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1.
Pan Afr Med J ; 39: 191, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34603572

RESUMO

Glioblastoma is the most common primary malignant brain tumour. Despite advances in diagnostic and therapeutic treatments, it is still associated with poor outcome The purpose of this study of cases is to describe the epidemiological, clinical, therapeutic and evolutionary features of patients with glioblastoma admitted to the Department of Hematology-Oncology (DHO) in Marrakech in 2016 and 2017. We conducted a literature review of epidemiological, clinical, radiological, anatomopathological, therapeutic and evolutionary data from 40 patients. Glioblastoma accounted for 47.6% of treated intracranial tumours. The average age of patients was 52.4±12.3 years. Functional impotence and signs of intracranial hypertension were the main symptoms. Tumours mainly occurred in the parietal region (44%) and were large (57.5%). Aphasia was related to tumour size (p=0.042). Nine cases had glioblastomas-IDH1-wild and one case had glioblastoma-IDH1-mutant. On admission, patients had poor performance-status. This was due to a prolonged time between surgery and DHO admission (p= 0.034). Patients with sensory impairments were older (62.5±3 years) than those without sensory impairments (51.2±12 years) (p=0,045). In-patient women received chemoradiotherapy (1.5±1 month) earlier than men (2.3±1.2 months) (p=0.03). Survival was 13.6±5.3 months; it was unrelated to the time to surgery (p=0.076), the time to DHO (p=0.058), and the time to chemoradiotherapy (p=0.073). The epidemiological, clinical, radiological and evolutionary features of our sample were comparable to literature data. The molecular profiling was not systematically realized. Despite prolonged treatment times, no link to survival was detected.


Assuntos
Neoplasias Encefálicas/epidemiologia , Glioblastoma/epidemiologia , Hipertensão Intracraniana/etiologia , Adulto , Fatores Etários , Afasia/epidemiologia , Afasia/etiologia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/terapia , Feminino , Glioblastoma/patologia , Glioblastoma/terapia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos , Estudos Retrospectivos , Fatores Sexuais , Taxa de Sobrevida , Tempo para o Tratamento
2.
Codas ; 33(6): e20190288, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34468630

RESUMO

PURPOSE: To analyze the Quality of Life of subjects with aphasia participating in an Interdisciplinary Living Group. METHODS: cross-sectional and quantitative study. Convenience sample submitted to two questionnaires: a semi-structured one, developed exclusively for the characterization of the subjects and the World Health Organization Quality of Life Scale - Bref (WHOQOL-Bref) to identify their Quality of Life (QOL). Data analysis was descriptive. RESULTS: Eight subjects were interviewed, aged between 35 and 78 years and schooling between Incomplete Elementary School and Incomplete Higher Education. The predominant occupation was that of a clerk and the income varied between one and four minimum wages. The time of brain injury was from three to 10 years, caused predominantly by Stroke caused by Systemic Arterial Hypertension. As for WHOQOL, there was an important variation between the subjects in the four domains (physical, psychological, social and environmental). However, most scored above 70 points. For all subjects, the Living Group was identified as a space for the production of life and health, motivating them to seek other services. CONCLUSION: The subjects were adults and elderly people belonging to the lower-middle class; presented chronic health conditions, impaired verbal expression and long monitoring time to their health needs. The WHOQOL-Bref revealed that five subjects perceived their favorable living/health conditions, however, they highlighted reduced social contact. The Living Group became an important space for improving QOL.


Assuntos
Afasia , Qualidade de Vida , Adulto , Idoso , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Organização Mundial da Saúde
3.
BMJ Open ; 11(9): e046609, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489271

