Rare Lexical Speech Automatisms in a Case of Progressive Nonfluent Aphasia

The production of aphasic lexical speech automatisms (yes and right) produced by C.S., a man with progressive speech impairment and primary progressive nonfluent aphasia, were analysed across a range of takes varying in complexity. More automatisms were produced during single word and nonword reading and repetition and picture description than during connected reading and counting, suggesting that internally generated (picture description) and externally triggered (single word and nonword reading and repetition) were equally affected. In addition, a complex speech task (connected reading) produced then fewest automatisms than easier ones (single words). However, tasks where there were increased opportunities for disinhibition produced more automatisms. Results do not suggest that the intrinsic or extrinsic motor speech systems are separately damaged, but do suggest that increased opportunities for disinhibition may produce more automatisms

The Influence of Psycholinguistic Variables on Articulatory Errors in Naming in Progressive Motor Speech Degeneration

We describe an analysis of speech errors on a naming task in a man with progressive speech degeneration. Early assessment indicated naming impairments with no significant phonological or semantic impairment. To examine naming and the factors that influence speech errors, we selected 210 words varying in lexical and phonetic variables and conducted logistic regression analysis on speech error types. No significant naming errors were found. The only significant predictor of articulation errors was phonemic length and the only error type predicted was phone omissions. Results suggest that the sound omissions in naming are caused by motor speech impairment unrelated to lexical factors

CreaTable Content and Tangible Interaction in Aphasia

Multimedia digital content (combining pictures, text and music) is ubiquitous. The process of creating such content using existing tools typically requires complex, language-laden interactions which pose a challenge for users with aphasia (a language impairment following brain injury). Tangible interactions offer a potential means to address this challenge, however, there has been little work exploring their potential for this purpose. In this paper, we present CreaTable – a platform that enables us to explore tangible interaction as a means of supporting digital content creation for people with aphasia. We report details of the co-design of CreaTable and findings from a digital creativity workshop. Workshop findings indicated that CreaTable enabled people with aphasia to create something they would not otherwise have been able to. We report how users’ aphasia profiles affected their experience, describe tensions in collaborative content creation and provide insight into more accessible content creation using tangibles

Assessment and treatment of short-term and working memory impairments in stroke aphasia - a practical tutorial

Background: Aphasia following stroke refers to impairments that affect the comprehension and expression of spoken and/or written language, and co‐occurring cognitive deficits are common. In this paper we focus on short‐term and working memory impairments that impact on the ability to retain and manipulate auditory–verbal information. Evidence from diverse paradigms (large group studies, case studies) report close links between short‐term/working memory and language functioning in aphasia. This evidence leads to the hypothesis that treating such memory impairments would improve language functioning. This link has only recently been acknowledged in aphasia treatment but has not been embraced widely by clinicians. Aims: To examine the association between language, and short‐term and working memory impairments in aphasia. To describe practical ways of assessing short‐term and working memory functioning that could be used in clinical practice. To discuss and critically appraise treatments of short‐term and working memory reported in the literature. Methods & Procedures: Taking a translational research approach, this paper provides clinicians with current evidence from the literature and practical information on how to assess and treat short‐term and working memory impairments in people with aphasia. Published treatments of short‐term and/or working memory in post‐stroke aphasia are discussed through a narrative review. Main Contributions: This paper provides the following. A theoretical rationale for adopting short‐term and working memory treatments in aphasia. It highlights issues in differentially diagnosing between short‐term, working memory disorders and other concomitant impairments, e.g. apraxia of speech. It describes short‐term and working memory assessments with practical considerations for use with people with aphasia. It also offers a description of published treatments in terms of participants, treatments and outcomes. Finally, it critically appraises the current evidence base relating to the treatment of short‐term and working memory treatments. Conclusions: The links between short‐term/working memory functioning and language in aphasia are generally acknowledged. These strongly indicate the need to incorporate assessment of short‐term/working memory functioning for people with aphasia. While the supportive evidence for treatment is growing and appears to highlight the benefits of including short‐term/working memory in aphasia treatment, the quality of the evidence in its current state is poor. However, because of the clinical needs of people with aphasia and the prevalence of short‐term/working memory impairments, incorporating related treatments through practice‐based evidence is advocated

The methodological quality of short-term/working memory treatments in post-stroke aphasia: A systematic review

Purpose: The aims of this systematic review are to provide a critical overview of short-term memory (STM) and working memory (WM) treatments in stroke aphasia and to systematically evaluate the internal and external validity of STM/WM treatments. Method: A systematic search was conducted in February 2014 and then updated in December 2016 using 13 electronic databases. We provided descriptive characteristics of the included studies and assessed their methodological quality using the Risk of Bias in N-of-1 Trials quantitative scale (Tate et al., 2015), which was completed by 2 independent raters. Results: The systematic search and inclusion/exclusion procedure yielded 17 single-case or case-series studies with 37 participants for inclusion. Nine studies targeted auditory STM consisting of repetition and/or recognition tasks, whereas 8 targeted attention and WM, such as attention process training including n-back tasks with shapes and clock faces as well as mental math tasks. In terms of their methodological quality, quality scores on the Risk of Bias in N-of-1 Trials scale ranged from 4 to 17 (M = 9.5) on a 0–30 scale, indicating a high risk of bias in the reviewed studies. Effects of treatment were most frequently assessed on STM, WM, and spoken language comprehension. Transfer effects on communication and memory in activities of daily living were tested in only 5 studies. Conclusions: Methodological limitations of the reviewed studies make it difficult, at present, to draw firm conclusions about the effects of STM/WM treatments in poststroke aphasia. Further studies with more rigorous methodology and stronger experimental control are needed to determine the beneficial effects of this type of intervention. To understand the underlying mechanisms of STM/WM treatment effects and how they relate to language functioning, a careful choice of outcome measures and specific hypotheses about potential improvements on these measures are required. Future studies need to include outcome measures of memory functioning in everyday life and psychosocial functioning more generally to demonstrate the ecological validity of STM and WM treatments

