Carol Leonard

Processing emotional tone from speech in Parkinson's disease: a role for the basal ganglia.

In this study, individuals with Parkinson’s disease were tested as a model for basal ganglia dysfunction to infer how these structures contribute to the processing of emotional speech tone (emotional prosody). Nondemented individuals with and without Parkinson’s disease (n = 21/group) completed neuropsychological tests and tasks that required them to process the meaning of emotional prosody in various ways (discrimination, identification, emotional feature rating). Individuals with basal ganglia disease exhibited abnormally reduced sensitivity to the emotional significance of prosody in a range of contexts, a deficit that could not be attributed to changes in mood, emotional-symbolic processing, or estimated frontal lobe cognitive resource limitations in most conditions. On the basis of these and broader findings in the literature, it is argued that the basal ganglia provide a critical mechanism for reinforcing the behavioral significance of prosodic patterns and other temporal representations derived from cue sequences (Lieberman, 2000), facilitating cortical elaboration of these events.

Treating anomia in semantic dementia: improvement, maintenance, or both?

A treatment programme for AK, an anomic patient with semantic dementia is described. The programme was based on home practice and resulted in re-learning the names of some objects AK could not name and/or comprehend prior to the treatment. The effects of treatment were still present one month post-treatment for items that AK could not name but could comprehend prior to treatment. In addition to items that AK could not name, items that she could both understand and name were also included in the programme. This allowed us to evaluate the influence of practice on the retention of words that appeared to be intact at the outset of the investigation. Results indicated that practice delayed the progression of loss. In addition, the programme was designed jointly with AK who made many important decisions related to treatment.

The Impact of Parkinson's Disease on Vocal-Prosodic Communication from the Perspective of Listeners.

An expressive disturbance of speech prosody has long been associated with idiopathic Parkinsons disease (PD), but little is known about the impact of dysprosody on vocal-prosodic communication from the perspective of listeners. Recordings of healthy adults (n=12) and adults with mild to moderate PD (n=21) were elicited in four speech contexts in which prosody serves a primary function in linguistic or emotive communication (phonemic stress, contrastive stress, sentence mode, and emotional prosody). Twenty independent listeners naive to the disease status of individual speakers then judged the intended meanings conveyed by prosody for tokens recorded in each condition. Findings indicated that PD speakers were less successful at communicating stress distinctions, especially words produced with contrastive stress, which were identifiable to listeners. Listeners were also significantly less able to detect intended emotional qualities of Parkinsonian speech, especially for anger and disgust. Emotional expressions that were correctly recognized by listeners were consistently rated as less intense for the PD group. Utterances produced by PD speakers were frequently characterized as sounding sad or devoid of emotion entirely (neutral). Results argue that motor limitations on the vocal apparatus in PD produce serious and early negative repercussions on communication through prosody, which diminish the social-linguistic competence of Parkinsonian adults as judged by listeners.

Methods to Enhance Verbal Communication between Individuals with Alzheimer's Disease and Their Formal and Informal Caregivers: A Systematic Review

Alzheimers disease is the leading cause of dementia in older adults. Although memory problems are the most characteristic symptom of this disorder, many individuals also experience progressive problems with communication. This systematic review investigates the effectiveness of methods to improve the verbal communication of individuals with Alzheimers disease with their caregivers. The following databases were reviewed: PsychINFO, CINAHL, EMBASE, MEDLINE, REHABDATA, and COMDIS. The inclusion criteria were: (i) experimentally based studies, (ii) quantitative results, (iii) intervention aimed at improving verbal communication of the affected individual with a caregiver, and (iv) at least 50% of the sample having a confirmed diagnosis of Alzheimers disease. A total of 13 studies met all of the inclusion criteria. One technique emerged as potentially effective: the use of memory aids combined with specific caregiver training programs. The strength of this evidence was restricted by methodological limitations of the studies. Both adoption of and further research on these interventions are recommended.

Treating naming impairments in aphasia: Findings from a phonological components analysis treatment

