Amy D. Rodriguez

A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy

This investigation reports the results of a pilot study concerning the application of principles of use-dependent learning developed in the motor rehabilitation literature as Constraint Induced Therapy to language rehabilitation in a group of individuals with chronic aphasia. We compared treatment that required forced use of the language modality, Constraint Induced Language Therapy, (CILT) to treatment allowing all modes of communication. Both treatments were administrated intensively in a massed practice paradigm, using the same therapeutic stimuli and tasks. Results suggest that whereas both interventions yielded positive outcomes, CILT participants showed more consistent improvement on standard aphasia measures and clinician judgments of narrative discourse. These findings suggest that CILT intervention may be a viable approach to aphasia rehabilitation.

Effects of gesture+verbal treatment for noun and verb retrieval in aphasia

Links between verbs and gesture knowledge suggest that verb retrieval may be particularly amenable to gesture+verbal training (GVT) in aphasia compared to noun retrieval. This study examines effects of GVT for noun and verb retrieval in nine individuals with aphasia subsequent to left hemisphere stroke. Participants presented an array of noun and verb retrieval deficits, including impairments of semantic and/or phonologic processing. In a single-participant experimental design, we investigated effects of GVT for noun and verb retrieval in two counterbalanced treatment phases. Effects were evaluated in spoken naming and gesture production to pictured objects and actions. Spoken naming improvements associated with large effect sizes were noted for trained nouns (5/9) and verbs (5/9); no improvements were evident for untrained words. Gesture production improved for trained nouns (8/9) and verbs (6/9), and for untrained nouns (2/9) and verbs (2/9). No significant differences were evident between nouns and verbs in spoken naming or gesture production. Improvements were evident across individuals with varied sources of word retrieval impairments. GVT has the potential to improve communication by increasing spoken word retrieval of trained nouns and verbs and by promoting use of gesture as a means to communicate when word retrieval fails.

Treatment of limb apraxia - Moving forward to improved action

Limb apraxia is a common disorder of skilled, purposive movement that is frequently associated with stroke and degenerative diseases such as Alzheimer disease. Despite evidence that several types of limb apraxia significantly impact functional abilities, surprisingly few studies have focused on development of treatment paradigms. Additionally, although the most disabling types of apraxia reflect damage to gesture and/or object memory systems, existing treatments have not fully taken advantage of principles of experience known to affect learning and neural plasticity. We review the current state of the art in the rehabilitation of limb apraxia, indicate possible points of contact with the learning literature, and generate suggestions for how translational principles might be applied to the development of future research on treatment of this disabling disorder.

Effects of gesture+verbal and semantic‐phonologic treatments for verb retrieval in aphasia

Background: Reports have indicated that gesture+verbal treatments and semantic‐phonologic treatments are effective for improving lexical retrieval in aphasia. Most studies focus on noun production, with verb production less commonly reported. Because of links between verbs and gesture knowledge, verbs may be particularly amenable to gesture+verbal training. We extend our appreciation to our four participants who diligently completed this study. This project was supported by NIH (NIDCD) grant P50 DC03888‐01A1 to the University of Florida (subcontract to Old Dominion University), and by the Dept. of Veterans Affairs Rehabilitation Research & Development Center of Excellence Grant F2182C to the Brain Rehabilitation Research Center, Gainesville, Florida. Aims: The purpose of this investigation was to study the effects of gesture+verbal and semantic‐phonologic treatments on verb retrieval in patients with chronic aphasia. Methods & Procedures: We report treatment results for four individuals, three men and one woman, with aphasia and verb retrieval impairments subsequent to left hemisphere stroke more than 8 months earlier. Word retrieval impairment was semantically based in one participant, phonologically based in another, and mixed semantic+phonologic in two others. In a single‐participant experimental treatment design, we investigated the effects of gesture+verbal treatment and semantic‐phonologic treatment for verb retrieval in two 10‐session training phases. The effects of treatment were evaluated in a verb picture‐naming task in which spoken naming and gestured responses were coded. Outcomes & Results: Spoken naming improvements associated with large effect sizes were noted in one participant during both the semantic‐phonologic training and gesture+verbal training. Gesture production improved in two other participants with severe anomia during gesture+verbal training. No improvements were evident in untrained words during either training phase. Conclusions: Gesture+verbal training and semantic‐phonologic training led to similar patterns of treatment results for verb spoken naming. The individual with phonologically based anomia responded better in treatment than the other three whose naming impairments were associated with semantic dysfunction. The item‐specific improvement in spoken naming for trained verbs only suggests that both treatments may affect individual lexical representations engaged during word retrieval. Gesture+verbal treatment may encourage use of a viable means of gestural communication for those who do not improve verbal production, even in the presence of severe limb apraxia.

