Effectiveness of a Verbal Expressive Skills Management Program for Pakistani Patients with Broca Aphasia: A Randomized Clinical Trial.

Background: It is estimated that 25% of the patients in Pakistan experience stroke resulting in problems with language. Among many of the conditions, problem with verbal expressive production (Broca's Aphasia) is one of the main problem faced by people having stoke. Many traditional therapies are incorporated to treat symptoms of Aphasia including fluent and non- fluent Aphasia. Objectives: The primary objective of the current study was to determine the effectiveness of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with convention speech therapy, Melodic Intonation therapy (MIT) in enhancing the verbal expressive skills in patients with severe Broca's Aphasia. Another objective of this study was to compare the efficacy of Verbal Expressive Skill Management Program in Urdu (VESMP-U) with traditional therapy, as well as the quality of life of patients with severe Broca's Aphasia. Methods: A randomized control trial (NCT03699605, clinicaltrials.gov) was conducted from November 2018 - June 2019 in Pakistan railway Hospital (PRH). Patients having a three-month history of severe Broca's Aphasia, aged between 40-60 years, bilingual (Urdu and English language) and having the ability to use a smart phone were included in the study. Patients with cognitive impairments were excluded. Total of 77 patients were evaluated for eligibility criteria according to the G Power software for sample size. Out of 77, 54 individuals fulfilled the inclusion criteria. The participants were divided into 2 groups (27 each) through sealed envelope method. Patients of both groups were assessed pre and post intervention using the Boston Diagnostic Aphasia Examination (BADE) battery (Primary outcome measure). Experimental group n = 25 received VESMP-U therapy and control group n = 25 (2 drop out in each group) received MIT for 16 weeks i.e. 4 days per week having 64 sessions altogether. Each intervention session lasted up to 30-45 minutes for both groups. Results: Within and between group analysis after intervention showed that the VESMP-U group had significantly improved BDAE scores (P = .001; 95% CI) than the MIT group for all variables (articulatory intelligibility, phrase length, grammatical form, prosody/intonation, spontaneous speech, word finding, repetition, and auditory comprehension). The BDAE scores of participants in experimental group having VESMP-U therapy pre- and post-intervention were statistically significant (P = .001; 95% CI), which indicates that participant's communication skills were enhanced by use of VESMP-U. Conclusion: Android based application VESMP-U has been found to be effective in improving expression and quality of life of patients with severe Broca's aphasia.

The efficacy and safety of acupuncture combined with language training for motor aphasia after stroke: study protocol for a multicenter randomized sham-controlled trial.

BACKGROUND: Motor aphasia after stroke is a common and intractable complication of stroke. Acupuncture and language training may be an alternative and effective approach. However, the efficacy of acupuncture and language training for motor aphasia after stroke has not been confirmed. The main objectives of this trial are to evaluate the effectiveness and safety of acupuncture and low-intensity, low-dose language training in treating ischemic motor aphasia after stroke from 15 to 90 days. METHODS: This is a multicenter randomized sham-controlled clinical trial. We will allocate 252 subjects aged between 45 and 75 years diagnosed with motor aphasia after stroke with an onset time ranging from 15 to 90 days into two groups randomly in a 1:1 ratio. Patients in the experimental group will be treated with "Xing-Nao Kai-Qiao" acupuncture therapy plus language training, and those in the control group will be treated with sham-acupoint (1 cun next to the acupoints) acupuncture therapy plus language training. All the patients will be given acupuncture and language training for 6 weeks, with a follow-up evaluation 6 weeks after the end of the treatment and 6 months after the onset time. The patients will mainly be evaluated using the Western Aphasia Battery and Chinese Functional Communication Profile, and the incidence of treatment-related adverse events at the 2nd, 4th, and 6th weeks of treatment will be recorded. The baseline characteristics of the patients will be summarized by group, the chi-squared test will be used to compare categorical variables, and repeated measures of analysis of variance or a linear mixed model will be applied to analyze the changes measured at different time points. DISCUSSION: The present study is designed to investigate the effectiveness and safety of traditional acupuncture therapy and language training in ischemic motor aphasia after stroke and explore the correlation between the treatment time and clinical effect of acupuncture. We hope our results will help doctors understand and utilize acupuncture combined with language training. TRIAL REGISTRATION: ChiCTR ChiCTR1900026740 . Registered on 20 October 2019.

