Elizabeth E. Galletta

Translational treatment of aphasia combining neuromodulation and behavioral intervention for lexical retrieval: implications from a single case study

Background: Transcranial direct current stimulation (tDCS), a non-invasive method of brain stimulation, is an adjunctive research-therapy for aphasia. The concept supporting translational application of tDCS is that brain plasticity, facilitated by language intervention, can be enhanced by non-invasive brain stimulation. This study combined tDCS with an ecologically focused behavioral approach that involved training nouns and verbs in sentences. Method: Participant: A 43-year-old, right-handed male with fluent-anomic aphasia who sustained a single-left-hemisphere-temporal-parietal stroke was recruited. Treatment: Instrumentation included the Soterix Medical 1 × 1 Device. Anodal tDCS was applied over Broca’s area. Behavioral materials included: sentence production, naming in the sentence context, and implementation of a social-conversational-discourse treatment. Design and Procedures: The independent variable of this crossover case-study was tDCS, and the dependent variables were language and quality-of-life measures. In each session the subject received language treatment with the first 20 minutes additionally including tDCS. Results: Performance in naming nouns and verbs in single words and sentences were obtained. Verb production in the sentence context increased after active anodal tDCS and speech-language treatment. Conclusion: Aphasia treatment that involves naming in the sentence context in conjunction with translational application of tDCS may be a promising approach for language-recovery post stroke.

Assessment of neglect dyslexia with functional reading materials.

Abstract Background: Spatial neglect is a neurocognitive disorder that affects perception, representation, and/or motor planning. Neglect dyslexia in spatial neglect after right hemisphere damage may co-occur with, or be dissociated from, other spatial neglect signs. Previous neglect dyslexia research focused on word-level stimuli and reading errors. Using single words for assessment may leave some people with neglect dyslexia undiagnosed, and assessment materials that are closer to texts read in real life may better capture neglect dyslexia. Method: The authors tested reading in 67 right hemisphere stroke survivors with 4 types of text materials: words, phrases, an article, and a menu. Results: Accuracy on reading the menu and article texts was significantly poorer than reading the words and phrases. The hypothesis that assessment materials with ecological validity such as reading a menu and reading an article may be more challenging than reading single words and phrases was supported. Conclusion: Results suggest that neglect dyslexia assessment after stroke should include text materials comparable to those read in everyday life. Increasing the spatial extent of training materials in future research might also yield better functional generalization after right brain stroke.

Use of tDCS in Aphasia Rehabilitation: A Systematic Review of the Behavioral Interventions Implemented With Noninvasive Brain Stimulation for Language Recovery

Purpose The purpose of this article is to review the behavioral treatments used in aphasia rehabilitation research that have been combined with transcranial direct current stimulation (tDCS). Although tDCS in aphasia treatment has shown promise, the results have not been conclusive, and their interpretation is further compounded by the heterogeneity of study characteristics. Because implementing a behavioral task during brain stimulation has been shown to be pivotal to the adjuvant effects of tDCS, we analyze the behavioral treatments that have been paired with tDCS. Method A computerized database search (PubMed) was completed to document and review aphasia treatment studies that combine behavioral treatment with noninvasive brain stimulation in the form of tDCS. Two authors reviewed each aphasia tDCS article published between 2008 and 2015 and evaluated (a) the behavioral interventions for aphasia that have been combined with tDCS, and (b) the methodological variables that may have influenced language outcomes in the tDCS aphasia literature. Conclusions A review of the behavioral treatments implemented in tDCS aphasia rehabilitation studies highlights several methodological considerations for future investigations. Impairment-focused and pragmatic treatments have been implemented in tDCS aphasia research studies. No one behavioral approach stands out as the best treatment to combine with tDCS for the promotion of language recovery.

Impairment and Functional Interventions for Aphasia: Having it All.

Aphasia, a cognitive-linguistic disorder secondary to stroke, is a frequent and often chronic consequence of stroke with detrimental effects on autonomy and health-related quality of life. Treatment of aphasia can be approached in a number of ways. Impairment-based approaches that focus on training a specific linguistic form can be implemented. Additionally, functionally oriented intervention such as supported conversation and aphasia groups are also frequently utilized when providing a treatment program for an individual with aphasia. Creating a treatment approach that includes both impairment and functional methodologies and considers how these relate to the three domains proposed by the International Classification of Functioning Disability and Health (ICF)—body functions and structure, activity, and participation—can provide an individual with aphasia an optimal treatment program that is person-centered and multi-faceted.

Stroke survivors over-estimate their medication self-administration (MSA) ability, predicting memory loss.

Abstract Background and objective: Medication self-administration (MSA) may be cognitively challenging after stroke, but guidelines are currently lacking for identifying high-functioning stroke survivors who may have difficulty with this task. Complicating this matter, stroke survivors may not be aware of their cognitive problems (cognitive anosognosia) and may over-estimate their MSA competence. The authors wished to evaluate medication self-administration and MSA self-awareness in 24 consecutive acute stroke survivors undergoing inpatient rehabilitation, to determine if they would over-estimate their medication self-administration and if this predicted memory disorder. Methods: Stroke survivors were tested on the Hopkins Medication Schedule and also their memory, naming mood and dexterity were evaluated, comparing their performance to 17 matched controls. Results: The anosognosia ratio indicated MSA over-estimation in stroke survivors compared with controls—no other over-estimation errors were noted relative to controls. A strong correlation was observed between over-estimation of MSA ability and verbal memory deficit, suggesting that formally assessing MSA and MSA self-awareness may help detect cognitive deficits. Conclusions: Assessing medication self-administration and MSA self-awareness may be useful in rehabilitation and successful community-return after stroke.

Response Time Inconsistencies in Object and Action Naming in Anomic Aphasia

Purpose The effect of repeated naming on both object and action picture naming in individuals with anomic aphasia is explored. We asked whether repeatedly naming the same items leads to improved accuracy and reduced response latency. Method Ten individuals with anomic aphasia and 6 healthy adults, 3 young and 3 old, named a set of 27 object pictures and a set of 27 action pictures presented 1 at a time on a computer screen. We examined accuracy and response times (RTs) across the 2 blocks of 10 repeated trials. Results Results demonstrated higher accuracy and faster RTs for object than for action naming for all participants, with lower accuracy rates and slower RTs for the people with aphasia (PWA) compared with the healthy individuals, and diverging patterns of change across trials. Unlike the healthy participants, whose RTs decreased across trials, PWA continued to demonstrate variability in response latencies across the trials. Conclusions Our preliminary results suggest that measuring RT may be useful in characterizing retrieval difficulty in anomic aphasia and that the retrieval processes in PWA, even in those who experience mild anomia, may be less efficient or different from those processes in neurologically healthy individuals.