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Zhang W, Liao Y. The effects of symbolic gestural training on enhancing recovery of spoken naming in people with aphasia: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-13. [PMID: 38563470 DOI: 10.1080/17549507.2024.2321939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE This study aimed to evaluate the effects of symbolic gestural training on enhancing recovery of spoken naming in people with aphasia (PWA) using a systematic review and meta-analysis. METHOD Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, article search was conducted from four databases: Web of Science Core Collection, Medline, PsycINFO, and EBSCO. A total of 45 participants from four studies investigating the symbolic gestural training effects on PWA and outcome measures of spoken naming were included. RESULT The meta-analysis showed a medium overall effect of symbolic gestural training on enhancing recovery of spoken naming in PWA. Subgroup analysis also revealed that the training effect was more remarkable in the gesture + verbal training paradigm than in the gesture-only training paradigm. However, the differences in the training effects between short and long duration, and training supplied with and without feedback, were nonsignificant. CONCLUSION This study illustrates the current state of the literature on symbolic gestural training in PWA, and serves as a reference for clinicians, patients, and health policy-makers regarding the application of symbolic gestural training in clinical or rehabilitation programs.
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Affiliation(s)
- Wei Zhang
- School of International Studies, Hainan University, Haikou, China
- Institute of Language Cognition, Carleton University, Ottawa, Canada
| | - Yi Liao
- School of Arts, Qiongtai Normal University, Haikou, China and
- School of Interdisciplinary Science, McMaster University, Hamilton, Canada
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Maggio MG, Stagnitti MC, Rizzo E, Andaloro A, Manuli A, Bruschetta A, Naro A, Calabrò RS. Limb apraxia in individuals with multiple sclerosis: Is there a role of semi-immersive virtual reality in treating the Cinderella of neuropsychology? Mult Scler Relat Disord 2023; 69:104405. [PMID: 36417812 DOI: 10.1016/j.msard.2022.104405] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Limb apraxia is an acquired cognitive-motor disorder characterized by spatial and temporal disorganization of limb movements, negatively affecting the quality of life of patients, including those with multiple sclerosis (MS). Although recent studies have shown the potential role of VR in increasing cognitive and motor functions, only a few studies have been carried out on the rehabilitation of upper limb apraxia. Hence, our study aims to evaluate the potential efficacy of VR training to improve upper limb ideomotor apraxia in patients with MS. METHODS One hundred and six patients, affected by secondary progressive MS, who attended our Robotic and Behavioral Neurorehabilitation Service from March 2019 to February 2020, were enrolled in this study and randomly divided into two groups: the control group (CG: 53 patients) performed traditional therapy whereas the experimental group (EG:53 patients) received training using semi-immersive VR. All patients underwent the same amount of cognitive training, 3 times a week for 8 weeks. They were submitted to a specific neuropsychological assessment before (T0) and after the rehabilitation treatment (T1). RESULTS The VR training led to a significant improvement in global cognitive functions, with regard to constructive and ideomotor apraxia. On the contrary, the CG achieved significant improvements only in ideomotor apraxia. Moreover, only in the EG, we observed an improvement in the mood at the end of training. CONCLUSION The present study demonstrates that VR rehabilitation can be an effective tool for the treatment of apraxia, which is a neuropsychological problem often underestimated in MS patients. Further studies with long-term follow-up periods are needed to confirm the effect of this promising approach.
