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1.
Magn Reson Imaging ; 95: 19-26, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36252694

RESUMO

PURPOSE: Using constrained spherical deconvolution (CSD)-based tractography, we aimed to obtain conjoint analysis of diffusion measures of major language white matter (WM) tracts in post-stroke aphasic patients bilaterally, and to correlate the measures of each tract to the different language deficits. MATERIAL AND METHODS: 17 aphasic patients with left hemispheric stroke, at the subacute stage, and ten age- matched controls underwent diffusion MRI examination. CSD-based tractography was performed. Diffusion measures [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD)] were extracted after dissection of major language tracts bilaterally. Aphasia was assessed using language subset of hemispheric stroke scale. Comparisons of diffusion measures, for all tracts, between the two groups were performed. Partial correlations between the diffusion measures and different language components were obtained. RESULTS: In the left hemisphere, significant lower FA and or higher MD with higher RD of patients' WM tracts compared to the control group. Significant differences of diffusion measures were also evident in the right hemisphere yet, less prominent. All changes reflected damage of the tracts' integrity. Significant correlations were found between comprehension and FA of the left arcuate fasciculus (AF) and left inferior longitudinal fasciculus. Additionally, a significant correlation was found between MD of the right AF and repetition. CONCLUSION: Conjoint analysis of diffusion measures, based on CSD tractography, can provide important markers for the underlying WM changes bilaterally. Moreover, our findings emphasize that language processing can be mediated by both ventral and dorsal streams and further highlight the contribution of the right AF in repetition.


Assuntos
Afasia , Acidente Vascular Cerebral , Substância Branca , Humanos , Substância Branca/diagnóstico por imagem , Idioma , Imagem de Tensor de Difusão , Vias Neurais , Afasia/diagnóstico por imagem , Afasia/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem
2.
Am J Speech Lang Pathol ; 31(6): 2825-2834, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36332144

RESUMO

PURPOSE: During the COVID-19 pandemic, clinicians and researchers have increasingly used remote online assessments to pursue their activities, but mostly with tests not validated for videoconference administration. This study aims to validate the remote online administration of picture description in Canadian French neurotypical speakers and to explore the thematic unit (TU) checklist recently developed. METHOD: Spoken discourse elicited through the picture description task of the Western Aphasia Battery-Revised (WAB-R) was collected from Canadian French neurotypical speakers from Québec aged between 50 and 79 years old. Forty-seven participants completed the task in person, and 49 participants completed the task by videoconference. Videos of each discourse sample were transcribed using CHAT conventions. Microstructural variables were extracted using the CLAN (Computerized Language ANalysis) program, whereas thematic informativeness was scored for each sample using TUs. Chi-square tests were conducted to compare both groups on each TU; t tests were also performed on the total score of TUs and microstructural variables. RESULTS: Groups were matched on sex, age, and education variables. The t tests revealed no intergroup difference for the total TU score and for the microstructural variables (e.g., mean length of utterances and number of words per minute). Chi-square tests showed no significant intergroup difference for all 16 TUs. CONCLUSIONS: These findings support remote online assessment of the picnic scene of the WAB-R picture description in Canadian French neurotypical speakers. These results also validate the 16 TUs most consistently produced. The use of videoconference could promote and improve the recruitment of participants who are usually less accessible, such as people using assistive mobility technologies. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21476961.


Assuntos
Afasia , COVID-19 , Humanos , Pessoa de Meia-Idade , Idoso , Idioma , Pandemias , Canadá , Comunicação por Videoconferência
3.
Am J Speech Lang Pathol ; 31(6): 2722-2740, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36332139

RESUMO

PURPOSE: We present a 20-item naming test, the Severity-Calibrated Aphasia Naming Test (SCANT), that can serve as a proxy measure for an aphasia severity scale that is derived from a thorough test battery of connected speech production, single-word production, speech repetition, and auditory verbal comprehension. METHOD: We use lasso regression and cross-validation to identify an optimal subset from a set of 174 pictures to be named for prediction of aphasia severity, based on data from 200 participants with left-hemisphere stroke who were quasirandomly selected to represent the full impairment scale. Data from 20 healthy controls (i.e., participant caretakers/spouses) were also analyzed. We examine interrater reliability, test-retest reliability, sensitivity and specificity to the presence of aphasia, sensitivity to therapy gains, and external validity (i.e., correlation with aphasia severity measures) for the SCANT. RESULTS: The SCANT has extremely high interrater reliability, and it is sensitive and specific to the presence of aphasia. We demonstrate the superiority of predictions based on the SCANT over those based on the full set of naming items. We estimate a 15% reduction in power when using the SCANT score versus the full test battery's aphasia severity score as an outcome measure; for example, to maintain the same power to detect a significant group average change in aphasia severity, a study with 25 participants using the full test battery to measure treatment effectiveness would require 30 participants if the SCANT were to be used as the testing instrument instead. CONCLUSION: We provide a linear model to convert SCANT scores to aphasia severity scores, and we identify a change score cutoff of four SCANT items to obtain a high degree of confidence based on test-retest SCANT data and the modeled relation between SCANT and aphasia severity scores. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21476871.


