Remarkable Recovery After Severe Gunshot Brain Injury: A Comprehensive Case Study of Functional Rehabilitation.

BACKGROUND Penetrating traumatic brain injury (TBI) caused by gunshots is a rare type of TBI that leads to poor outcomes and high mortality rates. Conducting a formal neuropsychological evaluation concerning a patient's neurologic status during the chronic recovery phase can be challenging. Furthermore, the clinical assessment of survivors of penetrating TBI has not been adequately documented in the available literature. Severe TBI in patients can provide valuable information about the functional significance of the damaged brain regions. This information can help inform our understanding of the brain's intricate neural network. CASE REPORT We present a case of a 29-year-old right-handed man who sustained a left-hemisphere TBI after a gunshot, causing extensive diffuse damage to the left cerebral and cerebellar hemispheres, mainly sparing the right hemisphere. The patient survived. The patient experienced spastic right-sided hemiplegia, facial hemiparesis, left hemiparesis, and right hemianopsia. Additionally, he had severe global aphasia, which caused difficulty comprehending verbal commands and recognizing printed letters or words within his visual field. However, his spontaneous facial expressions indicating emotions were preserved. The patient received a thorough neuropsychological assessment to evaluate his functional progress following a severe TBI and is deemed to have had a favorable outcome. CONCLUSIONS Research on cognitive function recovery following loss of the right cerebral hemisphere typically focuses on pediatric populations undergoing elective surgery to treat severe neurological disorders. In this rare instance of a favorable outcome, we assessed the capacity of the fully developed right hemisphere to sustain cognitive and emotional abilities, such as language.

Does SLT combined with NIBS enhance naming recovery in post-stroke aphasia? A meta-analysis and systematic review.

BACKGROUND: Non-invasive brain stimulation has been widely used as an adjunctive treatment for aphasia following stroke. OBJECTIVE: The aim of this study was to investigate the effect of non-invasive brain stimulation as an adjunctive treatment on naming function in aphasia following stroke. METHODS: This review included randomized controlled trials (RCTs) involving 5 databases (Web of Science, Embase, Cochrane Library, OVID and PubMed) that investigated the effects of electrical stimulation on stroke patients. The search included literature published up to November 2023. RESULTS: We identified 18 studies, and the standardized mean differences (SMDs) showed that the effect sizes of TMS and tDCS were small to medium. Moreover, the treatment effects persisted over time, indicating long-term efficacy. CONCLUSION: This study suggested that NIBS combined with speech and language therapy can effectively promote the recovery of naming function in patients with post-stroke aphasia (PSA) and that the effects are long lasting.

Efficacy of different rehabilitation therapies on post-stroke aphasia patients: A network meta-analysis.

BACKGROUND: Although several rehabilitation interventions are effective in post-stroke aphasia (PSA), the efficacy of different rehabilitation interventions compared to each other remains controversial. Here, we aimed to compare the effectiveness of varying rehabilitation interventions in PSA. METHODS: Randomized controlled trials on 8 kinds of rehabilitation interventions to improve speech function in patients with PSA were searched by computer from 10 databases, including PubMed, Web of Science, Cochrane, OVID, CINAHL, Embase, CNKI, WanFang, CBM, and VIP. The search scope was from the establishment of the database to August 2023. The literature screening, extraction of basic information, and quality assessment of the literature were conducted independently by 2 researchers. Network meta-analysis (NMA) was performed using Stata 17.0 software. RESULTS: Fifty-four studies involving 2688 patients with PSA were included. The results of NMA showed that: ① in terms of improving the severity of aphasia, the therapeutic effects of repetitive transcranial magnetic stimulation were the most significant; ② motor imagery therapy was the most effective in improving spontaneous speech, repetition, and naming ability; ③ in terms of improving listening comprehension ability, the therapeutic effects of mirror neuron therapy was the most significant. CONCLUSION: The 8 rehabilitation interventions have different focuses in improving the speech function of PSA patients, and the clinical therapists can select the optimal rehabilitation interventions in a targeted manner according to the results of this NMA and the patients' conditions and other relevant factors.

Elizabeth Usher memorial lecture: Beyond our practice borders-using a biopsychosocial framework to improve long-term outcomes for people living with aphasia.

Purpose: Over 140 000 Australians live with aphasia after stroke, with this number of people living with aphasia increasing significantly when aphasia arising from traumatic brain injury, neoplasm, and infectious and progressive neurological diseases is also included. The resulting communication disability frequently compromises every aspect of daily life, significantly impacting everyday activity, employment, social participation, mental health, identity, and family functioning. Rehabilitation services rarely meet the needs of this group who have, for example, poorer healthcare outcomes than stroke peers without aphasia, nor address long-term recovery and support needs.Method: In this discussion paper, I argue that given the broad impacts of aphasia, a biopsychosocial approach to aphasia rehabilitation is required. Rehabilitation must include: interventions to improve the communication environment; programs that directly target identity, wellbeing, and mental health; and therapies focusing on functional activity, communication participation, and long-term self-management.Result: The evidence for these approaches is mounting and includes strongly stated consumer needs. I discuss the need for multidisciplinary involvement and argue that for speech-language pathologists to achieve such comprehensive service provision, an expanded scope of practice is required.Conclusion: There is a need to rethink standard therapy approaches, timeframes, and funding mechanisms. It is time to reflect on our practice borders to ask what must change and define how change can be achieved.

