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PubMed1985

[Recovery in aphasia (Part 1)].

In order to elucidate the factors which have an influence on the prognosis of aphasia, a correlation was studied in 76 right-handed aphasic patients between recovery rates and various factors: i.e. aphasia type, age, educational level, time between onset of aphasia and institution of therapy and initial severity. Initial evaluations on Standard Language Test of Aphasia (SLTA) were obtained within 5 months after the cerebrovascular accident and reevaluations were obtained 3 months after the initial evaluation. Recovery rates were determined by comparing scores of these 2 tests in order to coincide with clinical impression. The results obtained were as follows: Aphasia type: The highest recovery rates were seen in conduction aphasics, followed by amnestic, Wernicke, and Broca aphasics. Global aphasics had significantly lower recovery rates. It was suggested that anarthria in Broca's aphasia and jargon in Wernicke's aphasia had a significant ratarding effect on recovery rates. Age: Age and recovery rates showed a significant negative correlation: younger patients recovered better, and this trend was remarkable in Wernicke aphasics but not Broca aphasics. Education: Patients with more education tended to improve more, and this trend was most remarkable in amnestic aphasics. Time between onset of aphasia and institution of therapy: Time elapsed from onset and recovery rates showed a significant negative correlation; recovery rates decreased as the time interval from onset increased. Initial severity: Correlation between the initial severity of aphasia, measured by the initial SLTA scores and recovery rates was very high; severily affected aphasics recovered to a lesser extent than mildly affected ones and this trend was remarkable in Wernicke and Broca aphasics.

Adult↗

PubMed1997

[The development of verbal communication in aphasic patients treated by neuropsychological therapy].

OBJECTIVE: Based on the theories dealing with reorganization of the functional system, which are usually the basis of the treatment of aphasology, this paper has as its objective to analyse the evolution of the ability to communicate in a series of 43 right-handed persons with aphasia due to a cerebro-vascular accident of the left hemisphere, who attended sessions of neuropsychological treatment. MATERIAL AND METHODS: The patients were grouped according to the type of aphasia initially diagnosed: global (G), Broca (B), conduction (C), anomia (A), transcortical motor (MT) and Wernicke (W). The output before and after treatment was evaluated using a scale from 0-6 points to grade the capacity of communication (comprehension-expression). In each group the 't' test was done to compare the average scores, initially and finally, both of comprehension and of expression. RESULTS: The results showed that group A had the most favourable course both of comprehension and of expression. Of the patients with a predominantly expression disorder, the best recovery was seen in groups C and MT. In group B verbal expression followed a very varied course. Those of G and W improved significantly, but great difficulty in communication persisted. Comparing expression in these two groups, those of W showed significantly more improvement than those of G, who showed very little improvement.

Aged↗

PubMed2000

The mapping from sound structure to the lexicon in aphasia: evidence from rhyme and repetition priming.

Two studies were conducted to explore the hypothesis that Broca's and Wernicke's aphasics have deficits arising from the processes involved in activating the lexicon from phonological form. The first study explored whether phonologically similar lexical entries differing only in their initial consonants show "rhyme priming." Results revealed that Broca's aphasics failed to show facilitation when the target was identical to the prime (i.e. identity priming) and they showed significant inhibition when targets were preceded by rhyming words. Wernicke's aphasics showed a pattern of results similar to that of normal subjects, i.e., identity priming and rhyme priming as well as significantly slower reaction-times in the rhyming condition compared to the identity condition. The second study investigated form-based repetition priming in aphasic patients at a number of intervals including when no other stimuli intervened between repeated stimuli (0 lag) or when 4, 8, or 12 stimuli intervened. Results showed that, unlike old normal subjects who showed repetition priming for both words and nonwords, both Broca's and Wernicke's aphasics showed repetition priming for word targets only. Moreover, in contrast to old normal subjects who showed a greater magnitude of priming at 0 lag for word targets, neither Broca's aphasics or Wernicke's aphasics showed priming at 0 lag. Implications of these findings are considered with respect to the hypotheses that Broca's and Wernicke's aphasics have deficits in the nature of the activation patterns within the lexicon itself and in auditory (working) memory.

