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New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia

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A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurolinguistics".

Deadline for manuscript submissions: closed (15 December 2020) | Viewed by 48786

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Prof. Dr. Paola Marangolo

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Guest Editor

Department of Humanities Studies, University of Naples Federico II, 80133 Naples & IRCSS Santa Lucia Foundation, 00179 Rome, Italy
Interests: aphasia; aphasia rehabilitation; neuromodulation; transcranial direct-current stimulation (tDCS); motor and language interaction; cognitive treatment; neurorehabilitation

Special Issue Information

Dear Colleagues,

Aphasia is a highly disabling acquired language disorder usually caused by a left-lateralized brain damage. Due to its profound impact on the patient’s life, clinicians and speech pathologists are continuously faced with the arduous challenge of enhancing aphasia recovery patterns and, subsequently, long-term outcomes in these individuals. However, even if traditional linguistic-based therapies have been proven to induce an adequate clinical improvement, a large percentage of patients are left with some degree of language impairments. Thus, new approaches to common speech therapies are urgently needed in order to maximize the recovery from aphasia. In these last decades, scientific advancements in language conceptualization and the progress of new technologies have made new tools available for professional therapists and educators. Although some of these approaches have shown promise, the results are not conclusive, and their interpretation is further compounded by the heterogeneity of study characteristics.

The focus of this Special Issue is to publish evidence-based studies which provide novel methods for the diagnosis and treatment of aphasia in clinical practice. This topic must be considered cutting-edge in the study of aphasia both because of the importance of the issues that have yet to be further elucidated and because of the urgency to find new solutions that accelerate the recovery process.

As the Guest Editor of this Special Issue “New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia”, I kindly ask you to contribute to this Special Issue. I thank you in advance for your interest and for furthering the research in this field.

Prof. Dr. Paola Marangolo
Guest Editor

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Keywords

aphasia treatment
diagnosis of aphasia
aphasia evaluation
language rehabilitation

Published Papers (13 papers)

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Editorial

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5 pages, 175 KiB

Open AccessEditorial

Editorial: New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia

by Francesca Pisano and Paola Marangolo

Brain Sci. 2021, 11(11), 1508; https://doi.org/10.3390/brainsci11111508 - 14 Nov 2021

Cited by 1 | Viewed by 1395

Abstract

Aphasia is a highly disabling acquired language disorder, usually caused by left-lateralized brain damage [...] Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

Research

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24 pages, 1977 KiB

Open AccessArticle

Defining Hypoperfusion in Chronic Aphasia: An Individualized Thresholding Approach

by Noelle T. Abbott, Carolyn J. Baker, Conan Chen, Thomas T. Liu and Tracy E. Love

Brain Sci. 2021, 11(4), 491; https://doi.org/10.3390/brainsci11040491 - 13 Apr 2021

Cited by 8 | Viewed by 2418

Abstract

Within the aphasia literature, it is common to link location of lesioned brain tissue to specific patterns of language impairment. This has provided valuable insight into the relationship between brain structure and function, but it does not capture important underlying alterations in function of regions that remain structurally intact. Research has demonstrated that in the chronic stage of aphasia, variable patterns of reduced cerebral blood flow (CBF; hypoperfusion) in structurally intact regions of the brain contribute to persisting language impairments. However, one consistent issue in this literature is a lack of clear consensus on how to define hypoperfusion, which may lead to over- or underestimation of tissue functionality. In the current study, we conducted an exploratory analysis in six individuals with chronic aphasia (>1 year post-onset) using perfusion imaging to (1) suggest a new, individualized metric for defining hypoperfusion; (2) identify the extent of hypoperfused tissue in perilesional bands; and (3) explore the relationship between hypoperfusion and language impairment. Results indicated that our individualized metric for defining hypoperfusion provided greater precision when identifying functionally impaired tissue and its effects on language function in chronic aphasia. These results have important implications for intervention approaches that target intact (or impaired) brain tissue. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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43 pages, 2194 KiB

Open AccessArticle

German Language Adaptation of the NAVS (NAVS-G) and of the NAT (NAT-G): Testing Grammar in Aphasia

by Ruth Ditges, Elena Barbieri, Cynthia K. Thompson, Sandra Weintraub, Cornelius Weiller, Marek-Marsel Mesulam, Dorothee Kümmerer, Nils Schröter and Mariacristina Musso

