1
|
Bahrami Balani A, Bickerton WL. Acquired reading impairment following brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-19. [PMID: 36745703 DOI: 10.1080/23279095.2023.2165923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This large-scale patient study investigated the rate, unique signatures associated with acquired reading impairments, its neurocognitive correlates, and long-term outcome in 731 acute stroke patients using the sentence and non-word reading subtests of Birmingham Cognitive Screen (BCoS). The objectives for the study were to explore the (i) potentially different error patterns among adult patients, (ii) associative relationship between the different subclasses of reading impairment and performance in other cognitive domains, and (iii) recovery rates in patients nine months post-lesion compared with their initial performance. The study revealed distinctive reading impairment profiles in patients with left hemisphere (LH) and right hemisphere (RH) lesions. Some interesting associations between reading disorder and other cognitive functions were observed. Nine months post-lesion, both groups showed some recovery in reading performance compared with their baseline performance, but the rate of improvement was higher for the LH group. The study reveals unique reading profiles and impairment patterns among left and right hemisphere lesions. The findings of the study provide a deeper understanding of reading deficits that will inform clinical practice, planning of rehabilitative interventions of brain injured patients, and the scientific community.
Collapse
|
2
|
Cassarly C, Doyle A, Ly T, Horn J, Aitchison M, Elm J, Fridriksson J, Bonilha L. Speech Entrainment for Aphasia Recovery (SpARc) phase II trial design. Contemp Clin Trials Commun 2021; 24:100876. [PMID: 34841125 PMCID: PMC8606333 DOI: 10.1016/j.conctc.2021.100876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/19/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background and purpose: Speech entrainment therapy (SET) is a computerized therapeutic approach that involves mimicking an audiovisual speech model to improve speech production. In a pilot study using SET for treatment of post-stroke non-fluent aphasia, significant gains were achieved in verbs per minute (VPM) during discourse using untrained items 1 and 6 weeks after treatment, suggesting that SET may yield meaningful improvements in fluent spontaneous speech for individuals with non-fluent aphasia. Methods The Speech Entrainment for Aphasia Recovery (SpARc) trial is a prospective, randomized, assessor-blinded, multicenter phase II clinical trial studying persons with chronic post-stroke non-fluent aphasia. Participants will be randomized to 3 weeks, 4.5 weeks, or 6 weeks of SET delivered via telehealth or a no SET control condition for 6 weeks. 80 adults (ages 21–81) with history of left hemisphere ischemic or hemorrhagic stroke with residual chronic (>6 months post stroke) non-fluent aphasia diagnosed by the Western Aphasia Battery-Revised (WAB-R) will be randomized (1:1:1:1) over 4 years. The trial will be conducted at the clinical research facilities at three sites: the Medical University of South Carolina, the University of South Carolina, and the University of Utah. Conclusions This paper details the trial design of the SpARc trial, which aims to determine the dose of SET that will generate the highest effect size on speech fluency, VPM, sustained at 3 months post-treatment compared to a no SET control arm, for individuals with chronic post-stroke non-fluent aphasia to permit a future definitive trial to test the clinical utility of SET.
Collapse
Affiliation(s)
- Christy Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Anna Doyle
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Trinh Ly
- National Institute on Deafness and Other Communication Disorders, Bethesda, MD, USA
| | - Janet Horn
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Mary Aitchison
- Department of Communications Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Jordan Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Julius Fridriksson
- Department of Communications Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
3
|
Fridriksson J, Basilakos A, Boyle M, Cherney LR, DeDe G, Gordon JK, Harnish SM, Hoover EL, Hula WD, Pompon RH, Johnson LP, Kiran S, Murray LL, Rose ML, Obermeyer J, Salis C, Walker GM, Martin N. Demystifying the complexity of aphasia treatment: Application of the Rehabilitation Treatment Specification System (RTSS). Arch Phys Med Rehabil 2021; 103:574-580. [PMID: 34748758 DOI: 10.1016/j.apmr.2021.08.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/13/2021] [Accepted: 08/01/2021] [Indexed: 11/15/2022]
Abstract
A considerable body of research supports the use of behavioral communication treatment as the standard of care for aphasia. In spite of robust progress in clinical aphasiology, many questions regarding optimal care remain unanswered. One of the major challenges to progress in the field is the lack of a common framework to adequately describe individual treatments, which, if available, would allow comparisons across studies as well as improved communication among researchers, clinicians, and other stakeholders. Here, we describe how aphasia treatment approaches can be systematically characterized using the Rehabilitation Treatment Specification System (RTSS). At the core of the RTSS is a tripartite structure that focuses on targets (the behavior that is expected to change as a result of treatment), ingredients (what a clinician does to affect change in the target), and mechanism(s) of action (why a given treatment works by linking the ingredients to the target). Three separate papers in the current issue specifically describe how the RTSS can be used to describe different kinds of aphasia treatment approaches: functional approaches, cognitive-linguistic approaches, and biological approaches. It is our hope that the application of the RTSS in clinical aphasiology will improve communication in published studies, grant proposals, and in the clinical care of persons with aphasia.
Collapse
Affiliation(s)
- Julius Fridriksson
- Center for the Study of Aphasia Recovery (C-STAR), University of South Carolina.
| | - Alexandra Basilakos
- Center for the Study of Aphasia Recovery (C-STAR), University of South Carolina
| | - Mary Boyle
- Department of Communication Sciences and Disorders, Montclair State University, Montclair, NJ
| | - Leora R Cherney
- Think and Speak, Shirley Ryan Ability Lab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gayle DeDe
- Department of Communication Sciences and Disorders, Temple University
| | - Jean K Gordon
- Department of Communication Sciences and Disorders, University of Iowa
| | - Stacy M Harnish
- Department of Speech and Hearing Science, The Ohio State University
| | | | - William D Hula
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA; Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Swathi Kiran
- Department of Speech-Language and Hearing Sciences, Boston University
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, Canada
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Jessica Obermeyer
- Department of Communication Sciences and Disorders, University of North Carolina at Greensboro, Greensboro, NC
| | - Christos Salis
- Speech and Language Sciences, Newcastle University, Newcastle upon Tyne
| | - Grant M Walker
- Department of Cognitive Sciences, University of California, Irvine, Irvine, CA
| | - Nadine Martin
- Department of Communication Sciences and Disorders, Temple University
| |
Collapse
|
4
|
McKinnon ET, Fridriksson J, Glenn GR, Jensen JH, Helpern JA, Basilakos A, Rorden C, Shih AY, Spampinato MV, Bonilha L. Structural plasticity of the ventral stream and aphasia recovery. Ann Neurol 2017. [PMID: 28628946 DOI: 10.1002/ana.24983] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Restrengthening of the residual language network is likely to be crucial for speech recovery in poststroke aphasia. Eight participants with chronic aphasia received intensive speech therapy for 3 weeks, with standardized naming tests and brain magnetic resonance imaging before and after therapy. Kurtosis-based diffusion tensor tractography was used to measure mean kurtosis (MK) along a segment of the inferior longitudinal fasciculus (ILF). Therapy-related reduction in the number of semantic but not phonemic errors was associated with strengthening (renormalization) of ILF MK (r = -0.90, p < 0.05 corrected), suggesting that speech recovery is related to structural plasticity of language-specific components of the residual language network. Ann Neurol 2017;82:147-151.
Collapse
Affiliation(s)
- Emilie T McKinnon
- Department of Neurology, Medical University of South Carolina, Charleston, SC.,Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC
| | - G Russell Glenn
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC
| | - Jens H Jensen
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Joseph A Helpern
- Department of Neurology, Medical University of South Carolina, Charleston, SC.,Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC
| | - Andy Y Shih
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC
| | - M Vittoria Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
5
|
Tabei KI, Satoh M, Nakano C, Ito A, Shimoji Y, Kida H, Sakuma H, Tomimoto H. Improved Neural Processing Efficiency in a Chronic Aphasia Patient Following Melodic Intonation Therapy: A Neuropsychological and Functional MRI Study. Front Neurol 2016; 7:148. [PMID: 27698650 PMCID: PMC5027199 DOI: 10.3389/fneur.2016.00148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/31/2016] [Indexed: 11/28/2022] Open
Abstract
Melodic intonation therapy (MIT) is a treatment program for the rehabilitation of aphasic patients with speech production disorders. We report a case of severe chronic non-fluent aphasia unresponsive to several years of conventional therapy that showed a marked improvement following intensive 9-day training on the Japanese version of MIT (MIT-J). The purpose of this study was to verify the efficacy of MIT-J by functional assessment and examine associated changes in neural processing by functional magnetic resonance imaging. MIT improved language output and auditory comprehension, and decreased the response time for picture naming. Following MIT-J, an area of the right hemisphere was less activated on correct naming trials than compared with before training but similarly activated on incorrect trials. These results suggest that the aphasic symptoms of our patient were improved by increased neural processing efficiency and a concomitant decrease in cognitive load.
