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Lemmetyinen S, Hokkanen L, Vehviläinen V, Klippi A. Recovery of gestures for persons with severe non-fluent aphasia and limb apraxia: A long-term follow-up study. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-12. [PMID: 38801404 DOI: 10.1080/23279095.2024.2355668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Persons with severe non-fluent aphasia would benefit from using gestures to substitute for their absent powers of speech. The use of gestures, however, is challenging for persons with aphasia and concomitant limb apraxia. Research on the long-term recovery of gestures is scant, and it is unclear whether gesture performance can show recovery over time. This study evaluated the recovery of emblems and tool use pantomimes of persons with severe non-fluent aphasia and limb apraxia after a left hemisphere stroke. The Florida Apraxia Screening Test-Revised (FAST-R) was used for measurements. The test includes 30 gestures to be performed (i) after an oral request, (ii) with the aid of a pictorial cue, or (iii) as an imitation. The gestures were rated on their degree of comprehensibility. The comprehensibility of gestures after an oral request improved significantly in five out of seven participants between the first (1-3 months after the stroke) and the last (3 years after) examination. Improvement continued for all five in the period between six months and three years. The imitation model did improve the comprehensibility of gestures for all participants, whereas the pictorial cue did so just slightly. The skill of producing gestures can improve even in the late phase post-stroke. Because of this potential, we suggest that gesture training should be systematically included in the rehabilitation of communication for persons with severe non-fluent aphasia.
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Affiliation(s)
- Sanna Lemmetyinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Services of Speech and Language Therapy, Wellbeing Services County of North Karelia, Joensuu, Finland
| | - Laura Hokkanen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Viivi Vehviläinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Anu Klippi
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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Agrawal M, Singh VK, Verma A, Pathak A, Kumar A, Joshi D, Mishra VN, Chaurasia RN. Clinico-radiological factors associated with aphasia outcome in post stroke patients: A prospective follow up study from eastern part of India. J Clin Neurosci 2024; 123:130-136. [PMID: 38574684 DOI: 10.1016/j.jocn.2024.03.002] [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: 11/16/2023] [Revised: 02/05/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Aphasia is a language disorder acquired secondary to brain damage. This study aims to evaluate clinical and radiological profile of patients with post stroke aphasia and factors affecting its recovery. METHODS We conducted a prospective study of patients with first left Middle or Anterior Cerebral Artery infarct or Intracerebral Hemorrhage (ICH) with aphasia admitted within 14 days of stroke onset. Aphasia Quotient (AQ) was assessed at 2 weeks (AQ1) and 3 months (AQ2) using Western Aphasia Battery-Hindi version. Magnetic Resonance Imaging of brain with Diffusion Tensor Imaging (DTI) of bilateral Arcuate Fasciculus (AF) and Corticospinal Tract was done at admission, and stroke volume, Laterality Indices of Fractional Anisotropy (LI-FA), Mean Diffusivity (LI-MD), Radial Diffusivity (LI-RD), Axial Diffusivity (LI-AD) and Apparent Diffusion Coefficient (LI-ADC) were obtained. RESULTS 36 patients [8 ICH and 28 Acute Ischemic Stroke (AIS)] were included. AQ1 and AQ2 were significantly higher in subcortical stroke than cortical. AQ2 and increase in AQ scores (including its subscores) were significantly higher in ICH than AIS. National Institutes of Health Stroke Scale score at admission and volume of stroke had significant negative correlation with AQ1 and AQ2. Laterality Index of Fractional Anisotropy of Arcuate Fasciculus [LI-FA (AF)] had significant positive correlation with AQ2 and naming score at 3 months. Laterality Index of Mean Diffusivity of Arcuate Fasciculus [LI-MD (AF)] had significant negative correlation with AQ1, AQ2 and all subcomponents of AQ2. Significant positive correlation was seen between improvements in Modified Rankin Scale score and AQ. CONCLUSION The study shows that DTI can be used to predict severity of aphasia at follow up and recovery in language and motor functions occur in parallel.
