Search Results (67)

Background: Transcranial Direct Current Stimulation (tDCS) in conjunction with behavioural language therapy in PPA has previously been modified for variation at the group level, but not at the individual level. This pilot study used individualised tDCS targeting by identifying regions of peak atrophy in the language system. Methods: Six PPA participants (four semantic and two non-fluent variant) were randomly allocated to receive tDCS or sham stimulation. The target electrode was selected for each based on their region of peak atrophy. Participants received naming therapy, individually calibrated according to baseline naming performance. Three sets of therapy were delivered in conjunction with tDCS (1 mA) or sham stimulation within participants’ homes. The study was not powered to demonstrate efficacy but to show proof-of-concept for an individualised, home-based tDCS targeting method. Results: All participants successfully completed the protocol. In one participant the region of peak atrophy differed from that predicted by clinical syndrome. Significant gains were observed at an individual level for treated items in both groups (2/3 tDCS and 2/3 Sham). No significant changes in untreated items were observed at an individual level. Significant naming improvement in untreated items was not observed for the tDCS group and was seen at one time point only for the Sham group. Conclusions: We have demonstrated the feasibility of a novel method for selecting neurostimulation targets for PPA at the individual level. A larger study would be required to determine the long-term therapeutic efficacy of this method. Full article

Background/Objectives: Primary Progressive Aphasia (PPA) is a neurodegenerative disorder characterized by gradual and progressive deterioration of speech and language abilities. Speech and language therapy is considered an important intervention to slow decline and support the recovery of linguistic functions in individuals with PPA. This study aims to examine the effectiveness of an elaborated Semantic Feature Analysis (SFA) approach in enhancing naming abilities and semantic networks in individuals with the logopenic and semantic variants of PPA. Methods: Fourteen participants were recruited, including seven individuals with logopenic PPA and seven with semantic PPA. All participants received an elaborated SFA intervention twice weekly for four weeks. The Aphasia Language Assessment Test (ADD), the Turkish Picture Naming Test (T-RAT), and the SAQOL-39 were conducted at the following three time points: prior to treatment (pre-test), immediately after treatment (post-test), and one month post-treatment (follow-up). Results: Significant improvements were observed in ADD, T-RAT, and SAQOL-39 scores in both logopenic and semantic PPA groups following treatment (p < 0.05). Although follow-up scores declined compared to posttest performance (p < 0.05), several follow-up scores remained higher than pretest levels. Between-group comparisons indicated no significant difference in ADD scores; however, logopenic PPA participants demonstrated higher T-RAT scores (p < 0.05), while semantic PPA participants showed higher SAQOL-39 scores, except at follow-up (p < 0.05). Conclusions: Preliminary results suggest that the elaborated SFA intervention is effective in improving naming skills, language functioning, and quality of life in both logopenic and semantic variants of PPA. Although treatment gains partially decreased after one month, many improvements were maintained above baseline, supporting the clinical value of SFA in managing language decline in PPA. Full article

Introduction: Due to the inherent difficulty in obtaining information using language-based questionnaires, research on the quality of life (QOL) for persons with aphasia (PWAs) is lacking. The purpose of this study was to investigate which factors have an impact on a PWA and to investigate the reliability of using proxy responses from either spouse/caregivers or speech-language pathologists (SLPs). Methods: A QOL scale was developed with 11 factors identified in the literature as having an impact on the QOL of PWAs. Data were collected through interviews with 31 PWAs and 26 spouse/caregivers recruited from a community aphasia therapy center. Thirty-six SLPs responded to an online survey. Results: Vocation was identified by PWAs as having the most impact on their QOL and family as having the least impact. Cronbach’s alpha and intraclass correlation coefficients (ICCs) showed decreased internal consistency and reliability across ratings and respondents. Conclusions: Overall results suggest that proxy responses may not accurately reflect the factors that impact the QOL of a PWA but that spouse/caregiver responses may be more representative than those of SLPs. Full article

