Language mixing patterns in a bilingual individual with non-fluent aphasia

Background: Language mixing in bilingual speakers with aphasia has been reported in a number of research studies, but the reasons for the mixing and whether it reflects typical or atypical behaviour has been a matter of debate.

Aims: In this study, we tested the hypothesis that language mixing behaviour in bilingual aphasia reflects lexical retrieval difficulty.

Methods & procedures: We recruited a Hebrew-English bilingual participant with mild-moderate non-fluent agrammatic aphasia and assessed his languages at three timepoints. We analysed the participant’s Hebrew and English production for retrieval during single-word naming, sentences, and discourse, and identified all instances of language mixing.

Outcomes & Results: We found that there was a greater frequency of language mixing during production of more difficult lexical items, namely the post-morbidly less proficient language (compared to the more proficient language), function words (compared to content words), and single-word naming (compared to retrieval in the context of connected speech tasks), but not for verbs (compared to nouns).

Conclusions: In this bilingual participant with non-fluent aphasia, language mixing behaviour closely resembles lexical retrieval difficulty. Thus, we suggest that bilingual speakers with aphasia may mix their languages as a strategy to maximise communication.     

A behavioral study of the nature of verb–noun dissociation in the nonfluent variant of primary progressive aphasia

Background: Patients with nonfluent/agrammatic variant primary progressive aphasia (nfvPPA) have more difficulty producing verbs than nouns, but the reason for this discrepancy remains unclear. One possibility is that it results from impaired access to motor programs integral to semantic representations of actions. Another is that the disruption affects specific lexical or grammatical features of verbs.

Aims: To use an oral picture naming task to examine the effects of motor associations on verb production in patients with nfvPPA.

Methods & Procedures: We administered noun and verb naming tasks to 12 nfvPPA patients and 9 controls. We varied the manipulability of target items across categories as a proxy for the degree to which lexical access depends on motor knowledge.

Outcomes & Results: Nonfluent PPA patients were significantly more impaired in both noun and verb naming compared to control participants. However, the nfvPPA patients were significantly more impaired in naming verbs than nouns, but there was no effect of manipulability.

Conclusions: The results suggest that the verb naming deficit in nfvPPA is not directly related to impaired motor knowledge and is more likely to be related to other properties that distinguish verbs from nouns.     

What a pooled data study tells us about the relationships between gender and knowledge of semantic categories

Introduction: Both the neuropsychological study of patients with category-specific semantic disorders (CSSD) and the experimental research on categorical processing in healthy subjects (HSs) have shown that men are mainly impaired with fruits and vegetables and women with animals and artifacts. Since this difference is more striking in patients with CSSD than in HSs, we hypothesized that the lack of power of some investigations conducted with HSs and the different methods used in studies conducted with HSs and patients with CSSD could explain some of these inconsistencies and that a study conducted with a very large number of HSs using visual naming tasks should strongly confirm the role of gender in categorical tasks.

Methods: Picture naming data gathered during the last ten years with our category-specificity paradigm from a large number (702) of HSs were reanalyzed.

Results: As predicted, men named significantly more animals and artifacts, while women named more plant life items.

Discussion: These data confirm that, if different domains of knowledge are studied in a very large sample of HSs using a picture naming task equivalent to the naming tasks used in most anatomo-clinical studies on CSSD, then the gender effects are highly significant.     

Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial

Objective: To determine the effect of activity-based mirror therapy (MT) on motor recovery and gait in chronic poststroke hemiparetic subjects.

Design: A randomised, controlled, assessor-blinded trial.

Setting: Rehabilitation institute.

Participants: Thirty-six chronic poststroke (15.89?±?9.01 months) hemiparetic subjects (age: 46.44?±?7.89 years, 30 men and functional ambulation classification of median level 3).

Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management.

Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT).

Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference?=?3.29, 95% CI?=?1.23–5.35, p?=?.003) and RVGA (mean difference?=?5.41, 95% CI?=?1.12–9.71, p?=?.015) in comparison to the control group. No considerable changes were observed on 10-MWT.

Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects.     

Cross-language generalisation in bilingual aphasia: what are we missing when we do not analyse discourse?

Background: Cross-language generalisation has been reported in about half of all published cases of bilingual aphasia treatment. However, many of those studies report data from only single-word naming tasks. In unbalanced bilinguals with aphasia, treating the post-morbidly less proficient language may result in apparent improvement to only the treated language.

Aims: To investigate whether when tools are used to measure language abilities beyond the single-word and sentence levels, such as analysing discourse production, improvement in the post-morbidly more proficient language may be observed.