Collapse
Affiliation(s)
- Ken-Ichi Tabei
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan; Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University , Mie , Japan
| | - Chizuru Nakano
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University , Mie , Japan
| | - Ai Ito
- Department of Neurology, Graduate School of Medicine, Mie University , Mie , Japan
| | - Yasuo Shimoji
- Department of Rehabilitation, Suzuka Central General Hospital , Mie , Japan
| | - Hirotaka Kida
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University , Mie , Japan
| | - Hajime Sakuma
- Department of Radiology, Graduate School of Medicine, Mie University , Mie , Japan
| | - Hidekazu Tomimoto
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan; Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| |
Collapse
|
6
|
Munro P, Siyambalapitiya S. Improved word comprehension in Global aphasia using a modified semantic feature analysis treatment. CLINICAL LINGUISTICS & PHONETICS 2016; 31:119-136. [PMID: 27548515 DOI: 10.1080/02699206.2016.1198927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Limited research has investigated treatment of single word comprehension in people with aphasia, despite numerous studies examining treatment of naming deficits. This study employed a single case experimental design to examine efficacy of a modified semantic feature analysis (SFA) therapy in improving word comprehension in an individual with Global aphasia, who presented with a semantically based comprehension impairment. Ten treatment sessions were conducted over a period of two weeks. Following therapy, the participant demonstrated improved comprehension of treatment items and generalisation to control items, measured by performance on a spoken word picture matching task. Improvements were also observed on other language assessments (e.g. subtests of WAB-R; PALPA subtest 47) and were largely maintained over a period of 12 weeks without further therapy. This study provides support for the efficacy of a modified SFA therapy in remediating single word comprehension in individuals with aphasia with a semantically based comprehension deficit.
Collapse
Affiliation(s)
- Philippa Munro
- a Discipline of Speech Pathology, James Cook University , Townsville , Australia
| | - Samantha Siyambalapitiya
- a Discipline of Speech Pathology, James Cook University , Townsville , Australia
- b Menzies Health Institute Queensland, Griffith University , Gold Coast , Australia
| |
Collapse
|
7
|
Woldag H, Voigt N, Bley M, Hummelsheim H. Constraint-Induced Aphasia Therapy in the Acute Stage. Neurorehabil Neural Repair 2016; 31:72-80. [DOI: 10.1177/1545968316662707] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Constraint-induced aphasia therapy (CIAT) has proven effective in patients with subacute and chronic forms of aphasia. It has remained unclear, however, whether intensity of therapy or constraint is the relevant factor. Data about intensive speech and language therapy (SLT) are conflicting. Objective. To identify the effective component of CIAT and assess the feasibility of SLT in the acute stage after stroke. Method. A total of 60 patients with aphasia (68.2 ± 11.7 years) were enrolled 18.9 days after first-ever stroke. They were randomly distributed into 3 groups: (1) CIAT group receiving therapy for 3 hours per day (10 workdays, total 30 hours); (2) conventional communication treatment group, with same intensity without constraints; and (3) control group receiving individual therapy twice a day as well as group therapy (total 14 hours). Patients were assessed pretreatment and posttreatment using the Aachener Aphasia Test (primary end point: token test) and the Communicative Activity Log (CAL). Results. Pretreatment, there were no between-group differences. Posttreatment, all groups showed significant improvements without between-group differences. Conclusion. It was found that 14 hours of aphasia therapy administered within 2 weeks as individual therapy, focusing on individual deficits, combined with group sessions has proven to be most efficient. This approach yielded the same outcome as 30 hours of group therapy, either in the form of CIAT or group therapy without constraints. SLT in an intensive treatment schedule is feasible and was well tolerated in the acute stage after stroke.
Collapse
Affiliation(s)
- Hartwig Woldag
- Neurologisches Rehabilitationszentrum Leipzig, University of Leipzig, Germany
| | - Nancy Voigt
- Neurologisches Rehabilitationszentrum Leipzig, University of Leipzig, Germany
| | | | - Horst Hummelsheim
- Neurologisches Rehabilitationszentrum Leipzig, University of Leipzig, Germany
| |
Collapse
|
8
|
Cortese MD, Riganello F, Arcuri F, Pignataro LM, Buglione I. Rehabilitation of aphasia: application of melodic-rhythmic therapy to Italian language. Front Hum Neurosci 2015; 9:520. [PMID: 26441615 PMCID: PMC4585219 DOI: 10.3389/fnhum.2015.00520] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/07/2015] [Indexed: 11/13/2022] Open
Abstract
Aphasia is a complex disorder, frequent after stroke (with an incidence of 38%), with a detailed pathophysiological characterization. Effective approaches are crucial for devising an efficient rehabilitative strategy, in order to address the everyday life and professional disability. Several rehabilitative procedures are based on psycholinguistic, cognitive, psychosocial or pragmatic approaches, including amongst those with a neurobehavioral approach the Melodic Intonation Therapy (MIT). Van Eeckhout's adaptation of MIT to French language (Melodic-Rhythmic Therapy: MRT) has implemented the training strategy by adding a rhythmic structure reproducing French prosody. The purpose of this study was to adapt MRT rehabilitation procedures to Italian language and to verify its efficacy in a group of six chronic patients (five males) with severe non-fluent aphasia and without specific aphasic treatments during the previous 9 months. The patients were treated 4 days a week for 16 weeks, with sessions of 30-40 min. They were assessed 6 months after the end of the treatment (follow-up). The patients showed a significant improvement at the Aachener Aphasie Test (AAT) in different fields of spontaneous speech, with superimposable results at the follow-up. Albeit preliminary, these findings support the use of MRT in the rehabilitation after stroke. Specifically, MRT seems to benefit from its stronger structure than the available stimulation-facilitation procedures and allows a better quantification of the rehabilitation efficacy.
Collapse
Affiliation(s)
- Maria Daniela Cortese
- Intensive Care Unit, S. Anna Institute and Research in Advanced Neurorehabilitation Crotone, Italy
| | - Francesco Riganello
- Intensive Care Unit, S. Anna Institute and Research in Advanced Neurorehabilitation Crotone, Italy
| | - Francesco Arcuri
- Intensive Care Unit, S. Anna Institute and Research in Advanced Neurorehabilitation Crotone, Italy
| | - Luigina Maria Pignataro
- Intensive Care Unit, S. Anna Institute and Research in Advanced Neurorehabilitation Crotone, Italy
| | - Iolanda Buglione
- Casa di Cura Villa Margherita, San Giuseppe Moscati Institute Benevento, Italy
| |
Collapse
|
9
|
Bonilha L, Gleichgerrcht E, Nesland T, Rorden C, Fridriksson J. Success of Anomia Treatment in Aphasia Is Associated With Preserved Architecture of Global and Left Temporal Lobe Structural Networks. Neurorehabil Neural Repair 2015; 30:266-79. [PMID: 26150147 DOI: 10.1177/1545968315593808] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Targeted speech therapy can lead to substantial naming improvement in some subjects with anomia following dominant-hemisphere stroke. We investigated whether treatment-induced improvement in naming is associated with poststroke preservation of structural neural network architecture. METHODS Twenty-four patients with poststroke chronic aphasia underwent 30 hours of speech therapy over a 2-week period and were assessed at baseline and after therapy. Whole brain maps of neural architecture were constructed from pretreatment diffusion tensor magnetic resonance imaging to derive measures of global brain network architecture (network small-worldness) and regional network influence (nodal betweenness centrality). Their relationship with naming recovery was evaluated with multiple linear regressions. RESULTS Treatment-induced improvement in correct naming was associated with poststroke preservation of global network small worldness and of betweenness centrality in temporal lobe cortical regions. Together with baseline aphasia severity, these measures explained 78% of the variability in treatment response. CONCLUSIONS Preservation of global and left temporal structural connectivity broadly explains the variability in treatment-related naming improvement in aphasia. These findings corroborate and expand on previous classical lesion-symptom mapping studies by elucidating some of the mechanisms by which brain damage may relate to treated aphasia recovery. Favorable naming outcomes may result from the intact connections between spared cortical areas that are functionally responsive to treatment.
