Wednesday, November 21, 2007

American Journal of Speech-Language Pathology


Purpose: The Kentucky Aphasia Test (KAT) is an objective measure of language functioning for persons with aphasia. This article describes materials, administration, and scoring of the KAT; presents the rationale for development of test items; reports information from a pilot study; and discusses the role of the KAT in aphasia assessment.

Method: The KAT has 3 parallel test batteries, KAT-1, KAT-2, and KAT-3. Each battery contains the same orientation test and 6 subtests, each with 10 items, assessing expressive and receptive language functions. Subtests for KAT-1, KAT-2, and KAT-3 systematically increase in difficulty so that it is possible to assess individuals with severe, moderate, and mild aphasia, respectively. The KAT was administered to 38 participants with aphasia and 31 non-brain-damaged (NBD) participants.

Results: Results with the KAT clearly differentiated the language performance of individuals with and without aphasia. NBD participants made few errors, and overall scores on the test for individuals with aphasia were rarely within 1 SD of the NBD group. Performance of the participants with aphasia administered KAT-1, KAT-2, and KAT-3 suggested that the 3 versions of the test represent a hierarchy of difficulty.

Veteran to recount war story that earned France's 'merci'


On Sunday, Nov. 4, just before heading to Washington for the ceremony, Bernie Rader will recount the harrowing adventure that led to his receiving the honor. He and his wife will show a documentary, For One English Officer, and answer questions about his experience at the Jewish Community Center of Central New Jersey at 10:30 a.m. The Raders talk is being cosponsored by Temple Emanu'El of Westfield.

The Raders have given their presentation on the POW exchange about 60 times at JCCs, libraries, and other venues throughout the region, working together since a stroke nine years ago left him with aphasia, a language impairment that can make it difficult to speak.

Aphasia

Yesterday, I saw P. She is in her seventies. She saw another physician, who had diagnosed her with Alzheimer's. Actually, she doesn't have that. She has progressive aphasia. Aphasia is when you lose language. She can't find the words that she wants to use. Alzheimer's patients also develop aphasia. But they develop other thinking issues. They have "global" cognitive decline. So this is different. Words that we need get put into a filing cabinet. Then, when we need them we go and retrieve them. P has lost the Next...

Sunday, November 18, 2007

Games for Word Retrieval Therapy

Matching games, such as the one on this site, are fun, simple ways of learning the identification of words and pictures. But they can also have a much higher purpose - - helping those with word retrieval difficulties. Speech and language pathologists often use matching games in their therapy to help patients with specific word retrieval disorders - - particularly aphasia.

Aphasia is a word-retrieval disorder characterized by the inability to think of the right word to say or write, or an inability to name common objects. The disorder is often a side affect of a stroke, or other brain injury and is a result of damage sustained to one of the areas of the brain responsible for language. Aphasia can also include difficulty understanding spoken words, speaking aloud, reading, or writing. Next...................

Friday, October 26, 2007

Aphasia victims find a voice in UA group

April R. Ford

Stroke and disease can sometimes cripple a person's ability to use and understand basic language. But a UA communication group offers a way for people with aphasia, a severe communication disorder, to re-establish who they are on their own terms.

"Aphasia is a language disorder, meaning it affects our ability to understand or use our words, vocabulary, grammar and all the pieces that go into framing a message," said Barbara Shadden, a professor at the College of Education and Health Professions.

The National Institute of Neurological Disorders and Stroke estimated that about a million people across the U.S. are affected by aphasia, which results from damage to the language parts of the brain.

Every person has their own sense of who they are, Shadden said, but the problem for victims of aphasia is that the idea of a self depends on how you use language.

For people who have suffered stroke or other disease, aphasia can hinder their ability to tell the world who they are, Shadden said.

"We all believe in our sense of self," Shadden said, "but the problem is it depends on others, and communication is the key."

A communication group was created at the UA's Speech and Hearing Clinic in 2004 to provide therapy to individuals having trouble telling their story because of aphasia. The group's focus centers on recreating the individual's sense of self through the development and communication of a life story, Shadden said.

Telling that story on their own terms is a crucial part of the communication group, said Patricia Koski, associate professor of sociology and criminal justice.

"People recreate a self," Koski said. "Although, if they don't have the tools to recreate that self, they are in danger of losing it in the sense that somebody else decides for them who they are or what they are capable of."

Members of the UA communication group use tools such as beliefs, gestures or words to share their life story with others.

A9.4: Participation Memo

Ashley Carr

October 19, 2007

Aims and Objectives:

This week, I set out to expand my knowledge of information within my research by continuing the research process, but by looking at it from a different perspective. This week it was important for me to go one step deeper into my research to seek information that I previously did not know. I also aimed for completing these assignments before Friday evening. This...Next....

STROKE GROUP GET INTO BOOKS

11:00 - 02 October 2007

A Reading group has been set up for people who have suffered a stroke or brain damage.

Members of Aphasia Nottingham have started sessions to share ideas about books, and help each other to understand them.

Aphasia is a condition which affects communication skills.

The group has the choice of audio or large-print versions of books from a library.

The next meeting is on Monday, October 15, at 2pm in Beeston Library

Books such as Chickenfeed by Minette Walters and The Builders by Maive Binchy are on the reading list.

Telephone Frances Cameron on 0115 937 4937 for more information.
Next...............

