The Epstein-Barr virus oncoprotein latent membrane protein 1 engages the tumor necrosis factor receptor-associated proteins TRADD and receptor-interacting protein (RIP) but does not induce apoptosis or require RIP for NF-kappaB activation

A site in the Epstein-Barr virus (EBV) transforming protein LMP1 that constitutively associates with the tumor necrosis factor receptor 1 (TNFR1)-associated death domain protein TRADD to mediate NF-kappaB and c-Jun N-terminal kinase activation is critical for long-term lymphoblastoid cell proliferation. We now find that LMP1 signaling through TRADD differs from TNFR1 signaling through TRADD. LMP1 needs only 11 amino acids to activate NF-kappaB or synergize with TRADD in NF-kappaB activation, while TNFR1 requires approximately 70 residues. Further, LMP1 does not require TRADD residues 294 to 312 for NF-kappaB activation, while TNFR1 requires TRADD residues 296 to 302. LMP1 is partially blocked for NF-kappaB activation by a TRADD mutant consisting of residues 122 to 293. Unlike TNFR1, LMP1 can interact directly with receptor-interacting protein (RIP) and stably associates with RIP in EBV-transformed lymphoblastoid cell lines. Surprisingly, LMP1 does not require RIP for NF-kappaB activation. Despite constitutive association with TRADD or RIP, LMP1 does not induce apoptosis in EBV-negative Burkitt lymphoma or human embryonic kidney 293 cells. These results add a different perspective to the molecular interactions through which LMP1, TRADD, and RIP participate in B-lymphocyte activation and growth.

The residues between the two transformation effector sites of Epstein-Barr virus latent membrane protein 1 are not critical for B-lymphocyte growth transformation

Epstein-Barr virus (EBV) latent membrane protein 1 (LMP1) is essential for EBV-mediated transformation of primary B lymphocytes. LMP1 spontaneously aggregates in the plasma membrane and enables two transformation effector sites (TES1 and TES2) within the 200-amino-acid cytoplasmic carboxyl terminus to constitutively engage the tumor necrosis factor receptor (TNFR)-associated factors TRAF1, TRAF2, TRAF3, and TRAF5 and the TNFR-associated death domain proteins TRADD and RIP, thereby activating NF-kappaB and c-Jun N-terminal kinase (JNK). To investigate the importance of the 60% of the LMP1 carboxyl terminus that lies between the TES1-TRAF and TES2-TRADD and -RIP binding sites, an EBV recombinant was made that contains a specific deletion of LMP1 codons 232 to 351. Surprisingly, the deletion mutant was similar to wild-type (wt) LMP1 EBV recombinants in its efficiency in transforming primary B lymphocytes into lymphoblastoid cell lines (LCLs). Mutant and wt EBV-transformed LCLs were similarly efficient in long-term outgrowth and in regrowth after endpoint dilution. Mutant and wt LMP1 proteins were also similar in their constitutive association with TRAF1, TRAF2, TRAF3, TRADD, and RIP. Mutant and wt EBV-transformed LCLs were similar in steady-state levels of Bcl2, JNK, and activated JNK proteins. The wt phenotype of recombinants with LMP1 codons 232 to 351 deleted further demarcates TES1 and TES2, underscores their central importance in B-lymphocyte growth transformation, and provides a new perspective on LMP1 sequence variation between TES1 and TES2.

Training verb argument structure production in agrammatic aphasia: behavioral and neural recovery patterns

INTRODUCTION

Neuroimaging and lesion studies indicate a left hemisphere network for verb and verb argument structure processing, involving both frontal and temporoparietal brain regions. Although their verb comprehension is generally unimpaired, it is well known that individuals with agrammatic aphasia often present with verb production deficits, characterized by an argument structure complexity hierarchy, indicating faulty access to argument structure representations for production and integration into syntactic contexts. Recovery of verb processing in agrammatism, however, has received little attention and no studies have examined the neural mechanisms associated with improved verb and argument structure processing. In the present study we trained agrammatic individuals on verbs with complex argument structure in sentence contexts and examined generalization to verbs with less complex argument structure. The neural substrates of improved verb production were examined using functional magnetic resonance imaging (fMRI).

