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Papageorgiou G, Kasselimis D, Angelopoulou G, Laskaris N, Tsolakopoulos D, Velonakis G, Tountopoulou A, Vassilopoulou S, Potagas C. Investigating Aphasia Recovery: Demographic and Clinical Factors. Brain Sci 2023; 14:7. [PMID: 38275512 PMCID: PMC10813398 DOI: 10.3390/brainsci14010007] [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: 10/22/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Post-stroke language recovery remains one of the main unresolved topics in the field of aphasia. In recent years, there have been efforts to identify specific factors that could potentially lead to improved language recovery. However, the exact relationship between the recovery of particular language functions and possible predictors, such as demographic or lesion variables, is yet to be fully understood. In the present study, we attempted to investigate such relationships in 42 patients with aphasia after left hemisphere stroke, focusing on three language domains: auditory comprehension, naming and speech fluency. Structural imaging data were also obtained for the identification of the lesion sites. According to our findings, patients demonstrated an overall improvement in all three language domains, while no demographic factor significantly contributed to aphasia recovery. Interestingly, specific lesion loci seemed to have a differential effect on language performance, depending on the time of testing (i.e., acute/subacute vs. chronic phase). We argue that this variability concerning lesion-deficit associations reflects the dynamic nature of aphasia and further discuss possible explanations in the framework of neuroplastic changes during aphasia recovery.
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Affiliation(s)
- Georgios Papageorgiou
- Neuropsychology & Language Disorders Unit, 1st Neurology Department, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.K.); (G.A.); (N.L.); (D.T.); (C.P.)
| | - Dimitrios Kasselimis
- Neuropsychology & Language Disorders Unit, 1st Neurology Department, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.K.); (G.A.); (N.L.); (D.T.); (C.P.)
- Department of Psychology, Panteion University of Social and Political Sciences, 17671 Athens, Greece
| | - Georgia Angelopoulou
- Neuropsychology & Language Disorders Unit, 1st Neurology Department, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.K.); (G.A.); (N.L.); (D.T.); (C.P.)
| | - Nikolaos Laskaris
- Neuropsychology & Language Disorders Unit, 1st Neurology Department, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.K.); (G.A.); (N.L.); (D.T.); (C.P.)
- Department of Industrial Design and Production Engineering, School of Engineering, University of West Attica, 12241 Athens, Greece
| | - Dimitrios Tsolakopoulos
- Neuropsychology & Language Disorders Unit, 1st Neurology Department, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.K.); (G.A.); (N.L.); (D.T.); (C.P.)
| | - Georgios Velonakis
- 2nd Department of Radiology, General University Hospital “Attikon”, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Argyro Tountopoulou
- Stroke Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (A.T.); (S.V.)
| | - Sophia Vassilopoulou
- Stroke Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (A.T.); (S.V.)
| | - Constantin Potagas
- Neuropsychology & Language Disorders Unit, 1st Neurology Department, Eginition Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (D.K.); (G.A.); (N.L.); (D.T.); (C.P.)
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Jacobs M, Evans E, Ellis C. Intersectional sociodemographic and neurological relationships in the naming ability of persons with post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2023; 105:106352. [PMID: 37331326 DOI: 10.1016/j.jcomdis.2023.106352] [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: 12/24/2022] [Revised: 05/16/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Significant attention has been given to the role of brain function and disruption in determining performance on naming tasks among individuals with aphasia. However, scholarly pursuit of a neurological explanation has overlooked the fundamental cornerstone of individual health-the underlying social, economic, and environmental factors that shape how they live, work, and age, also known as the social determinants of health (SDOH). This study examines the correlation between naming performance and these underlying factors. METHODS Individual level data from the 2010 Moss Aphasia Psycholinguistic Project Database (MAPPD) was matched with the 2009-2011 Medical Expenditure Panel Survey (MEPS) using a propensity score algorithm based on functional, health, and demographic characteristics. Multilevel, generalized, nonlinear regression models were applied to the resulting data set to assess the correlation between the Boston Naming Test (BNT) percentile score and age, income, sex, race, household size, marital status, aphasia type, and region of residence. Poisson regression models with bootstrapped standard errors were used to estimate these relationships RESULTS: Discrete dependent variable estimation with non-normal prior specification included individual level (age, marital status, years of education), socioeconomic (family income), health (aphasia type), household (family size), and environmental (region of residence) characteristics. Regression results indicated that, relative to individuals with Wernicke's, individuals with Anomic (0.74, SE = 0.0008) and Conduction (0.42, SE = 0.0009) aphasia performed better on the BNT. While age at the time of testing was not significantly correlated, higher income level (0.15, SE = 0.0003) and larger family size (0.002, SE = 0.002) was associated with higher BNT score percentiles. Finally, Black persons with aphasia (PWA) (-0.0124, SE = 0.0007) had lower average score percentiles when other factors were held constant. CONCLUSIONS The findings reported here suggest higher income and larger family size are associated with better outcomes. As expected, aphasia type was significantly associated with naming outcomes. However, poorer performance by Black PWA and individuals with low income suggests that SDOH can play a critical role (positive and negative) in naming impairment in some populations with aphasia.
