Words in Action: retrieval errors in aphasia, a topic for therapy

An aphasia is defined as an acquired impairment of language based on brain damage (Benson & Ardila 1996). All modes of language use may be involved: spontaneous speech, writing and comprehension of written and spoken language. Therefore, aphasia is labelled as a supramodal language disorder. The nature and severity of the disorder in each language mode may vruy between and within individual patients

Localization patterns of speech and language errors during awake brain surgery:a systematic review

Awake craniotomy with direct electrical stimulation (DES) is the standard treatment for patients with eloquent area gliomas. DES detects speech and language errors, which indicate functional boundaries that must be maintained to preserve quality of life. During DES, traditional object naming or other linguistic tasks such as tasks from the Dutch Linguistic Intraoperative Protocol (DuLIP) can be used. It is not fully clear which speech and language errors occur in which brain locations. To provide an overview and to update DuLIP, a systematic review was conducted in which 102 studies were included, reporting on speech and language errors and the corresponding brain locations during awake craniotomy with DES in adult glioma patients up until 6 July 2020. The current findings provide a crude overview on language localization. Even though subcortical areas are in general less often investigated intraoperatively, still 40% out of all errors was reported at the subcortical level and almost 60% at the cortical level. Rudimentary localization patterns for different error types were observed and compared to the dual-stream model of language processing and the DuLIP model. While most patterns were similar compared to the models, additional locations were identified for articulation/motor speech, phonology, reading, and writing. Based on these patterns, we propose an updated DuLIP model. This model can be applied for a more adequate “location-to-function” language task selection to assess different linguistic functions during awake craniotomy, to possibly improve intraoperative language monitoring. This could result in a better postoperative language outcome in the future. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10143-022-01943-9

Differential contribution of language and executive functioning to verbal fluency performance in glioma patients

Glioma patients often suffer from deficits in language and executive functioning. Performance in verbal fluency (generating words within one minute according to a semantic category–category fluency, or given letter–letter fluency) is typically impaired in this patient group. While both language and executive functioning play a role in verbal fluency, the relative contribution of both domains remains unclear. We aim to retrospectively investigate glioma patients' performance on verbal and nonverbal fluency and to explore the influence of language and executive functioning on verbal fluency. Sixty-nine adults with gliomas in eloquent areas underwent a neuropsychological test battery (verbal fluency, nonverbal fluency, language, and executive functioning tests) before surgery (T1) and a subgroup of 31 patients also at three (T2) and twelve months (T3) after surgery. Preoperatively, patients were impaired in all verbal fluency tasks and dissociations were found based on tumour location. In contrast, nonverbal fluency was intact. Different language and executive functioning tests predicted performance on category fluency animals and letter fluency, while no significant predictors for category fluency professions were found. The longitudinal results indicated that category fluency professions deteriorated after surgery (T1–T2, T1–T3) and that nonverbal fluency improved after surgery (T1–T3, T2–T3). Verbal fluency performance can provide information on different possible underlying deficits in language and executive functioning in glioma patients, depending on verbal fluency task selection. Efficient task (order) selection can be based on complexity. Category fluency professions can be selected to detect more permanent long-term deficits.</p

Recovery of linguistic deficits in stroke patients: a three-year-follow-up study

In a three-year-follow-up study aphasic patients (n=17) received the ScreeLing, a screeningstest for semantic, phonological and syntactic processing, the Token Test and an interview at 2-4 days, 9-12 days, 2 months, 3 months, 6 months and 3 years post onset. The greatest improvement on all measures occurred between 9-12 days and 2 months post onset. The severity at 2 months post onset was decisive for the final outcome at 3 years p.o

Constraint-induced Aphasia Therapy versus Intensive Semantic Treatment in Fluent Aphasia

Objective: To compare the effectiveness of two intensive therapy methods: Constraint- 4 Induced Aphasia Therapy (CIAT) and semantic therapy (BOX). Method: Nine patients with chronic fluent aphasia participated in a therapy programme 6 to establish behavioral treatment outcomes. Participants were randomly assigned to one of two groups (CIAT or BOX). Results: Intensive therapy significantly improved verbal communication. However, BOX 9 treatment showed a more pronounced improvement on two communication measures, namely on a standardized assessment for verbal communication, the Amsterdam Nijmegen Everyday Language Test (Blomert, Koster, & Kean, 1995) and on a subjective rating scale, the Communicative Effectiveness Index (Lomas et al., 1989). All 13 participants significantly improved on one (or more) subtests of the Aachen Aphasia Test (Graetz et al., 1992), an impairment-focused assessment. There was a treatment-specific effect. Therapy with BOX had a significant effect on language comprehension and on semantics, while of CIAT affected language production and phonology. Conclusion: The findings indicate that in patients with fluent aphasia (1) intensive treatment has a significant effect on language and verbal communication, (2) intensive therapy results in selective treatment effects and (3) an intensive semantic treatment shows a more striking mean improvement on verbal communication in comparison to communication-based CIAT-treatment

Melodic Intonation Therapy in subacute aphasia

Melodic Intonation Therapy (MIT) is based on the observation that persons with severe nonfluent aphasia are often able to sing words or even short phrases they cannot produce during speech. MIT uses the melodic elements of speech, such as intonation and rhythm, to facilitate and improve language production. Although clinicians disagree about the usefulness of MIT, it has been translated into several languages and is frequently applied worldwide. Many studies have reported successful application of MIT. However, most studies are case-studies without control condition in chronic patients. Hence, the level of evidence for MIT is low and little is known about its effect in earlier phases post stroke, when treatment interacts with processes of spontaneous recovery. We examined MIT in the subacute phase post stroke. The purpose of this multicenter study was threefold. First, we evaluated the efficacy of MIT in the subacute phase. Further, we examined the effect of the timing of MIT in this early phase post stroke. Thirdly, we investigated potential determinants influencing therapy outcome