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PubMed1984

Current concepts in adult aphasia.

This paper provides a review of recent research from the areas of speech and language pathology, cognitive psychology, psycholinguistics, neurology, and rehabilitation medicine which is used to refine and extend current definitions of aphasia. Evidence is presented from these diverse disciplines, which supports a multimodality, performance-based, verbal and non-verbal, cortical and subcortical, and cognitively multidimensional view of aphasia. A summary of current practice in the assessment and treatment of adult aphasia is summarized.

Aphasia↗

PubMed1996

Weightings of items on the Code-Müller Protocols: the effects of clinical experience of aphasia therapy.

One hundred and twenty-two professionals engaged in aphasia therapy (graduates and undergraduates) ranked and weighted the relevance of the items of the Code-Müller Protocols (CMP) for assessing perceptions of psychosocial adjustment to aphasia using the multiattribute utility technique (MAUT). The degree of clinical experience with aphasia had a significant influence on participants' weightings of the items 'ability to follow interests and hobbies' and 'receiving speech therapy'.

Adaptation, Psychological↗

PubMed2001

Measuring quality of life in people with aphasia: the Stroke Specific Quality of Life Scale.

Assessing health related quality of life (HRQOL) in people with communication disabilities is a challenge in health related research. Materials used to assess HRQOL are often linguistically complex and their mode of administration usually does not facilitate people with communication disabilities to give their experiences. We are currently running a medium scale study (80 participants) which aims to explore the HRQOL of people with long-term aphasia and to assess the psychometric properties and the acceptability of the Stroke Specific Quality of Life Scale (SS-QOL) (Williams et al. 1999) as a single measure for the assessment of HRQOL in this population. Here the initial stages of modifying the SS-QOL for use with people with aphasia will be presented. We will concentrate on the process of making the scale communicatively accessible to people with aphasia and increasing its content validity with this population group.

Aphasia↗

PubMed1978

Aphasia and left thalamic hemorrhage.

Left thalamic hemorrhage as a cause of aphasia has not been widely recognized. Large thalamic hemorrhages cause coma, making speech examination impossible; smaller thalamic hemorrhages were difficult to document until recent diagnostic advances. Nine cases of thalamic hemorrhage with aphasia have been described in the literature. This report presents four additional cases. These patients had acute onset of aphasia, supranuclear paralysis of upward gaze, right hemisensory deficits, and mild right hemiparesis. Three of the four patients responded to ventriculostomy drainage with rapid clearing of the supranuclear paralysis of upward gaze, and two later required placement of permanent ventricular shunts. After 1 year, two patients exhibited no clinically detectable speech malfunction and the other two were severely aphasic. The hemiparesis, hemisensory deficits, and ocular pareses all cleared. These cases are discussed with respect to present models of the role of the thalamus in speech.

Adult↗

PubMed2006

The sounds of silence: relating to people with aphasia.

For people with aphasia, the struggle to communicate creates powerful emotions, such as anger and frustration, and feelings of isolation and depression. The author, who has had aphasia for more than 25 years, calls on health care professionals to relate to people with aphasia with patience, active listening, and motivation for success.

Adaptation, Psychological↗

PubMed1976

[Dissolutive and non-dissolutive elements in the phonetic disorders of aphasia patients].

The authors, by proceeding on the view that only part of the pathological phenomena may be satisfactorily explained by Jackson's theory of dissolution, have made an analysis of phonetic disorders (sound exchanges) for ten patients with sensory aphasia and mixed aphasia which is a mixture of motor and sensory aphasia. The results of preliminary studies of the ontogenetic occurrence of Bulgarian sounds in the development of the child's language were taken as a base for distinguishing dissolutive from non-dissolutive sound exchanges. It has been found that 36% and 64% of the sound exchanges were dissolutive and nondissolutive, respectively.

Aphasia↗

PubMedDate not supplied

[Acquired epileptic aphasia].

