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Godlove J, Anantha V, Advani M, Des Roches C, Kiran S. Comparison of Therapy Practice at Home and in the Clinic: A Retrospective Analysis of the Constant Therapy Platform Data Set. Front Neurol 2019; 10:140. [PMID: 30858819 PMCID: PMC6398324 DOI: 10.3389/fneur.2019.00140] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/04/2019] [Indexed: 12/03/2022] Open
Abstract
Background: Computer-based therapies can provide an affordable and practical alternative by providing frequent intervention for stroke survivors with chronic aphasia by allowing the opportunity for home exercise practice, however more evidence is needed. The goal of this retrospective analysis was to compare the time course of therapy engagement when therapy was targeted in the clinic or at home by post-stroke individuals. We examined if home users of the therapy were compliant in therapy and if this documented practice time was associated with improved outcomes similar to clinic patients who practiced under the guidance of a clinician. Methods: A retrospective analysis of anonymously aggregated data collected for 3,686 patients with post-stroke aphasia over the course of four years (2013-2017) was conducted. Participants either received therapy delivered through Constant Therapy only at home (N = 2,100) or only in the clinic (N = 1,577). Constant Therapy includes over 70 evidence-based therapies for language and cognitive skills. This program was individualized for each patient with targeted tasks that dynamically adapted to each individual's progress. Results: Patients with <60% accuracy were analyzed to determine how long it took them to reach >90% accuracy. Results showed that both home-therapy and clinic patients reached 90% accuracy on their tasks similarly (Median = 3 sessions), but the frequency of therapy was significantly different with 50% of home users receiving therapy at least every 2 days while 50% of clinic patients only had therapy once every 5 days (p < 0.001). Thus, home-therapy users were able to master tasks in a shorter time (median of 6 days) than clinic patients (median of 12 days) (p < 0.001). Conclusion: Outcomes of treatment are similar for home users and clinic patients indicating the potential usability of a home-based treatment program for rehabilitation for post-stroke aphasia.
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Affiliation(s)
| | | | | | | | - Swathi Kiran
- The Learning Corporation, Newton, MA, United States
- Aphasia Research Laboratory, Speech Language and Hearing Sciences, Boston University, Boston, MA, United States
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202
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Heikkinen PH, Pulvermüller F, Mäkelä JP, Ilmoniemi RJ, Lioumis P, Kujala T, Manninen RL, Ahvenainen A, Klippi A. Combining rTMS With Intensive Language-Action Therapy in Chronic Aphasia: A Randomized Controlled Trial. Front Neurosci 2019; 12:1036. [PMID: 30778280 PMCID: PMC6369187 DOI: 10.3389/fnins.2018.01036] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
Neuromodulation technologies, such as transcranial magnetic stimulation (TMS), are promising tools for neurorehabilitation, aphasia therapy included, but not yet in common clinical use. Combined with behavioral techniques, in particular treatment-efficient Intensive Language-Action Therapy (ILAT, previously CIAT or CILT), TMS could substantially amplify the beneficial effect of such behavioral therapy alone (Thiel et al., 2013; Martin et al., 2014; Mendoza et al., 2016; Kapoor, 2017). In this randomized study of 17 subjects with post-stroke aphasia in the chronic stage, we studied the combined effect of ILAT and 1-Hz placebo-controlled navigated repetitive TMS (rTMS) to the right-hemispheric inferior frontal cortex—that is, to the anterior part of the non-dominant hemisphere's homolog Broca's area (pars triangularis). Patients were randomized to groups A and B. Patients in group A received a 2-week period of rTMS during naming training where they named pictures displayed on the screen once every 10 s, followed by 2 weeks of rTMS and naming combined with ILAT. Patients in group B received the same behavioral therapy but TMS was replaced by sham stimulation. The primary outcome measures for changes in language performance were the Western Aphasia Battery's aphasia quotient AQ; the secondary outcome measures were the Boston naming test (BNT) and the Action naming test (Action BNT, ANT). All subjects completed the study. At baseline, no statistically significant group differences were discovered for age, post-stroke time or diagnosis. ILAT was associated with significant improvement across groups, as documented by both primary and secondary outcome measures. No significant effect of rTMS could be documented. Our results agree with previous results proving ILAT's ability to improve language in patients with chronic aphasia. In contrast with earlier claims, however, a beneficial effect of rTMS in chronic post-stroke aphasia rehabilitation was not detected in this study. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03629665
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Affiliation(s)
- Paula H Heikkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, WE4, Freie Universität Berlin, Berlin, Germany
| | - Jyrki P Mäkelä
- BioMag Laboratory, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Pantelis Lioumis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Teija Kujala
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Riitta-Leena Manninen
- BioMag Laboratory, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Ahvenainen
- BioMag Laboratory, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Klippi
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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203
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Richardson JD, Dalton SGH. Main concepts for two picture description tasks: An addition to. APHASIOLOGY 2019; 34:119-136. [PMID: 32952259 PMCID: PMC7500506 DOI: 10.1080/02687038.2018.1561417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/10/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND Proposition analysis of the discourse of persons with aphasia has a long history, yielding important advancements in our understanding of communication impairments in this population. Recently, discourse measures have been considered primary outcome measures, and multiple calls have been made for improved psychometric properties of discourse measures. AIMS To advance the use of discourse analysis in persons with aphasia by providing Main Concept Analysis checklists and descriptive statistics for healthy control performance on the analysis for the Cat in the Tree and Refused Umbrella narrative tasks utilized in the AphasiaBank database protocol. METHODS & PROCEDURES Ninety-two control transcripts, stratified into four age groups (20-39 years; 40-59; 60-79; 80+), were downloaded from the AphasiaBank database. Relevant concepts were identified, and those spoken by at least one-third of the control sample were considered to be a main concept. A multi-level coding system was used to determine the accuracy and completeness of the main concepts produced by control speakers. OUTCOMES & RESULTS Main concept checklists for two discourse tasks are provided. Descriptive statistics are reported and examined to assist readers with evaluation of the normative data. CONCLUSIONS These checklists provide clinicians and researchers with a tool to reliably assess the discourse of persons with aphasia. They also help address the gap in available psychometric data with which to compare persons with aphasia to healthy controls.
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204
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Bose A, Höbler F, Saddy D. Deciphering the mechanisms of phonological therapy in jargon aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:123-142. [PMID: 30474174 PMCID: PMC7816090 DOI: 10.1111/1460-6984.12437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 10/02/2018] [Accepted: 10/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Severe word production difficulties remain one of the most challenging clinical symptoms to treat in individuals with jargon aphasia. Clinically, it is important to determine why some individuals with jargon aphasia improve following therapy when others do not. We report a therapy study with AM, an individual with severe neologistic jargon aphasia, and provide a subsequent comparison with previous cases, with the purpose of informing both our theoretical and clinical understanding of jargon aphasia. AIMS To investigate AM's locus of word production deficit and determine the effectiveness of phonological component analysis (PCA) therapy, a phonological cueing therapy, in the re-learning and generalization of naming responses for words. In addition, AM's performance in therapy, linguistic profile and ability to engage with therapy/cues were compared in a retrospective analysis with the background linguistic and therapy data of two other individuals with jargon aphasia (P9 and FF), who responded differentially to PCA. This was undertake to explore possible prognostic indicators of phonological therapy for jargon aphasia. METHODS & PROCEDURES A battery of linguistic and neuropsychological tests was used to identify AM's word production deficit. A single-subject multiple probe design across behaviours was employed to evaluate the effects of PCA therapy on the re-learning and generalization of naming responses. In the retrospective analysis of AM, P9 and FF, we compared differences and similarities in performance on various linguistic tasks, the ability to engage in therapy (i.e., ability to generate and use the cues), as well as to retain and maintain cues. OUTCOMES & RESULTS AM's locus of deficit was identified in the mapping between semantics and phonology. PCA was found to be effective in improving naming in two of the three treated word lists during the treatment phase; however, these gains were not maintained. Generalization to untreated picture names was not observed. Findings from the retrospective analysis illustrated that oral reading skills, the ability to segment phonological information from words and active engagement with provided cues are likely prerequisites for obtaining robust and long-term gains. CONCLUSIONS & IMPLICATIONS We demonstrated that phonological therapy could be beneficial for the remediation of naming abilities at least in the re-learning phase; however, maintenance and generalization of these gains were limited. This research helps to elucidate the considerations and evaluations necessary for the appropriateness of phonological therapy and candidacy of individuals with jargon aphasia for this treatment approach.
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Affiliation(s)
- Arpita Bose
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Fiona Höbler
- Department of Speech–Language PathologyUniversity of TorontoTorontoONCanada
- Department of ResearchToronto Rehabilitation InstituteTorontoONCanada
| | - Douglas Saddy
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
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205
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Norrving B, Barrick J, Davalos A, Dichgans M, Cordonnier C, Guekht A, Kutluk K, Mikulik R, Wardlaw J, Richard E, Nabavi D, Molina C, Bath PM, Stibrant Sunnerhagen K, Rudd A, Drummond A, Planas A, Caso V. Action Plan for Stroke in Europe 2018-2030. Eur Stroke J 2018; 3:309-336. [PMID: 31236480 PMCID: PMC6571507 DOI: 10.1177/2396987318808719] [Citation(s) in RCA: 253] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
Two previous pan-European consensus meetings, the 1995 and 2006 Helsingborg meetings, were convened to review the scientific evidence and the state of current services to identify priorities for research and development and to set targets for the development of stroke care for the decade to follow. Adhering to the same format, the European Stroke Organisation (ESO) prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the Stroke Alliance for Europe (SAFE). The ESAP included seven domains: primary prevention, organisation of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment and life after stroke. Research priorities for translational stroke research were also identified. Documents were prepared by a working group and were open to public comments. The final document was prepared after a workshop in Munich on 21-23 March 2018. Four overarching targets for 2030 were identified: (1) to reduce the absolute number of strokes in Europe by 10%, (2) to treat 90% or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care, (3) to have national plans for stroke encompassing the entire chain of care, (4) to fully implement national strategies for multisector public health interventions. Overall, 30 targets and 72 research priorities were identified for the seven domains. The ESAP provides a basic road map and sets targets for the implementation of evidence-based preventive actions and stroke services to 2030.