Aged↗

PubMed1998

Beliefs about effectiveness of treatment for aphasia after stroke.

A postal survey of SLTs in Scotland was conducted. 598 SLTs responded, 194 worked with people aphasic after stroke. A number of obstacles to the provision of the SLT service to aphasic people were identified. SLTs expressed concern about the effectiveness of the treatments they offered, and about factors which may influence effectiveness. A number of suggestions are made for further research into this area including into the problems of competing client groups.

Aphasia↗

PubMed1982

WAIS performance IQ in aphasia as a function of auditory comprehension and constructional apraxia.

This study investigated differences in nonverbal intelligence between diagnostic subgroups of aphasics using the Performance Tests of the Wechsler Adult Intelligence Scale (WAIS). Subjects were 98 right-handed hospitalized males with unilateral left-hemisphere damage who had unambiguous clinical diagnoses of Broca's, Anomic, Conduction, Mixed Non-Fluent, Wernicke's, or Global aphasia. Group differences were examined using the WAIS Performance IQ (PIQ), and subscores for spatial organization (Block Design and Object Assembly) and for verbalizability (Picture Completion and Picture Arrangement). There were significant group differences for each WAIS score, determined by the impaired performance of the Global aphasics. With covariance correction for level of auditory comprehension, group differences were eliminated on the verbalizable subtests, but not on the spatial organization subtests. Covarying for level of constructional apraxia (assessed with drawings, sticks, and blocks), however, eliminated group differences for both subscores. Using demographic, neurological, and linguistic variables, multiple regression analyses confirmed the covariate analysis findings; constructional apraxia was the most predictive variable for both spatial and verbalizability subscores, while auditory comprehension and education level predicted performance on the verbalizable subtests.

Anomia↗

PubMed1984

[Localization of lesions in aphasia: clinical-CT scan correlations (Part 1)].

Using a microcomputer, the locus and extent of the lesions, as demonstrated by computed tomography for 127 cases with various types of aphasia were superimposed onto standardized matrices. The relationship between the foci of the lesions and the types of aphasia was investigated. Broca ++aphasics (n = 39): Since the accumulated site of the lesions highly involved the deep structures of the lower part of the precentral gyrus as well as the insula and lenticular nucleus, only 60% of the Broca aphasics had lesions on these areas. This finding has proved to have little localizing value. Wernicke aphasics (n = 23): The size of the lesion was significantly smaller than Broca's aphasia. At least 70% of the patients had the superior temporal lesions involving Wernicke's area and subcortical lesions of the superior and middle temporal gyri. The site of lesion corresponded roughly to the previous clinico-pathological reports but located a little deep. Amnestic aphasics (n = 18): The size of the lesion was smaller than any other types. While there was some concentration of the lesions (maximum 40%) in the area of the subcortical region of the anterior temporal gyrus adjacent to Wernicke's area and the lenticular nucleus, the lesions were distributed throughout the left hemisphere. Amnestic aphasia was thought to be the least localizable. Conduction aphasics (n = 11): The lesions were relatively small in size. Many patients had posterior speech area lesions involving at least partially Wernicke's area. In particular, more than 80% of the conduction aphasics had lesions of the supramarginal gyrus and it's adjacent deep structures. Global aphasics (n = 36): In general, the size of the lesion was very large and 70% of the global aphasics had extensive lesions involving both Broca's and Wernicke's areas. However, there were observations showing that the lesions can be small and confined. Because of the large variability in lesion patterns and speech disturbances, it is necessary to expand the number of cases for relate detailed neuropsychological examinations with morphological CT-findings. Our method permits it easily to process and to analyze a large number of cases. By studying larger series, the better definition in the relationship between anatomic lesion location and aphasia type, even for less common aphasia syndromes could be obtained.

Adolescent↗

PubMed1997

An evaluation of short-term group therapy for people with aphasia.