METHODS

Eight individuals with chronic agrammatic aphasia participated in the study (four experimental and four control participants). Production of three-argument verbs in active sentences was trained using a sentence generation task emphasizing the verb's argument structure and the thematic roles of sentential noun phrases. Before and after training, production of trained and untrained verbs was tested in naming and sentence production and fMRI scans were obtained, using an action naming task.

RESULTS

Significant pre- to post-training improvement in trained and untrained (one- and two-argument) verbs was found for treated, but not control, participants, with between-group differences found for verb naming, production of verbs in sentences, and production of argument structure. fMRI activation derived from post-treatment compared to pre-treatment scans revealed upregulation in cortical regions implicated for verb and argument structure processing in healthy controls.

CONCLUSIONS

Training verb deficits emphasizing argument structure and thematic role mapping is effective for improving verb and sentence production and results in recruitment of neural networks engaged for verb and argument structure processing in healthy individuals.

A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

RATIONALE

Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities.

METHODS

We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed.

RESULTS

We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool.

CONCLUSIONS

By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.

Training Pseudoword Reading in Acquired Dyslexia: A Phonological Complexity Approach

BACKGROUND

Individuals with acquired phonological dyslexia experience difficulty associating written letters with corresponding sounds, especially in pseudowords. Previous studies have shown that reading can be improved in these individuals by training letter-sound correspondence, practicing phonological skills, or using combined approaches. However, generalization to untrained items is typically limited.

AIMS

We investigated whether principles of phonological complexity can be applied to training letter-sound correspondence reading in acquired phonological dyslexia to improve generalization to untrained words. Based on previous work in other linguistic domains, we hypothesized that training phonologically "more complex" material (i.e., consonant clusters with small sonority differences) would result in generalization to phonologically "less complex" material (i.e., consonant clusters with larger sonority differences), but this generalization pattern would not be demonstrated when training the "less complex" material.

METHODS & PROCEDURES

We used a single-participant, multiple baseline design across participants and behaviors to examine phonological complexity as a training variable in five individuals. Based on participants' error data from a previous experiment, a "more complex" onset and a "less complex" onset were selected for training for each participant. Training order assignment was pseudo-randomized and counterbalanced across participants. Three participants were trained in the "more complex" condition and two in the "less complex" condition while tracking oral reading accuracy of both onsets.

OUTCOMES & RESULTS

As predicted, participants trained in the "more complex" condition demonstrated improved pseudoword reading of the trained cluster and generalization to pseudowords with the untrained, "simple" onset, but not vice versa.

CONCLUSIONS

These findings suggest phonological complexity can be used to improve generalization to untrained phonologically related words in acquired phonological dyslexia. These findings also provide preliminary support for using phonological complexity theory as a tool for designing more effective and efficient reading treatments for acquired dyslexia.

A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

RATIONALE

Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities.

METHODS

We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed.

RESULTS

We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool.

CONCLUSIONS

By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.

Semantic Typicality Effects in Primary Progressive Aphasia

Prototypical items within a semantic category are processed faster than atypical items within the same category. This typicality effect reflects normal representation and processing of semantic categories and when absent may be reflective of lexical-semantic deficits. We examined typicality effects in individuals with semantic and nonsemantic variants of primary progressive aphasia (PPA; semantic-PPA-S, agrammatic-PPA-G), a neurodegenerative disorder characterized by specific decline in language function, and age-matched controls. Using a semantic category verification task, where participants were asked to decide whether visual or auditory words (category typical, atypical, or nonmembers) belonged within a specified superordinate category, we found a typicality effect (ie, faster response times for typical vs atypical items) for all participant groups. However, participants with more severe PPA-S did not show a typicality effect in either modality. Findings may reflect increased intracategory semantic blurring as the disease progresses and semantic impairment becomes more severe.

