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"Aphasia"
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Broca's region
Broca's region has been in the news ever since scientists realized that particular cognitive functions could be localized to parts of the cerebral cortex. Its discoverer, Paul Broca, was one of the first researchers to argue for a direct connection between a concrete behavior—in this case, the use of language—and a specific cortical region. Today, Broca's region is perhaps the most famous part of the human brain, and for over a century, has persisted as the focus of intense research and numerous debates. The name has even penetrated mainstream culture through popular science and the theater. Broca's region is famous for a good reason: As language is one of the most distinctive human traits, the cognitive mechanisms that support it and the tissues in which these mechanisms are housed are also quite complex, and so have the potential to reveal a lot not only about how words, phrases, sentences, and grammatical rules are instantiated in neural tissue, but also, and more broadly, about how brain function relates to behavior. Paul Broca's discoveries were an important, driving force behind the more general effort to relate complex behavior to particular parts of the cerebral cortex, which, significantly, produced the first brain maps.
eBook
Validation of a Cantonese Version of the Amsterdam-Nijmegen Everyday Language Test
The current study aimed to validate the Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (CANELT), a functional communication assessment tool for Cantonese speakers with aphasia. A quantitative scoring method was adopted to examine the pragmatics and informativeness of the production of people with aphasia (PWA). CANELT was translated from its English version with cultural adaptations. The performance on the 20-item CANELT collected from 56 PWA and 100 neurologically healthy Cantonese-speaking controls aged 30 to 79 years was orthographically transcribed. Scoring was based on the completeness of the main concepts produced in the preamble and subsequent elaborations, defined as Opening (O) and New Information (NI). Measures examining the validity and reliability were conducted. An age effect was found in neurologically healthy controls, and therefore z scores were used for subsequent comparisons between neurologically healthy controls and PWA. The test showed strong evidence for known-group validity in both O [X.sup.2 (2) = 95.2, p < .001] and NI [X.sup.2 (2) = 100.4, p < .001]. A moderate to strong correlation was found between CANELT and standardized aphasia assessment tools, suggesting satisfactory concurrent validity. Reliability measures were excellent in terms of internal consistency (Cronbach's [alpha] of .95 for both 'O' and 'NI'), test-retest reliability (ICC = .96; p < .001), intra-rater reliability (ICC = 1.00; p < .001), and inter-rater reliability for O (ICC = .99; p < .001) and NI (ICC = .99; p < .001). Sensitivity and specificity for O are 97% and 76.8%, respectively, while for NI, a sensitivity of 95% and specificity of 91.1% were obtained. Measures on validity and reliability yielded promising results, suggesting CANELT as a useful and reliable functional communication assessment for PWA. Its application in managing PWA and potential areas for development are discussed.
Journal Article
C118 Dejavu mechanical thrombectomy in medium vessel occlusion at same location in a patient with severe mitral stenosis and warfarin resistance: a case report
IntroductionMedium vessel occlusion (MeVO) mechanical thrombectomy (MT) has enhanced the scope of eligibility for the procedure. We study a patient with Mitral Stenosis (MS) and Warfarin resistance who underwent MT in MeVO twice at same location in a span of 1.5 years with DWI negative stroke second time and recovered completely with TICI3 recanalisation twice.Case DescriptionA 54 year old lady with severe MS on Warfarin presented with an acute onset right leg weakness with aphasia of three hours duration on 29/12/2022. MRA brain showed left ACA territory infarct with left A2 occlusion. Her INR was 1.3 hence thrombolysed with Inj Tenecteplase 14 mg. Her cerebral DSA showed MeVO at the bifurcation of left ACA A2 segment into Pericallosal and callosomarginal arteries. MT was performed using 0.062’ Red aspiration catheter using ADAPT technique resulting in TICI3 recanalisation after first pass.The same patient on 10/07/2024 again presented with Right leg weakness and aphasia of one hour duration with NIHSS 8. MRA brain did not show acute infarct. However, considering past history of similar presentation and subtherapeutic INR patient was taken for direct MT which showed thrombus at same location. Hence repeat MT was performed using same device and patient once again recovered with TICI 3 recanalisation.ConclusionsRepeat (Dejavu) MT of MeVO at same location with DWI negative stroke in a patient with severe MS and Warfarin resistance and patient recovering twice is once in a lifetime occurrence. Patient has been advised Mitral Valve Replacement at the earliest to prevent future stroke.Conflict of InterestNo
Journal Article
\If You Just Stay With Me and Wait...You'll Get an Idea of What I'm Saying\: The Communicative Benefits of Time for Conversational Self-Repair for People With Aphasia