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Affiliation(s)
- Mukund Agrawal
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Varun Kumar Singh
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Ashish Verma
- Department of Radiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Abhishek Pathak
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Anand Kumar
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Deepika Joshi
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Vijaya Nath Mishra
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
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3
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Bunker LD, Bailey DJ, Poss E, Mauszycki S, Wambaugh JL. Stability Over Time of Word Syllable Duration for Speakers With Acquired Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024:1-15. [PMID: 38527280 DOI: 10.1044/2024_jslhr-23-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE Neurogenic speech and language disorders-such as acquired apraxia of speech (AOS) and aphasia with phonemic paraphasia (APP)-are often misdiagnosed due to similarities in clinical presentation. Word syllable duration (WSD)-a measure of average syllable length in multisyllabic words-serves as a proxy for speech rate, which is an important and arguably more objective clinical characteristic of AOS and APP. This study reports stability of WSD over time for speakers with AOS (and aphasia). METHOD Twenty-nine participants with AOS and aphasia (11 women and 18 men, Mage = 53.5 years, SD = 13.3) repeated 30 multisyllabic words (of three-, four-, and five-syllable lengths) on three occasions across 4 weeks. WSDs were calculated for each word and then averaged across each list (i.e., word length), as well as across combined lists (i.e., all 30 words) to yield four WSDs for each participant at each time point. Stability over time was calculated using Friedman's test for the group and using Spearman's rho for the individual level. Effects of time and word length were examined using robust mixed-effects linear regression. RESULTS Friedman's tests and correlations indicated no significant difference in WSDs across sampling occasions for each word length separately or combined. WSD correlated positively with AOS severity and negatively with intelligibility but was not correlated with aphasia severity. Regression analyses confirmed WSD to be stable over time, while WSD calculated from only five tokens (i.e., WSD-5) was less stable over time. CONCLUSIONS Results indicate that WSD can be a stable measure over time, at the individual and group level, providing support for its use in diagnosis and/or as an outcome measure, both clinically and for research. In general, WSD outperformed WSD-5, suggesting that it may be better to calculate WSD from more than five tokens. Stability of WSD in other populations and suitability for differential diagnosis need to be determined. Currently, differentiating disorders by speaking rate, alone, is not recommended. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25438735.
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Affiliation(s)
| | | | - Elaine Poss
- VA Sierra Nevada Health Care System, Reno, NV
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4
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Li TT, Zhang PP, Zhang MC, Zhang H, Wang HY, Yuan Y, Wu SL, Wang XW, Sun ZG. Meta-analysis and systematic review of the relationship between sex and the risk or incidence of poststroke aphasia and its types. BMC Geriatr 2024; 24:220. [PMID: 38438862 PMCID: PMC10910787 DOI: 10.1186/s12877-024-04765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE To analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based guidance for the prevention and treatment of poststroke aphasia in clinical practice. DATA SOURCES Embase, PubMed, Cochrane Library and Web of Science were searched from January 1, 2002, to December 1, 2023. STUDY SELECTION Including the total number of strokes, aphasia, the number of different sexes or the number of PSA corresponding to different sex. DATA EXTRACTION Studies with missing data, aphasia caused by nonstroke and noncompliance with the requirements of literature types were excluded. DATA SYNTHESIS 36 papers were included, from 19 countries. The analysis of 168,259 patients with stroke and 31,058 patients with PSA showed that the risk of PSA was 1.23 times higher in female than in male (OR = 1.23, 95% CI = 1.19-1.29, P < 0.001), with a prevalence of PSA of 31% in men and 36% in women, and an overall prevalence of 34% (P < 0.001). Analysis of the risk of the different types of aphasia in 1,048 patients with PSA showed a high risk in females for global, broca and Wenicke aphasia, and a high risk in males for anomic, conductive and transcortical aphasia, which was not statistically significant by meta-analysis. The incidence of global aphasia (males vs. females, 29% vs. 32%) and broca aphasia (17% vs 19%) were higher in females, and anomic aphasia (19% vs 14%) was higher in males, which was statistically significant (P < 0.05). CONCLUSIONS There are gender differences in the incidence and types of PSA. The risk of PSA in female is higher than that in male.
