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Purpose: Persons with unilateral brain damage in the right hemisphere (RH) or left hemisphere (LH) show limitations in processing linguistic prosody, with yet inconclusive results on their ability to process prosodically marked structural boundaries for syntactic ambiguity resolution. We aimed at systematically investigating production and comprehension of three prosodic cues ( f 0 range, final lengthening, and pause) at structural boundaries in coordinate sequences in participants with right hemisphere brain damage (RHDP) and participants with left hemisphere brain damage (LHDP). Method: Twenty RHDP and 15 LHDP participated in our study. Comprehension experiment: Participants and a control group listened to coordinate name sequences with internal grouping by a prosodically marked structural boundary (grouped condition, e.g., “(Gabi und Leni) # und Nina”) or without internal grouping (ungrouped condition, e.g., “Gabi und Leni und Nina”) and had to identify the target condition. The strength and combinations of prosodic cues in the stimuli were manipulated. Production experiment: Participants were asked to produce coordinate sequences in the two conditions (grouped, ungrouped) in two different tasks: a Reading Aloud and a Repetition experiment. Accuracy of participants' productions was subsequently assessed in a rating study and productions were analyzed with respect to use of prosodic cues. Results: In the Comprehension experiment, RHDP and LHDP had overall lower identification accuracies than unimpaired control participants and LHDP were found to have particular problems with boundary identification when the pause cue was reduced. In production, LHDP and RHDP employed all three prosodic cues for boundary marking, but struggled to clearly mark prosodic boundaries in 28% of all productions. Both groups showed better performance in reading aloud than in repetition. LHDP relied more on using f 0 range and pause duration to prosodically mark structural boundaries, whereas RHDP employed final lengthening more vigorously than LHDP in reading aloud. Conclusions: We conclude that processing of linguistic prosody is affected in RHDP and LHDP, but not completely impaired. Therefore, prosody can serve as a relevant communicative resource. However, it should also be considered as a target area for assessment and treatment in both groups. Supplemental Material: https://doi.org/10.23641/asha.21637505

The breakdown of rapid and accurate retrieval of words is a hallmark of aphasic speech and a prime target of therapeutic intervention. Complementary, psycho- and neurolinguistic research have developed a spectrum of models, how and by which neuronal network uncompromised speakers can rely on remarkable lexical retrieval capacities. Motivated by both lines of research we invited 32 participants with a chronic left hemispheric brain lesion to name pictures in the presence of distractor words. This picture-word-interference (PWI) paradigm is widely used in psycho- and neurolinguistic research.We find that also after brain lesion categorically related words (CAT → [dog]picture) impede naming, while associatively related words (BONE → [dog]picture) ease access, when compared to unrelated distractor words. The effects largely affecting latencies in neurotypical populations, are reproduced for error rate in our participants with lesions in the language network. Unsurprisingly, overall naming abilities varied greatly across patients. Notably, however, the two effects (categorical interference / associative facilitation) differ between participants. Correlating performance with lesion patterns we find support for the notion of a divergence of brain areas affording different aspects of the task: (i) lesions in the left middle temporal gyurs (MTG) deteriorate overall naming, confirming previous work; more notably, (ii) lesions comprising the inferior frontal hub (inferior frontal gyrus, IFG) of the language-network increase the interference effect for the categorical condition; on the contrary, (iii) lesions to the mid-to-posterior temporal hub (posterior middle and superior temporal gyri, pMTG/ pSTG) increase the facilitatory effect for the associative condition on error rates.The findings can be accommodated in a neuro-linguistic framework, which localizes lexical activation but also lexical interference in posterior parts of the language network (pMTG/pITG); conversely, selection between co-activated categorically related entries is afforded by frontal language areas (IFG). While purely experimental in nature our study highlights that lesion site differentially influences specific aspects of word retrieval. Since confrontational naming is a cornerstone of aphasia rehabilitation, this may be of note when designing and evaluating novel therapeutic regimes.

Summary Background Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. Methods In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam–Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. Findings We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (−0·03 points [4·04]; −0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation. Interpretation 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods. Funding German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.

Background Decades of research highlight the importance of formulaic expressions in everyday spoken language. Utterances of this linguistic category are, by definition, fixed in form and embedded in communicative-pragmatic context (e.g., ‘Thank you,’ ‘How are you?’ or ‘I’m fine’). A growing body of neuroscience evidence suggests that formulaic expressions engage, in particular, right-hemisphere cortical and bilateral subcortical neural networks (cf. Stahl and Van Lancker Sidtis, 2015 ). This may explain why left-hemisphere stroke patients often suffer from impaired speech-motor planning, while they are still able to communicate relatively well based on a repertoire of formulaic expressions (cf. Stahl et al., 2011 ). The current study aims to provide clear behavioral evidence for the notion that using preserved formulaic language skills facilitates the spontaneous production of word onsets, one major symptom in apraxia of speech. Methods In a cross-sectional repeated-measures design, 19 individuals with chronic apraxia of speech produced German target words (e.g., /Tur/), including critical syllable onsets (e.g., /T/). Target words were preceded by a range of cues that differed, most notably, in language formulaicity (e.g., non-formulaic priming: /mu/-/Tur/, derived from /mutig/; formulaic priming: /gu/-/Tur/, derived from /guten Tag/). The experiment controlled for various influences, such as consonant–vowel structure, syllable frequency, syllable transition frequency, practice effects, meter, and articulatory tempo. Two independent phoneticians assessed the articulatory quality of the critical syllable onsets in each experimental condition (inter-rater reliability: r 0.98 ). Results Preliminary data indicate a significant articulatory benefit from formulaic language cues on critical syllable onsets, as confirmed by Wilcoxon signed-rank tests (non-formulaic versus formulaic priming: z = 3.52; p 0.001 ). Discussion The present data demonstrate an immediate effect of preserved formulaic language skills on articulatory quality in individuals with chronic apraxia of speech. As one major reason for this promising finding, we propose that patients may be capable of retrieving intact speech-motor sequences from formulaic expressions in order to re-activate the spontaneous production of word onsets. If indeed bilateral neural resources of verbal communication help reduce failures in speech-motor planning, the current results are consistent with a highly dynamic interplay of left perilesional and right intact language networks in post-stroke rehabilitation.

