Efficacy and safety of mirror therapy for post-stroke aphasia: A systematic review and meta-analysis protocol.

BACKGROUND: Aphasia is one of the most common complications of stroke. Mirror therapy (MT) is promising rehabilitation measure for the treatment of post-stroke aphasia. Although some studies suggested that MT is effective and safe for aphasia, the effects and safety remain uncertain due to lacking strong evidence, such as the relevant systematic review and meta- analysis. METHODS: This study will search PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network (CNKI), WANFANG, China Biomedical Literature Database (CBM), from inception to 1th May 2023 to identify any eligible study. No language or date of publication shall be limited. We will only include randomised controlled trials of MT in the Treatment of poststroke aphasia. Two investigators will work separately on the study selection, data extraction, and study quality assessment. The western aphasia battery (WAB) and aphasia quotient (AQ) will be included as the main outcomes. Boston diagnostic aphasia examination method (BDAE), Chinese standard aphasia examination (CRRCAE) will be included as the secondary outcomes. The statistical analysis will be conducted by RevMan V.5.4 software. The risk of bias of included studies will be assessed by the Cochrane 'Risk of bias' tool. The quality of proof of the results will be evaluated by using the Grading of Recommendations Assessment, Development and Evaluation guidelines. RESULTS: The finding will be presented in a journal or related conferences. CONCLUSION: This study will provide a basis for whether mirror therapy (MT) is effective and safe in the treatment of post-stroke aphasia. TRIAL REGISTRATION: Systematic review registration INPLASY registration number: INPLASY 202340054.

Understanding experiences, unmet needs and priorities related to post-stroke aphasia care: stage one of an experience-based co-design project.

OBJECTIVE: People with post-stroke aphasia (language/communication impairment) and their supporters report mixed satisfaction with stroke and aphasia care. To date, however, their journey of care and the key service interactions that shape their experience have not been comprehensively explored. We aimed to investigate the lived experience of post-stroke aphasia care, across the continuum of care and by geographical location, to establish priorities for service design. DESIGN: This is the first stage of an experience-based co-design study. We purposively sampled people with aphasia (PWA) and significant others (SOs) across 21 hospital and health service sites, community groups and by self-referral. Participants shared experiences of care in online interviews and focus groups. Touchpoints (key moments that shape experience) and unmet needs were identified using qualitative thematic analysis. Priorities for service design were established using an adapted nominal group technique. SETTING: Sites spanned remote, regional and metropolitan areas in Queensland, Australia. PARTICIPANTS: PWA (n=32; mild=56%; moderate=31%; severe=13%) and SOs (n=30) shared 124 experiences of acute, rehabilitation and community-based care in 23 focus groups and 13 interviews. RESULTS: Both positive and negative healthcare experiences occurred most frequently in hospital settings. Negative experiences regularly related to communication with health professionals, while positive experiences related to the interpersonal qualities of healthcare providers (eg, providing hope) for PWA, or witnessing good rapport between a PWA and their health professional for SOs. To improve services, PWA prioritised communicatively accessible education and information and SOs prioritised access to psychological and peer support. CONCLUSIONS: We identified key aspects of post-stroke aphasia care that shape experience. The needs of PWA and SOs may be better met through health professional training in supported communication, increased service availability in regional and remote areas, communication-accessible hospital environments, increased access to psychological and peer support, and meaningful involvement of SOs in rehabilitation.

Personalised functional imaging-guided multitarget continuous theta burst stimulation for post-stroke aphasia: study protocol for a randomised controlled trial.

