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PubMed2006

Psychosocial aspects of aphasia: speech and language therapists' views on professional practice.

BACKGROUND: Although the psychosocial dimensions of aphasia are relatively well understood, there may be variations in how these effects are managed in routine intervention. Speech and language therapists may hold a variety of views about this dimension of the aphasic experience, and these views may play a role in how intervention is managed.Aims. To survey practitioner views on the pertinence of psychosocial dimensions in the management of the aphasia speaker. METHODS AND PROCEDURES: Five hundred and twenty-one speech and language therapists who were members of the British Aphasiology Society were surveyed by questionnaire about their views on the importance and role of psychosocial effects (response rate to questionnaire, 33%). The questionnaire was composed of (i) background details of the participants' work context; (ii) attitude towards preparation for working in this area; (iii) attitude towards the importance of psychosocial effects in the management of aphasia; (iv) perceptions of clinical time devoted to this aspect of management; (v) attitude towards the rated importance of specific dimensions of psychosocial effects; (vi) details of methods used; (vii) an open question asking for further comments. OUTCOME AND RESULTS: Overall, strong agreement was shown about the importance of this aspect of aphasia intervention. Participants who believed that psychosocial aspects were important to overall management of the client also believed that these factors were important to the outcome of the intervention. Quality of life (QOL) was found to be an important dimension in psychosocial function, and premorbid experiences were perceived as affecting the outcome of interventions. A range of methods for working on psychosocial functions were reported. Concerns about managing service delivery in this area were expressed, with variations in reported time spent on this type of intervention. CONCLUSIONS: For this population of participants, the psychosocial dimensions were reported as important to management and outcome from intervention. Although variations in views and reported practice were evident, there were a range of responses, which showed a majority view, and these form the basis of key questions to be examined in further studies.

Anxiety↗
PubMed2006

Primary progressive aphasia in a bilingual woman.

Multilingual aphasias are common because most people in the world know more than one language, but little is known of these syndromes except in patients who have had a stroke. We present a 76-year-old right-handed woman, fluent in English and Chinese, who developed anomia at age 70 and then progressed to aphasia. Functional neuroimaging disclosed mild left temporoparietal hypometabolism. Neurolinguistic testing was performed in both English and Chinese, representing a unique contribution to the literature. Results revealed conduction-like aphasia that was comparable in the two languages, although English was slightly better preserved. Primary progressive aphasia has disrupted 2 languages in a similar manner, suggesting their close neuroanatomic relationship in this case.

Aged↗
PubMed1977

Recovery patterns and prognosis in aphasia.

Ninety-three aphasics were studied with repeated language assessment by a scorable test (the Western Aphasia Battery). Recovery rates were determined by measuring language performance (Aphasia Quotient) at nought to forty-five days post-onset, and three, six and twelve months and yearly after. Recovery rates were higher in post-traumatic than in cerebrovascular cases. When the stable infarcts were separately studied, the greatest recovery was seen in "Broca's" aphasics, followed by the "conduction" group. Anomic aphasia appeared to be a common end-stage of evolution. Long-term follow-up (twelve months or more) demonstrated that global aphasics have a poor prognosis, while Broca's and Wernicke's have an intermediate one. Complete recovery occurred frequently among anomic, conduction and transcortical aphasics and in more than half of the traumatic cases. Initial severity and outcome correlated significantly. Age and rate of initial recovery showed a trend of negative correlation; younger patients recovered better, but there were frequent exceptions, depending on other factors, such as the initial severity of aphasia. Although some cases recovered exceptionally well while under therapy, there was no significant difference between the treated and untreated groups, where such a comparison was possible.

Adolescent↗
PubMed1998

Dynamic aphasia: an inability to select between competing verbal responses?

