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PubMed2004

"Speaking for another": the management of participant frames in aphasia.

A sociolinguistic analysis of an interaction between a woman with aphasia and a nonaphasic speaking partner was conducted to investigate participant framing in aphasia. Participant frames, or the stances that people take in conversation, help conversational participants structure their talk and collaboratively negotiate meaning (I. Goffman, 1974). This analysis revealed a configuration in which a person with severe aphasia enlisted her speaking partner to speak for her. That is, the interaction was framed such that the nonaphasic speaking partner served as the "spokesperson" for messages that were authored by the person with aphasia. The clinical requirements of adopting a "speaking for another" framework are discussed.

Adult↗
PubMed2003

Intensity of aphasia therapy, impact on recovery.

BACKGROUND: It has been speculated that the conflicting results demonstrated across poststroke aphasia therapy studies might be related to differences in intensity of therapy provided across studies. The aim of this study is to investigate the relationship between intensity of aphasia therapy and aphasia recovery. METHODS: A MEDLINE literature search was conducted to retrieve clinical trials investigating aphasia therapy after stroke. Changes in mean scores from each study were recorded. Intensity of therapy was recorded in terms of length of therapy, hours of therapy provided per week, and total hours of therapy provided. Pearson correlation was used to assess the relationship between changes in mean scores of outcome measures and intensity of therapy. RESULTS: Studies that demonstrated a significant treatment effect provided 8.8 hours of therapy per week for 11.2 weeks versus the negative studies that only provided approximately 2 hours per week for 22.9 weeks. On average, positive studies provided a total of 98.4 hours of therapy, whereas negative studies provided 43.6 hours of therapy. Total length of therapy time was found to be inversely correlated with hours of therapy provided per week (P=0.003) and total hours of therapy provided (P=0.001). Total length of therapy was significantly inversely correlated with mean change in Porch Index of Communicative Abilities (PICA) scores (P=0.0001). The number of hours of therapy provided in a week was significantly correlated to greater improvement on the PICA (P=0.001) and the Token Test (P=0.027). Total number of hours of therapy was significantly correlated with greater improvement on the PICA (P<0.001) and the Token Test (P<0.001). CONCLUSIONS: Intense therapy over a short amount of time can improve outcomes of speech and language therapy for stroke patients with aphasia.

Aphasia↗
PubMed1995

Bromocriptine treatment of nonfluent aphasia.

Using a double-blind, placebo-controlled, crossover design, we studied the effect of bromocriptine (15 mg daily) in 20 men with chronic nonfluent aphasia. The study was conducted over a 28-week period in two phases. In phase I, the patients received either bromocriptine or placebo; in phase II the treatments were crossed over. We evaluated each patient's language and nonverbal cognitive skills at the beginning and end of each phase and 6 weeks after completion of phase II. When compared with placebo treatment, bromocriptine did not significantly improve the patient's speech fluency, language content, overall degree of aphasia severity, or nonverbal cognitive abilities. Based on these results, bromocriptine is not recommended as monotherapy for the treatment of chronic nonfluent aphasia.

Adult↗
PubMed1993

Aphasia in bilinguals.

The neurophysiological and the neurolinguistic basis of multilingualism is not yet fully elucidated. A study of the occurrence of aphasia in multilingual patients and the pattern of recovery may help to clarify some unsolved problems. For e.g. is the ability to use a second language stored in a different area of the left hemisphere and what is the extent of involvement of the right hemisphere in language skills? When recovery from aphasia occurs, what factors determine the rate of recovery of different languages and the priorities of recovery? To understand some of the problems, a study of aphasia in multilinguals was conducted in Madras, South India, where multilingualism is common. 88 patients were studied with 40 healthy controls, using standard protocols. It was found that the pattern of recovery was dispersed widely in time, rate, level, degree and between the languages known. No support was obtained for the notion that the patients' mother tongue recovers first, nor was support found for the importance of language proficiency viewed globally. Evidence was found that the languages in which routine thinking, mental calculations and praying were carried out were the ones most resistant to damage in brain insults. It is interesting that these functions are all highly overlearned, acquired early in life and used frequently over the course of many years. Another observation made was that the incidence of crossed aphasia was fairly high, in both uni- and multi-linguals, with the latter showing a slightly higher incidence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Perception and production of tone in aphasia.