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Affiliation(s)
- Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Skåne
University Hospital, Lund University, Lund, Sweden
| | | | - Antoni Davalos
- Department of Neurosciences, Hospital Universitari Germans Trias
i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital,
Ludwig-Maximilians University, Munich, and Munich Cluster of Systems Neurology
(SyNergy), Munich, Germany
| | | | - Alla Guekht
- Clinical Center for Neuropsychiatry, Russian National Research
Medical University, Moscow, Russia
| | - Kursad Kutluk
- Department of Neurology, Stroke Unit, University of Dokuz Eylul,
Izmir, Turkey
| | - Robert Mikulik
- International Clinical Research Center and Neurology Department,
St Anne's University Hospital Brno and Masaryk University Brno, Czech
Republic
| | - Joanna Wardlaw
- Centre for Clinical Neurosciences, Edinburgh Imaging and UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edo Richard
- Department of Neurology, Radboud University Medical Centre,
Nijmegen, and Department of Neurology, Academic Medical Centre, Amsterdam, the
Netherlands
| | - Darius Nabavi
- Department of Neurology with Stroke Unit, Vivantes Hospital
Neukölln, Berlin, Germany
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Hospital Vall d´Hebron
Barcelona, Spain
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience,
University of Nottingham, Nottingham, UK
| | | | - Anthony Rudd
- Guy's and St Thomas' NHS Foundation Trust, Stroke NHS England
and Royal College of Physicians, London, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham,
Nottingham, UK
| | - Anna Planas
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB),
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona,
Spain
| | - Valeria Caso
- Stroke Unit, Department of Medicine and Cardiovascular
Medicine, University of Perugia, Perugia, Italy
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206
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Aguilar OM, Kerry SJ, Ong YH, Callaghan MF, Crinion J, Woodhead ZVJ, Price CJ, Leff AP, Hope TMH. Lesion-site-dependent responses to therapy after aphasic stroke. J Neurol Neurosurg Psychiatry 2018; 89:1352-1354. [PMID: 29666209 PMCID: PMC6288693 DOI: 10.1136/jnnp-2017-317446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/15/2018] [Accepted: 02/26/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Oscar M Aguilar
- Department of Brain Repair and Rehabilitation, University College London, London, UK.,Wellcome Centre for Human Neuroimaging, University College London, London, UK.,Facultad de Psicologia, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Sheila J Kerry
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Yean-Hoon Ong
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Martina F Callaghan
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Jennifer Crinion
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Zoe Victoria Joan Woodhead
- Department of Brain Repair and Rehabilitation, University College London, London, UK.,Wellcome Centre for Human Neuroimaging, University College London, London, UK.,Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Alexander P Leff
- Department of Brain Repair and Rehabilitation, University College London, London, UK.,Wellcome Centre for Human Neuroimaging, University College London, London, UK.,Institute of Cognitive Neuroscience, University College London, London, UK
| | - Thomas M H Hope
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
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207
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Groeneveld IF, Goossens PH, van Meijeren-Pont W, Arwert HJ, Meesters JJL, Rambaran Mishre AD, Van Vree F, Vliet Vlieland TPM. Value-Based Stroke Rehabilitation: Feasibility and Results of Patient-Reported Outcome Measures in the First Year After Stroke. J Stroke Cerebrovasc Dis 2018; 28:499-512. [PMID: 30503680 DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/23/2018] [Accepted: 10/26/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Structured application of patient-reported outcome measures (PROMs) is a key element in Value Based Healthcare. This study aimed to evaluate the feasibility of a broad set of PROMs reflecting similar patient reported health domains as proposed within the International Standard Set of Patient-Centered Outcome Measures After Stroke within the first year after stroke. METHODS The study included consecutive stroke patients admitted to inpatient or outpatient specialized rehabilitation. PROMs were administered upon admission, discharge (inpatients only), and at 3, 6, and 12 months. PROMs included: EuroQol 5 Dimensions (EQ-5D), Stroke Impact Scale (SIS), Stroke and Aphasia Quality of Life Scale (SAQOL-39NL), Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), Hospital Anxiety and Depression Scale (HADS), and Fatigue Severity Scale (FSS). Feasibility was defined as participation, retention, and response rates. Paired t tests were conducted to analyze their changes over time. RESULTS Of 485 inpatients and 189 outpatients who were invited, 291 (60.0%) and 82 (43.3%) participated, of whom 45 (15.5%) and 7 (8.5%) dropped out before 12 months, respectively. Two hundred seven (71.1%) and 71 (86.6%) of the inpatients and outpatients returned the questionnaires on all or all but one time points, respectively. Between admission and 12 months statistically significant improvements of PROMs addressing general health and quality of life (EQ-5D), psychiatric functioning (HADS), motor functioning (SIS mobility), and social functioning (USER-P, SIS communication) were seen. The SIS memory scale, the SAQOL-39NL and the FSS did not show any changes. CONCLUSIONS Participation, retention, and response rates for a comprehensive set of PROMS for stroke in patients in rehabilitation were moderate to good, with clinical improvements seen until 1 year post stroke. The SAQOL-39NL and FSS did not demonstrate changes over time and cannot be recommended for repetitive measurements in this setting. By simplifying the set of questionnaires, participation and response rates may be further enhanced.
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Affiliation(s)
- I F Groeneveld
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Orthopaedics, Leiden University Medical Center, Rehabilitation, and Physical Therapy, Leiden, The Netherlands.
| | - P H Goossens
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Orthopaedics, Leiden University Medical Center, Rehabilitation, and Physical Therapy, Leiden, The Netherlands
| | - W van Meijeren-Pont
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Orthopaedics, Leiden University Medical Center, Rehabilitation, and Physical Therapy, Leiden, The Netherlands
| | - H J Arwert
- Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Rehabilitation Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - J J L Meesters
- Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Orthopaedics, Leiden University Medical Center, Rehabilitation, and Physical Therapy, Leiden, The Netherlands
| | - A D Rambaran Mishre
- Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Rehabilitation Medicine, Reinier de Graaf Groep, Delft, The Netherlands
| | - F Van Vree
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation Centre, The Hague, The Netherlands
| | - T P M Vliet Vlieland
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Orthopaedics, Leiden University Medical Center, Rehabilitation, and Physical Therapy, Leiden, The Netherlands
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208
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Abstract
PURPOSE OF REVIEW We now know that speech and language therapy (SALT) is effective in the rehabilitation of aphasia; however, there remains much individual variability in the response to interventions. So, what works for whom, when and how? RECENT FINDINGS This review evaluates the current evidence for the efficacy of predominantly impairment-focused aphasia interventions with respect to optimal dose, intensity, timing and distribution or spacing of treatment. We conclude that sufficient dose of treatment is required to enable clinical gains and that e-therapies are a promising and practical way to achieve this goal. In addition, aphasia can be associated with other cognitive deficits and may lead to secondary effects such as low mood and social isolation. In order to personalise individual treatments to optimise recovery, we need to develop a greater understanding of the interactions between these factors.
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Affiliation(s)
- Catherine Doogan
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
- Institute of Cognititive Neuroscience, UCL, 17 Queen Square, London, UK.
| | - Jade Dignam
- UQ Centre for Clinical Research and School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - David Copland
- UQ Centre for Clinical Research and School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Alex Leff
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Institute of Cognititive Neuroscience, UCL, 17 Queen Square, London, UK
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209
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Haghighi M, Mazdeh M, Ranjbar N, Seifrabie MA. Further Evidence of the Positive Influence of Repetitive Transcranial Magnetic Stimulation on Speech and Language in Patients with Aphasia after Stroke: Results from a Double-Blind Intervention with Sham Condition. Neuropsychobiology 2018; 75:185-192. [PMID: 29402816 DOI: 10.1159/000486144] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND After a stroke, up to 20% of patients suffer from aphasia. The preferred treatment for stroke-related aphasia (SRA) is regular speech and language training (SLT). In the present study, we investigated to what extent adjuvant repetitive transcranial magnetic stimulation (rTMS) might enhance recovery. While there is growing evidence of the positive effect of adjuvant rTMS on aphasia, no study has yet been based on an Iranian sample. METHOD A total of 12 patients (mean age: 55 years; right-handed; 7 women) underwent treatment for SRA 1 month after stroke. The standard treatment consisted of regular 45-min SLT sessions 5 times a week for 2 consecutive weeks. Additionally, patients were randomly assigned either to adjuvant rTMS (5 times a week for 30 min) or to a sham condition (5 times a week for 30 min). At baseline and after 2 weeks of intervention, the degree of aphasia was assessed with the Farsi version of the Western Aphasia Battery. rTMS was applied to the inferior posterior frontal gyrus of the right hemisphere. RESULTS Speech and language improved over time, but more so in the rTMS than in the sham condition. Large effect sizes were observed for content, fluency, and the aphasia quotient; medium effect sizes were observed for command comprehension and repetition, while effect sizes were small for auditory comprehension and naming. CONCLUSIONS Among patients with SRA, compared to a sham condition, adjuvant rTMS improved speech and language skills. The present results add to the accumulating evidence that rTMS as a neuromodulation technique has the capacity to enhance the effect of conventional SLT.
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Affiliation(s)
- Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehrdokht Mazdeh
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nazila Ranjbar
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
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210
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Fridriksson J, Elm J, Stark BC, Basilakos A, Rorden C, Sen S, George MS, Gottfried M, Bonilha L. BDNF genotype and tDCS interaction in aphasia treatment. Brain Stimul 2018; 11:1276-1281. [PMID: 30150003 PMCID: PMC6293970 DOI: 10.1016/j.brs.2018.08.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Several studies, including a randomized controlled trial by our group, support applying anodal tDCS (A-tDCS) to the left hemisphere during behavioral aphasia treatment to improve outcomes. A clear mechanism explaining A-tDCS’s efficacy has not been established, but modulation of neuroplasticity may be involved. Objective/hypothesis: The brain-derived neurotrophic factor (BDNF) gene influences neuroplasticity and may modulate the effects of tDCS. Utilizing data from our recently completed trial, we conducted a planned test of whether aphasia treatment outcome is influenced by interaction between A-tDCS and a single-nucleotide polymorphism of the BDNF gene, rs6265. Methods: Seventy-four individuals with chronic stroke-induced aphasia completed 15 language therapy sessions and were randomized to receive 1 mA A-tDCS or sham tDCS (S-tDCS) to the intact left temporoparietal region for the first 20 min of each session. BDNF genotype was available for 67 participants: 37 participants had the typical val/val genotype. The remaining 30 participants had atypical BDNF genotype (Met allele carriers). The primary outcome factor was improvement in object naming at 1 week after treatment completion. Maintenance of treatment effects was evaluated at 4 and 24 weeks. Results: An interaction was revealed between tDCS condition and genotype for treatment-related naming improvement (F = 4.97, p = 0.03). Participants with val/val genotype who received A-tDCS showed greater response to aphasia treatment than val/val participants who received S-tDCS, as well as the Met allele carriers, regardless of tDCS condition. Conclusion: Individuals with the val/val BDNF genotype are more likely to benefit from A-tDCS during aphasia treatment.
