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Background: Word production difficulty is one of the most common and persisting symptoms in people suffering from aphasia (i.e., anomia). However, there is a considerable variability in patients' responses to treatment, leading to the need of new effective approaches. Also, the mechanisms underlying word (re)learning is little known in production even in neurotypical adult native language and especially in relationship with the lexical-semantic integration of (re)learnt words. The lexical-semantic network being highly contextual and multimodal, new technologies such as immersive virtual reality (iVR) may become pertinent approaches, but still need scientific proof, especially as past studies have found no advantage over a control method and have never used an immersive version of VR. Yet, the immersion has been identified as being a key factor of positive outcomes in learning. Therefore, the aim of the present study was to investigate whether iVR provides a benefit in word learning in neurotypical adults (Study 1) and in the treatment for anomia in people suffering from aphasia following stroke (Study 2)., Method: In study 1, 32 neurotypical adults learned two matched lists of 30 rare words each in their native language (French) during a one-week protocol alternating test and learning sessions with iVR and a digital static learning method. Study 2 followed the same design over a two week-period with 16 people with aphasia (re)learning two matched lists of 28 frequent words., Results: Neurotypical adults demonstrated a higher accuracy rate in word production for words learned with iVR in comparison to those learned with the digital static learning method. For people suffering from anomia, the iVR did not differ from the control method on total accuracy but led to a greater reduction of lexical errors., Conclusion: iVR has a potential of use for learning new words but also for the treatment of word production difficulties, especially in people with aphasia that produce mainly lexical errors. These two main results lead to the hypothesis that iVR promotes lexical-semantic processes., Competing Interests: Conflicts of interest The authors declare no conflict of interest., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Repetitive transcranial magnetic stimulation (rTMS) can enhance aphasia recovery. Most studies have used inhibitory stimulation targeting the right inferior frontal gyrus. However, the motor cortex, observed to contribute to the prediction of aphasia recovery, is involved in word production and could be an appropriate target for rTMS. We aimed to observe behavioral changes in a picture naming task induced by inhibitory rTMS targeting the right motor cortex of the lips in people with poststroke aphasia., Method: Using a single-case experimental design, we included three participants with chronic poststroke aphasia who had phonological deficits. Each participant performed a verbal picture naming task 3 times a week for 2, 3, or 4 weeks (pseudorandom across participants) to establish a baseline naming ability for each participant. These were not therapy sessions, and no feedback was provided. Then, each participant received the intervention, inhibitory continuous theta burst stimulation targeting the right motor cortex of the lips, 3 times a week for 2 weeks. Naming testing continued 3 times a week, for these latter 2 weeks. No therapy was performed at any time during the study., Results: Visual analysis of the graphs showed a positive effect of rTMS for P2 and P3 on picture naming accuracy and a tendency toward improvement for P1. Statistical analysis showed an improvement after rTMS for P1 (τ = 0.544, p = . 013, SE Tau = 0.288) and P2 (τ = 0.708, p = . 001, SE Tau = 0.235). For P3, even if the intervention allowed some improvement, this was statistically nonsignificant due to a learning effect during the baseline naming testing, which lasted the longest, 4 weeks. Regarding specific language features, phonological errors significantly decreased in all patients., Conclusions: The motor cortex of the lips could be an appropriate target for rTMS to improve naming in people with poststroke aphasia suffering from a phonological deficit. This suggests the possibility to individualize the target for rTMS, according to the patient's linguistic impairment.

