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There are many different approaches to the rehabilitation of aphasia, a communication disorder that affects a person's understanding and expression of spoken and written language. One approach called “functional communication interventions” aims to enhance communication success as opposed to solely improve linguistic abilities. This approach encompasses many skills (e.g., gesturing) and factors (e.g., access to communication supports) that support sending and receiving messages in “real world” daily activities and environments. Functional communication treatments are highly diverse and not always well described. A framework that may provide structure to the description of functional communication interventions for aphasia is the Rehabilitation Treatment Specification System (RTSS). The RTSS was developed by an interdisciplinary research team to describe interventions across any rehabilitation discipline and in any setting or format. The RTSS uses a common language and a systematic approach to describing treatment and includes three connected elements – a single target, one or more ingredients, and a mechanism of action – that, taken together, attempt to explain how and why a treatment works. While the RTTS has been described previously within the field of speech-language pathology, it has not yet been applied to the field of aphasiology. We applied the RTSS framework to a sample of peer-reviewed studies that represent functional communication treatments, including Promoting Aphasics’ Communicative Effectiveness (PACE), Modified Response Elaboration Training (M-RET), Script Training, Conversation Treatment, and Communication Partner Training. We discuss both the advantages and disadvantages of using the RTSS framework to better understand the important elements of functional communication treatment approaches for aphasia.

Purpose Aphasia is a complex, neurogenic language disorder, with different aphasia syndromes hallmarked by impairment in fluency, auditory comprehension, naming, and/or repetition. Broad, standardized assessments of language domains and specific language and cognitive assessments provide a holistic impairment profile of a person with aphasia. While many recognize the correlations between assessments, there remains a need to continue understanding the complexity of relationships between assessments for the purpose of better characterization of language impairment profiles of persons with aphasia. We explored the use of network analysis to identify the complex relationships between a variety of language assessments. Method We computed a regularized partial correlation network and a directed acyclic graph network to estimate the relations between different aphasia assessments in 128 persons with aphasia. Results Western Aphasia Battery–Revised Comprehension subtest was the most central assessment in the aphasia symptom network, whereas the Philadelphia Naming Test had the most putative causal influence on other assessments. Additionally, the language assessments segregated into three empirically derived communities denoting phonology, semantics, and syntax. Furthermore, several assessments, including the Philadelphia Naming Test, belonged to multiple communities, suggesting that certain assessments may capture multiple language impairments. Conclusion We discuss the implications of using a network analysis approach for clinical intervention and driving forward novel questions in the field of clinical aphasiology. Supplemental Material https://doi.org/10.23641/asha.16620229

BACKGROUND Many speakers with non-fluent aphasia (NFA) are able to produce some well-formed word combinations such as 'I like it' or 'I don't know', although they may not use variations such as 'He likes it' or 'I don't know that person'. This suggests that these utterances represent fixed forms. AIMS This case series investigation explored the impact of a novel intervention aimed at enhancing the connected speech of individuals with NFA. The intervention, motivated by usage-based principles, involved filling open slots in semi-fixed sentence frames. METHODS & PROCEDURES Five participants with NFA completed a 6-week intervention programme. The intervention trained participants to insert a range of different lexical items into the open slots of high-frequency phrases such as 'I like it' to enable more productive sentences (e.g., 'they like flowers'). The outcomes and acceptability were examined: The primary outcome measure focused on changes in connected narrative, and the availability of trained constructions (e.g., 'I like it') was explored through a story completion test. Two baseline measures of behaviour were taken prior to intervention, and outcomes assessed immediately after intervention and at a 6-week maintenance assessment. OUTCOME & RESULTS A pre-/post-treatment comparison of connected speech measures showed evidence of enhanced connected speech for two of the five participants (P2 and P5). An analysis of story completion test scores revealed positive change for two participants (P1 and P2). Findings were mixed with regard to baseline stability of outcome measures and post-intervention stability of language changes. The intervention was acceptable to all participants. CONCLUSION & IMPLICATIONS While this pilot study yielded promising findings with regard to the intervention's acceptability and increased connected speech for some participants, the findings were mixed across the sample of five participants. This research helps inform hypotheses and selection criteria for future studies. WHAT THIS PAPER ADDS What is already known on the subject Despite difficulties producing grammatically correct sentences, many speakers with aphasia are able to produce well-formed utterances, often representing familiar expressions such as 'I don't know' and 'I like it'. In usage-based Construction Grammar (CxG) theories, familiar utterances are assumed to be processed as one unit and are therefore more resilient to brain damage. CxG assumes that residual utterances such as 'I like it' map onto more abstract sentence frames (e.g., '[REFERENT] like-TENSE [THING]'). What this paper adds to existing knowledge Sentence therapy, informed by CxG principles, is novel in aphasiology, and usage-based interventions need to be evaluated with regard to their impact on language processing at the connected speech level. This case series report explores the acceptability and outcomes of a usage-based sentence therapy. We also introduce and explore the value of an automated, frequency-based analysis tool for evaluating connected speech outcomes in aphasia therapy. What are the potential or actual clinical implications of this work? The findings inform further development of usage-based aphasia interventions targeting word combinations.

This project aims to build capacity for research into acquired language impairments in adults (aphasia). The project aims to provide a web-resource with access to anonymised behavioural data collected from adults with aphasia. This data can then be used by scholars and researchers across disciplines for analysis and data-mining projects.

This study investigated the underlying nature of apraxia of speech (AOS) by testing two competing hypotheses. The Reduced Buffer Capacity Hypothesis argues that people with AOS can plan speech only one syllable at a time Rogers and Storkel [1999. Planning speech one syllable at a time: The reduced buffer capacity hypothesis in apraxia of speech. Aphasiology, 13(9-11), 793-805. https://doi.org/10.1080/026870399401885]. The Program Retrieval Deficit Hypothesis states that selecting a motor programme is difficult in face of competition from other simultaneously activated programmes Mailend and Maas [2013. Speech motor programming in apraxia of speech: Evidence from a delayed picture-word interference task. American Journal of Speech-Language Pathology, 22(2), S380-S396. https://doi.org/10.1044/1058-0360(2013/12-0101)]. Speakers with AOS and aphasia, aphasia without AOS, and unimpaired controls were asked to prepare and hold a two-word utterance until a go-signal prompted a spoken response. Phonetic similarity between target words was manipulated. Speakers with AOS had longer reaction times in conditions with two similar words compared to two identical words. The Control and the Aphasia group did not show this effect. These results suggest that speakers with AOS need additional processing time to retrieve target words when multiple motor programmes are simultaneously activated.

