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PubMed2005

Analyzing aphasia data in a multidimensional symptom space.

The utility of single-case vs. group studies has been debated in neuropsychology for many years. The purpose of the present study is to illustrate an alternative approach to group studies of aphasia, in which the same symptom dimensions that are commonly used to assign patients to classical taxonomies (fluency, naming, repetition, and comprehension) are used as independent and continuous predictors in a multivariate design, without assigning patients to syndromes. One hundred twenty-six Italian-speaking patients with aphasia were first classified into seven classic aphasia categories, based on fluency, naming, auditory comprehension, and repetition scales. There were two goals: (1) compare group analyses based on aphasia types with multivariate analyses that sidestep classification and treat aphasic symptoms as continuous variables; (2) present correlation-based outlier analyses that can be used to identify individuals who occupy unusual positions in the multivariate "symptom space." In the service of the first goal, group performance on an external validation measure (the Token Test) was assessed in three steps: analyses of variance based on aphasia type, regressions using the same cut-offs for fluency, naming, comprehension and repetition as independent but dichotomous predictors, and regressions using the same subscales as continuous predictors (with no cut-offs). More variance in Token Test performance was accounted for when symptoms were treated as continuous predictors than with the other two methods, though use of independent but dichotomous predictors accounted for more variance than aphasia taxonomies. Thus, if we by-pass classical taxonomies and treat patients as points in a multidimensional symptom space, better predictions are obtained. Outlier analyses show that group results depend on heterogeneity among patients, which can be used as a search tool to identify potentially interesting dissociations. Hence this multivariate group approach is complementary to and compatible with single-case methods.

Aphasia↗
PubMedDate not supplied

Vocational and social outcomes of adults with chronic aphasia.

UNLABELLED: Vocational and social outcomes of rehabilitation, such as employment, Social Integration, and life satisfaction, are critical determinants of the usefulness of rehabilitation. The purpose of this study was to describe the employment status, Social Integration, and perceived life satisfaction of adults with chronic aphasia 2 years after discharge from an intensive treatment program. Among the 20 survey respondents, 62% of those who had been working prior to aphasia onset were also working at the time of follow-up. Those who were working before but not after onset had higher Home Integration scores. There was a relatively large perceived change in communication from clinic discharge to the 2-year follow-up. Eighty-five percent of the respondents indicated a positive life satisfaction rating. There was a significant positive relationship between Home Integration and life satisfaction ratings. The results are discussed in relation to other reports of employment and social outcomes for stroke and aphasia. LEARNING OUTCOMES: As a result of this activity, the participant will be able to: (1) identify factors that may contribute to the successful return to work for adults with chronic aphasia; (2) describe the vocational and social outcomes of a select group of adults with chronic aphasia after participation in an intensive treatment program; and (3) discuss future need areas in understanding vocational and social participation for adults with chronic aphasia after intervention.

Adult↗
PubMed1997

Language processing in aphasia: changes in lateralization patterns during recovery reflect cerebral plasticity in adults.

During single word processing the negative cortical DC-potential reveals a left frontal preponderance in normal right-handers as well as in patients with a history of transient aphasia. Lateralization of DC-negativity therefore provides a reliable and robust method for the assessment of language dominance. In 11 stroke patients with permanent aphasia this physiological pattern changed to bilateral activation reflecting an additional right-hemispheric involvement in compensatory mechanisms in aphasia. Along with complete clinical recovery the classical aphasic syndromes revealed specific differences in changes of their lateralization patterns. In Broca's aphasia the initial right-hemispheric preponderance changed to a left frontal lateralization while in Wernicke's aphasia a presumably permanent shift towards the right hemisphere occurred. Differences in lateralization patterns might reflect different mechanisms of recovery such as the initial disinhibition of homologous areas contralaterally and subsequent collateral sprouting and synaptic modulation. The assessment of changes in lateralization of the cortical DC-potential during language tasks in a non-invasive, safe method with excellent time resolution that might provide further insights in the neural basis of recovery from aphasia.

Action Potentials↗
PubMed1977

Aphasia: a divergent semantic interpretation.

