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PubMed1999

The emotional impact of aphasia.

In this article we review the negative impact of aphasia on emotional well-being. Depression is the emotional response that has been examined most, and we examine the different causes of depression for people with aphasia. We discuss the relationships between recovery and emotional state and the clinical implications of these relationships, then review briefly issues of drug treatment for depression. We conclude that the emotional impact of aphasia can have a marked negative impact on recovery, response to rehabilitation, and psychosocial adjustment.

Aphasia↗
PubMed1998

Functional outcome assessment of aphasia following left hemisphere stroke.

This article discusses issues regarding the assessment of functional outcomes in individuals who have aphasia following stroke. Some different approaches to functional outcome measurement are critically reviewed, ranging from general measures of stroke outcome to measures that have been designed specifically for aphasic individuals, to measurements focusing on aphasia's effects on quality of life. Examples of how to relate treatment of aphasia directly to functional outcomes assessment are also provided.

Aphasia↗
PubMed2003

Nothing to say, something to sing: primary progressive dynamic aphasia.

We describe a 76-year-old man (ADY) with dynamic aphasia in the setting of a degenerative frontal lobe dementia: primary progressive dynamic aphasia. He displayed a striking paucity of propositional speech despite intact speech production, and preserved singing and prosody. Vocal expression in the verbal and musical domains was investigated in a series of neuropsychological experiments based on novel language and musical tasks that were designed to establish the nature and specificity of the verbal output deficit. The features of the language disorder indicated that the speech output pathway was disrupted at the early stage of generation of a new pre-verbal message. In contrast, tests of musical output demonstrated that the generation of new musical ideas was unimpaired. The domain-specificity of dynamic aphasia may result from the disruption of specific cognitive processes necessary for the creation of verbal messages, as well as selective damage of brain regions involved in language production.

Aged↗
PubMed2004

Auditory-visual speech perception in an adult with aphasia.

The evaluation of auditory-visual speech perception is not typically undertaken in the assessment of aphasia; however, treatment approaches utilise bimodal presentations. Research demonstrates that auditory and visual information are integrated for speech perception. The strongest evidence of this cross-modal integration is the McGurk effect. This indirect measure of integration shows that presentation of conflicting tokens may change perception (e.g. auditory /bi/ + visual /gi/ = /di/). The purpose of this study was to investigate the ability of a person with mild aphasia to identify tokens presented in auditory-only, visual-only and auditory-visual conditions. It was hypothesized that performance would be best in the bimodal condition and that presence of the McGurk effect would demonstrate integration of speech information. Findings did not support the hypotheses. It is suspected that successful integration of AV speech information was limited by a perseverative response pattern. This case study suggests the use of bisensory speech information may be impaired in adults with aphasia.

Acoustic Stimulation↗
PubMed2006

Functional communication and executive function in aphasia.

The purpose of this exploratory study was to investigate the relationship between functional communication and executive function ability in aphasia. Twenty-five participants with aphasia underwent examination with an extensive test battery including measures of functional communication, executive function ability, and language impairment. Compared to published norms, most participants did not perform within normal limits on the executive function tests. As expected, the correlation between severity of language impairment and functional communication ratings exceeded that among the executive functioning and functional communication measures. Eight of ten correlation coefficients for the relationship between executive functioning and functional communication reached statistical significance suggesting a clear relationship between scores on the executive functioning measures and functional communication ability. Based on these results, it appears that decreased executive functioning ability may coincide with decreased functional communication ability in persons with aphasia.

Adult↗
PubMed2001

Voice recognition and aphasia: can computers understand aphasic speech?

PURPOSE: This preliminary investigation of the use of voice recognition software by people with aphasia presents a new method of training the software, which allows the aphasic user to by-pass the linguistically demanding standard training. It examines how accurately voice recognition software performed with aphasic speech and language as compared to that of control subjects. METHOD: Five non-impaired controls and six participants with aphasia used a vocabulary of 50 words and 24 phrases to train the software over a maximum of five sessions. For the people with aphasia baseline assessments provided a profile of speech and language impairment. Measures of software accuracy were taken for all subjects at baseline and after four subsequent training sessions, for both single word and phrase level dictation. RESULTS: Word level production resulted in similar accuracy levels for both groups. Phrase level production showed greater accuracy levels than single word level production for both aphasics and controls, but participants with greater speech difficulties had lower software accuracy scores. CONCLUSIONS: Training the software on a specific vocabulary allows people to access it whose speech and language difficulties would otherwise have prevented them. Findings are discussed in relation to use of the software as a dictation tool and as an input device to therapy software.

