Frequency of neurolopsychological deficits after traumatic brain injury

El traumatismo craneoencefálico (TCE) puede conllevar impactantes cambios en la vida cotidiana, que incluyen alteraciones a nivel social, profesional, comunicativo y cognitivo (dificultades atencionales, mnemónicas y ejecutivas). Este estudio tuvo por objeto caracterizar la ocurrencia de déficits neuropsicológicos post-TCE y constatar el impacto ocasionado por el nivel de severidad del trauma en el desempeño cognitivo de los pacientes. Participaron 96 adultos en la muestra total, que fue dividida en dos grupos para evaluar el nivel de severidad del trauma: TCE leve (n=39) y TCE grave (n=77). La gravedad de la lesión se clasificó por medio de la Escala de Coma de Glasgow, por la duración de la pérdida de consciencia, o por la amnesia post-traumática. No había diferencias entre la edad y la escolaridad de los participantes. Para la comparación entre los grupos en cuanto a la distribución de ocurrencia de déficits neuropsicológicos, se utilizó el Chi-cuadrado. Se utilizó una batería de evaluación neuropsicológica flexible conformada por tareas verbales y visoespaciales de habilidades lingüísticas, mnemónicas y ejecutivas. Los grupos no se diferenciaron en cuanto a las variables sociodemográficas. Los pacientes con TCE leve tuvieron mejores puntajes comparados con los de TCE grave (número de errores y categorías completadas del Test de clasificación de tarjetas de Wisconsin- [WCST, por sus siglas en inglés]; errores en la parte B del Test de Hayling; y en la interferencia retro y proactiva del Test de aprendizaje auditivo verbal de Rey [RAVLT, por sus siglas en inglés]. El nivel de severidad del trauma parece mostrar diferencias en los individuos en cuanto al desempeño en memoria episódica de información nueva y en el control de interferencia entre los recuerdos; lo mismo se aplica a las funciones de flexibilidad e inhibición. Estos resultados sugieren que es necesaria una mayor inversión en acciones de políticas públicas, priorizando intervenciones neurocognitivas reeducativas y métodos de prevención de accidentes relacionados con lesiones traumáticas que tengan alta incidencia de secuelas.El traumatismo craneoencefálico (TCE) puede conllevar impactantes cambios en la vida cotidiana, que incluyen alteraciones a nivel social, profesional, comunicativo y cognitivo (dificultades atencionales, mnemónicas y ejecutivas). Este estudio tuvo por objeto caracterizar la ocurrencia de déficits neuropsicológicos post-TCE y constatar el impacto ocasionado por el nivel de severidad del trauma en el desempeño cognitivo de los pacientes. Participaron 96 adultos en la muestra total, que fue dividida en dos grupos para evaluar el nivel de severidad del trauma: TCE leve (n=39) y TCE grave (n=77). La gravedad de la lesión se clasificó por medio de la Escala de Coma de Glasgow, por la duración de la pérdida de consciencia, o por la amnesia post-traumática. No había diferencias entre la edad y la escolaridad de los participantes. Para la comparación entre los grupos en cuanto a la distribución de ocurrencia de déficits neuropsicológicos, se utilizó el Chi-cuadrado. Se utilizó una batería de evaluación neuropsicológica flexible conformada por tareas verbales y visoespaciales de habilidades lingüísticas, mnemónicas y ejecutivas. Los grupos no se diferenciaron en cuanto a las variables sociodemográficas. Los pacientes con TCE leve tuvieron mejores puntajes comparados con los de TCE grave (número de errores y categorías completadas del Test de clasificación de tarjetas de Wisconsin- [WCST, por sus siglas en inglés]; errores en la parte B del Test de Hayling; y en la interferencia retro y proactiva del Test de aprendizaje auditivo verbal de Rey [RAVLT, por sus siglas en inglés]. El nivel de severidad del trauma parece mostrar diferencias en los individuos en cuanto al desempeño en memoria episódica de información nueva y en el control de interferencia entre los recuerdos; lo mismo se aplica a las funciones de flexibilidad e inhibición. Estos resultados sugieren que es necesaria una mayor inversión en acciones de políticas públicas, priorizando intervenciones neurocognitivas reeducativas y métodos de prevención de accidentes relacionados con lesiones traumáticas que tengan alta incidencia de secuelas.Traumatic brain injury (TBI) can lead to significant changes in daily life, as well as in social, labor, communicative, and cognitive domains (attention, memory and executive functions). This study aimed to characterize the occurrence of post-TBI neuropsychological deficits as well as to determine whether there is an impact related to the level of severity of the trauma on the patient's performance. Ninety-six adults participated in the study, who were divided in two groups to assess the trauma's level of severity: mild TBI (n=39) and severe TBI (n=57). This severity was classified by the Glasgow Coma Scale, by the duration of consciousness loss, or by post-traumatic amnesia. There were no differences between the groups regarding variables of age and years of schooling. A Chi- square test was used to do a comparison between the two groups in terms of occurrence of neuropsychological deficits. Verbal, visuospatial, mnemonic, linguistic and executive tests composed a flexible neuropsychological battery. Patients with mild TBI had better scores compared to those with severe TBI (number of errors and in completed categories of the Modified Wisconsin Card Sorting Test (MWCST); errors in Part B of The Hayling Test; and proactive and retroactive interference in the Rey Auditory Verbal Learning Test (RAVLT). The severity of the trauma seems to differentiate individual's performance on episodic memory of new information and in the control of interference between memories; the same is applied to flexibility and inhibition functions. These results suggest the need for more investments in public health policy actions, prioritizing neurocognitive remedial intervention and prevention methods for such condition with high incidence of sequelae

