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Staiger A, Schroeter ML, Ziegler W, Pino D, Regenbrecht F, Schölderle T, Rieger T, Riedl L, Müller-Sarnowski F, Diehl-Schmid J. Speech Motor Profiles in Primary Progressive Aphasia. Am J Speech Lang Pathol 2023; 32:1296-1321. [PMID: 37099755 DOI: 10.1044/2023_ajslp-22-00319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Previous research on motor speech disorders (MSDs) in primary progressive aphasia (PPA) has largely focused on patients with the nonfluent/agrammatic variant of PPA (nfvPPA), with few systematic descriptions of MSDs in variants other than nfvPPA. There has also been an emphasis on studying apraxia of speech, whereas less is known about dysarthria or other forms of MSDs. This study aimed to examine the qualitative and quantitative characteristics of MSDs in a prospective sample of individuals with PPA independent of subtype. METHOD We included 38 participants with a root diagnosis of PPA according to current consensus criteria, including one case with primary progressive apraxia of speech. Speech tasks comprised various speech modalities and levels of complexity. Expert raters used a novel protocol for auditory speech analyses covering all major dimensions of speech. RESULTS Of the participants, 47.4% presented with some form of MSD. Individual speech motor profiles varied widely with respect to the different speech dimensions. Besides apraxia of speech, we observed different dysarthria syndromes, special forms of MSDs (e.g., neurogenic stuttering), and mixed forms. Degrees of severity ranged from mild to severe. We also observed MSDs in patients whose speech and language profiles were incompatible with nfvPPA. CONCLUSIONS The results confirm that MSDs are common in PPA and can manifest in different syndromes. The findings emphasize that future studies of MSDs in PPA should be extended to all clinical variants and should take into account the qualitative characteristics of motor speech dysfunction across speech dimensions. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22555534.
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Affiliation(s)
- Anja Staiger
- Clinical Neuropsychology Research Group (EKN), Institute of Phonetics and Speech Processing, Ludwig-Maximilians-Universität (LMU) München, Germany
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences Leipzig & Clinic for Cognitive Neurology, University Hospital Leipzig, Germany
| | - Wolfram Ziegler
- Clinical Neuropsychology Research Group (EKN), Institute of Phonetics and Speech Processing, Ludwig-Maximilians-Universität (LMU) München, Germany
| | - Danièle Pino
- Max Planck Institute for Human Cognitive and Brain Sciences Leipzig & Clinic for Cognitive Neurology, University Hospital Leipzig, Germany
| | - Frank Regenbrecht
- Max Planck Institute for Human Cognitive and Brain Sciences Leipzig & Clinic for Cognitive Neurology, University Hospital Leipzig, Germany
| | - Theresa Schölderle
- Clinical Neuropsychology Research Group (EKN), Institute of Phonetics and Speech Processing, Ludwig-Maximilians-Universität (LMU) München, Germany
| | - Theresa Rieger
- Clinical Neuropsychology Research Group (EKN), Institute of Phonetics and Speech Processing, Ludwig-Maximilians-Universität (LMU) München, Germany
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, Technical University of Munich School of Medicine, Germany
| | - Felix Müller-Sarnowski
- Department of Psychiatry and Psychotherapy, Technical University of Munich School of Medicine, Germany
- Medical Information Sciences, Faculty of Medicine, University of Augsburg, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich School of Medicine, Germany
- Munich Cluster for Systems Neurology (SyNergy), Germany
- kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Wasserburg am Inn, Germany
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Chapman CA, Polyakova M, Mueller K, Weise C, Fassbender K, Fliessbach K, Kornhuber J, Lauer M, Anderl-Straub S, Ludolph A, Prudlo J, Staiger A, Synofzik M, Wiltfang J, Riedl L, Diehl-Schmid J, Otto M, Danek A, Hartwigsen G, Schroeter ML, Engel A, Pfüller G, Pino D, Regenbrecht F, Thöne-Otto A, Oberstein T, Landwehrmeyer B, Lombardi J, Semler E, Kassubek J. Structural correlates of language processing in primary progressive aphasia. Brain Commun 2023; 5:fcad076. [PMID: 37013177 PMCID: PMC10066572 DOI: 10.1093/braincomms/fcad076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/27/2022] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
Abstract
