Novel associative processing and aging: effect on creative production.

Creative production has been reported to decline with age. This study investigated age-related differences in creative verbal production. Participants were 30 younger and 30 older adults. Study testing included language and cognitive assessments and the experimental task wherein participants created short stories incorporating words that are not commonly related, semantically or associatively. The resulting stories were rated by independent blinded judges for originality, cohesion, appropriateness, and organization. Younger adults' stories were rated as being significantly more original and more appropriate. Integrating unrelated words to create original stories requires activating widely distributed lexical-semantic networks to develop novel associations. Potential decreased neural network connectivity due to white matter degradation, commonly seen in normal aging, as well as decrements in front-executive disengagement may have affected older adults' performance on this story creation task. Future research using neuroimaging may elucidate possible neuroanatomic correlates of age-related changes in associative creative production..

Callosal ideomotor apraxia in Alzheimer's disease.

BACKGROUND/OBJECTIVE: Impaired ability to perform skilled movements with the left upper limb in patients with corpus callosum injury has been well described (callosal apraxia) with some displaying spatial-temporal errors primarily in response to verbal commands (verbal callosal disconnection apraxia), with imitation, and when using actual tools (callosal ideomotor apraxia). Additionally some patients with callosal injury also make content errors when selecting and using the incorrect tool with their left upper limb (callosal conceptual apraxia). Interestingly, patients with Alzheimer's disease (AD) reveal anatomic evidence of callosal degeneration but callosal apraxia in AD has not been described. The purpose of this study was to learn whether patients with AD display forms of callosal apraxia. METHOD: Participants were 22 right-handed patients with AD and 24 matched controls. Both upper limbs were tested by having subjects pantomime transitive movements to command and imitation. Participants also viewed pictures of an incomplete task and attempted to pantomime the action needed to complete the task. RESULTS AND CONCLUSIONS: When compared to controls, the participants with AD demonstrated ideomotor and conceptual apraxias of both upper limbs; however, ideomotor apraxia of their left hand was more robust than that of their right hand, suggesting a hemispheric disconnection.

Narrative Discourse Cohesion in Early Stage Parkinson's Disease.

BACKGROUND: Models of basal ganglia (BG) function suggest that expressive language deficits will likely and consistently present in BG disease. Disparities currently exist between the predictions of models of BG function in expressive language and data from studies of BG disease. Traditional expressive language assessment methodologies that emphasize measures of language form (word and sentence productivity) while not carefully considering how language is used, may only partially account for these disparities. OBJECTIVE: To use measures of cohesion to examine the use of cohesive markers in narrative discourse. METHODS: Twelve individuals with idiopathic Parkinson's disease (PD) were compared to 12 matched neurologically intact controls on measures of discourse performance. Three discourse samples (typical day, memorable vacation and family) were analyzed for measures of narrative productivity, number of cohesive ties and cohesive adequacy. Mixed model analyses were completed for group comparisons. RESULTS: Group differences were not observed on measures of language form as measured by narrative productivity, communication units, and number of cohesive ties produced. In contrast, group differences were observed in cohesive adequacy as individuals with PD produced a higher percentage of incomplete and erroneous cohesive ties relative the control subjects across narratives. CONCLUSIONS: These results support the conclusion that the BG in PD may have an executive role in expressive language use that can be disrupted without impacting language form.

Anomia treatment platform as behavioral engine for use in research on physiological adjuvants to neurorehabilitation.

The purpose of this study was to create a "behavioral treatment engine" for future use in research on physiological adjuvants in aphasia rehabilitation. We chose the behavioral target anomia, which is a feature displayed by many persons who have aphasia. Further, we wished to saturate the treatment approach with many strategies and cues that have been empirically reported to have a positive influence on aphasia outcome, with the goal being to optimize the potential for positive response in most participants. A single-subject multiple baseline design with replication across eight participants was employed. Four men and four women, with an average age of 62 yr and an average of 63.13 mo poststroke onset, served as participants. Word-retrieval treatment was administered 3 d/wk, 1 h/d for a total of 20 treatment hours (6-7 wk). Positive acquisition effects were evident in all eight participants (d effect size [ES] = 5.40). Treatment effects were maintained 3 mo after treatment termination for five participants (d ES = 2.94). Within and across semantic category, generalization was minimal (d ES = 0.43 within and 1.09 across). This study demonstrates that this behavioral treatment engine provides a solid platform on which to base future studies whereby various treatment conditions are manipulated and pharmacologic support is added.

Dosing of a cued picture-naming treatment for anomia.

