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PubMed2005

Children and adolescents with chronic cerebellar lesions show no clinically relevant signs of aphasia or neglect.

We studied language and visuospatial functions of 12 children and adolescents who had undergone surgery for cerebellar astrocytoma without subsequent radiation or chemotherapy and compared them with 27 age-, gender-, and education-matched healthy control subjects. To study possible lateralization of the functions of the left and right cerebellar hemispheres, subjects performed several language tasks including a verb-generation task as well as standard neglect and extinction tests. Three-dimensional-MR images confirmed that lesions affected cerebellar hemispheres in all children but one who had a pure vermal lesion. The right cerebellar hemisphere was affected in six, the left hemisphere in four children, and both hemispheres in one child. There were no signs of aphasia in the children or adolescents with cerebellar lesions. Language abilities did not differ between cerebellar patients and control subjects except for small increases in reaction times in verb generation in patients with left-sided lesions. Visuospatial functions were also intact in cerebellar subjects except for minor group differences in neglect tasks. In sum, chronic focal cerebellar lesions acquired in childhood or youth do not result in persistent language disorders or clinically significant signs of spatial neglect or extinction.

Adolescent↗
PubMedDate not supplied

Managing aphasia: then and now.

The nature and attitudes of the professionals who 'manage' aphasia have changed significantly over the 75 years the IALP has existed. This review shows how IALP publications have reflected this, and considers recent developments, particularly in respect of the role played by the cognitive neuropsychological approach in evidence-based healthcare and by conversational approaches in the empowerment of aphasic people.

Aphasia↗
PubMedDate not supplied

Generalizable outcomes of bilingual aphasia research.

A number of constructs developed to account for bilingual aphasia phenomena have been advantageously extended to increase our understanding of language representation, processing, breakdown and rehabilitation in unilinguals as well. In particular, focus on the right-hemisphere-based pragmatic component of verbal communicative competence, the activation threshold, the control of resources, the role of emotion in second language acquisition and that of procedural vs. declarative memory, has led to the suggestion that unilinguals are in fact at one end of a continuum, with multilinguals who speak genetically unrelated languages at the other end. No function is available to the bilingual speaker that is not already available to the unilingual, unidialectal speaker. The only difference seems to be the degree of use the speaker makes of each of the relevant cerebral systems.

Aphasia↗
PubMedDate not supplied

Acquired alexia in multilingual aphasia and computer-assisted treatment in both languages: issues of generalisation and transfer.

This single-subject study addresses the issue of investigation and remediation of an acquired reading impairment observed in a Spanish-English bilingual speaker. Detailed bilingual reading testing showed parallel disturbances in the two languages, both from a qualitative and a quantitative point of view, with characteristics of letter-by-letter and aphasic alexia. On the basis of this mixed pattern, common to both languages, a two-step computer-assisted remediation programme was designed for English, then for Spanish, using a crossover AB-AB design. Therapy A consisted of tasks aimed at the inhibition of letter-by-letter reading. This was alternated with therapy B, which was designed to address phonological assembly. Results on therapy reveal transfer of gains when common reading processing are involved and language-specific gains with a greater benefit on the mother tongue when phonological representations are required in therapy and assessment. Consequences for language choice in bilingual aphasia therapy are discussed on the basis of these results.

Aphasia↗
PubMed1984

Deep dyslexia in a patient with crossed aphasia.

A single case study of a 33-year-old right-handed man who suddenly developed left hemiplegia and nonfluent aphasia is reported. Extensive testing of the patient's reading ability revealed the symptom complex of deep dyslexia. The relevance of crossed deep dyslexia in a reader of Italian is discussed.

Adult↗
PubMed1993

Crossed aphasia: analysis of a case with special reference to the nature of the lesion.

We report a case of crossed aphasia in a strongly right-handed woman due to a parieto-occipital tumor in the right hemisphere, documented by CT and MR images. Neuropsychological assessment was conducted on four different occasions: results revealed an uncommon feature in our case, because of the nature of the lesion and the evolution of the clinical picture. These findings are discussed in relation to the literature.

Aphasia↗
PubMed1992

Attenuated late positivity in the visual evoked potential in aphasia induced by lesions in anterior speech area.

Seven anterior aphasics, 7 nonbrain-damaged subjects and 7 normal controls were tested for their visual evoked potentials. Aphasics showed an attenuation of the long latency positivity related to interest in the stimulus. The attenuation may indicate the subject's failure to signal communicative intention. Thus the attenuated positivity may be a physiological correlate of a behavioral state (aphasia) induced by brain lesions.

Adult↗
PubMed1980

Emotional and psychotic reactions induced by aphasia.