Background Magnetoencephalography (MEG) and electroencephalography (EEG) record two main types of data: continuous measurements at rest or during sleep, and event-related potentials/evoked magnetic fields (ERPs/EMFs) that involve specific and repetitive tasks. In this systematic review, we summarized longitudinal studies on recovery from post-stroke aphasia that used continuous or event-related temporal imaging (EEG or MEG). Methods We searched PubMed and Scopus for English articles published from 1950 to May 31, 2022. Results 34 studies were included in this review: 11 were non-interventional studies and 23 were clinical trials that used specific rehabilitation methods, neuromodulation, or drugs. The results of the non-interventional studies suggested that poor language recovery was associated with slow-wave activity persisting over time. The results of some clinical trials indicated that behavioral improvements were correlated with significant modulation of the N400 component. Discussion Compared with continuous EEG, ERP/EMF may more reliably identify biomarkers of therapy-induced effects. Electrophysiology should be used more often to explore language processes that are impaired after a stroke, as it may highlight treatment challenges for patients with post-stroke aphasia., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Stroke rehabilitation interventions are routinely personalized to address individuals' needs, goals, and challenges based on evidence from aggregated randomized controlled trials (RCT) data and meta-syntheses. Individual participant data (IPD) meta-analyses may better inform the development of precision rehabilitation approaches, quantifying treatment responses while adjusting for confounders and reducing ecological bias., Aim: We explored associations between speech and language therapy (SLT) interventions frequency (days/week), intensity (h/week), and dosage (total SLT-hours) and language outcomes for different age, sex, aphasia severity, and chronicity subgroups by undertaking prespecified subgroup network meta-analyses of the RELEASE database., Methods: MEDLINE, EMBASE, and trial registrations were systematically searched (inception-Sept2015) for RCTs, including ⩾ 10 IPD on stroke-related aphasia. We extracted demographic, stroke, aphasia, SLT, and risk of bias data. Overall-language ability, auditory comprehension, and functional communication outcomes were standardized. A one-stage, random effects, network meta-analysis approach filtered IPD into a single optimal model, examining SLT regimen and language recovery from baseline to first post-intervention follow-up, adjusting for covariates identified a-priori . Data were dichotomized by age (⩽/> 65 years), aphasia severity (mild-moderate/ moderate-severe based on language outcomes' median value), chronicity (⩽/> 3 months), and sex subgroups. We reported estimates of means and 95% confidence intervals. Where relative variance was high (> 50%), results were reported for completeness., Results: 959 IPD (25 RCTs) were analyzed. For working-age participants, greatest language gains from baseline occurred alongside moderate to high-intensity SLT (functional communication 3-to-4 h/week; overall-language and comprehension > 9 h/week); older participants' greatest gains occurred alongside low-intensity SLT (⩽ 2 h/week) except for auditory comprehension (> 9 h/week). For both age-groups, SLT-frequency and dosage associated with best language gains were similar. Participants ⩽ 3 months post-onset demonstrated greatest overall-language gains for SLT at low intensity/moderate dosage (⩽ 2 SLT-h/week; 20-to-50 h); for those > 3 months, post-stroke greatest gains were associated with moderate-intensity/high-dosage SLT (3-4 SLT-h/week; ⩾ 50 hours). For moderate-severe participants, 4 SLT-days/week conferred the greatest language gains across outcomes, with auditory comprehension gains only observed for ⩾ 4 SLT-days/week; mild-moderate participants' greatest functional communication gains were associated with similar frequency (⩾ 4 SLT-days/week) and greatest overall-language gains with higher frequency SLT (⩾ 6 days/weekly). Males' greatest gains were associated with SLT of moderate (functional communication; 3-to-4 h/weekly) or high intensity (overall-language and auditory comprehension; (> 9 h/weekly) compared to females for whom the greatest gains were associated with lower-intensity SLT (< 2 SLT-h/weekly). Consistencies across subgroups were also evident; greatest overall-language gains were associated with 20-to-50 SLT-h in total; auditory comprehension gains were generally observed when SLT > 9 h over ⩾ 4 days/week., Conclusions: We observed a treatment response in most subgroups' overall-language, auditory comprehension, and functional communication language gains. For some, the maximum treatment response varied in association with different SLT-frequency, intensity, and dosage. Where differences were observed, working-aged, chronic, mild-moderate, and male subgroups experienced their greatest language gains alongside high-frequency/intensity SLT. In contrast, older, moderate-severely impaired, and female subgroups within 3 months of aphasia onset made their greatest gains for lower-intensity SLT. The acceptability, clinical, and cost effectiveness of precision aphasia rehabilitation approaches based on age, sex, aphasia severity, and chronicity should be evaluated in future clinical RCTs.