This paper reports an evaluation of a group therapy intervention conducted with aphasic people (n = 6). The intervention comprised 10 sessions of approximately 90 min duration and included two participants with stuttering difficulties. The therapy programme consisted of communication activities within the group which encouraged sharing of personal experiences, videotaping of role-play activities for self- and group-evaluation and practice tasks completed outside the group. Measures of functional communicative ability, attitudes to communication and psychological adjustment were obtained before and after the intervention. Findings showed significant improvements in communicative competence and attitudes to communication over the course of the intervention. Before the intervention self-esteem and communicative competence were highly intercorrelated. By the end of the therapy sessions the correlation between self-esteem and communicative competence was significantly smaller and was non-significant. This indicates that communicative function was not related to feelings of self-worth by the end of the intervention. Improvements in attitude to communication, greater attendance and completion of assignments were each predictive of reduced levels of depression. There was also evidence that stronger beliefs about the role of personal effort in improving speech were predictive of improvements in communication attitudes. A measure of satisfaction showed extremely positive evaluation of the intervention by participants. It is concluded that shortterm group therapy can produce improvements in communicative abilities and attitudes, and have psychological benefits for participants. Several suggestions for future research are outlined.

Adaptation, Psychological↗

PubMed1983

[Apparent deafness as a manifestation of an aphasia-epilepsy syndrome].

Seven children with clinically evident deafness not confirmed by objective audiometric tests, and an acquired language deficiency, presented marked paroxysmal anomalies on electroencephalogram tracings. The aphasia-epilepsy syndrome can only be recognized by routine electroencephalograms, conducted in such cases even when a history of epileptic attacks is not abtained.

Aphasia↗

PubMed1994

Rhyme priming in aphasia: the role of phonology in lexical access.

The present experiment was conducted to explore the facilitory effects of rhyme in lexical processing in brain-damaged individuals. Normal subjects and non-fluent and fluent aphasic subjects performed auditory lexical decision and rhyme judgement tasks, in which prime-target pairs were phonologically related (either identical or rhyming) or unrelated. Results revealed rhyme facilitation of lexical decisions to real-word targets for normal and non-fluent aphasic subjects; for fluent aphasic subjects, results were equivocal. In the rhyme judgement task, facilitory effects of rhyme were found for all three groups with real-word targets. None of the groups showed clear rhyme facilitation effects with non-word targets in either task. Findings are discussed with reference to the role of phonology in lexical processing in normal and aphasic populations.

Adult↗

PubMed2003

Aphasia after stroke: type, severity and prognosis. The Copenhagen aphasia study.

AIM: To determine the types, severity and evolution of aphasia in unselected, acute stroke patients and evaluate potential predictors for language outcome 1 year after stroke. METHODS: 270 acute stroke patients with aphasia (203 with first-ever strokes) were included consecutively and prospectively from three hospitals in Copenhagen, Denmark, and assessed with the Western Aphasia Battery. The assessment was repeated 1 year after stroke. RESULTS: The frequencies of the different types of aphasia in acute first-ever stroke were: global 32%, Broca's 12%, isolation 2%, transcortical motor 2%, Wernicke's 16%, transcortical sensory 7%, conduction 5% and anomic 25%. These figures are not substantially different from what has been found in previous studies of more or less selected populations. The type of aphasia always changed to a less severe form during the first year. Nonfluent aphasia could evolve into fluent aphasia (e.g., global to Wernicke's and Broca's to anomic), whereas a fluent aphasia never evolved into a nonfluent aphasia. One year after stroke, the following frequencies were found: global 7%, Broca's 13%, isolation 0%, transcortical motor 1%, Wernicke's 5%, transcortical sensory 0%, conduction 6% and anomic 29%. The distribution of aphasia types in acute and chronic aphasia is, thus, quite different. The outcome for language function was predicted by initial severity of the aphasia and by the initial stroke severity (assessed by the Scandinavian Stroke Scale), but not by age, sex or type of aphasia. Thus, a scoring of general stroke severity helps to improve the accuracy of the prognosis for the language function. One year after stroke, fluent aphasics were older than nonfluent aphasics, whereas such a difference was not found in the acute phase.