INTRODUCTION: Continuous theta burst stimulation (cTBS), a form of repetitive transcranial magnetic stimulation (rTMS), targeting the language network in the right hemisphere of post-stroke aphasia (PSA) patients shows promising results in clinical trials. However, existing PSA studies have focused on single-target rTMS, leaving unexplored the potential benefits of multitarget brain stimulation. Consequently, there is a need for a randomised clinical trial aimed to evaluate the efficacy and safety of cTBS targeting on multiple critical nodes in the language network for PSA. METHODS AND ANALYSIS: This is a prospective, multicentre, double-blind, two-arm parallel-group, sham-controlled randomised trial. The study will include a total of 60 participants who will be randomly assigned in a 1:1 ratio to either the active cTBS group or the sham cTBS group. Using precision resting-state functional MRI for each participant, we will map personalised language networks and design personalised targets in the inferior frontal gyrus, superior temporal gyrus and superior frontal gyrus. Participants will undergo a 3-week cTBS intervention targeting the three personalised targets, coupled with speech and language therapy. The primary outcome is the change in the Western Aphasia Battery-Revised aphasia quotient score among participants after a 3-week treatment. Secondary outcomes include Boston Diagnostic Aphasia Examination severity ratings, Token Test and the Chinese-version of the Stroke and Aphasia Quality of Life Scale 39-generic version. ETHICS AND DISSEMINATION: The study has been approved by the ethics committees of Affiliated Hospital of Hebei University, Hebei General Hospital and Affiliated Hospital of Chengde Medical University. The findings of this study will be reported in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: The study has been registered on ClinicalTrials.gov (NCT05957445).

Developing consensus-based clinical competencies to guide stroke clinicians in the implementation of psychological care in aphasia rehabilitation.

Background People with aphasia experience depression and anxiety associated with negative outcomes across a range of time post-stroke. Stroke clinicians are well-positioned to facilitate low-intensity psychotherapeutic interventions after aphasia (e.g. mood screening, behavioural activation, problem-solving therapy, relaxation therapy); however, they self-report a lack of knowledge, skills and confidence to do so. The Theoretical Domains Framework (TDF) provides a lens through which to view and target clinician behaviours and training needs in this area of practice. The aim of this study was to develop and gain consensus on items for a rating scale of clinical competencies in facilitating individual-based, low-intensity psychotherapeutic interventions for people with aphasia. Methods An e-Delphi methodology using focus groups and survey rounds was used to gain consensus on clinical competencies considered important. Results Eight stroke clinicians (speech pathologists and psychologists), two people with aphasia and three family members participated in one of four focus groups. Four themes were derived from the data: (1) Communication support, (2) Assessment and therapy structure, (3) Interpersonal skills, and (4) Needs of the significant other (family or friend). Themes informed an initial list of 23 self-rated and observer-rated competency items. Following two rounds of e-Delphi surveys, 11 stroke clinicians (six speech pathologists and five psychologists) reached consensus (80-100%) for 19 competencies. Conclusions The Psychological Care in Aphasia Rehabilitation Competency scale offers a preliminary list of items to guide and train clinicians to implement low-intensity psychotherapeutic interventions for people with aphasia.

The Effects of Yoga Breathing Before Motor Speech Practice in Acquired Apraxia of Speech: An n-of-1 Trial.

A previous study discovered that two speakers with moderate apraxia of speech increased their sequential motion rates after unilateral forced-nostril breathing (UFNB) practiced as an adjunct to speech-language therapy in an AB repeated-measures design. The current study sought to: (1) delineate possible UFNB plus practice effects from practice effects alone in motor speech skills; (2) examine the relationships between UFNB integrity, participant-reported stress levels, and motor speech performance; and (3) sample a participant-led UFNB training schedule to contribute to the literature's growing understanding of UFNB dosage. A single-subject (n-of-1 trial), ABAB reversal design was used across four motor speech behaviors. A 60-year-old female with chronic, severe apraxia of speech participated. The researchers developed a breathing app to assess UFNB practice integrity and administer the Simple Aphasia Stress Scale after each UFNB session. The participant improved from overall severe to moderate apraxia of speech on the Apraxia Battery for Adults. Visual inspection of graphs confirmed robust motor speech practice effects for all variables. Articulatory-kinematic variables demonstrated sensitivity to the UFNB-plus-practice condition and correlated to stress scale scores but not UFNB integrity scores. The participant achieved 20-minute UFNB sessions 4 times per week. Removal of UFNB during A2 (UFNB withdrawal) and after a 10-day break during B2 (UFNB full dosage) revealed UFNB practice effects on stress scale scores. UFNB with motor speech practice may benefit articulatory-kinematic skills compared to motor speech practice alone. Regular, cumulative UFNB practice appeared to lower self-perceived stress levels. These findings, along with prior work, provide a foundation to further explore yoga breathing and its use with speakers who have apraxia of speech.

