The effects of adding attention training to naming treatment for individuals with aphasia.

AIM: Given the ever-increasing evidence for the co-occurrence of attention impairments and language disorders in chronic aphasia, this study aimed to compare the effects of two naming treatment programs, one with and one without attention training components, on the naming performance of participants with aphasia. MATERIALS AND METHODS: This was a single-subject crossover study in which six people with chronic aphasia and different degrees of naming and attention impairments participated. Two treatment programs were implemented for each participant, with the sequence of the treatments with crossover design. Each program consisted of 12 treatment sessions plus pre- and post-treatment assessment sessions (15 weeks for each participant). The visual analysis and WEighted STatistics methods were employed for data analysis. RESULTS: Based on visual analysis, both treatments improved in comparison to the baseline phase. Statistical analysis revealed that the number of participants with significant naming improvement following combined program (5 participants) was larger than the number of participants showing improvement following completion of the single, program. CONCLUSION: Although integrating attention training into a conventional treatment for anomia can increase the effect of treatment on naming ability, more studies are required to clarify the role of attention in remediating naming impairments in aphasia.

The Efficacy of Structural Priming in the Production of Sentences with Prepositions in Persian Patients with Poststroke Aphasia.

INTRODUCTION: Problems with the production of sentences with prepositions are one of the most common language problems in people with aphasia (PWA). Structural priming (SP) is one of the theory-based therapeutic approaches to improve these deficits. Although several studies have been conducted on the sentence construction problems of PWA, there is no study on the SP protocol for the production of sentences with Persian prepositions. This study aimed to investigate the effectiveness of SP in the production of these sentences among Persian-speaking PWA. METHODS: This study, with a single-subject ABA design, evaluated the efficacy of SP in the production of trained and untrained sentences containing Persian prepositions in four aphasic individuals with agrammatism and investigated the maintenance effects at 4 weeks post-training. RESULTS: Two subjects (A.G. and M.S.) showed notable changes in the production of trained sentences with Persian prepositions (50% to 91.67% for A.G. and 0% to 66.67% for M.S.). This significant improvement was generalized to sentences with untrained prepositions (50% to 91.67% for A.G. and 0% to 83.33% for M.S.). The treatment effects were also maintained in the 4-week follow-up (d2 = 10.3 for A.G. and d2 = 19.06 for M.S.). However, the other two participants only showed a slight increase in these variables after treatment. CONCLUSION: The findings of the present study revealed that SP for sentences with prepositions could be useful to varying degrees for Persian-speaking PWA with agrammatism and lead to improved language skills in producing these sentences. Overall, individuals with better language skills and cognitive status in early assessments showed better treatment outcomes than others.

Translation and Cross-cultural Adaptation of the Aphasia Check List in Persian Speakers With Aphasia.

INTRODUCTION: The Aphasia Check List (ACL) is a comprehensive, time-saving tool for language evaluation in aphasia, including a cognitive assessment part. This cross-sectional study aimed to translate ACL into Persian and analyze the psychometric features of the translated version. The original version of the ACL was translated and adapted from German; its psychometric features were then determined. METHODS: Twenty People With Aphasia (PWA) and 50 age- and education-matched, cognitively healthy controls participated in this research. Possible floor and ceiling effects, discriminant validity, test-retest reliability, and internal consistency of the test were analyzed in addition to the evaluation of internal correlations between the test parts (language & cognition). RESULTS: Regarding the performance of PWAs in the language section and the cognitive subtests assessing attention, memory, and reasoning, there were no floor and ceiling effects. Adequate discriminant validities for the language section of the test [i.e., total score: (Mann-Whitney U= 6.000, P<0.001); diagnostic subtests scores: (Mann-Whitney U= 3.000, P<0.001), and each subtest individually. Besides, the attention subtest of the cognition section (Mann-Whitney U= 16.500, P<0.001) was also observed. There was no difference between the control and patient groups in the subtests of memory (Mann-Whitney U= 497.500, P=0.973) and reasoning (Mann-Whitney U= 3.000, P= 308). The test-retest reliability was acceptable in all subtests (ICC agreement= 0.573-0.984). The ACL-P suggested appropriate internal consistency (Cronbach's alpha coefficient= 0.761 for test & retest scores). There were also significant correlations between language and cognition in the control and patient groups. CONCLUSION: The ACL-P test indicated sufficient reliability and validity for the evaluation of Persian-speaking PWAs and is suggested to be used in studies on this population.