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Affiliation(s)
- Maria Grazia Maggio
- University of Catania, Department of Biomedical and Biotechnological Science, Via S. Sofia, 64, 95125 Catania (CT), Italy
| | - Maria Chiara Stagnitti
- Studio di Psicoterapia Relazionale e Riabilitazione Cognitiva, viale Europa, 107, 98121, Messina (ME), Italy
| | - Erika Rizzo
- I.O.M.I. "Franco Scalabrino", Via Consolare Pompea, 360, 98165 Ganzirri, Messina (ME), Italy
| | - Adriana Andaloro
- Studio di Riabilitazione Nutrizionale e Cognitiva, Via Sant'Agostino, 14, 98122, Messina (ME), Italy
| | - Alfredo Manuli
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
| | - Antongiulio Bruschetta
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
| | - Antonino Naro
- Azienda Ospedaliera Universitaria di Messina "G. Martino", Via Consolare Valeria, 98125, Messina (ME), Italy
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Kristensson J, Saldert C, Östberg P, Smith SR, Åke S, Longoni F. Naming vs. non-naming treatment in aphasia in a group setting-A randomized controlled trial. JOURNAL OF COMMUNICATION DISORDERS 2022; 97:106215. [PMID: 35367876 DOI: 10.1016/j.jcomdis.2022.106215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Anomia affects numerous persons with aphasia. Treatment effects of anomia group therapy have been reported, but the evidence is not comprehensive. This study aimed to explore treatment effects of a naming treatment compared with a non-naming treatment delivered in a group setting. METHODS In a randomized controlled trial, 17 participants with chronic poststroke aphasia underwent group therapy, 2 hours a session, 3 times per week, for a total of 20 hours. The treatment given in the naming group was modified semantic feature analysis (SFA). Treatment content in the non-naming group comprised auditory comprehension, copying text, and reading. The primary outcome measure was accuracy in confrontation naming of participant-selected trained nouns and verbs. Generalization effects were evaluated in single-word naming, connected speech, and everyday communication. RESULTS Participants in both groups significantly improved their naming of trained items. There were no differences between the groups. The treatment effect did not remain at follow-up 10 weeks after therapy. No other statistically significant changes occurred in either group. CONCLUSIONS Group intervention can improve naming ability in individuals with chronic aphasia. However, similar treatment effects can be achieved using a non-naming treatment as using a naming treatment, such as modified SFA. Further research is warranted to identify the most important elements of anomia group therapy.
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Affiliation(s)
- Joana Kristensson
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden.
| | - Charlotta Saldert
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Per Östberg
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Signe Rödseth Smith
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Sabina Åke
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
| | - Francesca Longoni
- Speech and Language Pathology Unit, Department of Health and Rehabilitation at the Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, PO Box 452, SE-405 30 Gothenburg, Sweden
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Kuyler A, Johnson E, Bornman J. Unaided communication behaviours displayed by adults with severe cerebrovascular accidents and little or no functional speech: A scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:403-421. [PMID: 34967962 DOI: 10.1111/1460-6984.12691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Unaided communication behaviours may provide communication support for persons with severe cerebrovascular accidents (CVA), as these individuals often experience severe communication difficulties, regardless of the aetiology. Though often subtle, these behaviours are present during all stages of recovery, and therefore communication partners need to know not only which unaided strategies are used as communication attempts, but also what their function is (i.e., what the person aims to achieve with the communication). AIM To identify the unaided communication behaviours that adults with severe CVA and little or no functional speech use to communicate, and to determine the communication functions addressed by these behaviours. METHODS & PROCEDURES The study used a scoping review methodology and included articles on communication partners of persons with CVA published between 1986 and 2020. Initially the searches yielded 732 studies from which 211 duplicates were identified. The remaining studies (n = 531) were then screened on title, abstract and full-text level resulting in a final inclusion of 18 studies. Of the 18 studies, five were qualitative and 13 consisted of quantitative methodologies. MAIN CONTRIBUTION The subtle communication behaviours used by persons with CVA (and resultant severe communication difficulties) are often misinterpreted or overlooked by their partners. If partners are trained to recognise such subtle or unaided communication behaviours, they can provide adequate support to access a range of communication functions. The unaided communication behaviours, which include 13 primary behaviours ranging from non-linguistic to linguistic, were utilised to convey 31 communication functions classified into four main communication categories. CONCLUSIONS & IMPLICATIONS Although unaided communication behaviours often appear as limiting, they can be utilised to communicate various communication functions. The findings of this review support the training of partners to identify these behaviours and improve person-partner communication. WHAT IS KNOWN?: Unaided communication has been widely researched. However, a summary is needed of the various unaided communication behaviours and of the different communication functions addressed by these behaviours. What the paper adds… This paper emphasises that unaided communication behaviours range from non-linguistic to linguistic, and they can support unintentional, pre-intentional and intentional communication functions. Clinical implications Even though aided communication is preferred, unaided communication behaviours are generally used in contexts with limited resources, as well as among culturally and linguistically diverse populations. This study advocates the identification of unaided communication behaviours by partners as well as the support and provision of access to communication strategies for persons with severe CVA. Future research should include more untrained communication partners.
