Telerehabilitation of anomia in primary progressive aphasia

Background: The efficacy of telerehabilitation-based treatment for anomia has been demonstrated in post-stroke aphasia, but the efficacy of this method of anomia treatment delivery has not been established within the context of degenerative illness.

Aims: The current study evaluated the feasibility and efficacy of a telerehabilitation-based approach to anomia treatment within the three subtypes of primary progressive aphasia (PPA).

Methods & Procedures: Each of the three telerehabilitation participants represented a distinct subtype of PPA. Following a baseline evaluation of language and cognition, a phonological treatment and an orthographic treatment were administered to all participants over the course of 6 months. One month after the end of treatment, a post-treatment evaluation began. All treatment sessions and the majority of the evaluation sessions were administered via telerehabilitation. Treatment effects were examined within each subject, and treatment effects were also compared between each telerehabilitation participant and a group of in-person participants who had the same subtype of PPA.

Outcomes & Results: All three telerehabilitation participants exhibited positive treatment effects. CGR (nonfluent/agrammatic variant PPA) and WCH (logopenic variant PPA) showed maintenance of naming for prophylaxis items under both treatment conditions, while ACR (semantic variant PPA) demonstrated increased naming of remediation items under the phonological treatment condition. Compared to in-person participants with the same subtype of PPA, each of the telerehabilitation participants typically showed effects that were either within the expected range or larger than expected.

Conclusions: Telerehabilitation-based anomia treatment is feasible and effective in all three subtypes of PPA.     

Slowed articulation rate is a sensitive diagnostic marker for identifying non-fluent primary progressive aphasia

Background: Primary progressive aphasia (PPA) is a neurodegenerative aphasic syndrome with three distinct clinical variants: non-fluent (nfvPPA), logopenic (lvPPA), and semantic (svPPA). Speech (non-) fluency is a key diagnostic marker used to aid identification of the clinical variants, and researchers have been actively developing diagnostic tools to assess speech fluency. Current approaches reveal coarse differences in fluency between subgroups, but often fail to clearly differentiate nfvPPA from the variably fluent lvPPA. More robust subtype differentiation may be possible with finer-grained measures of fluency.

Aims: We sought to identify the quantitative measures of speech rate – including articulation rate and pausing measures – that best differentiated PPA subtypes, specifically the non-fluent group (nfvPPA) from the more fluent groups (lvPPA, svPPA). The diagnostic accuracy of the quantitative speech rate variables was compared to that of a speech fluency impairment rating made by clinicians.

Methods & Procedures: Automatic estimates of pause and speech segment durations and rate measures were derived from connected speech samples of participants with PPA (N = 38; 11 nfvPPA, 14 lvPPA, 13 svPPA) and healthy age-matched controls (N = 8). Clinician ratings of fluency impairment were made using a previously validated clinician rating scale developed specifically for use in PPA. Receiver operating characteristic (ROC) analyses enabled a quantification of diagnostic accuracy.

Outcomes & Results: Among the quantitative measures, articulation rate was the most effective for differentiating between nfvPPA and the more fluent lvPPA and svPPA groups. The diagnostic accuracy of both speech and articulation rate measures was markedly better than that of the clinician rating scale, and articulation rate was the best classifier overall. Area under the curve (AUC) values for articulation rate were good to excellent for identifying nfvPPA from both svPPA (AUC = .96) and lvPPA (AUC = .86). Cross-validation of accuracy results for articulation rate showed good generalisability outside the training dataset.

Conclusions: Results provide empirical support for (1) the efficacy of quantitative assessments of speech fluency and (2) a distinct non-fluent PPA subtype characterised, at least in part, by an underlying disturbance in speech motor control. The trend towards improved classifier performance for quantitative rate measures demonstrates the potential for a more accurate and reliable approach to subtyping in the fluency domain, and suggests that articulation rate may be a useful input variable as part of a multidimensional clinical subtyping approach.     

