Validity and features of spontaneous speech in acute aphasia as evaluated with the Brief Aphasia Evaluation: is fluent aphasia more severe than nonfluent aphasia? / Validez y características del habla espontánea en la afasia aguda evaluada con la Evaluación Breve de la Afasia: ¿Es la afasia fluente más severa que la no fluente?

ABSTRACT Purpose To explore the relationship between the two components of spontaneous speech in the Brief Aphasia Evaluation (BAE) and the rest of the scale represented by its three main factors: The Expression, Comprehension, and Complementary factors. Methods BAE has proven validity and reliability. The evaluation of spontaneous speech in this scale comprises two components: Performance Rank (score: 0-3) and Type of Disorder (Fluency [F], Content [C], or Mixed [FC]) when rank < 3. Sixty-seven patients with left brain damage and 30 demographically matched healthy participants (HP) were studied. It was analyzed the correlation between Performance Rank and the three BAE factors and, recoding 3 as 0 and < 3 as 1, the sensitivity/specificity of this component for each factor. The effect of Type of Disorder on the three factors was analyzed. Results 1) Performance Rank: Correlations of 0.84 (Expression), 0.81 (Comprehension), and 0.76 (Complementary) were observed, with a sensitivity and specificity ≥ 78% for any factor; 2) Type of Disorder: The performance significantly decreased from FC to C and from C to F in Expression (FC < C < F), from FC to C and from FC to F also in Comprehension and Complementary, from patients with any type of disorder to HP. Conclusion Performance Rank was a relevant indicator of aphasia by its consistency with valid and comprehensive dimensions of acute language impairments. A degree difference between F and C was observed, being F a milder disorder; i.e., fluency problems were less severe than retrieval or anomia ones.

RESUMEN Objetivo Explorar la relación entre los dos componentes del habla espontánea en la Evaluación Breve de la Afasia (EBA) y el resto de la escala, representada por sus tres factores principales: Expresión, Comprensión y Complementario. Método EBA ha demostrado validez y confiabilidad. La evaluación del habla espontánea consta de dos componentes: Grado de Desempeño (puntuación: 0-3) y Tipo de Trastorno (Fluidez (F), Contenido (C), o Mixto (FC)) cuando grado<3. Se estudiaron 67 pacientes con lesión cerebral izquierda y 30 participantes sanos (PS), emparejados demográficamente. Se analizó la correlación entre Grado de Desempeño y los tres factores de EBA y, recodificando 3 como 0 y <3 como 1, la sensibilidad/especificidad del componente para cada factor. Se analizó el efecto de Tipo de Trastorno sobre los tres factores. Resultados 1) Grado de Desempeño: Se observaron correlaciones de 0,84 (Expresión), 0,81 (Comprensión), y 0,76 (Complementario), con una sensibilidad y especificidad ≥ 78% para cualquier factor; 2) Tipo de Trastorno: El desempeño disminuyó significativamente desde FC a C y desde C a F en Expresión (FC<C<F); desde FC a C y desde FC a F también en Comprensión y Complementario; desde los pacientes con cualquier tipo de trastorno a PS. Conclusión Grado de Desempeño fue un indicador relevante de la afasia por su consistencia con dimensiones válidas y comprensivas de trastornos agudos del lenguaje. Se observó una diferencia de grado entre F y C, siendo F un trastorno más leve, vale decir, los problemas de fluidez fueron menos severos que los de evocación o anomia.

Afasia: una perspectiva clínica / Aphasia: a clinical perspective

Language is a complex and dynamic system of conventional signs that results from the functioning of different brain areas located mainly in the left hemisphere. Clinical evaluation of aphasia implicates the examination of oral and written language. Aphasia is an acquired language disorders due to a brain damage that affect all modalities: oral expression, auditory comprehension, reading and writing. Various types of aphasias can be induced, each with well defined clinical characteristics that can be correlated with specific areas of the brain. The prognosis depends mainly on the etiology, size of the lesion, type of aphasia and its severity. Treatment objectives include: satisfying the communicational needs of the patient, and achieving psychosocial adaptation of the subject and his family. Both objectives improve the quality of life of our patients...