Brain Sci. 2021, 11(4), 474; https://doi.org/10.3390/brainsci11040474 - 08 Apr 2021

Cited by 4 | Viewed by 3570

Abstract

Grammar provides the framework for understanding and producing language. In aphasia, an acquired language disorder, grammatical deficits are diversified and widespread. However, the few assessments for testing grammar in the German language do not consider current linguistic, psycholinguistic, and functional imaging data, which have been shown to be crucial for effective treatment. This study developed German language versions of the Northwestern Assessment of Verbs and Sentences (NAVS-G) and the Northwestern Anagram Test (NAT-G) to examine comprehension and production of verbs, controlling for the number and optionality of verb arguments, and sentences with increasing syntactic complexity. The NAVS-G and NAT-G were tested in 27 healthy participants, 15 right hemispheric stroke patients without aphasia, and 15 stroke patients with mild to residual aphasia. Participants without aphasia showed near-perfect performance, with the exception of (object) relative sentences, where accuracy was associated with educational level. In each patient with aphasia, deficits in more than one subtest were observed. The within and between population-groups logistic mixed regression analyses identified significant impairments in processing syntactic complexity at the verb and sentence levels. These findings indicate that the NAVS-G and NAT-G have potential for testing grammatical competence in (German) stroke patients. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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16 pages, 1575 KiB

Open AccessArticle

Nonverbal Semantics Test (NVST)—A Novel Diagnostic Tool to Assess Semantic Processing Deficits: Application to Persons with Aphasia after Cerebrovascular Accident

by Katharina Hogrefe, Georg Goldenberg, Ralf Glindemann, Madleen Klonowski and Wolfram Ziegler

Brain Sci. 2021, 11(3), 359; https://doi.org/10.3390/brainsci11030359 - 11 Mar 2021

Cited by 6 | Viewed by 4090

Abstract

Assessment of semantic processing capacities often relies on verbal tasks which are, however, sensitive to impairments at several language processing levels. Especially for persons with aphasia there is a strong need for a tool that measures semantic processing skills independent of verbal abilities. Furthermore, in order to assess a patient’s potential for using alternative means of communication in cases of severe aphasia, semantic processing should be assessed in different nonverbal conditions. The Nonverbal Semantics Test (NVST) is a tool that captures semantic processing capacities through three tasks—Semantic Sorting, Drawing, and Pantomime. The main aim of the current study was to investigate the relationship between the NVST and measures of standard neurolinguistic assessment. Fifty-one persons with aphasia caused by left hemisphere brain damage were administered the NVST as well as the Aachen Aphasia Test (AAT). A principal component analysis (PCA) was conducted across all AAT and NVST subtests. The analysis resulted in a two-factor model that captured 69% of the variance of the original data, with all linguistic tasks loading high on one factor and the NVST subtests loading high on the other. These findings suggest that nonverbal tasks assessing semantic processing capacities should be administered alongside standard neurolinguistic aphasia tests. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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Graphical abstract

14 pages, 1150 KiB

Open AccessFeature PaperArticle

A Brief Executive Language Screen for Frontal Aphasia

by Gail A. Robinson, Lucy Shi, Zoie Nott and Amelia Ceslis

Brain Sci. 2021, 11(3), 353; https://doi.org/10.3390/brainsci11030353 - 10 Mar 2021

Cited by 4 | Viewed by 2691

Abstract

Aphasia assessment tools have primarily focused on classical aphasia type and severity, with minimal incorporation of recent findings that suggest a significant role of executive control operations in language generation. Assessment of the interface between language and executive functions is needed to improve detection of spontaneous speech difficulties. In this study we develop a new Brief Executive Language Screen (BELS), a brief tool specifically designed to assess core language and executive functions shown to be involved in spontaneous generation of language. Similar to other measures of aphasia, the BELS assesses articulation and core language skills (repetition, naming and comprehension). Unique additions to the BELS include assessments of spontaneous connected speech, word fluency (phonemic/semantic) and sentence completion (verbal initiation, inhibition and selection). One-hundred and eight healthy controls and 136 stroke patients were recruited. Confirmatory factor analysis was used to determine construct validity and logistic regression was used to evaluate the discriminative validity, informing the final version of the BELS. The results showed that the BELS is sensitive for articulation and nominal language deficits, and it measures executive aspects of spontaneous language generation, which is a hallmark of frontal dynamic aphasia. The results have encouraging theoretical and practical implications. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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18 pages, 5976 KiB