Collapse
Affiliation(s)
| | | | - Travis Nesland
- Medical University of South Carolina, Charleston, SC, USA
| | | | | |
Collapse
|
10
|
Dąbrowska E. What exactly is Universal Grammar, and has anyone seen it? Front Psychol 2015; 6:852. [PMID: 26157406 PMCID: PMC4477053 DOI: 10.3389/fpsyg.2015.00852] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/08/2015] [Indexed: 11/14/2022] Open
Abstract
Universal Grammar (UG) is a suspect concept. There is little agreement on what exactly is in it; and the empirical evidence for it is very weak. This paper critically examines a variety of arguments that have been put forward as evidence for UG, focussing on the three most powerful ones: universality (all human languages share a number of properties), convergence (all language learners converge on the same grammar in spite of the fact that they are exposed to different input), and poverty of the stimulus (children know things about language which they could not have learned from the input available to them). I argue that these arguments are based on premises which are either false or unsubstantiated. Languages differ from each other in profound ways, and there are very few true universals, so the fundamental crosslinguistic fact that needs explaining is diversity, not universality. A number of recent studies have demonstrated the existence of considerable differences in adult native speakers’ knowledge of the grammar of their language, including aspects of inflectional morphology, passives, quantifiers, and a variety of more complex constructions, so learners do not in fact converge on the same grammar. Finally, the poverty of the stimulus argument presupposes that children acquire linguistic representations of the kind postulated by generative grammarians; constructionist grammars such as those proposed by Tomasello, Goldberg and others can be learned from the input. We are the only species that has language, so there must be something unique about humans that makes language learning possible. The extent of crosslinguistic diversity and the considerable individual differences in the rate, style and outcome of acquisition suggest that it is more promising to think in terms of a language-making capacity, i.e., a set of domain-general abilities, rather than an innate body of knowledge about the structural properties of the target system.
Collapse
Affiliation(s)
- Ewa Dąbrowska
- Department of Humanities, Northumbria University , Newcastle upon Tyne, UK
| |
Collapse
|
11
|
Beukelman DR, Hux K, Dietz A, McKelvey M, Weissling K. Using Visual Scene Displays as Communication Support Options for People with Chronic, Severe Aphasia: A Summary of AAC Research and Future Research Directions. Augment Altern Commun 2015; 31:234-45. [DOI: 10.3109/07434618.2015.1052152] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
12
|
Kocher M, Gleichgerrcht E, Nesland T, Rorden C, Fridriksson J, Spampinato MV, Bonilha L. Individual variability in the anatomical distribution of nodes participating in rich club structural networks. Front Neural Circuits 2015; 9:16. [PMID: 25954161 PMCID: PMC4405623 DOI: 10.3389/fncir.2015.00016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 04/01/2015] [Indexed: 12/22/2022] Open
Abstract
With recent advances in computational analyses of structural neuroimaging, it is possible to comprehensively map neural connectivity, i.e., the brain connectome. The architectural organization of the connectome is believed to play an important role in several biological processes. Central to the conformation of the connectome are connectivity hubs, which are likely to be organized in accordance with the rich club phenomenon, as evidenced by graph theory analyses of neural architecture. It is yet unclear whether rich club connectivity hubs are consistently organized in the same anatomical framework across healthy adults. We constructed the brain connectome from 43 healthy adults, based on T1-weighted and diffusion tensor MRI data. Probabilistic fiber tractography was used to evaluate connectivity between each possible pair of cortical anatomical regions of interest. Connectivity hubs were identified in accordance with the rich club phenomenon applied to binarized matrices, and the variability in frequency of hub participation was assessed node-wise across all subjects. The anatomical location of nodes participating in rich club networks was fairly consistent across subjects. The most common locations for rich club nodes were identified in integrative areas, such as the cingulate and pericingulate regions, medial aspect of the occipital areas and precuneus; or else, they were found in important and specialized brain regions (such as the oribitofrontal cortex, caudate, fusiform gyrus, and hippocampus). Marked anatomical consistency exists across healthy brains in terms of nodal participation and location of rich club networks. The consistency of connections between integrative areas and specialized brain regions highlights a fundamental connectivity pattern shared among healthy brains. We propose that approaching brain connectivity with this framework of anatomical consistencies may have clinical implications for early detection of individual variability.
Collapse
Affiliation(s)
- Madison Kocher
- Department of Neurology and Neurosurgery, Medical University of South Carolina Charleston, SC, USA
| | - Ezequiel Gleichgerrcht
- Department of Neurology and Neurosurgery, Medical University of South Carolina Charleston, SC, USA
| | - Travis Nesland
- Department of Neurology and Neurosurgery, Medical University of South Carolina Charleston, SC, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communications Sciences and Disorders, University of South Carolina Columbia, SC, USA
| | - Maria V Spampinato
- Department of Radiology, Medical University of South Carolina Charleston, SC, USA
| | - Leonardo Bonilha
- Department of Neurology and Neurosurgery, Medical University of South Carolina Charleston, SC, USA
| |
Collapse
|
13
|
Fink RB, Schwartz MF. MossRehab Aphasia Center: A Collaborative Model for Long-Term Rehabilitation. Top Stroke Rehabil 2015. [DOI: 10.1310/k3mm-9wp3-7e18-dqj5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
14
|
Al-Janabi S, Nickels LA, Sowman PF, Burianová H, Merrett DL, Thompson WF. Augmenting melodic intonation therapy with non-invasive brain stimulation to treat impaired left-hemisphere function: two case studies. Front Psychol 2014; 5:37. [PMID: 24550864 PMCID: PMC3912988 DOI: 10.3389/fpsyg.2014.00037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/13/2014] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to investigate whether or not the right hemisphere can be engaged using Melodic Intonation Therapy (MIT) and excitatory repetitive transcranial magnetic stimulation (rTMS) to improve language function in people with aphasia. The two participants in this study (GOE and AMC) have chronic non-fluent aphasia. A functional Magnetic Resonance Imaging (fMRI) task was used to localize the right Broca's homolog area in the inferior frontal gyrus for rTMS coil placement. The treatment protocol included an rTMS phase, which consisted of 3 treatment sessions that used an excitatory stimulation method known as intermittent theta burst stimulation, and a sham-rTMS phase, which consisted of 3 treatment sessions that used a sham coil. Each treatment session was followed by 40 min of MIT. A linguistic battery was administered after each session. Our findings show that one participant, GOE, improved in verbal fluency and the repetition of phrases when treated with MIT in combination with TMS. However, AMC showed no evidence of behavioral benefit from this brief treatment trial. Post-treatment neural activity changes were observed for both participants in the left Broca's area and right Broca's homolog. These case studies indicate that a combination of MIT and rTMS applied to the right Broca's homolog has the potential to improve speech and language outcomes for at least some people with post-stroke aphasia.
