Home treatment for aphasic patients by trained nonprofessionals.

Thirty-seven aphasic men received 8-10 hr of individual treatment each week for 12 weeks from a home therapist (wife, friend, relative) who was trained and directed by a speech pathologist. Treatment was followed by 12 weeks of no treatment. Patients were evaluated at entry and at 6, 12, 18, and 24 weeks after entry with a battery of speech and language measures. The group made substantial progress on all measures during the 12 weeks of treatment and ceased to progress when treatment was discontinued. Progress for the home treatment patients did not differ significantly from that of patients who received 12 weeks of individual treatment from speech pathologists or from that of patients for whom treatment was deferred for 12 weeks. Patient selection, training of the home therapists, and other methodological aspects are described to assist speech pathologists in making decisions about the use of trained volunteers in aphasia treatment.

Comparison of clinic, home, and deferred language treatment for aphasia. A Veterans Administration Cooperative Study.

Aphasic patients who met stringent selection criteria were assigned randomly to three groups: clinic treatment by a speech pathologist for 12 weeks, followed by 12 weeks of no treatment; home treatment by a trained volunteer for 12 weeks, followed by 12 weeks of no treatment; or deferred treatment for 12 weeks, followed by 12 weeks of treatment by a speech pathologist. At 12 weeks after entry, language measures indicated that the clinic-treatment patients made significantly more improvement than did the deferred-treatment patients, and improvement in home-treatment patients did not differ significantly from either clinic- or deferred-treatment patients. At 24 weeks after entry, after deferred-treatment patients had received clinic treatment, there were no significant differences among the groups. These results suggest that clinic treatment for aphasia is efficacious, and delaying treatment for 12 weeks does not compromise ultimate improvement.

Self-monitoring behavior in a case of severe auditory agnosia with aphasia.

This case report describes an unusual combination of speech and language deficits secondary to bilateral infarctions in a 62-year-old woman. The patient was administered an extensive series of speech, language, and audiologic tests and was found to exhibit a fluent aphasia in which reading and writing were extremely well preserved in comparison to auditory comprehension and oral expression, and a severe auditory agnosia. In spite of her auditory processing deficits, the patient exhibited unexpected self-monitoring ability and the capacity to form acoustic images on visual tasks. The manner in which she corrected and attempted to correct her phonemic errors, while ignoring semantic errors, suggests that different mechanisms may underlie the monitoring of these errors.

Lipid peroxidation in alcoholic myopathy and cardiomyopathy.

The hypothesis is presented that lipid peroxidation is responsible for the damage in skeletal and cardiac muscle of chronic alcoholic subjects. The enhanced lipid peroxidation is caused by the accumulation of oxygen radicals. Both excessive production and decreased disposal of oxygen radicals can arise from the acetaldehyde formed in the oxidation of ethanol. Although acetaldehyde from hepatic sources may contribute, muscle itself can generate significant amounts of acetaldehyde through the action of muscle catalase. The effects of alcohol on other tissues, and its known long-term effects on membranes lend support to this hypothesis. The ultrastructural features of the alcoholic myopathies provide further support. The resemblance between vitamin E-deficiency myopathy and the alcoholic myopathies is strong additional evidence in favor of this hypothesis.

Apneic spells in progressive dialysis encephalopathy.

A 53-year-old patient with progressive dialysis encephalopathy is discussed. In addition to the clinical features previously described in this syndrome, the patient had spells of sudden respiratory arrest in close association with the episodic EEG abnormalities characteristic of the syndrome.

Connective tissue metabolism in normal and atrophic skeletal muscle.

The first two enzymes of the pentose-phosphate pathway (G6PD and 6PGD) were studied in rabbit skeletal muscle. Their activities closely paralleled the connective tissue levels in each individual muscle, and they increased in atrophying muscles at the same rate as connective tissue. Skeletal muscle tendons and subcutaneously implanted polyvinyl sponges, both of which consist of relatively pure connective tissue, displayed much higher activity of these enzymes than the muscle homogenates. These results suggest that pentose synthesis in muscle is mostly confined to its connective tissue elements, raising the possibility of a role for connective tissue in the biosynthetic processes of skeletal muscle. The contribution of connective tissue to the results of muscle quantitative studies may be significant, and even overshadow other values in atrophic muscles, where the muscle cell population may be greatly reduced. The interpretation of quantitative biochemical studies on pathological muscle samples should take this factor into consideration.