BACKGROUND: Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias. AIM: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database. METHODS: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori. Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness. RESULTS: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week. CONCLUSIONS: We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.
Aphasia , Stroke Rehabilitation , Stroke , Aged , Female , Humans , Infant, Newborn , Male , Aphasia/rehabilitation , Language , Speech Therapy/methods , Stroke/complications
The processing of sensory-motor aspect of word's meaning, and its difference between nouns and verbs, is the main topic of neurolinguistic research. The present study aimed to examine the lexical-semantic processing of Persian non-action nouns and action verbs. The possible effects of semantic correlates on noun/verb dissociation were evaluated without morphological confound. A total of 62 neurologically intact Persian speakers responded to a computerized semantic similarity judgment task, including 34 triplets of non-action nouns and 34 triplets of action verbs by pressing a key. Response Time (RT) and percentage error were considered as indirect measures of lexical-semantic encoding efficiency. We also assessed the latency of hand movement execution with no linguistic demand. The results showed that action verbs elicited more errors and had slower RT compared with object nouns. Mixed ANOVA revealed that the observed noun/verb distinction was not affected by demographic factors. These results provided evidence that the lexical-semantic encoding of Persian action verbs, compared to non-action nouns, requires more support from cognitive sources during the processing of the motor - related semantic feature. The possible accounts for the different processing of action verbs in terms of semantic view are suggested.
Judgment , Semantics , Humans , Language , Linguistics , Reaction Time
Stroke is a major cause of serious disabilities in adults. While communication deficits post stroke are prevalent and disabling, early detection of them is important during acute phase. There is limited data published on the incidence of communication disorders in Persian speaking adults following post stroke to our knowledge. The present study aims to determine the incidence and associated factors of aphasia, cognitive deficits, motor speech disorders (apraxia and dysarthria) as well as dysphagia following acute post stroke in Persian speaking adults. 100 stroke patients were assessed using P-WAB, MMSE, Oral Apraxia test, Informal Dysarthria assessment, and MASA. The data was collected from 2 hospitals in Tehran using convenient sampling for the duration of 1 year. Based on our findings, the incidence of aphasia, cognitive deficits, oral apraxia, dysarthria, and dysphagia was in respectively 61.8%, 76%, 30%, 61%, and 39% of stroke patients during the acute phase. Patients with aphasia were significantly older (mean age, 59.29 vs. 64.95), and had fewer education years (9.21 vs. 5.45) compared to individuals without aphasia (p < .05). Co-occurrence of aphasia and dysarthria, dysphasia, cognitive deficits, and apraxia was in respectively 40%, 31%, 55%, and 25%. Due to the high incidence of neurogenic communication disorders and dysphagia during the acute post stroke, especially in the elderly and the less educated patients, prompt and rapid detection of these deficits and rehabilitation is essential to ameliorate patients' quality of life and social participation, and reduce the comorbidities risk.
INTRODUCTION: about 20% to 30% of patients with epilepsy are diagnosed with drug-resistant epilepsy and one third of these are candidates for epilepsy surgery. Surgical resection of the epileptogenic tissue is a well-established method for treating patients with intractable focal epilepsy. Determining language laterality and locality is an important part of a comprehensive epilepsy program before surgery. Functional Magnetic Resonance Imaging (fMRI) has been increasingly employed as a non-invasive alternative method for the Wada test and cortical stimulation. Sensitive and accurate language tasks are essential for any reliable fMRI mapping. METHODS: The present study reviews the methods of presurgical fMRI language mapping and their dedicated fMRI tasks, specifically for patients with epilepsy. RESULTS: Different language tasks including verbal fluency are used in fMRI to determine language laterality and locality in different languages such as Persian. there are some considerations including the language materials and technical protocols for task design that all presurgical teams should take into consideration. CONCLUSION: Accurate presurgical language mapping is very important to preserve patients language after surgery. This review was the first part of a project for designing standard tasks in Persian to help precise presurgical evaluation and in Iranian PWFIE.
As one of the most common neurological diseases in children, epilepsy affects 0.9-2% of children. Complex interactions among the etiologies of epilepsy, interictal discharges, seizures, and antiepileptic drugs lead to cognitive impairments in children with epilepsy. Since epilepsy is considered as a network disorder, in which seizures have a widespread impact on many parts of the brain, childhood epilepsy can even affect the normal development of language. About 25% of children with epilepsy do not respond to medications; therefore, brain surgery is considered as a treatment option for some of them. Presurgical neuropsychological evaluations including language mapping are recommended to preserve cognitive and language abilities of patients after surgery. Functional magnetic resonance imaging as a non-invasive technique for presurgical language mapping has been widely recommended in many epileptic centers. The present study reviewed language representation and presurgical language mapping in children with epilepsy. Mapping language in children with epilepsy helps to localize the epileptogenic zone, and also, to predict the cognitive outcome of epilepsy surgery and possible cognitive rehabilitation. This review collected information about language representation and language mapping in pediatric epilepsy settings.
