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Language modality performance patterns in aphasia.

The purpose of this study was to investigate and describe the performance of 20 aphasic subjects across the four language modalities of auditory comprehension, verbal expression, reading, and writing. Subtests from the Boston Diagnostic Aphasia Examination and the Porch Index of Communicative Ability were administered to each subject. Results indicated that aphasia differentially affects performance in the four language modalities investigated. In this study, aphasic subjects as a group demonstrated variability in the degree of difficulty experienced in auditory comprehension, verbal expression, reading, and writing for both single words and short connected units. Furthermore, there was a consistent pattern of performance differences across modalities regardless of the length of the stimulus. This modality performance pattern is presented and plausible explanations are discussed.

Adult↗

Oral form identification as a measure of cortical sensory dysfunction in apraxia of speech and aphasia.

Oral form identification scores were obtained for nine anterior and nine posterior left-hemisphere brain lesion subjects exhibiting speech apraxic behavior and aphasia. An objective measure of speech apraxic difficulty and a standardized aphasia assessment were obtained for each subject. Despite the traditional association of a cortical sensory deficit including asterognosis in posterior brain-injured patients, oral form identification scores did not differ significantly for the two subject groups. However, a previously reported heterogeneity of performance was observed in the present data. The oral form identification deficit was unrelated to the severity of apraxia but exhibited its highest correlation value with a task of linguistic symbol discrimination. Results were interpreted to suggest that oral form identification deficits are most probably not causally related to motor speech programming problems nor should such deficits in this population be viewed as a valid indicator of cortical sensory dysfunction.

Adult↗

Acquired aphasia in children: revisited.

Observations of acquired aphasia in a more numerous series of children with cortical lesions modifies somewhat the conclusions of an earlier study. Aphasic syndromes in these children seem to result almost exclusively from left hemispheric lesions in right-handers. Aphasia is more frequent, at least among the youngest children, than in adults. The factors most responsible for language disorders in these children are lesion localization and etiology.

Adolescent↗

[Visuoverbal disconnection (optical aphasia) for objects, pictures, colors and faces with abstractive alexia].

The case is reported of a patient who, after a left occipital infarction, presented a deficit in naming visually presented objects with neither aphasia, nor perturbation in the perceptive and associative processing of visual informations. This visuo-verbal disconnection was accompanied by disturbance of the semantic function when this was explored via the visual channel. In addition the patient showed an alexia which could be described as an abstraction defect. Finally, the patient showed a deficit in naming colors and faces, without evidence for agnosia. This observation argues in favor of maintaining a distinction between visual associative agnosia and optic aphasia. It also demonstrates that the naming deficit implies a deficit in extracting semantic values from visual informations such as objects or graphic symbols.

Aged↗

The design and application of a data- and methodbase system for the Aachen Aphasia Test.

The basic components of a data- and methodbase system useful for both individual diagnosis and (group-study) research in neuropsychology are described. Such a system enables one to organize, access and evaluate large data-sets of behavioural, neuroradiological and neurological information. The most important component of the system, the data- and methodbase management system, is described in some detail. It operates on databases comprised of Aachen Aphasia Test examinations and standardized CT evaluations as well as on methodbases containing various sets of analysis routines for the psychometric evaluation of (individual) aphasia test results and the evaluation and (graphical) presentation of standardized (individual) CT lesions. Although exemplified for AAT scores the techniques and principles employed are applicable to data- and methodbase systems in general.

Aphasia↗

Right motor neglect associated with dynamic aphasia, loss of drive and amnesia: case report and cerebral blood flow study.

A 30-year-old right-handed man had right motor neglect, amnesia, aphasia and loss of drive following bilateral thalamic and subthalamic infarctions. Serial resting cerebral blood flow (CBF) measurements with either Xenon 133 inhalation or positron emission tomography at 1, 8 and 10 months post-onset showed a widespread and long-lasting low CBF in the cortex. An additional CBF measurement, during motor tasks, showed a marked interhemispheric asymmetry in the pattern of activation: whereas left hand movement resulted in a CBF increase in contralateral superior rolandic and prerolandic areas, no significant regional CBF changes were seen during right hand movement, despite recovery from motor neglect. This loss of CBF increase in cortical motor and premotor areas during voluntary movement of the previously neglected side points to a disruption of cortico-subcortical pathways subserving motor activation. The pathophysiology of aphasia, loss of drive and amnesia as well as their relationships to motor neglect, may also be discussed on the basis of thalamo-cortical disconnections.

Adult↗

Comparison of metabolic rates, language, and memory in subcortical aphasias.

