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Angelopoulou G, Kasselimis D, Varkanitsa M, Tsolakopoulos D, Papageorgiou G, Velonakis G, Meier E, Karavassilis E, Pantoleon V, Laskaris N, Kelekis N, Tountopoulou A, Vassilopoulou S, Goutsos D, Kiran S, Weiller C, Rijntjes M, Potagas C. Investigating silent pauses in connected speech: integrating linguistic, neuropsychological, and neuroanatomical perspectives across narrative tasks in post-stroke aphasia. Front Neurol 2024; 15:1347514. [PMID: 38682034 PMCID: PMC11047180 DOI: 10.3389/fneur.2024.1347514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/07/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Silent pauses are regarded as integral components of the temporal organization of speech. However, it has also been hypothesized that they serve as markers for internal cognitive processes, including word access, monitoring, planning, and memory functions. Although existing evidence across various pathological populations underscores the importance of investigating silent pauses' characteristics, particularly in terms of frequency and duration, there is a scarcity of data within the domain of post-stroke aphasia. Methods The primary objective of the present study is to scrutinize the frequency and duration of silent pauses in two distinct narrative tasks within a cohort of 32 patients with chronic post-stroke aphasia, in comparison with a control group of healthy speakers. Subsequently, we investigate potential correlation patterns between silent pause measures, i.e., frequency and duration, across the two narrative tasks within the patient group, their performance in neuropsychological assessments, and lesion data. Results Our findings showed that patients exhibited a higher frequency of longer-duration pauses in both narrative tasks compared to healthy speakers. Furthermore, within-group comparisons revealed that patients tended to pause more frequently and for longer durations in the picture description task, while healthy participants exhibited the opposite trend. With regard to our second research question, a marginally significant interaction emerged between performance in semantic verbal fluency and the narrative task, in relation to the location of silent pauses-whether between or within clauses-predicting the duration of silent pauses in the patient group. However, no significant results were observed for the frequency of silent pauses. Lastly, our study identified that the duration of silent pauses could be predicted by distinct Regions of Interest (ROIs) in spared tissue within the left hemisphere, as a function of the narrative task. Discussion Overall, this study follows an integrative approach of linguistic, neuropsychological and neuroanatomical data to define silent pauses in connected speech, and illustrates interrelations between cognitive components, temporal aspects of speech, and anatomical indices, while it further highlights the importance of studying connected speech indices using different narrative tasks.
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Affiliation(s)
- G. Angelopoulou
- Neuropsychology&Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D. Kasselimis
- Neuropsychology&Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | - M. Varkanitsa
- Center for Brain Recovery, Boston University, Boston, MA, United States
| | - D. Tsolakopoulos
- Neuropsychology&Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - G. Papageorgiou
- Neuropsychology&Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - G. Velonakis
- 2nd Department of Radiology, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - E. Meier
- The Aphasia Network Lab, Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States
| | - E. Karavassilis
- 2nd Department of Radiology, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - V. Pantoleon
- 2nd Department of Radiology, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - N. Laskaris
- Neuropsychology&Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Industrial Design and Production Engineering, School of Engineering, University of West Attica, Athens, Greece
| | - N. Kelekis
- 2nd Department of Radiology, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A. Tountopoulou
- Stroke Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - S. Vassilopoulou
- Stroke Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D. Goutsos
- Department of Linguistics, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
| | - S. Kiran
- Center for Brain Recovery, Boston University, Boston, MA, United States
| | - C. Weiller
- Department of Neurology and Clinical Neuroscience, University Hospital Freiburg, Freiburg, Germany
| | - M. Rijntjes
- Department of Neurology and Clinical Neuroscience, University Hospital Freiburg, Freiburg, Germany
| | - C. Potagas
- Neuropsychology&Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Deng BM, Liang LS, Zhao JX, Zheng HQ, Hu XQ. Correct Information Unit Analysis in Different Discourse Tasks Among Persons With Anomic Aphasia Based on Mandarin AphasiaBank. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:800-813. [PMID: 38099824 DOI: 10.1044/2023_ajslp-23-00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE This study aimed to explore how well persons with anomic aphasia communicate information during discourse regarding quantity, quality, and efficiency compared to neurotypical controls, to investigate the influence of discourse tasks on informativeness and efficiency and to examine impact factors like aphasia severity and cognitive ability. METHOD Language samples of four discourse tasks from 31 persons with anomic aphasia and 31 neurotypical controls were collected from Mandarin AphasiaBank. Correct information unit (CIU) analysis measures including the total number of CIUs, percentage of CIUs, CIUs per minute, and words per minute were calculated. Group differences and the effects of discourse tasks on informativeness and efficiency were investigated. Correlations of CIU analysis measures with aphasia severity and cognitive ability were examined. RESULTS Persons with anomic aphasia showed lower efficiency in conveying information than controls. They underperformed controls on all CIU analysis measures when executing story narrative tasks. Discourse tasks influenced the informativeness and efficiency of both groups. Neurotypical controls delivered the greatest quantity of information most efficiently when narrating stories. Persons with anomic aphasia exhibited reduced quantity of information during procedural discourse and displayed superior information quality in sequential-picture descriptions. Discourse information may be impacted by aphasia severity and cognitive ability, with varying effects depending on the task. CONCLUSIONS Persons with anomic aphasia are inefficient in communicating discourse messages and perform poorly on all measures in story narratives. When measuring discourse information, the effects of discourse tasks and factors like aphasia severity and cognitive ability should be considered.
