Aphasia and Aphasia Rehabilitation

The need for a specific, language-based treatment approach to aphasic impairments associated with attentional deficits is well documented. We describe language-specific attention treatment, a specific skill-based approach for aphasia that exploits increasingly complex linguistic tasks that focus attention. The program consists of eight tasks, some with multiple phases, to assess and treat lexical and sentence processing. Validation results demonstrate that these tasks load on six attentional domains: (1) executive attention; (2) attentional switching; (3) visual selective attention/processing speed; (4) sustained attention; (5) auditory-verbal working memory; and (6) auditory processing speed. The program demonstrates excellent inter-and intrarater reliability and adequate test-retest reliability. Two of four people with aphasia exposed to this program demonstrated good language recovery whereas three of the four participants showed improvements in auditory-verbal working memory. The results provide support for this treatment program in patients with aphasia having no greater than a moderate degree of attentional impairment. Learning Outcomes: As a result of this activity, the reader will be able to (1) discuss the attentional requirements for language processing; (2) list language deficits that arise from attentional impairments following aphasia; (3) describe a language-specific attention treatment for remediating deficits in language and attention associated with aphasia.

Background: Little is known about the linguistic, structural and functional recovery on
which the production of aphasic recurring utterances (RUs) is based.
Methods & Procedures: Retrospective database analysis was performed to study the
prevalence of RUs among aphasia patients. Language features and recovery were
examined in patients with RUs, who were matched with aphasic controls with similar
demographic and clinical characteristics.
Outcomes & Results: Of the 147 aphasia patients admitted to a rehabilitation unit,
between 2008 and 2012, 12.92% exhibited some form of RU. When we examined the
prevalence among those with global aphasia, it increased to 24.6%. Each patient displayed
the stereotypy, with some meaningful modulation or intonation with communicative
intent. Although there was some recovery (particularly in comprehension),
language of all patients remained severely impaired. Patients with RU scored considerably
less than the control group in aphasia quotient (U = 209.00; p = .000), in naming
task (U = 174.0; p = .002) and in word repetition (U = 196.0; p = .000). But there were
no significant differences between the two groups on a comprehension task (t = −.75
(1,28); p = .261) and Token test scores (U = 321.1; p = .130).
Conclusions: Our data support the notion that RUs do not represent an absence of
language abilities. Language characteristics and recovery pattern were discussed in terms
of cognitive processes and neuroplasticity. The social impact of RUs is also highlighted.

Throughout the history of both linguistic and the psychic concepts, there have been points of extreme proximity, and points of departure. The history of “madness”, particularly those events which brought forth language's own pathology, exposes a unique aspect of this relationship. In the
pages following, I discuss linguistic pathology, particularly aphasia, utilizing the image of madness (psychopathology) Foucault presents in Madness and Civilization as a point of comparison (Foucault, 1988).

Purpose: This study was conducted to examine the comparative effectiveness of 2 different approaches, 1 domain-specific and the other domain-general, to language and attention rehabilitation in participants with stroke-induced aphasia. The domain-specific treatment consisted of language-specific attention treatment (L-SAT), and the domain-general treatment consisted of direct attention training (DAT) using the computerized exercises included in Attention Process Training-3 (Sohlberg & Mateer, 2010). Method: Four individuals with mild-moderate aphasia participated in this study. A randomized controlled cross-over single-subject design was used to assess the effectiveness of the 2 treatments administered in this study. Treatment outcomes were evaluated in terms of participants' task performance for each program, standardized language and attention measures, tests of functional abilities, and patient-reported outcomes. Results: Visual comparisons demonstrated linear improvements following L-SAT and variable patterns following DAT. Omnibus effect sizes were statistically significant for 9 of the 13 L-SAT tasks. The weighted standardized effect sizes for posttreatment changes following L-SAT ranged from small to large, with the exception of 1 task. The average group gain following DAT was 5%. The Western Aphasia Battery-Revised Aphasia Quotients (Kertesz, 2007) demonstrated reliable improvements for 3 of the 4 participants following L-SAT, whereas only 1 of the participants improved reliably following DAT. The margins of improvements in functional language were substantially larger following L-SAT than DAT. Performance on the Test of Everyday Attention improved significantly for 2 participants following L-SAT and for 1 participant following DAT on selected Test of Everyday Attention (Robertson, Ward, Ridgeway, & Nimmo-Smith, 1994) subtests. Patient-reported outcomes for communication and attention following treatment favored L-SAT compared to DAT. Conclusions: The results support the view that attention is allocated in ways that are particular to specific tasks rather than as a general resource that is allocated equivalently to all processing tasks. Domain-specific treatment for language deficits due to attentional impairment appears to be a suitable, if not preferable, approach for aphasia rehabilitation. Supplemental Material: https://doi.org/10.23641/asha. 8986427

Aphasia is an amalgamation of a speech and language disorders mainly produced by damage to the brain. Most often is caused by a cerebral vascular accident (CVA), which is also known as a stroke, aphasia can cause temporary and definitive impairments in speech and language. Other causes include brain tumours, traumatic brain injury, and progressive neurological disorders. The damage occurs typically in the left half of the brain. Individuals who experience damage to the right side of the brain may have additional difficulties beyond speech and language issues, like dysarthria, apraxia, or swallowing problems. Aphasia may causes difficulties in speaking, listening, reading, and writing, but does not affect intelligence.