Functional Connectivity of Language Regions of Stroke Patients with Expressive Aphasia During Real-Time Functional Magnetic Resonance Imaging Based Neurofeedback.

Stroke lesions in the language centers of the brain impair the language areas and their connectivity. This article describes the dynamics of functional connectivity (FC) of language areas (FCL) during real-time functional magnetic resonance imaging (RT-fMRI)-based neurofeedback training for poststroke patients with expressive aphasia. The hypothesis is that FCL increases during the upregulation of language areas during neurofeedback training and that the training improves FCL with an increasing number of sessions and restores it toward normalcy. Four test and four control patients with expressive aphasia were recruited for the study along with four healthy volunteers termed as the normal group. The test and normal groups were administered four neurofeedback training sessions in between two test sessions, whereas the control group underwent only the two test sessions. The training session requires the subject to exercise language activity covertly so that it upregulates the feedback signal obtained from the Broca's area (in left inferior frontal gyrus) and amplifies the feedback when it is correlated with the Wernicke's area (in left superior temporal gyrus) using RT-fMRI. FC was measured by Pearson's correlation coefficient. The results indicate that the FC of the test group was weaker in the left hemisphere than that of the normal group, and post-training the connections have strengthened (correlation coefficient increases) in the left hemisphere when compared with the control group. The connections of language areas strengthened in both hemispheres during neurofeedback-based upregulation, and multiple training sessions strengthened new pathways and restored left hemispheric connections toward normalcy.

Clinical study of acupuncture treatment on motor aphasia after stroke.

OBJECTIVE: To study the safety and effectiveness of the Heart-Gallbladder acupuncture treatment for motor aphasia after stroke via clinical studies. METHODS: Sixty valid patients were divided into two groups randomly with a ratio of 1:1. The treatment group was the Heart-Gallbladder acupuncture group and the control group was the conventional acupuncture group. The two groups underwent testing before and after treatments, which included: the Aphasia Battery of Chinese (ABC), the Chinese functional communication profile (CFCP), and the Boston diagnostic aphasia examination (BDAE). RESULTS: All the BDAE, CFCP and ABC results showed a significant difference between the two groups after treatment (P< 0.05), indicating that the Heart-Gallbladder acupuncture treatment for motor aphasia after stroke can reduce the degree of aphasia and improve patients' daily communication skills more than the conventional acupuncture treatment. The Heart-Gallbladder acupuncture treatment is better than the conventional acupuncture treatments for motor aphasia after stroke, with significantly improved scores for fluency, repetition, naming, and reading. CONCLUSIONS: Both the Heart-Gallbladder acupuncture and the conventional acupuncture are effective in the treatment of motor aphasia after stroke. Nevertheless, when compared to the conventional acupuncture, the Heart-Gallbladder acupuncture had better efficacy and it is safe as well.

Epidural Cortical Stimulation as a Treatment for Poststroke Aphasia: A Systematic Review of the Literature and Underlying Neurophysiological Mechanisms.

BACKGROUND: Nearly 15 million people suffer from stroke every year worldwide, with about 20% of the survivors retaining chronic aphasic symptoms. Spontaneous recovery is limited to 3 to 6 months. Cortical stimulation techniques have been proposed to enhance the recovery process. OBJECTIVE: The goal of this study was to evaluate the benefit of epidural cortical stimulation for the treatment of poststroke aphasia, based on a systematic review of the literature. METHODS: An extensive PubMed search was performed for English language articles published from 1990 to 2014 with the keywords (cortical OR epidural) AND stimulation AND stroke AND (aphasia OR language OR speech). The criteria analyzed included the type of study, epidemiology of patients, stroke, aphasia, stimulation protocol, concurrent rehabilitation therapies, language evaluations, results observed, and follow-up. RESULTS: Seven cases were reported to date (3 case reports, 1 randomized controlled trial). All patients experienced nonfluent aphasia following an ischemic stroke. All four studies reported encouraging effects of the stimulation with improved lexical access and fluency for all patients. The effects were specific, independent of the motor recovery or of the pain reported by the patients, and they were linked to the stimulation parameters. CONCLUSIONS: Due to the small number of existing cases in the literature, the strength of the evidence is still low. Two main hypotheses of neurobiological mechanisms have been explored: either using continuous stimulation to modify cortical perilesional inhibition or using intermittent stimulation during the speech and language therapy sessions to explore synaptic plasticity and long-term potentiation or depression. To establish the role of epidural stimulation and the relevant stimulation protocols and parameters, large randomized controlled trials are mandatory. We suggest avenues of investigation.

