Applying the Correlation Between Aphasia Severity and Quality of Life Measures to a Life Participation Approach to Aphasia
When clinicians are operating under a Life Participation Approach to Aphasia (LPAA) while treating persons with aphasia (PWAs), one measurement used to quantify outcomes is quality of life (QOL). Studies of QOL after stroke have identified multiple factors as cause agents. There is not an extensive body of research in the literature that compares the extent of aphasia and QOL and no literature as to how this applies in an LPAA. This article reports a comparison of aphasia quotients obtained from the Western Aphasia Battery-Revised with QOL scores obtained from the Stroke and Aphasia Quality of Life Scale-39 and discusses how the results are incorporated into long-term communication programs at a community-based center that employs an LPAA.
The concept of peer mentorship can be applied to a variety of populations. In this article, literature will be reviewed discussing the principles of mentorship and how they have been applied to persons living with aphasia through the development and implementation of an Aphasia Mentorship Program. The protocol of this program (created at the National Rehabilitation Hospital [NRH] in Washington, DC), a case report of a successful mentorship experience, and conclusions regarding the success of the program and future directions will be discussed.
One of the most frequent symptoms of unilateral stroke is aphasia, the impairment or loss of language functions. Over the past few years, behavioral and neuroimaging studies have shown that rehabilitation interventions can promote neuroplastic changes in aphasic patients that may be associated with the improvement of language functions. Following left hemisphere strokes, the functional reorganization of language in aphasic patients has been proposed to involve both intrahemispheric interactions between damaged left hemisphere and perilesional sites and transcallosal interhemispheric interactions between the lesioned left hemisphere language areas and homotopic regions in the right hemisphere. A growing body of evidence for such reorganization comes from studies using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), two safe and noninvasive procedures that can be applied clinically to modulate cortical excitability during post-stroke language recovery. We discuss a hierarchical model for the plastic changes in language representation that occur in the setting of dominant hemisphere stroke and aphasia. We further argue that TMS and tDCS are potentially promising tools for enhancing functional recovery of language and for further elucidating mechanisms of plasticity in patients with aphasia.
from Brain and Language
Several studies have reported improved naming using the Semantic Feature Analysis (SFA) approach in individuals with aphasia. Whether the SFA can be modified and still produce naming improvements in aphasia is unknown. The present study was designed to address this question by using a modified version of the SFA approach. Three, rather than the typical six, features were used, and written along with verbal responses were allowed in an individual with both aphasia and apraxia of speech. A single-subject multiple-baseline design across behaviors was used to treat naming of single objects across three different semantic categories in a 72-year-old individual with aphasia and apraxia of speech. Stimulus generalization of training was measured by using photographs of trained items presented in natural contexts. Training of the three different categories resulted in improved naming. At a 6-week follow-up session, naming remained above pre-treatment levels but declines were noted compared to treatment levels. Generalization to the same trained items presented in different contexts was also demonstrated although declines in performance were also noted over time. Results of the study provide qualified support for the use of three features in promoting long-term improvement of naming in an individual with both aphasia and apraxia of speech. Future SFA studies should focus on whether it is the number or types of features used, aphasia severity, or length of treatment that are critical factors in rehabilitating naming deficits in aphasia.
from the Journal of Communication Disorders
The effects of low frequency Repetitive Transcranial Magnetic Stimulation (rTMS) and sham condition rTMS on behavioural language in chronic non-fluent aphasia: Short term outcomes
Introduction: The application of low frequency (1 Hz) Repetitive Transcranial Magnetic Stimulation (rTMS) to right hemisphere (RH) language homologues in non-fluent aphasic populations has yielded improvements in behavioural language function, up to 43 months post stimulation . Functional imaging studies have demonstrated RH language homologue “overactivation” post left inferior frontal gyrus (IFG) damage, in chronic non-fluent aphasia. The effects of low frequency (inhibitory) rTMS are postulated to be as a result of a reduction of overactivation in RH language homologues, facilitating the reorganisation of neural language networks.
Textbooks dealing with the anatomical representation of language in the human brain display two language-related zones, Broca’s area and Wernicke’s area, connected by a single dorsal fiber tract, the arcuate fascicle. This classical model is incomplete. Modern imaging techniques have identified a second long association tract between the temporal and prefrontal language zones, taking a ventral course along the extreme capsule. This newly identified ventral tract connects brain regions needed for language comprehension, while the well-known arcuate fascicle is used for “sensorimotor mapping” during speech production. More than 130 years ago, Carl Wernicke already described a ventral connection for language, almost identical to the present results, but during scientific debate in the following decades either its function or its existence were rejected. This article tells the story of how this knowledge was lost and how the ventral connection, and in consequence the dual system, fits into current hypotheses and how language relates to other systems.
from Brain and Language
The relatively intact ability of individuals with aphasia to assign prominence to information in narratives sheds light on the neurological underpinnings of modalising language, and suggests possible skills associated with the ability of aphasic persons to “communicate better than they talk” (Holland, 1977). The clinical potential for assessment and treatment that incorporates narrative evaluative devices and modalising language needs to be further explored.
