The role of verbal short-term memory in complex sentence comprehension: An observational study on aphasia.

BACKGROUND: The comprehension profile of people with agrammatism is a debated topic. Syntactic complexity and cognitive resources, in particular phonological short-term memory (pSTM), are considered as crucial components by different interpretative accounts. AIM: To investigate the interaction of syntactic complexity and of pSTM in sentence comprehension in a group of persons with aphasia with and without agrammatism. METHODS & PROCEDURES: A cohort of 30 participants presenting with aphasia was assessed for syntactic comprehension and for pSTM. A total of 15 presented with agrammatism and 15 had fluent aphasia. OUTCOMES & RESULTS: Linear nested mixed-model analyses revealed a significant interaction between sentence type and pSTM. In particular, participants with lower pSTM scores showed a reduced comprehension of centre-embedded object relatives and long coordinated sentences. Moreover, a significant interaction was found between sentence type and agrammatism, with a lower performance for passives within the agrammatic group. CONCLUSIONS & IMPLICATIONS: These results confirm that pSTM is involved in the comprehension of complex structures with an important computational load, in particular coordinated sentences, and long-distance filler gap dependencies. On the contrary, the specific deficit of the agrammatic group with passives is a pure syntactic deficit, with no involvement of pSTM.

Effect of High Frequency Transcranial Magnetic Stimulation on Recovery of Chronic Post-Stroke Aphasia.

BACKGROUND: Both hemispheres have role in post-stroke aphasia recovery but better recovery is expected with the restoration of function by the left hemisphere. Transcranial stimulation has been used to favor recruitment of left-hemispheric language networks and increase activity of the left hemisphere, thus helps aphasia recovery . OBJECTIVE: The aim of this study is to evaluate the effect of excitatory repetitive transcranial magnetic stimulation (rTMS) on recovery of post stroke aphasic patients . MATERIALS AND METHODS: Twenty patients with post stroke chronic aphasia were enrolled in the study. Aphasia severity was assessed using Aphasia Severity Rating Scale (ASRS). Linguistic deficits were assessed using Kasr Al-Aini Arabic Aphasia test (KAAT). Real rTMS was applied three for 10 sessions of 10-Hz stimulation, positioned over the left Broca's area of the affected hemisphere. All patients were evaluated before, after the end of treatment sessions and one month later . RESULTS: There was a significant improvement in the mean total score and mean scores of components of KAAT scale before, immediately after and after one month of rTMS (P< 0.05). Moreover, there was a significant improvement in mean scores of ASRS before, immediately after and after one month of rTMS (P= 0.000). There was a significant difference in mean scores of ASRS and KAAT before, immediately after the last session and after one month between small, medium and large brain infarcts. (P< 0.05). CONCLUSION: Excitatory rTMS is a beneficial adjuvant therapy that improves language skills in patients with chronic post-stroke non-fluent aphasia in short and long term. The protocol of this observational study was registered in clinical trial registration: www.ClinicalTrials.gov, identifier: NCT04708197.

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.

Improved language in chronic aphasia after self-delivered iPad speech therapy.

Self-delivered speech therapy provides an opportunity for individualised dosage as a complement to the speech-therapy regime in the long-term rehabilitation pathway. Few apps for speech therapy have been subject to clinical trials, especially on a self-delivered platform. In a crossover design study, the Comprehensive Aphasia Test (CAT) and Cookie Theft Picture Description (CTPD) were used to measure untrained improvement in a group of chronic expressive aphasic patients after using a speech therapy app. A pilot study (n = 3) and crossover design (n = 7) comparing the therapy app with a non-language mind-game were conducted. Patients self-selected their training on the app, with a recommended use of 20 minutes per day. There was significant post-therapy improvement on the CAT and CTPD but no significant improvement after the mind-game intervention, suggesting there were language-specific effects following use of the therapy app. Improvements on the CTPD, a functional measurement of speech, suggest that a therapy app can produce practical, important changes in speech. The improvements post-therapy were not due to type of language category trained or amount of training on the app, but an inverse relationship with severity at baseline and post-therapy improvement was shown. This study suggests that self-delivered therapy via an app is beneficial for chronic expressive aphasia.

