Facilitating fluency in adults who stutter

This scientific commentary refers to ‘Transcranial direct current stimulation over left inferior frontal cortex improves speech fluency in adults who stutter’, by Chesters et al. (doi:10.1093/brain/awy011)

Using functional imaging to understand therapeutic effects in poststroke aphasia

PURPOSE OF REVIEW: The evidence base for the treatment of poststroke aphasia continues to grow, so too does interest in the neural mechanisms that underlie these therapy-driven improvements. Although the majority of patients respond to therapy, not all of those who do improve do so in a predictable way. Here, we review 17 of the most recent articles that have attempted to deal with this important question, dividing them into those that target speech perception and production. RECENT FINDINGS: There are many methodological differences between the studies, but some neuroimaging patterns have emerged: whether the in-scanner language task is speech perception or production, left hemisphere fronto-temporal cortex is often activated/correlated with language improvement and; right inferior frontal gyrus is frequently identified although what this represents is still hotly contested. We are concerned that many studies are not well controlled making it difficult to ascribe neuroimaging changes directly to the therapeutic intervention. SUMMARY: Encouragingly, there are many more functional imaging studies in this challenging area of research. Behaviour, either alone or paired with structural imaging data, only goes part way in explaining aphasic patients’ responses to therapy. An important emerging theme is exploring the role that nonlanguage cognitive processes play in aphasia recovery

The left superior temporal gyrus is a shared substrate for auditory short-term memory and speech comprehension: evidence from 210 patients with stroke

Competing theories of short-term memory function make specific predictions about the functional anatomy of auditory short-term memory and its role in language comprehension. We analysed high-resolution structural magnetic resonance images from 210 stroke patients and employed a novel voxel based analysis to test the relationship between auditory short-term memory and speech comprehension. Using digit span as an index of auditory short-term memory capacity we found that the structural integrity of a posterior region of the superior temporal gyrus and sulcus predicted auditory short-term memory capacity, even when performance on a range of other measures was factored out. We show that the integrity of this region also predicts the ability to comprehend spoken sentences. Our results therefore support cognitive models that posit a shared substrate between auditory short-term memory capacity and speech comprehension ability. The method applied here will be particularly useful for modelling structure–function relationships within other complex cognitive domains

Evaluation Champions: What They Need and Where They Fit in Organizational Learning

Evaluation champions in four state Extension systems described needs for training and support and perspectives on building evaluation capacity in their organization as part of a larger interview study exploring their roles, growth, and motivations. These 40 evaluation leaders identified needs for basic and advanced evaluation skills training, technical assistance, and practical learning via mentoring and project teams. Recommendations for organizational change in evaluation capacity included “top-down” investments in communication, training, and practical support, as well as increased “bottom-up” efforts by champions like themselves to advocate, model best practice, and contribute to training and mentoring peers. Implications for professional development and evaluation capacity building in Extension and other community-based organizations are discussed

Evaluation Champions: What They Do, Why They Do It, and Why It Matters to Organizations

Evaluation champions are individuals who serve as catalysts for building evaluation capacity within an organization. They advocate for the importance of program evaluation, model good evaluation behaviors, and mentor their peers in program evaluation skills and competencies. Interviews with 40 peer-nominated champions in four purposively-sampled Extension organizations identified the roles, contexts, and motivations of staff who act as evaluation champions. Findings underline the importance—and the limits—of mentors and project teams in building evaluation capacity in complex organizations. Implications for practice, research, and policy are discussed

