Speech therapy and hyperbaric oxygen for aphasia after carbon monoxide intoxication.

Acute carbon monoxide (CO) intoxication may result in delayed neurological sequelae, which can include amnesia, ataxia, aphasia, emotional lability, disorientation, dysphagia, and other manifestations. A 27-year-old man reported symptoms of aphasia with agraphia and alexia in a review after CO intoxication. The patient received outpatient speech therapy, as well as repeated sessions of hyperbaric oxygen for 15 days, interspersing speech therapy with hyperbaric oxygen therapy for two months. After this period of combined treatment the aphasic symptomatology remitted, and oral and written language was normal. The complete disappearance of aphasia with agraphia and alexia confirms the efficacy of the combined intervention. More data from large clinical studies are needed to assess the outcomes of hyperbaric oxygen treatment in patients with delayed neurological sequelae after CO intoxication, but this case suggests it may be a good therapeutic option in combination with specific speech therapy.

Involvement of Thalamocortical Networks in Patients With Poststroke Thalamic Aphasia.

BACKGROUND AND OBJECTIVE: Theories assume that thalamic stroke may cause aphasia because of dysfunction in connected cortical networks. This takes into account that brain functions are organized in distributed networks, and in turn, localized damage may result in a network disorder such as thalamic aphasia. With this study, we investigate whether the integration of the thalamus into specific thalamocortical networks underlies symptoms after thalamic stroke. We hypothesize that thalamic lesions in patients with language impairments are functionally connected to cortical networks for language and cognition. METHODS: We combined nonparametric lesion mapping methods in a retrospective cohort of patients with acute or subacute first-ever thalamic stroke. A relationship between lesion location and language impairments was assessed using nonparametric voxel-based lesion-symptom mapping. This method reveals regions more frequently damaged in patients with compared with those without a symptom of interest. To test whether these symptoms are linked to a common thalamocortical network, we additionally performed lesion-network-symptom mapping. This method uses normative connectome data from resting-state fMRI of healthy participants (n = 65) for functional connectivity analyses, with lesion sites serving as seeds. Resulting lesion-dependent network connectivity of patients with language impairments was compared with those with motor and sensory deficits as baseline. RESULTS: A total of 101 patients (mean [SD] age 64.1 [14.6] years, 57 left, 42 right, and 2 bilateral lesions) were included in the study. Voxel-based lesion-symptom mapping showed an association of language impairments with damage to left mediodorsal thalamic nucleus lesions. Lesion-network-symptom mapping revealed that language compared with sensory deficits were associated with higher normative lesion-dependent network connectivity to left frontotemporal language networks and bilateral prefrontal, insulo-opercular, midline cingular, and parietal domain-general networks. Lesions related to motor and sensory deficits showed higher lesion-dependent network connectivity within the sensorimotor network spanning prefrontal, precentral, and postcentral cortices. DISCUSSION: Thalamic aphasia relates to lesions in the left mediodorsal thalamic nucleus and to functionally connected left cortical language and bilateral cortical networks for cognitive control. This suggests that dysfunction in thalamocortical networks contributes to thalamic aphasia. We propose that inefficient integration between otherwise undamaged domain-general and language networks may cause thalamic aphasia.

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).

Spirituality and Post-Stroke Aphasia Recovery.

The role of spirituality in post-stroke aphasia recovery has been ignored despite its potential contribution to positive health outcomes, particularly stroke recovery. The present study examines the spiritual experience of adults with aphasia in an effort to better understand the role of one's spirituality in the aphasia recovery process. Thirteen adults with aphasia completed a modified spirituality questionnaire and participated in semi-structured interviews. All participants considered themselves spiritual and reported improvements in communication during post-stroke recovery. Two themes related to spirituality that emerged from the interviews were (a) a greater power being in control of events and (b) a greater power as helper.

Choral singing therapy following stroke or Parkinson's disease: an exploration of participants' experiences.

PURPOSE: People with stroke or Parkinson's disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others. METHOD: Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23). RESULTS: Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice. CONCLUSIONS: Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties. IMPLICATIONS FOR REHABILITATION: Choral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition. Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms. CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks.