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Affiliation(s)
- Ariné Kuyler
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20, Hatfield, 0028, South Africa
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20, Hatfield, 0028, South Africa
| | - Juan Bornman
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20, Hatfield, 0028, South Africa
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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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Murteira A, Nickels L. Can gesture observation help people with aphasia name actions? Cortex 2019; 123:86-112. [PMID: 31760340 DOI: 10.1016/j.cortex.2019.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/04/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
Abstract
It has been suggested that gesture can play a role in the treatment of naming impairments in aphasia, however investigation is still sparse, especially when compared to research on verbal treatments. Critically, previous studies have included either verbal or gesture production in the training. However, while in speakers without language impairment, action naming is facilitated by gesture observation, no study has yet systematically determined whether gesture observation alone influences word retrieval in people with aphasia. This is the aim of the research presented here. In a gesture priming experiment, participants with aphasia named actions that were preceded by the observation of videos of congruent or unrelated gestures or a non-gesture control condition. At the group-level, action naming was facilitated by observation of congruent gestures. However, single-case analyses revealed variability in the extent to which the participants benefited from gesture cueing. The potential mechanisms underlying the effects of gesture observation on action picture naming in people with aphasia were examined by exploring participant-related and item-related predictors of improvement. It is concluded that gesture observation may facilitate verb retrieval at either semantic or lexical levels. In addition, and despite variability across individuals, gesture observation seems more likely to facilitate action naming in people with spared gesture semantics and mild-moderate deficits in lexical-semantic or post-semantic processing.
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Affiliation(s)
- Ana Murteira
- Department of Cognitive Science, Macquarie University, Sydney, Australia; International Doctorate of Experimental Approaches to Language and Brain - IDEALAB, Universities of Trento, Groningen, Potsdam, Newcastle and Macquarie University, Australia.
| | - Lyndsey Nickels
- Department of Cognitive Science, Macquarie University, Sydney, Australia
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Abstract
Limb apraxia is a heterogeneous disorder of skilled action and tool use that has long perplexed clinicians and researchers. It occurs after damage to various loci in a densely interconnected network of regions in the left temporal, parietal, and frontal lobes. Historically, a highly classificatory approach to the study of apraxia documented numerous patterns of performance related to two major apraxia subtypes: ideational and ideomotor apraxia. More recently, there have been advances in our understanding of the functional neuroanatomy and connectivity of the left-hemisphere "tool use network," and the patterns of performance that emerge from lesions to different loci within this network. This chapter focuses on the left inferior parietal lobe, and its role in tool and body representation, action prediction, and action selection, and how these functions relate to the deficits seen in patients with apraxia subsequent to parietal lesions. Finally, suggestions are offered for several future directions that will benefit the study of apraxia, including increased attention to research on rehabilitation of this disabling disorder.
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Affiliation(s)
- Laurel J Buxbaum
- Moss Rehabilitation Research Institute, Elkins Park, PA, United States.
| | - Jennifer Randerath
- Motor Cognition Group, Clinical Neuropsychology and Lurija Institute for Rehabilitation and Health Sciences, University of Konstanz, Konstanz; and Schmieder Foundation for Sciences and Research, Allensbach, Germany
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8
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van Nispen K, van de Sandt-Koenderman WME, Krahmer E. Production and Comprehension of Pantomimes Used to Depict Objects. Front Psychol 2017; 8:1095. [PMID: 28744232 PMCID: PMC5504161 DOI: 10.3389/fpsyg.2017.01095] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 06/13/2017] [Indexed: 11/26/2022] Open
Abstract
Pantomime, gesture in absence of speech, has no conventional meaning. Nevertheless, individuals seem to be able to produce pantomimes and derive meaning from pantomimes. A number of studies has addressed the use of co-speech gesture, but little is known on pantomime. Therefore, the question of how people construct and understand pantomimes arises in gesture research. To determine how people use pantomimes, we asked participants to depict a set of objects using pantomimes only. We annotated what representation techniques people produced. Furthermore, using judgment tasks, we assessed the pantomimes' comprehensibility. Analyses showed that similar techniques were used to depict objects across individuals. Objects with a default depiction method were better comprehended than objects for which there was no such default. More specifically, tools and objects depicted using a handling technique were better understood. The open-answer experiment showed low interpretation accuracy. Conversely, the forced-choice experiment showed ceiling effects. These results suggest that across individuals, similar strategies are deployed to produce pantomime, with the handling technique as the apparent preference. This might indicate that the production of pantomimes is based on mental representations which are intrinsically similar. Furthermore, pantomime conveys semantically rich, but ambiguous, information, and its interpretation is much dependent on context. This pantomime database is available online: https://dataverse.nl/dataset.xhtml?persistentId=hdl:10411/QZHO6M. This can be used as a baseline with which we can compare clinical groups.