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Affiliation(s)
- Julius Fridriksson
- Department of Communication Sciences & Disorders, University of South Carolina, USA.
| | - Jordan Elm
- Department of Public Health Sciences, Medical University of South Carolina, USA
| | - Brielle C Stark
- Department of Communication Sciences & Disorders, University of South Carolina, USA
| | - Alexandra Basilakos
- Department of Communication Sciences & Disorders, University of South Carolina, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, USA
| | - Souvik Sen
- Department of Neurology, University of South Carolina, USA
| | - Mark S George
- Department of Psychiatry, Medical University of South Carolina, USA; Department of Neurology, Medical University of South Carolina, USA; Ralph H. Johnson VA Medical Center, Charleston, USA
| | - Michelle Gottfried
- Department of Public Health Sciences, Medical University of South Carolina, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, USA
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211
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Wilson SM, Yen M, Eriksson DK. An adaptive semantic matching paradigm for reliable and valid language mapping in individuals with aphasia. Hum Brain Mapp 2018; 39:3285-3307. [PMID: 29665223 PMCID: PMC6045968 DOI: 10.1002/hbm.24077] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 11/08/2022] Open
Abstract
Research on neuroplasticity in recovery from aphasia depends on the ability to identify language areas of the brain in individuals with aphasia. However, tasks commonly used to engage language processing in people with aphasia, such as narrative comprehension and picture naming, are limited in terms of reliability (test-retest reproducibility) and validity (identification of language regions, and not other regions). On the other hand, paradigms such as semantic decision that are effective in identifying language regions in people without aphasia can be prohibitively challenging for people with aphasia. This paper describes a new semantic matching paradigm that uses an adaptive staircase procedure to present individuals with stimuli that are challenging yet within their competence, so that language processing can be fully engaged in people with and without language impairments. The feasibility, reliability and validity of the adaptive semantic matching paradigm were investigated in sixteen individuals with chronic post-stroke aphasia and fourteen neurologically normal participants, in comparison to narrative comprehension and picture naming paradigms. All participants succeeded in learning and performing the semantic paradigm. Test-retest reproducibility of the semantic paradigm in people with aphasia was good (Dice coefficient = 0.66), and was superior to the other two paradigms. The semantic paradigm revealed known features of typical language organization (lateralization; frontal and temporal regions) more consistently in neurologically normal individuals than the other two paradigms, constituting evidence for validity. In sum, the adaptive semantic matching paradigm is a feasible, reliable and valid method for mapping language regions in people with aphasia.
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Affiliation(s)
- Stephen M. Wilson
- Department of Hearing and Speech SciencesVanderbilt University Medical CenterNashvilleTennessee
| | - Melodie Yen
- Department of Hearing and Speech SciencesVanderbilt University Medical CenterNashvilleTennessee
| | - Dana K. Eriksson
- Department of SpeechLanguage, and Hearing Sciences, University of ArizonaTucsonArizona
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212
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Clarke DJ, Burton LJ, Tyson SF, Rodgers H, Drummond A, Palmer R, Hoffman A, Prescott M, Tyrrell P, Brkic L, Grenfell K, Forster A. Why do stroke survivors not receive recommended amounts of active therapy? Findings from the ReAcT study, a mixed-methods case-study evaluation in eight stroke units. Clin Rehabil 2018; 32:1119-1132. [PMID: 29582712 PMCID: PMC6068965 DOI: 10.1177/0269215518765329] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/24/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify why the National Clinical Guideline recommendation of 45 minutes of each appropriate therapy daily is not met in many English stroke units. DESIGN Mixed-methods case-study evaluation, including modified process mapping, non-participant observations of service organisation and therapy delivery, documentary analysis and semi-structured interviews. SETTING Eight stroke units in four English regions. SUBJECTS Seventy-seven patients with stroke, 53 carers and 197 stroke unit staff were observed; 49 patients, 50 carers and 131 staff participants were interviewed. RESULTS Over 1000 hours of non-participant observations and 433 patient-specific therapy observations were undertaken. The most significant factor influencing amount and frequency of therapy provided was the time therapists routinely spent, individually and collectively, in information exchange. Patient factors, including fatigue and tolerance influenced therapists' decisions about frequency and intensity, typically resulting in adaptation of therapy rather than no provision. Limited use of individual patient therapy timetables was evident. Therapist staffing levels were associated with differences in therapy provision but were not the main determinant of intensity and frequency. Few therapists demonstrated understanding of the evidence underpinning recommendations for increased therapy frequency and intensity. Units delivering more therapy had undertaken patient-focused reorganisation of therapists' working practices, enabling them to provide therapy consistent with guideline recommendations. CONCLUSION Time spent in information exchange impacted on therapy provision in stroke units. Reorganisation of therapists' work improved alignment with guidelines.
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Affiliation(s)
- David J Clarke
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
| | - Sarah F Tyson
- School of Health Sciences, Manchester
Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Helen Rodgers
- Stroke Research Group, Institute of
Neuroscience, Newcastle University, Newcastle, UK
| | - Avril Drummond
- Faculty of Medicine and Health Sciences,
University of Nottingham, Nottingham, UK
| | - Rebecca Palmer
- Health Services Research, School of
Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alex Hoffman
- Sentinel Stroke National Audit
Programme, Royal College of Physicians, London, UK
| | - Matthew Prescott
- Physiotherapy Department, Bradford
Teaching Hospitals NHS Trust, Bradford, UK
| | - Pippa Tyrrell
- Salford Royal NHS Foundation Trust and
Manchester Academic Health Science Centre, The University of Manchester, Manchester,
UK
| | - Lianne Brkic
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
- Stroke Research Group, Institute of
Neuroscience, Newcastle University, Newcastle, UK
| | - Katie Grenfell
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
| | - Anne Forster
- Academic Unit of Elderly Care and
Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary,
Bradford, UK
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213
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Baliki MN, Babbitt EM, Cherney LR. Brain network topology influences response to intensive comprehensive aphasia treatment. NeuroRehabilitation 2018; 43:63-76. [DOI: 10.3233/nre-182428] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Marwan N. Baliki
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Edna M. Babbitt
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Leora R. Cherney
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
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214
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Acupuncture Treatment for Post-Stroke Dysphagia: An Update Meta-Analysis of Randomized Controlled Trials. Chin J Integr Med 2018; 24:686-695. [DOI: 10.1007/s11655-018-3005-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 10/28/2022]
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215
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Palmer R, Witts H, Chater T. What speech and language therapy do community dwelling stroke survivors with aphasia receive in the UK? PLoS One 2018; 13:e0200096. [PMID: 29990345 PMCID: PMC6039008 DOI: 10.1371/journal.pone.0200096] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background Speech and language therapy provision for aphasia (a language disorder) post stroke has been studied over time through surveys completed by speech and language therapists. This paper revisits provision based on what was received by 278 patients in 21 UK speech and language therapy departments in 2014–2016. Aims To explore the speech and language therapy received by community dwelling people with post stroke aphasia in the UK. Methods and procedures A quantitative content analysis was conducted by two speech and language therapist researchers. Therapy goals recorded were coded into categories and subcategories. Descriptive statistics were used to identify the frequency with which goal categories were targeted, average therapy time received, length and frequency of therapy sessions, personnel involved and mode of delivery. Outcomes and results Forty-five percent of participants were in receipt of therapy in the three month window observed. Six goal categories were identified. Rehabilitation was the most frequent (60%) followed by enabling (17.2%), review (4.3%), assessment (3.6%), supportive (3.5%) and activity to support therapy (2.8%). The median amount of therapy received in three months was 6.3 hours at an average of one 60-minute session every two weeks. Seventy-seven percent of therapy sessions were delivered by qualified speech and language therapists and 23% by assistants. Ninety percent of sessions were one to one, face to face sessions whilst 9.5% were group sessions. Discussion In line with previous reports, speech and language therapy for community dwelling stroke survivors with aphasia is restricted. Rehabilitation is a large focus of therapy but the intensity and dose with which it is provided is substantially lower than that required for an effective outcome. Despite this, one to one face to face therapy is favoured. More efficient methods to support more therapeutic doses of therapy are not commonly used in routine clinical services.
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Affiliation(s)
- Rebecca Palmer
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- * E-mail:
| | - Helen Witts
- Speech and Language Therapy, Derbyshire Community Health Services NHS Foundation Trust, Chesterfield, United Kingdom
| | - Timothy Chater
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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216
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Stahl B, Mohr B, Büscher V, Dreyer FR, Lucchese G, Pulvermüller F. Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2018; 89:586-592. [PMID: 29273692 PMCID: PMC6031278 DOI: 10.1136/jnnp-2017-315962] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent evidence has fuelled the debate on the role of massed practice in the rehabilitation of chronic post-stroke aphasia. Here, we further determined the optimal daily dosage and total duration of intensive speech-language therapy. METHODS Individuals with chronic aphasia more than 1 year post-stroke received Intensive Language-Action Therapy in a randomised, parallel-group, blinded-assessment, controlled trial. Participants were randomly assigned to one of two outpatient groups who engaged in either highly-intensive practice (Group I: 4 hours daily) or moderately-intensive practice (Group II: 2 hours daily). Both groups went through an initial waiting period and two successive training intervals. Each phase lasted 2 weeks. Co-primary endpoints were defined after each training interval. RESULTS Thirty patients-15 per group-completed the study. A primary outcome measure (Aachen Aphasia Test) revealed no gains in language performance after the waiting period, but indicated significant progress after each training interval (gradual 2-week t-score change [CI]: 1.7 [±0.4]; 0.6 [±0.5]), independent of the intensity level applied (4-week change in Group I: 2.4 [±1.2]; in Group II: 2.2 [±0.8]). A secondary outcome measure (Action Communication Test) confirmed these findings in the waiting period and in the first training interval. In the second training interval, however, only patients with moderately-intensive practice continued to make progress (Time-by-Group interaction: P=0.009, η2=0.13). CONCLUSIONS Our results suggest no added value from more than 2 hours of daily speech-language therapy within 4 weeks. Instead, these results demonstrate that even a small 2-week increase in treatment duration contributes substantially to recovery from chronic post-stroke aphasia.
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Affiliation(s)
- Benjamin Stahl
- Department of Neurology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Psychologische Hochschule Berlin, Berlin, Germany
| | - Bettina Mohr
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Verena Büscher
- Department of Philosophy and Humanities, Brain Language Laboratory, Freie Universität Berlin, Berlin, Germany
| | - Felix R Dreyer
- Department of Philosophy and Humanities, Brain Language Laboratory, Freie Universität Berlin, Berlin, Germany
| | - Guglielmo Lucchese
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany.,Department of Philosophy and Humanities, Brain Language Laboratory, Freie Universität Berlin, Berlin, Germany
| | - Friedemann Pulvermüller
- Department of Philosophy and Humanities, Brain Language Laboratory, Freie Universität Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
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217
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Kurland J, Liu A, Stokes P. Effects of a Tablet-Based Home Practice Program With Telepractice on Treatment Outcomes in Chronic Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1140-1156. [PMID: 29710115 PMCID: PMC6195077 DOI: 10.1044/2018_jslhr-l-17-0277] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/19/2017] [Indexed: 05/14/2023]
Abstract
PURPOSE The aim of this study was to determine if a tablet-based home practice program with weekly telepractice support could enable long-term maintenance of recent treatment gains and foster new language gains in poststroke aphasia. METHOD In a pre-post group study of home practice outcomes, 21 individuals with chronic aphasia were examined before and after a 6-month home practice phase and again at follow-up 4 months later. The main outcome measure studied was change in naming previously treated or untreated, practiced or unpracticed pictures of objects and actions. Individualized home practice programs were created in iBooks Author with semantic, phonemic, and orthographic cueing in pictures, words, and videos in order to facilitate naming of previously treated or untreated pictures. RESULTS Home practice was effective for all participants with severity moderating treatment effects, such that individuals with the most severe aphasia made and maintained fewer gains. There was a negative relationship between the amount of training required for iPad proficiency and improvements on practiced and unpracticed pictures and a positive relationship between practice compliance and same improvements. CONCLUSION Unsupervised home practice with weekly video teleconferencing support is effective. This study demonstrates that even individuals with chronic severe aphasia, including those with no prior smart device or even computer experience, can attain independent proficiency to continue practicing and improving their language skills beyond therapy discharge. This could represent a low-cost therapy option for individuals without insurance coverage and/or those for whom mobility is an obstacle to obtaining traditional aphasia therapy.
