Neuroimaging in aphasia treatment research: quantifying brain lesions after stroke.

New structural and functional neuroimaging methods continue to rapidly develop, offering promising tools for cognitive neuroscientists. In the last 20 years, advanced magnetic resonance imaging (MRI) techniques have provided invaluable insights into how language is represented and processed in the brain and how it can be disrupted by damage to, or dysfunction of, various parts of the brain. Current functional MRI (fMRI) approaches have also allowed researchers to purposefully investigate how individuals recover language after stroke. This paper presents recommendations for quantification of brain lesions derived from discussions among international researchers at the Neuroimaging in Aphasia Treatment Research Workshop held at Northwestern University (Evanston, Illinois, USA). Methods for detailing and characterizing the brain damage that can influence results of fMRI studies in chronic aphasic stroke patients are discussed. Moreover, we aimed to provide the reader with a set of general practical guidelines and references to facilitate choosing adequate structural imaging strategies that facilitate fMRI studies in aphasia treatment research.

Speech entrainment enables patients with Broca's aphasia to produce fluent speech.

A distinguishing feature of Broca's aphasia is non-fluent halting speech typically involving one to three words per utterance. Yet, despite such profound impairments, some patients can mimic audio-visual speech stimuli enabling them to produce fluent speech in real time. We call this effect 'speech entrainment' and reveal its neural mechanism as well as explore its usefulness as a treatment for speech production in Broca's aphasia. In Experiment 1, 13 patients with Broca's aphasia were tested in three conditions: (i) speech entrainment with audio-visual feedback where they attempted to mimic a speaker whose mouth was seen on an iPod screen; (ii) speech entrainment with audio-only feedback where patients mimicked heard speech; and (iii) spontaneous speech where patients spoke freely about assigned topics. The patients produced a greater variety of words using audio-visual feedback compared with audio-only feedback and spontaneous speech. No difference was found between audio-only feedback and spontaneous speech. In Experiment 2, 10 of the 13 patients included in Experiment 1 and 20 control subjects underwent functional magnetic resonance imaging to determine the neural mechanism that supports speech entrainment. Group results with patients and controls revealed greater bilateral cortical activation for speech produced during speech entrainment compared with spontaneous speech at the junction of the anterior insula and Brodmann area 47, in Brodmann area 37, and unilaterally in the left middle temporal gyrus and the dorsal portion of Broca's area. Probabilistic white matter tracts constructed for these regions in the normal subjects revealed a structural network connected via the corpus callosum and ventral fibres through the extreme capsule. Unilateral areas were connected via the arcuate fasciculus. In Experiment 3, all patients included in Experiment 1 participated in a 6-week treatment phase using speech entrainment to improve speech production. Behavioural and functional magnetic resonance imaging data were collected before and after the treatment phase. Patients were able to produce a greater variety of words with and without speech entrainment at 1 and 6 weeks after training. Treatment-related decrease in cortical activation associated with speech entrainment was found in areas of the left posterior-inferior parietal lobe. We conclude that speech entrainment allows patients with Broca's aphasia to double their speech output compared with spontaneous speech. Neuroimaging results suggest that speech entrainment allows patients to produce fluent speech by providing an external gating mechanism that yokes a ventral language network that encodes conceptual aspects of speech. Preliminary results suggest that training with speech entrainment improves speech production in Broca's aphasia providing a potential therapeutic method for a disorder that has been shown to be particularly resistant to treatment.

How to use apps clinically in the treatment of aphasia.

This article is designed to provide aphasia clinicians with some general guidelines for selecting apps that are appropriate for individuals on their caseloads. Further, it provides a template, consisting of some things we have learned while we have instituted the use of apps at the Adler Aphasia Center in Maywood, NJ and at the Carondelet Aphasia Program in Tucson, AZ, in the hopes that clinicians who are interested in using this technology can profit from our experiences.

Aphasia centers in North America: a survey.

There is a growing trend toward dedicated programs designed to improve the lives of people with aphasia and their families. We are referring to these programs collectively as "aphasia centers." These programs purportedly differ from more traditional medically based aphasia rehabilitation. However, there is no directory of aphasia centers and no definition of what constitutes such a program. Therefore, an online survey was designed to identify and describe aphasia centers in the United States and Canada. A 37-question survey was posted online via SurveyMonkey. An introductory letter was distributed by electronic mail to a listserv and mailing lists of programs associated with aphasia. Potential respondents who considered themselves an aphasia center were asked to complete the survey. A total of 33 survey responses were analyzed, and descriptive data were compiled resulting in a description of the following aspects of aphasia centers: demographic information, mission, admission and discharge policies, assessment practices, program logistics, staffing patterns, marketing, funding, and services offered. In addition, a qualitative analysis of written text responses revealed the following key themes that appear to characterize the responding programs: services that differ from traditional aphasia rehabilitation; a sense of community; a holistic focus on quality of life, psychosocial well-being, participation, and social support; the centrality of group interaction; and variety/intensity of services.

