Cerebral perfusion mediated by thalamo-cortical functional connectivity in non-dominant thalamus affects naming ability in aphasia.

Naming is a commonly impaired language domain in various types of aphasia. Emerging evidence supports the cortico-subcortical circuitry subserving naming processing, although neurovascular regulation of the non-dominant thalamic and basal ganglia subregions underlying post-stroke naming difficulty remains unclear. Data from 25 subacute stroke patients and 26 age-, sex-, and education-matched healthy volunteers were analyzed. Region-of-interest-wise functional connectivity (FC) was calculated to measure the strength of cortico-subcortical connections. Cerebral blood flow (CBF) was determined to reflect perfusion levels. Correlation and mediation analyses were performed to identify the relationship between cortico-subcortical connectivity, regional cerebral perfusion, and naming performance. We observed increased right-hemispheric subcortical connectivity in patients. FC between the right posterior superior temporal sulcus (pSTS) and lateral/medial prefrontal thalamus (lPFtha/mPFtha) exhibited significantly negative correlations with total naming score. Trend-level increased CBF in subcortical nuclei, including that in the right lPFtha, and significant negative correlations between naming and regional perfusion of the right lPFtha were observed. The relationship between CBF in the right lPFtha and naming was fully mediated by the lPFtha-pSTS connectivity in the non-dominant hemisphere. Our findings suggest that perfusion changes in the right thalamic subregions affect naming performance through thalamo-cortical circuits in post-stroke aphasia. This study highlights the neurovascular pathophysiology of the non-dominant hemisphere and demonstrates thalamic involvement in naming after stroke.

Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Language Recovery in Poststroke Survivors With Aphasia: An Updated Meta-analysis.

The effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) on treating poststroke aphasia (PSA) remain inconclusive. We aimed to evaluate the efficacy and safety of LF-rTMS on language function poststroke and determine potential factors that may affect treatment effects. Electronic databases, including MEDLINE, EMBASE, and Cochrane Library were searched to identify relevant randomized controlled trials (RCTs) concerning the effects of LF-rTMS on language performance poststroke. We adopted fixed- and random-effects models to estimate intervention effects, which were represented by the Hedges' g and 95% CIs. Subgroup analyses regarding several factors potentially influencing the effects of LF-rTMS on language recovery were also conducted. A total of 14 RCTs involving 374 participants were included in the meta-analysis. The pooled analysis showed the positive and significant effects of LF-rTMS on language function, both short-term (Hedges' g = 0.65; P < .05) and long-term (Hedges' g = 0.46; P < .05). Subgroup analyses demonstrated that LF-rTMS for 20 minutes per day over 10 days yielded the largest effect size (Hedges' g = 1.02; P < .05) and that LF-rTMS significantly improved language performance in the chronic stage after stroke (Hedges' g = 0.55; P < .05). Patients with different native languages might have diverse responses to LF-rTMS treatment efficacy. Additionally, there were significant improvements in language subtests, including naming, repetition, comprehension, and writing. Overall, this updated meta-analysis demonstrated that LF-rTMS has significant positive effects on PSA, with moderate treatment effects. It provides additional evidence to support LF-rTMS as a promising complementary therapy to promote language recovery in PSA.

Assessing Self-Reported Mood in Aphasia Following Stroke: Challenges, Innovations and Future Directions.

Assessment of mood is critical in determining rehabilitation outcomes for stroke and other acquired brain injury, yet a common consequence of such injuries is aphasia, where language is impaired. Consequently, the use of language-based measures in this population is often not possible. Following a critical review of the neuropsychological aspects of self-reported mood, this paper evaluates the problems in reporting mood after stroke due to aphasia, and discusses implications for the design of adapted instruments. The paper then appraises the construction and psychometric properties of existing, adapted self-report measures developed to try and address these problems, and evaluates their utility and limitations. This includes a focus on the recently validated tablet-based Dynamic Visual Analog Mood Scales (D-VAMS), which uses innovative non-verbal assessment methods based on facial expression modulated via a slider control on a touchscreen interface. Currently, most studies evaluating recovery interventions simply omit individuals with aphasia because of the difficulty of assessing mood and quality of life in this population. However, adapted scales such as the D-VAMS appear to represent an important step forward in assessing mood in people with language impairments, with the use of interactive modulated imagery having wider applications for nonverbal communication as well as the quantification of subjective phenomena.