Objective: To evaluate if positioning the upper-limb promoting abduction, external rotation and flexion of the shoulder reduces the intensity of post-stroke shoulder pain at day-7 compared to usual clinical practice., Design & Setting: Prospective single-center randomized clinical trial using a superiority design comparing two preventive strategies of post-stroke shoulder pain in a stroke unit., Subjects: Patients were included within 2 days from a first symptomatic ischemic stroke affecting shoulder motor function., Interventions: Intervention group included specific positioning of the shoulder in abduction, external rotation and flexion in bed, chair and during mobilization. Control group referred to usual practice i.e. positioning using a standard support scarf., Main Measures: Primary outcome was the intensity of shoulder pain assessed by the visual analog scale (VAS) (0-100) at day-7 post-stroke. Other outcomes measured at day-7 and 2 months post-stroke were the VAS, motor function, spasticity, depression, functional independence and rates of complex regional Pain syndrome (CRPS)., Results: 76 patients (49 males; mean age = 68.3) were randomized. The shoulder pain at day-7 was not different between the control group (16.1, SD = 27.4) and the intervention group (10.3, SD = 21.5, p  = 0.18) as well as at 2 months ( p  = 0.12). A lower rate of depression was observed in the intervention group at 2 months 36.7% (CI95% 19.9;56.1) vs 52.9% (CI95% 35.1;70.2). No between-group difference in other outcomes was observed at 2 months., Conclusions: This study failed to demonstrate the benefit of a specific positioning tool in reducing the intensity of post-stroke shoulder pain which was lower than previously reported in the literature.

Background: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool that induces neuromodulation in the brain. Several studies have shown that rTMS improves language recovery in patients with post-stroke aphasia., Objective: This systematic review summarizes the role of rTMS in aphasia rehabilitation., Methods: We searched MEDLINE via PubMed and Scopus on 30October, 2020, for English articles (1996-2020). Eligible studies involved post-stroke aphasia rehabilitation with rTMS. In some of these studies, rTMS was also combined with speech therapy., Results: In total, seven meta-analyses and 59studies (23randomized clinical trials) were included in this systematic review. The methods used in these studies were heterogeneous. Only six studies did not find that rTMS had a significant effect on language performance., Conclusions: The evidence from the peer-reviewed literature suggests that rTMS is an effective tool in post-stroke aphasia rehabilitation. However, the precise mechanisms that underlie the effects of rTMS and the reorganization of language networks in patients who have had a stroke remain unclear. We discuss these crucial challenges in the context of future studies., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Robotic devices are often used in rehabilitation and might be efficient to improve walking capacity after stroke., Objective: First to investigate the effects of robot-assisted gait training after stroke and second to explain the observed heterogeneity of results in previous meta-analyses., Methods: All randomized controlled trials investigating exoskeletons or end-effector devices in adult patients with stroke were searched in databases (MEDLINE, EMBASE, CENTRAL, CINAHL, OPENGREY, OPENSIGLE, PEDRO, WEB OF SCIENCE, CLINICAL TRIALS, conference proceedings) from inception to November 2019, as were bibliographies of previous meta-analyses, independently by 2 reviewers. The following variables collected before and after the rehabilitation program were gait speed, gait endurance, Berg Balance Scale (BBS), Functional Ambulation Classification (FAC) and Timed Up and Go scores. We also extracted data on randomization method, blinding of outcome assessors, drop-outs, intention (or not) to treat, country, number of participants, disease duration, mean age, features of interventions, and date of outcomes assessment., Results: We included 33 studies involving 1466 participants. On analysis by subgroups of intervention, as compared with physiotherapy alone, physiotherapy combined with body-weight support training and robot-assisted gait training conferred greater improvement in gait speed (+0.09m/s, 95% confidence interval [CI] 0.03 to 0.15; p=0.002), FAC scores (+0.51, 95% CI 0.07 to 0.95; p=0.022) and BBS scores (+4.16, 95% CI 2.60 to 5.71; p=0.000). A meta-regression analysis suggested that these results were underestimated by the attrition bias of studies., Conclusions: Robot-assisted gait training combined with physiotherapy and body-weight support training seems an efficient intervention for gait recovery after stroke., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