Epidural Cortical Stimulation as Adjunctive Treatment for Nonfluent Aphasia: Phase 1 Clinical Trial Follow-up Findings.

BACKGROUND: There is increasing interest in the application of cortical stimulation (CS) as an adjuvant strategy in aphasia rehabilitation. Epidural CS, although more invasive than other methods, can provide high-frequency ipsilesional stimulation with greater spatial specificity. OBJECTIVE: We review methods and results of a phase 1 study of epidural CS in combination with rehabilitation therapy in aphasia and provide new objective and self-report data collected between 6 and 21 months after the end of treatment. METHODS: Eight stroke survivors with nonfluent aphasia received intensive language therapy, 3 hours a day, for 6 weeks. Four participants also underwent surgical implantation of an epidural stimulation device that was activated only during therapy sessions. Behavioral data were collected before treatment, at the end of treatment, and at 6 and 12 weeks after the end of treatment. Of the 8 participants, 7 also participated in the longer-term follow-up visit. RESULTS: Changes in objective scores from baseline were larger in investigational participants than controls at all assessments, including the longer-term follow-up visit. Satisfaction ratings and ratings of overall improvement by investigational participants and their companions were more varied than those of the controls, but all indicated that they would recommend the investigational treatment to others with aphasia. CONCLUSIONS: Improvements were generally maintained for at least 12 weeks posttreatment and possibly as long as 21 months posttreatment. Epidural CS is a potentially safe, feasible adjunctive intervention for persons with chronic nonfluent aphasia that spares the ventral premotor cortex and warrants further investigation.

[Clinical research of post-stroke motor aphasia treated with acupoint application of jieyu plaster combined with acupuncture].

OBJECTIVE: To compare the difference in clinical efficacy on post-stroke motor aphasia among the combined therapy of acupoint application of jieyu plaster and acupuncture, simple acupuncture and simple acupoint application of jieyu plaster. METHODS: Eighty-six patients of post-stroke motor aphasia were randomized into an acupuncture group (28 cases) , an acupoint application gruop (29 cases) and the combined therapy group (29 cases). In the acupuncture group, acupuncture was applied at the Speech No. 1 area and three-tongue needling points, once a day, 6 times a week. In the acupoint application group, jieyue plaster was applied to Yongquan (KI 1) and Laogong (PC 8), once a day, and the bilateral acupoints were selected alternatively. In the combined therapy group, the therapeutic methods of the first two groups were used in combination. The treatment lasted for 4 weeks in the three groups. The speech function score was observed and compared before and after treatment in the three groups and the efficacy was compared among the three groups. RESULTS: The total effective rate was 86.2% (25/29) in the combined therapy group, which was better than 67.9% (19/28) in the acupuncture group and 69.0% (20/29) in the acupoint application group (both P < 0.05). After treatment, the scores of spontaneous conversation, restatement and nomenclature in the speech function were all improved as compared with those before treatment in the three groups (all P < 0.01). The results in the combined therapy group were apparently better than those in the acupuncture group and the acupoint application group (all P < 0.01). CONCLUSION: The combined therapy of acupoint application of jieyu plaster and acupuncture apparently improves the speech function in the treatment of post-stroke motor aphasia and the efficacy is better than that of simple acupuncture or simple acupoint application.

Something to talk about: enhancement of linguistic cohesion through tdCS in chronic non fluent aphasia.

Several studies have shown that the modulation of cortical activity through transcranial direct current stimulation (tDCS) enhances naming performance in persons with aphasia. In this study, we investigated the potential effects of tDCS in improving spontaneous speech and the ability to use connective words to establish cohesion among adjacent utterances in a group of eight participants with chronic non fluent aphasia. They were administered five short videoclips representing everyday life contexts and two picture description tasks. Three videoclips were used to elicit spontaneous conversation during the treatment, while the remaining tasks were presented to the patients only before and after the therapy. Patients were required to talk about each videoclip, with the help of a therapist, while they were treated with tDCS (20 min, 1 mA) over the left hemisphere in three different conditions: anodic tDCS over the Broca's area, anodic tDCS over the Wernicke's area and a sham condition. Each experimental condition was performed for ten consecutive daily sessions with 14 days of intersession interval. Only after Broca's stimulation, patients showed a greater improvement in producing words that enhanced the cohesion of their speech samples (i.e., pronouns, ellipses, word repetitions, conjunctions). Beneficial effects of the stimulation were generalized also to contexts presented to the patients at the beginning and at the end of the therapy sessions. Our data further confirm the key role of the left inferior frontal gyrus in binding words into a coherent speech. We believe that positive tDCS effects may be further extended to different linguistic domains, useful to promote language recovery.

