Benefits of a targeted rehabilitation of number transcoding in secondary acalculia: A single-case experimental design.

BACKGROUND: Despite its potentially significant functional and emotional impact, acalculia is still too rarely assessed and managed by speech and language therapists. Research on the rehabilitation of numerical transcoding remains scarce in the literature and, despite positive results, presents a low level of evidence. AIMS: The present study aims to evaluate the effectiveness of a targeted rehabilitation of numerical transcoding in two patients suffering from a chronic secondary acalculia. METHODS & PROCEDURES: Two post-brain injury females with secondary acalculia took part in a single-case experimental design with multiple baseline across subjects according to a three-phase experimental protocol: baseline involving global cognitive rehabilitation (5-7 measurements with randomized sequential introduction); targeted intervention (10 measurements); follow-up (2 immediate measurements and 1 month after the end of the intervention). Repeated outcome measures consisted of six lists composed of numbers of equivalent difficulty that were used alternately to assess numerical transcoding. We used a reverse digit span as a control measure to assess the specificity of the intervention. Rehabilitation lasted 5 weeks and consisted of errorless learning with colour cues, tables and number-words cards. OUTCOMES & RESULTS: During baseline period involving global cognitive rehabilitation, transcoding scores remained unchanged. In contrast, there was a significant improvement in scores for both patients during the intervention phase targeting transcoding and maintenance of benefits 1-month post-intervention. CONCLUSIONS & IMPLICATIONS: This study demonstrates that a specific rehabilitation targeting numerical transcoding following chronic secondary acalculia can be effective in improving transcoding skills. WHAT THIS PAPER ADDS: What is already known on the subject Transcoding difficulties in patients with acalculia can cause a significant disability in everyday life activities. In secondary acalculia, rehabilitation of cognitive functions associated with number processing (attention, working memory, language) is not sufficient for improvement of transcoding. What this paper adds to existing knowledge An intervention specifically targeting numerical transcoding significantly and durably improves the skills of patients with chronic secondary acalculia. What are the potential or actual clinical implications of this work? Procedural error-free intervention using colour cueing, tables, cards with number-words, copy and repetition seems effective to improve transcoding skills in chronic acalculia.

Assessment tools and rehabilitation treatments for aprosodia following acquired brain injury: A scoping review.

BACKGROUND: Acquired brain injury (ABI), especially to the right hemisphere, can result in difficulty using or understanding prosodic contours in speech. Prosody is used to convey emotional connotation or linguistic intent and includes pitch, loudness, rate, and voice quality. A disorder in the comprehension or production of prosody is known as aprosodia; despite the communication disability caused by prosodic disorders, the assessment and treatment of aprosodia following ABI has received scant attention. AIMS: The aim of this scoping review is to gather and synthesise useful knowledge on aprosodia and provide therapists with an exhaustive document in order to guide clinical decision-making encouraging active identification and treatment of this disorder. METHODS & PROCEDURES: This scoping review, conducted in accordance with PRISMA-ScR guidelines, investigated the existing literature concerning the assessment and treatments of linguistic and affective aprosodia in adult patients after ABI. A systematic search in four electronic databases (PubMed, CINAHL, Web of Science, ScienceDirect) was conducted for articles written in English, French, or Italian published between 1970 and 2020. After all evaluative criteria were applied, 15 articles were included for final review. OUTCOMES & RESULTS: Results show the presence of six assessment tools for affective aprosodia and five evaluation tools targeting affective and linguistic prosody. Assessment of aprosodia is generally accomplished through acoustic and perceptual approaches. Current treatments for prosodic disorders focus on expressive aprosodia and have applied mostly two different approaches: imitative and cognitive-linguistic methods. CONCLUSION & IMPLICATIONS: Findings suggest that aprosodia can be assessed by therapists through various techniques and may be amenable to behavioural treatments. Nevertheless, although there are several assessment tools available, no one currently offers a comprehensive assessment that incorporates an ecological dimension. It therefore seems necessary to continue research in this direction. The rehabilitation of receptive prosody abilities also remains to be explored. WHAT THIS PAPER ADDS: What is already known on the subject Prosody has a fundamental role in communication and conveys speakers' intentions and emotions. Therefore, a deficit of prosody (aprosodia) after acquired brain injury can reduce social participation and engagement. Assessment tools and rehabilitation treatments are necessary in order to improve this disorder and patients' quality of life. What this paper adds to existing knowledge The evaluation tools currently available focuses mostly on affective aprosodia, whereas the linguistic prosody is less assessed. There exist two treatments for expressive aprosodia: motoric-imitative and cognitive-linguistic treatments; however, their efficacy is tested on small groups of patients. No treatments targeting receptive aprosodia were found. What are the potential or actual clinical implications of this work? We need more sensitive and reliable tools and systematic evaluations of all the components of prosody (affective and linguistic, receptive and expressive prosody). We need researches who analyse bigger samples of patients after right hemisphere brain injury and we identified the need of more well-designed studies and better understanding of the pathophysiology of aprosodia.

Impact of Combined Transcranial Direct Current Stimulation and Speech-language Therapy on Spontaneous Speech in Aphasia: A Randomized Controlled Double-blind Study.