Terapias musicales en la rehabilitación del lenguaje y musicoterapia en personas con demencia / No disponible

La música surgió de manera simultánea al lenguaje dada la necesidad de los humanos de comunicarse y cooperar. Todas las personas, al nacer, contamos con las habilidades necesarias para procesar la música, una acción que implica una amplia red de conexiones cerebrales para la activación de diversas funciones cognitivas y su producción. Estas activaciones nos pueden resultar muy útiles tanto para el tratamiento de las personas con demencia como para otro tipo de trastornos, ya que en ellas se observan respuestas cognitivas, motoras, emocionales, etc. En el presente trabajo se revisan las intervenciones llevadas a cabo en personas con demencia utilizando la música y sus diferentes componentes, así como la Terapia de Entonación Melódica (TEM), utilizada en el tratamiento de la afasia no fluente(AU)

Music and language emerged simultaneously, due to the human necessity to communicate and cooperate. Every person is born with the basic abilities needed to process music, this process involves a wide network of cerebral connections that activate diverse cognitive functions. These activations can be very useful not only for the treatment of people with dementia but also for other kind of disorders as it has been observed the fact that there are reactions at cognitive, motor, emotional, etc. In this paper work we review these interventions done in people with dementia using music and its different components, it is also reviewed Melodic Intonation Therapy (MIT), used in the treatment of nonfluent aphasia(AU)

Facilitation of naming in aphasia with auditory repetition: an investigation of neurocognitive mechanisms.

Prior phonological processing can enhance subsequent picture naming performance in individuals with aphasia, yet the neurocognitive mechanisms underlying this effect and its longevity are unknown. This study used functional magnetic resonance imaging to examine the short-term (within minutes) and long-term (within days) facilitation effects from a phonological task in both participants with aphasia and age-matched controls. Results for control participants suggested that long-term facilitation of subsequent picture naming may be driven by a strengthening of semantic-phonological connections, while semantic and object recognition mechanisms underlie more short-term effects. All participants with aphasia significantly improved in naming accuracy following both short- and long-term facilitation. A descriptive comparison of the neuroimaging results identified different patterns of activation for each individual with aphasia. The exclusive engagement of a left hemisphere phonological network underlying facilitation was not revealed. The findings suggest that improved naming in aphasia with phonological tasks may be supported by changes in right hemisphere activity in some individuals and reveal the potential contribution of the cerebellum to improved naming following phonological facilitation. Conclusions must be interpreted with caution, however, due to the comparison of corrected group control results to that of individual participants with aphasia, which were not corrected for multiple comparisons.

The dorsal stream contribution to phonological retrieval in object naming.

Meaningful speech, as exemplified in object naming, calls on knowledge of the mappings between word meanings and phonological forms. Phonological errors in naming (e.g. GHOST named as 'goath') are commonly seen in persisting post-stroke aphasia and are thought to signal impairment in retrieval of phonological form information. We performed a voxel-based lesion-symptom mapping analysis of 1718 phonological naming errors collected from 106 individuals with diverse profiles of aphasia. Voxels in which lesion status correlated with phonological error rates localized to dorsal stream areas, in keeping with classical and contemporary brain-language models. Within the dorsal stream, the critical voxels were concentrated in premotor cortex, pre- and postcentral gyri and supramarginal gyrus with minimal extension into auditory-related posterior temporal and temporo-parietal cortices. This challenges the popular notion that error-free phonological retrieval requires guidance from sensory traces stored in posterior auditory regions and points instead to sensory-motor processes located further anterior in the dorsal stream. In a separate analysis, we compared the lesion maps for phonological and semantic errors and determined that there was no spatial overlap, demonstrating that the brain segregates phonological and semantic retrieval operations in word production.

Auditory object cognition in dementia.

