Efficacy of Elaborated Semantic Features Analysis in Aphasia: a quasi-randomised controlled trial

Background: Word finding difficulty is one of the most common features of aphasia. Semantic Features Analysis (SFA) directly aims to improve word finding in people with aphasia. Evidence from systematic reviews suggests that SFA leads to positive outcomes, yet the evidence comprises single case studies and case series. There is a need to evaluate the efficacy of SFA in controlled group studies/trials. Aims: To evaluate the efficacy of Elaborated Semantic Feature Analysis (ESFA) for word finding in people with aphasia. We investigated: (a) the efficacy of ESFA versus a delayed therapy/control, (b) the efficacy of two therapy approaches– individual versus a combination of individual and group therapy. Methods and procedures: We ran a multi-centre, quasi-randomised controlled trial, nested in a larger study (Thales-Aphasia). Participants were recruited from community settings. They had to be people with aphasia due to stroke at least four months post-onset. Participants were randomized to individual vs combination vs delayed therapy/control groups. Both therapy groups had three hours of ESFA per week for 12 weeks. Delayed therapy/control group had no intervention for 12 weeks and were then randomized to either individual or combination therapy. The primary outcome was confrontation naming. Secondary outcomes were the Boston Naming Test, Discourse, the Functional Assessment of Communication Skills for adults (ASHA–FACS), the Stroke and Aphasia Quality of Life scale (SAQOL-39g), the General Health Questionnaire-12 item, and the EQ-5D. Outcomes and Results: Of the 72 participants of the Thales-Aphasia project, 58 met eligibility criteria for speech-language therapy and 39 were allocated to ESFA. The critical p-value was adjusted for multiple comparisons (.005). For the therapy versus control comparison, there was a significant main effect of time on the primary outcome (p<.001, η2p=.42) and a significant interaction effect (p=.003, η2p=.21). An interaction effect for the SAQOL-39g (p=.015, η2p=.11) and its psychosocial domain (p=.013, η2p=.12) did not remain significant after Bonferroni adjustment. For the individual versus combination ESFA comparison, there were significant main effects of time on the primary outcome (p<.001, η2p=.49), the BNT (p<.001, η2p=.29) and the ASHA-FACS (p=.001, η2p=.18). Interaction and group effects were not significant. Conclusion: Though underpowered, this study provides evidence on the efficacy of ESFA to improve word finding in aphasia, with gains similar in the two therapy approaches. Trial registration: ISRCTN71455409, https://doi.org/10.1186/ISRCTN7145540

Preliminary Psychometric Analyses of Two Assessment Measures Quantifying Communicative and Social Activities: the COMACT and SOCACT

Background: There is a need for clinical tools that capture the real-life impact of aphasia (Simmons-Mackie, Threats & Kagan, 2005). This study reports on a psychometric investigation of two self-report tools: the Communicative Activities Checklist and the Social Activities Checklist (COMACT; SOCACT: Cruice, 2001), which assess the dimensions of communication activity and social participation in aphasia. Aims: (1) To investigate internal consistency, convergent and known validity of the COMACT and SOCACT; and (2) To investigate the impact of personal contextual factors: gender, age, years in education, linguistic ability and emotional health on communicative and social activities. Method: 30 participants with mild-moderate chronic aphasia (PWA: mean age 71 years, mean time post-onset 41 months, mean years in education 10.77) and 75 control neurologically healthy participants (NHP: mean age 74 years, mean years in education 13.18) completed the COMACT and SOCACT reporting how frequently they engaged in particular activities. The COMACT has 45 communication activities with sub-scales of Talking, Listening, Reading and Writing. The SOCACT contains 20 social activities with sub-scales of Leisure, Informal and Formal. Internal consistency (IC) was examined using Cronbach’s alpha (α). Correlations with published assessments, Western Aphasia Battery (WAB: Kertesz, 1982) and Communication Activities of Daily Living (CADL-2: Holland, Frattali & Fromm, 1999) were computed for COMACT only. Multiple regression models were examined for differences in participant (PWA vs. NHP) performance on COMACT and SOCACT. COMACT & SOCACT: psychometric investigation Results: Total COMACT IC was 0.83 (PWA), and 0.84 (NHP). Following deletion of four items, to further improve sub-scale ICs, total COMACT IC was 0.83 (PWA) and 0.86 (NHP). COMACT total score and WAB AQ were moderately correlated (r = 0.55). Total SOCACT IC was 0.58 (PWA) and 0.63 (NHP). Following single item deletion, total IC was 0.65 (PWA) and 0.64 (NHP). Statistical analysis revealed PWA, in comparison to NHP, participated in significantly fewer communication and social activities. Personal contextual factors impacted both groups differently; particular aspects were associated with communication activity (age and language severity) and social activity (age only). For NHP, ageing, emotional health and years in education were significant predictors of social and communication activity. Conclusion: This study finds the COMACT to be a reliable, valid measure of communication activity. The SOCACT had ‘questionable’ IC and requires further psychometric investigation. Both tools demonstrate known group validity. Relationships between impairment-level and personal contextual factors for communication activity and social participation are highlighted

The role of learning in improving functional writing in stroke aphasia.

