Aphasia

Schwartz & Dell (2010) advocated for a major role for case series investigations in cognitive neuropsychology. They defined the key features of this approach and presented a number of arguments and examples illustrating the benefits of case series studies and their contribution to computational cognitive neuropsychology. In the Special Issue on "Case Series in Cognitive Neuropsychology" there are six commentaries on Schwartz and Dell (2010) as well as a response to the six commentaries by Dell and Schwartz. In this paper, I provide a brief summary of the key points made in Schwartz and Dell (2010) and I review the promise and perils of case series design as revealed by the six commentaries. I conclude by placing the set of papers within a broader perspective, providing some clarification of the historical record on case series and single case approaches, raising some cautionary notes for case series studies and situating both case series and single case approaches within the larger context of theory development in the cognitive sciences. Schwartz & Dell (2010) presented a number of arguments and examples in advocating for a major role for case series investigations in cognitive neuropsychology. This Special Issue includes six commentaries on Schwartz and Dell (2010) (referred to as S&D), as well as a response to the six commentaries by Dell and Schwartz (D&S). My goal in this paper is to provide a backdrop for the complete set of papers. I will do so by first providing a brief summary of key points made in S&D, then I will discuss the promise and perils of case series design as revealed by the six commentaries; I will end by attempting to place the discussion within a broader perspective.

We sought to identify the core lexicon of a picture description task using transcripts from the AphasiaBank database, and to determine differences in core lexicon usage between control speakers and persons with aphasia (PWAs). We also investigated the relationship between core lexicon and an established discourse measure, main concept analysis. A core lexicon was developed by identifying lemmas produced by 92 control speakers. 165 control transcripts and 238 PWA transcripts were scored using the core lexicon and a recently developed main concept list. Median tests examined differences between controls, PWAs, and aphasia subtypes. Spearman's correlations assessed the relationship between core lexicon and main concept performance. A 24-item core lexicon was identified. Significant differences were found between control speakers and PWAs, and between aphasia subtypes, for core lexicon and main concept scores. Core lexicon and main concept performance was significantly and positivel...

Resumo: Analises exploratorias de dados Multidimensionais foram usadas para avaliar dois componentes de um teste de nomeacao para o estudo do acesso lexical em pacientes com afasia, ou seja, o acordo de nomeacao de imagens e a idade de aquisicao de nomes relacionados a um teste de origem internacional. Para o estudo ser confiavel as imagens devem ser inequivocamente reconhecidas por qualquer individuo usando a mesma palavra/imagem. Suposicoes teoricas sobre as palavras afirmam que palavras adquiridas mais tarde na aprendizagem tendem a serem as primeiras a serem perdidas devido a um dano cerebral em afasia. Assim, estas duas variaveis sao importantes preditoras da recuperacao de palavras. Primeiro selecionamos as imagens de reconhecimento com juizes normais; entao, as classificamos com relacao a sua primitividade. Estas imagens foram submetidas a dois conjuntos de juizes, que tiveram que responder de acordo com duas diferentes escalas. Os dados foram analisados com tecnicas de Anali...

Twenty-six aphasic patients who had an ischaemic infarct in the territory of the left middle cerebral artery (MCA) were investigated. Cranial computed tomography (CT) showed various lesion sites: infarcts restricted to cortical structures in 12 patients, combined eortical and subcortical infarcts in 7 and isolated subcortical infarcts sparing the left cortex in another 7 cases. 18F-2-fluoro-2-deoxyglucose positron emission tomography revealed remote hypometabolism of the left convexity cortex and of the left basal ganglia, which was extended further than the morphological infarct zone in all cases. Types and degrees of aphasia were classified using the Aachener Aphasie Test (AAT): 10 patients had global aphasia, 2 Broca's, 5 Wernicke's, and 5 amnesic aphasia. Four patients suffered from minimal or residual aphasic symptoms. The A A T results were compared with the regional cerebral metabolic rates of glucose of the left hemisphere, frrespective of the infarct location all five A A T subtests (Token test, repetition, written language, confrontation naming, äuditory and reading comprehension) were closely correlated among each other and with left parieto-temporal metabolic rates, whereas left frontal and left basal ganglia metabolism showed no significant correlation. The close relation between left temporo-parietal functional äctivity and alt five A A T subtests suggests that the different aspects of aphasia tested by A A T can be related to a common disorder of language processing in those areas.