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Affiliation(s)
- Jacquie Kurland
- Department of Communication Disorders, University of Massachusetts Amherst
| | - Anna Liu
- Department of Mathematics and Statistics, University of Massachusetts Amherst
| | - Polly Stokes
- Department of Communication Disorders, University of Massachusetts Amherst
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218
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Marcotte K, Laird L, Bitan T, Meltzer JA, Graham SJ, Leonard C, Rochon E. Therapy-Induced Neuroplasticity in Chronic Aphasia After Phonological Component Analysis: A Matter of Intensity. Front Neurol 2018; 9:225. [PMID: 29686646 PMCID: PMC5900891 DOI: 10.3389/fneur.2018.00225] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
Despite the growing evidence regarding the importance of intensity and dose in aphasia therapy, few well-controlled studies contrasting the effects of intensive and non-intensive treatment have been conducted to date. Phonological components analysis (PCA) treatment for anomia has been associated with improvements in some patients with chronic aphasia; however, the effect of treatment intensity has not yet been studied with PCA. Thus, the aim of the present study was to identify the effect of intensity on neural processing associated with word retrieval abilities after PCA treatment. We used functional magnetic resonance imaging to examine therapy-induced changes in activation during an overt naming task in two patients who suffered from a stroke in the left middle cerebral artery territory. P1 received intensive PCA treatment whereas P2 received the standard, non-intensive, PCA treatment. Behavioral results indicate that both standard and intensive conditions yielded improved naming performance with treated nouns, but the changes were only significant for the patient who received the intensive treatment. The improvements were found to be long lasting as both patients maintained improved naming at 2-months follow-ups. The associated neuroimaging data indicate that the two treatment conditions were associated with different neural activation changes. The patient who received the standard PCA showed significant increase in activation with treatment in the right anterior cingulate, as well as extensive areas in bilateral posterior and lateral cortices. By contrast, the patient who received intensive PCA showed more decreases in activation following the treatment. Unexpectedly, this patient showed subcortical increase in activation, specifically in the right caudate nucleus. We speculate that the recruitment of the caudate nucleus and the anterior cingulate in these patients reflects the need to suppress errors to improve naming. Thus, both short-term intensive and standard, non-intensive, PCA treatment can improve word retrieval in chronic aphasia, but neuroimaging data suggest that improved naming is associated with different neural activation patterns in the two treatment conditions.
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Affiliation(s)
- Karine Marcotte
- Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Laura Laird
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Tali Bitan
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Psychology, IIPDM, IBBR, University of Haifa, Haifa, Israel
| | - Jed A Meltzer
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Rotman Research Institute - Baycrest Centre, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada.,Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Carol Leonard
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.,Audiology and Speech-Language Pathology Program, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.,Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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219
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Øra HP, Kirmess M, Brady MC, Winsnes IE, Hansen SM, Becker F. Telerehabilitation for aphasia - protocol of a pragmatic, exploratory, pilot randomized controlled trial. Trials 2018; 19:208. [PMID: 29606148 PMCID: PMC5880095 DOI: 10.1186/s13063-018-2588-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/02/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Cochrane review on the effectiveness of speech and language therapy for aphasia following stroke suggests intensity of therapy is a key predictor for outcome. Current aphasia services cannot provide intervention at the intensity observed within trial contexts because of resource limitations. Telerehabilitation could widen access to speech-language pathologists (SLPs) in geographically remote contexts and reduce the time spent on travel by the therapist and patient. The current academic literature within this field is in its infancy, with few trials of speech and language therapy (SLT) delivered by videoconference. Our pilot randomized controlled trial (RCT) will explore feasibility aspects and effectiveness of telerehabilitation for aphasia in addition to standard SLT. METHOD/DESIGN Our study is a pragmatic, exploratory, pilot randomized controlled trial, where participants will be randomized to a telerehabilitation group or a control group. Both groups receive standard SLT (usual care) but the telerehabilitation group receives an additional 5 h of telerehabilitation per week over 4 weeks through videoconference. This additional telerehabilitation focuses on spoken language with an emphasis on word naming. We aim to include 40 patients in each group, with inclusion criteria being aphasia any time post stroke. Participants will be assessed blindly at pre-randomization (baseline), and 4 weeks and 4 months after randomization. The primary endpoint is naming ability 3 months after the completed intervention, measured by the Norwegian Basic Aphasia Assessment (NGA) naming subtest. Secondary endpoints include other subtests of the NGA, the VAST (Verb and Sentence Test) subtest sentence production, Communicative Effectiveness Index (CETI) and the Stroke and Aphasia Quality of Life scale (SAQOL-39). Experiences of patients and SLPs with telerehabilitation are assessed using questionnaires and semi-structured interviews. Statistical between group comparisons will be in line with an intention-to-treat analysis. DISCUSSION This pilot RCT of intensive language training by videoconference will contribute new scientific evidence to the field of aphasia telerehabilitation. Here, we describe our trial which will explore the feasibility of telerehabilitation for aphasia as an intervention, our choice of primary and secondary outcome measures and proposed analyses. Our trial will provide information for the development and delivery of future definitive RCTs. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02768922 . Registered on 11 May 2016. Last updated on 17 November 2017.
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Affiliation(s)
- Hege Prag Øra
- Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1450, Nesoddtangen, Norway. .,Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern, 0318, Oslo, Norway.
| | - Melanie Kirmess
- Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1450, Nesoddtangen, Norway.,Department of Special Needs Education, University of Oslo, PO Box 1171, Blindern, 0318, Oslo, Norway
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G40BA, Scotland
| | | | - Silje Merethe Hansen
- Department of Special Needs Education, University of Oslo, PO Box 1171, Blindern, 0318, Oslo, Norway
| | - Frank Becker
- Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1450, Nesoddtangen, Norway.,Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern, 0318, Oslo, Norway
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220
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Richardson JD, Hudspeth Dalton SG, Fromm D, Forbes M, Holland A, MacWhinney B. The Relationship Between Confrontation Naming and Story Gist Production in Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:406-422. [PMID: 29497752 PMCID: PMC6111489 DOI: 10.1044/2017_ajslp-16-0211] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 04/18/2017] [Accepted: 10/06/2017] [Indexed: 05/19/2023]
Abstract
PURPOSE The purpose of this study was to examine the relationship between picture naming performance and the ability to communicate the gist, or essential elements, of a story. We also sought to determine if this relationship varied according to Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007) aphasia subtype. METHOD Demographic information, test scores, and transcripts of 258 individuals with aphasia completing 3 narrative tasks were retrieved from the AphasiaBank database. Narratives were subjected to a main concept analysis to determine gist production. A correlation analysis was used to investigate the relationship between naming scores and main concept production for the whole group of persons with aphasia and for WAB-R subtypes separately. RESULTS We found strong correlations between naming test scores and narrative gist production for the large sample of persons with aphasia. However, the strength of the correlations varied by WAB-R subtype. CONCLUSIONS Picture naming may accurately predict gist production for individuals with Broca's and Wernicke's aphasia, but not for other WAB-R subtypes. Given the current reprioritization of outcome measurement, picture naming may not be an appropriate surrogate measure for functional communication for all persons with aphasia. SUPPLEMENTAL MATERIALS https://doi.org/10.23641/asha.5851848.
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221
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Hersh D. From individual to global: Human rights and aphasia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:39-43. [PMID: 29143547 DOI: 10.1080/17549507.2018.1397749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
- Deborah Hersh
- a Speech Pathology, School of Medical and Health Sciences , Edith Cowan University , Perth , Australia
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222
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Sackley CM, Smith CH, Rick CE, Brady MC, Ives N, Patel S, Woolley R, Dowling F, Patel R, Roberts H, Jowett S, Wheatley K, Kelly D, Sands G, Clarke CE. Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson's disease: a pilot randomised controlled trial (PD COMM pilot). Pilot Feasibility Stud 2018; 4:30. [PMID: 29344405 PMCID: PMC5763537 DOI: 10.1186/s40814-017-0222-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Speech-related problems are common in Parkinson's disease (PD), but there is little evidence for the effectiveness of standard speech and language therapy (SLT) or Lee Silverman Voice Treatment (LSVT LOUD®). METHODS The PD COMM pilot was a three-arm, assessor-blinded, randomised controlled trial (RCT) of LSVT LOUD®, SLT and no intervention (1:1:1 ratio) to assess the feasibility and to inform the design of a full-scale RCT. Non-demented patients with idiopathic PD and speech problems and no SLT for speech problems in the past 2 years were eligible. LSVT LOUD® is a standardised regime (16 sessions over 4 weeks). SLT comprised individualised content per local practice (typically weekly sessions for 6-8 weeks). Outcomes included recruitment and retention, treatment adherence, and data completeness. Outcome data collected at baseline, 3, 6, and 12 months included patient-reported voice and quality of life measures, resource use, and assessor-rated speech recordings. RESULTS Eighty-nine patients were randomised with 90% in the therapy groups and 100% in the control group completing the trial. The response rate for Voice Handicap Index (VHI) in each arm was ≥ 90% at all time-points. VHI was highly correlated with the other speech-related outcome measures. There was a trend to improvement in VHI with LSVT LOUD® (difference at 3 months compared with control: - 12.5 points; 95% CI - 26.2, 1.2) and SLT (difference at 3 months compared with control: - 9.8 points; 95% CI - 23.2, 3.7) which needs to be confirmed in an adequately powered trial. CONCLUSION Randomisation to a three-arm trial of speech therapy including a no intervention control is feasible and acceptable. Compliance with both interventions was good. VHI and other patient-reported outcomes were relevant measures and provided data to inform the sample size for a substantive trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register: ISRCTN75223808. registered 22 March 2012.
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Affiliation(s)
| | - Christina H. Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
| | - Caroline E. Rick
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Francis Dowling
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Ramilla Patel
- Parkinson’s UK West Midlands Regional Branch, London, UK
| | - Helen Roberts
- Faculty of Medicine, University of Southampton, London, UK
| | - Sue Jowett
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Debbie Kelly
- School of Rehabilitation Sciences, University of East Anglia, Norwich, UK
| | - Gina Sands
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Carl E. Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Clinical Neurology City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH UK
| | - on behalf of the PD COMM Pilot Collaborative Group
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
- Parkinson’s UK West Midlands Regional Branch, London, UK
- Faculty of Medicine, University of Southampton, London, UK
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
- School of Rehabilitation Sciences, University of East Anglia, Norwich, UK
- Department of Neurology, Clinical Neurology City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
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223
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Mitchell C, Bowen A, Tyson S, Conroy P. A feasibility randomized controlled trial of ReaDySpeech for people with dysarthria after stroke. Clin Rehabil 2017; 32:1037-1046. [PMID: 29278019 PMCID: PMC6088453 DOI: 10.1177/0269215517748453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the feasibility of a multicentre randomized controlled trial of ReaDySpeech, an online speech therapy programme for people with dysarthria. Design: Feasibility randomized controlled trial, 2:1 minimization procedure. Setting: Four UK NHS services across hospital and community. Participants: Forty participants with dysarthria at least one week post-stroke. Interventions/comparator: ReaDySpeech with usual care (n = 26) versus usual care only (n = 14). Main outcomes: Feasibility measures included the following: recruitment and retention rate, time taken to carry out assessments, success of outcome assessor blinding, fidelity and adherence. Participant baseline and outcome measures collected before and after 8–10 weeks of intervention were the Frenchay Dysarthria Assessment II, Therapy Outcome Measure, Communication Outcomes After Stroke Scale, EQ-5D-5L and Dysarthria Impact Profile. Results: Recruited 40 participants out of 74 eligible people, 1–13 weeks post stroke and mean age 69 years (37–99). Retention was very high (92%). Assessor blinding was not achieved with intervention allocation correctly guessed for 70% of participants (26/37). Time to carry out assessments was acceptable to participants. ReaDySpeech was delivered to 16 of 26 allocated participants, who completed 55% of prescribed activities, but both interventions were delivered at low intensity (mean 6.6 face-to-face sessions of 40-minute duration). Conclusion: Recruitment and retention in this randomized controlled trial of computerized therapy for dysarthria is feasible for acute stroke. However, further feasibility work is needed to evaluate whether it is possible to recruit chronic stroke; increase intervention delivery, intensity and adherence; achieve outcome assessor blinding by video-recording and to determine sample size for a larger trial of effectiveness.
