What neuropsychological functions best discriminate performance in adults post-stroke?

This study aimed to develop a short version of an instrument to detect cognitive impairment in stroke patients, investigate which cognitive dimensions best discriminate between stroke patients and healthy adults and to graphically analyze the relationships among the neuropsychological variables and groups. This pilot study included 94 adults (49 post-stroke and 45 neurologically healthy) who answered the Brief Neuropsychological Assessment Battery NEUPSILIN for patients with expressive aphasia (NEUPSILIN-Af) to assess orientation, perception, memory, praxis, executive functions, oral language, and academic achievement (written language and arithmetic). The IRT Rasch model for dichotomous data indicated the exclusion of items that could not be used to discriminate performances. ROC curves indicated that only the orientation, oral language, academic achievement, and executive function dimensions could be used to differentiate between the clinical and healthy groups. Graphical analysis indicated that independently of the relation among variables, orientation and executive functions tasks are essentials in the neuropsychological assessments. This study contributes to the development of specific and sensitive neuropsychological instruments to assess stroke patients and to better understand the common deficits present in this clinical population.

Acquired dysgraphia in adults following right or left-hemisphere stroke.

OBJECTIVE: This study aimed to assess the strengths and difficulties in word and pseudoword writing in adults with left- and right-hemisphere strokes, and discuss the profiles of acquired dysgraphia in these individuals. METHODS: The profiles of six adults with acquired dysgraphia in left- or right-hemisphere strokes were investigated by comparing their performance on word and pseudoword writing tasks against that of neurologically healthy adults. A case series analysis was performed on the patients whose impairments on the task were indicative of acquired dysgraphia. RESULTS: Two patients were diagnosed with lexical dysgraphia (one with left hemisphere damage, and the other with right hemisphere damage), one with phonological dysgraphia, another patient with peripheral dysgraphia, one patient with mixed dysgraphia and the last with dysgraphia due to damage to the graphemic buffer. The latter patients all had left-hemisphere damage (LHD). The patterns of impairment observed in each patient were discussed based on the dual-route model of writing. CONCLUSION: The fact that most patients had LHD rather than right-hemisphere damage (RHD) highlights the importance of the former structure for word processing. However, the fact that lexical dysgraphia was also diagnosed in a patient with RHD suggests that these individuals may develop writing impairments due to damage to the lexical route, leading to heavier reliance on phonological processing. Our results are of significant importance to the planning of writing interventions in neuropsychology.

OBJETIVO: Investigar aspectos preservados e dificuldades na escrita de palavras e pseudopalavras em adultos que sofreram acidente vascular cerebral (AVC) à esquerda e à direita e discutir os perfis de disgrafia adquirida nesses indivíduos. MÉTODOS: Investigaram-se perfis de disgrafia adquirida a partir da avaliação das habilidades e dificuldades na escrita de palavras e pseudopalavras de seis adultos que sofreram AVC no hemisfério direito (LHD) e no hemisfério esquerdo (LHE), comparados a adultos neurologicamente saudáveis. Realizou-se análise de séries de casos com os pacientes que apresentaram desempenho deficitário na escrita de palavras, que indicavam a presença de uma disgrafia adquirida. RESULTADOS: Foram identificados dois casos com disgrafia lexical (sendo um com LHE e outro com LHD), um caso com disgrafia fonológica, um com disgrafia periférica, um com disgrafia mista e um com disgrafia por déficit no buffer grafêmico, todos estes com LHE. Destacou-se nesse estudo a heterogeneidade das habilidades linguísticas dos casos clínicos, discutidas de acordo com o modelo cognitivo de dupla-rota de escrita. CONCLUSÃO: O maior prejuízo encontrado nos pacientes com LHE ressalta a importância desse hemisfério cerebral para o processamento da escrita de palavras. A presença de um caso com LHD com perfil de disgrafia lexical destaca a necessidade de melhor estudar o papel do hemisfério direito no processamento de palavras. Espera-se que esse estudo contribua para o planejamento de estratégias de intervenção neuropsicológica direcionadas à escrita de palavras.

Rehabilitation of language in expressive aphasias: a literature review.

OBJECTIVE: This paper reviews the methodological characteristics of studies on rehabilitation of expressive aphasia, describing the techniques of rehabilitation used. METHODS: The databases Medline, Science Direct and PubMed were searched for relevant articles (January 1999 to December 2011) using the keywords Expressive / Broca / Nonfluent Aphasia, combined with Language or Speech Rehabilitation / Therapy / Intervention. RESULTS: A total of 56 articles were retrieved describing rehabilitation techniques, including 22 with a focus on lexical processing, 18 on syntax stimulation, seven with the aim of developing speech and nine with multiple foci. CONCLUSION: A variety of techniques and theoretical approaches are available, highlighting the heterogeneity of research in this area. This diversity can be justified by the uniqueness of patients' language deficits, making it difficult to generalize. In addition, there is a need to combine the formal measures of tests with measures of pragmatic and social skills of communication to determine the effect of rehabilitation on the patient's daily life.

OBJETIVO: Revisar as características metodológicas dos estudos sobre a reabilitação da afasia expressiva, descrevendo as técnicas de reabilitação utilizadas. MÉTODOS: Foram pesquisados artigos nas bases de dados Medline, Science Direct e PubMed (Janeiro de 1999 a Dezembro de 2011), utilizando as palavras-chave Expressive / Broca / Nonfluent Aphasia, combinado com Language or Speech Rehabilitation / Therapy / Intervention. RESULTADOS: Foram encontrados 56 artigos descrevendo técnicas de reabilitação, incluindo 22 com foco no processamento lexical, 18 na estimulação da sintaxe, sete com objetivo de desenvolver a fala e nove com múltiplos focos. CONCLUSÃO: Há variedade de técnicas e abordagens teóricas, destacando a heterogeneidade da investigação nesta área, que pode justificar-se pela singularidade dos deficits linguísticos dos pacientes, tornando-se difícil a generalização. Existe também necessidade de combinar as medidas formais de testes com medidas de habilidades pragmáticas e sociais da comunicação, para determinar o efeito da reabilitação na vida diária do paciente.