[Comparison of picture naming ability in fluent and non-fluent aphasics: an analysis of 4 cases]

Impairment of noun retrieval is common among aphasic patients, but some of previous studies represent differences between noun retrieval ability of various aphasia syndromes. Current study investigates and compares the picture naming ability of 4 patients with fluent and non-fluent aphasia. Present study investigated the naming ability of 2 fluent and 2 non-fluent aphasic patients with oral picture naming test. This test contains line drawing of 109 nouns. Patients were asked to name each picture with a single word. Responses were classified according to Philadelphia Naming Test scoring system as correct and semantic, formal, mixed, non-word, unrelated and others error [no response, description/circumlocution, miscellaneous error]. Then, the data were investigated in terms of descriptive statistics and analyzed by Mann-Whitney U test. The score of non-fluent aphasics was more than fluent ones. The percentage of semantic errors in fluent group and no responses among non-fluent patients were more than the other types. Despite of personal differences, all error types were found in responses of patients. The difference between score and error types in fluent and non-fluent patients was not significant [p>.05]. This scoring system can define a variety of word retrieval errors. The fluent aphasics have more noun retrieval problems than non-fluent patients. Although, there are differences between two groups, but error type in picture naming is not a precise factor for distinguish between various aphasia syndromes and there is similarity in impaired underling mechanisms and naming behavior of them

Lexical-semantic processing in the semantic priming paradigm in aphasic patients / Processamento léxico-semântico no paradigma de priming semântico em pacientes afásicos

There is evidence that the explicit lexical-semantic processing deficits which characterize aphasia may be observed in the absence of implicit semantic impairment. The aim of this article was to critically review the international literature on lexical-semantic processing in aphasia, as tested through the semantic priming paradigm. Specifically, this review focused on aphasia and lexical-semantic processing, the methodological strengths and weaknesses of the semantic paradigms used, and recent evidence from neuroimaging studies on lexical-semantic processing. Furthermore, evidence on dissociations between implicit and explicit lexical-semantic processing reported in the literature will be discussed and interpreted by referring to functional neuroimaging evidence from healthy populations. There is evidence that semantic priming effects can be found both in fluent and in non-fluent aphasias, and that these effects are related to an extensive network which includes the temporal lobe, the pre-frontal cortex, the left frontal gyrus, the left temporal gyrus and the cingulated cortex.

Há evidências de que os déficits de processamento léxico-semântico explícitos que caracterizam a afasia podem ser observados na ausência de déficits semânticos implícitos. O objetivo deste artigo foi analisar criticamente a literatura internacional sobre processamento léxico-semântico na afasia, avaliado por meio do paradigma de priming semântico. Especificamente, esta revisão teve seu foco na afasia e processamento léxico-semântico, pontos fortes e fracos da metodologia dos paradigmas léxico-semânticos usados, e evidências recentes de estudos de neuroimagem sobre o processamento léxico-semântico. Além disso, evidências de dissociações entre processamento léxico-semântico implícito e explícito relatadas na literatura serão discutidas e interpretadas, relacionando-se aos dados de neuroimagem funcional de amostras saudáveis. Há indícios de que os efeitos de priming semântico podem ser encontrados tanto em afasias fluentes como em não fluentes, e que esses efeitos são relacionados a uma extensa rede que inclui o lobo temporal, o córtex pré-frontal, o giro frontal esquerdo, o giro temporal esquerdo e o córtex cingulado.