Aged↗

PubMedDate not supplied

[A case of Foix-Chavany-Marie syndrome and crossed aphasia after right corona radiata infarction with history of left hemispheric infarction].

Foix-Chavany-Marie syndrome (FCMS) is a syndrome that presents facio-pharyngo-glosso-masticatory diplegia with automatic voluntary dissociation. Its most common etiology is stroke in the regions of bilateral opercula. We described a 75-year-old woman with FCMS and crossed aphasia. She had cerebral infarction of left middle cerebral artery territory 23 years before. At that time she had transient right hemiparesis, but no aphasia. This time, she suddenly became mute and was brought to our hospital. Neurological examination revealed severe weakness in her bilateral lower face, pharynx, tongue, and sternocleidomastoideus. She had no weakness of limbs. Her listening comprehension was moderately disturbed and handwriting was paragraphic. Her emotional facial movement was maintained despite of disturbed volitional facial movement. CT scan disclosed fresh infarction at the right corona radiata and old infarction at the left middle cerebral artery territory. In this patient, lesions at the left operculum and right corona radiata with the preserved right operculum gave rise to FCMS. This implies following possibilities: 1) the corticobulbar tract and corticospinal tract run separately at the corona radiata, 2) volitional and emotional tracts of facial movement run separately at the corona radiata. It was demonstrated that FCMS is not always caused by bilateral operculum lesions. Our patient did not show aphasia after the first stroke including left language area, but became severely aphasic after the right corona radiata infarction. Simultaneous occurrence of FCMS and aphasia after corona radiata lesion suggested that the corticobulbar tract and a tract that conducts linguistic information are running adjacently in the corona radiata. Our case suggested that restricted corona radiata lesion may cause severe subcortical aphasia and in case of additional contralateral corticobulbar tract lesion, severe dysarthria may occur.

Aged↗

PubMed1976

The "tip-of-the-tongue" phenomenon in aphasia.

Forty-two male aphasics, classified as Broc's, Wernicke's, anomic, and conduction, were examined for their ability to partially retrieve acoustic features of words they could not provide in a confrontation naming task (the "tip-of-the-tongue" phenomenon). The results indicated that conduction aphasics were superior to Wernicke's and anomic asphasics in their ability to identify both the first letter and the syllabic length of the words they could not name. Since the aphasic groups were comparable in their naming difficulty, the findings could not be attributed to degree of wordfinding impairment. The difference between groups that were obtained using the TOT technique are discussed with regard to differences in the word finding process.

Aphasia↗

PubMed1998

Neuropsychological characteristics of five children with the Landau-Kleffner syndrome: dissociation of auditory and phonological discrimination.

The Landau-Kleffner Syndrome (LKS) is characterized by acquired receptive aphasia and EEG abnormality with onset between the ages of 3 and 8 years. This study presents neuropsychological assessments in 5 children with LKS. The aims were (1) to specify the neuropsychological deficits characteristic of these children; and (2) to clarify the nature of the receptive aphasia by comparing nonverbal and verbal auditory discrimination. Receptive aphasia was present in all children. Retardation, poor motor coordination, hyperkinesia, and conduct problems were frequent but variable. All children exhibited a dissociation between the discrimination of environmental sounds and phonological auditory discrimination, the latter being more impaired than the former. This suggests that the primary deficit of the receptive aphasia is an impairment of auditory phonological discrimination rather than a generalized auditory agnosia.

Agnosia↗

PubMed1990

Effects of speech rate on the absolute and relative timing of apraxic and conduction aphasic sentence production.