Background: A new phonologically based treatment that we developed for addressing naming deficits in aphasia—the phonological components analysis (PCA) treatment—is presented. The PCA was modelled after the semantic feature analysis (SFA) approach (Boyle & Coelho, 1995). The SFA approach was chosen as a model for two reasons. First, results from the semantic therapies that have used SFA have been encouraging (e.g., Boyle, 2004; Boyle & Coelho, 1995; Coelho, McHugh, & Boyle, 2000; Conley & Coelho, 2003; Lowell, Beeson, & Holland, 1995). Second, SFA incorporates the principle of choice, a factor that has been identified by some as being important in producing longer‐lasting effects of treatment (e.g., Hickin, Best, Herbert, Howard, & Osborne, 2002). The PCA was developed to serve as a comparable phonological comparison for the SFA approach with the future goal of comparing the relative effects of both types of therapies. Portions of this work were presented at the Academy of Aphasia meetings in New York, October 2002 (Rochon, Leonard, & Laird, 2002) and Victoria, October 2006 (Rochon et al., 2006a), at the American Speech and Hearing Association meeting, Philadelphia, November 2004, and at the Rotman Research Conference, Toronto, March 2006 (Rochon et al., 2006b). This project was supported by grant number 44069 from the Canadian Institutes of Health Research and by grant number NA 5379 from the Heart and Stroke Foundation of Ontario. The authors are grateful to the North York Aphasia Institute, the York Durham Aphasia Centre, and the Aphasia Centre of Ottawa‐Carleton for allowing us to recruit participants from their institutions, and to all the individuals who participated in this research. James Andrews, Eleanor Arabia, Jennifer Cupit, Kit Flynn, Heather McCallum, Lauren Reznick, and Patty Vlachos, provided valuable assistance on this project. Thank you also to two anonymous reviewers for their helpful comments. Aims: The primary aim of this investigation was to document the effectiveness of PCA treatment for the remediation of naming deficits in aphasia. In addition, we wished to examine potential maintenance and generalisation effects associated with this treatment. Methods & Procedures: The PCA treatment followed the protocol of Coelho et al. (2000). The target picture was presented in the centre of a chart and the participant was asked to name it. Irrespective of his/her ability to name the picture, the participant was asked to identify five phonological components related to the target item (i.e., rhymes with, first sound, first sound associate, final sound, number of syllables). For each component targeted, if a participant could not spontaneously provide a response, he/she was asked to choose one from a list. A single‐subject multiple‐baseline across behaviours design was employed, with maintenance effects examined 4 weeks post‐treatment. Generalisation effects were examined by comparing pre‐ and post‐treatment scores on the Philadelphia Naming Test (Roach, Schwartz, Martin, Grewal, & Brecher, 1996). Ten individuals with aphasia participated. Outcomes & Results: Of the 10 individuals, 7 demonstrated notable treatment effects. Follow‐up testing indicated maintenance of treatment gains over a 4‐week period, with some generalisation to untreated items. Conclusions: This investigation was successful in demonstrating the effectiveness of a new phonological approach to the remediation of naming deficits in aphasia and in supporting the notion that a components analysis treatment protocol (similar to a semantic feature based treatment) is useful in strengthening activations within the lexical system with the potential result of longer‐lasting effects.

The ability of right- and left-hemisphere-damaged individuals to produce and interpret prosodic cues marking phrasal boundaries.

Two experiments were conducted with the purpose of investigating the ability of right- and left-hemisphere-damaged individuals to produce and perceive the acoustic correlates to phrase boundaries. In the production experiment, the utterance pink and black and green was elicited in three different conditions corresponding to different arrangements of colored squares. Acoustic analyses revealed that both left- and right-hemisphere-damaged patients exhibited fewer of the expected acoustic patterns in their productions than did normal control subjects. The reduction in acoustic cues to phrase boundaries in the utterances of both patient groups was perceptually salient to three trained listeners. The perception experiment demonstrated a significant impairment in the ability of both left-hemisphere-damaged and right-hemisphere-damaged individuals to perceive phrasal groupings. Results are discussed in relation to current hypotheses concerning the cerebral lateralization of speech prosody.

Word retrieval therapies in primary progressive aphasia

Background: Primary progressive aphasia (PPA) with its three variants is a progressive neurodegenerative dementia in which language impairment is the first and most dominant symptom. Traditionally, speech-language pathologists who deliver therapy to adults with acquired neurogenic language disorders shy away from treatment of progressive aphasia as there is no promise of lasting effects and only limited data regarding treatment efficacy. Aims: This paper comprises the most current review of the literature focused on treatment of naming impairments in PPA, and aims to encourage and assist clinicians in selecting intervention approaches for individuals with PPA. It highlights current trends and challenges in delivering successful therapy for naming deficits in PPA. Main Contribution: We reviewed papers that reported different forms of naming therapy for patients with PPA, which included interventions that, although not always aimed directly at anomic deficits, brought about improvement in naming. Immediate gains, maintenance, and generalisation effects are summarised, along with a variety of approaches and methodologies that can be applied to the PPA population. We also provide a list of factors that were found to contribute to the success of therapy and to the maintenance and/or generalisation of treatment gains. Conclusions: Current literature delivers encouraging evidence for clinicians wanting to provide naming therapy to patients with PPA. Although PPA is a progressive disorder, both the immediate treatment effects and, in many cases, maintenance results show that improvements are possible. The issues of generalisation of naming gains beyond the clinician’s office still require more studies to determine the best conditions, designs, and patient suitability.

