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.

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.

The Effects of Yoga Breathing Before Motor Speech Practice in Acquired Apraxia of Speech: An n-of-1 Trial.

A previous study discovered that two speakers with moderate apraxia of speech increased their sequential motion rates after unilateral forced-nostril breathing (UFNB) practiced as an adjunct to speech-language therapy in an AB repeated-measures design. The current study sought to: (1) delineate possible UFNB plus practice effects from practice effects alone in motor speech skills; (2) examine the relationships between UFNB integrity, participant-reported stress levels, and motor speech performance; and (3) sample a participant-led UFNB training schedule to contribute to the literature's growing understanding of UFNB dosage. A single-subject (n-of-1 trial), ABAB reversal design was used across four motor speech behaviors. A 60-year-old female with chronic, severe apraxia of speech participated. The researchers developed a breathing app to assess UFNB practice integrity and administer the Simple Aphasia Stress Scale after each UFNB session. The participant improved from overall severe to moderate apraxia of speech on the Apraxia Battery for Adults. Visual inspection of graphs confirmed robust motor speech practice effects for all variables. Articulatory-kinematic variables demonstrated sensitivity to the UFNB-plus-practice condition and correlated to stress scale scores but not UFNB integrity scores. The participant achieved 20-minute UFNB sessions 4 times per week. Removal of UFNB during A2 (UFNB withdrawal) and after a 10-day break during B2 (UFNB full dosage) revealed UFNB practice effects on stress scale scores. UFNB with motor speech practice may benefit articulatory-kinematic skills compared to motor speech practice alone. Regular, cumulative UFNB practice appeared to lower self-perceived stress levels. These findings, along with prior work, provide a foundation to further explore yoga breathing and its use with speakers who have apraxia of speech.

Effects of mindfulness meditation on three individuals with aphasia.

BACKGROUND: There is evidence to suggest that people with aphasia (PWA) may have deficits in attention stemming from the inefficient allocation of resources. The inaccurate perception of task demand, or sense of effort, may underlie the misallocation of the available attention resources. Given the lack of treatment options for improving attention in aphasia, Mindfulness Meditation, shown to improve attention in neurologically intact individuals, may prove effective in increasing attention in PWA. AIMS: The purpose of the present study was to determine if Mindfulness Meditation improves divided attention or language in PWA and if it affects the overall sense of effort. METHODS & PROCEDURES: A multiple baseline single-subject design was used to determine the effects of Mindfulness Meditation on divided attention for three PWA. Divided attention was measured using a non-linguistic divided attention task. Visual inspection of the data was used to determine changes in performance (sense of effort, reaction time and accuracy, language) over time. OUTCOMES & RESULTS: High performance observed on the attention measures suggests that PWA have varying degrees of attentional impairment that may surface when certain demands are presented. There were no observable changes in the performance on the sense of effort or language measures; however, measures of reaction time may indicate Mindfulness Meditation improved efficiency of task completion. CONCLUSIONS & IMPLICATIONS: All three participants reported that Mindfulness Meditation was easy to learn and carry out on a daily basis, and reported feeling more 'relaxed' and 'peaceful' after Mindfulness Meditation training than before. With the knowledge that PWA can learn meditative practices, and with such successful findings in neurologically intact individuals, it is important to continue evaluating the benefits of Mindfulness Meditation in PWA.

Performance differences between aphasia and healthy aging on an executive function test battery.

Purpose: Executive function (EF) deficits commonly co-occur with other linguistic and non-linguistic deficits in aphasia. The questions about whether, and to what extent, people with aphasia (PWA) present deficits on different executive functions (EFs) is relatively understudied.Method: In this study, four EFs, set-switching, updating, inhibition, and dual task processing were evaluated in aphasia and healthy groups. Three groups of participants: 30 healthy young, 30 healthy old, and 10 PWA were assessed on four tasks, Colour Trails Test (CTT 1 and 2), Conners' Continuous Performance Test II (CPT II), n-back (1- and 2-back), and divided attention task that tapped into different EFs. In order to examine performance differences on the EF tasks between the participant groups, repeated measures and multivariate analysis of variances with follow-up pairwise comparisons were computed. Pearson product-moment correlations were conducted to evaluate the strength and direction of the association between aphasia severity (on Western Aphasia Battery-Revised) and executive functioning.Result: PWA demonstrated significantly diminished performance on all EF tasks in comparison to healthy groups and differences were distinct on the higher-level complexity tasks such as the 2-back and CTT 2. The healthy older group demonstrated elevated response times on the CTT, CPT II, and divided attention tasks, and decreased sensitivity scores on the CPT II and n-back in comparison to the younger group. Also, aphasia severity correlated with reduced performance on selective EF measures.Conclusion: This study emphasises the importance of investigating EF deficits in PWA and its potential relationship to language behaviour. Understanding EF is critical for comprehension of linguistic and non-linguistic deficits and in planning treatment for PWA.

