Improving Production of Treated and Untreated Verbs in Aphasia:A Meta-Analysis

Background: Demographic and clinical predictors of aphasia recovery have been identified in the literature. However, little attention has been devoted to identifying and distinguishing predictors of improvement for different outcomes, e.g., production of treated vs. untreated materials. These outcomes may rely on different mechanisms, and therefore be predicted by different variables. Furthermore, treatment features are not typically accounted for when studying predictors of aphasia recovery. This is partly due to the small numbers of cases reported in studies, but also to limitations of data analysis techniques usually employed. Method: We reviewed the literature on predictors of aphasia recovery, and conducted a meta-analysis of single-case studies designed to assess the efficacy of treatments for verb production. The contribution of demographic, clinical, and treatment-related variables was assessed by means of Random Forests (a machine-learning technique used in classification and regression). Two outcomes were investigated: production of treated (for 142 patients) and untreated verbs (for 166 patients). Results: Improved production of treated verbs was predicted by a three-way interaction of pre-treatment scores on tests for verb comprehension and word repetition, and the frequency of treatment sessions. Improvement in production of untreated verbs was predicted by an interaction including the use of morphological cues, presence of grammatical impairment, pre-treatment scores on a test for noun comprehension, and frequency of treatment sessions. Conclusion: Improvement in the production of treated verbs occurs frequently. It may depend on restoring access to and/or knowledge of lexeme representations, and requires relative sparing of semantic knowledge (as measured by verb comprehension) and phonological output abilities (including working memory, as measured by word repetition). Improvement in the production of untreated verbs has not been reported very often. It may depend on the nature of impaired language representations, and the type of knowledge engaged by treatment: it is more likely to occur where abstract features (semantic and/or grammatical) are damaged and treated.</p

Global statistical regularities modulate the speed of visual search in patients with focal attentional deficits

There is growing evidence that the statistical properties of ensembles of similar objects are processed in a qualitatively different manner than the characteristics of individual items. It has recently been proposed that these types of perceptual statistical representations are part of a strategy to complement focused attention in order to circumvent the visual system’s limited capacity to represent more than a few individual objects in detail. Previous studies have demonstrated that patients with attentional deficits are nonetheless sensitive to these sorts of statistical representations. Here, we examined how such global representations may function to aid patients in overcoming focal attentional limitations by manipulating the statistical regularity of a visual scene while patients performed a search task. Three patients previously diagnosed with visual neglect searched for a target Gabor tilted to the left or right of vertical in displays of horizontal distractor Gabors. Although the local sizes of the distractors changed on every trial, the mean size remained stable for several trials. Patients made faster correct responses to targets in neglected regions of the visual field when global statistics remained constant over several trials, similar to age-matched controls. Given neglect patients’ attentional deficits, these results suggest that stable perceptual representations of global statistics can establish a context to speed search without the need to represent individual elements in detail

The role of semantics and repair processes in article-noun gender disagreement in Italian:An ERP study

In this sentence reading study, we used event-related potentials (ERPs) to investigate the processing mechanism of article-noun gender disagreement in two kinds of nouns in Italian. The first are nouns with syntactic gender (il treno(M) 'train' la sedia(F) 'chair') for which the processing and repair of gender disagreement entails only one repair option, namely for the article (morphosyntactic repair). The second kind are nouns with semantic gender (il bambino(M) 'boy', la bambina(F) 'girl'). Here, there are two options for processing and repairing gender mismatch: repairing the article (morphosyntactic repair) or repairing the noun (both morphosyntactic and semantic repair). Both classes of nouns elicited the LAN, indicating that gender disagreement is always registered at the morphosyntactic level. In addition, the P600 was elicited in both conditions, but was larger for semantic gender, reflecting a more complex repair for this class of nouns

Language processing from the perspective of electrical stimulation mapping

Electrical Stimulation (ES) is a neurostimulation technique that is used to localize language functions in the brain of people with intractable epilepsy and/or brain tumors. We reviewed 25 ES articles published between 1984 and 2018 and interpreted them from a cognitive neuropsychological perspective. Our aim was to highlight ES as a tool to further our understanding of cognitive models of language. We focused on associations and dissociations between cognitive functions within the framework of two non-neuroanatomically specified models of language. Also, we discussed parallels between the ES and the stroke literatures and showed how ES data can help us to generate hypotheses regarding how language is processed. A good understanding of cognitive models of language is essential to motivate task selection and to tailor surgical procedures, for example, by avoiding testing the same cognitive functions and understanding which functions may be more or less relevant to be tested during surgery

Can tDCS enhance item-specific effects and generalization after linguistically motivated aphasia therapy for verbs?