Cortical stimulation in aphasia following ischemic stroke: toward model-guided electrical neuromodulation.

The aim of this paper is to integrate different bodies of research including brain traveling waves, brain neuromodulation, neural field modeling and post-stroke language disorders in order to explore the opportunity of implementing model-guided, cortical neuromodulation for the treatment of post-stroke aphasia. Worldwide according to WHO, strokes are the second leading cause of death and the third leading cause of disability. In ischemic stroke, there is not enough blood supply to provide enough oxygen and nutrients to parts of the brain, while in hemorrhagic stroke, there is bleeding within the enclosed cranial cavity. The present paper focuses on ischemic stroke. We first review accumulating observations of traveling waves occurring spontaneously or triggered by external stimuli in healthy subjects as well as in patients with brain disorders. We examine the putative functions of these waves and focus on post-stroke aphasia observed when brain language networks become fragmented and/or partly silent, thus perturbing the progression of traveling waves across perilesional areas. Secondly, we focus on a simplified model based on the current literature in the field and describe cortical traveling wave dynamics and their modulation. This model uses a biophysically realistic integro-differential equation describing spatially distributed and synaptically coupled neural networks producing traveling wave solutions. The model is used to calculate wave parameters (speed, amplitude and/or frequency) and to guide the reconstruction of the perturbed wave. A stimulation term is included in the model to restore wave propagation to a reasonably good level. Thirdly, we examine various issues related to the implementation model-guided neuromodulation in the treatment of post-stroke aphasia given that closed-loop invasive brain stimulation studies have recently produced encouraging results. Finally, we suggest that modulating traveling waves by acting selectively and dynamically across space and time to facilitate wave propagation is a promising therapeutic strategy especially at a time when a new generation of closed-loop cortical stimulation systems is about to arrive on the market.

Increased Functional Connectivity Within Intrinsic Neural Networks in Chronic Stroke Following Treatment with Red/Near-Infrared Transcranial Photobiomodulation: Case Series with Improved Naming in Aphasia.

Objective: To examine effects of four different transcranial, red/near-infrared (NIR), light-emitting diode (tLED) protocols on naming ability in persons with aphasia (PWA) due to left hemisphere (LH) stroke. This is the first study to report beneficial effects from tLED therapy in chronic stroke, and parallel changes on functional magnetic resonance imaging (fMRI). Materials and methods: Six PWA, 2-18 years poststroke, in whom 18 tLED treatments were applied (3 × /week, 6 weeks) using LED cluster heads: 500 mW, red (633 nm) and NIR (870 nm), 22.48 cm2, 22.2 mW/cm2. Results: After Protocol A with bilateral LED placements, including midline, at scalp vertex over left and right supplementary motor areas (L and R SMAs), picture naming was not improved. P1 underwent pre-/postovert, picture-naming task-fMRI scans; P2 could not. After Protocol A, P1 showed increased activation in LH and right hemisphere, including L and R SMAs. After Protocol B with LEDs only on ipsilesional, LH side, naming ability significantly improved for P1 and P2; the fMRI scans for P1 then showed activation only on the ipsilesional LH side. After Protocol C with LED placements on ipsilesional LH side, plus one midline placement over mesial prefrontal cortex (mPFC) at front hairline, a cortical node of the default mode network (DMN), P3 and P4 had only moderate/poor response, and no increase in functional connectivity on resting-state functional-connectivity MRI. After Protocol D, however, with LED placements on ipsilesional LH side, plus over two midline nodes of DMN, mPFC, and precuneus (high parietal) simultaneously, P5 and P6 each had good response with significant increase in functional connectivity within DMN, p < 0.0005; salience network, p < 0.0005; and central executive network, p < 0.05. Conclusions: NIR photons can affect surface brain cortex areas subjacent to where LEDs are applied on the scalp. Improved naming ability was present with optimal Protocol D. Transcranial photobiomodulation may be an additional noninvasive therapy for stroke.

The white matter architecture underlying semantic processing: A systematic review.

