Rehabilitación neuropsicológica de un caso con sintomatología de afasia de conducción y anómica por evento isquémico / Neuropsychological rehabilitation in a case of conduction and anomic aphasia symptomatology by ischemic event

El tema de la rehabilitación de las afasias es explorado con frecuencia en la literatura de las últimas décadas, debido a que es una de las secuelas más comunes del daño cerebral y de las que más presenta variaciones dependiendo del caso, por lo cual los profesionales a cargo de los pacientes que sufren de esta condición se ven en la necesidad de buscar métodos eficaces para tratarlos. El objetivo de esta investigación es mostrar el diseño de un único caso con sintomatología de afasia de conducción y anomia pura. Se trata de un paciente masculino de 62 años de edad, con nivel académico de doctorado, diagnóstico de afasia de conducción y anomia a causa de un evento isquémico con 18 meses de evolución. Recibió tratamiento neuropsicológico en base a modelos histórico-culturales y neurocognitivos en dos periodos diferentes, una hora por semana. Se llevó a cabo una evaluación neuropsicológica antes y después del programa de rehabilitación, además se hizo uso de líneas bases en ambos periodos y se tomó en cuenta la perspectiva del paciente y su esposa. El rendimiento en la primera y segunda evaluación muestra un mejor desempeño en algunas áreas del lenguaje, mientras que en las líneas bases y en la apreciación del paciente y su esposa se observaron cambios importantes, concluyendo que el programa tuvo efectos favorables en la comunicación del paciente en el hogar.

The subject of aphasia rehabilitation is frequently explored in recent literature since it is one of the most common forms of brain damage and presents an assortment of variations depending on the specific case, making it so that professionals who are in charge of patients with this condition find themselves in need of effective treatment methods. This article aims to present the design for the single case study rehabilitation of a patient with conduction aphasia and pure anomia. The patient in question is a 62-year-old male with a P.h.D. level education, diagnosed with conduction aphasia and anomia caused by an ischemic event with an 18-month evolution, he received neuropsychological treatment following the historic-cultural and neurocognitive models, spanning two different treatment periods, one hour a week. A neuropsychological evaluation was made before and after the rehabilitation program, as well as using a baseline for both periods and taking into account the perspective of both the patient and his wife. Patient performance in the first and second evaluations shows improvement in some language areas, while the baselines, as well as the patient and his wife's assessment speak of important changes, concluding that the program had favorable effects on the patient's communication at home

Terapia de restricción inducida en afasia: diseño de sujeto único en afasia de conducción / Induced Aphasia Therapy Restriction: Design Single Subject in Conduction Aphasia / Terapia de restrição induzida em afasia: desenho de sujeito único em afasia de condução

Introducción: la terapia de restricción inducida en afasia (TRIA) es un método terapéutico para la recuperación funcional del lenguaje expresivo en pacientes con afasia, cuyo efecto ha sido comprobado a partir de estudios de corte experimental desde hace más de una década en países como Estados Unidos y Alemania y, más recientemente, se ha instaurado en la práctica profesional del fonoaudiólogo en Colombia. Objetivo: el presente artículo muestra un diseño de sujeto único en afasia de conducción, en el cual se estima el efecto de un protocolo de terapia de restricción inducida del lenguaje. Materiales y métodos: se trata de una paciente de género femenino de 49 años de edad, con nivel de educación superior y con afasia de conducción, resultado de un accidente cerebro vascular de 2 años de evolución, quien recibió TRIA, con una intensidad de 2 horas diarias, cinco días a la semana, durante 4 semanas. Como parte del protocolo de TRIA, fueron presentados 40 estímulos verbales diferentes cada cinco sesiones (grupo de estímulos 1 y 2: verbos y sustantivos, grupo 3: expresiones frecuentes y grupo 4: antónimos) para un total de 160 estímulos, con estrategias de estimulación y facilitación del lenguaje oral, pero con restricción de las formas no verbales de la comunicación. Se tomaron mediciones antes y después de la TRIA, mediante el uso de pruebas estandarizadas. Resultados: el rendimiento comparativo pre- y pos- de las pruebas indican una mejoría en varios dominios del lenguaje expresivo, tales como la fluidez verbal, la longitud de frase, la línea melódica, la forma gramatical, la producción de estructuras sintácticas de mayor complejidad, el incremento en el uso de conectores, sustantivos, adjetivos y verbos y la disminución de neologismos, parafasias, dubitaciones y muletillas. La hipótesis inicial plantea que la TRIA induce cambios en el desempeño verbal de los pacientes; sin embargo, se requiere de una exposición sostenida en el tiempo para inducir generalización de los aprendizajes.

