they finished all the logographemes without sound until grade six. Characters with left-right, top-bottom and enclosing configurations constituted about 94% of all single-unit characters acquired in primary school years. Statistics derived from the data corpus regarding these features across grades enable us to make specific predictions about stages of literacy development and suggestions for investigation into processes involved in character production.

[The efficacy of donepezil for post-stroke aphasia: a pilot case control study.]

OBJECTIVE

To evaluate the efficacy of donepezil for post-stroke aphasia.

METHODS

Sixty patients with acute post-stroke aphasia were divided into treatment group and a control group. All patients had been treated for secondary prevention according to the guideline. The treatment group received donepezil hydrochloride (5 mg/d) for 12 weeks. The efficacy of treatment was measured by comparing the changes of scores of Western Aphasia Battery (WAB) between baseline and 12 weeks later.

RESULTS

Compared with the baseline, the changes of scores of all items of WAB and Aphasia Quotient (AQ) in both group after 12 weeks follow-up were great, however, the change of AQ was significantly greater in donepezil group (34.14 +/- 17.70)than that in control group (20.69 +/- 17.26)(P = 0.004). The patients in donepezil group also showed significant recovery in spontaneous speech, comprehension, repetition, and naming than those in control group (P < 0.05). The rate of significant improving in donepezil group was 60.0% which was significantly greater than that in control group (26.7%) (P = 0.009).

CONCLUSION

There are spontaneous recovery of post-stroke aphasia within 3 months. Donepezil may facilitate the recovery in spontaneous speech, comprehension, repetition, and naming functions.

Stroke-like syndrome in a middle aged Nigerian woman with metastatic brain cancer

BACKGROUND

Metastatic brain cancer constitutes about 24 to 25 % of brain tumours worldwide and in Nigeria it constitutes about 40% of brain tumors. The clinical presentation of metastatic tumors may be atypical.

OBJECTIVE

To present a middle aged Nigerian woman with a metastatic brain cancer who had a stroke-like syndrome.

METHODS

The patient was a 47-year old woman who presented with a two-week history of progressive weakness of the right upper and lower limbs, associated with headache, blurring of vision and slurring of speech. There was a history of weight loss but no history of cough or evening pyrexia. She was not a known hypertensive or diabetic patient though, there were positive history of diabetes mellitus in her father and elder senior brother. Her other systemic review and past medical history were not contributory.

RESULTS

Examination revealed a woman with expressive dysphasia and right spastic hemiparesis. Her pulse, blood pressure and heart sounds were normal. There was no carotid bruit. Imaging studies showed metastases in the brain, liver, chest, cervical lymph nodes and bone marrow. Cervical lymph node histology showed metastatic adenocarcinoma. She was managed with chemotherapy, steroids and other supportive therapy but she died on the 40th day of admission due to disease progression and aspiration pneumonitis.

CONCLUSION

Metastatic brain cancer may manifest atypically. Physicians should screen any patient with stroke without any apparent risk factors for possibilities of underlying metastatic brain cancer.

Speech perception in MRI scanner noise by persons with aphasia

PURPOSE

To examine reductions in performance on auditory tasks by aphasic and neurologically intact individuals as a result of concomitant magnetic resonance imaging (MRI) scanner noise.

METHOD

Four tasks together forming a continuum of linguistic complexity were developed. They included complex-tone pitch discrimination, same-different discrimination of minimal pair syllables, lexical decision, and sentence plausibility. Each task was performed by persons with aphasia (PWA) and by controls. The stimuli were presented in silence and also in the noise recorded from within the bore of a 3 Tesla MRI scanner at 3 signal-to-noise (S/N) ratios.

RESULTS

Across the 4 tasks, the PWA scored lower than the controls, and performance fell as a function of decreased S/N. However, the rate at which performance fell was not different across the 2 listener groups in any task.

CONCLUSIONS

Depending on the relative levels of the signals and noise, the intense noise accompanying MRI scanning has the potential to severely disrupt performance. However, PWA are no more susceptible to the disruptive influence of this noise than are unimpaired individuals usually employed as controls. Thus, functional MRI data from aphasic and control individuals may be interpreted without complications associated with large interactions between scanner noise and performance reduction.