In a longitudinal prospective study of dementia, 158 patients were investigated post mortem. Sixteen patients were classified as frontal lobe dementia (FLD) of non-Alzheimer type and four cases as Pick's disease. Positive heredity for dementia was reported in 50% of these cases compared to 30% in a reference group of patients with Alzheimer's disease (AD). The typical clinical picture in FLD and Pick's disease was that of a slowly progressive dementia, at an early stage dominated by personality change, lack of insight, disinhibition, and later on stereotypy and increased apathy. There was also a progressive dynamic aphasia ending in mutism and amimia. Memory and spatial functions were comparatively spared. Disinhibition, oral/dietary hyperactivity, and echolalia were more consistently found in Pick's disease compared to FLD. The differential diagnosis against AD, cerebrovascular dementia, and other degenerative dementias and against affective disorders and psychotic reactions are discussed.

Both hemispheres are engaged in recovery from word production deficits in aphasia. Lexical therapy has been shown to induce brain reorganization even in patients with chronic aphasia. However, the interplay of factors influencing reorganization patterns still remains unresolved. We were especially interested in the relation between lesion site, therapy-induced recovery, and beneficial reorganization patterns. Thus, we applied intensive lexical therapy, which was evaluated with functional magnetic resonance imaging, to 14 chronic patients with aphasic word retrieval deficits. In a group study, we aimed to illuminate brain reorganization of the naming network in comparison with healthy controls. Moreover, we intended to analyse the data with joint independent component analysis to relate lesion sites to therapy-induced brain reorganization, and to correlate resulting components with therapy gain. As a result, we found peri-lesional and contralateral activations basically overlapping with premorbid naming networks observed in healthy subjects. Reduced activation patterns for patients compared to controls before training comprised damaged left hemisphere language areas, right precentral and superior temporal gyrus, as well as left caudate and anterior cingulate cortex. There were decreasing activations of bilateral visuo-cognitive, articulatory, attention, and language areas due to therapy, with stronger decreases for patients in right middle temporal gyrus/superior temporal sulcus, bilateral precuneus as well as left anterior cingulate cortex and caudate. The joint independent component analysis revealed three components indexing lesion subtypes that were associated with patient-specific recovery patterns. Activation decreases (i) of an extended frontal lesion disconnecting language pathways occurred in left inferior frontal gyrus; (ii) of a small frontal lesion were found in bilateral inferior frontal gyrus; and (iii) of a large temporo-parietal lesion occurred in bilateral inferior frontal gyrus and contralateral superior temporal gyrus. All components revealed increases in prefrontal areas. One component was negatively correlated with therapy gain. Therapy was associated exclusively with activation decreases, which could mainly be attributed to higher processing efficiency within the naming network. In our joint independent component analysis, all three lesion patterns disclosed involved deactivation of left inferior frontal gyrus. Moreover, we found evidence for increased demands on control processes. As expected, we saw partly differential reorganization profiles depending on lesion patterns. There was no compensatory deactivation for the large left inferior frontal lesion, with its less advantageous outcome probably being related to its disconnection from crucial language processing pathways.

A detailed language assessment was conducted with MM, a 17-year-old bilingual teenager with Rasmussen syndrome who had undergone a left functional hemispherectomy. Results revealed important deficits in French and English, affecting expressive and receptive language in both the written and the oral modality. MMÕs linguistic profile was coherent with previous description of language function following left hemispherectomy, and what is known of the linguistic potential of the right hemisphere (RH). The impairment pattern showed overall similarities between French and English, thus supporting the existence of a common underlying system for these two languages. However, the profiles in each language were not identical, implying that distinct subsystems may also be at play. These findings support previous descriptions of acquired language impairments and recovery in bilingual individuals.

