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PubMed1997

Speech-induced cerebral metabolic activation reflects recovery from aphasia.

Six stroke patients with clinically significant aphasia were studied 4 weeks and again 12-18 months after their first left hemispheric ictus. The regional cerebral metabolic rate of glucose (rCMRglc) was measured repeatedly by PET at rest and during word repetition, and severity of speech impairment was assessed by a neuropsychologic test battery. The patterns of speech-associated activation of glucose metabolism were related to improvement in language performance as measured by the Token test. Three patients experienced significant recovery from aphasia (Token test: 47 to 3, 45 to 12, and 37 to 5 points, respectively), whereas 3 patients had poor outcome (Token test from 48 to 45, and from 47 to 39 and 24, respectively). Good recovery was related to activation of left hemispheric speech areas surrounding the infarct, especially left superior temporal gyrus. In contrast, the 3 patients with persistent aphasia showed rCMRglc recruitment in right hemispheric regions and were unable to activate left hemispheric speech areas on follow-up. These results indicate that favorable outcome is related to partial sparing of speech areas of the dominant hemisphere that can be (re-) activated. Predominant recruitment of contralateral areas is not efficacious for a considerable recovery from aphasia. It rather indicates unspecific involvement of widespread networks in the effort to perform a complex task.

Adult↗
PubMed2002

Prognostic relevance of quantitative topographical EEG in patients with poststroke aphasia.

In this prospective study we analyzed the prognostic value of topographical quantitative EEG (qEEG) in poststroke aphasia. Twenty-three right-handed patients (ages 56 +/- 12 years) with different types of aphasia were studied. Quantitative EEG under resting conditions and an aphasia test battery were applied twice, 2 and 8 weeks after a stroke. EEG power fast Fourier transform was performed for delta (2-3.5 Hz), theta (4-7.5 Hz), alpha (8-13 Hz), and beta (13.5-20 Hz) frequency bands. EEG abnormalities within and outside speech relevant areas are related to restitution of poststroke aphasia. In the ischemic regions they indicate local disturbances; outside they reflect failures in neuronal networks involved in the generation and propagation of the alpha rhythm.

Adult↗
PubMed2001

[Long term outcome of a severe non fluent aphasia. The effect of prolonged rehabilitation].

INTRODUCTION: Long-term clinical outcome of severe non-fluent aphasia is poorly reported. The efficacy of intensive speech therapy has been previously demonstrated but not the efficacy of prolonged speech rehabilitation. METHOD: We report a single case of aphasia, with a description of the initial clinical features and the long term outcome. Moreover we discuss the rehabilitation efficacy in two situations : delayed rehabilitation and long-lasting rehabilitation. RESULTS: A young adult was admitted after fronto-temporal cerebral infarction and presented with a severe non fluent aphasia. Spontaneous recovery involved comprehension but not verbal expression. Speech therapy began 10 months after onset and an improvement of oral expression was observed during at least 6 years. DISCUSSION: This case illustrates long term-recovery patterns of aphasia and the efficacy of delayed speech therapy, and moreover its efficacy at a long time after onset. No rehabilitation was performed during the period of spontaneous recovery. Consequently recovery of spontaneous oral expression can be attributed to speech rehabilitation. Furthermore long-lasting improvement can also be attributed to prolonged rehabilitation. Total amount of speech therapy for the patient can be similar to the amount of efficacious intensive therapy previously described. CONCLUSION: These findings confirm the efficacy of speech therapy in the late stage of recovery, and the possibility of late improvement after stroke.

Adult↗
PubMed1980

Some critical notes about "the epilepsy-aphasia syndrome" in children.

The clinical entity epilepsy-aphasia in children begins from an analytical study of cases published in the literature and from the study of eight cases personally observed. This condition is not an univocal syndrome but it must be differentiated into at least three different conditions even if, very often, they are superimposed: 1) a first condition in which the aphasia is critical and transient; 2) a second condition where it acts rather as a series congenital dysphasia, and 3) a third condition in which it acts as an acquired aphasia, in the strict sense, even though very atypical. The relations between aphasia and epilepsy are disussed especially for what concerns the dynamic of the diffusive forms of epilepsy in the child even in their psychiatric aspects. Both the pharmacological and reeducative problems of therapy are discussed.