Semantic Typicality Effects in Acquired Dyslexia: Evidence for Semantic Impairment in Deep Dyslexia

BACKGROUND: Acquired deep dyslexia is characterized by impairment in grapheme-phoneme conversion and production of semantic errors in oral reading. Several theories have attempted to explain the production of semantic errors in deep dyslexia, some proposing that they arise from impairments in both grapheme-phoneme and lexical-semantic processing, and others proposing that such errors stem from a deficit in phonological production. Whereas both views have gained some acceptance, the limited evidence available does not clearly eliminate the possibility that semantic errors arise from a lexical-semantic input processing deficit. AIMS: To investigate semantic processing in deep dyslexia, this study examined the typicality effect in deep dyslexic individuals, phonological dyslexic individuals, and controls using an online category verification paradigm. This task requires explicit semantic access without speech production, focusing observation on semantic processing from written or spoken input. METHODS #ENTITYSTARTX00026; PROCEDURES: To examine the locus of semantic impairment, the task was administered in visual and auditory modalities with reaction time as the primary dependent measure. Nine controls, six phonological dyslexic participants, and five deep dyslexic participants completed the study. OUTCOMES #ENTITYSTARTX00026; RESULTS: Controls and phonological dyslexic participants demonstrated a typicality effect in both modalities, while deep dyslexic participants did not demonstrate a typicality effect in either modality. CONCLUSIONS: These findings suggest that deep dyslexia is associated with a semantic processing deficit. Although this does not rule out the possibility of concomitant deficits in other modules of lexical-semantic processing, this finding suggests a direction for treatment of deep dyslexia focused on semantic processing.

EEG Error Prediction as a Solution for Combining the Advantages of Retrieval Practice and Errorless Learning

Given the frequency of naming errors in aphasia, a common aim of speech and language rehabilitation is the improvement of naming. Based on evidence of significant word recall improvements in patients with memory impairments, errorless learning methods have been successfully applied to naming therapy in aphasia; however, other evidence suggests that although errorless learning can lead to better performance during treatment sessions, retrieval practice may be the key to lasting improvements. Task performance may vary with brain state (e.g., level of arousal, degree of task focus), and changes in brain state can be detected using EEG. With the ultimate goal of designing a system that monitors patient brain state in real time during therapy, we sought to determine whether errors could be predicted using spectral features obtained from an analysis of EEG. Thus, this study aimed to investigate the use of individual EEG responses to predict error production in aphasia. Eight participants with aphasia each completed 900 object-naming trials across three sessions while EEG was recorded and response accuracy scored for each trial. Analysis of the EEG response for seven of the eight participants showed significant correlations between EEG features and response accuracy (correct vs. incorrect) and error correction (correct, self-corrected, incorrect). Furthermore, upon combining the training data for the first two sessions, the model generalized to predict accuracy for performance in the third session for seven participants when accuracy was used as a predictor, and for five participants when error correction category was used as a predictor. With such ability to predict errors during therapy, it may be possible to use this information to intervene with errorless learning strategies only when necessary, thereby allowing patients to benefit from both the high within-session success of errorless learning as well as the longer-term improvements associated with retrieval practice.

Abnormal development of B cells and B cell progenitors in autoimmune (NZB x NZW)F1 mice

The (NZB x NZW)F1 (BWF1) autoimmune strain displays reduced numbers of both c mu+ pre-B cells and Ly5(220)+ B cell progenitors in the bone marrow. The loss of these B cell precursor populations in the bone marrow increases with age. In contrast, the bone marrow of BWF1 mice possesses sIg+ B cells comparable in both number and surface phenotype to that observed in conventional strains. Analysis of the surface densities of both sIg and Ly5(220) antigens indicates that BWF1 bone marrow B cells comprise a heterogeneous population of both immature and mature B cells. In addition, BWF1 bone marrow still possessed progenitor cells capable of yielding newly generated B cell precursors and B cells in vitro. The diminished levels of intermediate B cell progenitors observed in BWF1 bone marrow may reflect abnormal regulation of B lineage differentiation during the life span of this autoimmune strain.