Purpose: This study investigated the communicative benefits of self-repair during conversation for persons with aphasia (PWAs). Self-repair of trouble sources is an interactional priority that emphasizes autonomy and competence. Of equal importance, conversationalists desire to minimize silences and work together to ensure forward movement (progressivity) of conversation. Simultaneously achieving progressivity and self-repair is challenging in aphasia, and PWAs and their partners often make trade-off decisions between these two activities. Conversation-level aphasia interventions usually focus on supportive techniques that promote participation while maintaining progressivity, effectively favoring progressivity over self-repair. This study evaluates the benefits of an alternative approach that shifts the emphasis to self-repair, thereby highlighting potential trade-off costs of routinely forgoing self-repair to achieve progressivity. Method: Ten people with mild-to-moderate aphasia each held two conversations with two different partners. When trouble sources characterized by silent and/or filled pauses occurred, partners maintained a supportive and engaged stance, allowing PWAs time to self-repair. We analyzed language produced during these \"edited turns\" using three paradigms considering form, content, and use. Results: The data yielded 311 edited turns. For form, on average, each edited turn resulted in 3.72 words; for content, most edited turns contained autobiographical information; for use, approximately 40% of edited turns introduced new information, and 40% added to the ongoing topic. The remainder were either ambiguous or comments such as, \"I can't think of it.\" Conclusions: When given engaged support and time to self-repair, PWAs contributed meaningful personal information to conversations for approximately 80% of edited turns. Importantly, self-repair often resulted in self-expression that directed the conversation, which is a communicative role critical for empowering agency and identity. This research opens a dialogue about benefits and limitations of approaches that prioritize either progressivity or self-repair and how to balance the two to optimize therapeutic benefits for each individual. Supplemental Material:
Journal Article
Functional neuroplasticity in chronic post-stroke aphasia following a singing intervention in a cross-over randomised trial
Group-based singing has been shown to improve language outcomes and induce structural neuroplasticity in chronic post-stroke aphasia (PSA). However, the functional neuroplasticity changes induced by such interventions remain unknown. Here our main aim was to determine these changes using a cross-over randomised trial. Nineteen patients with PSA were randomly allocated to a 4-month multicomponent singing-based intervention (singing group) or standard care (control group). With a pre-post design, we pooled data from both groups and analysed verbal learning and task-based fMRI activation of two novel songs (trained or untrained during intervention) at two time points (pre- and post-intervention). Post-intervention, patients with PSA produced more correct syllables from the trained song and for the trained relative to the untrained song. fMRI results revealed increased activation when singing along to the trained song in the right postcentral gyrus, and in the right posterior superior temporal gyrus (pSTG) when singing along to the trained vs. untrained song. Notably, right pSTG activation increases correlated with improved naming abilities. Collectively, these findings indicate that group-based singing is associated with verbal learning and induces functional neuroplasticity changes in the singing network, derived from demographically matched healthy controls, which are associated to improved naming abilities in chronic PSA.
https://www.clinicaltrials.gov
, Unique identifier: NCT03501797.
Journal Article
Primary progressive aphasia: a clinical approach
The primary progressive aphasias are a heterogeneous group of focal ‘language-led’ dementias that pose substantial challenges for diagnosis and management. Here we present a clinical approach to the progressive aphasias, based on our experience of these disorders and directed at non-specialists. We first outline a framework for assessing language, tailored to the common presentations of progressive aphasia. We then consider the defining features of the canonical progressive nonfluent, semantic and logopenic aphasic syndromes, including ‘clinical pearls’ that we have found diagnostically useful and neuroanatomical and other key associations of each syndrome. We review potential diagnostic pitfalls and problematic presentations not well captured by conventional classifications and propose a diagnostic ‘roadmap’. After outlining principles of management, we conclude with a prospect for future progress in these diseases, emphasising generic information processing deficits and novel pathophysiological biomarkers.
Journal Article
Is semantic feature analysis effective when applied intensively? A randomized pilot study with non-fluent aphasic individuals
Objective: In this study, it was investigated the effects of intensive aphasia treatment applied to individuals with non-fluent aphasia. Methods: Sixteen patients diagnosed with non-fluent aphasia were included in the study and were randomly divided into two groups. The therapy interventions were one day per week for the eight patients in the first group, for a total of 8 hours in 2 months (standard intervention). For the eight patients in the second group, therapy was applied for a total of 48 hours in 2 months, for one hour per day, six days a week, excluding Sundays (intensive intervention). Participants were tested using the Turkish aphasia test (ADD), Aphasia Impact Scale-21 (AIQ-21), and Boston Naming Test (BNT) before starting the treatment (pretest), after the treatment (posttest), and one month after the treatment ended (follow-up). Results: At the end of the treatments, a significant increase in ADD and BNT scores and a significant decrease in AIQ-21 scores were observed in both groups. Although there was a change in the follow-up test, the scores were still significantly different than the pretest scores. The rate of improvement in test scores of group II patients who received intensive aphasia treatment was superior to the group I patients. Conclusion: Intensive application was superior to once-weekly aphasia treatment, and post-treatment improvement continued for at least one month after the treatments.
Journal Article