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Affiliation(s)
- Bao-Mei Deng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li-Si Liang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia-Xin Zhao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hai-Qing Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi-Quan Hu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Nguyen TAS, Castro N, Vitevitch MS, Harding A, Teng R, Arciuli J, Leyton CE, Piguet O, Ballard KJ. Do age and language impairment affect speed of recognition for words with high and low closeness centrality within the phonological network? INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:915-928. [PMID: 36416187 DOI: 10.1080/17549507.2022.2141323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Speed and accuracy of lexical access change with healthy ageing and neurodegeneration. While a word's immediate phonological neighbourhood density (i.e. words differing by a single phoneme) influences access, connectivity to all words in the phonological network (i.e. closeness centrality) may influence processing. This study aimed to investigate the effect of closeness centrality on speed and accuracy of lexical processing pre- and post- a single word-training session in healthy younger and older adults, and adults with logopenic primary progressive aphasia (lvPPA), which affects phonological processing. METHOD Participants included 29 young and 17 older healthy controls, and 10 adults with lvPPA. Participants received one session of word-training on words with high or low closeness centrality, using a picture-word verification task. Changes in lexical decision reaction times (RT) and accuracy were measured. RESULT Baseline RT was unaffected by age and accuracy was at ceiling for controls. Post-training, only young adults' RT were significantly faster. Adults with lvPPA were slower and less accurate than controls at baseline, with no training effect. Closeness centrality did not influence performance. CONCLUSION Absence of training effect for older adults suggests higher threshold to induce priming, possibly associated with insufficient dosage or fatigue. Implications for word-finding interventions with older adults are discussed.
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Affiliation(s)
| | - Nichol Castro
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Annabel Harding
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Renata Teng
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Joanne Arciuli
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Cristian E Leyton
- School of Psychology and the Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Olivier Piguet
- School of Psychology and the Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Kirrie J Ballard
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Psychology and the Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
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de Grosbois J, Canthiya L, Philipp-Muller AE, Hickey NK, Hodzic-Santor B, Heleno MC, Jokel R, Meltzer JA. Asynchronous, online spaced-repetition training alleviates word-finding difficulties in aphasia. Neuropsychol Rehabil 2023; 33:1672-1696. [PMID: 36378584 DOI: 10.1080/09602011.2022.2143822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
Word-finding difficulties for naming everyday objects are often prevalent in aphasia. Traditionally, treating these difficulties has involved repeated drilling of troublesome items with a therapist. Spaced repetition schedules can improve the efficiency of such training. However, spaced repetition in a therapy environment can be both difficult to implement and time-consuming. The current study evaluated the potential utility of automated, asynchronous, online spaced repetition training for the treatment of word-finding difficulties in individuals with aphasia. Twenty-one participants completed a two-week training study, completing approximately 60 minutes per day of asynchronous online drilling. The training items were identified using a pretest, and word-finding difficulties were evaluated both at the end of training (i.e., a post-test) and four weeks later (i.e., a retention test). The trained items were separated into three different spaced-repetition schedules: (1) Short-spacing; (2) Long-spacing; and (3) Adaptive-spacing. At the retention-test, all trained items outperformed non-trained items in terms of accuracy and reaction time. Further, preliminary evidence suggested a potential reaction time advantage for the adaptive-spacing condition. Overall, online, asynchronous spaced repetition training appears to be effective in treating word-finding difficulties in aphasia. Further research will be required to determine if different spaced repetition schedules can be leveraged to enhance this effect.
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Affiliation(s)
- John de Grosbois
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
| | - Lathushikka Canthiya
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Aaron E Philipp-Muller
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Natasha K Hickey
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
| | | | - Madeline C Heleno
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
| | - Regina Jokel
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
| | - Jed A Meltzer
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
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Schumacher R, Halai AD, Lambon Ralph MA. Attention to attention in aphasia - elucidating impairment patterns, modality differences and neural correlates. Neuropsychologia 2022; 177:108413. [PMID: 36336090 PMCID: PMC7614452 DOI: 10.1016/j.neuropsychologia.2022.108413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
It is increasingly acknowledged that patients with aphasia following a left-hemisphere stroke often have difficulties in other cognitive domains. One of these domains is attention, the very fundamental ability to detect, select, and react to the abundance of stimuli present in the environment. Basic and more complex attentional functions are usually distinguished, and a variety of tests has been developed to assess attentional performance at a behavioural level. Attentional performance in aphasia has been investigated previously, but often only one specific task, stimulus modality, or type of measure was considered and usually only group-level analyses or data based on experimental tasks were presented. Also, information on brain-behaviour relationships for this cognitive domain and patient group is scarce. We report detailed analyses on a comprehensive dataset including patients' performance on various subtests of two well-known, standardised neuropsychological test batteries assessing attention. These tasks allowed us to explore: 1) how many patients show impaired performance in comparison to normative data, in which tasks and on what measure; 2) how the different tasks and measures relate to each other and to patients' language abilities; 3) the neural correlates associated with attentional performance. Up to 32 patients with varying aphasia severity were assessed with subtests from the Test of Attentional Performance (TAP) as well as the Test of Everyday Attention (TEA). Performance was compared to normative data, relationships between attention measures and other background data were explored with principal component analyses and correlations, and brain-behaviour relationships were assessed by means of voxel-based correlational methodology. Depending on the task and measure, between 3 and 53 percent of the patients showed impaired performance compared to normative data. The highest proportion of impaired performance was noted for complex attention tasks involving auditory stimuli. Patients differed in their patterns of performance and only the performance in the divided attention tests was (weakly) associated with their overall language impairment. Principal components analyses yielded four underlying factors, each being associated with distinct neural correlates. We thus extend previous research in characterizing different aspects of attentional performance within one sample of patients with chronic post stroke aphasia. Performance on a broad range of attention tasks and measures was variable and largely independent of patients' language abilities, which underlines the importance of assessing this cognitive domain in aphasic patients. Notably, a considerable proportion of patients showed difficulties with attention allocation to auditory stimuli. The reasons for these potentially modality-specific difficulties are currently not well understood and warrant additional investigations.