Open AccessArticle

Effects of tDCS on Sound Duration in Patients with Apraxia of Speech in Primary Progressive Aphasia

by Charalambos Themistocleous, Kimberly Webster and Kyrana Tsapkini

Brain Sci. 2021, 11(3), 335; https://doi.org/10.3390/brainsci11030335 - 06 Mar 2021

Cited by 11 | Viewed by 3827

Abstract

Transcranial direct current stimulation (tDCS) over the left inferior frontal gyrus (IFG) was found to improve oral and written naming in post-stroke and primary progressive aphasia (PPA), speech fluency in stuttering, a developmental speech-motor disorder, and apraxia of speech (AOS) symptoms in post-stroke aphasia. This paper addressed the question of whether tDCS over the left IFG coupled with speech therapy may improve sound duration in patients with apraxia of speech (AOS) symptoms in non-fluent PPA (nfvPPA/AOS) more than sham. Eight patients with non-fluent PPA/AOS received either active or sham tDCS, along with speech therapy for 15 sessions. Speech therapy involved repeating words of increasing syllable-length. Evaluations took place before, immediately after, and two months post-intervention. Words were segmented into vowels and consonants and the duration of each vowel and consonant was measured. Segmental duration was significantly shorter after tDCS compared to sham and tDCS gains generalized to untrained words. The effects of tDCS sustained over two months post-treatment in trained and untrained sounds. Taken together, these results demonstrate that tDCS over the left IFG may facilitate speech production by reducing segmental duration. The results provide preliminary evidence that tDCS may maximize efficacy of speech therapy in patients with nfvPPA/AOS. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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24 pages, 2985 KiB

Open AccessArticle

Extended fMRI-Guided Anodal and Cathodal Transcranial Direct Current Stimulation Targeting Perilesional Areas in Post-Stroke Aphasia: A Pilot Randomized Clinical Trial

by Leora R. Cherney, Edna M. Babbitt, Xue Wang and Laura L. Pitts

Brain Sci. 2021, 11(3), 306; https://doi.org/10.3390/brainsci11030306 - 28 Feb 2021

Cited by 10 | Viewed by 2885

Abstract

Transcranial direct current stimulation (tDCS) may enhance speech and language treatment (SLT) for stroke survivors with aphasia; however, to date, there is no standard protocol for the application of tDCS in post-stroke aphasia. We explored the safety and efficacy of fMRI-guided tDCS on functional language and cortical activity when delivered to the lesioned left hemisphere concurrently with SLT across an extended, six-week treatment period. Twelve persons with chronic, nonfluent aphasia following a single left-hemisphere stroke participated in the three-arm (anodal vs. cathodal vs. sham) single-blind, parallel, pilot trial. No serious adverse events occurred during 30 treatment sessions or in the following six weeks. All groups demonstrated functional language gains following intensive treatment; however, active tDCS resulted in greater gains in standardized, probe, and caregiver-reported measures of functional language than sham. Evidence declaring one polarity as superior for inducing language recovery was mixed. However, cathodal stimulation to the lesioned left hemisphere, expected to have a down-regulating effect, resulted in increased areas of cortical activation across both hemispheres, and specifically perilesionally. Generalization of these preliminary findings is limited; however, results are nevertheless compelling that tDCS combined with SLT can be safely applied across extended durations, with the potential to enhance functional language and cortical activation for persons with aphasia. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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11 pages, 725 KiB

Open AccessArticle

Prediction of Aphasia Severity in Patients with Stroke Using Diffusion Tensor Imaging

by Jin-Kook Lee, Myoung-Hwan Ko, Sung-Hee Park and Gi-Wook Kim

Brain Sci. 2021, 11(3), 304; https://doi.org/10.3390/brainsci11030304 - 27 Feb 2021