The neuronal loss resulting from stroke forces 80% of the patients to undergo motor rehabilitation, for which Brain-Computer Interfaces (BCIs) and NeuroFeedback (NF) can be used. During the rehabilitation, when patients attempt or imagine performing a movement, BCIs/NF provide them with a synchronized sensory (e.g., tactile) feedback based on their sensorimotor-related brain activity that aims at fostering brain plasticity and motor recovery. The co-activation of ascending (i.e., somatosensory) and descending (i.e., motor) networks indeed enables significant functional motor improvement, together with significant sensorimotor-related neurophysiological changes. Somatosensory abilities are essential for patients to perceive the feedback provided by the BCI system. Thus, somatosensory impairments may significantly alter the efficiency of BCI-based motor rehabilitation. In order to precisely understand and assess the impact of somatosensory impairments, we first review the literature on post-stroke BCI-based motor rehabilitation (14 randomized clinical trials). We show that despite the central role that somatosensory abilities play on BCI-based motor rehabilitation post-stroke, the latter are rarely reported and used as inclusion/exclusion criteria in the literature on the matter. We then argue that somatosensory abilities have repeatedly been shown to influence the motor rehabilitation outcome, in general. This stresses the importance of also considering them and reporting them in the literature in BCI-based rehabilitation after stroke, especially since half of post-stroke patients suffer from somatosensory impairments. We argue that somatosensory abilities should systematically be assessed, controlled and reported if we want to precisely assess the influence they have on BCI efficiency. Not doing so could result in the misinterpretation of reported results, while doing so could improve (1) our understanding of the mechanisms underlying motor recovery (2) our ability to adapt the therapy to the patients' impairments and (3) our comprehension of the between-subject and between-study variability of therapeutic outcomes mentioned in the literature., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Transcranial direct current stimulation (tDCS) is a non-invasive tool that induces neuromodulation in the brain. Several studies have shown the effectiveness of tDCS in improving language recovery in post-stroke aphasia. However, this innovative technique is not currently used in routine speech and language therapy (SLT) practice., Objective: This systematic review aimed to summarise the role of tDCS in aphasia rehabilitation., Methods: We searched MEDLINE via PubMed and Scopus on October 5, 2018 for English articles published from 1996 to 2018. Eligible studies involved post-stroke aphasia rehabilitation with tDCS combined or not with SLT., Results: We retained 5 meta-analyses and 48 studies. Among the 48 studies, 39 were randomised controlled trials (558 patients), 2 prospective studies (56 patients), and 5 case studies (5 patients). Two articles were sub-analyses of a randomised clinical trial. Methods used in these studies were heterogeneous. Only 6 studies did not find a significant effect of tDCS on language performance. As compared with earlier meta-analyses, the 2 latest found significant effects., Conclusion: Evidence from published peer reviewed literature is effective for post-stroke aphasia rehabilitation at the chronic stages. tDCS devices are easy to use, safe and inexpensive. They can be used in routine clinical practice by speech therapists for aphasia rehabilitation. However, further studies should investigate the effectiveness in the subacute post-stroke phase and determine the effect of the lesion for precisely identifying the targeted brain areas. We discuss crucial challenges for future studies., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background/objective: General practitioners (GPs) are pivotal in the organization of the entire post-stroke management system. This study aimed to examine the sequelae of chronic post-stroke patients and to assess whether the medical follow-up organized by GPs is truly in accordance with current recommendations and patients' clinical needs., Methods: This was an observational study including chronic post-stroke patients after a first stroke. Their post-stroke follow-ups (visits to GPs and specialist doctors) were compared with guidelines and with clinical needs as evaluated through a number of questionnaires., Results: Overall, 53.2% of patients visited a neurologist as recommended and, although 49.4% had neuropsychiatric consequences, only 6.3% visited a psychiatrist. Similarly, while 34.2% had significant post-stroke disability, only 6.3% saw a rehabilitation physician., Conclusion: Taking into account not only cardiovascular prevention, but all post-stroke consequences, medical follow-ups as organized by GPs were not in accordance with recommendations and failed to take advantage of the currently available multidisciplinary resources required to improve patients' needs., (Copyright © 2018. Published by Elsevier Masson SAS.)

