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Sheppard SM, Sebastian R. Diagnosing and managing post-stroke aphasia. Expert Rev Neurother 2021; 21:221-234. [PMID: 33231117 PMCID: PMC7880889 DOI: 10.1080/14737175.2020.1855976] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Introduction: Aphasia is a debilitating language disorder and even mild forms of aphasia can negatively affect functional outcomes, mood, quality of life, social participation, and the ability to return to work. Language deficits after post-stroke aphasia are heterogeneous. Areas covered: The first part of this manuscript reviews the traditional syndrome-based classification approach as well as recent advances in aphasia classification that incorporate automatic speech recognition for aphasia classification. The second part of this manuscript reviews the behavioral approaches to aphasia treatment and recent advances such as noninvasive brain stimulation techniques and pharmacotherapy options to augment the effectiveness of behavioral therapy. Expert opinion: Aphasia diagnosis has largely evolved beyond the traditional approach of classifying patients into specific syndromes and instead focuses on individualized patient profiles. In the future, there is a great need for more large scale randomized, double-blind, placebo-controlled clinical trials of behavioral treatments, noninvasive brain stimulation, and medications to boost aphasia recovery.
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Affiliation(s)
- Shannon M. Sheppard
- Department of Communication Sciences and Disorder, Chapman University, Irvine, CA, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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2
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Kierońska S, Świtońska M, Meder G, Piotrowska M, Sokal P. Tractography Alterations in the Arcuate and Uncinate Fasciculi in Post-Stroke Aphasia. Brain Sci 2021; 11:brainsci11010053. [PMID: 33466403 PMCID: PMC7824889 DOI: 10.3390/brainsci11010053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 01/01/2023] Open
Abstract
Fiber tractography based on diffuse tensor imaging (DTI) can reveal three-dimensional white matter connectivity of the human brain. Tractography is a non-invasive method of visualizing cerebral white matter structures in vivo, including neural pathways surrounding the ischemic area. DTI may be useful for elucidating alterations in brain connectivity resulting from neuroplasticity after stroke. We present a case of a male patient who developed significant mixed aphasia following ischemic stroke. The patient had been treated by mechanical thrombectomy followed by an early rehabilitation, in conjunction with transcranial direct current stimulation (tDCS). DTI was used to examine the arcuate fasciculus and uncinate fasciculus upon admission and again at three months post-stroke. Results showed an improvement in the patient’s symptoms of aphasia, which was associated with changes in the volume and numbers of tracts in the uncinate fasciculus and the arcuate fasciculus.
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Affiliation(s)
- Sara Kierońska
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University, 85-168 Bydgoszcz, Poland; (S.K.); (M.Ś.); (M.P.)
| | - Milena Świtońska
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University, 85-168 Bydgoszcz, Poland; (S.K.); (M.Ś.); (M.P.)
- Faculty of Health Science, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland
| | - Grzegorz Meder
- Department of Interventional Radiology, Jan Biziel University Hospital No. 2, 85-168 Bydgoszcz, Poland;
| | - Magdalena Piotrowska
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University, 85-168 Bydgoszcz, Poland; (S.K.); (M.Ś.); (M.P.)
| | - Paweł Sokal
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University, 85-168 Bydgoszcz, Poland; (S.K.); (M.Ś.); (M.P.)
- Faculty of Health Science, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-600954415
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Boucher J, Marcotte K, Brisebois A, Courson M, Houzé B, Desautels A, Léonard C, Rochon E, Brambati SM. Word-finding in confrontation naming and picture descriptions produced by individuals with early post-stroke aphasia. Clin Neuropsychol 2020; 36:1422-1437. [PMID: 32924789 DOI: 10.1080/13854046.2020.1817563] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The present study aims to assess the relationship between quantitative measures of connected speech production and performance in confrontation naming in early post-stroke aphasia (8-14 days post-stroke). Method: We collected connected speech samples elicited by a picture description task and administered a confrontation naming task to 20 individuals with early post-stroke aphasia and 20 healthy controls. Transcriptions were made in compliance with the CHAT format guidelines. Several micro- (i.e. duration, total number of words, words per minute, mean length of utterances, ratio of open- to closed-class words and noun-to-verb ratio, VOC-D, repetitions, self-corrections, and phonological and semantic errors) and macrolinguistic (i.e. informativeness and efficiency) measures were extracted. Results: We provide evidence for the presence of impairments in an array of micro- and macrolinguistic measures of speech in individuals with early post-stroke aphasia. We show that in the patient group, confrontation naming abilities most strongly relate to informativeness in a picture description task. Conclusion: Our findings contribute to a better understanding of the relationship between performance in confrontation naming and in connected speech production in the first days after stroke onset and also suggest that discourse analysis may provide unique, possibly more complex information.