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Affiliation(s)
- Ting-Ting Li
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Ping-Ping Zhang
- Shanghai University of Medicine & Health Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ming-Chen Zhang
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Hui Zhang
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Hong-Ying Wang
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Ying Yuan
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Shan-Lin Wu
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China.
| | - Zhong-Guang Sun
- School of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China.
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5
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Isakova EV, Kotov SV, Guts ES, Zenina VA. [Possibilities of mirror therapy in cognitive rehabilitation after stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:64-71. [PMID: 39166936 DOI: 10.17116/jnevro202412408264] [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] [Indexed: 08/23/2024]
Abstract
The review provides a brief overview of the history of the development of mirror therapy. Current data on the putative mechanisms of mirror therapy as well as the theory of mirror neurons are presented. The authors describe the implementation of the effects of mirror therapy in motor rehabilitation after stroke, including motor imagination or mental simulation of actions, strengthening of spatial attention and self-perception, activation of the ipsilateral corticospinal tract, reorganization of neuronal networks that influence the state of structurally intact but functionally inactive neurons. The authors reflected the prerequisites for the use of mirror therapy in the rehabilitation of cognitive impairment in poststroke patients. The results of current clinical studies and case reports of the use of mirror therapy for the rehabilitation of speech and non-speech cognitive disorders, and neglect syndrome after stroke are presented.
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Affiliation(s)
- E V Isakova
- Vladimirskiy Moscow Regional Research Clinical Institute, Moscow, Russia
| | - S V Kotov
- Vladimirskiy Moscow Regional Research Clinical Institute, Moscow, Russia
| | - E S Guts
- Vladimirskiy Moscow Regional Research Clinical Institute, Moscow, Russia
| | - V A Zenina
- Vladimirskiy Moscow Regional Research Clinical Institute, Moscow, Russia
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6
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Filipska-Blejder K, Zielińska J, Zieliński M, Wiśniewski A, Ślusarz R. How Does Aphasia Affect Quality of Life? Preliminary Reports. J Clin Med 2023; 12:7687. [PMID: 38137755 PMCID: PMC10744265 DOI: 10.3390/jcm12247687] [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: 10/26/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Aphasia leads to disability, which, in turn, limits and can result in a complete breakdown of roles and social bonds. Thus, the aim of this study was to assess the impact of aphasia disorders on the quality of life of patients after an ischemic stroke. A prospective study among 116 patients with an ischemic stroke (the study group: 68 participants, 38.25% female, included patients with aphasia after a stroke; the control group: 48 patients, 37.5% female, without aphasia) was conducted at the Neurological Department of the Provincial Specialist Hospital in Włocławek. The patients were assessed twice: the first assessment was conducted during hospitalization using the Aphasia Dynamics Assessment Scale and the Aphasia Test Method of Jadwiga Szumska, and the second assessment of the quality of life after six months was conducted using the WHOQOL-BREF questionnaire. The patients from the control group rated their overall quality of life more highly than the patients from the study group. Statistically significant differences were observed in the physical domain, the psychological domain, and the environmental domain. The analysis of sociodemographic factors indicated a negative impact on the quality of life of the following variables: female gender, 55-64 years of age, vocational education, and place of residence-rural area. The degree and type of aphasia influenced the overall quality of life. Studies with larger samples are necessary.