Effects of CPAP on Language Recovery in Post-Stroke Aphasia: A Review of Recent Literature

Obstructive sleep apnea is highly prevalent in the post-stroke population, and has been shown to affect cognitive, neurological, and functional status. Continuous positive airway pressure (CPAP) treatment is one of the most effective interventions for obstructive sleep apnea, but compliance is often low due to confounding effects of co-occurring conditions, side effects of treatment titration procedures, and individual patient personality characteristics, perceptions, and social factors. Current research suggests that CPAP treatment for obstructive sleep apnea is not associated with significant risk and can subsequently improve post-stroke motor and neurocognitive function. However, effects of CPAP treatment on post-stroke speech and language recovery remain unclear. Post-stroke communication disorders (e.g., aphasia, dysarthria, and apraxia) are also highly prevalent in this population. Knowledge of the potential positive impact of CPAP on language recovery could contribute to patients’ motivation to comply with CPAP treatment and provide incentive for speech-language pathologists to refer patients to sleep medicine specialists. In this review of the literature, we examine the question of what effect CPAP treatment may have on post-stroke speech and language function and recovery, as well as summarize the current knowledge on cognitive, neurological, and functional effects. While this review of the literature found CPAP to have varying effects on different cognitive domains, there was not sufficient evidence to determine effects on language recovery. Further research is necessary to determine the potential effects of CPAP treatment on speech and language recovery among stroke patients.

Sleepiness, Exertion Fatigue, Arousal, and Vigilant Attention in Persons With Chronic Aphasia

Purpose Individuals in the acute and chronic stages of stroke recovery often report more daytime sleepiness (Sterr, Herron, Dijk, & Ellis, 2008) and fatigue that qualitatively differs from "normal" feelings of fatigue they experienced prestroke (De Doncker, Dantzer, Ormstad, & Kuppuswamy, 2018). Speech-language pathologists frequently observe signs of fatigue in their clients with aphasia and perceive that client fatigue impedes therapeutic interventions (Riley, 2017). The current study aimed to quantify daytime sleepiness, exertion fatigue, and physiologically measured arousal and vigilant attention in persons with aphasia. Method We measured sleepiness, exertion fatigue, arousal, and vigilant attention in 10 participants with aphasia and 10 neurologically healthy adults. Daytime sleepiness was measured using the Epworth Sleepiness Scale (Johns, 1991). Exertion fatigue was measured using the Visual Analog Fatigue Scale (B. Y. Tseng, Gajewski, & Kluding, 2010) before and after a 72-min computer-administered language task. Arousal was measured using heart rate and variability (Shaffer & Ginsberg, 2017). Vigilant attention was measured using electroencephalography and subsequently classified into 1 of 4 levels of vigilant attention using a classification algorithm (Berka et al., 2004). Results Persons with aphasia did not show significant differences from controls in reported amount of daytime sleepiness, exertion fatigue, or overall physiological arousal but demonstrated different patterns of electroencephalography-measured vigilant attention and error production as compared to controls. Conclusions Although overall sleepiness, exertion fatigue, and overall arousal did not differ between groups, physiological measures of vigilant attention may be more sensitive to differences and may explain feelings of fatigue that persons with chronic aphasia experience.