Methods & Procedures: A Hebrew-English bilingual person with mild-moderate non-fluent agrammatic aphasia was recruited. He received 36 h of Verb Network Strengthening Treatment (VNeST) in English only, with pre- and post- treatment assessment of his language abilities in both English and Hebrew.

Outcome & Results: Significant improvement was observed in the treated language (English) for noun and verb retrieval in object and action picture naming and within sentence production, but not for the untreated language (Hebrew). In discourse, greater and more widespread improvement was observed in the untreated language (Hebrew) than in the treated language (English).

Conclusions: We advocate for more wide-ranging measurement tools in the field to reduce the risk of missing valuable information regarding generalisation. Only with a more representative understanding of the effects of language treatment in bilinguals with aphasia can we better understand the mechanisms behind cross-language generalisation.     

A Note on the “One Case per Stagger Position” Character of Common Multiple-Baseline Intervention Designs

Purpose: To overcome the constraint of common multiple-baseline designs that only one case per stagger position is permitted.

Methods: Three alternative strategies for assigning more than one case to each stagger position are examined.

Results: The three recommended strategies achieve the objective while maintaining the study’s internal and statistical-conclusion validities.

Conclusions: ExPRT, a freely available Excel-based randomization-test package, can be used to assist in both the design and statistical analysis associated with each of the strategies.     

Rasch analysis of the upper-limb subscale of the stroke rehabilitation assessment of movement (STREAM) tool in an acute stroke cohort Rasch analysis of the upper-limb subscale of the STREAM tool in an acute stroke population

Background: Stroke is a leading cause of disability worldwide. The most common impairment resulting from stroke is upper-limb weakness.

Objectives: To determine the usefulness and psychometric validity of the upper-limb subscale of the STREAM in an acute stroke population.

Methods: Rasch Analysis, including unidimensionality assumption testing, determining model fit, and analysis of: reliability, residual correlations, and differential item functioning.

Results: 125 individuals were assessed using the upper-limb subscale of the Stroke Rehabilitation Assessment of Movement (STREAM) tool. Rasch analysis suggests the STREAM is a unidimensional measure. However, when scored using the originally proposed method (0–2), or using the response pattern (0–5) neither variant fit the Rasch model (p < 0.05). Although, the reliability was good (Person-Separation Index – 0.847 and 0.903, respectively). Correcting for the disordered thresholds, and thereby producing the new scoring pattern, led to substantial improvement in the overall fit (chi-square probability of fit – 22%), however, the reliability was slightly reduced (PSI – 0.806).

Conclusions: The study proposes a new scoring method for the upper-limb subscale of the STREAM outcome measure in the acute stroke population.     

Modeling confrontation naming and discourse informativeness using structural equation modeling

Background: People with aphasia (PWA) and their families identify as their priority the ability to use language at the discourse level in order to meet their daily communicative needs. However, measuring connected speech can be a challenging task due to the complex and multidimensional nature of discourse. As a result, professionals often depend on confrontation naming tests to identify and measure impaired underlying cognitive mechanisms that are also hypothesized to be important for discourse production.

Aims: In the current study, we investigated the validity of making inferences about discourse performance based on scores from confrontation naming tests. Specifically, we investigated the strength of the relationship between word retrieval abilities, and the ability to convey information during discourse production.

Method & Procedures: Data from 118 monolingual PWA were retrieved from AphasiaBank and analyzed using structural equation modeling. Performance in confrontation naming tests was modeled as a latent variable based on the Boston Naming Test, the Western Aphasia Battery – R Naming Subtest, and the Verb Naming Test. Performance at the discourse level was modeled based on indices of informativeness in three discourse tasks (free speech, eventcasts, and story re-tell). Informativeness was quantified using the percentage of Correct Information Units.

Outcomes and Results: Based on the fit statistics, the model exhibited adequate fit, indicating that the relationship between confrontation picture naming and informativeness was adequately reflected in the model. We found a strong relationship between confrontation naming test performance and discourse informativeness (standardized regression coefficient between the two latent factors = .79).

Conclusions: Performance on confrontation naming tests was a strong predictor of the amount of information PWA communicated during discourse production. However, our results also highlight that performance on the latter cannot be predicted solely from the former, as evidenced by the large proportion of unexplained variance in the informativeness latent variable.     

Use of co-verbal gestures during word-finding difficulty among Cantonese speakers with fluent aphasia and unimpaired controls

Background: Co-verbal gestures refer to hand or arm movements made during speaking. Spoken language and gestures have been shown to be tightly integrated in human communication.