“It was a terrible,terrible journey”: an instrumental case study of a spouse’s experience of living with a partner diagnosed with semantic variant primary progressive aphasia

Background: Semantic variant primary progressive aphasia (svPPA) is an uncommon neurodegenerative condition that causes prominent changes in communication skills, personality and behaviour. Insidious deterioration in conceptual–semantic memory abilities is the hallmark feature underpinning these impairments from the early-to-middle phases. Very little research has explored how svPPA is experienced by spouses/partners, particularly how they “make sense” of the presenting difficulties, deal with everyday issues and manage the changing psychosocial aspects of their intimate relationship.

Aims: This instrumental case study explored the experience of a spouse who supported her husband with svPPA throughout the course of the condition, with a particular focus on how she dealt with the relational changes svPPA imposed on them.

Methods & Procedures: Instrumental case study design with thematic narrative analysis was applied to the in-depth interview data, in order to obtain an understanding of the lived experience from the perspective of a wife whose husband had svPPA.

Outcome & Results: Analysis of the interview data revealed five main themes of the spousal experience of svPPA: (1) Us, (2) The way he was … The way he is now, (3) Floundering with unpredictability, (4) Adjusting and accepting support and (5) Taking control. This case study explored how and why this spouse worked towards renegotiating the relational context of their relationship over the illness course.

Conclusions: From the spouse’s perspective, learning to live with a “different person” was traumatic and involved floundering with unpredictability, adjusting and accepting support, and taking control. Clinicians need to remain sensitive to the pivotal role the spouse has in their partner’s life and mindful of that they may benefit from assistance and support to modify the relational aspects of their relationship with their partner throughout the course of the condition.     

“Do you have mowing the lawn?” – improvements in word retrieval and grammar following constraint-induced language therapy in primary progressive aphasia

Background: Much recent progress has been made in developing speech–language therapy in primary progressive aphasia (PPA). Several treatment approaches that have shown significant effects with people with aphasia have been adapted and re-evaluated for PPA. Constraint-induced aphasia therapy (CIAT) is a well-evaluated method that has yielded significant language improvements in people with post-stroke aphasia but has not yet been evaluated with people with PPA. Nevertheless, the combination of CIAT features like massed practice and a motivating communicative setting seem likely to make it a suitable tool for improving the speech and language performance of individuals with PPA as well.

Aims: This study investigates the effectiveness of a modified CIAT protocol on word retrieval, grammatical structure and connected speech in two individuals with non-fluent variant PPA (nfvPPA).

Methods and procedures: Two participants with nfvPPA took part in a 9-day intensive CIAT-based group therapy with additional computer-based home training. Stimuli were 120 photos of people performing daily life activities, which could be described using a simple (e.g., “The man is mowing the lawn”) or reduced (e.g., “mowing the lawn”) sentence structure. During the treatment phase, the participants were required to request picture cards from other group members using spoken language only. The task difficulty was increased hierarchically (shaped) in accordance to each participant’s performance level.

Outcomes and results: Directly after therapy, both participants achieved significant improvements in their noun and verb naming accuracy and their grammatical structure for trained items. Training effects were maintained 2 months after therapy. Moreover, generalisation to different pictures of the same item was found for both participants and one participant also showed improved grammatical structure when describing untrained pictures. No significant generalisation to untrained connected speech samples was observed for either participant.

Conclusion: This study illustrates that CIAT can be effective in people with PPA. However, further modifications of CIAT should be considered to facilitate generalisation and in order to determine which aspects of the treatment are most important.     

The relationship between baseline volume in temporal areas and post-treatment naming accuracy in primary progressive aphasia

Background: Structural imaging has not been used previously to predict the effect of treatment in primary progressive aphasia (PPA).

Aims: This study examined relationships between baseline brain volume and the effects of phonological and orthographic treatments for anomia in PPA. It was predicted that lower baseline volume would be associated with lower post-treatment naming accuracy for treated items and smaller generalisation effects.