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Affiliation(s)
- Karin van Nispen
- Tilburg Center for Cognition and Communication, Department of Communication and Information Sciences, Tilburg UniversityTilburg, Netherlands
| | - W Mieke E van de Sandt-Koenderman
- Rijndam Rehabilitation Center, RoNeResRotterdam, Netherlands.,Erasmus Medical Center, Institute of Rehabilitation MedicineRotterdam, Netherlands
| | - Emiel Krahmer
- Tilburg Center for Cognition and Communication, Department of Communication and Information Sciences, Tilburg UniversityTilburg, Netherlands
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Worthington A. Treatments and technologies in the rehabilitation of apraxia and action disorganisation syndrome: A review. NeuroRehabilitation 2017; 39:163-74. [PMID: 27314872 PMCID: PMC4942853 DOI: 10.3233/nre-161348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Apraxia and Action Disorganisation Syndrome are characterised by an inability to use tools and carry out ordered sequences of movements in the absence of motor or sensory impairment. To date treatment for these complex but debilitating conditions has received little attention. OBJECTIVES: To provide an overview of apraxia and action disorganisation syndrome and its treatment, providing a state of the art summary for practitioners including likely future therapeutic directions. METHOD: Review of apraxia literature and treatment studies collated from internet searches involving MEDLINE, PubMed, PyscINFO and Google Scholar as well as the author’s own catalogue. RESULTS: Evidence for current restitution and compensatory approaches is critically reviewed, with limited evidence to date in support of either method. Strategy training is the most promising intervention type with no support for sensory and exploratory interventions, practice effects only for direct task-specific training, and modest support for gestural training. CONCLUSIONS: Larger controlled studies are needed but evidence is sufficient to indicate certain approaches over others. Advances in assistive technology have not translated into mainstream therapy but future interventions are likely to require a model-based approach which embraces current technologies in order to provide a more accessible, effective and cost-efficient approach to rehabilitation.
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10
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Park JE. Apraxia: Review and Update. J Clin Neurol 2017; 13:317-324. [PMID: 29057628 PMCID: PMC5653618 DOI: 10.3988/jcn.2017.13.4.317] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022] Open
Abstract
Praxis, the ability to perform skilled or learned movements is essential for daily living. Inability to perform such praxis movements is defined as apraxia. Apraxia can be further classified into subtypes such as ideomotor, ideational and limb-kinetic apraxia. Relevant brain regions have been found to include the motor, premotor, temporal and parietal cortices. Apraxia is found in a variety of highly prevalent neurological disorders including dementia, stroke and Parkinsonism. Furthermore, apraxia has been shown to negatively affect quality of life. Therefore, recognition and treatment of this disorder is critical. This article provides an overview of apraxia and highlights studies dealing with the neurophysiology of this disorder, opening up novel perspectives for the use of motor training and noninvasive brain stimulation as treatment.
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Affiliation(s)
- Jung E Park
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
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Roper A, Marshall J, Wilson S. Benefits and Limitations of Computer Gesture Therapy for the Rehabilitation of Severe Aphasia. Front Hum Neurosci 2016; 10:595. [PMID: 27965554 PMCID: PMC5126070 DOI: 10.3389/fnhum.2016.00595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/09/2016] [Indexed: 11/13/2022] Open
Abstract
Aphasia intervention has made increasing use of technology in recent years. The evidence base, which is largely limited to the investigation of spoken language outcomes, indicates positive treatment effects for people with mild to moderate levels of aphasia. Outcomes for those with severe aphasia, however, are less well documented and – where reported – present less consistent gains for measures of spoken output. This study investigates the effects of a purpose-built gesture therapy technology for people with severe aphasia: GeST+. Study outcomes show significant improvement in gesture production abilities for adults with severe aphasia following computer intervention. They indicate no transfer of effects into naming gains or interactive gesture. Outcomes offer encouraging results for computer therapy methods within this hitherto under-researched population but indicate a need for further refinement of interventions in order to maximize persistence of effects and generalization into everyday communication.