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Affiliation(s)
- Rahel Schumacher
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom; Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Matthew A Lambon Ralph
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom.
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Walker GM, Fridriksson J, Hillis AE, den Ouden DB, Bonilha L, Hickok G. The Severity-Calibrated Aphasia Naming Test. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2722-2740. [PMID: 36332139 PMCID: PMC9911092 DOI: 10.1044/2022_ajslp-22-00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE We present a 20-item naming test, the Severity-Calibrated Aphasia Naming Test (SCANT), that can serve as a proxy measure for an aphasia severity scale that is derived from a thorough test battery of connected speech production, single-word production, speech repetition, and auditory verbal comprehension. METHOD We use lasso regression and cross-validation to identify an optimal subset from a set of 174 pictures to be named for prediction of aphasia severity, based on data from 200 participants with left-hemisphere stroke who were quasirandomly selected to represent the full impairment scale. Data from 20 healthy controls (i.e., participant caretakers/spouses) were also analyzed. We examine interrater reliability, test-retest reliability, sensitivity and specificity to the presence of aphasia, sensitivity to therapy gains, and external validity (i.e., correlation with aphasia severity measures) for the SCANT. RESULTS The SCANT has extremely high interrater reliability, and it is sensitive and specific to the presence of aphasia. We demonstrate the superiority of predictions based on the SCANT over those based on the full set of naming items. We estimate a 15% reduction in power when using the SCANT score versus the full test battery's aphasia severity score as an outcome measure; for example, to maintain the same power to detect a significant group average change in aphasia severity, a study with 25 participants using the full test battery to measure treatment effectiveness would require 30 participants if the SCANT were to be used as the testing instrument instead. CONCLUSION We provide a linear model to convert SCANT scores to aphasia severity scores, and we identify a change score cutoff of four SCANT items to obtain a high degree of confidence based on test-retest SCANT data and the modeled relation between SCANT and aphasia severity scores. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21476871.
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Affiliation(s)
- Grant M. Walker
- Department of Cognitive Sciences, University of California, Irvine
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Argye E. Hillis
- Departments of Neurology, Physical Medicine & Rehabilitation, and Cognitive Science, Johns Hopkins Medicine, Baltimore, MA
| | - Dirk B. den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | | | - Gregory Hickok
- Department of Cognitive Sciences, University of California, Irvine
- Department of Language Science, University of California, Irvine
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Gore KR, Woollams AM, Bruehl S, Halai AD, Lambon Ralph MA. Direct Neural Evidence for the Contrastive Roles of the Complementary Learning Systems in Adult Acquisition of Native Vocabulary. Cereb Cortex 2022; 32:3392-3405. [PMID: 34875018 PMCID: PMC9376875 DOI: 10.1093/cercor/bhab422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 01/01/2023] Open
Abstract
The Complementary Learning Systems (CLS) theory provides a powerful framework for considering the acquisition, consolidation, and generalization of new knowledge. We tested this proposed neural division of labor in adults through an investigation of the consolidation and long-term retention of newly learned native vocabulary with post-learning functional neuroimaging. Newly learned items were compared with two conditions: 1) previously known items to highlight the similarities and differences with established vocabulary and 2) unknown/untrained items to provide a control for non-specific perceptual and motor speech output. Consistent with the CLS, retrieval of newly learned items was supported by a combination of regions associated with episodic memory (including left hippocampus) and the language-semantic areas that support established vocabulary (left inferior frontal gyrus and left anterior temporal lobe). Furthermore, there was a shifting division of labor across these two networks in line with the items' consolidation status; faster naming was associated with more activation of language-semantic areas and lesser activation of episodic memory regions. Hippocampal activity during naming predicted more than half the variation in naming retention 6 months later.
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Affiliation(s)
- Katherine R Gore
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester M13 9GB, UK
| | - Anna M Woollams
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester M13 9GB, UK
| | - Stefanie Bruehl
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester M13 9GB, UK
- St Mauritius Rehabilitation Centre, Meerbusch & Heinrich-Heine University, 40225 Duesseldorf, Germany
- Clinical and Cognitive Neurosciences, Department of Neurology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Ajay D Halai
- MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
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Associations between Brain Microstructure and Phonological Processing Ability in Preschool Children. CHILDREN 2022; 9:children9060782. [PMID: 35740719 PMCID: PMC9221994 DOI: 10.3390/children9060782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Abstract
Neuroimaging studies have associated brain changes in children with future reading and language skills, but few studies have investigated the association between language skills and white matter structure in preschool-aged children. Using 208 data sets acquired in 73 healthy children aged 2–7 years, we investigated the relationship between developmental brain microstructure and phonological processing ability as measured using their phonological processing raw score (PPRS). The correlation analysis showed that across the whole age group, with increasing age, PPRS increased, fractional anisotropy (FA) of the internal capsule and inferior fronto-occipital fasciculus and some other regions increased, and mean diffusivity (MD) of the corpus callosum and internal capsule and some other regions decreased. The results of the mediation analysis suggest that increased FA may be the basis of phonological processing ability development during this period, and the increased number of fiber connections between the right inferior parietal lobule and right supramarginal gyrus may be a key imaging feature of phonological processing ability development. Our study reflects the changes in brain microstructure and contributes to understanding the underlying neural mechanisms of language development in preschool children.