Collapse
Affiliation(s)
- Shahd Al-Janabi
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University Sydney, NSW, Australia ; Department of Cognitive Science, Macquarie University Sydney, NSW, Australia
| | - Lyndsey A Nickels
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University Sydney, NSW, Australia ; Department of Cognitive Science, Macquarie University Sydney, NSW, Australia ; NHMRC Centre of Clinical Research Excellence in Aphasia Rehabilitation, Macquarie University Sydney, NSW, Australia
| | - Paul F Sowman
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University Sydney, NSW, Australia ; Department of Cognitive Science, Macquarie University Sydney, NSW, Australia
| | - Hana Burianová
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University Sydney, NSW, Australia ; Centre for Advanced Imaging, The University of Queensland Sydney, NSW, Australia
| | - Dawn L Merrett
- Melbourne School of Psychological Sciences, The University of Melbourne Melbourne, VIC, Australia
| | - William F Thompson
- ARC Centre of Excellence in Cognition and its Disorders, Macquarie University Sydney, NSW, Australia ; Department of Psychology, Macquarie University Sydney, NSW, Australia
| |
Collapse
|
15
|
Mylius V, Zouari HG, Ayache SS, Farhat WH, Lefaucheur JP. Stroke rehabilitation using noninvasive cortical stimulation: aphasia. Expert Rev Neurother 2014; 12:973-82. [DOI: 10.1586/ern.12.76] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
16
|
Miller S, Kühn D, Ptok M. [Repetitive transcranial magnetic stimulation. A reasonable adjuvant therapeutic method in the treatment of post-stroke aphasia?]. HNO 2013; 61:58-64. [PMID: 23223923 DOI: 10.1007/s00106-012-2571-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, painless method used to stimulate areas of the brain through the intact skull by means of magnetic fields. Depending on the stimulation frequency, the effect on concurrent brain areas is either inhibiting or exciting. As a result, it should be possible to inhibit compensatory hyperactivation in certain brain areas or to temporarily enhance cortical excitability. Therefore, rTMS potentially represents an adjuvant treatment for aphasia. In this article, the literature regarding rTMS as a treatment for aphasia is reviewed and followed by a case report of a 79-year-old man who 3 years after stroke received rTMS (3 × 10 sessions) in combination with articulation therapy. Even though linguistic assessments did not show enhancements in language skills, the patient's family reported changes in communication patterns and behavior and explicitly asked to continue the rTMS treatment sessions. Reasons why no enhancements could be reported might be found in the type of language disorder (a comorbid speech disorder) or the stimulation protocol. Further studies are needed to evaluate the true potential of rTMS in the treatment of aphasia.
Collapse
Affiliation(s)
- S Miller
- Klinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, OE 6510, 30623, Hannover, Deutschland.
| | | | | |
Collapse
|
17
|
Vallila-Rohter S, Kiran S. Non-linguistic learning and aphasia: evidence from a paired associate and feedback-based task. Neuropsychologia 2012; 51:79-90. [PMID: 23127795 DOI: 10.1016/j.neuropsychologia.2012.10.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
Abstract
Though aphasia is primarily characterized by impairments in the comprehension and/or expression of language, research has shown that patients with aphasia also show deficits in cognitive-linguistic domains such as attention, executive function, concept knowledge and memory. Research in aphasia suggests that cognitive impairments can impact the online construction of language, new verbal learning, and transactional success. In our research, we extend this hypothesis to suggest that general cognitive deficits influence progress with therapy. The aim of our study is to explore learning, a cognitive process that is integral to relearning language, yet underexplored in the field of aphasia rehabilitation. We examine non-linguistic category learning in patients with aphasia (n=19) and in healthy controls (n=12), comparing feedback and non-feedback based instruction. Participants complete two computer-based learning tasks that require them to categorize novel animals based on the percentage of features shared with one of two prototypes. As hypothesized, healthy controls showed successful category learning following both methods of instruction. In contrast, only 60% of our patient population demonstrated successful non-linguistic category learning. Patient performance was not predictable by standardized measures of cognitive ability. Results suggest that general learning is affected in aphasia and is a unique, important factor to consider in the field of aphasia rehabilitation.
Collapse
Affiliation(s)
- Sofia Vallila-Rohter
- Aphasia Research Laboratory, Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215, USA.
| | | |
Collapse
|
18
|
Cherney LR, Harvey RL, Babbitt EM, Hurwitz R, Kaye RC, Lee JB, Small SL. Epidural cortical stimulation and aphasia therapy. APHASIOLOGY 2012; 26:1192-1217. [PMID: 23667287 PMCID: PMC3647471 DOI: 10.1080/02687038.2011.603719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND There are several methods of delivering cortical brain stimulation to modulate cortical excitability and interest in their application as an adjuvant strategy in aphasia rehabilitation after stroke is growing. Epidural cortical stimulation, although more invasive than other methods, permits high frequency stimulation of high spatial specificity to targeted neuronal populations. AIMS First, we review evidence supporting the use of epidural cortical stimulation for upper limb recovery after focal cortical injury in both animal models and human stroke survivors. These data provide the empirical and theoretical platform underlying the use of epidural cortical stimulation in aphasia. Second, we summarize evidence for the application of epidural cortical stimulation in aphasia. We describe the procedures and primary outcomes of a safety and feasibility study (Cherney, Erickson & Small, 2010), and provide previously unpublished data regarding secondary behavioral outcomes from that study. MAIN CONTRIBUTION In a controlled study comparing epidural cortical stimulation plus language treatment (CS/LT) to language treatment alone (LT), eight stroke survivors with nonfluent aphasia received intensive language therapy for 6 weeks. Four of these participants also underwent surgical implantation of an epidural stimulation device which was activated only during therapy sessions. Behavioral data were collected before treatment, immediately after treatment, and at 6 and 12 weeks following the end of treatment. The effect size for the primary outcome measure, the Western Aphasia Battery Aphasia Quotient, was benchmarked as moderate from baseline to immediately post-treatment, and large from baseline to the 12-week follow-up. Similarly, effect sizes obtained at the 12-week follow-up for the Boston Naming Test, the Communicative Effectiveness Index, and for correct information units on a picture description task were greater than those obtained immediately post treatment. When effect sizes were compared for individual subject pairs on discourse measures of content and rate, effects were typically larger for the investigational subjects receiving CS/LT than for the control subjects receiving LT alone. These analyses support previous findings regarding therapeutic efficacy of CS/LT compared to LT i.e. epidural stimulation of ipsilesional premotor cortex may augment behavioral speech-language therapy, with the largest effects after completion of therapy. CONCLUSIONS Continued investigation of epidural cortical stimulation in combination with language training in post-stroke aphasia should proceed cautiously. Carefully planned studies that customize procedures to individual profiles are warranted. Information from research on non-invasive methods of CS/LT may also inform future studies of epidural cortical stimulation.
Collapse
|
19
|
Douglas J, Brown L, Barry S. Is Aphasia Therapy Effective? Exploring the Evidence in Systematic Reviews. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.3.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIn December 1999, Greener, Enderby and Whurr reported the findings of their Cochrane review to assess the effects of formal speech and language therapy for people with aphasia following stroke. They concluded that aphasia therapy had not been shown to be “clearly effective or clearly ineffective within a randomised controlled trial (RCT)” (p. 1). Their conclusion led to much discussion among speech pathologists with some expressing grave concern that the outcome of the review would undermine the provision of services for people with aphasia and their carers. In this paper, evidence for the effectiveness of aphasia therapy that has been provided by published systematic reviews is critically explored. Clearly, challenges remain with respect to provision of evidence-based aphasia therapy. However, the weight of evidence accumulated over the years and synthesised in systematic reviews supports the broad conclusion that aphasia therapy is effective.
Collapse
|
20
|
Vines BW, Norton AC, Schlaug G. Non-invasive brain stimulation enhances the effects of melodic intonation therapy. Front Psychol 2011; 2:230. [PMID: 21980313 PMCID: PMC3180169 DOI: 10.3389/fpsyg.2011.00230] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 08/26/2011] [Indexed: 11/13/2022] Open
Abstract
Research has suggested that a fronto-temporal network in the right hemisphere may be responsible for mediating melodic intonation therapy's (MIT) positive effects on speech recovery. We investigated the potential for a non-invasive brain stimulation technique, transcranial direct current stimulation (tDCS), to augment the benefits of MIT in patients with non-fluent aphasia by modulating neural activity in the brain during treatment with MIT. The polarity of the current applied to the scalp determines the effects of tDCS on the underlying tissue: anodal-tDCS increases excitability, whereas cathodal tDCS decreases excitability. We applied anodal-tDCS to the posterior inferior frontal gyrus of the right hemisphere, an area that has been shown both to contribute to singing through the mapping of sounds to articulatory actions and to serve as a key region in the process of recovery from aphasia, particularly in patients with large left hemisphere lesions. The stimulation was applied while patients were treated with MIT by a trained therapist. Six patients with moderate to severe non-fluent aphasia underwent three consecutive days of anodal-tDCS + MIT, and an equivalent series of sham-tDCS + MIT. The two treatment series were separated by 1 week, and the order in which the treatments were administered was randomized. Compared to the effects of sham-tDCS + MIT, anodal-tDCS + MIT led to significant improvements in fluency of speech. These results support the hypothesis that, as the brain seeks to reorganize and compensate for damage to left hemisphere language centers, combining anodal-tDCS with MIT may further recovery from post-stroke aphasia by enhancing activity in a right hemisphere sensorimotor network for articulation.