The present paper reinterprets aphasia relative to the divergent and convergent components of Guilford's model of behavior. It suggests that some aphasiologists have defined aphasia as a convergent semantic disorder. They have determined the presence or absence of an aphasic impairment on the basis of each individual's ability to recognize and reproduce previously learned material and to converge upon one correct answer. The present analysis also shows that there are a number of theoretical models of aphasia which indicate that aphasia involves more than a convergent semantic impairment. Aphasia, interpreted according to Guilford's model, appears to have a divergent component. Aphasia involves a decrease in an individual's ablilty to provide ideas in situations where a proliferation of ideas on some topic is required, or to extend the boundaries of what he already knows. The individual who is impaired in his ability to produce a number of relevant ideas and a variety of different kinds or categories of responses has a divergent semantic impairment.

Aphasia↗
PubMed1983

[Differential diagnosis in phoniatrics and pediatric audiology. Language-aphasia].

The incidence of aphasia in a population of 100 000 is about 60 new cases a year. Although the aphasic patient represents a neurological problem, aphasia seems rather to be a linguistic one. Therefore, this report on the diagnosis of aphasia includes a comprehensive linguistic introduction on the function and structure of language. After a presentation of different aphasiologic schools and their classification of the aphasic syndromes, the differential diagnoses of other neurological disorders of verbal communication from aphasia are given. The subsequent section concerns the clinical investigation of aphasia. Finally, the most common tests for aphasia are reviewed.

Aphasia↗
PubMed1999

Perceptions of psychosocial adjustment to aphasia: applications of the Code--Müller Protocols.

We review research that has examined people's perceptions of likely psychosocial adjustment of aphasia. People's perceptions differ depending on whether they have aphasia themselves, are related closely to a person with aphasia, or work with the aphasic person in a professional capacity. In addition, people differ in what they perceive are the most important or relevant factors for psychosocial adjustment, and this too depends on whether they have aphasia themselves, are a relative or "significant other" in the aphasic person's life, or are a health professional working with the person with aphasia. Furthermore, there are marked differences in the way individuals predict likely psychosocial adjustment, and these perceptions can change over time. Most of this research has used the Code-Müller Protocols (CMP) to examine these perceptions. This article describes the development and application of the CMP in aphasia.

Adaptation, Psychological↗
PubMed1999

Problems of patients with chronic aphasia: different perspectives of husbands and wives?

During the early phase following stroke, patients with aphasia and their families are totally involved in the rehabilitation programme, but later, in the chronic phase, after discharge, the family generally has no support and many problems may arise or become more acute and provoke disturbances in this system. The patients with aphasia and their spouses may feel the situation differently according to their own characteristics, including gender. The present study includes 55 spouses of patients with chronic aphasia and 37 controls (spouses of subjects without physical or cognitive impairments) who filled out a questionnaire concerning their respective spouses (European Brain Injury Questionnaire--EBIQ) and some aspects about themselves. It was concluded, from the opinions expressed by the spouses of patients with chronic aphasia that they have problems in several domains not only related to communication or physical impairments. The opinions of husbands and wives of patients with aphasia, but not of the controls, were different, with more references to behaviour changes in women with aphasia. Spouses' responses also show important changes in their own lives. These results stress the importance of adequate attention to the long-term psychosocial problems of patients and relatives.

Adaptation, Psychological↗
PubMedDate not supplied

Evaluating the use of TalksBac, a predictive communication device for nonfluent adults with aphasia.

This paper describes the design and evaluation of a computer-based communication system called 'TalksBac' with four nonfluent adults with aphasia. Despite the increased availability of computer-based augmentative and alternative communication (AAC) devices, their use with adults with aphasia is limited as few devices have been designed for this population. The TalksBac system was designed specifically for nonfluent adults with aphasia and was used by four nonfluent aphasic individuals for a period of 9 months. The TalksBac system is word-based and exploits the ability of some nonfluent individuals with aphasia to recognize familiar words and short sentences. The system consists of two programs. Personal sentences and stories are entered into the TalksBac database by use of a 'carer program'. The 'user program' assists the nonfluent aphasic user to retrieve these prestored conversational items by offering probable items based on previous use of the system. The database has a hierarchical structure, but the links to individual items adapt automatically to reflect usage by individual users over time. Four nonfluent adults with aphasia were selected to participate in the study. Each subject was assessed by use of a battery of tests to provide pre-intervention data about their comprehension, expression and communication skills. Subjects and their carers were trained to use the TalksBac system and were involved in developing personalized databases. They were supported in use of the personalized systems for an intervention period of 9 months. At the end of this period, subjects' communication skills wre reassessed by use of a battery of tests. Clients' conversational abilities with and without the TalksBac system were also compared to see if use of TalksBac did augment their conversation and allow the aphasic partner to participate more fully within conversations. This was done by analysing videotaped conversations between subjects and non-aphasic partners. Results from the formal assessments indicated that there was little change in the underlying comprehension and expressive abilities of the subjects. An analysis of videotaped conversations showed that 1 subject was unable to carry out conversations using TalksBac independently, so the data for this subject was not included in the results of the analysis of conversations. Results from the video analysis for the remaining three subjects indicated that when using the TalksBac system, the conversational abilities of two subjects improved. The conversational abilities of the other subject were not enhanced by using the system as he had developed his own nonverbal strategies which he found to be more effective. This study has shown that TalksBac has the potential to augment the communication abilities of nonfluent adults with aphasia, who have not been able to develop their own compensatory strategies. Work continues to improve the efficiency of the software and to develop techniques to facilitate the carers' ability to generate conversational information for the system.