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Affiliation(s)
- Molly Jacobs
- Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, United States
| | - Elizabeth Evans
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, United States
| | - Charles Ellis
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, United States.
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Stockbridge MD, Faria AV, Fridriksson J, Rorden C, Bonilha L, Hillis AE. Subacute aphasia recovery is associated with resting-state connectivity within and beyond the language network. Ann Clin Transl Neurol 2023; 10:1525-1532. [PMID: 37403712 PMCID: PMC10502663 DOI: 10.1002/acn3.51842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE To examine changes to connectivity after aphasia treatment in the first 3 months after stroke. METHODS Twenty people experiencing aphasia within the first 3 months of stroke completed MRI before and immediately following 15 hours of language treatment. They were classified based on their response to treatment on a naming test of nouns as either high responders (10% improvement or more), or low responders (<10% improvement). Groups were similar in age, gender distribution, education, days since stroke, stroke volume, and baseline severity. Resting-state functional connectivity analysis was limited to the connectivity of the left fusiform gyrus with the bilateral inferior frontal gyrus, supramarginal gyrus, angular gyrus, and superior, middle, and inferior temporal gyrus, based on previous studies showing the importance of left fusiform gyrus in naming performance. RESULTS Baseline ipsilateral connectivity between the left fusiform gyrus and the language network was similar between high and low responders to therapy when controlling for stroke volume. Following therapy, change in connectivity was significantly greater among high responders between the left fusiform gyrus and the ipsilateral and contralateral pars triangularis, ipsilateral pars opercularis and superior temporal gyrus, and contralateral angular gyrus when compared with low responders. INTERPRETATION An account of these findings incorporates primarily proximal connectivity restoration, but also potentially reflects select contralateral compensatory reorganization. The latter is often associated with chronic recovery, reflecting the transitional nature of the subacute period.
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Affiliation(s)
- Melissa D. Stockbridge
- Department of NeurologyJohns Hopkins University School of MedicineBaltimore21287MarylandUSA
| | - Andreia V. Faria
- Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimore21287MarylandUSA
| | - Julius Fridriksson
- Department of Communication Sciences and DisordersUniversity of South CarolinaColumbia29208South CarolinaUSA
| | - Chris Rorden
- Department of Communication Sciences and DisordersUniversity of South CarolinaColumbia29208South CarolinaUSA
| | - Leonardo Bonilha
- Department of NeurologyEmory University School of MedicineAtlanta30322GeorgiaUSA
| | - Argye E. Hillis
- Department of NeurologyJohns Hopkins University School of MedicineBaltimore21287MarylandUSA
- Department of Physical Medicine and RehabilitationJohns Hopkins University School of MedicineBaltimore21287MarylandUSA
- Department of Cognitive Science, Krieger School of Arts and SciencesJohns Hopkins UniversityBaltimore21218MarylandUSA
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Song SE, Krishnamurthy LC, Rodriguez AD, Han JH, Crosson BA, Krishnamurthy V. Methodologies for task-fMRI based prognostic biomarkers in response to aphasia treatment. Behav Brain Res 2023; 452:114575. [PMID: 37423319 DOI: 10.1016/j.bbr.2023.114575] [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: 11/16/2022] [Revised: 06/14/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
With the diversity in aphasia coupled with diminished gains at the chronic phase, it is imperative to deliver effective rehabilitation plans. Treatment outcomes have therefore been predicted using lesion-to-symptom mapping, but this method lacks holistic functional information about the language-network. This study, therefore, aims to develop whole-brain task-fMRI multivariate analysis to neurobiologically inspect lesion impacts on the language-network and predict behavioral outcomes in persons with aphasia (PWA) undergoing language therapy. In 14 chronic PWA, semantic fluency task-fMRI and behavioral measures were collected to develop prediction methodologies for post-treatment outcomes. Then, a recently developed imaging-based multivariate method to predict behavior (i.e., LESYMAP) was optimized to intake whole-brain task-fMRI data, and systematically tested for reliability with mass univariate methods. We also accounted for lesion size in both methods. Results showed that both mass univariate and multivariate methods identified unique biomarkers for semantic fluency improvements from baseline to 2-weeks post-treatment. Additionally, both methods demonstrated reliable spatial overlap in task-specific areas including the right middle frontal gyrus when identifying biomarkers of language discourse. Thus whole-brain task-fMRI multivariate analysis has the potential to identify functionally meaningful prognostic biomarkers even for relatively small sample sizes. In sum, our task-fMRI based multivariate approach holistically estimates post-treatment response for both word and sentence production and may serve as a complementary tool to mass univariate analysis in developing brain-behavior relationships for improved personalization of aphasia rehabilitation regimens.