Structural Neuroplasticity Effects of Singing in Chronic Aphasia.

Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine the structural neuroplasticity changes underpinning group-based singing-induced treatment effects in chronic aphasia. Twenty-eight patients with at least mild nonfluent poststroke aphasia were randomized into two groups that received a 4-month multicomponent singing intervention (singing group) or standard care (control group). High-resolution T1 images and multishell diffusion-weighted MRI data were collected in two time points (baseline/5 months). Structural gray matter (GM) and white matter (WM) neuroplasticity changes were assessed using language network region of interest-based voxel-based morphometry (VBM) and quantitative anisotropy-based connectometry, and their associations to improved language outcomes (Western Aphasia Battery Naming and Repetition) were evaluated. Connectometry analyses showed that the singing group enhanced structural WM connectivity in the left arcuate fasciculus (AF) and corpus callosum as well as in the frontal aslant tract (FAT), superior longitudinal fasciculus, and corticostriatal tract bilaterally compared with the control group. Moreover, in VBM, the singing group showed GM volume increase in the left inferior frontal cortex (Brodmann area 44) compared with the control group. The neuroplasticity effects in the left BA44, AF, and FAT correlated with improved naming abilities after the intervention. These findings suggest that in the poststroke aphasia group, singing can bring about structural neuroplasticity changes in left frontal language areas and in bilateral language pathways, which underpin treatment-induced improvement in speech production.

Predicting Language Function Post-Stroke: A Model-Based Structural Connectivity Approach.

BACKGROUND: The prediction of post-stroke language function is essential for the development of individualized treatment plans based on the personal recovery potential of aphasic stroke patients. OBJECTIVE: To establish a framework for integrating information on connectivity disruption of the language network based on routinely collected clinical magnetic resonance (MR) images into Random Forest modeling to predict post-stroke language function. METHODS: Language function was assessed in 76 stroke patients from the Non-Invasive Repeated Therapeutic Stimulation for Aphasia Recovery trial, using the Token Test (TT), Boston Naming Test (BNT), and Semantic Verbal Fluency (sVF) Test as primary outcome measures. Individual infarct masks were superimposed onto a diffusion tensor imaging tractogram reference set to calculate Change in Connectivity scores of language-relevant gray matter regions as estimates of structural connectivity disruption. Multivariable Random Forest models were derived to predict language function. RESULTS: Random Forest models explained moderate to high amount of variance at baseline and follow-up for the TT (62.7% and 76.2%), BNT (47.0% and 84.3%), and sVF (52.2% and 61.1%). Initial language function and non-verbal cognitive ability were the most important variables to predict language function. Connectivity disruption explained additional variance, resulting in a prediction error increase of up to 12.8% with variable omission. Left middle temporal gyrus (12.8%) and supramarginal gyrus (9.8%) were identified as among the most important network nodes. CONCLUSION: Connectivity disruption of the language network adds predictive value beyond lesion volume, initial language function, and non-verbal cognitive ability. Obtaining information on connectivity disruption based on routine clinical MR images constitutes a significant advancement toward practical clinical application.

Response Latencies During Confrontation Picture Naming in Aphasia: Are Proxy Measurements Sufficient?

PURPOSE: Anomia, or word-finding difficulty, is a prevalent and persistent feature of aphasia, a neurogenic language disorder affecting millions of people in the United States. Anomia assessments are essential for measuring performance and monitoring outcomes in clinical settings. This study aims to evaluate the reliability of response time (RT) annotation based on spectrograms and assess the predictive utility of proxy RTs collected during computerized naming tests. METHOD: Archival data from 10 people with aphasia were used. Trained research assistants phonemically transcribed participants' responses, and RTs were generated from the onset of picture stimulus to the initial phoneme of the first complete attempt. RTs were measured in two ways: hand-generated RTs (from spectrograms) and proxy RTs (automatically extracted online). Interrater agreement was evaluated based on interclass correlation coefficients and generalizability theory tools including variance partitioning and the φ-coefficient. The predictive utility of proxy RTs was evaluated within a linear mixed-effects framework. RESULTS: RT annotation reliability showed near-perfect agreement across research assistants (φ-coefficient = .93), and the variance accounted for by raters was negligible. Furthermore, proxy RTs significantly and strongly predicted hand-annotated RTs (R2 = ~0.82), suggesting their utility as an alternative measure. CONCLUSIONS: The study confirms the reliability of RT annotation and demonstrates the predictive utility of proxy RTs in estimating RTs during computerized naming tests. Incorporating proxy RTs can enhance clinical assessments, providing additional information for cognitive measurement. Further research with larger samples and exploring the impact of using proxy RTs in different psychometric models could optimize clinical protocols and improve communication interventions for individuals with aphasia.