A systematic study of the emotional and psychotic reactions induced by aphasia was conducted on 63 aphasic patients. 'Indifference reaction' was found in 19 cases and 'depressive reaction' in 36 cases. In 3 aphasics, we observed 'Goldstein's catastrophic reaction' and in 3 other patients, a state of 'euphoric unrestrained excitement'. Finally, in 2 aphasics 'psychotic reaction' was found, characterized by a state of psychomotor catatonic excitement. The hypothesis is advanced that the catatonic phenomenology of these subjects may be interpreted as 'Bonhoeffer's acute exogenous reaction' with catatonic symptoms.

Affective Symptoms↗
PubMed1990

Mixed transcortical aphasia without anatomic isolation of the speech area.

We report two patients with mixed transcortical aphasia following left frontal lobe infarctions. Although there was no evidence of anatomic isolation of the speech area on computed tomograms or magnetic resonance imaging scans, single-photon emission computed tomography in one case demonstrated diminished blood flow over the left parietal convexity suggestive of "functional isolation" of the posterior perisylvian language zone.

Aged↗
PubMed1999

Cortical language activation in stroke patients recovering from aphasia with functional MRI.

BACKGROUND AND PURPOSE: Two mechanisms for recovery from aphasia, repair of damaged language networks and activation of compensatory areas, have been proposed. In this study, we investigated whether both mechanisms or one instead of the other take place in the brain of recovered aphasic patients. METHODS: Using blood oxygenation level-dependent functional MRI (fMRI), we studied cortical language networks during lexical-semantic processing tasks in 7 right-handed aphasic patients at least 5 months after the onset of left-hemisphere stroke and had regained substantial language functions since then. RESULTS: We found that in the recovered aphasic patient group, functional language activity significantly increased in the right hemisphere and nonsignificantly decreased in the left hemisphere compared with that in the normal group. Bilateral language networks resulted from partial restitution of damaged functions in the left hemisphere and activation of compensated (or recruited) areas in the right hemisphere. Failure to restore any language function in the left hemisphere led to predominantly right hemispheric networks in some individuals. However, better language recovery, at least for lexical-semantic processing, was observed in individuals who had bilateral rather than right hemisphere-predominant networks. CONCLUSIONS: The results indicate that the restoration of left-hemisphere language networks is associated with better recovery and inversely related to activity in the compensated or recruited areas of the right hemisphere.

Adult↗
PubMed2002

Modality-specific deterioration in naming verbs in nonfluent primary progressive aphasia.

A longitudinal study of oral and written naming and comprehension of nouns and verbs in an individual (M. M. L.) with nonfluent primary progressive aphasia (PPA) is reported. M. M. L. showed progressive deterioration of oral naming of verbs well before deterioration of written naming of verbs and before deterioration of oral or written naming of nouns. Her comprehension of both nouns and verbs remained intact, at least relative to oral naming of verbs. Her performance is compared to that of two other individuals with nonfluent PPA, who were tested at two time points. These patients showed similar patterns with respect to grammatical word class (verbs more impaired than nouns) and modality (spoken production more impaired than written production), but somewhat different courses of deterioration. The modality-specific nature of the observed verb production deficits rules out a semantic locus for the grammatical class effects. The results provide a new source of evidence for the hypothesis that there are distinct neural mechanisms for accessing lexical representations of nouns and verbs in language production.

Aged↗
PubMed2005

Role of the right and left hemispheres in recovery of function during treatment of intention in aphasia.

Two patients with residual nonfluent aphasia after ischemic stroke received an intention treatment that was designed to shift intention and language production mechanisms from the frontal lobe of the damaged left hemisphere to the right frontal lobe. Consistent with experimental hypotheses, the first patient showed improvement on the intention treatment but not on a similar attention treatment. In addition, in keeping with experimental hypotheses, the patient showed a shift of activity to right presupplementary motor area and the right lateral frontal lobe from pre- to post-intention treatment functional magnetic resonance imaging (fMRI) of language production. In contrast, the second patient showed improvement on both the intention and attention treatments. During pre-treatment fMRI, she already showed lateralization of intention and language production mechanisms to the right hemisphere that continued into post-intention treatment imaging. From pre- to post-treatment fMRI of language production, both patients demonstrated increased activity in the posterior perisylvian cortex, although this activity was lateralized to left-hemisphere language areas in the second but not the first patient. The fact that the first patient's lesion encompassed almost all of the dominant basal ganglia and thalamus whereas the second patient's lesion spared these structures suggests that the dominant basal ganglia could play a role in spontaneous reorganization of language production functions to the right hemisphere. Implications regarding the theoretical framework for the intention treatment are discussed.

Aphasia↗
PubMed1983

Comparison of schizophrenic patients with formal thought disorder and neurologically impaired patients with aphasia.

