A targeted review of prosodic production in agrammatic aphasia.

It is unclear whether individuals with agrammatic aphasia have particularly disrupted prosody, or in fact have relatively preserved prosody they can use in a compensatory way. A targeted literature review was undertaken to examine the evidence regarding the capacity of speakers with agrammatic aphasia to produce prosody. The aim was to answer the question, how much prosody can a speaker "do" with limited syntax? The literature was systematically searched for articles examining the production of grammatical prosody in people with agrammatism, and yielded 16 studies that were ultimately included in this review. Participant inclusion criteria, spoken language tasks, and analysis procedures vary widely across studies. The evidence indicates that timing aspects of prosody are disrupted in people with agrammatic aphasia, while the use of pitch and amplitude cues is more likely to be preserved in this population. Some, but not all, of these timing differences may be attributable to motor speech programming deficits (AOS) rather than aphasia, as these conditions frequently co-occur. Many of the included studies do not address AOS and its possible role in any observed effects. Finally, the available evidence indicates that even speakers with severe aphasia show a degree of preserved prosody in functional communication.

The Effect of Prosodic Timing Structure on Unison Production in People With Aphasia.

PURPOSE: Unison production is a common aphasia treatment technique in which the clinician and the person with aphasia (PWA) produce phrases aloud together. It can be implemented using a typical "conversational," syntax-influenced prosodic timing structure, or with a "metrical," beat-based timing structure, but to date no study has directly compared these two approaches. This study compared the effects of metrical versus conversational prosodic timing during unison production on the (a) accuracy of participants' spoken output and (b) timing alignment of participants' productions with the stimuli. METHOD: PWAs and controls listened to conversationally timed and metrically timed sentences and repeated them in unison with audio recordings. Productions were transcribed and scored in two ways: (a) Accuracy was calculated as the percentage of correctly produced syllables, and (b) timing alignment was determined by extracting the voice onset moment of identical target syllables in the unison stimuli and participant productions in both conditions and comparing the corresponding time points. RESULTS: Metrical timing yielded a greater number of accurate syllables in both groups, with larger effect in PWAs than in controls. Both groups exhibited more anticipatory, less variable timing when speaking along with metrical stimuli, though evidence of such prediction was also present in the conversational condition. CONCLUSIONS: Results suggest that unison production works via entrainment-a process that utilizes prediction to guide synchronous production of spoken output. Metrically regular stimuli may facilitate this process as they are more rhythmically predictable. Future work will examine key behavioral variables that predict benefit from unison production and metrical timing.

Get in Sync: Active Ingredients and Patient Profiles in Scripted-Sentence Learning in Spanish Speakers With Aphasia.

PURPOSE: Script training is a well-established treatment for aphasia, but its evidence comes almost exclusively from monolingual English speakers with aphasia. Furthermore, its active ingredients and profiles of people with aphasia (PWA) that respond to this treatment remain understudied. This study aimed to adapt a scripted-sentence learning protocol to Colombian Spanish speakers with aphasia, investigate speech entrainment (i.e., unison production of sentences) as an active ingredient for scripted-sentence learning, and identify patient profiles associated with better scripted-sentence learning. METHOD: Fourteen monolingual Spanish speakers with aphasia learned a set of 30 sentences. To examine speech entrainment as an active ingredient for scripted-sentence learning, we investigated whether sentences containing externally added rhythmic cues (involving stress-aligned vs. metronomic rhythmic cues) would result in better scripted-sentence learning compared with control sentences. Learning was measured via postsession probes and analyzed using mixed-effects logistic regression models. The relationship between scripted-sentence learning and baseline language and rhythmic processing measures was also examined. RESULTS: Significant scripted-sentence learning over time indicated a successful adaptation of a script-training protocol to Spanish. PWA learned significantly more scripted sentences in the rhythmically enhanced conditions compared with the control condition. There were no differences between rhythmically enhanced conditions (stress-aligned vs. metronomic). In terms of patient profiles, it was found that PWA with more severe aphasia demonstrated larger learning gains, but rhythmic processing showed little association with learning estimates. CONCLUSIONS: To our knowledge, this study provides the first adaptation of a scripted-sentence learning protocol for monolingual Spanish speakers with aphasia, demonstrating cross-linguistic benefits of script training interventions. Highlighting rhythmic features during speech entrainment facilitated scripted-sentence learning in Spanish speakers with aphasia, suggesting that speech entrainment may be an active ingredient for scripted-sentence learning. More severe aphasia was associated with better scripted-sentence learning, suggesting that more severely impaired individuals are likely to benefit most from this treatment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19241847.