In stroke-induced aphasia, left hemispheric lesions generally disturb the word production network. The left inferior frontal gyrus (LIFG) and the left middle temporal gyrus (LMTG) are involved in word production, but their respective contribution remains ambiguous. Previous investigations have largely focused on semantic interference to gather information about word production. Here we assessed the sensitivity of twenty-five aphasic speakers with either LIFG or LMTG lesions and matched controls to both semantic facilitation and interference in word production using the picture-word (PWP) and the blocked-cyclic naming (BCNP) paradigms. In the PWP (Exp. 1), semantic facilitation was exaggerated in participants with LIFG damage as compared to age-matched controls. In the BCNP (Exp. 2), repetition priming on production speed was larger in participants with LMTG damage than in controls, without any decrease of semantic errors. In the light of the results in the PWP, the LIFG appears to be a necessary structure to shape semantic facilitation. It might play an important role in properly adjusting the lexical selection threshold within the word production network. The results in the BCNP suggest that the LMTG conveys semantic-to-lexical connections likely involved in repetition priming and in mapping concepts to their correct lexical label. As consequences, participants with LIFG lesions possibly rely more on strategic vs automatic processes to efficiently select lexical entries in semantically competitive contexts, whereas participants with LMTG might exploit residual semantic-to-lexical activation., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Aphasia recovery remains difficult to predict initially in particular for the most severe cases. The features of impaired verbal communication which are the basis for cognitive-linguistic diagnosis and treatment could be part of prediction of recovery from aphasia., Aim: This study investigated whether some components of language screening in the acute phase of stroke are reliable prognostic factors for language recovery in the post-acute phase., Design: Monocentric prospective study., Setting: University hospital stroke unit., Population: Eighty-six patients aged between 21 and 92 years (mean=67.4, SD=15.3) were admitted after a first left hemisphere stroke with aphasia and were consecutively included., Methods: Language assessment was performed in the acute phase and 3 months post-stroke with the LAnguage Screening Test (LAST) and the Aphasia Severity Rating Scale (ASRS) of the Boston Diagnostic Aphasia Examination (BDAE). Severe aphasia was defined as ASRS<3. Good recovery was defined as an ASRS≥4. Language scores and other potential predictors of recovery were analysed by comparing groups of patients with good versus poor recovery and as predictors of change with multiple regression approaches., Results: LAST Total score as well as all the individual items of LAST, NIHSS and ASRS measured in the acute phase significantly differentiated good and poor recovery from aphasia at three months for all aphasic patients and for the most severe cases. In multivariable analyses the repetition score of LAST at the acute phase was significantly associated with the delta of ASRS between the acute phase and 3 months after the stroke reflecting changes in symptom severity., Conclusions: For patients with initial severe aphasia, word repetition from a language screening task seems to be a more relevant predictor of recovery than initial severity to enrich the prognosis of poststroke aphasia recovery three month after a stroke. These findings show the importance of phonological perception and production as well as speech motor components in the recovery of language. These linguistic aspects of the assessment seem more relevant than severity for prediction in the acute phase., Clinical Rehabilitation Impact: These findings could improve aphasia management pathway for people with severe aphasia and their families and minimize the evidence-practice gap for speech pathologists.

Purpose: This study had twofold objective: (1) assessing change and dynamic processes over time between severity of aphasia and functional autonomy and (2) examining the temporal relationships between functional autonomy, depressive mood and quality of life in stroke patients with aphasia., Method: Prospective study of patients with aphasia consecutively included after a first stroke and examined 1 year later at home (n = 101). Assessment included a visual analogical scale assessing QoL, a functional autonomy scale, a severity of aphasia scale, a communication questionnaire and a depression scale. Structural equation modeling was used to estimate competitive models, in which depressive mood or QoL was the ultimate endogenous variable (i.e., vulnerability vs. scar model)., Results: One year after stroke, there were a slight improvement in language impairment (stability coefficient = .61, p < .001) and a moderate improvement in functional autonomy (stability coefficient = .44, p < .001). There were prospective reciprocal effects between severity of aphasia and functional autonomy, i.e., each state exerted a temporal dynamic prediction on the other over time. Cross-sectional results from path analysis showed that depressive mood negatively predicted QoL (i.e., scar model); there was no evidence of the reverse association., Conclusion: Results and their practical relevance in treatment were discussed. Predicting as soon as possible which factors would be related to late QoL in stroke patients with aphasia is of major importance.

Background and Purpose: Poststroke depression (PSD) is a frequent complication of stroke with detrimental consequences in terms of quality of life and functional outcomes. In individuals with major depression, several studies have demonstrated an alteration of affective prosody. The aim of this study is to identify prosodic markers that may be predictive of PSD., Methods: Patient voices were recorded at baseline and 3 months after stroke. We extracted prosodic parameters, including fundamental frequency, percentage of voice breaks, and shimmer. Depression and anxiety symptoms were assessed 3 months later., Results: Among the 49 patients included in the study, 22.5% developed PSD 3 months after stroke. A significant decrease was observed concerning the fundamental frequency among patients who developed PSD. Discriminant analysis demonstrated that initial voice breaks coupled with shimmer are strongly predictive of subsequent PSD., Conclusions: Early alterations of affective prosody are associated with a higher risk of PSD 3 months after a stroke. This new physiological approach overcomes traditional barriers associated with clinical instruments and contributes to the prediction of this disorder., (© 2016 American Heart Association, Inc.)

