Donna C. Tippett

Critical role of the right uncinate fasciculus in emotional empathy

Common neurological diseases or injuries that can affect the right hemisphere, including stroke, traumatic brain injury, and frontotemporal dementia, disrupt emotional empathy—the ability to share in and make inferences about how other people feel. This impairment negatively impacts social interactions and relationships. Accumulating evidence indicates that emotional empathy depends on coordinated functions of orbitofrontal cortex, anterior insula, anterior cingulate, temporal pole, and amygdala, but few studies have investigated effects of lesions to white matter tracts that connect these structures. We tested the hypothesis that percentage damage to specific white matter tracts connecting these gray matter structures predicts error rate in an emotional empathy task after acute right hemisphere ischemic stroke.

Effects of laryngeal cancer on voice and swallowing.

Specific deficits that may be encountered as well as interventional strategies and evidence-based practice are discussed. When discussing the voice, it is important to consider that for many people the voice is not just a tool for communication, but also an identifying feature that allows expression of personality. Eating and swallowing are vital to life sustenance and also allow for a myriad of social interactions. Laryngeal cancer can have a dramatic impact on this delicately balanced system leading to disturbances of voice and swallowing.

Swallowing outcomes in patients with oropharyngeal cancer undergoing organ-preservation treatment.

The purpose of this study was to assess swallowing outcomes in a cohort of patients with oropharyngeal squamous cell carcinoma (SCC) undergoing nonoperative treatment.

Stroke Recovery: Surprising Influences and Residual Consequences

There is startling individual variability in the degree to which people recover from stroke and the duration of time over which recovery of some symptoms occurs. There are a variety of mechanisms of recovery from stroke which take place at distinct time points after stroke and are influenced by different variables. We review recent studies from our laboratory that unveil some surprising findings, such as the role of education in chronic recovery. We also report data showing that the consequences that most plague survivors of stroke and their caregivers are loss of high level cortical functions, such as empathy or written language. These results have implications for rehabilitation and management of stroke.

Preserving Oral Communication in Individuals With Tracheostomy and Ventilator Dependency

How to preserve oral communication in patients with tracheostomy is the primary focus of this paper. We review the approaches applicable to patients who breathe independently and to patients who de...

Treatment of Primary Progressive Aphasia

Opinion statementPrimary progressive aphasia (PPA) is a neurodegenerative disease that primarily affects language functions and often begins in the fifth or sixth decade of life. The devastating effects on work and home life call for the investigation of treatment alternatives. In this paper, we present a review of the literature on treatment approaches for this neurodegenerative disease. We also present new data from two intervention studies we have conducted, a behavioral one and a neuromodulatory one using transcranial direct current stimulation (tDCS) combined with written production intervention. We show that speech-language intervention improves language outcomes in individuals with PPA, and especially in the short term, tDCS augments generalization and maintenance of positive language outcomes. We also outline current issues and challenges in intervention approaches in PPA.

Distinguishing psychogenic from neurogenic dysfluency when neurologic and psychologic factors coexist

Abstract Reports of acquired dysfluency emphasize the diagnostic importance of symptom reversibility in distinguishing a psychogenic from a neurogenic etiology. This paper describes the onset of dysfluency in a 23-year-old man who had anoxic encephalopathy with diffuse weakness and spasticity, pseudoseizures, and depression following an episode of status epilepticus. Differential diagnosis was complicated by the presence of both objective neurologic abnormalities and psychologic factors. The history, physical examination and analysis of speech characteristics were insufficient to make the diagnosis; however, the effect of a therapeutic trial strongly suggested psychogenicity.

The association of insular stroke with lesion volume.

The insula has been implicated in many sequelae of stroke. It is the area most commonly infarcted in people with post-stroke arrhythmias, loss of thermal sensation, hospital acquired pneumonia, and apraxia of speech. We hypothesized that some of these results reflect the fact that: (1) ischemic strokes that involve the insula are larger than strokes that exclude the insula (and therefore are associated with more common and persistent deficits); and (2) insular involvement is a marker of middle cerebral artery (MCA) occlusion. We analyzed MRI scans of 861 patients with acute ischemic hemispheric strokes unselected for functional deficits, and compared infarcts involving the insula to infarcts not involving the insula using t-tests for continuous variables and chi square tests for dichotomous variables. Mean infarct volume was larger for infarcts including the insula (n = 232) versus excluding the insula (n = 629): 65.8 ± 78.8 versus 10.2 ± 15.9 cm3 (p < 0.00001). Even when we removed lacunar infarcts, mean volume of non-lacunar infarcts that included insula (n = 775) were larger than non-lacunar infarcts (n = 227) that excluded insula: 67.0 cm3 ± 79.2 versus 11.5 cm3 ± 16.7 (p < 0.00001). Of infarcts in the 90th percentile for volume, 87% included the insula (χ2 = 181.8; p < 0.00001). Furthermore, 79.0% infarcts due to MCA occlusion included the insula; 78.5% of infarcts without MCA occlusion excluded the insula (χ2 = 93.1; p < 0.0001). The association between insular damage and acute or chronic sequelae likely often reflects the fact that insular infarct is a marker of large infarcts caused by occlusion of the MCA more than a specific role of the insula in a range of functions. Particularly in acute stroke, some deficits may also be due to ischemia of the MCA or ICA territory caused by large vessel occlusion.

Important considerations in lesion-symptom mapping: Illustrations from studies of word comprehension

Lesion‐symptom mapping is an important method of identifying networks of brain regions critical for functions. However, results might be influenced substantially by the imaging modality and timing of assessment. We tested the hypothesis that brain regions found to be associated with acute language deficits depend on (1) timing of behavioral measurement, (2) imaging sequences utilized to define the “lesion” (structural abnormality only or structural plus perfusion abnormality), and (3) power of the study. We studied 191 individuals with acute left hemisphere stroke with MRI and language testing to identify areas critical for spoken word comprehension. We use the data from this study to examine the potential impact of these three variables on lesion‐symptom mapping. We found that only the combination of structural and perfusion imaging within 48 h of onset identified areas where more abnormal voxels was associated with more severe acute deficits, after controlling for lesion volume and multiple comparisons. The critical area identified with this methodology was the left posterior superior temporal gyrus, consistent with other methods that have identified an important role of this area in spoken word comprehension. Results have implications for interpretation of other lesion‐symptom mapping studies, as well as for understanding areas critical for auditory word comprehension in the healthy brain. We propose that lesion‐symptom mapping at the acute stage of stroke addresses a different sort of question about brain–behavior relationships than lesion‐symptom mapping at the chronic stage, but that timing of behavioral measurement and imaging modalities should be considered in either case. Hum Brain Mapp 38:2990–3000, 2017.

Speech-language pathology care and short- and long-term outcomes of laryngeal cancer treatment in the elderly.

To examine associations between speech‐language pathology (SLP) care and pretreatment variables, swallowing and airway impairment, and survival in elderly patients treated for laryngeal cancer.