Relationship Between Physiologically Measured Attention and Behavioral Task Engagement in Persons With Chronic Aphasia

Purpose Persons with aphasia (PWAs) have been shown to have impaired attention skills that may interfere with their ability to successfully participate in speech and language therapy. Fluctuations in attention can be detected using physiological measures such as electroencephalography (EEG), but these measures can be impractical for clinical use. The primary purpose of this study was to investigate observable behavioral signs of attention as a means of measuring within-session fluctuations in attention by comparing behavioral ratings to physiological changes. Other aims were to understand the relationship between observable behaviors and task performance and to determine whether syntactic complexity influences behavioral attention. Method Ten PWAs and 10 neurologically healthy adults underwent a sentence-reading task with 45 active and 45 passive sentences while video/audio and EEG data were recorded continuously. EEG data for each trial were classified into one of four levels of attention using a classification algorithm (Berka et al., 2004), and video/audio data were scored for accuracy and behavioral engagement by two trained speech-language pathologist students using a behavioral rating scale of inattention (Whyte et al., 1996). Results Results showed that behavioral engagement was significantly correlated with task performance, with higher engagement scores associated with fewer errors. Behavioral engagement did not differ based on syntactic complexity for either group, but PWAs had significantly lower behavioral engagement scores when they were in lower/distracted states of physiologically measured vigilant attention. Conclusion Behavioral observation may provide an alternative means of detecting clinically significant lapses in attention during aphasia therapy.

Eating disorders as addictive behavior. Integrating 12-step programs into treatment planning

To be effective in treating eating-disordered individuals, we must be open to working with an electric model of treatment. Often health care providers have difficulty with the addiction model of treatment, even though many eating-disordered patients will attest to the assistance and support they receive from these programs. It will be useful for both health care professionals and 12-step programs to avoid taking competitive positions. It is far more useful for professionals to have a working knowledge of how these programs work and how they can be of use to the individuals with eating disorders. Knowledge of local resources will also be of great value. Given the assistance that the clients tell us they receive at these programs, it makes more sense to understand and use these programs more, not less. There is evidence that eating disorder behaviors are addictive behavior, both from a psychological and physiologic perspective. Use of a 12-step program will assist with the practical details of helping individuals to stop employing self-destructive behaviors as well as provide support and decrease feelings of isolation and depression. It is important to integrate the 12-step program components into an overall treatment program to make the best use of both programs and decrease the competition usually inherent in both programs.

Pervasiveness of speech-language disorders and fatigue in stroke: A systematic scoping review

BACKGROUND

After a stroke, it is highly likely that an individual will experience substantial fatigue that can significantly affect recovery and function; stroke survivors also have more than a 50% chance of having at least one speech-language disorder. Current reviews of post-stroke fatigue have not provided evidence focused on speech-language disorders or the potential influence they may have on post-stroke fatigue and related recovery.

OBJECTIVES

The aim of this review was to determine how speech-language disorders are represented in post-stroke fatigue research and to catalogue methods used to identify speech-language disorders and measure fatigue.

METHODS

A systematic scoping review was conducted to identify studies measuring post-stroke fatigue. To identify these studies, a comprehensive literature search was conducted using relevant databases and grey literature sources, followed by several stages of review that adhered to PRISMA guidelines. We evaluated these studies using pre-established eligibility criteria and extracted data regarding the inclusion/exclusion of persons with speech-language disorders and the assessment methods used.

RESULTS

The scoping review analysis was conducted on 161 studies. Of these, 41 (26%) excluded all speech-language disorders, 71 (44%) excluded severe speech-language disorders, and 49 (30%) included participants with speech-language disorders. Of the 120 studies that did not explicitly exclude all speech-language disorders, only 34 were confirmed to report data from at least one person with a speech-language disorder. Further, only 5 studies reported data that could be used to determine a relationship between speech-language disorders and fatigue.

