Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire-German version.

BACKGROUND: Reading comprehension is frequently impaired in persons with aphasia (PWA). For goal-setting and outcome measurement, speech and language therapists (SLTs) need to determine an individual's perspective of their reading difficulties and everyday reading activities. The Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire provides a person-centred tool to find out the individual perception of reading functions, reading-related emotions and reading activities in PWA. It was developed and evaluated in English. So far, there is no equivalent instrument in German. AIMS: To translate and adapt the CARA reading questionnaire into German language and culture, to evaluate its practicability and acceptance, and to provide the first psychometric properties of the German version. METHODS & PROCEDURES: Based on translation and adaptation guidelines, we conducted two forward translations that were merged and then adapted. A back translation was prepared and compared with the original version. It was found to be semantically equivalent by one of the authors of the original version. We performed pilot testing with 12 PWA, and the pilot version was adapted according to the comments of these participants. We then collected data on self-reported perception of reading and on psychometric properties of the translated and adapted German version. A total of 22 German-speaking PWA completed the questionnaire at least five times during an intervention study. We analysed retest reliability with Spearman correlation, internal consistency with Cronbach's alpha, internal responsiveness with the standardized response mean, as well as the relationship between outcomes of the questionnaire and text comprehension measures using repeated measures correlations. OUTCOMES & RESULTS: Our data suggest good practicability and acceptance of the German version of the CARA reading questionnaire as well as appropriate validity, reliability and sensitivity to measure therapy-induced change. We found moderate correlations between outcomes of the questionnaire and text-level reading speed. CONCLUSIONS & IMPLICATIONS: The German version of the CARA reading questionnaire could be helpful in intervention planning and goal-setting with German-speaking PWA. By using the questionnaire, SLTs can find out about a person's individual perception of reading difficulties as well as individually relevant reading activities. The questionnaire provides a tool to measure change and is therefore valuable to demonstrate self-reported individual progress. As reading speed seems to be an indicator of personal perception of reading difficulty, it is important to consider reading speed in reading interventions and in reading comprehension assessments. WHAT THIS PAPER ADDS: What is already known on the subject Reading comprehension is frequently impaired in PWA. Reading preferences, the perception of difficulties and the impact on everyday life reading activities are specific to the individual and thus need to be known for goal-setting, intervention planning and monitoring of change. As part of a comprehensive assessment of reading, Morris et al. developed a person-centred English language questionnaire for this purpose. So far, there is no equivalent tool in German. What this paper adds to the existing knowledge In this study, we translated and adapted the questionnaire to German language and culture, and analysed its validity and reliability with German-speaking PWA. We demonstrated that the German version is accessible for German-speaking PWA, and that it has appropriate validity, reliability and sensitivity to measure self-reported change. Outcomes of the questionnaire correlate with text level reading speed. What are the potential or actual clinical implications of this work? The German version of the questionnaire could be a valuable self-reported outcome measure to assess individual perceptions of reading and to measure progress (as perceived by an individual) as a consequence of recovery or intervention in either clinical or research settings. As reading speed might be an indicator of everyday life reading as perceived by an individual, it should be considered in reading assessments and interventions.

Efficacy of reading strategies on text-level reading comprehension in people with post-stroke chronic aphasia: A repeated measures study.