To estimate the lifetime risk, prevalence, incidence, and mortality of the principal clinical syndromes associated with frontotemporal lobar degeneration (FTLD) using revised diagnostic criteria and including intermediate clinical phenotypes. Multisource referral over 2 years to identify all diagnosed or suspected cases of frontotemporal dementia (FTD), progressive supranuclear palsy (PSP), or corticobasal syndrome (CBS) in 2 UK counties (population 1.69 million). Diagnostic confirmation used current consensus diagnostic criteria after interview and reexamination. Results were adjusted to the 2013 European standard population. The prevalence of FTD, PSP, and CBS was 10.8/100,000. The incidence and mortality were very similar, at 1.61/100,000 and 1.56/100,000 person-years, respectively. The estimated lifetime risk is 1 in 742. Survival following diagnosis varied widely: from PSP 2.9 years to semantic variant FTD 9.1 years. Age-adjusted prevalence peaked between 65 and 69 years at 42....

We report the case of an aphasic and acalculic patient with selective preservation of approximation abilities. The patient's deficit was so severe that he judged 2 + 2 = 5 to be correct, illustrating a radical impairment in exact calculation. However, he easily rejected grossly false additions such as 2 + 2 = 9, therefore demonstrating a preserved knowledge of the approximate result. The dissociation between impaired exact processing and preserved approximation was identified in several numerical tasks: solving and verifying arithmetical operations, number reading, short-term memory, number comparison, parity judgement, and number knowledge. We suggest the existence of two distinct number-processing routes in the normal subject. One route permits exact number representation, memory and calculation using symbolic notation. The other route allows for approximate computations using an analog representation of quantities.

report bears on the behavior of 188 unilateral stroke subjects when administered an aphasia screening test comprising a short interview as well as naming, repetition, word-picture matching and sentence-picture matching tasks. All subjects were unilingual lusophone adult (40 yr of age or older) right-handers. Furthermore, they were either totally unschooled illiterates or they had received school education and thereafter retained writing skills and reading habits. Subjects were tested less than 2 months after a first unilateral stroke. In all tasks, global error scores were greater among left and right brain-damaged illiterate and literate subjects than among their controls. In repetition and matching, these differences were statistically significant for the left but not for the right-stroke groups, irrespective of the literacy factor. In naming, on the other hand, significant differences were found not only for the two left-stroke groups but also for the right-stroke illiterate group although not for the right-stroke literate one. Likewise, some degree of word-finding difficulty and of reduction in speech output as well as a sizeable prodllction of phonemic paraphasias were observed in the interviews of several right-stroke illiterates, clearly less in those of right-stroke literates. These findings lead us to suggest that cerebral representation of language is more ambilateral in illiterates than it is in school educated subjects although left cerebral "dominance" remains the rule in both.

This study focuses on the assessment and treatment of the conversations of a couple where one partner has aphasia. The assessment and treatment, informed by conversation analysis, are described, and some implications for the relation between language and psychosocial issues discussed.

Purpose. To develop a portable computerised communication aid for aphasic people to support communication in everyday life. Method. A multidisciplinary team of aphasiologists, augmentative and alternative communication specialists, speech and language therapists and technicians developed a portable, modular system, PCAD (portable communication assistant for people with dysphasia), running on a commercially available handheld computer. The system was tested in a multiple case study. Aphasia therapy services In the UK, Portugal and The Netherlands referred 28 people with aphasia, who were considered eligible for a computerised communication aid. Participants were trained following a protocol and used the device in self-chosen real life settings. Results. Six of the 28 selected aphasic patients decided not to test the device; 22 participated in the training. All 22 learned to operate the aid, 17 used it functionally, in everyday life. Five people did not use the aid outside the therapy room, although they were able to operate the aid and to use it in role play. These unsuccessful clients were younger, and tended to have a shorter duration of the aphasia. Conclusions. Carefully selected aphasic patients may benefit from a computerised communication aid, using it functionally in everyday communicative settings.

Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns. Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy....