RESUMO

OBJECTIVE: This study aimed to assess the cost-effectiveness of combined scalp acupuncture therapy with speech and language therapy for patients with Broca's aphasia after stroke. DESIGN: A within-trial cost-effectiveness analysis. SETTINGS: Community health centres. SUBJECTS: A total of 203 participants with Broca's aphasia after stroke who had been randomly assigned to receive scalp acupuncture with speech and language therapy (intervention) or speech and language therapy alone (control). INTERVENTION: Both groups underwent speech and language therapy (30 min per day, 5 days a week, for 4 weeks), while the intervention group simultaneously received scalp acupuncture. PRIMARY OUTCOMES: All outcomes were collected at baseline, and after the 4-week intervention and 12-week follow-up. Cost-effectiveness measures included the Chinese Rehabilitation Research Center Standard Aphasia Examination (CRRCAE) and Boston Diagnostic Aphasia Examination (BDAE). Cost-utility was evaluated using quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios were expressed, and sensitivity analysis was conducted. RESULTS: The total cost to deliver the intervention was €4001.72, whereas it was €4323.57 for the control group. The incremental cost-effectiveness ratios showed that the intervention was cost-effective (€495.1 per BDAE grade gained; €1.8 per CRRCAE score gained; €4597.1 per QALYs gained) relative to the control over the 12 weeks. The intervention had a 56.4% probability of being cost-effective at the ¥50 696 (€6905.87) Gross Domestic Product (GDP) per capita threshold. Sensitivity analyses confirmed the robustness of the results. CONCLUSIONS: Compared with speech and language therapy alone, the addition of scalp acupuncture was cost-effective in Chinese communities. As the costs of acupuncture services in China are likely to differ from other countries, these results should be carefully interpreted and remain to be confirmed in other populations. TRIAL REGISTRATION NUMBER: ChiCTR-TRC-13003703.


Assuntos
Terapia por Acupuntura , Afasia , Acidente Vascular Cerebral , Afasia/etiologia , Afasia/terapia , Análise Custo-Benefício , Humanos , Terapia da Linguagem , Couro Cabeludo , Fala , Acidente Vascular Cerebral/complicações
4.
BMJ Open ; 11(8): e047994, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34341046

RESUMO

OBJECTIVE: To evaluate systematically the fidelity of a peer-befriending intervention for people with aphasia. DESIGN: SUpporting wellbeing through Peer-befriending (SUPERB) was a feasibility randomised controlled trial comparing usual care to usual care +peer-befriending. This paper reports on the fidelity of all intervention aspects (training and supervision of providers/befrienders; intervention visits) which was evaluated across all areas of the Behaviour Change Consortium framework. SETTING: Community. PARTICIPANTS: People with aphasia early poststroke and low levels of distress, randomised to the intervention arm of the trial (n=28); 10 peer-befrienders at least 1-year poststroke. INTERVENTION: Peer-befrienders were trained (4-6 hours); and received regular supervision (monthly group while actively befriending, and one-to-one as and when needed) in order to provide six 1-hour peer-befriending visits over 3 months. MAIN MEASURES: Metrics included number and length of training, supervision sessions and visits. All training and supervision sessions and one (of six) visits per pair were rated against fidelity checklists and evaluated for inter-rater and intrarater reliability (Gwets AC1 agreement coefficient). Per-cent adherence to protocol was evaluated. RESULTS: All peer-befrienders received 4-6 hours training over 2-3 days as intended. There were 25 group supervision sessions with a median number attended of 14 (IQR=8-18). Twenty-six participants agreed (92.8%) to the intervention and 21 (80.8%) received all six visits (median visit length 60 min). Adherence was high for training (91.7%-100%) and supervision (83%-100%) and moderate-to-high for befriending visits (66.7%-100%). Where calculable, inter-rater and intrarater reliability was high for training and supervision (Gwets AC1 >0.90) and moderate-to-high for intervention visits (Gwets AC1 0.44-1.0). CONCLUSION: Planning of fidelity processes at the outset of the trial and monitoring throughout was feasible and ensured good-to-high fidelity for this peer-befriending intervention. The results permit confidence in other findings from the SUPERB trial. TRIAL REGISTRATION NUMBER: NCT02947776.


Assuntos
Afasia , Estudos de Viabilidade , Humanos , Grupo Associado , Reprodutibilidade dos Testes
5.
Behav Neurol ; 2021: 8887012, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367374

RESUMO

Stroke is one of the most deliberating causes of mortality and disability worldwide. Studies have implicated Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF) gene as a genetic factor influencing stroke recovery. Still, the role of BDNF polymorphism in poststroke aphasia is relatively unclear. This review assesses the recent evidence on the association between the BDNF polymorphism and aphasia recovery in poststroke patients. The article highlights BNDF polymorphism characteristics, speech and language interventions delivered, and the influence of BNDF polymorphism on poststroke aphasia recovery. We conducted a literature search through PubMed and Google Scholar with the following terms: "brain derived-neurotrophic factor" and "aphasia" for original articles from January 2000 until June 2020. Out of 69 search results, a detailed selection process produced a total of 3 articles that met the eligibility criteria. All three studies included Val66Met polymorphism as the studied human BDNF gene. One of the studies demonstrated insufficient evidence to conclude that BDNF polymorphism plays a role in poststroke aphasia recovery. The remaining two studies have shown that Met allele genotype (either single or double nucleotides) was associated with poor aphasia recovery, in either acute or chronic stroke. Carriers of the Val66Met polymorphism of BDNF gave a poorer response to aphasia intervention and presented with more severe aphasia.