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Affiliation(s)
- Abi Roper
- Division of Language and Communication Science, City, University of London London, UK
| | - Jane Marshall
- Division of Language and Communication Science, City, University of London London, UK
| | - Stephanie Wilson
- Centre for Human-Computer Interaction Design, City, University of London London, UK
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van Nispen K, van de Sandt-Koenderman M, Mol L, Krahmer E. Pantomime Production by People With Aphasia: What Are Influencing Factors? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:745-58. [PMID: 27387394 DOI: 10.1044/2015_jslhr-l-15-0166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 11/02/2015] [Indexed: 05/21/2023]
Abstract
PURPOSE The present article aimed to inform clinical practice on whether people with aphasia (PWA) deploy pantomime techniques similarly to participants without brain damage (PWBD) and if not, what factors influence these differences. METHOD We compared 38 PWA to 20 PWBD in their use of 6 representation techniques (handling, enact, object, shape, deictic, and other) when pantomiming objects, and determined whether PWA used the same defaults as PWBD. We assessed the influence of (non-)dominant arm use, ideomotor apraxia, semantic processing, aphasia severity, and oral naming. RESULTS PWA used various pantomime techniques. Enact, deictic, and other were used infrequently. No differences were found for the use of shape techniques, but PWA used fewer handling and object techniques than PWBD and they did not use these for the same objects as PWBD did. No influence was found for (non-)dominant arm use. All other variables correlated with the use of handling, object, and defaults. CONCLUSION In our study, PWA were able to use various pantomime techniques. As a group, they used these techniques differently from PWBD and relied more heavily on the use of shape techniques. This was not influenced by a hemiparesis, but seemed dependent on semantic processing. Clinical implications are discussed.
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13
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Kong APH, Law SP, Wat WKC, Lai C. Co-verbal gestures among speakers with aphasia: Influence of aphasia severity, linguistic and semantic skills, and hemiplegia on gesture employment in oral discourse. JOURNAL OF COMMUNICATION DISORDERS 2015; 56:88-102. [PMID: 26186256 PMCID: PMC4530578 DOI: 10.1016/j.jcomdis.2015.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 06/08/2015] [Accepted: 06/29/2015] [Indexed: 05/20/2023]
Abstract
UNLABELLED The use of co-verbal gestures is common in human communication and has been reported to assist word retrieval and to facilitate verbal interactions. This study systematically investigated the impact of aphasia severity, integrity of semantic processing, and hemiplegia on the use of co-verbal gestures, with reference to gesture forms and functions, by 131 normal speakers, 48 individuals with aphasia and their controls. All participants were native Cantonese speakers. It was found that the severity of aphasia and verbal-semantic impairment was associated with significantly more co-verbal gestures. However, there was no relationship between right-sided hemiplegia and gesture employment. Moreover, significantly more gestures were employed by the speakers with aphasia, but about 10% of them did not gesture. Among those who used gestures, content-carrying gestures, including iconic, metaphoric, deictic gestures, and emblems, served the function of enhancing language content and providing information additional to the language content. As for the non-content carrying gestures, beats were used primarily for reinforcing speech prosody or guiding speech flow, while non-identifiable gestures were associated with assisting lexical retrieval or with no specific functions. The above findings would enhance our understanding of the use of various forms of co-verbal gestures in aphasic discourse production and their functions. Speech-language pathologists may also refer to the current annotation system and the results to guide clinical evaluation and remediation of gestures in aphasia. LEARNING OUTCOMES None.
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Affiliation(s)
- Anthony Pak-Hin Kong
- Department of Communication Sciences and Disorders, University of Central Florida, HPA-2 106, PO Box 162215, Orlando, FL 32816-2215, USA.
| | - Sam-Po Law
- Division of Speech and Hearing Sciences, The University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Watson Ka-Chun Wat
- Division of Speech and Hearing Sciences, The University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Christy Lai
- Division of Speech and Hearing Sciences, The University of Hong Kong, Hong Kong SAR, Hong Kong
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Vanbellingen T, Schumacher R, Eggenberger N, Hopfner S, Cazzoli D, Preisig BC, Bertschi M, Nyffeler T, Gutbrod K, Bassetti CL, Bohlhalter S, Müri RM. Different visual exploration of tool-related gestures in left hemisphere brain damaged patients is associated with poor gestural imitation. Neuropsychologia 2015; 71:158-64. [PMID: 25841335 DOI: 10.1016/j.neuropsychologia.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 02/09/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
According to the direct matching hypothesis, perceived movements automatically activate existing motor components through matching of the perceived gesture and its execution. The aim of the present study was to test the direct matching hypothesis by assessing whether visual exploration behavior correlate with deficits in gestural imitation in left hemisphere damaged (LHD) patients. Eighteen LHD patients and twenty healthy control subjects took part in the study. Gesture imitation performance was measured by the test for upper limb apraxia (TULIA). Visual exploration behavior was measured by an infrared eye-tracking system. Short videos including forty gestures (20 meaningless and 20 communicative gestures) were presented. Cumulative fixation duration was measured in different regions of interest (ROIs), namely the face, the gesturing hand, the body, and the surrounding environment. Compared to healthy subjects, patients fixated significantly less the ROIs comprising the face and the gesturing hand during the exploration of emblematic and tool-related gestures. Moreover, visual exploration of tool-related gestures significantly correlated with tool-related imitation as measured by TULIA in LHD patients. Patients and controls did not differ in the visual exploration of meaningless gestures, and no significant relationships were found between visual exploration behavior and the imitation of emblematic and meaningless gestures in TULIA. The present study thus suggests that altered visual exploration may lead to disturbed imitation of tool related gestures, however not of emblematic and meaningless gestures. Consequently, our findings partially support the direct matching hypothesis.