National Guidelines for Cognitive Assessment and Rehabilitation of Iranian Traumatic Brain Injury Patients.

BACKGROUND: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. METHODS: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients' conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). RESULTS: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. CONCLUSION: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system.

The effects of spaced transcranial Direct Current Stimulation combined with conventional dysphagia therapy in Parkinson's disease: A case report.

Parkinson's disease (PD) is a neurodegenerative disease of the central nervous system that is characterized by a set of motor and non-motor symptoms. Impaired swallowing or dysphagia is one relatively common motor symptom in patients with PD. We investigated whether neuroplasticity induction by spaced transcranial Direct Current Stimulation (tDCS) combined with conventional swallowing therapy leads to long-lasting effects on swallowing ability in patients with PD. We present a case of a 61-year-old male PD patient with dysphagia. Conventional Swallowing Therapy (CDT) combined with tDCS (bilateral anodal, 1 mA, 20 min, 10 online sessions, twice daily with a 20 min interval in between for five days over two weeks) was applied over the pharyngeal motor cortex. Our findings suggest that anodal tDCS combined with CDT is feasible, safe, and well-tolerated, and leads to a clinically relevant improvement of swallowing functions.

A Study of Vocal Facilitating Techniques Compared to Manual Circumlaryngeal Therapy in Teachers With Muscle Tension Dysphonia.

OBJECTIVE: There are several voice therapy techniques been suggested in patients with muscle tension dysphonia (MTD), however a few studies are compared between them. The purpose of present study was to compare the effect of vocal facilitating techniques (VFTs) and manual circumlaryngeal therapy (MCT) in teachers with MTD. STUDY DESIGN: This is a randomized clinical trial study. METHODS: Sixteen teachers with MTD (female; mean age: 38.6 ± 4.6 years) participated in this study. The participants allocated to two treatment groups: the first group received VFTs (n: 8) and MCT was presented to the second one (n: 8). In each group, the voice therapy techniques were given for 10 individual sessions twice a week. The effect of both techniques was assessed using voice handicap index (VHI) and dysphonia severity index (DSI). RESULTS: Within group comparison, the VHI, DSI, and theirs components showed significantly better results after both treatment groups (P ≤ 0.05). Although, effect size was strong for all target features (η2 > 0.36); the greatest magnitude was obtained on the physical subscale of VHI following MCT and for the DSI after VFTs (η2 = 0.92 and 0.90, respectively). Moreover, the interactive effect of time and treatment groups indicated that there was significant main effect on the physical and functional subscales of VHI (P = 0.00 and 0.02, respectively) as well as I-low and DSI (P = 0.01 and 0.02, respectively). CONCLUSION: VFTs and MCT are two effective techniques in voice therapy of teachers with MTD. However, the greatest improvement obtained on the DSI following VFTs and for the physical aspect of VHI after MCT demonstrated voice therapist can use appropriate technique based on the voice complaints and results of voice assessments in MTD.

The effect of traditional dysphagia therapy on the swallowing function in patients with Multiple Sclerosis: A pilot double-blinded randomized controlled trial.

BACKGROUND: Dysphagia is common following Multiple Sclerosis (MS) and is associated with significant morbidity and mortality. The current rehabilitation program to swallowing therapy is Traditional Dysphagia Therapy (TDT), but there is a dearth of evidence about its effectiveness in MS patients. OBJECTIVES: This study was aimed to determine the effects of the TDT on the swallowing function in MS patients with dysphagia. METHODS: A pilot double blind randomized clinical trial was carried out on 20 patients with MS. Patients were randomly divided into experimental group (TDT) comprising sensorimotor exercises and swallowing maneuvers, and Usual Care (UC) comprising diet prescription and postural changes. Patients in both groups received treatments for 6 weeks, 18 treatment sessions, 3 times per week, every other day. The Mann Assessment of Swallowing Ability (MASA) was the main outcome measure. The swallowing ability was assessed before treatment (T0), after the end of 9th session (T1), after the end of 18th session (T2), and after 6 weeks follow-up (T3). Penetration-Aspiration Scale (PAS) and Pharyngeal Residue Rating Scale (PRRS) as secondary outcome measures were applied at T0 and T2. RESULTS: Both groups had improved regarding MASA, PAS and PRRS scores over the time (P < 0.001). The improvements achieved in all outcomes were significantly greater in the TDT group than those of the UC group. The Main effect of the Time × Group interaction was significant for MASA score (P < 0.001). The large effect sizes were found for MASA score in both the TDT (d = 3.91) and the UC (d = 1.11) groups. CONCLUSIONS: This pilot randomized controlled trial showed that the TDT significantly improved the swallowing function of the MS patients with dysphagia.