OBJECTIVE: Aphasia recovery depends on neural reorganization, which can be enhanced by speech-language therapy and noninvasive brain stimulation. Several studies suggested that transcranial direct current stimulation (tDCS) associated with speech-language therapy may improve verbal performance evaluated by analytic tests, but none focused on spontaneous speech. We explored the effect of bihemispheric tDCS on spontaneous speech in patients with poststroke aphasia. METHODS: In this multicentric controlled randomized cross-over double-blind study, we included 10 patients with poststroke aphasia (4 had aphasia >6 months and 6 with aphasia <6 months). We combined the sessions of speech-language therapy and bihemispheric tDCS (2 mA, 20 min). After three baseline speech evaluations (1/week), two different conditions were randomly consecutively proposed: active and sham tDCS over 3 weeks with 1 week of washout in between. The main outcome measure was the number of different nouns used in 2 min to answer the question "what is your job." RESULTS: There was no significant difference between conditions concerning the main outcome measure (p = .47) nor in the number of verbs, adjectives, adverbs, pronouns, repetitions, blank ideas, ideas, utterances with grammatical errors or paraphasias used. Other cognitive functions (verbal working memory, neglect, or verbal fluency) were not significantly improved in the tDCS group. No adverse events occurred. CONCLUSION: Our results differed from previous studies using tDCS to improve naming in patients with poststroke aphasia possibly due to bihemispheric stimulation, rarely used previously. The duration of the rehabilitation period was short given the linguistic complexity of the measure. This negative result should be confirmed by larger studies with ecological measures.

Multimodal therapy of word retrieval disorder due to phonological encoding dysfunction.

OBJECTIVE: To determine whether phonological multimodal therapy can improve naming and communication in a patient showing a lexical phonological naming disorder. This study employed oral and written learning tasks, using an error reduction procedure. METHODS: A single-case design computer-assisted treatment was used with a 52 year-old woman with fluent aphasia consecutive to a cerebral infarction. The cognitive analysis of her word retrieval disorder exhibited a phonological encoding dysfunction. Thus, a phonological procedure was designed addressing the output phonological lexicon using computer analysis of spoken and written words. The effects were tested for trained words, generalization to untrained words, maintenance and specificity. Transfer of improvement to daily life was also assessed. OUTCOMES AND RESULTS: After therapy, the verbal naming of both trained and untrained words was improved at p < 0.001. The improvement was still maintained after 3 months without therapy. This treatment was specific since the word dictation task did not change. Communication in daily life was improved at p < 0.05. CONCLUSIONS: This study of a patient with word retrieval disorder due to phonological encoding dysfunction demonstrated the effectiveness of a phonological and multimodal therapeutic treatment.

Non-pharmacological intervention for posterior cortical atrophy.

Posterior cortical atrophy (PCA) is a rare neurodegenerative condition characterized by progressive visual-perceptual deficits. Although the neurocognitive profile of PCA is a growing and relatively well-established field, non-pharmacological care remains understudied and to be widely established in clinical practice. In the present work we review the available literature on non-pharmacological approaches for PCA, such as cognitive rehabilitation including individual cognitive exercises and compensatory techniques to improve autonomy in daily life, and psycho-education aiming to inform people with PCA about the nature of their visual deficits and limits of cognitive rehabilitation. The reviewed studies represented a total of 7 patients. There is a scarcity of the number of studies, and mostly consisting of case studies. Results suggest non-pharmacological intervention to be a potentially beneficial approach for the partial compensation of deficits, improvement of daily functionality and improvement of quality of life. Clinical implications and future directions are also highlighted for the advancement of the field, in order to clarify the possible role of non-pharmacological interventions, and its extent, in PCA.

Rehabilitation of word deafness due to auditory analysis disorder.

BACKGROUND: Word deafness refers to an inability to understand spoken words despite intact hearing. In a cognitive approach, word deafness could be explained by a deficiency at the lower perceptive level of the auditory process. The impairment of the auditory analysis system would explain a disorder of identification of speech sounds. Only few studies addressed rehabilitation of central auditory processing and have described therapy focused on phoneme discrimination. OBJECTIVE: To determine whether a specific auditory analysis rehabilitation addressing phoneme discrimination and phoneme recognition may improve oral comprehension and communication. METHOD: A single-case experimental design was used in a 65 year-old woman, with word deafness consecutive to a cerebral infarction which occurred 10 months before. Verbal naming, written expression and written comprehension were normal. Verbal comprehension, repetition and phoneme discrimination and recognition were impaired. In terms of cognitive model of auditory processing, the patient showed impairment of the auditory analysis system affecting verbal comprehension. A computerized rehabilitation of auditory analysis system was carried out in two consecutive tasks: phoneme discrimination and phoneme recognition. Errorless learning therapy was used, with a difficulty hierarchy practised from the easier to the most difficult phoneme and systematic visual cues which were progressively delayed and suppressed. This study tested the efficacy and the specificity of this therapy on the addressed tasks (phoneme discrimination and recognition), related tasks (oral comprehension and repetition), independent tasks (recognition of environmental sounds) and daily life (questionnaire). RESULTS: The phoneme discrimination and recognition impairment was stable over 4 months before therapy. After therapy, phoneme discrimination (p < 0.001) and phoneme recognition (p < 0.0001) were improved. The improvement was specific to verbal sounds recognition, while non-verbal sounds recognition was unchanged. An improvement occurred for repetition (p < 0.05) and oral comprehension (p < 0.01). The communication disability decreased (p < 0.05). CONCLUSION: In a case of word deafness, this study demonstrates not only the efficacy of a specific phoneme processing therapy but also its efficacy in the improvement of higher level of cognitive treatment such as oral comprehension and its transfer in daily life. The role of errorless therapy using systematic visual cues and difficulty hierarchy must be underlined.