Collapse
Affiliation(s)
- Bradley W Vines
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
| | | | | |
Collapse
|
21
|
Berthier ML, Pulvermüller F. Neuroscience insights improve neurorehabilitation of poststroke aphasia. Nat Rev Neurol 2011; 7:86-97. [PMID: 21297651 DOI: 10.1038/nrneurol.2010.201] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
22
|
Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA. Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient. Stroke 2010; 41:2402-48. [PMID: 20813995 DOI: 10.1161/str.0b013e3181e7512b] [Citation(s) in RCA: 456] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
23
|
Thompson CK, den Ouden DB, Bonakdarpour B, Garibaldi K, Parrish TB. Neural plasticity and treatment-induced recovery of sentence processing in agrammatism. Neuropsychologia 2010; 48:3211-27. [PMID: 20603138 PMCID: PMC3164559 DOI: 10.1016/j.neuropsychologia.2010.06.036] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 06/01/2010] [Accepted: 06/28/2010] [Indexed: 11/20/2022]
Abstract
This study examined patterns of neural activation associated with treatment-induced improvement of complex sentence production (and comprehension) in six individuals with stroke-induced agrammatic aphasia, taking into account possible alterations in blood flow often associated with stroke, including delayed time-to-peak of the hemodynamic response function (HRF) and hypoperfused tissue. Aphasic participants performed an auditory verification fMRI task, processing object cleft, subject cleft, and simple active sentences, prior to and following a course of Treatment of Underlying Forms (TUF; Thompson et al., 2003), a linguistically based approach for treating aphasic sentence deficits, which targeted object relative clause constructions. The patients also were scanned in a long-trials task to examine HRFs, to account for any local deviations resulting from stroke, and perfusion images were obtained to evaluate regions of hypoperfused tissue. Region-of-interest (ROI) analyses were conducted (bilaterally), modeling participant-specific local HRFs in left hemisphere areas activated by 12 healthy age-matched volunteers performing the same task, including the middle and inferior frontal gyri, precentral gyrus, middle and superior temporal gyri, and insula, and additional regions associated with complex syntactic processing, including the posterior perisylvian and superior parietal cortices. Results showed that, despite individual variation in activation differences from pre- to post-treatment scans in the aphasic participants, main-effects analyses revealed a general shift from left superior temporal activation to more posterior temporoparietal areas, bilaterally. Time-to-peak of these responses correlated negatively with blood flow, as measured with perfusion imaging.
Collapse
Affiliation(s)
- Cynthia K Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL 60208, USA.
| | | | | | | | | |
Collapse
|
24
|
Mielke R, Szelies B. Neuronal plasticity in poststroke aphasia: insights by quantitative electroencephalography. Expert Rev Neurother 2010; 3:373-80. [PMID: 19810904 DOI: 10.1586/14737175.3.3.373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
After stroke, the interhemispheric reorganization of the neural network implicated in language is hypothesized to be a function not only at the site of the lesion but also of dynamic right hemispheric and subcortical neural systems. These neural systems may have different functional shares in the utilization of particular language tasks. Important insights in language rehabilitation have been gained by quantitative topographical electroencephalography. It has been demonstrated that abnormalities within and outside speech relevant areas are related to restitution of poststroke aphasia. In the ischemic regions they indicate local disturbances, outside they reflect failures in neuronal networks involved in the generation and propagation of the alpha-rhythm. Treatment by a neuromodulatory agent has shown a significant shift of alpha-rhythm from frontal to occipital regions which may be due to a restitution of corticothalamic circuits in parallel to an improvement of neuropsychological scores in different language domains.
Collapse
Affiliation(s)
- Ruediger Mielke
- Max Planck Institut für neurologische Forschung, Gleueler Str. 50, D 50931 Köln, Germany.
| | | |
Collapse
|
25
|
Price CJ, Seghier ML, Leff AP. Predicting language outcome and recovery after stroke: the PLORAS system. Nat Rev Neurol 2010; 6:202-10. [PMID: 20212513 PMCID: PMC3556582 DOI: 10.1038/nrneurol.2010.15] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ability to comprehend and produce speech after stroke depends on whether the areas of the brain that support language have been damaged. Here, we review two different ways to predict language outcome after stroke. The first depends on understanding the neural circuits that support language. This model-based approach is a challenging endeavor because language is a complex cognitive function that involves the interaction of many different brain areas. The second approach, by contrast, does not require an understanding of why a lesion impairs language; instead, predictions are made on the basis of the recovery of previous patients with the same lesion. This approach requires a database that records the speech and language capabilities of a large population of patients who have, collectively, incurred a comprehensive range of focal brain lesions. In addition, a system is required that converts an MRI scan from a new patient into a three-dimensional description of the lesion and compares this lesion against all others on the database. The outputs of this system are the longitudinal language outcomes of corresponding patients in the database. This approach will provide the patient with a range of probable recovery patterns over a variety of language measures.
Collapse
Affiliation(s)
- Cathy J Price
- Wellcome Trust Center for Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3BG, UK.
| | | | | |
Collapse
|
26
|
Patient-reported changes in communication after computer-based script training for aphasia. Arch Phys Med Rehabil 2009; 90:623-7. [PMID: 19345778 DOI: 10.1016/j.apmr.2008.10.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 10/29/2008] [Accepted: 10/31/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate changes in patient-reported communication difficulty after a home-based, computer-delivered intervention designed to improve conversational skills in adults with aphasia. DESIGN Delayed treatment design with baseline, preintervention, postintervention, and follow-up observations. SETTING Outpatient rehabilitation. PARTICIPANTS Twenty subjects with chronic aphasia. INTERVENTIONS Sessions with the speech-language pathologist to develop personally relevant conversational scripts, followed by 9 weeks of intensive home practice using a computer program loaded on a laptop, and weekly monitoring visits with the speech-language pathologist. MAIN OUTCOME MEASURE Communication Difficulty (CD) subscale of the Burden of Stroke Scale (BOSS). RESULTS The intervention resulted in a statistically and clinically significant decrease of 6.79 points (P=.038) in the CD subscale of the BOSS during the intervention, maintained during the follow-up period. CONCLUSIONS The findings of this study provide positive albeit preliminary and limited support for the use of a home-based, computer-delivered language intervention program for improving patient-reported communication outcomes in adults with chronic aphasia. Additional research will be required to examine the efficacy and effectiveness of this intervention.
Collapse
|
27
|
Abstract
The use of functional neuroimaging techniques has advanced what is known about the neural mechanisms used to support language processing in aphasia resulting from brain damage. This paper highlights recent findings derived from neuroimaging studies focused on neuroplasticity of language networks, the role of the left and right hemispheres in this process, and studies examining how treatment affects the neurobiology of recovery. We point out variability across studies as well as factors related to this variability, and we emphasize challenges that remain for research.