Assuntos
Afasia , Fator Neurotrófico Derivado do Encéfalo , Acidente Vascular Cerebral , Afasia/genética , Fator Neurotrófico Derivado do Encéfalo/genética , Genótipo , Humanos , Polimorfismo de Nucleotídeo Único , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/genética
6.
Medicina (Kaunas) ; 57(8)2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34441005

RESUMO

Cognitive status epilepticus is an uncommon form of focal status epilepticus presenting with a dysfunction of language, thinking or associated higher cortical functions. The absence of ictal manifestations can be misleading and delay a prompt diagnosis. Here we present two patients; one with amnesic and one with aphasic status epilepticus. Through these cases, we aim to highlight the value of EEG performance early in the diagnostic work-up and early antiepileptic drug initiation in cases where an epileptic disorder cannot be excluded.


Assuntos
Afasia , Epilepsia , Estado Epiléptico , Cognição , Eletroencefalografia , Humanos , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/etiologia
7.
BMJ Open ; 11(8): e050308, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408055

RESUMO

OBJECTIVES: The Solution Focused Brief Therapy in Post-Stroke Aphasia feasibility trial had four primary aims: to assess (1) acceptability of the intervention to people with aphasia, including severe aphasia, (2) feasibility of recruitment and retention, (3) acceptability of research procedures and outcome measures, and (4) feasibility of delivering the intervention by speech and language therapists. DESIGN: Two-group randomised controlled feasibility trial with wait-list design, blinded outcome assessors and nested qualitative research. SETTING: Participants identified via two community NHS Speech and Language Therapy London services and through community routes (eg, voluntary-sector stroke groups). PARTICIPANTS: People with aphasia at least 6 months post stroke. INTERVENTION: Solution-focused brief therapy, a psychological intervention, adapted to be linguistically accessible. Participants offered up to six sessions over 3 months, either immediately postrandomisation or after a delay of 6 months. OUTCOME MEASURES: Primary endpoints related to feasibility and acceptability. Clinical outcomes were collected at baseline, 3 and 6 months postrandomisation, and at 9 months (wait-list group only). The candidate primary outcome measure was the Warwick-Edinburgh Mental Well-being Scale. Participants and therapists also took part in in-depth interviews. RESULTS: Thirty-two participants were recruited, including 43.8% with severe aphasia. Acceptability endpoints: therapy was perceived as valuable and acceptable by both participants (n=30 interviews) and therapists (n=3 interviews); 93.8% of participants had ≥2 therapy sessions (90.6% had 6/6 sessions). Feasibility endpoints: recruitment target was reached within the prespecified 13-month recruitment window; 82.1% of eligible participants consented; 96.9% were followed up at 6 months; missing data <0.01%. All five prespecified feasibility progression criteria were met. CONCLUSION: The high retention and adherence rates, alongside the qualitative data, suggest the study design was feasible and therapy approach acceptable even to people with severe aphasia. These results indicate a definitive randomised controlled trial of the intervention would be feasible. TRIAL REGISTRATION NUMBER: NCT03245060.


Assuntos
Afasia , Psicoterapia Breve , Acidente Vascular Cerebral , Afasia/etiologia , Afasia/terapia , Estudos de Viabilidade , Humanos , Londres , Acidente Vascular Cerebral/complicações
8.
Neuroimage Clin ; 31: 102774, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34371239