Four patients with subcortical lesions and either aphasia or amnesia were compared to four patients with cortical lesions and aphasia. Each patient had [18F] fluorodeoxyglucose positron-emission computed tomography, language, and memory evaluations. Marked metabolic depression was found in the thalamus and caudate in all patients. The subcortical patients had only mild left-cortical changes, while the cortical patients showed marked cortical metabolic changes in the left hemisphere. Language changes were mild in the subcortical patients, while moderate to severe in the cortical patients. All patients showed severe verbal memory dysfunction. The only common abnormalities in the two groups were metabolic changes in the thalamus and severity of verbal memory dysfunction. These findings suggest a relationship between verbal memory and thalamic function.

Adult↗

Correlations of glucose metabolism and structural damage to language function in aphasia.

Studies of aphasic patients using [18F]fluorodeoxyglucose positron computed tomographs have shown areas of metabolic depression in the left hemisphere larger than the area of infarction noted on CT. To evaluate these metabolic differences in relationship to language abnormalities, 11 patients had metabolic scans, CT, and were administered the Boston Diagnostic Aphasia Battery and the Porch Index of Communicative Ability. Correlation analyses were computed between metabolic, CT, and language data. CT demonstrated reliable correlations of speaking, oral reading, and repetition to Wernicke' area, consistent with current anatomic language models, while metabolic data from areas posterior, inferior, and superior to the traditional Wernicke's area and the head of the caudate nucleus also had reliable correlations with aphasic language function. The utilization of both structural and metabolic brain measures may improve our understanding of the anatomy of language as related to aphasia.

Adult↗

Optic aphasia, optic apraxia, and loss of dreaming.

A 47-year-old man with a left temporo-occipital infarct in the area of the posterior cerebral artery is presented. The neuropsychological examination did not reveal aphasia or gross mental deficits. The patient presented with alexia without agraphia, color agnosia, but few visual perceptual deficits. The main impairment was in confrontation naming; he was incapable of naming objects and pictures, not from lack of recognition (excluding visual agnosia) but from lack of access to the appropriate word (optic aphasia). The patient also exhibited a deficit in the evocation of gesture from the visual presentation of an object (optic apraxia) and a difficulty in "conjuring up" visual images of objects (impaired visual imagery) and loss of dreams. The fundamental deficit of this patient is tentatively explained in terms of visuoverbal and visuogestural disconnection and a deficit of mental imagery.

Aphasia↗

Aphasia for Morse code: a comment on Wyler and Ray (1986).

A. R. Wyler and R. W. Ray (1986, Brain and Language, 27, 195-199), present a case of aphasia for Morse code; they relate the deficit to the inability to detect high-speed auditory temporal sequences. Based on a personal observation of transient aphasia for Morse code, we proposed that at least three different abilities participate in recognizing and producing Morse code messages: (1) a specific linguistic ability, (2) a praxic skill, and (3) an auditory discrimination skill. Our patient presents difficulties in the first and second abilities, Wyler and Ray's in the third ability.

Aphasia↗

Anticipatory coarticulation in aphasia: acoustic and perceptual data.

Two experiments investigated speech motor planning in aphasia by contrasting the degree of labial and lingual anticipatory coarticulation evident in normal subjects' speech with that found in the speech of aphasic subjects. In the first experiment, Linear Predictive Coding (LPC) analyses were conducted for the initial consonants of CV [si su ti tu ki ku] and CCV [sti stu ski sku] productions by 6 normal and 10 aphasic (5 anterior, 5 posterior) subjects. For normal subjects' productions, reliable coarticulatory shift was found for almost all measurements, indicating that acoustic correlates for anticipatory coarticulation obtain for [s], [t], and [k] in a prevocalic environment, as well as when [s] is the initial consonant of a CCV syllable. The data for the aphasic subjects were statistically indistinguishable from those of the normal subject group, and there were no differences noted as a function of aphasia type. In the second experiment, a subset of the consonantal stimuli produced by the normal and aphasic subjects was presented to a group of 10 naive listeners for a vowel identification task. Listeners were able to identify the productions of all subjects at a level well above chance. In addition, small but statistically significant Group differences were observed, with the [sV], [skV], and [tV] productions by anterior aphasics showing significantly lower perceptual scores than those of normal subjects.

Aged↗

Auditory event-related potential probes and behavioral measures of aphasia.