Although facilitated group conversations for aphasia are a popular practice within contemporary clinical aphasiology, only a small number of published studies have shed some light on how interactio...

A.R. Luria is one of the most prestigious scientists in neuroscience, neuropsychology in particular. His contribution to aphasiology and neurolinguistics is well known. However, today some researchers believe that A.R. Luria's main ideas have lost their relevance and have little influence on contemporary discussions. The paper presents the views of A.R. Luria on the brain organization of speech and aphasia. Although he developed his concept of the relationship between cognitive processes and brain work several decades ago, scientific and technological achievements in our days largely confirm many of his ideas and hypotheses. A.R. Luria's basic views of the brain and language are considered in this article in the light of modern neuroscience. Two main monographs and some works of A.R. Luria, which are dedicated to the brain organization of speech and to the classification of aphasia, are analyzed. In particular, comparisons are made between his initial assumptions about aphasia and their theoretical rationale in the book «Traumatic Aphasia» (1947) and his more complex interpretation of the cerebral organization of speech, which is presented in his work «Basic Problems of Neurolinguistics» (1975). The paper discusses differences between these two books and also linguistic issues, which received much attention in his later publication. It considers the concepts of functional systems, systemic and dynamic organization of speech, proposed by A.R. Luria. It is shown that his interpretation of the cerebral organization of speech as a specific contribution of various brain regions to the speech system continues to be widely used, and his significant contribution to neurolinguistics is widely recognized. Many ideas of A.R. Luria have been integrated into contemporary aphasiology, while some questions of his proposed classification of aphasia remain debatable.

This Master Thesis deals with a typology of aphasia (Broca's, Wernicke's, conductive, transcortical-motor and sensory) and also with various variables that affect the type of aphasia. The thesis also deals with linguistics specifics of aphasia symptoms (circulation, perseveration, semantic and phonemic paraphasias, agramatism). In a practical part of the thesis, the symptoms of aphasia are observed in particular aphasic patients while their speech has been recorded. An author of the thesis is responsible for the correct citations of all sources used. key words: aphasia; aphasiology; agrammatism; cognitive science; Czech; syntax

Inflection impairments are commonly noted in aphasia, particularly non-fluent variants, where descriptions of such difficulties often focus on inflection omission. This aligns withrule-basedtheory, in which inflected forms should be more difficult to produce than their uninflected counterparts. Recent studies address noun inflection for number and potential effects of the relative frequency of singular and plural forms (dominance effects). However, none examine number errors qualitatively or in spontaneous speech. We present quantitative and qualitative analyses of such errors in nouns produced by twelve people with aphasia in spoken Cinderella narratives, examining: error rate; error types and nouns involved; relationship between error production and dominance; and speakers’ consistency with error production and flexibility in varying the noun forms concerned. Twelve unimpaired speakers provide comparison data. While error rates were low, arguably more important is error type. Singularisation and pluralisation errors were observed, all on regular nouns and involving production of the dominant form. The pluralisation errors, all occurring on references to Cinderella’s glass slipper, arguably challenge rule-based predictions that the singular is easier to retrieve than the plural. We suggestconstructivist, usage-basedtheory as a promising framework to characterise such productions. Implications for aphasiology and clinical practice are also discussed.

A multidisciplinary team of experts took stock of the current state of affairs about many aspects of aphasia in India, including community burden, diagnostic assessment, therapy, rehabilitation, research, education, and advocacy. The broad spectrum of aphasiology was matched by the types of participants ranging from neurologists, speech-language pathologists, clinical psychologists, linguists, to experts in neuroimaging and computer sciences. Threadbare discussion in 16 sessions over 3 days leads to the identification of pressing problems and possible solutions. Many action plans have been envisaged and recommendations made. A few examples with high priority are community-based and hospital-based study incidence and prevalence of aphasia, development of test batteries for the assessment of many components of speech and communication in Indian languages which are validated on rigorous psychometric, and linguistic criteria, national registry for aphasia, educational modules about aphasia for different target groups, resources for advocacy and its training, a bank of research questions and outlines of research protocols for young professionals to pursue. The expert group will continue to oversee execution of some of the actionable plans in short and long term.

Of all the nineteenth-century physicians whose names still resonate today, Armand Trousseau is perhaps the one most familiar, for his description of carpal spasm as a sign of hypocalcemia (Trousseau's sign) and his description of the hypercoagulable state associated with cancer (Trousseau's syndrome). In the last three years of his life, Trousseau turned his attention to aphasia, which he included in his 1864 and 1865 lectures given at Hotel-Dieu Hospital in Paris and which he discussed in an address to the Imperial Academy of Medicine in 1865. Trousseau preceded Wernicke in describing aphasia as a symptom complex, in which he included Broca's aphemia, receptive aphasia, the inability to read with and without the inability to write (alexia with and without agraphia), the inability to name common objects (amnesic aphasia or anomia) and to recognize numbers (acalculia), and the inability to draw. Trousseau concluded that such a varied symptomatology could not arise from a single area, and he proposed that lesions of the posterior inferior frontal convolution identified by Broca, of the insula and corpus striatum and of the temporal and parietal lobes, could give rise to aphasia. The role of the posterior temporal lobe in receptive aphasia was confirmed by Wernicke in 1874, and the role of the inferior parietal lobule in agraphia and alexia was confirmed by Dejerine in 1891. Trousseau thought that aphasia resulted from the loss of the memory for words and for the synergistic actions of the movements of articulations learned in early childhood. Trousseau added inattention, lack of comprehension, and cognitive decline to amnesia as contributing factors to the verbal and nonverbal expression of thought. Trousseau constructed a comprehensive theory of aphasia that unified its semiology, localization, and pathophysiology. This construct had the virtue of being predictive and falsifiable by the clinico-pathological method. Through insight born of observation, Trousseau identified the issues that dominated aphasiology into the twenty-first century.