RESUMO

BACKGROUND: The complex crossing-fiber characteristics in the dual-stream system have been ignored by traditional diffusion tensor models regarding disconnections in post-stroke aphasia. It is valuable to identify microstructural damage of crossing-fiber pathways and reveal accurate fiber-specific language mapping in patients with aphasia. METHODS: This cross-sectional study collected magnetic resonance imaging data from 29 participants with post-stroke aphasia in the subacute stage and from 33 age- and sex-matched healthy controls. Fixel-based analysis was performed to examine microstructural fiber density (FD) and bundle cross-section alterations of specific fiber populations in crossing-fiber regions. Group comparisons were performed, and relationships with language scores were assessed. RESULTS: The aphasic group exhibited significant fixel-wise FD reductions in the dual-stream tracts, including the left inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus, and superior longitudinal fasciculus (SLF) III (family-wise-error-corrected p < 0.05). Voxel- and fixel-wise comparisons revealed mismatched distributions in regions with crossing-fiber nexuses. Fixel-wise correlation analyses revealed significant associations between comprehension impairment and reduced FD in the temporal and frontal segments of the left IFOF, and also mapped naming ability to the IFOF. Average features along the whole course of dominant tracts assessed with tract-wise analyses attributed word-level comprehension to the IFOF (r = 0.723, p < 0.001) and revealed a trend-level correlation between sentence-level comprehension and FD of the SLF III (r = 0.451, p = 0.021). The mean FD of the uncinate fasciculus (UF) and IFOF correlated with total and picture naming scores, and the IFOF also correlated with responsive naming subdomains (Bonferroni corrected p < 0.05). CONCLUSIONS: FD reductions of dual streams suggest that intra-axonal volume reduction constitutes the microstructural damage of white matter integrity in post-stroke aphasia. Fixel-based analysis provides a complementary method of language mapping that identifies fiber-specific tracts in the left hemisphere language network with greater specificity than voxel-based analysis. It precisely locates the precise segments of the IFOF for comprehension, yields fiber-specific evidence for the debated UF-naming association, and reveals dissociative subdomain associations with distinct tracts.


Assuntos
Afasia , Acidente Vascular Cerebral , Substância Branca , Afasia/diagnóstico por imagem , Afasia/etiologia , Estudos Transversais , Imagem de Tensor de Difusão , Humanos , Idioma , Vias Neurais/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Substância Branca/diagnóstico por imagem
9.
Medicine (Baltimore) ; 100(31): e26840, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397854

RESUMO

RATIONALE: We report on a patient whose arcuate fasciculus (AF) and corticobulbar tract (CBT) recovered following an infarct in the middle cerebral artery (MCA) territory, demonstrated on serial diffusion tensor tractography (DTT). PATIENT CONCERNS: The patient showed moderate conduction aphasia on the Western Aphasia Battery with an aphasia quotient of 46.5‰ (spontaneous speech: 35.0‰, auditory comprehension: 36.0‰, and naming: 53.1‰) at 1 month after onset. His aphasia improved with an aphasia quotient of 49‰ (spontaneous speech: 71.0‰, auditory comprehension: 52.0‰, and naming: 59.0‰) at 10 months after onset. DIAGNOSIS: A 44-year-old right-handed male patient presented with aphasia and quadriplegia, which occurred at the onset of an infarct in the left MCA territory. INTERVENTION: Diffusion tensor imaging data were acquired twice (1 month and 10 months after onset). OUTCOMES: On one-month DTT, the discontinuation of the left AF and severe narrowing of the right CBT were observed. However, on ten-month DTT, the left AF was connected to the opposite AF by a new tract that passed through the splenium of corpus callosum, and the right CBT had become thicker. LESSONS: We believe that our results suggest a recovery mechanism of injured AF and CBT in stroke patients.


Assuntos
Afasia , Encéfalo , Área de Broca , Infarto da Artéria Cerebral Média , Área de Wernicke , Adulto , Afasia/diagnóstico , Afasia/etiologia , Afasia/reabilitação , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Humanos , Infarto da Artéria Cerebral Média/diagnóstico , Infarto da Artéria Cerebral Média/fisiopatologia , Infarto da Artéria Cerebral Média/reabilitação , Masculino , Vias Neurais/patologia , Vias Neurais/fisiopatologia , Reabilitação Neurológica/métodos , Tratos Piramidais/patologia , Recuperação de Função Fisiológica , Fonoterapia/métodos , Resultado do Tratamento
10.
Am J Speech Lang Pathol ; 30(5): 2115-2129, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34411485

