Gopee Krishnan

Revisiting the acquired neurogenic stuttering in the light of developmental stuttering

Abstract The neural underpinnings of acquired neurogenic stuttering (ANS) remain largely speculative owing to the multitude of etiologies and cerebral substrates implicated with this fluency disorder. Systematic investigations of ANS under various fluency-enhancing conditions have begun only in the recent past and these studies are indicative of the heterogeneous nature of the disorder. In this context, we present the case of a subject with ANS who exhibited marked reduction in dysfluencies under masked auditory feedback (MAF), singing, and pacing (speech therapy). However, the adaptation effect was absent in our subject. By explaining these features in the light of recent explanatory hypotheses derived from developmental stuttering (DS), we highlight on the possible similarity in the neural underpinnings of ANS and DS.

Adaptation and validation of stroke-aphasia quality of life (SAQOL-39) scale to Hindi

Background: Stroke is a major detriment to the quality of life (QOL) in its victims. Several functional limitations following stroke contribute to the denigrated QOL in this population. Aphasia, a disturbance in the comprehension, processing, and/or expression of language, is a common consequence of stroke. Yet, in most Indian languages, including the national language (Hindi), there are no published tools to measure the QOL of persons with stroke-aphasia. Objective: The current study was carried out to adapt and validate a well-known tool to measure the QOL (i.e., Stroke-Aphasia Quality of Life-39; SAQOL-39) to Hindi. Materials and Methods: We presented the original (English) version of the SAQOL-39 to a group of six Hindi-speaking Speech Language Pathologists hailing from the central and northern regions of India to examine the sociocultural suitability of items and indicate modifications, if any. The linguistic adaptation was performed through a forward-backward translation scheme. The socioculturally and linguistically adapted (to Hindi) version was then administered on a group of 84 Hindi-speaking persons with aphasia to examine the acceptability, test-retest reliability as well as the internal consistency of the instrument. Results: The SAQOL-39 in Hindi exhibited high test-retest reliability (ICC = 0.9) as well as acceptability with minimal missing data. This instrument exhibited high internal consistency (Chronbach′s ∝ = 0.98) as well as the both item-to-total and inter-domain correlations. Conclusions: The socioculturally and linguistically adapted Hindi version of SAQOL-39 is a robust tool to measure the QOL of persons with stroke-aphasia. It may serve as an essential tool to measure the QOL in this population for both clinical and research purposes.

Adaptation and validation of stroke-aphasia quality of life (SAQOL-39) scale to Malayalam.

Background: Aphasia, an acquired inability to understand and/or speak language, is a common repercussion of stroke that denigrates the quality of life (QOL) in the affected persons. Several languages in India experience the dearth of instruments to measure the QOL of persons with aphasia. Malayalam, the language spoken by more than 33 million people in Kerala, the southern state of India, is not an exception to this. Objective: This study aimed to adapt and validate the widely-used stroke-aphasia quality of life (SAQOL-39) scale to Malayalam. Materials and Methods: We required seven Malayalam-speaking Speech Language Pathologists (SLPs), hailing from different regions of Kerala, to examine the socio-cultural suitability of the original items in SAQOL-39 and indicate modifications, wherever necessary. Subsequently, the linguistic adaptation was performed through a forward-backward translation scheme. The socio-culturally and linguistically adapted Malayalam version was then administered on a group of 48 Malayalam-speaking persons with aphasia to examine the test-retest reliability, acceptability, as well as the internal consistency of the instrument. Results: The Malayalam SAQOL-39 scale showed high test-retest reliability (intraclass correlation coefficient, ICC = 0.91) as well as acceptability with minimal missing data (0.52%). Further, it yielded high internal consistency (Chronbach′s ∝ = 0.98) as well as item-to-total and inter-domain correlations. Conclusions: The Malayalam version of SAQOL-39 is the first socio-culturally and linguistically adapted tool to measure the QOL of persons with stroke-aphasia speaking this language. It may serve as a potential tool to measure the QOL of this population in both clinical practice and future research endeavors.