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Affiliation(s)
- Tim Vanbellingen
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland; Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| | - Rahel Schumacher
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland; Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Noëmi Eggenberger
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland
| | - Simone Hopfner
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland
| | - Dario Cazzoli
- Nuffield Department of Clinical Neurosciences, Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Basil C Preisig
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland
| | - Manuel Bertschi
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland; Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| | - Klemens Gutbrod
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Claudio L Bassetti
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland
| | - Stephan Bohlhalter
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland; Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| | - René M Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland; Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland; Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland.
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Kroenke KM, Kraft I, Regenbrecht F, Obrig H. Lexical learning in mild aphasia: gesture benefit depends on patholinguistic profile and lesion pattern. Cortex 2013; 49:2637-49. [PMID: 24001598 DOI: 10.1016/j.cortex.2013.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/30/2013] [Accepted: 07/06/2013] [Indexed: 11/30/2022]
Abstract
Gestures accompany speech and enrich human communication. When aphasia interferes with verbal abilities, gestures become even more relevant, compensating for and/or facilitating verbal communication. However, small-scale clinical studies yielded diverging results with regard to a therapeutic gesture benefit for lexical retrieval. Based on recent functional neuroimaging results, delineating a speech-gesture integration network for lexical learning in healthy adults, we hypothesized that the commonly observed variability may stem from differential patholinguistic profiles in turn depending on lesion pattern. Therefore we used a controlled novel word learning paradigm to probe the impact of gestures on lexical learning, in the lesioned language network. Fourteen patients with chronic left hemispheric lesions and mild residual aphasia learned 30 novel words for manipulable objects over four days. Half of the words were trained with gestures while the other half were trained purely verbally. For the gesture condition, rootwords were visually presented (e.g., Klavier, [piano]), followed by videos of the corresponding gestures and the auditory presentation of the novel words (e.g., /krulo/). Participants had to repeat pseudowords and simultaneously reproduce gestures. In the verbal condition no gesture-video was shown and participants only repeated pseudowords orally. Correlational analyses confirmed that gesture benefit depends on the patholinguistic profile: lesser lexico-semantic impairment correlated with better gesture-enhanced learning. Conversely largely preserved segmental-phonological capabilities correlated with better purely verbal learning. Moreover, structural MRI-analysis disclosed differential lesion patterns, most interestingly suggesting that integrity of the left anterior temporal pole predicted gesture benefit. Thus largely preserved semantic capabilities and relative integrity of a semantic integration network are prerequisites for successful use of the multimodal learning strategy, in which gestures may cause a deeper semantic rooting of the novel word-form. The results tap into theoretical accounts of gestures in lexical learning and suggest an explanation for the diverging effect in therapeutical studies advocating gestures in aphasia rehabilitation.
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Abstract
SUMMARY Apraxia is a cognitive-motor disorder affecting gestural communication and tool use, and is seen in various neurodegenerative disorders. Apraxia is a major feature of the corticobasal syndrome associated with nonlevodopa-responsive, typically asymmetric parkinsonism. Mild apraxia may also be seen in Parkinson’s disease, at least in later stages of the disease. Furthermore, patients with Alzheimer’s disease or posterior cortical atrophy are prone to develop apraxia during their disease course. However, apraxia may be difficult to dissect from other motor (e.g., dystonia and bradykinesia in corticobasal syndrome) or cognitive (e.g., dysexecutive or semantic memory deficits in Alzheimer’s disease) dysfunction. Therefore, the ecological significance of apraxia in neurodegenerative disorders may not always be obvious. Although treatment protocols for apraxia have been developed in stroke, there is little information on the management of apraxia in neurodegenerative disorders. Owing to their progressive nature, benefits from therapeutic interventions are certainly limited, although some capacity of motor learning may be preserved, at least in earlier disease stages. In advanced cases, management of apraxia should focus on compensatory measures, for instance, on adapting the patient’s environment to their needs, particularly when related to safety and comfort.