Understanding the relationships between brain structure and language behavior in primary progressive aphasia provides crucial information about these diseases’ pathomechanisms. However, previous investigations have been limited from providing a statistically reliable view of broad language abilities by sample size, variant focus, and task focus. In this study, the authors aimed to determine the relationship between brain structure and language behavior in primary progressive aphasia, to determine the degree to which task-associated regions were atrophied across disease variants, and to determine the degree to which task-related atrophy overlaps across disease variants. Participants were 118 primary progressive aphasia patients and 61 healthy, age-matched controls tested from 2011 to 2018 in the German Consortium for Frontotemporal Lobar Degeneration cohort. Diagnosis of primary progressive aphasia required progressive deterioration of mainly speech and language for ≥ 2 years, and variant was diagnosed by the criteria of Gorno-Tempini et al.2 Twenty-one participants not fulfilling a specific subtype were classified as mixed-variant and excluded. Language tasks of interest included the Boston Naming Test, a German adaptation of the Repeat and Point task, phonemic and category fluency tasks, and the reading/writing subtest of the Aachen Aphasia Test. Brain structure was measured by cortical thickness. We observed networks of language task-associated temporal, frontal, and parietal cortex. Overlapping task-associated atrophy was observed in the left lateral, ventral, and medial temporal lobe, middle and superior frontal gyrus, supramarginal gyrus, and insula. Some regions, primarily in the perisylvian region were associated with language behavior despite showing no significant atrophy. The results crucially extend less powerful studies associating brain and language measures in primary progressive aphasia. Cross-variant atrophy in task-associated regions suggests partially shared underlying deficits, whereas unique atrophy reinforces variant-specific deficits. Language task-related regions that are not obviously atrophied suggest regions of future network disruption and encourage understanding of task deficits beyond clearly atrophied cortex. These results may pave the way for new treatment approaches.
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Affiliation(s)
- Curtiss A Chapman
- Max Planck Institute for Human Cognitive and Brain Sciences, Lise Meitner Group for Cognition and Plasticity , Leipzig 04103 , Germany
| | - Maryna Polyakova
- Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology , Leipzig 04103 , Germany
- Department of Neurology, University of Leipzig Medical Center , Leipzig 04103 , Germany
| | - Karsten Mueller
- Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology , Leipzig 04103 , Germany
| | - Christopher Weise
- Department of Neurology, University of Leipzig Medical Center , Leipzig 04103 , Germany
- Department of Neurology, University of Halle Medical Center , Halle 06120 , Germany
| | - Klaus Fassbender
- Department of Neurology, Saarland University Hospital , Homburg 66421 , Germany
| | - Klaus Fliessbach
- Department of Psychiatry and Psychotherapy, University Hospital Bonn , Bonn 53127 , Germany
- German Center for Neurodegenerative Diseases (DZNE) , Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen , Erlangen 91054 , Germany
| | - Martin Lauer
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg , Würzburg 97080 , Germany
| | | | - Albert Ludolph
- Department of Neurology, University of Ulm , Ulm 89081 , Germany
| | - Johannes Prudlo
- German Center for Neurodegenerative Diseases (DZNE) , Germany
- Department of Neurology, University Medicine Rostock , Rostock 18051 , Germany
| | - Anja Staiger
- Clinical Neuropsychology Research Group, Institute of Phonetics and Speech Processing, Ludwig-Maximilians-University Munich , Munich 80539 , Germany
| | - Matthis Synofzik
- German Center for Neurodegenerative Diseases (DZNE) , Germany
- Department of Neurodegenerative Diseases, Center of Neurology, Hertie Institute for Clinical Brain Research , Tübingen 72076 , Germany
| | - Jens Wiltfang
- German Center for Neurodegenerative Diseases (DZNE) , Germany
- Department of Psychiatry and Psychotherapy, Medical University Göttingen , Göttingen 37075 , Germany
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, Technical University of Munich , Munich 80333 , Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technical University of Munich , Munich 80333 , Germany
| | - Markus Otto
- Department of Neurology, University of Ulm , Ulm 89081 , Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich 80539 , Germany
| | - Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Lise Meitner Group for Cognition and Plasticity , Leipzig 04103 , Germany
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology , Leipzig 04103 , Germany
- Department of Neurology, University of Leipzig Medical Center , Leipzig 04103 , Germany