BACKGROUND: Language disorders may affect receptive and/or expressive language skills. The use of a validated and reliable assessment tool is essential to assess these skills in children. The present study aimed to develop a valid and reliable language development instrument for Persian-speaking children aged 2-6 years. METHODS: The present cross-sectional study was conducted during 2016-2017 in three main Iranian cities, namely Mashhad, Tehran, and Isfahan. The target population was children between the ages of 2 and 6 in various kindergartens and schools. The Persian Language Development Scale (PLDS) was developed by incorporating linguistic characteristics of the Persian language and Iranian culture. Following a number of iterations, including a pilot study of 36 children, the final version of the PLDS tool was used to assess the receptive and expressive language skills of 460 children. The reliability and validity of the PLDS tool were examined. RESULTS: The content validity ratio (CRV) of the PLDS tool was 0.85. The tool could differentiate children by age, but not by sex. The test-retest reliability, with 10 days interval, showed a significant correlation between the coefficients of receptive (0.96) and expressive (0.93) scales. The intraclass correlation coefficient (ICC) for receptive and expressive scales was 0.93 and 0.98, respectively. The internal consistency, using the KR-21, for the receptive and expressive scales was 0.88 and 0.92, respectively. CONCLUSION: A language development scale has been developed to assess receptive and expressive language skills in Iranian children aged 2-6 years. The validity and reliability of the tool were confirmed.
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).
INTRODUCTION: This study examined the effect of proficiency level on the second Language (L2) syntactic and semantic processing by addressing the role of procedural and declarative memory systems in light of the Declarative/Procedural (DP) model. The primary purpose was to determine to what extent proficiency accounts for native-like language processing in L2 in adult bilinguals who learned English (L2) after the age of 15 under explicit instruction. METHODS: Using a mixed-method design and an oddball violation paradigm, we examined the functional neural correlates of syntactic and semantic processing in two groups of Persian-English bilinguals (L1=Persian, L2=English; N=10 high-proficient, N=10 pre-intermediate levels; Gender= Female; mean age=25.50 years, SD = 5.09 years, age range = 19-35 years of age) across 6 different conditions. They included a visual stimulus task of 240 English sentences with three different experimental conditions (violated regular past forms or phrase structure rules or final-word semantic violation) and three control conditions (sets of correct sentences for each experimental condition). Both groups started learning English late (age of onset=15+) and under an explicit learning context. To evaluate the effect of L2 proficiency, Event-related potentials (ERPs) to target words in each condition were elicited across the N400 time window (300-500 ms) and the P600 time window (500-700 ms). RESULTS: Results showed different cortical responses in the two groups. Upon processing the violated forms, high-proficient subjects showed more native-like patterns of scalp activity in both lexical-semantic and syntactic processing. In contrast, less proficient learners have shown delayed onsets and or peaks of components, reduced amplitudes, or absent components in some regions. For instance, the difference in N400 amplitude for the incorrect regular past conditions was observed only in the pre-intermediate (PI) subjects in the O1 channel. This finding is compatible with the DP Model in that at lower levels of L2 proficiency, the participants show N400s or N400-like posterior negativities instead of Anterior Negativities (ANs). This finding shows the initial reliance on the declarative memory system for syntactic processing at lower levels of L2. CONCLUSION: Our findings suggest that attained proficiency was a more determinant factor in the L1-like cortical representation of L2 than the age of acquisition and or the type of instruction/context. Several brain areas, similar to those observed for L1, were activated during L2 syntactic processing in high-proficient subjects addressing their reliance on the procedural memory system for syntactic processing to gain more proficiency. For instance, our results showed a significant difference in N400 amplitude for the incorrect regular past conditions in O1 for the PI subjects, which shows the initial reliance on the declarative memory system for syntactic processing at lower levels of L2.