First decade of research on constrained-induced treatment approaches for aphasia rehabilitation.

Approaches for treating poststroke language impairments (aphasia) based on constraint-induced (CI) principles were first introduced in 2001. CI principles as previously applied to upper extremity and locomotor retraining in stroke survivors were derived from basic neuroscience. They comprise forced-use of the affected modality, a gradual rebuilding of targeted functions using a highly intensive treatment protocol, administered in a behaviorally relevant context. CI-based approaches have stimulated considerable neurorehabilitation research interest in the past decade. The original CI aphasia treatment protocol was tailored to improve functional communication in chronic aphasia (ie, 6-12mo after stroke) and more recently, it has been adapted to treat language impairments in acute stroke survivors as well. Moreover, CI therapy applied to aphasia has been used as a model to assess language network plasticity in response to treatment using functional imaging techniques. In the following article, we review the first 10 years of behavioral and functional brain imaging research on CI-based approaches for aphasia rehabilitation.

Treatment of naming in nonfluent aphasia through manipulation of intention and attention: A phase 1 comparison of two novel treatments

Twenty-three chronic nonfluent aphasia patients with moderate or severe word-finding impairments and 11 with profound word-finding impairments received two novel picture-naming treatments. The intention treatment initiated picture-naming trials with a complex left-hand movement and was designed to enhance right frontal participation during word retrieval. The attention treatment required patients to view visual stimuli for picture-naming trials in their left hemispace and was designed to enhance right posterior perisylvian participation during word retrieval. Because the intention treatment addressed action mechanisms and nonfluent aphasia reflects difficulty initiating or maintaining action (i.e., language output), it was hypothesized that intention component of the treatment would enhance re-acquisition of picture naming more than the attention component. Patients with moderate and severe word-finding impairment showed gains with both treatments but greater incremental improvement from one treatment phase to the next with the intention than the attention treatment. Thus, the hypothesis that intention component would be a more active constituent than the attention component was confirmed for these patients. Patients with profound word-finding impairment showed some improvement with both treatments but no differential effects for the intention treatment. Almost all patients who showed treatment gains on either treatment also demonstrated generalization from trained to untrained items.

Cognition, language, and clinical pathological features of non-Alzheimer's dementias: An overview

UNLABELLED There are many distinct forms of dementia whose pharmacological and behavioral management differ. Differential diagnosis among the dementia variants currently relies upon a weighted combination of genetic and protein biomarkers, neuroanatomical integrity, and behavior. Diagnostic specificity is complicated by a high degree of overlap in the initial presenting symptoms across dementia subtypes. For this reason, reliable markers are of considerable diagnostic value. Communication disorders have proven to be among the strongest predictors for discriminating among dementia subtypes. As such, speech-language pathologists may be poised to make an increasingly visible contribution to dementia diagnosis and its ongoing management. The value and durability of this potential contribution, however, demands an improved discipline-wide knowledge base about the unique features associated with different dementia variants. To this end we provide an overview of cognition, language, and clinical pathological features of four of the most common non-Alzheimers dementias: frontotemporal dementia, vascular dementia, Lewy body disease dementia, and Parkinsons disease dementia. LEARNING OUTCOMES Readers will learn characteristics and distinguishing features of several non-Alzheimers dementias, including Parkinsons disease dementia, frontotemporal dementia, vascular dementia, and Lewy body dementia. Readers will also learn to distinguish between several variants of frontotemporal dementia. Finally, readers will gain knowledge of the term primary progressive aphasia as it relates to the aforementioned dementia etiologies.