RESUMO

Purpose Aphasia intervention research aims to improve communication and quality of life outcomes for people with aphasia. However, few studies have evaluated the translation and implementation of evidence-based aphasia interventions to clinical practice. Treatment dosage may be difficult to translate to clinical settings, and a mismatch between dosage in research and clinical practice threatens to attenuate intervention effectiveness. The purpose of this study is to quantify a potential research-practice dosage gap in outpatient aphasia rehabilitation. Method This study utilized a two-part approach. First, we estimated clinical treatment dosage in an episode of care (i.e., treatment provided from outpatient assessment to discharge) via utilization in a regional provider in the United States. Second, we undertook a scoping review of aphasia interventions published from 2009 to 2019 to estimate the typical dosage used in the current aphasia literature. Results Outpatient clinical episodes of care included a median of 10 treatment sessions and a mean of 14.8 sessions (interquartile range: 5-20 sessions). Sessions occurred 1-2 times a week over 4-14 weeks. The median total hours of treatment was 7.5 hr (interquartile range: 3.75-15 hr). In contrast, published interventions administered a greater treatment dosage, consisting of a median of 20 hr of treatment (interquartile range: 12-30 hr) over the course of 15 sessions (interquartile range: 10-24 sessions) approximately 3 times per week. Conclusions Results demonstrate a meaningful research-practice dosage gap, particularly in total treatment hours and weekly treatment intensity. This gap highlights the potential for attenuation of effectiveness from research to outpatient settings. Future translational research should consider clinical dosage constraints and take steps to facilitate intervention implementation, particularly with regard to dosage. Conversely, health care advocacy and continued development of alternative delivery methods are necessary for the successful implementation of treatments with dosage that is incompatible with current clinical contexts. Pragmatic, implementation-focused trials are recommended to evaluate and optimize treatment effectiveness in outpatient clinical settings. Supplemental Material https://doi.org/10.23641/asha.15161568.


Assuntos
Afasia , Qualidade de Vida , Afasia/diagnóstico , Afasia/terapia , Comunicação , Atenção à Saúde , Humanos
11.
No Shinkei Geka ; 49(4): 909-913, 2021 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-34376623

RESUMO

In this case report, we describe a rare case of anterior cranial fossa dural arteriovenous fistula(ACF-dAVF)that had drained into the fronto-basal vein and refluxed to the superficial middle cerebral vein(SMCV). A 45-year-old man presented with aphasia and swelling of the left eye after head trauma. MRI detected a flow void in the left frontal basal area, and digital subtraction angiography revealed ACF-dAVF, which was fed from the ophthalmic arteries on both sides and had a shunt point within the left front basal dura. It drained into the left front basal vein and refluxed to the left SMCV via the cavernous sinus. Aphasia occurred due to the reflux of the SMCV. We treated the patient with transcatheter arterial embolization(TAE)by injecting n-butyl-2-cyanoacrylate(NBCA)into the shunt point. Immediately after TAE, the aphasia and swelling of the left eye of the patient improved. Cases of ACF-dAVF that drain not into the frontal cortical veins but into the fronto-basal vein and SMCV are relatively rare. As ACF-dAVF occasionally causes frontal symptoms such as aphasia, we should carefully investigate such patients and consider the presence of ACF-dAVF.


Assuntos
Afasia , Malformações Vasculares do Sistema Nervoso Central , Traumatismos Craniocerebrais , Afasia/etiologia , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Fossa Craniana Anterior , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade
12.
J Stroke Cerebrovasc Dis ; 30(9): 105954, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34217069

RESUMO

OBJECTIVES: An isolated intraventricular cerebral varix is a rare entity. Although it is generally asymptomatic, there have been reports of symptomatic cases. Here, we report a case of right hemiplegia and aphasia due to venous infarction caused by thrombosis of the intraventricular varix. CASE PRESENTATION: A 79-year-old woman presented with right-sided hemiplegia and aphasia accompanied by conjugate eye deviation to the left. She had a history of hypertension, dyslipidemia, and asymptomatic isolated cerebral varix located in the left lateral ventricle. Blood analysis indicated no abnormalities in coagulation or fibrinolysis. Plain head computed tomography showed an intraventricular varix in the form of a high-density mass, indicating acute phase thrombosis, and contrast-enhanced computed tomography depicted a filling defect in the varix. In addition, fluid-attenuated inversion recovery imaging showed hyperintense lesions in the deep white matter of the frontal-parietal lobe, indicating venous infarction due to occlusion of the varix of the thalamostriate vein. Glycerol and prophylactic levetiracetam were administered, and she was transferred to another hospital for rehabilitation 23 days after treatment initiation. CONCLUSION: This is the first reported case in which a typically asymptomatic condition, intraventricular cerebral varix, caused venous infarction due to thrombosis and occlusion of the varix of the thalamostriate vein. Careful selection of the treatment strategy is required on a case-by-case basis because an intraventricular varix can cause both bleeding and infarction, which are treated differently.