The Relationship between Emotional Content and Word Processing in Normal Persian Speaking Children.

OBJECTIVES: Emotion is a key component in language processing, but emotional words processing in children is still controversial. We aimed to investigate the relationship between emotional dimensions, arousal and valence, word familiarity, comprehension, use, and emotional content recognition. Eventually, a list of emotional content words for this age was prepared in Persian. MATERIALS&METHODS: The study was conducted in selected elementary schools in Tehran, Iran from April to June 2017. Emotional words, from adult emotional words list, were categorized into 5 groups according to their arousal and valence scores, including neutral, happy, calm, anxious and sad. Evaluation of familiarity, use, comprehension and emotional content recognition of the list was conducted with a checklist in 60 first grade children by speech and language pathologist. RESULTS: Neutral words gained the highest score in familiarity, use, comprehension and emotional content recognition (the mean=0.74). Afterward, there were the emotional words with high valence, calm (the mean=0.64) and happy (the mean=0.52). Finally, it was found the low score for valence emotional words, sad (the mean=0.46) anxious (the mean =0.43) in end of score rating. There was a significant difference between all word groups in four aspects (P-value<0.001). There were no significant differences between boys and girls in four aspects. CONCLUSION: Neutral words are better comprehended and expressed than emotional words. Valence is more effective than arousal in emotional words. Gender was not a determinant factor in all of the aspects. An emotional word list which is comprehensible for children in Persian language was prepared.

Development, Cross-Cultural Adaptation, and Psychometric Characteristics of the Persian Progressive Aphasia Language Scale in Patients With Primary Progressive Aphasia: A Pilot Study.

INTRODUCTION: Primary Progressive Aphasia (PPA) is a neurological condition characterized by progressive dissolution of language capabilities. The Progressive Aphasia Language Scale (PALS) is an easy-to-apply bedside clinical scale capable of capturing and grading the key language features essential for the classification of PPA. The objective of the present study was to develop and validate the Persian version of the PALS (PALS-P) as a clinical language assessment test. METHODS: In this cross-sectional study, PALS was translated and adapted into Persian according to the international guidelines. A total of 30 subjects (10 subjects with PPA and 20 control subjects without dementia) were recruited to evaluate the intra-rater reliability and discriminant validity of PALS-P. RESULTS: The intra-rater reliability of the PALS-P within a 14-day interval was excellent for each subtest (ICC agreement range=0.81-1.0). PALS-P results were statistically significant among groups, suggesting its discriminative validity. CONCLUSION: This preliminary study indicates that PALS-P was successfully developed and translated. It seems to be a valid and reliable screening tool to assess language skills in Persian-speaking subjects with progressive aphasia.

Patient-Based Assessment of Effectiveness of Voice Therapy in Vocal Mass Lesions with Secondary Muscle Tension Dysphonia.

INTRODUCTION: Use of patient-based voice assessment scales is an appropriate method that is frequently used to demonstrate effectiveness of voice therapy. This study was aimed at determining the effectiveness of voice therapy among patients with secondary muscle tension dysphonia (MTD) and vocal mass lesions. MATERIALS AND METHODS: The study design was prospective, with within-participant repeated measures. Thirty-three patients with secondary MTD and vocal mass lesions participated in the study, selected on the basis of voice history, laryngeal palpation, and videostroboscopy examination. An experienced otolaryngologist and one experienced speech language pathologist undertook the diagnostic process. Voice therapy included both direct and indirect techniques and lasted approximately 2 months for all included patients. The voice handicap index (VHI) was used to evaluate the effectiveness of voice therapy among included patients. Paired t-test, size of the standardized effect (ESI), and mean standardized response (ESII) were used to analyze effectiveness of the target voice therapy. RESULTS: The findings of this study indicate a statistically significant improvement after the voice therapy protocol (P<0.05; t>1.96). Results of ESI and ESII demonstrate that the VHI scale is sufficiently responsive to detect voice therapy change (ES>0.8). CONCLUSION: This study recommends a combination of direct and indirect voice therapy in the vocal rehabilitation of patients with secondary MTD and vocal mass lesions. Furthormore, we recommend use of the VHI scale to show voice therapy changes for both clinical and research purposes.

