Use of video technology for verbal repetition in modified ACT and CART

Three individuals with a moderate to severe aphasia and coexisting AOS post left hemisphere stroke participated in this study. A modified Anagram and Copy Treatment (ACT) and Copy and Recall Treatment (CART) with video technology for verbal home practice was implemented. The least severe participant demonstrated some benefit from verbal repetition training, whereas the others had difficulty with independent practice. In the writing condition, all participants met criteria for the trained sets, and one participant demonstrated generalization to untrained items. The results showed that the 5-point scoring system (Helm-Estabrooks, 2003) provided more detailed data on progress, than traditional binary scoring

Influence of the stimulus on verbal and nonverbal responses by individuals with and without aphasia

Aphasia influences performance in multiple response modalities.  Models of lexical access, pantomime, and drawing production suggest that performance may be influenced by the mode of stimulus presentation.  In this study, twelve individuals with aphasia and twelve individuals without aphasia completed a set of experimental conditions in which one of three stimulus modes (pictorial, auditory, printed) were paired with one of four response modalities (speaking, writing, pantomime, drawing).  Significant differences were found between aphasic and nonaphasic performance.  Individuals with aphasia demonstrated superior performance in speaking and pantomime compared to writing and drawing.  In general, performance was superior in the pictorial condition

Cortical Stimulation and Language Outcomes in Aphasia

With the increased focus on evidenced-based outcomes in Speech-Language Pathology, a trend towards inclusion of instrumentation and technology in the treatment of aphasia has emerged. One technique at the forefront of this movement is the use of cortical stimulation as an adjunct to behavioral interventions. The purposes of this brief analysis are to review articles published over the course of six years (2006-2011) that combine stimulation with language treatment and to report trends that emerge

Design and Implementation of an Instrumented Cane for Gait Recognition

Independent mobility is an important aspect of an individual's life and must sometimes be augmented by use of an assistive device such as a wheeled walker or cane following a fall, injury, or functional decline. Physical therapists perform functional gait assessments to gauge the probability of an individual experiencing a fall and often recommend use of a walker, cane, or walking stick to decrease fall risk. Our team has developed a clinical assessment tool centered on a standard walking cane embedded system that can enhance a therapist's observation-based gait assessment with use of additional objective and quantitative data. This system can be utilized to detect timing and speed of cane placement, angular acceleration of the cane, and amounts of weight borne on the cane. This system is designed to assist physical therapists at the basic level in collection of objective data during gait analysis, to facilitate appropriate assistive gait device prescription, to provide patients and therapists feedback during gait training, and to reduce wrist and shoulder injuries with cane usage. However, more importantly, using the plethora of objective data that can be obtained from this cane, automated gait analysis and gait pattern classification can be performed to understand a patient's walking performance

An Open Dataset of Connected Speech in Aphasia with Consensus Ratings of Auditory-Perceptual Features

Auditory-perceptual rating of connected speech in aphasia (APROCSA) is a system in which trained listeners rate a variety of perceptual features of connected speech samples, representing the disruptions and abnormalities that commonly occur in aphasia. APROCSA has shown promise as an approach for quantifying expressive speech and language function in individuals with aphasia. The aim of this study was to acquire and share a set of audiovisual recordings of connected speech samples from a diverse group of individuals with aphasia, along with consensus ratings of APROCSA features, for future use as training materials to teach others how to use the APROCSA system. Connected speech samples were obtained from six individuals with chronic post-stroke aphasia. The first five minutes of participant speech were excerpted from each sample, and five researchers independently evaluated each sample using APROCSA, rating its 27 features on a five-point scale. The researchers then discussed each feature in turn to obtain consensus ratings. The dataset will provide a useful, freely accessible resource for researchers, clinicians, and students to learn how to evaluate aphasic speech with an auditory-perceptual approach

Dysarthria Subgroups in Talkers with Huntington’s Disease: Comparison of Two Data-Driven Classification Approaches

Although researchers have recognized the need to better account for the heterogeneous perceptual speech characteristics among talkers with the same disease, guidance on how to best establish such dysarthria subgroups is currently lacking. Therefore, we compared subgroup decisions of two data-driven approaches based on a cohort of talkers with Huntington’s disease (HD): (1) a statistical clustering approach (STATCLUSTER) based on perceptual speech characteristic profiles and (2) an auditory free classification approach (FREECLASS) based on listeners’ similarity judgments. We determined the amount of overlap across the two subgrouping decisions and the perceptual speech characteristics driving the subgrouping decisions of each approach. The same speech samples produced by 48 talkers with HD were used for both grouping approaches. The STATCLUSTER approach had been conducted previously. The FREECLASS approach was conducted in the present study. Both approaches yielded four dysarthria subgroups, which overlapped between 50% to 78%. In both grouping approaches, overall bizarreness and speech rate characteristics accounted for the grouping decisions. In addition, voice abnormalities contributed to the grouping decisions in the FREECLASS approach. These findings suggest that apart from overall bizarreness ratings, indexing dysarthria severity, speech rate and voice characteristics may be important features to establish dysarthria subgroups in HD