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Affiliation(s)
- Serena E Song
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neuroscience and Behavioral Biology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Lisa C Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Joint GSU, Georgia Tech, and Emory Center for Translational Research in Neuroimaging and Data Science (TReNDS), Atlanta, GA, United States; Department of Physics and Astronomy, Georgia State University, Atlanta, GA 30302, United States; Department of Radiology and Imaging Sciences, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Amy D Rodriguez
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neurology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Joo H Han
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Physics and Astronomy, Georgia State University, Atlanta, GA 30302, United States
| | - Bruce A Crosson
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neurology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neurology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States; Department of Medicine, Division of Geriatrics and Gerontology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States.
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Berthier ML, Edelkraut L, López-González FJ, López-Barroso D, Mohr B, Pulvermüller F, Starkstein SE, Jorge RE, Torres-Prioris MJ, Dávila G. Donepezil alone and combined with intensive language-action therapy on depression and apathy in chronic post-stroke aphasia: A feasibility study. BRAIN AND LANGUAGE 2023; 236:105205. [PMID: 36495749 DOI: 10.1016/j.bandl.2022.105205] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
This study explored the feasibility and effectiveness of a short-term (10-week) intervention trial using Donepezil administered alone and combined with intensive language action therapy (ILAT) for the treatment of apathy and depression in ten people with chronic post-stroke aphasia. Outcome measures were the Western Aphasia Battery and the Stroke Aphasia Depression Questionnaire-21. Structural magnetic resonance imaging and 18fluorodeoxyglucose positron emission tomography were acquired at baseline and after two endpoints (Donepezil alone and Donepezil-ILAT). The intervention was found to be feasible to implement. Large treatment effects were found. Donepezil alone and combined with ILAT reduced aphasia severity, while apathy and depression only improved with Donepezil-ILAT. Structural and functional neuroimaging data did not show conclusive results but provide hints for future research. Given these overall positive findings on feasibility, language and behavioral benefits, further studies in larger sample sizes and including a placebo-control group are indicated.
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Affiliation(s)
- Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain
| | - Lisa Edelkraut
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain; Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Francisco J López-González
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of Malaga, Malaga, Spain; Molecular Imaging Group, Radiology Department, Faculty of Medicine, University of Santiago de Compostela, Galicia, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain; Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Bettina Mohr
- Zentrum für Neuropsychologie und Intensive Sprachtherapie - ZeNIS, Berlin, Germany
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, WE4, Freie Universität Berlin, Germany; Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Germany
| | - Sergio E Starkstein
- Faculty of Health and Medical Sciences, The University of Western Australia (M704), Perth, Australia
| | - Ricardo E Jorge
- Department of Psychiatry and Behavioural Sciences, Baylor College of Medicine, Houston, TX, United States
| | - María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain; Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain; Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.