Aims: The present study investigated whether co-verbal gesture use was associated with lexical retrieval in connected speech in unimpaired speakers and persons with aphasia (PWA).

Methods & Procedures: Narrative samples of 58 fluent PWA and 58 control speakers were extracted from Cantonese AphasiaBank. Based on the indicators of word-finding difficulty (WFD) in connected speech adapted from previous research and a gesture annotation system with independent coding of gesture forms and functions, all WFD instances were identified. The presence and type of gestures accompanying each incident of WFD were then annotated. Finally, whether the use of gesture was accompanied by resolution of WFD (i.e., the corresponding target word could be retrieved) was examined.

Outcomes & Results: Employment of co-verbal gesture did not seem to be related to the success of word retrieval. PWA’s naming ability at single-word level and their overall language ability (as reflected by the aphasia quotient of the Cantonese version of the Western Aphasia Battery) were found to be the two strongest predictors of success rate of resolving WFD.

Conclusions: The Lexical Retrieval Hypothesis highlighting the facilitative functions of iconic and metaphoric gestures in lexical retrieval was not supported. Challenges in conducting research related to WFD, and the clinical implications in gesture-based language intervention for PWA were discussed.     

Effects of phonomotor treatment on discourse production

Background: Aphasia is an acquired language disorder that makes it difficult for people to produce and comprehend language, with all people with aphasia (PWA) demonstrating difficulty accessing and selecting words (anomia). While aphasia treatments typically focus on a single aspect of language, such as word retrieval, the ultimate goal of aphasia therapy is to improve communication, which is best seen at the level of discourse.

Aims: This retrospective study investigated the effects of one effective anomia therapy, Phonomotor Treatment (PMT), on discourse production.

Methods & Procedures: Twenty-six PWA participated in 60 h of PMT, which focuses on building a person’s ability to recognize, produce, and manipulate phonemes in progressively longer nonword and real-word contexts. Language samples were collected prior to, immediately after, and 3 months after the treatment program. Percent Correct Information Units (CIUs) and CIUs per minute were calculated.

Outcomes & Results: Overall, PWA showed significantly improved CIUs per minute, relative to baseline, immediately after treatment and 3 months later, as well as significantly improved percent CIUs, relative to baseline, 3 months following treatment.

Conclusions: PMT, which focuses on phonological processing, can lead to widespread improvement throughout the language system, including to the functionally critical level of discourse production.     

French translation and validation of a fragile X syndrome screening checklist

Background: Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability among men. This syndrome is frequently underdiagnosed in adults. The aim of this study was to develop and validate a French translation of the screening checklist Fragiele-X screeningslijst.

Method: The validation sample for the translated checklist included 22 pairs of men between the ages of 18 and 52, matched by age and degree of intellectual impairment.

Results: The translated checklist achieved coefficients of 0.92 for internal consistency, 0.90 for test-retest reliability and 0.65 for inter-rater reliability. These psychometric properties are commensurate with those of the original checklist.

Conclusion: Therefore, the translated checklist developed in this study can be considered a valid screening instrument for the detection of FXS in men with intellectual disabilities.

Abbreviations: FXS: fragile X syndrome; FMR1: fragile X mental retardation 1 (gene)     

Impaired lexical selection and fluency in post-stroke aphasia

Background: Deficits in fluent language production are a hallmark of aphasia and may arise from impairments at different levels in the language system. It has been proposed that difficulty resolving lexical competition contributes to fluency deficits.

Aims: The present study tested this hypothesis in a novel way: by examining whether narrative speech production fluency is associated with difficulty resolving lexical competition in spoken word recognition as measured by sensitivity to phonological neighborhood density.

Methods & Procedures: Nineteen participants with aphasia and 15 neurologically intact older adults identified spoken words that varied in phonological neighborhood density and were presented in moderate noise.

Outcomes & Results: Neurologically intact participants exhibited the standard inhibitory effect of phonological neighborhood density on response times: slower recognition of spoken words from denser neighborhoods. Among participants with aphasia, the inhibitory effect of phonological neighborhood density (less accurate recognition of spoken words from denser neighborhoods) was smaller for participants with greater fluency. The neighborhood effect was larger for participants with greater receptive vocabulary knowledge, indicating that the fluency effect was not a result of general lexical deficits.

Conclusions: These results are consistent with the hypothesis that impaired lexical selection is a contributing factor in fluency deficits in poststroke aphasia.     