Background. Little is known about the efficacy of language production treatment in subacute severe nonfluent aphasia. Although Melodic Intonation Therapy (MIT) is a language production treatment for this disorder, until now MIT effect studies have focused on chronic aphasia. Purpose. This study examines whether language production treatment with MIT is effective in subacute severe nonfluent aphasia. Methods. A multicenter, randomized controlled trial was conducted in a waiting-list control design: patients were randomly allocated to the experimental group (MIT) or the control group (control intervention followed by delayed MIT). In both groups, therapy started at 2 to 3 months poststroke and was given intensively (5 h/wk) during 6 weeks. In a second therapy period, the control group received 6 weeks of intensive MIT. The experimental group resumed their regular treatment. Assessment was done at baseline (T1), after the first intervention period (T2), and after the second intervention period (T3). Efficacy was evaluated at T2. The impact of delaying MIT on therapy outcome was also examined. Results. A total of 27 participants were included: n = 16 in the experimental group and n = 11 in the control group. A significant effect in favor of MIT on language repetition was observed for trained items, with mixed results for untrained items. After MIT there was a significant improvement in verbal communication but not after the control intervention. Finally, delaying MIT was related to less improvement in the repetition of trained material. Conclusions. In these patients with subacute severe nonfluent aphasia, language production treatment with MIT was effective. Earlier treatment may lead to greater improvement.

People with stroke or Parkinson's disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others. Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23). Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options...

Background: Spontaneous speech of aphasic persons is often scored on rating scales assessing aphasic symptoms. Rating scales have the advantage of an easy and fast scoring system, but might lack sensitivity. Quantitative analysis of either aphasic symptoms or basic parameters provides a useful alternative. Basic parameters are essential units of language like word categories or syntactic completeness and can be identified in both impaired and unimpaired adult and child language. Aims: To examine whether basic parameters of spontaneous speech are more sensitive to change during the course of recovery from aphasia than conventional spontaneous speech rating scales. Methods & Procedures: Spontaneous speech samples of 28 aphasic participants were analysed using a quantitative computer-assisted method as well as conventional spontaneous speech rating scales before and after 7 weeks of intensive language treatment. The analysis focused on the following basic parameters: percentage words, percentage open class words, syntactic completeness, complexity, and mean length of utterances. The participants were also tested with the Aachen Aphasia Test before and after treatment. Outcome & Results: Significant change in at least one basic parameter was observed in 20 participants, while only four participants showed significant change in one of the spontaneous speech rating scales. Conclusions: In comparison with conventional spontaneous speech rating scales, the basic parameters proved to be more sensitive to change. For the time being,

I argue that the general epistemological conservatism, typical for the post-socialist “transition,” taken together with the imagined or experienced feeling of radically limited spatial choices, gave rise to a series of interesting symbolic shifts. An urgent search for a “new beginning,” a perceived state of semantic “indeterminacy” and “cognitive vacuum,” a recognition of the loss of all meaningful bearings was often represented as a disintegration of speech, as a deficiency of symbolic forms that could no longer express essential qualities of the current condition. The absence of comprehensive cognitive “maps” capable of representing the trajectory of development led to a pronounced preoccupation with the domain of minutiae, with tangible yet fragmented context. Also, this “being at a dead end” precipitated a move from the symbolism of space to the symbolism of time: “geography” gave place to “history.”

Simmons-Mackie N, Raymer A, Armstrong E, Holland A, Cherney LR. Communication partner training in aphasia: a systematic review. Arch Phys Med Rehabil 2010;91: 1814-37. Objectives: To describe the effects of communication partner training on persons with aphasia and their communication partners. Specifically the systematic review addressed 3 clinical questions regarding the impact of partner training on language, communication activity and participation, psychosocial adjustment, and quality of life for adults with aphasia and their communication partners.

Previous research has shown that word-to-picture matching for targets that cannot be named at pre-test results in improved naming relative to untreated control items for people with aphasia. This paper replicates and extends this finding and investigates its source. Is the effect a result of priming of semantic representations, or of post-semantic mechanisms in word retrieval?The first experiment shows that word-to-picture matching with unrelated distractors improves naming at short (2-3 minutes) and long (up to 25 minute) lags. There was no effect of being made aware of the relationship between word-to- picture matching and picture naming. People who have a semantic impairment improve only with a short lag between word-to-picture matching and naming. Participants with less semantic impairment show larger priming effects that are equal at short and long lags between word-to-picture matching and naming.The second experiment shows that the facilitation effect is just as large for word-to-picture matching with unrelated distractors as with semantically-related distractors. Furthermore, overall there was no difference between matching with coordinate items and with associated items.The results of these experiments show that facilitation of naming by word-to-picture matching in people with aphasia cannot be a result of the priming of semantic representations. Instead they are consistent with two effects: word-to-picture matching results in priming at a lemma level for aphasic people with a semantic impairment that is only found with a short lag between word-to-picture matching and naming. Word-to-picture matching causes priming of the lemma to output lexicon entry mapping that benefits participants with less semantic impairment that is evident at both a short and long lag between word-to-picture matching and naming. These findings fit well with previous research on repetition priming of naming with normal subjects.