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Schumacher R, Halai AD, Lambon Ralph MA. Assessing executive functions in post-stroke aphasia-utility of verbally based tests. Brain Commun 2022; 4:fcac107. [PMID: 35602650 PMCID: PMC9118101 DOI: 10.1093/braincomms/fcac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/16/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
It is increasingly acknowledged that, often, patients with post-stroke aphasia not only have language impairments but also deficits in other cognitive domains (e.g. executive functions) that influence recovery and response to therapy. Many assessments of executive functions are verbally based and therefore usually not administered in this patient group. However, the performance of patients with aphasia in such tests might provide valuable insights both from a theoretical and clinical perspective. We aimed to elucidate (i) if verbal executive tests measure anything beyond the language impairment in patients with chronic post-stroke aphasia, (ii) how performance in such tests relates to performance in language tests and nonverbal cognitive functions, and (iii) the neural correlates associated with performance in verbal executive tests. In this observational study, three commonly used verbal executive tests were administered to a sample of patients with varying aphasia severity. Their performance in these tests was explored by means of principal component analyses, and the relationships with a broad range of background tests regarding their language and nonverbal cognitive functions were elucidated with correlation analyses. Furthermore, lesion analyses were performed to explore brain-behaviour relationships. In a sample of 32 participants, we found that: (i) a substantial number of patients with aphasia were able to perform the verbal executive tests; (ii) variance in performance was not explained by the severity of an individual's overall language impairment alone but was related to two independent behavioural principal components per test; (iii) not all aspects of performance were related to the patient's language abilities; and (iv) all components were associated with separate neural correlates, some overlapping partly in frontal and parietal regions. Our findings extend our clinical and theoretical understanding of dysfunctions beyond language in patients with aphasia.
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Affiliation(s)
- Rahel Schumacher
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Ajay D. Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Matthew A. Lambon Ralph
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
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Bonkhoff AK, Hope T, Bzdok D, Guggisberg AG, Hawe RL, Dukelow SP, Chollet F, Lin DJ, Grefkes C, Bowman H. Recovery after stroke: the severely impaired are a distinct group. J Neurol Neurosurg Psychiatry 2022; 93:369-378. [PMID: 34937750 DOI: 10.1136/jnnp-2021-327211] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/06/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Stroke causes different levels of impairment and the degree of recovery varies greatly between patients. The majority of recovery studies are biased towards patients with mild-to-moderate impairments, challenging a unified recovery process framework. Our aim was to develop a statistical framework to analyse recovery patterns in patients with severe and non-severe initial impairment and concurrently investigate whether they recovered differently. METHODS We designed a Bayesian hierarchical model to estimate 3-6 months upper limb Fugl-Meyer (FM) scores after stroke. When focusing on the explanation of recovery patterns, we addressed confounds affecting previous recovery studies and considered patients with FM-initial scores <45 only. We systematically explored different FM-breakpoints between severe/non-severe patients (FM-initial=5-30). In model comparisons, we evaluated whether impairment-level-specific recovery patterns indeed existed. Finally, we estimated the out-of-sample prediction performance for patients across the entire initial impairment range. RESULTS Recovery data was assembled from eight patient cohorts (n=489). Data were best modelled by incorporating two subgroups (breakpoint: FM-initial=10). Both subgroups recovered a comparable constant amount, but with different proportional components: severely affected patients recovered more the smaller their impairment, while non-severely affected patients recovered more the larger their initial impairment. Prediction of 3-6 months outcomes could be done with an R2=63.5% (95% CI=51.4% to 75.5%). CONCLUSIONS Our work highlights the benefit of simultaneously modelling recovery of severely-to-non-severely impaired patients and demonstrates both shared and distinct recovery patterns. Our findings provide evidence that the severe/non-severe subdivision in recovery modelling is not an artefact of previous confounds. The presented out-of-sample prediction performance may serve as benchmark to evaluate promising biomarkers of stroke recovery.