Horses visit Meadow Ridge residents

By CATHERINE SAMOSE

Horse ‘Honey’ with Maura Curry from HORSE of CT SENIORS meets Betty Poggenburg, who is about to turn 99. —Scott Mullin photo
Meadow Ridge residents were entertained last Wednesday by horses that traveled to Redding from their farm in New Preston.

“This is the second year we’ve had horses visit from HORSE of CT SENIORS,” said Joy Hodge, recreation director for assisted living at Meadow Ridge. “They’ve been really wonderful in coming. It’s an all-volunteer group. They interact with our residents. They bring carrots and special cookies for the residents to feed the horses.” The group brought a senior horse and a senior pony.

“These are retired horses and it makes sense that they should be with retired people,” said Kevin Curry, who volunteers with the group along with his brother Patrick and their sister Maura, who is program director. “The horses are also seniors. Coming here to visit senior humans is a nice program.”

“I think this is the most wonderful afternoon,” Peggy Smith, a Meadow Ridge resident, said. “It’s such a fun time because we’re getting to see the horses. And my little granddaughter is coming today. I hope they get here in time to see the horses.”

When spoken to, Charlotte Kelly could not respond because she has a condition called aphasia. “We converse without language,” her assistant said. “She is wonderful. She really is. She loves the horses.” Ms. Kelly was extremely communicative with her smile and her beautiful face.

Another resident, Edith Sutter, said she’s been at Meadow Ridge only two months. “This is a little unusual. I didn’t expect anything like this,” she said. “I think it’s great. A good human touch to it. I did some feeding and a lot of petting.”

Mary Swallen, who also fed and petted a horse, said, “It’s been nice. I had fun.”

“They’re wonderful,” said Stanley Andrysek. “It’s nice to see the horses.”

HORSE (Humane Organization Representing Suffering Equines) of CT SENIORS (Society of Equines Nurturing Individuals of Retirement Status), according to Ms. Curry, is an organization that rescues horses.Next.....

Thursday, September 27, 2007

Writing As Therapy

Medical Student Aphasia: The Language of Medicine

"Aphasia" is the loss of the ability to produce or comprehend language. The first day of med school is typically a period of aphasia for the young Medi. He or she enters a world in which obscure terms become common parlance, and the terms flow freely from the mouths of experienced practitioners. This lack of knowledge, this pseudo-aphasia, is of course a necessary part of the learning process, but learning to speak in medicine is unlike learning any other language in the world.

One of the most challenging aspects of learning medicine is learning how to speak the language. Although I have learned to speak in many abstract languages over the years (English, Spanish, Hindi, programming languages, social languages), learning "medicalese" has proved to be quite daunting. The breadth of the vocabulary nearly matches a modern spoken language. The time in which one has to learn the language is brief, relative to other languages. The words are complex and not always easily related. The presence of multiple synonyms and eponyms (using a person's name to describe a disease) complicates the picture. Yet, somehow, after a few years, we as students slowly begin to make sense of the terminology and begin to take ownership of the medical words we produce.
NEXT...................

Thursday, August 30, 2007

Cognitive Stimulation Using The Serper Method™

Summary: The Serper Method™ is a cognitive stimulation program that emphasizes personal and cultural information, along with social and conversational skills. Although more testing is needed, anecdotal reports and results of a small pilot program are encouraging.

Dr. Lynn Serper, a teacher for children with learning disabilities, was in her late 40s when she suffered a ruptured brain aneurysm, then a stroke and fell into a coma. When she awoke, she couldn’t talk, read, write or think clearly.

Ignoring her doctors’ pessimism about her condition, she decided to put together a recovery program for herself based on exercises she had developed for the classroom. “If children with learning disabilities could learn from my methods, why couldn’t I?” she says.

She attributes her eventual recovery to her program, which combined reading exercises with information about history, geography and current events. After working through the program for six years, she was able to complete a dissertation, and earned a doctorate in Cognitive Education.

During her recovery, she refined the exercises to develop The Serper Method, a cognitive stimulation program for people with dementia, aphasia [loss of ability to speak or understand speech] and traumatic brain injury. In her book, BRAINSTORMING: The Serper Method of Brain Recovery, Re-Growth and Vitality, Dr. Serper tells the story of her illness and recovery, and how she developed her program. She has also published a series of workbooks which can be used by individuals, or in group or private sessions led by someone trained in the The Serper Method.

A Different Approach to Cognitive Stimulation

Because of Dr. Serper’s background, The Serper Method emphasizes personal and cultural information, as well as social and conversational skills.

From her experience as a teacher, Dr. Serper knew that children seemed to learn more when the learning process was related to their culture and their interests. And in her opinion, as her students learned more, their self-esteem and socialization skills increased.

She applied the same concepts when developing her workbooks. “The stories in the workbooks are true and inspirational,” she says. “The history is drawn from the American experience, often within the lifetime of the learner, and geography is based upon location, facts and tales from the different regions of the United States. In this re-learning, individuals have an opportunity to gather information for conversations based on memories and experiences.”

Comparing her method to other cognitive stimulation programs, Dr. Serper says she thinks “both methods effectively offer individuals ways to strengthen brain function, though by different means. The Serper Method adds a focus on conversation and social interaction. In a perfect world, persons would have the opportunity to take part in both programs.”

Initial Results

Through her company Brain Enhancement Services, Inc., Dr. Serper provides consulting and training services based on her method. She reports that she has been able to stabilize the cognitive abilities of persons with dementia and that two community programs using her method have shown encouraging results, either improving/stabilizing cognitive abilities or increasing socialization.