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Affiliation(s)
- Karolina Filipska-Blejder
- Neurological and Neurosurgical Nursing Department, Faculty of Health Science, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Łukasiewicza 1 Street, 85-821 Bydgoszcz, Poland
| | - Jolanta Zielińska
- Faculty of Health Science, Cuiavian University in Włocławek, Plac Wolności 1 Street, 87-800 Włocławek, Poland; (J.Z.); (M.Z.)
| | - Marek Zieliński
- Faculty of Health Science, Cuiavian University in Włocławek, Plac Wolności 1 Street, 87-800 Włocławek, Poland; (J.Z.); (M.Z.)
| | - Adam Wiśniewski
- Department of Neurology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej 9 Street, 85-094 Bydgoszcz, Poland;
| | - Robert Ślusarz
- Neurological and Neurosurgical Nursing Department, Faculty of Health Science, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Łukasiewicza 1 Street, 85-821 Bydgoszcz, Poland
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7
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Federico S, Cacciante L, De Icco R, Gatti R, Jonsdottir J, Pagliari C, Franceschini M, Goffredo M, Cioeta M, Calabrò RS, Maistrello L, Turolla A, Kiper P. Telerehabilitation for Stroke: A Personalized Multi-Domain Approach in a Pilot Study. J Pers Med 2023; 13:1692. [PMID: 38138919 PMCID: PMC10744683 DOI: 10.3390/jpm13121692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Stroke, a leading cause of long-term disability worldwide, manifests as motor, speech language, and cognitive impairments, necessitating customized rehabilitation strategies. In this context, telerehabilitation (TR) strategies have emerged as promising solutions. In a multi-center longitudinal pilot study, we explored the effects of a multi-domain TR program, comprising physiotherapy, speech therapy, and neuropsychological treatments. In total, 84 stroke survivors (74 analyzed) received 20 tailored sessions per domain, addressing individual impairments and customized to their specific needs. Positive correlations were found between initial motor function, cognitive status, independence in activities of daily living (ADLs), and motor function improvement after TR. A lower initial health-related quality of life (HRQoL) perception hindered progress, but improved ADL independence and overall health status, and reduced depression correlated with a better QoL. Furthermore, post-treatment improvements were observed in the entire sample in terms of fine motor skills, upper-limb functionality, balance, independence, and cognitive impairment. This multi-modal approach shows promise in enhancing stroke rehabilitation and highlights the potential of TR in addressing the complex needs of stroke survivors through a comprehensive support and interdisciplinary collaboration, personalized for each individual's needs.
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Affiliation(s)
- Sara Federico
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (P.K.)
| | - Luisa Cacciante
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (P.K.)
| | - Roberto De Icco
- Department of Brain and Behavioral Science, University of Pavia, 27100 Pavia, Italy;
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Roberto Gatti
- Humanitas Clinical and Research Center, IRCCS, Rozzano, 20148 Milan, Italy;
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20148 Milan, Italy
| | | | - Chiara Pagliari
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (J.J.); (C.P.)
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy; (M.F.); (M.G.); (M.C.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00163 Rome, Italy
| | - Michela Goffredo
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy; (M.F.); (M.G.); (M.C.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00163 Rome, Italy
| | - Matteo Cioeta
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy; (M.F.); (M.G.); (M.C.)
| | | | | | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences—DIBINEM, Alma Mater Studiorum Università di Bologna, 40138 Bologna, Italy;
- Unit of Occupational Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pawel Kiper
- Laboratory of Healthcare Innovation Technology, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (P.K.)