Anticonvulsants↗
PubMed1999

Acquired aphasia in acute disseminated encephalomyelitis.

A 12-year-old boy developed a convulsion, hemiparesis, and acquired aphasia with paroxysmal electroencephalogram (EEG) abnormalities consisting of repetitive spikes and waves in the left centro-parietal region. T2-weighted magnetic resonance imaging disclosed high intensity lesions in the left pre-Sylvian and right frontal areas. He was diagnosed as having acute disseminated encephalomyelitis, and thus the oral administration of phenytoin and steroid pulse therapy were begun. With these treatments, his hemiparesis disappeared and the aphasia also improved gradually. Magnetic resonance imaging examination revealed the disappearance of the previously noted abnormalities, and the EEG abnormalities disappeared as well. This patient is a rare case of acute disseminated encephalomyelitis presenting an acquired aphasia. A focal lesion of acute disseminated encephalomyelitis may be responsible for the acquired aphasia. The distinction from Landau-Kleffner syndrome is also discussed.

Anti-Inflammatory Agents↗
PubMed2004

"Speaking for another": the management of participant frames in aphasia.

A sociolinguistic analysis of an interaction between a woman with aphasia and a nonaphasic speaking partner was conducted to investigate participant framing in aphasia. Participant frames, or the stances that people take in conversation, help conversational participants structure their talk and collaboratively negotiate meaning (I. Goffman, 1974). This analysis revealed a configuration in which a person with severe aphasia enlisted her speaking partner to speak for her. That is, the interaction was framed such that the nonaphasic speaking partner served as the "spokesperson" for messages that were authored by the person with aphasia. The clinical requirements of adopting a "speaking for another" framework are discussed.

Adult↗
PubMed2003

Auditory serial position effects in story retelling for non-brain-injured participants and persons with aphasia.

Using story retelling as an index of language ability, it is difficult to disambiguate comprehension and memory deficits. Collecting data on the serial position effect (SPE), however, illuminates the memory component. This study examined the SPE of the percentage of information units (%IU) produced in the connected speech samples of adults with aphasia and age-matched, non-brain-injured (NBI) participants. The NBI participants produced significantly more direct and alternate IUs than participants with aphasia. Significant age and gender differences were found in subsamples of the NBI controls, with younger and female participants generating significantly more direct IUs than male and older NBI participants. Alternate IU productions did not generate an SPE from any group. There was a significant linear increase from the initial (primacy) to the final (recency) portion of the recalled alternate IUs for both the NBI group and the group of participants with aphasia. Results provide evidence that individuals with aphasia recall discourse length information using similar memory functions as the nonimpaired population, though at a reduced level of efficiency or quantity. A quadratic model is suggested for the recall of information directly recalled from discourse-length language material.

Acoustic Stimulation↗
PubMed1979

A translation of Finkelnburg's (1870) lecture on aphasia as "asymbolia" with commentary.

On March 21, 1870, Dr. D.C. Finkelnburg addressed the Society of the Lower Rhine in Bonn on the popular topic of aphasia. He challenged the prevailing view that aphasia was a disorder of speech only and the emphasis that had been given to the issue of cerebral localization. The disorder, he pointed out, not only extended beyond the speech modality to include verbal comprehension, reading, and writing but also included many extraverbal disturbances of symbolic usage. In support of his argument, he presented five detailed case studies of aphasics (two with autopsy data) who demonstrated a variety of verbal and extraverbal deficits. Because the term aphasia referred specifically to speech disturbance and inadequately signified the full extent of the disorder, Finkelnburg proposed the more generic term asymbolia as a more accurate representation of the nature of the disorder. This translation makes available a previously inaccessible but historically important and still viable contribution to the study of the nature of aphasia.

Aphasia↗
PubMed1996

Speech timing in apraxia of speech versus conduction aphasia.

This study examined temporal parameters of speech in subjects with apraxia of speech, conduction aphasia, and normal speech. They were asked to repeat target words in a carrier phrase 10 times. Acoustic analyses involved measurement of stop gap duration, voice onset time, vowel nucleus duration, and consonant-vowel (CV) duration. Speakers with apraxia of speech had longer and more variable stop gap, vowel, and CV durations than did subjects with aphasia or normal speech. Speakers with conduction aphasia had longer vowel durations and CV durations than subjects with normal speech. Also, subjects with apraxia of speech showed greater token-to-token variability than the other subject groups. The variability shown by subjects with apraxia of speech was significantly correlated with perceptual judgments of their speech. The significance of these results is discussed in the context of motoric and phonological explanations for apraxia of speech and conduction aphasia.