We present the case of a patient with left homonymous hemianopia and chronic left neglect consequent to a stroke in the occipito-temporal regions of the right hemisphere. When the patient performed cancellation tasks with her right (dominant) hand, she had severe and persistent left neglect at retest 7 and 8 years after onset. However, her performance on line bisection was invariably within normal limits. Strikingly, performance on cancellation tests reverted to normal when the patient used her left hand. White matter tractography using spherical deconvolution demonstrated damage to the splenium of the corpus callosum, as well as a relative preservation of the right fronto-parietal network. Effector-dependent neglect may occur because splenial disconnection deprives the right fronto-parietal network from visual information processed by the left hemisphere. Consequently, spatial exploration reverts to normal when the patient uses her left hand, thus involving more directly the fronto-parietal attentional networks in the right-hemisphere.

Introduction Aphasia is the main cause of communication disorders following stroke. The individual prognosis of aphasia recovery remind difficult to establish in the acute phase. The aim of this study was to investigate whether the motor evoked potentials (MEP) of the hand and the orbicularis oris in the acute phase of stroke could predict aphasia recovery. Materials and methods This study is ongoing at the University Hospital of Bordeaux. All consecutive patients with aphasia, first left hemispheric stroke confirmed by imaging, right-handed, non-demented, have been proposed for inclusion. MEPs were collected after stimulation of M1 the abductor pollicis and the orbicularis oris, right and left. The assessment of language performed in the acute phase was composed of: Language Screening Test (LAST) and the aphasia severity rating scale (ASRS) of the Boston Diagnostic Aphasia Examination (BDAE). Three and six months later, the language assessment was composed by: LAST, ASRS and BDAE. Good recovery from aphasia was defined as a score of ASRS 4 or 5. The association between the presence of a MEP after stimulation and good recovery was studied by Fischer exact tests. Results In our interim analysis, 46 patients were followed at 3 months, and 23 at 6 months. The presence of MEP of the right hand (left cortical stimulation) was significantly associated with good recovery 3 months ( P = 0.003) and 6 months ( P = 0.003) after a stroke. The presence of MEP of the right orbicularis oris (left cortical stimulation) was significantly associated with good recovery 3 months ( P = 0.003) and 6 months ( P = 0.011). Conclusion MEP of hand and lips predict recovery from aphasia. This results suggest the importance of production systems in the recovery of language, suggesting a new approach compared semantic core highlighted in the old classic models such as Lichtheim. [ABSTRACT FROM AUTHOR]

Introduction The individual prognosis of aphasia recovery remains difficult to establish initially. The aim of this study was to determine whether some components of language evaluated in the acute phase of stroke could be prognosis factors for aphasia recovery, and if these components could predict the clinical pattern of aphasia in the chronic phase. Materials and methods Were included all consecutive right-handed patients with aphasia, after a first stroke, confirmed by imagery, left hemisphere injured, without dementia. Assessment was performed at the acute phase: Language Screening Test (LAST) and Aphasia Severity Rating Scale (ASRS) of the Boston Diagnostic Aphasia Examination (BDAE). Three months after: LAST, ASRS and BDAE and good recovery from aphasia was defined as an ASRS score of 4 or 5. Results Twenty-eight patients (30–89 years) were included from November 2013 to February 2014. LAST total, LAST receptive and expression index, item order execution and naming and ASRS were significantly associated with good recovery at 3 months (Mann-Whitney; P < 0.05). Expression index was significantly associated with good recovery (OR = 2.2; CI95%: 1.2–3.8; P < 0.001) in a multi-variable analysis including receptive index and expression index, and also including expression index and ASRS in the acute phase. Naming, order execution, picture recognition, word repetition and automatic speech items of LAST (acute phase) and BDAE (3 months after) were correlated (Spearman and Mann-Whitney; P < 0,05). Discussion These results underline the importance of tests in the acute phase of stroke, both in terms of the prediction of recovery, better than severity in the acute phase, and the clinical evolution of aphasia. [ABSTRACT FROM AUTHOR]