Estudio del discurso de una paciente con discapacidad congénita sensorial y motriz: análisis comparativo de dos momentos del tratamiento / Study of the discourse of a patient suffering a congenital sensory and motor handicap: comparative analysis of two moments in the treatment

Una dificultad insoslayable en la clínica con personas con discapacidad congénita, es la de sintonizar con un aparato psíquico cuya constitución es diferente al de las personas sin déficit. Objetivo: La investigación tiene por objeto el estudio del tipo de función psíquica dominante, en el discurso de un paciente con discapacidad congénita sensorial y motriz, analizando en particular la importancia del pensamiento abstracto. Metodología: Aplicamos el programa computarizado del Algoritmo David Liberman (ADL), construido sobre la base de la teoría freudiana de las pulsiones. Se parte de la idea que la pulsión se conquista un determinado lenguaje en el yo. Este método es sensible en detectar en un discurso tanto las fijaciones libidinales como las defensas. El diccionario corresponde, en el marco del ADL, al nivel de análisis de las palabras. También aplicamos al material el análisis de los actos del habla. Procedimiento: Se privilegian las verbalizaciones de la paciente tanto del inicio como del final de dos sesiones psicoterapéuticas espaciadas en el tratamiento. Se le aplica a los fragmentos seleccionados el diccionario. Se analizan sus resultados y luego se los compara. Finalmente se cruzan los datos con los obtenidos en el análisis de los actos del hablaResultados: Se pone en evidencia el predominio del erotismo oral primario en primer lugar y en segundo lugar el anal secundario, lo cual manifiesta el énfasis puesto por la paciente en su actividad intelectual y cognoscitiva, que se da de manera exitosa. Realizamos una propuesta metodológica para discernir a través del método la diferencia entre ambos tipos de pensamiento.

Treatment of congenitally handicapped people presents the unavoidable difficulty of harmonizing with a psychic constitution which differs from the one of people presenting no deficit. Aim: The aim of the research is the study of the type of main psychic function in the speech of a patient with congenital sensory and motor impairment, analyzing in particular the importance of abstract thinking. Methodology: The application of the David Liberman computerized program (DLA), based on the Freudian theory of drives. The core idea is that the drive gains control ofa determined language in the ego. This method is sensitive to the detection of libidinal fixations in discourse as well as to defenses. The dictionary corresponds, in the DLA frame, to the word analysis level. The speech acts analysis was also applied to the segment. Procedure: The patient´s verbalizations are privileged at the beginning as well as atthe end of two time spaced psychotherapeutic sessions. The dictionary was applied to the selected fragments. The results were analyzed and then compared. Finally the dataobtained was contrasted with the data obtained in the speech acts analysis.Results: The primary oral language is dominant and the secondary anal is next in importance. This is a manifestation of the patient´s emphasis on her intellectual and cognitive activity, which proves successful. A methodological proposition is put forward to discriminate between both types of thinking.

Language Profiles of Transcortical Aphasia

BACKGROUND: The term "transcortical aphasia" is applied to primary lesions not involving the receptive and expressive language areas, but rather the areas connected to the association cortex. By definition, patients with transcortical aphasia can repeat what they have heard, but they have difficulty producing spontaneous speech or understanding speech. This paper reports the clinical features of stroke patients with transcortical aphasia to delineate the language profiles of its subtypes. METHODS: Eighty patients with stroke were divided into three subtypes of transcortical aphasia: transcortical sensory aphasia, transcortical motor aphasia, and mixed transcortical aphasia. A Korean version of the Western Aphasia Battery was used to compare the subdomains of language ability among the three groups. RESULTS: The patients showed a relatively preserved repetition ability, but the performances in repetition and generative naming, and the aphasia quotient were highest in the transcortical sensory aphasic group, followed by the transcortical motor aphasic and mixed transcortical aphasic groups. CONCLUSIONS: The present study provides detailed information on the language profiles of the three subtypes of transcortical aphasia, which can be differentiated based on the aphasia quotient and generative naming scores.