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Nadeau SE. Treatment of disorders of emotional comprehension, expression, and emotional semantics. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:283-297. [PMID: 34389123 DOI: 10.1016/b978-0-12-822290-4.00013-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurological disease can impair emotional communication by several means: damaging the networks important in understanding the meaning of emotional stimuli (emotional semantics); damaging networks important in the perceptual recognition and production of emotional stimuli, and damaging the connections between networks supporting emotional semantics and recognition/production networks. Disorders of emotional expression, comprehension, and emotional semantics may improve with pharmacological or behavioral treatments. Pharmacological treatments can be used to redress naturally occurring or disease-related alterations in the computational properties of target neural systems. No drug treatment can replace a loss of cerebral knowledge related to the pathological loss of neural connectivity. Behavioral treatments that benefit either comprehension or expression of specific emotions may be of value if these emotions are particularly important in enabling human social interaction. However, behavioral treatments that achieve generalization, that is, improve performance with untrained exemplars and in daily life, are much to be preferred, even as they pose the greatest methodological challenges. This chapter will discuss possible mechanisms of generalization and then review what is known about the treatment of expressive and receptive affective aprosodia, deficits in recognition of facial emotions, and pseudobulbar affect. The final section of the chapter is devoted to a discussion of three disorders of emotional semantics, apathy, alexithymia, and impaired empathy.
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Affiliation(s)
- Stephen E Nadeau
- Research Service and the Brain Rehabilitation Research Center, Malcom Randall Veteran Affairs Medical Center, Gainesville, FL, United States; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States.
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Berthier ML, Edelkraut L, Mohr B, Pulvermüller F, Starkstein SE, Green-Heredia C, Dávila G. Intensive aphasia therapy improves low mood in fluent post-stroke aphasia: Evidence from a case-controlled study. Neuropsychol Rehabil 2020; 32:148-163. [PMID: 32867571 DOI: 10.1080/09602011.2020.1809463] [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: 10/23/2022]
Abstract
Introduction: Depressive symptoms are a major drawback of aphasia, negatively impacting on functional outcomes. In a previous study, Intensive Language-Action Therapy (ILAT) was effective in improving depression and low mood in persons with chronic non-fluent aphasia. We present a proof-of-concept case-control study that evaluates language and mood outcomes amongst persons with fluent post-stroke aphasia.Participants: Thirteen Spanish speaking persons with fluent aphasia due to chronic stroke lesions in the left hemisphere participated in the study.Intervention: Five participants (intervention group) received ILAT for 3 h/day during two consecutive weeks, for an overall of 30 h, and 8 participants (control group) entered a waiting-list no-treatment arm.Results: The main finding was that participants receiving active treatment showed significant improvements on depression and aphasia severity scores, whereas no significant changes were found in the control group.Conclusions: The implementation of ILAT was efficient in improving clinical language deficits in people with fluent aphasia and contributes to improvement in mood after therapy.Trial registration: EUDRACT (2008-008481-12).
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Affiliation(s)
- Marcelo L Berthier
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech and Language Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain
| | - Lisa Edelkraut
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech and Language Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech and Language Therapy, University of Málaga, Málaga, Spain
| | - Bettina Mohr
- Department of Psychiatry, Charité Universitätsmedizin, Berlin, Germany.,Zentrum für Neuropsychologie und Intensive Sprachtherapie, ZENIS, Berlin, Germany
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, WE4, Freie Universität Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany
| | - Sergio E Starkstein
- Division of Psychiatry, School of Medicine, The University of Western Australia, Perth, Australia
| | | | - Guadalupe Dávila
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech and Language Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech and Language Therapy, University of Málaga, Málaga, Spain
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Hunting Pompon R, Amtmann D, Bombardier C, Kendall D. Modifying and Validating a Measure of Chronic Stress for People With Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:2934-2949. [PMID: 30515511 DOI: 10.1044/2018_jslhr-l-18-0173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/25/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE Chronic stress is likely a common experience among people with the language impairment of aphasia. Importantly, chronic stress reportedly alters the neural networks central to learning and memory-essential ingredients of aphasia rehabilitation. Before we can explore the influence of chronic stress on rehabilitation outcomes, we must be able to measure chronic stress in this population. The purpose of this study was to (a) modify a widely used measure of chronic stress (Perceived Stress Scale [PSS]; Cohen & Janicki-Deverts, 2012) to fit the communication needs of people with aphasia (PWA) and (b) validate the modified PSS (mPSS) with PWA. METHOD Following systematic modification of the PSS (with permission), 72 PWA completed the validation portion of the study. Each participant completed the mPSS, measures of depression, anxiety, and resilience, and provided a sample of the stress hormone cortisol extracted from the hair. Pearson's product-moment correlations were used to examine associations between mPSS scores and these measures. Approximately 30% of participants completed the mPSS 1 week later to establish test-retest reliability, analyzed using an interclass correlation coefficient. RESULTS Significant positive correlations were evident between the reports of chronic stress and depression and anxiety. In addition, a significant inverse correlation was found between reports of chronic stress and resilience. The mPSS also showed evidence of test-retest reliability. No association was found between mPSS score and cortisol level. CONCLUSION Although questions remain about the biological correlates of chronic stress in people with poststroke aphasia, significant associations between chronic stress and several psychosocial variables provide evidence of validity of this emerging measure of chronic stress.