Optimal treatment outcome can be witnessed by methodically working on the functional communication skills and progressively move up the hierarchy to achieve effective communication. Since a complex interplay between various levels of linguistic skills exists, reinforcing relatively holistic skills like that of functional communication is hypothesized to strengthen other linguistic skills. Therefore, the present study aims to highlight the positive results of working on functional communication skills on the domains of Naming, Repetition, Comprehension and Expression using the Manual for Adult Aphasia Therapy (MAAT). This study involved comparing the scores of the 1st, 7th, 14th and the 21st sessions of Speech-Language Therapy using MAAT. The therapy outcomes of 20 PWAs in the age range of 19-70 years were examined. A general trend of improved scores across sessions was found across all participants in the domains of Functional Communication, Naming, Repetition and Comprehension & Expression. Also, correlation between the distinct domains of the manual was demonstrated. The authors have qualitatively described the correlation between Functional Communication and the other prospective domains since the former can facilitate improvements in the latter.

Spoken language comprehension, including comprehension for inferential material in narrative discourse, is diminished in dementia of the Alzheimer type (DAT). There are, however, no empirical data concerning comprehension by adults with DAT of main ideas versus details in narratives. Evidence from other groups with and without brain damage has shown that comprehension for main ideas is relatively better than for details and that comprehension for stated material is relatively better than comprehension for inferential material. Participants in the present investigation were 24 older adults, 8 with early-stage DAT (EDAT), 8 with middle-stage DAT (MDAT), and 8 with no brain damage (NBD). Selected narratives and associated sets of yes-no questions from the Discourse Comprehension Test (DCT) (Brookshire and Nicholas, 1993) were presented on videotape. Participants with EDAT and MDAT had significantly poorer overall comprehension of DCT narratives than did those in the NBD group (p < .0001), but they did not differ significantly from each other. Responses to DCT narratives by participants in the NBD, EDAT, and MDAT groups followed the same pattern of relatively better comprehension for main ideas than for details and relatively better comprehension for stated than for implied information. Working memory and episodic memory were shown to be significantly associated with DCT overall scores. Together, these findings suggest that although overall narrative comprehension is diminished in those with DAT, individuals appear to retain a mental representation for narratives that facilitates better comprehension of main ideas than of details as well as better comprehension of stated information than of implied information. This interpretation is consistent with schema-based accounts of narrative comprehension.

OBJECTIVES Following the completion of this chapter, the reader will be able to identify the features of global aphasia, its etiology, the patterns of evolution and outcome in global aphasia, and some factors that are related to recovery from this syndrome. The reader also will be able to provide a rationale for early intervention with these patients, describe contemporary goals for assessment, and develop treatment plans that exploit the residual language capacity and/or other functional abilities of patients with global aphasia. Finally, the reader will be able to identify current testing measures and both impairment-based and socially oriented treatment programs that emphasize improved language and functional communication and are appropriate for assessing and treating patients with global aphasia.

The aim of this study was to compare the performance in speech tasks of Chilean adults according to age and gender in order to obtain normative data for the assessment of speech's evaluation of our population. A total of 90 subjects between 40 and 69 years old were evaluated. The test battery was comprised of measures of Maximum Phonation Duration (MPD), oral, jaw, lips and lingual movements, oral diadochokinesis, oral reading speed and automatic speech speed. Male subjects performed significantly better than female subjects in MPD, tongue movements, and repetition of syllables and words. Adults aged 50-59 years performed significantly better than the other age groups in lips movements, syllables and words repetitions, and automatic speech speed. Based on these findings this study reveals that the performance in speech tasks differs according to the age and gender of this subjects. The values obtained differ from those reported in studies of English-speaking subjects.

A multidisciplinary team of experts took stock of the current state of affairs about many aspects of aphasia in India, including community
burden, diagnostic assessment, therapy, rehabilitation, research, education, and advocacy. The broad spectrum of aphasiology was matched by
the types of participants ranging from neurologists, speech‑language pathologists, clinical psychologists, linguists, to experts in neuroimaging
and computer sciences. Threadbare discussion in 16 sessions over 3 days leads to the identification of pressing problems and possible
solutions. Many action plans have been envisaged and recommendations made. A few examples with high priority are community‑based
and hospital‑based study incidence and prevalence of aphasia, development of test batteries for the assessment of many components of
speech and communication in Indian languages which are validated on rigorous psychometric, and linguistic criteria, national registry for
aphasia, educational modules about aphasia for different target groups, resources for advocacy and its training, a bank of research questions
and outlines of research protocols for young professionals to pursue. The expert group will continue to oversee execution of some of the
actionable plans in short and long term.