Aged↗
PubMed2005

A new test battery to assess aphasic disturbances and associated cognitive dysfunctions -- German normative data on the aphasia check list.

Aphasia, defined as an acquired impairment of linguistic abilities, can be accompanied by a diversity of neuropsychological dysfunction. Accordingly, the necessity to include cognitive testing in the diagnosis of aphasia is increasingly recognized. Here we present the Aphasia Check List (ACL), a new test battery for the assessment of aphasic and associated cognitive disorders. The language part of the battery provides a differentiated profile of important linguistic abilities. In addition, the ACL includes nonverbal screening tests for three neuropsychological domains: memory, attention, and reasoning. Dysfunctions in these domains have been observed in aphasic patients and can have an impact on language function. The ACL is applicable to patients with language disturbances of different etiologies, different stages of disease, and to patients with mild to severe aphasia. As the entire test duration is only about 30 minutes, the ACL is also economically valuable. It thus presents an adequate starting point in aphasia diagnosis for a wide range of patients. Here we describe the construction of the ACL, and the normative study of its original German version with 154 aphasic patients and 106 healthy comparison subjects. The ACL cognition part revealed additional neuropsychological dysfunction in the aphasia group. We present the patterns of these dysfunctions and their correlations with language deficits.

Adult↗
PubMed1998

A case of primary progressive aphasia. A 14-year follow-up study with neuropathological findings.

Primary progressive aphasia has been clinically defined as a progressive language deficit leading to the dissolution of almost all language functions with relative preservation of other cognitive functions until late in the course of the disease. Two types of language impairment have been described for primary progressive aphasia, which differ with respect to the degree of fluency of spontaneous speech. Whereas some authors have emphasized non-fluency as a defining characteristic of primary progressive aphasia, others have proposed that phonemic rather than semantic paraphasias in naming, both in the fluent and the non-fluent subtype, should be used as a criterion to distinguish primary progressive aphasia from slowly progressive aphasia in other forms of degenerative brain disease. Patients with fluent speech and semantic dementia, as typically seen in Alzheimer's disease, produce semantic paraphasias and circumlocutions rather than phonemic errors in naming. This paper reports the long-term follow-up of a patient with fluent aphasic speech, whose language profile over a decade was similar to that of patients with semantic dementia. Neuropathological examination revealed no evidence of Alzheimer's disease. Pick's disease or Pick variant, but showed spongiform changes of cortical layers (II and III) in temporal and, less severely, in frontal gyri. The present case indicates that semantic dementia is not a reliable indicator of probable Alzheimer's disease and supports the notion that there are different subtypes of primary progressive aphasia which cannot be defined by fluency or by the presence of phonemic paraphasia. Progress in identifying the neuropathological correlates of these subtypes in cases with lobar atrophy and spongiform changes should be expected from hereditary variants of progressive disorder.

Aphasia, Primary Progressive↗
PubMed1998

Prospective and retrospective studies of recovery in aphasia. Changes in cerebral blood flow and language functions.

