Kristine Lundgren

Improved language in a chronic nonfluent aphasia patient after treatment with CPAP and TMS.

ObjectiveTo present pretreatment and post-treatment language data for a nonfluent aphasia patient who received 2 treatment modalities: (1) continuous positive airway pressure (CPAP) for his sleep apnea, starting 1-year poststroke; and (2) repetitive transcranial magnetic brain stimulation (TMS), starting 2 years poststroke. BackgroundLanguage data were acquired beyond the spontaneous recovery period of 3 to 6 months poststroke onset. CPAP restores adequate oxygen flow throughout all stages of sleep, and may improve cognition. A series of slow, 1 Hz repetitive TMS treatments to suppress a posterior portion of right pars triangularis has been shown to improve phrase length and naming in chronic nonfluent aphasia. MethodThe Boston Diagnostic Aphasia Examination and Boston Naming Test were administered pre-CPAP, and after 2 to 5 months of CPAP. These same tests were administered pre-TMS, and at 3 and 6 months post-TMS, and again 2.4 years later. ResultsPost-CPAP testing showed increased Phrase Length, Auditory Comprehension, and naming Animals and Tools/Implements (Boston Diagnostic Aphasia Examination). Testing at 3 and 6 months post-TMS showed significant increase in Phrase Length, Auditory Comprehension, and Boston Naming Test compared with pre-TMS. These gains were retained at 2.4 years post-TMS. CPAP use continued throughout. ConclusionsPhysiologic treatment interventions may promote language recovery in chronic aphasia.

Stuttering Following Acquired Brain Damage: A Review of the Literature.

Communication problems resulting from acquired brain damage are most frequently manifested as motor speech disorders such as dysarthria, syndromes of aphasia, and impairments of pragmatics. A much less common phenomenon is the onset of stuttering in adults who sustain a stroke, traumatic brain injury, or other neurologic events. When stuttering occurs in association with neuropathology, precise characterization and explanation of observed behaviors is often difficult. Among the clinical challenges presented by acquired stuttering are the problem of distinguishing this form of dysfluency from those associated with dysarthria and aphasia, and identifying the neuropathological condition(s) and brain lesion site(s) giving rise to this speech disorder. Another challenge to the precise characterization of acquired stuttering is the fact that some cases of acquired stuttering apparently have a psychological or neuropsychiatric genesis rather than a neuropathological one. In this paper we provide a review of the literature pertaining to the complicated phenomenon of acquired stuttering in adults and draw some tentative explanatory conclusions regarding this disorder.

A metaphor comprehension intervention for patients with right hemisphere brain damage: A pilot study

This intervention program addresses an important need in the clinical literature: tools for remediation of communication deficits associated with right hemisphere brain damage (RHD). Our program is motivated by the literature documenting non aphasic communication deficits, including deficits in metaphor comprehension, subsequent to RHD (Joanette et al., 1990, Myers, 1999 and Tompkins, 1995). The intervention is based on two themes. One is that RHD, particularly in posterior regions, limits a patient’s ability to process “coarse grained” semantic information such as, for example, weak or connotative associations between words (Beeman, 1998). A second notion is that lesion in frontal regions (in either hemisphere) can affect working memory and thereby curtail a patient’s ability to review information and to select the most relevant alternative from a set (e.g., Tompkins, Bloise, Timko, & Baumgaertner, 1994). For example, the concepts “family” and “cradle” each give rise to several associations, as illustrated in the figure below. The metaphor “a family is a cradle” works if a listener can generate a broad range of associations to each concept and, then, can identify appropriate shared associations, such as safety and comfort.

Using lexical familiarity judgments to assess verbally mediated intelligence in aphasia.

In this study, a task using forced-choice lexical familiarity judgments of irregular versus archaic words (a newly developed measure called the Lexical Orthographic Familiarity Test; LOFT) was compared to a standardized oral word-reading measure (the Wechsler Test of Adult Reading; WTAR) in a group of 35 aphasic adults and a comparison group of 125 community dwelling, nonbrain damaged adults. When compared to the comparison group, aphasics had significantly lower scores on the WTAR but not the LOFT. Although both the WTAR and LOFT were significantly correlated with education in the nonbrain-damaged group, only the LOFT was correlated with education and also with the Barona full scale IQ index in the aphasic group. Lastly, WTAR performance showed a significantly greater relationship to the severity of language disorder in the aphasic group than did the LOFT. These results have both theoretical and clinical implications for the assessment of language-disordered adults, as they indicate that patients with aphasia may retain aspects of verbally mediated intelligence, and that the LOFT may provide a better estimate of premorbid functioning in aphasia than other currently available measures.

Practice Update: What Professionals Who Are Not Brain Injury Specialists Need to Know About Intimate Partner Violence-Related Traumatic Brain Injury.

There is growing recognition of the risk for traumatic brain injury (TBI) among victims and survivors of intimate partner violence (IPV). A wide range of physically abusive behaviors may lead to injuries to the head or neck and place an individual at risk for a TBI. The purpose of this article is to consolidate current research and present practical guidelines for professionals, who are not brain injury specialists, but work with clients who may have sustained a TBI in the context of IPV. Recommendations are provided for TBI risk screening, making appropriate referrals, and providing services in light of a potential TBI.