BACKGROUND: People with aphasia (PWA) frequently experience difficulties in understanding longer written content such as paragraphs or books. Reading strategies are a promising approach to treat text-level reading comprehension deficits in PWA. Nevertheless, empirical evidence for their efficacy remains rare. AIMS: The primary objective of this study was to analyse the efficacy of a strategy-based intervention on text-level reading comprehension in PWA. Secondary objectives were to compare the effects of two strategy-based intervention components and to explore potential moderator effects. METHODS & PROCEDURES: A protocol was published prior to data acquisition. In a repeated measures trial, 26 German participants with chronic, post-stroke aphasia participated in a waiting period without aphasia treatment (control condition) followed by a strategy-based intervention called 'Strategiebasierte Textverständnis-Therapie bei Aphasie' (StraTexT, 14 face-to-face-sessions, twice per week, 60 min each). Two strategy combinations, Intervention Micro targeting microstructure and Intervention Macro targeting macrostructure, were applied to newspaper and magazine articles. Participants were randomly allocated to two parallel groups that received these strategy combinations in interchanged sequences. Assessments were implemented before and after each period as well as 3 and 6 months after the intervention. The primary outcome measure was text-level reading comprehension measured with the total score of a German version of the Test de Compréhension de Textes (TCT-D). Secondary outcome measures addressed the self-reported perception of reading abilities, reading activities and feelings about reading (German version of the Comprehensive Assessment of Reading in Aphasia CARA reading questionnaire) as well as selected cognitive functions. OUTCOMES & RESULTS: The per-protocol-analysis included data from 22 participants. We found significant small improvements up to 6 months post-intervention compared to pre-intervention in the TCT-D Total (d  =  0.35-0.46) as well as medium to large improvements in the CARA questionnaire (d  =  0.68-0.96). Up to 3 months after the intervention, treatment-induced improvements in the TCT-D Total were significantly larger than change without treatment during the control condition. There was no evidence of moderator effects. Furthermore, we found improvements in several cognitive functions. CONCLUSIONS & IMPLICATIONS: Reading strategies can lead to long-term improvements in text-level reading comprehension and in self-reported reading abilities, feelings about reading and reading activities in aphasia. In regular clinical settings, it seems reasonable to implement both Intervention Micro and Intervention Macro. It remains important to investigate participant characteristics that contribute to treatment success. WHAT THIS PAPER ADDS: What is already known on the subject Systematic reviews and multiple case studies suggest that reading strategies are a promising approach to treat text-level reading comprehension in aphasia. The efficacy of reading strategies has been demonstrated for different populations. However, to date no group study has evaluated the efficacy of reading strategies on text-level reading comprehension in people with aphasia. What this study adds This study provides the first group-level evidence about the efficacy of a systematic strategy-based intervention in 22 people with post-stroke chronic aphasia. During 14 treatment sessions, participants applied four reading strategies to newspaper and magazine articles within two intervention components called Intervention Micro and Intervention Macro (two strategies per intervention component). We found improvements in text-level reading comprehension for at least 3 months post-intervention, as well as effects on selected cognitive functions and self-reported reading abilities, thoughts and feelings about reading and the ability to engage in reading activities. What are the clinical implications of this work? The strategies and materials evaluated in this study could be used in clinical practice with people with aphasia. In order to replicate treatment effects in clinical practice, we suggest applying the strategy combination with the same protocol features (e.g., frequency, duration, homework, product orientation) as in this study, implementing Intervention Micro and Intervention Macro sequentially in either order. As treatment response was not equal in all individuals, it seems important to investigate individual features that contribute to treatment success.

Why do He and She Disagree: The Role of Binary Morphological Features in Grammatical Gender Agreement in German.

In many languages, grammatical gender is an inherent property of nouns and, as such, forms a basis for agreement relations between nouns and their dependent elements (e.g., adjectives, determiners). Mental gender representation is traditionally assumed to be categorial, with categorial gender nodes corresponding to the given gender specifications in a certain language (e.g., [masculine], [feminine], [neuter] in German). In alternative models, inspired by accounts put forward in theoretical linguistics, it has been argued that mental gender representations consist of sets of binary features which might be fully specified (e.g., masc [+ m, - f], fem [- m, + f], neut [- m, - f]) or underspecified (e.g., masc [+ m], fem [+ f], neut [] or masc [+ m, - f], fem [], neut [- f]). We have conducted two experiments to test these controversial accounts. Native speakers of German were asked to decide on the (un-)grammaticality of gender agreement of visually presented combinations of I) definite determiners and nouns, and II) anaphoric personal pronouns and nouns in an implicit nominative singular setting. Overall, agreement violations with neuter das / es increased processing costs compared to violations with die / sie or der / er for masculine or feminine target nouns, respectively. The observed pattern poses a challenge for models involving categorial gender representation. Rather, it is consistent with feature-based representations of grammatical gender in the mental lexicon.

Language analysis of spontaneous descriptions of restless legs syndrome: Gender differences?

