Cognitive linguistic Treatment in Landau Kleffner Syndrome: Improvement in Daily Life Communication.

We report a case study of cognitive linguistic treatment in a teenager with chronic severe Landau Kleffner Syndrome. The effect of speech and language therapy in LKS is rarely examined and our case is unique in that we use an effective approach in adult aphasia to treat language deficits in aphasia in LKS. The results show successful acquisition of a considerable amount of new words as well as improved communication in daily life. However, auditory verbal agnosia, the most prominent feature in LKS, persisted. Cognitive linguistic treatment seems a promising treatment to improve spoken language production in LKS, but more research is needed to optimize speech and language therapy of auditory verbal agnosia and auditory language comprehension in children with LKS.

Transcranial Direct Current Stimulation Does Not Improve Language Outcome in Subacute Poststroke Aphasia.

BACKGROUND AND PURPOSE: The aim of the present study is to investigate the effect of transcranial direct current stimulation on word-finding treatment outcome in subacute poststroke aphasia. METHODS: In this multi-center, double-blind, randomized controlled trial with 6-month follow-up, we included 58 patients with subacute aphasia (<3 months poststroke), who were enrolled in a stroke rehabilitation program. Patients participated in 2 separate intervention weeks. Each intervention week included 5 daily sessions of 45-minute word-finding therapy combined with either anodal transcranial direct current stimulation (1 mA, 20 minutes; experimental group) or sham transcranial direct current stimulation (control group) over the left inferior frontal gyrus. The primary outcome measure was the Boston Naming Test. Secondary outcome measures included naming performance for trained/untrained picture items and verbal communication. RESULTS: Both the experimental (n=26) and the control group (n=32) improved on the Boston Naming Test over the intervention period and 6-month follow-up; however, there were no significant differences between groups. Also for the secondary outcome measures, no significant differences were found. CONCLUSIONS: The results of the present study do not support an effect of transcranial direct current stimulation as an adjuvant treatment in subacute poststroke aphasia. CLINICAL TRIAL REGISTRATION: URL: http://www.trialregister.nl/trialreg/admin/rctview.asp. Unique identifier: NTR4364.

The Role of the BDNF Val66Met Polymorphism in Recovery of Aphasia After Stroke.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) is assumed to play a role in mediating neuroplasticity after stroke. Carriers of the function-limiting Val66Met (rs6265) single nucleotide polymorphism (SNP) may have a downregulation in BDNF secretion, which may lead to a poorer prognosis after stroke compared to noncarriers in motor learning and motor function recovery. The present study investigates whether this polymorphism may also affect the recovery of poststroke aphasia (ie, language impairment). OBJECTIVE: To study the influence of the BDNF Val66Met polymorphism on the recovery of poststroke aphasia. METHODS: We included 53 patients with poststroke aphasia, all participating in an inpatient rehabilitation program with speech and language therapy. All patients were genotyped for the Val66Met SNP and subdivided into carriers (at least one Met allele) and noncarriers (no Met allele). Primary outcome measures included the improvement over rehabilitation time on the Amsterdam-Nijmegen Everyday Language Test (ANELT) and the Boston Naming Test (BNT). RESULTS: The outcome measures showed a large variability in the improvement scores on both the ANELT and BNT. There was no significant difference between noncarriers and carriers in the primary outcome measures. CONCLUSION: This study investigated the effect of the BDNF Val66Met polymorphism on clinical recovery of poststroke aphasia. In contrast to earlier studies describing a reducing effect of this polymorphism on motor function recovery after stroke, the present study does not support a reduction in language recovery for carriers compared to noncarriers with poststroke aphasia.

Production and Comprehension of Pantomimes Used to Depict Objects.