PURPOSE: Recent investigations into effects of intensity or distribution of aphasia therapy have provided moderate evidence supporting intensive therapy schedules on aphasia treatment response. The purpose of the present study was to investigate the feasibility of creating an intensive therapy session without extending the amount of daily time a person spends in treatment. METHOD: Individuals who presented with chronic anomia poststroke (N = 8) participated in 2 weeks of a computerized, therapist-delivered, cued, picture-naming treatment. Dosing parameters for each session were 8 presentations of 50 pictures, totaling 400 teaching episodes per session. RESULTS: Of the 8 participants, 6 achieved significant increases from baseline on trained items after 400 teaching episodes (i.e., 1 treatment hr), and the remaining 2 participants achieved significant increases from baseline after 1200 teaching episodes (i.e., 3 treatment hr). Maintenance data from 7 of the participants indicated that 6 participants maintained significant improvement from baseline on trained items. CONCLUSIONS: Given an intensive and saturated context, anomic individuals were surprisingly quick at relearning to produce problematic words successfully. Most participants demonstrated retention of the gains 2 months after treatment ended. The high density of teaching episodes within the treatment session (i.e., the intensive treatment schedule) may have contributed to the behavioral gains.

A Behavioral Manipulation Engages Right Frontal Cortex During Aphasia Therapy.

Background An aphasia treatment was designed to shift laterality from the left to right lateral frontal lobe during word production by initiating word-finding trials with complex left-hand movements. Previous findings indicated successful relateralization. Objective The current study was designed to ascertain whether the shift was attributable to the left-hand movement. Methods Using stratified random sampling, 14 subjects were equally divided between Intention (IT) and Control (CT) treatments. CT was identical to IT, except with no left-hand movements. Both treatments trained picture naming (phases 1 and 2) and category-member generation (phase 3), each phase lasting 10 sessions. Functional magnetic resonance imaging of category member generation occurred at pretreatment, posttreatment, and 3-month follow-up. Results IT shifted lateral frontal activity rightward compared with pretreatment both at posttreatment (t = -2.602, df = 6, P < .05) and 3-month follow-up (t = -2.332, df = 5, P < .05), but CT did not. IT and CT yielded similar changes for all picture-naming and category probes. However, IT patients showed gains for untrained category (t = 3.33, df = 6, P < .01) and picture-naming probes (t = 3.77, df = 5, P < .01), but CT patients did not. Conclusions The rightward shift in lateral frontal activity for IT was because of the left-hand movements. IT evoked greater generalization than CT.

First decade of research on constrained-induced treatment approaches for aphasia rehabilitation.

Approaches for treating poststroke language impairments (aphasia) based on constraint-induced (CI) principles were first introduced in 2001. CI principles as previously applied to upper extremity and locomotor retraining in stroke survivors were derived from basic neuroscience. They comprise forced-use of the affected modality, a gradual rebuilding of targeted functions using a highly intensive treatment protocol, administered in a behaviorally relevant context. CI-based approaches have stimulated considerable neurorehabilitation research interest in the past decade. The original CI aphasia treatment protocol was tailored to improve functional communication in chronic aphasia (ie, 6-12mo after stroke) and more recently, it has been adapted to treat language impairments in acute stroke survivors as well. Moreover, CI therapy applied to aphasia has been used as a model to assess language network plasticity in response to treatment using functional imaging techniques. In the following article, we review the first 10 years of behavioral and functional brain imaging research on CI-based approaches for aphasia rehabilitation.

Development of a short form of the Boston naming test for individuals with aphasia.

PURPOSE: The purpose of this study was to develop a short form of the Boston Naming Test (BNT; Kaplan, Goodglass, & Weintraub, 2001) for individuals with aphasia and compare it with 2 existing short forms originally analyzed with responses from people with dementia and neurologically healthy adults. METHOD: Development of the new BNT-Aphasia Short Form and analysis of the other 2 forms were completed with archival data from 100 individuals with aphasia. The authors developed the BNT-Aphasia Short Form using items from the original 60-item instrument based on item response theory. Rasch analysis was computed on the short forms developed by Graves, Bezeau, Fogarty, and Blair (2004) and by Mack, Freed, Williams, and Henderson (1992). RESULTS: Analysis of the Graves et al. (2004) short form resulted in the smallest range of item difficulty and the largest floor effect compared with the Mack et al. (1992) short form and the BNT-Aphasia short form. The BNT-Aphasia Short Form showed an increase in information in the middle of the scale relative to both the Graves et al. and the Mack et al. forms. CONCLUSIONS: The new short form demonstrates good psychometric properties when used with individuals with aphasia. However, the Mack et al. form proved to be as psychometrically sound as the BNT-Aphasia Short Form and is also appropriate for individuals with aphasia.