Responsiveness of Persian Version of Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), Persian Version of Voice Handicap Index (VHI), and Praat in Vocal Mass Lesions with Muscle Tension Dysphonia.

OBJECTIVES: This study was aimed at determining the internal and external responsiveness of the Persian version of the Consensus Auditory-Perceptual Evaluation of Voice (called ATSHA), Persian version of the Voice Handicap Index (VHI), and Praat scales among patients with vocal mass lesions and secondary muscle tension dysphonia. STUDY DESIGN: Prospective, within-participant repeated measures. METHOD: Thirty patients with vocal fold nodules, polyps, and cysts related to secondary muscle tension dysphonia participated in the study. The measures of interest and videostroboscopy examination were used before and after treatment. The Global Perceived Effect questionnaire was used to separate those improved (moderately or greatly improved) and stable (slightly improved) patients. RESULTS: The mean standardized response, standardized effect size, and Guyatt analyses indicated high internal responsiveness for the all target parameters of the ATSHA, total score of the VHI, and two parameters of the Praat (0.8<). There was poor correlation between the videostroboscopy and the other target scales (r Pearson = -0.1-0.1). The receiver operating characteristic analysis indicated that all the target scales did not significantly separate those improved and stable subjects (area under the curve = 0), except for the overall severity and roughness parameters of the ATSHA scale (area under the curve = 1). CONCLUSION: This study recommends both the Consensus Auditory-Perceptual Evaluation of Voice and the VHI scales to show voice therapy changes. The target voice scale changes were not able to predict the videostroboscopy changes as external standard. Furthermore, we recommend that the overall severity and roughness may properly classify those improved and stable patients.

Validation of the Persian version of the dysphagia handicap index in patients with neurological disorders.

BACKGROUND: Dysphagia as a common condition affecting many aspects of the patient's life. The Dysphagia Handicap Index (DHI) is a reliable self-reported questionnaire developed specifically to measure the impact of dysphagia on the patient's quality of life. The aim of this study was to translate the questionnaire to Persian and to measure its validity and reliability in patients with neurogenic oropharyngeal dysphagia. METHODS: A formal forward-backward translation of DHI was performed based on the guidelines for the cross-cultural adaptation of self-report measures. A total of 57 patients with neurogenic dysphagia who were referred to the neurology clinics of Tehran University of Medical Sciences, Iran, participated in this study. Internal consistency reliability of the DHI was examined using Cronbach's alpha, and test-retest reliability of the scale was evaluated using intraclass correlation coefficient (ICC). RESULTS: The internal consistency of the Persian DHI (P-DHI) was considered to be good; Cronbach's alpha coefficient for the total P-DHI was 0.88. The test-retest reliability for the total and three subscales of the P-DHI ranged from 0.95 to 0.98 using ICC. CONCLUSION: The P-DHI demonstrated a good reliability, and it can be a valid instrument for evaluating the dysphagia effects on quality of life among Persian language population.

Development, cross-cultural adaptation, and validation of the Persian Mississippi Aphasia Screening Test in patients with post-stroke aphasia.