RELEASE: a protocol for a systematic review based, individual participant data, meta- and network meta-analysis, of complex speech-language therapy interventions for stroke-related aphasia.

Background: Speech and language therapy (SLT) benefits people with aphasia following stroke. Group level summary statistics from randomised controlled trials hinder exploration of highly complex SLT interventions and a clinically relevant heterogeneous population. Creating a database of individual participant data (IPD) for people with aphasia aims to allow exploration of individual and therapy-related predictors of recovery and prognosis. Aim: To explore the contribution that individual participant characteristics (including stroke and aphasia profiles) and SLT intervention components make to language recovery following stroke. Methods and procedures: We will identify eligible IPD datasets (including randomised controlled trials, non-randomised comparison studies, observational studies and registries) and invite their contribution to the database. Where possible, we will use meta- and network meta-analysis to explore language performance after stroke and predictors of recovery as it relates to participants who had no SLT, historical SLT or SLT in the primary research study. We will also examine the components of effective SLT interventions. Outcomes and results: Outcomes include changes in measures of functional communication, overall severity of language impairment, auditory comprehension, spoken language (including naming), reading and writing from baseline. Data captured on assessment tools will be collated and transformed to a standardised measure for each of the outcome domains. Conclusion: Our planned systematic-review-based IPD meta- and network meta-analysis is a large scale, international, multidisciplinary and methodologically complex endeavour. It will enable hypotheses to be generated and tested to optimise and inform development of interventions for people with aphasia after stroke. Systematic review registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018110947).

Integrative intervention: a new perspective and brief review in aphasia.

PURPOSE: While integrative treatment practices have become a popular treatment in different areas of study, its use in the field of aphasiology is still limited. The following paper is an attempt to address the different alternative practices that could potentially be used to remediate aphasia. METHOD: A narrative review was completed regarding integrative intervention that could potentially apply to aphasia population. RESULTS: Through this article we have explored various treatment options for integrative health care in aphasiology. Integrative treatments including brain specific antioxidants, progesterone and estradiol therapy, nutrition, synbiotic treatment, exercise, yoga, meditation and positive mood states have demonstrated positive changes in health and behavior in healthy aging or disorders such as stroke and aphasia. Offering integrative treatment for people with aphasia allows potential for high impact gains when combined with current speech language therapeutic practices. CONCLUSION: This paper highlights the rehabilitation possibilities for aphasia therapy. Combining complementary and traditional treatment approaches could be viewed as one of the contemporary approaches to clinical practice and research for practitioners and health care systems. Implications for Rehabilitation There has been very little research that explores the potential of various types of integrative treatment for individuals with aphasia. An integrative approach to the treatment of aphasia has potential for future clinical application. Combining treatment approaches could be viewed as a viable approach to clinical practice and in the health care system.

Mindfulness meditation in aphasia: A case report.

BACKGROUND: Despite the potential behavioral and neurological benefits of Mindfulness Meditation (MM), its use in treating stroke related communication disabilities appears to be underexplored. Specifically, aphasia, a language disorder resulting from stroke, may be amenable to the benefits of MM because of the observed attention problems often underlying the language symptoms. OBJECTIVE: The current paper presents a case report of an adult with aphasia who was trained in MM. METHOD: An adult with aphasia completed a five-day mindfulness training, and was assessed on measures of language, attention, and physiological measures of cortisol and heart rate variability. She completed four assessments: two baseline measures, immediately post training, and one week post training (maintenance). RESULTS: Overall, changes were observed in both psychophysiological measures (heart rate and heart rate variability) and behavioral measures (word productivity, phrase length, word generation, decreased impulsivity, and increased attention). CONCLUSION: Given the psychophysiological and behavioral changes observed in this individual, further exploration of the influence of MM in the treatment of post-stroke aphasia is warranted.

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.

Exploring the benefits of unilateral nostril breathing practice post-stroke: attention, language, spatial abilities, depression, and anxiety.