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8
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Wilson SM, Entrup JL, Schneck SM, Onuscheck CF, Levy DF, Rahman M, Willey E, Casilio M, Yen M, Brito AC, Kam W, Davis LT, de Riesthal M, Kirshner HS. Recovery from aphasia in the first year after stroke. Brain 2023; 146:1021-1039. [PMID: 35388420 PMCID: PMC10169426 DOI: 10.1093/brain/awac129] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/02/2022] [Accepted: 03/27/2022] [Indexed: 11/13/2022] Open
Abstract
Most individuals who experience aphasia after a stroke recover to some extent, with the majority of gains taking place in the first year. The nature and time course of this recovery process is only partially understood, especially its dependence on lesion location and extent, which are the most important determinants of outcome. The aim of this study was to provide a comprehensive description of patterns of recovery from aphasia in the first year after stroke. We recruited 334 patients with acute left hemisphere supratentorial ischaemic or haemorrhagic stroke and evaluated their speech and language function within 5 days using the Quick Aphasia Battery (QAB). At this initial time point, 218 patients presented with aphasia. Individuals with aphasia were followed longitudinally, with follow-up evaluations of speech and language at 1 month, 3 months, and 1 year post-stroke, wherever possible. Lesions were manually delineated based on acute clinical MRI or CT imaging. Patients with and without aphasia were divided into 13 groups of individuals with similar, commonly occurring patterns of brain damage. Trajectories of recovery were then investigated as a function of group (i.e. lesion location and extent) and speech/language domain (overall language function, word comprehension, sentence comprehension, word finding, grammatical construction, phonological encoding, speech motor programming, speech motor execution, and reading). We found that aphasia is dynamic, multidimensional, and gradated, with little explanatory role for aphasia subtypes or binary concepts such as fluency. Patients with circumscribed frontal lesions recovered well, consistent with some previous observations. More surprisingly, most patients with larger frontal lesions extending into the parietal or temporal lobes also recovered well, as did patients with relatively circumscribed temporal, temporoparietal, or parietal lesions. Persistent moderate or severe deficits were common only in patients with extensive damage throughout the middle cerebral artery distribution or extensive temporoparietal damage. There were striking differences between speech/language domains in their rates of recovery and relationships to overall language function, suggesting that specific domains differ in the extent to which they are redundantly represented throughout the language network, as opposed to depending on specialized cortical substrates. Our findings have an immediate clinical application in that they will enable clinicians to estimate the likely course of recovery for individual patients, as well as the uncertainty of these predictions, based on acutely observable neurological factors.
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Affiliation(s)
- Stephen M Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jillian L Entrup
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Sarah M Schneck
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Caitlin F Onuscheck
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Deborah F Levy
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Maysaa Rahman
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Emma Willey
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Marianne Casilio
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Melodie Yen
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Wayneho Kam
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt Stroke and Cerebrovascular Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - L Taylor Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Michael de Riesthal
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Howard S Kirshner
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt Stroke and Cerebrovascular Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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9
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Bian R, Huo M, Liu W, Mansouri N, Tanglay O, Young I, Osipowicz K, Hu X, Zhang X, Doyen S, Sughrue ME, Liu L. Connectomics underlying motor functional outcomes in the acute period following stroke. Front Aging Neurosci 2023; 15:1131415. [PMID: 36875697 PMCID: PMC9975347 DOI: 10.3389/fnagi.2023.1131415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Objective Stroke remains the number one cause of morbidity in many developing countries, and while effective neurorehabilitation strategies exist, it remains difficult to predict the individual trajectories of patients in the acute period, making personalized therapies difficult. Sophisticated and data-driven methods are necessary to identify markers of functional outcomes. Methods Baseline anatomical T1 magnetic resonance imaging (MRI), resting-state functional MRI (rsfMRI), and diffusion weighted scans were obtained from 79 patients following stroke. Sixteen models were constructed to predict performance across six tests of motor impairment, spasticity, and activities of daily living, using either whole-brain structural or functional connectivity. Feature importance analysis was also performed to identify brain regions and networks associated with performance in each test. Results The area under the receiver operating characteristic curve ranged from 0.650 to 0.868. Models utilizing functional connectivity tended to have better performance than those utilizing structural connectivity. The Dorsal and Ventral Attention Networks were among the top three features in several structural and functional models, while the Language and Accessory Language Networks were most commonly implicated in structural models. Conclusions Our study highlights the potential of machine learning methods combined with connectivity analysis in predicting outcomes in neurorehabilitation and disentangling the neural correlates of functional impairments, though further longitudinal studies are necessary.