Sensory-spatial transformations in the left posterior parietal cortex may contribute to reach timing.

The posterior parietal cortex (PPC) contains viewer-centered spatial maps important for reaching movements. It is known that spatial reaching deficits emerge when this region is damaged, yet less is known about temporal deficits that may also emerge because of a failure in sensory-spatial transformations. This work introduces a new geometric measure to quantify multimodal sensory transformation and integration deficits affecting the tempo of reaching trajectories that are induced by injury to the left PPC. Erratic rates of positional change involving faulty maps from rotational angular displacements to translational linear displacements contributed to temporal abnormalities in the reach. Such disruptions were quantified with a time-invariant geometric measure. This measure, paired with an experimental paradigm that manipulated the source of visual guidance for reaches, was used to compare the performance of normal controls to those from a patient (T.R.) who had a lesion in his left-PPC. For controls, the source of visual guidance significantly scaled the tempo of target-directed reaches but did not change the geometric measure. This was not the case in patient T.R., who altered this measure. With continuous, extrapersonal visual feedback of the target, however, these abnormalities improved. Vision of the target rather than vision of his moving hand also improved his arm-joint rotations for posture control. These results show that the left PPC is critically important for visuo-motor transformations that specifically rely on extrapersonal cues to align rotational-arm and linear-hand displacements and to continuously integrate their rates of change. The intactness of this system contributes to the fluidity of the reach's tempo.

Florida Apraxia Battery-Extended and revised Sydney (FABERS): design, description, and a healthy control sample.

There exist few clinical assessments for limb apraxia, a disorder of learned, purposeful action, that enable clinicians to distinguish pathological from normal variance in limb praxis performance. We describe a theoretically motivated, comprehensive assessment battery for limb apraxia and present control comparison scores for 16 older healthy normal individuals on subtests designed to distinguish the integrity of components of the praxis system.

Phoneme-based rehabilitation of anomia in aphasia.

This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed that if treatment were directed at the level of the phonologic processor, opportunities for naming via a phonological route, as opposed to a strictly whole word route, would be enhanced, thereby improving naming. The participants, ten people with anomia and aphasia due to left hemisphere stroke, received 96 h of phoneme based treatment in 12 weeks. To learn if treatment improved naming, a single-subject, repeated probe design with replication was employed. The primary outcome measure was confrontation naming. Secondary outcome measures included phonologic production, nonword repetition and discourse production. Results suggest a positive treatment effect (confrontation naming), improvements in phonologic production and nonword repetition, and generalization to discourse production. When tested 3 months after the completion of treatment the effects appeared to be maintained.

Treatment of limb apraxia: moving forward to improved action.

Limb apraxia is a common disorder of skilled, purposive movement that is frequently associated with stroke and degenerative diseases such as Alzheimer disease. Despite evidence that several types of limb apraxia significantly impact functional abilities, surprisingly few studies have focused on development of treatment paradigms. Additionally, although the most disabling types of apraxia reflect damage to gesture and/or object memory systems, existing treatments have not fully taken advantage of principles of experience known to affect learning and neural plasticity. We review the current state of the art in the rehabilitation of limb apraxia, indicate possible points of contact with the learning literature, and generate suggestions for how translational principles might be applied to the development of future research on treatment of this disabling disorder.

Neuroplasticity and rehabilitation research for speech, language, and swallowing disorders.

PURPOSE: This article introduces a collection of consensus statements regarding the application of neuroplasticity principles to rehabilitation of dysphagia, dysarthria, apraxia, and aphasia.

Translational research in aphasia: from neuroscience to neurorehabilitation.

PURPOSE: In this article, the authors encapsulate discussions of the Language Work Group that took place as part of the Workshop in Plasticity/NeuroRehabilitation Research at the University of Florida in April 2005. METHOD: In this narrative review, they define neuroplasticity and review studies that demonstrate neural changes associated with aphasia recovery and treatment. The authors then summarize basic science evidence from animals, human cognition, and computational neuroscience that is relevant to aphasia treatment research. They then turn to the aphasia treatment literature in which evidence exists to support several of the neuroscience principles. CONCLUSION: Despite the extant aphasia treatment literature, many questions remain regarding how neuroscience principles can be manipulated to maximize aphasia recovery and treatment. They propose a framework, incorporating some of these principles, that may serve as a potential roadmap for future investigations of aphasia treatment and recovery. In addition to translational investigations from basic to clinical science, the authors propose several areas in which translation can occur from clinical to basic science to contribute to the fundamental knowledge base of neurorehabilitation. This article is intended to reinvigorate interest in delineating the factors influencing successful recovery from aphasia through basic, translational, and clinical research.

Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: an exploratory randomized controlled trial.

OBJECTIVE: To test the potential adjuvant effect of repetitive transcranial magnetic stimulation (rTMS) on motor learning in a group of stroke survivors undergoing constraint-induced therapy (CIT) for upper-limb hemiparesis. DESIGN: This was a prospective randomized, double-blind, sham-controlled, parallel group study. Nineteen individuals, one or more years poststroke, were randomized to either a rTMS + CIT (n = 9) or a sham rTMS + CIT (n = 10) group and participated in the 2-wk intervention. RESULTS: Regardless of group assignment, participants demonstrated significant gains on the primary outcome measures: the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL)--Amount of Use, and on secondary outcome measures including the Box and Block Test (BBT) and the MAL--How Well. Participants receiving rTMS failed to show differential improvement on either primary outcome measure. CONCLUSIONS: Although this study provided further evidence that even relatively brief sessions of CIT can have a substantial effect, it provided no support for adjuvant use of rTMS.

Treatment of word-finding deficits in fluent aphasia through the manipulation of spatial attention: Preliminary findings.

BACKGROUND: Attention, the processing of one source of information to the exclusion of others, is important for most cognitive processes, including language. Evidence suggests not only that dysfunctional attention mechanisms contribute to language deficits after stroke, but also that orienting attention to a patient's ipsilesional hemispace recruits attention mechanisms in the intact hemisphere and improves language functions in some persons with aphasia. AIMS: The aim of the current research was to offer proof of concept for the strategy of improving picture-naming performance in fluent aphasia by moving stimuli into the left hemispace. It was hypothesised that repeated orientation of attention to the ipsilesional hemispace during picture naming would lead to improved naming accuracy for participants with fluent aphasia. METHODS #ENTITYSTARTX00026; PROCEDURES: Three participants with stable fluent aphasia received daily treatment sessions that consisted of naming simple line drawings presented 45 degrees to the left of body midline on a computer monitor. Naming probes were administered before initiation of the treatment protocol to establish a baseline, and before each treatment session to measure change during treatment. The C statistic was used to establish the stability of baseline performance and to determine whether the slope of the treatment phases differed significantly from the slope of the baseline. OUTCOMES #ENTITYSTARTX00026; RESULTS: Two of the three participants showed significant improvement over baseline performance in the percent correct of naming probes. One participant showed no improvement over baseline accuracy. CONCLUSIONS: Results suggest that engaging right-hemisphere attention mechanisms may improve naming accuracy in some people with fluent aphasia. Findings justify further investigation of this treatment in a larger controlled study.

Limited dose response to constraint-induced movement therapy in patients with chronic stroke.

OBJECTIVE: To compare outcomes in motor skill, perceived amount of use and ability of the paretic arm in daily activities between traditional Constraint-Induced Movement Therapy, consisting of 6 hours of in-clinic, therapist-guided task practice, and a shortened Constraint-Induced Movement Therapy, consisting of 1 hour of in clinic, therapist-guided task practice coupled with 5 hours of unsupervised practice at home. DESIGN: A secondary analysis of two previous randomized, controlled, double-blind, parallel group studies. SETTING: A research clinic. PARTICIPANTS: Thirty-nine individuals with hemiparesis from a chronic unilateral stroke who were able to extend the wrist 10 degrees and the fingers and thumb 10 degrees from a flexed position and were participants in one of the two studies examining the efficacy of adding neuroplasticity adjuvants to Constraint-Induced Movement Therapy. MAIN OUTCOME MEASURES: The Wolf Motor Function Test was used to assess motor skill and the Motor Activity Log amount of use and quality of movement scales were used to assess perceived amount of use and ability respectively. INTERVENTIONS: Constraint-Induced Movement Therapy plus donepezil in the CIMT-6 study (the traditional 6 hours of in-clinic task practice) and Constraint-Induced Movement Therapy plus repetitive transcranial magnetic stimulation in the CIMT-1 study (1 hour of in-clinic task practice). RESULTS: Motor skill gains after two weeks of therapy were equivalent for both groups (n=39; mean difference=2.81, P>0.22), but gains were not maintained six months later with either intervention protocol. Despite this, participants in the CIMT-6 group reported greater use (mean difference=1.52, P<0.001) and movement quality (mean difference=0.95, P<0.004) than those with less therapist-guided practice. Both groups had regressed somewhat in use and ability at the six-month follow-up. CONCLUSION: These results suggest that 6 hours of therapist-guided practice may not be necessary to facilitate motor skill gains, but may influence patterns of use.