Montreal–Toulouse Language Assessment Battery: Evidence of criterion validity from patients with aphasia

Enhancing Speech Rehabilitation in a Young Adult with Trisomy 21: Integrating Transcranial Direct Current Stimulation (tDCS) with Rapid Syllable Transition Training for Apraxia of Speech

Apraxia of speech is a persistent speech motor disorder that affects speech intelligibility. Studies on speech motor disorders with transcranial Direct Current Stimulation (tDCS) have been mostly directed toward examining post-stroke aphasia. Only a few tDCS studies have focused on apraxia of speech or childhood apraxia of speech (CAS), and no study has investigated individuals with CAS and Trisomy 21 (T21, Down syndrome). This N-of-1 randomized trial examined the effects of tDCS combined with a motor learning task in developmental apraxia of speech co-existing with T21 (ReBEC RBR-5435x9). The accuracy of speech sound production of nonsense words (NSWs) during Rapid Syllable Transition Training (ReST) over 10 sessions of anodal tDCS (1.5 mA, 25 cm) over Broca's area with the cathode over the contralateral region was compared to 10 sessions of sham-tDCS and four control sessions in a 20-year-old male individual with T21 presenting moderate-severe childhood apraxia of speech (CAS). The accuracy for NSW production progressively improved (gain of 40%) under tDCS (sham-tDCS and control sessions showed < 20% gain). A decrease in speech severity from moderate-severe to mild-moderate indicated transfer effects in speech production. Speech accuracy under tDCS was correlated with Wernicke's area activation (P3 current source density), which in turn was correlated with the activation of the left supramarginal gyrus and the Sylvian parietal-temporal junction. Repetitive bihemispheric tDCS paired with ReST may have facilitated speech sound acquisition in a young adult with T21 and CAS, possibly through activating brain regions required for phonological working memory.

Translation and Adaptation of the English Story Retell Procedure to Portuguese: A Preliminary Study

INTRODUCTION

The comprehension and production of connected language are essential for effective communication. However, few assessment and intervention programs requiring connected language have been made available in Brazilian Portuguese. One connected language sampling procedure, the Story Retell Procedure (SRP), has been widely studied in English and primarily for people with aphasia. The SRP employs 12 stories, whose individual plots are quite different and still equivalent in terms of verbal productivity measures. The first objective of this study was to present the translation and adaptation of the SRP stories into Portuguese and to determine whether the translations are similar to English stories. The second objective was to analyze a small group of healthy adults' responses to this assessment, thus observing whether the retellings of the SRP story forms in Portuguese would be similar to each other in the number of words, information units (IUs), and propositions - as demonstrated in English.

METHODS

This preliminary study translated and adapted into Portuguese, the 12 original English SRP stories. Only small cultural adaptations were made, preserving the essential content of the stories. The stories were then presented to 14 healthy adults, and the participants' retellings from each story were compared to the other stories regarding the number of words, IUs, and propositions.

RESULTS

Few differences were found in the retellings considering the variables analyzed. Particularly, the retells of Gasolina (Gas), Biblioteca (Library), Empréstimo (Loan), Sanduíche (Sandwich), Futebol (Baseball), and Multas (Ticket) were not significantly different in the three aspects investigated in this study (percentages of words, IUs, and propositions).

CONCLUSION

The SRP stories adapted to Portuguese, despite having a quite close number of words, IUs, and propositions to those in the original stories, did not result in retellings with similar number of words, IUs, or propositions across stories. Nonetheless, the parameters analyzed were not significantly different among the majority of the stories, and some were nearly identical. This study identified the SRP stories that can be equivalently used in assessment, reassessment, and possibly in the rehabilitation of patients with communication disorders. Likewise, differences must be considered when the stories are used with pathological populations.

Assessing oral comprehension with an eye tracking based innovative device in critically ill patients and healthy volunteers: a cohort study

PURPOSE

Communication of caregivers and relatives to patients is a major difficulty in intensive care units (ICU). Patient's comprehension capabilities are variable over time and traditional comprehension tests cannot be implemented. Our purpose was to evaluate an oral comprehension test adapted for its automatic implementation using eye-tracking technology among ICU patients.

METHODS

Prospective bi-centric cohort study was conducted on 60 healthy volunteers and 53 ICU patients. Subjects underwent an oral comprehension test using an eye-tracking device: Their results and characteristics were collected. The total duration of the test was 2 and a half minutes.

RESULTS

While performing the test, 48 patients (92%) received invasive ventilation. Among healthy volunteers, the median rate of right answers was very high (93% [interquartile range 87, 100]), whereas it was lower (33% [20, 67]) for patients. For both groups, a significantly lower right answers rate was observed with advancing age (67% [27, 80] vs. 27% [20, 38] among patients and 93% [93, 100] vs. 87% [73, 93] among healthy volunteers, below and above 60 years of age, respectively) and in case of lack of a bachelor's degree (60% [38, 87] vs. 27% [20, 57] among patients and 93% [93, 100] vs. 87% [73, 93] among healthy volunteers). For patients, the higher the severity of disease was, the lower the rate of correct answers was.