Gestures accompany speech and enrich human communication. When aphasia interferes with verbal abilities, gestures become even more relevant, compensating for and/or facilitating verbal communication. However, small-scale clinical studies yielded diverging results with regard to a therapeutic gesture benefit for lexical retrieval. Based on recent functional neuroimaging results, delineating a speech-gesture integration network for lexical learning in healthy adults, we hypothesized that the commonly observed variability may stem from differential patholinguistic profiles in turn depending on lesion pattern. Therefore we used a controlled novel word learning paradigm to probe the impact of gestures on lexical learning, in the lesioned language network. Fourteen patients with chronic left hemispheric lesions and mild residual aphasia learned 30 novel words for manipulable objects over four days. Half of the words were trained with gestures while the other half were trained purely verbally. For the gesture condition, rootwords were visually presented (e.g., Klavier, [piano]), followed by videos of the corresponding gestures and the auditory presentation of the novel words (e.g., /krulo/). Participants had to repeat pseudowords and simultaneously reproduce gestures. In the verbal condition no gesture-video was shown and participants only repeated pseudowords orally. Correlational analyses confirmed that gesture benefit depends on the patholinguistic profile: lesser lexico-semantic impairment correlated with better gesture-enhanced learning. Conversely largely preserved segmental-phonological capabilities correlated with better purely verbal learning. Moreover, structural MRI-analysis disclosed differential lesion patterns, most interestingly suggesting that integrity of the left anterior temporal pole predicted gesture benefit. Thus largely preserved semantic capabilities and relative integrity of a semantic integration network are prerequisites for successful use of the multimodal learning strategy, in which gestures may cause a deeper semantic rooting of the novel word-form. The results tap into theoretical accounts of gestures in lexical learning and suggest an explanation for the diverging effect in therapeutical studies advocating gestures in aphasia rehabilitation.

Behaviorale Ergebnisse • Trotz Lasionen im Sprachnetzwerk sind Patienten mit Restaphasie dazu in der Lage neue Worter zu lernen (M = 39%, SD = 30%). • Obwohl auf der Gruppenebene kein Unterschied bestand zwischen Lernen mit Gesten (M = 39%, SD = 30%) und Lernen in der verbalen Bedingung (M = 38%, SD = 33%), so zeigte sich ein gestufter Gesteneffekt auf der individuellen Ebene: • Je besser die lexiko-semantischen Fahigkeiten umso erfolgreicher war das Wortlernen mit Gesten (R2 = 0.46, p < .05) • Je schlechter die segmental-phonologischen Fahigkeiten umso erfolgreicher war Wortlernen mit Gesten (R2 = 0.17, p = .07) [4, 7, 8] • Eine hierarchische multiple Regression ergab, dass die erklarte Varianz des positiven Gesteneffekts erhoht werden kann (von 46% auf 76%), wenn zusatzlich das phonologische Arbeitsgedachtnis (digit-span backwards) berucksichtigt wird.

Seit einigen Jahren wird zunehmend die Frage diskutiert, welche Schwierigkeiten aphasische Patienten bei der Textproduktion haben (z.B. Ulatowska et al., 1983; Chapman & Ulatowska, 1989; Dressler & Pleh, 1984). Haufig wird bei Untersuchungen zu diesem Thema auf das Problem hingewiesen, das auf der Ebene des Textes und innerhalb komplexer Kommunikationssituationen eine schwer zu kontrollierende Anzahl sprachlicher und nichtsprachlicher Leistungen zusammenspielen (z.B. Huber, 1990; Kahn, 1991). So interagie-ren bei der Textproduktion verschiedene Teilleistungen, insbesondere solche des Problemlosens, des Gedachtnisses sowie des lexikalischen und grammatischen Wissens. Weiterhin erfordert die Auswahl und Anordnung textrelevanter Informationen neben der Aktivierung von sprachlichem Wissen immer auch eine adaquate Berucksichtigung von Weltwissen und situativem Kontext (vgl. Rickheit, 1991). Im Hinblick auf eine zielorientierte Therapieplanung ist deshalb zu fragen: Mussen die Schwierigkeiten, die Aphasiker mit der Textproduktion haben, vorwiegend sprachsystematisch erklart werden, oder lassen sich auch vorsprachliche Planungsbeeintrachtigungen beschreiben, die gerade bei der Textproduktion besonders stark zum Tragen kommen?