Assuntos
Afasia , Acidente Vascular Cerebral , Humanos , Reprodutibilidade dos Testes , Afasia/diagnóstico , Afasia/terapia , Testes de Linguagem , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Fala
4.
Am J Speech Lang Pathol ; 31(6): 2920-2942, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36356216

RESUMO

PURPOSE: Conversation-focused speech-language pathology services are a top priority for people living with aphasia, but little is known about how researchers measure conversation as an outcome of treatment. This scoping review was undertaken to systematically review the evidence regarding the measurement of conversation in aphasia studies and to identify current practices and existing gaps. METHOD: A systematic literature search was conducted for studies published between January 1995 and September 2019 in multiple electronic databases. Covidence software was used to manage search results, study selection, and data charting processes. Data were extracted from each study and then collated and organized to elucidate the breadth of approaches, tools, or procedures oriented to measuring conversation as an outcome and identify gaps in the existing literature. RESULTS: The systematic search of the literature resulted in 1,244 studies. A total of 64 studies met inclusion criteria and were included in the review. The review summarizes the various tools and procedures used to measure conversation as an outcome of aphasia intervention, including variations in data collection and analysis procedures. The review also evaluates the quality of conversation measures in terms of psychometric properties and informal measures of validity. There was a total of 211 measures used across the 64 studies. CONCLUSIONS: While there was no clear measure that was objectively superior, several measures show promise and warrant future exploration. Some of the orientations, conceptualizations, and procedures we have presented can be seen as options that might be included in a future conversation-focused core outcome set. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21514062.


Assuntos
Afasia , Humanos , Afasia/diagnóstico , Afasia/terapia , Comunicação , Psicometria
5.
Am J Speech Lang Pathol ; 31(5S): 2404-2420, 2022 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-36252946

RESUMO

PURPOSE: This scoping review examined studies reporting restorative treatments designed to improve auditory comprehension in people with aphasia. METHOD: We searched eight databases using keywords aphasia, auditory comprehension, treatment, intervention, and rehabilitation, for studies published between 1970 and 2020. Searches returned 170 records, and after applying exclusionary criteria, 28 articles remained. For each article, two authors independently extracted data on study design parameters, participant characteristics, treatment protocol, and treatment outcomes, including generalization. RESULTS: Studies were categorized by treatment focus: direct auditory (n = 7), mixed auditory (n = 13), or indirect (n = 8). Study designs were group (n = 12), single-subject experimental design (n = 11), or case study (n = 5). Fifteen studies had a control condition and/or a control group. Thirteen studies included two to 10 participants. Aphasia severity and auditory comprehension severity were infrequently reported, and most participants were greater than 1-year poststroke. Treatment targets and tasks varied. Sessions ranged from 8 to 240 min, once or more per week, for eight to 60 total sessions over 2-20 weeks. Impairment-based outcome measures were typically used. Improvement and generalization were regularly reported; however, authors frequently did not report statistical significance. CONCLUSIONS: A variety of treatments have addressed auditory comprehension deficits in people with aphasia, with many reporting improvements in auditory comprehension for some people. However, the variability in treatment tasks and delivery and outcome measurements preclude confidently offering specific clinical recommendations for implementing auditory comprehension treatments. Gaps identified by the current study may guide the development and exploration of transparent, repeatable, patient-centered treatments. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21291345.


Assuntos
Afasia , Compreensão , Humanos , Afasia/terapia , Afasia/reabilitação , Resultado do Tratamento
6.
Am J Speech Lang Pathol ; 31(5S): 2378-2394, 2022 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-36260759