Patients with restless legs syndrome (RLS) use various terms when describing their symptoms. Whether gender might influence this has not been investigated so far. The aim of this study was to evaluate possible gender differences in spontaneous descriptions of RLS symptoms. This prospective study, conducted in 100 consecutive German-speaking RLS patients, used a single standardized question. Answers were digitally recorded and transcribed. A content-related linguistic analysis of the transcripts was performed by two independent blinded raters. The lengths of the answers and content-related linguistic features were compared between women and men. Ninety-eight patients were included in the final analysis, 59 women (60.2%) and 39 men (39.8%), with a median age of 62 (23-94) and 63 (31-82) years, respectively (p = 0.602). Demographic and clinical features, including educational level and RLS treatment class, did not differ between genders (p > 0.05). Total word or sentence count showed no gender differences (p = 0.159 and 0.259, respectively), although men used more words per sentence than women (p = 0.018). More men than women described quiescegenic (i.e., triggered by rest or inactivity) symptoms (p = 0.006) and successful attempts at relief (p = 0.039). There was a non-significant trend toward a more frequent use of the first-person perspective in men (median times used = 5 [0-10.5] vs. 3.8 [0-17.5], p = 0.068). The more frequent mention of quiescegenic symptoms and successful attempts at relief in men could indicate differences in phenotypic presentation of RLS between genders, a more precise description of RLS symptoms or a higher experience of self-efficacy in men compared to women.

German normative data with naming latencies for 283 action pictures and 600 action verbs.

Timed picture naming is a common psycholinguistic paradigm. In this task, participants are asked to label visually depicted objects or actions. Naming performance can be influenced by several picture and verb characteristics which demands fully characterized normative data. In this study, we provide a first German normative data set of picture and verb characteristics associated with a compilation of 283 freely available action pictures and 600 action verbs including naming latencies from 55 participants. We report standard measures for pictures and verbs such as name agreement indices, visual complexity, word frequency, word length, imageability and age of acquisition. In addition, we include less common parameters, such as orthographic Levenshtein distance, transitivity, reflexivity, morphological complexity, and motor content of the pictures and their associated verbs. We use repeated measures correlations in order to investigate associations between picture and word characteristics and linear mixed effects modeling for the prediction of naming latency. Our analyses reveal comparable results to previous studies in other languages, indicating high construct validity. We found that naming latency varied as a function of entropy of responses, word frequency and motor content of pictures and words. In summary, we provide first German normative data for action pictures and their associated verbs and identify variables influencing naming latency.

Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting.

BACKGROUND: Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. METHODS: In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam-Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. FINDINGS: We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (-0·03 points [4·04]; -0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation. INTERPRETATION: 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods. FUNDING: German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.

The Role of Sensory Perception, Emotionality and Lifeworld in Auditory Word Processing: Evidence from Congenital Blindness and Synesthesia.

Although it has been established that human beings process concrete and abstract words differently, it is still a matter of debate what factors contribute to this difference. Since concrete concepts are closely tied to sensory perception, perceptual experience seems to play an important role in their processing. The present study investigated the processing of nouns during an auditory lexical decision task. Participants came from three populations differing in their visual-perceptual experience: congenitally blind persons, word-color synesthetes, and sighted non-synesthetes. Specifically, three features with potential relevance to concreteness were manipulated: sensory perception, emotionality, and Husserlian lifeworld, a concept related to the inner versus the outer world of the self. In addition to a classical concreteness effect, our results revealed a significant effect of lifeworld: words that are closely linked to the internal states of humans were processed faster than words referring to the outside world. When lifeworld was introduced as predictor, there was no effect of emotionality. Concerning participants' perceptual experience, an interaction between participant group and item characteristics was found: the effects of both concreteness and lifeworld were more pronounced for blind compared to sighted participants. We will discuss the results in the context of embodied semantics, and we will propose an approach to concreteness based on the individual's bodily experience and the relatedness of a given concept to the self.

Behavioural evidence for sex differences in the overlap between subtraction and multiplication.

The present study aims to identify factors that may influence the dissociability of number magnitude processing and arithmetic fact retrieval at the behavioural level. To that end, we assessed both subtraction and multiplication performance in a within-subject approach and evaluated the interdependence of unit-decade integration measures on the one hand as well as sex differences in the interdependence of performance measures on the other hand. We found that subtraction items requiring borrowing (e.g. 53-29 = 24, 3 < 9) are more error prone than subtraction items not requiring borrowing (e.g. 59-23 = 34, 9 > 3), thereby demonstrating a borrowing effect, which has been suggested as a measure of unit-decade integration in subtraction. Furthermore, we observed that multiplication items with decade-consistent distractors (e.g. 6 × 4 = 28 instead of 24) are more error prone that multiplication items with decade-inconsistent distractors (e.g. 6 × 4 = 30 instead of 24), thereby demonstrating a decade-consistency effect, which has been suggested as a measure of unit-decade integration in simple multiplication. However, the borrowing effect in subtraction was not correlated with the effect of decade consistency in simple multiplication in either men or women. This indicates that unit-decade integration arises from different systems in subtraction and multiplication. Nevertheless, men outperformed women not only in subtraction, but also in multiplication. Furthermore, subtraction and multiplication performance on correct solution probes were correlated in women, but unrelated in men. Thus, the view of differential systems for number magnitude processing and arithmetic fact retrieval may not be universal across sexes.