The benefit of singing for people with acquired brain conditions is becoming wellestablished. The CeleBRation Choir at The University of Auckland's Centre for Brain Research was established in September 2009 for people with neurological conditions, carers and supporters. The community choir is the first of its type in New Zealand. This paper describes the process of establishing the choir, and evaluates the perceived benefits for members with Parkinson's disease or non-fluent aphasia. The choir has generated great support within the New Zealand community. Future research is envisaged, to investigate our preliminary conclusion that group choral singing is an enjoyable social and community oriented therapeutic approach for people with brain disease.

by Joanna Moura

The purpοse οf this study is tο map the prοfile οf patients with aphasia in the οral language areas by analyzing the types of paraphasia. Specifically, the speech samples were acquired from the Greek Corpus of Aphasic Discourse, which consists of examination interviews in aphasic patients. All the interviews took place at Athens Eginition Hospital. Of these samples 26 were annotated and transcribed. The interview techniques were based on the Boston Diagnostic Aphasia Examination, while the annotation and transcription follow text linguistics conventions. Paraphasias concerning all levels of linguistic analysis in the interviews were identified. The study aims at analyzing and assessing paraphasias of speech of aphasic patients.

Objectives So far, The Persian Aphasia Battery (PAB) has been widely used by clinicians as the first clinical
linguistic test to assess and rehabilitate aphasia and language impairments among adult Iranian brain
damaged aphasic patients (Fluent/Non-Fluent). The first version was provided based on linguistic and
cultural adaptations on healthy Persian speaking adults and has been used by clinicians for more than 20
years. The purpose of this study was to report on the validity and reliability of PAB, based on the results
obtained from aphasic patients.
Methods & Materials In this research we report on data obtained from 57 Persian speaking brain damaged
patients with the age range of 19 to 83 years who were recruited from clinics in Tehran, Mashhad,
Karaj, Yazd, Isfahan, and Shiraz cities, Iran during 2006 to 2011 through purposeful sampling system. The
clinical language profiles of the patients were checked by an experienced speech language pathologist
(SLP) for diagnosis. The internal consistency of the Battery, the subtests and items in each subtest were
assessed based on the Cronbach α index. The internal consistency of the structure of the Battery was
based on the correlation between its subtests and each language skill.
Results The overall measure of internal consistency of the Battery was 0.93 and the internal consistency
of major language skills was significant (r=0.3-0.76, P<0.05). The subtests had high to medium internal
consistencies (r=0.63-0.83, P<0.01). The profiles of different language skills and subtests of PAB are consistent
with the diagnosis of aphasia type by expert SLP clinicians.
Conclusion Based on the obtained validity and reliability measures, the Battery has high internal consistency
and clinical utility and can be used for differential diagnosis and measuring severity of aphasia in
clinical linguistic studies among adult Persian speaking brain damaged patients.

Is there a relation between socioeconomic factors and aphasia severity and recovery? describe correlations between the educational level and socioeconomic status of aphasic subjects with aphasia severity and subsequent recovery. As stated in the introduction by , studies of the influence of educational level and literacy (or illiteracy) on aphasia severity have yielded conflicting results, while no significant link between socioeconomic status and aphasia severity and recovery has been established. In this brief note, we will comment on their findings and conclusions, beginning first with a brief review of literacy and aphasia research, and complexities encountered in these fields of investigation. This serves as a general background to our specific comments on , which will be focusing on methodological issues and the importance of taking normative values in consideration when subjects with different socio-cultural or socio-economic backgrounds are assessed.

Aphasia is a chronic communication disability and the communication, information and psychosocial support needs of individuals and families impacted by aphasia change across time (Hilton et al., 2014; Lyon & Shadden, 2001). This is particularly so following discharge from formal inpatient and outpatient rehabilitation services, when with a newly acquired chronic communication disability, PWA face the large challenge of readjustment to work, family and community life (Howe,