Background: Traditional aphasia therapy is often limited by insufficient dosage, a barrier that AI-assisted digital therapies are poised to overcome. However, it remains unclear whether gains on specific tasks translate to functional, real-world communication. This systematic review evaluates the effectiveness of these novel interventions and investigates the potential for a “generalization gap” when compared to conventional treatments for post-stroke aphasia rehabilitation. Methods: Following PRISMA guidelines, we systematically reviewed randomized controlled trials (2010–2024) from six databases. We included studies examining AI-powered digital platforms for adults with chronic post-stroke apha-sia that reported standardized language outcomes. Results: Our analysis of five trials (n = 366) shows that AI-assisted therapies successfully deliver high-dose interventions, leading to significant improvements in trained language skills, including word retrieval (up to 16.4% gain) and auditory comprehension. However, a critical “generalization gap” was consistently identified: these impairment-level gains rarely transferred to functional, real-world communication. Conclusions: AI-assisted digital therapies effectively solve the dosage problem in aphasia care and improve specific linguistic deficits. Their primary limitation is the failure to generalize skills to everyday use. Future platforms must therefore be strategically redesigned to incorporate therapeutic principles that explicitly target the transfer of skills, bridging the gap between clinical improvement and functional communication. Full article

Background/Objectives: People with primary progressive aphasia (PPA) and their communication partners report that having conversations becomes more difficult over time. They want speech and language therapy to help them have better conversations. Communication partner training has shown promise as an approach for people with PPA and their communication partners. However, there are currently no communication partner training programs available in Norwegian for people with PPA. The Better Conversations with Primary Progressive Aphasia (BCPPA) is a communication partner training program developed in the UK. In this study, we aimed to culturally adapt the BCPPA to meet the needs of Norwegian people with PPA. Methods: Guided by adaptation elements identified in a systematic review of frameworks for cultural adaptation, we translated the BCPPA into Norwegian before piloting it with four participant dyads, comprising people with PPA and their communication partners. The translated BCPPA was compared to the original BCPPA to identify adherence with core intervention components. Semi-structured interviews were used to explore the acceptability of the intervention to participant dyads. Outcome data, including Goal Attainment Scaling, coding of conversation behaviours from video samples, the Aphasia Impact Questionnaire, and the Communicative Effectiveness Index, were recorded pre-, post-, and three months after intervention delivery to explore outcomes for Norwegian participant dyads. We used the Framework for Reporting Adaptations and Modifications-Enhanced to document the modifications. Results: The results indicate high adherence to the core components in the original BCPPA. The pilot demonstrated that the participant dyads found the BCPPA acceptable, but they made some additional suggestions to complete the cultural adaptation further. Despite the progressive nature of PPA, the participant dyads achieved their goals on the Goal Attainment Scaling, and group analysis demonstrated maintenance on the Aphasia Impact Questionnaire and the Communicative Effectiveness Index over the three time points. Conclusions: This study demonstrates that the Norwegian version of the BCPPA was acceptable to the participants with PPA and their communication partner in this study. As the first communication partner training program for people with PPA and their communication partners in Norwegian, the BCPPA has the potential to be a valuable treatment tool to support people affected by PPA to have better conversations. Full article