The cognition of nonverbal sounds in dementia has been relatively little explored. Here we undertook a systematic study of nonverbal sound processing in patient groups with canonical dementia syndromes comprising clinically diagnosed typical amnestic Alzheimer's disease (AD; n=21), progressive nonfluent aphasia (PNFA; n=5), logopenic progressive aphasia (LPA; n=7) and aphasia in association with a progranulin gene mutation (GAA; n=1), and in healthy age-matched controls (n=20). Based on a cognitive framework treating complex sounds as 'auditory objects', we designed a novel neuropsychological battery to probe auditory object cognition at early perceptual (sub-object), object representational (apperceptive) and semantic levels. All patients had assessments of peripheral hearing and general neuropsychological functions in addition to the experimental auditory battery. While a number of aspects of auditory object analysis were impaired across patient groups and were influenced by general executive (working memory) capacity, certain auditory deficits had some specificity for particular dementia syndromes. Patients with AD had a disproportionate deficit of auditory apperception but preserved timbre processing. Patients with PNFA had salient deficits of timbre and auditory semantic processing, but intact auditory size and apperceptive processing. Patients with LPA had a generalised auditory deficit that was influenced by working memory function. In contrast, the patient with GAA showed substantial preservation of auditory function, but a mild deficit of pitch direction processing and a more severe deficit of auditory apperception. The findings provide evidence for separable stages of auditory object analysis and separable profiles of impaired auditory object cognition in different dementia syndromes.

Speech perception, rapid temporal processing, and the left hemisphere: a case study of unilateral pure word deafness.

The mechanisms and functional anatomy underlying the early stages of speech perception are still not well understood. One way to investigate the cognitive and neural underpinnings of speech perception is by investigating patients with speech perception deficits but with preserved ability in other domains of language. One such case is reported here: patient NL shows highly impaired speech perception despite normal hearing ability and preserved semantic knowledge, speaking, and reading ability, and is thus classified as a case of pure word deafness (PWD). NL has a left temporoparietal lesion without right hemisphere damage and DTI imaging suggests that he has preserved cross-hemispheric connectivity, arguing against an account of PWD as a disconnection of left lateralized language areas from auditory input. Two experiments investigated whether NL's speech perception deficit could instead result from an underlying problem with rapid temporal processing. Experiment 1 showed that NL has particular difficulty discriminating sounds that differ in terms of rapid temporal changes, be they speech or non-speech sounds. Experiment 2 employed an intensive training program designed to improve rapid temporal processing in language impaired children (Fast ForWord; Scientific Learning Corporation, Oakland, CA) and found that NL was able to improve his ability to discriminate rapid temporal differences in non-speech sounds, but not in speech sounds. Overall, these data suggest that patients with unilateral PWD may, in fact, have a deficit in (left lateralized) temporal processing ability, however they also show that a rapid temporal processing deficit is, by itself, unable to account for this patient's speech perception deficit.

Epidural cortical stimulation as adjunctive treatment for non-fluent aphasia: preliminary findings.

BACKGROUND AND PURPOSE: This study evaluated the safety and feasibility of targeted epidural cortical stimulation delivered concurrently with intensive speech-language therapy for treatment of chronic non-fluent aphasia. METHODS: Eight stroke survivors with non-fluent aphasia received intensive behavioural therapy for 3 h daily for 6 weeks using a combination of articulation drills, oral reading and conversational practice. Four of these participants (investigational participants) also underwent functional MRI guided surgical implantation of an epidural stimulation device which was activated only during therapy sessions. Behavioural data were collected before treatment, immediately after treatment and at 6 and 12 weeks following termination of therapy. Imaging data were collected before and after treatment. RESULTS: Investigational participants showed a mean Aphasia Quotient change of 8.0 points immediately post-therapy and at the 6 week follow-up, and 12.3 points at 12 weeks. The control group had changes of 4.6, 5.5 and 3.6 points, respectively. Similar changes were noted on subjective caregiver ratings. Functional imaging suggested increased consolidation of activity in interventional participants. CONCLUSIONS: Behavioural speech-language therapy improves non-fluent aphasia, independent of cortical stimulation. However, epidural stimulation of the ipsilesional premotor cortex may augment this effect, with the largest effects after completion of therapy. The neural mechanisms underlying these effects are manifested in the brain by decreases in the volume of activity globally and in particular regions. Although the number of participants enrolled in this trial precludes definitive conclusions, targeted epidural cortical stimulation appears safe and may be a feasible adjunctive treatment for non-fluent aphasia, particularly when the aphasia is more severe.

The effects of cortical ischemic stroke on auditory processing in humans as indexed by transient brain responses.