Epidural electrical stimulation for the treatment of chronic poststroke aphasia: still compulsory 6 years later!

Implanted cortical stimulation is foreseen to facilitate functional poststroke recovery. Until now, no study has concluded on its pathophysiological mechanism. We report a case of a 58-year-old patient for whom cortical stimulation triggered a drastic enhancement of speech performances. The effects remain reversible after 6 years of stimulation, reflecting intra/inter-hemispheric modulation.

Speech entrainment enables patients with Broca's aphasia to produce fluent speech.

A distinguishing feature of Broca's aphasia is non-fluent halting speech typically involving one to three words per utterance. Yet, despite such profound impairments, some patients can mimic audio-visual speech stimuli enabling them to produce fluent speech in real time. We call this effect 'speech entrainment' and reveal its neural mechanism as well as explore its usefulness as a treatment for speech production in Broca's aphasia. In Experiment 1, 13 patients with Broca's aphasia were tested in three conditions: (i) speech entrainment with audio-visual feedback where they attempted to mimic a speaker whose mouth was seen on an iPod screen; (ii) speech entrainment with audio-only feedback where patients mimicked heard speech; and (iii) spontaneous speech where patients spoke freely about assigned topics. The patients produced a greater variety of words using audio-visual feedback compared with audio-only feedback and spontaneous speech. No difference was found between audio-only feedback and spontaneous speech. In Experiment 2, 10 of the 13 patients included in Experiment 1 and 20 control subjects underwent functional magnetic resonance imaging to determine the neural mechanism that supports speech entrainment. Group results with patients and controls revealed greater bilateral cortical activation for speech produced during speech entrainment compared with spontaneous speech at the junction of the anterior insula and Brodmann area 47, in Brodmann area 37, and unilaterally in the left middle temporal gyrus and the dorsal portion of Broca's area. Probabilistic white matter tracts constructed for these regions in the normal subjects revealed a structural network connected via the corpus callosum and ventral fibres through the extreme capsule. Unilateral areas were connected via the arcuate fasciculus. In Experiment 3, all patients included in Experiment 1 participated in a 6-week treatment phase using speech entrainment to improve speech production. Behavioural and functional magnetic resonance imaging data were collected before and after the treatment phase. Patients were able to produce a greater variety of words with and without speech entrainment at 1 and 6 weeks after training. Treatment-related decrease in cortical activation associated with speech entrainment was found in areas of the left posterior-inferior parietal lobe. We conclude that speech entrainment allows patients with Broca's aphasia to double their speech output compared with spontaneous speech. Neuroimaging results suggest that speech entrainment allows patients to produce fluent speech by providing an external gating mechanism that yokes a ventral language network that encodes conceptual aspects of speech. Preliminary results suggest that training with speech entrainment improves speech production in Broca's aphasia providing a potential therapeutic method for a disorder that has been shown to be particularly resistant to treatment.

When right is all that is left: plasticity of right-hemisphere tracts in a young aphasic patient.

Using an adapted version of Melodic Intonation Therapy (MIT), we treated an adolescent girl with a very large left-hemisphere lesion and severe nonfluent aphasia secondary to an ischemic stroke. At the time of her initial assessment 15 months after her stroke, she had reached a plateau in her recovery despite intense and long-term traditional speech-language therapy (approximately five times per week for more than one year). Following an intensive course of treatment with our adapted form of MIT, her performance improved on both trained and untrained phrases, as well as on speech and language tasks. These behavioral improvements were accompanied by functional MRI changes in the right frontal lobe as well as by an increased volume of white matter pathways in the right hemisphere. No increase in white matter volume was seen in her healthy twin sister, who was scanned twice over the same time period. This case study not only provides further evidence for MIT's effectiveness, but also indicates that intensive treatment can induce functional and structural changes in a right-hemisphere fronto-temporal network.

Effective music therapy techniques in the treatment of nonfluent aphasia.