Evolución de la afasia en adolescentes con secuela de ACV: serie de casos / Post-stroke aphasia in adolescents' progress: case series

La afasia como secuela de un accidente cerebrovascular es un trastorno del lenguaje poco estudiado en adolescentes, tanto en Latinoamérica como a nivel mundial. Independientemente del hecho de que un número significativo de afasias mejora espontáneamente, la necesidad del inicio oportuno del tratamiento es imprescindible. En esta serie de casos se describe la presentación clínica y evolución de la afasia en 3 adolescentes con secuelas de accidente cerebrovascular que ingresaron a un instituto de neurorehabilitación. Fueron dos mujeres y un varón, de entre 15 y 17 años, que recibieron rehabilitación integral intensiva desde las áreas de fisioterapia, terapia ocupacional, neuropsicología, psicopedagogía, musicoterapia y fonoaudiología. Fueron evaluados con la versión chilena de la herramienta Western Aphasia Battery (WAB). A los 3 meses todos mejoraron y evolucionaron a un tipo de afasia más leve. Este estudio expone la importancia del tratamiento precoz e intensivo en esta población de adolescentes en plena etapa de construcción social como personas, en donde la alteración del lenguaje impacta en sus vínculos, grupo de pertenencia, estado anímico y a nivel académico. Se considera fundamental la evaluación y seguimiento sistemático con el objetivo de identificar los cambios y avances alcanzados durante la rehabilitación.

Aphasia as a sequela of stroke is an understudied language disorder in adolescents, both in Latin America and worldwide. Although a significant number of aphasia cases improve spontaneously, it is necessary to initiate treatment as soon as possible. This cases series describes the clinical presentation and evolution of aphasia in 3 adolescents with stroke sequelae who were admitted to a neurorehabilitation facility. Two females and one male, aged between 15 and 17 years, received intensive comprehensive rehabilitation from the areas of physiotherapy, occupational therapy, neuropsychology, psychopedagogy, music therapy and speech therapy. They were evaluated with the Chilean version of the Western Aphasia Battery (WAB). After 3 months, all of them improved and evolved to a milder type of aphasia. This study shows the importance of early, intensive treatment in adolescents who are in the height of their social development, where language alteration impacts on their bonds, their groups of belonging, their mood and their academic process. Systematicassessment and follow-up are considered essential to identify the changes and progress achieved during rehabilitation.

Head Acupuncture Plus Schuell's Language Rehabilitation for Post-Stroke Aphasia: A Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials.

OBJECTIVE: To evaluate the existing randomized controlled trials (RCTs) for evidence of the efficacy and safety of head acupuncture (HA) plus Schuell's language rehabilitation (SLR) in post-stroke aphasia. METHODS: Seven databases including Embase, PubMed, Cochrane Library, Technology Periodical Database, the China National Knowledge Infrastructure, SinoMed and Wanfang Data Information Site were searched for RCTs published from database inception until November 14, 2021. RCTs that compared HA plus SLR with sham (or blank) control, acupuncture therapy alone, certain language rehabilitation therapy alone or other therapies for post-stroke aphasia were included. Data were extracted and assessed, and the quality of RCTs was evaluated. Fixed-effects model was used, with meta-inflfluence analysis, meta-regression, and regression-based sub-group analyses applied for exploration of heterogeneity. Publication bias was estimated by funnel plots and Egger's tests. RESULTS: A total of 32 RCTs with 1,968 patients were included and 51 comparisons were conducted classified as types of strokes and aphasia. (1) For patients with aphasia after ischemic stroke, HA plus PSA showed significantly higher accumulative markedly effective rate [relative risk (RR)=1.55, 95% confidence interval (CI): 1.19-2.02, I2=0%] and accumulative effective rate (RR=1.22, 95% CI: 1.09-1.36, I2=0%). (2) For patients with comprehensive types of stroke, HA plus PSA was more effective in increasing recovery rate (RR=1.89, 95% CI: 1.39-2.56, I2=0%), accumulative markedly effective rate (RR=1.53, 95% CI: 1.36-1.72, I2=9%) and accumulative effective rate (RR=1.14, 95% CI: 1.09-1.19, I2=34%). (3) For patients with aphasia after stroke, HA plus PSA was superior to PSA alone with statistical significance in increasing recovery rate (RR=2.08, 95% CI: 1.24-3.46, I2=0%), accumulative markedly effective rate (RR=1.49, 95% CI: 1.24-1.78, I2=0%) and accumulative effective rate (RR=1.15, 95% CI: 1.06-1.24, I2=39%). (4) For patients with multiple types of aphasia, HA plus PSA also demonstrated significantly higher recovery rate (RR=1.86, 95% CI: 1.28-2.72, I2=0%), accumulative markedly effective rate (RR=1.55, 95% CI: 1.35-1.78, I2=22%), and accumulative effective rate (RR=1.17, 95% CI: 1.11-1.23, I2=41%). (5) For patients with motor aphasia after ischemic stroke, compared with PSA alone, HA plus PSA showed significantly higher accumulative markedly effective rate (RR=1.38, 95% CI: 1.06-1.79, I2=0%) and accumulative effective rate (RR=1.20, 95% CI: 1.05-1.37, I2=0%). Meta-regression analyses were performed without significant difference, and publication bias was found in some comparisons. CONCLUSION: HA plus SLR was significantly associated with better language ability and higher effective rate for patients with post-stroke aphasia, and HA should be operated cautiously especially during acupuncture at eye and neck. (Registration No. CRD42020154475).