Oral and written picture description in individuals with aphasia

Aim: To explore the differences between the oral and written description of a picture in individuals with chronic aphasia (IWA) and healthy controls. Descriptions were controlled for productivity, efficiency, grammatical organization, substitution behavior and discourse organization. Method: 50 IWA and 50 healthy controls matched for age, gender and education, provided an oral and written description of a black and white situational drawing from the Dutch version of the Comprehensive Aphasia Test. Between- and within-group analyses were carried out and the reliability of the test instrument was assessed. Results: The language samples of the healthy controls were more elaborate, more efficient, syntactically richer, more coherent and consisted of fewer spoken and written language errors than the samples of the IWA. Within-group comparisons showed that connected writing is more sensitive than connected speech to capture aphasic symptoms. Conclusion: The analysis of both modalities (speech and writing) at discourse level allows to simultaneously assess microlinguistic and macrolinguistic skills and their potential interrelations in a given IWA. Connected writing appears to be more sensitive in discriminating IWA from healthy controls than connected speech. This method for analyzing language samples should, however, be used in conjunction with other assessment tools

Language control and parallel recovery of language in individuals with aphasia

Background: The causal basis of the different patterns of language recovery following stroke in bilingual speakers is not well understood. Our approach distinguishes the representation of language from the mechanisms involved in its control. Previous studies have suggested that difficulties in language control can explain selective aphasia in one language as well as pathological switching between languages. Here we test the hypothesis that difficulties in managing and resolving competition will also be observed in those who are equally impaired in both their languages even in the absence of pathological switching. Aims: To examine difficulties in language control in bilingual individuals with parallel recovery in aphasia and to compare their performance on different types of conflict task. Methods & procedures: Two right-handed, non-native English-speaking participants who showed parallel recovery of two languages after stroke and a group of non-native English-speaking, bilingual controls described a scene in English and in their first language and completed three explicit conflict tasks. Two of these were verbal conflict tasks: a lexical decision task in English, in which individuals distinguished English words from non-words, and a Stroop task, in English and in their first language. The third conflict task was a non-verbal flanker task. Outcomes & Results: Both participants with aphasia were impaired in the picture description task in English and in their first language but showed different patterns of impairment on the conflict tasks. For the participant with left subcortical damage, conflict was abnormally high during the verbal tasks (lexical decision and Stroop) but not during the non-verbal flanker task. In contrast, for the participant with extensive left parietal damage, conflict was less abnormal during the Stroop task than the flanker or lexical decision task. Conclusions: Our data reveal two distinct control impairments associated with parallel recovery. We stress the need to explore the precise nature of control problems and how control is implemented in order to develop fuller causal accounts of language recovery patterns in bilingual aphasia

Cross-linguistic adaptations of The Comprehensive Aphasia Test: Challenges and solutions

Comparative research on aphasia and aphasia rehabilitation is challenged by the lack of comparable assessment tools across different languages. In English, a large array of tools is available, while in most other languages, the selection is more limited. Importantly, assessment tools are often simple translations and do not take into consideration specific linguistic and psycholinguistic parameters of the target languages. As a first step in meeting the needs for comparable assessment tools, the Comprehensive Aphasia Test is currently being adapted into a number of languages spoken in Europe. In this article, some key challenges encountered in the adaptation process and the solutions to ensure that the resulting assessment tools are linguistically and culturally equivalent, are proposed. Specifically, we focus on challenges and solutions related to the use of imageability, frequency, word length, spelling-to-sound regularity and sentence length and complexity as underlying properties in the selection of the testing material

A Systematic Review of Semantic Feature Analysis Therapy Studies for Aphasia

Purpose : The purpose of this study was to review treatment studies of semantic feature analysis (SFA) for persons with aphasia . The review documents how SFA is used, appraises the quality of the included studies and evaluates the efficacy of SFA. Methods : The following electronic databases were systematically searched (last search February 2017) : Academic Search Complete; CINAHL Plus; E -journals; Health Policy Reference Centre; MEDLINE; PsycART ICLES; PsycINFO; and SocINDEX. The quality of the included studies was rated. Clinical efficacy was determined by calculating effect sizes ( Cohen’s d ) or percent of non-overlapping data when d could not be calculated. Results: Twenty -one studies were reviewed reporting on 55 persons with aphasia. SFA was used in six different types of studies: confrontation naming of nouns, of verbs , connected speech /discourse, group, multilingual and studies where SFA was compared with other approaches . The quality of included studies was high [ Single Case Experimental Design Scale (SCED S) average (range) =9.55 ( 8.0- 11 )]. Naming of trained items improved for 45 participants ( 81.82%). Effect sizes indicated there was a small treatment effect. Conclusions: SFA leads to p ositive outcomes despite the variability of treatment procedures, dosage, duration and variations to the traditional SFA protocol. Further research is warranted to examine the efficacy of SFA and generalization effects in larger controlled studies