RESUMO

PURPOSE: The purpose of this study was to evaluate potential changes on a hierarchy of language tasks and measures of functional communication and quality of life in a group of people with aphasia (PWA) who attended a community aphasia center for 2 years. A secondary purpose was to determine whether there were any predictors of change. METHOD: Twenty-seven PWA who attended Brooks Rehabilitation Aphasia Center (BRAC) were evaluated on an aphasia battery, confrontation naming, and structured discourse in addition to completing self-reported measures of functional communication and quality of life at three time points: before attending BRAC and after 1 (N = 27) and 2 (N = 20) years of BRAC participation. Twenty-six communication partners who communicated regularly with the PWA completed a questionnaire about their functional communication at the same time points. A mixed linear model was conducted for all dependent variables to determine change over time. Tau-b correlations were conducted between demographic and aphasia-related variables and difference scores for outcome measures that exhibited significant improvements. RESULTS: At 1-year testing, significant improvements were observed on the aphasia battery, object and action naming, and all self- and communication partner-reported measures. At 2-year testing, all improvements were maintained except for the self-reported measure of functional communication. Structured discourse showed increases in average number of words, percentage of meaningful words and utterances, and efficiency of meaningful word production after 2 years. No significant correlations were observed between predictor variables and difference scores. CONCLUSIONS: Participation in aphasia centers can result in significant changes in language, functional communication, and quality of life in people with chronic aphasia. These findings support the importance of aphasia centers in the continuum of care for PWA. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21313689.


Assuntos
Afasia , Qualidade de Vida , Humanos , Afasia/diagnóstico , Afasia/reabilitação , Linguística , Comunicação , Inquéritos e Questionários
7.
Am J Speech Lang Pathol ; 31(5S): 2421-2443, 2022 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-36264648

RESUMO

PURPOSE: In the aphasia literature, motivation has been described as potentially influencing rehabilitation outcomes, and there are reports that researchers and clinicians have acted to promote it. However, studies directly investigating the range of beliefs and practices surrounding motivation do not exist currently. The purpose of this scoping review is to develop themes related to the beliefs and practices appearing in the recent aphasia literature. METHOD: Four databases (CINAHL, PsycINFO, PubMed, and Google Scholar) were searched using keywords aphasia and motivation (including derivatives such as motiv*) for articles published between 2009 and 2020. Searches returned 19,731 articles; after deleting duplicates and applying inclusionary criteria, 365 articles remained. In each article, text surrounding the term motivation was highlighted and thematic analysis was applied to these quotations. RESULTS: Sixteen themes were developed through thematic analysis and placed into two groups. The first group contained five themes suggesting that researchers believed that motivation should be studied and recognized the value of motivation in person(s) with aphasia when participating in research or clinical activities. The second group contained 11 themes reporting diverse beliefs and practices in how motivation is incorporated in research and clinical activities. CONCLUSIONS: Results from this scoping review suggest that aphasia researchers, clinicians, and persons with aphasia hold beliefs about motivation that can influence clinical and research decisions. In general, beliefs and decisions related to motivation appeared to be guided by intuition rather than theories of motivation. These themes are discussed within the context of three psychological needs proposed by self-determination theory: competency, autonomy, and relatedness. Applying theories of motivation to future study in aphasia rehabilitation will guide work that can provide empirical support for these beliefs.


Assuntos
Afasia , Motivação , Humanos , Afasia/reabilitação , Autonomia Pessoal
8.
Cortex ; 156: 71-85, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36183573

RESUMO

Semantic control allows us to focus semantic activation on currently relevant aspects of knowledge, even in the face of competition or when the required information is weakly encoded. Diverse cortical regions, including left prefrontal and posterior temporal cortex, are implicated in semantic control, however; the relative contribution of these regions is unclear. For the first time, we compared semantic aphasia (SA) patients with damage restricted to temporoparietal cortex (TPC; N = 8) to patients with infarcts encompassing prefrontal cortex (PF+; N = 22), to determine if prefrontal lesions are necessary for semantic control deficits. These SA groups were also compared with semantic dementia (SD; N = 10), characterised by degraded semantic representations. We asked whether TPC cases with semantic impairment show controlled retrieval deficits equivalent to PF+ cases or conceptual degradation similar to patients with SD. Independent of lesion location, the SA subgroups showed similarities, whereas SD patients showed a qualitatively distinct semantic impairment. Relative to SD, both TPC and PF+ SA subgroups: (1) showed few correlations in performance across tasks with differing control demands, but a strong relationship between tasks of similar difficulty; (2) exhibited attenuated effects of lexical frequency and concept familiarity, (3) showed evidence of poor semantic regulation in their verbal output - performance on picture naming was substantially improved when provided with a phonological cue, and (4) showed effects of control demands, such as retrieval difficulty, which were equivalent in severity across TPC and PF+ groups. These findings show that semantic impairment in SA is underpinned by damage to a distributed semantic control network, instantiated across anterior and posterior cortical areas.