In this study we report a patient (A.N.G.) who, following a malignant left frontal meningioma impinging upon Brodmann area 45, presented a 'pure' dynamic aphasia. Her spontaneous speech was markedly reduced in the absence of any syntactical impairment. Her naming, repetition and reading skills were completely normal. Two experimental investigations were carried out. The first investigation found that A.N.G. had a profound impairment in phrase and sentence generation tasks given a verbal context. However, her verbal generative skills were normal when she was asked to describe pictorial scenes and complex actions. Moreover, it was found that A.N.G. had no difficulty ordering the constituent words of a sentence. Thus, it was concluded that her verbal planning skills were intact. The second investigation tested a hypothesis that dynamic aphasia is due to an inability to select a verbal response option whenever the stimulus activates many competing verbal responses. Predictions based upon this hypothesis were confirmed on three different verbal generation tasks. It was found that our patient's grave verbal generative impairment was present for tasks involving stimuli which activate many potential responses. However, it was absent for tasks involving stimuli which activate few or only a single 'prepotent' response. The findings are discussed with reference to traditional interpretations of dynamic aphasia and more general interpretations of prefrontal cortex functioning. On the basis of a computational model of prefrontal cortex functioning, we propose that pure dynamic aphasia may be caused by damage to a 'context' module containing units responsible for selection of verbal response options. Moreover, it is suggested that our findings support the view that Brodmann area 45 is involved in verbal response generation to stimuli which activate many potential response options.

Aphasia↗
PubMed1999

Training-induced brain plasticity in aphasia.

It has long been a matter of debate whether recovery from aphasia after left perisylvian lesions is mediated by the preserved left hemispheric language zones or by the homologous right hemisphere regions. Using PET, we investigated the short-term changes in the cortical network involved in language comprehension during recovery from aphasia. In 12 consecutive measurements of regional cerebral blood flow (rCBF), four patients with Wernicke's aphasia, caused by a posterior left middle cerebral artery infarction, were tested with a language comprehension task. Comprehension was estimated directly after each scan with a modified version of the Token Test. In the interval between the scans, the patients participated in brief, intense language comprehension training. A significant improvement in performance was observed in all patients. We correlated changes in blood flow measured during the language comprehension task with the scores achieved in the Token Test. The regions which best correlated with the training-induced improvement in verbal comprehension were the posterior part of the right superior temporal gyrus and the left precuneus. This study supports the role of the right hemisphere in recovery from aphasia and demonstrates that the improvement in auditory comprehension induced by specific training is associated with functional brain reorganization.

Adult↗
PubMed2002

Behavioural analysis of an inherited speech and language disorder: comparison with acquired aphasia.

Genetic speech and language disorders provide the opportunity to investigate the biological bases of language and its development. Critical to these investigations are the definition of behavioural phenotypes and an understanding of their interaction with epigenetic factors. Here, we report our investigations of the KE family, half the members of which are affected by a severe disorder of speech and language, which is transmitted as an autosomal-dominant monogenic trait. The cognitive manifestations of this disorder were investigated using a number of linguistic and non-linguistic tests. The aims of these investigations were to establish the existence of a 'core' deficit, or behavioural phenotype, and to explain how such a deficit during development might give rise to the range of other impairments demonstrated by affected family members. The affected family members were compared both with the unaffected members and with a group of adult patients with aphasia resulting from a stroke. The score on a test of repetition of non-words with complex articulation patterns successfully discriminated the affected and unaffected family members. The affected family members and the patients with aphasia had remarkably similar profiles of impairment on the tests administered. Pre-morbidly, however, the patients with aphasia had enjoyed a normal course of cognitive development and language experience. This benefit was reflected on a number of tests in which the patients with aphasia performed significantly better than the affected family members and, in the case of some tests, at normal levels. We suggest that, in the affected family members, the verbal and non-verbal deficits arise from a common impairment in the ability to sequence movement or in procedural learning. Alternatively, the articulation deficit, which itself might give rise to a host of other language deficits, is separate from a more general verbal and non-verbal developmental delay.

Adolescent↗
PubMedDate not supplied

Familial primary progressive aphasia.