Patterns of linguistic and numerical performance in aphasia.

BACKGROUND: Empirical research on the relationship between linguistic and numerical processing revealed inconsistent results for different levels of cognitive processing (e.g., lexical, semantic) as well as different stimulus materials (e.g., Arabic digits, number words, letters, non-number words). Information of dissociation patterns in aphasic patients was used in order to investigate the dissociability of linguistic and numerical processes. The aim of the present prospective study was a comprehensive, specific, and systematic investigation of relationships between linguistic and numerical processing, considering the impact of asemantic vs. semantic processing and the type of material employed (numbers compared to letters vs. words). METHODS: A sample of aphasic patients (n = 60) was assessed with a battery of linguistic and numerical tasks directly comparable for their cognitive processing levels (e.g., perceptual, morpho-lexical, semantic). RESULTS AND CONCLUSIONS: Mean performance differences and frequencies of (complementary) dissociations in individual patients revealed the most prominent numerical advantage for asemantic tasks when comparing the processing of numbers vs. letters, whereas the least numerical advantage was found for semantic tasks when comparing the processing of numbers vs. words. Different patient subgroups showing differential dissociation patterns were further analysed and discussed. A comprehensive model of linguistic and numerical processing should take these findings into account.

Prosody affects visual perception in polysyllabic words: Evidence from a letter search task.

Previous research has shown that phonology influences the visual perception of a word's letters. However, the influence of prosody, including word stress, on grapheme perception in polysyllabic words is poorly investigated. The present study addresses this issue with a letter search task. Participants searched for vowel letters (Experiment 1) and consonant letters (Experiment 2) in stressed and unstressed syllables of bisyllabic words. Results reveal facilitated vowel letter detection in stressed syllables compared with unstressed syllables, indicating that prosodic information affects visual letter perception. Moreover, an analysis of the response time distribution revealed that the effect was present even for the fastest decisions but increased for slower response times. However, no systematic stress effect emerged for consonants. We discuss possible sources and dynamics of the observed pattern and the importance to accommodate feedback processes of prosody on letter perception in models of polysyllabic word reading.

Word stress processing in specific language impairment: auditory or representational deficits?

Word stress processing has repeatedly been reported to be affected in specific language impairment (SLI) with potential consequences for various aspects of language development. However, it still remains unresolved whether word stress impairments in SLI are due to deficits in basic auditory processing or to a degraded phonological representation or both. We addressed this question examining an unselected sample of 10 children with SLI and 11 typically developing (TD) children, aged about 8 years, with respect to their basic auditory processing (duration and skewness discrimination) and phonological representation of prosodic (word stress) and segmental (consonant) contrasts. Our results show lower performance of the SLI group compared to the TD group in all tasks. Crucially, two subgroups of children with SLI emerged from our analyses: While one group was impaired in basic auditory perception, particularly affecting duration discrimination, the other showed no significant auditory processing deficits but a representational impairment.

The plural counts: Inconsistent grammatical number hinders numerical development in preschoolers - A cross-linguistic study.

The role of grammar in numerical development, and particularly the role of grammatical number inflection, has already been well-documented in toddlerhood. It is unclear, however, whether the influence of grammatical language structure further extends to more complex later stages of numerical development. Here, we addressed this question by exploiting differences between Polish, which has a complex grammatical number paradigm, leading to a partially inconsistent mapping between numerical quantities and grammatical number, and German, which has a comparatively easy verbal paradigm: 151 Polish-speaking and 123 German-speaking kindergarten children were tested using a symbolic numerical comparison task. Additionally, counting skills (Give-a-Number and count-list), and mapping between non-symbolic (dot sets) and symbolic representations of numbers, as well as working memory (Corsi blocks and Digit span) were assessed. Based on the Give-a-Number and mapping tasks, the children were divided into subset-knowers, CP-knowers-non-mappers, and CP-knowers-mappers. Linguistic background was related to performance in several ways: Polish-speaking children expectedly progressed to the CP-knowers stage later than German children, despite comparable non-numerical capabilities, and even after this stage was achieved, they fared worse in the numerical comparison task. There were also meaningful differences in spatial-numerical mapping between the Polish and German groups. Our findings are in line with the theory that grammatical number paradigms influence. the development of representations and processing of numbers, not only at the stage of acquiring the meaning of the first number-words but at later stages as well, when dealing with symbolic numbers.