Severity of Post-stroke Aphasia According to Aphasia Type and Lesion Location in Koreans

To determine the relations between post-stroke aphasia severity and aphasia type and lesion location, a retrospective review was undertaken using the medical records of 97 Korean patients, treated within 90 days of onset, for aphasia caused by unilateral left hemispheric stroke. Types of aphasia were classified according to the validated Korean version of the Western Aphasia Battery (K-WAB), and severities of aphasia were quantified using WAB Aphasia Quotients (AQ). Lesion locations were classified as cortical or subcortical, and were determined by magnetic resonance imaging. Two-step cluster analysis was performed using AQ values to classify aphasia severity by aphasia type and lesion location. Cluster analysis resulted in four severity clusters: 1) mild; anomic type, 2) moderate; Wernicke's, transcortical motor, transcortical sensory, conduction, and mixed transcortical types, 3) moderately severe; Broca's aphasia, and 4) severe; global aphasia, and also in three lesion location clusters: 1) mild; subcortical 2) moderate; cortical lesions involving Broca's and/or Wernicke's areas, and 3) severe; insular and cortical lesions not in Broca's or Wernicke's areas. These results revealed that within 3 months of stroke, global aphasia was the more severely affected type and cortical lesions were more likely to affect language function than subcortical lesions.

Non-convulsive status epilepticus presenting with wernick's aphasia

Ictal aphasia in adults is a rare phenomenon. Most reported cases manifest with non-fluent [Broca] aphasia. Ictal fluent [Wernicke] aphasia is less common. We report a 47-year-old, right-handed woman that presented with recurrent episodes of non-convulsive seizures in the form of Wernickes aphasia for 2 weeks. An MRI of the brain showed an old cerebral infarction in the left parieto-occipital area. Scalp EEG revealed continuous periodic sharp waves at the left temporal regions with diffusion to the whole left hemisphere and at occasions to the right. This is followed by variable periods of post ictal slowing. Recurrence of the described ictal pattern was noted. Management of status epilepticus was started in the form of intravenous diazepam and a loading dose of phenytoin and phenobarbitone. After treatment, she improved clinically and the EEG improved with disappearance of the left temporal ictal rhythm and normalization of the EEG background. Thus, establishing the diagnosis of non-convulsive partial status epilepticus manifesting as ictal aphasia

The Therapeutic Effect of Inhibitory Repetitive Transcranial Magnetic Stimulation on Right Inferior Frontal Gyrus in Subcortical Aphasia

OBJECTIVE: To investigate whether suppression of right inferior frontal gyrus (Broca's homologue) by 1 Hz repetitive transcranial magnetic stimulation (rTMS) can improve speech recovery. METHOD: We applied low frequency rTMS on right Broca's homologue twice a week for 6 weeks in eight subcortical aphasia patients who were 3 months to 3 years poststroke onset. They were tested with Korean Version-Western Aphasia Battery before and after procedure. Also, they were tested with Parallel Short Forms for the Korean-BostonNaming Test and Animal Naming Test serially for outcome measure. rTMS was performed with intensity of 80% of motor threshold for 10 min (600 pulses) at 1 Hz frequency. RESULTS: Significant improvement was observed in picture naming at post-rTMS only in nonfluent aphasia patients but not in fluent aphasia patients. CONCLUSION: rTMS may provide a novel treatment for aphasia by possibly modulating the distributed, bi-hemispheric language network.

Expresión de la pantomima en pacientes afásicos / Pantomimic expression in aphasic patients

El paciente afásico comúnmente muestra alteraciones a nivel gestual, observándose diferencias entre afásicos fluentes y no fluentes. Sin embargo, no está claro si la naturaleza del déficit es simbólica o práxica. El presente estudio compara el rendimiento de la pantomima en pacientes afásicos (Broca y Wernicke) según: severidad de afasia, comprensión de la pantomima, apraxia ideomotora y déficit cognitivo. Además, compara el rendimiento entre pacientes y sujetos normales, realizándose un análisis cualitativo de los tipos de errores cometidos por los pacientes. Los resultados muestran que los pacientes afásicos rinden significativamente peor que los normales y que los afásicos de Broca rinden significativamente mejor que los afásicos de Wernicke. Por otra parte, la severidad de afasia correlaciona significativamente con el rendimiento de la pantomima en ambos. La comprensión de la pantomima y la apraxia ideomotora correlacionaron significativamente solo con los afásicos de Wernicke. La respuesta más común en los afásicos de Broca fue la de tipo incompleta y en los afásicos de Wernicke fue la de tipo relacionada.