Psychometric properties of discourse measures in aphasia: acceptability, reliability, and validity

BACKGROUND: Discourse in adults with aphasia is increasingly the focus of assessment and therapy research. A broad range of measures is available to describe discourse, but very limited information is available on their psychometric properties. As a result, the quality of these measures is unknown, and there is very little evidence to motivate the choice of one measure over another. AIMS: To explore the quality of a range of discourse measures, targeting sentence structure, coherence, story structure and cohesion. Quality was evaluated in terms of the psychometric properties of acceptability (data completeness and skewness), reliability (inter- and intra-rater), and validity (content, convergent, discriminant and known groups). METHODS & PROCEDURES: Participants with chronic mild-to-moderate aphasia were recruited from community groups. They produced a range of discourses which were grouped into Cinderella and everyday discourses. Discourses were then transcribed orthographically and analyzed using macro- and microlinguistic measures (Story Grammar, Topic Coherence, Local Coherence, Reference Chains and Predicate Argument Structure-PAS). Data were evaluated against standard predetermined criteria to ascertain the psychometric quality of the measures. OUTCOMES & RESULTS: A total of 17 participants took part in the study. All measures had high levels of acceptability, inter- and intra-rater reliability, and had good content validity, as they could be related to a level of the theoretical model of discourse production. For convergent validity, as expected, 8/10 measures correlated with the Western Aphasia Battery-Revised (WAB-R) spontaneous speech scores, and 7/10 measures correlated with the Kissing and Dancing Test (KDT) scores (r ≥ 0.3), giving an overall positive rating for construct validity. For discriminant validity, as predicted, all measures had low correlations with Raven's Coloured Progressive Matrices (RCPM) and WAB-R Auditory Verbal Comprehension scores (r < 0.3), giving an overall positive rating for construct validity. Finally, for known groups validity, all measures indicated a difference between speakers with mild and moderate aphasia except for the Local Coherence measures. Overall, Story Grammar, Topic Coherence, Reference Chains and PAS emerged as the strongest measures in the current study because they achieved the predetermined thresholds for quality in terms of each of the psychometric parameters profiled. CONCLUSIONS & IMPLICATIONS: The current study is the first to psychometrically profile measures of discourse in aphasia. It contributes to the field by identifying Story Grammar, Topic Coherence, Reference Chains and PAS as the most psychometrically robust discourse measures yet profiled with speakers with aphasia. Until further data are available indicating the strength of other discourse measures, caution should be applied when using them

Comparing uni-modal and multi-modal therapies for improving writing in acquired dysgraphia after stroke.

Writing therapy studies have been predominantly uni-modal in nature; i.e., their central therapy task has typically been either writing to dictation or copying and recalling words. There has not yet been a study that has compared the effects of a uni-modal to a multi-modal writing therapy in terms of improvements to spelling accuracy. A multiple-case study with eight participants aimed to compare the effects of a uni-modal and a multi-modal therapy on the spelling accuracy of treated and untreated target words at immediate and follow-up assessment points. A cross-over design was used and within each therapy a matched set of words was targeted. These words and a matched control set were assessed before as well as immediately after each therapy and six weeks following therapy. The two approaches did not differ in their effects on spelling accuracy of treated or untreated items or degree of maintenance. All participants made significant improvements on treated and control items; however, not all improvements were maintained at follow-up. The findings suggested that multi-modal therapy did not have an advantage over uni-modal therapy for the participants in this study. Performance differences were instead driven by participant variables

Effects of syntactic cueing therapy on picture naming and connected speech in acquired aphasia

Language therapy for word-finding difficulties in aphasia usually involves picture naming of single words with the support of cues. Most studies have addressed nouns in isolation, even though in connected speech nouns are more frequently produced with determiners. We hypothesised that improved word finding in connected speech would be most likely if intervention treated nouns in usual syntactic contexts. Six speakers with aphasia underwent language therapy using a software program developed for the purpose, which provided lexical and syntactic (determiner) cues. Exposure to determiners with nouns would potentially lead to improved picture naming of both treated and untreated nouns, and increased production of determiner plus noun combinations in connected speech. After intervention, picture naming of treated words improved for five of the six speakers, but naming of untreated words was unchanged. The number of determiner plus noun combinations in connected speech increased for four speakers. These findings attest to the close relationship between frequently co-occurring content and function words, and indicate that intervention for word-finding deficits can profitably proceed beyond single word naming, to retrieval in appropriate syntactic contexts. We also examined the relationship between effects of therapy, and amount and intensity of therapy. We found no relationship between immediate effects and amount or intensity of therapy. However, those participants whose naming maintained at follow-up completed the therapy regime in fewer sessions, of relatively longer duration. We explore the relationship between therapy regime and outcomes, and propose future considerations for research