Agrammatism is a language disorder characterised by a morphological and/or syntactic deficit in spontaneous speech. Such deficits are usually associated with comprehension disorders - though it is said that this is not always the case - which result in a certain degree of variability in syntactic, lexical, and morpholexical performance. The purpose of this study is to reconsider the nature of comprehension disorders in agrammatism, to test whether Grodzinsky"s Trace Deletion Hypothesis (TDH) can be generalised to all agrammatic patients, and to ascertain whether the pattern of impairment observed in agrammatism differs from that present in fluent aphasic patients. Eleven agrammatic patients were tested by means of a sentence comprehension task comprising simple active and passive reversible sentences. The performance of the agrammatic patients was compared to that of 16 fluent aphasic (10 Wernicke"s and 6 conduction) and 10 control subjects. The deficits observed in the agrammatic subjects were compatible with the TDH, but there was also impaired processing of pronouns (elements that are also subject to movement) and a mild deficit on the processing of simple active sentences. The fluent aphasic patients showed a similar pattern of impairment. A logistic regression analysis was then applied to each single case separately, in order to study the homogeneity of the patients" performance within each aphasic subgroup. Of the 11 agrammatic patients, 3 did not show comprehension disorders, 5 had a specific deficit for passive movement, 1 a lexical deficit for pronouns only, and 1 a pattern of impairment compatible with Linebarger et al."s trade-off theory. The last patient showed a deficit for simple active reversible sentences compatible with damage to the mapping of grammatical functions to thematic roles. Similar patterns of impairment were also found in the fluent aphasic sample. Overall, the results lead to the conclusion that the TDH cannot be generalised to all agrammatic patients, that the mechanism it invokes is not the only source responsible for agrammatic comprehension disorders and also contributes to comprehension disorders in fluent aphasic patients.

A life without language as a system of communication is a life that cannot be lived to the fullest. Aphasia, a multimodal neurophysiologic disorder manifested by a substantial communication restriction due to brain damage, is one of the many possible causes that can make life language-less. Fortunately, it can be treated by speech therapy to rehabilitate language skills and can even be improved by therapy via an app to supplement communication experiences as proven by recent studies. As a contribution to the gaming rehabilitation industry, this paper aims: i) to design and develop a speech therapy game application, as an additional neurorehabilitation modality for aphasia patients, and ii) to assess its applicability as an adjunct to the traditional neuromuscular rehabilitation through a pilot study. Eight sessions of game-based speech therapy were applied to seven aphasic patients, 10-15 minutes per day, once a week, for 8 successive weeks. Aphasia assessment in stroke patients was performed with a multidimensional assessment tool, built-in to the therapeutic game, based from Quick Aphasia Battery (QAB) before and after treatment. The comparison of before and after treatment revealed an improvement in all of the QAB subtests: level of consciousness, connected speech, word comprehension, sentence comprehension, picture naming, repetition, reading aloud, and motor speech. This suggests that the development of this speech therapy game and the preliminary findings from the pilot study may indeed be an effective neurorehabilitation instrument for therapy of aphasia patients.

Se retoma la denominada teoría universalista de Jakobson para analizar la producción de un paciente con afasia motora eferente, incapaz de producir habla conectada, por lo que ha desarrollado un facilitador: una "pseudo-lengua" que le sirve para "comunicarse". El análisis se centró en la naturaleza de los estereotipos que la conforman, particularmente en sus características fonéticas-fonológicas y fonotácticas. El principal objetivo fue determinar si estos estereotipos siguen reglas fonológicas particulares o no. El informante es un hablante de 37 años, diagnosticado con afasia motora eferente, producto de un EVC, que afectó zonas frontales posteriores corticales y subcorticales izquierdas, incluyendo zonas de movimiento manual. Los datos fueron obtenidos a través de la tarea de habla espontánea, donde se le pidió al hablante que utilizara su "pseudo-lengua". El análisis indica que los estereotipos producidos siguen leyes fonológicas universales, de oposición y combinación, que coinciden con las que se adquieren primero en el desarrollo, apoyando el planteamiento sobre la desintegración en espejo del sistema fonológico en la afasia. Palabras clave: neurolingüística, sistema fonológico, fonotáctica.