Background: Aphasia therapy focusing on abstract properties of language promotes both item-specific effects and generalization to untreated materials. Neuromodulation with transcranial Direct Current Stimulation (tDCS) has been shown to enhance item-specific improvement, but its potential to enhance generalization has not been systematically investigated. Here, we test the efficacy of ACTION (a linguistically motivated protocol) and tDCS in producing item-specific and generalized improvement in aphasia. Method: Nine individuals with post-stroke aphasia participated in this study. Participants were pre-tested with a diagnostic language battery and a cognitive screening. Experimental tasks were administered over multiple baselines. Production of infinitives, of finite verbs and of full sentences were assessed before and after each treatment phase. Nonword repetition was used as a control measure. Each subject was treated in two phases. Ten daily 1-h treatment sessions were provided per phase, in a double-blind, cross-over design. Linguistically-motivated language therapy focusing on verb inflection and sentence construction was provided in both phases. Each session began with 20 min of real or sham tDCS. Stimulation site was determined individually, based on MRI scans. Results: Group data showed improved production of treated and untreated verbs, attesting the efficacy of behavioral treatment, and its potential to yield generalization. Each individual showed significant item-specific improvement. Generalization occurred in the first phase of treatment for all subjects, and in the second phase for two subjects. Stimulation effects at the group level were significant for treated and untreated verbs altogether, but a ceiling effect for Sham cannot be excluded, as scores between real tDCS and Sham differed only before treatment. Conclusion: Our data demonstrate the efficacy of ACTION and suggest that tDCS may enhance both item-specific effects and generalization.17 page(s

Effects of feeding green forage of sulla (Hedysarum coronarium L.) on lamb growth and carcass and meat quality.

The nutritional effects of sulla (Hedysarum coronarium L.) forage containing condensed tannins (CT) on growth of lambs, and carcass and meat quality were investigated. Thirty-two male Comisana lambs aged 100 ± 8 days weighing 19.0 ± 2.8 kg were fed fresh forage of sulla or CT-free annual ryegrass (Lolium multiflorum Lam. subsp. Wersterwoldicum) for 49 days until slaughter; in addition, each lamb was supplied with 200 g/days of concentrate. Eight lambs per diet had been previously treated with anthelmintic drugs to remove nematode parasites. Measurements of BW and feed intake, and counts of faecal nematode eggs were made. Carcass parameters were recorded after slaughter, and tissue components of the hind leg were determined. Longissimus dorsi meat was evaluated for pH, colour, thawing and cooking losses, Warner-Bratzler shear force, chemical composition and sensory properties based on triangle tests. Relative to ryegrass-fed lambs, sulla-fed lambs had significantly greater dry matter (DM) and protein intake, a more favourable feed conversion ratio, and superior growth rate, final BW at 150 days of age, carcass weight, yield and fatness. These results were attributed to the high protein and non-structural carbohydrate content of sulla, and also to the moderate CT content of sulla (16.7 and 20.3 g/kg of DM in offered and consumed sulla forage, respectively). Anthelmintic treatment did not affect lamb growth, as the level of parasitic infection (initial and final) was low. The physical, chemical and sensory properties of the lamb meat were not influenced by diet

Clinical characteristics and prognostic impact of atrial fibrillation in patients with chronic heart failure

AIMS: To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation (AF) in chronic heart failure (CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers (BB). METHODS: We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB. RESULTS: A total of 903 patients were evaluated (mean age 68\ub112 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients 6460 and 6577 years, respectively. Besides the older age, patients with AF had more symptoms (NYHA II-III 60 vs. 44%), lower prevalence of dyslipidemia (23 vs. 37%), coronary artery disease (28 vs. 52%) and left bundle branch block (9 vs. 16%). On the contrary, they more frequently presented with an idiopathic etiology (50 vs. 24%), a history of valve surgery (13 vs. 4%) and received overall more devices implantation (31% vs. 21%). The use of disease-modifying medications (i.e. BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF (72 vs. 80% e 71 vs. 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics (87 vs. 69%) and digoxin (51 vs. 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm (45% vs. 34%, p value &lt;0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of all-cause mortality, the univariate relationship between AF and death (HR 1.49, 95% CI 1.15-1.92) became not statistically significant (HR 0.98, 95% CI 0.73-1.32). Nonetheless, patients with AF not receiving BB treatment were found to have the worst prognosis, followed by patients with sinus rhythm not receiving BB therapy and patients with AF receiving BB therapy, who both had similarly worse survival when compared to patients with sinus rhythm receiving BB therapy. CONCLUSIONS: AF was highly prevalent and associated with older age, worse clinical presentation and underutilization of disease-modifying medications such as BB in a population of elderly patients with CHF. AF had no independent impact on mortality, but the underutilization of BB in this group of patients was associated to a worse long-term prognosis