Adult↗
PubMed2003

Services for aphasia, other acquired adult neurogenic communication and swallowing disorders in the United Kingdom, 2000.

PURPOSE: We developed a questionnaire designed to determine the state of services provided by the National Health Service within the UK for adults with acquired neurologically caused communication disorders. A further aim was to compare our results with those from a similar survey conducted 10 years ago by Mackenzie et al. METHOD: We sent questionnaires to 264 managers and directors of adult speech and language therapy services in the UK. We asked questions about staffing levels, regional variations, patterns of service delivery at acute and chronic stages and staff time spent working with different communication and swallowing problems. RESULTS: Nearly 53% of average staff time was spent working with swallowing disorders accompanying neurological damage (dysphagia) compared to 24% with aphasia. As the percentage of time spent working with swallowing increased, the percentage of time spent working with aphasia reduced. Out of the time spent on aphasia treatment, 48% averages less than 3 h per week duration and just 4.8% averages more than 3 h per week, which was correlated with total number of speech and language therapists employed by a service. We found a significant difference only between London, with the highest total staff numbers, and the South West, with the lowest. We also found significant relationships between staff numbers and population size and staff numbers and the level of referrals to the service. CONCLUSIONS: Our main conclusions are: (1) while there may have been an increase in the number of speech and language therapists working with acquired and progressive neurogenic conditions in the past 10 years, they are mainly working with swallowing disorders, and (2) findings agree with recent studies showing that the amount of treatment or therapy that aphasic clients receive is well below that recommended by the literature.

Aphasia↗
PubMed2005

High scores on the Western Aphasia Battery correlate with good functional communication skills (as measured with the Communicative Effectiveness Index) in aphasic stroke patients.

OBJECTIVE: To examine the correlation between an impairment-level and a functional-level assessment scale of aphasia. DESIGN: Prospective, longitudinal study. SETTING: A stroke rehabilitation unit. SUBJECTS: Sixty-seven aphasic acute stroke patients who were undergoing a multi-disciplinary rehabilitation programme, including conventional speech and language therapy (SLT). INTERVENTION: Patients were assessed on study entry and 4, 8, 12 and 24 weeks after the start of SLT. The language impairment was assessed with the Western Aphasia Battery (WAB) and the communicative functional limitation associated with aphasia was measured with the Communicative Effectiveness Index (CETI).Results. There was a statistically significant correlation between the two scales for all assessment periods (Pearson's r=0.71; P<0.01). CONCLUSION: The study suggests that in the acute and subacute stages of stroke the scores of WAB and CETI can be surmised from one another.

Acute Disease↗
PubMed2005

A computerised communication aid for people with aphasia.

PURPOSE: To develop a portable computerised communication aid for aphasic people to support communication in everyday life. METHOD: A multidisciplinary team of aphasiologists, augmentative and alternative communication specialists, speech and language therapists and technicians developed a portable, modular system, PCAD (portable communication assistant for people with dysphasia), running on a commercially available handheld computer. The system was tested in a multiple case study. Aphasia therapy services In the UK, Portugal and The Netherlands referred 28 people with aphasia, who were considered eligible for a computerised communication aid. Participants were trained following a protocol and used the device in self-chosen real life settings. RESULTS: Six of the 28 selected aphasic patients decided not to test the device; 22 participated in the training. All 22 learned to operate the aid, 17 used it functionally, in everyday life. Five people did not use the aid outside the therapy room, although they were able to operate the aid and to use it in role play. These unsuccessful clients were younger, and tended to have a shorter duration of the aphasia. CONCLUSIONS: Carefully selected aphasic patients may benefit from a computerised communication aid, using it functionally in everyday communicative settings.

Adult↗
PubMedDate not supplied

'Helping or something': perceptions of students with aphasia and tutors in further education.