A Generative Model of Speech Production in Broca’s and Wernicke’s Areas

Speech production involves the generation of an auditory signal from the articulators and vocal tract. When the intended auditory signal does not match the produced sounds, subsequent articulatory commands can be adjusted to reduce the difference between the intended and produced sounds. This requires an internal model of the intended speech output that can be compared to the produced speech. The aim of this functional imaging study was to identify brain activation related to the internal model of speech production after activation related to vocalization, auditory feedback, and movement in the articulators had been controlled. There were four conditions: silent articulation of speech, non-speech mouth movements, finger tapping, and visual fixation. In the speech conditions, participants produced the mouth movements associated with the words “one” and “three.” We eliminated auditory feedback from the spoken output by instructing participants to articulate these words without producing any sound. The non-speech mouth movement conditions involved lip pursing and tongue protrusions to control for movement in the articulators. The main difference between our speech and non-speech mouth movement conditions is that prior experience producing speech sounds leads to the automatic and covert generation of auditory and phonological associations that may play a role in predicting auditory feedback. We found that, relative to non-speech mouth movements, silent speech activated Broca’s area in the left dorsal pars opercularis and Wernicke’s area in the left posterior superior temporal sulcus. We discuss these results in the context of a generative model of speech production and propose that Broca’s and Wernicke’s areas may be involved in predicting the speech output that follows articulation. These predictions could provide a mechanism by which rapid movement of the articulators is precisely matched to the intended speech outputs during future articulations

The Role of Brodmann Area 47 in Acute Stroke Patients with Language Impairment

A recent study in chronic stroke patients found that left Brodmann area 47 was among the most commonly lesioned area (more commonly than Brodmann area 44/45) in patients with chronic deficits in reading, naming, and repetition. We hypothesized that the same would not be true in acute stroke; that left BA 44 and 45 would be more commonly associated with these acute lexical deficits. We confirmed this hypothesis and speculate that left BA 47 is an area is critical for recovery of lexical production, perhaps because it can assume lexical production when BA 44/45 are damaged when it is spared

What do people with aphasia want from the Queen Square Intensive Comprehensive Aphasia Programme and do they achieve it? A quantitative and qualitative analysis of their short, medium, long-term and economic goals

Background: The most effective model for achieving therapist-delivered, high-dose SLT for People with Aphasia (PWA) is through Intensive Comprehensive Aphasia Programmes (ICAPs). ICAPs are often assessed using standardised outcome measures; however, as SLT is personalised, it is of interest to examine individualised goal-based outcome measures as well. In the Queen Square ICAP, we use a goal-setting approach (Goal Attainment Setting [GAS]) where the PWA and their therapist negotiate which goals to work on and over what timescales. This process involves recording and scoring the agreed goals, which makes them amenable to formal quantitative and qualitative analysis. Aims: The aim of this study was twofold. Firstly, to test the hypothesis that a pre- versus post- ICAP analysis of individual’s goal scores would show statistically significant and clinically meaningful improvements. Secondly, to better understand what PWA wanted to achieve from the ICAP service, we performed a qualitative analysis across all agreed goals. Methods & Procedures: Forty-four PWA who varied in aphasia severity from mild to severe took part. PWA jointly set goals with their therapists using the SMART framework (Specific, Measurable, Achievable, Relevant, and Time-Bound). The goals were split into four categories: short (3 weeks), medium (3-6 months), long-term (12 months) and economic, (defined as any outcome that will improve, either directly or indirectly, the economic system that the PWA lives within). Quantitative scores were obtained for each PWA both pre- and post- ICAP and were analysed using paired t-tests, with subsequent ANOVAs to investigate possible confounding factors. The qualitative analysis was carried out by two researchers not involved in delivering the ICAP. Data was collapsed across all goal categories and analysed using thematic analysis. Outcomes & Results: Quantitatively, statistically significant gains were made across all four goal categories (ps < 0.001). Unstandardized effect-sizes were clinically significant (ΔGAS ~16). Qualitatively, we identified five main themes: staying connected with the world, understanding aphasia better, raising awareness, the importance of having a work identity and managing personal relationships. Conclusions: Quantitative goal-setting for PWA in the context of an ICAP provides robust evidence that PWA can achieve a variety of aspirational goals given high enough doses of specialist input from SLTs and a clinical psychologist. Although the ICAP only spanned 3 weeks, PWA continued to reach medium, long-term and even economic goals up to a year post-recruitment. This is the first time that economic goals have been captured in PWA using GAS. The qualitative analysis describes what the PWA wanted to achieve from participating in our ICAP, while the quantitative analyses demonstrate how much they succeeded in doing so