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Affiliation(s)
- Johémie Boucher
- Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.,Département de psychologie, Faculté des arts et des sciences, Université de Montréal, Montréal, Québec, Canada
| | - Karine Marcotte
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Québec, Canada.,École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Amélie Brisebois
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Québec, Canada.,École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Melody Courson
- Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Bérengère Houzé
- Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.,Département de psychologie, Faculté des arts et des sciences, Université de Montréal, Montréal, Québec, Canada
| | - Alex Desautels
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Québec, Canada.,Département des neurosciences, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Carol Léonard
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Elizabeth Rochon
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, Toronto, Canada.,Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | - Simona M Brambati
- Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.,Département de psychologie, Faculté des arts et des sciences, Université de Montréal, Montréal, Québec, Canada
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Osa García A, Brambati SM, Brisebois A, Désilets-Barnabé M, Houzé B, Bedetti C, Rochon E, Leonard C, Desautels A, Marcotte K. Predicting Early Post-stroke Aphasia Outcome From Initial Aphasia Severity. Front Neurol 2020; 11:120. [PMID: 32153496 PMCID: PMC7047164 DOI: 10.3389/fneur.2020.00120] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/03/2020] [Indexed: 12/11/2022] Open
Abstract
Background: The greatest degree of language recovery in post-stroke aphasia takes place within the first weeks. Aphasia severity and lesion measures have been shown to be good predictors of long-term outcomes. However, little is known about their implications in early spontaneous recovery. The present study sought to determine which factors better predict early language outcomes in individuals with post-stroke aphasia. Methods: Twenty individuals with post-stroke aphasia were assessed <72 h (acute) and 10-14 days (subacute) after stroke onset. We developed a composite score (CS) consisting of several linguistic sub-tests: repetition, oral comprehension and naming. Lesion volume, lesion load and diffusion measures [fractional anisotropy (FA) and axial diffusivity (AD)] from both arcuate fasciculi (AF) were also extracted using MRI scans performed at the same time points. A series of regression analyses were performed to predict the CS at the second assessment. Results: Among the diffusion measures, only FA from right AF was found to be a significant predictor of early subacute aphasia outcome. However, when combined in two hierarchical models with FA, age and either lesion load or lesion size, the initial aphasia severity was found to account for most of the variance (R 2 = 0.678), similarly to the complete models (R 2 = 0.703 and R 2 = 0.73, respectively). Conclusions: Initial aphasia severity was the best predictor of early post-stroke aphasia outcome, whereas lesion measures, though highly correlated, show less influence on the prediction model. We suggest that factors predicting early recovery may differ from those involved in long-term recovery.
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Affiliation(s)
- Alberto Osa García
- Centre de Recherche du Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- École d'Orthophonie et d'Audiologie, Université de Montréal, Montreal, QC, Canada
| | - Simona Maria Brambati
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
- Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - Amélie Brisebois
- Centre de Recherche du Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- École d'Orthophonie et d'Audiologie, Université de Montréal, Montreal, QC, Canada
| | - Marianne Désilets-Barnabé
- Centre de Recherche du Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- École d'Orthophonie et d'Audiologie, Université de Montréal, Montreal, QC, Canada
| | - Bérengère Houzé
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | - Christophe Bedetti
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, Toronto, ON, Canada
- Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Carol Leonard
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Alex Desautels
- Centre de Recherche du Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- Département de Neurosciences, Université de Montréal, Montreal, QC, Canada
- Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Karine Marcotte
- Centre de Recherche du Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- École d'Orthophonie et d'Audiologie, Université de Montréal, Montreal, QC, Canada