Background: Transcranial direct current stimulation (tDCS) has emerged as a promising neuromodulatory tool for language rehabilitation in chronic aphasia. However, the effects of bi-hemispheric, multisite stimulation remain largely unexplored, especially in people with chronic and treatment-resistant language impairments. The goal of this study is to look at the effects on behavior and brain activity of an individualized language training program that combines bi-hemispheric multisite anodal tDCS with personalized language training for Albert, a patient with long-standing, treatment-resistant non-fluent aphasia. Methods: Albert, a right-handed retired physician, had transcortical motor aphasia (TCMA) subsequent to a left-hemispheric ischemic stroke occurring more than six years before the operation. Even after years of traditional treatment, his expressive and receptive language deficits remained severe and persistent despite multiple rounds of traditional therapy. He had 15 sessions of bi-hemispheric multisite anodal tDCS aimed at bilateral dorsal language streams, administered simultaneously with language training customized to address his particular phonological and syntactic deficiencies. Psycholinguistic evaluations were performed at baseline, immediately following the intervention, and at 1, 2, 3, and 6 months post-intervention. Resting-state fMRI was conducted at baseline and following the intervention to evaluate alterations in functional connectivity (FC). Results: We noted statistically significant enhancements in auditory sentence comprehension and oral reading, particularly at the 1- and 3-month follow-ups. Neuroimaging showed decreased functional connectivity (FC) in the left inferior frontal and precentral regions (dorsal stream) and in maladaptive right superior temporal regions, alongside increased FC in left superior temporal areas (ventral stream). This pattern suggests that language networks may be reorganizing in a more efficient way. There was no significant improvement in phonological processing, which may indicate reduced connectivity in the left inferior frontal areas. Conclusions: This case underscores the potential of combining individualized, network-targeted language training with bi-hemispheric multisite tDCS to enhance recovery in chronic, treatment-resistant aphasia. The convergence of behavioral gains and neuroplasticity highlights the importance of precision neuromodulation approaches. However, findings are preliminary and warrant further validation through controlled studies to establish broader efficacy and sustainability of outcomes. Full article

Background: Our study aimed to evaluate the impact of EVT on stroke outcomes in patients with LVO with a National Institute of Health Stroke Scale (NIHSS) score of ≤5, exhibiting primarily cortical signs. Methods: We conducted a multicenter registry-based analysis of patients with acute ischemic stroke with LVO who arrived within 12 h of onset. Among these, patients with low NIHSS scores and prominent cortical signs (Items 2, 3, 9, or 11) were included. Patients were divided into two groups: those who underwent EVT and those treated with the best medical therapy (BMT), which included intravenous thrombolysis where appropriate. The primary outcome measure was a modified Rankin scale (mRS) score of 0–1 at 3 months and symptomatic hemorrhagic transformation (SHT). We performed logistic regression analysis to evaluate the impact of EVT on the outcomes. Results: Of the 970 patients with LVO, 291 met the inclusion criteria, with 95 and 196 undergoing EVT and BMT, respectively. The EVT group demonstrated a significantly higher rate of 3-month mRS score of 0–1 (65.3% vs. 39.3%, p < 0.001) and a lower incidence of SHT than the BMT group (3.2% vs. 12.8%, p = 0.01). Multivariate analysis confirmed that EVT was associated with improved functional recovery (mRS score, 0–1; odds ratio [OR], 3.61; 95% confidence interval [CI], 1.82–7.06; p < 0.001) and reduced risk of SHT (OR, 0.19; 95% CI, 0.05–0.74; p = 0.02). Notably, patients with specific cortical signs, such as aphasia and spatial neglect, exhibited better outcomes with EVT. Conclusions: EVT may significantly improve the functional outcomes in patients with mild LVO stroke who present with cortical signs, despite low NIHSS scores. These findings suggest that cortical signs should be a key factor in EVT decision-making for mild stroke cases, thereby advocating for a more individualized approach in acute stroke management. Full article

Background: Primary progressive aphasia (PPA) is a neurodegenerative disease characterised by progressive impairment of speech and language abilities. Intensive speech and language teletherapy combined with remotely supervised, self-administered transcranial direct current stimulation (tDCS) may be suited to remove barriers to accessing potentially effective treatments, but there is only limited evidence on the feasibility of this combined approach. Methods: This pilot case series investigated the feasibility, tolerability and preliminary efficacy of a novel telerehabilitation programme combined with home-based, self-administered tDCS for people with primary progressive aphasia (pwPPA). The intervention programme was co-developed with pwPPA and their caregivers, to reflect their priorities regarding treatment content and outcomes (i.e., naming, functional communication). Results: Two pwPPA successfully completed the telerehabilitation intervention with daily naming training and communicative-pragmatic therapy paired with tDCS, over 10 consecutive workdays. Caregivers assisted in the setup of equipment required for teletherapy and home-based tDCS. Participants successfully completed the programme with a 95% completion rate. Home-based tDCS was well tolerated. Both participants showed improvements in naming and communication, suggesting preliminary efficacy of the intervention. Conclusions: Overall, this study demonstrates the feasibility and potential benefit of a novel, easily accessible and patient-relevant telerehabilitation intervention for pwPPA, which requires confirmation in a future larger-scale exploratory trial. Full article