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Affiliation(s)
- Claire Mitchell
- 1 Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,2 Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Audrey Bowen
- 1 Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Tyson
- 3 Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Paul Conroy
- 1 Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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224
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Komagamine J, Komagamine T. Temporal changes in the documentation of neurological findings among patients with acute ischaemic stroke in a single centre in Japan: a retrospective cross-sectional study. BMJ Open 2017; 7:e019480. [PMID: 29247116 PMCID: PMC5736093 DOI: 10.1136/bmjopen-2017-019480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate temporal differences in the documentation of neurological findings by the same physicians in patients with ischaemic stroke while in hospital. We also investigated differences in the rate of documentation of neurological findings in patients with stroke between internists and neurosurgeons. DESIGN A retrospective medical chart review. PARTICIPANTS Hospitalised adult patients with acute ischaemic stroke who stayed 7 or more days in our hospital. Neurosurgeons (n=8) and internists (n=19) caring for these patients (including up to 10 patients per physician). MAIN OUTCOME MEASURES The documentation rate of any neurological finding in the patients on each day (from day 1 to 7 and on discharge). The documentation rates of eight neurological finding components (consciousness, mental status, cranial nerves, motor function, sensory function, coordination, reflexes and gait). We included only documentation by the same physician. Fisher's exact test was used to evaluate differences in outcomes between neurosurgeons and internists. RESULTS During the study period, we identified 172 patients with stroke who were cared for by 27 physicians. The documentation rates of any neurological findings were 94% (day 1), 58% (day 2), 35% (day 3), 40% (day 4), 32% (day 5), 30% (day 6) and 23% (day 7). On discharge, all eight neurological finding components were documented in less than 10% of all cases. The documentation rate was significantly higher by internists than that by neurosurgeons on each day but not on discharge. CONCLUSIONS The documentation rate of neurological findings by physicians during usual stroke care decreased to less than 50% after the third hospital day. Given the importance of temporal changes in the neurological symptoms of patients with stroke, further study is needed to determine whether this low documentation rate after the third hospital day was due to a lack of physician interest in neurological findings or other factors.
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Affiliation(s)
- Junpei Komagamine
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Tomoko Komagamine
- Department of Neurology, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
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225
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Mohr B, Stahl B, Berthier ML, Pulvermüller F. Intensive Communicative Therapy Reduces Symptoms of Depression in Chronic Nonfluent Aphasia. Neurorehabil Neural Repair 2017; 31:1053-1062. [PMID: 29192534 PMCID: PMC5784455 DOI: 10.1177/1545968317744275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Patients with brain lesions and resultant chronic aphasia frequently suffer from depression. However, no effective interventions are available to target neuropsychiatric symptoms in patients with aphasia who have severe language and communication deficits. Objective. The present study aimed to investigate the efficacy of 2 different methods of speech and language therapy in reducing symptoms of depression in aphasia on the Beck Depression Inventory (BDI) using secondary analysis (BILAT-1 trial). Methods. In a crossover randomized controlled trial, 18 participants with chronic nonfluent aphasia following left-hemispheric brain lesions were assigned to 2 consecutive treatments: (1) intensive language-action therapy (ILAT), emphasizing communicative language use in social interaction, and (2) intensive naming therapy (INT), an utterance-centered standard method. Patients were randomly assigned to 2 groups, receiving both treatments in counterbalanced order. Both interventions were applied for 3.5 hours daily over a period of 6 consecutive working days. Outcome measures included depression scores on the BDI and a clinical language test (Aachen Aphasia Test). Results. Patients showed a significant decrease in symptoms of depression after ILAT but not after INT, which paralleled changes on clinical language tests. Treatment-induced decreases in depression scores persisted when controlling for individual changes in language performance. Conclusions. Intensive training of behaviorally relevant verbal communication in social interaction might help reduce symptoms of depression in patients with chronic nonfluent aphasia.
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Affiliation(s)
- Bettina Mohr
- 1 Charité Universitätsmedizin Berlin, Department of Psychiatry, Berlin, Germany
| | - Benjamin Stahl
- 2 Charité Universitätsmedizin Berlin, Department of Neurology, Berlin, Germany.,3 Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,4 Universität Greifswald, Department of Neurology, Germany.,5 Freie Universität Berlin, Brain Language Laboratory, Department of Philosophy and Humanities, Berlin, Germany
| | - Marcelo L Berthier
- 6 University of Malaga and Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Medico-Sanitarias (CIMES), Malaga, Spain.,7 Cathedra ARPA of Aphasia, Malaga, Spain
| | - Friedemann Pulvermüller
- 5 Freie Universität Berlin, Brain Language Laboratory, Department of Philosophy and Humanities, Berlin, Germany.,8 Berlin School of Mind and Brain, Humboldt University, Berlin, Germany.,9 Einstein Center for Neurosciences, Berlin, Germany
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226
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Nardo D, Holland R, Leff AP, Price CJ, Crinion JT. Less is more: neural mechanisms underlying anomia treatment in chronic aphasic patients. Brain 2017; 140:3039-3054. [PMID: 29053773 PMCID: PMC5808641 DOI: 10.1093/brain/awx234] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/22/2017] [Accepted: 07/21/2017] [Indexed: 11/12/2022] Open
Abstract
See Thompson and Woollams (doi:10.1093/brain/awx264) for a scientific commentary on this article. Previous research with aphasic patients has shown that picture naming can be facilitated by concurrent phonemic cueing [e.g. initial phoneme(s) of the word that the patient is trying to retrieve], both as an immediate word retrieval technique, and when practiced repeatedly over time as a long-term anomia treatment. Here, to investigate the neural mechanisms supporting word retrieval, we adopted—for the first time—a functional magnetic resonance imaging task using the same naming procedure as it occurs during the anomia treatment process. Before and directly after a 6-week anomia treatment programme, 18 chronic aphasic stroke patients completed our functional magnetic resonance imaging protocol—a picture naming task aided by three different types of phonemic cues (whole words, initial phonemes, final phonemes) and a noise-control condition. Patients completed a naming task based on the training materials, and a more general comprehensive battery of language tests both before and after the anomia treatment, to determine the effectiveness and specificity of the therapy. Our results demonstrate that the anomia treatment was effective and specific to speech production, significantly improving both patients’ naming accuracy and reaction time immediately post-treatment (unstandardized effect size: 29% and 17%, respectively; Cohen’s d: 3.45 and 1.83). Longer term gains in naming were maintained 3 months later. Functional imaging results showed that both immediate and long-term facilitation of naming involved a largely overlapping bilateral frontal network including the right anterior insula, inferior frontal and dorsal anterior cingulate cortices, and the left premotor cortex. These areas were associated with a neural priming effect (i.e. reduced blood oxygen level-dependent signal) during both immediate (phonemically-cued versus control-cue conditions), and long-term facilitation of naming (i.e. treated versus untreated items). Of note is that different brain regions were sensitive to different phonemic cue types. Processing of whole word cues was associated with increased activity in the right angular gyrus; whereas partial word cues (initial and final phonemes) recruited the left supplementary motor area, and right anterior insula, inferior frontal cortex, and basal ganglia. The recruitment of multiple and bilateral areas may help explain why phonemic cueing is such a successful behavioural facilitation tool for anomia treatment. Our results have important implications for optimizing current anomia treatment approaches, developing new treatments, and improving speech outcome for aphasic patients.
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Affiliation(s)
- Davide Nardo
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Rachel Holland
- Division of Language and Communication Science, City University London, London, UK
| | - Alexander P Leff
- Institute of Cognitive Neuroscience, University College London, London, UK
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, UK
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Cathy J Price
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Jennifer T Crinion
- Institute of Cognitive Neuroscience, University College London, London, UK
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227
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Galliers J, Wilson S, Marshall J, Talbot R, Devane N, Booth T, Woolf C, Greenwood H. Experiencing EVA Park, a Multi-User Virtual World for People with Aphasia. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2017. [DOI: 10.1145/3134227] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Virtual worlds are used in wide-ranging ways by many people with long-term health conditions, but their use by people with aphasia (PWA) has been limited. In contrast, this article reports the use of EVA Park, a multi-user virtual world designed for PWA to practice conversations, focusing on people's emotional, social, and conversational experiences. An analysis of observation and interview data collected from 20 people with aphasia who participated in a 5-week therapy intervention revealed key themes related to user experience. The themes offer a rich insight into aspects of the virtual world experience for PWA that go beyond therapeutic outcomes. They are as follows: affect (positive and negative); types of conversation, miscommunication, and misunderstanding; immersion in the virtual world; social presence and initiative and flow. Overall, the study showed that participants experienced positive emotional and social outcomes. We argue that this was achieved as a consequence of EVA Park being not only accessible but also a varied and entertaining environment within which PWA experienced both the realistic and the quirky while engaging with others and having fun.
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228
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Abstract
PURPOSE OF REVIEW Aphasia is a common feature of stroke, affecting 21-38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes. RECENT FINDINGS During the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Independence Measures (FIM) scores, longer stays in rehabilitation settings, poorer function in activities of daily living, and mortality. Factors that complicate the analysis of aphasia on post-stroke outcomes, however, include widely different systems of care across international settings that result in varying admission patterns to acute stroke units, allowable length of stays based on reimbursement, and criteria for rehabilitation placement. Aphasia arising from stroke is associated with worse outcomes both in the acute and chronic periods. Future research will have to incorporate disparate patterns in analytic models, and to take into account specific aphasia profiles and evolving methods of post-stroke speech-language therapy.
