Normas dialectales de la versión española del Análisis de Conceptos Principales para cuantificar el discurso hablado de personas con alteración neurológica

Aphasia is an acquired language impairment caused by damage in the regions of the brain that support language. The Main Concept Analysis (MCA; Kong, 2016b) is a published formal assessment battery that allows the quantification of the presence, accuracy, completeness, and efficiency of content in spoken discourse produced by persons with aphasia (PWA). It utilizes a sequential picture description task (with four sets of pictures) for language sample elicitation. The MCA results can also be used clinically for targeting appropriate interventions of aphasic output. The purpose of this research is to develop a Spanish adaptation of the MCA (i.e., Span-MCA) by establishing normative data based on native unimpaired speakers of Spanish from four different dialect origins (Central American Caribbean, Andean-Pacific, Mexican, and Central-Southern Peninsular regions). A total of 91 unimpaired participants that consisted of different age groups, education levels, and dialect origins were recruited to establish four sets of dialect-specific norms and scoring criteria of Span-MCA, including target main concepts and corresponding lexical items related to the picture sets. The Span-MCA was also applied to one pilot native Spanish PWA. The normative data suggested that speakers who were younger or with a higher level of education produced significantly more accurate and complete main concepts in their spoken discourse. The application of Span-MCA to the pilot native Spanish PWA successfully identified impaired performance, as compared to the dialectally-sensitive norms established in this study. This study highlighted the clinical value of Span-MCA as a supplement to evaluate spoken discourse and target intervention by speech-language pathologists and related healthcare practitionersLa afasia es una alteración adquirida del lenguaje causada por un daño en las regiones del cerebro que se encargan del procesamiento del lenguaje. El Main Concept Analysis (MCA; Kong, 2016b) es una evaluación formal publicada que permite la cuantificación de la presencia, la precisión, la integridad y la eficiencia del contenido en el discurso hablado producido por las personas con afasia. Esta prueba utiliza una tarea de imagenes secuencial (utilizando 4 conjuntos de imágenes) para provocar una muestras de lenguaje. Los resultados del MCA se pueden utilizar clínicamente para orientar las intervenciones adecuadas de la producción afásica. El propósito de esta investigación es desarrollar una adaptación al español del MCA estableciendo datos normativos basados en hablantes nativos de español sin discapacidades de cuatro orígenes dialectales diferentes (regiones del Caribe centroamericano, andino-pacífico, mexicano y centro-sur peninsular). Se reclutaron un total de 91 participantes de diferentes grupos de edad, niveles de formación y orígenes dialectales para establecer cuatro conjuntos de normas específicas para cada dialecto y criterios de puntuación, incluyendo los conceptos principales objetivo y los elementos léxicos correspondientes relacionados con los conjuntos de imágenes. También se aplicó el Span-MCA a una persona con afasia en un estudio piloto. Los datos normativos sugirieron que los hablantes más jóvenes o con un mayor nivel educativo producían conceptos principales significativamente más precisos y completos en su discurso hablado. La aplicación del Span-MCA a la persona con afasia identificó con éxito un rendimiento deteriorado, en comparación con las normas dialectalmente sensibles establecidas en este estudio. Este estudio pone de manifiesto el valor clínico del Span-MCA como complemento para evaluar el discurso hablado y orientar la intervención de los logopeda

Design Principles and Outcomes of "Aphasia House" an University Intensive Comprehensive Aphasia Program (ICAP)

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Executive and Language Control in the Multilingual Brain

Neuroimaging studies suggest that the neural network involved in language control may not be specific to bi-/multilingualism but is part of a domain-general executive control system. We report a trilingual case of a Cantonese (L1), English (L2), and Mandarin (L3) speaker, Dr. T, who sustained a brain injury at the age of 77 causing lesions in the left frontal lobe and in the left temporo-parietal areas resulting in fluent aphasia. Dr. T\u27s executive functions were impaired according to a modified version of the Stroop color-word test and the Wisconsin Card Sorting Test performance was characterized by frequent perseveration errors. Dr. T demonstrated pathological language switching and mixing across her three languages. Code switching in Cantonese was more prominent in discourse production than confrontation naming. Our case suggests that voluntary control of spoken word production in trilingual speakers shares neural substrata in the frontobasal ganglia system with domain-general executive control mechanisms. One prediction is that lesions to such a system would give rise to both pathological switching and impairments of executive functions in trilingual speakers

