Speech disfluencies in Parkinson's disease Zaburzenia płynności mówienia w chorobie Parkinsona

Abstract Introduction: Even though speech disfluency is listed in the clinical description of Parkinson's disease (PD), its nature, intensity, symptomatology, and the effect on verbal communication have not hitherto been defined. Aim of the research: The research paper presents the results of studies aimed at the description of speech disfluencies in PD and the influence on verbal communication. Material and methods: The tests involved 10 patients from 54 to 72 years of age with documented PD, responsive to L-dopa preparations. The principal method of the study was based on the linguistic analysis of the utterances produced by the people with PD. Results: The intensity of the speech disfluency observed in the utterances of persons with PD ranged from 6.6% to 23.0%, so it was significantly higher than that which is assumed as acceptable (3-5%); the speaking rate of the examined persons ranged from 0.7 syllabes (syl.)/s to 4.0 syl./s, and only 2 examined persons spoke with a rate considered to be correct (4-6 syl./s). This demonstrates that speech disfluency is a communication barrier in PD. Conclusions: The absence of differentiation in the speech disfluency (SD) severity between different types of verbal utterances (difference not statistically significant) and a specified hierarchy of SD symptoms indicate that the speech disfluency in PD has an essentially organic background and is generated by cognitive, linguistic, and motor deficits resulting from the damage to the central nervous system. This is also confirmed by the established hierarchy of utterances with respect to the SD intensity, not excluding the simultaneous participation of the emotional factor

Augmentative and Alternative Communication (AAC) for a patient with a nonfluent/ agrammatic variant of PPA in the mutism stage

Introduction The paper presents an example of the successful administration of the Augmentative and Alternative Communication (AAC) system. Such an approach is of particular significance in cases of patients with speech and language deterioration, which is observed in a nonfluent/agrammatic variant of primary progressive aphasia (PPA-G). Regaining the ability to communicate with others proves to be very important for the patients’ self-esteem and enables them to restore previously broken social bonds. Case history The patient A.G., aged 73, a right-handed woman, had been a teacher of Polish before suffering from speech disorders of the PPA-G type. As the disease progressed, her communication deteriorated and finally she developed mutism. The patient was given a clinical and imaging-supported diagnosis of an isolated nonfluent/ agrammatic variant of primary progressive aphasia (PPA-G). The Augmentative and Alternative Communication (AAC) system specially designed for her needs was introduced to help the patient to regain the possibility to communicate. After 20 sessions of training with the use of simple equipment she was again able to communicate non-verbally with her son and with the staff of the nursing home. At the same time, a considerable improvements in her social functioning, including daily activities, was observed. Conclusions Loss of the ability to communicate with others has a serious impact upon a patient’s quality of life, and often results in withdrawal and an inability to lead an independent life. The introduction of the Augmentative and Alternative Communication (AAC) system proves to be a great help, not only for regaining the ability to communicate, but also for the restoration of social bonds. In consequence, the previously mute patient begins to show signs of social cooperation

Application of ERPs neuromarkers for assessment and treatment of a patient with chronic crossed aphasia after severe TBI and long-term coma – Case Report

Objective The study aimed to evaluate the application of ERPs neuromarkers for the assessment and treatment of a patient with chronic crossed aphasia after severe TBI and a long-term coma. Case report. An ambidextrous female patient, aged 29, suffered from posttraumatic chronic crossed aphasia, severe TBI and a prolonged coma after a car accident. The patient took part in two differentiated rehabilitation programmes of neurotherapy included 20 sessions of relative beta training and 20 sessions of rTMS; both programmes were combined with behavioural training. The patient was tested 3 times: before the experiment, after completion of programme A, and after completion of programme B. Results In the 1st recording, the neuromarker of aphasia was found – an excess of the P2 wave over the left temporal area. There was a cognitive control deficit – an excess of omission errors and an increase of RT variability – all indexes of sporadic ADHD. In the 2nd recording, slight improvements in cognitive control, and language functions were found. In the 3rd recording, after the rTMS sessions most of her cognitive dysfunctions had been resolved, including language functions. It should be stressed that the activation (especially the increase in the ERP potential of the right side over the frontal lobe) was found. The neuromarker of aphasia did not change, only the location had slightly moved frontally. Conclusions The application of ERP neuromarkers assists in the diagnosis, treatment, and academic success of an ambidextrous patient with chronic posttraumatic aphasia and sporadic ADHD. ERPs can be used to assess the functional brain changes induced by neurotherapeutical programme