Do caregiver proxy reports and congruence of client-proxy activity participation goals relate to quality of life in people with aphasia?

BACKGROUND: Achieving activity participation goals is a key factor in quality of life (QOL) for people with aphasia (PWA), but expressing participation goals can be difficult for many of them. Proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, and discrepancies in these goals between PWA and their caregivers may affect QOL, based on the assumption that caregivers' awareness of their loved ones' unique participation goals may be important to increasing PWA activity participation. AIMS: To examine everyday activities valued by PWA using the Life Interests and Values (LIV) Cards; to measure congruence between PWA and their caregivers on life participation goals; and to measure how congruence of PWA-caregiver participation goals related to QOL. METHODS & PROCEDURES: A convenience sample of 25 PWA completed the LIV Card assessment and the Stroke Aphasia Quality of Life Scale-39 to assess participation goals and QOL. Participation goals were also evaluated with respect to age, time post-onset and aphasia severity. A total of 12 caregivers were administered the LIV Cards to calculate agreement between PWA-proxy activity reports and the relationship between agreement and QOL. OUTCOMES & RESULTS: PWA endorsed wanting to participate more in a wide range of activities, with common interests in walking/running, going to the beach and eating out, among others. PWA-caregiver activity agreement was fair to moderate with point-to-point agreement averaging 70%. However, no relationship between degree of congruence in PWA-proxy pairs and QOL was found. CONCLUSIONS & IMPLICATIONS: PWA have a variety of activity participation goals that can be integrated into intervention plans. Dependence on proxy respondents should be reduced as much as possible to support self-determination for PWA. What this paper adds What is already known on the subject Achieving activity participation goals is a key factor in QOL for PWA, but communicating about participation goals can be difficult for many of them. Because proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, this study examined how both PWA and their caregivers responded to an aphasia-friendly assessment for determining participation goals, and then compared level of agreement about these goals to QOL. Because activity participation is known to be an important factor in QOL, the reason for investigating how agreement relates to QOL is that caregivers' awareness of their loved ones' unique participation goals likely facilitates increased participation by PWA in their ongoing desired activities. The relationship between PWA-caregiver agreement regarding participation goals and QOL in PWA had not yet been investigated before this study. What this paper adds to existing knowledge This study adds additional as well as confirmatory information to the existing literature about life participation goals of community-dwelling individuals with chronic aphasia. Top activities endorsed by a group of 25 PWA are reported within four activity domains (home and community activities, creative and relaxing activities, physical activities, and social activities). Results indicated that agreement between PWA and their caregiver proxies on PWA's most desired activities was < 50%. However, the level of agreement between caregivers and proxies on participation goals was not significantly related to QOL in this sample. What are the potential or actual clinical implications of this work? PWA have a variety of participation goals that can be integrated into intervention plans to be carried out with clinicians, caregivers and family members. The use of proxy respondents when determining participation goals should be reduced as much as possible to support self-determination for PWA. Use of the LIV Cards, a picture-based sorting-task assessment, reduces the need for proxy responders and guesswork about the specific participation goals of PWA.

Factors Affecting Voice Therapy Completion in Singers.