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Affiliation(s)
- Anna K Bonkhoff
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Hope
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Danilo Bzdok
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University Faculty of Medicine and Health Sciences, Montreal, Québec, Canada.,Mila - Quebec Artificial Intelligence Institute, Montreal, Québec, Canada.,Canadian Institute for Advanced Research (CIFAR), Montreal, Québec, Canada
| | - Adrian G Guggisberg
- Department of Clinical Neurosciences, Hopitaux Universitaires de Geneve Hopital de Beau-Sejour, Geneva, Switzerland
| | - Rachel L Hawe
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - François Chollet
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Grefkes
- Department of Neurology, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Howard Bowman
- School of Psychology, University of Birmingham, Birmingham, UK.,School of Computing, University of Kent, Canterbury, UK
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What is Functional Communication? A Theoretical Framework for Real-World Communication Applied to Aphasia Rehabilitation. Neuropsychol Rev 2022; 32:937-973. [PMID: 35076868 PMCID: PMC9630202 DOI: 10.1007/s11065-021-09531-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aphasia is an impairment of language caused by acquired brain damage such as stroke or traumatic brain injury, that affects a person’s ability to communicate effectively. The aim of rehabilitation in aphasia is to improve everyday communication, improving an individual’s ability to function in their day-to-day life. For that reason, a thorough understanding of naturalistic communication and its underlying mechanisms is imperative. The field of aphasiology currently lacks an agreed, comprehensive, theoretically founded definition of communication. Instead, multiple disparate interpretations of functional communication are used. We argue that this makes it nearly impossible to validly and reliably assess a person’s communicative performance, to target this behaviour through therapy, and to measure improvements post-therapy. In this article we propose a structured, theoretical approach to defining the concept of functional communication. We argue for a view of communication as “situated language use”, borrowed from empirical psycholinguistic studies with non-brain damaged adults. This framework defines language use as: (1) interactive, (2) multimodal, and (3) contextual. Existing research on each component of the framework from non-brain damaged adults and people with aphasia is reviewed. The consequences of adopting this approach to assessment and therapy for aphasia rehabilitation are discussed. The aim of this article is to encourage a more systematic, comprehensive approach to the study and treatment of situated language use in aphasia.
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BONEs not CATs attract DOGs: Semantic context effects for picture naming in the lesioned language network. Neuroimage 2021; 246:118767. [PMID: 34856377 DOI: 10.1016/j.neuroimage.2021.118767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
The breakdown of rapid and accurate retrieval of words is a hallmark of aphasic speech and a prime target of therapeutic intervention. Complementary, psycho- and neurolinguistic research have developed a spectrum of models, how and by which neuronal network uncompromised speakers can rely on remarkable lexical retrieval capacities. Motivated by both lines of research we invited 32 participants with a chronic left hemispheric brain lesion to name pictures in the presence of distractor words. This picture-word-interference (PWI) paradigm is widely used in psycho- and neurolinguistic research. We find that also after brain lesion categorically related words (CAT → [dog]picture) impede naming, while associatively related words (BONE → [dog]picture) ease access, when compared to unrelated distractor words. The effects largely affecting latencies in neurotypical populations, are reproduced for error rate in our participants with lesions in the language network. Unsurprisingly, overall naming abilities varied greatly across patients. Notably, however, the two effects (categorical interference / associative facilitation) differ between participants. Correlating performance with lesion patterns we find support for the notion of a divergence of brain areas affording different aspects of the task: (i) lesions in the left middle temporal gyurs (MTG) deteriorate overall naming, confirming previous work; more notably, (ii) lesions comprising the inferior frontal hub (inferior frontal gyrus, IFG) of the language-network increase the interference effect for the categorical condition; on the contrary, (iii) lesions to the mid-to-posterior temporal hub (posterior middle and superior temporal gyri, pMTG/ pSTG) increase the facilitatory effect for the associative condition on error rates. The findings can be accommodated in a neuro-linguistic framework, which localizes lexical activation but also lexical interference in posterior parts of the language network (pMTG/pITG); conversely, selection between co-activated categorically related entries is afforded by frontal language areas (IFG). While purely experimental in nature our study highlights that lesion site differentially influences specific aspects of word retrieval. Since confrontational naming is a cornerstone of aphasia rehabilitation, this may be of note when designing and evaluating novel therapeutic regimes.
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Cavanaugh R, Kravetz C, Jarold L, Quique Y, Turner R, Evans WS. Is There a Research-Practice Dosage Gap in Aphasia Rehabilitation? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2115-2129. [PMID: 34411485 PMCID: PMC8702848 DOI: 10.1044/2021_ajslp-20-00257] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 06/03/2023]
Abstract
Purpose Aphasia intervention research aims to improve communication and quality of life outcomes for people with aphasia. However, few studies have evaluated the translation and implementation of evidence-based aphasia interventions to clinical practice. Treatment dosage may be difficult to translate to clinical settings, and a mismatch between dosage in research and clinical practice threatens to attenuate intervention effectiveness. The purpose of this study is to quantify a potential research-practice dosage gap in outpatient aphasia rehabilitation. Method This study utilized a two-part approach. First, we estimated clinical treatment dosage in an episode of care (i.e., treatment provided from outpatient assessment to discharge) via utilization in a regional provider in the United States. Second, we undertook a scoping review of aphasia interventions published from 2009 to 2019 to estimate the typical dosage used in the current aphasia literature. Results Outpatient clinical episodes of care included a median of 10 treatment sessions and a mean of 14.8 sessions (interquartile range: 5-20 sessions). Sessions occurred 1-2 times a week over 4-14 weeks. The median total hours of treatment was 7.5 hr (interquartile range: 3.75-15 hr). In contrast, published interventions administered a greater treatment dosage, consisting of a median of 20 hr of treatment (interquartile range: 12-30 hr) over the course of 15 sessions (interquartile range: 10-24 sessions) approximately 3 times per week. Conclusions Results demonstrate a meaningful research-practice dosage gap, particularly in total treatment hours and weekly treatment intensity. This gap highlights the potential for attenuation of effectiveness from research to outpatient settings. Future translational research should consider clinical dosage constraints and take steps to facilitate intervention implementation, particularly with regard to dosage. Conversely, health care advocacy and continued development of alternative delivery methods are necessary for the successful implementation of treatments with dosage that is incompatible with current clinical contexts. Pragmatic, implementation-focused trials are recommended to evaluate and optimize treatment effectiveness in outpatient clinical settings. Supplemental Material https://doi.org/10.23641/asha.15161568.