Assuntos
Infarto Cerebral/etiologia , Trombose Intracraniana/etiologia , Varizes/complicações , Trombose Venosa/etiologia , Idoso , Afasia/etiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/terapia , Feminino , Hemiplegia/etiologia , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/terapia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
13.
BMJ Open ; 11(7): e048126, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34321303

RESUMO

INTRODUCTION: At least 68% of persons with aphasia (PWA) experience reading difficulties. Even though strategy-based interventions are a promising treatment approach for text level reading comprehension deficits in PWA, empirical evidence for their efficacy remains rare. The primary objective of this study is the analysis of the efficacy of a strategy-based intervention on text-level reading comprehension and on reading activities in PWA. METHODS AND ANALYSIS: In a repeated measures trial, 24 PWA will first participate in a waiting period and then in a strategy-based intervention (14 face-to-face-sessions, 60 min each). We will apply two combinations of strategies to treat either the microstructure or the macrostructure, respectively. Participants will be randomly allocated to two parallel groups that will receive these combinations in interchanged sequences. Assessments will be implemented before and after each period as well as 3 and 6 months after the intervention. The primary outcome measure is text-level reading comprehension measured with a German version of the Test de Compréhension de Textes (TCT-D) and represented by the score TCT-D Total . A non-blinded and a blinded rater will evaluate the primary outcome measure. Secondary outcome measures will address specific reading functions, reading activities and cognitive functions. The sample size was determined with an a priori power analysis. For statistical analysis, we will use contrast analyses within repeated measures analysis of variance models. We expect significant improvements in primary and secondary outcome measures during the intervention as compared with changes during the waiting period. ETHICS AND DISSEMINATION: This study was approved by the ethics committee of Deutscher Bundesverband für akademische Sprachtherapie und Logopädie (20-10074-KA-MunmErw+Ko). Results and relevant data will be disseminated in peer-reviewed journals, at conferences and on the Open Science Framework. TRIAL REGISTRATION NUMBER: DRKS00021411 (see Supplementary Table 1).


Assuntos
Afasia , Compreensão , Afasia/terapia , Humanos , Leitura , Projetos de Pesquisa , Tamanho da Amostra
14.
Neuropsychologia ; 160: 107961, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34274379

RESUMO

Anosognosia, or lack of self-awareness, is often present following neurological injury and can result in poor functional outcomes. The specific phenomenon of intellectual awareness, the knowledge that a function is impaired in oneself, has not been widely studied in post-stroke aphasia. We aim to identify behavioral and neural correlates of intellectual awareness by comparing stroke survivors' self-reports of anomia to objective naming performance and examining lesion sites. Fifty-three participants with chronic aphasia without severe comprehension deficits rated their naming ability and completed a battery of behavioral tests. We calculated the reliability and accuracy of participant self-ratings, then examined the relationship of poor intellectual awareness to speech, language, and cognitive measures. We used support vector regression lesion-symptom mapping (SVR-LSM) to determine lesion locations associated with impaired and preserved intellectual awareness. Reliability and accuracy of self-ratings varied across the participants. Poor intellectual awareness was associated with reduced performance on tasks that rely on semantics. Our SVR-LSM results demonstrated that anterior inferior frontal lesions were associated with poor awareness, while mid-superior temporal lesions were associated with preserved awareness. An anterior-posterior gradient was evident in the unthresholded lesion-symptom maps. While many people with chronic aphasia and relatively intact comprehension can accurately and reliably report the severity of their anomia, others overestimate, underestimate, or inconsistently estimate their naming abilities. Clinicians should consider this when administering self-rating scales, particularly when semantic deficits or anterior inferior frontal lesions are present. Administering self-ratings on multiple days may be useful to check the reliability of patient perceptions.