Lessons from a clinical life in aphasia.

Not only do clinicians play a role in shaping the lives of their clients, but they are shaped by the individuals they work with. This article interweaves selected aspects from the stories of 12 aphasic individuals into a story about some of the things they have taught me about my clinical life.

A Survey of Counseling Curricula Among Accredited Communication Sciences and Disorders Graduate Student Programs.

Purpose The purpose of this article is to examine the current state of counseling curriculum within the discipline. The last systematic survey of counseling curriculum within the disciplines of communication sciences and disorders was completed with data from 1983 (McCarthy et al., 1986). The Council on Academic Accreditation in Audiology and Speech-Language Pathology (2017) states that counseling should be included in accredited programs but does not specify to what extent. Currently, there are no standards to specify number of credits, need for a stand-alone course, or guidance regarding content delivered. Method The present investigation collected data on the status of counseling curricula in accredited communication sciences and disorders graduate programs. A Qualtrics survey was distributed to identify counseling curriculum practices across accredited programs. Quantitative data such as percentages and frequency counts were compiled to summarize program offerings. Qualitative analyses were used to characterize written responses. Survey responses were also cross-validated with a review of offerings listed on program websites. Results Of programs currently accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology, 42.4% responded to the current survey. Fifty-nine percent of programs offer a stand-alone course. Review of curricula from program websites indicated that only 40% of accredited programs offer a stand-alone counseling course. Quantitative details about requirements, number of credits, and embedding counseling within other courses were compared to data from the 1983 survey. Qualitative analyses identified common learner outcomes and the nature of course or curricular content. Conclusions Investigators found a lack of consistency in incorporating counseling across programs and discussed implications of this in speech-language pathology practice. A decrease in the number of programs that offer a stand-alone counseling course was identified as compared to offerings in 1983, as well as a disparity regarding how programs provide training in counseling. Furthermore, survey responses differed from curriculum listings on program websites. Information derived from this study may serve as a starting point for the development of flexible standards that provide direction for achieving consistent preparation of counseling skills. Supplemental Material https://doi.org/10.23641/asha.12149703.

Computerized script training for aphasia: preliminary results.

PURPOSE: This article describes computer software that was developed specifically for training conversational scripts and illustrates its use with 3 individuals with aphasia. METHOD: Three participants with chronic aphasia (Broca's, Wernicke's, and anomic) were assessed before and after 9 weeks of a computer script training program. For each participant, 3 individualized scripts were developed, recorded on the software, and practiced sequentially at home. Weekly meetings with the speech-language pathologist occurred to monitor practice and assess progress. Baseline and posttreatment scripts were audiotaped, transcribed, and compared to the target scripts for content, grammatical productivity, and rate of production of script-related words. Interviews with the person with aphasia and his or her significant other were conducted at the conclusion of treatment. RESULTS: All measures (content, grammatical productivity, and rate of production of script-related words) improved for each participant on every script. Two participants gained more than 5 points on the Aphasia Quotient of the Western Aphasia Battery. Five positive themes were consistently identified from the exit interviews-increased verbal communication, improvements in other modalities and situations, communication changes noticed by others, increased confidence, and satisfaction with the software. CONCLUSION: Computer-based script training potentially may be an effective intervention for persons with chronic aphasia.

Living successfully with aphasia: three variations on the theme.

This article describes three individuals who live full and satisfying lives despite aphasia following stroke. The three were deliberately chosen to reflect different types and severities of aphasia and lengths of time post onset, as well as different prestroke lifestyles and circumstances. Commonalities as well as unique features of their successful adjustments are discussed. The article then compares them in a general way to a larger sample of individuals who live well with aphasia and contrasts them to another larger sample of individuals who have been less able to establish fulfilling lives following stroke and aphasia. Implications for counseling aphasic individuals and their families are discussed.

Tell me your story: analysis of script topics selected by persons with aphasia.