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Affiliation(s)
- Robert Cavanaugh
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
| | - Christina Kravetz
- Centers for Rehab Services, University of Pittsburgh Medical Center, PA
| | - Lillian Jarold
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
- Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Yina Quique
- Center for Education in Health Sciences, Northwestern University, Chicago, IL
| | - Rose Turner
- Health Sciences Library System, University of Pittsburgh, PA
| | - William S. Evans
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
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14
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Mis R, Giovannetti T. Similarities between Cognitive Models of Language Production and Everyday Functioning: Implications for Development of Interventions for Functional Difficulties. Top Cogn Sci 2021; 14:295-310. [PMID: 34128585 DOI: 10.1111/tops.12550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Abstract
The loss of the ability to independently complete activities of daily living, such as meal preparation and household chores, is a defining characteristic of clinical dementia; however, minor difficulties in completing everyday activities emerge in the mild cognitive impairment stage, and even healthy older adults exhibit subtle functional difficulties compared to younger adults. These functional difficulties are associated with an array of negative outcomes, including decreased quality of life, higher costs of care, and increased frustration, depression, caregiver burden, and institutionalization. While cognitive models have been proposed to explain the functional deficits seen in dementia and subtler forms of cognitive decline, in contrast to other cognitive disorders such as aphasia, there are essentially no theoretically motivated interventions to address difficulties in everyday functioning. Proposed models of functional impairment share features with cognitive processing models of language, including hierarchical organization of representations and interactive, spreading activation; thus, an examination of aphasia interventions has the potential to inform the development of theoretically motivated interventions for everyday activities. This review first addresses the shared characteristics of cognitive models of everyday function and language, with a focus on linguistic production. Next, we will present aphasia interventions that target single-word production, sentence production, short-term memory, and semantics, and discuss their implications for everyday functioning interventions. We conclude with a discussion of limitations of the language-everyday functioning comparison as well as areas of future research.
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Affiliation(s)
- Rachel Mis
- Department of Psychology, Temple University
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15
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Evans WS, Quique YM. Understanding Speed-Accuracy Processing Dynamics in Aphasia Using Response Time Modeling. Semin Speech Lang 2021; 42:240-255. [PMID: 34261166 DOI: 10.1055/s-0041-1727251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
People with aphasia demonstrate language impairments evident in both performance accuracy and processing speed, but the direct relationship between accuracy and speed requires further consideration. This article describes two recent attempts to make quantitative progress in this domain using response time modeling: the diffusion model (Ratcliff, 1978) applied to two-choice tasks and a multinomial ex-Gaussian model applied to picture naming. The diffusion model may be used to characterize core linguistic processing efficiency and speed-accuracy tradeoffs independently, and research suggests that maladaptive speed-accuracy tradeoffs lead to performance impairments in at least some people with aphasia. The multinomial ex-Gaussian response time model of picture naming provides a simple and straightforward way to estimate the optimal response time cutoffs for individual people with aphasia (i.e., the cutoff where additional time is unlikely to lead to a correct response). While response time modeling applied to aphasia research is at an early stage of development, both the diffusion model and multinomial ex-Gaussian response time model of picture naming show promise and should be further developed in future work. This article also provides preliminary recommendations for clinicians regarding how to conceptualize, identify, and potentially address maladaptive speed-accuracy tradeoffs for people with aphasia.
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Affiliation(s)
- William S Evans
- Department of Communication Sciences and Disorders, University of Pittsburgh Schools of the Health Sciences, Pittsburgh, Pennsylvania
| | - Yina M Quique
- Center for Education in Health, Northwestern University, Evanston, Illinois
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16
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Fridriksson J, Hillis AE. Current Approaches to the Treatment of Post-Stroke Aphasia. J Stroke 2021; 23:183-201. [PMID: 34102754 PMCID: PMC8189855 DOI: 10.5853/jos.2020.05015] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/21/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022] Open
Abstract
Aphasia, impairment of language after stroke or other neurological insult, is a common and often devastating condition that affects nearly every social activity and interaction. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to augment the effects of the behavioral therapy. In this narrative review, we discuss advances in aphasia therapy in the last 5 years and focus primarily on properly powered, randomized, controlled trials of both behavioral therapies and interventions to augment therapy for post-stroke aphasia. These trials include evaluation of behavioral therapies and computer-delivered language therapies. We also discuss outcome prediction trials as well as interventional trials that have employed noninvasive brain stimulation, or medications to augment language therapy. Supported by evidence from Phase III trials and large meta-analyses, it is now generally accepted that aphasia therapy can improve language processing for many patients. Not all patients respond similarly to aphasia therapy with the most severe patients being the least likely responders. Nevertheless, it is imperative that all patients, regardless of severity, receive aphasia management focused on direct therapy of language deficits, counseling, or both. Emerging evidence from Phase II trials suggests transcranial brain stimulation is a promising method to boost aphasia therapy outcomes.
