Neuromodulation of the Right Motor Cortex of the Lips With Repetitive Transcranial Magnetic Stimulation to Reduce Phonological Impairment and Improve Naming in Three Persons With Aphasia: A Single-Case Experimental Design.

PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) can enhance aphasia recovery. Most studies have used inhibitory stimulation targeting the right inferior frontal gyrus. However, the motor cortex, observed to contribute to the prediction of aphasia recovery, is involved in word production and could be an appropriate target for rTMS. We aimed to observe behavioral changes in a picture naming task induced by inhibitory rTMS targeting the right motor cortex of the lips in people with poststroke aphasia. METHOD: Using a single-case experimental design, we included three participants with chronic poststroke aphasia who had phonological deficits. Each participant performed a verbal picture naming task 3 times a week for 2, 3, or 4 weeks (pseudorandom across participants) to establish a baseline naming ability for each participant. These were not therapy sessions, and no feedback was provided. Then, each participant received the intervention, inhibitory continuous theta burst stimulation targeting the right motor cortex of the lips, 3 times a week for 2 weeks. Naming testing continued 3 times a week, for these latter 2 weeks. No therapy was performed at any time during the study. RESULTS: Visual analysis of the graphs showed a positive effect of rTMS for P2 and P3 on picture naming accuracy and a tendency toward improvement for P1. Statistical analysis showed an improvement after rTMS for P1 (τ = 0.544, p = .013, SETau = 0.288) and P2 (τ = 0.708, p = .001, SETau = 0.235). For P3, even if the intervention allowed some improvement, this was statistically nonsignificant due to a learning effect during the baseline naming testing, which lasted the longest, 4 weeks. Regarding specific language features, phonological errors significantly decreased in all patients. CONCLUSIONS: The motor cortex of the lips could be an appropriate target for rTMS to improve naming in people with poststroke aphasia suffering from a phonological deficit. This suggests the possibility to individualize the target for rTMS, according to the patient's linguistic impairment.

Benefits of a targeted rehabilitation of number transcoding in secondary acalculia: A single-case experimental design.

BACKGROUND: Despite its potentially significant functional and emotional impact, acalculia is still too rarely assessed and managed by speech and language therapists. Research on the rehabilitation of numerical transcoding remains scarce in the literature and, despite positive results, presents a low level of evidence. AIMS: The present study aims to evaluate the effectiveness of a targeted rehabilitation of numerical transcoding in two patients suffering from a chronic secondary acalculia. METHODS & PROCEDURES: Two post-brain injury females with secondary acalculia took part in a single-case experimental design with multiple baseline across subjects according to a three-phase experimental protocol: baseline involving global cognitive rehabilitation (5-7 measurements with randomized sequential introduction); targeted intervention (10 measurements); follow-up (2 immediate measurements and 1 month after the end of the intervention). Repeated outcome measures consisted of six lists composed of numbers of equivalent difficulty that were used alternately to assess numerical transcoding. We used a reverse digit span as a control measure to assess the specificity of the intervention. Rehabilitation lasted 5 weeks and consisted of errorless learning with colour cues, tables and number-words cards. OUTCOMES & RESULTS: During baseline period involving global cognitive rehabilitation, transcoding scores remained unchanged. In contrast, there was a significant improvement in scores for both patients during the intervention phase targeting transcoding and maintenance of benefits 1-month post-intervention. CONCLUSIONS & IMPLICATIONS: This study demonstrates that a specific rehabilitation targeting numerical transcoding following chronic secondary acalculia can be effective in improving transcoding skills. WHAT THIS PAPER ADDS: What is already known on the subject Transcoding difficulties in patients with acalculia can cause a significant disability in everyday life activities. In secondary acalculia, rehabilitation of cognitive functions associated with number processing (attention, working memory, language) is not sufficient for improvement of transcoding. What this paper adds to existing knowledge An intervention specifically targeting numerical transcoding significantly and durably improves the skills of patients with chronic secondary acalculia. What are the potential or actual clinical implications of this work? Procedural error-free intervention using colour cueing, tables, cards with number-words, copy and repetition seems effective to improve transcoding skills in chronic acalculia.