The effectiveness of script training to restore lost communication in a patient with Broca's aphasia.

Aphasia is considered as an acquired neurological disorder of communication, which is characterised by the symptoms on all levels of language dysfunction. The current study was planned to explore the outcomes of script training in a patient with Broca's aphasia through quantitative approach using a single-subject-multiple-baseline research design across behaviours. The probes were obtained during the baseline, treatment, maintenance and generalisation phases for tracking the spoken use of scripted content. All the probes were transcribed verbatim and no value of Cohen's Kappa Coefficient (K) was below 0.61, indicating robust inter-rater reliability. The subject learned all six scripts successively and over 80% of mastery level on all dependent variables was achieved. The largest effect size, above 10.1, was reported for the percent of intelligible scripted words (PISW). Script training was found to be an effective therapy for rejuvenating lost communication of patients with severe Broca's aphasia.

Executive Dysfunction and Behavioral Symptoms Are Associated with Deficits in Instrumental Activities of Daily Living in Frontotemporal Dementia.

BACKGROUND: Deficits in instrumental activities of daily living (ADLs) may be more prominent in behavioral variant frontotemporal dementia (bvFTD) than in nonfluent/agrammatic variant primary progressive aphasia (nfvPPA) or semantic variant primary progressive aphasia (svPPA). It is uncertain whether frontotemporal dementia (FTD) subgroups exhibit different patterns and/or predictors of functional impairment. METHODS: We examined data from participants diagnosed with bvFTD (n = 607), svPPA (n = 132), and nfvPPA (n = 155) who were included in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) and assessed with the Functional Activities Questionnaire (FAQ). Stepwise multiple linear regression analyses were performed to identify associations between FAQ scores and cognitive/behavioral deficits using the NACC UDS neuropsychological testing battery and the Neuropsychiatric Inventory Questionnaire. RESULTS: FAQ scores were higher in bvFTD than svPPA or nfvPPA. Functional deficits across FTD subtypes differed in severity, but not pattern, and were driven by executive dysfunction and behavioral symptoms. CONCLUSION: Executive dysfunction and behavioral symptoms underlie instrumental ADL deficits in FTD, which are most prominent in bvFTD.

Characterisation of "Positive" Behaviours in Primary Progressive Aphasias.

BACKGROUND/AIMS: Although some patients with primary progressive aphasia (PPA) exhibit novel or improved skills after the onset of dementia, these changes have yet to be quantified. Therefore, this study systematically explored and identified the emergence of positive behaviours after dementia onset. METHODS: This study included 48 carers of patients with PPA: 12 nonfluent/agrammatic PPA (nfvPPA), 22 semantic variant PPA (svPPA), and 14 logopenic variant PPA (lvPPA). The presence and frequency of positive behaviour changes after dementia onset were established using the Hypersensory and Social/Emotional Scale (HSS). RESULTS: Scores on Sensitivity to Details, Visuospatial Activities, and Music Activities differed significantly among the groups. More specifically, svPPA was associated with increased visuospatial activity, but only in the mild stage of the disease; nfvPPA was associated with increased visuospatial activity and decreased music activity, while lvPPA exhibited the reverse profile. CONCLUSIONS: The results demonstrate that subsets of PPA patients show novel or increased positive behaviours following dementia onset, and differences among subtypes may be helpful for improving diagnostic accuracy. Additionally, harnessing these skills may improve the quality of life of both patients and carers.

Identifying mechanisms of change in a conversation therapy for aphasia using behaviour change theory and qualitative methods.