Introduction: Constraint-induced therapy in aphasia (CITA) is a therapeutic method for functional recovery of expressive language in aphasia patients, whose effect has been found from experimental studies in countries as Germany and United States of America for more than one decade and it has been established in the practice of the speech- language therapist in Colombia. Objective: This research consists on a case study of conduction aphasia which estimates the effect of a protocol constraint-induced therapy on language performance. Materials and methods: The patient is a female 49 years with superior education level that has conduction aphasia results of stroke with two years of evolution; she received CITA with an intensity of two hours per day, five days week, for four weeks. As part of the protocol of CITA, 40 different verbal stimuli were presented in five sessions (Set 1 and Set 2: verbs and nouns, Set 3: expressions and Set 4: antonyms) conforming 160 stimuli to strategies of stimulation and facilitation of oral language but using restriction of nonverbal forms of communication. Measurements were taken before and after the CITA using standardized tests. Results: The pre and pos comparative performance tests indicate an improvement in multiple domains of expressive language such as: verbal fluency related to sentence length, grammatical melodic line and form, production of more complex syntactic structures, better employment of connectors, nouns, adjectives and verbs into the oral productions; and decreased neologisms, anomies, hesitations and interjections. The hypothesis is CITA induces positive changes in the verbal performance of aphasia patients; however, it requires a sustained exposure over time to induce generalization of learning.

Introdução: a terapia de restrição induzida em afasia (TRIA) é um método terapêutico para a recuperação funcional da linguagem expressiva em pacientes com afasia, cujo efeito tem sido comprovado a partir de estudos de corte experimental desde há mais de uma década em países como os Estados Unidos e a Alemanha e, mais recentemente, se tem instaurado na prática profissional do fonoaudiólogo na Colômbia. O presente artigo mostra um desenho de sujeito único em afasia de condução, no qual se estima o efeito de um protocolo de terapia de restrição induzida da linguagem. Materiais e métodos: trata-se de uma paciente de gênero feminino de 49 anos, com nível de educação superior e com afasia de condução resultado de um acidente cerebrovascular de dois anos de evolução, quem recebeu TRIA com uma intensidade de duas horas diárias, cinco dias à semana, durante quatro semanas. Como parte do protocolo de TRIA foram apresentados 40 estímulos verbais diferentes cada cinco sessões (grupo de estímulos 1 e 2: verbos e substantivos, grupo 3: expressões frequentes e grupo 4: antónimos) para um total de 160 estímulos, com estratégias de estimulação e facilitação da linguagem oral, mas com restrição das formas não verbais da comunicação. Tomaram-se medições antes e depois da TRIA, mediante o uso de provas estandardizadas. Resultados: o rendimento comparativo pré- e pós- das provas indicam uma melhoria em vários domínios da linguagem expressivo, tais como: a fluidez verbal, a longitude de frase, a linha melódica, a forma gramatical, a produção de estruturas sintáticas de maior complexidade, o incremento no uso de conetores, substantivos, adjetivos e verbos, e a diminuição de neologismos, parafasias, dubitações e batologias. A hipótese inicial apresenta que a TRIA induz mudanças no desempenho verbal dos pacientes; no entanto, requer-se de uma exposição sustentada no tempo para induzir generalização das aprendizagens.

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...

Watt de Beckett: o cômico e a privação da linguagem / Watt de Beckett: the comic and the deprivation of language / Watt de Beckett: el cómico e la privación del lenguaje

Nesse trabalho primeiramente lemos Watt de Samuel Beckett como parábola de uma suposta temporalidade do cômico (riso amargo, riso amarelo e riso sem alegria) a qual aproximamos aos três lugares de comparação que segundo Freud propiciam o efeito cômico (o outro, o eu frente a um outro e o eu). Em um segundo momento, partindo de uma indicação de Lacan sobre o efeito cômico da fala dos sujeitos afásicos, investigamos a pertinência do reconhecimento de um semelhante deslocamento por esses três tempos/lugares afins ao cômico para a compreensão do percurso a ser percorrido pelo sujeito atingido pela privação da linguagem.

In this paper, first I read Beckett's novel Watt as a parable of a presumed timing of the comic (bitter laugh, hollow laugh and mirthless laugh) which I colligate with the trhree places of comparison that, according to Freud, promote the comical effect (the other, the ego opposite to another, and the ego). Second, beginning from a hint made by Lacan about acknowledgement of such a move in those three times / places belonging to the comic is pertinent to the understanding of the path that the individual suffering from language deprivation has to pass through.