A considerable body of research supports the use of behavioral communication treatment as the standard of care for aphasia. In spite of robust progress in clinical aphasiology, many questions regarding optimal care remain unanswered. One of the major challenges to progress in the field is the lack of a common framework to adequately describe individual treatments, which, if available, would allow comparisons across studies as well as improved communication among researchers, clinicians, and other stakeholders. Here, we describe how aphasia treatment approaches can be systematically characterized using the Rehabilitation Treatment Specification System (RTSS). At the core of the RTSS is a tripartite structure that focuses on targets (the behavior that is expected to change as a result of treatment), ingredients (what a clinician does to affect change in the target), and mechanism(s) of action (why a given treatment works by linking the ingredients to the target). Three separate articles in the current issue specifically describe how the RTSS can be used to describe different kinds of aphasia treatment approaches: functional approaches, cognitive-linguistic approaches, and biological approaches. It is our hope that the application of the RTSS in clinical aphasiology will improve communication in published studies, grant proposals, and in the clinical care of persons with aphasia.

Background Evaluating patients in the acute phase of brain damage allows for the early detection of cognitive and linguistic impairments and the implementation of more effective interventions. However, few cross-cultural instruments are available for the bedside assessment of language abilities. The aim of this study was to develop a brief assessment instrument and evaluate its content validity. Methods Stimuli for the new assessment instrument were selected from the M1-Alpha and MTL-BR batteries (Stage 1). Sixty-five images were redesigned and analyzed by non-expert judges (Stage 2). This was followed by the analysis of expert judges (Stage 3), where nine speech pathologists with doctoral training and experience in aphasiology and/or linguistics evaluated the images, words, nonwords, and phrases for inclusion in the instrument. Two pilot studies (Stage 4) were then conducted in order to identify any remaining errors in the instrument and scoring instructions. Results Sixty of the 65 figures examined by the judges achieved inter-rater agreement rates of at least 80%. Modifications were suggested to 22 images, which were therefore reanalyzed by the judges, who reached high levels of inter-rater agreement (AC1 = 0.98 [CI = 0.96–1]). New types of stimuli such as nonwords and irregular words were also inserted in the Brief Battery and favorably evaluated by the expert judges. Optional tasks were also developed for specific diagnostic situations. After the correction of errors detected in Stage 4, the final version of the instrument was obtained. Conclusion This study confirmed the content validity of the Brief MTL-BR Battery. The method used in this investigation was effective and can be used in future studies to develop brief instruments based on preexisting assessment batteries.

A afasia é um distúrbio adquirido da linguagem resultante de uma lesão cerebral focal no hemisfério dominante da linguagem que afeta o funcionamento comunicativo e social da pessoa e sua qualidade de vida. O objetivo desse estudo foi realizar uma revisão narrativa sobre as descobertas históricas na afasiologia, destacando os principais teóricos e trabalhos até o século XX. Foram consultados livros, as bases de dados disponíveis no Portal de Periódicos da CAPES e, para complementar, o Google Acadêmico. A compreensão da afasia como um distúrbio de linguagem teve início ainda na Idade Antiga. No século XIX, o estudo da relação entre linguagem e cérebro foi dominado pela questão da localização funcional. No século XX, o foco mudou lentamente para modelos de produção e compreensão da linguagem formulados psicolinguisticamente

Luria’s interpretation of brain organization for language and aphasia is analyzed. He published two major books and a myriad of papers devoted to this topic. Luria is one of the major founders of contemporary aphasiology, as from the fundamental point of view as from the clinical perspective. His significant influence has continued during the 21st century. Many of Luria’s ideas have been integrated into contemporary aphasiology. His aphasia classification, however, remains partially controversial.

ObjectiveTo explore atrophy–deficit correlations of word comprehension and repetition in temporoparietal cortices encompassing the Wernicke area, based on patients with primary progressive aphasia (PPA).MethodsCortical thickness in regions within and outside the classical Wernicke area, measured by FreeSurfer, was correlated with repetition and single word comprehension scores in 73 right-handed patients at mild to moderate stages of PPA.ResultsAtrophy in the Wernicke area was correlated with repetition (r = 0.42, p = 0.001) but not single word comprehension (r = −0.072, p = 0.553). Correlations with word comprehension were confined to more anterior parts of the temporal lobe, especially its anterior third (r = 0.60, p < 0.001). A single case with postmortem autopsy illustrated preservation of word comprehension but not repetition 6 months prior to death despite nearly 50% loss of cortical volume and severe neurofibrillary degeneration in core components of the Wernicke area.ConclusionsTemporoparietal cortices containing the Wernicke area are critical for language repetition. Contrary to the formulations of classic aphasiology, their role in word and sentence comprehension is ancillary rather than critical. Thus, the Wernicke area is not sufficient to sustain word comprehension if the anterior temporal lobe is damaged. Traditional models of the role of the Wernicke area in comprehension are based almost entirely on patients with cerebrovascular lesions. Such lesions also cause deep white matter destruction and acute network diaschisis, whereas progressive neurodegenerative diseases associated with PPA do not. Conceptualizations of the Wernicke area that appear to conflict, therefore, can be reconciled by considering the hodologic and physiologic differences of the underlying lesions.

Background: There are many validated and widely used assessments within aphasiology. Few, however, describe language and life with aphasia from the perspective of the person with aphasia. Across healthcare, patient experience and user involvement are increasingly acknowledged as fundamental to person-centred care. As part of this movement, Patient Reported Outcome Measures (PROMs) are being used in service evaluation and planning.\ud \ud Aims: This paper reports the quantitative aspects of a mixed methods study that developed and validated a concise PROM, the Aphasia Impact Questionnaire (AIQ), co-produced with People with Aphasia (PWA).\ud \ud Methods & Procedures: The AIQ was developed within the social model of disability and all stages of the development of the AIQ were performed in partnership with PWA. It was adapted from a pre-existing and lengthier PROM for PWA, the Communication Disability Profile. The first iterations of the AIQ focused on domains of communication, participation and well-being/emotional state. Subsequently the AIQ was extended to include additional items relating to reading and writing (AIQ-21). The research design was iterative. Initially, concurrent validity, internal consistency, and sensitivity of the AIQ-prototype were obtained. The AIQ-prototype was modified to become the AIQ-21. Statistical testing with a new group of PWA was performed, investigating internal consistency and concurrent validity of the AIQ-21.\ud \ud Outcomes & Results: Results for both the AIQ-prototype and AIQ-21 showed statistically significant concurrent validity and good internal consistency. Repeated measurement using the AIQ-prototype demonstrated statistically significant change after PWA accessed a community intervention.\ud \ud Conclusions: The AIQ-21 is a PROM that has great potential to be one of the core set of aphasia tests for clinical and research use. Results can be used alongside language assessment to enable person-centred goal setting and partnership working for people with aphasia.