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Affiliation(s)
- Ronald M Lazar
- Department of Neurology, University of Alabama at Birmingham, 1720 7th Ave S-SC 650, Birmingham, AL, 35294, USA.
| | - Amelia K Boehme
- Department of Neurology, Columbia University Medical Center, 710 W168th St, New York, NY, 10032, USA
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229
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Pierce JE, Menahemi-Falkov M, O’Halloran R, Togher L, Rose ML. Constraint and multimodal approaches to therapy for chronic aphasia: A systematic review and meta-analysis. Neuropsychol Rehabil 2017; 29:1005-1041. [DOI: 10.1080/09602011.2017.1365730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- John E. Pierce
- School of Allied Health, La Trobe University, Melbourne, Australia
- Speech Pathology, Cabrini Health, Melbourne, Australia
| | | | - Robyn O’Halloran
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Miranda L. Rose
- School of Allied Health, La Trobe University, Melbourne, Australia
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230
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Cope TE, Wilson B, Robson H, Drinkall R, Dean L, Grube M, Jones PS, Patterson K, Griffiths TD, Rowe JB, Petkov CI. Artificial grammar learning in vascular and progressive non-fluent aphasias. Neuropsychologia 2017; 104:201-213. [PMID: 28843341 PMCID: PMC5637161 DOI: 10.1016/j.neuropsychologia.2017.08.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 11/24/2022]
Abstract
Patients with non-fluent aphasias display impairments of expressive and receptive grammar. This has been attributed to deficits in processing configurational and hierarchical sequencing relationships. This hypothesis had not been formally tested. It was also controversial whether impairments are specific to language, or reflect domain general deficits in processing structured auditory sequences. Here we used an artificial grammar learning paradigm to compare the abilities of controls to participants with agrammatic aphasia of two different aetiologies: stroke and frontotemporal dementia. Ten patients with non-fluent variant primary progressive aphasia (nfvPPA), 12 with non-fluent aphasia due to stroke, and 11 controls implicitly learned a novel mixed-complexity artificial grammar designed to assess processing of increasingly complex sequencing relationships. We compared response profiles for otherwise identical sequences of speech tokens (nonsense words) and tone sweeps. In all three groups the ability to detect grammatical violations varied with sequence complexity, with performance improving over time and being better for adjacent than non-adjacent relationships. Patients performed less well than controls overall, and this was related more strongly to aphasia severity than to aetiology. All groups improved with practice and performed well at a control task of detecting oddball nonwords. Crucially, group differences did not interact with sequence complexity, demonstrating that aphasic patients were not disproportionately impaired on complex structures. Hierarchical cluster analysis revealed that response patterns were very similar across all three groups, but very different between the nonsense word and tone tasks, despite identical artificial grammar structures. Overall, we demonstrate that agrammatic aphasics of two different aetiologies are not disproportionately impaired on complex sequencing relationships, and that the learning of phonological and non-linguistic sequences occurs independently. The similarity of profiles of discriminatory abilities and rule learning across groups suggests that insights from previous studies of implicit sequence learning in vascular aphasia are likely to prove applicable in nfvPPA.
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Affiliation(s)
- Thomas E Cope
- Department of Clinical Neurosciences, University of Cambridge, UK; Institute of Neuroscience, Newcastle University, UK.
| | | | - Holly Robson
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Rebecca Drinkall
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Lauren Dean
- Institute of Neuroscience, Newcastle University, UK
| | - Manon Grube
- Institute of Neuroscience, Newcastle University, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Karalyn Patterson
- Department of Clinical Neurosciences, University of Cambridge, UK; Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | | | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, UK; Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
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231
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Zhang J, Yu J, Bao Y, Xie Q, Xu Y, Zhang J, Wang P. Constraint-induced aphasia therapy in post-stroke aphasia rehabilitation: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0183349. [PMID: 28846724 PMCID: PMC5573268 DOI: 10.1371/journal.pone.0183349] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/02/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Constraint-induced aphasia therapy (CIAT) has been widely used in post-stroke aphasia rehabilitation. An increasing number of clinical controlled trials have investigated the efficacy of the CIAT for the post-stroke aphasia. PURPOSE To systematically review the randomized controlled trials (RCTs) concerning the effect of the CIAT in post-stroke patients with aphasia, and to identify the useful components of CIAT in post-stroke aphasia rehabilitation. METHODS A computerized database search was performed through five databases (Pubmed, EMbase, Medline, ScienceDirect and Cochrane library). Cochrane handbook domains were used to evaluate the methodological quality of the included RCTs. RESULTS Eight RCTs qualified in the inclusion criteria. Inconsistent results were found in comparing the CIAT with conventional therapies without any component from the CIAT based on the results of three RCTs. Five RCTs showed that the CIAT performed equally well as other intensive aphasia therapies, in terms of improving language performance. One RCT showed that therapies embedded with social interaction were likely to enhance the efficacy of the CIAT. CONCLUSION CIAT may be useful for improving chronic post-stroke aphasia, however, limited evidence to support its superiority to other aphasia therapies. Massed practice is likely to be a useful component of CIAT, while the role of "constraint" is needed to be further explored. CIAT embedded with social interaction may gain more benefits.
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Affiliation(s)
- Jiaqi Zhang
- Master of Science in Neurological Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiadan Yu
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Sichuan, China
| | - Yong Bao
- Ruijin Rehabilitation Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Xu
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Sichuan, China
| | - Junmei Zhang
- Department of Physical Education, Wuhan University of Technology, Wuhan, China
| | - Pu Wang
- Department of Rehabilitation Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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232
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Leonardi S, Cacciola A, De Luca R, Aragona B, Andronaco V, Milardi D, Bramanti P, Calabrò RS. The role of music therapy in rehabilitation: improving aphasia and beyond. Int J Neurosci 2017; 128:90-99. [PMID: 28689476 DOI: 10.1080/00207454.2017.1353981] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Music is part of the human nature, and it is also philogenically relevant to language evolution. Language and music are bound together in the enhancement of important social functions, such as communication, cooperation and social cohesion. In the last few years, there has been growing evidence that music and music therapy may improve communication skills (but not only) in different neurological disorders. One of the plausible reasons concerning the rational use of sound and music in neurorehabilitation is the possibility to stimulate brain areas involved in emotional processing and motor control, such as the fronto-parietal network. In this narrative review, we are going to describe the role of music therapy in improving aphasia and other neurological disorders, underlying the reasons why this tool could be effective in rehabilitative settings, especially in individuals affected by stroke.
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Affiliation(s)
| | | | | | - Bianca Aragona
- a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy
| | | | - Demetrio Milardi
- a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy.,b Department of Biomedical , Dental Sciences and Morphological and Functional Images, University of Messina , Messina , Italy
| | - Placido Bramanti
- a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy.,b Department of Biomedical , Dental Sciences and Morphological and Functional Images, University of Messina , Messina , Italy
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233
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Woodhead ZVJ, Crinion J, Teki S, Penny W, Price CJ, Leff AP. Auditory training changes temporal lobe connectivity in 'Wernicke's aphasia': a randomised trial. J Neurol Neurosurg Psychiatry 2017; 88:586-594. [PMID: 28259857 PMCID: PMC5659142 DOI: 10.1136/jnnp-2016-314621] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/24/2016] [Accepted: 02/01/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Aphasia is one of the most disabling sequelae after stroke, occurring in 25%-40% of stroke survivors. However, there remains a lack of good evidence for the efficacy or mechanisms of speech comprehension rehabilitation. TRIAL DESIGN This within-subjects trial tested two concurrent interventions in 20 patients with chronic aphasia with speech comprehension impairment following left hemisphere stroke: (1) phonological training using 'Earobics' software and (2) a pharmacological intervention using donepezil, an acetylcholinesterase inhibitor. Donepezil was tested in a double-blind, placebo-controlled, cross-over design using block randomisation with bias minimisation. METHODS The primary outcome measure was speech comprehension score on the comprehensive aphasia test. Magnetoencephalography (MEG) with an established index of auditory perception, the mismatch negativity response, tested whether the therapies altered effective connectivity at the lower (primary) or higher (secondary) level of the auditory network. RESULTS Phonological training improved speech comprehension abilities and was particularly effective for patients with severe deficits. No major adverse effects of donepezil were observed, but it had an unpredicted negative effect on speech comprehension. The MEG analysis demonstrated that phonological training increased synaptic gain in the left superior temporal gyrus (STG). Patients with more severe speech comprehension impairments also showed strengthening of bidirectional connections between the left and right STG. CONCLUSIONS Phonological training resulted in a small but significant improvement in speech comprehension, whereas donepezil had a negative effect. The connectivity results indicated that training reshaped higher order phonological representations in the left STG and (in more severe patients) induced stronger interhemispheric transfer of information between higher levels of auditory cortex.Clinical trial registrationThis trial was registered with EudraCT (2005-004215-30, https://eudract.ema.europa.eu/) and ISRCTN (68939136, http://www.isrctn.com/).
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Affiliation(s)
- Zoe VJ Woodhead
- Department of Brain Repair and Rehabilitation, University College London, London, UK
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Jennifer Crinion
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Sundeep Teki
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Will Penny
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
| | - Cathy J Price
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
| | - Alexander P Leff
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
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234
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Mohr B. Neuroplasticity and Functional Recovery after Intensive Language Therapy in Chronic Post Stroke Aphasia: Which Factors Are Relevant? Front Hum Neurosci 2017; 11:332. [PMID: 28701937 PMCID: PMC5487528 DOI: 10.3389/fnhum.2017.00332] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/08/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bettina Mohr
- Department of Psychiatry, Campus Benjamin Franklin, Charité Universitätsmedizin BerlinBerlin, Germany
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235
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Stahl B, Mohr B, Dreyer FR, Lucchese G, Pulvermüller F. Communicative-Pragmatic Assessment Is Sensitive and Time-Effective in Measuring the Outcome of Aphasia Therapy. Front Hum Neurosci 2017; 11:223. [PMID: 28579951 PMCID: PMC5437145 DOI: 10.3389/fnhum.2017.00223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/18/2017] [Indexed: 01/08/2023] Open
Abstract
A range of methods in clinical research aim to assess treatment-induced progress in aphasia therapy. Here, we used a crossover randomized controlled design to compare the suitability of utterance-centered and dialogue-sensitive outcome measures in speech-language testing. Fourteen individuals with post-stroke chronic non-fluent aphasia each received two types of intensive training in counterbalanced order: conventional confrontation naming, and communicative-pragmatic speech-language therapy (Intensive Language-Action Therapy, an expanded version of Constraint-Induced Aphasia Therapy). Motivated by linguistic-pragmatic theory and neuroscience data, our dependent variables included a newly created diagnostic instrument, the Action Communication Test (ACT). This diagnostic instrument requires patients to produce target words in two conditions: (i) utterance-centered object naming, and (ii) communicative-pragmatic social interaction based on verbal requests. In addition, we administered a standardized aphasia test battery, the Aachen Aphasia Test (AAT). Composite scores on the ACT and the AAT revealed similar patterns of changes in language performance over time, irrespective of the treatment applied. Changes in language performance were relatively consistent with the AAT results also when considering both ACT subscales separately from each other. However, only the ACT subscale evaluating verbal requests proved to be successful in distinguishing between different types of training in our patient sample. Critically, testing duration was substantially shorter for the entire ACT (10–20 min) than for the AAT (60–90 min). Taken together, the current findings suggest that communicative-pragmatic methods in speech-language testing provide a sensitive and time-effective measure to determine the outcome of aphasia therapy.