Introduction/Background Several studies identified age, gender, handedness, lesion size, stroke subtype, aphasia/stroke initial severity as prognostic factors for recovery from aphasia. However, prediction of recovery still remains difficult to establish initially for patients with initial severe aphasia. The aim of this study was to identify the lesion location associated with poor recovery. Material and method One hunderd aphasic patients were included within fourteen days after a first ischemic or haemorrhagic stroke of the left hemisphere and had analysable MRI sequences. The severity of aphasia was determined using the Aphasia Severity Rating Scale in the acute phase and six months post-stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. Good recovery at M6 was defined as an ASRS = 4–5. In a first step, axial diffusion-weighted images, or T2*-weighted images for intra-cerebral haemorrhage, were imported. Lesions were drawn manually as regions of interest blinded to clinical data. Images were normalized to a standard brain template. The resulting normalized lesion maps were analysed in a VLSM approach, which applies the graded information at the behavioural level to voxel-wise binary lesion information. The resulting maps were corrected for multiple comparisons. Results Regarding all patients, a better outcome was significantly associated ( P < 0.01) with lesion excluding the following areas of the left hemisphere: Putamen, transverse temporal gyrus (Heschl gyrus), Insula, Rolandic Operculum. Regarding patients with severe aphasia initially, a poor recovery (i.e. ASRS at M6 < 4) was significantly associated ( P < 0.05) with lesion in the Putamen and transverse temporal gyrus (Heschl gyrus). Conclusion The present study identified critical areas associated with poor outcomes for aphasia, particularly lesions of the superior temporal gyrus for patients with severe aphasia initially. These findings are in line with previous results in the literature. [ABSTRACT FROM AUTHOR]

Introduction/Background Stroke-related aphasia affects 20% to 40% stroke patients and early prediction of aphasia recovery remains extremely difficult to predict. Leukoaraiosis LA is recognised as one of the neuroimaging features of cerebral small vessel disease and is associated with brain disturbances. LA is known to be associated with long term cognitive decline, mood disorders, gait disability and has a negative impact of post-stroke functional outcome. The aim of this study was to determine whether the extent of LA could contribute to the prediction of recovery from post-stroke aphasia. Material and method Hundred and ten right handed aphasic patients with analyzable MRI sequences were included and assessed as soon as possible within fourteen days after a first left hemispheric stroke. The severity of aphasia was assessed using the Aphasia Severity Rating Scale (ASRS) at baseline and 6month (M6) after the stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. Good recovery at M6 was defined as an ASRS = 4–5. In a first step, axial diffusion-weighted images, or T2*-weighted images for intra-cerebral haemorrhage, and Flair images were imported. Lesions were drawn manually in order to measure the lesion size, as well as the volume of LA in Flair sequences. Results Good recovery from aphasia was significantly associated with lower severity of aphasia initially ( P < 0.001) and smaller lesions ( P < 0.001). No significant association was found between the volume of LA and recovery from aphasia, even adjusted to the lesion size or age in a multi variable model. Conclusion The extent of leukoaraiosis is not a predictor of aphasia recovery, even adjusted to the lesion size or age. Hence, aphasia recovery seems to be poorly influenced by diffuse lesions of sub-cortical white matter, strengthening the idea of crucial and localised brain areas and networks involved in recovery. [ABSTRACT FROM AUTHOR]

Introduction Stroke, even if sequels are considered minimal, can lead to participation restrictions (PR) for patients. Objectives To determine whether, in the absence of management in physical and rehabilitation medicine (PRM), the discomfort felt by stroke patients are screened by their general practitioner (GP). Methods We have conducted a pilot study on patients less than 75 years old included more than 6 months after their stroke, with minimal sequelae, gone back home without rehabilitation management. They were assessed by the G-MAP questionnaire composed by 24 items that assessed their activity limitations (AL), their PR, any trouble, and the influence of the environment. In parallel, we have contacted their doctor to evaluate his feelings of trouble, compared to patients’ by Wilcoxon signed ranks test. Results Seventeen patients and 39 controls were included. There was a statistically significant difference in perception of trouble underevaluated by the GP for only 3 items out of 24: romantic relationships ( P = 0.038), sex ( P = 0.016) and group hobbies ( P = 0.026). Discussion GP have a good perception of the troubles of their patients, except for the romantic and sexual relationships, as well as group hobby. This involves coordination between PRM and GP in order to improve the assessment of PR and the environment of post-stroke patients. [ABSTRACT FROM AUTHOR]