Primary progressive aphasia (PPA) is a neurodegenerative disease presenting with isolated, progressive, language dysfunction. After at least 2 years, dementia may develop, but the aphasia predominates. Few families with hereditary PPA have been reported; some have autosomal dominance. A chromosome 17 mutation in tau exon 13 has been found in one family, and a few have linkage to chromosome 17. However, early appearance of prominent memory, behavior, and motor impairments differentiates these patients from typical PPA. The objective was to report clinical features, pathology, and genetic analysis of a family with typical PPA. We report three siblings with the typical clinical syndrome of PPA. Each presented with word-finding difficulties and early anomia. Ages at onset were 60, 61, and 65 years. Aphasia was the only symptom for at least 2 years. A nonaffected brother is 75 years of age. Family history review found no other affected relatives. Neuropathology in one patient demonstrated "dementia lacking distinctive histopathology" with ubiquitin-positive cortical neurons. DNA analysis of the proband did not detect any known mutation in tau exons 1-5, 7, or 9-13. To our knowledge, this is the first family presenting with hereditary aphasia in which typical PPA occurs in all affected members.

Age of Onset↗
PubMed2005

Prognostic value of brain perfusion single-photon emission computed tomography (SPECT) for language recovery in patients with aphasia.

AIM: To determine the prognostic value of brain perfusion single-photon emission computed tomography (SPECT) in patients with aphasia after a stroke. METHODS: Brain perfusion SPECT with 99mTc-ethyl cysteinate dimer (99mTc-ECD) was used in 16 right-handed patients with aphasia after a left-sided cerebrovascular accident (CVA) in the early chronic period after the onset of CVA. The region of interest (ROI) method was used to calculate the relative regional cerebral blood flow (rCBF) in each cerebral lobe, the thalamus, the putamen and the cerebellum as ratios to the count in the left cerebellar hemisphere. The Standard Language Test of Aphasia (SLTA) was performed twice, once at the same time as SPECT, a mean of 2.3 months after CVA onset (early SLTA), and again a mean of 17.0 months after CVA onset (late SLTA). In addition to the overall language function score, scores for taking dictation (Dictation), oral reading (Speaking) and comprehension (Comprehension) were calculated, and the correlations with each of the rCBF values were evaluated. RESULTS: Left temporal CBF correlated with the late Dictation score; bilateral frontal, bilateral temporal and right parietal CBF correlated with the late Speaking score; and right frontal, left temporal and left occipital CBF correlated with the late Comprehension score. CONCLUSION: Brain perfusion SPECT in the early chronic stage was shown to be useful for predicting recovery from aphasia, recovery of oral reading, ability to take dictation and comprehension.

Aged↗
PubMed2006

Disorders of speech and language: aphasia, apraxia and dysarthria.

PURPOSE OF REVIEW: We review recent important papers pertaining to acquired aphasia, apraxia of speech and dysarthria with special attention to clinically significant work published in the last 12 months. RECENT FINDINGS: The role of the contralateral inferior frontal gyrus in language recovery after stroke is controversial, but is an area of active research, particularly in functional imaging studies. Recent treatment studies in poststroke aphasia have shown that intensity of language therapy may be more important than the method of therapy. Some studies have indicated that amphetamines, piracetam and repetitive transcortical magnetic stimulation may be effective adjuncts to speech and language therapy. Treatment studies for poststroke dysarthria indicate that speech supplementation strategies may be effective and deserve further study. SUMMARY: Recent studies of aphasia provide clues regarding language recovery poststroke, but further studies of the role of the ipsi and contralateral inferior frontal gyrus are necessary, and should be longitudinal. There are relatively few recent studies on the treatment of acquired disorders of speech and language, other than poststroke aphasia.

Aphasia↗
PubMed1988

Is aphasia an additional prognostic factor in ischemic stroke with regard to the severity of hemiparesis in the subacute stage?