Combined ilioinguinal block and local infiltration anaesthesia for inguinal hernia repair

To evaluate the benefit of adding ilioinguinal block to local infiltration anaesthesia for intraoperative analgesia in inguinal hernia repair. We performed a singled blinded randomized study on 232 patients. They had inguinal hernia repair using proline Darn under local infiltration anaesthesia, with or without additional ilioinguinal block. Intra operative and three hour post operative pain was accessed using visual analogue pain scale. Pain during operation was better controlled in patient who had local infiltration anaesthesia with the addition of ilioinguinal block, showing significant P value of .0009. Similarly duration of operation was significantly shorter in these patients with the P value of .005. Combination of ilioinguinal blockade improves the intraoperative analgesia and shortens the duration of operation

Aproximaciones lingüísticas a la afasiología en torno a la repetición / Neurolinguistic approaches about aphasia

Las afasias son una patología del lenguaje y éste es un sistema de mediación cultural lógica, situado netamente por encima de lo meramente natural. Arranca de la función simbólica, que establece la distinción y el nexo entre significante y significado. Se establece, a grandes rasgos, una clasificación neurolingüística de las afasias, rechazando las expresiones inadecuadas de sensitiva o sensorial y motora. Se insiste particularmente aquí sobre la cuestión de la "repetición" en la semiología afásica, tanto en lo que se refiere a su pérdida como a su "exaltación". Ello conduce a una revisión de la mal llamada afasia "de conducción" y del "transcorticalismo".

Aphasias are language pathologies, therefore the acquaintance of its structure is required for proper understanding. Language is a cultural interaction system, logical, set much above common natural. It separates the symbolic function, which establishes the distinction between significant and signification. We establish a neurolinguistic classification of aphasias, refuting improper expressions. We broach the wrongly called "conduction aphasia". We detach the unit of speech act and we distinguish the existence of a joint project that sheds light on all sentences brought forth. The complex texture of the "transcorticalism" qualify is analyzed. Aphasia field and some forms of its unfolding are questions aborded under the light of basic neurolinguistic concepts. We detach the unit of speech act and we distinguish the existence of a common project that sheds light on all sentences brought forth.

A Case of the Fluent Form of Primary Progressive Aphasia Presenting as Conduction Aphasia

Primary progressive aphasia(PPA) can be classified into nonfluent and fluent types. The fluent PPA usually manifests as Wernicke's or transcortical sensory aphasia. We report a 61-year-old right-handed woman who presented with a fluent PPA. An aphasia test revealed fluent speech and intact comprehension but decreased repetition and naming, consistent with conduction aphasia. Other cognitive functions and activities of daily living were preserved. Brain MRI and SPECT respectively showed a focal atrophy and a hypoperfusion in the left temporal lobe.

Dysphasia

The aim of this article was to provide a review study for the problem of dysphasia regarding its glossary etiology, the protocol of assessment and the different approaches of its rehabilitation. The investigated and the control groups were evaluated by the same quasiobjective scheme. There was a strong evidence that the rehabilitation program used in this study led to a significant improvement of the scores in the investigated group in comparison with the control. No significant correlation was detected between the age of the patient, the premorbid educational level and the time post onset of dysphasia. On the other hand, the degree of recovery was more noticeable in less severe forms of dysphasia and in posterior lesions than the anterior lesions

The relevance of patient individuality in the evaluation and treatment of aphasia

The usual approach to language disorders relies on standardised evaluations in which pattern-tests characterise the subject's status according to the classical aphasiological typology. Those data are then analysed to support a traditional prevalent criterion for the distinction between "normal" and "pathological" linguistic performance, which is strictly focused on a quantitative approach. In the present study a method for evaluation and treatment of aphasia is proposed in which socio-cultural conditions are emphasised, in order to expand this conventional criterion as to encompass a qualitative (individualised) one. Although the methodology draws the attention, the results here obtained also point to the importance of re-evaluating what is presently considered as the most appropriate criterion for "normal" cognitive processes, particularly those related to language.

Lesion Sites on Computed tomography Scan in 7 Cases of Conduction Aphasia

The lesions on computerized tomography (CT) scan were evaluated in 7 cases of conduction aphasia. On Modified Westem Aphasia Battery (MWAB), all the patients showed fluent aphasia with some paraphasic errors, good comprehension, marked repetition dificit and variable degree of impairment in naming. The three most common lesions on CT scan were supramarginal gyrus and it's white matter, primary auditory cortex, and insular region, which were involved in 6,5,4 cases out of 7 respectively. Of the three lesions, one or variable combinations of them may be the critical structures for repetition difict in these patients, as has been reported in previous studies. In 5 cases Wermicke area was relatively intact and prominent involvement was seen in only 2 cases, which is thought to be associated with relative preseration foaural comprehension in conduction aphasia.