An acoustical and perceptual study of lexical tone was conducted to evaluate the extent and nature of tonal disruption in aphasia. The language under investigation was Thai, a tone language which has five lexical tones--mid, low, falling, high, and rising. Subjects included six left brain-damaged aphasics (two Broca's, one transcortical motor, one global, one conduction, one Wernicke), one right brain-damaged nonaphasic, one cerebellar dysarthric, and five normals. High-quality tape recordings of each subject's productions of a minimal set of five, monosyllabic Thai words were presented to 10 adult Thai listeners for identification. Results from the phonemic identification tests indicated that tone production is relatively spared in aphasic patients with unilateral left hemisphere lesions. The performance of the global aphasic, however, was considerably below normal. Patterns of tonal confusions further revealed that the performance of all aphasics, except the global, differed from that of normal speakers primarily in degree rather than in kind. Tonal contrasts were signaled at a high level of proficiency by the right brain-damaged and dysarthric patients. Acoustical analysis revealed that F0 contours associated with the five tones for all aphasics, except the global, were similar in overall shape as well as position in the tone space to those of normals. F0 contours for the right brain-damaged patient and the dysarthric also generally agreed with those of normals in terms of shape and position. F0 ranges of both aphasic and nonaphasic brain-damaged speakers were generally larger than those of normals for all five tones. The relationship between tone and vowel duration was generally similar to that of normals for all brain-damaged speakers. A comparison of aphasics' performance on tone perception (J. Gandour & R. Dardarananda, 1983, Brain and Language, 18, 94-114) and tone production indicated that, for the normal and right brain-damaged subjects, performance on the perception task was higher than on production, whereas the opposite was true for the aphasics. These data are brought to bear on issues related to tone production in aphasia, consonant and vowel production in aphasia, hemispheric specialization for tone production, intonation production in aphasia, relationship between speech perception and speech production, and tone production in dysarthria with cerebellar disease.

Adult↗
PubMed1997

Phonological, semantic, and mediated priming in aphasia.

An auditory lexical decision task was conducted to examine rhyme, semantic, and mediated priming in nonfluent and fluent aphasic patients and normal controls. Overall, monosyllabic word targets were responded to faster when preceded by rhyming word and nonword primes than unrelated primes. Similarly, semantically related primes facilitated lexical decisions to word targets. No evidence of mediated priming emerged. Results for individual subjects suggest differences in patterns across the subject groups. Implications of the findings for the integrity of lexical access in aphasic patients are considered.

Adult↗
PubMed2004

Cognitive and cognate-based treatments for bilingual aphasia: a case study.

Two consecutive treatments were conducted to investigate skill learning and generalization within and across cognitive-linguistic domains in a 62-year-old Spanish-English bilingual man with severe non-fluent aphasia. Treatment 1 was a cognitive-based treatment that emphasized non-linguistic skills, such as visual scanning, categorization, and simple arithmetic. Treatment 2 was a lexically based treatment that trained cognates (cross-linguistic word pairs that are similar in meaning and form, such as rosa/rose) and non-cognates (cross-linguistic word pairs with shared meaning but different forms, such as mesa/table). Treatment 1 resulted in modest gains in both Spanish and English. Treatment 2 resulted in improved naming for non-cognates as well as cognates within each language. However, the generalization of gains from Spanish to English was apparent only for cognate stimuli.

Aphasia↗
PubMed2006

Corticobasal degeneration and progressive aphasia.

OBJECTIVE: To describe language impairment in the corticobasal degeneration syndrome (CBDS) presenting as either a cognitive or motor disorder, to compare the evolution of aphasia in CBDS with primary progressive aphasia (PPA), and to examine whether the side of maximal cerebral atrophy or akinesia reflects the severity of aphasia. METHODS: We divided 40 patients with CBDS according to motor or cognitive onsets and conducted detailed language assessments with the Western Aphasia Battery (WAB). We analyzed scores according to the side of atrophy and motor rigidity. Longitudinal performance over three annual assessments was compared against matched patients with PPA and Alzheimer disease. RESULTS: Language at baseline was more impaired in cognitive than motor-onset CBDS but there was no correlation between the side of atrophy or motor impairment and the WAB. Serial assessment (n = 19) showed a similar evolution of aphasia in cognitive-onset CBDS and PPA and delayed aphasia in motor-onset CBDS. CONCLUSION: Aphasia is common in the corticobasal degeneration syndrome but there is little correlation with the laterality of clinical deficits. Cognitive-onset corticobasal degeneration syndrome and primary progressive aphasia are similar such that their aphasia appears identical.

Aged↗
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↗
PubMed2002

Aphasia type and aging in Hindi-speaking stroke patients.

In this study, the clinical profile of Hindi-speaking stroke patients with aphasia from northern India has been investigated. We examined the interactional effect between age and gender with aphasia type in 97 Hindi-speaking right-handed individuals, the majority of them with a confirmed diagnosis of a cerebrovascular accident. The subjects included in the study ranged from 3 weeks to two years post-onset with a diagnosis of a common classical aphasia (Broca's, Wernicke's, anomic, global, conduction, and transcortical) types involving both males and females. Also examined was the interaction between literacy and aphasia type since the subjects had varied exposures to education (total illiteracy to professional/university education). While the data reported here about Hindi-speaking aphasics are relatively in agreement with the age-aphasia type patterns discussed in western countries, nonetheless some differences were also observed. The mean age of Indian patients with aphasia was significantly lower. Also, in addition to some gender and literacy related differences, an outstanding difference was that many clinical symptoms that are known to co-occur with aphasia were not readily reported by subjects with stroke.

Adult↗
PubMed2007

Taxing working memory with syntax: bihemispheric modulations.