The outcome of 122 patients with ischemic stroke in the left carotid territory (ascertained by CT) was investigated using mailed questionnaires after a mean follow-up time of 60.7 months (SD 20.5 months). Patients who had had cerebrovascular accidents others than TIA prior to the stroke were not included in the study. The relationship between the degree of aphasia in the postacute stage and the long-term outcome was evaluated with regard to the severity of motor deficits. With respect to survival, recurrent stroke, single activities of daily living such as dressing, personal hygiene, walking, feeding, bowel management and overall self-care status, the outcome of patients was not dependent on the severity of aphasia. Aphasia did also not serve as a prognostic factor in returning to work after left hemispheric cerebral infarction. Our results indicate that in presence of motor deficits the severity of aphasia in the subacute stage does not additionally influence the long-term outcome after left hemispheric cerebral infarction.

Activities of Daily Living↗
PubMed1989

A case of acquired conduction aphasia in a child.

A 10-year-old right-handed boy showed conduction aphasia with left-ear verbal extinction (paradoxical ipsilateral ear extinction) after removal of a arteriovenous malformation in the left parietal lobe. Buccofacial and ideomotor apraxia were not observed. Recovery from aphasia was dramatic. Postoperative computed tomography (CT) and magnetic resonance imaging scans demonstrated damage confined to the left supramarginal gyrus invading the arcuate fasciculus. Together with recently reported cases of acquired fluent aphasia in children with CT-verified left posterior lesions, this case seems to support the current view that both fluent and nonfluent aphasia that share many similarities with the symptoms and lesion localization associated with adult cases may exist in children.

Aphasia↗
PubMed1978

Dissociated disorders of speaking and writing in aphasia.

Of 500 left brain-damaged patients with educational level above elementary school investigated with a standard quantitative battery for dissociation between oral and written expression, speech was found to be selectively impaired in seven (three with "pure anarthria," two with anarthria in the context of Broca's aphasia, and two with fluent aphasia with remarkable sparing of writing), and writing in another seven (two with "pure" agraphia, two with "agraphia with mild alexia," and three with "agraphia with mild fluent aphasia.") The nature of three conditions (pure anarthria, fluent aphasia with sparing of writing, and pure agraphia) is discussed, with evidence of a selective association between pure agraphia and lesions of the upper left parietal lobule.

Adult↗
PubMed1977

Cranial computed tomography in aphasia. Correlation of anatomical lesions with functional deficits.

A variety of aphasic patients were studied to determine the relationship betweeen lesion size, as demonstrated by cranial computed tomography (CCT), and the type of aphasia, as classified by the Boston Diagnostic Aphasia Examination (BDAE). CCT demonstrated a variety of lesions. Those in nonfluent Broca's aphasics and fluent Wernicke's aphasics were separable into pre-Rolandic and post-Rolandic areas, respectively. Conduction, global, and anomic aphasics had different lesion sites. Correlation of lesion location by CCT with aphasia type supports Geschwind's concepts of aphasia.

Adult↗
PubMedDate not supplied

Psychosocial aspects of aphasia: whose perspectives?

This paper reviews some different meanings of the term 'psychosocial' and identifies the different ways in which the social and psychological sequelae of aphasia can be explored. These include qualitative methods, which seem well suited to addressing such complex issues. Having outlined some features of qualitative research, the paper describes a study in which fifty people talked about the consequences and significance of their long-term aphasia. Their 'insider perspective' on aphasia suggests its impacts are extensive, complex, direct and indirect, interconnected, systemic, dynamic and diversely experienced. The paper discusses the various implications of the study for clinicians and researchers concerned with the psychosocial aspects of aphasia and outlines how some of the issues raised in the interviews might be addressed.

Aged↗
PubMed1977

A neurolinguistic model for the study of aphasia.