Methods & Procedures: Twenty-one individuals with PPA participated. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (Prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (Remediation items). All 21 participants had Prophylaxis items, while 10 participants had Remediation items. Naming accuracy for Untrained and Trained items (Exemplar set 1) was measured. In addition, stimulus generalisation was examined by having participants name an alternative exemplar of each Untrained and Trained item (Exemplar set 2). Correlational analyses focused on the relationships between naming accuracy and volume of regions previously identified as having a role in naming and semantic processing.

Outcomes & Results: Unexpectedly, there were no significant correlations between baseline volume and post-treatment accuracy for treated items. However, baseline volume within the left temporal pole was positively correlated with post-treatment accuracy for Untrained Exemplar set 2 Prophylaxis items, while baseline volume in the left inferior temporal gyrus (ITG) was positively correlated with post-treatment accuracy for Untrained Exemplar set 1 Remediation items.

Conclusions: These findings suggest that lower volume in the left temporal pole is associated with decline for Untrained items, while lower volume in the left ITG is associated with a lack of improvement for Untrained items. Possible explanations for the different patterns observed across exemplar sets are discussed.     

Reading impairment in neurodegenerative diseases: a multiple single-case study

Background: Reading impairment is frequently associated with neurodegenerative diseases, such as Alzheimer disease (AD), primary progressive aphasia (PPA), and posterior cortical atrophy (PCA). Notwithstanding the clinical relevance of reading processes in these conditions, only a relatively small number of studies have been published on this topic so far.

Aims: We investigated the reading impairment in patients with different types of neurodegenerative diseases. In the light of the marked variability in pathological changes affecting brain areas potentially relevant to reading, it could be hypothesised that these neurodegenerative conditions may lead to different patterns of reading impairment.

Methods & Procedures: Three groups of patients (AD, PPA, and PCA) and a control sample of neurologically healthy participants were examined with five tasks to test the ability to read and to repeat words and nonwords, as well as with an auditory and visual lexical decision task.

Outcomes & Results: No specific pattern emerged as strongly diagnostic of a specific degenerative disease. Overall, AD and PPA patients were significantly more impaired in reading nonwords than words. Lexical decision impairment in the visual modality appears to be related to PCA, while a similar deficit in the auditory modality is more suggestive of AD. A multiple single-case analysis on the reading performance was run to identify the distribution of different kinds of dyslexia: phonological dyslexia occurred in 50% of patients affected by PCA: it occurred less often in patients affected by AD (15.8%) and PPA (16.7%). Surface dyslexia occurred only in one case of AD. Age of acquisition was predictive of the reading performance for AD patients, but not for PCA and PPA patients.

Conclusions: Phonological dyslexia predominates in PCA. Surface dyslexia occurred only in one AD patient. Reading nonwords was predominantly impaired in AD and PPA cases. Impairment in visual lexical decision was associated with PCA, whereas a lexical decision deficit in the auditory modality emerged in AD. Data indicate the importance of extensive testing of reading and input lexical abilities in neurodegenerative diseases.     

Developmental profile of speech-language and communicative functions in an individual with the Preserved Speech Variant of Rett syndrome

Objective: We assessed various aspects of speech-language and communicative functions of an individual with the preserved speech variant of Rett syndrome (RTT) to describe her developmental profile over a period of 11 years.

Methods: For this study, we incorporated the following data resources and methods to assess speech-language and communicative functions during pre-, peri- and post-regressional development: retrospective video analyses, medical history data, parental checklists and diaries, standardized tests on vocabulary and grammar, spontaneous speech samples and picture stories to elicit narrative competences.

Results: Despite achieving speech-language milestones, atypical behaviours were present at all times. We observed a unique developmental speech-language trajectory (including the RTT typical regression) affecting all linguistic and socio-communicative sub-domains in the receptive as well as the expressive modality.

Conclusion: Future research should take into consideration a potentially considerable discordance between formal and functional language use by interpreting communicative acts on a more cautionary note.     