Aphasia is an acquired neurological disorder of communication with a range of language impairments. Aphasia rehabilitation is becoming an important concern in clinical aphasiology. Traditional approaches for rehabilitation are being practiced. In addition to this, computer-based strategies are also employed in aphasiology. In this study, a qualitative phenomenological research approach is used to gain an understanding on how the SLPs of Pakistan perceive the changing trends of clinical practice in aphasia towards technology-based treatment method. This study presents lived experiences and preferences of the SLPs regarding changing trends from the traditional approach to the technology-based method. Ten SLPs participated and were recruited through purposive sampling. The participants were included if they were qualified SLPs and had at least 2 years of experience. The data was collected through audiotapes of detailed group discussions with the participants. The data was analyzed by using thematic analysis. The findings were grouped into five themes: traditional rehab activities, auditory and visual input, cost-effective approach, access and prognosis note. A range of sub-themes were also identified. The findings suggest the SLPs’ preferences are showing limited trends towards adapting the technology-based method.

Almost 70 years ago, Alexander Luria incorporated semantic aphasia among his aphasia classifications by demonstrating that deficits in linking the logical relationships of words in a sentence could co-occur with non-linguistic disorders of calculation, spatial gnosis and praxis deficits. In line with his comprehensive approach to the assessment of language and other cognitive functions, he argued that deficits in understanding semantically reversible sentences and prepositional phrases, for example, were in line with a single neuropsychological factor of impaired spatial analysis and synthesis, since understanding such grammatical relationships would also draw on their spatial relationships. Critically, Luria demonstrated the neural underpinnings of this syndrome with the critical implication of the cortex of the left temporal-parietal-occipital (TPO) junction. In this study, we report neuropsychological and lesion profiles of 10 new cases of semantic aphasia. Modern neuroimaging techniques provide support for the relevance of the left TPO area for semantic aphasia, but also extend Luria's neuroanatomical model by taking into account white matter pathways. Our findings suggest that tracts with parietal connectivity the arcuate fasciculus (long and posterior segments), the inferior fronto-occipital fasciculus, the inferior longitudinal fasciculus, the superior longitudinal fasciculus II and III, and the corpus callosum are implicated in the linguistic and non-linguistic deficits of patients with semantic aphasia. (C) 2016 Elsevier Ltd. All rights reserved.

• Characterization of mixed cases of aphasia, the most commonly attested in clinical practice.

Objective To evaluate the types and severity of subcortical aphasia after stroke and to determine the predictors of the degree of aphasic impairment. Methods Medical records of 38 patients with post-stroke subcortical aphasia (19 males; mean age, 61.7±13.8 years) were reviewed retrospectively with respect to the following tests: the Korean version of the Western Aphasia Battery (K-WAB), the Korean version of the Modified Barthel Index (K-MBI), and the Fugl-Meyer Index (FMI). The severity of aphasia was evaluated by the aphasia quotient (AQ) and the language quotient (LQ). Results Anomic aphasia was the most frequent type of aphasia (n=15, 39.5%), and the lesion most frequently observed in subcortical aphasia was located in the basal ganglia (n=19, 50.0%). Patients with lesions in the basal ganglia exhibited the lowest scores on the FMI for the upper extremities (p=0.04). Severity of aphasia was significantly correlated with the K-MBI (Pearson correlation coefficient: γ=0.45, p=0.01 for AQ and γ=0.53, p=0.01 for LQ) and FMI scores for the lower extremities (γ=0.43, p=0.03 for AQ and γ=0.49, p=0.05 for LQ). In a multivariate logistic regression analysis, K-MBI remained the only explanatory variable closely associated with aphasia severity. Conclusion This study showed the general characteristics of post-stroke subcortical aphasia, and it revealed that K-MBI was an associated and explanatory factor for aphasia severity.

Many stroke survivors with aphasia in the acute period experience spontaneous recovery within the first six months after the stroke. However, approximately 30–40% sustain permanent aphasia and the factors determining incomplete recovery are unclear. Suboptimal recovery may be influenced by disruption of areas seemingly spared by the stroke due to loss of white matter connectivity and network integrity. We reconstructed individual anatomical whole-brain connectomes from 90 left hemisphere stroke survivors using diffusion MR images. We measured the modularity of the residual white matter network organization, the probability of brain regions clustering together, and the degree of fragmentation of left hemisphere networks. Greater post-stroke left hemisphere network fragmentation and higher modularity index were associated with more severe chronic aphasia, controlling for the size of the stroke lesion. Even when the left hemisphere was relatively spared, subjects with disorganized community structure had significantly worse aphasia, particularly when key temporal lobe regions were isolated into segregated modules. These results suggest that white matter integrity and disorganization of neuronal networks could be important determinants of chronic aphasia severity. Connectome white matter organization measured through modularity and other topological features could be used as a personalized variable for clinical staging and aphasia treatment planning.

Comprehension impairments in Wernicke's aphasia are thought to result from a combination of impaired phonological and semantic processes. However, the relationship between these cognitive processes and language comprehension has only been inferred through offline neuropsychological tasks. This study used ERPs to investigate phonological and semantic processing during online single word comprehension. EEG was recorded in a group of Wernicke's aphasia n=8 and control participants n=10 while performing a word-picture verification task. The N400 and Phonological Mapping Negativity/Phonological Mismatch Negativity (PMN) event-related potential components were investigated as an index of semantic and phonological processing, respectively. Individuals with Wernicke's aphasia displayed reduced and inconsistent N400 and PMN effects in comparison to control participants. Reduced N400 effects in the WA group were simulated in the control group by artificially degrading speech perception. Correlation analyses in the Wernicke's aphasia group found that PMN but not N400 amplitude was associated with behavioural word-picture verification performance. The results confirm impairments at both phonological and semantic stages of comprehension in Wernicke's aphasia. However, reduced N400 responses in Wernicke's aphasia are at least partially attributable to earlier phonological processing impairments. The results provide further support for the traditional model of Wernicke's aphasia which claims a causative link between phonological processing and language comprehension impairments.