In addition, Boston University Researchers conducted a six month pilot program to test whether The Serper Method could improve memory and cognitive and social functioning for persons with early-stage Alzheimer’s disease. According to Dr. Serper, focus groups and questionnaires showed that participation improved self-image, conversation, socialization and interest in daily experiences. However, standard neuropsychological tests did not show improved scores for participants. More testing with a larger group is needed to confirm these results.

The Workbooks

“Following my stroke,” Dr. Serper says, “I found that losing access to factual information of the past limited my ability to understand the information of each present day. Reading the newspaper was confusing since I had limited information of past events and struggled with concepts and understanding. It was amazing to me how much of what we all know and learn is based upon the foundations and building blocks that were learned in the past. I felt like all the knowledge and categorization of that knowledge was no longer available to me.” She focused on the foundations she felt she couldn’t access – history and geography – when developing her workbook series.
Serper_workbook
“The workbooks contain predominantly frustration-free activities,” she says, “with lots of repetition, or memory stimulation, in the form of puzzles, brain twisters and a reference or clue system for answering questions. The goal is exercising different segments of the brain.”

Can persons with early-stage dementia get results by going through the workbook exercises on their own? “I believe that most persons with MCI [Mild Cognitive Impairment] or early-stage dementia will need to be taught how to use The Serper Method over a period of a month or two,” she says. “Individuals with mid-stage dementia will need the assistance of a Cognitive Educator [her trademarked term for someone trained to guide learning sessions based on her method]. Family members can also be trained to guide, if they would like.” CD recordings of the workbooks are available for those with visual, reading or speech limitations.

Whether or not a person with dementia is using her method, Dr. Serper has some advice for them. “Individuals and families should know that learning and socialization does not end with a diagnosis,” she says. “As long as there are healthy brain cells there is hope for enjoying life experiences and increasing life’s vigor and possibilities.“

Wednesday, August 1, 2007

Games useful for speech therapy

I have a good friend who suffered head injuries in a recent accident and is now in rehab. He is clearly able to understand what people are saying to him and can respond with gestures. He is able to write intelligibly. He can respond with short phrases and uses simpler common ones like "hello", "yes", "no" and "thank you" correctly. Longer sentences, however, are somewhat problematic. He produces syntactically correct and logically consistent sentences, but his choices of words and phrases are rather unusual. I don't know if doctors would call what he has aphasia, or not, but he is getting speech therapy.

It has been suggested that games could help him. I've put the best few games that I could think of to start this list. Please add your own recommendations, keeping in mind that any additions should probably be word games that involve speaking. I'd also appreciate thumbs and comments to keep this list visible on the front page so that more people will see it to contribute to it.

Sunday, July 15, 2007

Gestures and Words: Facilitating Recovery in Aphasia

cite as:
Raymer, A. (2007, June 19). Gestures and words: Facilitating recovery in aphasia. The ASHA Leader, 12(8), 8-11.

by Anastasia Raymer

One of my patients with aphasia, a gentleman who had a serious brain hemorrhage more than 10 years ago, recently presented with me to a class of physical therapy students. Because of his profound aphasia, he struggled for words to describe the event that caused his aphasia, an automobile accident that led to a left hemisphere hemorrhage. By pantomiming a driving motion with his arms, he eventually got the idea across. One of the students asked why he gestured: Was it to communicate the idea through pantomime? Was it to help him get words out? He astutely responded that it was both.

Like many individuals with aphasia, this gentleman often resorts to gestures when he is unable to retrieve specific words. Sometimes using a gesture seems to increase the likelihood that he can say the word. As in the gesturing we all do to embellish a message or as we pause to think of words, it is a natural step in communication. Luria (1970) wrote about this phenomenon decades ago, calling the process intersystemic reorganization—using one part of the brain to facilitate increased activity in another part of the brain. Recent research efforts in our lab and others in America and abroad represent renewed interest in the use of gesture to facilitate language recovery in aphasia.

Limb Apraxia

Individuals with severe aphasia often attempt gesturing to communicate. Using gestures is not without complications, however. The brain’s left hemisphere, which controls the ability to retrieve words and construct grammatical sentences, also is the dominant hemisphere for controlling the performance of learned, skilled limb movements. Daily activities in the home and at work, such as writing, cooking, self-care, and manual labor, depend upon stored memories, including the sequences of muscle packages necessary for skilled limb movements. Damage to the left hemisphere can lead to limb apraxia—impairment in the ability to use skilled limb movements.

The typical clinical test that evaluates limb praxis abilities has a patient perform pantomimes to verbal command, including use of transitive tool use gestures (e.g., show me how to use a hammer to pound a nail into the wall), or intransitive symbolic gestures (e.g., show me how you salute). Gesture performance to verbal command is often compared to gesture production for viewed tools or gesture imitation. In general, pantomime to verbal command for transitive gestures tends to be more difficult and, thus, makes detecting limb apraxia more sensitive as compared to other gesture tasks.

Just as the pattern of aphasia varies depending upon what regions of the left hemisphere are disturbed, so too can limb apraxia take different forms. Two types of limb apraxia, described extensively (e.g., Heilman, Watson, & Rothi, 2006), include conceptual apraxia and ideomotor apraxia. Conceptual apraxia represents impairment in conceptual knowledge about tools, the objects they act upon, and the actions required to use them. Patients with conceptual apraxia have difficulty determining the appropriate tool or action needed to complete a given task. In pantomime testing, they may make conceptual errors (e.g., hammering when asked to demonstrate how to use a screwdriver), using no tool (e.g., using their hand to smooth their hair when asked to demonstrate how to use a comb), or providing no response at all.