Taking words to a new level: a preliminary investigation of discourse intervention in primary progressive aphasia

Background: Despite a growing literature characterising connected speech and discourse impairments associated with primary progressive aphasia (PPA), intervention in PPA has focused predominantly on lexical retrieval and picture-naming treatments, with limited generalisation of therapy gains reported. Recent developments in the post-stroke aphasia literature with discourse-level approaches have provided highly promising findings for the generalisation of language gains to everyday communication, and an opportunity to investigate whether the same benefits may be found in the PPA population.

Aims: This study evaluated the effectiveness of a discourse intervention in two individuals with PPA to determine whether significant improvements were seen in word retrieval and discourse organisation in everyday discourse.

Methods & Procedures: KW, a 54-year-old man, who presented with semantic variant PPA, and AS, a 59-year-old woman, presenting with logopenic variant PPA, completed the NARNIA intervention programme (Whitworth, Leitão et al., 2015) in 20 sessions over a 10-week period. Discourse performance was sampled prior to intervention across 10 tasks involving four different genres, at one time point, and compared to performance immediately and four weeks post intervention. The multilevel intervention protocol aimed to increase awareness of word retrieval, sentence structure, and macrostructure of a range of discourse genre.

Outcomes & Results: Both participants made significant gains in discourse production immediately after intervention and when reassessed four weeks later, in the absence of change on naming tasks and in the context of stable overall cognitive performance. Significant gains were seen in the amount of overall output, noun and verb usage, and the number of body elements in macrostructure in everyday discourse in topics that were not trained in treatment. Further to the findings of the original NARNIA study in post-stroke aphasia, significant gains were also seen in narrative discourse across lexical categories for both participants. Informativeness and efficiency of communication also improved significantly for KW across all genres. Both participants reported significant gains in measures of social communication and participation.

Conclusions: The study suggests that improvements in everyday discourse may be possible when the discourse level is directly targeted, that lexical access can improve in the absence of targeting lexical items, and that discourse-level interventions have the potential to impact real-life communication in individuals with PPA. As the first known study to trial a multilevel intervention in the context of PPA, the findings may be of clinical and theoretical significance, and warrant further investigation.     

Mobile technology to support lexical retrieval during activity retell in primary progressive aphasia

Background: Augmentative and alternative communication (AAC) strategies and tools developed for individuals with chronic aphasia have been found to facilitate generative language skills. There exists a need to identify effective AAC strategies and tools for individuals experiencing primary progressive aphasia (PPA), a neurodegenerative dementia, for which compensatory treatment paradigms are yet to be systematically evaluated.

Aims: To examine the treatment effects of a novel language compensation tool, CoChat, and to determine if lexical retrieval skills improve are maintained during activity retell with use of this AAC application.

Methods and procedures: Six individuals with PPA participated. The study was implemented using a single-subject alternating treatments experimental design to compare lexical retrieval during activity retell in three conditions: Absence of technology support, presence of photos only, and presence of CoChat app, with photo and labels. The number of target words produced by the participant during activity retell with a conversation partner was the primary dependent variable. There were two phases of this experiment: Three conditions presented in a fixed-order and three conditions presented in a counterbalanced order. For one participant, an additional implementation of CoChat was piloted at 6- and 9-month post-intervention to examine sustained effect of CoChat during activity retell.

Outcomes and results: In the fixed-order phase, results indicated a higher number of target words produced in the CoChat condition for all participants. In the counterbalanced phase, results indicated a higher number of target words in the CoChat condition for two-thirds of the participants. Maintenance probes showed same level of lexical retrieval at 6 and 9 months following intervention.

Conclusions: This single-case research design demonstrated that mobile technology compensatory strategies provide necessary support during natural conversations about personally relevant topics for people with PPA. CoChat, a newly developed mobile technology research app that uses social networks and an NLP engine to create a co-constructed external lexicon with visual scene display, significantly increased lexical retrieval during activity retell. Future research should further develop AAC strategies and tools that aid in maintenance of vocabulary access and communication participation for people with PPA over the course of disease progression.     