Wstępne badanie jąkania i zwykłych niepłynności w mowie u dwujęzycznych polsko‑angielskich dorosłych osób z jąkaniem – studia przypadków

This study analyzes the frequency of stuttering and typical disfluencies in Polish‑English bilingual adults who stutter during cross‑linguistic dialogue, monologue, and oral reading contexts. Additionally, the relationship between English proficiency and stuttering and typical disfluency frequencies was examined. The study aims to contribute to the body of research regarding differential considerations between monolingual and bilinguals who stutter. Data collection took place via video conferencing. Participants first completed an English proficiency cloze test, where they entered missing words in a short English text. Following this, randomized dialogue, monologue, and oral reading speech samples in Polish and English were collected. The correlation between cloze test scores and frequency of stuttering and typical disfluency in the English samples was also examined. All participants experienced more stuttering in English (L2) than Polish (L1) during dialogue. Overall, participants had increased stuttering in L2 for at least one speaking task. Seventy one percent of participants had increased typical disfluencies in L2 for dialogue and monologue. Most participants evidenced an increase in stuttering and typical disfluencies in L2 compared to L1. The results suggest that language proficiency may share a relationship between frequency of stuttering and typical disfluencies, highlighting the importance of collecting cross‑linguistic speech data during assessment to reach clinical decisions related to fluency disorders in bilingual populations.W artykule przeanalizowano częstotliwość występowania symptomów jąkania i tzw. zwykłych niepłynności u dwujęzycznych (polsko‑angielskich) dorosłych osób z jąkaniem. Próbki zbierano podczas dialogu, monologu i czytania. Dokonano porównań pomiędzy obydwoma językami. Dodatkowo zbadano związek pomiędzy znajomością języka angielskiego a częstotliwością występowania symptomów jąkania i tzw. zwykłych niepłynności. Celem badania było pogłębienie wiedzy na temat różnic pomiędzy jedno‑ i dwujęzycznymi osobami, które się jąkają. Dane były pozyskiwane podczas sesji online. Uczestnicy najpierw wypełnili angielski test biegłości Cloze. Następnie zbierano randomizowane próbki mowy podczas dialogu, monologu i głośnego czytania w języku polskim i angielskim. Zbadano również korelację pomiędzy wynikami testu Cloze a częstotliwością jąkania i tzw. zwykłych niepłynności w próbkach angielskich. Wszyscy uczestnicy manifestowali więcej przejawów jąkania się w języku angielskim niż polskim podczas dialogu. Uczestnicy jąkali się bardziej w języku angielskim w co najmniej jednym zadaniu (dialog, monolog lub czytanie). Siedemdziesiąt jeden procent uczestników prezentowało podwyższony poziom tzw. zwykłych niepłynności w tym języku podczas dialogu i monologu. U większości uczestników objawy jąkania się i tzw. zwykłych niepłynności były bardziej nasilone w języku angielskim w porównaniu z polskim. Wyniki sugerują, że biegłość językowa może mieć związek z częstotliwością występowania objawów jąkania się i tzw. zwykłych niepłynności. W celu podejmowania decyzji klinicznych związanych z zaburzeniami płynności mowy w populacjach dwujęzycznych podczas diagnozy istotne jest dokonanie oceny w obu językach

Preliminary findings on the reliability and validity of the Cantonese Birmingham Cognitive Screen in patients with acute ischemic stroke