Aphasia is a serious consequence of stroke but aphasics patients have been routinely excluded from participation in some areas of stroke research.To assess the role of specific linguistic and non-verbal cognitive abilities on the short-term motor recovery of patients with aphasia due to first-ever stroke to the left hemisphere after an intensive rehabilitation treatment.48 post-acute aphasic patients, who underwent physiotherapy and speech language therapy, were enrolled for this retrospective cohort-study. Four types of possible predictive factors were taken into account: clinical variables, functional status, language and non-verbal cognitive abilities. The motor FIM at discharge was used as the main dependent variable.Patients were classified as follows: 6 amnestic, 9 Broca's, 7 Wernicke's, and 26 global aphasics. Motor FIM at admission (p = 0.003) and at discharge (p = 0.042), all linguistic subtests of Aachener AphasieTest (p = 0.001), and non-verbal reasoning abilities (Raven's CPM, p = 0.006) resulted significantly different across different types of aphasia. Post-hoc analyses showed differences only between global aphasia and the other groups. A Multiple Linear Regression shows that admission motor FIM (p = 0.001) and Token test (p = 0.040), adjusted for clinical, language, and non-verbal reasoning variables, resulted as independent predictors of motor FIM scores at discharge, while Raven's CPM resulted close to statistical significance.Motor function at admission resulted as the variable that most affects the motor recovery of post-stroke patients with aphasia after rehabilitation. A linguistic test requiring also non-linguistic abilities, including attention and working memory (i.e. Token test) is an independent predictor as well.

The purpose of the paper is to review the literature on the neurocognitive control in bilingual aphasia and extrapolate research findings into clinical guidelines. Neurocognitive control, as well as bilingualism, are multifaceted phenomena whose complex interaction is disrupted by stroke. Bilingualism is an added factor of complexity to aphasia assessment and rehabilitation. Rehabilitation specialists are more aware of the need to understand language and nonverbal cognitive abilities, for a better treatment outcome (Ansaldo, Saidi, Ruiz, 2010; Green, 2005; Helm-Estabrooks, 2002). Consequently, assessment and management of neurocognitive skills in bilingual aphasia are gradually gaining momentum. Applying principles from language-cognitive control interactions to the rehabilitation of bilingual populations with aphasia appears to be a valuable intervention strategy for this population.

Communication in humans activates almost every part of the brain. Of course, the use of language predominates, but other cognitive functions such as attention, memory, emotion, and executive processes are also involved. However, in order to explain how our brain “understands,” “speaks,” and “writes,” and in order to rehabilitate aphasic disorders, neuroscience has faced the challenge for years to reveal the responsible neural networks. Broca and Wernicke (and Lichtheim and many others), during the 19th century, when brain research was mainly observational and autopsy driven, offered fundamental knowledge about the brain and language, so the Wernicke-Geschwind model appeared and aphasiology during the 20th century was based on it. This model is still useful for a first approach into the classical categorization of aphasic syndromes, but it is outdated, because it does not adequately describe the neural networks relevant for language, and it offers a modular perspective, focusing mainly on cortical structures. During the last three decades, neuroscience conquered new imaging, recording, and manipulation techniques for brain research, and a new model of the functional neuroanatomy of language was developed, the dual stream model, consisting of two interacting networks (“streams”), one ventral, bilaterally organized, for language comprehension, and one dorsal, left hemisphere dominant, for production. This new model also has its limitations but helps us to understand, among others, why patients with different brain lesions can have similar language impairments. Furthermore, interesting aspects arise from studying language functions in aging brains (and also in young, developing brains) and in cognitively impaired patients and neuromodulation effects on reorganization of brain networks subserving language. In this selective review, we discuss methods for coupling new knowledge regarding the functional reorganization of the brain with sophisticated techniques capable of activating the available supportive networks in order to provide improved neurorehabilitation strategies for people suffering from neurogenic communication disorders.

In a series of papers which appeared in 1906, Pierre Marie advanced a new concept of aphasiology against the classical view based on functional localization of cerebral cortex. He denied the role of Broca's area in language function and proposed as the center for articulation "zone lenticulaire," the lesion of which causes anarthria. But his illustration of "zone lenticulaire" which appears repeatedly in his papers dealing with aphasia, is anatomically incorrect since the most important portions of Broca's area, opercular part and triangular part of the inferior frontal gyrus are missing in his illustration. The detailed anatomical investigation of Marie's illustrations reveals that he repeated the same errors in identifying rolandic and frontal opercula. But the similar mistake of identifying these opercula is also seen in Dejerine's "Anatomie des Centres Nerveux."

Background and Aims: The psychosocial impact of stroke and aphasia is considerable. We aimed to explore UK speech and language therapists’ clinical practice in addressing psychological and social needs of people with aphasia including their experiences of working with mental health professionals. Methods and Procedures: A 22-item on-line survey distributed to UK speech and language therapists via British Aphasiology Society mailing list and Clinical Excellence Networks. Results were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results: UK speech and language therapists (n=124) overwhelmingly considered that addressing psychological well-being (93%) and social participation (99%) was part of their role. To achieve this they frequently/very frequently used supportive listening (100%) and selected holistic goals collaboratively with clients (87%) including social goals (83%). However, only 42% felt confident in addressing the psychological needs of clients. Main barriers to addressing psychosocial well-being were time/caseload pressures (72%); feeling under-skilled/lack of training (64%) and lack of on-going support (61%). Main barriers to referring on to mental health professionals were that mental health professionals were perceived as under-skilled working with people with aphasia (44%); were difficult to access (41%); and provided only a limited service (37%). A main theme from the free text responses was concern that those with aphasia, particularly more severe aphasia, received inadequate psychological support due to the stretched nature of many mental health services, mental health professionals lacking skills working with aphasia, and speech and language therapists lacking the necessary time, training and support. Main enablers to addressing psychosocial well-being were collaborative working between speech and language therapists and stroke-specialist clinical psychologists; speech and language therapists with training in providing psychological and social therapy; and ongoing support provided by the voluntary sector. Conclusions and Implications: The vast majority of speech and language therapists consider the psychosocial well-being of their clients, and work collaboratively with people with aphasia in selecting holistic goals. It is, however, of concern that most respondents felt they lacked confidence and received insufficient training to address psychological well-being. In order to improve psychological services for this client group, there is a strong case that stroke-specialist mental health professionals should strive to make their service truly accessible to people with even severe aphasia, which may involve working more closely with speech and language therapists. Further, improving the skills and confidence of speech and language therapists may be an effective way of addressing psychological distress in people with aphasia.