Agrammatism in Tagalog: voice and relativisation

Background: Virtually nothing is known about the ability of Tagalog speakers with agrammatic aphasia to cope with basic grammatical features of their language. Tagalog is unusual in exhibiting competing transitive patterns thanks to a system of voice that can make either of the verb’s arguments syntactically prominent – a prerequisite for undergoing syntactic operations such as relativisation.

Aims: Our objective is to investigate the nature of the syntactic impairment associated with agrammatic aphasia in Tagalog, with special attention to voice patterns and relative clauses (RCs).

Methods and Procedures: Five native Tagalog-speaking patients diagnosed with agrammatism took part in (1) elicited-production and (2) comprehension tasks to assess their ability with respect to voice patterns and (3) elicited-production, (4) imitation, and (5) comprehension tasks to assess their performance on RCs.

Outcomes and Results: Although the participants did poorly on grammatical morphemes, the classic symptom of agrammatism, their impairment was somewhat less severe in patterns involving verb–agent–patient order, the patient-voice in declarative clauses, and the agent voice in RCs.

Conclusions: Our findings reveal a departure from a general cross-linguistic tendency to favour agent-prominent constructions (e.g., the active voice in languages like English), as shown by the participants’ greater accuracy on patient voice declaratives than on their agent voice counterparts. Nonetheless, we found evidence of a subject preference in RCs, consistent with reports of a similar advantage in many other languages.     

Semantic knowledge use in discourse produced by individuals with anomic aphasia

Background: Researchers have demonstrated that people with aphasia (PWA) have preserved semantic knowledge. However, some PWA have impaired access to certain types of knowledge more than others. Yet, all these studies used single concepts. It has not been demonstrated whether PWA have difficulty accessing certain types of features within a discourse sample.

Aims: The main goals of this study were to determine whether semantic knowledge and two category types were used differently within discourse produced by participants with anomic aphasia and healthy controls.

Methods & Procedures: Participants with anomic aphasia (n = 19) and healthy controls (n = 19) told stories that were transcribed and coded for 10 types of semantic knowledge and two category types, living and non-living things.

Outcomes & Results: A Poisson regression model was conducted. The results indicated a significant difference between the groups for the semantic knowledge types, sound and internal state, but no difference was found for category types. Yet the distribution of semantic knowledge and category types produced within the discourse samples were similar between the groups.

Conclusions: PWA might have differential access to certain types of semantic knowledge within discourse production, but it does not rise to the level of categorical deficits. These findings extend single-concept research into the realm of discourse.     

Narrative review of the psychometric properties of language tests used in anomia treatment for primary progressive aphasia (PPA)

Background: Primary progressive aphasia (PPA) is a neurodegenerative dementia in which language decline is the first and most prominent symptom. Among several interventions for PPA, language rehabilitation has been the most frequently used.

Aims: This narrative review aimed to evaluate existing standardised language tests used in the assessment of PPA, in order to determine whether they are appropriate and psychometrically adequate to detect change over time in the treatment of anomia.

Main Contribution: The present findings highlight the scarcity of psychometrically robust instruments used to measure therapy-induced gains in PPA. Additionally, most of these instruments were not validated for use with the PPA population, which consequently might bias the results. There is a need for population-based norms for existing instruments.

Conclusions: The accurate assessment of lexico-semantic deficits in PPA should rely on objective, reliable, valid, and responsive outcome measures. Psychometric studies are needed to evaluate and eventually improve the quality of language tests used in clinical practice.     

A review of lexical retrieval intervention in primary progressive aphasia and Alzheimer’s disease: mechanisms of change,generalisation, and cognition

Background: While significant benefits of lexical retrieval intervention are evident within the primary progressive aphasia (PPA) and Alzheimer’s disease (AD) literature, an understanding of the mechanisms that underlie change is limited. Change mechanisms have been explored in the post-stroke aphasia literature and offer insight into how change occurs through interventions with progressive language disorders. Exploration of change mechanisms may progress our understanding as to how and why generalisation is likely, or not, to occur, as well as gain insight into the non-linguistic cognitive functions that may play a role.