INTRODUCTION: Word retrieval problems are among the limitations observed in children with specific language impairment during the initial schooling years. These restrictions are predictive of reading problems and poor performance at school. Additionally, studies on lexical access in Persian speaking children are scarce. Therefore, this study aimed to investigate and compare naming accuracy and latency in children with and without specific language impairment. METHODS: Twenty 7-9-year-old children with specific language impairment and 20 age-matched peers were recruited as the study participants. They were requested to name the 128 black and white line-drawing pictures from a Persian picture naming set for children, as rapidly as possible. We compared the effects of psycholinguistic variables on naming latency in the explored children with and without specific language impairment. RESULTS: Linear mixed-effects modeling presented an interaction between the research groups and the psycholinguistic variables. Significant main effects were found for name agreement (P≤0.00) and the age of acquisition (P=0.05) in children with typical language development; significant effects for name agreement (P≤0.00) and log frequency (P≤0.00) were revealed in children with specific language impairment. CONCLUSION: The obtained models indicated that psycholinguistic factors could differently affect the naming latency in children with and without specific language impairment. Factors that may have accounted for the findings are discussed in this paper.
The Persian language can be considered to have a relatively more complex and combinatorial morpho-syntax than languages like Chinese and English. For example, the Persian verbal system is largely constituted of light verb constructions, in which light verbs are combined with specific items coming from other grammatical classes to generate entirely new verbal entities. This study was designed to examine the mediating effect of language-inherent properties related to morpho-syntax on activation of the left inferior frontal gyrus (LIFG), a brain area involved in morpho-syntactic processing. To this end, 20 late Persian-English bilinguals were required to covertly generate verbs and nouns from object and action pictures, within a cued grammatical context. Consistent with predictions, the results of an ROI analysis revealed an interaction between task and language in BA 44 of the LIFG and its right homologue, with greater activation of this region during the production of Persian compared to English verbs. In contrast, there was greater activation of the BA 44 during the production of English compared to Persian nouns, consistent with the more effortful processing of their less proficient second language (English). The findings suggest that language-specific properties such as morpho-syntactic complexity can modulate the recruitment of Broca's area, over and above the more well-documented effects of language proficiency.
Brain Mapping/methods , Broca Area/diagnostic imaging , Broca Area/physiology , Magnetic Resonance Imaging/methods , Multilingualism , Adult , Cues , Female , Humans , Male , Prefrontal Cortex/diagnostic imaging , Prefrontal Cortex/physiology , Young Adult
INTRODUCTION: In this study, we reported the reliability and validity of Bedside version of Persian WAB (P-WAB-1) adapted from Western Aphasia Battery (WAB-R) (1,2). P-WAB-1 is a clinical linguistic measuring tool to determine severity and type of aphasia in brain damaged patients based on Aphasia Quotient (AQ) as a functional measure. For the purposes of a quick clinical screening of aphasia in Persian, we adapted the bedside version of WAB-R to assess the performance of Persian aphasic patients. METHODS: The data we reported on adaptation, validity and reliability of P-WAB-1 are based on faithful translation and criterion validity ratio (CVR) taken from the expert panel and the performance of 60 consecutive brain damaged patients referred to different university clinics for rehabilitation and 30 healthy subjects as norms and 40 age-matched epileptic patients as the control group. RESULTS: Based on the results of this study, P-WAB-1 has internal consistency (a=0.71) and test-retest reliability (r=.65 P<0.001) and the subtests are sensitive enough to contribute to Aphasia Quotient (AQ) as a functional measure of severity of aphasia in Iranian brain damaged patients. Based on AQ results, our aphasic patients were classified into four distinct groups of severity. DISCUSSION: P-WAB-1 is the first clinical linguistic test to determine severity of aphasia based on an operational index and can be considered as a valid baseline for screening and diagnosis of aphasia among Persian speaking brain damaged patients. This study is the initial step on adaptation of different versions of WAB-R to measure the severity of aphasia using AQ, LQ and CQ as operational measures and to classify Persian speaking aphasic patients into different types.
In this study, we report normative data by native Persian speakers for concept familiarity, age of acquisition (AoA), imageability, image agreement, name agreement, and visual complexity, as well as values for word frequency, word length, and naming latency for 200 of the colored Snodgrass and Vanderwart (Journal of Experimental Psychology: Human Learning and Memory 6:174-215, 1980) pictures created by Rossion and Pourtois (Perception 33:217-236, 2004). Using multiple regression analysis, we found independent effects of name agreement, image agreement, word frequency, and AoA on picture naming by native Persian speakers from Iran. We concluded that the psycholinguistic properties identified in studies of picture naming in many other languages also predict timed picture naming in Persian. Normative data for the ratings and picture-naming latencies for the 200 Persian object nouns are provided as an Excel file in the Supplemental materials.