While integrative treatment practices have become a popular treatment in different areas of study, its use in the field of aphasiology is still limited. The following paper is an attempt to address the different alternative practices that could potentially be used to remediate aphasia.A narrative review was completed regarding integrative intervention that could potentially apply to aphasia population.Through this article we have explored various treatment options for integrative health care in aphasiology. Integrative treatments including brain specific antioxidants, progesterone and estradiol therapy, nutrition, synbiotic treatment, exercise, yoga, meditation and positive mood states have demonstrated positive changes in health and behavior in healthy aging or disorders such as stroke and aphasia. Offering integrative treatment for people with aphasia allows potential for high impact gains when combined with current speech language therapeutic practices.This paper highlights the rehabilitation possibilities for aphasia therapy. Combining complementary and traditional treatment approaches could be viewed as one of the contemporary approaches to clinical practice and research for practitioners and health care systems. Implications for Rehabilitation There has been very little research that explores the potential of various types of integrative treatment for individuals with aphasia. An integrative approach to the treatment of aphasia has potential for future clinical application. Combining treatment approaches could be viewed as a viable approach to clinical practice and in the health care system.

Many dementia subtypes have more shared signs and symptoms than defining ones. We shall review eight cases with four overlapping syndromes and demonstrate how to distinguish the cases. These include focal cortical presentations of Alzheimer’s Disease(AD) (Posterior Cortical Atrophy and Corticobasal Syndrome), fluent aphasia (Semantic Dementia and Logopenic Aphasia), late-onset slowly progressive dementia (Hippocampal Sclerosis and Limbic Predominant AD) and rapidly progressive dementia (Creutzfeldt-Jakob Disease and Limbic Encephalitis). Recognizing the different syndromes described in this paper can help the clinician improve their diagnostic skills leading to improved patient outcomes by early and accurate diagnosis, prompt treatment, appropriate counseling and guidance.

Objective. We assessed the changes in EEG and event-related potential (P300) in elderly patients with poststroke aphasia and epilepsy. Materials and Methods. We examined 57 patients with poststroke aphasia (age 55-79 years). Cortical aphasia was revealed in 47 cases, and 10 patients had subcortical aphasia. Control group consisted patients with chronic brain chronic brain ischemia and healthy persons. Results. Local slow activity in the left hemisphere in EEG were revealed in 78% of patients with cortical aphasia, and in 20% of cases with subcortical aphasia. Local epileptic activity along with slow activity was spike-and-slow-wave complexes and sharp waves; temporal intermittent delta activity (TIRDA); both spike-and-wave complexes and TIRDA. In two cases epileptic activity was revealed as periodic lateralizing epileptiform discharges (PLEDs) besides local slow waves, and may deteriorate the aphasia. According to P300 data patients with poststroke aphasia hadn’t severe cognitive impairment, and the worst changes were noted in the group with chronic brain ischemia. In some patients with heavy aphasia it was possible to recorded P300 in passive perception of stimuli. Conclusion. In cases with PLEDs and persistent epileptic activity antiepileptic treatment probably reduces the aphasia. P300 is important in diagnostic of cognitive decline in patients with poststroke aphasia, especially when aphasia is heavy and neuropsychological tests can’t be done.

This study examined patterns of acquired dyslexia in Serbian aphasic speakers, comparing profiles of groups with Broca’s versus Wernicke’s aphasia. The study also looked at the relationship of reading and auditory comprehension and between reading comprehension and reading aloud in these groups. Participants were 20 people with Broca’s and 20 with Wernicke’s aphasia. They were asked to read aloud and to understand written material from the Serbian adaptation of the Boston Diagnostic Aphasia Examination. A Serbian Word Reading Aloud Test was also used. The people with Broca’s aphasia achieved better results in reading aloud and in reading comprehension than those with Wernicke’s aphasia. Those with Wernicke’s aphasia showed significantly more semantic errors than those with Broca’s aphasia who had significantly more morphological and phonological errors. From the data we inferred that lesion sites accorded with previous work on networks associated with Broca’s and Wernicke’s aphasia and with a posterior-anterior axis for reading processes centred on (left) parietal-temporal-frontal lobes.