Aims: This review of the literature aimed to (1) map the mechanisms of change that have been proposed or hypothesised within the PPA and AD lexical retrieval intervention literature to a theoretical framework based on a framework of motor recovery following stroke and accounts of change mechanisms within the post-stroke aphasia literature and explore whether particular mechanisms of change were associated with more effective outcomes; (2) determine whether particular mechanisms of change were associated with within- and across-level linguistic generalisation, and (3) investigate the role of non-linguistic cognitive functions in the lexical retrieval intervention studies reviewed here.

Main Contribution: A search of Medline, PsycINFO, and CINAHL identified 37 papers published between 1982 and April 2016 that reported lexical retrieval intervention in people with PPA or AD, categorised here according to whether the proposed change mechanism was stimulation (12 studies), relearning (21 studies), reorganisation (three studies), or cognitive-relay (two studies). Significant treatment gains, predominantly based on linguistic performance measures, were reported for both diagnostic groups in association with the proposed mechanisms of stimulation and relearning. Significant treatment gains were also reported for people with PPA in association with reorganisation and cognitive-relay mechanisms; these mechanisms were only employed in PPA studies. Varying outcomes for linguistic generalisation were reported in 26 PPA and six AD studies. Nineteen studies incorporated non-linguistic cognitive functions in intervention; these were limited to autobiographical memory (17 studies), episodic memory (three studies), or both (one study).

Conclusion: This review highlights that individuals with PPA and AD benefit from lexical retrieval intervention, irrespective of the mechanism of change, and that linguistic generalisation was reported in studies proposing different change mechanisms. Insufficient exploration of the role of non-linguistic cognitive functions was highlighted with respect to assessment, planning intervention, and interpreting intervention outcomes. Recommendations are made, with a view to heightening our ability to interpret intervention outcomes.     

The role of intensity in constraint-induced language therapy for people with chronic aphasia

Background: Studies of intensive aphasia treatments vary widely in terms of treatment focus, in patient population and, in particular, in definition of what is considered “intensive”. Variability makes it difficult to compare among studies and to definitively determine whether more treatment is actually better. Constraint-induced language therapy (CILT) is one treatment that has been successfully replicated at approximately the same dosage with generally positive results.

Aims: The current study used a modified multiple baseline design across participants to investigate the administration of CILT at the standard intensive dosage of 30 hours over 2 weeks (CILT-I) compared to a more distributed dosage of 30 hours over 10 weeks (CILT-D).

Methods & Procedures: Eight participants with chronic aphasia participated in either CILT-I or CILT-D. Standardised and discourse measures were taken pre- and post-treatment and also 4 weeks after the completion of treatment. Discourse probes were administered after every 6 hours of treatment to assess change in productivity and efficiency over time.

Outcomes & Results: All of the participants who received CILT-I and CILT-D showed either an increased effect size on a discourse measure, a clinically significant change on a standardised battery or both. Gains were maintained in nearly all cases.

Conclusions: CILT administered in both intensive and distributed dosages resulted in positive changes in aphasia severity and discourse. This study adds evidence to the still inconclusive role of intensity to CILT.     

Primary progressive aphasia: a review of neuropsychological tests for the assessment of speech and language disorders

Background: Speech and language impairments are the key clinical feature in several neurodegenerative disorders and primary progressive aphasia (PPA) is the syndrome where they are the prominent features. Their accurate and early identification may increase the diagnosis in the clinical setting. This approach may allow a better discrimination between the different neurodegenerative disorders and the PPA variants, i.e., nonfluent, semantic, logopenic.

Aims: The aim of this work is twofold: (1) to provide an overview of the available neuropsychological tests for the diagnosis of PPA and/or for the differentiation among the PPA variants and (2) to evaluate the methodological quality and the psychometric characteristics of these tests.