Cited by 10 | Viewed by 4175

Abstract

This study classified the severity of aphasia through the Western Aphasia Battery and determined the optimal cut-off value for each Language-Related White Matter fiber and their combinations, we further examined the correlations between Language-Related White Matter and Western Aphasia Battery subscores. This retrospective study recruited 64 patients with aphasia. Mild/moderate and severe aphasia were classified according to cut-off Aphasia Quotient score of 51 points. Diffusion tensor imaging and fractional anisotropy reconstructed Language-Related White Matter in multiple fasciculi. We determined the area under the covariate-adjusted receiver operating characteristic curve to evaluate the accuracy of predicting aphasia severity. The optimal fractional-anisotropy cut-off values for the individual fibers of the Language-Related White Matter and their combinations were determined. Their correlations with Western Aphasia Battery subscores were analyzed. The arcuate and superior longitudinal fasciculi showed fair accuracy, the inferior frontal occipital fasciculus poor accuracy, and their combinations fair accuracy. Correlations between Language-Related White Matter parameters and Western Aphasia Battery subscores were found between the arcuate, superior longitudinal, and inferior frontal occipital fasciculi and spontaneous speech, auditory verbal comprehension, repetition, and naming. Diffusion-tensor-imaging-based language-Related White Matter analysis may help predict the severity of language impairment in patients with aphasia following stroke. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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15 pages, 1111 KiB

Open AccessArticle

Sentence Recall in Latent and Anomic Aphasia: An Exploratory Study of Semantics and Syntax

by Christos Salis, Nadine Martin and Laura Reinert

Brain Sci. 2021, 11(2), 230; https://doi.org/10.3390/brainsci11020230 - 12 Feb 2021

Cited by 8 | Viewed by 2639

Abstract

We investigated whether semantic plausibility and syntactic complexity affect immediate sentence recall in people with latent and anomic aphasia. To date, these factors have not been explored in these types of aphasia. As with previous studies of sentence recall, we measured accuracy of verbatim recall and uniquely real-time speech measures. The results showed that accuracy did not distinguish performance between latent aphasia and neurotypical controls. However, some of the real-time speech measures distinguished performance between people with latent aphasia and neurotypical controls. There was some evidence, though not pervasive, that semantic plausibility and syntactic complexity influenced recall performance. There were no interactions between semantic plausibility and syntactic complexity. The speed of preparation of responses was slower in latent aphasia than controls; it was also slower in anomic aphasia than both latent and control groups. It appears that processing speed as indexed by temporal speech measures may be differentially compromised in latent and anomic aphasia. However, semantic plausibility and syntactic complexity did not show clear patterns of performance among the groups. Notwithstanding the absence of interactions, we advance an explanation based on conceptual short-term memory as to why semantically implausible sentences are typically more erroneous and possibly also slower in recall. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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18 pages, 2274 KiB

Open AccessArticle

Creating a Theoretical Framework to Underpin Discourse Assessment and Intervention in Aphasia

by Lucy Dipper, Jane Marshall, Mary Boyle, Deborah Hersh, Nicola Botting and Madeline Cruice

Brain Sci. 2021, 11(2), 183; https://doi.org/10.3390/brainsci11020183 - 02 Feb 2021

Cited by 15 | Viewed by 5105

Abstract

Discourse (a unit of language longer than a single sentence) is fundamental to everyday communication. People with aphasia (a language impairment occurring most frequently after stroke, or other brain damage) have communication difficulties which lead to less complete, less coherent, and less complex discourse. Although there are multiple reviews of discourse assessment and an emerging evidence base for discourse intervention, there is no unified theoretical framework to underpin this research. Instead, disparate theories are recruited to explain different aspects of discourse impairment, or symptoms are reported without a hypothesis about the cause. What is needed is a theoretical framework that would clarify the specific linguistic skills that create completeness, coherence, and complexity (i.e., richness) in discourse, and illuminate both the processes involved in discourse production and the reasons for breakdown. This paper reports a review and synthesis of the theoretical literature relevant to spoken discourse in aphasia discourse, and we propose a novel theoretical framework which unites these disparate sources. This framework is currently being tested as the foundation for Linguistic Underpinnings of Narrative in Aphasia (LUNA) treatment research. In this paper, we outline the novel framework and exemplify how it might be used to guide clinical practice and research. Future collaborative research is needed to develop this framework into a processing model for spoken discourse. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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26 pages, 1416 KiB

Open AccessArticle

Main Concept, Sequencing, and Story Grammar Analyses of Cinderella Narratives in a Large Sample of Persons with Aphasia

by Jessica D. Richardson, Sarah Grace Dalton, Kathryn J. Greenslade, Adam Jacks, Katarina L. Haley and Janet Adams

Brain Sci. 2021, 11(1), 110; https://doi.org/10.3390/brainsci11010110 - 15 Jan 2021