Leukoaraiosis Is Not Associated With Recovery From Aphasia in the First Year After Stroke.

After a stroke, individuals with aphasia often recover to a certain extent over time. This recovery process may be dependent on the health of surviving brain regions. Leukoaraiosis (white matter hyperintensities on MRI reflecting cerebral small vessel disease) is one indication of compromised brain health and is associated with cognitive and motor impairment. Previous studies have suggested that leukoaraiosis may be a clinically relevant predictor of aphasia outcomes and recovery, although findings have been inconsistent. We investigated the relationship between leukoaraiosis and aphasia in the first year after stroke. We recruited 267 patients with acute left hemispheric stroke and coincident fluid attenuated inversion recovery MRI. Patients were evaluated for aphasia within 5 days of stroke, and 174 patients presented with aphasia acutely. Of these, 84 patients were evaluated at ∼3 months post-stroke or later to assess longer-term speech and language outcomes. Multivariable regression models were fit to the data to identify any relationships between leukoaraiosis and initial aphasia severity, extent of recovery, or longer-term aphasia severity. We found that leukoaraiosis was present to varying degrees in 90% of patients. However, leukoaraiosis did not predict initial aphasia severity, aphasia recovery, or longer-term aphasia severity. The lack of any relationship between leukoaraiosis severity and aphasia recovery may reflect the anatomical distribution of cerebral small vessel disease, which is largely medial to the white matter pathways that are critical for speech and language function

Designing and Implementing a Community Aphasia Group: An Illustrative Case Study of the Aphasia Group of Middle Tennessee.

PurposeCommunity aphasia groups serve an important purpose in enhancing the quality of life and psychosocial well-being of individuals with chronic aphasia. Here, we describe the Aphasia Group of Middle Tennessee, a community aphasia group with a 17-year (and continuing) history, housed within Vanderbilt University Medical Center in Nashville, Tennessee.MethodWe describe in detail the history, philosophy, design, curriculum, and facilitation model of this group. We also present both quantitative and qualitative outcomes from group members and their loved ones.ResultsGroup members and their loved ones alike indicated highly positive assessments of the format and value of the Aphasia Group of Middle Tennessee.ConclusionBy characterizing in detail the successful Aphasia Group of Middle Tennessee, we hope this can serve as a model for clinicians interested in starting their own community aphasia groups, in addition to reaching individuals living with chronic aphasia and their loved ones through the accessible and aphasia-friendly materials provided with this clinical focus article

Multivariate lesion symptom mapping for predicting trajectories of recovery from aphasia.

Individuals with post-stroke aphasia tend to recover their language to some extent; however, it remains challenging to reliably predict the nature and extent of recovery that will occur in the long term. The aim of this study was to quantitatively predict language outcomes in the first year of recovery from aphasia across multiple domains of language and at multiple timepoints post-stroke. We recruited 217 patients with aphasia following acute left hemisphere ischaemic or haemorrhagic stroke and evaluated their speech and language function using the Quick Aphasia Battery acutely and then acquired longitudinal follow-up data at up to three timepoints post-stroke: 1 month (n = 102), 3 months (n = 98) and 1 year (n = 74). We used support vector regression to predict language outcomes at each timepoint using acute clinical imaging data, demographic variables and initial aphasia severity as input. We found that ∼60% of the variance in long-term (1 year) aphasia severity could be predicted using these models, with detailed information about lesion location importantly contributing to these predictions. Predictions at the 1- and 3-month timepoints were somewhat less accurate based on lesion location alone, but reached comparable accuracy to predictions at the 1-year timepoint when initial aphasia severity was included in the models. Specific subdomains of language besides overall severity were predicted with varying but often similar degrees of accuracy. Our findings demonstrate the feasibility of using support vector regression models with leave-one-out cross-validation to make personalized predictions about long-term recovery from aphasia and provide a valuable neuroanatomical baseline upon which to build future models incorporating information beyond neuroanatomical and demographic predictors