Motivated by claims that relegate the syntactic functions of Broca's region to working memory (WM) and not to language-specific mechanisms, we conducted an fMRI and an aphasia study that featured two varieties of intrasentential dependency relations: One was syntactic movement (e.g., Which boy does the girl think [symbol in text] examined Steven?), the other was antecedent-reflexive binding (e.g., Jill thinks the boy examined himself). In both, WM is required to link two nonadjacent positions. Syntactically, they are governed by distinct rule systems. In health, the two dependencies modulated activity in distinct brain regions within the left inferior frontal gyrus and the left middle temporal gyrus. Binding uniquely modulated activation in the right frontal lobe. Receptive abilities in brain damaged patients likewise distinguished among these syntactic types. The results indicate that sentence comprehension is governed by syntactically carved neural chunks and provide hints regarding a language related region in the right hemisphere.

Adult↗
PubMed1983

The production of morphological and lexical opposites in aphasia.

Four unselected groups of Broca's, Wernicke's, conduction, amnesic aphasic patients and a group of normal controls were asked to produce the best opposite of 60 adjectives. For half of the stimuli the expected opposite was morphologically related to the stimulus word (e.g. "formal"/"informal"), for the other half it could be obtained only by selecting a new base-form within the lexicon (e.g. "good"/"bad"). Following some neurolinguistic observations by Hécaen et al., it was predicted that amnesic patients should produce mainly morphological opposites, whereas conduction aphasics should produce mainly lexical antonyms. Results confirmed the predictions, since amnesic aphasics showed a prevalent impairment in the selection lexical opposites, whereas conduction aphasics showed a selective impairment in the production of morphological antonyms.

Anomia↗
PubMed2003

Sentence comprehension and working memory limitation in aphasia: a dissociation between semantic-syntactic and phonological reactivation.

The relation between working memory (WM) limitation and sentence comprehension was assessed in Hebrew-speaking aphasics, three conduction aphasics and three agrammatics. The study compared sentences that required different types of reactivation-syntactic-semantic reactivation, in relative clauses, and word form/phonological reactivation, in sentences with reanalysis of lexical ambiguity. The effect of phonological memory load, manipulated by number of words intervening between the activation and the reactivation, on comprehension of the two sentence types was examined. The findings were that agrammatic aphasics failed in the comprehension of object relatives but not on subject relatives irrespective of their antecedent-gap distance. Conduction aphasics, on the other hand, who showed severe WM limitation, comprehended well all types of relative clauses and were unaffected by antecedent-gap distance. The conduction aphasics failed to understand the sentences that required phonological reactivation when the phonological distance was long. These results suggest that the type of reactivation required by the sentence, as well as the type of memory overload are crucial in determining the effect of WM limitation on sentence comprehension.

Adult↗
PubMed1994

Acquired epileptic aphasia: neuropsychologic follow-up of 12 patients.

A study of specific neuropsychologic, neurolinguistic, and behavioral features of acquired epileptic aphasia or Landau-Kleffner syndrome was conducted in a group of 12 patients followed-up for 2-15 years (mean: 8 yr). Seventy-five percent had exhibited some language disturbance prior to acquired epileptic aphasia. Even when 9 patients had normal electroencephalographic findings in the long-term course of the disease, only 3 achieved normal language. No patient with persisting electroencephalographic abnormalities recovered normal or near normal language. The need to perform detailed neurolinguistic and neuropsychologic evaluations in the work-up and follow-up of children with acquired epileptic aphasia is stressed. An adapted neuropsychologic profile battery proved to be practical and objective for the follow-up of these patients.

Agnosia↗
PubMed1976

[Recovery processes in 2 cases of bilingual aphasia].

Recovery processes of two English-Japanese bilingual aphasics were investigated with special emphasia on the effect of language therapy. Although the two patients had different types of aphasia (one Broca's aphasia and the other Wernicke's aphasia), the degree of the language impairment initially manifested in English and Japanese was almost equivalent in each case with the pattern of impairment corresponding to the respective types of aphasia. In either case, language therapy was conducted in English, and the course of recovery during the first six months was analyzed. The results indicated that auditory comprehension improved almost simultaneously in both treated (English) and untreated (Japanese) languages regardless of the type of the patients' aphasia. In contrast, oral language production in Broca's aphasia improved only for the treated language while that in Wernicke's aphasia improved simultaneously for both languages. Writing ability seemed to improve as a function of language therapy in both cases. The implications for the relationship between spontaneous recovery and the effects of treatment were discussed.

Aged↗
PubMed1978

Lesion localization in aphasia with cranial computed tomography and the Boston Diagnostic Aphasia Exam.

Nineteen stable left-hemisphere stroke patients with aphasia were evaluated by the Boston Diagnostic Aphasia Examination (BDAE) and the Token Test (TT), and by cranial computed tomography (CT). The types of aphasia included Broca (three patients), Wernicke (four patients), conduction (four patients), transcortical motor (four patients), and global (four patients). The lesions, as localized by CT scan, were superimposed onto five composite lesion localization maps for these five aphasia syndromes. There was good correlation between BDAE aphasia type and lesion localization. On CT scans, the locations of cortical language areas lie in a specific relationship to parts of the ventricular system.

Aged↗