From a holistic point of view, semantic processes are subserved by large-scale subcortico-cortical networks. The dynamic routing of information between grey matter structures depends on the integrity of subcortical white matter pathways. Nonetheless, controversy remains on which of these pathways support semantic processing. Therefore, a systematic review of the literature was performed with a focus on anatomo-functional correlations obtained from direct electrostimulation during awake tumor surgery, and conducted between diffusion tensor imaging metrics and behavioral semantic performance in healthy and aphasic individuals. The 43 included studies suggest that the left inferior fronto-occipital fasciculus contributes to the essential connectivity that allows semantic processing. However, it remains uncertain whether its contributive role is limited to the organization of semantic knowledge or extends to the level of semantic control. Moreover, the functionality of the left uncinate fasciculus, inferior longitudinal fasciculus and the posterior segment of the indirect arcuate fasciculus in semantic processing has to be confirmed by future research.

Lexical processing depends on sublexical processing: Evidence from the visual world paradigm and aphasia.

Some early studies of people with aphasia reported strikingly better performance on lexical than on sublexical speech perception tasks. These findings challenged the claim that lexical processing depends on sublexical processing and suggested that acoustic information could be mapped directly to lexical representations. However, Dial and Martin (Neuropsychologia 96: 192-212, 2017) argued that these studies failed to match the discriminability of targets and distractors for the sublexical and lexical stimuli and showed that when using closely matched tasks with natural speech tokens, no patient performed substantially better at the lexical than at the sublexical processing task. In the current study, we sought to provide converging evidence for the dependence of lexical on sublexical processing by examining the perception of synthetic speech stimuli varied on a voice-onset time continuum using eye-tracking methodology, which is sensitive to online speech perception processes. Eight individuals with aphasia and ten age-matched controls completed two visual world paradigm tasks: phoneme (sublexical) and word (lexical) identification. For both identification and eye-movement data, strong correlations were observed between the sublexical and lexical tasks. Critically, no patient within the control range on the lexical task was impaired on the sublexical task. Overall, the current study supports the claim that lexical processing depends on sublexical processing. Implications for inferring deficits in people with aphasia and the use of sublexical tasks to assess sublexical processing are also discussed.

Acupuncture combined with swallowing training for poststroke dysphagia: a meta-analysis of randomised controlled trials.

OBJECTIVE: This meta-analysis aimed to assess the efficacy and safety of the combination of acupuncture with swallowing training for poststroke dysphagia. METHOD: Nine electronic databases (including PubMed and China National Knowledge Infrastructure) were searched from their inception through June 2016. Seventeen studies were included in this meta-analysis. Data on 1479 eligible patients were extracted, and the relative risk (RR) and standard mean difference (SMD) with 95% CI for the effective rate (ER), swallowing function assessment (SFA), individual activity (IA), eg., modified Barthel Index (MBI) and quality of life (QOL) were evaluated. RESULTS: The pooled ER (RR 1.26, 95% CI 1.19 to 1.34, P<0.001, 14 studies) and SFA (SMD 1.06, 95% CI 0.79 to 1.32, P<0.001, five studies) suggested that combination therapy yielded a significantly higher ER and improved the SFA scores to a greater degree than swallowing training alone in patients with poststroke dysphagia. The pooled QOL score (SMD 1.06; 95% CI -0.04 to 2.17, P=0.06, two studies) did not differ between groups. The MBI data (SMD 1.47, 95% CI 1.07 to 1.87, P<0.001, one study) showed significant improvement in IA. Some evidence of publication bias was observed for the ER, although the trim-and-fill analysis and fail-safe number indicated no influence of publication bias on its pooled effect size. There was no evidence of publication bias of any other outcome measures. CONCLUSION: This study showed that acupuncture combined with swallowing training may improve the ER, swallowing function and activities of daily life of patients with poststroke dysphagia compared with conventional swallowing training alone.

A Case Study Using a Multimodal Approach to Melodic Intonation Therapy.

Purpose: The purpose of this study was to assess the efficacy. of increasing spontaneous expressive language using a modified melodic intonation therapy (MIT) approach with a male participant diagnosed with acquired aphasia and apraxia who was 10 years post onset. Method: A therapeutic protocol consisting of vocal and linguistic tasks was administered. The participant attended two 50-min individual sessions and a 4-hr/week socialization program for three 12-week semesters. Measures of speech and language were administered before intervention and at the completion of each of the 3 semesters. Results: At the completion of the study, the participant demonstrated reduced apraxia of speech as measured by The Apraxia Battery for Adults, Second Edition (Dabul, 2000). He also showed improvements in auditory comprehension skills as measured on the Boston Diagnostic Aphasia Evaluation (Goodglass, Kaplan, & Barresi, 2000). His spontaneous utterances were characterized by an increased number of complete sentences and questions. Several language parameters including mean length of utterance, total number of spontaneous (untrained) utterances, and number of different words spoken were also improved as revealed through language analysis. Conclusions: Integration of melodic intonation therapy through the addition of musical elements may result in improved speech and expressive language skills when administered over a 9-month period in conjunction with a group socialization program.

