Luise Springer

Agrammatism: Deficit or compensation? Consequences for aphasia therapy

During the natural course of aphasia, agrammatism occurs as a symptom complex of either the acute or the chronic phase. Distinguishing these two clinical forms, we discuss its underlying nature in term of deficit and compensation. Furthermore, variations due to adaptation and/or restriction in information processing capacities are considered. In recent years, we developed a new approach to the treatment of severe agrammatism, which is called Reduced Syntax Therapy (REST, Schlenck, Schlenck, & Springer, 1995). This approach comprises three major features: (1) activation of functional level information, (2) mapping of thematic roles onto simplified syntactic structures, and (3) leaving aside morphosyntactic markings. From a linguistic point of view, only basic processes of constituent structure formation are considered, which are in part also present in elliptic speech of normal speakers. The patients are instructed to expand one-word utterances into two- and three-constituent utterances in several steps, while ignoring function words and inflectional endings. The efficacy of REST was studied in 11 patients with severe chronic agrammatism due to extensive left hemisphere lesions. In 9 patients significant expansion of simple phrase structures could be achieved whereas increase in closed class elements (function words and inflectional endings) remained small and limited to few patients. Therefore, we concluded that REST most likely enhances elementary proto-language functions of labelling and sequencing in the unimpaired right hemisphere, which may become the starting point for a gradual and laborious learning of simple syntax and grammar.

Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting

BACKGROUND Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. METHODS In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam-Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. FINDINGS We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (-0·03 points [4·04]; -0·94 to 0·88; between-group difference Cohens d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation. INTERPRETATION 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods. FUNDING German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.

Training in the use of wh-questions and prepositions in dialogues: A comparison of two different approaches in aphasia therapy

Abstract In this language treatment experiment we compared a stimulation technique and a linguistically oriented learning approach for the use of interrogative words and prepositions. These function words had to be used in a short dialogue text comprising a wh-question with an interrogative word and an elliptic answer with a temporal prepositional phrase. The text was embedded in a short description of the situational context. Twelve chronic aphasic patients took part in this two-period cross-over treatment experiment-nine had Brocas aphasia, three Wernickes aphasia. They had a medium overall level of aphasic impairment as measured by the Aachen Aphasia Test. Nonparametric tests yielded significantly larger direct effects for the linguistically oriented learning approach (L), but significantly larger after-effects for the stimulation approach (S). Thus, the S/L sequence was more efficacious. Transfer effects to non-trained spatial function words were also present, but to a lesser degree. Methods from cr...

How efficacious is pace-therapy when ‘language systematic training’ is incorporated?

Abstract The traditional PACE approach was compared with a modified PACE approach, which incorporated a semantic classification task for the training of lexical-semantic difficulties. In a cross-over design, four patients were treated over a period of five weeks. The modified PACE approach was found to have a more effective impact on the improvement of both verbal naming and general communicative behaviour.

Aphasic Communities of Learning on the Web.

This article presents the case study of a cooperative Web-learning environment — SOCRATES — to foster barrier-free learning on the Web. While the growth of the Internet was exponential in the last years, still many communities don’t benefit from Web-learning technology due to improper tools and constricted communication processes. These problems increase when developing applications for communities of people with special needs. SOCRATES supports a community of learning comprising patients suffering from aphasia (aphasics), therapists, researchers on linguistics, and system developers. Aphasics can improve their conversation skills with a specially designed talk/chat tool, while therapists and linguistic researchers can monitor conversations from automatically generated transcripts. Aphasics in remote areas using SOCRATES are now able to communicate freely among each other without being afraid that they might get lost in rapid conversation in a distributed privacy protecting virtual community.

A cross-language analysis of conversation in a trilingual speaker with aphasia

Abstract This study explores the relationship between formal and functional language performance of a trilingual speaker with aphasia, focusing on her monolingual use of German and English in free conversations and semi structured interviews with different interlocutors. We use a conversation analysis framework to highlight the contrasting pictures between her formal test scores and sources of trouble across different conversations. In the discussion possible reasons for divergences across settings and languages are examined.

The efficacy of modelling in pace-therapy

Abstract An important factor in PACE-Therapy is modelling (Davis and Wilcox 1981), which was first formulated in social learning theory (Bandura 1969). The patient is indirectly encouraged to follow the verbal model of the therapist. As examples of modelling, we investigated naming and describing. We wondered whether aphasic patients would switch successhlly between naming and describing according to the verbal model given by the therapist.

Aphasics' communities learning on the Web

Barrier free learning on the web is one of the greatest challenges for computer science in the future. While the growth of the internet was exponential in the last years, still many communities don’t benefit from web technology for their learning issues due to improper tools and constricted communication processes. These problems increase when developing applications for communities of people with special needs. In this paper we present the case study of a cooperative web-learning environment called SOCRATES to overcome difficulties in new media usage. It supports a learning community comprising patients suffering from aphasia (aphasics), therapists, researchers on linguistics, and system developers. Aphasics using SOCRATES are now able to communicate freely among others without having to be afraid that they might get lost in rapid conversation and are now able to meet others over spatial distances while protecting their privacy in an insular virtual community.