BACKGROUND: Conversation therapy for aphasia is a complex intervention comprising multiple components and targeting multiple outcomes. UK Medical Research Council (MRC) guidelines published in 2008 recommend that in addition to measuring the outcomes of complex interventions, evaluation should seek to clarify how such outcomes are produced, including identifying the hypothesized mechanisms of change. AIMS: To identify mechanisms of change within a conversation therapy for people with aphasia and their partners. Using qualitative methods, the study draws on behaviour change theory to understand how and why participants make changes in conversation during and after therapy. METHODS & PROCEDURES: Data were derived from 16 participants (eight people with aphasia; eight conversation partners) who were recruited to the Better Conversations with Aphasia research project and took part in an eight session conversation therapy programme. The dataset consists of in-therapy discussions and post-therapy interviews, which are analysed using Framework Analysis. OUTCOMES & RESULTS: Seven mechanisms of conversational behaviour change are identified and linked to theory. These show how therapy can activate changes to speakers' skills and motivation for using specific behaviours, and to the conversational opportunities available for strategy use. CONCLUSIONS & IMPLICATIONS: These clinically relevant findings offer guidance about the processes involved in producing behavioural change via conversation therapy. A distinction is made between the process involved in motivating change and that involved in embedding change. Differences are also noted between the process engaged in reducing unhelpful behaviour and that supporting new uses of compensatory strategies. Findings are expected to have benefits for those seeking to replicate therapy's core processes both in clinical practice and in future research.

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.

Type-specific proactive interference in patients with semantic and phonological STM deficits.

Prior neuropsychological evidence suggests that semantic and phonological components of short-term memory (STM) are functionally and neurologically distinct. The current paper examines proactive interference (PI) from semantic and phonological information in two STM-impaired patients, DS (semantic STM deficit) and AK (phonological STM deficit). In Experiment 1 probe recognition tasks with open and closed sets of stimuli were used. Phonological PI was assessed using nonword items, and semantic and phonological PI was assessed using words. In Experiment 2 phonological and semantic PI was elicited by an item recognition probe test with stimuli that bore phonological and semantic relations to the probes. The data suggested heightened phonological PI for the semantic STM patient, and exaggerated effects of semantic PI in the phonological STM case. The findings are consistent with an account of extremely rapid decay of activated type-specific representations in cases of severely impaired phonological and semantic STM.

Perceived liveliness and speech comprehensibility in aphasia: the effects of direct speech in auditory narratives.

BACKGROUND: Previous studies have shown that in semi-spontaneous speech, individuals with Broca's and anomic aphasia produce relatively many direct speech constructions. It has been claimed that in 'healthy' communication direct speech constructions contribute to the liveliness, and indirectly to the comprehensibility, of speech. AIMS: To examine the effects of the occurrence of direct speech constructions on the perceived liveliness and speech comprehensibility of narratives produced by individuals with and without aphasia. METHODS & PROCEDURES: Thirty-seven naive listeners rated 30 speech fragments with and without direct speech from ten speakers with and ten speakers without aphasia. The fragments originated from semi-structured interviews. The raters scored the perceived liveliness and the perceived comprehensibility of these fragments. OUTCOMES & RESULTS: For both groups of speakers, fragments containing direct speech constructions received higher scores for liveliness than fragments without direct speech constructions. However, no effect of direct speech was found on perceived comprehensibility. CONCLUSIONS & IMPLICATIONS: This is the first research to demonstrate that communication is perceived as more lively when it contains direct speech than when it does not, but yet is not more comprehensible. Individuals with Broca's and anomic aphasia are known to produce regularly direct speech constructions in elicited narratives. Given that liveliness is known to increase listeners' involvement and to help listeners stay focused, we suggest that this relative increase in direct speech by aphasic speakers may reflect a strategy to increase not only the liveliness of their discourse, but also listener focus and involvement.

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.

Asymmetric inhibitory treatment effects in multilingual aphasia.

