Rebecca Shisler Marshall

Performance of individuals with left hemisphere stroke and aphasia and individuals with right brain damage on forward and backward digit span tasks

Background: Working memory (WM) limitations have been suggested as a significant source of the linguistic processing deficits observed in individuals with aphasia (IWA). Digits forward (DF) and digits backward (DB) span tasks are frequently used to study WM in both healthy and clinical populations. Unfortunately only a handful of studies have explored digit span in IWA. Aims: The purpose of the current study is to measure the DF and DB spans of IWA and compare their digit spans to a group with right brain damage, but no aphasia (RBD). Additionally, DF and DB span is compared within each group to determine if there is indeed a performance differential that may support the idea that DB is a more difficult WM task in these populations. Methods & Procedures: A total of 17 IWA and 14 individuals with RBD participated in a DF and DB span task. Modifications to the span tasks were implemented to accommodate language deficits. A series of two digits were orally presented to each participant continuing to a maximum of eight digits. There were seven trials per digit series. Participants were asked to point to the correct order of digits on a written one- to nine-digit list provided on individual note cards or to verbally repeat the numbers if the participant was able to do so. Outcomes & Results: IWA demonstrated shorter digit spans than the RBD group. Both groups performed worse on the DB span tasks than the DF span tasks. Conclusions: The results are consistent with previous studies suggesting that DB span is shorter than DF span in other populations and that there are differences in performance on digit span tasks between the two groups. The differences between RBD group and IWA may be explained by decreased attentional capacity or inefficient resource allocation in IWA, or alternatively, a deficient phonological loop. Future studies should explore these possibilities.

Mindfulness meditation in aphasia: A case report.

BACKGROUND Despite the potential behavioral and neurological benefits of Mindfulness Meditation (MM), its use in treating stroke related communication disabilities appears to be underexplored. Specifically, aphasia, a language disorder resulting from stroke, may be amenable to the benefits of MM because of the observed attention problems often underlying the language symptoms. OBJECTIVE The current paper presents a case report of an adult with aphasia who was trained in MM. METHOD An adult with aphasia completed a five-day mindfulness training, and was assessed on measures of language, attention, and physiological measures of cortisol and heart rate variability. She completed four assessments: two baseline measures, immediately post training, and one week post training (maintenance). RESULTS Overall, changes were observed in both psychophysiological measures (heart rate and heart rate variability) and behavioral measures (word productivity, phrase length, word generation, decreased impulsivity, and increased attention). CONCLUSION Given the psychophysiological and behavioral changes observed in this individual, further exploration of the influence of MM in the treatment of post-stroke aphasia is warranted.

Yogic Breathing and Ayurveda in Aphasia: A Case Study

Abstract Purpose: We present a case study of a woman who used yogic breathing as Ayurvedic medicine in her recovery from poststroke aphasia. Ayurvedic medicine is one of the most ancient medicines of the world, but it is not widely used for aphasia rehabilitation in many Western countries. The description of this case aims to further the understanding of the benefits that this type of medicine may provide to poststroke patients living with aphasia. Method: After her stroke, the patient received brief conventional language therapy for her aphasia. At 5 weeks post stroke, she received no further conventional rehabilitation; instead, she consulted with a Vedic priest. She followed a regimen of different body manipulations, yogic breathing techniques, and ingestion of coconut oil. Cognitive and language testing was performed throughout a 3-month period while she was involved in this therapy. Results: Overall, improvement was noted in language, visual attention, and some mood measures. Conclusion: Although case studies lead to limited conclusions, changes were observed for this individual using Ayurvedic medicine. Given the changes in language and some aspects of cognition seen in this patient, further exploration of the effectiveness of yogic breathing and Ayurvedic medicine in the treatment of poststroke aphasia is warranted.

An exploratory study of auditory extinction in ageing: Now you hear it, now you don't

Background: One phenomenon used to study attention is auditory extinction and binding. Extinction is typically defined as a failure to respond to a contralesional target during simultaneous presentations of stimuli to both left and right hemispace (double simultaneous stimulation) or when both stimuli are presented on the same side. Due in part to this ability to identify a single stimulus, extinction has been characterised as an attentional deficit. Binding refers to the integration of sensory information (identification and localisation) into a whole, thus resulting in the perception of an object or event. Previous studies noted that patients with visual extinction frequently have lesions that may disconnect the dorsal and ventral visual pathways. This suggests that extinction may be related to difficulty in connecting (or binding) information from the two pathways. While this has been studied in stroke patients, and mostly with visual modality, few of these studies have utilised non‐brain‐damaged control groups to determine if this occurs in the healthy ageing population. The assumption has been that auditory extinction is an attentional deficit that should not be observable in healthy adults. Generous funding by NIDCD (5R03DC5128‐2), the University of Georgias Gerontology Center, and Research Foundation (UGARF) and University of Georgia‐Medical College supported this work. Aims: It is hypothesised that healthy ageing individuals will demonstrate mild auditory extinction as observed in a previous study using individuals with aphasia. If healthy ageing individuals do demonstrate auditory extinction, it would be important to determine whether adults demonstrate differential performance on binding versus non‐binding tasks. This has not been studied for healthy ageing individuals in the auditory modality and will help to determine the nature of extinction in the non‐stroke system. Methods & Procedures: Auditory extinction was preliminarily examined in 40 healthy adults in four groups of 10 (20–35; 36–50; 51–65; 66–83 years of age) using a double simultaneous stimulation methodology. Three experiments were conducted wherein the auditory stimuli, consisting of male and female voices speaking the letters “T” or “O” were systematically varied to investigate whether binding of identification (“what”) to location (“where”) contributes to extinction and with what time delay that extinction decreases. Outcomes & Results: Participants in all groups made significant omission errors in both binding and non‐binding conditions, demonstrating extinction in healthy individuals. Additionally, older participants required increased stimulus delays to decrease percentage of omission errors. Conclusions: These results suggested that auditory extinction within healthy individuals should be studied further to determine the extent of the influence of normal extinction performance for individuals following stroke.

Integrative intervention: a new perspective and brief review in aphasia.

Abstract Purpose: While integrative treatment practices have become a popular treatment in different areas of study, its use in the field of aphasiology is still limited. The following paper is an attempt to address the different alternative practices that could potentially be used to remediate aphasia. Method: A narrative review was completed regarding integrative intervention that could potentially apply to aphasia population. Results: Through this article we have explored various treatment options for integrative health care in aphasiology. Integrative treatments including brain specific antioxidants, progesterone and estradiol therapy, nutrition, synbiotic treatment, exercise, yoga, meditation and positive mood states have demonstrated positive changes in health and behavior in healthy aging or disorders such as stroke and aphasia. Offering integrative treatment for people with aphasia allows potential for high impact gains when combined with current speech language therapeutic practices. Conclusion: This paper highlights the rehabilitation possibilities for aphasia therapy. Combining complementary and traditional treatment approaches could be viewed as one of the contemporary approaches to clinical practice and research for practitioners and health care systems. Implications for Rehabilitation There has been very little research that explores the potential of various types of integrative treatment for individuals with aphasia. An integrative approach to the treatment of aphasia has potential for future clinical application. Combining treatment approaches could be viewed as a viable approach to clinical practice and in the health care system.