Repeated awake surgery and quality of life in patients with diffuse glioma: a systematic review and meta-analysis.

Diffuse gliomas significantly affect patients' daily lives. Because of the high risk of recurrence and anaplasic transformation, repeated surgery can be proposed in awake condition to prolongs overall survival by limiting and reducing residual tumour volume. However, oncological interest alone is no longer sufficient due to the consequent increase in median survival, and quality of life is becoming an important issue in clinical decision-making. This systematic review focuses on the effects of repeated surgery in awake condition on the quality of life of adults with diffuse glioma through three parameters: return to work, presence of postoperative neurocognitive disorders, and occurrence of epileptic seizures. A systematic review of the last 20 years was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards. Summarized data from selected studies were processed quantitatively, using a meta-analysis process, with the Review Manager 5.4 software. Five databases (PubMed, Web of Science, Science Direct, Dimensions, and Embase) were used. Fifteen articles were selected for qualitative analysis and 11 for meta-analysis. One hundred and fifty-one patients (85%) returned to an active socio-professional life after repeated surgery, and 78 (41%) presented neurocognitive disorders in the immediate postoperative period, only 3% (n = 4) of them suffering from permanent disorders. One hundred and forty-nine (78%) participants were free of epileptic seizure after repeated surgery. This systematic review of the literature highlights the benefit of repeated surgery on the quality of life of patients with adult diffuse glioma.

Assessment tools and rehabilitation treatments for aprosodia following acquired brain injury: A scoping review.

BACKGROUND: Acquired brain injury (ABI), especially to the right hemisphere, can result in difficulty using or understanding prosodic contours in speech. Prosody is used to convey emotional connotation or linguistic intent and includes pitch, loudness, rate, and voice quality. A disorder in the comprehension or production of prosody is known as aprosodia; despite the communication disability caused by prosodic disorders, the assessment and treatment of aprosodia following ABI has received scant attention. AIMS: The aim of this scoping review is to gather and synthesise useful knowledge on aprosodia and provide therapists with an exhaustive document in order to guide clinical decision-making encouraging active identification and treatment of this disorder. METHODS & PROCEDURES: This scoping review, conducted in accordance with PRISMA-ScR guidelines, investigated the existing literature concerning the assessment and treatments of linguistic and affective aprosodia in adult patients after ABI. A systematic search in four electronic databases (PubMed, CINAHL, Web of Science, ScienceDirect) was conducted for articles written in English, French, or Italian published between 1970 and 2020. After all evaluative criteria were applied, 15 articles were included for final review. OUTCOMES & RESULTS: Results show the presence of six assessment tools for affective aprosodia and five evaluation tools targeting affective and linguistic prosody. Assessment of aprosodia is generally accomplished through acoustic and perceptual approaches. Current treatments for prosodic disorders focus on expressive aprosodia and have applied mostly two different approaches: imitative and cognitive-linguistic methods. CONCLUSION & IMPLICATIONS: Findings suggest that aprosodia can be assessed by therapists through various techniques and may be amenable to behavioural treatments. Nevertheless, although there are several assessment tools available, no one currently offers a comprehensive assessment that incorporates an ecological dimension. It therefore seems necessary to continue research in this direction. The rehabilitation of receptive prosody abilities also remains to be explored. WHAT THIS PAPER ADDS: What is already known on the subject Prosody has a fundamental role in communication and conveys speakers' intentions and emotions. Therefore, a deficit of prosody (aprosodia) after acquired brain injury can reduce social participation and engagement. Assessment tools and rehabilitation treatments are necessary in order to improve this disorder and patients' quality of life. What this paper adds to existing knowledge The evaluation tools currently available focuses mostly on affective aprosodia, whereas the linguistic prosody is less assessed. There exist two treatments for expressive aprosodia: motoric-imitative and cognitive-linguistic treatments; however, their efficacy is tested on small groups of patients. No treatments targeting receptive aprosodia were found. What are the potential or actual clinical implications of this work? We need more sensitive and reliable tools and systematic evaluations of all the components of prosody (affective and linguistic, receptive and expressive prosody). We need researches who analyse bigger samples of patients after right hemisphere brain injury and we identified the need of more well-designed studies and better understanding of the pathophysiology of aprosodia.

