Visual Attention to Semantic and Orthographic Associations in Fluent Aphasia: Evidence from Eye-Tracking.

We examined the allocation of visual attention in an association task by both neurotypical participants (n = 11) and adults with fluent aphasia (n = 12). Participants were presented with a picture (e.g., a basket) followed by a semantically related association (i.e., "strawberry") and an orthographically related association (i.e., "b," the first letter of "basket"). An eye tracker recorded their eye movements for three areas of interest (AOI): the picture, the semantic associate, and the orthographic associate, over 1396 observations. Results showed that both neurotypical participants and participants with aphasia looked longer at the semantic associate than at the picture, and this difference was more pronounced for neurotypicals than for people with aphasia (PWA). Neurotypicals also looked longer than the PWA group at the orthographic associate than at the prior picture. Regarding eye fixation counts, both participant groups looked more frequently at the semantic associate than at either the picture or the orthographic associate. Notably, this pattern was more pronounced among neurotypical participants than PWA. Our findings emphasize the importance of semantic associations in fluent aphasia and suggest a potential rehabilitative approach in speech and language therapy.

[Improved instrumental activities of daily living in acquired savant syndrome patient after developing interest in drawing].

We performed examinations of a 73-year-old, right-handed man who developed herpes simplex encephalitis, with cognitive dysfunction including severe Wernicke's aphasia. Although he had never previously been interested in arts, use of a coloring book, recommended by his wife, led him to start drawing. A few years after the onset of brain disease, the patient began to copy pictures of landscapes. The lesion was in the left hemisphere and his work showed a strongly realistic tendency, thus we think that this case demonstrated characteristics of acquired savant syndrome. Along with the increase in drawing ability, instrumental activities of daily living (IADL), such as shopping and use of public transport, were also considerably improved in this patient. On the other hand, results of neuropsychological tests, such as the Standard Language Test of Aphasia, were not improved. We concluded that a sense of accomplishment from the drawing activity and communication with supporters might have led to improvement of IADL in this case.

Book talk and aphasia: the power of a book.

BACKGROUND: Reading is most often affected in aphasia and this has an impact on most aspects of everyday life. Being able to read makes a significant difference to how well a person can participate in society. In this study, people with aphasia recount their experiences of being in a book club. AIMS: This small scale, exploratory study employs a qualitative approach to investigate how persons with aphasia (PWA) and a librarian experience participating in a book club. The aim was to explore their overall experiences of participation, including their views regarding the design of the book club. The research questions were: How did participants experience participating in a book club? How did participants experience the structure and the content of the book club? METHODS & PROCEDURES: Three men and one woman with aphasia took part in a book club, which was led by a librarian and met once a week for 9 weeks. The group read a book that had been adapted to suit adults who are not very skilled readers or who have a poor knowledge of the Swedish language; it was also available in an audio version. Data were collected through observations, interviews and field notes, and were analysed thematically to find patterns across data and across participants. OUTCOMES & RESULTS: The analysis showed that, despite their language difficulties, the participants experienced the book club as highly rewarding, possibly because the focus was on the content of the book and not on each individual's reading ability. The overarching theme identified in the data was 'Empowerment through a joint reading experience'. This encompassed three sub-themes: 'Structure and flexibility', 'Enjoyment of reading' and 'Fruitful discussions'. CONCLUSIONS & IMPLICATIONS: The PWA experienced the activity as positive and encouraging despite their language difficulties. What yielded the positive experience were the joint literary discussions. The project also showed that a dedicated group leader (here the librarian) and a flexible structure based on the situation and abilities of each individual were crucial for the encouraging findings.

Inflectional Morphology in Fluent Aphasia: A Case Study in a Highly Inflected Language.