In music therapy for nonfluent aphasia patients who have difficulty producing meaningful words, phrases, and sentences, various benefits of singing have been identified: strengthened breathing and vocal ability, improved articulation and prosody of speech, and increased verbal and nonverbal communicative behaviors. This paper will introduce these various techniques used in clinical music therapy, and summarize findings based on our recent study to illustrate the strength of different techniques emphasizing rhythm, pitch, memory, and vocal/oral motor components dealing with different symptoms. The efficacy of each component is enhanced or diminished by the choice of music and the way it is interactively delivered. This indicates that neural mechanisms underlying speech improvement vary greatly with available acoustic and social cues in aphasic brain.

[Simple motor aphasia caused by cerebral infarction treated with blood-pricking at Yamen (GV 15) combined with language training].

OBJECTIVE: To explore an effective method for pure motor aphasia caused by cerebral infarction. Methods Ninety-six cases were randomized into a blood-pricking therapy combined with rehabilitation group (comprehensive group), a blood-pricking therapy group and a rehabilitation group, 30 cases in each group. Based on the routine therapy of primary disease, blood-pricking at Yamen (GV 15) combined with language rehabilitation training was applied in comprehensive group, blood-pricking at Yamen (GV 15) was applied only in blood-pricking therapy group, and language rehabilitation training was applied in rehabilitation group. The classification table of speech ability in Speech Therapy and Chinese Standard Aphasia Test Battery by Beijing Medical University were adopted to evaluate the clinical effects of speaking functions and words information, fluency, retelling, and naming of aphasia. RESULTS: After 30 days treatment, the speaking functions of 3 groups were all significantly improved. The total effective rate was 90.6% (29/32) in comprehensive group, which was superior to that of 84.4% (27/32) in blood-pricking therapy group and 75.0% (24/32) in rehabilitation group (both P < 0.01), and it in blood-pricking therapy group was superior to that in rehabilitation group (P < 0.05). The scores of words information and fluency in comprehensive group were much more higher than those in blood-pricking therapy group and rehabilitation group (both P < 0.01); retelling and naming in comprehensive group were higher than those in other two groups (both P < 0.05); the scores of words information and fluency in blood-pricking therapy group were higher than those in rehabilitation group (both P < 0.05). CONCLUSION: The curative effect of simple motor aphasia caused by cerebral infarction treated with blood-pricking at Yamen (GV 15) combined with language training was significantly, superior to that with either blood-pricking therapy or rehabilitation, especially in words information and fluency aspects.

Measuring and inducing brain plasticity in chronic aphasia.

UNLABELLED: Brain plasticity associated with anomia recovery in aphasia is poorly understood. Here, I review four recent studies from my lab that focused on brain modulation associated with long-term anomia outcome, its behavioral treatment, and the use of transcranial brain stimulation to enhance anomia treatment success in individuals with chronic aphasia caused by left hemisphere stroke. In a study that included 15 participants with aphasia who were compared to a group of 10 normal control subjects, we found that improved naming ability was associated with increased left hemisphere activity. A separate study (N = 26) revealed similar results in that improved anomia treatment outcome was associated with increased left hemisphere recruitment. Taken together, these two studies suggest that improved naming in chronic aphasia relies on the damaged left hemisphere. Based on these findings, we conducted two studies to appreciate the effect of using low current transcranial electrical stimulation as an adjuvant to behavioral anomia treatment. Both studies yielded positive findings in that anomia treatment outcome was improved when it was coupled with real brain stimulation as compared with a placebo (sham) condition. Overall, these four studies support the notion that the intact cortex in the lesioned left hemisphere supports anomia recovery in aphasia. LEARNING OUTCOMES: Readers will (a) be able to appreciate the possible influence of animal research upon the understanding of brain plasticity induced by aphasia treatment, (b) understand where functional changes associated with anomia treatment occur in the brain, (c) understand the basic principles of transcranial direct current stimulation, and (d) understand how brain stimulation coupled with aphasia treatment may potentially improve treatment outcome.

Melodic intonation therapy: shared insights on how it is done and why it might help.

For more than 100 years, clinicians have noted that patients with nonfluent aphasia are capable of singing words that they cannot speak. Thus, the use of melody and rhythm has long been recommended for improving aphasic patients' fluency, but it was not until 1973 that a music-based treatment [Melodic Intonation Therapy (MIT)] was developed. Our ongoing investigation of MIT's efficacy has provided valuable insight into this therapy's effect on language recovery. Here we share those observations, our additions to the protocol that aim to enhance MIT's benefit, and the rationale that supports them.