CONCLUSIONS

Persons with speech-language disorders are underrepresented in post-stroke fatigue research and very few studies have examined the relationship between post-stroke fatigue and speech-language disorders, limiting conclusions that can be drawn. This is problematic because medical professionals relying on this evidence to guide clinical practice are likely to be treating individuals with co-occurring fatigue and speech-language disorders and the current research does not provide enough information about the potential impact of fatigue on speech-language disorders or vice versa. To bridge this gap, we suggest methods of assessment that could provide ways to more accurately 1) reflect the real population in post-stroke fatigue studies, and 2) measure and document fatigue in post-stroke speech-language disorder studies. We also propose the Filter-Funnel Model of Post-Stroke Fatigue, which considers the role of speech-language disorders and communicative demands in the context of post-stroke fatigue.

Evidence of physiological changes associated with single-session pre-frontal tDCS: a pilot study

Objective

Transcranial direct current stimulation (tDCS), a non-invasive, painless method of applying direct current electrical stimulation to specific areas of the brain, is an effective method for enhancing attention and post-stroke fatigue, as shown by behavioral improvements in post-stroke populations. While behavioral evidence supports this method, there is a paucity of physiological data corroboration of this improvement. The current study is designed to investigate if a single session of tDCS will improve attention and fatigue as shown by relevant physiological methods in persons with post-stroke aphasia.

Methods

Ten participants (5 male; mean age: 62.8) engaged in two identically structured data collection sessions with at least a 3-day wash-out period between them. Sessions started with a sustained attention task with simultaneous electroencephalography (EEG) and pupillometry data collection, followed by an attention training program with simultaneous active or sham tDCS. Following tDCS, participants repeated the sustained attention task with simultaneous EEG and pupillometry data collection. Participants received active tDCS during one session, and sham tDCS during the other, with the order randomized.

Results

No differences between conditions were found for either behavioral results from the sustained attention task (i.e., reaction time of correct responses; n = 9 p = 0.39) or EEG measured attention state data for any of the four attention states: no attention (n = 10, p = 0.83), distracted attention (n = 10, p = 0.20), moderate attention (n = 10, p = 0.95), or high attention (n = 10, p = 0.62). Pupil dilation was significantly greater in the post-active tDCS stimulation condition than in either pre-training condition (n = 10, p < 0.01). tDCS stimulation lessened the increase in task-based fatigue from the beginning to the end of the session such that there was a significant increase in task-based fatigue when participants received sham tDCS (n = 10, p = 0.01) but no significant change in task-based fatigue during the active condition session (n = 10, p = 0.12).

Conclusion

Changes in pupil diameter observed in the active stimulation condition suggest activation of the locus coeruleus-norepinephrine (LC-NE) pathway within a single session of tDCS administration, but the lack of significant changes for either response time or attention states indicate no direct effect on behaviorally measured or EEG measured attention within the same timeframe. Responses to active stimulation in terms of subjective fatigue rating varied between individual participants; overall, active tDCS mitigated task-based fatigue. More research is needed to investigate this relationship.

Vigilant Attention During Cognitive and Language Processing in Aphasia

PURPOSE

Persons with aphasia (PWA) experience differences in attention after stroke, potentially impacting cognitive/language performance. This secondary analysis investigated physiologically measured vigilant attention during linguistic and nonlinguistic processing in PWA and control participants.

METHOD

To evaluate performance and attention in a language task, seven PWA read sentences aloud (linguistic task) and were compared to a previous data set of 10 controls and 10 PWA. To evaluate performance and attention in a language-independent task, 11 controls and nine PWA completed the Bivalent Shape Task (nonlinguistic task). Continuous electroencephalogram (EEG) data were collected during each session. A previously validated EEG algorithm classified vigilant-attention state for each experiment trial into high, moderate, distracted, or no attention. Dependent measures were task accuracy and amount of time spent in each attention state (measured by the number of trials).

RESULTS

PWA produced significantly more errors than controls on the linguistic task, but groups performed similarly on the nonlinguistic task. During the linguistic task, controls spent significantly more time than PWA in a moderate-attention state, but no statistically significant differences were found between groups for other attention states. For the nonlinguistic task, amount of time controls and PWA spent in each attention state was more evenly distributed. When directly comparing attention patterns between linguistic and nonlinguistic tasks, PWA showed significantly more time in a high-attention state during the linguistic task as compared to the nonlinguistic task; however, controls showed no significant differences between linguistic and nonlinguistic tasks.