OBJECTIVE: The purpose of this study was to determine (a) which factors may affect singers' completing voice therapy, and (b) develop predictive profiles to capture those singers at risk for dropping out of voice therapy. STUDY DESIGN: A case-control study was conducted comparing singers who completed voice therapy to singers who dropped out of voice therapy. METHODS: Six factors, including age, gender, diagnosis, length of time between laryngology referral and commencement of therapy, type of singer, and referral source were investigated in relation to voice therapy completion using the medical records of 409 singers in the Massachusetts General Hospital Voice Center database. RESULTS: Referral source and type of singer were demonstrated to be the most robust predictor of singers' completion of therapy. CONCLUSIONS: Forty-seven percent of singers who were referred to voice therapy completed their course of treatment. Sixty percent of singers who dropped out of voice therapy were reliably identified based on what types of music they sing (type of singer) and who referred them for laryngology evaluation (referral source), aiding in early identification of those singers who may need additional support to reach their therapy goals. Identifying specific characteristics of singers completing or dropping out of voice therapy may allow medical professionals to better serve the specialized needs of singers who use their voices professionally and recreationally.

Tapped out: do people with aphasia have rhythm processing deficits?

PURPOSE: In this study, the authors tested whether people with aphasia (PWAs) show an impaired ability to process rhythm, both in terms of perception and production. METHOD: Two experiments were conducted. In Experiment 1, 16 PWAs and 15 age-matched control participants performed 3 rhythm tasks: tapping along to short rhythms, tapping these same rhythms from memory immediately after presentation, and making same-different judgments about pairs of tapped rhythms that they heard. Comparison tasks measured same-different judgment ability with visual stimuli and nonverbal working memory (Corsi blocks). In Experiment 2, 14 PWAs and 16 control participants made same-different judgments for pairs of auditory stimuli that differed in terms of rhythm or pitch (for comparison). RESULTS: In Experiment 1, PWAs performed worse than control participants across most measures of rhythm processing. In contrast, PWAs and control participants did not differ in their performance on the comparison tasks. In Experiment 2, the PWAs performed worse than control participants across all conditions but with a more marked deficit in stimulus pairs that differed in rhythm than in those that differed in pitch. CONCLUSIONS: The results support the hypothesis that at least some PWAs exhibit deficits of rhythm and timing. This may have implications for treatments involving tapping or other rhythmic cues.

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.

Auditory-motor mapping training as an intervention to facilitate speech output in non-verbal children with autism: a proof of concept study.

Although up to 25% of children with autism are non-verbal, there are very few interventions that can reliably produce significant improvements in speech output. Recently, a novel intervention called Auditory-Motor Mapping Training (AMMT) has been developed, which aims to promote speech production directly by training the association between sounds and articulatory actions using intonation and bimanual motor activities. AMMT capitalizes on the inherent musical strengths of children with autism, and offers activities that they intrinsically enjoy. It also engages and potentially stimulates a network of brain regions that may be dysfunctional in autism. Here, we report an initial efficacy study to provide 'proof of concept' for AMMT. Six non-verbal children with autism participated. Prior to treatment, the children had no intelligible words. They each received 40 individual sessions of AMMT 5 times per week, over an 8-week period. Probe assessments were conducted periodically during baseline, therapy, and follow-up sessions. After therapy, all children showed significant improvements in their ability to articulate words and phrases, with generalization to items that were not practiced during therapy sessions. Because these children had no or minimal vocal output prior to treatment, the acquisition of speech sounds and word approximations through AMMT represents a critical step in expressive language development in children with autism.

A MEG investigation of single-word auditory comprehension in aphasia.

PURPOSE: To explore whether individuals with aphasia exhibit differences in the M350, an electrophysiological marker of lexical activation, compared with healthy controls. METHOD: Seven people with aphasia, 9 age-matched controls, and 10 younger controls completed an auditory lexical decision task while cortical activity was recorded with magnetoencephalography. There were 2 stimulus conditions of interest: identity primed (i.e., a word preceded by itself) and semantic primed (i.e., a word preceded by a semantically related word). Latency and amplitude of the M350 response as well as reaction time were measured. RESULTS: Consistent with the age-matched control group, the group with aphasia showed both identity and semantic priming behaviorally. In contrast to the control groups, the group with aphasia did not show either semantic or identity priming of the M350 response. This group also demonstrated longer M350 latencies than either control group. Furthermore, within this group, M350 latency was positively correlated with a measure of semantic impairment. CONCLUSIONS: These findings highlight the usefulness of temporally sensitive measures when studying aphasia and demonstrate that the latency of electrophysiological markers is of interest in this population. In particular, increased M350 latency appears to be indicative of a semantic processing impairment.