OBJECTIVE: To investigate the effects of cortical ischemic stroke and aphasic symptoms on auditory processing abilities in humans as indicated by the transient brain response, a recently documented cortical deflection which has been shown to accurately predict behavioral sound detection. METHODS: Using speech and sinusoidal stimuli in the active (attend) and the passive (ignore) recording condition, cortical activity of ten aphasic stroke patients and ten control subjects was recorded with whole-head MEG and behavioral measurements. RESULTS: Stroke patients exhibited significantly diminished neuromagnetic transient responses for both sinusoidal and speech stimulation when compared to the control subjects. The attention-related increase of response amplitude was slightly more pronounced in the control subjects than in the stroke patients but this difference did not reach statistical significance. CONCLUSIONS: Left-hemispheric ischemic stroke impairs the processing of sinusoidal and speech sounds. This deficit seems to depend on the severity and location of stroke. SIGNIFICANCE: Directly observable, non-invasive brain measures can be used in assessing the effects of stroke which are related to the behavioral symptoms patients manifest.

Using transcranial direct-current stimulation to treat stroke patients with aphasia.

BACKGROUND AND PURPOSE: Recent research suggests that increased left hemisphere cortical activity, primarily of the left frontal cortex, is associated with improved naming performance in stroke patients with aphasia. Our aim was to determine whether anodal transcranial direct-current stimulation (tDCS), a method thought to increase cortical excitability, would improve naming accuracy in stroke patients with aphasia when applied to the scalp overlying the left frontal cortex. METHODS: Ten patients with chronic stroke-induced aphasia received 5 days of anodal tDCS (1 mA for 20 minutes) and 5 days of sham tDCS (for 20 minutes, order randomized) while performing a computerized anomia treatment. tDCS positioning was guided by a priori functional magnetic resonance imaging results for each individual during an overt naming task to ensure that the active electrode was placed over structurally intact cortex. RESULTS: Results revealed significantly improved naming accuracy of treated items (F[1,9]=5.72, P<0.040) after anodal tDCS compared with sham tDCS. Patients who demonstrated the most improvement were those with perilesional areas closest to the stimulation site. Crucially, this treatment effect persisted at least 1 week after treatment. CONCLUSIONS: Our findings suggest that anodal tDCS over the left frontal cortex can lead to enhanced naming accuracy in stroke patients with aphasia and, if proved to be effective in larger studies, may provide a supplementary treatment approach for anomia.

Influence of continual biofeedback on jaw pursuit-tracking in healthy adults and in adults with apraxia plus aphasia.

Apraxia of speech (AOS) is a disorder of motor programming resulting from damage to premotor or anterior insula cortex. The authors used a pursuit visuomotor tracking task to test whether such a disorder interferes with development of motor programs or with modification of existing programs via integration of feedback. Healthy older adults (n = 15) and adults with AOS plus aphasia and nonverbal apraxia (n = 8) performed a jaw movement task with (a) continuous visual feedback of a target movement pattern and their jaw movement and (b) no feedback. Healthy speakers were more accurate and less variable with feedback, suggesting accurate development of a program and feedback integration. Apraxic individuals' performance accuracy and response to feedback suggested that the neurological damage impairs both development of new programs and efficient integration of feedback.

Auditory lexical-semantic processing impairments in aphasic patients reflected in event-related potentials (N400).

OBJECTIVE: Event-related potentials (ERPs) and response latencies were recorded from aphasic subjects with auditory language processing impairments and age-matched normal controls, while performing a lexical-semantic evaluation task, aiming at clarifying whether ERPs could be a reliable measure for indicating language impairments in aphasic patients. METHODS: The stimuli were 50 pairs of spoken words (prime word-target word): 25 pairs, which were semantically and/or associatively related to each other, and 25 pairs which were not. The subjects pressed a switch in response to the presentation of target words semantically related to the prime words. The ERP component analyzed in this study was N400. RESULTS: With the performances, the response latencies were longer in the aphasic subjects than in the normal controls. With the ERPs, onset latencies of N400 were shifted behind in the aphasic patients compared to the normal controls. For the aphasic patients, there were correlations between the size of N400 and performances in auditory comprehension evaluated in the aphasia test. CONCLUSION: The conclusions drawn from the results are that not only response latencies in the lexical-semantic judgement task, but also N400 effects, may be a reliable clinical measure of the severity of even mild lexical-semantic impairments in aphasic patients.