Mobile computing technology and aphasia: an integrated review of accessibility and potential uses

Background: Recently, the use of mobile computer technology in health management has received attention in research and clinical domains. The role of mobile devices such as smart phones and tablet PCs in the management of aphasia has not yet been thoroughly reviewed in the literature, and research on mobile technology and aphasia is scarce. Aims: The aim of this paper is to review accessibility issues and the potential uses of mobile computing for people with aphasia, with a view to stimulating and guiding further research. Main Contribution: The literature reviewed is synthesised into key design features which may enhance the accessibility of technology for people with aphasia. The importance of access to technology for non-rehabilitative purposes and the potential role of smart phones as a cost-effective, time-efficient and context-sensitive health management tool are outlined. Potential functions of speech pathology applications (apps) are also proposed, with the aim of improving the organisation and direction of research in this area. Conclusions: Improving access to mobile computing technology by people with aphasia has the potential for enhancing both social participation and management of aphasia. It is clear from this review that more research is needed into how accessibility may be improved, as well as on the development of mobile applications that aid management of aphasia.

Aphasia LIFT: Exploratory investigation of an intensive comprehensive aphasia programme

Background: Intensive comprehensive aphasia programs (ICAPs) are gaining popularity in the international aphasia rehabilitation community. ICAPs comprise at least three hours of treatment per day over at least two weeks, have definable start and end dates for one cohort and use a variety of formats including individual treatment, group therapy, education and technology to improve language and communication. While intensive treatment approaches have demonstrated equivocal results on impairment-based measures, positive changes on activity/participation measures provide support for ICAPs in rehabilitation of chronic aphasia. Aphasia Language Impairment and Functional Therapy (LIFT) is a research-based ICAP developed for the purpose of evaluating treatment outcomes across the International Classification of Functioning, Disability and Health (ICF) domains. Aims: The aim of this study was to estimate the magnitude of treatment effects yielded by Aphasia Aphasia LIFT in the domains of language impairment, functional communication and communication-related quality of life (QOL). Methods & Procedures: Eleven individuals with chronic post-stroke aphasia (mean = 26.9 months) completed Aphasia LIFT. The programme comprised individual impairment-based and functional treatment, group therapy, and computer-based treatment for 40 hours over two weeks (n = 4, LIFT 1) or 100 hours over four weeks (n = 7, LIFT 2). Assessments of confrontation naming, discourse production, functional communication and communication-related quality of life were completed at pre-treatment, immediately post-treatment and six to eight weeks following treatment termination. Outcomes & Results: Group-level analyses revealed acquisition and maintenance of treatment effects, as evidenced by significant improvement on at least one outcome measure at follow-up in all domains. The most consistent pattern of improvement at an individual level was observed on measures of functional communication and communication-related QOL. Conclusions: Aphasia LIFT yielded positive outcomes across ICF domains, and in many cases the treatment effect was enduring. These results demonstrate that Aphasia LIFT was successful in meeting the overarching goal of ICAPs, to maximise communication and enhance life participation in individuals with aphasia. Further research into ICAPs is warranted.

Influence of intensive phonomotor rehabilitation on apraxia of speech.

In this phase I rehabilitation study, we investigated the effects of an intensive phonomotor rehabilitation program on verbal production in a 73-year-old male, 11 years postonset a left-hemisphere stroke, who exhibited apraxia of speech and aphasia. In the context of a single-subject design, we studied whether treatment would improve phoneme production and generalize to repetition of multisyllabic words, words of increasing length, discourse, and measures of self-report. We predicted that a predominant motor impairment would respond to intensive phonomotor rehabilitation. While able to learn to produce individual sounds, the subject did not exhibit generalization to other aspects of motor production. Discourse production was judged perceptually slower in rate and less effortful, but also less natural. Finally, self-report indicated less apprehension toward speaking with unfamiliar people, increased telephone use, and increased ease of communication.