A physician survey of poststroke aphasia diagnosis and treatment in China: SPEECH study.

ABSTRACT: The current status of the diagnosis and management of poststroke aphasia (PSA) in China is unknown.To analyze the physicians' strategy and knowledge about the management of PSA in clinical practice and the needs for standardization of diagnosis and treatment.This survey was conducted in March-August 2019 at 32 tertiary hospitals in 16 provinces/municipalities in China. The attending physicians from the Neurology and Neuro-rehabilitation/Rehabilitation Departments were included. The online questionnaire inquired about patient information, physicians' diagnosis and treatment behavior for PSA, and physicians' understanding of PSA.A total of 236 physicians completed the survey. Regarding PSA assessment, 99.2% of the physicians reported using medical history and physical examination, 93.2% reported using neuroimaging, and 76.3% reported using dedicated scales. Most physicians used a combination of drug and non-drug treatment. Neuro-regenerators/cerebral activators and anti-dementia drugs were the most common pharmacotherapies; butylphthalide, edaravone, and memantine were most frequently prescribed. Six months poststroke was rendered as a spontaneous language recovery period, and a ≥6-month treatment for PSA was suggested by many physicians. The lack of standardized treatment regimen/clinical guidelines and the limited number of approved drugs for PSA were the primary challenges encountered by physicians during practice. The majority of the physicians agreed with the necessity of guidelines or consensus for the diagnosis and treatment of PSA.The knowledge gaps exist among physicians in China regarding the assessment and management of PSA. The improved awareness of the available guidelines/consensus could improve the performance of the physicians.

Convergence of heteromodal lexical retrieval in the lateral prefrontal cortex.

Lexical retrieval requires selecting and retrieving the most appropriate word from the lexicon to express a desired concept. Few studies have probed lexical retrieval with tasks other than picture naming, and when non-picture naming lexical retrieval tasks have been applied, both convergent and divergent results emerged. The presence of a single construct for auditory and visual processes of lexical retrieval would influence cognitive rehabilitation strategies for patients with aphasia. In this study, we perform support vector regression lesion-symptom mapping using a brain tumor model to test the hypothesis that brain regions specifically involved in lexical retrieval from visual and auditory stimuli represent overlapping neural systems. We find that principal components analysis of language tasks revealed multicollinearity between picture naming, auditory naming, and a validated measure of word finding, implying the existence of redundant cognitive constructs. Nonparametric, multivariate lesion-symptom mapping across participants was used to model accuracies on each of the four language tasks. Lesions within overlapping clusters of 8,333 voxels and 21,512 voxels in the left lateral prefrontal cortex (PFC) were predictive of impaired picture naming and auditory naming, respectively. These data indicate a convergence of heteromodal lexical retrieval within the PFC.

A retrospective review of speech-language therapy services provided to adult inpatients at a central-level hospital in Gauteng, South Africa.

BACKGROUND: The quadruple burden of disease (BoD) and multimorbidity reflected in South Africa's public health sector challenges speech-language therapists (SLTs) to optimise patient management in this context. For planning and delivery of appropriate services, it is important to understand the profile of speech-language therapy (SLT) patients and the public healthcare services provided by SLTs. OBJECTIVES: This study aimed to describe the prevalence of inpatient adult speech, language and swallowing disorders associated with various medical conditions and South Africa's BoD, in addition to the target areas and duration of SLT interventions provided at a central public hospital. METHOD: A retrospective review was conducted on records of 2549 adult inpatients who received SLT services between January 2014 and December 2015 at Chris Hani Baragwanath Academic Hospital. Data, including demographics, medical and SLT diagnoses, and treatment recommendations, were analysed using descriptive and inferential statistics. RESULTS: Non-communicable diseases (NCDs) were most prevalent (77.48%), with multimorbidity of BoD categories in 29.27% of patients. Cerebrovascular disease (CeVD) comprised 52.45% patients, with CeVD, traumatic brain injury, other neurological conditions, cancer and burns comprising 88.74% patients. More than a third of the patients with CeVD were 56 years (n = 486; 36.35%). Dysphagia (48.96%), aphasia (30.95%) and dysarthria (23.62%) were the most common, with 44.68% of patients having multiple SLT diagnoses. The number of SLT sessions significantly correlated with SLT comorbidity (rs = 0.4200; p = 0.0000), but not BoD comorbidity (rs = 0.0049; p = 0.8058). CONCLUSION: Speech-language therapy patients reflected a heavy NCD burden and multimorbidity. Provision of SLT services should take into consideration a profile of increased complexity of medical conditions and SLT diagnoses.