Apraxic agraphia: An insight into the writing disturbances of posterior aphasias.

Background: Reading and writing disturbances are common accompaniments of aphasia following brain damage. However, impaired writing in the absence of apparent primary linguistic disturbances is infrequently reported in the literature. Materials and Methods: A 67-year-old right-handed subject underwent neurological, neuroradiological, and linguistic investigations following development of a minimal right upper limb weakness. Result: The patient had polycythemia and the neurological investigation revealed right upper limb paresis. The neuroradiological investigation revealed hypodense areas involving the gray-white matter of the left postero-parietal and frontal lobe, left caudate and lentiform nuclei, and the anterior limb of the internal capsule, suggesting an infarct. The linguistic investigation revealed a mild anomic aphasia with apraxic agraphia. This mild anomic aphasia resulted primarily from the relatively poor scores on the verbal fluency tests. Discussion: The marked writing impairment, even with the left hand, points to disturbances in written output – apraxic agraphia – in the presence of near-normal spoken output. This finding should raise suspicion about hidden apraxic agraphia in subjects with posterior aphasias.

Variability in aphasia following subcortical hemorrhagic lesion

Background Vascular lesion of the subcortical structures leads to aphasia. Cortical hypoperfusion has been proposed to be the etiological mechanism in aphasia following subcortical vascular lesion. Subcortical aphasia shows considerable variability in its clinical profile. Such variability has been attributed to the variable sites of cortical hypoperfusion following ischemic lesion of the subcortical structures. Purpose This study investigated the variability in clinical aphasic profile following subcortical hemorrhagic lesion. Methods We retrospectively investigated the clinical aphasic profiles of twelve patients who reported to our hospital during a period of one year with subcortical hemorrhagic lesions. All patients underwent routine neurological examination, neuroimaging (CT/MRI) investigations and linguistic assessment. Results Eight patients exhibited lesion to the basal ganglia and four showed thalamic lesion. All of them showed considerable variability in their aphasic profile. Conclusion Subcortical hemorrhagic lesion leads to variability in aphasia. Variability in aphasia may be considered as an important consequence in subcortical vascular lesion. Observations from this study were suggestive of better preservation of, and when affected, faster recovery of comprehension skills.

Clinical evidence for the compensatory role of the right frontal lobe and a novel neural substrate in developmental stuttering: A single case study

Abstract The neural substrates of stuttering have been a topic of extensive debate in the field of both neuroscience and communication disorders. Although a consensus on this issue is yet to emerge, the recent neuroimaging studies have shown consistent neural over-activations in the right hemisphere suggestive of its possible compensatory role in stuttering. In this context, we report on a 51-year-old, right-handed male subject with a history of resolved developmental stuttering who presented with sudden onset stutter speech and left hemiparesis following an episode of right frontal stroke. The speech and language evaluation revealed apparently dysfluent speech. Unlike the people with neurogenic stuttering, our subject revealed clinical features suggestive of developmental stuttering. Combining our observations with the evidences from the previous neuroimaging studies of developmental stuttering as well as clinical studies of both neurogenic and (post-stroke) reappeared stuttering, we support the hypothesis on the compensatory role of the right frontal lobe in developmental stuttering. In addition to this, we extend the currently known neural substrates of stuttering to a novel area – the right frontal parafalcine region.

