Exploring the usability and feasibility of a mobile music listening application for people living in the community with post-stroke aphasia.

PURPOSE: Language and communication disorders can inhibit participation in activities that have potential therapeutic benefits for recovery. This exploratory research examined the usability and feasibility of a purpose-built music listening mobile application for people living in the community with post-stroke aphasia, and examined relationships between useability and participant age, aphasia severity and time post-stroke. METHODS: Nineteen participants with chronic aphasia tested the application for two weeks. Prior to use, music preferences, technology use and confidence, self-efficacy and music engagement questionnaires were completed. System usability scale, music listening data and a satisfaction rating were completed following use. RESULTS: Overall, the application was perceived as being usable and feasible with a high system usability rating and moderate effectiveness, efficiency and satisfaction. The system usability scores were not associated with aphasia severity, age, years post-stroke, self-efficacy or music engagement. Technology confidence was positively associated with system usability. CONCLUSION: The music listening application is a feasible and usable option for listening to music in people with chronic post-stroke aphasia. This study provides a foundation for the rigorous examination of the usability of music listening technology for people with post-stroke aphasia and the potential investigation of use in acute care facilities and other clinical populations.IMPLICATIONS FOR REHABILITATIONMusic listening has potential therapeutic benefits for people with post-stroke aphasia.Applications for music listening require customisation to enable people with post-stroke aphasia opportunity to listen to their preferred music.Music listening applications that are perceived as usable and feasible by people with post-stroke aphasia may have potential application within rehabilitation and community settings.

Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke.

BACKGROUND: White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated. OBJECTIVE: To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables. METHODS: Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating. RESULTS: The presence of severe WMH explained an additional 18% and 25% variance in early subacute (t = -3.00, p = .004) and chronic (t = -3.60, P = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores. CONCLUSIONS: Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.

Right hemispheric structural connectivity and poststroke language recovery.

Poststroke aphasia typically results from brain damage to the left-lateralized language network. The contribution of the right-lateralized homologues in aphasia recovery remains equivocal. In this longitudinal observational study, we specifically investigated the role of right hemisphere structural connectome in aphasia recovery. Twenty-two patients with aphasia after a left hemispheric stroke underwent comprehensive language assessment at the early subacute and chronic stages. A novel structural connectometry approach, using multi-shell diffusion-weighted MRI data collected at the early subacute stage, was used to evaluate the relationship between right hemisphere white matter connectome and language production and comprehension abilities at early subacute stage. Moreover, we evaluated the relationship between early subacute right hemisphere white matter connectome and longitudinal change in language production and comprehension abilities. All results were corrected for multiple comparisons. Connectometry analyses revealed negative associations between early subacute stage right hemisphere structural connectivity and language production, both cross-sectionally and longitudinally (pFDR < .0125). In turn, only positive associations between right hemisphere structural connectivity and language comprehension were observed, both cross-sectionally and longitudinally (pFDR < .0125). Interhemispheric connectivity was highly associated with comprehension scores. Our results shed light on the discordant interpretations of previous findings, by providing evidence that while some right hemisphere white matter pathways may make a maladaptive contribution to the recovery of language, other pathways support the recovery of language, especially comprehension abilities.

An fMRI Study of Concreteness Effects during Spoken Word Recognition in Aging. Preservation or Attenuation?

It is unclear whether healthy aging influences concreteness effects (i.e., the processing advantage seen for concrete over abstract words) and its associated neural mechanisms. We conducted an fMRI study on young and older healthy adults performing auditory lexical decisions on concrete vs. abstract words. We found that spoken comprehension of concrete and abstract words appears relatively preserved for healthy older individuals, including the concreteness effect. This preserved performance was supported by altered activity in left hemisphere regions including the inferior and middle frontal gyri, angular gyrus, and fusiform gyrus. This pattern is consistent with age-related compensatory mechanisms supporting spoken word processing.

An fMRI study of concreteness effects in spoken word recognition.

BACKGROUND: Evidence for the brain mechanisms recruited when processing concrete versus abstract concepts has been largely derived from studies employing visual stimuli. The tasks and baseline contrasts used have also involved varying degrees of lexical processing. This study investigated the neural basis of the concreteness effect during spoken word recognition and employed a lexical decision task with a novel pseudoword condition. METHODS: The participants were seventeen healthy young adults (9 females). The stimuli consisted of (a) concrete, high imageability nouns, (b) abstract, low imageability nouns and (c) opaque legal pseudowords presented in a pseudorandomised, event-related design. Activation for the concrete, abstract and pseudoword conditions was analysed using anatomical regions of interest derived from previous findings of concrete and abstract word processing. RESULTS: Behaviourally, lexical decision reaction times for the concrete condition were significantly faster than both abstract and pseudoword conditions and the abstract condition was significantly faster than the pseudoword condition (p < 0.05). The region of interest analysis showed significantly greater activity for concrete versus abstract conditions in the left dorsolateral prefrontal cortex, posterior cingulate and bilaterally in the angular gyrus. There were no significant differences between abstract and concrete conditions in the left superior temporal gyrus or inferior frontal gyrus. CONCLUSIONS: These findings confirm the involvement of the bilateral angular gyrus, left posterior cingulate and left dorsolateral prefrontal cortex in retrieving concrete versus abstract concepts during spoken word recognition. Significant activity was also elicited by concrete words relative to pseudowords in the left fusiform and left anterior middle temporal gyrus. These findings confirm the involvement of a widely distributed network of brain regions that are activated in response to the spoken recognition of concrete but not abstract words. Our findings are consistent with the proposal that distinct brain regions are engaged as convergence zones and enable the binding of supramodal input.