Pantomime, gesture in absence of speech, has no conventional meaning. Nevertheless, individuals seem to be able to produce pantomimes and derive meaning from pantomimes. A number of studies has addressed the use of co-speech gesture, but little is known on pantomime. Therefore, the question of how people construct and understand pantomimes arises in gesture research. To determine how people use pantomimes, we asked participants to depict a set of objects using pantomimes only. We annotated what representation techniques people produced. Furthermore, using judgment tasks, we assessed the pantomimes' comprehensibility. Analyses showed that similar techniques were used to depict objects across individuals. Objects with a default depiction method were better comprehended than objects for which there was no such default. More specifically, tools and objects depicted using a handling technique were better understood. The open-answer experiment showed low interpretation accuracy. Conversely, the forced-choice experiment showed ceiling effects. These results suggest that across individuals, similar strategies are deployed to produce pantomime, with the handling technique as the apparent preference. This might indicate that the production of pantomimes is based on mental representations which are intrinsically similar. Furthermore, pantomime conveys semantically rich, but ambiguous, information, and its interpretation is much dependent on context. This pantomime database is available online: https://dataverse.nl/dataset.xhtml?persistentId=hdl:10411/QZHO6M. This can be used as a baseline with which we can compare clinical groups.

Transcranial direct current stimulation in post-stroke sub-acute aphasia: study protocol for a randomized controlled trial.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a promising new technique to optimize the effect of regular Speech and Language Therapy (SLT) in the context of aphasia rehabilitation. The present study focuses on the effect of tDCS provided during SLT in the sub-acute stage after stroke. The primary aim is to evaluate the potential effect of tDCS on language functioning, specifically on word-finding, as well as generalization effects to verbal communication. The secondary aim is to evaluate its effect on social participation and quality of life, and its cost-effectiveness. METHODS: We strive to include 58 stroke patients with aphasia, enrolled in an inpatient or outpatient stroke rehabilitation program, in a multicenter, double-blind, randomized controlled trial with two parallel groups and 6 months' follow-up. Patients will participate in two separate intervention weeks, with a pause of 2 weeks in between, in the context of their regular aphasia rehabilitation program. The two intervention weeks comprise daily 45-minute sessions of word-finding therapy, combined with either anodal tDCS over the left inferior frontal gyrus (1 mA, 20 minutes; experimental condition) or sham-tDCS over the same region (control condition). The primary outcome measure is word-finding. Secondary outcome measures are verbal communication, social participation, quality of life, and cost-effectiveness of the intervention. DISCUSSION: Our results will contribute to the discussion on whether tDCS should be implemented in regular aphasia rehabilitation programs for the sub-acute post-stroke population in terms of (cost-)effectiveness. TRIAL REGISTRATION: Nederlands Trail Register: NTR4364 . Registered on 21 February 2014.

The Efficacy and Timing of Melodic Intonation Therapy in Subacute Aphasia.

Background Little is known about the efficacy of language production treatment in subacute severe nonfluent aphasia. Although Melodic Intonation Therapy (MIT) is a language production treatment for this disorder, until now MIT effect studies have focused on chronic aphasia. Purpose This study examines whether language production treatment with MIT is effective in subacute severe nonfluent aphasia. Methods A multicenter, randomized controlled trial was conducted in a waiting-list control design: patients were randomly allocated to the experimental group (MIT) or the control group (control intervention followed by delayed MIT). In both groups, therapy started at 2 to 3 months poststroke and was given intensively (5 h/wk) during 6 weeks. In a second therapy period, the control group received 6 weeks of intensive MIT. The experimental group resumed their regular treatment. Assessment was done at baseline (T1), after the first intervention period (T2), and after the second intervention period (T3). Efficacy was evaluated at T2. The impact of delaying MIT on therapy outcome was also examined. Results A total of 27 participants were included: n = 16 in the experimental group and n = 11 in the control group. A significant effect in favor of MIT on language repetition was observed for trained items, with mixed results for untrained items. After MIT there was a significant improvement in verbal communication but not after the control intervention. Finally, delaying MIT was related to less improvement in the repetition of trained material. Conclusions In these patients with subacute severe nonfluent aphasia, language production treatment with MIT was effective. Earlier treatment may lead to greater improvement.

Aphasia rehabilitation and the role of computer technology: can we keep up with modern times?