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de Beer C, Hofmann A, Regenbrecht F, Huttenlauch C, Wartenburger I, Obrig H, Hanne S. Production and Comprehension of Prosodic Boundary Marking in Persons With Unilateral Brain Lesions. J Speech Lang Hear Res 2022; 65:4774-4796. [PMID: 36455138 DOI: 10.1044/2022_jslhr-22-00258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Persons with unilateral brain damage in the right hemisphere (RH) or left hemisphere (LH) show limitations in processing linguistic prosody, with yet inconclusive results on their ability to process prosodically marked structural boundaries for syntactic ambiguity resolution. We aimed at systematically investigating production and comprehension of three prosodic cues (f 0 range, final lengthening, and pause) at structural boundaries in coordinate sequences in participants with right hemisphere brain damage (RHDP) and participants with left hemisphere brain damage (LHDP). METHOD Twenty RHDP and 15 LHDP participated in our study. Comprehension experiment: Participants and a control group listened to coordinate name sequences with internal grouping by a prosodically marked structural boundary (grouped condition, e.g., "(Gabi und Leni) # und Nina") or without internal grouping (ungrouped condition, e.g., "Gabi und Leni und Nina") and had to identify the target condition. The strength and combinations of prosodic cues in the stimuli were manipulated. Production experiment: Participants were asked to produce coordinate sequences in the two conditions (grouped, ungrouped) in two different tasks: a Reading Aloud and a Repetition experiment. Accuracy of participants' productions was subsequently assessed in a rating study and productions were analyzed with respect to use of prosodic cues. RESULTS In the Comprehension experiment, RHDP and LHDP had overall lower identification accuracies than unimpaired control participants and LHDP were found to have particular problems with boundary identification when the pause cue was reduced. In production, LHDP and RHDP employed all three prosodic cues for boundary marking, but struggled to clearly mark prosodic boundaries in 28% of all productions. Both groups showed better performance in reading aloud than in repetition. LHDP relied more on using f 0 range and pause duration to prosodically mark structural boundaries, whereas RHDP employed final lengthening more vigorously than LHDP in reading aloud. CONCLUSIONS We conclude that processing of linguistic prosody is affected in RHDP and LHDP, but not completely impaired. Therefore, prosody can serve as a relevant communicative resource. However, it should also be considered as a target area for assessment and treatment in both groups. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21637505.
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Affiliation(s)
- Carola de Beer
- Cognitive Sciences, University of Potsdam, Germany
- Faculty of Linguistics and Literary Studies and Medical School OWL, University of Bielefeld, Germany
| | | | - Frank Regenbrecht
- University Hospital Leipzig and Max Planck Institute for Human Cognitive and Brain Sciences, Germany
| | | | | | - Hellmuth Obrig
- University Hospital Leipzig and Max Planck Institute for Human Cognitive and Brain Sciences, Germany
| | - Sandra Hanne
- Cognitive Sciences, University of Potsdam, Germany
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van Scherpenberg C, Abdel Rahman R, Regenbrecht F, Obrig H. Semantic Interference through Multiple Distractors in Picture Naming in People with Aphasia. J Cogn Neurosci 2021; 33:1612-1633. [PMID: 34496369 DOI: 10.1162/jocn_a_01731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
When we refer to an object or concept by its name, activation of semantic and categorical information is necessary to retrieve the correct lexical representation. Whereas in neurotypical individuals it is well established that semantic context can interfere with or facilitate lexical retrieval, these effects are much less studied in people with lesions to the language network and impairment at different steps of lexical-semantic processing. Here, we applied a novel picture naming paradigm, where multiple categorically related and unrelated words were presented as distractors before a to-be-named target picture. Using eye tracking, we investigated preferential fixation on the cohort members versus nonmembers. Thereby, we can judge the impact of explicit acknowledgment of the category and its effect on semantic interference. We found that, in contrast to neurotypical participants [van Scherpenberg, C., Abdel Rahman, R., & Obrig, H. A novel multiword paradigm for investigating semantic context effects in language production. PLoS One, 15, e0230439, 2020], participants suffering from mild to moderate aphasia did not show a fixation preference on category members but still showed a large interference effect of ∼35 msec, confirming the implicit mechanism of categorical interference. However, preferential fixation on the categorically related cohort words correlated with clinical tests regarding nonverbal semantic abilities and integrity of the anterior temporal lobe. This highlights the role of supramodal semantics for explicit recognition of a semantic category, while semantic interference is triggered if the threshold of lexical cohort activation is reached. Confirming psycholinguistic evidence, the demonstration of a large and persistent interference effect through implicit lexico-semantic activation is important to understand deficits in people with a lesion in thelanguage network, potentially relevant for individualized intervention aiming at improving naming skills.
