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Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
Wernicke's (fluent) aphasia is caused by lesions affecting the dominant temporal lobe. This mainly limits comprehension of speech but sentence structure and word use can be affected. Repetition, reading and writing abilities are also impaired. Transcortical sensory aphasia is similar to Wernicke's aphasia but those affected are still able to repeat phrases. Anomic aphasia is a milder form of aphasia affecting Wernicke's area, with difficulty finding some words, resulting in circumlocution and evident frustration. There is a good understanding of speech and those affected can usually read well but have the same word-finding problems when writing. Repetition is unaffected.
Rehabilitation of Language Disorders in Adults and Children
Published in Barbara A. Wilson, Jill Winegardner, Caroline M. van Heugten, Tamara Ownsworth, Neuropsychological Rehabilitation, 2017
Anastasia Raymer, Lyn Turkstra
The last two forms of aphasia are characterised by fluent production and intact repetition. Individuals with transcortical sensory aphasia (TSA) have fluent verbal expression and naming with numerous paraphasias and impaired auditory comprehension (Reilly and Martin, 2015). Lesions affect the left posterior temporal or parietal cortex, thus TSA may be associated with Gerstmann syndrome. In anomic aphasia, word retrieval problems (anomia), which are common across aphasia types, can occur as an isolated syndrome (Harnish, 2015). Word retrieval errors in conversation or picture naming tasks may include circumlocutions, semantic paraphasias and response omissions. Anomic aphasia may occur acutely with lesions in the left temporo-occipital junction or thalamus (Race and Hillis, 2015).
Differential impairments of semantic cognition in progressive versus stroke-related aphasias
Published in Lars-Göran Nilsson, Nobuo Ohta, Dementia and Memory, 2013
In recent work, we have explored the neural basis of ‘semantic control’ and its disorders. Like the previous research on semantic representation, a multi-method approach was adopted in order to generate a convergent picture for the nature of semantic control and the identification of the core neural regions. The first crucial step was the use of comparative case-series neuropsychology in order to compare multimodal semantic impairment in semantic dementia vs. stroke-related aphasic patients (Jefferies & Lambon Ralph, 2006). Multimodal semantic impairments are observed in some patients with aphasia after stroke (Chertkow, Bub, Deaudon, & Whitehead, 1997; Jefferies & Lambon Ralph, 2006). Key to identifying this disorder, all patients with SA exhibit impaired performance across the same range of verbal and nonverbal semantic tasks that are routinely failed by SD patients (e.g., word and picture versions of the Camel and Cactus semantic association task; Bozeat et al., 2000). Although other aspects of aphasia may vary amongst patients, SA cases share many features of their broader neuropsychological profiles with SD – for example, patients with SD and transcortical sensory aphasia (a subtype of SA) both show poor comprehension in the context of fluent speech and good repetition. Similar multimodal semantic impairments in SD and SA, however, follow very different patterns of brain damage. In contrast to the bilateral ATL atrophy in SD, patients with SA commonly have damage affecting the left inferior prefrontal cortex (IFC) and/or posterior superior temporal/inferior parietal areas around the left temporoparietal junction (TPJ: Bates et al., 2003; Berthier, 2001; Chertkow et al., 1997; Hart & Gordon, 1990; Jefferies & Lambon Ralph, 2006). Although some SA patients have more widespread lesions beyond these key regions, the extent of damage through the temporal lobe is never sufficiently anterior to encroach on the important ventrolateral areas of atrophy in SD.
The usability of an AAC pain description system for patients with acquired expressive communication disorders
Published in Augmentative and Alternative Communication, 2023
Chen-li Kuo, Tsai-Hsuan Tsai, Shen-Mei Tung, Yueh-E Lin
The PainDiary app used in this study was designed for people whose listening comprehension and basic symbol processing abilities are intact; however, a proportion of patients with global aphasia, mixed transcortical aphasia, Wernicke’s aphasia, or transcortical sensory aphasia are unable to comprehend spoken messages. In addition, it is common for patients treated in neurosurgery wards to have impairments in the cognitive abilities required to use the app effectively, such as attention, memory, and visual retention. In situations where using a high-tech AAC app such as PainDiary independently is not possible, support from communication partners is desirable. A wide range of augmented inputs such as written support, gestures, and images implemented by communication partners could improve communication effectiveness for people with auditory comprehension deficits (Brown & Thiessen, 2018). With appropriate visuographic support, partner involvement is important for people with auditory comprehension difficulty (Dada et al., 2019). In the current study, the participants interacted with PainDiary through a series of questions related to pain assessment. Because there are also images associated with pain, the app has the potential to be used by nurses and other health care professionals to augment conversations about pain with patients who have auditory comprehension challenges.
Intensive aphasia therapy improves low mood in fluent post-stroke aphasia: Evidence from a case-controlled study
Published in Neuropsychological Rehabilitation, 2022
Marcelo L. Berthier, Lisa Edelkraut, Bettina Mohr, Friedemann Pulvermüller, Sergio E. Starkstein, Cristina Green-Heredia, Guadalupe Dávila
The significant improvement in language function with ILAT in our subjects with fluent aphasia and mild deficits in auditory comprehension complements recent findings of a study which used the same intensive therapy in participants with Wernicke’s and transcortical sensory aphasia of moderate severity (Wilssens et al., 2015). However, the present study is the first one that demonstrate significant improvement in symptoms of depression amongst subjects with fluent aphasia treated with ILAT. Our present findings are particularly relevant as subjects with fluent aphasia have not been included in previous studies of post-stroke depression, mainly because of the severe auditory comprehension deficits in this clinical population. Our findings are in line with results from a previous RCT study using ILAT and intensive naming therapy in persons with chronic non-fluent aphasia (Mohr et al., 2017) demonstrating a decrease in depressive symptoms after ILAT. As only persons with fluent aphasia were included in our study, the data suggest that ILAT is effective in improving language and symptoms of depression not only in non-fluent, but also in fluent aphasia subjects.
The impact of phonological versus semantic repetition training on generalisation in chronic stroke aphasia reflects differences in dorsal pathway connectivity
Published in Neuropsychological Rehabilitation, 2018
Rachel Holland, Sasha L. Johns, Anna M. Woollams
In terms of dysfunction, damage to these two different language pathways has been strongly implicated in aphasia (Binder, Medler, Desai, Conant, & Liebenthal, 2005; Ueno, Saito, Rogers, & Lambon Ralph, 2011). Indeed, different aphasic language profiles support the existence of two simultaneous, parallel anatomical pathways involved in language processing (Friederici & Gierhan, 2013). Disturbance of the dorsal pathway may lead to conduction aphasia, which is characterised by a selective impairment of repetition with preserved comprehension and the production of phonological paraphasias. In contrast, disruption of the ventral route may lead to transcortical sensory aphasia, whose predominant feature is preserved repetition and production in the context of poor comprehension (Kummerer et al., 2013; Noonan, Jefferies, Corbett, & Lambon Ralph, 2010). The degree of lateralisation of function in each processing pathway in the dual-stream model has also been informed by neuropsychological data (Hickok & Poeppel, 2007). The ventral stream is organised bilaterally with each hemisphere supporting different, but complementary, parallel processing systems. The dorsal stream, on the other hand, is proposed to be strongly left-hemisphere dominant (Berthier, Lambon Ralph, Pujol, & Green, 2012; Catani & Mesulam, 2008).