Effects of Verbal plus Gestural Treatment in a Patient with Aphasia and Severe Apraxia of Speech

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Treatment of Auditory Processing in Noise in Individuals With Mild Aphasia: Pilot Study

Purpose: Listening in noise challenges listeners with auditory comprehension impairments in aphasia. We examined the effects of Trivia Game, a computerized program with questions spoken in increasing levels of background noise with success in the game. Methods: We piloted Trivia Game in four individuals with chronic aphasia and mild auditory comprehension impairments. Participants played Trivia Game for 12 twenty-minute sessions. In addition to the Western Aphasia Battery (WAB), we measured outcomes on Quick Speech in Noise (QSIN), a sentence repetition test, administered in auditory (AUD) and auditory+visual (AV) conditions as signal-to-noise ratio varied from 25 to 0 dB. Results: All four participants showed progress within the game in the noise level attained. Increases in repetition accuracy were seen in two participants for the QSIN AUD condition (average of 5.5 words), and in three participants for QSIN AV (average of 16.5 words). One individual increased performance on the WAB. Conclusions: Use of Trivia Game led to improved auditory processing abilities in all four individuals with aphasia. Greater gains noted in the AV condition over AUD suggest that Trivia Game may facilitate speech-reading skills to support comprehension of speech in situations with background noise

Contrasting Effects of Errorless Naming Treatment and Gestural Facilitation for Word Retrieval in Aphasia

Purpose- We compared the effects of two treatments for aphasic word retrieval impairments, errorless naming treatment (ENT) and gestural facilitation of naming (GES), within the same individuals, anticipating that the use of gesture would enhance the effect of treatment over errorless treatment alone. In addition to picture naming, we evaluated results for other outcome measures that were largely untested in earlier ENT studies. Methods- In a single participant crossover treatment design, we examined the effects of ENT and GES in eight individuals with stroke-induced aphasia and word retrieval impairments (three semantic anomia, five phonological anomia) in counterbalanced phases across participants. We evaluated effects of the two treatments for a daily picture naming/gesture production probe measure and in standardised aphasia tests and communication rating scales administered across phases of the experiment. Results- Both treatments led to improvements in naming of trained words (small-to-large effect sizes) in individuals with semantic and phonological anomia. Small generalised naming improvements were noted for three individuals with phonological anomia. GES improved use of corresponding gestures for trained words (large effect sizes). Results were largely maintained at one month post-treatment completion. Increases in scores on standardised aphasia testing also occurred for both ENT and GES training. Discussion- Both ENT and GES led to improvements in naming measures, with no clear difference between treatments. Increased use of gestures following GES provided a potential compensatory means of communication for those who did not improve verbal skills. Both treatments are considered to be effective methods to promote recovery of word retrieval and verbal production skills in individuals with aphasia

Transcortical motor aphasia

The defining symptoms of transcortical motor aphasia (TCMA) are nonfluent verbal output with relatively preserved repetition. Other symptoms, such as naming difficulties, agrammatic output, or even some paraphasias, may occur, but these are not cardinal symptoms defining TCMA and are not necessary for the diagnosis. The core anatomy involved in TCMA is a lesion of the medial frontal cortex, especially the left presupplementary motor area (pre-SMA) and adjacent Brodmann’s area 32; a lesion of the left posterior inferior frontal cortex, especially pars opercularis and ventral lateral premotor cortex; or a lesion of the pathways between these frontal structures. TCMA occasionally has been reported with a lesion of the left basal ganglia, the left thalamus, or the ascending dopaminergic pathways. From a cognitive standpoint, TCMA can be conceptualized as a disorder of intention, in other words, as a disorder of initiation and continuation of spoken language that is internally motivated. The medial frontal cortex provides the impetus to speak; this impetus to speak is conveyed to lateral frontal structures through frontal-subcortical pathways where it activates various language production mechanisms. The influence of the ascending dopaminergic pathways may occur either through their heavy connections with the pre- SMA region or through their influence on the basal ganglia. The influence of the basal ganglia and thalamus probably occurs through their connections with the medial frontal cortex. Assessments for TCMA should involve a thorough evaluation of conversational or narrative language output and repetition. New treatments are available that attemto engage right- hemisphere intention mechanisms with left- hand movements and may be effective in TCMA. Although dopamine agonists have also shown some positive effects in increasing verbal output in TCMA, trials have been small, and some caution must be exercised in interpreting these findings

Executive Functions and Student Success During Physical Therapist Education: An Exploratory Study

BACKGROUND: Clinical reasoning relies on executive functions (EFs) that manage attention, inhibition, organization, and decision-making. Assessment of EFs may help identify students who excel at clinical reasoning, yet data showing this relationship in physical therapy (PT) education programs are lacking. The primary purpose of this exploratory study was to examine EFs in relationship to success in PT educational programs. METHODS: Thirteen third-year PT graduate students completed two EF tests which were compared to culminating scores in the program and admissions scores. RESULTS: A relationship existed between National Physical Therapy Examination (NPTE) and comprehensive exam results and one EF test score; comprehensive exams and NPTE scores related to the other EF test. CONCLUSIONS: EF measures may provide insights into student successes, especially as they pertain to outcomes requiring clinical reasoning

The Oxford Handbook of Aphasia and Language Disorders

What is immediately clear when meeting individuals with acquired brain damage is that the patterns of communication impairments vary in remarkable ways among these individuals. Aphasia and related communication disorders, while devastating life events for individuals who acquire brain damage, provide lessons of considerable interest to many clinicians and researchers trying to understand the brain\u27s neurological and psychological complexity and develop methods to facilitate optimum recovery of lost language and communication functions following brain damage. The Oxford Handbook of Aphasia and Language Disorders weaves theoretical and neurological foundations with rational, motivated clinical approaches to assessment, diagnosis, and intervention for aphasia and related communication disorders. The contributing authors, experienced clinicians and scientists with strong backgrounds in neurological and cognitive neuropsychological theories, bridge theory to clinical practice, reviewing the extant literature in each aphasia syndrome while exploring implications for guiding clinical decision-making. … [From Amazon.com]https://digitalcommons.odu.edu/cdse_books/1010/thumbnail.jp

Effects of gesture+verbal treatment for noun and verb retrieval in aphasia

Links between verbs and gesture knowledge suggest that verb retrieval may be particularly amenable to gesture+verbal training (GVT) in aphasia compared to noun retrieval. This study examines effects of GVT for noun and verb retrieval in nine individuals with aphasia subsequent to left hemisphere stroke. Participants presented an array of noun and verb retrieval deficits, including impairments of semantic and/or phonologic processing. In a single-participant experimental design, we investigated effects of GVT for noun and verb retrieval in two counterbalanced treatment phases. Effects were evaluated in spoken naming and gesture production to pictured objects and actions. Spoken naming improvements associated with large effect sizes were noted for trained nouns (5/9) and verbs (5/9); no improvements were evident for untrained words. Gesture production improved for trained nouns (8/9) and verbs (6/9), and for untrained nouns (2/9) and verbs (2/9). No significant differences were evident between nouns and verbs in spoken naming or gesture production. Improvements were evident across individuals with varied sources of word retrieval impairments. GVT has the potential to improve communication by increasing spoken word retrieval of trained nouns and verbs and by promoting use of gesture as a means to communicate when word retrieval fails. (JINS, 2006, 12, 867-882.) © 2006 The International Neuropsychological Society