Adesão ao tratamento fonoaudiológico por pessoas com afasia encaminhadas após alta hospitalar: estudo de dois casos / Adherence to speech-language therapy by people with aphasia referred after hospital discharge: study of two cases

RESUMO Diante da percepção do impacto na comunicação e na qualidade de vida ocasionado por um quadro de afasia, compreende-se a relevância da adesão ao tratamento fonoaudiológico. Porém, há casos em que a procura por tal tratamento não ocorre, por motivos que ainda não foram investigados de modo aprofundado. O objetivo deste estudo foi analisar a adesão ao tratamento fonoaudiológico de pessoas com afasia, encaminhadas após alta hospitalar. Foi realizado um estudo qualitativo de dois casos. Participaram deste estudo duas idosas com afasia após acidente vascular cerebral (AVC), acompanhadas em um hospital municipal de referência microrregional. Foi realizada a coleta de dados sociodemográficos e clínicos em prontuário e por meio de entrevista com um familiar de cada participante, durante a internação. Após dois meses, aproximadamente, foi realizada nova entrevista para investigar a procura por atendimento fonoaudiológico. A instalação de sequelas físicas pós-AVC, que afetam membro inferior, sua gravidade e a fase de recuperação contribuem para a não adesão ao tratamento fonoaudiológico público em nível ambulatorial, por pessoas com afasia. A interação entre fatores sociodemográficos, aspectos clínicos e características da rede pública de saúde (como a inexistência de fonoaudiólogo no serviço de atenção domiciliar) pode influenciar a procura por tratamento domiciliar particular nesses casos. É possível afirmar que múltiplos fatores, clínicos e sociodemográficos, influenciam a não procura por tratamento fonoaudiológico por essa população. Além disso, tais fatores indicam a existência de dificuldades no acesso a serviços de saúde públicos, por limitações na rede de atenção à saúde regional.

ABSTRACT Given the perceived impact on communication and quality of life of aphasia, the importance of adherence to speech therapy treatment is clear. However, there are cases in which this treatment is not sought, for reasons that have not been fully investigated. The aim of this study was to analyze adherence to speech therapy by people with aphasia referred after hospital discharge. A qualitative case study of two cases was carried out. Two elderly women with aphasia after stroke treated at a micro-regional public referral hospital participated in this study. Sociodemographic and clinical data were collected from patient medical records and drawn from an interview with a family member during hospitalization. After about two months, a second interview was conducted to investigate whether speech therapy had been sought. The presence of post-stroke physical sequelae affecting lower limbs, its severity, and the post-stroke recovery phase were all factors contributing to non-adherence to public outpatient speech-therapy treatment by these individuals with aphasia. The interaction between sociodemographic factors, clinical aspects and characteristics of the public health network (such as non-availability of speech therapists in the home-care service) can influence the seeking of private home-based treatment in these cases. Results revealed that multiple clinical and sociodemographic factors influence nonadherence to speech therapy in this population. In addition, these factors indicate difficulties accessing public health services as a result of shortcomings in the regional health care network.

Intervenção fonoaudiológica na afasia expressiva: revisão integrativa / Speech-language intervention in expressive aphasia: integrative review

RESUMO Introdução Por meio da intervenção fonoaudiológica, é possível diminuir os sintomas da afasia. Objetivos Verificar os métodos de intervenção fonoaudiológica na afasia expressiva. Estratégia de pesquisa Trata-se de uma revisão integrativa da literatura. Realizou-se a busca nas bases SciELO, PubMed e PsycINFO, no período de fevereiro a abril de 2018. Para as bases de dados PubMed e PsycINFO foram estabelecidos os descritores em inglês "non-fluent aphasia", OR "broca" OR "transcortical motor aphasia" OR "motor aphasia" OR "amnestic aphasia" OR "semantic aphasia" OR "dymanic aphasia" OR "anomi*" AND "intervention" OR "therapy" OR "rehabilitation" OR "treatment". Para base SciELO, apenas o descritor "aphasia". Critérios de seleção Artigos publicados nos últimos dez anos (de 2009 a 2018) em português, inglês ou espanhol foram incluídos, sendo ou não de periódicos de acesso livre, além de estudos com indivíduos com idade superior a 19 anos. Foram excluídos artigos não relacionados à terapia tradicional, estudos que não apresentassem indivíduos com afasia expressiva e aqueles que tratavam de distúrbios motores de fala, como disartria e apraxia pura. Estudos de revisão de literatura e que envolvessem participantes bilíngues também foram excluídos. Resultados Um total de 174 artigos foram encontrados. Após análise e aplicação dos critérios de seleção estabelecidos, foram selecionados 32 artigos completos. Entre as terapias tradicionais encontradas, observaram-se: terapia de recuperação de palavras, terapia melódica e terapia conversacional. Conclusão A terapia de recuperação de palavras foi o método tradicional mais utilizado.