Assuntos
Afasia , Semântica , Humanos , Testes Neuropsicológicos , Afasia/patologia , Lobo Temporal/patologia , Córtex Pré-Frontal/patologia
9.
Cortex ; 156: 126-143, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36244204

RESUMO

Semantic processing is a central component of language and cognition. The anterior temporal lobe is postulated to be a key hub for semantic processing, but the posterior temporoparietal cortex is also involved in thematic associations during language. It is possible that these regions act in concert and depend on an anteroposterior network linking the temporal pole with posterior structures to support thematic semantic processing during language production. We employed connectome-based lesion-symptom mapping to examine the causal relationship between lesioned white matter pathways and thematic processing language deficits among individuals with post-stroke aphasia. Seventy-nine adults with chronic aphasia completed the Philadelphia Naming Test, and semantic errors were coded as either thematic or taxonomic to control for taxonomic errors. Controlling for nonverbal conceptual-semantic knowledge as measured by the Pyramids and Palm Trees Test, lesion size, and the taxonomic error rate, thematic error rate was associated with loss of white matter connections from the temporal pole traversing in peri-Sylvian regions to the posterior cingulate and the insula. These findings support the existence of a distributed network underlying thematic relationship processing in language as opposed to discrete cortical areas.


Assuntos
Afasia , Conectoma , Humanos , Adulto , Idioma , Semântica , Mapeamento Encefálico , Imageamento por Ressonância Magnética , Afasia/etiologia , Redes Neurais de Computação
10.
J Speech Lang Hear Res ; 65(10): 3854-3872, 2022 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-36201169

RESUMO

PURPOSE: The impact of stimulus-level psycholinguistic variables and person-level semantic and phonological processing skills on treatment outcomes in individuals with aphasia requires further examination to inform clinical decision making in treatment prescription and stimuli selection. This study investigated the influence of stimulus-level psycholinguistic properties and person-level semantic and phonological processing skills on word production accuracy and treatment response. METHOD: This retrospective analysis included 35 individuals with chronic, poststroke aphasia, 30 of whom completed typicality-based semantic feature treatment. Mixed-effects logistic regression models were used to predict binary naming accuracy (a) at baseline and (b) over the course of treatment using stimulus-level psycholinguistic word properties and person-level semantic and phonological processing skills as predictors. RESULTS: In baseline naming, words with less complex lexical-semantic and phonological properties showed greater predicted accuracy. There was also an interaction at baseline between stimulus-level lexical-semantic properties and person-level semantic processing skills in predicting baseline naming accuracy. With treatment, words that were more complex from a lexical-semantic standpoint (vs. less complex) and less complex from a phonological standpoint (vs. more complex) improved more. Individuals with greater baseline semantic and phonological processing skills showed a greater treatment response. CONCLUSIONS: This study suggests that future clinical research and clinical work should consider semantic and phonological properties of words in selecting stimuli for semantically based treatment. Furthermore, future clinical research should continue to evaluate baseline individual semantic and phonological profiles as predictors of response to semantically based treatment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21256341.


Assuntos
Anomia , Afasia , Anomia/terapia , Afasia/etiologia , Afasia/terapia , Humanos , Linguística , Estudos Retrospectivos , Semântica
11.
J Stroke Cerebrovasc Dis ; 31(12): 106838, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36283235

RESUMO

BACKGROUND AND PURPOSE: Although findings from published studies suggest post-stroke aphasia is associated with an increased risk of dementia, few studies have evaluated its association in a nationally representative cohort with long-term follow-up. No studies have reported data by type of stroke. Therefore, we examined the association between post-stroke aphasia and the risk of developing dementia. METHODS: Using claims data from Taiwan's universal health insurance program, a cohort of patients ≥18 years old with an initial hospitalization for stroke in 2002-2005 were identified and followed up until December 31, 2016. Patients with newly diagnosed aphasia during stroke hospitalization or within 6 months of discharge were defined as the aphasia group. Cox proportional hazards models were used to estimate hazard ratios (HRs) for developing overall, vascular, and non-vascular dementia in patients with and without post-stroke aphasia. RESULTS: During a median follow-up period of 7.9 and 8.6 years for the aphasia (n=17063) and non-aphasia groups (n=105940), respectively, overall dementia incidence was similar, whereas vascular dementia incidence was higher in the aphasia group (7.52 vs. 5.52 per 1000 person-years). The adjusted HRs (95% confidence intervals) were 1.11 (1.06-1.17), 1.42 (1.31-1.53), and 0.94 (0.88-1.01) for overall, vascular, and non-vascular dementia, respectively. The association between aphasia and the risk of vascular dementia did not differ by stroke type (P for interaction=0.43). The analysis of 16856 propensity score-matched pairs revealed similar results. CONCLUSION: Patients with post-stroke aphasia have an increased risk of developing vascular dementia irrespective of the type of stroke.