Ideomotor apraxia, in contrast, represents an impairment related to praxis production knowledge. Although patients with ideomotor apraxia know the tools and actions required, they have difficulty accurately performing the actions. When pantomiming, they make errors in which they move the wrong combination of joints (e.g., fixate at the shoulder rather than the elbow when demonstrating use of a screwdriver, leading to a circular motion rather than a rotating motion), orient their hands in the wrong direction (e.g., use an iron with the palm of the hand oriented perpendicular to the table), or configure their hand poorly (e.g., saluting with the hand in a fist, rather than fingers extended), including use of a body part as tool (e.g., forming the hand in the shape of a tool such as scissors or comb).

Some pantomimes can be unrecognizable, making it difficult to determine whether a patient has conceptual apraxia or severe ideomotor apraxia. The presence of conceptual apraxia and moderate-to-severe ideomotor apraxia can impede the ability of patients with aphasia to use gestures to communicate, as their gestures often are not meaningful or cannot be interpreted readily.

Limb apraxia can cause other problems as well, at times posing a safety risk. The same people who produce unrecognizable gestures may have great difficulty using tools and utensils during daily activities. In a study several years ago, we found that individuals with limb apraxia often have difficulty with routine tasks such as eating (Foundas et al., 1995). Some people had such difficulty using utensils that they gave up and ate their food by shoveling it with a slice of bread or by hand. Others used the wrong objects and implements, such as stirring tea with a knife or sprinkling salt into their tea. When testing one patient in his home for another apraxia study, I observed him struggle to plug in a video recorder and to unlock a deadbolt. Thus individuals with limb apraxia should be closely supervised when using implements, as some apraxic mistakes could place them at risk for injury.

Gestural Facilitation of Word Retrieval

The interplay between limb apraxia and aphasia is important to consider as we promote using gestures to enhance communication and language recovery in patients with aphasia. With colleagues at Old Dominion University and the University of Florida, we have engaged in a series of studies examining gestural training to facilitate word retrieval in patients with aphasia. In the training protocol, participants learn to form an appropriate gesture corresponding to a given picture, rehearse the words spoken, and then pair the gesture and spoken word to encourage gestural facilitation of word retrieval. Our study shows that this verbal+gestural training protocol is effective for improving retrieval of both nouns and verbs in patients with varied patterns of aphasia (Raymer et al., 2006). One important issue, however, was to determine the extent to which limb apraxia affected the ability to produce gestures during word retrieval training. Even people with severe limb apraxia improved their ability to produce recognizable gestures. Furthermore, there was no relationship between severity of limb apraxia and treatment effects for word retrieval. Gestural facilitation of word retrieval was effective in individuals with mild and severe limb apraxia. We also found that the effects of verbal+gestural training were as strong as effects of a more conventional treatment method encouraging activation of semantic and phonologic information during word retrieval training.

Several people who participated in our studies did not improve word retrieval with training, whether wirh verbal+gestural or semantic-phonologic training. Most had particularly severe word retrieval impairments. An advantage of verbal+gestural training for these individuals was that many who did not increase their use of spoken words nonetheless demonstrated remarkable improvements in the use of gestures. In fact, the physician of one participant called to say how amazed she was at the improvements her patient had made since participating in our aphasia treatment research. Although the patient did not increase word retrieval abilities, he significantly improved his ability to produce meaningful, recognizable gestures. Furthermore, because all participants in our recent studies participated in videotaped conversations with a spouse or caregiver, we documented that he dramatically increased use of conversational gestures following treatment, more than any other participant in our studies. We suspected that the physician appreciated the improved communication afforded through the patient’s increased use of gestures in conversation.

Nonsymbolic Movements

Unfortunately, not all words can be expressed through gestures. Bruce Crosson and colleagues at the University of Florida (Richards et al., 2002) have implemented a different type of word retrieval treatment using non-symbolic limb movements that can be used in training for all types of words, regardless of whether the word has a characteristic pantomime. In their intentional movement training, participants perform a complex non-meaningful movement of the left limb in left space, first in the form of reaching and turning a lever in a box, and later reducing the movement to a circular motion with the left hand, all when paired with rehearsal of spoken target words. The premise of the treatment is that the complex left limb movement engages intact right frontal regions to facilitate activation of that region for word retrieval as well.

The advantage of intentional training is that the complex circular movement can be used quite naturally during conversation, without regard to the topic, whereas pantomime facilitation of word retrieval is limited to concepts that can be expressed by pantomime. Whether it is the rhythm of the intentional movement or the ability of the movement to engage other parts of the brain to improve language recovery is not clear. But these preliminary studies suggest that complex limb movements, not just pantomimes, have the potential to enhance communication attempts in individuals with aphasia and limb apraxia.

Supported Communication

Recent discussions of supported communication in patients with aphasia emphasize the use of gesture to enhance communication with conversational partners. Clinicians must bear in mind that severe limb apraxia can hinder gestural communication in some patients with aphasia. Patients may need training to address the limb apraxia directly, which several studies indicate is amenable to treatment. At times people with aphasia insist they want to speak and are unwilling to use gestures, as was one of my patients with severe aphasia. We had to work gently and diligently to help her see that not only could gestures be an effective means to communicate some ideas, but they also could promote retrieval of spoken words. Once she understood that gestures might help her recover verbal abilities, she started to incorporate them in communication attempts.