Relearning lost vocabulary in nonfluent progressive aphasia with MossTalk Words

Background: The literature on aphasia has been growing rapidly, with reports of different therapeutic approaches for a post‐stroke anomia. While individuals with post‐stroke anomia frequently recover to some extent, the other end of the aphasia recovery continuum is occupied by those who experience relentless language dissolution as a result of progressive disorders such as primary progressive aphasia. One of the most recent additions to the field of aphasia rehabilitation is therapy whereby either part of or the entire therapy is administered via computer‐based programmes. There have been few treatment studies investigating the rehabilitation of language abilities in people with primary progressive aphasia (PPA). Aims: The objectives of this investigation were to examine the ability of PPA individuals to relearn lost words and to determine the extent of benefits derived from MossTalk Words®, a computer‐based treatment for anomia. Methods and Procedures: Using a multiple baseline across behaviours design, we explored treatment‐specific effects, maintenance, and generalisation of improvements derived from this therapy programme. Two participants with nonfluent PPA were treated, each on three lists of words for which low and stable baselines were first established. Sessions occurred two to three times a week. Treatment involved the presentation of a picture on the computer screen, with the participants being required to name it. Success in treatment was measured by probing list naming every second session. Once a participant attained 80% accuracy over two consecutive probes, or participated in 12 sessions (whichever occurred first), treatment of a list was terminated and the next list was started. Each participant was tested on all items immediately after therapy, and again 1 month later. Outcomes and Results: Both participants improved their naming skills with the MossTalk Words®. P1 required only four sessions to reach the proposed criterion of 80% (up to 100%) correct on each list. The effects of treatment were maintained immediately and, to a lesser degree, 4 weeks later. P2 required all 12 sessions for each of the three lists. Results were variable immediately after testing, but seemingly maintained 4 weeks later. Conclusions: The results demonstrate that both participants with primary progressive aphasia benefited (although to a different extent) from a computer‐based treatment for anomia. These results are encouraging and suggest that such a treatment may be a viable therapy approach for patients who suffer from PPA in the absence of a generalised cognitive impairment. We are indebted to both participants for their cooperation and tenacity, and to our talented research assistants Eleanor Arabia and Lyndsay White. We also thank Ruth Fink for making the MossTalk Words® available to us. This study was supported by a CIHR IA Fellowship to R. Jokel, and a CIHR Doctoral Award to J. Cupit. The authors acknowledge the support of the Toronto Rehabilitation Institute, which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long Term Care in Ontario, Canada.

Neural changes after phonological treatment for anomia: An fMRI study

Functional magnetic resonance imaging (fMRI) was used to investigate the neural processing characteristics associated with word retrieval abilities after a phonologically-based treatment for anomia in two stroke patients with aphasia. Neural activity associated with a phonological and a semantic task was compared before and after treatment with fMRI. In addition to the two patients who received treatment, two patients with aphasia who did not receive treatment and 10 healthy controls were also scanned twice. In the two patients who received treatment, both of whose naming improved after treatment, results showed that activation patterns changed after treatment on the semantic task in areas that would have been expected (e.g., left hemisphere frontal and temporal areas). For one control patient, there were no significant changes in brain activation at the second scan; a second control patient showed changes in brain activation at the second scan, on the semantic task, however, these changes were not accompanied with improved performance in naming. In addition, there appeared to be bilateral, or even more right than left hemisphere brain areas activated in this patient than in the treated patients. The healthy control group showed no changes in activation at the second scan. These findings are discussed with reference to the literature on the neural underpinnings of recovery after treatment for anomia in aphasia.

The Use of Contextual Information by Right Brain-Damaged Individuals in the Resolution of Ambiguous Pronouns ☆ ☆☆ ★

Two experiments were conducted with the primary purpose of investigating the ability of right brain-damaged (RBD) individuals to use contextual information--at the level of the single sentence, in terms of the integration of information between clauses, and at the level of a minimal discourse (i.e., two sentences)--in the resolution of ambiguous pronouns. The investigation was extended to a group of left brain-damaged (LBD) and non-brain-damaged (NBD) individuals. Contrary to the prevailing view that RBD patients have difficulty in the use of contextual information to process language, both experiments were consistent in demonstrating that the RBD group was influenced by contextual information in a manner similar to that demonstrated by both the LBD and NBD groups.