Selection for sentence generation in the context of severe anomia: A case series of left temporal patients

Introduction: Anomia is an impairment of naming: the retrieval of specific lexical items from the mental lexicon. Theoretically, whether anomia reflects a failure of selection at the preverbal “idea” level or at the subsequent linguistic formulation stage remains a topic of debate. We investigated the preverbal mechanism of idea selection for sentence generation, which requires the selection of a proposition from among competing alternatives during message formulation, in patients with severe anomia.

Method: Patients with lesions to the left temporal lobe (N = 12), presenting with clinically defined anomia, and matched healthy controls (N = 24) completed sentence-level tasks that required the oral generation of a sentence or single word when presented with a word, a word pair, or a sentence. Selection demands were manipulated so that the stimuli activated many competing response options (low constraint) or one dominant or few response options (high constraint).

Results: There was no effect of stimuli constraint in the patient group that differed from that in the healthy control group on any of the generation tasks, suggesting that idea-level selection is intact in the patient group.

Conclusions: These findings have implications for theoretical models of spoken language production and for clinical treatments of anomia.     

Effects of stimulus-related variables on mental states recognition in Huntington’s disease

Background: Cognitive abnormalities in Huntington’s Disease (HD) can involve the specific impairment of the social perspective taking as well as difficulties in recognizing others’ mental state many years before the onset of motor symptoms.

Aims: At the scope of assessing how the difficulties in mental state recognition might be an HD early sign before motor symptoms appear, our study was aimed to investigate how the recognition of others’ mental states in HD subjects is moderated by different stimulus related features (gender, difficulty (low, medium, high), and valence (positive, negative, neutral) of the mental states that are to be recognized).

Methods: Subjects with premanifest (n?=?20) and manifest (n?=?40) HD performed the revised ‘Reading the Mind in the Eyes Test’ and were compared with age-matched healthy controls (HC, 40 subjects per cohort).

Results: Our results highlight an early impairment in mental state recognition preceding manifest HD symptoms and a deterioration of these abilities with HD progression. Moreover, we found in HD premanifest subjects an impairment concerning the recognition of negative and neutral mental states, as well as of mental states with moderate recognition difficulty. Finally, we found that participant gender did not influence the performance in recognizing others’ mental states, while all participants recognized mental states displayed by females more accurately than those displayed by males.

Conclusions: We conclude that difficulties in the recognition of complex mental states can be considered as an early sign of HD, before evident behavioral manifestations, and peculiar features of the stimulus influence it.     

Functional detection of the original generation of hippocampal cells planted on to the micro-fluidic chip with artificial neuronal network using the patch clamp recording technique: a preliminary study

Purpose: The design of pattern that limits the hippocampal cells growth is an important explore for realizing a simplified artificial neuronal network in vitro.

Materials and methods: In this study, we examined the pattern in micro-fluidic chip to stipulate the hippocampal cells adhesion, growth and the formation of a functional neuronal network in vitro. Patch clamp recording technique was used to detect the growth situation and biological function of the haippocampal cells on the micro-fluidic chip which could simulate environment in vivo.

Results: We showed that the number of neurons cultured was about 5000–6000 cells on the micro-fluidic chip, which was conductive to the hippocampal cells growth. The result of patch clamp recording technique showed the signals of sodium and potassium channels, meanwhile, it also revealed the signals of synaptic connection.

Conclusions: These findings involve placing cells in specific locations to create organized structures, and explore the spread function of synaptic on the micro-fluidic chip.     

Estimation of skeletal muscle mass in patients with spinocerebellar ataxia type 3 and 10

Background: Neurodegenerative diseases may progress to a level in which patients present spontaneous weight loss, resulting in increased falls and functional disabilities when the disease is associated with muscle mass depletion.

Objective: Evaluate the muscle compartment in patients presenting spinocerebellar ataxia (SCA) type 3 and 10.

Methods: Forty-six patients presenting SCA type 3 and 10 were assessed and 76 volunteers were selected to the control group. In order to evaluate the muscle compartment, muscle mass anthropometric measurements were assessed and total skeletal muscle mass calculated through a predictive equation.

Results: Women with SCA3 presented greater weight loss and muscle mass reduction compared to those with SCA10 and the control group. Among the predictive measurements, calf muscle circumference showed a more significant correlation with total skeletal muscle mass (p = 0.718).

Conclusion: Patients presenting both types of ataxia did not show severe depletion in their nutritional status; however, those with SCA3 displayed greater weight loss and muscle mass reduction compared to the SCA10 group.     