End Article Logo

Anastasia Raymer is a professor in the Department of Early Childhood, Speech Pathology, and Special Education at Old Dominion University in Norfolk, Va. She is chair of the ASHA/American Psychological Association Joint Committee on Interprofessional Relations with Neuropsychology, and is the past coordinator of ASHA Special Interest Division 2, Neurophysiology and Neurogenic Speech and Language Disorders. Contact her at sraymer@odu.edu.

Sunday, July 1, 2007

Language, Writing, and the Spatial Representation of Events

Picture in your head one person throwing a ball to another. How were the two people oriented spatially? Was one on the left, and the other on the right? If so, which one was on the left, and which on the right? Chances are, the thrower was on the left, and the catcher was on the right. For some reason, that seems to be our default way of representing actions: with the actor on the right, the patient on the left, and the actions occurring from left to right(1), as in this beautifully drawn figure:

ballthrow.JPG

Why is that? Good question, but before we answer it, let's look at some research.

The most striking work on the relationship between language and the spatial representation of actions has been done by Chatterjee and his colleagues. They first looked at the relationship in a patient with profound agrammatism, an aphasia that makes it difficult to put grammatical sentences together. Here's an example of their agrrammatic aphasic's speech(2, p. 58):

Well, uh, essentially language abandon preposition. I telegraph... I, I... consciously, uh, continuity...I, I, uh, this subtle of prepositional phrases this simply cannot do. Under stress, under stress rapid I just flustered ... but continue to do basically.

As you can see, it's a mess. When they had this aphasic identify the agents and patients in pictures, he almost always said that the figure on the left was the agent, and the one on the right was the patient, regardless of which one was actually the agent and the patient in the figure(3).

Interesting, but this could be the product of the aphasia right? What about people with normal speech and comprehension abilities? To answer this question, Chatterjee et al.(4) conducted a series of studies with non-aphasic participants. In their first study, they had participants (all right-handed) read one of three types of sentences: an action by a patient in the direction of the patient (e.g., "John pushes Tom"), an action by an agent towards the agent and away from the patient ("John pulls Tom"), or a state requiring an agent and a patient ("John likes Tom"). Participants were then asked to draw the events on a piece of paper. In almost all cases, participants drew the agents on the left and patients on the right for each type of sentence, with drawings of the first type (action moving from agent towards the patient, as in "John pushes Tom") tending to represent the agent the furthest to the left relative to the patient.

In their second experiment, they had participants draw actions that occurred on either a horizontal (e.g., "staggering drunk") or vertical (e.g., "falling book") axis. The vertical actions were used as a control. For the horizontal actions, participants drew 8 out of 10 moving from left to right, on average. Here are a couple example drawings, from their Figure 1 (p. 398):

chaterjeeetal1999Fig1.jpg

In their third experiment, Chatterjee et al. had participants listen to sentences, after which they were presented with figures that either represented the actions in the sentences (e.g., "Square pushes Circle," with a picture of a square-headed stick figure pushing a circle-headed stick figure). The sentences either involved actions moving from the actor to the patient (like pushing) or from the patient to the agent (like pulling). Half of the pictures presented the agent on the left and the patient on the right. The participants were told to indicate as quickly as they could (by pressing the right or left mouse buttons) whether the picture represented the action in the sentence they'd just heard. Overall, participants were faster to indicate whether the picture represented the sentence when the agent was on the left and the patient on the right.

So there's good evidence that we represent actors on the left and agents on the right, and tend to think of actions as occurring from left to right. But why? Chatterjee et al. argue that this is because our representations of actions have an inherent spatial component, and that this is due to the way our nervous system is organized. They write:

The left to right directional bias is likely to be linked to the neural encoding of events[ Both cerebral hemispheres deploy spatial attention with vectors in opposing directions[ The left hemisphere deploys spatial attention with a vector from left to right. As previously speculated, development of languagein the left hemisphere may have coopted left hemisphere spatial attentional networks opportunistically. An overlap of neural circuits mediating spatial attention, the directional representations of events and the instantiation of verbs, may provide the neural link between the spatial and propositional representation of events. (p. 401)

However, recent evidence argues against this explanation. Several studies have shown that adults who learned to write in a right-to-left writing system (as in Hebrew), as opposed to left-to-right (as in English), tend to put agents on the right and patients on the left, with actions tending to be represented as moving from right to left. In other words, the inherent spatial aspect of action representations could be a product of the writing system we use, rather than the wiring of our brain.

Aphasia and Its Therapy (Medicine)



Product Details

»Book Publisher: Oxford University Press, USA (08 January, 2003)
»ISBN: 0195135873
»Book author: Anna Basso
»Amazon Rating:

Book Description:
This is the first single-authored book to attempt to bridge the gap between aphasia research and the rehabilitation of patients with this language disorder. Studies of the deficits underlying aphasia and the practice of aphasia rehabilitation have often diverged, and the relationship between theory and practice in aphasiology is loose. The goal of this book is to help close this gap by making explicit the relationship between what is to be rehabilitated and how to rehabilitate it.L Early chapters cover the history of aphasia and its therapy from Broca’s discoveries to the 1970’s, and provide a description of the classic aphasia syndromes. The middle section describes the contribution of cognition neuropsychology and the treatment models it has inspired. It includes discussion of the relationship between the treatment approach and the functional model upon which it is based. The final chapters deal with aphasia therapy. After providing a sketch of a working theory of aphasia, Basso describes intervention procedures for disorders resulting from damage at the lexical and sentence levels as well as a more general conversation-based intervention for severe aphasics.L Anna Basso has run an aphasia rehabilitation unit for more than thirty years. In this book she draws on her considerable experience to provide researchers, clinicians, and their students and trainees with comprehensive coverage of the evolution and state of the art of aphasia research and ther

Research Project on Aphasia Training Software


Research Project on Aphasia Training Software
Published: Jun 19, 2007

A team from the Hungarian University of Veszprém has developed Aphasia training software to support patients in learning everyday words. The software can also be useful for children with severe mental disabilities, according to the research team.