Where the mass counts: common cortical activation for different kinds of nonsingularity.

Typically, plural nouns are morphosyntactically marked for the number feature, whereas mass nouns are morphosyntactically singular. However, both plural count nouns and mass nouns can be semantically interpreted as nonsingular. In this study, we investigated the hypothesis that their commonality in semantic interpretation may lead to common cortical activation for these different kinds of nonsingularity. To this end, we examined brain activation patterns related to three types of nouns while participants were listening to a narrative. Processing of plural compared with singular nouns was related to increased activation in the left angular gyrus. Processing of mass nouns compared with singular count nouns was related to increased activity bilaterally in the superior temporal cortex and also in the left angular gyrus. No significant activation was observed in the direct comparison between plural and mass nouns. We conclude that the left angular gyrus, also known to be relevant for numerical cognition, is involved in the semantic interpretation of different kinds of nonsingularity.

Neuro-cognitive foundations of word stress processing - evidence from fMRI.

BACKGROUND: To date, the neural correlates of phonological word stress processing are largely unknown. METHODS: In the present study, we investigated the processing of word stress and vowel quality using an identity matching task with pseudowords. RESULTS: In line with previous studies, a bilateral fronto-temporal network comprising the superior temporal gyri extending into the sulci as well as the inferior frontal gyri was observed for word stress processing. Moreover, we found differences in the superior temporal gyrus and the superior temporal sulcus, bilaterally, for the processing of different stress patterns. For vowel quality processing, our data reveal a substantial contribution of the left intraparietal cortex. All activations were modulated by task demands, yielding different patterns for same and different pairs of stimuli. CONCLUSIONS: Our results suggest that the left superior temporal gyrus represents a basic system underlying stress processing to which additional structures including the homologous cortex site are recruited with increasing difficulty.

A case of 'task-switching acalculia'.

In this study we describe a patient (FR) with left frontal lesions due to a cerebrovascular disorder of embolic origin. Beyond a general slowness, FR showed deficits in simple multiplication only when problems were presented in a mixed operations list (multiplication, addition, and subtraction), while no such deficits were observed for the same multiplication problems in blocked presentation. Deficits were restricted to trials directly affected by a switch (increased switch costs), but not to subsequent trials (no increased mixing costs). Thus, we provide the first detailed description of a condition which could be termed 'task-switching acalculia' in a stroke patient. This case highlights the need for mixed operation lists in the diagnosis of acalculia.

Neural processing of nouns and verbs in spontaneous speech of patients with schizophrenia.

Previous fMRI-studies investigating the production of nouns and verbs in healthy participants reported predominantly activation in the left inferior frontal gyrus (IFG) for both classes of words with increased neural responses for verbs. To date, comparable imaging data for spontaneous speech in patients with schizophrenia is missing. These results are novel and may contribute to understand the neural basis of noun and verb production in a "natural" environment. Fifteen patients with schizophrenia and fifteen healthy control participants described pictures for one minute each while BOLD signal changes were measured with fMRI. In an event-related design, activations related to noun and verb production were extracted in the imaging analysis. Imaging results revealed increased activation for nouns and decreased activation for verbs in the left IFG in the patients. A post-hoc analysis revealed that patients produced significantly more transitive verbs which were negatively associated with activation in the left IFG. We conclude that a subtle linguistic processing deficit in schizophrenia may lead to an increased use of transitive as compared to intransitive verbs in connected speech and to a deviant pattern of brain activation related to the processing of verbs.

Efficacy of a strategy-based intervention on text-level reading comprehension in persons with aphasia: a study protocol for a repeated measures study.