Stroke and aphasia quality of life scale in Kannada-evaluation of reliability, validity and internal consistency

Background: Quality of life (QoL) dwells in a persons overall well-being. Recently, QoL measures have become critical and relevant in stroke survivors. Instruments measuring QoL of individuals with aphasia are apparently rare in the Indian context. The present study aimed to develop a Kannada instrument to measure the QoL of people with aphasia. Study objectives were to validate Stroke and aphasia quality of life-39 (SAQOL-39) into Kannada, to measure test–retest reliability and internal consistency. Materials and Methods: The original English instrument was modified considering socio-cultural differences among native English and Kannada speakers. Cross-linguistic adaptation of SAQOL-39 into Kannada was carried out through forward–backward translation scheme. The scale was administered on 32 people from Karnataka (a state in India) having aphasia. For a direct understanding of the subjects QoL, scores were categorized into QoL severity levels. Item reliability of the Kannada version was examined by measuring Cronbachs alpha. Test–retest reliability was examined by calculating the intraclass correlation coefficient (ICC). Results: Kannada SAQOL-39 showed good acceptability with minimum missing data and excellent test–retest reliability (ICC = 0.8). Value of Cronbachs α observed for four items modified in the original version was 0.9 each and the mean α of all Kannada items was 0.9, demonstrating high internal consistency. Conclusions: The present study offers a valid, reliable tool to measure QoL in Kannada-speaking individuals with aphasia. This tool is useful in a cross-center, cross-national comparison of QoL data from people with aphasia. This instrument also permits direct translation into other Indian languages as the items are culturally validated to the Indian population. This study promotes future research using the Kannada SAQOL-39.

Global aphasia without hemiparesis: A case series

Background: Global aphasia without hemiparesis (GAWH) is a rare stroke syndrome characterized by the unusual dissociation of motor and language functions. Issues regarding its etio-pathogenesis, lesion sites, and recovery patterns are extensively being debated in contemporary neuroscience literature. Materials and Methods: Four patients admitted in our hospital between 2005 and 2009 with GAWH caused by ischemic stroke were studied retrospectively with emphasis on number and site of lesions, etiology, and recovery patterns. Results: The clinical findings from our subjects showed that GAWH could result from either single/multiple lesions including subcortical lesions. The recovery was rapid, although not complete. One case evolved into Wernickes aphasia as seen in earlier studies. Two subjects revealed evolution to transcortical sensory aphasia and one to Brocas aphasia which is distinct from previous proposals. Two cases showed lack of clinico-anatomic correlation during recovery. Conclusions: GAWH could result from both embolic and large vessel strokes and single or multiple lesions. The recovery pattern may be variable and may show lack of clinico-anatomical correlation indicating anomalous cerebral functional reorganization, questioning the conventional teaching of language representation in the brain.

Selective L2 cognate retrieval deficit in a bilingual person with aphasia: A case report

Abstract Lexical access in bilinguals has been debated for the last several decades. Although a large majority of bilingual people often experience aphasia in both languages, some show language-selective disturbances. Yet, selective difficulties in retrieving words that share similar semantic and phonological forms in the two languages have seldom been reported. Here, we report the case of a 45-year-old, right-handed, balanced bilingual subject (Kannada–Malayalam) who presented with aphasia following an episode of stroke. Language evaluation revealed word-selection type of anomia with selective naming disturbance in L2 compared to L1 (in spite of having native-like fluency in L2). On further probing into his anomia, he showed an inability to name cognate words in L2 even after successfully naming them in L1. These observations are discussed in the light of lexical access theories in bilinguals.

Word Processing Deficits in Persons with Right Hemisphere Damage: Evidence from in-Depth Analyses of Verbal Fluency Tasks

The role of the right hemisphere (RH) in word processing continues to interest the neuroscientists. Occasional explorations of the word retrieval functions of the RH with verbal fluency tasks have shown poor performance in persons with right hemisphere damage (RHD). However, there are differing views on the mechanism underlying the poor performance in this population. Some investigations attribute the deficient performance on verbal fluency task to the lexico-semantic deficits, whereas, others ascribe it to deficient cognitive agility. To illustrate these differing views, we performed in-depth analyses of (i.e., accuracy scores, clusters, switches, & time course of word retrieval) a group of 22 participants with RHD on eight semantic and three phoneme fluency tasks. Comparisons with the neuro-typical participants yielded evidence in favor of the linguistic rather than cognitive deficits as the mechanism behind poor word retrieval skills in persons with RHD