Findings from recent psycholinguistic studies of bilingual processing support the hypothesis that both languages of a bilingual are always active and that bilinguals continually engage in processes of language selection. This view aligns with the convergence hypothesis of bilingual language representation. Furthermore, it is hypothesized that when bilinguals perform a task in one language they need to inhibit their other, nontarget language(s) and that stronger inhibition is required when the task is performed in the weaker language than in the stronger one. The study of multilingual individuals who acquire aphasia resulting from a focal brain lesion offers a unique opportunity to test the convergence hypothesis and the inhibition asymmetry. We report on a trilingual person with chronic nonfluent aphasia who at the time of testing demonstrated greater impairment in her first acquired language (Persian) than in her third, later learned language (English). She received treatment in English followed by treatment in Persian. An examination of her connected language production revealed improvement in her grammatical skills in each language following intervention in that language, but decreased grammatical accuracy in English following treatment in Persian. The increased error rate was evident in structures that are used differently in the two languages (e.g., auxiliary verbs). The results support the prediction that greater inhibition is applied to the stronger language than to the weaker language, regardless of their age of acquisition. We interpret the findings as consistent with convergence theories that posit overlapping neuronal representation and simultaneous activation of multiple languages and with proficiency-dependent asymmetric inhibition in multilinguals.

Gestural depiction in acquired language disorders: on the form and use of iconic gestures in aphasic talk-in-interaction.

This paper uses conversation analysis to investigate the form and use of iconic gestures by a man with severe Broca-type aphasia in interaction with his speech and language therapist. Deconstructing iconic gestures into the different types of methods used to produce them, the paper analyzes how these gestures can depict certain entities, such as actions or types of people, in ways that may be understandable to the recipient. It is also observed that these iconic gestures can constitute gestural contributions, which not only communicate certain semantic meanings, but also accomplish social actions, such as answering or repairing. The implications of this analysis for our understanding of compensatory behavior in aphasia, and of augmentative and alternative communication in social interaction more generally, are discussed.

Adaptation to aphasia: grammar, prosody and interaction.

This paper investigates recurrent use of the phrase very good by a speaker with non-fluent agrammatic aphasia. Informal observation of the speaker's interaction reveals that she appears to be an effective conversational partner despite very severe word retrieval difficulties that result in extensive reliance on variants of the phrase very good. The question that this paper addresses using an essentially conversation analytic framework is: What is the speaker achieving through these variants of very good and what are the linguistic and interactional resources that she draws on to achieve these communicative effects? Tokens of very good in the corpus were first analyzed in a bottom-up fashion, attending to sequential position, structure and participant orientation. This revealed distinct uses that were subsequently subjected to detailed acoustic analysis in order to investigate specific prosodic characteristics within and across the interactional variants. We identified specific clusters of prosodic cues that were exploited by the speaker to differentiate interactional uses of very good. The analysis thus shows how, in the adaptation to aphasia, the speaker exploits the rich interface between prosody, grammar and interaction both to manage the interactional demands of conversation and to communicate propositional content.

Efficacy of Jellow app as an adjunct to stimulation therapy in improvement in language and quality of life in patients with chronic Broca's Aphasia.

Purpose: Stimulation approach is a therapy technique to improve language production using auditory and visual stimulation. Jellow app is a mobile app designed for compensating for impaired language skills and may be used in the intervention of persons with aphasia. The study aimed to determine the benefits of using the Jellow app as a facilitator of stimulus therapy to improve language and psychosocial domains in chronic Broca's Aphasia.Methods: Ten right-handed male adults with Broca's Aphasia were assessed on WAB and SIQOL39g tests. The control group (n = 5) was enrolled only for stimulation therapy. Pictures of objects were used for therapy with the help of auditory or auditory and visual cues. In the study group (n = 5), along with stimulus therapy, subjects were also trained on the use of icons in the Jellow app to facilitate functional communication needs. After six-months tests were readministered. Results: Post-therapy, on WAB, the improvement in spontaneous speech, repetition, and naming were found to be significantly more in the study group (4.6 ± 0.55, 4.89 ± 0.56, 5.74 ± 0.24 respectively) than the control group (2.6 ± 0.89, 3.22 ± 0.49, 3.97 ± 0.3 respectively) on 2-sample t-test. Similarly, significantly more improvement was seen in the communication domain of SAQOL39g in the study group (2.03 ± 0.17) compared to the control group (1.14 ± 0.45).Conclusion: Use of the Jellow app may be a beneficial adjunct to stimulation therapy for improving linguistic abilities and quality of life in persons with chronic Broca's aphasia.IMPLICATIONS FOR REHABILITATIONFollowing are the implications of this study in the rehabilitation of persons with chronic Broca's Aphasia:• Multimodality in therapy approach in traditional stimulation therapy is beneficial.• AAC Apps like the Jellow app can be used as an adjunct to the traditional stimulation approach of language intervention which facilitates the language abilities like spontaneous speech, repetition, and naming.• Language improvement due to rehabilitation is beneficial in improving the quality of life in this population.• The caregivers must be involved in the therapy program as they act as communication partners and can repeat the therapy tasks at home.• Similar type of study is warranted in a larger population so that people with chronic Broca's aphasia may get the benefit of the latest technology which may be cheaper and easier to use.