Adult↗
PubMed1998

Spoken language of individuals with mild fluent aphasia under focused and divided-attention conditions.

The spoken language of individuals with mild aphasia and age-matched control subjects was studied under conditions of isolation, focused attention, and divided attention. A picture-description task was completed alone and in competition with a tone-discrimination task. Regardless of condition, individuals with aphasia performed more poorly on most morphosyntactic, lexical, and pragmatic measures of spoken language than control subjects. Increasing condition complexity resulted in little quantitative or qualitative change in the spoken language of the control group. In contrast, the individuals with aphasia showed dual-task interference; as they shifted from isolation to divided-attention conditions, they produced fewer syntactically complete and complex utterances, fewer words, and poorer word-finding accuracy. In pragmatic terms, their communication was considered less successful and less efficient. These results suggest that decrements of attentional capacity or its allocation may negatively affect the quantity and quality of the spoken language of individuals with mild aphasia.

Adult↗
PubMed2004

Transcranial magnetic stimulation as a complementary treatment for aphasia.

Functional brain imaging with nonfluent aphasia patients has shown increased cortical activation (perhaps "overactivation") in right (R) hemisphere language homologues. These areas of overactivation may represent a maladaptive strategy that interferes with, rather than promotes, aphasia recovery. Repetitive transcranial magnetic stimulation (rTMS) is a painless, noninvasive procedure that utilizes magnetic fields to create electric currents in discrete brain areas affecting about a 1-cm square area of cortex. Slow frequency, 1 Hz rTMS reduces cortical excitability. When rTMS is applied to an appropriate cortical region, it may suppress the possible overactivation and thus modulate a distributed neural network for language. We provide information on rTMS and report preliminary results following rTMS application to R Broca's area (posterior, R pars triangularis) in four stroke patients with nonfluent aphasia (5-11 years after left hemisphere stroke). Following 10 rTMS treatments, significant improvement in naming pictures was observed. This form of rTMS may provide a novel, complementary treatment for aphasia.

Aphasia↗
PubMed1999

Quality of life with aphasia.

This article considers quality of life (QOL) with aphasia. The problems surrounding definition and measurement of QOL are reviewed. Dimensions of QOL that have been suggested include elements relating to physical problems, the toxicity dimension, body image and mobility, communication, and psychological, interpersonal, spiritual, and financial issues. These issues are placed in the context of wider dimensions of satisfaction and life quality related to individuality, culture, and philosophical and time elements. Research on the illness experience is related to QOL. Research on QOL after stroke and aphasia is reviewed. Clinical approaches that integrate models of betterment of life quality in aphasia are suggested. Notions of coping and of Aristos, "making the best of a given situation," are considered in the discussion of adjustment and accommodation to life with aphasia.

Adaptation, Psychological↗
PubMed1989

Adult follow-up of the acquired aphasia-epilepsy syndrome in childhood. Report of 7 cases.

The authors report at adult age 7 patients (6 men, one woman) with the syndrome of "acquired aphasia-epilepsy", 6 of which had been previously studied as children. The results of the language, neuropsychological and socio-educational evaluation detailed many years after the onset of the aphasia are the subject of this report. One man has recovered completely, one has a normal oral language but is severely dyslexic, one has recovered normal comprehension but has severe expressive language problems. Four have absent language comprehension and lack of expressive speech, and only one of them has learned and is using sign language with some efficiency. None has developed functional written language. Attempts to offer a substitutive language to children with prolonged inability to understand and use oral language appears important but is fraught with problems. Although there are no conclusive data about the role of the continuous paroxysmal EEG discharges and the effect of their suppression with drug treatment on the prognosis of the aphasia, the definite fluctuations of the aphasia in some cases, the isolated recent case reports of definitive improvement with drug treatment justify further trials in this potentially severe and chronic condition.

Adolescent↗
PubMed1986

Contrecoup injury in the misdiagnosis of crossed aphasia.