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Affiliation(s)
- Benjamin Stahl
- Department of Neurology, Charité Universitätsmedizin Berlin, Campus MitteBerlin, Germany.,Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany.,Department of Neurology, Universitätsmedizin GreifswaldGreifswald, Germany.,Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität BerlinBerlin, Germany
| | - Bettina Mohr
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Campus Benjamin FranklinBerlin, Germany
| | - Felix R Dreyer
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität BerlinBerlin, Germany
| | - Guglielmo Lucchese
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität BerlinBerlin, Germany
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität BerlinBerlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu BerlinBerlin, Germany
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236
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Abstract
Stroke units reduce death and disability through the provision of specialist multidisciplinary care for diagnosis, emergency treatments, normalisation of homeostasis, prevention of complications, rehabilitation and secondary prevention. All stroke patients can benefit from provision of high-quality basic medical care and some need high impact specific treatments, such as thrombolysis, that are often time dependent. A standard patient pathway should include assessment of neurological impairment, vascular risk factors, swallowing, fluid balance and nutrition, cognitive function, communication, mood disorders, continence, activities of daily living and rehabilitation goals. Good communication and shared decision making with patients and their families are key to high-quality stroke care. Patients with mild or moderate disability, who are medically stable, can continue rehabilitation at home with early supported discharge teams rather than needing a prolonged stay in hospital. National clinical guidelines and prospective audits are integral to monitoring and developing stroke services in the UK.
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Affiliation(s)
- Helen Rodgers
- Newcastle University and honorary consultant stroke physician, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Chris Price
- Newcastle University and honorary consultant stroke physician, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
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237
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Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Burridge J. Time spent in rehabilitation and effect on measures of activity after stroke. Hippokratia 2017. [DOI: 10.1002/14651858.cd012612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Beth Clark
- Poole Hospital NHS Foundation Trust; Stroke Care Unit; Poole Dorset UK BH15 2JB
| | - Jill Whitall
- University of Maryland; Department of Physical Therapy and Rehabilitation Science; Baltimore MD USA 21403
| | - Gert Kwakkel
- VU University Medical Center; Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam Neurosciences; De Boelelaan 1118 Amsterdam Netherlands 1007 MB
| | - Jan Mehrholz
- Technical University Dresden; Department of Public Health, Dresden Medical School; Fetscherstr. 74 Dresden Germany 01307
| | - Sean Ewings
- University of Southampton; Southampton Statistical Sciences Research Institute; Southampton Hampshire UK SO17 1BJ
| | - Jane Burridge
- University of Southampton; Research Group, Faculty of Health Sciences; Building 45, University of Southampton Southampton UK SO17 1BJ
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238
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Wenke R, Cardell E, Lawrie M, Gunning D. Communication and well-being outcomes of a hybrid service delivery model of intensive impairment-based treatment for aphasia in the hospital setting: a pilot study. Disabil Rehabil 2017; 40:1532-1541. [DOI: 10.1080/09638288.2017.1300949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rachel Wenke
- Speech Pathology Services, Gold Coast Health, Southport, QLD, Australia
- Clinical Governance, Education & Research – Allied Health, Gold Coast Health, Southport, QLD, Australia
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia
| | - Elizabeth Cardell
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
| | - Melissa Lawrie
- Speech Pathology Services, Gold Coast Health, Southport, QLD, Australia
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia
| | - Dana Gunning
- Speech Pathology Services, Gold Coast Health, Southport, QLD, Australia
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239
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Nouwens F, de Lau LM, Visch-Brink EG, van de Sandt-Koenderman WM, Lingsma HF, Goosen S, Blom DM, Koudstaal PJ, Dippel DW. Efficacy of early cognitive-linguistic treatment for aphasia due to stroke: A randomised controlled trial (Rotterdam Aphasia Therapy Study-3). Eur Stroke J 2017; 2:126-136. [PMID: 29900407 PMCID: PMC5992741 DOI: 10.1177/2396987317698327] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/14/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction One third of patients with acute stroke have aphasia. The majority receive speech and language therapy. There is evidence for a beneficial effect of speech and language therapy on restoring communication, but it is unknown whether and how efficacy of speech and language therapy is influenced by timing of treatment. We studied whether speech and language therapy early after stroke by way of intensive cognitive-linguistic treatment is more effective than no speech and language therapy in the Rotterdam Aphasia Therapy Study-3, a multicentre randomised single-blind trial. Methods and patients Stroke patients with first-ever aphasia were randomised within 2 weeks of onset to either 4 weeks of early intensive cognitive-linguistic treatment (1 h/day) or no language treatment. Hereafter, both groups received regular speech and language therapy. Primary outcome was the score on the Amsterdam-Nijmegen Everyday Language Test, measuring everyday verbal communication, 4 weeks after randomisation. Secondary outcomes were Amsterdam-Nijmegen Everyday Language Test at 3 and 6 months. The study was powered to detect a clinically relevant difference of four points on the Amsterdam-Nijmegen Everyday Language Test. Results Of the 152 included patients, 80 patients were allocated to intervention. Median treatment intensity in the intervention-group was 24.5 h. The adjusted difference between groups in mean Amsterdam-Nijmegen Everyday Language Test-scores 4 weeks after randomisation was 0.39, 95% confidence interval: [-2.70 to 3.47], p = 0.805. No statistically significant differences were found at 3 and 6 months after randomisation either. Conclusion Four weeks of intensive cognitive-linguistic treatment initiated within 2 weeks of stroke is not more effective than no language treatment for the recovery of post-stroke aphasia. Our results exclude a clinically relevant effect of very early cognitive-linguistic treatment on everyday language.
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Affiliation(s)
- Femke Nouwens
- Department of Neurology, Erasmus MC University Medical Center, The Netherlands
| | - Lonneke Ml de Lau
- Department of Neurology, Erasmus MC University Medical Center, The Netherlands.,Department of Neurology, Slotervaart Medical Center, The Netherlands
| | - Evy G Visch-Brink
- Department of Neurology, Erasmus MC University Medical Center, The Netherlands
| | - Wme Mieke van de Sandt-Koenderman
- Research Department, Rijndam Rehabilitation, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center, The Netherlands
| | - Sylvia Goosen
- Department of Neurology, Amphia Medical Center, The Netherlands
| | - Dineke Mj Blom
- Adult Inpatient Rehabilitation Department, Revant Rehabilitation Center, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, The Netherlands
| | - Diederik Wj Dippel
- Department of Neurology, Erasmus MC University Medical Center, The Netherlands
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240
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Abstract
In the past decade, the definition of stroke has been revised and major advances have been made for its treatment and prevention. For acute ischaemic stroke, the addition of endovascular thrombectomy of proximal large artery occlusion to intravenous alteplase increases functional independence for a further fifth of patients. The benefits of aspirin in preventing early recurrent ischaemic stroke are greater than previously recognised. Other strategies to prevent recurrent stroke now include direct oral anticoagulants as an alternative to warfarin for atrial fibrillation, and carotid stenting as an alternative to endarterectomy for symptomatic carotid stenosis. For acute intracerebral haemorrhage, trials are ongoing to assess the effectiveness of acute blood pressure lowering, haemostatic therapy, minimally invasive surgery, anti-inflammation therapy, and neuroprotection methods. Pharmacological and stem-cell therapies promise to facilitate brain regeneration, rehabilitation, and functional recovery. Despite declining stroke mortality rates, the global burden of stroke is increasing. A more comprehensive approach to primary prevention of stroke is required that targets people at all levels of risk and is integrated with prevention strategies for other diseases that share common risk factors.
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Affiliation(s)
- Graeme J Hankey
- School of Medicine & Pharmacology, The University of Western Australia, Perth, WA, Australia; Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA, Australia; Western Australian Neuroscience Research Institute (WANRI), Perth, WA, Australia.
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241
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The Influence of Speech-Language-Hearing Therapy Duration on the Degree of Improvement in Poststroke Language Impairment. Rehabil Res Pract 2017; 2017:7459483. [PMID: 28168056 PMCID: PMC5266857 DOI: 10.1155/2017/7459483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/21/2016] [Accepted: 12/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background. The relevance of speech-language-hearing therapy (ST) duration to language impairment remains unclear. Objective. To determine the effect of ST duration on improvement in language impairment as a stroke sequela and to compare the findings with those for occupational therapy (OT) and physical therapy (PT). Methods. Data regarding patients with stroke sequelae who were registered in the Japanese Association of Rehabilitation Medicine database were analyzed. Propensity scores for ST, OT, and PT duration were calculated using logistic regression, followed by inverse probability weighting in generalized estimating equations to examine the odds ratio for improvement in the Functional Independence Measures scores for comprehension, expression, and memory. Analyses stratified by age and dementia severity were also conducted. Results. Compared with short-duration ST, long-duration ST was significantly associated with improved scores for comprehension and expression in the overall study population and in some groups, with higher benefit especially for younger participants (<64 years) and those with more severe dementia. A significant but less pronounced effect was also observed for OT and PT. Conclusion. Long-duration ST is more effective than long-duration OT or PT for improving language impairment occurring as stroke sequela. However, these effects are limited by age and severity of dementia.