CONCLUSIONS

This study provides new evidence that PWA experience a heightened state of vigilant attention when language processing demands are higher (during a linguistic task) than when language demands are lower (during a nonlinguistic task). Collectively, results of this study suggest that when processing language, PWA may allocate more attentional resources than when completing other kinds of cognitive tasks.

Codependency and the eating-disorder client

The treatment of eating-disordered individuals with codependency is difficult. This article reviews the causes of eating disorders and codependency and cites similarities between these disorders. The recovery process and treatment needs of this population are explored. Psychotherapy, which is the treatment of choice, is reviewed in detail.

Development of the Fatigue Interference and Severity Scale for Aphasia

PURPOSE

Poststroke fatigue, which is characterized by an overwhelming feeling of exhaustion that affects daily life, is prevalent among stroke survivors and can negatively affect cognition, motor function, employment, life participation, and quality of life. However, individuals with aphasia are often excluded from fatigue studies because of communication barriers, leading to underdiagnosis and an inaccurate picture of the occurrence and impact of poststroke fatigue in persons with aphasia.

METHOD

This study aimed to develop a more aphasia-accessible tool that would be similar to the Fatigue Severity Scale (FSS), a self-reported fatigue measure commonly used to identify significant poststroke fatigue. The Fatigue Interference and Severity Scale for Aphasia (FISS-A) was developed using a modified nominal group technique involving two focus groups: individuals with aphasia and speech-language pathologists. The groups provided feedback on the format, wording, administration, and response methods of the FSS. Focus group feedback led to several key recommendations, including simplifying language, increasing text spacing and font size, incorporating images, and enabling nonverbal responses.

RESULTS

The FISS-A retains the original nine items of the FSS but presents them with lexical and syntactic modifications to enhance clarity and comprehensibility for individuals with aphasia. Visual aids and explicit instructions for providers were added to ensure an accurate administration and response collection. An additional open-ended item was included to capture any fatigue-related symptoms that were not covered by the standard items, and two visual analog scales were added to collect additional ratings of general fatigue severity and its impact on language ability.

CONCLUSIONS

This study highlights the importance of creating accessible assessment tools for clinical and research purposes. Future research will focus on validating the FISS-A across diverse populations and exploring its integration into clinical practice.

Bone marrow stromal cells modulate both kappa light chain and Ly1 antigen expression on Ly1+ pre-B cell lines in vitro

Murine Ly1+ pre-B cell lines, including 70Z/3 and three pre-B cell lines derived from long-term bone marrow cultures, exhibited selective adherence to bone marrow stromal cells. In contrast, splenic B cells, the A20 B-cell lymphoma, and four Ly1- B cell lines derived from long-term bone marrow cultures failed to adhere substiantially to bone marrow cultures failed to adhere substiantially to bone marrow stroma. Ly1+ pre-B cell lines were induced to express kappa light chains by exposure to either lipopolysaccharide (LPS), recombinant interleukin-1 (IL-1), or stromal cells. However, induction of kappa light chains failed to prevent pre-B cell adherence to stromal cells. Supernatants derived from primary bone marrow stromal cells decreased Ly1 expression on the Ly1+ pre-B cell lines. These experiments suggest that (1) expression of immunoglobulin light chains by developing Ly1+ pre-B cells is mediated by bone marrow stromal cells; (2) loss of specific adherence to stroma is progressive and occurs post-light chain induction; and (3) soluble products of stromal cells may downregulate expression of surface Ly1 on otherwise Ly1+ pre-B cells. The importance of these observations to the development of both the Ly1- and Ly1+ B cell lineages in the mouse is discussed.