CONCLUSION

The eye-tracking-adapted comprehension test is easy and fast to use among ICU patients, and results seem coherent with various potential levels of comprehension as hypothesized in this study.

Clustering and switching in verbal fluency: a comparison between control and individuals with brain damage

PURPOSE

The aim of this study is to analyze and compare the performance and strategies used by control subjects and patients with unilateral brain damage on phonemic and semantic Verbal Fluency tasks.

METHODS

The sample consisted of 104 participants divided into four groups (26 with left hemisphere damage and aphasia- LHDa, 28 with left hemisphere damage and no aphasia- LHDna, 25 with right hemisphere damage- RHD and 25 neurologically healthy control subjects). All participants were administered the phonemic ("M" letter-based) and semantic (animals) verbal fluency tasks from the Montreal-Toulouse Language Assessment Battery (MTL-BR).

RESULTS

Patients in the LHDa group showed the worst performance (fewer words produced, fewer clusters and switches) in both types of fluency task. RHD group showed fewer switching productions when compared with controls and LHDna had fewer words productions than controls in the first 30 seconds block.

CONCLUSION

Our findings suggest that the LHDa group obtained lower scores in most measures of SVF and PVF when compared to the other groups.

What are the barriers to participation in a neuromodulation pilot trial for aphasia after stroke?

PURPOSE

Aphasia is a common and debilitating manifestation of stroke. Transcranial electrical stimulation uses low-intensity electric currents to induce changes in neuronal activity. Recent evidence suggests that noninvasive techniques can be a valuable rehabilitation tool for patients with aphasia. However, it is difficult to recruit patients with aphasia for trials, and the reasons for this are not well understood. This study aimed to elucidate the main difficulties involved in patient's recruitment and inclusion in a randomized clinical study of neuromodulation in aphasia.

METHODS

We evaluated the reasons for the exclusion of patients in a pilot, randomized, double-blinded clinical trial in which patients diagnosed with motor aphasia after stroke were recruited from March to November 2018. A descriptive statistical analysis was performed.

RESULTS

Only 12.9% (4) of patients with ischemic stroke were included in the clinical trial. A total of 87.1% (27) of the 31 recruited patients were excluded for various reasons including: sensory aphasia (32.2%), dysarthria (25.8%), spontaneous clinical recovery (16.1%), previous stroke (6.4%), and death or mutism (3.2%).

CONCLUSION

The presence of other types of aphasia, dysarthria, spontaneous recovery, deaths, and mutism were barriers to recruiting patients evidenced in this neuromodulation study.

Brief Montreal-Toulouse Language Assessment Battery: adaptation and content validity

BACKGROUND

Evaluating patients in the acute phase of brain damage allows for the early detection of cognitive and linguistic impairments and the implementation of more effective interventions. However, few cross-cultural instruments are available for the bedside assessment of language abilities. The aim of this study was to develop a brief assessment instrument and evaluate its content validity.

METHODS

Stimuli for the new assessment instrument were selected from the M1-Alpha and MTL-BR batteries (Stage 1). Sixty-five images were redesigned and analyzed by non-expert judges (Stage 2). This was followed by the analysis of expert judges (Stage 3), where nine speech pathologists with doctoral training and experience in aphasiology and/or linguistics evaluated the images, words, nonwords, and phrases for inclusion in the instrument. Two pilot studies (Stage 4) were then conducted in order to identify any remaining errors in the instrument and scoring instructions.

RESULTS

Sixty of the 65 figures examined by the judges achieved inter-rater agreement rates of at least 80%. Modifications were suggested to 22 images, which were therefore reanalyzed by the judges, who reached high levels of inter-rater agreement (AC1 = 0.98 [CI = 0.96-1]). New types of stimuli such as nonwords and irregular words were also inserted in the Brief Battery and favorably evaluated by the expert judges. Optional tasks were also developed for specific diagnostic situations. After the correction of errors detected in Stage 4, the final version of the instrument was obtained.

CONCLUSION

This study confirmed the content validity of the Brief MTL-BR Battery. The method used in this investigation was effective and can be used in future studies to develop brief instruments based on preexisting assessment batteries.

Formal language assessment in low-educated healthy subjects

Although many studies have shown the influence of education on cognition, the impact of low education on the various cognitive functions appears to differ. The hypothesis of the present study is that, with regards to language, the use of parameters derived from populations with 5-8 years of education leads to false-positive results.

OBJECTIVE

to determine the influence of low education on the language tasks assessed by the MTL-Brazil Battery.

METHODS

30 healthy adults with 2-4 years of education were submitted to the MTL-Br Battery, comprising 22 subtests. The data were submitted to descriptive statistical analysis for each subtest and Z-scores were then calculated based on the parameters of a population with 5-8 years of education. All participants would be considered impaired if the Battery had been applied according to published normative criteria for a population with 5-8 years of education.

RESULTS

Separate analysis revealed that published scores for 17 out of the 22 Battery tasks were inappropriate for a population with 2-4 years of education.

CONCLUSION

Education was found to effect performance for each of the language abilities differently. In addition, the study results can be applied to language assessments of individuals with 1-4 years of education using the MTL-Br battery, since this is the only language test for adults available in Brazil, and for which there are no normative data for low-educated subjects.