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Affiliation(s)
- Rebecca Hunting Pompon
- Department of Speech and Hearing Sciences, University of Washington, Seattle
- VA Puget Sound Health Care System, Seattle, WA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Charles Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Diane Kendall
- Department of Speech and Hearing Sciences, University of Washington, Seattle
- VA Puget Sound Health Care System, Seattle, WA
- Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Crosson B, Hampstead BM, Krishnamurthy LC, Krishnamurthy V, McGregor KM, Nocera JR, Roberts S, Rodriguez AD, Tran SM. Advances in neurocognitive rehabilitation research from 1992 to 2017: The ascension of neural plasticity. Neuropsychology 2017; 31:900-920. [PMID: 28857600 DOI: 10.1037/neu0000396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The last 25 years have seen profound changes in neurocognitive rehabilitation that continue to motivate its evolution. Although the concept of nervous system plasticity was discussed by William James (1890), the foundation for experience-based plasticity had not reached the critical empirical mass to seriously impact rehabilitation research until after 1992. The objective of this review is to describe how the emergence of neural plasticity has changed neurocognitive rehabilitation research. METHOD The important developments included (a) introduction of a widely available tool that could measure brain plasticity (i.e., functional MRI); (b) development of new structural imaging techniques that could define limits of and opportunities for neural plasticity; (c) deployment of noninvasive brain stimulation to leverage neural plasticity for rehabilitation; (d) growth of a literature indicating that exercise has positively impacts neural plasticity, especially for older persons; and (e) enhancement of neural plasticity by creating interventions that generalize beyond the boundaries of treatment activities. Given the massive literature, each of these areas is developed by example. RESULTS The expanding influence of neural plasticity has provided new models and tools for neurocognitive rehabilitation in neural injuries and disorders, as well as methods for measuring neural plasticity and predicting its limits and opportunities. Early clinical trials have provided very encouraging results. CONCLUSION Now that neural plasticity has gained a firm foothold, it will continue to influence the evolution of neurocognitive rehabilitation research for the next 25 years and advance rehabilitation for neural injuries and disease. (PsycINFO Database Record
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Affiliation(s)
- Bruce Crosson
- Veterans Affairs Rehabilitation Research and Development Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center
| | - Benjamin M Hampstead
- Neuropsychology Section, Department of Mental Health Services, Veterans Affairs Ann Arbor Healthcare Systems
| | | | | | | | | | | | - Amy D Rodriguez
- Atlanta Veterans Affairs Rehabilitation Research and Development Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center
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Persad C, Wozniak L, Kostopoulos E. Retrospective Analysis of Outcomes from Two Intensive Comprehensive Aphasia Programs. Top Stroke Rehabil 2015; 20:388-97. [DOI: 10.1310/tsr2005-388] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Nadeau SE, Davis SE, Wu SS, Dai Y, Richards LG. A pilot randomized controlled trial of D-cycloserine and distributed practice as adjuvants to constraint-induced movement therapy after stroke. Neurorehabil Neural Repair 2014; 28:885-95. [PMID: 24769437 DOI: 10.1177/1545968314532032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Phase III trials of rehabilitation of paresis after stroke have proven the effectiveness of intensive and extended task practice, but they have also shown that many patients do not qualify, because of severity of impairment, and that many of those who are treated are left with clinically significant deficits. Objective. To test the value of 2 potential adjuvants to normal learning processes engaged in constraint-induced movement therapy (CIMT): greater distribution of treatment over time and the coadministration of d-cycloserine, a competitive agonist at the glycine site of the N-methyl-D-aspartate glutamate receptor. Methods. A prospective randomized single-blind parallel-group trial of more versus less condensed therapy (2 vs 10 weeks) and d-cycloserine (50 mg) each treatment day versus placebo (in a 2 × 2 design), as potential adjuvants to 60 hours of CIMT. Results. Twenty-four participants entered the study, and 22 completed it and were assessed at the completion of treatment and 3 months later. Neither greater distribution of treatment nor treatment with d-cycloserine significantly augmented retention of gains achieved with CIMT. Conclusions. Greater distribution of practice and treatment with d-cycloserine do not appear to augment retention of gains achieved with CIMT. However, concentration of CIMT over 2 weeks ("massed practice") appears to confer no advantage either.