A Meta-Analysis of Anomia Treatment in Bilingual Aphasia: Within- and Cross-Language Generalization and Predictors of the Treatment Outcomes.

PURPOSE: The present meta-analysis investigated the efficacy of anomia treatment in bilingual and multilingual persons with aphasia (BPWAs) by assessing the magnitudes of six anomia treatment outcomes. Three of the treatment outcomes pertained to the "trained language": improvement of trained words (treatment effect [TE]), within-language generalization of semantically related untrained words (WLG-Related), and within-language generalization of unrelated words (WLG-Unrelated). Three treatment outcomes were for the "untrained language": improvement of translations of the trained words (cross-language generalization of trained words [CLG-Tx]), cross-language generalization of semantically related untrained words (CLG-Related), and cross-language generalization of unrelated untrained words (CLG-Unrelated). This study also examined participant- and treatment-related predictors of these treatment outcomes. METHOD: This study is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42023418147. Nine electronic databases were searched to identify word retrieval treatment studies of poststroke BPWAs of at least 6 months postonset. Pre- and posttreatment single-word naming scores were extracted for each eligible participant and used to calculate effect sizes (within-case Cohen's d) of the six treatment outcomes. Random-effects meta-analyses were conducted to assess weighted mean effect sizes of the treatment outcomes across studies. Multiple linear regression analyses were used to examine the effects of participant-related variables (pretreatment single-word naming and comprehension representing poststroke lexical processing abilities) and treatment-related variables (type, language, and duration). The methodological quality of eligible studies and the risk of bias in this meta-analysis were assessed. RESULTS: A total of 17 published studies with 39 BPWAs were included in the meta-analysis. The methodological quality of the included studies ranged from fair (n = 4) to good (n = 13). Anomia treatment produced a medium effect size for TE (M = 8.36) and marginally small effect sizes for WLG-Related (M = 1.63), WLG-Unrelated (M = 0.68), and CLG-Tx (M = 1.56). Effect sizes were nonsignificant for CLG-Related and CLG-Unrelated. TE was significantly larger than the other five types of treatment outcomes. TE and WLG-Related effect sizes were larger for BPWAs with milder comprehension or naming impairments and for treatments of longer duration. WLG-Unrelated was larger when BPWAs received phonological treatment than semantic and mixed treatments. The overall risk of bias in the meta-analysis was low with a potential risk of bias present in the study identification process. CONCLUSIONS: Current anomia treatment practices for bilingual speakers are efficacious in improving trained items but produce marginally small within-language generalization and cross-language generalization to translations of the trained items. These results highlight the need to provide treatment in each language of BPWAs and/or investigate other approaches to promote cross-language generalization. Furthermore, anomia treatment outcomes are influenced by BPWAs' poststroke single-word naming and comprehension abilities as well as treatment duration and the provision of phonological treatment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25595712.

Clinico-radiological factors associated with aphasia outcome in post stroke patients: A prospective follow up study from eastern part of India.