A Case of the Fluent Form of Primary Progressive Aphasia Presenting as Conduction Aphasia

Primary progressive aphasia(PPA) can be classified into nonfluent and fluent types. The fluent PPA usually manifests as Wernicke's or transcortical sensory aphasia. We report a 61-year-old right-handed woman who presented with a fluent PPA. An aphasia test revealed fluent speech and intact comprehension but decreased repetition and naming, consistent with conduction aphasia. Other cognitive functions and activities of daily living were preserved. Brain MRI and SPECT respectively showed a focal atrophy and a hypoperfusion in the left temporal lobe.

Abordagem discursiva no tratamento da afasia de Wernicke: a eficácia da intervenção fonoaudiológica / Discursive approach in the treatment of Wernicke aphasia: efficacy of speech and language therapy intervention

Tema: este trabalho refere-se ao caso de uma paciente com afasia de Wernicke subseqüente a acidente vascular cerebral isquêmico e seu tratamento. Objetivo: buscar interações sociais mais satisfatórias por meio de uma maior contextualização das interações comunicativas. Material e Método: a abordagem discursiva visou retomar de forma efetiva a vivência lingüística da paciente. Resultados: a abordagem foi motivadora, promoveu uma maior adesão ao tratamento e privilegiou a atuação dos familiares como facilitadores desde que orientados pelo fonoaudiológo. Conclusão: houve reintegração social apesar dos limites da patologia.

Neuropsychological and Neuroimaging Findings of Semantic Dementia

BACKGROUND: Semantic dementia (SD) is a temporal variant of frontotemporal lobar degeneration (FTLD), which is characterized by naming difficulty, decreased comprehension of words, prosopagnosia and object visual agnosia. We report clinical features, neuropsychological and neuroimaging findings of 4 patients with SD. METHODS: Of 55 patients diagnosed as having FTLD between Jan 1995 and May 2001 at Samsung Medical Center, four patients fulfilled the diagnostic criteria of SD proposed by consensus on FTLD diagnostic criteria. We investigated their clinical features such as presenting symptoms and abnormal behaviors, neuropsychological and neuroimaging findings. Neuropsychological tests included the Seoul Neuropsychological Screening Battery, the Korean-version of Western Aphasia Battery and Hanja reading and writing. All patients underwent brain MRI and FDG-PET. RESULTS: All of the patients showed naming difficulty as a presenting symptom. Language assessments showed severe naming and compre-hension difficulties with preserved fluency and repetition, which were compatible with transcortical sensory aphasia. Whereas Hangul reading aloud and writing were intact, three patients were impaired at Hanja reading and writing. Other neuropsychological tests were remarkable for prosopagnosia, object visual agnosia and memory loss. Brain MRI showed asymmetric temporal atrophies, mainly left antero-inferior temporal cortices. FDG-PET also showed hypome-tabolism in bilateral anterior temporal lobes, more severe on the left. CONCLUSIONS: Our SD patients had characteristic neuropsychological and neuroimaging findings, which can be differentiated from other neurodegenerative diseases. We also found Hanja alexia and agraphia in SD patients, which has not been reported yet.

Preliminary results of the treatment of Hirschprung's disease by survey through posterior sagittal approach

The aim of the study is to describe the technique of operation for Hirschprung's disease by a Soave modified procedure through the posterior sagittal approach, to propose the indications and to evaluate the early result. From January 2000 to April 2000, 26 children suffering from Hirschprung's disease were operated by this technique. There was no mortality during and after operation. The anastomosis leakage occurred in one patient. The posterior sagittal approach is a convenient and safe one in survey for Hirschprung's disease with the ganglionic segment involves in the rectum and sigmoid.