Inflectional morphology difficulties are typically reported in non-fluent aphasia with agrammatism, but a growing number of studies show that they can also be present in fluent aphasia. In agrammatism, morphological difficulties are conceived as the consequence of impaired phonological encoding and would affect regular verbs more than irregular verbs. However, studies show that inflectional morphology difficulties concern both regular and irregular verbs, and that their origin could be more conceptual/semantic in nature. Additionally, studies report more pronounced impairments for the processing of the past tense compared to other tenses. The goal of this study was to characterize the impairment of inflectional morphology in fluent aphasia. RY, a 69-year-old man with chronic fluent aphasia completed a short neuropsychological and language battery and three experimental tasks of inflectional morphology. The tasks assessed the capacity to select the correct inflected form of a verb based on time information, to access the time information included in an inflectional morpheme, and to produce verbs with tense inflection. His performance was compared to a group of five adults without language impairments. Results showed that RY had difficulties selecting the correct inflected form of a verb, accessing time information transmitted by inflectional morphemes, and producing inflected verbs. His difficulties affected both regular and irregular verbs, and verbs in the present, past, and future tenses. The performance also shows the influence of processing limitations over the production and comprehension of inflectional morphology. More studies of inflectional morphology in fluent aphasia are needed to understand the origin of difficulties.

Deciphering the mechanisms of phonological therapy in jargon aphasia.

BACKGROUND: Severe word production difficulties remain one of the most challenging clinical symptoms to treat in individuals with jargon aphasia. Clinically, it is important to determine why some individuals with jargon aphasia improve following therapy when others do not. We report a therapy study with AM, an individual with severe neologistic jargon aphasia, and provide a subsequent comparison with previous cases, with the purpose of informing both our theoretical and clinical understanding of jargon aphasia. AIMS: To investigate AM's locus of word production deficit and determine the effectiveness of phonological component analysis (PCA) therapy, a phonological cueing therapy, in the re-learning and generalization of naming responses for words. In addition, AM's performance in therapy, linguistic profile and ability to engage with therapy/cues were compared in a retrospective analysis with the background linguistic and therapy data of two other individuals with jargon aphasia (P9 and FF), who responded differentially to PCA. This was undertake to explore possible prognostic indicators of phonological therapy for jargon aphasia. METHODS & PROCEDURES: A battery of linguistic and neuropsychological tests was used to identify AM's word production deficit. A single-subject multiple probe design across behaviours was employed to evaluate the effects of PCA therapy on the re-learning and generalization of naming responses. In the retrospective analysis of AM, P9 and FF, we compared differences and similarities in performance on various linguistic tasks, the ability to engage in therapy (i.e., ability to generate and use the cues), as well as to retain and maintain cues. OUTCOMES & RESULTS: AM's locus of deficit was identified in the mapping between semantics and phonology. PCA was found to be effective in improving naming in two of the three treated word lists during the treatment phase; however, these gains were not maintained. Generalization to untreated picture names was not observed. Findings from the retrospective analysis illustrated that oral reading skills, the ability to segment phonological information from words and active engagement with provided cues are likely prerequisites for obtaining robust and long-term gains. CONCLUSIONS & IMPLICATIONS: We demonstrated that phonological therapy could be beneficial for the remediation of naming abilities at least in the re-learning phase; however, maintenance and generalization of these gains were limited. This research helps to elucidate the considerations and evaluations necessary for the appropriateness of phonological therapy and candidacy of individuals with jargon aphasia for this treatment approach.

The Relationship Between Confrontation Naming and Story Gist Production in Aphasia.

Purpose: The purpose of this study was to examine the relationship between picture naming performance and the ability to communicate the gist, or essential elements, of a story. We also sought to determine if this relationship varied according to Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007) aphasia subtype. Method: Demographic information, test scores, and transcripts of 258 individuals with aphasia completing 3 narrative tasks were retrieved from the AphasiaBank database. Narratives were subjected to a main concept analysis to determine gist production. A correlation analysis was used to investigate the relationship between naming scores and main concept production for the whole group of persons with aphasia and for WAB-R subtypes separately. Results: We found strong correlations between naming test scores and narrative gist production for the large sample of persons with aphasia. However, the strength of the correlations varied by WAB-R subtype. Conclusions: Picture naming may accurately predict gist production for individuals with Broca's and Wernicke's aphasia, but not for other WAB-R subtypes. Given the current reprioritization of outcome measurement, picture naming may not be an appropriate surrogate measure for functional communication for all persons with aphasia. Supplemental Materials: https://doi.org/10.23641/asha.5851848.

Exploring Treatment Fidelity in Persons With Aphasia Autonomously Practicing With Computerized Therapy Materials.