OBJECTIVE: Unilateral nostril breathing (UNB) is a yogic pranayama technique that has been shown to improve verbal and spatial cognition in neurologically intact individuals. Early study of UNB in healthy individuals has shown benefits for attention and memory. This preliminary study explored whether UNB influenced various measures of attention, language, spatial abilities, depression, and anxiety in post-stroke individuals, both with and without aphasia. DESIGN: A within-subjects repeated-measures design was used to determine whether UNB improved cognitive, linguistic, and affect variables in post-stroke individuals. Within-subjects comparisons determined UNB's effects over time, and between-subjects comparison was used to determine whether changes in these variables differed between post-stroke individuals with and without aphasia. SETTING: Athens and Atlanta, Georgia. PARTICIPANTS: Eleven post-stroke individuals participated in a 10-week UNB program. Five individuals had stroke-induced left hemisphere damage with no diagnosis of aphasia (left hemisphere damage control group; LHD), and six individuals experienced left hemisphere damage with a diagnosis of aphasia (individuals with aphasia group; IWA). MEASURES: Individuals were assessed on measures of attention, language, spatial abilities, depression, and anxiety before, during, and after UNB treatment. RESULTS: UNB significantly decreased levels of anxiety for individuals in both groups. Performance on language measures increased for the individuals with aphasia. CONCLUSIONS: Significant findings for language and affect measures indicate that further investigation regarding duration of UNB treatment and use of UNB treatment alongside traditional speech-language therapy in post-stroke individuals is warranted.

Further evidence of auditory extinction in aphasia.

PURPOSE: Preliminary research (Shisler, 2005) suggests that auditory extinction in individuals with aphasia (IWA) may be connected to binding and attention. In this study, the authors expanded on previous findings on auditory extinction to determine the source of extinction deficits in IWA. METHOD: Seventeen IWA (M(age) = 53.19 years) and 17 neurologically intact controls (M(age) = 55.18 years) participated. Auditory stimuli were spoken letters presented in a free-field listening environment. Stimuli were presented in single-stimulus stimulation (SSS) or double-simultaneous stimulation (DSS) trials across 5 conditions designed to determine whether extinction is related to binding, inefficient attention resource allocation, or overall deficits in attention. All participants completed all experimental conditions. RESULTS: Significant extinction was demonstrated only by IWA when sounds were different, providing further evidence of auditory extinction. However, binding requirements did not appear to influence the IWA's performance. CONCLUSIONS: Results indicate that, for IWA, auditory extinction may not be attributed to a binding deficit or inefficient attention resource allocation because of equivalent performance across all 5 conditions. Rather, overall attentional resources may be influential. Future research in aphasia should explore the effect of the stimulus presentation in addition to the continued study of attention treatment.

Performance of Individuals with Left-Hemisphere Stroke and Aphasia and Individuals with Right Brain Damage on Forward and Backward Digit Span Tasks.

BACKGROUND: Working memory (WM) limitations have been suggested as a significant source of the linguistic processing deficits observed in individuals with aphasia (IWA). Digits forward (DF) and digits backward (DB) span tasks are frequently used to study WM in both healthy and clinical populations. Unfortunately, only a handful of studies have explored digit span in IWA. AIMS: The purpose of the current study is to measure the DF and DB spans of IWA and compare their digit spans to a group with right brain damage, but no aphasia (RBD). Additionally, DF and DB span is compared within each group to determine if there is indeed a performance differential that may support the idea that DB is a more difficult WM task in these populations. METHODS AND PROCEDURES: Seventeen IWA and 14 individuals with RBD participated in a DF and DB span task. Modifications to the span tasks were implemented to accommodate language deficits. A series of two digits were orally presented to each participant continuing to a maximum of eight digits. There were seven trials per digit series. Participants were asked to point to the correct order of digits on a written 1-9 digit list provided on individual note cards or verbally repeat the numbers if the participant was able to do so. OUTCOMES AND RESULTS: IWA demonstrated shorter digit spans than the RBD group. Both groups performed worse on the DB span tasks than the DF span tasks. CONCLUSIONS: The results are consistent with previous studies suggesting that DB span is shorter than DF span in other populations and that there are differences in performance on digit span tasks between the two groups. The differences between RBD group and IWA may be explained by decreased attentional capacity or inefficient resource allocation in IWA, or alternatively, a deficient phonological loop. Future studies should explore these possibilities.