Assuntos
Afasia , Acidente Vascular Cerebral , Afasia/diagnóstico por imagem , Afasia/etiologia , Mapeamento Encefálico , Humanos , Imageamento por Ressonância Magnética , Reprodutibilidade dos Testes , Semântica , Acidente Vascular Cerebral/complicações
15.
Neuroimage Clin ; 31: 102760, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34274725

RESUMO

BACKGROUND: Foreign accent syndrome (FAS) is a rare acquired speech disorder wherein an individual's spoken accent is perceived as "foreign." Most reported cases involve left frontal brain lesions, but it is known that various other lesions can also cause FAS. To determine whether heterogeneous FAS-causing lesions are localized to a common functional speech network rather than to a single anatomical site, we employed a recently validated image analysis technique known as "lesion network mapping." METHODS: We identified 25 published cases of acquired neurogenic FAS without aphasia, and mapped each lesion volume onto a reference brain. We next identified the network of brain regions functionally connected to each FAS lesion using a connectome dataset from normative participants. Network maps were then overlapped to identify common network sites across the lesions. RESULTS: Classical lesion overlap analysis showed heterogeneity in lesion anatomical location, consistent with prior reports. However, at least 80% of lesions showed network overlap in the bilateral lower and middle portions of the precentral gyrus and in the medial frontal cortex. The left lower portion of the precentral gyrus is suggested to be the location of lesions causing apraxia of speech (AOS), and the middle portion is considered to be a larynx-specific motor area associated with the production of vowels and stop/nasal consonants and with the determination of pitch accent. CONCLUSIONS: The lesions that cause FAS are anatomically heterogeneous, but they share a common functional network located in the bilateral posterior region of the frontal lobe. This network specifically includes not only the lower portion of the central gyrus, but also its middle region, which is referred to as the larynx motor cortex and is known to be associated with phonation. Our findings suggest that disrupted networks in FAS might be anatomically different from those in AOS.


Assuntos
Afasia , Córtex Motor , Encéfalo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Distúrbios da Fala , Síndrome
16.
Am J Speech Lang Pathol ; 30(5): 2228-2240, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34310195

RESUMO

Purpose Speech-language pathologists (SLPs) who work with people with aphasia focus on assessment and intervention to support improved communication outcomes for their clients. Friendship, a key component of quality of life, often depends on communicative interaction, and many people with aphasia report having reduced social circles. The purpose of this study was to explore the perceptions of SLPs working with clients with aphasia on their role in supporting friendship development and maintenance. Method An online survey composed of questions addressing SLP perspectives and goal setting, assessment, and treatment practices related to aphasia and friendship was distributed to SLPs across the United States. Survey data were analyzed using both quantitative and qualitative methods. Results Forty-seven SLPs completed the survey. While many SLPs reported that the friendships of their clients with aphasia were impacted by aphasia and that it was within their scope of practice to support friendship development and maintenance, many did not specifically assess or target friendship and friendship outcomes in the treatment plan. SLPs identified barriers and facilitators to focusing on friendship within the context of speech and language therapy. Conclusions Findings suggest the majority of participating SLPs were interested in addressing friendship with clients with aphasia; however, they experienced barriers in practice. Further examination of SLP perspectives and clinical practice regarding friendship and aphasia is warranted. Additionally, research investigating effective assessment and therapeutic methods that target friendship in aphasia is needed to support clinical practice and the well-being of clients with aphasia. Supplemental Material https://doi.org/10.23641/asha.15032217.


Assuntos
Afasia , Patologia da Fala e Linguagem , Afasia/diagnóstico , Afasia/terapia , Amigos , Humanos , Patologistas , Qualidade de Vida , Fala , Estados Unidos
17.
Am J Speech Lang Pathol ; 30(5): 2053-2068, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34314249