Short-term memory treatment: patterns of learning and generalisation to sentence comprehension in a person with aphasia.

Auditory-verbal short-term memory deficits (STM) are prevalent in aphasia and can contribute to sentence comprehension deficits. This study investigated the effectiveness of a novel STM treatment in improving STM (measured with span tasks) and sentence comprehension (measured with the Token Test and the Test for the Reception of Grammar, TROG) in a person with severe aphasia (transcortical motor). In particular, the research questions were: (1) Would STM training improve STM? (2) Would improvements from the STM training generalise to improvements in comprehension of sentences? STM was trained using listening span tasks of serial word recognition. No other language or sentence comprehension skills were trained. Following treatment, STM abilities improved (listening span, forward digit span). There was also evidence of generalisation to untreated sentence comprehension (only on the TROG). Backward digit span, phonological processing and single word comprehension did not improve. Improvements in sentence comprehension may have resulted from resilience to rapid decay of linguistic representations within sentences (words and phrases). This in turn facilitated comprehension.

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.

Rapidly progressive atypical parkinsonism associated with frontotemporal lobar degeneration and motor neuron disease.

OBJECTIVE: To report the rare but distinct clinical and neuropathological phenotype of non-familial, rapidly progressive parkinsonism and dementia associated with frontotemporal lobar degeneration with motor neuron disease (FTLD-MND). METHODS: Subjects included two 70-year-old women presenting with rapidly progressive severe postural instability, axial-predominant parkinsonism, oculomotor dysfunction and frontal-predominant dementia with language impairment and pseudobulbar palsy. One had diffuse weakness without signs of lower motor neuron disease. Post-mortem evaluations included immunohistochemistry with antiphospho-TAR DNA-binding protein 43 (TDP-43) and genetic analysis of the TARDBP and PGRN genes. RESULTS: Subjects died within 14 months from symptom onset. TDP-43-positive neuronal intracytoplasmic inclusions were prominent in the primary motor cortex, granule cell layer of the hippocampus, and several cranial and spinal cord nuclei. TDP-43 globular glial inclusions (GGI) were identified in one case. There were no mutations in PGRN or TARDBP genes. CONCLUSIONS: FTLD-MND due to TDP-43-proteinopathy should be considered in patients with rapidly progressive parkinsonism and dementia phenotype, especially when aphasia and/or weakness are also present.

Selective impairment of masculine gender processing: evidence from a German aphasic.

The present single case study describes the performance of the German aphasic E.M. who exhibited a severe impairment of grammatical gender processing in masculine nouns but relatively spared performance regarding feminine and neuter ones. This error pattern was assessed with tests of gender assignment to orally or visually presented words, with oral or written responses, and with tests of gender congruency decision on noun phrases. The pattern occurred across tasks and modalities, thus suggesting a gender-specific impairment at a modality-independent level of processing. It was sensitive to frequency, thus supporting the assumption that access to gender features as part of grammatical processing is frequency sensitive. Besides being the first description of a gender-specific impairment in an aphasic subject, the data therefore have implications regarding the modelling of representation and processing of grammatical gender information within the mental lexicon.