Anosognosia in amyotrophic lateral sclerosis: A cross-sectional study of 85 individuals and their relatives.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) has long been considered a pure motor neurodegenerative disease. However, now, extra-motor manifestations such as cognitive-behavioral disorders are considered not rare and are even a severity factor of the disease. Experiencing anosognosia (i.e., the inability to recognize neurological symptoms) might affect care and treatment compliance in ALS. Regardless, this pivotal feature has been little investigated. OBJECTIVES: By comparing patients' and caregivers' reports, we analysed whether patients with ALS would experience a lack of awareness about their executive disorders and their apathy symptoms. METHODS: From the ALS reference center in Paris, we included 85 patients (47 men, mean [SD] age 60.5 [12] years and ALS-Functional Rating Scale-revised score 8 to 46) and their primary family caregivers who all completed the Dysexecutive Questionnaire (DEX) and the Apathy Evaluation Scale (AES). Overall scores and answers were compared by agreement/disagreement statistical methods. RESULTS: Caregivers reported higher levels of cognitive-behavioral disorders than did patients, but reports matched when cognitive-behavioral disorders were absent or mild. With published DEX and AES cutoffs, 32% and 51% of patients had executive disorders and apathy, respectively. In these patients with significant impairment, Bland-Altman plots (i.e., visual display agreement that represents the difference between the patient's and caregiver's scores as a function of their average) showed a strong discrepancy between joint reports: patients underestimated their symptoms by a mean bias of -6.81 DEX points (95% confidence interval -11.88, -1.75) and -8.85 AES points (95% confidence interval -11.72, -5.98). We found no clear relationship between bulbar or spinal ALS subtypes and anosognosia. CONCLUSIONS: ALS patients with a cognitive-behavioral phenotype show anosognosia by a mismatch between self and proxy reports, which warrants further investigation in neuroimaging. Systematic longitudinal screening of anosognosia is needed to propose targeted psychoeducation in patient-caregiver dyads showing disagreement.

New factors that affect quality of life in patients with aphasia.

BACKGROUND: Aphasia severity is known to affect quality of life (QoL) in stroke patients, as is mood disorders, functional limitations, limitations on activities of daily life, economic status and level of education. However, communication limitation or fatigue has not been explored in this specific population. OBJECTIVE: We aimed to investigate whether these factors were associated with QoL in patients with aphasia after stroke. METHODS: Patients with aphasia were included from April 2014 to November 2017 after a first stroke and were followed for 2 years post-stroke. QoL was assessed at follow-up by the French Sickness Impact Profile 65 (SIP-65). We explored predictors such as mood disorders, communication impairment, fatigue, limitations on activities of daily life, and aphasia severity in addition to socio-demographic factors. RESULTS: We included 32 individuals (22 men; mean age 60.7 [SD 16.6] years) with aphasia after a first stroke. Poor QoL as assessed by the SIP-65 was significantly associated (Pearson correlations) with increased severity of aphasia initially (P=0.008) and at follow-up (P=0.01); increased communication activity limitations at follow-up (P<0.001); increased limitations on activities of daily life at baseline (P=0.008) and follow-up (P<0.001); increased fatigue at follow-up (P=0.001); and increased depression symptoms at follow-up (P=0.001). On multivariable analysis, QoL was associated with communication activity limitations, limitations on activities of daily life, fatigue and depression, explaining more than 75% of the variance (linear regression R2=0.756, P<0.001). The relative importance in predicting the variance was 32% for limitations on activities of daily life, 21% fatigue, 23% depression and 24% communication activity limitations. CONCLUSION: Aphasia severity, mood disorders and functional limitations may have a negative effect on QoL in patients with aphasia. Also, for the first time, we show that fatigue has an important impact on QoL in this population. Specific management of this symptom might be beneficial and should be explored in future studies.

Very early social support following mild stroke is associated with emotional and behavioral outcomes three months later.