Assuntos
Afasia , Demência , Acidente Vascular Cerebral , Humanos , Adolescente , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Incidência , Afasia/diagnóstico , Afasia/epidemiologia , Afasia/etiologia , Estudos de Coortes , Modelos de Riscos Proporcionais , Demência/diagnóstico , Demência/epidemiologia , Demência/etiologia , Fatores de Risco , Taiwan/epidemiologia
12.
J Speech Lang Hear Res ; 65(11): 4327-4345, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36264665

RESUMO

PURPOSE: Emotional stimuli have been shown to influence language processing (both language comprehension and production) in people with aphasia (PWA); however, this finding is not universally reported. Effects of emotional stimuli on language performance in PWA could have clinical and theoretical implications, yet the sparsity of studies and variability among them make it difficult to appraise the significance of this effect. The purpose of this scoping review was to (a) determine the extent and range of research examining the effect of emotional stimuli on language processing in PWA, (b) summarize and evaluate research findings, and (c) identify gaps in the literature that may warrant future study. METHOD: PsycINFO, PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched for articles that compared performance in response to emotional and nonemotional stimuli on at least one language measure in one or more adults with aphasia. Data related to methods and results were extracted from each article and charted in Excel. RESULTS: Five hundred forty unique articles were found, and 18 articles, consisting of 19 studies, met inclusion/exclusion criteria for this review. Of the 19 studies included, 11 studies reported enhanced performance on a language task for emotional compared to nonemotional stimuli, seven reported no difference, and one reported worse performance for emotional compared to nonemotional stimuli. Possible modulating variables such as task type, measurement, stimulus characteristics, and sample characteristics are discussed along with gaps in the literature. CONCLUSION: The extent of research in this area is sparse; however, there does appear to be some early evidence for better performance in response to emotional over nonemotional stimuli in PWA for some, but not all, language processes investigated.


Assuntos
Afasia , Idioma , Adulto , Humanos , Afasia/psicologia , Testes de Linguagem , Emoções
13.
J Speech Lang Hear Res ; 65(11): 4112-4132, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36306508

RESUMO

PURPOSE: The aim of this study was to use acoustic and kinematic speech measures to characterize type of motor speech impairment-apraxia of speech (AOS) versus dysarthria-in individuals with four-repeat tauopathy (4RT)-associated syndromes, including nonfluent variant primary progressive aphasia (nfvPPA), primary progressive AOS (PPAOS), corticobasal syndrome (CBS), and progressive supranuclear palsy syndrome (PSPs). METHOD: Twenty patient participants were recruited and stratified into two groups: (a) a motor-speech-impaired group of individuals with nfvPPA, PPAOS, CBS, or PSPs and suspected 4RT pathology ("MSI+") and (b) a non-motor-speech-impaired group of individuals with logopenic variant primary progressive aphasia ("MSI-"). Ten healthy, age-matched controls also participated in the study. Participants completed a battery of speech tasks, and 15 acoustic and kinematic speech measures were derived. Quantitative speech measures were grouped into feature categories ("AOS features," "dysarthria features," "shared features"). In addition to quantitative speech measures, two certified speech-language pathologists made independent, blinded auditory-perceptual ratings of motor speech impairment. A principal component analysis (PCA) was conducted to investigate the relative contributions of quantitative features. RESULTS: Quantitative speech measures were generally concordant with independent clinician ratings of motor speech impairment severity. Hypothesis-driven groupings of quantitative measures differentiated predominantly apraxic from predominantly dysarthric presentations within the MSI+ group. PCA results provided additional evidence for differential profiles of motor speech impairment in the MSI+ group; heterogeneity across individuals is explained in large part by varying levels of overall severity-captured by the shared feature variable group-and degree of apraxia severity, as measured by the AOS feature variable group. CONCLUSIONS: Quantitative features reveal heterogeneity of MSI in the 4RT group in terms of both overall severity and subtype of MSI. Results suggest the potential for acoustic and kinematic speech assessment methods to inform characterization of motor speech impairment in 4RT-associated syndromes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21401778.