BACKGROUND: There are no currently effective cognitive assessment tools for patients who have suffered stroke in the People’s Republic of China. The Birmingham Cognitive Screen (BCoS) has been shown to be a promising tool for revealing patients’ poststroke cognitive deficits in specific domains, which facilitates more individually designed rehabilitation in the long run. Hence we examined the reliability and validity of a Cantonese version BCoS in patients with acute ischemic stroke, in Guangzhou. METHOD: A total of 98 patients with acute ischemic stroke were assessed with the Cantonese version of the BCoS, and an additional 133 healthy individuals were recruited as controls. Apart from the BCoS, the patients also completed a number of external cognitive tests, including the Montreal Cognitive Assessment Test (MoCA), Mini Mental State Examination (MMSE), Albert’s cancellation test, the Rey–Osterrieth Complex Figure Test, and six gesture matching tasks. Cutoff scores for failing each subtest, ie, deficits, were computed based on the performance of the controls. The validity and reliability of the Cantonese BCoS were examined, as well as interrater and test–retest reliability. We also compared the proportions of cases being classified as deficits in controlled attention, memory, character writing, and praxis, between patients with and without spoken language impairment. RESULTS: Analyses showed high test–retest reliability and agreement across independent raters on the qualitative aspects of measurement. Significant correlations were observed between the subtests of the Cantonese BCoS and the other external cognitive tests, providing evidence for convergent validity of the Cantonese BCoS. The screen was also able to generate measures of cognitive functions that were relatively uncontaminated by the presence of aphasia. CONCLUSION: This study suggests good reliability and validity of the Cantonese version of the BCoS. The Cantonese BCoS is a very promising tool for the detection of cognitive problems in Cantonese speakers

Which outcomes are most important to people with aphasia and their families? an international nominal group technique study framed within the ICF

PURPOSE: To identify important treatment outcomes from the perspective of people with aphasia and their families using the ICF as a frame of reference. METHODS: The nominal group technique was used with people with aphasia and their family members in seven countries to identify and rank important treatment outcomes from aphasia rehabilitation. People with aphasia identified outcomes for themselves; and family members identified outcomes for themselves and for the person with aphasia. Outcomes were analysed using qualitative content analysis and ICF linking. RESULTS: A total of 39 people with aphasia and 29 family members participated in one of 16 nominal groups. Inductive qualitative content analysis revealed the following six themes: (1) Improved communication; (2) Increased life participation; (3) Changed attitudes through increased awareness and education about aphasia; (4) Recovered normality; (5) Improved physical and emotional well-being; and (6) Improved health (and support) services. Prioritized outcomes for both participant groups linked to all ICF components; primary activity/participation (39%) and body functions (36%) for people with aphasia, and activity/participation (49%) and environmental factors (28%) for family members. Outcomes prioritized by family members relating to the person with aphasia, primarily linked to body functions (60%). CONCLUSIONS: People with aphasia and their families identified treatment outcomes which span all components of the ICF. This has implications for research outcome measurement and clinical service provision which currently focuses on the measurement of body function outcomes. The wide range of desired outcomes generated by both people with aphasia and their family members, highlights the importance of collaborative goal setting within a family-centred approach to rehabilitation. These results will be combined with other stakeholder perspectives to establish a core outcome set for aphasia treatment research. Implications for Rehabilitation Important outcomes for people with aphasia and their families span all components of the ICF. The relevancy and translation of research findings may be increased by measuring and reporting research outcomes which are important to people living with aphasia. The results of this study indicate that important treatment outcomes for people living with aphasia most frequently link to the activity/participation and body function components of the ICF. The outcomes identified in this study suggest a broad role for clinicians working in aphasia rehabilitation. The categories of identified outcomes may be used clinically as a starting point in goal-setting discussions with clients and their families

Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review based, individual participant data network subgroup meta-analysis

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 ( 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

Precision rehabilitation for aphasia by patient age, sex, aphasia severity, and time since stroke? A prespecified, systematic review-based, individual participant data, network, subgroup meta-analysis

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 ( 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