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Affiliation(s)
- Rong Bian
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ming Huo
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Wan Liu
- Department of Rehabilitation, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | | | - Onur Tanglay
- Omniscient Neurotechnology, Sydney, NSW, Australia
| | | | | | - Xiaorong Hu
- Xijia Medical Technology Company Limited, Shenzhen, China
| | - Xia Zhang
- Xijia Medical Technology Company Limited, Shenzhen, China.,International Joint Research Center on Precision Brain Medicine, Xidian Group Hospital, Xi'an, China
| | | | - Michael E Sughrue
- Omniscient Neurotechnology, Sydney, NSW, Australia.,International Joint Research Center on Precision Brain Medicine, Xidian Group Hospital, Xi'an, China
| | - Li Liu
- Department of Rehabilitation, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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10
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Swann Z, Daliri A, Honeycutt CF. Impact of Startling Acoustic Stimuli on Word Repetition in Individuals With Aphasia and Apraxia of Speech Following Stroke. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1671-1685. [PMID: 35377739 DOI: 10.1044/2022_jslhr-21-00486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The StartReact effect, whereby movements are elicited by loud, startling acoustic stimuli (SAS), allows the evaluation of movements when initiated through involuntary circuitry, before auditory feedback. When StartReact is applied during poststroke upper extremity movements, individuals exhibit increased muscle recruitment, reaction times, and reaching distances. StartReact releases unimpaired speech with similar increases in muscle recruitment and reaction time. However, as poststroke communication disorders have divergent neural circuitry from upper extremity tasks, it is unclear if StartReact will enhance speech poststroke. Our objective is to determine if (a) StartReact is present in individuals with poststroke aphasia and apraxia and (b) SAS exposure enhances speech intelligibility. METHOD We remotely delivered startling, 105-dB white noise bursts (SAS) and quiet, non-SAS cues to 15 individuals with poststroke aphasia and apraxia during repetition of six words. We evaluated average word intensity, pitch, pitch trajectories, vowel formants F1 and F2 (first and second formants), phonemic error rate, and percent incidence of each SAS versus non-SAS-elicited phoneme produced under each cue type. RESULTS For SAS trials compared to non-SAS, speech intensity increased (∆ + 0.6 dB), speech pitch increased (∆ + 22.7 Hz), and formants (F1 and F2) changed, resulting in a smaller vowel space after SAS. SAS affected pitch trajectories for some, but not all, words. Non-SAS trials had more stops (∆ + 4.7 utterances) while SAS trials had more sustained phonemes (fricatives, glides, affricates, liquids; ∆ + 5.4 utterances). SAS trials had fewer distortion errors but no change in substitution errors or overall error rate compared to non-SAS trials. CONCLUSIONS We show that stroke-impaired speech is susceptible to StartReact, evidenced by decreased intelligibility due to altered formants, pitch trajectories, and articulation, including increased incidence of sounds that could not be produced without SAS. Future studies should examine the impact of SAS on voluntary speech intelligibility and clinical measures of aphasia and apraxia.