The role of visual imagery in spelling.

Current models of spelling posit that information from the orthographic output buffer can be translated into physical letter codes for written output or into name letter codes for spoken output. It is not known, at present, whether or not visualization of these codes is necessary to spell or recognize orally spelled words. We report a 73-year-old woman who could spell words better than she could image them and who demonstrated near flawless recognition of orally spelled words. We conclude that visual imagery is not necessary to either spell or recognize orally spelled words.

Aphasic and parkinsonian signing: differences in phonological disruption.

Since movements of the articulators in sign, unlike in speech, are directly observable, we can investigate signing not only as linguistic behavior but also as motor behavior and directly contrast linguistic-representational and motor-execution disorders of signing. We compared the temporal sequencing characteristics (duration of segments, pausing, periods of change in handshape posture), intactness of distinctive features, and correct use of prosodic templates in three pairs of signers--two Deaf aphasic signers with posterior damage in the left hemisphere, two signers with Parkinson's disease, and two gender- and age-matched control signers. With respect to distinctive features, the aphasic signers exhibited selection errors in the American Sign Language (ASL) distinctive features system, while the Parkinsonian signers showed an intact distinctive feature inventory, but with disturbances in executing these features. The Parkinsonian signers, unlike the aphasic and control signers, showed marked disturbances in the temporal organization and coordination of what we argue are the two subsystems of the ASL sign stream--handshape and movement. The findings demonstrate a phonetic deficit in Parkinsonian signers, in contrast with aphasic signers who showed a disruption in the underlying representation and syllabification processes in the language.

Anticipatory tonal coarticulation in Thai noun compounds after unilateral brain damage.

The time course and extent of anticipatory coarticulation between tones was investigated in normal and brain-damaged Thai-speaking subjects. Subjects were classified into five groups including 11 young normal, 9 old normal, 12 right hemisphere, 9 left hemisphere fluent, and 6 left hemisphere nonfluent. Stimuli consisted of five bisyllabic noun compounds with a falling tone on the initial syllable and each of the five Thai tones (mid, low, falling, high, rising) on the final syllable. Height and slope of F0 was measured at 10% intervals throughout the duration of the initial syllable. Results indicated anticipatory effects on both height and slope of the falling tone. Height effects extended throughout from the beginning. The falling tone was generally higher when occurring before the low/rising tones than when occurring before the mid/falling/high tones. Slope effects were restricted to the terminal portion. The falling tone before low/rising tones exhibited a steeper slope than before falling/high tones. In magnitude of effect, patients with left and right hemisphere lesions were statistically indistinguishable from those of normal subjects. No differences were noted in coarticulatory patterns as a function of aphasia type. All brain-damaged speakers were more variable in F0 production than normals. Findings are interpreted to highlight properties of nonfluent aphasic speech and neurological bases of speech production.

Cortical differences in tonal versus vowel processing as revealed by an ERP component called mismatch negativity (MMN).

Event-related potentials were recorded from four aphasic subjects in order to study if discrimination of synthetic vowels is impaired by left posterior brain damage. A component called the mismatch negativity (MMN) which is assumed to reflect basic discriminatory processes of auditory stimuli was measured. In accordance with the hypothesis, two patients with posterior lesions failed to show any MMN response to synthetic vowels, whereas two patients with predominantly anterior lesions produced the response. The fact that all four patients produced an MMN response to sine wave stimuli indicates that the result does not reflect an across-the-board effect.

Hemianesthesia and aphasia. An anatomical and behavioral study.

A 61-year-old right-handed man with a history of lacunar cerebrovascular disease and hypertension had the sudden onset of right-sided numbness and difficulty speaking. Neurologic evaluation revealed a dense right hemianesthesia that included the face, trunk, arm, and leg. Neuropsychological examination documented a conduction aphasia, which resolved nearly completely several months later. Computed tomographic and magnetic resonance imaging studies showed a lesion in the left hemisphere that involved the posterior insula and disrupted thalamocortical connections but entirely spared the thalamus proper. We suggest that the combination of hemianesthesia and aphasia indicates a white matter lesion subjacent to inferior parietal and posterior temporal cortices.