Purpose: Current computer technologies permit independent practice for people with cognitive-communicative disorders. Previous research has investigated compliance rates and outcome changes but not treatment fidelity per se during practice. Our aim was to examine adherence to procedures (treatment fidelity) and accuracy while persons with aphasia independently practiced word production using interactive, multimodal, user-controlled, word-level icons on computers. Method: Four persons with aphasia independently practiced single-word production after stimulation via user-initiated interactions in 3 conditions: (I) auditory stimulus with static representational drawing; (II) auditory stimulus with synchronized articulation video; and (III) users' choice between the 2 prior conditions. Sessions were video-recorded for subsequent analysis, which established emergently refined behavioral taxonomies using an iterative, mixed-methods approach. Results: In independent practice, users only sometimes adhere to modeled behaviors, other times improvising novel behaviors. The latter sometimes co-occurred with successful productions. Differences in success rates were noted between Conditions I and II across behaviors with Condition II generally favored. In Condition III, participants tended to choose the stimulus that resulted in highest success rates. Conclusions: During independent practice with technology, persons with aphasia do not necessarily comply with clinicians' practice instructions, and treatment fidelity does not determine success. Autonomy and choice in practice may reveal unanticipated dimensions for computerized aphasia treatment.

A Comparison of Coverbal Gesture Use in Oral Discourse Among Speakers With Fluent and Nonfluent Aphasia.

Purpose: Coverbal gesture use, which is affected by the presence and degree of aphasia, can be culturally specific. The purpose of this study was to compare gesture use among Cantonese-speaking individuals: 23 neurologically healthy speakers, 23 speakers with fluent aphasia, and 21 speakers with nonfluent aphasia. Method: Multimedia data of discourse samples from these speakers were extracted from the Cantonese AphasiaBank. Gestures were independently annotated on their forms and functions to determine how gesturing rate and distribution of gestures differed across speaker groups. A multiple regression was conducted to determine the most predictive variable(s) for gesture-to-word ratio. Results: Although speakers with nonfluent aphasia gestured most frequently, the rate of gesture use in counterparts with fluent aphasia did not differ significantly from controls. Different patterns of gesture functions in the 3 speaker groups revealed that gesture plays a minor role in lexical retrieval whereas its role in enhancing communication dominates among the speakers with aphasia. The percentages of complete sentences and dysfluency strongly predicted the gesturing rate in aphasia. Conclusions: The current results supported the sketch model of language-gesture association. The relationship between gesture production and linguistic abilities and clinical implications for gesture-based language intervention for speakers with aphasia are also discussed.

Variability of writing disorders in Wernicke's aphasia underperforming different writing tasks: A single-case study.

The aim of our study was to evolve views on writing disorders in Wernicke's agraphia by comparing group data and analysis of a single patient. We showed how a single-case study can be useful in obtaining essential results that can be hidden by averaging group data. Analysis of a single patient proved to be important for resolving contradictions of the "holistic" and "elementaristic" paradigms of psychology and for the development of theoretical knowledge with the example of a writing disorder. The implementation of a holistic approach was undertaken by presenting the tasks differing in functions in which writing had been performed since its appearance in human culture (communicative, mnestic, and regulatory). In spite of the identical composition of involved psychological components, these differences were identified when certain types of errors were analyzed in the single subject. The results are discussed in terms of used writing strategy, resulting in a way of operation of involved components that lead to qualitative and quantitative changes of writing errors within the syndrome of Wernicke's agraphia.

Varieties of semantic 'access' deficit in Wernicke's aphasia and semantic aphasia.