After having briefly discussed some of the most important models that are now used to understand or to classify the aphasic troubles, the authors explain the neurolinguistic model they are actually using to study some aspects of aphasics' verbal and nonverbal behavior. This theoretical model distinguishes proper linguistic from extralinguistic disturbances in the various clinical forms of aphasia. The existence in aphasia of extralinguistic components that might, in some way, influence verbal performances, is accepted by most authors. Much less obvious is the existence, at least in some clinical forms of aphasia, of proper linguistic (competence) disturbances. Our theoretical model assumes that in most clinical forms of aphasia some impairment of the semantic (lexical) structures of language exists, and it maintains that this trouble can be found both at the expressive and at the receptive level, both in verbal and in nonverbal tasks. Th results of some experimental investigations which give some support to this theoretical model, are briefly discussed.

Aphasia↗
PubMed1996

A clinical profile of corticobasal degeneration presenting as primary progressive aphasia.

We report a patient with primary progressive aphasia who first presented with amnesic aphasia that developed over the course of 3 years into nonfluent aphasia with buccofacial apraxia, followed in the next year by cognitive impairment and parkinsonism. Pathological findings were typical for corticobasal degeneration except for the distribution of cortical atrophy. This case suggests that corticobasal degeneration should be included in the differential diagnosis of primary progressive aphasia, especially in association with parkinsonism.

Aphasia, Primary Progressive↗
PubMed2005

Role of the contralateral inferior frontal gyrus in recovery of language function in poststroke aphasia: a combined repetitive transcranial magnetic stimulation and positron emission tomography study.

BACKGROUND AND PURPOSE: Functional neuroimaging studies have demonstrated right inferior frontal gyrus (IFG) activation in poststroke aphasia. It remains unclear whether this activation is essential for language performance. We tested this hypothesis in a positron emission tomography (PET) activation study during a semantic task with repetitive transcranial magnetic stimulation (rTMS) on right-handed patients experiencing poststroke aphasia and examined whether rTMS stimulation over the right and left IFG would interfere with language performance. METHODS: Eleven patients with left-sided middle cerebral arterial infarction, 50 to 75 years of age, were tested with the Aachen Aphasia Test Battery and underwent (15)O-H2O PET activation during a semantic task within 2 weeks after stroke. PET activation images were coregistered to T1-weighted MRIs. Stimulation sites were determined on renderings of head and brain over the maximum activation within left and right IFG. rTMS was performed with 20% maximum output (2.1 T), 10-s train duration, at 4 Hz frequency. A positive rTMS effect was defined as an increased reaction time latency or error rate in the semantic task. RESULTS: PET activations of the IFG were observed on the left (3 patients) and bilaterally (8 patients). Right IFG stimulation was positive in 5 patients with right IFG activation, indicating essential language function. In a verbal fluency task, these patients had a lower performance than patients without right-sided TMS effect. CONCLUSIONS: In some poststroke aphasics, right IFG activation is essential for residual language function. However, its compensatory potential seems to be less effective than in patients who recover left IFG function. These results suggest a hierarchy in recovery from poststroke aphasia and a (limited) compensatory potential of the nondominant hemisphere.

Aged↗
PubMedDate not supplied

Aphasia outcome in stroke: a clinical neuroradiological correlation.

Fourteen aphasic patients with acute onset of thromboembolic cerebrovascular insults demonstrable by angiography or radioscintigrams who were available for long-term follow-up have been studied. Their aphasia evolution was compared with acute angiographical and radioisotopic findings, and the lesions shown by follow-up computerized axial tomography (CT). Angiographical site of occlusion, evidence of early reopening of occluded vessels, and radioisotopic flow asymmetries including the "hot-stroke" luxury perfusion failed to correlate with aphasia outcome. Radioisotopic static images were more helpful by depicting lesion location and number but lacked the definition seen on the CT scan. The long-term CT scan by showing the size, location and number of lesions had a good correlation with aphasia outcome. Those patients with large dominant hemisphere involvements, either one large or many smaller lesions, fared poorly while those with lesser lesions did better. Bilateral lesions, at times evasive clinically, helped to account for significant aphasia residuals.

Adult↗