RESUMO

Purpose This study sought to determine the initial feasibility and benefit of a novel intervention that combines speech-language treatment with counseling treatment for an individual with the nonfluent/agrammatic variant of primary progressive aphasia (PPA). Method Using a single-case experimental design, we evaluated the utility of modified script training paired with aphasia-modified cognitive behavioral therapy. The study employed a multiple baseline design across scripts for the primary linguistic outcome measure and a mixed methods approach for analyzing counseling outcomes. Psychosocial and communicative functioning scales were administered in conjunction with a phenomenological analysis of semi-structured interviews. Results The participant completed all study phases and participated in all treatment components. She met the criterion of 90% correct, intelligible scripted words on all trained scripts through 12 months post-treatment. Treatment outcomes were comparable to a comparison cohort that received script training without counseling (Henry et al., 2018). At post-treatment, the participant demonstrated stability or improvement on all measures of psychosocial and communicative functioning, with stability documented on seven out of 11 scales at follow-ups through 12 months post-treatment. A phenomenological analysis revealed pervasive themes of loss and resilience at both time points, and emerging themes of positive self-perception, sense of agency, and emotional attunement following treatment. Conclusions Results indicate that script training with aphasia-modified cognitive behavioral therapy is a feasible treatment for an individual with the nonfluent/agrammatic variant of PPA, with immediate and lasting benefits to speech-language production and psychosocial functioning. These findings are the first to support the integration of personal adjustment counseling techniques within a speech-language treatment paradigm for PPA. Supplemental Material https://doi.org/10.23641/asha.14925330.


Assuntos
Afasia Primária Progressiva , Afasia , Terapia Cognitivo-Comportamental , Afasia Primária Progressiva/diagnóstico , Afasia Primária Progressiva/terapia , Feminino , Humanos , Projetos Piloto , Fonoterapia
19.
Am J Speech Lang Pathol ; 30(4): 1750-1766, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-34100632

RESUMO

Purpose The main concept analysis (MCA; Kong, 2009) quantifies the effectiveness and efficiency of information transfer during verbal discourse by means of four sets of sequential pictorial stimuli. This test was originally developed for a Cantonese-speaking population. The main goals of this study were (a) to translate and adapt the MCA to Dutch; (b) to establish normative data for healthy native Dutch-speaking adults; (c) to assess the effect of age, education level, and gender on MCA outcome; and (d) to establish inter- and intrarater reliability of the Dutch MCA. Method Language samples were collected from 60 healthy native Dutch speakers, equally recruited in different age (20-39 years, 40-59 years, 60-79 years) and education (middle and highly educated) categories through administration of the MCA. Utterances produced by at least 75% of the participants were included as a main concept in the Dutch MCA. Subsequently, age-specific normative data were established for each of the MCA parameters. Finally, an ICC was calculated in order to verify inter- and intrarater reliability of the Dutch MCA. Results The translated MCA consisted of 19 main concepts. Age-specific normative data were obtained. Both age and education level had a significant effect on MCA outcome. Information transfer in elderly was both less effectively and efficiently compared to young- and middle-aged adults. In addition, highly educated participants transferred information less efficiently compared to middle educated participants. Based on inter- and intrarater reliability measures, the Dutch MCA proved to be a reliable measuring instrument. Conclusions The MCA was translated to Dutch, and age-specific normative data were established for a healthy, Dutch-speaking population. The Dutch MCA is a reliable tool for eliciting and quantifying discourse production. Validation of the test for people with aphasia is necessary in order for the test to be useful in a clinical practice.


Assuntos
Afasia , Idioma , Adulto , Idoso , Escolaridade , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Traduções , Adulto Jovem
20.
Artigo em Russo | MEDLINE | ID: mdl-34184478

RESUMO

OBJECTIVE: To evaluate the effectiveness of computer stimulating programs in rehabilitation of post-traumatic cognitive impairments in patients with concomitant aphasia. MATERIAL AND METHODS: The study included 32 young and middle-aged patients with moderate and severe cognitive impairment with concomitant and mild aphasia that occurred after traumatic brain injury. RESULTS: The advantageous restoration of cognitive functions in patients with concomitant aphasia was observed when computer stimulating programs of both types were used, while the improvement of verbal-mediated functions (auditory speech memory and speech activity) was observed when the author's method VerbalCOG was utilized. CONCLUSION: The methods of computerized cognitive training have proven their effectiveness in the recovery from post-traumatic cognitive impairment in patients with concomitant aphasia in comparison with the control group that received medications only. At the same time, the author's program VerbalCOG showed the best results in restoration of verbal-mediated functions in comparison with other presented methods of treatment.


Assuntos
Afasia , Disfunção Cognitiva , Acidente Vascular Cerebral , Afasia/etiologia , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/etiologia , Humanos , Pessoa de Meia-Idade , Fala , Fonoterapia
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