BACKGROUND: The Mississippi Aphasia Screening Test (MAST) is a brief screening test for assessing the expressive and receptive language abilities in patients with aphasia. The objective of the study was to develop and validate the Persian version of the MAST (MASTp) as a screening test for language disorders in patients with post-stroke aphasia. METHODS: This study used a cross-sectional design to cross-culturally adapt the MASTp following the guidelines for the process of cross-cultural adaptation of measures. A total of 40 subjects (20 patients with post-stroke aphasia and 20 healthy subjects) were included. The MASTp was tested for floor or ceiling effects, internal consistency reliability, intra-rater reliability, discriminative validity, and factor structure. RESULTS: There were no floor or ceiling effects for MASTp total score. The MASTp yielded values for internal consistency reliability that were not adequate (Cronbach's alpha 0.64 and 0.66 for test and retest, respectively. The intra-rater reliability of the MASTp within a 7 day-interval was excellent for total score (ICC agreement = 0.96) and both expressive index (ICC = 0.95) and receptive index (ICC agreement = 0.98). here were statistically significant differences in MASTp total scores and both indexes between patients and healthy subjects suggesting the discriminative validity of the MASTp (P < 0.001). Factor analysis revealed a 3-factor solution, which jointly accounted for 72.06% of the total variance. Additional factor analysis suggested 6-item MASTp as a unidimensional measure. CONCLUSION: The MASTp is useful as a valid and reliable screening tool for evaluation of language abilities in Persian speaking patients with aphasia after stroke.

A Single-subject Study to Examine the Effects of Constrained-induced Aphasia Therapy on Naming Deficit.

Aphasia is prevalent in people following stroke, which can have a significant impact on the quality of life of the patients with stroke. One of the new methods for treatment of patients with aphasia is constraint-induced aphasia therapy (CIAT). The aim of this study was to investigate the efficacy of CIAT on naming deficits in individuals with chronic aphasia. This study had a prospective, single-subject study with A-B-A design. The CIAT was administered to two patients with chronic aphasia. Participants were a 57-year-old male and a 45-year-old female and had a stroke 60 and 36 months ago, respectively. In this study, the naming test was used as the outcome measure. The naming test was administered in three baseline sessions with 1 week interval between tests (phase A). Patients received CIAT for four consecutive weeks (3 days/week). Four measurements were taken during the treatment phase (phase B). In follow-up phase (phase A) two other measurements were performed. Visual analysis consisting of level, regression line, and variability were used to determine the effects of CIAT on naming. Both participants increased scores on naming test after phase A and B. The mean of the naming score improved from the baseline to the intervention phase in both participants. There was a positive trend in naming scores during the treatment phase compared with the trend in the baseline demonstrated by both participants. The results of this study showed that the CIAT can be effective in improving the naming deficit in patients with chronic post-stroke aphasia.

Speed of word retrieval in multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a common inflammatory - degenerative disease of myelin sheet of central nervous system that affects more young people. These patients show some degrees of cognition problems such as memory and processing disorders. The aim of this study was to evaluate the speed processing ability by word finding assessment in three categories include fruits, animals and objects in MS patients. MATERIALS AND METHODS: This study carried out as case-control and descriptive-analytic on 47 MS patients and 29 healthy controls. We measured the reaction time (RT) in three stages. Each stage includes 25 words (animals, fruits and objects words with high familiarity) that were presented randomly. In each stage, the subject should press a key when recognized the target category. Collected data analyzed with repeated measure ANOVA, two-way ANOVA test, and independent-samples t-test. RESULTS: MS patients in comparison to normal healthy subjects show delay in speed of processing in which there was significant difference between MS patients and control subjects in mean reaction time in all three categories (P < 0.001). CONCLUSION: The speed of processing is impaired in MS patients. Consequently, more evaluation and planning treatment programs based of speed processing for memory in these patients are necessary for them because of the role of memory in daily activities of life.

Verbal Fluency Performance in Patients with Non-demented Parkinson's Disease.

OBJECTIVE: While Parkinson's disease (PD) has traditionally been defined by motor symptoms, many researches have indicated that mild cognitive impairment is common in non-demented PD patients. The purpose of this study was to compare verbal fluency performance in non-demented Parkinson's disease patients with healthy controls. METHOD: In this cross-sectional study thirty non-demented Parkinson's disease patients and 30 healthy controls, matched by age, gender and education, were compared on verbal fluency performance. Verbal fluency was studied with a Phonemic Fluency task using the letters F, A, and S, a semantic fluency task using the categories animals and fruits. The independent t-test was used for data analysis. RESULTS: Overall, participants generated more words in the semantic fluency task than in the phonemic fluency task. Results revealed significant differences between patients and controls in semantic fluency task (p<.05). In addition, PD patients showed a significant reduction of correctly generated words in letter fluency task. The total number of words produced was also significantly lower in the PD group (p<.05). CONCLUSION: Verbal fluency disruption is implied in non-demented PD patients in association with incipient cognitive impairment.