Aphasia is an impairment of language affecting the production or comprehension of speech and the ability to read or write. The most common cause of aphasia is acquired aphasia, affecting 23–40 % of stroke survivors. The rehabilitation of aphasia is a medical, specialized treatment (speech therapy), which is the task of a psychologist.

The software package contains two programs. The first program was developed in Flash, the second in Macromedia Director. The goal of the software is to teach the most important everyday words.

The research reports states that “one result of the first tests done was that the software is a useful device not only in the education of aphasics but heavy mental deficient children too. Moreover, both the children and the teachers can use it easily. Considering the advice of the teachers helping us during the program development, the children need some motivating animation and reassurance on the right answer and increasing their interest for the oncoming items and adults do not require such motivating exercises or tasks.”

Image of a bathroom with simple assignment (click clock on the wall).

Aphasia patients that used the software and had difficulties in naming objects managed to get through levels 1-3 easily. At the 4th level, naming of the objects, especially in case of long words, required more time than at the previous ones.

The results of the research team of University of Veszprém can help other projects worldwide in development of Aphasia training and rehabilitation software.

Nonfluent aphasia in a patient with Waldenstrom’s macroglobulinemia

Abstract

Waldenstrom’s macroglobulinemia (WM) is an uncommon low-grade lymphoma. Cognitive impairment due to central nervous system infiltration by lymphoplasmocytoid cells (Bing-Neel syndrome) has been rarely reported. We describe a 54-year-old man who was referred to a memory disorder clinic with a 9-month history of clinically obvious nonfluent aphasia and WM. He underwent extensive neuropsychological testing, clinical examination and structural and functional brain imaging. The diagnosis of the diffuse form of the Bing-Neel syndrome was supported by abnormal lymphoid cells found in the cerebrospinal fluid. Structural and functional brain imaging revealed impairment of brain areas due to white matter changes and subsequent functional deficits mimicking the neuropsychological syndrome encountered in progressive nonfluent aphasia. The diffuse form of Bing-Neel syndrome and neurological deficits are assumed to be the result of leptomeningeal infiltration by malignant cells and/or neoplastic vascular obstruction.

Keywords: Waldenstrom’s macroglobulinemia; Bing-Neel syndrome; Neuropsychology

Aphasia: A neurological challenge

June is National Aphasia Awareness Month. Aphasia is the total or partial inability to use or understand language. It is typically the result of stroke, brain disease or injury. These patients have no intellectual impairment and no outward sign of handicap.

There are two broad categories of aphasia:
1. Non-fluent or motor aphasia is an inability to enunciate words. Patients with this form of aphasia fully understand language and accommodate for their loss of speech by writing or drawing responses.
2. Fluent or receptive aphasia is an inability to understand words. These patients will often have difficulty finding the right word or following a command. They will sometimes make up new words to try and express their thoughts.

Injuries causing aphasia involve the dominant brain hemisphere which contains the neural pathways necessary for speech. In 95% of right-handed people and a majority of left-handed people, this is the left hemisphere.

Aphasia is a treatable condition. Speech pathologists are trained to perform detailed testing to fully analyze the extent of the impairment and implement a rehabilitation program. These programs require intense effort and patience on the part of people with aphasia. Newly designed computer software provides drills for patients as they retrain the neural pathways necessary for speech.

Recovery is often incomplete and can be frustrating for patients and those around them. Speaking slowly is essential, as is calmly waiting for a response. Aphasic patients are not deaf, yet there is often an inclination to speak loudly to someone who has a speech deficit.

Aphasia represents a fascinating neurological condition. If someone you know is recovering from aphasia, applaud their efforts and never underestimate their intellectual ability.
Anthony G. Alessi, MD, is a neurologist on The William W. Backus Hospital Medical Staff with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Dr. Alessi and all of the Healthy Living columnists at healthliving@wwbh.org

Comments:
Good useful article, we live in India, my father in law has been diognised with receptive aphasia after the recent brain surgery that he had undergone. In searching the web for more info, I stumbled on this article and thought I will leave a note of appreciation. Thanks.
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Thursday, June 28, 2007

VoiSec

VoiSec is a tiny button for recording, storing and playing short spoken messages with unique design and qualities. The buttons can easily be attached to other objects, e.g. to tell the contents of a package. VoiSec runs on batteries, requires no other devices and can be re-used time after time.

Designed for all – Multiple applications

At times, every person will be in an environment or situation where reading or writing is difficult. All individuals may appreciate VoiSec, one way or another, sooner or later.
A lot of people prefer spoken information to written. For some individuals, VoiSec may be of particular value due to personal conditions.

Safer Medical Information

The ability to distinguish and identify medication and to get information about the content and the prescribed usage can reduce the risk of harmful errors. For many patients,personalized spoken information is a valuable complement to the commonly provided texts. VoiSec can keep it available at one touch.

Independent Everyday Living

VoiSec is easily attached to different surfaces and objects. A variety of attachment means, including double-sided adhesives, magnets and Velcro, allow for a variety of applications at home. The marking of food packages, drawers or potentially harmful objects are but a few examples.

