Therapeutic effect of an intensive, comprehensive aphasia program: Aphasia LIFT

The development of intensive, comprehensive aphasia programs (ICAPs) is increasing due to evidence in favour of greater treatment intensity (Cherney, Patterson, Raymer, Frymark, & Schooling, 2008), the adoption of a broad, holistic, biopsychosocial approach in aphasia rehabilitation (Byng & Duchan, 2005; Kagan et al., 2008; Martin, Thompson, & Worrall, 2008; Simmons-Mackie & Kagan, 2007), and the desire to meet the needs of people with aphasia and their family members in therapy (Howe et al., 2012; Worrall et al., 2012). ICAPs comprise a range of therapy approaches (individual therapy, group therapy, patient/family education, technology), delivered at high intensity (minimum of three hours per day over at least two weeks), to a defined group of participants within a specified amount of time (Cherney, Worrall, & Rose, 2012). Aphasia LIFT (Language Impairment and Functioning Therapy) is a research-based ICAP that uses evidence-based therapy approaches to target language and functioning across the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) domains (WHO, 2001). The aim of this study was to determine the therapeutic effect of Aphasia LIFT on language impairment, functional communication, and communication-related quality of life (QOL)

An fMRI investigation of the effects of attempted naming on word retrieval in aphasia

In healthy controls, picture naming performance can be facilitated by a single prior exposure to the same picture ("priming"). This priming phenomenon is utilized in the treatment of aphasia, which often includes repeated picture naming as part of a therapeutic task. The current study sought to determine whether single and/or multiple exposures facilitate subsequent naming in aphasia and whether such facilitatory effects act through normal priming mechanisms. A functional magnetic resonance imaging paradigm was employed to explore the beneficial effects of attempted naming in two individuals with aphasia and a control group. The timing and number of prior exposures was manipulated, with investigation of both short-term effects (single prior exposure over a period of minutes) and long-term effects (multiple presentations over a period of days). Following attempted naming, both short-term and long-term facilitated items showed improvement for controls, while only the long-term condition showed benefits at a behavioral level for the participants with aphasia. At a neural level, effects of long-term facilitation were noted in the left precuneus for one participant with aphasia, a result also identified for the equivalent contrast in controls. It appears that multiple attempts are required to improve naming performance in the presence of anomia and that for some individuals with aphasia the source of facilitation may be similar to unimpaired mechanisms engaged outside the language network

Exercise Training Reverses Extrapulmonary Impairments in Smoke-exposed Mice

Purpose: Cigarette smoking is the main risk factor for chronic obstructive pulmonary disease and emphysema. However, evidence on the extrapulmonary effects of smoke exposure that precede lung impairments remains unclear at present, as are data on nonpharmacological treatments such as exercise training. Methods: Three groups of mice, including control (n = 10), smoking (n = 10), and smoking with 6 wk of high-intensity interval treadmill running (n = 11), were exposed to 20 wk of fresh air or whole-body cigarette smoke. Exercise capacity (peak oxygen uptake) and lung destruction (histology) were subsequently measured, whereas the heart, peripheral endothelium (aorta), and respiratory (diaphragm) and limb (extensor digitorum longus and soleus) skeletal muscles were assessed for in vivo and in vitro function, in situ mitochondrial respiration, and molecular alterations. Results: Smoking reduced body weight by 26% (P 0.05). Smoking impaired exercise capacity by 15% while inducing right ventricular dysfunction by ~20%, endothelial dysfunction by ~20%, and diaphragm muscle weakness by ~15% (all P < 0.05), but these were either attenuated or reversed by exercise training (P < 0.05). Compared with controls, smoking mice had normal limb muscle and mitochondrial function (cardiac and skeletal muscle fibers); however, diaphragm measures of oxidative stress and protein degradation were increased by 111% and 65%, respectively (P < 0.05), but these were attenuated by exercise training (P < 0.05). Conclusions: Prolonged cigarette smoking reduced exercise capacity concomitant with functional impairments to the heart, peripheral endothelium, and respiratory muscle that preceded the development of overt emphysema. However, high-intensity exercise training was able to reverse these smoke-induced extrapulmonary impairments