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Menichelli A, Furlanis G, Sartori A, Ridolfi M, Naccarato M, Caruso P, Pesavento V, Manganotti P. Thrombolysis' benefits on early post-stroke language recovery in aphasia patients. J Clin Neurosci 2019; 70:92-95. [PMID: 31439485 DOI: 10.1016/j.jocn.2019.08.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/07/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Thrombolysis may affect ischemic stroke-related size, pattern and nature of infarcts, and has the potential to change aphasia presentation and recovery. Data on evolution of post-stroke aphasia following thrombolysis are still scarce. The aim of this study was to determine the course of language recovery through a well-validated language assessment battery after acute ischemic stroke and investigate whether traditional categorical classifications of aphasia can describe the clinical picture in post-thrombolysis phase. MATERIALS AND METHODS Demographic, clinical, and language assessment data of 116 patients presenting sub-acute ischemic stroke aphasia (41 treated with r-tPA; 75 non-treated) were retrospectively analyzed. The participants were assessed by a clinical neuropsychologist with a variety of subtests taken from a well-validated Italian language battery (Neuro-Psychological Aphasia Evaluation). RESULTS The percentage of resolved aphasia was significantly higher in treated patients compared to non-treated patients (p = 0.005) and global aphasia was more common in the non-treated group (non-treated 30.7% vs treated 17.1%). Aphasia subtypes and stroke etiologies showed no significant association, except for small vessel etiology and resolved aphasia (p = 0.041). Reperfusion treatment, baseline NIHSS, and lacunar stroke were the predictors of aphasia recovery. CONCLUSION The percentage of resolved aphasia was significantly higher in the treated patients compared to the non-treated, with the latter showing a higher percentage of global aphasia. Identifying classic aphasia subtypes after thrombolysis is still possible since reperfused areas do not necessary change the classification or lead to completely different aphasic syndromes. Reperfusion treatment, baseline NIHSS, and lacunar stroke were the main predictors of aphasia recovery.
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Affiliation(s)
- Alina Menichelli
- Rehabilitation Medicine, Department of Medicine, Surgery and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Services of Trieste, University of Trieste, Trieste, Italy.
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Mariana Ridolfi
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Paola Caruso
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Valentina Pesavento
- Rehabilitation Medicine, Department of Medicine, Surgery and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Services of Trieste, University of Trieste, Trieste, Italy
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Wilson SM, Eriksson DK, Brandt TH, Schneck SM, Lucanie JM, Burchfield AS, Charney S, Quillen IA, de Riesthal M, Kirshner HS, Beeson PM, Ritter L, Kidwell CS. Patterns of Recovery From Aphasia in the First 2 Weeks After Stroke. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:723-732. [PMID: 30950735 PMCID: PMC6802900 DOI: 10.1044/2018_jslhr-l-18-0254] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Purpose Recovery from aphasia after stroke has a decelerating trajectory, with the greatest gains taking place early and the slope of change decreasing over time. Despite its importance, little is known regarding evolution of language function in the early postonset period. The goal of this study was to characterize the dynamics and nature of recovery of language function in the acute and early subacute phases of stroke. Method Twenty-one patients with aphasia were evaluated every 2-3 days for the first 15 days after onset of acute ischemic or hemorrhagic stroke. Language function was assessed at each time point with the Quick Aphasia Battery (Wilson, Eriksson, Schneck, & Lucanie, 2018), which yields an overall summary score and a multidimensional profile of 7 different language domains. Results On a 10-point scale, overall language function improved by a mean of 1.07 points per week, confidence interval [0.46, 1.71], with 19 of 21 patients showing positive changes. The trajectory of recovery was approximately linear over this time period. There was significant variability across patients, and patients with more impaired language function at Day 2 poststroke experienced greater improvements over the subsequent 2 weeks. Patterns of recovery differed across language domains, with consistent improvements in word finding, grammatical construction, repetition, and reading, but less consistent improvements in word comprehension and sentence comprehension. Conclusion Overall language function typically improves substantially and steadily during the first 2 weeks after stroke, driven mostly by recovery of expressive language. Information on the trajectory of early recovery will increase the accuracy of prognoses and establish baseline expectations against which to evaluate the efficacy of interventions. Supplemental Material https://doi.org/10.23641/asha.7811876.
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Affiliation(s)
- Stephen M. Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
- Department of Neurology, The University of Arizona, Tucson
| | - Dana K. Eriksson
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Temre H. Brandt
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Sarah M. Schneck
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Jillian M. Lucanie
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Annie S. Burchfield
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Sara Charney
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Ian A. Quillen
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Michael de Riesthal
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Howard S. Kirshner
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Pélagie M. Beeson
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
- Department of Neurology, The University of Arizona, Tucson
| | - Leslie Ritter
- Department of Neurology, The University of Arizona, Tucson
- College of Nursing, The University of Arizona, Tucson
| | - Chelsea S. Kidwell
- Department of Neurology, The University of Arizona, Tucson
- Department of Medical Imaging, The University of Arizona, Tucson
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