This study examined the relationship between an auditory event-related potential probe technique measure of differential hemispheric processing and traditional tests of aphasia in aphasic patients. Subjects were 10 aphasic and 10 normal adult males. The results of the electrophysiological measures indicated that the aphasic subjects responded differently from the normal group particularly when the task required processing of verbal information. During the verbal task the aphasic group showed higher amplitude right hemisphere responses as compared to left. The normal group showed little hemispheric task related asymmetries. The pattern of electrical asymmetry in the aphasic group seems to be an indicator of severity as measured by traditional aphasia examinations.

Adult↗

Three variant forms of subcortical aphasia in Chinese stroke patients.

Five right-handed patients with subcortical aphasia that involved the left hemisphere subcortical lesion sites were subjected to CT scans. Given their etiology, two cases were infarctions and the other three were hemorrhages. Two of the patients presented an involvement of the anterior limb of the internal capsule and of the basal ganglia and an anterior superior white-matter lesion extension. In both cases slow scanty dysarthric speech was noted; one had markedly impaired auditory comprehension, and the others were only partially impaired. The third patient presented an involvement of the posterior limb of the internal capsule and of the thalamus and a posterior paraventricular white-matter lesion extension. He had poor auditory comprehension, echolalia, and fluent speech. The last two patients presented an involvement of the internal capsule, the basal ganglia, and the thalamus and an anterior posterior paraventricular white-matter lesion extension. The latter two showed poor auditory comprehension with nonfluent and scanty spontaneous speech. The speech sounds were nonsensical monosyllabic words with a pattern similar to that of global aphasia. All patients had lasting right hemiplegia.

Aged↗

Interaction between verbal and gestural language in progressive aphasia: a longitudinal case study.

The objective of this longitudinal study is to investigate the on-line interaction between praxis and linguistic abilities in a progressive aphasia case. During 3 years of evolution, procedural discourse of a progressive aphasic patient was videotaped five times, allowing us to analyze the progression of both language and gestural production as well as the interaction between these two. We anticipated that, in the absence of apraxia, the patient would compensate for her speech deficit by producing progressively more and more meaningful gestures. Our compensatory hypothesis was confirmed but the compensation was not as efficient as one would expect given the absence of apraxia. With the progression of the speech deficit, the patient could not replace some verbs by pantomimes that were otherwise accompanying her discourse in the preceding testing sessions. We suggest that such a compensatory ability may constitute one important characteristic of the progressive aphasia syndrome.

Aphasia↗

Drawing: its contribution to naming in aphasia.

Drawing in aphasia therapy has been used predominately as a substitution for speech or to augment communication when other modalities are non-functional. The value of drawing as a route for facilitating verbal expression has not been a focus of prior research. We compared the usefulness of drawing and writing as compensatory strategies for improving naming in individuals with aphasia. Activation patterns of writing and drawing in healthy adults were examined using fMRI. Clinical results suggest that drawing facilitated naming whereas writing diminished accurate naming responses, and that drawing quality is not relevant to this facilitatory effect. Functional MRI findings revealed strong bi-hemispheric activation of semantic and phonological networks while drawing that may support our clinical findings.

Aged↗

Temporal processing and context dependency of phoneme discrimination in patients with aphasia.

Standard diagnostic procedures for assessing temporal-processing abilities of adult patients with aphasia have so far not been developed. In our study, temporal-order measurements were conducted using two different experimental procedures to identify a suitable measure for clinical studies. Additionally, phoneme-discrimination abilities were tested on the word, as well as on the sentence level, as a relationship between temporal processing and phoneme-discrimination abilities is assumed. Patients with aphasia displayed significantly higher temporal-order thresholds than control subjects. The detection of an association between temporal processing and speech processing, however, depended on the stimuli and the phoneme-discrimination tasks used. Our results also suggest top-down feedback on phonemic processing.

Adult↗

A proposed regional hierarchy in recovery of post-stroke aphasia.

Activation studies in patients with aphasia due to stroke or tumours in the dominant hemisphere have revealed effects of disinhibition in ipsilateral perilesional and in contralateral homotopic cortical regions, referred to as collateral and transcallosal disinhibition. These findings were supported by studies with selective disturbance of cortical areas by repetitive transcranial magnetic stimulation (rTMS) in healthy volunteers and in patients with focal brain lesions. Both, collateral as well as transcallosal disinhibition might be relevant for the compensation of lesions within a functional network. From these data a hierarchical organization of recovery of aphasia after stroke and of compensation of language defects due to brain tumours can be deduced, by which the reactivation of undamaged network areas of the ipsilateral hemisphere usually lead to better outcome than the involvement of homotopic contra-lateral regions. rTMS can be used to identify areas relevant for speech production and might play a role in treatment strategies targeted at modulating the activity of contralateral homotopic areas of the functional network which might interfere with language recovery.

Aphasia↗