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Affiliation(s)
- Stephan Bohlhalter
- Neurology & Neurorehabilitation Center, Department of Internal Medicine, Luzerner Kantonsspital & Department of Clinical Research, University of Bern, 6000 Luzern 16, Switzerland
| | - Francois Osiurak
- Laboratoire d’Etude des Mécanismes Cognitifs (EA 3082), Université Lyon 2, Lyon, France
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Caute A, Pring T, Cocks N, Cruice M, Best W, Marshall J. Enhancing communication through gesture and naming therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2013; 56:337-351. [PMID: 22896049 DOI: 10.1044/1092-4388(2012/11-0232)] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE In this study, the authors investigated whether gesture, naming, and strategic treatment improved the communication skills of 14 people with severe aphasia. METHOD All participants received 15 hr of gesture and naming treatment (reported in a companion article [Marshall et al., 2012]). Half the group received a further 15 hr of strategic therapy, whereas the remaining 7 participants received no further input. The effects of therapy on communication were assessed with 2 novel measures. These measures required each participant to convey simple messages and narratives to his or her communication partner. In both assessments, a subset of the stimuli featured items that had been targets in gesture or naming treatment. RESULTS Performance on the communication measures was stable over 2 baseline assessments but improved after gesture and naming treatment. Those participants who received additional strategic therapy made further gains on the message but not on the narrative task. Communication gains were not specific to the stimuli featuring trained items. CONCLUSIONS This study suggests that gesture and naming treatments can benefit interactive communication. The additional benefits of strategic therapy were less clear-cut but did have an impact on the transmission of simple messages. Gains seem to reflect the development of general communication skills rather than the use of trained gestures and/or words.
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Kamm CP, Heldner MR, Vanbellingen T, Mattle HP, Müri R, Bohlhalter S. Limb Apraxia in Multiple Sclerosis: Prevalence and Impact on Manual Dexterity and Activities of Daily Living. Arch Phys Med Rehabil 2012; 93:1081-5. [DOI: 10.1016/j.apmr.2012.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 01/10/2012] [Accepted: 01/16/2012] [Indexed: 11/24/2022]
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Cantagallo A, Maini M, Rumiati RI. The cognitive rehabilitation of limb apraxia in patients with stroke. Neuropsychol Rehabil 2012; 22:473-88. [DOI: 10.1080/09602011.2012.658317] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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20
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Marshall J, Best W, Cocks N, Cruice M, Pring T, Bulcock G, Creek G, Eales N, Mummery AL, Matthews N, Caute A. Gesture and naming therapy for people with severe aphasia: a group study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2012; 55:726-738. [PMID: 22337498 DOI: 10.1044/1092-4388(2011/11-0219)] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE In this study, the authors (a) investigated whether a group of people with severe aphasia could learn a vocabulary of pantomime gestures through therapy and (b) compared their learning of gestures with their learning of words. The authors also examined whether gesture therapy cued word production and whether naming therapy cued gestures. METHOD Fourteen people with severe aphasia received 15 hr of gesture and naming treatments. Evaluations comprised repeated measures of gesture and word production, comparing treated and untreated items. RESULTS Baseline measures were stable but improved significantly following therapy. Across the group, improvements in naming were greater than improvements in gesture. This trend was evident in most individuals' results, although 3 participants made better progress in gesture. Gains were item specific, and there was no evidence of cross-modality cueing. Items that received gesture therapy did not improve in naming, and items that received naming therapy did not improve in gesture. CONCLUSIONS Results show that people with severe aphasia can respond to gesture and naming therapies. Given the unequal gains, naming may be a more productive therapy target than gesture for many (although not all) individuals with severe aphasia. The communicative benefits of therapy were not examined but are addressed in a follow-up article.
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Roby-Brami A, Hermsdörfer J, Roy AC, Jacobs S. A neuropsychological perspective on the link between language and praxis in modern humans. Philos Trans R Soc Lond B Biol Sci 2012; 367:144-60. [PMID: 22106433 DOI: 10.1098/rstb.2011.0122] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Hypotheses about the emergence of human cognitive abilities postulate strong evolutionary links between language and praxis, including the possibility that language was originally gestural. The present review considers functional and neuroanatomical links between language and praxis in brain-damaged patients with aphasia and/or apraxia. The neural systems supporting these functions are predominantly located in the left hemisphere. There are many parallels between action and language for recognition, imitation and gestural communication suggesting that they rely partially on large, common networks, differentially recruited depending on the nature of the task. However, this relationship is not unequivocal and the production and understanding of gestural communication are dependent on the context in apraxic patients and remains to be clarified in aphasic patients. The phonological, semantic and syntactic levels of language seem to share some common cognitive resources with the praxic system. In conclusion, neuropsychological observations do not allow support or rejection of the hypothesis that gestural communication may have constituted an evolutionary link between tool use and language. Rather they suggest that the complexity of human behaviour is based on large interconnected networks and on the evolution of specific properties within strategic areas of the left cerebral hemisphere.