Changes in Resting-State Connectivity following Melody-Based Therapy in a Patient with Aphasia.

Melody-based treatments for patients with aphasia rely on the notion of preserved musical abilities in the RH, following left hemisphere damage. However, despite evidence for their effectiveness, the role of the RH is still an open question. We measured changes in resting-state functional connectivity following melody-based intervention, to identify lateralization of treatment-related changes. A patient with aphasia due to left frontal and temporal hemorrhages following traumatic brain injuries (TBI) more than three years earlier received 48 sessions of melody-based intervention. Behavioral measures improved and were maintained at the 8-week posttreatment follow-up. Resting-state fMRI data collected before and after treatment showed an increase in connectivity between motor speech control areas (bilateral supplementary motor areas and insulae) and RH language areas (inferior frontal gyrus pars triangularis and pars opercularis). This change, which was specific for the RH, was greater than changes in a baseline interval measured before treatment. No changes in RH connectivity were found in a matched control TBI patient scanned at the same intervals. These results are compatible with a compensatory role for RH language areas following melody-based intervention. They further suggest that this therapy intervenes at the level of the interface between language areas and speech motor control areas necessary for language production.

Brief mindfulness meditation group training in aphasia: exploring attention, language and psychophysiological outcomes.

BACKGROUND: Stroke is currently the leading cause of long-term disability in adults in the United States. There is a need for accessible, low-cost treatments of stroke-related disabilities such as aphasia. AIMS: To explore an intervention for aphasia utilizing mindfulness meditation (MM). This preliminary study examines the feasibility of teaching MM to individuals with aphasia. Since physiological measures have not been collected for those with aphasia, the study was also an exploration of the potential attention, language and physiological changes after MM in adults with aphasia during a brief, daily group training. METHODS & PROCEDURES: A 5-day MM group training was provided to adults with aphasia (n = 5) with a waitlist control group (n = (3) who engaged in 'mind wandering'. Participants were assigned to groups in a pseudo-random manner. A double baseline (2 days apart) was administered prior to the training and/or control group beginning. Both the training and the control groups met in a group setting. Salivary cortisol, heart rate and heart rate variability were measured during each day for both groups. Measures of attention, auditory comprehension and fluency were collected immediately after the study period and 1 week post-completion. OUTCOME & RESULTS: This study reinforces findings from previous work indicating that adults with aphasia can learn MM. Although not statistically significant, the training group demonstrated improved fluency immediately after MM; however, changes were not maintained at follow-up. Physiological measures showed little effect associated with MM training. No changes in attention were observed for either group. CONCLUSION & IMPLICATIONS: This is an emerging area of interest due to the potential low cost of MM training. Furthermore, MM is easily taught to patients, suggesting the possibility for widespread use in clinical practice as a supplement to existing language-focused interventions.

The Nature of Error Consistency in Individuals With Acquired Apraxia of Speech and Aphasia.

PURPOSE: The primary characteristics used to define acquired apraxia of speech (AOS) have evolved to better reflect a disorder of motor planning/programming. However, there is debate regarding the feature of relatively consistent error location and type. METHOD: Ten individuals with acquired AOS and aphasia and 11 individuals with aphasia without AOS participated in this study. In the context of a 2-group experimental design, error consistency was examined via 5 repetitions of 30 multisyllabic words. The influence of error rate, severity of impairment, and stimulus presentation condition (blocked vs. random) on error consistency was also explored, as well as between-groups differences in the types of errors produced. RESULTS: Groups performed similarly on consistency of error location; however, adults with AOS demonstrated greater variability of error type in a blocked presentation condition only. Stimulus presentation condition, error rate, and severity of impairment did not influence error consistency in either group. Groups differed in the production of phonetic errors (e.g., sound distortions) but not phonemic errors. CONCLUSIONS: Overall, findings do not support relatively consistent errors as a differentiating characteristic of AOS.