Cited by 15 | Viewed by 4057

Abstract

Recently, a multilevel analytic approach called Main Concept, Sequencing, and Story Grammar (MSSG) was presented along with preliminary normative information. MSSG analyses leverage the strong psychometrics and rich procedural knowledge of both main concept analysis and story grammar component coding, complementing it with easy-to-obtain sequencing information for a rich understanding of discourse informativeness and macrostructure. This study is the next critical step for demonstrating the clinical usefulness of MSSG’s six variables (main concept composite, sequencing, main concept+sequencing, essential story grammar components, total episodic components, and episodic complexity) for persons with aphasia (PWAs). We present descriptive statistical information for MSSG variables for a large sample of PWAs and compare their performance to a large sample of persons not brain injured (PNBIs). We observed significant differences between PWAs and PNBIs for all MSSG variables. These differences occurred at the omnibus group level and for each aphasia subtype, even for PWAs with very mild impairment that is not detected with standardized aphasia assessment. Differences between PWAs and PNBIs were also practically significant, with medium to large effect sizes observed for nearly all aphasia subtypes and MSSG variables. This work deepens our understanding of discourse informativeness and macrostructure in PWAs and further develops an efficient tool for research and clinical use. Future research should investigate ways to expand MSSG analyses and to improve sensitivity and specificity. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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Review

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29 pages, 334 KiB

Open AccessFeature PaperReview

Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety

by Chiara Picano, Agnese Quadrini, Francesca Pisano and Paola Marangolo

Brain Sci. 2021, 11(1), 41; https://doi.org/10.3390/brainsci11010041 - 02 Jan 2021

Cited by 20 | Viewed by 6117

Abstract

Aphasia is one of the most socially disabling post-stroke deficits. Although traditional therapies have been shown to induce adequate clinical improvement, aphasic symptoms often persist. Therefore, unconventional rehabilitation techniques which act as a substitute or as an adjunct to traditional approaches are urgently needed. The present review provides an overview of the efficacy and safety of the principal approaches which have been proposed over the last twenty years. First, we examined the effectiveness of the pharmacological approach, principally used as an adjunct to language therapy, reporting the mechanism of action of each single drug for the recovery of aphasia. Results are conflicting but promising. Secondly, we discussed the application of Virtual Reality (VR) which has been proven to be useful since it potentiates the ecological validity of the language therapy by using virtual contexts which simulate real-life everyday contexts. Finally, we focused on the use of Transcranial Direct Current Stimulation (tDCS), both discussing its applications at the cortical level and highlighting a new perspective, which considers the possibility to extend the use of tDCS over the motor regions. Although the review reveals an extraordinary variability among the different studies, substantial agreement has been reached on some general principles, such as the necessity to consider tDCS only as an adjunct to traditional language therapy. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

23 pages, 779 KiB

Open AccessReview

Are People with Aphasia (PWA) Involved in the Creation of Quality of Life and Aphasia Impact-Related Questionnaires? A Scoping Review

by Marina Charalambous, Maria Kambanaros and Jean-Marie Annoni

Brain Sci. 2020, 10(10), 688; https://doi.org/10.3390/brainsci10100688 - 29 Sep 2020

Cited by 13 | Viewed by 4149

Abstract

Background: Quality of Life (QoL) questionnaires are used to describe the impact of aphasia on stroke survivors’ life. People with aphasia (PWA) are traditionally excluded from research, potentially leading to a mismatch between the factors chosen in the tools and the realistic needs of PWA. The purpose of this review was to determine the direct involvement of PWA in the creation of QoL and aphasia impact-related questionnaires (AIR-Qs). Methods: A scoping review methodology was conducted by an expert librarian and two independent reviewers on health sciences based on the Preferred Reporting Items for Systematic Reviews and Metanalyses extension for Scoping Reviews (PRISMA-ScR) protocol, through a literature search in five databases: Medline Complete, PubMed, PsychINFO, Scopus, and Google Scholar. Search terms included ‘stroke’, ‘people with aphasia’, ‘communication’, ‘well-being’, and ‘quality of life’. Results: Of 952 results, 20 studies met the eligibility criteria. Of these, only four AIR-Qs studies (20%) were found reporting the direct involvement of PWA, while no QoL tools did so. Evidence showed involvement in the creation phase of AIR-Q, mainly in a consultation role. Conclusions: There is an absence of a framework for conducting and reporting the involvement of PWA in qualitative participatory research studies, which limits effectiveness to promote equitable best practice in aphasia rehabilitation. Full article

(This article belongs to the Special Issue New Perspectives and Methodologies in the Diagnosis and Rehabilitation of Aphasia)

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