BACKGROUND: Aphasia is a language disorder acquired secondary to brain damage. This study aims to evaluate clinical and radiological profile of patients with post stroke aphasia and factors affecting its recovery. METHODS: We conducted a prospective study of patients with first left Middle or Anterior Cerebral Artery infarct or Intracerebral Hemorrhage (ICH) with aphasia admitted within 14 days of stroke onset. Aphasia Quotient (AQ) was assessed at 2 weeks (AQ1) and 3 months (AQ2) using Western Aphasia Battery-Hindi version. Magnetic Resonance Imaging of brain with Diffusion Tensor Imaging (DTI) of bilateral Arcuate Fasciculus (AF) and Corticospinal Tract was done at admission, and stroke volume, Laterality Indices of Fractional Anisotropy (LI-FA), Mean Diffusivity (LI-MD), Radial Diffusivity (LI-RD), Axial Diffusivity (LI-AD) and Apparent Diffusion Coefficient (LI-ADC) were obtained. RESULTS: 36 patients [8 ICH and 28 Acute Ischemic Stroke (AIS)] were included. AQ1 and AQ2 were significantly higher in subcortical stroke than cortical. AQ2 and increase in AQ scores (including its subscores) were significantly higher in ICH than AIS. National Institutes of Health Stroke Scale score at admission and volume of stroke had significant negative correlation with AQ1 and AQ2. Laterality Index of Fractional Anisotropy of Arcuate Fasciculus [LI-FA (AF)] had significant positive correlation with AQ2 and naming score at 3 months. Laterality Index of Mean Diffusivity of Arcuate Fasciculus [LI-MD (AF)] had significant negative correlation with AQ1, AQ2 and all subcomponents of AQ2. Significant positive correlation was seen between improvements in Modified Rankin Scale score and AQ. CONCLUSION: The study shows that DTI can be used to predict severity of aphasia at follow up and recovery in language and motor functions occur in parallel.

Digital Avatars and Personalized Voices-How AI Is Helping to Restore Speech to Patients.

In this Medical News article, Edward Chang, MD, chair of the department of neurological surgery at the University of California, San Francisco Weill Institute for Neurosciences joins JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, to discuss the potential for AI to revolutionize communication for those unable to speak due to aphasia.

Lesion-symptom Mapping of Acceptability Judgments in Chronic Poststroke Aphasia Reveals the Neurobiological Underpinnings of Receptive Syntax.

Disagreements persist regarding the neural basis of syntactic processing, which has been linked both to inferior frontal and posterior temporal regions of the brain. One focal point of the debate concerns the role of inferior frontal areas in receptive syntactic ability, which is mostly assessed using sentence comprehension involving complex syntactic structures, a task that is potentially confounded with working memory. Syntactic acceptability judgments may provide a better measure of receptive syntax by reducing the need to use high working memory load and complex sentences and by enabling assessment of various types of syntactic violations. We therefore tested the perception of grammatical violations by people with poststroke aphasia (n = 25), along with matched controls (n = 16), using English sentences involving errors in word order, agreement, or subcategorization. Lesion data were also collected. Control participants performed near ceiling in accuracy with higher discriminability of agreement and subcategorization violations than word order; aphasia participants were less able to discriminate violations, but, on average, paralleled control participants discriminability of types of violations. Lesion-symptom mapping showed a correlation between discriminability and posterior temporal regions, but not inferior frontal regions. We argue that these results diverge from models holding that frontal areas are amodal core regions in syntactic structure building and favor models that posit a core hierarchical system in posterior temporal regions.

Invaluable Benefits of 10 Years of the International Collaboration of Aphasia Trialists (CATs).

Aphasia research has traditionally been considered a (unidisciplinary) niche topic in medical science. The international Collaboration of Aphasia Trialists (CATs) is a global collaboration of multidisciplinary aphasia researchers. Over the past 10 years, CATs has collectively taken a rigorous approach to systematically address persistent challenges to aphasia research quality. This article summarizes the achievements over the past decade. CATs' achievements include: standardizing terminology, advancing aphasia research design by aphasia expert consensus recommendations, developing a core data set and intervention descriptors, facilitating the involvement of people with the language impairment aphasia in the research process, translating, and adapting assessment tools into global languages, encouraging data sharing, developing innovative secondary data analysis methodologies and promoting the transparency and accessibility of high quality aphasia research reports. CATs' educational and scientific achievements over the past 10 years far exceed what individual researchers in the field could have ever achieved.

Meta-analysis and systematic review of the relationship between sex and the risk or incidence of poststroke aphasia and its types.