Singing for people with aphasia (SPA): a protocol for a pilot randomised controlled trial of a group singing intervention to improve well-being

Introduction: The singing for people with aphasia (SPA) intervention aims to improve quality of life and well-being for people with poststroke aphasia. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost effectiveness of SPA. The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design. Methods and analysis: A two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. Forty-eight participants discharged from clinical speech and language therapy will be individually randomised 1:1 to SPA (10 group sessions plus a resource booklet) or control (resource booklet only). Outcome assessment at baseline, 3 and 6 months postrandomisation include: ICEpop CAPability measure for adults, Stroke and Aphasia Quality of Life, EQ-5D-5L, modified Reintegration into Normal Living Index, Communication Outcome After Stroke, Very Short Version of the Minnesota Aphasia Test, Service Receipt Inventory and Care Related Quality of Life. Feasibility, acceptability and process outcomes include recruitment and retention rates, with measurement burden and trial experiences being explored in qualitative interviews (15 participants, 2 music facilitators and 2 music champions). Analyses include: descriptive statistics, with 95% CIs where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis. Ethics and dissemination: NHS National Research Ethics Service and the Health Research Authority confirmed approval in April 2017; recruitment commenced in June 2017. Outputs will include: pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised intervention manual for multicentre replication of SPA; presentations at conferences, public involvement events; internationally recognised peer reviewed journal publications, open access sources and media releases

International Comparisons of the Public Awareness of Aphasia: Greece, Argentina and Norway

Awareness of aphasia was surveyed in shoppers in Greece, Argentina and Norway (N=1851) using translations of the questionnaire used by Simmons-Mackie et al, 2002. Between 57.4% (Norway) and 20% (Argentina) had heard of aphasia (37.1% overall), but those who had basic knowledge ranged from 13.9% (Norway) to 6.25% (Argentina) (combined 9.2%). We found significant variability in knowledge of aphasia between the countries surveyed and previous surveys. As with previous studies, this appears to provide further evidence of differences in levels of awareness of aphasia in different cultures, which will be discussed. Such information is vital for targeting awareness raising

Singing for people with aphasia (SPA): results of a pilot feasibility randomised controlled trial of a group singing intervention investigating acceptability and feasibility

Objectives: Pilot feasibility randomised controlled trial (RCT) for the singing groups for people with aphasia (SPA) intervention to assess: (1) the acceptability and feasibility of participant recruitment, randomisation and allocation concealment; (2) retention rates; (3) variance of continuous outcome measures; (4) outcome measure completion and participant burden; (5) fidelity of intervention delivery; (6) SPA intervention costs; (7) acceptability and feasibility of trial and intervention to participants and others involved. Design: A two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. Setting: Three community-based cohorts in the South-West of England. Participants: Eligible participants with post-stroke aphasia were randomised 1:1 to SPA or control. Intervention: The manualised SPA intervention was delivered over 10 weekly singing group sessions, led by a music facilitator and assisted by an individual with post-stroke aphasia. The intervention was developed using the Information-Motivation-Behavioural skills model of behaviour change and targeted psychosocial outcomes. Control and intervention participants all received an aphasia information resource pack. Outcome measures: Collected at baseline, 3 and 6 months post-randomisation, candidate primary outcomes were measured (well-being, quality of life and social participation) as well as additional clinical outcomes. Feasibility, acceptability and process outcomes included recruitment and retention rates, and measurement burden; and trial experiences were explored in qualitative interviews. Results: Of 87 individuals screened, 42 participants were recruited and 41 randomised (SPA=20, control=21); 36 participants (SPA=17, control=19) completed 3-month follow-up, 34 (SPA=18, control=16) completed 6-month follow-up. Recruitment and retention (83%) were acceptable for a definitive RCT, and participants did not find the study requirements burdensome. High fidelity of the intervention delivery was shown by high attendance rates and facilitator adherence to the manual, and participants found SPA acceptable. Sample size estimates for a definitive RCT and primary/secondary outcomes were identified. Conclusions: The SPA pilot RCT fulfilled its objectives, and demonstrated that a definitive RCT of the intervention would be both feasible and acceptable. Trial registration number: NCT03076736

Esophageal motor abnormalities in scleroderma and related diseases

Esophageal motor activity was measured by intra-esophageal pressure recordings in 53 patients with scleroderma and 29 patients with other collagen diseases. The purpose of the study was to determine the relationship of motor abnormalities to esophageal symptoms, to compare the abnormalities in scleroderma with those in other collagen diseases, and to try to increase understanding of the responsible mechanism. Methacholine was given to 36 of the 53 patients with scleroderma to confirm that the Mecholyl test is negative in scleroderma and to see whether intraluminal pressure changes accompany the resulting improvement in esophageal emptying.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44360/1/10620_2005_Article_BF02233564.pd