Prospective and retrospective language evaluations and single photon emission computed tomography (SPECT) scans were performed in order to study the relationship between post-stroke recovery from aphasia and changes in cerebral blood flow (CBF) in groups of patients who had made a good recovery and those who had not. For the prospective study, 20 right-handed patients with aphasia secondary to an acute cerebrovascular accident (CVA) in the left middle cerebral artery territory received language evaluations with a Japanese Standard Language Test of Aphasia (SLTA), and SPECT scans performed twice, at a mean of 3.2 and a mean of 9.2 months post-onset. Only one slice of SPECT data was analysed. A significant correlation was observed between the severity of the initial language deficit and initial CBF on the left side, but not the right. Initial CBF was not a predictor for future language recovery in either hemisphere. There was a correlation between the change in the left mean hemispheric CBF (but not the right) and the change in the overall SLTA severity rating from 3 to 9 months post-stroke. In the retrospective study, 16 right-handed patients with residual aphasia secondary to CVA in the left middle cerebral artery territory received SLTA and SPECT at a mean of 82.8 months post-onset. The patients had also received initial language evaluation with SLTA at a mean of 6.5 months post-onset. In contrast to the prospective study, the results demonstrated that the mean left hemispheric CBF at approximately 7 years post-onset did not differ between good and poor recovery groups. However, the mean right hemispheric CBF of the good recovery group was higher than that of the poor recovery group in the frontal and the thalamic regions, and also in the left frontal region. The results of these complementary studies suggest that the initial language recovery within the first year post-onset may be linked primarily to functional recovery in the dominant hemisphere, where an increase in CBF was observed at 9 months post-onset. The increased perfusion adjacent to the lesion may be crucial for early recovery in aphasia. Subsequent language recovery and the long-term recovery in aphasia may be related to slow and gradual compensatory functions in the contralateral hemisphere, specifically in the homotopic frontal and thalamic areas.

Adult↗
PubMed1993

Tc-99m HMPAO brain perfusion SPECT in acute aphasia. Correlation with clinical and structural findings.

Tc-99m hexamethylpropylene amineoxime (HMPAO) brain perfusion SPECT was correlated with CT, MRI, and clinical findings in 17 patients with acute and subacute aphasia to determine its diagnostic potential in the early phases of stroke-associated language dysfunction. SPECT was performed using a dedicated brain imaging system after intravenous injection of 20 mCi (740 MBq) of Tc-99m HMPAO. Transaxial and three-dimensional surface rendered images were evaluated visually, and perfusion defects were correlated with CT, MRI, and a standard battery of clinical tests for aphasia. Clinical examination was insufficient for anatomic localization of aphasia in more than 40% of patients. CT exams were normal in 5 patients, although SPECT demonstrated perfusion defects in all 17. Nonfluent aphasia was present in only 6 of 10 patients with perfusion defects in Broca's area and fluent aphasia was present in only 5 of 10 patients with lesions in Wernicke's area. Auditory comprehension defect was associated with perfusion defects in the inferior parietal region in 9 of 12 patients (P = 0.05); reading and writing abnormalities were associated with perfusion defects in the posterior frontal, superior and inferior parietal cortex, and superior temporal gyri, and repetition deficit was associated with defects involving the inferior parietal cortex, the supramarginal and angular gyri, and the ipsilateral thalamus in 8 of 11 patients (P < 0.05). Brain perfusion SPECT should be included in the initial evaluation of aphasic patients, because clinical tests of aphasia and morphological imaging have limited value for accurately determining the extent and location of functional deficits.

Acute Disease↗
PubMed1993

Crossed aphasia: a PET follow up study of two cases.

Two cases of aphasia after right hemispheric stroke in right handed patients are described. The first patient had a severe mixed transcortical aphasia, apraxia and neglect after a lesion involving the right lenticular nucleus and periventricular white matter; aphasia was still present after three months. The second patient had a mild, transient fluent aphasia after a small right hemispheric periventricular lesion. Studies with [18F]FDG and positron emission tomography (PET) showed functional depression extending to the structurally unaffected left hemisphere in both patients in the acute stage. After three months, in the patient with persistent aphasia, metabolism was still reduced in the right hemisphere, with some recovery of hypometabolism on the left, while metabolic values had returned to normal in the patient with full language recovery. A close parallelism between glucose metabolism and clinical course in crossed aphasia is shown, as well as the presence of a functional involvement of the structurally unaffected left hemisphere in the acute stage.

Aged↗
PubMedDate not supplied

Aphasia, apraxia, and agnosia in the diagnosis of dementia.

The association of aphasia, apraxia and agnosia with cortical but not subcortical dementias, is a widely held belief. The purpose of the present study was to determine the frequency of aphasia, apraxia, and agnosia in groups of cortical and subcortical dementia patients, and to assess the diagnostic utility of these symptoms. Subjects were 64 patients with subcortical dementias (Parkinson's disease and normal pressure hydrocephalus) and 192 patients with cortical dementia (probable Alzheimer's disease) matched for sex, age, and Mini-Mental State Examination score. Each patient was evaluated for the presence of aphasia, apraxia, and agnosia. Results indicated that only aphasia was reported significantly more often in cortical dementia patients than in subcortical dementia patients. The presence of either of these three symptoms has very low diagnostic sensitivity, specificity, and total predictive value. The severity of the patient's dementia was predicted whether the patient had aphasia or apraxia; type of dementia had no predictive value. These data led to the conclusion that cortical and subcortical dementias cannot be reliably dissociated on the basis of aphasia, apraxia, or agnosia.