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Affiliation(s)
- Agnes Roby-Brami
- Laboratory of Neurophysics and Physiology, University Paris Descartes, CNRS UMR 8119, 45 rue des Saints Pères, 75006 Paris, France.
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Dovern A, Fink GR, Weiss PH. Diagnosis and treatment of upper limb apraxia. J Neurol 2012; 259:1269-83. [PMID: 22215235 PMCID: PMC3390701 DOI: 10.1007/s00415-011-6336-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 11/22/2011] [Indexed: 10/30/2022]
Abstract
Upper limb apraxia, a disorder of higher motor cognition, is a common consequence of left-hemispheric stroke. Contrary to common assumption, apraxic deficits not only manifest themselves during clinical testing but also have delirious effects on the patients' everyday life and rehabilitation. Thus, a reliable diagnosis and efficient treatment of upper limb apraxia is important to improve the patients' prognosis after stroke. Nevertheless, to date, upper limb apraxia is still an underdiagnosed and ill-treated entity. Based on a systematic literature search, this review summarizes the current tools of diagnosis and treatment strategies for upper limb apraxia. It furthermore provides clinicians with graded recommendations. In particular, a short screening test for apraxia, and a more comprehensive diagnostic apraxia test for clinical use are recommended. Although currently only a few randomized controlled studies investigate the efficacy of different apraxia treatments, the gesture training suggested by Smania and colleagues can be recommended for the therapy of apraxia, the effects of which were shown to extend to activities of daily living and to persist for at least 2 months after completion of the training. This review aims at directing the reader's attention to the ecological relevance of apraxia. Moreover, it provides clinicians with appropriate tools for the reliable diagnosis and effective treatment of apraxia. Nevertheless, this review also highlights the need for further research into how to improve diagnosis of apraxia based on neuropsychological models and to develop new therapeutic strategies.
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Affiliation(s)
- A Dovern
- Institute of Neuroscience and Medicine, Research Centre Jülich, Leo-Brandt-Straße 5, Jülich, Germany.
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Darrigrand B, Dutheil S, Michelet V, Rereau S, Rousseaux M, Mazaux JM. Communication impairment and activity limitation in stroke patients with severe aphasia. Disabil Rehabil 2010; 33:1169-78. [PMID: 20958196 DOI: 10.3109/09638288.2010.524271] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study investigated how patients with severe aphasia communicated in daily living, which verbal and non-verbal communication skills were spared and which were impaired, and whether activity limitations in communication are related to verbal impairments. METHODS Twenty-seven patients with severe aphasia and 9 with moderate aphasia originating from a sample of 102 aphasic persons followed up in a French regional survey were assessed with a communication test and a communication activity limitation questionnaire 12-18 months after a first stroke. RESULTS Patients with severe aphasia suffered severe activity limitations in communication, with performance 3-fold lower than that of patients with moderate aphasia, and 4-fold lower than scores attained by normals. Both aphasia severity and communication disability at follow-up were related to the initial severity of aphasia. Using a phone, credit card and a chequebook, reading and filling in administrative documents, and communication behaviours involved in social life were the most severely impaired. Non-verbal communication performance was not related to aphasia severity. CONCLUSIONS We conclude that there is a great need for speech therapy research to develop new compensatory or alternative strategies for patients with severe aphasia.
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Affiliation(s)
- Benedicte Darrigrand
- Academic Hospital of Bordeaux and Research group EA 4136 Handicap and Nervous System, University of Bordeaux, France
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Abstract
Abstract
Instructing individuals with aphasia in the usage of AAC strategies and devices is a challenging endeavor. Not only does this population present with a wide range of linguistic impairments, but many individuals also demonstrate cognitive deficits, which may adversely affect communication. This paper will summarize the wide variety of cognitive deficits demonstrated by individuals with aphasia, specifically attention, memory and executive functioning problems. In addition, we will review the impact of these cognitive impairments on communicative competence. Finally, we will discuss an intervention, the Multimodality Communication Training Program (MCTP), designed to address the cognitive impairments that influence AAC intervention.
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Affiliation(s)
- Mary Purdy
- Southern Connecticut State University New Haven, CT
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