Collapse
|
28
|
Pulvermüller F, Berthier ML. Aphasia therapy on a neuroscience basis. APHASIOLOGY 2008; 22:563-599. [PMID: 18923644 PMCID: PMC2557073 DOI: 10.1080/02687030701612213] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 08/06/2007] [Indexed: 05/04/2023]
Abstract
BACKGROUND: Brain research has documented that the cortical mechanisms for language and action are tightly interwoven and, concurrently, new approaches to language therapy in neurological patients are being developed that implement language training in the context of relevant linguistic and non-linguistic actions, therefore taking advantage of the mutual connections of language and action systems in the brain. A further well-known neuroscience principle is that learning at the neuronal level is driven by correlation; consequently, new approaches to language therapy emphasise massed practice in a short time, thus maximising therapy quantity and frequency and, therefore, correlation at the behavioural and neuronal levels. Learned non-use of unsuccessful actions plays a major role in the chronification of neurological deficits, and behavioural approaches to therapy have therefore employed shaping and other learning techniques to counteract such non-use. AIMS: Advances in theoretical and experimental neuroscience have important implications for clinical practice. We exemplify this in the domain of aphasia rehabilitation. MAIN CONTRIBUTION: Whereas classical wisdom had been that aphasia cannot be significantly improved at a chronic stage, we here review evidence that one type of intensive language-action therapy (ILAT)-constraint-induced aphasia therapy-led to significant improvement of language performance in patients with chronic aphasia. We discuss perspectives for further improving speech-language therapy, including drug treatment that may be particularly fruitful when applied in conjunction with behavioural treatment. In a final section we highlight intensive and rapid therapy studies in chronic aphasia as a unique tool for exploring the cortical reorganisation of language. CONCLUSIONS: We conclude that intensive language action therapy is an efficient tool for improving language functions even at chronic stages of aphasia. Therapy studies using this technique can open new perspectives for research into the plasticity of human language circuits.
Collapse
|
29
|
Maher LM, Kendall D, Swearengin JA, Rodriguez A, Leon SA, Pingel K, Holland A, Rothi LJG. A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy. J Int Neuropsychol Soc 2006; 12:843-52. [PMID: 17064447 DOI: 10.1017/s1355617706061029] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 05/09/2006] [Accepted: 05/09/2006] [Indexed: 11/07/2022]
Abstract
This investigation reports the results of a pilot study concerning the application of principles of use-dependent learning developed in the motor rehabilitation literature as Constraint Induced Therapy to language rehabilitation in a group of individuals with chronic aphasia. We compared treatment that required forced use of the language modality, Constraint Induced Language Therapy, (CILT) to treatment allowing all modes of communication. Both treatments were administrated intensively in a massed practice paradigm, using the same therapeutic stimuli and tasks. Results suggest that whereas both interventions yielded positive outcomes, CILT participants showed more consistent improvement on standard aphasia measures and clinician judgments of narrative discourse. These findings suggest that CILT intervention may be a viable approach to aphasia rehabilitation.
Collapse
Affiliation(s)
- Lynn M Maher
- Michael E. DeBakey VA Medical Center, Rehabilitation Research, Houston, Texas 77030, USA.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Thompson CK. Single subject controlled experiments in aphasia: the science and the state of the science. JOURNAL OF COMMUNICATION DISORDERS 2006; 39:266-91. [PMID: 16635494 PMCID: PMC1847620 DOI: 10.1016/j.jcomdis.2006.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2005] [Accepted: 02/14/2006] [Indexed: 05/08/2023]
Abstract
UNLABELLED This paper discusses the use of single subject controlled experimental designs for investigating the effects of treatment for aphasia. A brief historical perspective is presented, followed by discussions of the advantages and disadvantages of single subject and group approaches, the basic requirements of single subject experimental research, and crucial considerations in design selection. In the final sections, results of reviews of published single subject controlled experiments are discussed, with emphasis on internal validity issues, the number of participants enrolled in published studies, operational specification of the dependent and independent variables, and reliability of measurement. LEARNING OUTCOMES As a result of reading this paper, the participant will: (1) understand the mechanisms required for demonstration of internal and external validity using single subject controlled experimental designs, (2) become familiar with the basic requirements of single subject controlled experimental research, (3) understand the types of single subject controlled experimental designs that are the most appropriate for studying the effects of treatment for aphasia, and (4) become familiar with trends in the published aphasia treatment literature in which single subject controlled experimental designs have been used.
Collapse
Affiliation(s)
- Cynthia K Thompson
- Aphasia and Neurolinguistics Research Laboratory, Department of Communication Sciences and Disorders, and Neurology, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA.
| |
Collapse
|
31
|
Korsukewitz C, Breitenstein C, Schomacher M, Knecht S. Pharmakologische Zusatzbehandlung in der Aphasietherapie. DER NERVENARZT 2006; 77:403-15. [PMID: 16273340 DOI: 10.1007/s00115-005-2006-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aphasia is one of the most frequent and disabling consequences of stroke. Poor spontaneous recovery and the limited success of conventional speech therapy bring up the question of how current treatment approaches can be improved. Besides increasing training frequency-with daily sessions lasting several hours and high repetition rates of language materials ("massed training")-adjuvant drug therapy may help to increase therapy efficacy. In this article, we illuminate the potential of monoaminergic (bromocriptine, levodopa, d-amphetamine) and cholinergic (donepezil) substances for treating aphasia. For a final evaluation of combined massed training and adjuvant pharmacotherapy, randomized, placebo-controlled (multicenter) clinical trials with sufficient numbers of patients are needed. Furthermore, results of experimental animal studies of functional recovery in brain damage raise hopes that neurotrophic factors or stem cells might find a place in recovery from aphasia in the intermediate future.
Collapse
Affiliation(s)
- C Korsukewitz
- Klinik und Poliklinik für Neurologie, Universität Münster.
| | | | | | | |
Collapse
|
32
|
Pulvermüller F, Hauk O, Zohsel K, Neininger B, Mohr B. Therapy-related reorganization of language in both hemispheres of patients with chronic aphasia. Neuroimage 2005; 28:481-9. [PMID: 16099176 DOI: 10.1016/j.neuroimage.2005.06.038] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 05/18/2005] [Accepted: 06/10/2005] [Indexed: 10/25/2022] Open
Abstract
The brain processes of language recovery after stroke are poorly understood, partly because past research did not allow to differentiate the effects of spontaneous restitution processes from those of learning-related cortical reorganization. Here, we use a new approach offered by recently developed intense neuropsychological therapy methods, which allow for improving language functions within a short time period. Stroke patients with chronic aphasia received intense language therapy for 2 weeks and, over this period, improved their language performance as assessed using clinical tests. Neurophysiological activity elicited by words and pseudowords was measured before and after treatment. Over the therapy interval, early word evoked potentials (latency 250-300 ms) became significantly stronger whereas pseudoword responses did not change. Word-specific changes were documented by analyses of ERP amplitudes and root mean square values, which revealed interactions of the factors Assessment time (before vs. after therapy) and Wordness (word vs. pseudoword). Source localization using Minimum Norm Current Estimates showed that bilateral cortical sources activated by word stimuli contributed to the change, suggesting that neuronal networks distributed over both hemispheres are the substrate of cortical reorganization of language processing in intense aphasia therapy. Word-evoked differences in source strengths were significantly correlated with performance on a clinical language test, demonstrating a link between behavioral and neurophysiological changes. We suggest that the early word-evoked negativity might represent an index of reorganization of language after stroke and thus an aphasia recovery potential.
Collapse
Affiliation(s)
- Friedemann Pulvermüller
- Medical Research Council, Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 2EF, UK.
| | | | | | | | | |
Collapse
|
33
|
Meinzer M, Elbert T, Wienbruch C, Djundja D, Barthel G, Rockstroh B. Intensive language training enhances brain plasticity in chronic aphasia. BMC Biol 2004; 2:20. [PMID: 15331014 PMCID: PMC515310 DOI: 10.1186/1741-7007-2-20] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Accepted: 08/25/2004] [Indexed: 11/10/2022] Open
Abstract
Background Focal clusters of slow wave activity in the delta frequency range (1–4 Hz), as measured by magnetencephalography (MEG), are usually located in the vicinity of structural damage in the brain. Such oscillations are usually considered pathological and indicative of areas incapable of normal functioning owing to deafferentation from relevant input sources. In the present study we investigated the change in Delta Dipole Density in 28 patients with chronic aphasia (>12 months post onset) following cerebrovascular stroke of the left hemisphere before and after intensive speech and language therapy (3 hours/day over 2 weeks). Results Neuropsychologically assessed language functions improved significantly after training. Perilesional delta activity decreased after therapy in 16 of the 28 patients, while an increase was evident in 12 patients. The magnitude of change of delta activity in these areas correlated with the amount of change in language functions as measured by standardized language tests. Conclusions These results emphasize the significance of perilesional areas in the rehabilitation of aphasia even years after the stroke, and might reflect reorganisation of the language network that provides the basis for improved language functions after intensive training.