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Affiliation(s)
- Cornelia van Scherpenberg
- Humboldt-Universität zu Berlin.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig.,University Clinic Leipzig
| | | | | | - Hellmuth Obrig
- Humboldt-Universität zu Berlin.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig.,University Clinic Leipzig
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Stahl B, Gawron B, Regenbrecht F, Flöel A, Kotz SA. Formulaic Language Resources May Help Overcome Difficulties in Speech-Motor Planning after Stroke. PLoS One 2020; 15:e0233608. [PMID: 32497064 PMCID: PMC7272023 DOI: 10.1371/journal.pone.0233608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/10/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Decades of research have explored communication in cerebrovascular diseases by focusing on formulaic expressions (e.g., “Thank you”—“You’re welcome”). This category of utterances is known for engaging primarily right-hemisphere frontotemporal and bilateral subcortical neural networks, explaining why left-hemisphere stroke patients with speech-motor planning disorders often produce formulaic expressions comparatively well. The present proof-of-concept study aims to confirm that using verbal cues derived from formulaic expressions can alleviate word-onset difficulties, one major symptom in apraxia of speech. Methods In a cross-sectional repeated-measures design, 20 individuals with chronic post-stroke apraxia of speech were asked to produce (i) verbal cues (e.g., /guː/) and (ii) subsequent German target words (e.g., “Tanz”) with critical onsets (e.g., /t/). Cues differed, most notably, in aspects of formulaicity (e.g., stereotyped prompt: /guː/, based on formulaic phrase “Guten Morgen”; unstereotyped prompt: /muː/, based on non-formulaic control word “Mutig”). Apart from systematic variation in stereotypy and communicative-pragmatic embeddedness possibly associated with holistic language processing, cues were matched for consonant-vowel structure, syllable-transition frequency, noun-verb classification, meter, and articulatory tempo. Results Statistical analyses revealed significant increases in correctly produced word onsets after verbal cues with distinct features of formulaicity (e.g., stereotyped versus unstereotyped prompts: p < 0.001), as reflected in large effect sizes (Cohen’s dz ≤ 2.2). Conclusions The current results indicate that using preserved formulaic language skills can relieve word-onset difficulties in apraxia of speech. This finding is consistent with a dynamic interplay of left perilesional and right intact language networks in post-stroke rehabilitation and may inspire new treatment strategies for individuals with apraxia of speech.
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Affiliation(s)
- Benjamin Stahl
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Psychologische Hochschule Berlin, Berlin, Germany
- * E-mail:
| | - Bianca Gawron
- Department of Speech Science, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Frank Regenbrecht
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, Rostock and Greifswald, Germany
| | - Sonja A. Kotz
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Regenbrecht F, Glindemann R, Büttner-Kunert J. Rating-Verfahren in der Therapieplanung bei kognitiven Kommunikationsstörungen. Sprache · Stimme · Gehör 2020. [DOI: 10.1055/a-1043-7259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Ralf Glindemann
- Entwicklungsgruppe Klinische Neuropsychologie (EKN), LMU München
| | - Julia Büttner-Kunert
- Fakultät für Sprach- und Literaturwissenschaften, Departement 13 Germanistik, Komparatistik, Nordistik, Deutsch als Fremdsprache/Studiengang Sprachtherapie, LMU München
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Stahl B, Flöel A, Amelew B, Regenbrecht F, Kotz S. FV5. Tapping into neural resources of verbal communication may help overcome difficulties in speech-motor planning after stroke. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Breitenstein C, Grewe T, Flöel A, Ziegler W, Springer L, Martus P, Huber W, Willmes K, Ringelstein EB, Haeusler KG, Abel S, Glindemann R, Domahs F, Regenbrecht F, Schlenck KJ, Thomas M, Obrig H, de Langen E, Rocker R, Wigbers F, Rühmkorf C, Hempen I, List J, Baumgaertner A. Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting. Lancet 2017; 389:1528-1538. [PMID: 28256356 DOI: 10.1016/s0140-6736(17)30067-3] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/14/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. METHODS In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam-Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. FINDINGS We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (-0·03 points [4·04]; -0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation. INTERPRETATION 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods. FUNDING German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.
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Affiliation(s)
- Caterina Breitenstein
- Department of General Neurology (formerly Department of Neurology), University of Münster, Münster, Germany.