INTRODUCTION: At least 68% of persons with aphasia (PWA) experience reading difficulties. Even though strategy-based interventions are a promising treatment approach for text level reading comprehension deficits in PWA, empirical evidence for their efficacy remains rare. The primary objective of this study is the analysis of the efficacy of a strategy-based intervention on text-level reading comprehension and on reading activities in PWA. METHODS AND ANALYSIS: In a repeated measures trial, 24 PWA will first participate in a waiting period and then in a strategy-based intervention (14 face-to-face-sessions, 60 min each). We will apply two combinations of strategies to treat either the microstructure or the macrostructure, respectively. Participants will be randomly allocated to two parallel groups that will receive these combinations in interchanged sequences. Assessments will be implemented before and after each period as well as 3 and 6 months after the intervention. The primary outcome measure is text-level reading comprehension measured with a German version of the Test de Compréhension de Textes (TCT-D) and represented by the score TCT-D Total . A non-blinded and a blinded rater will evaluate the primary outcome measure. Secondary outcome measures will address specific reading functions, reading activities and cognitive functions. The sample size was determined with an a priori power analysis. For statistical analysis, we will use contrast analyses within repeated measures analysis of variance models. We expect significant improvements in primary and secondary outcome measures during the intervention as compared with changes during the waiting period. ETHICS AND DISSEMINATION: This study was approved by the ethics committee of Deutscher Bundesverband für akademische Sprachtherapie und Logopädie (20-10074-KA-MunmErw+Ko). Results and relevant data will be disseminated in peer-reviewed journals, at conferences and on the Open Science Framework. TRIAL REGISTRATION NUMBER: DRKS00021411 (see Supplementary Table 1).

Categorical and continuous--disentangling the neural correlates of the carry effect in multi-digit addition.

BACKGROUND: Recently it was suggested that the carry effect observed in addition involves both categorical and continuous processing characteristics. METHODS: In the present study, we aimed at identifying the specific neural correlates associated with processing either categorical or continuous aspects of the carry effect in an fMRI study on multi-digit addition. RESULTS: In line with our expectations, we observed two distinct parts of the fronto-parietal network subserving numerical cognition to be associated with either one of these two characteristics. On the one hand, the categorical aspect of the carry effect was associated with left-hemispheric language areas and the basal ganglia probably reflecting increased demands on procedural and problem solving processes. Complementarily, the continuous aspect of the carry effect was associated with increased intraparietal activation indicating increasing demands on magnitude processing as well as place-value integration with increasing unit sum. CONCLUSIONS: In summary, the findings suggest representations and processes underlying the carry effect in multi-digit addition to be more complex and interactive than assumed previously.

Improved single-letter identification after whole-word training in pure alexia.

Pure alexia is characterised by a very time-consuming letter-by-letter reading strategy due to an impaired identification or integration of single letters. So far, therapy interventions have addressed impaired letter identification using specific single-letter training approaches. In the present study, we report patient KA with pure alexia and letter-by-letter reading. Contrary to common approaches, we investigated whether a whole-word reading approach can be successful despite severe impairments at the level of single-letter identification. As a first step, auditory-visual verification tasks were used to familiarise the patient with the training items, which in a second step were read with limited exposure duration. After a four week intervention, KA's word reading performance improved significantly for trained and control items in terms of speed and accuracy. Although not specifically addressed during our training programme, even single-letter identification and text reading performance increased significantly. However, the patient's reading was still based on a letter-by-letter strategy.

Rehabilitation of arithmetic fact retrieval via extensive practice: a combined fMRI and behavioural case-study.

The present study investigates the effects of a training of arithmetic fact retrieval in a patient suffering from particular difficulties with multiplication facts. Over a period of four weeks simple multiplication facts were trained extensively. The outcome of the training was assessed behaviourally and changes in cerebral activation patterns were investigated using fMRI. The training led to a change in calculation strategies: Prior to training, the patient used predominantly time-consuming back-up strategies, after training he relied increasingly on the direct retrieval of arithmetic facts from long-term memory. Regarding the fMRI results, prefrontal activations were observed for untrained problems, which can be attributed to the application of back-up strategies strongly relying on fronto-executive functions. Interestingly, significant foci of activation for both trained and untrained items were found in the angular gyrus of the right hemisphere, which, however, differed in their exact localisation. For the trained condition, activations were observed in anterior parts of the angular gyrus which may be related to the training-based automatisation in fact retrieval. Activations in the untrained condition were found in a more posterior portion of the angular gyrus, that might be attributable to one of the patient's back-up strategies, namely to recite a whole multiplication row to get to the correct answer.