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Affiliation(s)
- Zoe Swann
- School of Life Sciences, Arizona State University, Tempe
| | - Ayoub Daliri
- College of Health Solutions, Arizona State University, Tempe
| | - Claire F Honeycutt
- School of Biological and Health Science Engineering, Arizona State University, Tempe
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Ziegler W, Aichert I, Staiger A, Willmes K, Baumgaertner A, Grewe T, Flöel A, Huber W, Rocker R, Korsukewitz C, Breitenstein C. The prevalence of apraxia of speech in chronic aphasia after stroke: A Bayesian hierarchical analysis. Cortex 2022; 151:15-29. [DOI: 10.1016/j.cortex.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 01/24/2023]
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Xu S, Yan Z, Pan Y, Yang Q, Liu Z, Gao J, Yang Y, Wu Y, Zhang Y, Wang J, Zhuang R, Li C, Zhang Y, Jia J. Associations between Upper Extremity Motor Function and Aphasia after Stroke: A Multicenter Cross-Sectional Study. Behav Neurol 2021; 2021:9417173. [PMID: 34795804 PMCID: PMC8595012 DOI: 10.1155/2021/9417173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 12/21/2022] Open
Abstract
METHODS Patients with stroke were compared and correlated from overall and three periods (1-3 months, 4-6 months, and >6 months). Fugl-Meyer assessment for the upper extremity (FMA-UE) and action research and arm test (ARAT) were used to compare the UE motor status between patients with PSA and without PSA through a cross-sectional study among 435 patients. Then, the correlations between the evaluation scale scores of UE motor status and language function of patients with PSA were analyzed in various dimensions, and the language subfunction most closely related to UE motor function was analyzed by multiple linear regression analysis. RESULTS We found that the scores of FMA-UE and ARAT in patients with PSA were 14 points ((CI) 10 to 18, p < 0.001) and 11 points lower ((CI) 8 to 13, p < 0.001), respectively, than those without PSA. Their FMA-UE (r = 0.70, p < 0.001) and ARAT (r = 0.62, p < 0.001) scores were positively correlated with language function. Regression analysis demonstrated that spontaneous speech ability may account for UE motor function (R 2 = 0.51, p < 0.001; R 2 = 0.42, p < 0.001). Consistent results were also obtained from the analyses within the three time subgroups. CONCLUSION Stroke patients with PSA have worse UE motor performance. UE motor status and language function showed positive correlations, in which spontaneous speech ability significantly accounts for the associations.
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Affiliation(s)
- Shuo Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhijie Yan
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Xinxiang Medical University, Xinxiang, China
| | - Yongquan Pan
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qing Yang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhilan Liu
- Department of Rehabilitation Medicine, Shanghai Fourth Rehabilitation Hospital, Shanghai, China
| | - Jiajia Gao
- Department of Neurorehabilitation, The Shanghai Third Rehabilitation Hospital, Shanghai, China
| | - Yanhui Yang
- Department of Rehabilitation Medicine, Shaanxi Provincial Rehabilitation Hospital, Shaanxi, China
| | - Yufen Wu
- Department of Rehabilitation Medicine, Liuzhou Traditional Chinese Medicine Hospital, Guangxi, China
| | - Yanan Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine, Jilin, China
| | - Jianhui Wang
- Department of Rehabilitation Medicine, Nanshi Hospital Affiliated to Henan University, Henan, China
| | - Ren Zhuang
- Department of Rehabilitation Medicine, Changzhou Dean Hospital, Jiangsu, China
| | - Chong Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai University of Sport, Shanghai, China
| | - Yongli Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Fujian University of Traditional Chinese Medicine, Fujian, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, China
- National Center for Neurological Disorders, Shanghai, China
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Mailend ML, Maas E, Story BH. Apraxia of speech and the study of speech production impairments: Can we avoid further confusion? Reply to Romani (2021). Cogn Neuropsychol 2021; 38:309-317. [PMID: 34881683 PMCID: PMC10011684 DOI: 10.1080/02643294.2021.2009790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We agree with Cristina Romani (CR) about reducing confusion and agree that the issues raised in her commentary are central to the study of apraxia of speech (AOS). However, CR critiques our approach from the perspective of basic cognitive neuropsychology. This is confusing and misleading because, contrary to CR's claim, we did not attempt to inform models of typical speech production. Instead, we relied on such models to study the impairment in the clinical category of AOS (translational cognitive neuropsychology). Thus, the approach along with the underlying assumptions is different. This response aims to clarify these assumptions, broaden the discussion regarding the methodological approach, and address CR's concerns. We argue that our approach is well-suited to meet the goals of our recent studies and is commensurate with the current state of the science of AOS. Ultimately, a plurality of approaches is needed to understand a phenomenon as complex as AOS.
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Affiliation(s)
- Marja-Liisa Mailend
- Moss Rehabilitation Research Institute, Einstein Healthcare Network, Elkins Park, PA, USA.,Department of Special Education, University of Tartu, Tartu, Estonia
| | - Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA, USA
| | - Brad H Story
- Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, USA
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