Language , Models, Psychological , Names , Psycholinguistics/methods , Reaction Time , Visual Perception , Adolescent , Adult , Female , Humans , Iran , Male , Memory , Recognition, Psychology , Regression Analysis , Reproducibility of Results , Young Adult
BACKGROUND: Increasing demand for memory assessment in clinical settings in Iran, as well as the absence of a comprehensive and standardized task based upon the Persian culture and language, requires an appropriate culture- and language-specific version of the commonly used neuropsychological measure of verbal learning and memory, the Rey Auditory Verbal Learning Test (RAVLT). METHODS: The Persian adapted version of the original RAVLT and two other alternate word lists were generated based upon criteria previously set for developing new word lists. A total of 90 subjects (three groups of 30 persons), aged 29.75±7.10 years, volunteered to participate in our study and were tested using the original word list. The practice effect was assessed by retesting the first and second groups using the same word list after 30 and 60 days, respectively. The test-retest reliability was evaluated by retesting the third group of participants twice using two new alternate word lists with an interval of 30 days. RESULTS: The re-administration of the same list after one or even two months led to significant practice effects. However, the use of alternate forms after a one-month delay yielded no significant difference across the forms. The first and second trials, as well as the total, immediate, and delayed recall scores showed the best reliability in retesting by the alternate list. CONCLUSION: The difference between the generated forms was minor, and it seems that the Persian version of the RAVLT is a reliable instrument for repeated neuropsychological testing as long as alternate forms are used and scores are carefully chosen.
Memory, Short-Term , Neuropsychological Tests , Verbal Learning , Adolescent , Adult , Female , Humans , Iran , Language , Learning Curve , Male , Middle Aged , Reproducibility of Results , Young Adult
BACKGROUND: Neural correlates of single word reading with the use of a functional MRI (fMRI) scan have been widely studied in different languages. These study patterns of cortical activation differ in different languages. In this report we used a similar technique to study cortical activation when reading single Persian words. METHODS: The subjects were comprised of nine healthy right-handed bilingual individuals who performed three consecutive fMRI paradigms. RESULTS: Our study showed activation of the inferior frontal gyrus (IFG) when single Persian words were read. These results revealed that the pattern of brain activation during word production in Persian has a similar topography to that of English equivalents. CONCLUSION: The paradigms selectively activate word production areas and are useful in neurological assessment of the Persian population.
Brain Mapping/methods , Cerebral Cortex/physiology , Language , Magnetic Resonance Imaging/methods , Adult , Humans , Iran , Male , Reading , Sampling Studies , Verbal Behavior/physiology , Young Adult
The full or partial recovery of cognitive functions following brain lesions is believed to rely on the recruitment of alternative neural networks. This has been shown anatomically for selective auditory cognitive functions (Adriani et al. 2003b). We investigate here behavioral correlates that may accompany the use of alternative processing networks and in particular the resulting increase in response times. The performance of 5 patients with right or left unilateral hemispheric infarction and 6 normal control subjects in sound identification, asemantic sound recognition, sound localization, and sound motion perception was evaluated by the number of correct replies and response times for correct and wrong replies. Performance and response times were compared across patients and normal control subjects. Two patients with left lesions were deficient in sound identification and sound motion perception and normal in sound localization and asemantic sound recognition; one patient with right lesion was deficient in sound localization and sound motion perception and normal in sound identification and asemantic sound recognition; deficient performance was associated with increased response times. The remaining 2 patients (1 with left, 1 with right lesion) had normal performance in all 4 tasks but had significantly longer response times in some (but not all) tasks. Patients with normal or deficient performance tended more often than normal subjects to give faster correct than wrong replies. We propose that increased response time is an indication of processing within an alternative network.
Auditory Perception , Cerebral Infarction/psychology , Cognition Disorders/etiology , Cognition Disorders/physiopathology , Perceptual Disorders/etiology , Perceptual Disorders/physiopathology , Auditory Pathways/physiopathology , Female , Humans , Male , Middle Aged , Reaction Time
This report is a short review of the form and content of speech and language therapy services and the trend of their institutionalization in Iran. A summary of formal education in speech and language therapy in Iran as originated by establishing a 4-year BS rehabilitation program in the College of Rehabilitation Sciences in Tehran is given. Since then, speech and language rehabilitation programs have been expanding both in size and quality, resulting in about 1,000 speech therapists practicing in hospitals and rehabilitation centers throughout the country. The expansion of graduate programs at MS level in three different institutions and a prospective PhD program are also adding to the quality of these services. The content of the theory courses and clinical practice courses as well as research on specific speech and language disorders and cross-linguistic studies are briefly described.
Speech-Language Pathology/organization & administration , Humans , Iran , Speech-Language Pathology/education , Speech-Language Pathology/trends