This study compares the speech and language of 14 schizophrenic patients having a formal thought disorder with 13 neurologically impaired patients with aphasia. Transcribed interviews with these patients were blindly assessed by five specialists for classification as schizophrenic or aphasic. Three of the five specialists performed better than chance but only one achieved high discriminating ability. Interrater reliability was poor. Five of 14 language abnormalities assessed differentiated the diagnostic groups. These findings suggest that schizophrenic patients share many language abnormalities with aphasic patients but do not exhibit a classic aphasic syndrome.

Aphasia↗
PubMed1987

Low erythrocyte zinc content in acquired aphasia with convulsive disorder (Landau-Kleffner syndrome).

Abnormal zinc metabolism in a 6-year-old male patient with Landau-Kleffner syndrome (acquired aphasia and convulsive disorder) is the subject of our report. We describe a significant decrease of erythrocyte and plasma zinc levels in the patient as compared with normal. Red blood cell zinc content is normally 38.5 +/- 2.7 micrograms/g hemoglobin v 16.5 micrograms/g hemoglobin found in the patient. Plasma zinc level is 94.6 +/- 10.4 micrograms/dL in normal in comparison with 50.4 micrograms/dL in the patient. Normal oral zinc tolerance test performed on the patient precludes altered zinc absorption or increased urinary loss. The possible connection between abnormal zinc metabolism and the pathophysiology of Landau-Kleffner syndrome is discussed.

Aphasia↗
PubMed2003

The Edwin Smith surgical papyrus: description and analysis of the earliest case of aphasia.

The Edwin Smith surgical papyrus, which dates back nearly five millennia, is the oldest known medical text and contains the first written example of the word "brain", as well as the earliest known descriptions of the meninges and the cerebrospinal fluid. The papyrus describes 48 cases and gives the first accounts of several forms of brain injury and their associated complications. The Egyptian author presents an analytical approach to the reported cases and classifies them as favourable, uncertain or intractable, depending on prognosis. The authors believe that case 20 of the papyrus presents the first possible case of aphasia, which occurred following head trauma. The patient, frustrated by his inability to speak, developed nuchal stiffness, which might have been due to meningeal irritation. The case concludes with the advice that a patient with such a grave condition should only be comforted, not treated.

Aphasia↗
PubMed2001

The meaning of skilled care providers' relationships with stroke and aphasia patients.

Little is known about the reciprocal influence of communication difficulties on the care relationship. To illuminate care providers' lived experiences of relationships with stroke and aphasia patients, narrative interviews were conducted with providers particularly successful at communicating with patients. A phenomenological hermeneutic analysis of the narratives revealed three themes: Calling forth responsibility through fragility, restoring the patient's dignity, and being in a state of understanding. The analysis disclosed caring with regard to the patient's desire, which has its starting point in intersubjective relationship and interplay, in which nonverbal communication is essential--that is, open participation while meeting the patient as a presence. Thus, care providers prepare for deep fellowship, or communion, by being available. They described an equality with patients, interpreted as fraternity and reciprocity, that is a necessary element in presence as communion. The works of Marcel, Hegel, Stern, and Ricoeur provided the theoretical framework for the interpretation.

Adult↗
PubMedDate not supplied

Primary progressive aphasia: a review of the neurobiology of a common presentation of Pick complex.

Primary progressive aphasia (PPA) is an identifiable and distinct form of clinical presentation of focal degenerative disease. The underlying pathology is often considered heterogeneous, but we propose that, in fact, this syndrome has a characteristic underlying neurobiology related to Pick's disease and frontotemporal dementia. The authors reviewed the literature of PPA andfound 58 cases with autopsy. The majority of the cases had related underlying pathology, termed "Pick complex," a form of non-Alzheimer's dementia. This includes Pick's disease, corticobasal degeneration, dementia lacking distinctive histology, and motor neuron disease inclusions. Several of the cases described with focal Alzheimer's pathology do not fulfill the criteria of PPA, but have Alzheimer's disease with a major aphasic component.

Aphasia, Primary Progressive↗
PubMed2000

Maintenance of oral production in agrammatic aphasia: verb tense morphology training.

We used a single-subject research design to examine long-term maintenance of treatment gains in a severely aphasic patient. We used a well-defined therapy protocol [i.e., Computerized Visual Communication System (C-VIC) training] to target production of tense morphology and an assessment specifically designed to measure improvements in the targeted behavior. We first trained Subject #1, a 65-year-old man with a severe nonfluent aphasia, to produce simple subject-verb-object sentences, then tense-marked sentences. Remarkable improvement was shown and was maintained five months after training was terminated. Sixteen months later, he maintained only the ability to produce trained root verb forms. A second training was initiated to examine the parameters of training that affect maintenance. Maintenance was demonstrated up to a year after termination of treatment. We attribute Subject #1's maintained performance to his continued involvement in general C-VIC sentence level therapy following tense training.

Aged↗