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Affiliation(s)
- Stephen E Nadeau
- Research Service and the Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, and Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sandra E Davis
- University of St Augustine for Health Sciences, St Augustine, FL, USA
| | - Samuel S Wu
- Department of Biostatistics, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Yunfeng Dai
- Department of Biostatistics, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Lorie G Richards
- Division of Occupational Therapy, University of Utah, Salt Lake City, UT, USA
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Moreno-Torres I, Berthier ML, Mar Cid MD, Green C, Gutiérrez A, García-Casares N, Froudist Walsh S, Nabrozidis A, Sidorova J, Dávila G, Carnero-Pardo C. Foreign accent syndrome: A multimodal evaluation in the search of neuroscience-driven treatments. Neuropsychologia 2013. [DOI: 10.1016/j.neuropsychologia.2012.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Mumby K, Whitworth A. Evaluating the effectiveness of intervention in long-term aphasia post-stroke: the experience from CHANT (Communication Hub for Aphasia in North Tyneside). INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2012; 47:398-412. [PMID: 22788226 DOI: 10.1111/j.1460-6984.2012.00153.x] [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
BACKGROUND Despite recognition of the need for increased long-term support for people with aphasia following stroke, there remains limited evidence for effective service-level interventions. AIMS To evaluate the outcomes and experiences of people participating in the Communication Hub for Aphasia in North Tyneside (CHANT), a 2-year partnership project between health, local authority and third-sector services, shaped by people with aphasia, which provided a coordinated programme of support and interventions for people with long-term aphasia following stroke. METHODS & PROCEDURES Quantitative and qualitative methods were used in the evaluation. Thirty-nine participants with aphasia were recruited to the 12-month study as they became part of CHANT, with 20 completing all measures at the end of the study. Participants had no other speech and language therapy during the study. Quantitative measures (before and after intervention) were used for quality of life, self-report outcomes and goal attainment. Three of the participants with aphasia and three further people involved in the service (carer, volunteer, public sector worker) each agreed to a series of five semi-structured interviews over a 9-month period. A total of 28 interviews were collected using neutral interviewers; these were transcribed and analysed by a team within NVivo8 software, based on interpretive principles from grounded theory. Thematic analysis of the narratives explored the experience of engaging with CHANT, and the barriers and facilitators affecting quality of life. OUTCOMES & RESULTS People with aphasia made significant gains in quality of life (in particular, in communication and psychosocial adjustment to stroke) and self-report measures of change. A total of 82% of real-life goals set as part of intervention were fully or partially achieved at follow-up. Five core themes emerged from the narratives: 'Quality of life', 'Barriers', 'Facilitators', 'Types of CHANT activity' and 'Effectiveness'. The intervention was evaluated through the theme of 'Effectiveness' in relation to the other themes, encapsulating emerging participant views (including the type and timeliness of activity, expectations of outcomes, resources and perceived value). The impact of the intervention was also analysed in terms of identifying barriers and providing facilitators. CONCLUSIONS & IMPLICATIONS The quantitative and qualitative (narrative) findings were complementary in demonstrating the effectiveness of the CHANT service delivery model. Moreover, the narratives, through a longitudinal perspective, provided evidence about people's experience of intervention for long-term aphasia. The findings provide foundations for further work into long-term recovery, intervention and adjustment to aphasia post-stroke.
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Affiliation(s)
- Katharyn Mumby
- Speech and Language Sciences, School of Education Communication and Language Sciences, Newcastle University, Newcastle-upon-Tyne, UK.
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Drug Therapy of Post-Stroke Aphasia: A Review of Current Evidence. Neuropsychol Rev 2011; 21:302-17. [DOI: 10.1007/s11065-011-9177-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/27/2011] [Indexed: 11/26/2022]
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