Methods & Procedures: This review was conducted following PRISMA guidelines. Search terms were chosen based on the research questions and used in a search in two databases. Then, inclusion criteria were formulated and papers meeting the criteria were reviewed. The methodological quality of the studies was evaluated examining the following items: (1) blindness of personnel, (2) consecutive inclusion of patients, and (3) representativeness of the sample.

Outcomes & Results: A total of 907 papers have been selected from the databases, and 9 of them were included in this review. Among these, three tests aimed to differentiate between PPA variants, two tests were designed for the assessment of language disorders in PPA patients, and four tests were developed to stage the severity of speech/language disorders in PPA patients. All the included studies provided psychometric data about the clinical validity of the tests; however, they present several limitations, both psychometric and methodological.

Conclusion: The number of validation studies is still limited. This brief review reveals the need of linguistically sophisticated tests, characterized by better quality of methods and psychometric characteristics, to be used to systematically evaluate the linguistic abilities of individuals with PPA.     

Recognition of thematic and taxonomic conceptual relations in patients with aphasia

Background: There is mounting evidence that there exist conceptual non-verbal deficits in patients with aphasia. In the current paper, taxonomic and thematic conceptual relations are the focus of interest. There is a debate surrounding this topic regarding whether they are part of the same semantic system or there are independent systems dedicated to each kind of relations.

Aims: Our aim was to study and look for possible dissociations in a group of fluent and non-fluent aphasic patients on their ability to recognise conceptual relations (taxonomic and thematic).

Methods & Procedures: Previous studies have usually proposed forced-choice tasks, which give the patients closed response options and do not allow the researcher to assess the criteria for the choice the participants have made. In the following study we assigned different types of conceptual tasks (forced choice and free choice) to a group of 25 stroke patients (7 fluent and 18 non-fluent aphasic patients), as well as 30 healthy control participants. We assessed the hit rates and the response criteria followed by the patients.

Outcomes & Results: The results showed that although all aphasic patients experienced difficulties in establishing both types of conceptual relations in verbal tasks, dissociations were observed particularly in non-verbal tasks showing poor performance in thematic relations. This was especially noticeable in non-fluent aphasic patients. Meanwhile, fluent aphasic patients showed more difficulty in establishing taxonomic relations in the pictorial free-choice task and a tendency to use thematic criteria.

Conclusion: These results support the claim that there exist separate systems for both kinds of conceptual relations. Implications for the assessment of semantic deficits in aphasic patients were discussed.     

A pilot study exploring public awareness and knowledge of right hemisphere communication disorder compared with aphasia and stroke in Northwest London,UK

Background: No previously published research has investigated public awareness and knowledge of Right Hemisphere Communication Disorders (RHCD). In comparison, there are a handful of published studies that have investigated public awareness and knowledge of aphasia. The results of these studies indicate that awareness and knowledge is low but has marginally increased in recent years, due to international efforts to raise the public profile of the disorder.

Aims: The current study investigated public awareness and knowledge of RHCD and compared it to that of aphasia. Information regarding awareness and knowledge of stroke was also determined for those participants who did not have awareness of RHCD or aphasia.

Methods & Procedures: A face-to-face survey of 87 members of the public was undertaken in North West London, United Kingdom.

Outcomes and Results: Of the 87 survey respondents, only 9.2% reported having heard of RHCD and 4.6% met the criteria for having basic knowledge of this disorder. In comparison, 32.2% of participants had heard of aphasia and 24% had basic knowledge about it. While the results show that fewer people were aware and had knowledge of RHCD compared to aphasia, this difference was not significant. Of those participants who had heard of neither disorder, all had heard of and the majority had knowledge of stroke.

Conclusions: The findings suggested that awareness of RHCD amongst members of the public is low. It is suggested that in order to improve quality of services, funding and social re-integration following a right hemisphere stroke, raising public awareness and knowledge is necessary.