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A 76-year-old male with poststroke depression, seizure disorder, and global aphasia improved markedly when treated with methylphenidate. The use of psychostimulants in this population as well as their effect on seizure threshold is discussed.
We present a preliminary report on a study of the treatment of word finding difficulties in aphasia using phonological and orthographic cues. These techniques although often used to cue word finding in the immediate term have been little evaluated in terms of therapy designed to improve word retrieval in the long term. The first phase using cued word retrieval in a picture naming task was followed by a second phase designed to facilitate use of treated words in real-life contexts. The results from both phases were encouraging with improved word retrieval for three out of the four participants. The implications for clinical practice are discussed.
The aim of this study was to improve the comprehension of single items in a subject with global aphasia. Existing models of semantic organisation were used to inform and guide the treatment programme. Detailed pre-therapy testing suggested a severe comprehension deficit with an inability to obtain a precise semantic specification of the items, irrespective of modality of input. A category-specific hierarchical treatment programme including generic and specific details about items was implemented through various exercises and drills. Post-therapy testing revealed a significant improvement on treated and untreated items of treated categories but limited generalisation to items in untreated categories. Improvement in the subject's general semantic abilities was also documented following treatment. The results, which are shown to be a direct consequence of the intervention programme, lend support to the categorical and hierarchical view of the organisation of semantics and provide a basis for future rehabilitation studies in this area.
Repetition is viewed typically as a primary deficit in conduction aphasia. Consequently, repetition is considered to be a target of treatment, as opposed to an approach to treatment for this syndrome. However, our experience with a conduction aphasic who had greater speech fluency in repetition than in conversation encouraged us to develop a treatment programme based on sentence repetition. The treatment programme has three components: (1) a pre-/post-test of sentence repetition; (2) the treatment component, in which a new set of sentences is introduced each week in outpatient therapy for daily repetition; (3) analysis of verbal picture description prior to and following treatment as an independent language measure. The patient CM participated in 2 months of sentence repetition treatment, after which he displayed improvement in both sentence repetition and picture description. The reasons for such improvement and the general utility of the treatment programme are discussed.
The Panjabi adaptation of the Aphasia Screening Test (AST) has been used with a small group of stroke patients and the preliminary results are reported. All the patients are described and their test results plotted. Observations are made about the test procedure, with recommendations for its further use.
A survey of the service available, in speech and language therapy departments, to adults with aphasia revealed that many districts in the United Kingdom are unable to fulfil the professional recommendations for the care of aphasic clients. Although individual 'good practice' criteria could be satisfied, only a minority of districts were able to provide a comprehensive service. Levels of staffing for the adult neurological caseload are variable and even, at best, hinder therapists in delivering the recommended standard of management to aphasic clients and their carers.
This paper explores the impact of linguistic impairments on conversational ability in aphasia using conversation analysis (CA). Using a combination of quantitative and qualitative techniques, an analysis of the distribution of turns at talk in three aphasic participants' conversations with a relative and with the researcher is described. Using extracts from the conversations for illustration, three major factors are proposed which influence the sharing of conversational turns: (1) shared knowledge of interlocutors, (2) the manifestations of linguistic impairments in conversation, and (3) individual discourse styles. Finally, the implications of the findings for remediation are considered.
This study focuses on the assessment and treatment of the conversations of a couple where one partner has aphasia. The assessment and treatment, informed by conversation analysis, are described, and some implications for the relation between language and psychosocial issues discussed.
This paper reports some of the findings from a survey of speech and language therapists (SLTs) regarding their practice in the assessment of aphasia and their views on the assessments currently available. The reason for the survey was a desire to investigate whether the concerns about the adequacy of current approaches expressed in the research literature were in line with the perceptions of practising clinicians. It is also seen as a means of helping to ensure that any new instruments that may be developed are relevant to the needs of clinicians.
Primary progressive aphasia (PPA) is a distinct clinical entity in which the patient develops language deficits while other cognitive domains remain relatively preserved until late in the course of the illness. The diagnosis can be relatively clear through an appropriate diagnostic approach based on the history and physical examination. There is no cure, but speech therapy is beneficial in this illness.
Although the N400 component of event-related potentials (ERPs) is suggested to reflect language processing, exactly which language processing functions N400 is sensitive to is not clear. We investigated this component in aphasic patients with some impairments of language processing. Meaningful and meaningless words in Kana (Japanese characters) were used as stimuli under a visual oddball paradigm. Increases in N400 latency and amplitude in the aphasic group were significant in comparison with the control group. In the aphasic group, N400 latency correlated significantly with the performance intelligence quotient employed besides language quotients. Moreover, the N400 effects were seen more clearly in the left hemisphere than in the right hemisphere for both groups. We propose that the abnormal variations in amplitude or latency of N400 in the aphasic group reflect language processing functions (controlled processing and automatic processing) that are different between slight and severe cases of aphasia. Moreover, N400 effects are sensitive to intellectual abilities besides language ability. We also suggest that N400 effects in the left hemisphere for the aphasic group are a reflection of active language processing as the substitution function.