OBJECTIVE: To analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based guidance for the prevention and treatment of poststroke aphasia in clinical practice. DATA SOURCES: Embase, PubMed, Cochrane Library and Web of Science were searched from January 1, 2002, to December 1, 2023. STUDY SELECTION: Including the total number of strokes, aphasia, the number of different sexes or the number of PSA corresponding to different sex. DATA EXTRACTION: Studies with missing data, aphasia caused by nonstroke and noncompliance with the requirements of literature types were excluded. DATA SYNTHESIS: 36 papers were included, from 19 countries. The analysis of 168,259 patients with stroke and 31,058 patients with PSA showed that the risk of PSA was 1.23 times higher in female than in male (OR = 1.23, 95% CI = 1.19-1.29, P < 0.001), with a prevalence of PSA of 31% in men and 36% in women, and an overall prevalence of 34% (P < 0.001). Analysis of the risk of the different types of aphasia in 1,048 patients with PSA showed a high risk in females for global, broca and Wenicke aphasia, and a high risk in males for anomic, conductive and transcortical aphasia, which was not statistically significant by meta-analysis. The incidence of global aphasia (males vs. females, 29% vs. 32%) and broca aphasia (17% vs 19%) were higher in females, and anomic aphasia (19% vs 14%) was higher in males, which was statistically significant (P < 0.05). CONCLUSIONS: There are gender differences in the incidence and types of PSA. The risk of PSA in female is higher than that in male.

[Features of aphasic disorders in patients with acute cerebrovascular disorder in the posterior cerebral artery basin]. / Osobennosti afaticheskikh rasstroistv u patsientov s ostrym narusheniem mozgovogo krovoobrashcheniya v basseine zadnei mozgovoi arterii.

Aphasia is a systemic disorder of formed speech that develops as a result of local brain lesions. Most aphasias are characterized by damage to secondary cortical fields, which in turn are responsible for the performance of the functions of gnosis and praxis, which explains the variability in the manifestations of speech disorders in patients with acute cerebrovascular accidents. However, it is necessary in each case to diagnose the central pathological mechanism, which underlies the development of the entire syndrome and determines the entire clinical picture. The most important task of a speech therapist-aphasiologist is to qualify the defect, namely to isolate the mechanism and analyze the syndrome in order to select individual methods of corrective restoration. This article presents a case of a patient with an ischemic stroke in the left posterior cerebral artery with the development of amnestic aphasia in combination with alexia without agraphia.

Comprehensive quality assessment for aphasia rehabilitation after stroke: protocol for a multicentre, mixed-methods study.

INTRODUCTION: People with aphasia following stroke experience disproportionally poor outcomes, yet there is no comprehensive approach to measuring the quality of aphasia services. The Meaningful Evaluation of Aphasia SeRvicES (MEASuRES) minimum dataset was developed in partnership with people with lived experience of aphasia, clinicians and researchers to address this gap. It comprises sociodemographic characteristics, quality indicators, treatment descriptors and outcome measurement instruments. We present a protocol to pilot the MEASuRES minimum dataset in clinical practice, describe the factors that hinder or support implementation and determine meaningful thresholds of clinical change for core outcome measurement instruments. METHODS AND ANALYSIS: This research aims to deliver a comprehensive quality assessment toolkit for poststroke aphasia services in four studies. A multicentre pilot study (study 1) will test the administration of the MEASuRES minimum dataset within five Australian health services. An embedded mixed-methods process evaluation (study 2) will evaluate the performance of the minimum dataset and explore its clinical applicability. A consensus study (study 3) will establish consumer-informed thresholds of meaningful change on core aphasia outcome constructs, which will then be used to establish minimal important change values for corresponding core outcome measurement instruments (study 4). ETHICS AND DISSEMINATION: Studies 1 and 2 have been registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12623001313628). Ethics approval has been obtained from the Royal Brisbane and Women's Hospital (HREC/2023/MNHB/95293) and The University of Queensland (2022/HE001946 and 2023/HE001175). Study findings will be disseminated through peer-reviewed publications, conference presentations and engagement with relevant stakeholders including healthcare providers, policy-makers, stroke and rehabilitation audit and clinical quality registry custodians, consumer support organisations, and individuals with aphasia and their families.