Comprehension deficits are common in stroke aphasia, including in cases with (i) semantic aphasia, characterized by poor executive control of semantic processing across verbal and non-verbal modalities; and (ii) Wernicke's aphasia, associated with poor auditory-verbal comprehension and repetition, plus fluent speech with jargon. However, the varieties of these comprehension problems, and their underlying causes, are not well understood. Both patient groups exhibit some type of semantic 'access' deficit, as opposed to the 'storage' deficits observed in semantic dementia. Nevertheless, existing descriptions suggest that these patients might have different varieties of 'access' impairment-related to difficulty resolving competition (in semantic aphasia) versus initial activation of concepts from sensory inputs (in Wernicke's aphasia). We used a case series design to compare patients with Wernicke's aphasia and those with semantic aphasia on Warrington's paradigmatic assessment of semantic 'access' deficits. In these verbal and non-verbal matching tasks, a small set of semantically-related items are repeatedly presented over several cycles so that the target on one trial becomes a distractor on another (building up interference and eliciting semantic 'blocking' effects). Patients with Wernicke's aphasia and semantic aphasia were distinguished according to lesion location in the temporal cortex, but in each group, some individuals had additional prefrontal damage. Both of these aspects of lesion variability-one that mapped onto classical 'syndromes' and one that did not-predicted aspects of the semantic 'access' deficit. Both semantic aphasia and Wernicke's aphasia cases showed multimodal semantic impairment, although as expected, the Wernicke's aphasia group showed greater deficits on auditory-verbal than picture judgements. Distribution of damage in the temporal lobe was crucial for predicting the initially 'beneficial' effects of stimulus repetition: cases with Wernicke's aphasia showed initial improvement with repetition of words and pictures, while in semantic aphasia, semantic access was initially good but declined in the face of competition from previous targets. Prefrontal damage predicted the 'harmful' effects of repetition: the ability to reselect both word and picture targets in the face of mounting competition was linked to left prefrontal damage in both groups. Therefore, patients with semantic aphasia and Wernicke's aphasia have partially distinct impairment of semantic 'access' but, across these syndromes, prefrontal lesions produce declining comprehension with repetition in both verbal and non-verbal tasks.

Grammatical comprehension deficits in non-fluent/agrammatic primary progressive aphasia.

IMPORTANCE: Grammatical comprehension difficulty is an essential supporting feature of the non-fluent/agrammatic variant of primary progressive aphasia (naPPA), but well-controlled clinical measures of grammatical comprehension are unavailable. OBJECTIVE: To develop a measure of grammatical comprehension and examine this comparatively in PPA variants and behavioural-variant frontotemporal degeneration (bvFTD) and to assess the neuroanatomic basis for these deficits with volumetric grey matter atrophy and whole-brain fractional anisotropy (FA) in white matter tracts. DESIGN: Case-control study. SETTING: Academic medical centre. PARTICIPANTS: 39 patients with variants of PPA (naPPA=12, lvPPA=15 and svPPA=12), 27 bvFTD patients without aphasia and 12 healthy controls. MAIN OUTCOME MEASURE: Grammatical comprehension accuracy. RESULTS: Patients with naPPA had selective difficulty understanding cleft sentence structures, while all PPA variants and patients with bvFTD were impaired with sentences containing a centre-embedded subordinate clause. Patients with bvFTD were also impaired understanding sentences involving short-term memory. Linear regressions related grammatical comprehension difficulty in naPPA to left anterior-superior temporal atrophy and reduced FA in corpus callosum and inferior frontal-occipital fasciculus. Difficulty with centre-embedded sentences in other PPA variants was related to other brain regions. CONCLUSIONS AND RELEVANCE: These findings emphasise a distinct grammatical comprehension deficit in naPPA and associate this with interruption of a frontal-temporal neural network.

Fundamental deficits of auditory perception in Wernicke's aphasia.

OBJECTIVE: This work investigates the nature of the comprehension impairment in Wernicke's aphasia (WA), by examining the relationship between deficits in auditory processing of fundamental, non-verbal acoustic stimuli and auditory comprehension. WA, a condition resulting in severely disrupted auditory comprehension, primarily occurs following a cerebrovascular accident (CVA) to the left temporo-parietal cortex. Whilst damage to posterior superior temporal areas is associated with auditory linguistic comprehension impairments, functional-imaging indicates that these areas may not be specific to speech processing but part of a network for generic auditory analysis. METHODS: We examined analysis of basic acoustic stimuli in WA participants (n = 10) using auditory stimuli reflective of theories of cortical auditory processing and of speech cues. Auditory spectral, temporal and spectro-temporal analysis was assessed using pure-tone frequency discrimination, frequency modulation (FM) detection and the detection of dynamic modulation (DM) in "moving ripple" stimuli. All tasks used criterion-free, adaptive measures of threshold to ensure reliable results at the individual level. RESULTS: Participants with WA showed normal frequency discrimination but significant impairments in FM and DM detection, relative to age- and hearing-matched controls at the group level (n = 10). At the individual level, there was considerable variation in performance, and thresholds for both FM and DM detection correlated significantly with auditory comprehension abilities in the WA participants. CONCLUSION: These results demonstrate the co-occurrence of a deficit in fundamental auditory processing of temporal and spectro-temporal non-verbal stimuli in WA, which may have a causal contribution to the auditory language comprehension impairment. Results are discussed in the context of traditional neuropsychology and current models of cortical auditory processing.