Objective: Central neurocytomas (CNs), classified as CNS (central nervous system) grade 2 tumors, are exceptionally rare tumors, accounting for approximately 0.1–0.5% of all intracranial neoplasms, and are typically characterized by a benign clinical course and frequent association with hydrocephalus. This study aims to present a comprehensive analysis of surgical and adjuvant therapies for CN. Methods: The study comprised all patients who underwent microsurgical tumor removal in our center over the past decade (2013–2023). Clinical manifestations, surgical and adjuvant therapy approaches, MRI and histological findings, clinical outcomes, and recurrence-free survival were evaluated. Results: A total of eleven patients (six men, mean age of 28.0 years; five women, mean age of 53.6 years) underwent surgical treatment. Intraventricular tumors were the most common (72.7%, n = 8). The predominant presenting symptoms were headache and visual disturbances. All tumors exhibited contrast enhancement on MRI. Hydrocephalus was present in five patients. The Ki67 proliferation index ranged from 2% to 10%, with nine patients exhibiting Ki67 > 3%. The median recurrence-free survival was 38.0 months (IQR: 25.0–53.0). The most severe postoperative complications included aphasia, hemiparesis, and memory impairment, resulting in a postoperative Karnofsky Performance Status (KPS) below 70% in five patients. Follow-up assessments showed significant symptomatic improvement in all affected patients. Conclusions: Gross total resection is the recommended first-line therapy with favorable neurological outcomes and for atypical CN as well. Adjuvant radiotherapy should be reserved for tumor progression and recurrence. The role of adjuvant chemotherapy remains unclear, but it may be an option for CN with a high proliferation index. Full article

Deep learning (DL) approaches to natural language processing (NLP) offer powerful tools for creating digital twins (DTs) of patients in psychiatry and neurological rehabilitation by processing unstructured textual data such as clinical notes, therapy transcripts, and patient-reported outcomes. Techniques such as transformer models (e.g., BERT, GPT) enable the analysis of nuanced language patterns to assess mental health, cognitive impairment, and emotional states. These models can capture subtle linguistic features that correlate with symptoms of degenerative disorders (e.g., aMCI) and mental disorders such as depression or anxiety, providing valuable insights for personalized treatment. In neurological rehabilitation, NLP models help track progress by analyzing a patient’s language during therapy, such as recovery from aphasia or cognitive decline caused by neurological deficits. DL methods integrate multimodal data by combining NLP with speech, gesture, and sensor data to create holistic DTs that simulate patient behavior and health trajectories. Recurrent neural networks (RNNs) and attention mechanisms are commonly used to analyze time-series conversational data, enabling long-term tracking of a patient’s mental health. These approaches support predictive analytics and early diagnosis by predicting potential relapses or adverse events by identifying patterns in patient communication over time. However, it is important to note that ethical considerations such as ensuring data privacy, avoiding bias, and ensuring explainability are crucial when implementing NLP models in clinical settings to ensure patient trust and safety. NLP-based DTs can facilitate collaborative care by summarizing patient insights and providing actionable recommendations to medical staff in real time. By leveraging DL, these DTs offer scalable, data-driven solutions to promote personalized care and improve outcomes in psychiatry and neurological rehabilitation. Full article