| | - Tanja Grewe
- Faculty of Health and Social Sciences, Fresenius University of Applied Sciences, Idstein and Hamburg, Germany
| | - Agnes Flöel
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Wolfram Ziegler
- Clinical Neuropsychology Research Group, Institute of Phonetics and Speech Processing, Ludwig-Maximilians-University, Munich, Germany
| | - Luise Springer
- Clinical and Cognitive Neuroscience, Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Tübingen, Germany
| | - Walter Huber
- Clinical and Cognitive Neuroscience, Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - Klaus Willmes
- Neuropsychology, Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany
| | - E Bernd Ringelstein
- Department of General Neurology (formerly Department of Neurology), University of Münster, Münster, Germany
| | - Karl Georg Haeusler
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Abel
- Neuropsychology, Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany; School of Biological Sciences, University of Manchester, Manchester, UK
| | - Ralf Glindemann
- Neuropsychological Department, Bogenhausen Hospital, Munich, Germany
| | - Frank Domahs
- Institute of Germanic Linguistics, University of Marburg, Marburg, Germany
| | - Frank Regenbrecht
- Clinic of Cognitive Neurology, University of Leipzig and Max Planck Institute for Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Marion Thomas
- Department of General Neurology (formerly Department of Neurology), University of Münster, Münster, Germany
| | - Hellmuth Obrig
- Clinic of Cognitive Neurology, University of Leipzig and Max Planck Institute for Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Roman Rocker
- Department of General Neurology (formerly Department of Neurology), University of Münster, Münster, Germany
| | - Franziska Wigbers
- Department of General Neurology (formerly Department of Neurology), University of Münster, Münster, Germany
| | - Christina Rühmkorf
- Department of General Neurology (formerly Department of Neurology), University of Münster, Münster, Germany
| | - Indra Hempen
- Department of General Neurology (formerly Department of Neurology), University of Münster, Münster, Germany
| | - Jonathan List
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annette Baumgaertner
- Faculty of Health and Social Sciences, Fresenius University of Applied Sciences, Idstein and Hamburg, Germany
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Henseler I, Regenbrecht F, Obrig H. Lesion correlates of patholinguistic profiles in chronic aphasia: comparisons of syndrome-, modality- and symptom-level assessment. ACTA ACUST UNITED AC 2014; 137:918-30. [PMID: 24525451 DOI: 10.1093/brain/awt374] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
One way to investigate the neuronal underpinnings of language competence is to correlate patholinguistic profiles of aphasic patients to corresponding lesion sites. Constituting the beginnings of aphasiology and neurolinguistics over a century ago, this approach has been revived and refined in the past decade by statistical approaches mapping continuous variables (providing metrics that are not simply categorical) on voxel-wise lesion information (voxel-based lesion-symptom mapping). Here we investigate whether and how voxel-based lesion-symptom mapping allows us to delineate specific lesion patterns for differentially fine-grained clinical classifications. The latter encompass 'classical' syndrome-based approaches (e.g. Broca's aphasia), more symptom-oriented descriptions (e.g. agrammatism) and further refinement to linguistic sub-functions (e.g. lexico-semantic deficits for inanimate versus animate items). From a large database of patients treated for aphasia of different aetiologies (n = 1167) a carefully selected group of 102 first ever ischaemic stroke patients with chronic aphasia (∅ 12 months) were included in a VLSM analysis. Specifically, we investigated how performance in the Aachen Aphasia Test-the standard clinical test battery for chronic aphasia in German-relates to distinct brain lesions. The Aachen Aphasia Test evaluates aphasia on different levels: a non-parametric discriminant procedure yields probabilities for the allocation to one of the four 'standard' syndromes (Broca, Wernicke, global and amnestic aphasia), whereas standardized subtests target linguistic modalities (e.g. repetition), or even more specific symptoms (e.g. phoneme repetition). Because some subtests of the Aachen Aphasia Test (e.g. for the linguistic level of lexico-semantics) rely on rather coarse and heterogeneous test items we complemented the analysis with a number of more detailed clinically used tests in selected mostly mildly affected subgroups of patients. Our results indicate that: (i) Aachen Aphasia Test-based syndrome allocation allows for an unexpectedly concise differentiation between 'Broca's' and 'Wernicke's' aphasia corresponding to non-overlapping anterior and posterior lesion sites; whereas (ii) analyses for modalities and specific symptoms yielded more circumscribed but partially overlapping lesion foci, often cutting across the above syndrome territories; and (iii) especially for lexico-semantic capacities more specialized clinical test-batteries are required to delineate precise lesion patterns at this linguistic level. In sum this is the first report on a successful lesion-delineation of syndrome-based aphasia classification highlighting the relevance of vascular distribution for the syndrome level while confirming and extending a number of more linguistically motivated differentiations, based on clinically used tests. We consider such a comprehensive view reaching from the syndrome to a fine-grained symptom-oriented assessment mandatory to converge neurolinguistic, patholinguistic and clinical-therapeutic knowledge on language-competence and impairment.
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Affiliation(s)
- Ilona Henseler
- 1 Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Henseler I, Regenbrecht F, Obrig H. Zusammenhang zwischen klinischer Aphasiediagnostik und hirnmorphologischen Läsionsmustern: Eine VLSM Studie bei Patienten mit chronischer Aphasie. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Krönke KM, Kraft I, Regenbrecht F, Domahs F, Obrig H. Differentielle Effekte von Gesten-unterstütztem Wortlernen bei Patienten mit Restaphasie. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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