Numerous computer applications have been developed specifically for aphasia rehabilitation. In this paper, the role of these computer programs is discussed in relation to three complementary treatment approaches in aphasia rehabilitation: disorder-oriented treatment, functional treatment, and participation-oriented treatment. Most of the programs available focus on disorder-oriented treatment and several studies have reported a beneficial effect on language skills. Nowadays, in the context of disorder-oriented treatment, these applications are indispensible to achieve an adequate treatment frequency of at least 2 hours per week. Computer applications aiming at functional and social participation goals are less well-developed. Several studies show that high-technology AAC can be used to support off-line communication. Moreover, it is reported that the AAC training has a positive effect on overall communicative functioning. In the near future, computer applications for interactive communicative training may become an important tool in aphasia rehabilitation. Theoretically, the internet offers excellent opportunities to improve social participation for people with aphasia, but reading and writing problems limit their access to the internet. So far, only a few initiatives have been reported to support and increase their access.

Measuring verbal and non-verbal communication in aphasia: reliability, validity, and sensitivity to change of the Scenario Test.

BACKGROUND: This study explores the psychometric qualities of the Scenario Test, a new test to assess daily-life communication in severe aphasia. The test is innovative in that it: (1) examines the effectiveness of verbal and non-verbal communication; and (2) assesses patients' communication in an interactive setting, with a supportive communication partner. AIMS: To determine the reliability, validity, and sensitivity to change of the Scenario Test and discuss its clinical value. METHODS & PROCEDURES: The Scenario Test was administered to 122 persons with aphasia after stroke and to 25 non-aphasic controls. Analyses were performed for the entire group of persons with aphasia, as well as for a subgroup of persons unable to communicate verbally (n = 43). Reliability (internal consistency, test-retest reliability, inter-judge, and intra-judge reliability) and validity (internal validity, convergent validity, known-groups validity) and sensitivity to change were examined using standard psychometric methods. OUTCOMES & RESULTS: The Scenario Test showed high levels of reliability. Internal consistency (Cronbach's alpha = 0.96; item-rest correlations = 0.58-0.82) and test-retest reliability (ICC = 0.98) were high. Agreement between judges in total scores was good, as indicated by the high inter- and intra-judge reliability (ICC = 0.86-1.00). Agreement in scores on the individual items was also good (square-weighted kappa values 0.61-0.92). The test demonstrated good levels of validity. A principal component analysis for categorical data identified two dimensions, interpreted as general communication and communicative creativity. Correlations with three other instruments measuring communication in aphasia, that is, Spontaneous Speech interview from the Aachen Aphasia Test (AAT), Amsterdam-Nijmegen Everyday Language Test (ANELT), and Communicative Effectiveness Index (CETI), were moderate to strong (0.50-0.85) suggesting good convergent validity. Group differences were observed between persons with aphasia and non-aphasic controls, as well as between persons with aphasia unable to use speech to convey information and those able to communicate verbally; this indicates good known-groups validity. The test was sensitive to changes in performance, measured over a period of 6 months. CONCLUSIONS & IMPLICATIONS: The data support the reliability and validity of the Scenario Test as an instrument for examining daily-life communication in aphasia. The test focuses on multimodal communication; its psychometric qualities enable future studies on the effect of Alternative and Augmentative Communication (AAC) training in aphasia.

A computerised communication aid in severe aphasia: an exploratory study.

PURPOSE: To investigate the efficacy of TouchSpeak (TS), a handheld computerised communication aid for aphasia. METHOD: A pre-post one-group design was used with a referred sample of 34 patients with a severe aphasia and a need for alternative and augmentative communication (AAC). The participants were trained to use TS in two self-chosen communicative situations. The ability to navigate the hierarchical vocabulary and overall communicative ability were assessed. Participants rated their communicative success with and without TS. Three years after completion of the training, participants were interviewed about their present use of TS. RESULTS: In total, 76% used TS outside the clinic in two trained communicative situations. Overall communicative ability improved, as tested in untrained scenarios. Quality of communication with TS was rated higher than without TS. Fifty per cent obtained their own TS after the training and after 3 years 6% still used TS. CONCLUSIONS: Aphasic communication can be supported effectively by TS. Patients with a severe aphasia are able to master a hierarchical computerised vocabulary and to use it in daily life for specific communicative situations. In addition, TS may also have a generalised effect on overall communicative ability. For most patients, the supportive role of TS is temporary.