Aged↗
PubMed2005

Eliciting information on differential sensation of heat in those with and without poststroke aphasia using a visual analogue scale.

BACKGROUND AND PURPOSE: Aphasia can result in an inability to communicate the presence, location, or intensity of pain. Although visual analogue scales (VASs) exist, it is unknown whether they are useful in assessing pain in individuals with aphasia. The objective was to determine whether those with poststroke aphasia could respond differentially to thermal stimuli of varying intensities using a standardized VAS. METHODS: Five groups of participants were assessed: those without stroke, those with stroke but without aphasia, and 3 groups with varying degrees of aphasia. A 10-cm vertical VAS was used to measure responses to varying thermal intensities delivered on the participant's forearm. RESULTS: Across all 5 groups, a similar proportion demonstrated ability to discriminate between 2 temperatures (chi2=1.899; P=0.75). When presented with 4 temperatures, all groups performed more poorly, yet with similar success rates across groups (chi2=0.1267; P=0.88). The repeated-measures ANOVA revealed no effect of group but a significant effect of temperature (P<0.0001). CONCLUSIONS: A VAS may be useful in clinical identification of differing intensities of stimuli in a substantial proportion of those with aphasia.

Adult↗
PubMedDate not supplied

Motor aphasia due to prolonged hypoglycaemic coma in a patient with insulin-dependent diabetes mellitus.

A 45-year-old insulin-dependent diabetic man was in a hypoglycaemic coma for one month but recovered after continuous infusion of glucose and insulin. An isolated neurological deficit, motor aphasia, persisted after recovery from the coma. Repeated computerized tomography did not demonstrate any abnormal findings attributable to coma or aphasia. Precise follow-up examinations of aphasia showed improvement of Broca type motor aphasia to transcortical motor aphasia. Hypoglycaemic aphasia in a patient after recovery from prolonged coma is rare and its clinical course and pathogenesis are discussed with reference to the available literature.

Aphasia, Broca↗
PubMed1979

Differential aphasia in tow bilingual individuals.

Moderate nonfluent aphasia following a left parietotemporal lesion was found in the native language of one bilingual patient, in contrast to less severe, fluent aphasia in the patient's secondary language. Conversely, mild anomia was found in the native language of a second patient, while global aphasia was found in the secondary language. His lesion was located in the left posterior frontal area. These examples of differential aphasia were assessed by standard aphasia tests and by language inventory translated into the appropriate languages. We propose that differential aphasia resulting from a single hemispheric lesion is related to the disruption of different basic cognitive functions, which participate to varying degrees in the performance of the languages affected. In terms of neurolinguistic theory, the findings in these patients support the observation that most frequently used language is the first to recover. They refute the notion that the native language recovers first.

Adult↗
PubMed1999

[Mechanisms of aphasia recovery and brain imaging].

Aphasia recovery may depend on right hemisphere or non-lesioned left hemisphere structures, pre-morbid brain language organization, and de novo learning of language. Here we review the brain imaging evidence supporting these different hypotheses. CT-scan studies have investigated the prognosis value of size and site of left hemisphere lesions. The size of the lesion is a global but not an individual predictor of the initial severity and subsequent recovery of aphasia. Studies on the site of the lesion have given different results for verbal expression and comprehension. There is no consensus on a single critical site for recovery of verbal expression in non-fluent aphasia, which may depend on sub-cortical more than cortical extend of the lesion. Conversely the extend of the lesion in the superior temporal gyrus emerges as a critical negative factor for comprehension recovery. Rest measurements of brain metabolism have consistently shown that aphasia severity depends much more on the degree of dysfunction of language-related areas in the left hemisphere than on the site of the lesion it-self. This suggests that aphasia recovery may depend on metabolic dysfunction recovery in peri-lesional structures. More recently, activation studies have shown consistent right hemisphere activation during language tasks in aphasic subjects, but their role in recovery remains debated. It is likely limited, and may depend on atypical pre-morbid language lateralization. Left hemisphere activations are also found in aphasic patients. They are often relocalized in peri-lesional areas, and emerge in most studies as the main factor of aphasia recovery.

Aphasia↗