OBJECTIVE: To evaluate clinical and EEG features, as well as treatment and progression in fifteen patients with a diagnosis of acquired epileptic aphasia. PATIENTS AND METHODS: The population comprised nine male and six female patients, whose mean age was 14.5 (r = 8.11-20 years). All were on routine antiepileptic drugs. Inclusion criteria were acute, subacute or chronic aphasia, lacking signs of motor deficit or demonstrable brain lesion, but displaying bilateral spikes or generalized spike-wave discharges. Throughout, sleep and waking EEG, neuroimaging, brainstem auditory evoked potentials and neuro-psychological evaluations were performed. Cortical brainstem auditory evoked potentials were carried out in ten cases. RESULTS: Median age at onset of verbal auditory agnosia was 5.6 years (r = 1.1-8.6 years), which eleven cases developed epileptic seizures at a median age of five years. Waking and sleep EEG were abnormal but brainstem auditory evoked potentials were normal throughout. Cortical brainstem auditory evoked potentials in ten patients displayed P300 wave and vertex potential alterations. Five cases received 1-3 mg/kg/day prednisone during 6-12 months, with almost complete speech recovery in four. At the last follow-up, language impairment was mild in five patients, moderate in five and severe in three, while two children recovered normal speech. CONCLUSIONS: Early acquired epileptic aphasia treatment is advisable with valproic acid, benzodiazepines or ethosuximide alone or in combinations, supplementary with corticoids for at least six months in the absence of clinical response and/or EEG improvement. Globally, seven out of fifteen patients overcame their speech disorder.

Adolescent↗

PubMed1999

[The significance of the study of aphasia, apraxia and agnosia at present time].

Neuropsychology initiated by the study of aphasia, apraxia and agnosia had been regarded as one division of psychiatry. This is one of the reasons why neuropsychology is minor territory in neurology. Some people say that neuropsychology seems difficult to understand, not scientific, not useful and is rather a man's taste than a medicine. I try to respond in this paper to these critics by way of analyzing our own cases while insisting on the today's importance of the study of aphasia, apraxia and agnosia. Our personal cases consist of the following three categories. 1) Primary progressive apraxia: proposal of the symptomatic concept suggested by the investigation of our own eight cases and those in the literature. 2) Musical alexia with agraphia in a trombone player: study of the cerebral localization in a person with special ability. 3) Disturbance of reaching proposal of intracerebral pathways in kinesthesia. Therefore it is highly possible that the significance of the study of aphasia, apraxia and agnosia should become enlarged now and after; and it seems urgent to answer its need that younger neurologists participate in this area.

Aged↗

PubMed2000

[Differences in non-verbal behavior in individuals with various types of aphasia].

The aim of this research was to investigate if there were differences in non-verbal behaviour at persons with different forms of aphasia while resolving certain problems, and time spent for finding solutions to them. The research involved 30 patients with motoric, sensory and senso-motoric aphasia, in the area of 7 non-verbal variables. Using the statistical method (discriminatory analysis) we came up with the results confirming that there is a difference in the quality of problem solution at patients with different forms of aphasia, but the time frame for problem solving does not differ significantly with the same patients.

Adult↗

PubMed2000

[A study of measles encephalitis with focal changes on MRI, auditory agnosia and expressive aphasia].

Acute measles encephalitis is a typical parainfectious encephalitis in which the brain is diffusely affected clinically and neuropathologically. We present here a 5-year-old case of measles encephalitis with intractable seizures, bitemporal MRI abnormalities, and neurological sequelae of auditory agnosia and aphasia. Pathophysiology of the focal MRI lesions and of expressive aphasia due to auditory agnosia was discussed. We stressed that the status convulsions and its ischemic effect played an important role on the development of the focal lesions rather than focal encephalitis or ADEM. In the course of auditory agnosia and acquired aphasia, the patient transiently expressed some meaningful words. The significance of this episode was discussed based on the sequential changes of symptoms and neuroimaging findings.

Acute Disease↗

PubMedDate not supplied

[Motor function and functional capacity in hemiplegia with global aphasia after rehabilitation].