Impairment of speech production predicted by lesion load of the left arcuate fasciculus.

BACKGROUND AND PURPOSE: Previous studies have suggested that patients' potential for poststroke language recovery is related to lesion size; however, lesion location may also be of importance, particularly when fiber tracts that are critical to the sensorimotor mapping of sounds for articulation (eg, the arcuate fasciculus) have been damaged. In this study, we tested the hypothesis that lesion loads of the arcuate fasciculus (ie, volume of arcuate fasciculus that is affected by a patient's lesion) and of 2 other tracts involved in language processing (the extreme capsule and the uncinate fasciculus) are inversely related to the severity of speech production impairments in patients with stroke with aphasia. METHODS: Thirty patients with chronic stroke with residual impairments in speech production underwent high-resolution anatomic MRI and a battery of cognitive and language tests. Impairment was assessed using 3 functional measures of spontaneous speech (eg, rate, informativeness, and overall efficiency) as well as naming ability. To quantitatively analyze the relationship between impairment scores and lesion load along the 3 fiber tracts, we calculated tract-lesion overlap volumes for each patient using probabilistic maps of the tracts derived from diffusion tensor images of 10 age-matched healthy subjects. RESULTS: Regression analyses showed that arcuate fasciculus lesion load, but not extreme capsule or uncinate fasciculus lesion load or overall lesion size, significantly predicted rate, informativeness, and overall efficiency of speech as well as naming ability. CONCLUSIONS: A new variable, arcuate fasciculus lesion load, complements established voxel-based lesion mapping techniques and, in the future, may potentially be used to estimate impairment and recovery potential after stroke and refine inclusion criteria for experimental rehabilitation programs.

From music making to speaking: engaging the mirror neuron system in autism.

Individuals with autism show impairments in emotional tuning, social interactions and communication. These are functions that have been attributed to the putative human mirror neuron system (MNS), which contains neurons that respond to the actions of self and others. It has been proposed that a dysfunction of that system underlies some of the characteristics of autism. Here, we review behavioral and imaging studies that implicate the MNS (or a brain network with similar functions) in sensory-motor integration and speech representation, and review data supporting the hypothesis that MNS activity could be abnormal in autism. In addition, we propose that an intervention designed to engage brain regions that overlap with the MNS may have significant clinical potential. We argue that this engagement could be achieved through forms of music making. Music making with others (e.g., playing instruments or singing) is a multi-modal activity that has been shown to engage brain regions that largely overlap with the human MNS. Furthermore, many children with autism thoroughly enjoy participating in musical activities. Such activities may enhance their ability to focus and interact with others, thereby fostering the development of communication and social skills. Thus, interventions incorporating methods of music making may offer a promising approach for facilitating expressive language in otherwise nonverbal children with autism.

From singing to speaking: facilitating recovery from nonfluent aphasia.

It has been reported for more than 100 years that patients with severe nonfluent aphasia are better at singing lyrics than they are at speaking the same words. This observation led to the development of melodic intonation therapy (MIT). However, the efficacy of this therapy has yet to be substantiated in a randomized controlled trial. Furthermore, its underlying neural mechanisms remain unclear. The two unique components of MIT are the intonation of words and simple phrases using a melodic contour that follows the prosody of speech and the rhythmic tapping of the left hand that accompanies the production of each syllable and serves as a catalyst for fluency. Research has shown that both components are capable of engaging fronto-temporal regions in the right hemisphere, thereby making MIT particularly well suited for patients with large left hemisphere lesions who also suffer from nonfluent aphasia. Recovery from aphasia can happen in two ways: either through the recruitment of perilesional brain regions in the affected hemisphere, with variable recruitment of right-hemispheric regions if the lesion is small, or through the recruitment of homologous language and speech-motor regions in the unaffected hemisphere if the lesion of the affected hemisphere is extensive. Treatment-associated neural changes in patients undergoing MIT indicate that the unique engagement of right-hemispheric structures (e.g., the superior temporal lobe, primary sensorimotor, premotor and inferior frontal gyrus regions) and changes in the connections across these brain regions may be responsible for its therapeutic effect.

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.