Background and Objectives: Post-stroke aphasia (PSA) severely limits communication and quality of life. This case study explores the impact of an integrated Neurologic Music Therapy (NMT) approach, combining Melodic Intonation Therapy (MIT) and Therapeutic Singing (TS), on language recovery and brain reorganization in a 59-year-old woman with non-fluent motor aphasia following an ischemic stroke. Methods: Over 8 weeks, the patient underwent 24 sessions of MIT alongside standard speech therapy. Language abilities were assessed using the Western Aphasia Battery-Revised, while fMRI scans captured neurophysiological changes pre- and post-intervention. Results: The results showed significant language improvements: spontaneous speech increased by 68.9%, auditory comprehension by 30.8%, and naming by 83.3%. The Aphasia Quotient rose from 39.3 to 61.4, marking a shift from severe to moderate aphasia. Neuroimaging revealed heightened activation in both hemispheres, especially in the superior frontal and parietal regions, supplementary motor area, and superior temporal gyrus. Increased engagement of the limbic system, particularly the paracingulate gyrus, pointed to emotional involvement and widespread cortical reorganization. Conclusions: These findings highlight the effectiveness of integrating MIT and TS with emotionally meaningful music, supporting language recovery and neural plasticity in PSA. Full article

Background: Primary progressive aphasia (PPA) is a neurodegenerative disorder that worsens over time without appropriate treatment. Although referral to a speech and language pathologist is essential for diagnosing language deficits and developing effective treatment plans, there is no scientific consensus regarding the most effective treatment. Thus, our study aims to assess the efficacy and safety of various therapeutic interventions for PPA. Methods: Google Scholar, PubMed, Web of Science, and the Cochrane Library databases were systematically searched to identify articles assessing different therapeutic interventions for PPA. To ensure comprehensive coverage, the search strategy employed specific medical subject headings. The primary outcome measure was language gain; the secondary outcome assessed overall therapeutic effects. Data on study characteristics, patient demographics, PPA subtypes, therapeutic modalities, and treatment patterns were collected. Results: Fifty-seven studies with 655 patients were included. For naming and word finding, errorless learning therapy, lexical retrieval cascade (LRC), semantic feature training, smartphone-based cognitive therapy, picture-naming therapy, and repetitive transcranial magnetic stimulation (rTMS) maintained effects for up to six months. Repetitive rTMS, video-implemented script training for aphasia (VISTA), and structured oral reading therapy improved speech fluency. Sole transcranial treatments enhanced auditory verbal comprehension, whereas transcranial direct current stimulation (tDCS) combined with language or cognitive therapy improved repetition abilities. Phonological and orthographic treatments improved reading accuracy across PPA subtypes. tDCS combined with speech therapy enhanced mini-mental state examination (MMSE) scores and cognitive function. Several therapies, including smartphone-based cognitive therapy and VISTA therapy, demonstrated sustained language improvements over six months. Conclusions: Various therapeutic interventions offer potential benefits for individuals with PPA. However, due to the heterogeneity in study designs, administration methods, small sample sizes, and lack of standardized measurement methods, drawing a firm conclusion is difficult. Further studies are warranted to establish evidence-based treatment protocols. Full article

Background/Objectives: In recent years, the popularity of non-verbal cognitive training for aphasia has increased. Building on evidence that language abilities engage brain areas involved in executive functions (EFs) processing, this review aims to analyze the utility of EFs training alone or combined with traditional rehabilitation approaches to improve language abilities in aphasia. Methods: Systematic searches were performed in four databases evaluating studies focusing on the effects of EFs training in language rehabilitation, yielding 185 studies. After reading the full text of the selected studies and applying predefined inclusion criteria, nine studies were included based on pertinence and relevance to the topic. This systematic review has been registered in the Prospective Register of Systematic Reviews (PROSPERO 2024) with the number CRD42024519087. Results: The results of the analyzed studies indicate that various EFs training methods, such as computer-assisted executive control training, Cognitive Flexibility in Aphasia Therapy (CFAT), and the Dr. Neuronowski^® program, as well as the combination of transcranial direct current stimulation (tDCS) with EFs training, can lead to improvements in language abilities in people with aphasia. Additionally, EFs training often results in specific effects on treated functions like working memory (near transfer effects) and untreated ones such as spoken sentence comprehension (far transfer effects). Conclusions: Despite the heterogeneity of the treatments and the small simple size of the studies analyzed, preliminary results are promising. Future research should further explore the effectiveness and specific contribution of EFs training to improving language functions in aphasia. Full article