The origins of age of acquisition and typicality effects: Semantic processing in aphasia and the ageing brain.

Age of acquisition (AOA) has frequently been shown to influence response times and accuracy rates in word processing and constitutes a meaningful variable in aphasic language processing, while its origin in the language processing system is still under debate. To find out where AOA originates and whether and how it is related to another important psycholinguistic variable, namely semantic typicality (TYP), we studied healthy, elderly controls and semantically impaired individuals using semantic priming. For this purpose, we collected reaction times and accuracy rates as well as event-related potential data in an auditory category-member-verification task. The present results confirm a semantic origin of TYP, but question the same for AOA while favouring its origin at the phonology-semantics interface. The data are further interpreted in consideration of recent theories of ageing.

[Dominant Thalamus and Aphasia].

Many studies have shown that lesions of the dominant thalamus precipitate language disorders in a similar manner to transcortical aphasias, in a phenomenon known as "thalamic aphasia." In some cases, however, aphasia may not occur or may appear transiently following thalamic lesions. Furthermore, dominant thalamic lesions can produce changes in character, as observed in patients with amnesic disorder. Previous work has explored the utility of thalamic aphasia as a discriminative feature for classification of aphasia. Although the thalamus may be involved in the function of the brainstem reticular activating system and play a role in attentional network and in memory of Papez circuit or Yakovlev circuit, the mechanism by which thalamic lesion leads to the emergence of aphasic disorders is unclear. In this review, we we survey historical and recent literature on thalamic aphasia in an attempt to understand the neural processes affected by thalamic lesions.

Pure word deafness with auditory object agnosia after bilateral lesion of the superior temporal sulcus.

Based on results from functional imaging, cortex along the superior temporal sulcus (STS) has been suggested to subserve phoneme and pre-lexical speech perception. For vowel classification, both superior temporal plane (STP) and STS areas have been suggested relevant. Lesion of bilateral STS may conversely be expected to cause pure word deafness and possibly also impaired vowel classification. Here we studied a patient with bilateral STS lesions caused by ischemic strokes and relatively intact medial STPs to characterize the behavioral consequences of STS loss. The patient showed severe deficits in auditory speech perception, whereas his speech production was fluent and communication by written speech was grossly intact. Auditory-evoked fields in the STP were within normal limits on both sides, suggesting that major parts of the auditory cortex were functionally intact. Further studies showed that the patient had normal hearing thresholds and only mild disability in tests for telencephalic hearing disorder. Prominent deficits were discovered in an auditory-object classification task, where the patient performed four standard deviations below the control group. In marked contrast, performance in a vowel-classification task was intact. Auditory evoked fields showed enhanced responses for vowels compared to matched non-vowels within normal limits. Our results are consistent with the notion that cortex along STS is important for auditory speech perception, although it does not appear to be entirely speech specific. Formant analysis and single vowel classification, however, appear to be already implemented in auditory cortex on the STP.

A Novel Pupillometric Method for Indexing Word Difficulty in Individuals With and Without Aphasia.

PURPOSE: Cognitive effort is a clinically important facet of linguistic processing that is often overlooked in the assessment and treatment of people with aphasia (PWA). Furthermore, there is a paucity of valid ways to index cognitive effort in PWA. The construct of cognitive effort has been indexed for decades via pupillometry (measurement of pupil dilation and constriction during a cognitive task), yet pupillometry has not been implemented in studies including PWA. In the present study, we tested a novel method for indexing cognitive effort during linguistic processing in people with and without aphasia. METHOD: Forty control participants and 39 PWA listened to semantically easy and difficult single nouns and looked at images while their pupillary responses were monitored. Mean pupil dilation in response to easy versus difficult nouns was calculated to index cognitive effort. RESULTS: Larger mean pupil dilation values were obtained for difficult compared with easy nouns for both groups. CONCLUSION: Results provide preliminary evidence that pupillometry can be used to index cognitive effort during linguistic processing of single nouns in people with and without aphasia. Methods for indexing cognitive effort will be a valuable addition to existing assessment methods. Suggestions for further research are offered.

Short- and long-term rhythmic interventions: perspectives for language rehabilitation.