The purpose of this investigation was to provide a constructive replication of the Kent and McNeil (1987, In Phonetic approaches to speech production in aphasia and related disorders. San Diego: College-Hill Press) study of the speech timing characteristics of apraxic and conduction aphasic speakers. Acoustic analysis was used to obtain absolute utterance durations, segment durations, and vowel formant trajectories from utterances produced under control, fast, and slow rate conditions. Segment-to-whole ratios and slope values were calculated. Results support the hypothesis presented by Kent and McNeil (1987) that there is a phonetic-motoric component contributing to the speech patterns of both the apraxic and conduction aphasic speakers sampled. Theories of rate control in normal and disordered speakers are discussed.

Aged↗

PubMed1993

To what extent can aphasic syndromes be localized?

Modern views on the representation of function in the cortex make it difficult to maintain the notion that specific subtypes of aphasia are associated with specific centres within the language area. We have conducted a retrospective study on 221 aphasic patients with one contiguous vascular lesion in the territory of the middle cerebral artery. The localization of CT lesions was established within a standardized grid model. Aphasiological data were based on one or more examinations with the Aachen Aphasia Test. Both sets of data were processed in a data- and methodbase system. No unequivocal association between type of aphasia and localization of lesion was found. In a smaller study, participation of basal ganglia and in particular of the head of the caudate nucleus in lesions producing aphasia was not confirmed. Concepts of the localization of a lesion in aphasia must account for changes in patterns of aphasic symptoms in the presence of a stable lesion and for the impact of the neurological condition that has produced the lesion.

Adult↗

PubMed1985

Picture-naming in aphasia.

The distribution of picture-naming errors for Broca's aphasics (n = 9), Wernicke's aphasics (n = 9), conduction aphasics (n = 9), frontal anomics (n = 7), and posterior anomics (n = 9) was examined to determine the diagnostic power of error types in picture-naming. Negated responses were associated with Broca's aphasia, whole-part errors ("hose" for nozzle) were associated with frontal anomia, and poor phonemic cuing was associated with Wernicke's aphasia. In addition, the relative distribution of the three most prominent naming errors-phonemic errors, semantic errors, and multiword circumlocutions-tended to distinguish the two anomic subgroups from the other aphasia subgroups. Anomic aphasics produced the fewest phonemic errors and the most multiword circumlocutions; this pattern suggests minimal word-production difficulty in anomic aphasia relative to the other aphasia syndromes. Despite such group differences, the overall picture indicates that there is considerable similarity among aphasia syndromes in terms of picture-naming behavior.

Anomia↗

PubMed2006

Evaluating single-subject treatment research: lessons learned from the aphasia literature.

The mandate for evidence-based practice has prompted careful consideration of the weight of the scientific evidence regarding the therapeutic value of various clinical treatments. In the field of aphasia, a large number of single-subject research studies have been conducted, providing clinical outcome data that are potentially useful for clinicians and researchers; however, it has been difficult to discern the relative potency of these treatments in a standardized manner. In this paper we describe an approach to quantify treatment outcomes for single-subject research studies using effect sizes. These values provide a means to compare treatment outcomes within and between individuals, as well as to compare the relative strength of various treatments. Effect sizes also can be aggregated in order to conduct meta-analyses of specific treatment approaches. Consideration is given to optimizing research designs and providing adequate data so that the value of treatment research is maximized.

Aphasia↗

PubMedDate not supplied

Caregiver strain and caregiver burden of primary caregivers of stroke survivors with and without aphasia.

Little is known about how the burden and strain of caring for stroke patients with or without aphasia affects primary caregivers. This article (a) critically examines the literature on the burden and strain of care experienced by caregivers of stroke patients and (b) examines the relationship between aphasia and caregiver burden and strain. Two literature reviews of three databases were conducted. Fourteen articles (12 quantitative articles, 1 mixed-design article, and 1 qualitative article) were found to comply with the study criteria for the first literature search. A second literature search focused on the effects of stroke survivors' aphasia on caregiving; none of the articles retrieved met the inclusion criteria. This article suggests that there is a lack of research in this area and that several key initiatives are needed, including the development of an instrument with psychometric properties appropriate for assessing the burden and strain on caregivers of stroke patients. Implications for future nursing practice and research are highlighted.

Adaptation, Psychological↗