Crossed aphasia is reported to be more frequent in traumatic series than in series of patients with other pathologies. A right-handed young man suffered a closed-head trauma and became aphasic and hemiparetic on the left. CT scan revealed a right frontal-lobe hematoma. Neuropsychological examination revealed a fluent aphasia and a Gerstmann syndrome. These signs were compatible with left supramarginal gyrus syndrome. However, the presence of a right frontal-lobe lesion suggested that this patient could be a crossed aphasic. Subsequent EEG study showed a left occipitotemporal focus and a right frontal one. Aphasic signs could thus be due to the left lesion, which was the result of a contrecoup mechanism. Fluent aphasias have been reported in closed-head trauma with right frontal impact. Attention is called for the possible bias of including cases like this in series of traumatic crossed aphasia.

Adult↗
PubMed2006

Identification of aphasia post stroke: a review of screening assessment tools.

INTRODUCTION: Aphasia is one of the most common consequences of stroke. Early identification, diagnosis and treatment of language deficits are important steps in maximizing rehabilitation gains. A routine screening test is an invaluable tool in the identification and appropriate referral of patients with potential communication problems. The present study presents an evaluation of the measurement properties of screening tools for aphasia found within the stroke research literature. METHODS: Screening tools were identified following searches of the published research literature in stroke. Instruments were reviewed on the basis of reliability, validity, classification sensitivity and practical utility. RESULTS: Six aphasia screening tools were identified. For most tools, information pertaining to measurement properties and clinical utility was limited. CONCLUSIONS: The Frenchay Aphasia Screening Test (FAST) appears to be the most widely used and thoroughly evaluated tool found within the stroke research literature. Further evaluation of the measurement properties and clinical utility of screening tools is recommended.

Aphasia↗
PubMed1999

Transcortical sensory aphasia due to a left frontal subcortical haemorrhage.

A case of transcortical sensory aphasia caused by a cerebral haemorrhage in the left frontal lobe is presented. A 72-year-old right-handed woman was admitted to the hospital, with a history of acute onset of speech disturbance and headache. On initial assessment, her spontaneous speech was fluent. She had no difficulty initiating speech, articulated normally, and did not exhibit logorrhea. Her ability to repeat phonemes and short sentences (5-6 words) was fully preserved, however she had severe difficulty with visual recognition of words, and with aural comprehension at the word level, although she was able to read words aloud. Computed tomography and magnetic resonance imaging showed cerebral haemorrhage in the left frontal lobe, involving the superior and middle frontal gyrus. Single photon emission CT revealed a wider area of low perfusion over the entire left frontal lobe, including the superior, middle and inferior frontal gyrus. The aphasia symptoms, mainly poor comprehension, disappeared quickly several weeks after the event. This may have been due to a reduction in the size of the haematoma and a resolution of the oedema around the haematoma. Clinically, the transcortical sensory aphasia in this case was indistinguishable from that caused by damage to the posterior language areas. Further case reports of transcortical sensory aphasia associated with frontal lobe lesions would help to confirm whether a relatively rapid recovery is characteristic in cases such as this.

Aged↗
PubMedDate not supplied

Prosodic disturbance in aphasia: speech timing versus intonation production.

Temporal control has often been suspected to be a critical factor in intonation production. In particular, disturbance in the production of fundamental frequency (F0) associated with intonation in patients with aphasia has been attributed to a primary underlying deficit in speech timing. The present study examined the speech timing abilities of two groups of patients with fluent and nonfluent aphasia who were found in a companion study to have relatively normal intonation production ability. Results indicated severe temporal control abnormalities for the patients with nonfluent aphasia. The fluent aphasic patients performed at comparable levels with the normal subjects, although in absolute terms their durations were also generally longer than normal. These findings do not support the view that intonation production depends critically on speech timing, and that its disturbance in aphasia is due to underlying temporal control deficit.

Aged↗
PubMedDate not supplied

Augmentative and Alternative Communication (AAC) for adults with severe aphasia: where we stand and how we can go further.

PURPOSE: To review literature specific to the use of AAC with adults who have severe aphasia. METHOD: The authors reviewed studies involving AAC interventions for adults with severe aphasia. RESULTS: Published data support the use of aided and unaided AAC with adults with severe aphasia in controlled treatment contexts. Reported gains in communication typically have not generalized to everyday settings. CONCLUSIONS: The application of AAC with persons with severe aphasia must address factors potentially limiting treatment success outside of training environments.

Adult↗