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Affiliation(s)
- Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Argye Elizabeth Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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17
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Schumacher R, Bruehl S, Halai AD, Lambon Ralph MA. The verbal, non-verbal and structural bases of functional communication abilities in aphasia. Brain Commun 2020; 2:fcaa118. [PMID: 33215082 PMCID: PMC7660039 DOI: 10.1093/braincomms/fcaa118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/08/2020] [Accepted: 07/02/2020] [Indexed: 11/20/2022] Open
Abstract
The ability to communicate, functionally, after stroke or other types of acquired brain injury is crucial for the person involved and the people around them. Accordingly, assessment of functional communication is increasingly used in large-scale randomized controlled trials as the primary outcome measure. Despite the importance of functional communication abilities to everyday life and their centrality to the measured efficacy of aphasia interventions, there is little knowledge about how commonly used measures of functional communication relate to each other, whether they capture and grade the full range of patients’ remaining communication skills and how these abilities relate to the patients’ verbal and non-verbal impairments as well as the underpinning lesions. Going beyond language-only factors is essential given that non-verbal abilities can play a crucial role in an individual’s ability to communicate effectively. This study, based on a large sample of patients covering the full range and types of post-stroke aphasia, addressed these important, open questions. The investigation combined data from three established measures of functional communication with a thorough assessment of verbal and non-verbal cognition as well as structural neuroimaging. The key findings included: (i) due to floor or ceiling effects, the full range of patients’ functional communication abilities was not captured by a single assessment alone, limiting the utility of adopting individual tests as outcome measures in randomized controlled trials; (ii) phonological abilities were most strongly related to all measures of functional communication and (iii) non-verbal cognition was particularly crucial when language production was relatively impaired and other modes of communication were allowed, when patients rated their own communication abilities, and when carers rated patients’ basic communication abilities. Finally, in addition to lesion load being significantly related to all measures of functional communication, lesion analyses showed partially overlapping clusters in language regions for the functional communication tests. Moreover, mirroring the findings from the regression analyses, additional regions previously associated with non-verbal cognition emerged for the Scenario Test and for the Patient Communication Outcome after Stroke rating scale. In conclusion, our findings elucidated the cognitive and neural bases of functional communication abilities, which may inform future clinical practice regarding assessments and therapy. In particular, it is necessary to use more than one measure to capture the full range and multifaceted nature of patients’ functional communication abilities and a therapeutic focus on non-verbal cognition might have positive effects on this important aspect of activity and participation.
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Affiliation(s)
- Rahel Schumacher
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK.,Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Stefanie Bruehl
- St Mauritius Rehabilitation Centre, 40670 Meerbusch, Germany.,Clinical and Cognitive Neurosciences, Department of Neurology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany.,Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester M13 9PL, UK
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
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18
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Msigwa SS, Cheng X. The management of subacute and chronic vascular aphasia: an updated review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00224-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Post-stroke aphasia (PSA) is an impairment of the generation or comprehension of language due to acute cerebrovascular lesions. Subacute phase span the 7th day to 24 weeks post-onset while > 6 months is termed chronic phase. Language recovery does not arise immediately in chronic PSA, unlike the acute phase. The majority of the treatment modalities in these two PSA phases are still in the infancy stage, facing dilemmas and considered experimental requiring constant updates. Hence, we aimed to upgrade the existing literature regarding available PSA management options, advances, and drawbacks pertaining to subacute and chronic phases.
Main text
In this review, we analyzed the management options for subacute and chronic vascular aphasia. MEDLINE, through PubMed, ScienceDirect, and Google Scholar were explored for English studies by utilizing the terms “stroke aphasia” Plus “vascular aphasia”; 160,753 articles were retrieved. The latest studies, published from 2016 to July 2020, were selected. Article headings and abstracts were analyzed for relevance and filtered; eventually, 92 articles were included in this review. Various management options were extracted as follows: noninvasive brain stimulation (NIBS), technology-based therapies, speech-language therapy (SLT), pharmacotherapy, music-based therapies, and psychosocial interventions.
Conclusion
The PSA therapy evolves towards more intense SLT therapy, yet the optimal dosage of the emerging high-intensity therapies is controversial. As spinal and cerebellar NIBS, Telespeech, and E-mental health mark PSA's future, distinct pharmacological options remain a dilemma. Across the continuum of care, PSA–depression comorbidity and inadequate PSA post-discharge education to patient’s families are the significant therapeutic challenges. Future therapeutic mechanisms, optimal dose/timing, and tolerability/safety exploration are obliged.
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19
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Schumacher R, Halai AD, Lambon Ralph MA. Assessing and mapping language, attention and executive multidimensional deficits in stroke aphasia. Brain 2020; 142:3202-3216. [PMID: 31504247 PMCID: PMC6794940 DOI: 10.1093/brain/awz258] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 01/06/2023] Open
Abstract
There is growing awareness that aphasia following a stroke can include deficits in other cognitive functions and that these are predictive of certain aspects of language function, recovery and rehabilitation. However, data on attentional and executive (dys)functions in individuals with stroke aphasia are still scarce and the relationship to underlying lesions is rarely explored. Accordingly in this investigation, an extensive selection of standardized non-verbal neuropsychological tests was administered to 38 individuals with chronic post-stroke aphasia, in addition to detailed language testing and MRI. To establish the core components underlying the variable patients’ performance, behavioural data were explored with rotated principal component analyses, first separately for the non-verbal and language tests, then in a combined analysis including all tests. Three orthogonal components for the non-verbal tests were extracted, which were interpreted as shift-update, inhibit-generate and speed. Three components were also extracted for the language tests, representing phonology, semantics and speech quanta. Individual continuous scores on each component were then included in a voxel-based correlational methodology analysis, yielding significant clusters for all components. The shift-update component was associated with a posterior left temporo-occipital and bilateral medial parietal cluster, the inhibit-generate component was mainly associated with left frontal and bilateral medial frontal regions, and the speed component with several small right-sided fronto-parieto-occipital clusters. Two complementary multivariate brain-behaviour mapping methods were also used, which showed converging results. Together the results suggest that a range of brain regions are involved in attention and executive functioning, and that these non-language domains play a role in the abilities of patients with chronic aphasia. In conclusion, our findings confirm and extend our understanding of the multidimensionality of stroke aphasia, emphasize the importance of assessing non-verbal cognition in this patient group and provide directions for future research and clinical practice. We also briefly compare and discuss univariate and multivariate methods for brain-behaviour mapping.