This paper brings together different perspectives on the investigation and understanding of temporal processing and temporal expectations. We aim to bridge different temporal deficit hypotheses in dyslexia, dysphasia, or deafness in a larger framework, taking into account multiple nested temporal scales. We present data testing the hypothesis that temporal attention can be influenced by external rhythmic auditory stimulation (i.e., musical rhythm) and benefits subsequent language processing, including syntax processing and speech production. We also present data testing the hypothesis that phonological awareness can be influenced by several months of musical training and, more particularly, rhythmic training, which in turn improves reading skills. Together, our data support the hypothesis of a causal role of rhythm-based processing for language processing and acquisition. These results open new avenues for music-based remediation of language and hearing impairment.

Unilateral forced nostril breathing and aphasia--exploring unilateral forced nostril breathing as an adjunct to aphasia treatment: a case series.

BACKGROUND AND PURPOSE: Unilateral forced nostril breathing (UFNB), a yogic pranayama technique, improves verbal and spatial cognition in healthy adults. The use of UFNB as an adjunct in aphasia recovery has not been explored. The current study investigated the use and potential benefit of combining UFNB with conventional speech-language therapy. METHODS: A multiple baseline single-subject AB design was conducted across three participants with stroke and aphasia. All participants practiced 40 minutes of UFNB daily at home, after instruction, and received conventional aphasia therapy. Speech and language skills were assessed before and after intervention, with individualized assessments throughout the period. Assessments included the Western Aphasia Battery-R (WAB-R) and the Communication Abilities of Daily Living-2 (CADL-2), as well as the Apraxia Battery for Adults if a diagnosis of apraxia was present. The Color Trails Test was performed and language samples collected for Correct Information Unit (CIU) and word productivity analyses. RESULTS: For the pre- and postassessments, visual inspection revealed an increase in CADL-2 scores for participants A2 and A3. In addition, A1 and A3 had a slight trend of increasing WAB-R aphasia quotients. Some change was observed for total number of CIUs and word productivity in two of the three participants. Attention did not markedly improve from baseline to treatment phase. CONCLUSION: This study suggests that UFNB combined with speech-language therapy may benefit overall language production and functional communication. Further investigation on use of UFNB treatment alongside traditional speech-language therapy is warranted.

Ultra-rapid access to words in chronic aphasia: the effects of intensive language action therapy (ILAT).

Effects of intensive language action therapy (ILAT) on automatic language processing were assessed using Magnetoencephalography (MEG). Auditory magnetic mismatch negativity (MMNm) responses to words and pseudowords were recorded in twelve patients with chronic aphasia before and immediately after two weeks of ILAT. Following therapy, Patients showed significant clinical improvements of auditory comprehension as measured by the Token Test and in word retrieval and naming as measured by the Boston Naming Test. Neuromagnetic responses dissociated between meaningful words and meaningless word-like stimuli ultra-rapidly, approximately 50 ms after acoustic information first allowed for stimulus identification. Over treatment, there was a significant increase in the left-lateralisation of this early word-elicited activation, observed in perilesional fronto-temporal regions. No comparable change was seen for pseudowords. The results may reflect successful, therapy-induced, language restitution in the left hemisphere.

Yogic breathing and Ayurveda in aphasia: a case study.

PURPOSE: We present a case study of a woman who used yogic breathing as Ayurvedic medicine in her recovery from poststroke aphasia. Ayurvedic medicine is one of the most ancient medicines of the world, but it is not widely used for aphasia rehabilitation in many Western countries. The description of this case aims to further the understanding of the benefits that this type of medicine may provide to poststroke patients living with aphasia. METHOD: After her stroke, the patient received brief conventional language therapy for her aphasia. At 5 weeks post stroke, she received no further conventional rehabilitation; instead, she consulted with a Vedic priest. She followed a regimen of different body manipulations, yogic breathing techniques, and ingestion of coconut oil. Cognitive and language testing was performed throughout a 3-month period while she was involved in this therapy. RESULTS: Overall, improvement was noted in language, visual attention, and some mood measures. CONCLUSION: Although case studies lead to limited conclusions, changes were observed for this individual using Ayurvedic medicine. Given the changes in language and some aspects of cognition seen in this patient, further exploration of the effectiveness of yogic breathing and Ayurvedic medicine in the treatment of poststroke aphasia is warranted.