Advances in medicine have enabled an aging population to survive neurological events such as strokes more frequently. Consequences of a stroke can be widespread and severe, and it is currently the leading cause of long-term disability in Canada (Public Health Agency of Canada [PHAC], 2011). The PHAC report indicated that in 2009 approximately 315,000 Canadians were living with the consequences of strokes (PHAC, 2011). Consequences of strokes may include hemiplegia, reduced cognition and emotional control, difficulty with language (aphasia), and visual impairment, to list a few of the impairments and disabilities that may occur (Warren, 2008). To address the needs of individuals with language impairments resulting from strokes, there is a need for low vision rehabilitation professionals (optometrists, ophthalmologists, low vision therapists, high technology assessors, orientation and mobility instructors, rehabilitation counsellors, independent living skills teachers, and occupational and physical therapists) to become familiar with the impact of neurological events on an individual's ability to communicate. An individual who has survived a stroke may be left with multiple impairments including those that affect vision and communication. Visual impairment is a possible result, and it may present as a defect of visual fields, impaired eye movements, and problems with perception or cortical blindness (Hillis, 2007; Jones & Shinton, 2006; Rowe et al., 2009). Up to a quarter of stroke survivors may have vision loss, according to the National Stroke Association (2012). It is not unusual to encounter patients who had a neurological event with multiple impairments (including vision loss) when assessing and implementing a low vision rehabilitation plan. This report describes some communication strategies that may be utilized to create a successful low vision rehabilitation assessment and plan for a patient with a coexisting visual impairment and aphasia following a stroke. WHAT IS APHASIA? Following a neurological event, some individuals experience aphasia, which is an acquired condition following damage to the speech and language areas in the brain and which affects a person's ability to communicate (Hillis, 2007). It is a problem with language, not intelligence (National Aphasia Association, 2015). The areas of the brain that are responsible for language are found on the left side (Damasio, 1992; Hillis, 2007). Individuals with aphasia may have difficulties speaking, understanding what others are saying, and problems with reading and writing. Due to the complex nature of communication, there are several different classifications of aphasia that are widely disputed (Ardila, 2010; Marshall, 2010). The broad and more classic classification used by the National Aphasia Association (2015), the Heart and Stroke Foundation (2013), the American Heart Association (2015), and the National Institute on Deafness and Other Communication Disorders (NIDCD, 2010) when discussing aphasia with the lay community includes three types: expressive aphasia, receptive aphasia, and global aphasia. Expressive aphasia Individuals with expressive aphasia are typically able to understand what is being communicated to them, but have difficulty or are unable to respond either verbally or in writing. This is also known as Broca's aphasia (attributed to the person who discovered the condition and the area of the brain that is thought to be affected) or nonfluent aphasia (as individuals with this type of aphasia exhibit great effort when attempting to speak). Any phrases that the individual uses are generally understood by their unaffected conversational partner, but speaking is very difficult, laborious, and slow. Individuals with expressive aphasia typically choose the correct nouns, but small words are often improperly used (Damasio, 1992; Hillis, 2007). There is a reduction in the length of the sentences expressed (Hillis, 2007). …

Background: Derived words have constituted an important bridge between aphasiology and psycholinguistics by addressing the extent to which morphology affects representation and processing in the mind/brain.Aims: Our goal was to assess how properties of whole words and their overlapping substrings affect the manner in which English derivationally suffixed words are recognised and produced.Methods & Procedures: We probed the processing of multimorphemic words containing strings of two derivational suffixes by healthy adult participants, employing both a progressive demasking naming task and a typing task. The progressive demasking paradigm that we employed integrates word recognition and production by requiring that a participant recognises a progressively demasked stimulus and then say it as quickly as possible. The typing task allowed us to focus on segment by segment aspects of processing during production by enabling us to construct per-letter typing times for each region of a word.Outcomes & Re...

Each year approximately 100,000 stroke survivors are diagnosed with aphasia. Although stroke is associated with age, the relationship between age and aphasia is less clear.To complete a review of the literature to examine the relationship between age and: (a) presence or likelihood of aphasia after stroke, (b) aphasia type, (c) aphasia recovery patterns, and (d) aphasia clinical outcomes.Articles were identified by a comprehensive search of "OneSearch," PubMed, and individual journals: Aphasiology, Stroke and the Journal of Stroke and Cerebrovascular Diseases.Inclusion criteria included: age and incidence of aphasia, likelihood of aphasia, aphasia recovery, and aphasia clinical outcome.Independent searches were completed by the authors. Each author independently assessed the full text of reports meeting inclusion criteria. Differences regarding study eligibility and need to proceed with data extraction were resolved by consensus.1617 articles were identified during the initial search. Forty studies including 14,795 study participants were included in the review. The review generally demonstrated that: (a) stroke patients with aphasia are typically older than stroke with patients without aphasia and (b) aphasia type and age are associated as younger patients with aphasia are more likely to exhibit non-fluent or Broca's type of aphasia. In contrast, studies examining aphasia recovery and aphasia clinical outcomes did not demonstrate a positive relationship between age and recovery or clinical outcomes.Stroke is a condition of the elderly. However, age appears to only influence likelihood of aphasia and aphasia type.

Background: Research data on the compensatory mechanisms in patients with stroke sequelae that have been accumulated within the last years, allows for reconsideration of conventional techniques to restore aphasia. Aim: To increase efficacy of the logopedic rehabilitation of patients with sequelae of the local posterior cortical lesions of the brain. Materials and methods: Two hundred and eighty six patients with aphatic speech disorders during the early and late restorative periods of stroke participated in the study. The presence of aphasia caused by suppressed functioning of the posterior cortical areas was confirmed by the results of neurologic and logopedic assessments using the method of speech assessment in aphasia (L.S. Tsvetkova et al., 1981). Depending on the type of aphasia, the patients were divided in the groups as follows: 1) those with acoustic + gnostic aphasia (middle temporal gyrus); 2) those with acoustic + amnestic aphasia (upper temporal gyrus); 3) those with semantic aphasia (parietal – temporal – occipital areas). All patients underwent a course of logopedic rehabilitation aimed at restoration of the speech thinking. Results: Until now, there was no technique for restoration of acoustic + amnestic and semantic types of aphasia with severe speech impairment. We have developed and implemented modified restoration methods for patients with posterior types of aphasia that increased the efficacy of rehabilitation. An improvement was seen in 61% of patients with severe aphasia, in 68% of those with moderate degree of aphasia and in 90% of patients with mild aphasia. Conclusion: The clue for achievement of very good results of speech thinking restoration was the consideration of the mechanisms of speech impairment and compensatory processes in patients with the stroke sequelae

Few studies have investigated language recovery patterns and the mechanisms of crossed bilingual aphasia following a subcortical stroke. In particular, Korean-Japanese crossed bilingual aphasia has not been reported. A 47-year-old, right-handed man was diagnosed with an extensive right basal ganglia hemorrhage. He was bilingual, fluent in both Korean and Japanese. After his stroke, the patient presented with crossed aphasia. We investigated changes in the Korean (L1) and Japanese (L2) language recovery patterns. Both Korean and Japanese versions of the Western Aphasia Battery (WAB) were completed one month after the stroke, and functional magnetic resonance imaging (fMRI) was performed using picture-naming tasks. The WAB showed a paradoxical pattern of bilingual aphasia, with an aphasia quotient (AQ) of 32 for Korean and 50.6 for Japanese, with Broca's aphasia. The patient scored better in the Japanese version of all domains of the tests. The fMRI study showed left lateralized activation in both language tasks, especially in the inferior frontal gyrus. After six months of language therapy targeting L1, the Korean-WAB score improved significantly, while the Japanese-WAB score showed slight improvement. In this case, the subcortical lesion contributed to crossed bilingual aphasia more highly affecting L1 due to loss of the cortico-subcortical control mechanism in the dominant hemisphere. The paradoxical pattern of bilingual aphasia disappeared after lengthy language therapy targeting L1, and the therapy effect did not transfer to L2. Language recovery in L1 might have been accomplished by reintegrating language networks, including the contralesional language homologue area in the left hemisphere.