Neuropsicologia. VII - Distúrbios da linguagem. Afasias - aspectos neuroclínicos/neuropsicológicos / Neuropsychology. VII - Language disordes. Aphasias - Neuroclinics/neuropsychologies aspects

A linguagem normal correspondente à recpçåo e à expressåo de idéias e sentimentos por meios verbais e nåo verbais. Os autores definem as funçöes/disfunçöes da linguagem e as principais síndromes afásicas. Såo feitas consideraçöes em relaçåo a aspectos especiais das afasias, assim como à comunicaçåo nåo verbal e seus distúrbios

Estudio de las funciones musicales en los pacientes afásicos / A study of musical function in aphasics

Las capacidades musicales fueron evaluadas en 20 pacientes afásicos, con lesiones únicas en hemisferio cerebral izquierdo. Las alteraciones musicales fueron raras en afasias de Broca (n=7), solo el 14% tenía trastornos rítmicos y el 28% melódicos. La mitad de los pacientes con afasias de Wernicke (n=4) mostraron compromiso en los aspectos rítmicos y de discriminación auditiva. Las mayores alteraciones neurosonoromusicales aparecieron en afasias globales (n=6), estando comprometidos los aspectos rítmicos en el 83% de los casos. Estas lesiones en hemisferio izquierdo mostraron que la función más alterada fue la rítmica (55%) cuyas superposiciones lesionales se encontraron sistemáticamente en el área postrolándica parietotemporal medial. Sólo el 20% tenía falla en los aspectos melódicos y el 25% en la discriminación auditiva

Afasias: evaluación-rehabilitación y pronóstico / Aphasias: evaluation-rehabilitation and prognostic

Con la finalidad de comprobar la utilidad del Test de Barcelona en la evolución Rahabilitadora de pacientes con Afasia, se estudiaron 100 pacientes del Servicio de Neuropsicología y Logopedia del Hospital Del Mar, Barcelona-España. La etiología fue Accidente cerebrovascular en 90 por ciento, Infección Cerebral 2 por ciento, tumores cerebrales 5 por ciento y Traumatismo Encéfalo craneano 3 por ciento. Se usó para el diagnóstico y seguimiento de la evolución y recuperación del paciente un pre-test y un post-test después de 6 meses de terapia intensiva y repetitiva del Lenguaje. Los datos fueron procesados estadísticamente

Afasia global sin hemiparesia por lesión frontal / Global aphasia without hemiparesis by frontal lesion

La afasia global sin hemiparesia es un síndrome neurológico reconocido a partir de 1982. El sustrato patológico de la presentación del síndrome ha sido relacionado con dos diferentes tipografías lesionales, demostradas por la tomografía axial computarizada cerebral; doble infarto que comprometen el área de BROCA y el área de WERNICKE, o infarto único perisilviano que respeta el territorio profundo capsular, en el hemisferio dominante. Siendo la encefalopatía embólica la causa más frecuente. Presentamos un nuevo caso de afasia global sin hemiparesia remarcando la localizacion perisilviana frontal como una de las localizaciones más frecuentes de lo que se puede esperar, asociado a signos de lesión frontal.

Distúrbio perceptual na anosognosia na afasia de Wernicke e o processo terapêutico / Perceptual disorder in anosognosia in Wernicke's aphasia and the therapeutic process

A case study of an Wernicke's aphasic with anosognosia pointed out a selective percentual disorder underlying the unconsciousness for his anomalous speech: a failure in phonemic decodification, whereas auditive form perception conected with the semantic lexicon maintainded intact. Speech pathology procedures for evaluation and therapy are discussed showing his speech improvement due to an attentional work and to the development of visual and somestesic strategies