Collapse
Affiliation(s)
- Marcus Meinzer
- Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464 Konstanz, Germany
- Lurija Institute for Rehabilitation Research, Kliniken Schmieder, 78476 Allensbach, Germany
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464 Konstanz, Germany
| | - Christian Wienbruch
- Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464 Konstanz, Germany
| | - Daniela Djundja
- Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464 Konstanz, Germany
- Lurija Institute for Rehabilitation Research, Kliniken Schmieder, 78476 Allensbach, Germany
| | - Gabriela Barthel
- Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464 Konstanz, Germany
- Lurija Institute for Rehabilitation Research, Kliniken Schmieder, 78476 Allensbach, Germany
| | - Brigitte Rockstroh
- Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464 Konstanz, Germany
| |
Collapse
|
34
|
Rossini PM, Dal Forno G. Integrated technology for evaluation of brain function and neural plasticity. Phys Med Rehabil Clin N Am 2004; 15:263-306. [PMID: 15029909 DOI: 10.1016/s1047-9651(03)00124-4] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The study of neural plasticity has expanded rapidly in the past decades and has shown the remarkable ability of the developing, adult, and aging brain to be shaped by environmental inputs in health and after a lesion. Robust experimental evidence supports the hypothesis that neuronal aggregates adjacent to a lesion in the sensorimotor brain areas can take over progressively the function previously played by the damaged neurons. It definitely is accepted that such a reorganization modifies sensibly the interhemispheric differences in somatotopic organization of the sensorimotor cortices. This reorganization largely subtends clinical recovery of motor performances and sensorimotor integration after a stroke. Brain functional imaging studies show that recovery from hemiplegic strokes is associated with a marked reorganization of the activation patterns of specific brain structures. To regain hand motor control, the recovery process tends over time to bring the bilateral motor network activation toward a more normal intensity/extent, while overrecruiting simultaneously new areas, perhaps to sustain this process. Considerable intersubject variability exists in activation/hyperactivation pattern changes over time. Some patients display late-appearing dorsolateral prefrontal cortex activation, suggesting the development of "executive" strategies to compensate for the lost function. The AH in stroke often undergoes a significant "remodeling" of sensory and motor hand somatotopy outside the "normal" areas, or enlargement of the hand representation. The UH also undergoes reorganization, although to a lesser degree. Although absolute values of the investigated parameters fluctuate across subjects, secondary to individual anatomic variability, variation is minimal with regards to interhemispheric differences, due to the fact that individual morphometric characters are mirrored in the two hemispheres. Excessive interhemispheric asymmetry of the sensorimotor hand areas seems to be the parameter with highest sensitivity in describing brain reorganization after a monohemispheric lesion, and mapping motor and somatosensory cortical areas through focal TMS, fMRI, PET, EEG, and MEG is useful in studying hand representation and interhemispheric asymmetries in normal and pathologic conditions. TMS and MEG allow the detection of sensorimotor areas reshaping, as a result of either neuronal reorganization or recovery of the previously damaged neural network. These techniques have the advantage of high temporal resolution but also have limitations. TMS provides only bidimensional scalp maps, whereas MEG, even if giving three-dimensional mapping of generator sources, does so by means of inverse procedures that rely on the choice of a mathematical model of the head and the sources. These techniques do not test movement execution and sensorimotor integration as used in everyday life. fMRI and PET may provide the ideal means to integrate the findings obtained with the other two techniques. This multitechnology combined approach is at present the best way to test the presence and amount of plasticity phenomena underlying partial or total recovery of several functions, sensorimotor above all. Dynamic patterns of recovery are emerging progressively from the relevant literature. Enhanced recruitment of the affected cortex, be it spared perilesional tissue, as in the case of cortical stroke, or intact but deafferented cortex, as in subcortical strokes, seems to be the rule, a mechanism especially important in early postinsult stages. The transfer over time of preferential activation toward contralesional cortices, as observed in some cases, seems, however, to reflect a less efficient type of plastic reorganization, with some aspects of maladaptive plasticity. Reinforcing the use of the affected side can cause activation to increase again in the affected side with a corresponding enhancement of clinical function. Activation of the UH MI may represent recruitment of direct (uncrossed) corticospinal tracts and relate more to mirror movements, but it more likely reflects activity redistribution within preexisting bilateral, large-scale motor networks. Finally, activation of areas not normally engaged in the dysfunctional tasks, such as the dorsolateral prefrontal cortex or the superior parietal cortex in motor paralysis, might reflect the implication of compensatory cognitive strategies. An integrated approach with technologies able to investigate functional brain imaging is of considerable value in providing information on the excitability, extension, localization, and functional hierarchy of cortical brain areas. Deepening knowledge of the mechanisms regulating the long-term recovery (even if partial), observed for most neurologic sequelae after neural damage, might prompt newer and more efficacious therapeutic and rehabilitative strategies for neurologic diseases.
Collapse
Affiliation(s)
- Paolo M Rossini
- Department of Clinical Neuroscience, Hospital Fatebenefratelli, Isola Tiberina 39, 00186-Rome, Italy
| | | |
Collapse
|
35
|
Neininger B, Pulvermüller F, Elbert T, Rockstroh B, Mohr B, Mohr B. Intensivierung, Fokussierung und Verhaltensrelevanz. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2004. [DOI: 10.1024/1016-264x.15.3.219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Gehirnwissenschaftliche Erkenntnisse der vergangenen Jahre haben neue neuropsychologische Therapieformen hervorgebracht, deren allgemeine Prinzipien sich mit den Termini Intensivierung, Verhaltensrelevanz und Fokussierung umreißen lassen (genannt Constraint-Induced Aphasia Therapy - CIA Therapie). Intensivierung der Therapie bedeutet, dass die Intervention mit besonders hoher Frequenz durchgeführt wird (engl.: massed practice). Die im therapeutischen Setting implementierten Interaktionstypen gleichen denjenigen im Alltag (behavioral relevance). “Fokussierung” heißt, dass der Patient durch Hilfsmittel und Regeln der therapeutischen Interaktion zu Handlungsweisen gebracht wird, die er aufgrund operanter Konditionierungen in Folge der Gehirnschädigung sonst vermeiden würde (constraints to avoid learned nonuse). In einer kontrollierten Effektivitätsstudie konnten wir beweisen, dass CIA Therapie auch bei chronischer Aphasie zu einer signifikanten Verbesserung der sprachlichen Leistungen führen kann. Wir gehen hier auf die historischen Wurzeln ein und diskutieren Fragen für zukünftige Forschungen.
Collapse
Affiliation(s)
- Bettina Neininger
- rehamed-neuro, ambulantes neurologisches Rehabilitationszentrum, Stuttgart
| | | | | | | | - Bettina Mohr
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Bettina Mohr
- Department of Applied Sciences, Anglia Polytechnical University, Cambridge, UK
| |
Collapse
|
36
|
Abstract
BACKGROUND It has been speculated that the conflicting results demonstrated across poststroke aphasia therapy studies might be related to differences in intensity of therapy provided across studies. The aim of this study is to investigate the relationship between intensity of aphasia therapy and aphasia recovery. METHODS A MEDLINE literature search was conducted to retrieve clinical trials investigating aphasia therapy after stroke. Changes in mean scores from each study were recorded. Intensity of therapy was recorded in terms of length of therapy, hours of therapy provided per week, and total hours of therapy provided. Pearson correlation was used to assess the relationship between changes in mean scores of outcome measures and intensity of therapy. RESULTS Studies that demonstrated a significant treatment effect provided 8.8 hours of therapy per week for 11.2 weeks versus the negative studies that only provided approximately 2 hours per week for 22.9 weeks. On average, positive studies provided a total of 98.4 hours of therapy, whereas negative studies provided 43.6 hours of therapy. Total length of therapy time was found to be inversely correlated with hours of therapy provided per week (P=0.003) and total hours of therapy provided (P=0.001). Total length of therapy was significantly inversely correlated with mean change in Porch Index of Communicative Abilities (PICA) scores (P=0.0001). The number of hours of therapy provided in a week was significantly correlated to greater improvement on the PICA (P=0.001) and the Token Test (P=0.027). Total number of hours of therapy was significantly correlated with greater improvement on the PICA (P<0.001) and the Token Test (P<0.001). CONCLUSIONS Intense therapy over a short amount of time can improve outcomes of speech and language therapy for stroke patients with aphasia.