ABSTRACT Introduction Aphasia symptoms can be improved via speech and language therapy. Purpose To analyze speech-language intervention methods in expressive aphasia. Research strategy An integrative review of the literature was performed using SciELO, PubMed and PsycINFO databases, from February to April 2018. The following search terms: "non-fluent aphasia", OR "broca" OR "transcortical motor aphasia" OR "motor aphasia" OR "amnestic aphasia" OR "semantic aphasia" OR "dymanic aphasia" OR "anomi*" AND "intervention" OR "therapy" OR "rehabilitation" OR "treatment" were used for PubMed and PsycINFO databases. In SciELO database, only the search term "aphasia" was used. Selection criteria Articles published in the last ten years (from 2009 to 2018) in Portuguese, English or Spanish, whether or not they were open access journals. Studies with participants older than 19 years were selected. Articles not related to traditional therapy were excluded, as well as those which did not present participants with expressive aphasia and those which treated speech motor disorders such as pure dysarthria and pure apraxia. Literature review studies and studies involving bilingual participants were also excluded. Results One hundred and seventy-four articles were found. After analysis and application of the established selection criteria, 32 complete articles were selected. Word retrieval therapy, melodic intonation therapy and conversation therapy were the traditional methods found in this study. Conclusion Word retrieval therapy was the method most commonly used.

Análise do reconhecimento populacional das figuras do sentence production program for aphasia / Analysis of population recognition of pictures from the sentence production program for aphasia

RESUMO Objetivo Analisar o reconhecimento das figuras e a familiaridade dos contextos do Sentence Production Program for Aphasia (SPPA), para obter dados sobre a possibilidade de uso para a língua portuguesa e/ou da necessidade de sua adaptação. Método Inicialmente, foi realizada a tradução dos estímulos por falantes do inglês e, em seguida, a retrotradução para ajustes sem a alteração das estruturas sintáticas das frases. O material foi então submetido para a análise de 39 indivíduos adultos de alta escolaridade. Na primeira fase do estudo, os adultos deveriam criar uma frase de acordo com cada figura apresentada. Na fase seguinte do estudo, os participantes foram expostos às frases originais associadas aos seus respectivos contextos. Os participantes receberam uma folha de registro das respostas com numeração segundo as figuras e julgaram a familiaridade dos contextos a partir de uma escala analógica de 0 a 10. Resultados Observou-se que a média geral de concordância dos estímulos com as respostas para as figuras do SPPA foi de 35,5%. Em relação à familiaridade dos contextos com as figuras, essa foi maior para as cenas relativas às frases com estrutura sintática mais usadas em português. Conclusão Pelo fato de os estímulos terem apresentado baixo grau de reconhecimento, adaptações serão necessárias para que o programa possa vir a ser utilizado na população brasileira. O estudo também permitiu identificar quais as figuras que necessitam de adaptação antes de serem usadas para a reabilitação de pacientes agramáticos no Brasil.

ABSTRACT Purpose To analyze the recognition of the pictures and contexts familiarity from the Sentence Production Program for Aphasia (SPPA) to acquire data determining its potential use in Portuguese and/or need for adaption. Methods The stimuli for English speakers were first translated, back-translated and adjusted without changing the syntactic structures of the phrases. The material was then tested in 39 highly literate individuals. In the first stage of the study, the adults had to produce a phrase corresponding to each picture. In the second stage, participants were exposed to the original phrases associated with their respective contexts. Participants were given an answer sheet containing numbered responses for each picture and rated the familiarity of the contexts on an analogic scale ranging from 0 to 10. Results Based on the sentences produced by the participants, the overall mean agreement of stimuli with responses for the pictures from the SPPA was 35.5%. Familiarity of the contexts with pictures was greater in scenes involving sentences with a syntactic structure similar to that of Portuguese. Conclusion Given most stimuli had a low level of recognition, adaptations are required for use of the program in the Brazilian population. The study allowed identification of those pictures which need adapting before use in the rehabilitation of agrammatic patients in Brazil.

Reabilitação pós-AVC: identificação de sinais e sintomas fonoaudiológicos por enfermeiros e médicos da Atenção Primária à Saúde / Post-stroke rehabilitation: identification of speech-language disorders signs and symptoms by physicians and nurses in Primary Health Care