[Clinical observation on treatment of cerebral infarction-induced broca aphasia by Tiaoshen Fuyin acupuncture therapy combined with language training].

OBJECTIVE: To observe therapeutic effect of Tiaoshen Fuyin acupuncture therapy on cerebral infarction-induced Broca aphasia. METHODS: Sixty cases were randomly divided into an observation group and a control group, 30 cases in each group. The observation group were treated with Tiaoshen Fuyin acupuncture therapy and language training, and the control group with simple language training. For the acupuncture treatment, Sishencong (EX-HN 1), Benshen (GB 13), Shenting (GV 24), Lianquan (CV 23), Xinshu (BL 15), Shentang (BL 44), Shendao (GV 11), Lingtao (HT 4) were selected and language training included training of phonatory organs in mouth, the mouth shape, sound, spoken language expression and practical exchange ability. They were treated for 5 therapeutic courses. Language examination was conducted once each before and after treatment with "Aphasia Battery of Chinese" (ABC method). RESULTS: The therapeutic effect of Tiaoshen Fuyin acupuncture therapy combined with language training was better than that of simple language training. CONCLUSION: Tiaoshen Fuyin acupuncture therapy combined with language training can significantly improve language function and increase life quality in the patient of cerebral infarction-induced Broca aphasia.

Improved naming after transcranial direct current stimulation in aphasia.

Transcranial direct current stimulation (tDCS) has been proposed as an adjuvant technique to improve functional recovery after ischaemic stroke. This study evaluated the effect of tDCS over the left frontotemporal areas in eight chronic non-fluent post-stroke aphasic patients. The protocol consisted of the assessment of picture naming (accuracy and response time) before and immediately after anodal or cathodal tDCS (2 mA, 10 minutes) and sham stimulation. Whereas anodal tDCS and sham tDCS failed to induce any changes, cathodal tDCS significantly improved the accuracy of the picture naming task by a mean of 33.6% (SEM 13.8%).

Protocol evaluation for effective music therapy for persons with nonfluent aphasia.

Although the notion of the language specificity of neural correlates has been widely accepted in the past (e.g., lefthemispheric dominance including Broca's and Wernike's area, N400 ERP component of semantic processing, and the P600 ERP component of syntactic processing, etc.), recent studies have shown that music and language share some important neurological aspects in their processing, both involving bilateral hemispheric activities. In line with this are the frequent behavioral clinical observations that persons with aphasia show improved articulation and prosody of speech in musically assisted phrases. Connecting recent neurological findings with clinical observations would not only inform clinical practice but would enhance understanding of the neurological mechanisms involved in the processing of speech/language and music. This article presents a music therapy treatment protocol study of 7 nonfluent patients with aphasia. The data and findings are discussed with regard to some of the recent focuses and issues addressed in the experimental studies using cognitive-behavioral, electrophysiological, and brain-imaging techniques.

A comparison of relaxation training and syntax stimulation for chronic nonfluent aphasia.

UNLABELLED: This study examined the effects of relaxation training and syntax stimulation on the spoken language abilities of a 59-year-old male with chronic, nonfluent aphasia of moderate severity. Relaxation training consisted of progressive muscle relaxation (PMR) and guided imagery (GI), whereas the syntax stimulation was a modified version of the Helm Elicited Program for Syntax Stimulation (HELPSS) [(1981). Helm Elicited Language Program for Syntax Stimulation. Austin, TX: Pro-Ed.]. These treatments were applied in the context of a single-subject alternating treatments plus baseline design. Results indicated that although both treatments produced improvements in spoken language, syntax stimulation was associated with larger improvements, particularly in terms of the proportions of grammatical utterances, correct information units (CIUs), and successful utterances produced by the participant. Analysis of treatment order, however, indicated that the participant's best performances of the syntax treatment and of the probe tasks occurred when relaxation training preceded syntax stimulation. These findings suggest that the simplicity and psychological benefits of relaxation training make it a complementary component to traditional linguistic programs for aphasia. EDUCATIONAL OBJECTIVES: (1) The reader will understand how psychological responses to stress may affect the language processing abilities of adults with aphasia. (2) The reader will be able to describe how relaxation training complements a traditional language treatment approach for remediating spoken language abilities of adults with chronic nonfluent aphasia.