PURPOSE: The influence of global aphasia on the outcome rehabilitation of hemiplegia has been considered in very few case studies. Aim of this study is to evaluate motor function and functional capacities of patients whit hemiplegia and global aphasia after rehabilitation. PATIENTS AND METHODS: A consecutive sample of 54 first-stroke patients was assessed. The mean age of the patients was 64.9. Assessments were made using the Barthel Index, Fugl-Meyer Scale and Standard Language Examination of Basso. RESULTS: At admission 98.1% of the patients showed a complete paresis of the upper limb, while 72.2% provided a complete paresis of the lower limb. After rehabilitation 90.7% of the cases showed a complete paresis of the upper limb while 29.6% maintained the paresis of the lower limb. The lower limb had motriciy in flexor- and extensor synergies, while the upper limb only in flexor-synergies. At admission all patients showed severe or very severe disability. After rehabilitation disability was very severe in 9.2% of the patients, severe in 16.7%, moderate in 38.9% and light in 35.2%. At discharge 33.3% of the patients had a Berthel Index score above 70 while the mean score was 59.2/100. The higher self-sufficiency was detected in the personal hygiene (83% self-sufficient) and walking (61.1%); a lower degree of self-sufficiency was observed in eating, dressing and toileting (100% of the patients needed assistance). The patients aged less than 65 years showed a recovery in the functional capacities better than the level detected in patients older than 65 (p < 0.001). CONCLUSIONS: These results demonstrate that patients whit hemiplegia and global aphasia recovery better functional capacities than motor function after rehabilitation.

Aged↗

PubMed1975

[Transcortical aphasia and echolalia; problems of speech initiative].

Transcortical aphasia accompanied by echolalia occurs with malacias involving the postero-median part of the frontal lobe which includes the supplementary motor field of Penfield and is nourished by the anterior cerebral artery. The syndrome manifests itself in such cases even in fine detials in the same form as does in Pick's atrophy. The same also holds true for cases in which a tumour involves the region mentioned. Sentences or fragments of sentences are echolalised; tendency to perseveration is very marked. It is hardly, if at all, possible to evaluate the verbal understanding of these patients. Analysis of their behaviour supports the assumption that they have not lost the adaptation to some situations. Echolalia is often associated with forced grasping and other compulsory phenomena. Therefore, it may be interpreted as a sign of disinhibition of the acusticomotor reflex present during the development of the speech. Competition between the intentionality and the appearance of compulsory phenomena greatly depends on the general condition of the patient, particularly on the clarity of consciousness. The integrity of the postero-median part of the frontal lobe is indespensable for a normal reaction by speech to stimuli received from the sensory areas. The influence of the supplementary motor field on speech intention seems to be linked to the dominant hemisphere. In case lesions of the territory of the anterior cerebral artery and the cortico-bulbar neuron system are coexisting in the dominant hemisphere, the speech disturbance shifts to complete motor aphasia. In such cases the pathomechanism is analogous to that of the syndrome of Liepmann, i.e., right-sided hemiparesis with left-sided apraxia. So-called transcortical motor aphasia without echolalia can be caused by loss of stimuli from the sensory fields.

Aged↗

PubMed1975

[Effect of the factor "frequency of words" on temporal and structural characteristics of speech reaction in patients with motor-efferent and motor-afferent aphasia].

The effect of the factor "Frequency of the words" on the speech and the structure of the actualised verbal responses in patients with motor aphasia has been studied. It was established that the rate of the verbal associations occurence depended on the frequency of the word-stimulus and on the probable frequency of the response - stimuli with low frequency prolong the time of the actualisation, especially of the period of sound realisation. Alterations in the psycholinguistic structure of the associative responses were detected - the percentage of the syntagmatic links in both forms of motor aphasia diminished in stimuli with low frequency, which showed that the difficulties in the processes of combination increased. In repeating, reading aloud, writing to dictation with and without pronouncing low frequency words, the number of the mistakes increased and parallel to that the possibilities for their correction decreased. In words with high frequency, reverse correlation to these mentioned above have been established. The results from the study suggested that in preparing the program for the reparative education in patients with motor aphasia, we could rely not only on the "round-about ways" for the reconstruction of the impaired speech system, but also to enlarge considerably the support of its "preserved links". Such a "link" undoubtedly is the considerably preserved speech content of high frequency words.

Afferent Pathways↗

PubMed1975

[Mental disorders in patients with vascular aphasia].