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Affiliation(s)
- Rahel Schumacher
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.,Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Neuroscience and Aphasia Research Unit, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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20
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Halai AD, Woollams AM, Lambon Ralph MA. Investigating the effect of changing parameters when building prediction models for post-stroke aphasia. Nat Hum Behav 2020; 4:725-735. [PMID: 32313234 DOI: 10.1038/s41562-020-0854-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 03/06/2020] [Indexed: 12/24/2022]
Abstract
Neuroimaging has radically improved our understanding of how speech and language abilities map to the brain in normal and impaired participants, including the diverse, graded variations observed in post-stroke aphasia. A handful of studies have begun to explore the reverse inference: creating brain-to-behaviour prediction models. In this study, we explored the effect of three critical parameters on model performance: (1) brain partitions as predictive features, (2) combination of multimodal neuroimaging and (3) type of machine learning algorithms. We explored the influence of these factors while predicting four principal dimensions of language and cognition variation in post-stroke aphasia. Across all four behavioural dimensions, we consistently found that prediction models derived from diffusion-weighted data did not improve performance over models using structural measures extracted from T1 scans. Our results provide a set of principles to guide future work aiming to predict outcomes in neurological patients from brain imaging data.
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Affiliation(s)
- Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - Anna M Woollams
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
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21
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Martin N, Dell GS. Maintenance Versus Transmission Deficits: The Effect of Delay on Naming Performance in Aphasia. Front Hum Neurosci 2019; 13:406. [PMID: 31827429 PMCID: PMC6890832 DOI: 10.3389/fnhum.2019.00406] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/01/2019] [Indexed: 11/13/2022] Open
Abstract
We propose that deficits in lexical retrieval can involve difficulty in transmission of activation between processing levels, or difficulty in maintaining activation. In support, we present an investigation of picture naming by persons with aphasia in which the naming response is generated after a 1 s (sec) cue to respond in one condition or a 5 s cue to respond in another. Some individuals did better after 5 s, some did worse after 5 s, and some were not impacted by the delay. It is suggested that better performance after 5 s indicates a transmission deficit and that worse performance after 5 s indicates a maintenance deficit. To support this hypothesis, we adapted the two-step semantic-phonological model of lexical retrieval (Schwartz et al., 2006) so that it can simulate the passage of time and can simulate lesions in transmission (its semantic and phonological connection strength parameters) and/or maintenance (its decay parameter). The naming error patterns after 1 and 5 s for each participant were successfully fit to the model. Persons who did better after 5 s were found to have low connection strength parameters, persons who did worse after 5 s were simulated with an increased decay rate, and persons whose performance did not differ with delay were found to have lesions of both types. Some potential theoretical and clinical implications are discussed.
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Affiliation(s)
- Nadine Martin
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA, United States
| | - Gary S Dell
- Beckman Institute and Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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22
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The neural and neurocomputational bases of recovery from post-stroke aphasia. Nat Rev Neurol 2019; 16:43-55. [DOI: 10.1038/s41582-019-0282-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/15/2022]
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23
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Harmon TG, Jacks A, Haley KL, Bailliard A. Dual-Task Effects on Story Retell for Participants With Moderate, Mild, or No Aphasia: Quantitative and Qualitative Findings. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1890-1905. [PMID: 31181172 DOI: 10.1044/2019_jslhr-l-18-0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aims of the study were to determine dual-task effects on content accuracy, delivery speed, and perceived effort during narrative discourse in people with moderate, mild, or no aphasia and to explore subjective reactions to retelling a story with a concurrent task. Method Two studies (1 quantitative and 1 qualitative) were conducted. In Study 1, participants with mild or moderate aphasia and neurotypical controls retold short stories in isolation and while simultaneously distinguishing between high and low tones. Story retell accuracy (speech productivity and efficiency), speed (speech rate, repetitions, and pauses), and perceived effort were measured and compared. In Study 2, participants completed semistructured interviews about their story retell experience. These interviews were recorded, transcribed orthographically, and coded qualitatively using thematic analysis. Results The dual task interfered more with spoken language of people with aphasia than controls, but different speed-accuracy trade-off patterns were noted. Participants in the moderate aphasia group reduced accuracy with little alteration to speed, whereas participants in the mild aphasia group maintained accuracy and reduced their speed. Participants in both groups also reported more negative emotional and behavioral reactions to the dual-task condition than their neurotypical peers. Intentional strategies for coping with the cognitive demands of the dual-task condition were only reported by participants with mild aphasia. Conclusion The findings suggest that, although communicating with a competing task is more difficult for people with aphasia than neurotypical controls, participants with mild aphasia may be better able to cope with cognitively demanding communication situations than participants with moderate aphasia. Supplemental Material https://doi.org/10.23641/asha.8233391.
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Affiliation(s)
- Tyson G Harmon
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Adam Jacks
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Katarina L Haley
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Antoine Bailliard
- Division of Occupational Science and Occupational Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
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