PURPOSE: This study examined the content of 100 short scripts, co-constructed by persons with aphasia (PWA) and a clinician. The PWA subsequently learned the scripts by interacting with a computerized virtual therapist. The goal was to provide clinicians with ideas regarding content for treatment that is meaningful to PWAs. METHOD: Thirty-three PWAs generated the scripts, typically including 1 monologue and 2 dialogues in which the PWA was either the initiator or the responder. Scripts were analyzed for common topics and themes. RESULTS: Thirty topics were identified and categorized into 10 themes. For the monologues, the largest category was personal stories (68%), with 12 of the 19 addressing their stroke and aphasia. For the dialogues, conversations with family were dominant (21%), followed by seeking or providing information (18%), and discussion of outside interests (14%). CONCLUSION: PWAs choose to speak about their life experiences, choose to reconnect with their families, and tend to focus on communication that can help them to negotiate mundane normal life. Independent of how this content is used in treatment, materials should emphasize matters of high personal relevance to those treated.

Spaced retrieval treatment of anomia.

BACKGROUND: Spaced Retrieval (SR) is a treatment approach developed to facilitate recall of information by individuals with dementia. Essentially an errorless learning procedure that can be used to facilitate recall of a variety of information, SR gradually increases the interval between correct recall of target items. AIMS: Given the success of using SR in dementia, the purpose of this study was to explore its usefulness in improving naming by individuals with aphasia. The rate of acquisition and retention of items was compared between SR and a more traditional treatment technique-cueing hierarchy (CH). Also, each oral naming treatment was run concurrently with a single word writing treatment. METHODS #ENTITYSTARTX00026; PROCEDURES: Three participants who had moderate or severe naming impairments and agraphia were studied. Single-subject design was applied across oral and written naming and treated and untreated items. OUTCOMES #ENTITYSTARTX00026; RESULTS: The results indicate that for these participants, SR resulted in improved naming of specific items. The data further suggest that SR compared favourably to CH with regard to both acquisition and retention of items. The participants also benefited nicely from the writing treatment. CONCLUSIONS: These findings suggest SR may be an alternative for managing naming impairment resulting from aphasia. Furthermore, the study supports providing treatments aimed at two different modalities concurrently.

The neuroscience of recovery and rehabilitation: what have we learned from animal research?

OBJECTIVES: To encourage rehabilitation specialists to develop a critical approach to the animal research literature that is relevant to human neurorehabilitation and to encourage clinicians to lend their perspectives to basic research. ATA SOURCES: Scientific publications cited in MEDLINE, PubMed, and PsychInfo, and professional presentations of leading neuroscience researchers. The focus was on current publications to 2001, with historical works included when appropriate. STUDY SELECTION: Studies were selected based on their relevance to the objectives. DATA EXTRACTION: Reviewed study methodology and findings and extracted key principles relevant to rehabilitation. DATA SYNTHESIS: Many themes emerging from neuroscience research are relevant to human rehabilitation, including issues related to timing of intervention and recovery, and characteristics of nervous system plasticity. CONCLUSIONS: Although animal research has many limitations, it provides a unique window on nervous system recovery and has generated important directions for future human research. Clinician involvement in basic animal research will improve the extent to which results are relevant to human rehabilitation and recovery.

Aphasia severity: Association with cerebral perfusion and diffusion.

BACKGROUND: Previous studies of the relationship between perfusion, diffusion, and stroke suggest that the extent of cerebral hypoperfusion may be a better indicator of neurological status than lesion size in the early phases of recovery. It is not clear how these factors are related to aphasia severity. AIMS: The purpose of this study was to investigate the relationship between cerebral perfusion, diffusion, and aphasia severity in stroke. METHODS #ENTITYSTARTX00026; PROCEDURE: Nine participants were examined within 24 hours of stroke onset and six were re-examined at 1 month post stroke. The examination included administration of an aphasia test, a face recognition task, and a neuroimaging session including T2-, perfusion-, and diffusion-weighted MRI. OUTCOMES #ENTITYSTARTX00026; RESULTS: Participants with a variety of aphasia types and severity were included in the study. Visual inspection suggested larger perfusion abnormality than the actual lesion in eight of nine subjects at day 1. The correlation between aphasia severity and hypoperfusion was significant at day 1 and at 1 month post stroke. However, this was not the case for the relationship between aphasia severity and lesion size where the correlation was not statistically significant at day 1 or at 1 month post stroke. CONCLUSIONS: These results suggest that cerebral hypoperfusion is a more accurate indicator of aphasia severity in early stroke than lesion volume.