Improving writing in people with aphasia could improve ability to communicate, reduce isolation and increase access to information. One area that has not been sufficiently explored is the effect of impairment based spelling therapies on functional writing. A multiple case study was conducted with eight participants with aphasia subsequent to stroke. This aimed to measure the effects of spelling therapy on functional writing and perception of disability.Participants engaged in 10 sessions of copy and recall spelling therapy. Outcome measures included spelling to dictation of trained and untrained words, written picture description, spelling accuracy within emails, a disability questionnaire and a writing frequency diary.All participants made significant gains on treated words and six demonstrated improvements to untreated words. Group analyses showed significant improvements to written picture description, but not email writing, writing frequency or perceptions of disability.These results show that small doses of writing therapy can lead to large gains in specific types of writing. These gains did not extend to improvements in frequency of writing in daily living, nor ecological measures of email writing. There is a need to develop bridging interventions between experimental tasks towards more multi-faceted and ecological everyday writing tasks. Implications for Rehabilitation Acquired dysgraphia can restrict people from participating in social, educational and professional life. This study has shown that copy and recall spelling therapies can improve the spelling of treated words, untreated words and written picture description in people with a range of types and severities of dysgraphia following stroke. The results of this study suggest that more specific additional training is required for other writing activities such as email writing

Enhancing communication through gesture and naming therapy

Purpose: This study investigated whether gesture, naming and strategic treatment improved the communication skills of 14 people with severe aphasia. Method: All participants received 15 hours of gesture and naming treatment (reported in a companion paper). Half the group received a further 15 hours of strategic therapy, while the remaining seven participants received no further input. The effects of therapy on communication were assessed with two novel measures. These required participants to convey simple messages and narratives to their communication partner. In both assessments a subset of the stimuli featured items that had been targets in gesture or naming treatment. Results: Performance on the communication measures was stable over two baseline assessments, but improved after gesture and naming treatment. Those who received additional strategic therapy made further gains on the message but not the narrative task. Communication gains were not specific to the stimuli featuring trained items. Conclusions: This study suggests that gesture and naming treatments can benefit interactive communication. The additional benefits of strategic therapy were less clear cut, but did impact on the transmission of simple messages. Gains seem to reflect the development of general communication skills, rather than the use of trained gestures and/or words

Heterodimerization of Glycosylated Insulin-Like Growth Factor-1 Receptors and Insulin Receptors in Cancer Cells Sensitive to Anti-IGF1R Antibody

Identification of predictive biomarkers is essential for the successful development of targeted therapy. Insulin-like growth factor 1 receptor (IGF1R) has been examined as a potential therapeutic target for various cancers. However, recent clinical trials showed that anti-IGF1R antibody and chemotherapy are not effective for treating lung cancer.In order to define biomarkers for predicting successful IGF1R targeted therapy, we evaluated the anti-proliferation effect of figitumumab (CP-751,871), a humanized anti-IGF1R antibody, against nine gastric and eight hepatocellular cancer cell lines. Out of 17 cancer cell lines, figitumumab effectively inhibited the growth of three cell lines (SNU719, HepG2, and SNU368), decreased p-AKT and p-STAT3 levels, and induced G 1 arrest in a dose-dependent manner. Interestingly, these cells showed co-overexpression and altered mobility of the IGF1R and insulin receptor (IR). Immunoprecipitaion (IP) assays and ELISA confirmed the presence of IGF1R/IR heterodimeric receptors in figitumumab-sensitive cells. Treatment with figitumumab led to the dissociation of IGF1-dependent heterodimeric receptors and inhibited tumor growth with decreased levels of heterodimeric receptors in a mouse xenograft model. We next found that both IGF1R and IR were N-linked glyosylated in figitumumab-sensitive cells. In particular, mass spectrometry showed that IGF1R had N-linked glycans at N913 in three figitumumab-sensitive cell lines. We observed that an absence of N-linked glycosylation at N913 led to a lack of membranous localization of IGF1R and figitumumab insensitivity.The data suggest that the level of N-linked glycosylated IGF1R/IR heterodimeric receptor is highly associated with sensitivity to anti-IGF1R antibody in cancer cells

Colorectal Adenocarcinoma Metastasis to the Tongue

This case presentation examines a rare clinical entity: colorectal adenocarcinoma (CRC) metastasis to the tongue. CRC is among the least common tumors to metastasize to the oral cavity. Objectives for this case report are to (1) maintain a high index of suspicion for oral cavity tumors representing metastatic disease, (2) consider appropriate surgical and adjunctive interventions, and (3) recognize the significance of identifying the primary tumor via immunohistochemical staining. We present a case of a 57-year-old male with a history of stage IV rectal adenocarcinoma metastatic to the lung who presented to our clinic with a painful mass of the right lateral tongue that he noticed one month before. MRI of the neck revealed a mass involving the anterior two-thirds of the right tongue with irregular margins and an ipsilateral enlarged right jugulodigastric lymph node. The patient underwent right partial glossectomy with primary reconstruction and right modified radical neck dissection. Pathology confirmed poorly differentiated adenocarcinoma consistent with a colorectal primary with lymphovascular and perineural invasion. The tumor was staged as T2N1, and the patient was referred for chemoradiation. In this report, we discuss the presentation, diagnosis, and treatment of this uncommon disease, with a thorough review of the world literature

An Unusual Presentation of Adenoid Cystic Carcinoma.

Adenoid cystic carcinoma (ACC) is a relatively rare tumor of epithelial cell origin, most commonly arising from major salivary glands. It is uncommonly found outside the major or minor salivary glands and is especially rare when located in the nasal cavity. Diagnosis and treatment of ACC pose numerous challenges, partly due to its biological behavior of slow growth, high tendency of local recurrence, and perineural invasion. We present the case of a 67-year-old male with complaints of facial pain and swelling, with a CT scan showing a soft tissue mass extending from the right nasal cavity with osseous destruction. Biopsy revealed ACC with perineural invasion. ACC of the nasal cavity continues to pose diagnostic and therapeutic challenges to physicians. Because this rare pathology presents in a vague manner, early diagnosis requires a high index of suspicion for this disease and close follow-up care. Since ACC of the nasal cavity is seldom reported in the literature, it is our hope that reporting these rare instances as case reports will heighten physician awareness of this rare disease, allowing for early diagnosis and treatment