Priming Picture Naming with a Semantic Task: An fMRI Investigation

Prior semantic processing can enhance subsequent picture naming performance, yet the neurocognitive mechanisms underlying this effect and its longevity are unknown. This functional magnetic resonance imaging study examined whether different neurological mechanisms underlie short-term (within minutes) and long-term (within days) facilitation effects from a semantic task in healthy older adults. Both short- and long-term facilitated items were named significantly faster than unfacilitated items, with short-term items significantly faster than long-term items. Region of interest results identified decreased activity for long-term facilitated items compared to unfacilitated and short-term facilitated items in the mid-portion of the middle temporal gyrus, indicating lexical-semantic priming. Additionally, in the whole brain results, increased activity for short-term facilitated items was identified in regions previously linked to episodic memory and object recognition, including the right lingual gyrus (extending to the precuneus region) and the left inferior occipital gyrus (extending to the left fusiform region). These findings suggest that distinct neurocognitive mechanisms underlie short- and long-term facilitation of picture naming by a semantic task, with long-term effects driven by lexical-semantic priming and short-term effects by episodic memory and visual object recognition mechanisms

The neural correlates of picture naming facilitated by auditory repetition

Background: Overt repetition of auditorily presented words can facilitate picture naming performance in both unimpaired speakers and individuals with word retrieval difficulties, but the underlying neurocognitive mechanisms and longevity of such effects remain unclear. This study used functional magnetic resonance imaging to examine whether different neurological mechanisms underlie short-term (within minutes) and long-term (within days) facilitation effects from an auditory repetition task in healthy older adults

A comparison of semantic feature analysis and phonological components analysis for the treatment of naming impairments in aphasia

Therapy for naming impairments post-stroke typically involves semantic and/or phonologically-based tasks. However, the relationship between individuals' locus of breakdown in word retrieval and their response to a particular treatment approach remains unclear, and direct comparisons of treatments with different targets (semantics, phonology) yet similar formats are lacking. This study examined eight people with aphasia who each received 12 treatment sessions; half the sessions involved a semantically-based treatment task, Semantic Feature Analysis (SFA), and the other half involved a phonologically-based treatment task, Phonological Components Analysis (PCA). Pre-therapy baseline accuracy scores were compared to naming accuracy post-treatment and at follow-up assessment. Seven of the eight participants showed significant improvements in naming items treated with PCA, with six of these seven participants maintaining improvements at follow-up. Four of the eight participants showed significant improvements for items treated with SFA, with three of the four maintaining improvements at follow-up. The semantic therapy was not beneficial for participants with semantic deficits. In contrast, the phonological therapy was beneficial for most participants, despite differences in underlying impairments. Understanding the relationship between an individual's locus of breakdown in word retrieval and response to different treatment tasks has the potential to optimise targeted treatment

Testing the Limits of Skill Transfer for Scrabble Experts in Behaviour and Brain

We investigated transfer of the skills developed by competitive Scrabble players. Previous studies reported superior performance for Scrabble experts on the lexical decision task (LDT), suggesting near transfer of Scrabble skills. Here we investigated the potential for far transfer to a symbol decision task (SDT); in particular, transfer of enhanced long-term working memory for vertically presented stimuli. Our behavioural results showed no evidence for far transfer. Despite years of intensive practice, Scrabble experts were no faster and no more accurate than controls in the SDT. However, our fMRI and EEG data from the SDT suggest that the neural repertoire that Scrabble experts develop supports task performance even outside of the practised domain, in a non-linguistic context. The regions engaged during the SDT were different across groups: controls engaged temporal-frontal regions, whereas Scrabble experts engaged posterior visual and temporal-parietal regions. In Scrabble experts, activity related to Scrabble skill (anagramming scores) included regions associated with visual-spatial processing and long-term working memory, and overlapped with regions previously shown to be associated with Scrabble expertise in the near transfer task (LDT). Analysis of source waveforms within these regions showed that participants with higher anagramming scores had larger P300 amplitudes, potentially reflecting greater working memory capacity, or less variability in the participants who perform the task more efficiently. Thus, the neuroimaging results provide evidence of brain transfer in the absence of behavioural transfer, providing new clues about the consequences of long-term training associated with competitive Scrabble expertise