Success rates of intensive aphasia therapy: real-world data from 448 patients between 2003 and 2020.

BACKGROUND: Aphasia is a devastating consequence after stroke, affecting millions of patients each year. Studies have shown that intensive speech and language therapy (SLT) is effective in the chronic phase of aphasia. Leveraging a large single-center cohort of persons with aphasia (PWA) including patients also in the subacute phase, we assessed treatment effects of intensive aphasia therapy in a real-world setting. METHODS: Data were collected at the Aachen aphasia ward in Germany between 2003 and 2020. Immediate treatment responses across different language domains were assessed with the Aachen Aphasia Test (AAT) using single-case psychometrics, conducted before and after 6-7 weeks of intensive SLT (10 h per week, median (IQR) dosage = 68 (61-76)). We adjusted for spontaneous recovery in subacute patients. Differential treatment effects between subgroups of chronicity and predictors of therapy response were investigated. RESULTS: A total of 448 PWA were included (29% female, median (IQR) age = 54 (46-62) years, median (IQR) time post-onset = 11 (6-20) months) with 12% in the early subacute, 15% in the late subacute and 74% in the chronic phase of aphasia. The immediate responder rate was 59%. Significant improvements in all AAT subtests und subscales were observed hinting at broad effectiveness across language domains. The degree of therapy-induced improvement did not differ between the chronicity groups. Time post-onset, dosage of therapy and aphasia severity at the beginning of treatment were predictors of immediate treatment response. DISCUSSION: Intensive therapy protocols for aphasia after stroke are yielding substantial responder rates in a routine clinical setting including a wide range of patients.

Mimicking effects of auditory verbal hallucinations on language production at the level of words, sentences and stories.

Schizophrenia is characterised foremost by hallucinations, delusions and disorganised speech. Deficits in the internal speech monitor may contribute to the development of auditory-verbal hallucinations. This study investigates potential effects in the opposite direction: could the presence of auditory-verbal hallucinations have an effect on speech production? To this end, a recent mimicking/simulation approach was adopted for 40 healthy participants who perceived either white noise or hallucination-like speech recordings during different language production tasks with increasing demands: picture naming, verbal fluency with and without category switch, sentence production, and discourse. In line with reports about real schizophrenia cases in the literature, mimicking auditory-verbal hallucinations affected verbal fluency (switch condition) and sentence production (duration) in a different way than mere noise. These effects were not correlated, suggesting that hallucinations may even affect different levels of linguistic complexity in different ways. Anyway, in both cases (mimicked), auditory hallucination appear to contribute to the emergence of disordered speech. The mimicking/simulation paradigm may in future help to identify and disentangle the various factors contributing to disorganised speech in schizophrenia. They may also support the development and implementation of new protocols, e.g., in speech and language therapy in persons with schizophrenia in order to improve their communication skills despite the presence of auditory-verbal hallucinations.

Computer-assisted analysis of spontaneous speech: quantification of basic parameters in aphasic and unimpaired language.

Although generally accepted as an important part of aphasia assessment, detailed analysis of spontaneous speech is rarely carried out in clinical practice mostly due to time limitations. The Aachener Sprachanalyse (ASPA; Aachen Speech Analysis) is a computer-assisted method for the quantitative analysis of German spontaneous speech that allows for a detailed assessment by means of linguistic basic parameters in an acceptable amount of time. It has previously been proven sensitive for monitoring changes over time. In this study, we present data of 52 aphasic participants whose spontaneous speech was analyzed retrospectively before and after an intensive therapy program. The measured changes are evaluated with reference to normative data of 60 non-brain-damaged speakers. Results confirm good sensitivity to document changes over time. Clinical relevance of changes is assessed with reference to critical score ranges derived from the normative data. Findings provide further evidence of the clinical applicability and usefulness of ASPA.

From a concept to a word in a syntactically complete sentence: an fMRI study on spontaneous language production in an overt picture description task.

Spontaneous language has rarely been subjected to neuroimaging studies. This study therefore introduces a newly developed method for the analysis of linguistic phenomena observed in continuous language production during fMRI. Most neuroimaging studies investigating language have so far focussed on single word or - to a smaller extent - sentence processing, mostly due to methodological considerations. Natural language production, however, is far more than the mere combination of words to larger units. Therefore, the present study aimed at relating brain activation to linguistic phenomena like word-finding difficulties or syntactic completeness in a continuous language fMRI paradigm. A picture description task with special constraints was used to provoke hesitation phenomena and speech errors. The transcribed speech sample was segmented into events of one second and each event was assigned to one category of a complex schema especially developed for this purpose. The main results were: conceptual planning engages bilateral activation of the precuneus. Successful lexical retrieval is accompanied - particularly in comparison to unsolved word-finding difficulties - by the left middle and superior temporal gyrus. Syntactic completeness is reflected in activation of the left inferior frontal gyrus (IFG) (area 44). In sum, the method has proven to be useful for investigating the neural correlates of lexical and syntactic phenomena in an overt picture description task. This opens up new prospects for the analysis of spontaneous language production during fMRI.

Basic parameters of spontaneous speech as a sensitive method for measuring change during the course of aphasia.

BACKGROUND: Spontaneous speech of aphasic persons is often scored on rating scales assessing aphasic symptoms. Rating scales have the advantage of an easy and fast scoring system, but might lack sensitivity. Quantitative analysis of either aphasic symptoms or basic parameters provides a useful alternative. Basic parameters are essential units of language like word categories or syntactic completeness and can be identified in both impaired and unimpaired adult and child language. AIMS: To examine whether basic parameters of spontaneous speech are more sensitive to change during the course of recovery from aphasia than conventional spontaneous speech rating scales. METHODS & PROCEDURES: Spontaneous speech samples of 28 aphasic participants were analysed using a quantitative computer-assisted method as well as conventional spontaneous speech rating scales before and after 7 weeks of intensive language treatment. The analysis focused on the following basic parameters: percentage words, percentage open class words, syntactic completeness, complexity, and mean length of utterances. The participants were also tested with the Aachen Aphasia Test before and after treatment. OUTCOME & RESULTS: Significant change in at least one basic parameter was observed in 20 participants, while only four participants showed significant change in one of the spontaneous speech rating scales. CONCLUSIONS: In comparison with conventional spontaneous speech rating scales, the basic parameters proved to be more sensitive to change. For the time being, however, some limitations remain with regard to the specificity of the basic parameters. Thus, additional data are needed to provide further support of the clinical significance of the measured changes.