Blog Archives

Extending the use of Spanish Computer-assisted Anomia Rehabilitation Program (CARP-2) in people with aphasia

Conclusions
The Spanish Computer-Assisted Rehabilitation Program (CARP-2) for anomia is an active treatment for a range of people who have anomia as part of their aphasia profile.

from the Journal of Communication Disorders

The Importance of Production Frequency in Therapy for Childhood Apraxia of Speech

Conclusions: Both treatment designs were effective, though frequent and intense practice of speech resulted in more rapid response to treatment in 2 children whose primary communication difficulty was childhood apraxia of speech.

from American Journal of Speech Language Pathology

Clinical Challenges in the Evaluation and Treatment of Individuals with Poststroke Dysphagia

Although reported frequencies vary due to study design, patient characteristics, and method of ascertainment, dysphagia is a commonly encountered morbidity after stroke. Consequently, speech-language pathologists’ clinical caseloads are heavily populated with individuals with poststroke dysphagia. The body of knowledge about swallowing and swallowing disorders has expanded exponentially over the last 3 decades, and speech-language pathologists are increasingly sophisticated in their evaluation and treatment of this patient population. Nevertheless, clinical quandaries persist regarding the management of these individuals. In this article, clinical challenges are discussed, including early detection of dysphagia and aspiration risk, treatment efficacy, refractory dysphagia, and noncompliance with treatment. Research relevant to these issues is reviewed to aid in formulating sound clinical decisions.

from Topics in Stroke Rehabilitation

Cochrane review: Interventions for acute otitis externa

Patients prescribed antibiotic/steroid drops can expect their symptoms to last for approximately six days after treatment has begun. Although patients are usually treated with topical medication for seven to 10 days it is apparent that this will undertreat some patients and overtreat others. It may be more useful when prescribing ear drops to instruct patients to use them for at least a week. If they have symptoms beyond the first week they should continue the drops until their symptoms resolve (and possibly for a few days after), for a maximum of a further seven days. Patients with persisting symptoms beyond two weeks should be considered treatment failures and alternative management initiated.

from Evidence-Based Child Health

Therapy for phonological assembly difficulties: A case series

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.

from Aphasiology

How intensive does anomia therapy for people with aphasia need to be?

The intensity of aphasia therapy has been a key clinical question. The aim of this case-series study was to compare the outcome of intensive and non-intensive therapy in the relearning of words for people with aphasia. Eight participants took part in a study comparing the intensity of delivery of the therapy. Participants received two courses of the same therapy (each lasting 10 sessions) delivered either intensively or non-intensively. Therapy consisted of confrontation naming with progressive phonemic and orthographic cues. Post-therapy assessments were carried out immediately after the study and one month later. Performance was also monitored during each therapy session. Immediately post-therapy, both types of therapy had improved naming accuracy considerably and there was no significant difference between the two interventions. One month later, seven out of eight participants showed a small yet significant difference in naming accuracy, favouring non-intensive over intense therapy. There were no differences in the learning patterns during the therapy sessions between the intensive and non-intensive therapies. For the majority of people with aphasia post-stroke, both intense and non-intense therapy for anomia leads to improved naming performance. Retention at one-month post therapy is relatively superior after non-intensive therapy.

from Neuropsychological Rehabilitation

Predicting the outcome of anomia therapy for people with aphasia post CVA: Both language and cognitive status are key predictors

The aim of this study was to determine whether it was possible to predict therapy gain from participants’ performance on background tests of language and cognitive ability. To do this, we amalgamated the assessment and therapy results from 33 people with aphasia following cerebral vascular accident (CVA), all of whom had received the same anomia therapy (based on progressive phonemic and orthographic cueing). Previous studies with smaller numbers of participants had found a possible relationship between anomia therapy performance and some language and cognitive assessments. Because this study had access to a larger data set than previous studies, we were able to replicate the previous findings and also to verify two overarching factors which were predictive of therapy gain: a cognitive factor and a phonological factor. The status of these two domains was able to predict both immediate and longer-term therapy gain. Pre-treatment naming ability also predicted gain after the anomia therapy. When combined, both cognitive and language (naming or phonological) skills were found to be independent predictors of therapy outcome.

from Neuropsychological Rehabilitation

Model-oriented naming therapy in semantic dementia: A single-case fMRI study

Conclusions: Cueing hierarchies were successful, resulting in specific and immediate treatment effects, corroborating previous treatment studies in semantic dementia. Treatment-induced changes in cortical activity were mainly concentrated in right temporal cortex. Since right-sided modulation of cortical activity was associated with training-induced improvements in task performance, it may reflect right hemispheric compensatory mechanisms in this participant.

from Aphasiology

Model-oriented naming therapy in semantic dementia: A single-case fMRI study

Conclusions: Cueing hierarchies were successful, resulting in specific and immediate treatment effects, corroborating previous treatment studies in semantic dementia. Treatment-induced changes in cortical activity were mainly concentrated in right temporal cortex. Since right-sided modulation of cortical activity was associated with training-induced improvements in task performance, it may reflect right hemispheric compensatory mechanisms in this participant.