Coverbal gestures in the recovery from severe fluent aphasia: a pilot study.

UNLABELLED: This post hoc study investigated coverbal gesture patterns in two persons with chronic Wernicke's aphasia. They had both received therapy focusing on multimodal communication therapy, and their pre- and post-therapy verbal and gestural skills in face-to-face conversational interaction with their speech therapist were analysed by administering a partial barrier Referential Communication Task (RCT). The RCT sessions were reviewed in order to analyse: (a) participant coverbal gesture occurrence and types when in speaker role, (b) distribution of iconic gestures in the RCT communicative moves, (c) recognisable semantic content, and (d) the ways in which gestures were combined with empty or paraphasic speech. At post-therapy assessment only one participant showed improved communication skills in spite of his persistent language deficits. The improvement corresponded to changes on all gesturing measures, suggesting thereby that his communication relied more on gestural information. No measurable changes were observed for the non-responding participant-a finding indicating that the coverbal gesture measures used in this study might account for the different outcomes. These results point to the potential role of gestures in treatment aimed at fostering recovery from severe fluent aphasia. Moreover, this pattern of improvement runs contrary to a view of gestures used as a pure substitute for lexical items, in the communication of people with severe fluent aphasia. LEARNING OUTCOMES: The readers will describe how to assess and interpret the patterns of coverbal gesturing in persons with fluent aphasia. They will also recognize the potential role of coverbal gestures in recovery from severe fluent aphasia.

Degenerative jargon aphasia: unusual progression of logopenic/phonological progressive aphasia?

Primary progressive aphasia (PPA) corresponds to the gradual degeneration of language which can occur as nonfluent/agrammatic PPA, semantic variant PPA or logopenic variant PPA. We describe the clinical evolution of a patient with PPA presenting jargon aphasia as a late feature. At the onset of the disease (ten years ago) the patient showed anomia and executive deficits, followed later on by phonemic paraphasias and neologisms, deficits in verbal short-term memory, naming, verbal and semantic fluency. At recent follow-up the patient developed an unintelligible jargon with both semantic and neologistic errors, as well as with severe deficit of comprehension which precluded any further neuropsychological assessment. Compared to healthy controls, FDG-PET showed a hypometabolism in the left angular and middle temporal gyri, precuneus, caudate, posterior cingulate, middle frontal gyrus, and bilaterally in the superior temporal and inferior frontal gyri. The clinical and neuroimaging profile seems to support the hypothesis that the patient developed a late feature of logopenic variant PPA characterized by jargonaphasia and associated with superior temporal and parietal dysfunction.

What's in a sentence? The crucial role of lexical content in sentence production in nonfluent aphasia.

This study investigated the effect of lexical content on sentence production in nonfluent aphasia. Five participants with nonfluent aphasia, four with fluent aphasia, and eight controls were asked to describe pictured events in subject-verb-object sentences. Experiment 1 manipulated speed of lexical retrieval by varying the frequency of sentence nouns. Nonfluent participants' accuracy was consistently higher for sentences commencing with a high- than with a low-frequency subject noun, even when errors on those nouns were themselves excluded. This was not the case for the fluent participants. Experiment 2 manipulated the semantic relationship between subject and object nouns. The nonfluent participants produced sentences less accurately when they contained related than when they contained unrelated lexical items. The fluent participants exhibited the opposite trend. We propose that individuals with nonfluent aphasia are disproportionately reliant on activated conceptual-lexical representations to drive the sentence generation process, an idea we call the content drives structure (COST) hypothesis.

Prolonged ictal aphasia: a diagnosis to consider.