RESUMO Objetivo O Acidente Vascular Cerebral (AVC) é um agravo comum para a população e um problema para a saúde pública global em termos de mortalidade, deficiência e demanda de custos. O objetivo deste estudo é verificar quais grupos de comorbidades ligados aos distúrbios fonoaudiológicos são identificados por médicos e enfermeiros das equipes de Estratégia de Saúde da Família (ESF) para encaminhamento à reabilitação fonoaudiológica e continuidade do cuidado de pacientes pós-AVC nas Atenções Primária e Secundária à Saúde (APS). Método Participaram 22 médicos e enfermeiros das equipes de ESF apoiadas pelo Núcleo de Apoio à Saúde da Família, no sul do Brasil. Um questionário desenvolvido para este estudo foi respondido, explorando variáveis sociodemográficas, histórico de formação, atuação profissional e condutas ao paciente com AVC. Análise descritiva dos dados (frequências absoluta e relativa) foi realizada no Software SPSS 22. Resultados Dos entrevistados, 77,3% encaminham pacientes pós-AVC para fisioterapia e 54,5%, para reabilitação fonoaudiológica. Nenhum profissional realiza encaminhamento por sequelas cognitivas de compreensão; 90,0% encaminham por distúrbios de linguagem expressiva na fala. Para alterações do sistema estomatognático, 80,0% dos médicos não encaminham para fonoaudiólogo e 83,3% dos enfermeiros o fazem. Conclusão Os profissionais demonstraram dificuldade em identificar distúrbios fonoaudiológicos ligados à cognição e ao sistema estomatognático, não encaminhando para reabilitação fonoaudiológica nas Atenções Primária e Secundária à Saúde. Os resultados apontam para a necessidade de ações que auxiliem no processo de educação permanente e melhorem o conhecimento das equipes de APS, para que as sequelas fonoaudiológicas sejam devidamente identificadas e encaminhadas para reabilitação.

ABSTRACT Purpose Stroke is a common disease for people and a global public health concern in terms of mortality, disability, and cost demand. This study aims to assess which groups of comorbidities related to speech-language disorders are identified by physicians and nurses of the Family Health Strategy (FHS) as to be referred to post-stroke speech-language rehabilitation at Primary and Secondary Health Care. Methods Twenty-two physicians and nurses, from the FHS supported by the Family Health Support Center in southern Brazil, answered a questionnaire developed for this study, exploring socio-demographic variables, education background, professional performance and conduct to post-stroke patients. A descriptive data analysis (absolute and relative frequencies) was performed in SPSS Software 22. Results Among the participants, 77.3% refer post-stroke patients to physiotherapy and 54.5% to speech-language rehabilitation. None refer to patients to treatment due to cognitive comprehension sequelae; 90.0% refer for significant speech-language disorders. In case of changes in the stomatognathic system, 80.0% of physicians do not refer to speech-language pathologists, and 83.3% of nurses usually do. Conclusion The professionals showed difficulty in identifying speech-language pathological signs and symptoms related to cognition and the stomatognathic system, not referring to speech-language rehabilitation at primary or secondary health care. The results highlight the importance of continuing education and improvement of the knowledge of the primary health care teams, so that speech-language sequelae are properly identified and sent for rehabilitation.

Stroke communication partner training: a national survey of 122 clinicians on current practice patterns and perceived implementation barriers and facilitators.

BACKGROUND: Communication partners (CPs) find it challenging to communicate with people with communication disorders post-stroke. Stroke communication partner training (CPT) can enhance CPs' ability to support the communication and participation of people post-stroke. While evidence for the efficacy of aphasia-based CPT is strong, implementation in healthcare settings is unclear. AIMS: To investigate Australian speech pathologists' current stroke CPT practices, factors influencing the implementation of CPT and how reported practice compares with the research evidence. METHODS & PROCEDURES: Speech pathologists in Australia who had worked with people post-stroke were invited to complete a 99-item online survey. The survey was informed by a comprehensive review of the literature review, the Template for Intervention Description and Replication (TIDieR) intervention taxonomy, and the theoretical domains framework. data were analyzed using descriptive statistics and content analysis. OUTCOMES & RESULTS: A total of 122 clinicians were surveyed. Most participants reported providing CPT to treat a range of post-stroke communication disorders. While 98.3% reported training familiar CPs, only 66.1% reported training unfamiliar CPs. Current stroke CPT practice is characterized by one to two < 1 h sessions of informal face-to-face education and skills training. Only 13.3% and 10.0% of participants used evidence-based published programmes with unfamiliar and familiar CPs respectively. The main barriers included the perceived lack of behavioural regulation, skills, reinforcement, beliefs about consequences, positive social influences and resources. The main facilitators included clinicians' intentions to provide CPT, perception of CPT as part of their role and perceived compatibility of CPT with clinical practice. CONCLUSION & IMPLICATIONS: A significant evidence-practice gap exists. Research exploring the implementation of stroke CPT in healthcare settings, expanding evidence to support CPT for the range of post-stroke communication disorders, developing freely accessible step-by-step CPT programmes that consider restrictions in current practice and providing explicit instructions of CPT best practice are warranted. A supportive workplace culture and freely accessible formal training opportunities are also needed.