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242
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Mitchell C, Bowen A, Tyson S, Butterfint Z, Conroy P. Interventions for dysarthria due to stroke and other adult-acquired, non-progressive brain injury. Cochrane Database Syst Rev 2017; 1:CD002088. [PMID: 28121021 PMCID: PMC6464736 DOI: 10.1002/14651858.cd002088.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dysarthria is an acquired speech disorder following neurological injury that reduces intelligibility of speech due to weak, imprecise, slow and/or unco-ordinated muscle control. The impact of dysarthria goes beyond communication and affects psychosocial functioning. This is an update of a review previously published in 2005. The scope has been broadened to include additional interventions, and the title amended accordingly. OBJECTIVES To assess the effects of interventions to improve dysarthric speech following stroke and other non-progressive adult-acquired brain injury such as trauma, infection, tumour and surgery. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (May 2016), CENTRAL (Cochrane Library 2016, Issue 4), MEDLINE, Embase, and CINAHL on 6 May 2016. We also searched Linguistics and Language Behavioral Abstracts (LLBA) (1976 to November 2016) and PsycINFO (1800 to September 2016). To identify further published, unpublished and ongoing trials, we searched major trials registers: WHO ICTRP, the ISRCTN registry, and ClinicalTrials.gov. We also handsearched the reference lists of relevant articles and contacted academic institutions and other researchers regarding other published, unpublished or ongoing trials. We did not impose any language restrictions. SELECTION CRITERIA We selected randomised controlled trials (RCTs) comparing dysarthria interventions with 1) no intervention, 2) another intervention for dysarthria (this intervention may differ in methodology, timing of delivery, duration, frequency or theory), or 3) an attention control. DATA COLLECTION AND ANALYSIS Three review authors selected trials for inclusion, extracted data, and assessed risk of bias. We attempted to contact study authors for clarification and missing data as required. We calculated standardised mean difference (SMD) and 95% confidence interval (CI), using a random-effects model, and performed sensitivity analyses to assess the influence of methodological quality. We planned to conduct subgroup analyses for underlying clinical conditions. MAIN RESULTS We included five small trials that randomised a total of 234 participants. Two studies were assessed as low risk of bias; none of the included studies were adequately powered. Two studies used an attention control and three studies compared to an alternative intervention, which in all cases was one intervention versus usual care intervention. The searches we carried out did not find any trials comparing an intervention with no intervention. The searches did not find any trials of an intervention that compared variations in timing, dose, or intensity of treatment using the same intervention. Four studies included only people with stroke; one included mostly people with stroke, but also those with brain injury. Three studies delivered interventions in the first few months after stroke; two recruited people with chronic dysarthria. Three studies evaluated behavioural interventions, one investigated acupuncture and another transcranial magnetic stimulation. One study included people with dysarthria within a broader trial of people with impaired communication.Our primary analysis of a persisting (three to nine months post-intervention) effect at the activity level of measurement found no evidence in favour of dysarthria intervention compared with any control (SMD 0.18, 95% CI -0.18 to 0.55; 3 trials, 116 participants, GRADE: low quality, I² = 0%). Findings from sensitivity analysis of studies at low risk of bias were similar, with a slightly wider confidence interval and low heterogeneity (SMD 0.21, 95% CI -0.30 to 0.73, I² = 32%; 2 trials, 92 participants, GRADE: low quality). Subgroup analysis results for stroke were similar to the primary analysis because few non-stroke participants had been recruited to trials (SMD 0.16, 95% CI -0.23 to 0.54, I² = 0%; 3 trials, 106 participants, GRADE: low quality).Similar results emerged from most of the secondary analyses. There was no evidence of a persisting effect at the impairment (SMD 0.07, 95% CI -0.91 to 1.06, I² = 70%; 2 trials, 56 participants, GRADE: very low quality) or participation level (SMD -0.11, 95% CI -0.56 to 0.33, I² = 0%; 2 trials, 79 participants, GRADE: low quality) but substantial heterogeneity on the former. Analyses of immediate post-intervention outcomes provided no evidence of any short-term benefit on activity (SMD 0.29, 95% CI -0.07 to 0.66, I² = 0%; 3 trials, 117 participants, GRADE: very low quality); or participation (SMD -0.24, 95% CI -0.94 to 0.45; 1 study, 32 participants) levels of measurement.There was a statistically significant effect favouring intervention at the immediate, impairment level of measurement (SMD 0.47, 95% CI 0.02 to 0.92, P = 0.04, I² = 0%; 4 trials, 99 participants, GRADE: very low quality) but only one of these four trials had a low risk of bias. AUTHORS' CONCLUSIONS We found no definitive, adequately powered RCTs of interventions for people with dysarthria. We found limited evidence to suggest there may be an immediate beneficial effect on impairment level measures; more, higher quality research is needed to confirm this finding.Although we evaluated five studies, the benefits and risks of interventions remain unknown and the emerging evidence justifies the need for adequately powered clinical trials into this condition.People with dysarthria after stroke or brain injury should continue to receive rehabilitation according to clinical guidelines.
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Affiliation(s)
- Claire Mitchell
- University of Manchester MAHSCDivision of Neuroscience and Experimental PsychologyEllen Wilkinson BuildingManchesterUK
- Central Manchester University Hospitals NHS Foundation Trust, MAHSCManchester Royal InfirmaryManchesterUK
| | - Audrey Bowen
- University of Manchester MAHSCDivision of Neuroscience and Experimental PsychologyEllen Wilkinson BuildingManchesterUK
| | - Sarah Tyson
- University of ManchesterDivision of Nursing, Midwifery & Social WorkOxford RoadManchesterUKM13 9PL
| | - Zoe Butterfint
- University of East AngliaSchool of Health SciencesQueen's BuildingEarlham RoadNorwichUKNR4 7TJ
| | - Paul Conroy
- University of Manchester MAHSCDivision of Neuroscience and Experimental PsychologyEllen Wilkinson BuildingManchesterUK
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243
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Sebastian R, Saxena S, Tsapkini K, Faria AV, Long C, Wright A, Davis C, Tippett DC, Mourdoukoutas AP, Bikson M, Celnik P, Hillis AE. Cerebellar tDCS: A Novel Approach to Augment Language Treatment Post-stroke. Front Hum Neurosci 2017; 10:695. [PMID: 28127284 PMCID: PMC5226957 DOI: 10.3389/fnhum.2016.00695] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/29/2016] [Indexed: 11/13/2022] Open
Abstract
People with post-stroke aphasia may have some degree of chronic deficit for which current rehabilitative treatments are variably effective. Accumulating evidence suggests that transcranial direct current stimulation (tDCS) may be useful for enhancing the effects of behavioral aphasia treatment. However, it remains unclear which brain regions should be stimulated to optimize effects on language recovery. Here, we report on the therapeutic potential of right cerebellar tDCS in augmenting language recovery in SMY, who sustained bilateral MCA infarct resulting in aphasia and anarthria. We investigated the effects of 15 sessions of anodal cerebellar tDCS coupled with spelling therapy using a randomized, double-blind, sham controlled within-subject crossover trial. We also investigated changes in functional connectivity using resting state functional magnetic resonance imaging before and 2 months post-treatment. Both anodal and sham treatments resulted in improved spelling to dictation for trained and untrained words immediately after and 2 months post-treatment. However, there was greater improvement with tDCS than with sham, especially for untrained words. Further, generalization to written picture naming was only noted during tDCS but not with sham. The resting state functional connectivity data indicate that improvement in spelling was accompanied by an increase in cerebro-cerebellar network connectivity. These results highlight the therapeutic potential of right cerebellar tDCS to augment spelling therapy in an individual with large bilateral chronic strokes.
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Affiliation(s)
- Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Sadhvi Saxena
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Andreia V. Faria
- Department of Radiology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Charltien Long
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Amy Wright
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Cameron Davis
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Donna C. Tippett
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | | | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNYNew York, NY, USA
| | - Pablo Celnik
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of MedicineBaltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of MedicineBaltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of MedicineBaltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins UniversityBaltimore, MD, USA
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244
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Roper A, Marshall J, Wilson S. Benefits and Limitations of Computer Gesture Therapy for the Rehabilitation of Severe Aphasia. Front Hum Neurosci 2016; 10:595. [PMID: 27965554 PMCID: PMC5126070 DOI: 10.3389/fnhum.2016.00595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/09/2016] [Indexed: 11/13/2022] Open
Abstract
Aphasia intervention has made increasing use of technology in recent years. The evidence base, which is largely limited to the investigation of spoken language outcomes, indicates positive treatment effects for people with mild to moderate levels of aphasia. Outcomes for those with severe aphasia, however, are less well documented and – where reported – present less consistent gains for measures of spoken output. This study investigates the effects of a purpose-built gesture therapy technology for people with severe aphasia: GeST+. Study outcomes show significant improvement in gesture production abilities for adults with severe aphasia following computer intervention. They indicate no transfer of effects into naming gains or interactive gesture. Outcomes offer encouraging results for computer therapy methods within this hitherto under-researched population but indicate a need for further refinement of interventions in order to maximize persistence of effects and generalization into everyday communication.
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Affiliation(s)
- Abi Roper
- Division of Language and Communication Science, City, University of London London, UK
| | - Jane Marshall
- Division of Language and Communication Science, City, University of London London, UK
| | - Stephanie Wilson
- Centre for Human-Computer Interaction Design, City, University of London London, UK
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245
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Abstract
Advancements in medical care over the last decades have contributed to a continuous decline in immediate post-stroke mortality. The flipside of this development is that patients surviving the initial stroke are forced to live with sometimes extreme functional motor and/or language limitations for the remaining life span. The following overview presents evidence-based neurorehabilitative interventions to promote motor and language recovery in the acute and chronic post-stroke stages. Therapeutic approaches comprise intensive training, neuropharmacological drugs and non-invasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS) or direct current stimulation (tDCS). Additionally, an outlook on promising future interventions for stroke neurorehabilitation is provided.
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246
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Koyuncu E, Çam P, Altınok N, Çallı DE, Duman TY, Özgirgin N. Speech and language therapy for aphasia following subacute stroke. Neural Regen Res 2016; 11:1591-1594. [PMID: 27904489 PMCID: PMC5116837 DOI: 10.4103/1673-5374.193237] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to investigate the time window, duration and intensity of optimal speech and language therapy applied to aphasic patients with subacute stroke in our hospital. The study consisted of 33 patients being hospitalized for stroke rehabilitation in our hospital with first stroke but without previous history of speech and language therapy. Sixteen sessions of impairment-based speech and language therapy were applied to the patients, 30-60 minutes per day, 2 days a week, for 8 successive weeks. Aphasia assessment in stroke patients was performed with Gülhane Aphasia Test-2 before and after treatment. Compared with before treatment, fluency of speech, listening comprehension, reading comprehension, oral motor evaluation, automatic speech, repetition and naming were improved after treatment. This suggests that 16 seesions of speech and language therapy, 30-60 minutes per day, 2 days a week, for 8 successive weeks, are effective in the treatment of aphasic patients with subacute stroke.
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Affiliation(s)
- Engin Koyuncu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Pınar Çam
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Nermin Altınok
- Department of Psychology, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Duygu Ekinci Çallı
- Department of Psychology, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Tuba Yarbay Duman
- Department of Linguistics, Amsterdam Center for Language and Communication, Amsterdam Brain and Cognition Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Neşe Özgirgin
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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247
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Marshall J, Booth T, Devane N, Galliers J, Greenwood H, Hilari K, Talbot R, Wilson S, Woolf C. Evaluating the Benefits of Aphasia Intervention Delivered in Virtual Reality: Results of a Quasi-Randomised Study. PLoS One 2016; 11:e0160381. [PMID: 27518188 PMCID: PMC4982664 DOI: 10.1371/journal.pone.0160381] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/17/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION This study evaluated an intervention for people with aphasia delivered in a novel virtual reality platform called EVA Park. EVA Park contains a number of functional and fantastic locations and allows for interactive communication between multiple users. Twenty people with aphasia had 5 weeks' intervention, during which they received daily language stimulation sessions in EVA Park from a support worker. The study employed a quasi randomised design, which compared a group that received immediate intervention with a waitlist control group. Outcome measures explored the effects of intervention on communication and language skills, communicative confidence and feelings of social isolation. Compliance with the intervention was also explored through attrition and usage data. RESULTS There was excellent compliance with the intervention, with no participants lost to follow up and most (18/20) receiving at least 88% of the intended treatment dose. Intervention brought about significant gains on a measure of functional communication. Gains were achieved by both groups of participants, once intervention was received, and were well maintained. Changes on the measures of communicative confidence and feelings of social isolation were not achieved. Results are discussed with reference to previous aphasia therapy findings.
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Affiliation(s)
- Jane Marshall
- Division of Language and Communication Science, City University London, London, United Kingdom
| | - Tracey Booth
- Centre for Human Computer Interaction Design, City University London, London, United Kingdom
| | - Niamh Devane
- Division of Language and Communication Science, City University London, London, United Kingdom
| | - Julia Galliers
- Centre for Human Computer Interaction Design, City University London, London, United Kingdom
| | - Helen Greenwood
- Division of Language and Communication Science, City University London, London, United Kingdom
| | - Katerina Hilari
- Division of Language and Communication Science, City University London, London, United Kingdom
| | - Richard Talbot
- Division of Language and Communication Science, City University London, London, United Kingdom
| | - Stephanie Wilson
- Centre for Human Computer Interaction Design, City University London, London, United Kingdom
| | - Celia Woolf
- Division of Language and Communication Science, City University London, London, United Kingdom
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