“Take Away” Communication

VoiSec can be handy as a personal memory and communication tool. Carried in a pocket, pinned to a jacket, hung in a neck-loop, strapped to a wrist…. Prepared phrases, buying lists, memos, etc. can easily be taken along when going out.

Caring for care-takers

VoiSec can communicate emotions as well as facts. The voices of those near and dear can be readily available e.g. for children and elderly in hospital care. Care givers instructions or patient feed-back can be recorded to improve the quality of communication.

Special Education and Training

VoiSecs size and attachability make for an excellent multi-purpose tool for cognitive training, memory support and multi-modal information. Permanent or removable means may attach a VoiSec to books, images and calendars. Use the surface for personalized marking by stickers or pens.

Workplace Adaption and Info Sharing

The qualities of VoiSec allow for quick and easy spoken notes and memos, speech labeling of magazine files, marking of rooms and objects, etc. Casual usage is easy since VoiSec runs on batteries and messages can be re-recorded time after time.

"Talking Signs” for clear information

Not all visible signage is clearly understood by all. Particularly in environmental or personal circumstances where visibility is of limited value. The quickest way from a given spot, the type of room behind a door, the floor number… VoiSec can add spoken information by a simple press, placed within reach for most individuals.

Pressing the lid is easier than writing

VoiSec will play the message when pressed. The construction is very robust and the entire lid activates the play-out. A forehead, a foot or an elbow may trigger the message, making VoiSec usable for many motorically impaired, e.g. mounted on an armrest.

Social Groups and Family Billboards

The ease-of-use and marking possibilities make VoiSec ideal for casual and personal voice messaging. Adhesive magnets are available, making VoiSec perfect for the common family billboard: the fridge door.

Recognition of Depression in Aphasic Stroke Patients

A.C. Laskaa, B. Mårtenssonc, T. Kahanb, M. von Arbina, V. Murraya

Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital,
aDivision of Internal Medicine,
bDivision of Cardiology, and
cDepartment of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

Address of Corresponding Author

Cerebrovascular Diseases 2007;24:74-79 (DOI: 10.1159/000103119)


goto top of page Key Words

  • Aphasia, depression
  • Acute stroke
  • Validity, assessment of depression

goto top of page Abstract

Background: Data on post-stroke depression in aphasia are scarce. Methods: Eighty-nine acute stroke patients with aphasia of all types were followed for 6 months to investigate if depression can be reliably diagnosed (DSM-IV criteria) and validly assessed by the verbal Montgomery-Åsberg Depression Rating Scale (MADRS) and a global technique (Clinical Global Impressions Rating Scale for Severity). A standard aphasia test was performed. Results: In 60 patients (67%) at baseline and in 100% at 6 months, comprehension allowed a reliable DSM-IV diagnosis. Among these patients MADRS was feasible in 95% at baseline and in 100% at 6 months. The assistance of relatives and staff increases the feasibility and decreases the validity. Depression was identified in 24% during the 6 months. Conclusion: Depression diagnosis and severity rating can reliably be made in the acute phase in at least two thirds of aphasic patients, and feasibility increases over time.

Copyright © 2007 S. Karger AG, Basel


goto top of page Author Contacts

Ann Charlotte Laska, MD
Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
Division of Internal Medicine
SE-182 88 Stockholm (Sweden)
Tel. +46 8 655 6409, Fax +46 8 622 6810, E-Mail ann-charlotte.laska@ds.se


goto top of page Article Information

Received: August 22, 2006
Accepted: January 3, 2007
Published online: May 23, 2007
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 3, Number of References : 23

Monday, June 4, 2007

Help for Dyslexics

None of my own kids are dyslexic, although I believe that one of them suffers from a mild case of visual aphasia.

Free Help for Dyslexia

Dyslexia? Now there is Free Help

Now there is free online help for people who have dyslexia or simply did not learn to read well while going to school. It is a click-‘n-learn program. Students and adults may learn decoding, basic reading skills, and advanced reading skills all with the click of a mouse.

The program is called ReadingBySix. It provides a systematic approach to helping people defeat dyslexia and related reading problems. You will notice measurable progress from week to week provided participants are active in their studies and do their assignments. The online courses are virtually free when you give a small donation. If you choose not to donate, they are completely free.

Dyslexia is a distinct learning disability characterized by difficulties in decoding individual words. These difficulties may not show up in other cognitive and academic abilities. Dyslexia results from the confusion caused by the brain’s inability to associate abstract symbols with abstract ideas. This includes associating letters and words with the sounds they represent. The key to defeating dyslexia is learning to decode English sounds.

NEXT........................................

We are blessed for help with hearing

Kathryn Byrd, Ph.D., CCC-SLP
Tuscaloosa
Dear Editor: May is Better Hearing and Speech Month, during which the services and accomplishments of speech-language pathologists and audiologists are recognized. As a speech-language pathologist, I am proud of those in our profession who serve children with communication impairments in schools, and, for preschoolers, in their natural environment, as well as those who serve the adult population who experience communication deficits because of strokes, accidents, disease, etc. Through their services, these individuals can lead more productive lives. Audiologists, of course, deal with hearing impairment, whose services, with our graying population, will be needed more and more.

I am a fan of the comic strip “For Better or Worse" by Lynn Patterson. How appropriate it is that in May, Better Hearing and Speech Month, there is a series on treating the grandfather Jim’s aphasia by a speech-language pathologist, and the frustrations Jim and his wife Iris experience when Jim wants to say one thing and something entirely different comes out. Patterson presents an excellent and compassionate depiction.