BACKGROUND: Every year, 10 000 people of working age in the UK have a stroke. Although half of all cases occur in those over 75 years of age, stroke affects more than 1000 people under the age of 30 years. The effects of stroke are far reaching and many people will find that they are unable to return to their previous lives. For some, a way to improve their situation is through further or higher education. Despite the increasing opportunities for people with disabilities to participate in further education, comparatively few studies have looked at this route for people who have had strokes. This study attempts to explore these issues. AIMS: This study investigated the experiences, views and expectations of two students with aphasia involved in further education, and those of their tutors. The study aimed to identify factors that acted as enablers and barriers in accessing education. METHODS & PROCEDURES: Two women with aphasia who had enrolled on further education courses following their strokes and their respective tutors contributed to this study. Questionnaires and semi-structured interviews were used to collect the data. Qualitative research methods were then used to reveal issues important to the participants in the teaching and learning dyad. OUTCOMES & RESULTS: Analysis of the interviews revealed that a core problem identified by all parties was access to learning support. The two underlying issues that were important for the students with aphasia were tutors' awareness of needs and problems with explaining their needs. For the tutors, awareness of the students' needs was most important. The perceptions of the students and the tutors of the educational experience were not the same. CONCLUSIONS: The disparities identified in the participants' accounts suggest that both parties need to be more aware of the roles and responsibilities if individuals with disability are to have equal opportunities in further education.

Adaptation, Psychological↗
PubMed2004

Recovery from aphasia: a longitudinal study on language recovery, lateralization patterns, and attentional resources.

Despite the large body of evidence on the neural basis of the recovery from aphasia, the role of either cerebral hemisphere remains controversial. This paper reports the results of a longitudinal single-case study on the patterns of lateralization for lexical semantic processing during the recovery from aphasia. The experimental protocol included a lateralized lexical decision task (LDT), an attentional task and a language test. There was no presentation site effect on the LDT, and the performance was jointly influences by attentional and language factors. These findings suggest that the recovery of lexical semantic processing may be sustained by both cerebral hemispheres, and highlights the importance of experimental protocols that allow examining both language and attentional factors modulating factors modulating the recovery from aphasia.

Analysis of Variance↗
PubMed1981

The epidemiology of aphasic and cognitive impairment in stroke: age, sex, aphasia type and laterality differences.

Sex differences and age distribution are examined in various types of aphasia and in right hemisphere-damaged patients due to acute infarct. The language and performance deficits were measured by a standardized test allowing us to group patients meaningfully. The higher male to female ratio of aphasia is shown to relate to a similar sex distribution in infarcts rather than to sex differences in cerebral organization. Broca's aphasics were somewhat younger than the other groups and the slight difference may be related to pathophysiological factors favouring embolic strokes in the anterior territory of the middle cerebral artery. Sex and aphasia types were not significantly different in various age groups except about 50 years of age where the female aphasics reversed the ratio.

Adolescent↗
PubMed1986

Brain lesions associated with nonfluent aphasia fifteen years following penetrating head injury.

Men who sustained penetrating head injuries resulting in nonfluent aphasia within six months following injury, were examined fifteen years later and classified into two groups, 13 with persistent nonfluent aphasia, and 26 without symptoms of aphasia. Relative to a normal control group on a comprehensive battery of speech and language tests, the chronic nonfluent aphasics demonstrated syntactic processing deficits in all language modalities, with only mild or no impairment in other language faculties. The recovered group demonstrated deficits only in written expressive syntax. The CT lesions of the two groups differed in the extent of left hemisphere lesion volume and the degree of posterior and deep lesion extension within the left hemisphere. The nonrecovered group did not have greater right hemisphere damage. Broca's area was equally involved in 77 per cent of patients in both groups. All patients in the nonrecovered group had posterior extension of their lesions in Wernicke's area with some involvement of the underlying white matter and basal ganglia in the left hemisphere.

Adolescent↗
PubMed1987

Correlations of subcortical CT lesion sites and aphasia profiles.

We have analysed the aphasia profiles of 19 cases with subcortical infarction or haemorrhage. Several components of the aphasic syndromes, especially sentence length and grammatical form (together compromising fluency), ease of speech initiation, articulation, voice volume, and auditory comprehension, were individually isolated for correlation with CT lesion site. Each component had a specific lesion site correlation, and lesions in various deep periventricular white matter regions were the critical ones for all components of aphasia. Simple tabulation of lesions as cortical or subcortical, and restricting analysis to lesions of basal ganglia would both have proved inadequate to account for clinical findings. A review of 61 subcortical cases in the neurological literature for which CT and aphasia data were available supports these conclusions.

Aphasia↗
PubMed1989

Preserved object recognition and reading comprehension in optic aphasia.

Optic aphasia is characterized by the ability to name from description and palpation but an inability to name visually-presented objects. Although originally attributed to a disconnection of visual information from object names, optic aphasia is often considered to be a mild form of visual agnosia. We describe a patient with optic aphasia who could access semantic information relevant to objects he could not name and comprehend written words he could not read. These data suggest that, at least in certain cases, this visual modality-specific naming impairment may not be attributable to impaired visual recognition. We suggest that this patient's preserved object recognition and reading comprehension was mediated by a semantic system supported by the right hemisphere.