Assuntos
Afasia Primária Progressiva , Afasia , Apraxias , Afasia Primária Progressiva não Fluente , Tauopatias , Humanos , Fala , Disartria , Fenômenos Biomecânicos , Apraxias/etiologia , Acústica
14.
Rev. logop. foniatr. audiol. (Ed. impr.) ; 42(4): 178-185, Oct-Dic. 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-211637

RESUMO

Antecedentes y objetivos: Mucho se ha discutido sobre el uso de la gestualidad en la afasia. Tradicionalmente, los estudios se han centrado en dos aspectos: a)determinar si su empleo se encuentra deteriorado o no en la afasia, y b)si la presencia o ausencia de fluidez tiene alguna influencia en su uso. Sin embargo, en español son pocas las investigaciones que han abordado el estudio de la gestualidad en la afasia y los aspectos antes mencionados. Por tal motivo, el objetivo de esta investigación es analizar el empleo de gestos en cuatro hablantes con afasia para saber si la gestualidad se mantiene a pesar de la patología y para determinar cuál es el papel que desempeña la fluidez en el uso de gestos. Materiales y métodos: Participaron cuatro sujetos con afasia —dos con afasia fluida y dos con afasia no fluida—, por lo que fueron distribuidos en dos grupos. El estudio fue de tipo descriptivo-exploratorio de las conductas no verbales de los participantes. A cada sujeto se le realizó una entrevista semiestructurada con la intención de promover un índice de participación alto. Se evaluó el tipo y la cantidad de gestos utilizados, considerando la variable fluidez/no fluidez, a partir de las propuestas teóricas de Cosnier (1987) y Ekman (2004), principalmente. Resultados: Se observó que los sujetos con afasia conservan el empleo de gestos; además, los participantes con afasia no fluida emplean más gestos con una alta carga semántica y sin la presencia de habla, mientras que los sujetos con afasia fluida emplean menos gestos y con la presencia de habla. Conclusiones: El habla y los gestos son dos procesos independientes que trabajan en paralelo, por lo que el uso de gestos puede permanecer a pesar de las alteraciones lingüísticas de los hablantes con afasia. Los gestos son empleados como estrategias compensatorias que ayudan a que los hablantes con afasia se comuniquen a pesar de la pérdida del habla.(AU)


Background and objective: Much has been discussed about the use of gestures in aphasia. Mainly, studies have been focused on two aspects: (i)to stablish if gestures are employed normally in aphasia or if there is some loss in this capacity, and (ii)to determine if fluency plays a major role. However, in Spanish there are few researches which has tackle study about gestuality in aphasia and the two aspects mentioned before. For this reason, the aim of this study is analyzing the use of gestures in four aphasic-speakers to figure out if gestuality remains despite pathology, and determine what role plays the fluency in the use of gestures. Materials and methods: A descriptive-exploratory study of four subjects with aphasia has been carried out: two with fluent aphasia and two with non-fluent aphasia. A semi-structured interview was conducted with each subject in order to obtain a high participation rate. The type and amount of gestures used were evaluated from the theoretical proposals of Cosnier (1987) and Ekman (2004) mainly, and considering the fluency/non-fluency variable. Results: Both groups employ gestures, but non-fluent subjects use more gestures with a high semantic content and with no speech, meanwhile fluent speakers use less gestures and accompanied of speech. Conclusions: Speech and gestures are two independent processes working in parallel, and gestures are utilized as compensatory strategies which help to speakers with aphasia to communicate despite loss of speech.(AU)


Assuntos
Humanos , Masculino , Afasia , Gestos , Comunicação não Verbal , Afasia Primária Progressiva não Fluente , Transtornos da Linguagem , Transtornos da Comunicação , Fala , Idioma , Fonoaudiologia
15.
Arq Neuropsiquiatr ; 80(7): 681-688, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36254440

RESUMO

BACKGROUND: Aphasia, the most common language disorder secondary to stroke, has been associated with increased mortality, longer hospitalization and rehabilitation times, worse performance in daily activities, increased financial burden, and short- and long-term complications. Aphasia can negatively impact functional communication skills, including social networks, social activities, relationships with other people and social support. OBJECTIVE: To evaluate patients with poststroke aphasia in their respective residences to investigate potential predictors of functional communication. METHODS: The prospective cohort included patients with poststroke aphasia aged 18 years or older who resided in the city of Salvador, Northeastern Brazil. Following discharge from the Stroke Unit (SU), the individuals themselves, or their guardians, were contacted by telephone to schedule a home visit no less than three months after discharge. At baseline, sociodemographic and clinical data were collected, in addition to the scores on the National Institutes of Health Stroke Scale (NIHSS) and modified Barthel Index (mBI). The American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) was applied at the patients' homes. Multivariate linear regression was employed using the total score on the ASHA FACS as the outcome of interest. RESULTS: A multivariate analysis of the associated factors identified using the linear regression revealed that only functional capacity (as assessed by the mBI) upon discharge from the SU remained as an independent predictor of functional communication performance (ß = 0.042; 95% confidence interval [95%CI] = 0.013-0.071; p = 0.002). CONCLUSION: The functional capacity to perform daily activities, evaluated upon discharge from a stroke unit, was identified as a potential predictor of functional communication performance, regardless of the time elapsed after the stroke.