In search of new methods. Qigong in stuttering therapy

Introduction : Even though stuttering is probably as old a phenomenon as the human speech itself, the stuttering therapy is still a challenge for the therapist and requires constant searching for new methods. Qigong may prove to be one of them. Aim of the research: The research paper presents the results of an experimental investigation evaluating the usefulness of qigong practice in stuttering therapy. Material and methods: Two groups of stuttering adults underwent 6-month therapy. In group I – the experimental one (n = 11) – the therapy consisted of speech fluency training, psychotherapy and qigong practice. In group II – the control one (n = 12) – it included speech fluency training and psychotherapy. In both groups 2-hour sessions of speech fluency training and psychotherapy were conducted twice a week. Two-hour qigong sessions took place once a week. Results: After 6 months the therapy results were compared with regard to the basic stuttering parameters, such as the degree of speech disfluency, the level of logophobia and speech disfluency symptoms. Improvement was observed in both groups, the beneficial effects, however, being more prominent in the qigong-practising group. Conclusions : Qigong exercises used in the therapy of stuttering people along with speech fluency training and psychotherapy give beneficial effects

Speech disfluencies in Parkinson’s disease

Introduction : Even though speech disfluency is listed in the clinical description of Parkinson’s disease (PD), its nature, intensity, symptomatology, and the effect on verbal communication have not hitherto been defined. Aim of the research: The research paper presents the results of studies aimed at the description of speech disfluencies in PD and the influence on verbal communication. Material and methods : The tests involved 10 patients from 54 to 72 years of age with documented PD, responsive to L-dopa preparations. The principal method of the study was based on the linguistic analysis of the utterances produced by the people with PD. Results: The intensity of the speech disfluency observed in the utterances of persons with PD ranged from 6.6% to 23.0%, so it was significantly higher than that which is assumed as acceptable (3–5%); the speaking rate of the examined persons ranged from 0.7 syllabes (syl.)/s to 4.0 syl./s, and only 2 examined persons spoke with a rate considered to be correct (4–6 syl./s). This demonstrates that speech disfluency is a communication barrier in PD. Conclusions : The absence of differentiation in the speech disfluency (SD) severity between different types of verbal utterances (difference not statistically significant) and a specified hierarchy of SD symptoms indicate that the speech disfluency in PD has an essentially organic background and is generated by cognitive, linguistic, and motor deficits resulting from the damage to the central nervous system. This is also confirmed by the established hierarchy of utterances with respect to the SD intensity, not excluding the simultaneous participation of the emotional factor

Neuropsychological diagnosis of a female patient with Arnold-Chiari malformation type I

Arnold–Chiari I malformation is a congenital malformation of the hindbrain characterized by displacement of the cerebellar tonsils into the foramen magnum, pressure on the fourth ventricle, and decreased fluid flow to the basal cisterns. It is a mild form of the neuro-cranio-vertebral syndrome (Arnold–Chiari syndrome) because in many cases it is asymptomatic or has few clinical signs and symptoms of mild severity. The case study presented in the article concerns a 16.5-year-old patient with Arnold–Chiari I malformation following surgery. Based on the neuropsychological diagnosis, clinical symptoms that might result from the course of structural and functional changes in the hindbrain in Arnold–Chiari I syndrome were described and explained. The following were observed: selective difficulties in planning and concentration (maintaining the direction of action) and a weakening of visual perception (described by the patient as a subjective state of derealization). The results of the neuropsychological diagnosis point to certain practical implications for the further therapeutic treatment of patients with a mild form of Arnold–Chiari I malformation, especially as there is a risk of clinical symptoms changing over time due to the posibility of progressive neurodegenerative changes in the hindbrain