Aphasia is a common symptom encountered by clinical neurologists. It is usually caused by strokes or lesions involving language regions of the brain, yet prolonged aphasia is rarely the sole manifestation of a simple partial status epilepticus. We report six patients, who suffered from prolonged ictal aphasia. All but one patient had a structural lesion in the left hemisphere, only three suffered from clinical seizures during or shortly prior to the aphasic episode. All patients had ictal patterns on the electroencephalogram (EEG), four of whom had periodic lateralized epileptiform discharges, and five showed frequent recurrent electrographic seizures during the aphasic state. The aphasia lasted several days in all patients, and it resolved after administration of antiepileptic drug treatment. In conclusion, prolonged ictal aphasia is a rare but important treatable cause of aphasia. Surface EEG recordings should be obtained in all patients with unexplained prolonged aphasia to diagnose this rare but treatable entity.

Expressing opinions and feelings in a conversational setting.

This article examines the ways in which individuals with aphasia communicate opinions and feelings using evaluative language during conversation in an aphasia group. Evaluative language refers to semantic resources conveying emotions, judgments, and valuations and includes emotive adjectives, nouns, verbs, and adverbs as well as metaphor. Although individuals with aphasia are known to be able to use evaluative language in a monologic context, little is known about how people with aphasia use evaluative language in conversation, or about the role of co-construction in such usage. The data for this study were collected during a conversation group consisting of five participants with aphasia and a facilitator. The analysis used is based on Appraisal theory (Martin and White 2005) and examined the evaluation categories of Affect, Appreciation, Judgment, and Graduation. Regardless of severity, all aphasic speakers contributed an equal amount of evaluation to the interaction and demonstrated some usage of all types of evaluation. However, those with more severe aphasia relied heavily on their conversational partners to scaffold their opinions and used a range of resources including lexical items, such as exactly, and repetition (e.g., "yeah yeah yeah") to agree emphatically with opinions expressed. Lexical variety was notably less in the aphasic speakers than the non-brain-damaged group facilitator. The article discusses the patterns of skills observed together with the clinical implications for working with people with aphasia on emotional meanings.

Compounds in different aphasia categories: a study on picture naming.

This study investigated the production of compounds in Italian-speaking patients affected by different aphasia categories (i.e., Broca's, Wernicke's, and anomic aphasia) in a confrontation naming task. Questions of theoretical interest concerning the processing of compounds within the framework of the "lemma theory" as well as the role of morphological productivity in compound processing are addressed. Results indicate that all persons with aphasia retain knowledge of the morphological status of words, even when they fail to retrieve the corresponding phonological form (the "compound effect"). A difference was found among aphasia categories in the type of errors produced (omission vs. substitution) and in the position (first or second) of these errors within the compound words. In Broca's aphasia, the first component is omitted more frequently than the second one, but only in verb-noun compounds. Anomic and Wernicke's aphasia, unlike in Broca's aphasia, seem to retain sensitivity to morphological productivity.

Negotiation of identity in group therapy for aphasia: the Aphasia Café.

BACKGROUND: There has been increasing interest in ensuring that aphasia intervention includes attention to the negotiation of a robust identity after the life-altering changes that often accompany the onset of aphasia. But how does one go about simultaneously improving communication and positive identity development within aphasia therapy? Socially oriented group therapy for aphasia has been touted as one means of addressing both psychosocial and communicative goals in aphasia. AIMS: This article describes the results of a sociolinguistic analysis of group therapy for aphasia in which positive personal and group identity are skilfully negotiated. METHODS & PROCEDURES: Sociolinguistic microanalysis of discourse in a group therapy session was undertaken. The session, described as group conversation therapy, included eight adults with aphasia, a speech-language pathologist and an assistant. The session was videotaped and transcribed, and the data were analysed to identify 'indices of identity' within the discourse. This included discourse that exposed members' roles, values or beliefs about themselves or others. The data were further analysed to identify 'patterns' of discourse associated with identity. The result is a detailed description of identity-enhancing discourse within group therapy for aphasia. OUTCOMES & RESULTS: The findings included several categories associated with the negotiation of identity in therapy including: (1) discourse demonstrating that group members were 'being heard', (2) that the competence of group members was assumed, (3) that 'solidarity' existed in the group, (4) that saving face and promoting positive personal identity was important, and (5) that markers of group identity were made visible via discourse that referenced both member inclusion as well as non-member exclusion. CONCLUSIONS & IMPLICATIONS: The results suggest that it is possible to create identity-enhancing interactions as part of therapy for aphasia; the analysis demonstrates the potential role of the group leader/clinician in managing identity negotiation in aphasia therapy.