Non-invasive brain stimulation and computational models in post-stroke aphasic patients: single session of transcranial magnetic stimulation and transcranial direct current stimulation. A randomized clinical trial

ABSTRACT CONTEXT AND OBJECTIVE: Patients undergoing the same neuromodulation protocol may present different responses. Computational models may help in understanding such differences. The aims of this study were, firstly, to compare the performance of aphasic patients in naming tasks before and after one session of transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS) and sham, and analyze the results between these neuromodulation techniques; and secondly, through computational model on the cortex and surrounding tissues, to assess current flow distribution and responses among patients who received tDCS and presented different levels of results from naming tasks. DESIGN AND SETTING: Prospective, descriptive, qualitative and quantitative, double blind, randomized and placebo-controlled study conducted at Faculdade de Ciências Médicas da Santa Casa de São Paulo. METHODS: Patients with aphasia received one session of tDCS, TMS or sham stimulation. The time taken to name pictures and the response time were evaluated before and after neuromodulation. Selected patients from the first intervention underwent a computational model stimulation procedure that simulated tDCS. RESULTS: The results did not indicate any statistically significant differences from before to after the stimulation.The computational models showed different current flow distributions. CONCLUSIONS: The present study did not show any statistically significant difference between tDCS, TMS and sham stimulation regarding naming tasks. The patients'responses to the computational model showed different patterns of current distribution.

Integrative intervention: a new perspective and brief review in aphasia.

PURPOSE: While integrative treatment practices have become a popular treatment in different areas of study, its use in the field of aphasiology is still limited. The following paper is an attempt to address the different alternative practices that could potentially be used to remediate aphasia. METHOD: A narrative review was completed regarding integrative intervention that could potentially apply to aphasia population. RESULTS: Through this article we have explored various treatment options for integrative health care in aphasiology. Integrative treatments including brain specific antioxidants, progesterone and estradiol therapy, nutrition, synbiotic treatment, exercise, yoga, meditation and positive mood states have demonstrated positive changes in health and behavior in healthy aging or disorders such as stroke and aphasia. Offering integrative treatment for people with aphasia allows potential for high impact gains when combined with current speech language therapeutic practices. CONCLUSION: This paper highlights the rehabilitation possibilities for aphasia therapy. Combining complementary and traditional treatment approaches could be viewed as one of the contemporary approaches to clinical practice and research for practitioners and health care systems. Implications for Rehabilitation There has been very little research that explores the potential of various types of integrative treatment for individuals with aphasia. An integrative approach to the treatment of aphasia has potential for future clinical application. Combining treatment approaches could be viewed as a viable approach to clinical practice and in the health care system.

Occurrence of communication and swallowing problems in neurological disorders: analysis of forty patients.

BACKGROUND: Communication and swallowing problems are common as a result of neurological conditions like stroke, traumatic brain injury, neoplasms of the nervous systems, viral encephalitis, diseases affecting neuromuscular junction and neuro degenerative conditions. The most frequently encountered problems are dysarthria, aphasia, dysphagia and apraxia of speech. OBJECTIVES: Although these disorders are mentioned in literature, very few studies describing the occurrence in different neurological conditions are available in Indian context. Hence, a need was felt to carry out such a study. METHODOLOGY: A heterogenous group of forty patients with neurological conditions were assessed for presence of speech, language and swallowing problems. A percent analysis was carried out to determine the occurrence of aphasia, dysarthria and dysphagia in general, in specific diseases and also to describe type of aphasia and dysarthria according to the characteristics presented. RESULTS: It was seen that the most frequently occurring disorder was dysarthria (60%), followed by dysphagia (55%) and aphasia (18%). It was also noted that dysarthria and dysphagia co-existed in around 45% patients with neurological diseases. CONCLUSIONS: It can be concluded that speech, language and swallowing problems are frequent in individuals with neurological conditions. Speech language pathologist plays an important role as a member of the rehabilitation team in a neurological setup with respect to identifying these problems and initiating intervention at the earliest. Hence, it is necessary for speech language pathologist to be well versed with the features each disorder may present with in terms of communication and swallowing.

Afasia: una perspectiva clínica / Aphasia: a clinical perspective

Language is a complex and dynamic system of conventional signs that results from the functioning of different brain areas located mainly in the left hemisphere. Clinical evaluation of aphasia implicates the examination of oral and written language. Aphasia is an acquired language disorders due to a brain damage that affect all modalities: oral expression, auditory comprehension, reading and writing. Various types of aphasias can be induced, each with well defined clinical characteristics that can be correlated with specific areas of the brain. The prognosis depends mainly on the etiology, size of the lesion, type of aphasia and its severity. Treatment objectives include: satisfying the communicational needs of the patient, and achieving psychosocial adaptation of the subject and his family. Both objectives improve the quality of life of our patients...

Tradução portuguesa e análise de aspectos psicométricos da escala "Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39)" / Portuguese translation and psychometric properties of the Portuguese version of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39)