The present study examines the influence of language proficiency and language combination on bilingual lexical access using category fluency in 109 healthy speakers. Participants completed a category fluency task in each of their languages in three main categories (animals, clothing, and food), each with two subcategories, as well as a language use questionnaire assessing their proficiency. Five language combinations were examined (Hindi–English, Kannada–English, Mandarin–English, Spanish–English, and Turkish–English). Multivariate analyses of variance revealed that the average number of correct items named in the category fluency task across the three main categories varied across the different groups only in English and not the other language. Further, results showed that language exposure composite (extracted from the questionnaire using a principal component analysis) significantly affected the average number of items named across the three main categories. Overall, these result...

Method: In this narrative review, they define neuroplasticity and review studies that demonstrate neural changes associated with aphasia recovery and treatment. The authors then summarize basic science evidence from animals, human cognition, and computational neuroscience that is relevant to aphasia treatment research. They then turn to the aphasia treatment literature in which evidence exists to support several of the neuroscience principles. Conclusion: Despite the extant aphasia treatment literature, many questions remain regarding how neuroscience principles can be manipulated to maximize aphasia recovery and treatment. They propose a framework, incorporating some of these principles, that may serve as a potential roadmap for future investigations of aphasia treatment and recovery. In addition to translational investigations from basic to clinical science, the authors propose several areas in which translation can occur from clinical to basic science to contribute to the fundamental knowledge base of neurorehabilitation. This article is intended to reinvigorate interest in delineating the factors influencing successful recovery from aphasia through basic, translational, and clinical research.

This study present a collection of examples of verbatim language in dreams, with analyses of how this is altered relative to waking language. Grammar is well-preserved in these dreams while meaningfulness is distorted relative to waking criteria. Novel nouns receive special emphasis as do extra-vocal cues such as voice tone. Dreams with verbatim language tend to be unusually long, vivid, and emotionally salient, though this may be a byproduct differential dream recall affecting both.  The present findings will be compared to past research data on language in dreams, and discussed in relation to what's known about brain areas involved in dreaming and areas involved in different linguistic processes.

As a defender of multidiscipline approaches, I have included in this study, knowledge from linguistics, informatics, neurology, biology and philosophy. Thus, this work begins with a journey since the primordial of mankind to show how, at the era of digitized societies, computers have a main role as extensions of the human being. Then I observe how informatics and technique incorporate with the human being to aid on the revelation of one of his greatest mysteries – the brain – focusing on the treatment of pathologies of language, and within these, on aphasias. I show afterwards some results on research with informatics’ applications (to assist on the treatment of aphasias) and propose a project to develop an application to facilitate the recovery of Portuguese aphasic individuals. Then some suggestions are given to improve the application. And finish with insights on how computation and the union of knowledge, can help on questions for which science still don’t have answers: what is the soul, the conscience, the mind?

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Background: This study aimed (i) to verify whether the classical word-naming models developed for English-speaking participants also account for the performance of patients who speak a shallow-orthography language such as Italian, and (ii) to study the effects of word frequency, concreteness, and grammatical class on word naming. Methods & Procedures: A total of 90 Italian aphasic patients participated in two reading tasks. The first task contained four sets of items: (i) concrete nouns (natural objects and artefacts), (ii) abstract nouns, (iii) function words, (iv) morphologically simple legal nonwords. The second task (trisyllabic words with unpredictable stress position) was designed to test reading ability along the lexical route (the position of the major word stress is the only opaque variable in the Italian reading system). The patients' performances on the two tasks were analysed for strong dissociations, and to test the effect of grammatical class, concreteness, word frequency, and item length. The effect of age of acquisition was tested in a subsequent analysis. Outcomes & Results: Reading scores were pathological for all patients. The present sample reflected the entire spectrum of reading impairments: phonological (49), surface (4), undifferentiated (32), and letter-by-letter (5) dyslexia, which is in line with data reported for English-speaking aphasic patients. Only one of the phonological dyslexic patients made semantic errors (a reading impairment compatible with the diagnosis of deep dyslexia). The vast majority of Broca's aphasic patients suffered from phonological dyslexia (76%), while fluent aphasic patients were distributed more evenly across dyslexia types; all four surface dyslexic patients belonged to the fluent aphasia group. Overall, grammatical class (concrete nouns vs function words) had a significant effect on 14 patients (15.6%), concreteness (concrete vs abstract nouns) on 15 (16.7%), and word frequency on 5 (5.6%). Grammatical class and concreteness affected the performance of phonological and undifferentiated dyslexic patients, and seemed not to influence the scores of the surface dyslexic patients. Age of acquisition turned out to have a highly significant effect and may account for most of the lexical effects emerging from the first analysis. Conclusions: The entire spectrum of reading impairments was observed in this group of Italian aphasic patients, thus confirming the validity of contemporary reading models also for shallow-orthography languages. Concreteness and grammatical class effects, present in deep dyslexia, also affected the performance of patients suffering from other types of dyslexia, although both phenomena might derive from a confounding effect of age of acquisition.