Repetitive verbalization in Alzheimer’s disease

Background: Repetitive verbalization in Alzheimer’s disease (AD) refers to the tendency of AD patients to repeat the same story/question to the same listener.

Aim: Our study assessed whether this verbal perseveration might be related to episodic memory decline, values of teaching, inhibitory decline, and/or decline in cognitive theory of mind.

Methods & Procedures: Thirty mild AD patients and 33 control older adults were asked to perform four verbal fluency tasks, and repeated words were retained as an index of repetitive verbalization. Participants were also administered the Grober and Buschke episodic memory task, scales of values of teaching, the Hayling inhibition task, and the false-belief task for the cognitive theory of mind.

Outcomes & Results: Results showed more repetitive verbalization in AD patients than in control older adults. Repetitive verbalization was significantly correlated with inhibition and episodic memory in AD patients. As for control older adults, repetitive verbalization was significantly correlated with values of teaching and inhibition. Regression analyses showed that repetitive verbalization was significantly predicted by inhibition in AD patients and values of teaching in control older adults.

Conclusions: Repetitive verbalization may reflect the difficulty in inhibiting irrelevant stimuli in AD patients, but it may serve as a tool to ensure transmission of personal knowledge in normal aging. Our findings suggest distinct functions of repetitive verbalization in normal aging and AD.     

Exploring dimensions of social support and resilience when providing care at the end of life: a qualitative study

Background: Research shows that formal and informal social support can facilitate resilience in carers. There is a paucity of research exploring social support and resilience amongst recently bereaved informal carers.

Aim: To examine how the presence or absence of distinct dimensions of social support facilitate or hinder resilience in recently bereaved informal carers.

Participants: 44 bereaved carers, who had been identified by GP as ‘main carer’ of someone recently deceased (3–12 months), aged between 38 and 87 years old (mean= 67).

Methods: Thematic analysis then the Ecological Framework of Resilience as an organisational tool to develop overarching themes in the data. We used the Sherbourne and Stewart model to identify social support that was lacking as well as social support that was present.

Results: A range of social support types were identified. There was an emphasis on the importance of relationships with both health professionals and family members, including the care recipient. However, social support was not necessary for resilience if the participant had other resources.

Conclusions: Social support for carers providing end of life care is almost exclusively based around end of life care ‘work’. In comparison to other research our study suggests that relationships with family and health professionals are paramount. Multidimensional support is needed for carers to enhance their resilience.     

Boston Naming Test performance in French-speaking Acadians

Background: Standardized tools for the assessment of language and cognition for French Canadians are limited, especially for those living outside of Quebec, making it difficult for clinicians to diagnose and treat language and cognitive impairments. Acadians are an understudied, linguistically diverse group with varying levels of bilingualism in French and English that affords the opportunity to study naming performance in individuals with varying degrees of bilingualism.

Aims: The goals of this investigation were threefold: a) to describe the naming performance of Acadians in French, including name agreement on individual Boston Naming Test (BNT) items and naming performance as a function of age and education; b) to investigate the effect of using different published datasets (Kaplan’s norms for English speakers and the Quebec naming dataset for French speakers) when calculating the naming ability level (i.e., high average, average, low average, borderline, and extremely low) on the BNT in French; and c) to examine the effects of bilingualism on BNT performance in French and English.

Methods & Procedures: French-speaking Acadians (N = 119) aged 20–81 years (M = 44.3, SD = 14.49) completed a questionnaire self-reporting their language proficiency and use, followed by the administration of the BNT (Kaplan et al., 2001) in French.

Outcomes & Results: Name agreement analyses revealed a high percentage of correct responses for many items, while other items were frequently described using regionalisms. Naming performance improved as a function of education, but there was no effect of age. The study also highlighted the effects of using different naming datasets to calculate each participant’s naming ability. Overall, the Acadian sample’s naming ability was lower than expected when calculating naming ability using either the Kaplan English norms (Kaplan et al, 2001) or the Quebec naming dataset for French speakers (Roberts & Doucet, 2011). Moreover, agreement in the naming ability level (from extremely low to high average) was poor. Consistent with previous studies, total BNT scores in French were significantly lower for French-speaking bilinguals (FS-BIs) compared to French-speaking unilinguals (FS-UNIs) after controlling for educational levels. It was also noted that French-English bilinguals performed better on the English compared to the French administration of the BNT.

Conclusion: The results of this study support the need for a separate naming dataset for bilingual and French-speaking Acadians. Implications for the assessment of naming ability and deficits in clinical practice with French and French/English bilingual speakers are discussed.