Treatment of Metaphor Interpretation Deficits Subsequent to Traumatic Brain Injury

Objective:To improve oral interpretation of metaphors by patients with traumatic brain injury (TBI). Design:Both single subject experimental design and group analysis. Setting:Patients’ homes. Participants:Eight adult patients with moderate to severe traumatic brain injury sustained 3 to 20 years before testing. Intervention:The Metaphor Training Program consisted typically of 10 baseline sessions, 3 to 9 1-hour sessions of structured intervention, and 10 posttraining baseline sessions. Training used extensive practice with simple graphic displays to illustrate semantic associations. Main Outcome Measures:Quality of orally produced metaphor interpretation and accuracy of line orientation judgments served as dependent measures obtained during baseline, training, posttraining, and at a 3- to 4-month follow-up. Untrained line orientation judgments provided a control measure. Results:Group data showed significant improvement in metaphor interpretation but not in line orientation. Six of 8 patients individually demonstrated significant improvement in metaphor interpretation. Gains persisted for 3 of the 6 patients at the 3- to 4-month follow-up. Conclusion:The Metaphor Training Program can improve cognitive-communication performance for individuals with moderate to severe traumatic brain injury. Results support the potential for treating patients’ residual cognitive-linguistic deficits.

Assessing quality of metaphor interpretation by right hemisphere damaged patients

Patients with right hemisphere damage (RHD) can display various cognitive-linguistic deficits including disrupted comprehension of figurative language such as metaphor (Myers, 1999 and Tompkins, 1995). Most studies documenting figurative language comprehension difficulties have used multiple choice tasks (Van Lancker & Kempler, 1987). Multiple choice formats are generally easier than open-ended verbal explanation formats and, therefore, may be less sensitive and, accordingly, less adequate for documenting clinically relevant changes in the quality of comprehension over time. However, scoring a patient’s extended verbal responses can be subjective. Also, there is uncertainty whether the resulting scores provide only ordinal information or approach interval level measurement, which makes statistical analysis easier. Although scales have been developed for scoring proverb interpretation (Gorham, 1956 and Nippold et al., 1997), we are not aware of a scoring system for representing the quality of metaphor interpretations.

Component analysis of verbal fluency performance in younger participants with moderate-to-severe traumatic brain injury

Abstract Primary objective: To investigate phonemic and semantic verbal fluency performance in a group of young adult participants with and without traumatic brain injury. Research design: Group comparison. Methods and procedures: Twenty-five participants with moderate-to-severe TBI and 25 participants with no brain damage (NBD) were given phonemic and semantic verbal fluency tasks. Responses were analysed quantitatively and qualitatively. Main outcomes and results: Young participants with moderate-to-severe TBI generated significantly fewer total correct words and sub-categories for both fluency conditions when compared to controls. The total number of correct words generated on the phonemic condition and for the semantic category of animals was positively correlated with the number of category switches produced during the task. Conclusions: While young participants with moderate-to-severe TBI produced fewer total correct words on both verbal fluency conditions in comparison to controls, these differences were greater on the phonemic condition. Participants with moderate-to-severe TBI switched less frequently on both fluency tasks and produced smaller cluster sizes only on the phonemic task in comparison to controls. These results are in contrast with previous investigations that have observed greater age-related declines on semantic tasks when compared to phonemic tasks.

Training theory of mind following right hemisphere damage: A pilot study

Successful communicative interactions in large part rely on an ability to infer the mental states of conversational partners. Understanding other people’s mental states, such as thoughts, beliefs, and emotions, allows us to understand and predict their behaviors. Mental states are often described in terms of two components of a “Theory of Mind” (ToM): first-order beliefs, that is, what a person believes about the world, and the more complex second-order beliefs, that is, what one person believes about the mental state of another person. Theory of Mind (ToM) deficits have been reported in individuals subsequent to RHD as well as in other populations such as autism and patients with prefrontal lesion (Baron-Cohen et al., 1985, Happe et al., 1999 and Stone et al., 1998). Theoretical accounts consider ToM in relation to, for example, executive function or empathy, or as a relatively independent cognitive ability.

A polymorphism in human estrogen-related receptor beta (ESRRβ) predicts audiometric temporary threshold shift

Abstract Objective: A non-synonymous single nucleotide polymorphism (rs61742642; C to T, P386S) in the ligand-binding domain of human estrogen-related receptor beta (ESRRβ) showed possible association to noise-induced hearing loss (NIHL) in our previous study. Design: This study was conducted to examine the effect of the ESRRβ rs61742642 T variant on temporary threshold shift (TTS). TTS was induced by 10 minutes of exposure to audiometric narrow-band noise centered at 2000 Hz. Hearing thresholds and distortion product otoacoustic emissions input output function (DP IO) at 2000, 3000, and 4000 Hz were measured before and after the noise exposure. Study sample: Nineteen participants with rs61742642 CT genotype and 40 participants with rs61742642 CC genotype were recruited for the study. Results: Participants with the CT genotype acquired a significantly greater TTS without convincing evidence of greater DP IO temporary level shift (DPTLS) compared to participants with the CC genotype. Conclusion: The results indicated that the ESRRβ polymorphism is associated with TTS. Future studies were recommended to explore molecular pathways leading to increased susceptibility to NIHL.