ANTECEDENTES: A afasia, distúrbio de linguagem mais comum secundário ao acidente vascular cerebral (AVC), está associada ao aumento da mortalidade, a um maior tempo de internação e reabilitação, ao pior desempenho nas atividades diárias, ao aumento da carga financeira, e às complicações de curto e longo prazos. Pode impactar negativamente as habilidades de comunicação funcional, incluindo atividades sociais, relacionamento com outras pessoas, e o apoio social. OBJETIVO: Avaliar pacientes com afasia pós-AVC em suas respectivas residências para investigar potenciais preditores de comunicação funcional. MéTODOS: A coorte prospectiva incluiu pacientes com afasia pós-AVC com 18 anos de idade ou mais, residentes em Salvador, Brasil. Após a alta da Unidade de AVC (UAVC), os próprios indivíduos, ou seus responsáveis, foram contatados por telefone para agendamento de visita domiciliar no mínimo três meses após a alta. Inicialmente, foram coletados dados sociodemográficos e clínicos, além das pontuações na National Institutes of Health Stroke Scale (NIHSS) e no Índice de Barthel modificado (IBM). O American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS) foi aplicado no domicílio dos pacientes. A regressão linear multivariada foi empregada usando a pontuação total no ASHA FACS como o desfecho de interesse. RESULTADOS: A análise multivariada por meio de regressão linear revelou que apenas a capacidade funcional avaliada na alta da UAVC permaneceu como preditor independente do desempenho da comunicação funcional (ß = 0,042; intervalo de confiança de 95% [IC95%] = 0,013­0,071; p = 0,002). CONCLUSãO: A capacidade funcional para realizar as atividades diárias, avaliada na alta hospitalar, foi identificada como potencial preditor do desempenho da comunicação funcional, independente do tempo desde o AVC.


Assuntos
Afasia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Afasia/etiologia , Comunicação , Humanos , Estudos Prospectivos , Acidente Vascular Cerebral/complicações
16.
PLoS One ; 17(10): e0275664, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36288353

RESUMO

Aphasia, the loss of language ability following damage to the brain, is among the most disabling and common consequences of stroke. Subcortical stroke, occurring in the basal ganglia, thalamus, and/or deep white matter can result in aphasia, often characterized by word fluency, motor speech output, or sentence generation impairments. The link between greater lesion volume and acute aphasia is well documented, but the independent contributions of lesion location, cortical hypoperfusion, prior stroke, and white matter degeneration (leukoaraiosis) remain unclear, particularly in subcortical aphasia. Thus, we aimed to disentangle the contributions of each factor on language impairments in left hemisphere acute subcortical stroke survivors. Eighty patients with acute ischemic left hemisphere subcortical stroke (less than 10 days post-onset) participated. We manually traced acute lesions on diffusion-weighted scans and prior lesions on T2-weighted scans. Leukoaraiosis was rated on T2-weighted scans using the Fazekas et al. (1987) scale. Fluid-attenuated inversion recovery (FLAIR) scans were evaluated for hyperintense vessels in each vascular territory, providing an indirect measure of hypoperfusion in lieu of perfusion-weighted imaging. We found that language performance was negatively correlated with acute/total lesion volumes and greater damage to substructures of the deep white matter and basal ganglia. We conducted a LASSO regression that included all variables for which we found significant univariate relationships to language performance, plus nuisance regressors. Only total lesion volume was a significant predictor of global language impairment severity. Further examination of three participants with severe language impairments suggests that their deficits result from impairment in domain-general, rather than linguistic, processes. Given the variability in language deficits and imaging markers associated with such deficits, it seems likely that subcortical aphasia is a heterogeneous clinical syndrome with distinct causes across individuals.


Assuntos
Afasia , Transtornos da Linguagem , Leucoaraiose , Acidente Vascular Cerebral , Substância Branca , Humanos , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Leucoaraiose/complicações , Leucoaraiose/diagnóstico por imagem , Afasia/etiologia , Afasia/complicações , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia , Idioma , Imageamento por Ressonância Magnética/efeitos adversos , Transtornos da Linguagem/complicações
17.
Semin Speech Lang ; 43(5): 426-444, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36288736

RESUMO

Researcher-initiated research often has little or no input from the groups who will be affected by the results of the research. The aim of this project was to describe practices of embracing patient-partners (i.e., individuals with aphasia and spouses/family members) in research. Six webinars were developed for both researchers and patient-partners that were required prior to participating in a joint conference that focused on collaborative research teams. The conference was designed based on an appreciative inquiry approach. Including patient-partners into research priorities and planning has been accomplished across various health domains in the United States, but this was the first organized national effort, in the United States, to support the inclusion of people with aphasia and their families as active partners in the research process. Consequently, it is hoped that future aphasia researchers also include patient-partner teams into their research process for more ecologically valid outcomes.