Background: Patients with functional neurological disorder presenting as stroke mimics or functional stroke mimics (FSMs) pose significant diagnostic challenges. In the acute phase, especially when patients are present within the therapeutic window for acute reperfusion treatments, a misdiagnosis of FSM can lead to unnecessary and costly interventions. Despite its clinical importance, the literature on the risk factors for FSM is limited. This study aims to compare the clinical and epidemiological characteristics of patients with FSM to those with confirmed acute ischemic stroke (AIS). Methods: This case–control study involved temporal matching between consecutive series of patients with FSM and controls with AIS from a single tertiary university hospital in southern Portugal. Results: A total of 188 patients were included: 64 cases (FSM) and 188 controls (AIS). The rate of stroke code activation and use of ambulance between was comparable between the two groups. The group of patients with FSM was younger (53.2 years vs. 69.5 years, p < 0.001) and had a higher proportion of females (52.4% vs. 47.6%, p = 0.001). There was no difference in terms of clinical severity at presentation. The proportion of specific signs, such as transcortical aphasia (3.1% vs. 20.9%, p = 0.014), gait abnormalities (15.6% vs. 33.9%, p = 0.004), and cranial nerve abnormalities (31.2% vs. 43.5%, p = 0.042), was lower in the FSM group compared to the AIS group. The proportion of patients on antithrombotic therapy (90.9% vs. 9.1%, p = 0.007) and antihypertensive drugs (78.5%, vs. 21.5%, p < 0.001) prior to the event was significantly higher in the AIS group. Likewise, the prevalence of cerebrovascular risk factors such as diabetes mellitus (14.3% vs. 85.7%, p = 0.005), arterial hypertension (23.8% vs. 76.2%, p = 0.001), and smoking (43.7% vs. 56.3%, p = 0.005) was lower in the FSM group compared to the AIS group. No statistically significant differences were observed in cholesterol levels or the prevalence of dyslipidemia between the two groups. Psychiatric comorbidities, including generalized anxiety disorder (71.4% vs. 28.6%, p = 0.05) and major depressive disorder (61.9% vs. 28.1%, p = 0.01), were more prevalent in the FSM group. Conclusions: Patients with FSM display different clinical and epidemiological profiles, with a higher likelihood of being younger, female, having prior psychiatric conditions, and lacking traditional cerebrovascular risk factors. Full article

Background: In current clinical practice, resources remain limited and are insufficient to address the needs of people with chronic post-stroke aphasia. To improve access to speech therapy, self-administered therapies using computers or smart tablets are increasingly recommended. In addition to enabling more intensive and prolonged treatment, computer- and smart-tablet-delivered therapies can be highly enjoyable and motivating for patients. Aims: This systematic review aimed to identify computer- and smart-tablet-based self-administered treatments and analyze the proposed interventions in terms of treatment targets, effectiveness (considering specificity, generalization, transfer, and maintenance), and clinician involvement (during and/or prior self-administered therapies). Methods: Terms encompassing three main concepts (rehabilitation, self-administration, and aphasia) were used to search three electronic databases (Scopus, PubMed, and PsycINFO). Two reviewers independently screened titles and abstracts against eligibility criteria. Data extraction of included studies was completed by three reviewers. Results: Thirty-nine studies were included in this study. In terms of treatment targets, anomia is the most treated symptom in published studies (n = 24), but the existence of promising studies for other disorders means that the targets can be broadened. Therapies are effective for trained items, and gains are maintained. There is some evidence of transfer effects for treatments targeting the sentence level. Most studies offer training sessions, previous self-administered therapy, and/or observation and monitoring sessions during therapy; more rarely, self-administered therapy is supplemented with face-to-face therapy. Conclusions: This systematic review is the first to focus specifically on self-administered technology-based therapies. It provides important evidence-based information for clinical practice in self-administered therapies via computer or smart tablet. Full article