Aged↗
PubMed1989

Crossed aphasias can be mirror image or anomalous. Case reports, review and hypothesis.

Individual cases of crossed aphasia (aphasia after a right hemisphere lesion in a right-hander) have often been reported. A number of theories have been proposed as to the neuropsychological and/or nerobiological mechanisms that might underlie this phenomenon, but there is still disagreement about its language phenomenology and possible significance. We report 2 cases of crossed aphasia after stroke and review 34 cases from the literature with anatomical documentation of lesion site. Analysis of this material suggests that they represent at least two populations. There may be general conclusions concerning mechanisms of cerebral lateralization to be learned from the investigation of anomalous groups such as crossed aphasics.

Aged↗
PubMed1976

A case of mixed transcortical aphasia with intact naming.

Altholgh Lichtheim recognized that Wernicke's 'reflex arch' (primary auditory area, to Wernicke's area, to Broca's area, to primary motor area) was important for repetition, he recognized that other areas of the brain (for example, area of concepts or semantic area) must be important in comprehension and voluntary speech. He suggested that Wernicke's area (phonemic area) not only projected to Broca's area (as Wernicke suggested) but that it also projected to the area of concepts. A lesion of this latter pathway or in the area of concepts would produce a syndrome where repetition was intact but comprehension was impaired (e.g. transcortical sensory aphasia). Lichtheim also thought that the area of concepts projected directly to Broca's area and that voluntary speech was mediated by this pathway. Although Lichtheim's model could explain the mechanism underlying transcortical aphasia, his schema could not explain anomic aphasia. Unlike Lichtheim's schema, Kussmaul's schema suggested that the area of concepts projects back to Wernicke's area before projecting to Broca's area. With this schema, a patient with a hypothetical lesion which interrupted the pathway from the area of concepts to Wernicke's area (but did not interrupt the pathway from Wernicke's area to the area of concepts) should be anomic, with normal comprehension and repetition. In order for this latter schema to be plausible there should also be a lesion which interrupts the pathway from Wernicke's area to the area of concepts but does not interrupt the pathway which goes from the area of concepts to Wernicke's area. A patient with this hypothetical lesion should comprehend poorly; however, in spite of poor comprehension, naming and repetition should be intact. We report a patient who demonstrates poor comprehension with intact naming and repetition. This patient could also read aloud but could not comprehend written language. Not only could this patient name objects but he could demonstrate their use. These observations suggest that comprehension of written language is mediated by a different pathway than the recognition of visually presented objects.

Aphasia↗
PubMed2006

Semantic dementia and fluent primary progressive aphasia: two sides of the same coin?

Considerable controversy exists regarding the relationship between semantic dementia (SD) and progressive aphasia. SD patients present with anomia and impaired word comprehension. The widely used consensus criteria also include the need for patients to exhibit associative agnosia and/or prosopagnosia: many authors have used the label SD for patients with non-verbal, as well as verbal, semantic deficits on formal testing even if they recognize the objects and people encountered in everyday life; others interpret the criterion of agnosia to require pervasive recognition impairments affecting daily life. According to this latter view, SD patients have pathology that disrupts both a bilateral ventrotemporal-fusiform network (resulting in agnosia) and the left hemisphere language network (resulting in profound aphasia). These authors suggest that this profile is different to that seen in the fluent form of primary progressive aphasia (fPPA), a neurodegenerative disease primarily affecting language function. We present data on seven patients who met the diagnostic criteria for fPPA. All seven showed deficits relative to matched controls on both verbal and non-verbal measures of semantic memory, and these deficits were modulated by degree of anomia, concept familiarity and item typicality. Voxel-based morphometry revealed reduced grey matter density in the temporal lobes bilaterally (more widespread on the left), with the severity of atrophy in the left inferior temporal lobe being significantly related to performance on both the verbal and non-verbal measures. Together these findings suggest that patients who meet the diagnostic criteria for fPPA, can also meet the diagnostic criteria for early-stage SD provided that the impact of concept familiarity and typicality is taken into account. In addition, these findings support a claim that the patients' deficits on both verbal and non-verbal tasks reflect progressive deterioration of an amodal integrative semantic memory system critically involving the rostral temporal lobes, rather than a combination of atrophy in the left language network and a separate bilateral ventrotemporal-fusiform network.

Aged↗