We report two aphasic patients who could discriminate Japanese syllables but could not identify them. Case 1 was a 51-year-old right handed woman with 12-year education. Case 2 was a 50-year-old right handed man with 9-year education. They developed fluent aphasia after a cerebral infarction. Brain MRI of case 1 revealed widely distributed lesions including inferior frontal, superior temporal, angular and supramarginal gyri. Lesions revealed by Brain CT in case 2 included the left superior and middle temporal, angular and supramarginal gyri. Both showed severe impairment of repetition and confrontation naming. No difference of performance was present between repetition of single syllables and polysyllabic words. On the contrary, oral reading of Kana characters were preserved. We examined their ability to perceive syllables in detail. In the discrimination task, they judged whether a pair of heard syllables was same or different. Case 1 was correct in 85% of the tasks and case 2 in 98%. In an identification task, they heard a syllable and chose a corresponding Kana, Kanji, or picture out of 10 respective candidates. Case 1 was correct only in 30% and case 2 in 50% of these tasks. On the other hand, selection of a correct target in response to a polysyllabic word was much better, i.e. 70% in case 1 and 90% in case 2. Based on these data we concluded that (1) syllabic identification is a different process from syllabic discrimination, and (2) comprehension of a polysyllabic word can be achieved even when the precise phonological analysis of continuent syllables are impaired.
A 54-year-old woman visited our emergency service complaining of a severe language disturbance. She was fluently speaking something but most of the words were merely meaningless syllables. This jargon state lasted only four hours, then her abnormal speech rapidly and completely recovered within 24 hours. She had also suffered from painful oral ulcers, fever and erythema-like eruptions on her face for about three weeks. Skin biopsy of a facial lesion revealed a dense infiltrate of neutrophils in the dermis and minimal features of vasculitis, which, with other typical clinical findings, led us to the diagnosis of Sweet's syndrome. Although head CT scans, MRIs, MRA or SPECT could not detect any brain lesions, a cerebrospinal fluid examination showed a mild pleocytosis of 38/mm3 with 47% polymorphonuclear cells. There have been a few case reports on Sweet's syndrome accompanying neurologic symptoms, most of which are mild meningitis. We speculate that the transient aphasia was due to a focal lesion in the central nervous system attributable to Sweet's syndrome. Sweet's syndrome might bring inflammatory or ischemic lesions to the cerebrum as Behçet's disease.
We reported on a subject with nonfluent primary progressive aphasia (PPA), NL, who demonstrated an impaired ability to make rhyme judgments (Dowhaniuk, Dixon, Roy, Black, & Square, in press). Our hypothesis was that these deficits represent a precursor to phonological alexia. However, no definitive evidence supported the existence of a phonological reading impairment as NL made relatively few errors reading nonwords. To further evaluate NL's nonword reading, nonword and real word reaction times were compared. NL's reaction times were significantly longer for only nonwords compared to the slowest control subject. We then assessed the first two stages of processing involved in nonword reading (Coltheart, 1996). NL did not demonstrate deficits with graphemic parsing or phoneme assignment. His continuing problems with auditory rhyme judgments support the presence of a phonological processing deficit not specific to reading. We conclude that reaction time measures allow for the detection of subtle nonword reading deficits.
Primary progressive aphasia (PPA) is a focal dementia characterized by an isolated and gradual dissolution of language function. The disease starts with word-finding disturbances (anomia) and frequently proceeds to impair the grammatical structure (syntax) and comprehension (semantics) of language. The speech output in PPA can be fluent or nonfluent. Memory, visual processing, and personality remain relatively well-preserved until the advanced stages and help to distiguish PPA from frontal lobe dementia and the typical forms of Alzheimer's disease. The term "semantic dementia" was originally introduced to designate a different group of patients with a combination of verbal and visual processing deficits. In practice, however, this diagnosis is also being used in a variant sense to denote a subtype of PPA with fluent speech and impaired comprehension, even in the absence of visual processing deficits. Insofar as the diagnosis of semantic dementia can have these two different meanings, it is important to specify whether it is being used in the original sense or to denote a subtype of PPA. Structural and physiological neuroimaging confirms the selective predilection of PPA for the left hemisphere, especially for its language-related cortices. A few patients with PPA display the neuropathological markers of Alzheimer's disease, but in an unusual distribution. The majority of the autopsies in PPA have shown either Pick's disease or lobar atrophy without distinctive histopathology. The suggestion has been made that PPA and frontal lobe dementia constitute phenotypical variations of a unitary disease process within the "Pick-lobar atrophy" spectrum. Recent advances in chromosome 17-linked dementias justify a rigorous search for tau polymorphisms and tauopathy in sporadic PPA. An informed approach to this syndrome will increase the effectiveness with which clinicians can address the unique challenges associated with the diagnosis and care of PPA.
INTRODUCTION: Human language is the final result of a group of brain activities directed towards the reception, integration and elaboration of linguistic messages. DEVELOPMENT: The disorganization of these activities following brain damage brings about a new linguistic functional level which constitutes the aphasic syndrome. Its assessment provides the clinician with information on the destroyed and impaired aspects and on those that have remained intact. The rehabilitation of aphasia should take into account the different components of the neurolinguistic semiology which have been evidenced by previous assessment, without forgetting that the rehabilitation process does not only have to deal with the expressive and receptive aspects of language, but also with a range of other possible cognitive impairments caused by the cerebral lesion and with the social and emotional problems that follow the new personal and social situation after the lesion.
The overall plan for this article reflects the author's experience of a full rehabilitation program for speech therapy in group. The organisation, the procedures, and the goals of an aphasia group are presented. The efficacy of such a training is discussed based on the controversial literature. The main current thoughts about this specific treatment as well as theoretical rationale for treatment processes are explained.
An account is given of the occupational resettlement and progress of four patients with severe dysphasia, due to cerebrovascular accidents. The dysphasia was predominantly expressive in two cases and predominantly receptive in the other two. Three of the patients were resettled in gainful employment and the fourth in a sheltered occupation. In all four cases, the patients attained a very adequate level of working efficiency, distinctly above what had been anticipated on clinical and psychometric grounds. While these results are encouraging, it is stressed that fuller and more extensive long-term follow-up studies of occupational resettlement in aphasia are necessary before firm conclusions can be drawn.