The author conducted a study of some personality traits in 30 patients with different forms of vascular aphasia with the aid of a polar profile test. The questionnaire had 16 polar qualities. According to each of these criteria 2 scales were formed: prior to and following the disease. Two main types of personality changes wered noted: pseudoneutrotic disorders of a different degree (in patients with articular motor and sensory aphasia) and moderately or slightly expressed symptoms of apatho-abulia (in patient with expressed motor and mixed motor-sensory aphasia).

Aphasia↗

PubMed1975

[Controlled study of language re-education in aphasia: comparison between treated and untreated aphasics].

This study was undertaken in order to ascertain the specific effect of language rehabilitation on the oral expression of aphasic patients. The outcome of language disorders has been investigated in 185 aphasics (91 reeducated and 94 not reeducated) submitted to control examination at least 6 months following the first examination. Four of the main variables involved in the recovery process were studied: a) dependent variable, i. e., improvement, and the effects thereupon of 3 independent variables, i. e., a) the time interval between onset of aphasia and first examination, b) clinical type of aphasia on first examination and c) presence or absence of rehabilitation between first and second examination. Age, educational level, etiology and the time interval between first and second examination were controlled in all comparisons. The statistical analysis has established that language rehabilitation has a positive effect on the improvement of oral expression, while the duration of aphasia at the time of the first examination has an equally significant, but negative effect on improvement.

Adult↗

PubMed2002

[Neuropeptide induction of compensatory processes at aphasias].

Dynamic changes of speech function were studied in patients with persistence aphatic disorders after stroke under the conditions of application of V2 vasopressin receptor agonist (1-desamino-8-D-arginin-vasopressin). A course of intranasal administration of the medical drug by using the double blind control showed a reliable reduction of frustration severity of expressive and impressive speech in patients with aphasias of different forms and degrees. A correlation of positive influence of vasopressin on speech, verbal memory and attention was found at efferent motor aphasias. The achieved effects preserved during a two-year catamnestic observation period. A repeated course of therapy resulted in an additional improvement of speech. Neuropeptide restored initially, in patients with aphasias, relatively simple forms of speech and later--complicated ones. This resulted in an improvement of speech functions which are regulated by both cerebral hemispheres. Supposedly, neuropeptide optimized the activity of both the right and left cerebral hemispheres. The stability of the obtained effects is explained by induction, due to vasopressin, of compensatory processes leading to reorganization of intercentral connections.

Administration, Intranasal↗

PubMed1976

[Speech and perception in acoustic-mnestic aphasia].

In clinical practice of brain lesions one of the frequently encountered disorders is the so-called acoustico-mnestic form of temporal aphasia, which was first described by A.R. Luria. However, its nature and the mechansim of speech disorders in this form of aphasia are still not clear, despite the theortical and practical significance of this problem. The convened experiments have demonstrated that disorders of such forms of speech as nominating, repeating and understanding in acoustico-mnestic aphasia emerges from visual and acoustical perception and its complicated connections with speech. Disorders of nominative functions of speech are related mainly to defects in the visual sphere, disorders of repeating and partially understanding speech - with the narrowing of the volume of acoustical perception. A possible pathophysiological mechanism of such speech disorders may be a decrease in the brain activity which leads to a substitution of simultaneous processes of perception by successional ones.

Aphasia↗

PubMed2003

[Writing disorders in primary progressive aphasia].

We investigated longitudinally three patients with primary progressive aphasia (PPA) who exhibited fluent aphasia at the early stage, in terms of writing disorders. The writing disorders were the most striking during the aphasia quotient (AQ) was 50-60 for all these patients. The characteristic features were as follows: (i) several types of perseverative errors, especially on spontaneous writing rather than on dictation (ii) confusion between letters and pictures (iii) preserved copying ability and (iv) total loss of writing ability at the final stage. Additionally, through the progression, linguistic level of the perseverative errors changed from sentence to word and finally to phoneme. The results suggest that the fluent type PPA patients have difficulty to recall proper letters and to arrange them in correct order following the writing plan, in addition to disinhibition and lexical stereotyping which were commonly observed in perseverative patients. The results also suggest that their writing disorders seem to be based on difficulty of letter manipulation as symbols.

Aged↗