OBJETIVO: Efetuar a tradução e analisar os aspectos psicométricos da adaptação portuguesa da Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39). Essa escala possui quatro domínios (Físico, Psicossocial, Comunicação e Energia) e foi criada especificamente para pacientes com afasia. MÉTODOS: Foi realizada a tradução e retroversão, a partir da escala original. A versão portuguesa foi aplicada em 33 pacientes com afasia. A avaliação da consistência interna foi obtida através do Alfa de Cronbach e foi efetuado um teste-reteste em 12 pacientes. Foram igualmente utilizados os coeficientes de Pearson e Spearman, para correlacionar os subdomínios da prova e os diferentes dados clínicos e biográficos. RESULTADOS: A versão portuguesa da SAQOL-39 manteve o mesmo formato da versão original, em tamanho e conteúdo semântico. O Alfa de Cronbach da SAQOL-39 foi 0,953 e variou entre 0,882 (domínio psicossocial) e 0,971 (domínio Físico). Os resultados do teste-reteste, referentes à SAQOL-39, foram de 0,927 e variaram de 0,80 a 0,97, entre os diferentes subdomínios. Não se verificou efeito de teto e não houve dados omissos. Não foram encontradas diferenças significativas entre o total da SAQOL-39 e a idade, ou a escolaridade. No entanto, evidenciou-se correlação significativa entre o Quociente de Afasia e o subdomínio Comunicação (r=0,62, p=0,000). CONCLUSÃO: Apesar do tamanho reduzido da amostra, a versão portuguesa da SAQOL-39 apresentou bons valores psicométricos. Este estudo mostra, igualmente, dados preliminares de boa aceitabilidade e confiabilidade dessa adaptação e realça a importância da avaliação da qualidade de vida em pacientes com alterações graves de linguagem.

PURPOSE: The main goals of this study were to translate and assess the psychometric properties and reliability of the Portuguese version of the SAQOL-39 in a group of chronic aphasia patients. METHODS: We used the translation and retroversion method from the original scale to ensure conceptual uniformity. The instrument was administered to 33 aphasia patients. Internal consistency was assessed with Cronbach´s alpha and test-retest reliability was explored (n=12). We also used Pearson´s and Spearman´s correlation coefficients to determine the correlations between the SAQOL-39 domains and other social and clinical variables. RESULTS: The translation process from the original scale was completed without difficulties. Cronbach´s alpha for SAQOL-39 was 0.953 and for each subdomain ranged from 0.882 (Psychosocial) to 0.971 (Physical). The test-retest reliability for total SAQOL-39 was 0.927 and for each subdomain ranged from 0.80 to 0.97. The global scores show neither floor nor ceiling effect and there were no missing data. There was no significant association between the total SAQOL-39 score and either age or years of education. We found a significant correlation between the Communication domain mean score and the Aphasia Quotient outcome (r=0.62, p=0.000). CONCLUSION: Despite the small sample size, the Portuguese version of the SAQOL-39 showed good internal consistency and test-retest reliability. This study also showed preliminary evidence for good acceptability, feasibility and reliability of this adaptation. The importance of communication ability in perceiving the quality of life in patients with aphasia has also been highlighted.

Recuperación motora y funcional en pacientes con afasia secundaria a un ictus / Motor and functional recovery in patients with aphasia secondary to stroke

Introducción: se realizó un estudio observacional y prospectivo. Objetivo: evaluar la recuperación motora y funcional en pacientes con afasia secundaria a un ictus, incorporados al Programa de Restauración Neurológica del Centro Internacional de Restauración Neurológica. Métodos: se estudiaron 132 pacientes durante los años 2007-2012, en tratamiento durante 4 sem. Se agruparon según la presencia o no de afasia. Se compararon ambos grupos, según la recuperación motora y funcional, mediante la Escala Escandinava del Ictus y el índice de Barthel, respectivamente. Resultados: los grupos estudiados no presentaron diferencias significativas en cuanto a edad, sexo, condición motora y funcional inicial, tiempo de evolución y factores de riesgo vascular. La recuperación motora resultó significativa en ambos grupos (p=0,00), aunque el porcentaje de recuperación motora resultó superior en los pacientes con ictus no afásicos. La recuperación funcional resultó significativa en ambos grupos (p=0,00), existió una recuperación cualitativamente superior en el ictus no afásico donde se identificó una mejora en las habilidades manipulativas (p=0,00), que no resultó significativa en el ictus con afasia. Conclusión: ambos grupos se beneficiaron con el tratamiento aplicado, sin embargo, los pacientes afásicos experimentaron menor recuperación motora y funcional, en comparación con los pacientes no afásicos

Introduction: an observational and prospective study was carried out. Objective: to evaluate motor and functional recovery in patients with aphasia secondary to a stroke, who were included in the Neurological Restoration Program of International Center of Neurological Restoration. Methods: 132 patients were studied from 2007 to 2012; they were in treatment during 4 weeks and they were grouped according to the presence or absence of aphasia. Comparisons between both groups were carried out according to their motor and functional recovery by using Scandinavian Stroke Scale and Barthel Index respectively. Results: significant differences were not found in the studied groups concerning age, sex, motor and functional initial conditions, evolution time and vascular risk factors. Motor recovery was significant in both groups (p=0,00), although motor recovery percent was higher in the patients with non aphasic stroke. Functional recovery was significant in both groups (p=0,00), a higher quality recovery was seen in non aphasic stroke patients, and improvement was identified in hand abilities (p=0,00) which was not significant in stroke with aphasia. Conclusion: both groups were benefitted with the applied treatment, however, the aphasic patients experienced a lower motor and functional recovery, in comparison with the non aphasic patients