Background: Comprehension deficits are more pervasive in aphasic syndromes than initially believed. They affect differentially distinct levels of auditory-verbal comprehension. Current evidence from functional imaging studies in healthy subjects indicates that distinct levels of auditory-verbal analysis involve specific networks.Aims: The aim of this study is (1) to assess the different levels of auditory-verbal analysis with real-time monitoring tasks in patients with aphasia, (2) to compare the performance profiles across aphasia types, (3) to analyse patterns of dissociations vs. co-occurrence at specific levels, and (4) to establish correlations between disturbances at specific levels of auditory-verbal analysis and sites of lesions.Methods & Procedures: Forty-two right-handed patients with aphasia associated with a first unilateral left-hemispheric lesion underwent tests monitoring (1) phonetic-phonological, (2) lexical, (3) morphosyntactic, (4) semantic-pragmatic (at sentence level), and (5)...

Introduction Speech disorders are often first symptoms of dementias with neurodegenerative basis. Differences in the clinical picture and different types of the speech difficulties may make diagnosis of this degenerative process easier. Aim To present an example of clinical evaluation of the patient with primary progressive aphasia (PPA) according to the newest diagnostic criteria. To shortly revise current knowledge about logopenic variant and its association with Alzheimer disease. Case study We present a case of a 75-year-old man suffering from progressive language difficulties, who was finally diagnosed as having primary progressive aphasia – logopenic variant. Clinical data, neuroimaging, psychological test batteries and speech therapist's examination based on the Boston Aphasia Test were used. Results and discussion In the first part we revise evolution of primary progressive aphasia diagnostic criteria and nomenclature, and focus on current approach to the patient with isolated, progressive speech difficulties. In the second part we attempt to summarize linguistic, neuropsychological and pathological findings that one may encounter in the case of logopenic variant of PPA. Conclusions Diagnosis of primary progressive aphasia requires a close cooperation between neurologist, speech therapists and psychologists. Clinical presentation, due to various level of cognitive decline at first stages of the disease and individualization of the clinical picture, is nonuniform. Recently created diagnostic criteria make both basic diagnosis and diagnosis of the primary progressive aphasia variants easier. This may lead choosing the rehabilitation methods easier in case of disordered language functions and other cognitive domains.

The background for this special issue of Aphasiology on Frequency, Language Processing and Aphasia reaches nearly 60 years into the past. In 1959, Chomsky, critiquing Skinner’s Verbal Behavior, dep...

Aphasia is an acquired impairment in the production or comprehension of language, typically caused by left hemisphere stroke. The subtyping framework used in clinical aphasiology today is based on the Wernicke-Lichtheim model of aphasia formulated in the late 19th century, which emphasizes the distinction between language production and comprehension. The current study used a data-driven approach that combined modern statistical, machine learning, and neuroimaging tools to examine behavioural deficit profiles and their lesion correlates and predictors in a large cohort of individuals with post-stroke aphasia. First, individuals with aphasia were clustered based on their behavioural deficit profiles using community detection analysis (CDA) and these clusters were compared with the traditional aphasia subtypes. Random forest classifiers were built to evaluate how well individual lesion profiles predict cluster membership. The results of the CDA analyses did not align with the traditional model of aphasia in either behavioural or neuroanatomical patterns. Instead, the results suggested that the primary distinction in aphasia (after severity) is between phonological and semantic processing rather than between production and comprehension. Further, lesion-based classification reached 75% accuracy for the CDA-based categories and only 60% for categories based on the traditional fluent/non-fluent aphasia distinction. The results of this study provide a data-driven basis for a new approach to classification of post-stroke aphasia subtypes in both research and clinical settings.

Background A core outcome set (COS; an agreed, minimum set of outcomes) was needed to address the heterogeneous measurement of outcomes in aphasia treatment research and to facilitate the production of transparent, meaningful, and efficient outcome data. Objective The Research Outcome Measurement in Aphasia (ROMA) consensus statement provides evidence-based recommendations for the measurement of outcomes for adults with post-stroke aphasia within phases I–IV aphasia treatment studies. Methods This statement was informed by a four-year program of research, which comprised investigation of stakeholder-important outcomes using consensus processes, a scoping review of aphasia outcome measurement instruments, and an international consensus meeting. This paper provides an overview of this process and presents the results and recommendations arising from the international consensus meeting. Results Five essential outcome constructs were identified: Language, communication, patient-reported satisfaction with treatment and impact of treatment, emotional wellbeing, and quality of life. Consensus was reached for the following measurement instruments: Language: The Western Aphasia Battery Revised (WAB-R) (74% consensus); emotional wellbeing: General Health Questionnaire (GHQ)-12 (83% consensus); quality of life: Stroke and Aphasia Quality of Life Scale (SAQOL-39) (96% consensus). Consensus was unable to be reached for measures of communication (where multiple measures exist) or patient-reported satisfaction with treatment or impact of treatment (where no measures exist). Discussion Harmonization of the ROMA COS with other core outcome initiatives in stroke rehabilitation is discussed. Ongoing research and consensus processes are outlined. Conclusion The WAB-R, GHQ-12, and SAQOL-39 are recommended to be routinely included within phases I–IV aphasia treatment studies. This consensus statement has been endorsed by the Collaboration of Aphasia Trialists, the British Aphasiology Society, the German Society for Aphasia Research and Therapy, and the Royal College of Speech Language Therapists.