OBJECTIVE: To investigate whether social contact and support received during hospitalization for acute ischemic stroke predict depression and daily life functioning three months later. DESIGN: Prospective observational study using Ecological Momentary Assessments to evaluate the number of social contacts as well as social support received from family, friends and medical staff within 24 hours following admission for stroke. Patients also monitored depression symptoms and behavior in real-time and in daily life contexts three months later. SETTING: A university hospital acute stroke unit. SUBJECTS: Thirty-four mild ischemic stroke patients. INTERVENTIONS: None. MAIN MEASURES: One-day Ecological Momentary Assessments immediately following stroke collected information concerning perceived social support, number of social contacts and depression symptoms. Ecological Momentary Assessments was repeated three months later and addressed depression levels as well as activities of daily living, such as working, cooking, shopping and housework. RESULTS: The number of social interactions received at hospitalization did not predict three-month outcomes. However, a better quality of moral support from friends and family immediately after stroke was associated with decreases in later depression levels ( p = 0.041) and increases in activities of daily living ( p = 0.011). Material support from friends and family was associated with increases in activities of daily living ( p = 0.012). No effect was observed for support received from medical staff. CONCLUSIONS: Patient perceptions of better support quality, and not quantity, immediately following mild stroke, are associated with better behavioral and emotional outcomes three months later.

Language features in the acute phase of poststroke severe aphasia could predict the outcome.

BACKGROUND: Aphasia recovery remains difficult to predict initially in particular for the most severe cases. The features of impaired verbal communication which are the basis for cognitive-linguistic diagnosis and treatment could be part of prediction of recovery from aphasia. AIM: This study investigated whether some components of language screening in the acute phase of stroke are reliable prognostic factors for language recovery in the post-acute phase. DESIGN: Monocentric prospective study. SETTING: University hospital stroke unit. POPULATION: Eighty-six patients aged between 21 and 92 years (mean=67.4, SD=15.3) were admitted after a first left hemisphere stroke with aphasia and were consecutively included. METHODS: Language assessment was performed in the acute phase and 3 months post-stroke with the LAnguage Screening Test (LAST) and the Aphasia Severity Rating Scale (ASRS) of the Boston Diagnostic Aphasia Examination (BDAE). Severe aphasia was defined as ASRS<3. Good recovery was defined as an ASRS≥4. Language scores and other potential predictors of recovery were analysed by comparing groups of patients with good versus poor recovery and as predictors of change with multiple regression approaches. RESULTS: LAST Total score as well as all the individual items of LAST, NIHSS and ASRS measured in the acute phase significantly differentiated good and poor recovery from aphasia at three months for all aphasic patients and for the most severe cases. In multivariable analyses the repetition score of LAST at the acute phase was significantly associated with the delta of ASRS between the acute phase and 3 months after the stroke reflecting changes in symptom severity. CONCLUSIONS: For patients with initial severe aphasia, word repetition from a language screening task seems to be a more relevant predictor of recovery than initial severity to enrich the prognosis of poststroke aphasia recovery three month after a stroke. These findings show the importance of phonological perception and production as well as speech motor components in the recovery of language. These linguistic aspects of the assessment seem more relevant than severity for prediction in the acute phase. CLINICAL REHABILITATION IMPACT: These findings could improve aphasia management pathway for people with severe aphasia and their families and minimize the evidence-practice gap for speech pathologists.

Affective Prosody and Depression After Stroke: A Pilot Study.

BACKGROUND AND PURPOSE: Poststroke depression (PSD) is a frequent complication of stroke with detrimental consequences in terms of quality of life and functional outcomes. In individuals with major depression, several studies have demonstrated an alteration of affective prosody. The aim of this study is to identify prosodic markers that may be predictive of PSD. METHODS: Patient voices were recorded at baseline and 3 months after stroke. We extracted prosodic parameters, including fundamental frequency, percentage of voice breaks, and shimmer. Depression and anxiety symptoms were assessed 3 months later. RESULTS: Among the 49 patients included in the study, 22.5% developed PSD 3 months after stroke. A significant decrease was observed concerning the fundamental frequency among patients who developed PSD. Discriminant analysis demonstrated that initial voice breaks coupled with shimmer are strongly predictive of subsequent PSD. CONCLUSIONS: Early alterations of affective prosody are associated with a higher risk of PSD 3 months after a stroke. This new physiological approach overcomes traditional barriers associated with clinical instruments and contributes to the prediction of this disorder.