Deep Learning Approach Using Diffusion-Weighted Imaging to Estimate the Severity of Aphasia in Stroke Patients / 대한뇌졸중학회지

Background@#and Purpose This study aimed to investigate the applicability of deep learning (DL) model using diffusion-weighted imaging (DWI) data to predict the severity of aphasia at an early stage in acute stroke patients. @*Methods@#We retrospectively analyzed consecutive patients with aphasia caused by acute ischemic stroke in the left middle cerebral artery territory, who visited Asan Medical Center between 2011 and 2013. To implement the DL model to predict the severity of post-stroke aphasia, we designed a deep feed-forward network and utilized the lesion occupying ratio from DWI data and established clinical variables to estimate the aphasia quotient (AQ) score (range, 0 to 100) of the Korean version of the Western Aphasia Battery. To evaluate the performance of the DL model, we analyzed Cohen’s weighted kappa with linear weights for the categorized AQ score (0–25, very severe; 26–50, severe; 51–75, moderate; ≥76, mild) and Pearson’s correlation coefficient for continuous values. @*Results@#We identified 225 post-stroke aphasia patients, of whom 176 were included and analyzed. For the categorized AQ score, Cohen’s weighted kappa coefficient was 0.59 (95% confidence interval [CI], 0.42 to 0.76; P<0.001). For continuous AQ score, the correlation coefficient between true AQ scores and model-estimated values was 0.72 (95% CI, 0.55 to 0.83; P<0.001). @*Conclusions@#DL approaches using DWI data may be feasible and useful for estimating the severity of aphasia in the early stage of stroke.

A Supragastric Belching Case Treated with Speech Therapy / 대한소화기학회지

No abstract available.

Oro-Pharyngeal Dysphagia in Parkinson's Disease and Related Movement Disorders

Oro-pharyngeal dysphagia is a common symptom in patients with Parkinson's disease (PD) and related disorders, even in their early stage of diseases. Dysphagia in these patients has been underdiagnosed, probably due to poor the self-awareness of the conditions and the underuse of validated tools and objective instruments for assessment. The early detection and intervention of dysphagia are closely related to improving the quality of life and decreasing the mortality rate in these patients. The purpose of this paper is to give an overview of the characteristics of dysphagia, including the epidemiology, pathophysiology, and clinical symptomatology, in patients with PD compared with other parkinsonian disorders and movement disorders. The management of dysphagia and future research directions related to these disorders are also discussed.

Improving Speech and Swallowing Functions in Patients with Stroke

Dysphagia incidence can be up to 90% of patients after CVA disease and most of the patients demonstrate speech problems as well as dysphagia. The term of swallowing includes the entire process of deglutition from the placement of food in the mouth until the food enters to the esophagus through the oral and pharyngeal cavities. Swallowing functions share common anatomic structures and characteristics of physiology with speech in many aspects. Therefore, speech-language pathologists can help people with swallowing disorders. Herein the approaches and rationales for improving speech and swallowing functions in patients with stroke need to be discussed depending on the lesion sites of the brain.

Word Definition Ability in Patients with Alzheimer's disease

BACKGROUND: The purposes of this study were (1) to investigate the abilities of word definition in patients with Alzheimer's disease (AD) according to the severity, and (2) to examine the error patterns in patients with Alzheimer's disease. METHODS: Eight individuals with MCI (CDR=0.5) and 16 patients with AD (eight for probable AD mild group of CDR=1 and eight for probable AD moderate group of CDR=2) participated in the study. Eight normal age-, gender-, and education-matched elderly adults served as a control group for the MCI and AD groups. As stimuli for the word definition, eleven semantic categories were used, and two concrete words were selected from each category, resulting in a total of 22 items. Prior to the task, four definition categories were provided: 1) functional, 2) relational, 3) perceptual, and 4) categorical. Statistical analyses were performed using Kruskal-Wallis test, and Bonferroni analyses were used as a post-hoc comparison for any significant results. RESULTS: There were significant differences in word definition scores among four groups. The probable AD moderate group showed the lower definition score than the probable AD mild group. And the probable AD moderate group showed the lower definition score than MCI group. Each group defined words in different ways. While the control group employed four definition different categories equally, the probable AD moderate group used a functional definition category mainly. However, relational and categorical definition categories were rarely observed in the probable AD moderate group. The analysis of error pattern showed that inadequate definition was frequently observed in all groups. CONCLUSIONS: The results from this study suggest that word definition task could be a sensitive indicator of the impairment of semantic knowledge in patients with AD.

Evaluation of Aphasia

Aphasia is an acquired language disorder caused by focal brain damage, which affect all modalities of language. Therefore, segregation of aphasia from speech disorders or modality specific problems such as dysarthria, apraxia of speech or agnosia is the first step of differential diagnosis. Even though cognitive dysfunctions affect language performance, cognitive communication disorder is also a different concept from aphasia which in confined to pure language disorders. The purpose of this study is to introduce various models and methods of evaluation on aphasia and to review of recent issues of aphasia research.

Pure Apraxia of Speech after the Left Insular Infarction

Apraxia of speech (AOS) is a disorder in programming the speech musculature to produce the correct sounds of words in the proper sequence. Pure AOS without other speech-language deficit is very rare. We report a patient with AOS without aphasia developed after the left insular infarction. For the case of impaired speech production, AOS should be recognized as a differential diagnosis. Correct diagnosis and early institution of speech therapy may have important implications in the prognosis of AOS.

Optic Aphasia: A Case Study

Optic aphasia is a rare syndrome in which patients are unable to name visually presented objects but have no difficulty in naming those objects on tactile or verbal presentation. We report a 79-year-old man who exhibited anomic aphasia after a left posterior cerebral artery territory infarction. His naming ability was intact on tactile and verbal semantic presentation. The results of the systematic assessment of visual processing of objects and letters indicated that he had optic aphasia with mixed features of visual associative agnosia. Interestingly, although he had difficulty reading Hanja (an ideogram), he could point to Hanja letters on verbal description of their meaning, suggesting that the processes of recognizing objects and Hanja share a common mechanism.