THE NEUROPSYCHOLOGY OF METAPHORS IN PATIENTS AWAKENED FROM POST-TRAUMATIC COMA

Metaphor simply is defined as a verbal construct with two referents: one literal, based on the ordinary, concrete meanings of the word or words involved, and the other metaphorical, that is one derived from an implicit analogy between the literal referent and some other phenomenon, usually an abstraction that is implied, but not named. The aim of this paper is a description of the neuropsychology of metaphors in patients awakened from post-traumatic coma. A group of 34 patients awakened from post-traumatic coma and treated at the Reintegrative and Teaching Centre of the Polish Neuropsychological Society, Poland during the period 2017- 2019 participated in this study. This group included 15 women and 17 men, with an average age of 31.2 ± 8.72 years; as a group, the women were somewhat older (32.6 ± 9.79 vs. 31.1 ± 9.18). We recorded the patients’ utterances with the use of video record- ings of open-ended conversations, and made occasional efforts to introduce proverbs, idioms, and other metaphors into their conversation, but this was done on an impromptu basis. The analysis of recordings of 100 randomly selected statements obtained from each patient revealed the presence of 4 types of errors: (1) non-comprehension, i.e. the listener’s inability to comprehend the meaning of the metaphor used by the speaker, as indicated by the lack of an adequate response, an expression of puzzlement, or a question as to the meaning of the metaphor used by the speaker; (2) concretization, which occurs when the listener reacts to the literal meaning of the word, phrase, or sentence, rather than its metaphorical referent; (3) misapplication, when the speaker uses a familiar metaphor in an inappropriate context; (4) the use of incomprehensible or bizarre metaphors by the speaker, so that the intended meaning is difficult or impossible for the listener to ascertain. On many occasions, however, the gist of the metaphor emerged at some later point in the discourse, despite the surface problems. It was found that the TBI patients we studied showed a marked tendency in spontaneous conversation to concretize or misunderstand the metaphors used by others, and to use inappropriate or bizarre metaphors in their own speech. On many occasions, however, the gist of the metaphor emerged at some later point in the discourse, despite the surface problems

VISUAL ART IN APHASIA THERAPY: THE LOST AND FOUND SELF

Recently, the relationship between visual art and brain function and disease has raised considerable interest among neurologists, neuroscientists, and artists themselves. Visual art production involves multiple processes including basic motor skills, such as the coordination of movements, visual-spatial processing, emotional output, a socio-cultural context, as well as obviously creativity. Thus, the relationship between artistic output and brain diseases is particularly complex, and brain disorders may lead to an impairment of artistic production in multiple domains. Understanding the nature of aphasia, which leads to significant changes in human life in the physical, psychological, social and professional sphere, makes us aware of the importance of the individual (objective and subjective) and the social (collective and cultural) self system in the process of creation, especially in artists. Observing the works of artists with aphasia, we notice that each of them perceives the surrounding world differently. One wonders what makes them present reality in one way and not in another. It is true that all works of art show reality in thousands of different ways, and only an unoriginal artist will employ someone else's vision - one already used in a work. It should not be forgotten, however, that the work of artists with aphasia often takes on features resulting from the nature of the problems they face and is initially unoriginal, as they have to overcome fundamental technical difficulties and problems of technique. In this article, we present the possibilities for rehabilitation, of strengthening artists with aphasia, in order for them to find the self lost as a result of illness

Effects of sauna bathing on stress-related genes expression in athletes and non-athletes

Introduction and objective Heat stress induces the expression of genes encoding heat-shock proteins and immune response mediators. The aim of this study was to determine the differences in the expression of genes encoding heat-shock proteins 70 kDa and27 kDa, interleukin 6, interleukin 10and C-reactive protein, between athletes and non-athletes after sauna bathing. Material and Methods Athletes (n=9) and non-athletes (n=9) were exposed to a Finnish sauna twice during one session at a temperature of 98.2 °C and humidity of 10% ± 2%, with a 5 min break for cooling down under a shower. The groups did not differ in terms of age, height or body mass. Blood samples were taken before and after sauna exposure in order to assess gene expression, using reverse transcription polymerase chain reaction. Results Differences were observed in leukocyte mRNA levels of tested genes between athletes and non-athletes. In the non-athlete group, all the tested genes were expressed at higher levels as a response to the same heat challenge. Conclusions It appears that expression of stress-related genes induced by heat stress is dependent on the level of physical activit