Collapse
Affiliation(s)
- Sanjit K Bhogal
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, St Joseph's Health Care London, Parkwood Hospital, Ontario, Canada
| | | | | |
Collapse
|
37
|
|
38
|
Sundin K, Jansson L, Norberg A. Understanding between care providers and patients with stroke and aphasia: a phenomenological hermeneutic inquiry. Nurs Inq 2002; 9:93-103. [PMID: 12071910 DOI: 10.1046/j.1440-1800.2002.00135.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Understanding between care providers and patients with stroke and aphasia: a phenomenological hermeneutic inquiry The present study illuminates the understanding in communication between formal care providers and patients with stroke and aphasia. Five care providers and three such patients participated in the study. Video recordings were made during conversations about pictures (n = 15), and the care providers were also interviewed (n = 15) after the video-recorded conversations. A phenomenological hermeneutic method of interpretation of the interview text was used. The findings showed that a range of conditions for 'understanding and being understood' in the communication on the part of the care providers exists. These different conditions are: lacking both knowledge and understanding; having knowledge but not necessarily accompanied by understanding; and being in understanding. Within the condition 'being in understanding', the care providers create a feeling of at-homeness in a relaxed atmosphere and thus have the opportunity to be in 'understanding and being understood' together with the patient. The condition 'being in understanding' appears in connection with the care providers' creating of a 'calm liturgy of caring' by mediating humility and calm vitality affects to the patients, and further, when needed, being present on the level of mystery, i.e. caring communion.
Collapse
Affiliation(s)
- Karin Sundin
- Department of Nursing and Health Sciences, Mid Sweden University, Ornsköldsvik, Sweden.
| | | | | |
Collapse
|
39
|
Godefroy O, Dubois C, Debachy B, Leclerc M, Kreisler A. Vascular aphasias: main characteristics of patients hospitalized in acute stroke units. Stroke 2002; 33:702-5. [PMID: 11872891 DOI: 10.1161/hs0302.103653] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Aphasia is frequent in stroke patients and is associated with poor prognosis. However, characteristics and determinants of vascular aphasias remain controversial. The aim of this study was to evaluate aphasia characteristics at the acute stage in patients admitted to a stroke unit. METHODS The study was performed in 308 patients consecutively assessed with a standardized aphasia battery. RESULTS Aphasia was observed in 207 patients; global and nonclassified aphasias accounted for 50% of aphasic syndromes at the acute stage, whereas classic aphasias (Wernicke's, Broca's, transcortical, and subcortical aphasias) were less frequent. Age differed across aphasic syndromes in ischemic stroke patients only; patients with conduction aphasia were younger, and patients with subcortical aphasia were older. Sex did not significantly differ across aphasic syndromes. The presence of a previous stroke was more frequent in nonclassified aphasia. CONCLUSIONS This study shows (1) that vascular aphasias are frequently severe or nonclassic at the acute stage, a finding explained in part by the presence of a previous stroke; (2) that the age effect is due mainly to its influence on infarct location; and (3) that the main determinant of aphasia characteristics is lesion location.
Collapse
Affiliation(s)
- O Godefroy
- Department of Neurovascular Disorders of Lille and Institut d'Orthophonie de Tours, Amiens, France.
| | | | | | | | | |
Collapse
|
40
|
Pulvermüller F, Neininger B, Elbert T, Mohr B, Rockstroh B, Koebbel P, Taub E. Constraint-induced therapy of chronic aphasia after stroke. Stroke 2001; 32:1621-6. [PMID: 11441210 DOI: 10.1161/01.str.32.7.1621] [Citation(s) in RCA: 468] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with chronic aphasia were assigned randomly to a group to receive either conventional aphasia therapy or constraint-induced (CI) aphasia therapy, a new therapeutic technique requiring intense practice over a relatively short period of consecutive days. CI aphasia therapy is realized in a communicative therapeutic environment constraining patients to practice systematically speech acts with which they have difficulty. Patients in both groups received the same amount of treatment (30 to 35 hours) as 10 days of massed-practice language exercises for the CI aphasia therapy group (3 hours per day minimum; 10 patients) or over a longer period of approximately 4 weeks for the conventional therapy group (7 patients). CI aphasia therapy led to significant and pronounced improvements on several standard clinical tests, on self-ratings, and on blinded-observer ratings of the patients' communicative effectiveness in everyday life. Patients who received the control intervention failed to achieve comparable improvements. Data suggest that the language skills of patients with chronic aphasia can be improved in a short period by use of an appropriate massed-practice technique that focuses on the patients' communicative needs.
Collapse
|
41
|
Affiliation(s)
- C K Thompson
- Department of Communication Sciences and Disorders, Neuroscience Institute, Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, Evanston, Illinois 60208-3570, USA.
| |
Collapse
|
42
|
Ruiz A. Aphasia treatment. On drugs, machines, and therapies: what will the future be? BRAIN AND LANGUAGE 2000; 71:200-203. [PMID: 10716845 DOI: 10.1006/brln.1999.2250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- A Ruiz
- Lexis Centro de Neuropsicología, Argentina.
| |
Collapse
|
43
|
Affiliation(s)
- C K Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL 60298-3570, USA.
| |
Collapse
|
44
|
Rogers MA, Alarcon NB, Olswang LB. Aphasia Management Considered in the Context of the World Health Organization Model of Disablements. Phys Med Rehabil Clin N Am 1999. [DOI: 10.1016/s1047-9651(18)30170-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
45
|
|
46
|
Aftonomos LB, Appelbaum JS, Steele RD. Improving outcomes for persons with aphasia in advanced community-based treatment programs. Stroke 1999; 30:1370-9. [PMID: 10390309 DOI: 10.1161/01.str.30.7.1370] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Studies have yet to document that community-based aphasia treatment programs routinely produce results comparable or superior to published research protocols. We explore this issue here in an outcome study of individuals with aphasia enrolled in 2 community-based, comparably managed and equipped therapy programs, which use a specially designed computer-based tool that is employed therapeutically in adherence to an extensive, detailed, and formally trained patient care algorithm. METHODS Patients (n=60) were assessed before and after treatment with standardized instruments at both the impairment and the disability levels. Pretreatment and posttreatment means were calculated and compared, with statistical significance of differences established with the use of 1-tailed matched t tests. One-way ANOVAs were used to analyze the comparability of patient performance changes among various subgroups, eg, patients in acute versus chronic stages of aphasia, patients by aphasia diagnostic type at start of care, patients by severity level at start of care, and patients by treatment location. RESULTS Analysis shows that patients spanned a wide range of aphasia diagnostic types, impairment severity levels at start of care, and times after onset. Patients' mean performance scores improved significantly in response to treatment in all measures assessed at both the impairment level and the functional communication level. Mean overall improvements ranged from 6.6% to 19.8%, with statistical significance ranging from P=0.0006 to P<0.0001. ANOVAs revealed no significant differences between improvements in patients in the acute versus chronic stages of aphasia, between those at different impairment severity levels at start of care, between those treated at different locations, or, at the functional level, between those with different diagnostic types of aphasia at start of care. CONCLUSIONS Measures of both language impairment and functional communication can be broadly, positively, and significantly influenced by therapy services that are delivered to persons with aphasia in these community-based programs. The significant improvements are shown to be available to individuals with chronic as well as acute aphasia and independent of diagnostic type of aphasia, impairment severity at start of care, or geographic program location.
Collapse
Affiliation(s)
- L B Aftonomos
- LingraphiCARE America, Inc, Language Care Center, Palo Alto, CA, USA
| | | | | |
Collapse
|