I hope those who experience hearing or speech/language difficulties seek help. So much can be done. We are blessed to have many excellent resources in West Alabama, with the public schools, the University of Alabama Speech and Hearing Center, Early Intervention, Easter Seals, the VA, the hospitals, etc. The phone book lists all these resources.

Saturday, June 2, 2007

www.aphasiatoolbox.com .


Please visit our website and let us know what you think. We are eager for feedback so we can continue traveling that pathway of improvement. Thanks to all of you who have helped us to develop the innovative and effective treatment and self-help protocols and materials. I have had the wonderful experience of working with the best patients and caregivers ever. Thanks you all so much. What a great beginning.

Saturday, May 19, 2007

DynaVox Release Visual Scene Display

Now available on the DynaVox V and Vmax is a new communication framework for individuals with chronic aphasia and traumatic brain injury. This exciting framework was developed by a collaborative team headed by Dr. David R. Beukelman, PhD, the AAC-RERC and jointly tested to ensure integration with the DynaVox Series 5 software.

The new Visual Scene Display for Aphasia and TBI allows device users to use their own contextually meaningful images or photographs for a variety of conversational situations. These new displays allow the ability to easily program conversational messages related to a person or setting, all without the need to navigate to a new page. These visual cues greatly enhance the communication experience for those with for Aphasia and TBI.

Wii Sports helps boxer recover from stroke


Here’s a heartwarming tale to start the week. Albert Liaw was a boxer, until a spontaneous stroke and brain injury laid him low. However, he’s now in rehabilitation, which includes heavy use of… Wii Sports Boxing!

Edmonton’s Glenrose Rehabilitation Hospital is using Wii Sports to help patients regain lost movement, and get their brains back up to speed. It’s not just boxing either, but also the tennis and golf elements of Wii Sports.

Good Dog Foundation Helps Patients Recover


The Good Dog Foundation is a pet friendly program that helps patients recover.

Robert Dresel is one of those people.

Robert was a decorated US Navy commander until he retired with his family to a farm in Virginia.

Bob says his great love was singing as a member of a barbershop quartet until six years ago when he suffered from a stroke and now he can remember the words, he just can not say them.

Bob suffers from aphasia which is an impairment of the ability to use or comprehend words.

Some speech pathologists use therapy dogs from the Good Dog Foundation to help their patients.

The dogs can not help the patients speak, but they can help them escape. "They are nonjudgmental. They are going to wait and be patient and give love. People don't understand, and they get a little impatient and they want to move on and they're saying is it this, is it that? And dogs aren't doing that, they're just giving their love,” says Ellen Potter, speech pathologist.

Saturday, April 7, 2007

The Center For Music Therapy

HRIS STEPAN - BEFORE THE ACCIDENT At the age of 17, Chris Stepan was a popular, good-looking athlete who loved playing high school football and spending time with his friends. Chris was the jovial type of young man who exhibited a tough physique but really had a very genuine caring and loving heart for others. Chris and his brother Darren and parents had an especially close relationship with each other so the impact of the car accident greatly affected the entire family unit. The night of Saturday, April 13, 1996, would never be forgotten by any of them.

APRIL 13, 1996 - THE ACCIDENT I am Chris's Mother and I want to help others to learn from our experience and to hopefully give some hope to those who are in despair. The phone call that we received about the car accident was the Real Nightmare that every parent thinks about on a Saturday night when they are waiting up for their child to get home. There had been three of Chris' classmates who had died in car accidents in the months preceding his accident. It seemed as though the students at the high school were jinxed in some way. So when we received the phone call I immediately thought , "Oh no, its happened to us." "It can't be real." For so long I thought it was really just a bad dream and that I would be waking up and everything would be just as before. The steps of grieving have been very arduous for each of us to go through and we are all at different steps in the process of acceptance of this life changing experience. I sincerely believe that God uses the lemons in our life to make lemonade for each of us, if we will just open our eyes and see the graciousness of our Lord even in the midst of adversity!

Sunday, March 11, 2007

Get

Friday, February 16, 2007

Other methods of treatment

Light therapy

Bright light (both sunlight and artificial light) is shown to be effective in seasonal affective disorder, and sometimes may be effective in other types of depression, especially atypical depression or depression with "seasonal phenotype" (overeating, oversleeping, weight gain, apathy).

Exercise

It is widely believed that physical activity and exercise help depressed patients and promote quicker and better relief from depression. They are also thought to help antidepressants and psychotherapy work better and faster. It can be difficult to find the motivation to exercise if the depression is severe, but sufferers should be encouraged to take part in some form of regularly scheduled physical activity. A workout need not be strenuous; many find walking, for example, to be of great help. Exercise produces higher levels of chemicals in the brain, notably dopamine, serotonin, and norepinephrine. In general this leads to improvements in mood, which is effective in countering depression.[22]

Meditation

Meditation is increasingly seen as a useful treatment for some cases of depression.[23] The current professional opinion on meditation is that it represents at least a complementary method of treating depression, a view that has been endorsed by the Mayo Clinic.[24] Since the late 1990s, much research has been carried out to determine how meditation affects the brain (see the main article on meditation). Although the effects on the mind are complex, they are often quite positive, encouraging a calm, reflective, and rational state of mind that can be of great help against depression.[citation needed] Although many religions include meditative practice, it is not necessary to be a member of any faith to meditate.