Lichtheim belongs to the ranks of most famous aphasiologists, in particular because of a diagram often referred to as ‘Lichtheim’s House’. His single paper on aphasia has drawn the attention of the aphasiological community for many years and may be considered a golden shot. But it became, to Lichtheim’s own disappointment, famous for its schema rather than for the theoretical proposals formulated in that paper regarding various aphasia syndromes. In this paper, a translation is presented on the part of Lichtheim’s memoirs, dealing with his views on his work on aphasia. I also discuss his insertion of the conceptual center in the model and Wernicke’s response to that. Finally, I argue that it is surprising that Lichtheim’s contribution has had such a lasting impact.
Conclusions: The success (or not) of returning to work with aphasia is multi-faceted and does not rest solely with the person with aphasia. The nature of the work may have a strong bearing on success, as will the ability and willingness of the employer to engage in the process. Partnership with the person and constant review of goals and management is of overwhelming importance. We need to consider what “success” may mean in this context and the need to consider therapeutic and rehabilitation needs over a longer time frame.
The production and comprehension of verbs with alternating transitivity by patients with non-fluent aphasia
Conclusion: We suggest, in agreement with other researchers (for example, Schwartz, Linebarger, Saffran, & Pate, 1987) that aphasic individuals overuse a mapping strategy that associates the theta roles of agent and theme with syntactic subject and object respectively, as they produce transitive (S)VO structures, to a large extent, instead of unaccusatives. In addition, as they had difficulties with unaccusative verbs marked for active voice, we suggest that they could not successfully interpret unaccusative verbs with active voice morphology as non-agentive structures.
Improved picture naming in aphasia patients treated with cathodal tDCS to inhibit the right Broca’s homologue area
Purpose: Previous reports have suggested that noninvasive cortical stimulation could influence speech production in patients with chronic stroke. Here, we evaluated the hypothesis that cathodal transcranial DC stimulation (ctDCS), a technique that decreases excitability of stimulated cortical sites, applied over a healthy right Broca’s homologue area could improve picture naming in patients with post-stroke aphasia. Methods: Ten right-handed patients with post-stroke aphasia were enrolled in this double blind, counterbalanced sham-controlled, crossover study. Each patient received an intervention of ctDCS (2 mA for 20 min) and of sham tDCS (2 mA for 1 min) daily for 5 consecutive days in a randomized crossover manner with a minimum interval of one week between interventions, over a healthy right Broca’s homologue area using a left supraorbital anode and simultaneous daily sessions of conventional word-retrieval training. The primary endpoint measure of this study was a standardized, validated Korean version of the Boston Naming Test, which is a measure of picture naming skills. Results: ctDCS was not found to have any adverse effects. Furthermore, significantly improved picture naming (p = 0.02) was observed at 1 hour following the last (5th) ctDCS treatment session, but no changes were observed after sham tDCS. Conclusion: These results demonstrate that cathodal tDCS over the right healthy Broca’s homologue area with a left supraorbital anodal location can improve picture naming task performance in post-stroke aphasia.
Theories of spoken word recognition deficits in Aphasia: Evidence from eye-tracking and computational modeling
We used eye-tracking to investigate lexical processing in aphasic participants by examining the fixation time course for rhyme (e.g., carrot–parrot) and cohort (e.g., beaker–beetle) competitors. Broca’s aphasic participants exhibited larger rhyme competition effects than age-matched controls. A re-analysis of previously reported data (Yee, Blumstein, & Sedivy, 2008) confirmed that Wernicke’s aphasic participants exhibited larger cohort competition effects. Individual-level analyses revealed a negative correlation between rhyme and cohort competition effect size across both groups of aphasic participants. Computational model simulations were performed to examine which of several accounts of lexical processing deficits in aphasia might account for the observed effects. Simulation results revealed that slower deactivation of lexical competitors could account for increased cohort competition in Wernicke’s aphasic participants; auditory perceptual impairment could account for increased rhyme competition in Broca’s aphasic participants; and a perturbation of a parameter controlling selection among competing alternatives could account for both patterns, as well as the correlation between the effects. In light of these simulation results, we discuss theoretical accounts that have the potential to explain the dynamics of spoken word recognition in aphasia and the possible roles of anterior and posterior brain regions in lexical processing and cognitive control.
from Brain and Language
Conclusions: Overall, all five participants with jargon demonstrated severely impaired speech monitoring under both listening conditions across all three production tasks, suggesting that the role of speech-monitoring impairment in jargon cannot be disregarded. The increase in amount of jargon and severity of speech-monitoring failure with increased linguistic demands of the production task (as in picture naming and non-word repetition) raises the possibility of a post-semantic deficit in accessing phonological codes. This possible locus of deficit, and implications for understanding production of jargon, are discussed.
Conclusions: Whereas Franklin et al.’s (2002) original client had a relatively pure post-lexical phonological assembly impairment, the three participants in the current study whose speech improved after therapy had a combination of lexical and post-lexical phonological impairments, and it is proposed that their item-specific improvements in picture naming occurred as a result of improved mapping between semantics and the phonological output lexicon. The participant in this study whose speech did not improve following therapy had a combination of phonological assembly difficulties and apraxia of speech. This study demonstrates that the same therapy can work at different levels for different individuals, depending on many factors, including their profile of linguistic and cognitive impairments.