Assuntos
Afasia , Humanos , Estados Unidos , Afasia/terapia , Cônjuges , Família
18.
Am J Speech Lang Pathol ; 31(6): 2569-2590, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36167067

RESUMO

BACKGROUND: Many people with aphasia (PWA) want to read books. Text-to-speech (TTS) technology sometimes provides comprehension and processing time benefits when PWA read short, multisentence passages. Currently, no research examines the effect of TTS support when PWA read books. AIMS: This study's primary purpose was to examine comprehension accuracy and total processing time of PWA and neurotypical healthy adults (NHAs) when reading book sections in read-only versus TTS-supported conditions. A secondary aim was to examine condition preference and perceived degree of understanding by people in both participant groups. METHOD AND PROCEDURE: Ten PWA and 10 NHAs alternated between read-only and TTS-supported conditions to read a book. Participants answered comprehension questions and provided feedback about their reading experience, condition preference, and desire to use TTS technology for future book reading. Outcomes and Result: Overall, PWA exhibited less accurate comprehension and slower processing times compared to NHAs in both conditions. No significant comprehension accuracy difference occurred between conditions for either group. However, four PWA exhibited a 10% or greater increase in comprehension accuracy when receiving TTS support. A significant processing time difference occurred with PWA processing text faster with TTS support, whereas NHAs did not demonstrate processing time differences. Most PWA preferred the TTS condition and expressed a desire to use TTS technology in the future. Most NHAs expressed the opposite preference. CONCLUSIONS: TTS support during book reading promotes faster processing without compromising comprehension for PWA. Clinicians should discuss with PWA the relative importance of comprehension accuracy, processing time, and comfort with technology when determining whether using TTS support during book reading is desirable.


Assuntos
Afasia , Leitura , Adulto , Humanos , Compreensão , Projetos Piloto , Afasia/diagnóstico , Livros
19.
Neurocase ; 28(4): 356-363, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36130333

RESUMO

Posterior cortical atrophy (PCA) describes a neurodegenerative syndrome characterized by progressive difficulties in cortical visual and other posterior cortical functions consistent with parieto-occipital and occipito-temporal involvement. It is increasingly recognized that many patients develop difficulties with other aspects of daily living, in particular, with language and communication. We present a case emphasizing how language difficulties may emerge in PCA. Difficulties are interpreted as arising from interacting effects of linguistic deficits and impaired detection of nonverbal (particularly, visual) turns that normally facilitate, schedule, and disambiguate the exchange of verbal messages between speakers. We propose that relatively simple speech and language therapy interventions may hold promise in addressing language and communication difficulties as secondary features of PCA by targeting the behaviors of both the person with PCA and their communication partners.


Assuntos
Afasia , Humanos , Idioma , Comunicação , Atrofia/complicações
20.
Sci Rep ; 12(1): 15108, 2022 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-36068279

RESUMO

The aphasia quotient of Western Aphasia Battery (WAB-AQ) has been used as an inclusion criterion and as an outcome measure in clinical, research, or community settings. The WAB-AQ is also commonly used to measure recovery. This study aimed to quantitatively determine levels of the linguistic deficit by using a cluster analysis of the WAB-AQ in post-stroke aphasia (PSA). 308 patients were extracted from the database. Cutoff scores are defined by mean overlap WAB-AQ scores of clusters by systematic cluster analysis, the method of which is the farthest neighbor element, and the metrics are square Euclidean distance and Pearson correlation, performed on the full sample of WAB-AQ individual subitem scores. A 1-way analysis of variance, with post hoc comparisons conducted, was used to determine whether clusters had significant differences. Three clusters were identified. The scores for severe, moderate, and mild linguistic deficit levels ranged from 0 to 30, 30.1 to 50.3, and 50.4 to 93.7, respectively. For PSA, the cluster analysis of WAB-AQ supports a 3-impairment level classification scheme.


Assuntos
Afasia , Afasia/diagnóstico , Afasia/etiologia , Análise por Conglomerados , Bases de Dados Factuais , Humanos , Linguística
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