from Aphasiology

The mirror neuron system and treatment of stroke

Mirror neurons discharge during the execution of ecological goal-directed manual and oral actions, as well as during the observation of the same actions done by other individuals. These neurons were first identified in the ventral premotor cortex (PMv; area F5) and later on in the inferior parietal lobule (areas PF and PFG) of monkey brain, constituting a “mirror neuron” system. Several pieces of experimental data suggest that a mirror neuron system devoted to hand, mouth, and foot actions might also be present in humans. In the present paper, we review the experimental evidence on the role of the mirror neuron system in action understanding and imitation, both in hand motor function and speech. Based on the features of the mirror neuron system and its role in action understanding and imitation, we discuss the use of action observation and imitation as an approach for systematic training in the rehabilitation of patients with motor impairment of the upper limb and aphasia following stroke. We present the results of some preliminary studies to test this concept, and a discussion of network models as a measure of neurobiological change.

from Developmental Psychobiology

Acute otitis media: To follow-up or treat?

Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in children. However, due to their widespread use, we are witnesses to increased development of bacterial resistance to antibiotics. The purpose of this study was to evaluate the necessity of antibiotic treatment in patients with AOM. Our study included 314 children, aged between 2 months and 6 years. Children were divided into two groups: the first group included children with less severe forms of AOM, who received symptomatic therapy and “wait-and-see” approach (237 children); the second group presented with purulent ear infection and received antibiotic treatment from the beginning (77 children). After symptomatic therapy, resolution of the disease, without use of any antibiotics, was established in 61% of patients, compared to the overall sample of children with AOM. None of the children developed complications that would require surgical treatment. In the second group of children, receiving antibiotics, almost the same therapeutic effects (80%) were achieved with the use of amoxicillin, amoxicillin-clavulanate and cefixime, while the worst results were obtained after using azithromycin.

from the International Journal of Pediatric Otorhinolaryngology

Implementing and evaluating aphasia therapy targeted at couples’ conversations: A single case study

Conclusions: The study provides evidence that directly targeting the conversational behaviours of the person with aphasia and/or a main conversational partner can produce positive change, and can achieve this in a way that is ecologically valid. In particular, it highlights the usefulness of targeting conversational behaviours that are proving to be maladaptive for the participants. It provides further evidence that creating change in the non-aphasic partner’s conversational behaviour may facilitate change in the person with aphasia’s conversational and linguistic performance.

from Aphasiology

Therapy Discharge Becomes Part of the Life Story

Despite great strides in the life-participation approach to aphasia therapy and the arduous work of several therapists to include patients in the decision-making and goal-setting process of therapy, the patient’s direct perspective on the experience of treatment is seldom portrayed in academic journals. In the current article, the voices and different agendas of a stroke survivor with aphasia, her speech-language therapists, and an aspiring qualitative researcher are discussed by means of intertwined narratives, dialogues, and discourses. During an in-depth interview process, the researcher hears the effects of a discharge report on the perceptions and life course of a person living with aphasia. The researcher explores her own reactions and thoughts about the discharge process and report writing. The narratives in this article illustrate the potentially serious impact of seemingly routine clinical procedures, such as a discharge report.

from Topics in Stroke Rehabilitation

From mathematics to language: A novel intervention for sentence comprehension difficulties in aphasia

We report an intervention for severe and chronic sentence comprehension difficulties that used the intact resources of one symbolic system (mathematics) to scaffold impaired capacity in a second symbolic system (language). The study evaluated the outcome of therapy for participant SO. SO retained the ability to understand structural principles such as reversibility in mathematics. The therapy attempted to link this awareness to language expressions in order to enhance his understanding of canonical active sentences. The investigation employed a single case study design, with multiple-baselines. Behaviour was measured prior to intervention, immediately post-intervention, and following an eight week no-therapy maintenance period. A four component therapy programme lasting five weeks was implemented. Untreated control behaviours displayed only minor change following intervention. The intervention resulted in significant and stable improvement in treated behaviours with increased scores for sentence comprehension, including the comprehension of spoken and written reversible sentences. There was generalisation of gains to untreated sentences, and also to sentences which shared the verb, but not the noun phrases of the treated sentences.

from the Journal of Neurolinguistics

From mathematics to language: A novel intervention for sentence comprehension difficulties in aphasia

We report an intervention for severe and chronic sentence comprehension difficulties that used the intact resources of one symbolic system (mathematics) to scaffold impaired capacity in a second symbolic system (language). The study evaluated the outcome of therapy for participant SO. SO retained the ability to understand structural principles such as reversibility in mathematics. The therapy attempted to link this awareness to language expressions in order to enhance his understanding of canonical active sentences. The investigation employed a single case study design, with multiple-baselines. Behaviour was measured prior to intervention, immediately post-intervention, and following an eight week no-therapy maintenance period. A four component therapy programme lasting five weeks was implemented. Untreated control behaviours displayed only minor change following intervention. The intervention resulted in significant and stable improvement in treated behaviours with increased scores for sentence comprehension, including the comprehension of spoken and written reversible sentences. There was generalisation of gains to untreated sentences, and also to sentences which shared the verb, but not the noun phrases of the treated sentences.

from the Journal of Neurolinguistics