The role of semantic complexity in treatment of naming deficits: training semantic categories in fluent aphasia by controlling exemplar typicality.

The effect of typicality of category exemplars on naming was investigated using a single subject experimental design across participants and behaviors in 4 patients with fluent aphasia. Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, while generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants. Results indicated that patients trained on naming of atypical exemplars demonstrated generalization to naming of intermediate and typical items. However, patients trained on typical items demonstrated no generalized naming effect to intermediate or atypical examples. Furthermore, analysis of errors indicated an evolution of errors throughout training, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias. Performance on standardized language tests also showed changes as a function of treatment. Theoretical and clinical implications regarding the impact of considering semantic complexity on rehabilitation of naming deficits in aphasia are discussed.     

The role of semantic complexity in treatment of naming deficits: training semantic categories in fluent aphasia by controlling exemplar typicality.

The effect of typicality of category exemplars on naming was investigated using a single subject experimental design across participants and behaviors in 4 patients with fluent aphasia. Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, while generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants. Results indicated that patients trained on naming of atypical exemplars demonstrated generalization to naming of intermediate and typical items. However, patients trained on typical items demonstrated no generalized naming effect to intermediate or atypical examples. Furthermore, analysis of errors indicated an evolution of errors throughout training, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias. Performance on standardized language tests also showed changes as a function of treatment. Theoretical and clinical implications regarding the impact of considering semantic complexity on rehabilitation of naming deficits in aphasia are discussed.     

Differentiating Alzheimer's patients from the normal elderly and stroke patients with aphasia

The performance of individuals with mild and moderate Alzheimer's disease (AD), normal age-matched elderly individuals, and stroke patients with fluent and nonfluent aphasia were compared on a group of neuropsychological tasks. The unique performance profiles associated with each subject group are discussed, and the best tasks for intergroup differentiation specified. Whereas the tasks employed were efficacious for discriminating early- and middle-stage AD patients from normal subjects and aphasic stroke patients, and early- from middle-stage AD patients, they were not efficacious for subtyping aphasia patients according to fluency. Generally, memory measures were best for intergroup differentiation.     

The trouble with nouns and verbs in Greek fluent aphasia

In the past verb retrieval problems were associated primarily with agrammatism and noun retrieval difficulties with fluent aphasia. With regards to fluent aphasia, so far in the literature, three distinct patterns of verb/noun dissociations have been described for individuals with fluent anomic aphasia in languages with different underlying forms; better verb retrieval, poorer verb retrieval and equal retrieval difficulties for verbs and nouns. Verbs and nouns in Greek are considered of similar morphological complexity thus it was predicted that anomic aphasic individuals would suffer from a non-dissociated impairment of verbs and nouns. Problems with verbs and/or nouns may arise at any stage in the process of lexical retrieval, i.e. lexical-semantic, lemma, lexeme or articulation. The aim of this research was to investigate verb and noun retrieval using a picture-naming task to explore any possible selective noun and/or verb comprehension or retrieval deficits in Greek individuals with anomic aphasia. The results revealed a significant verb/noun dichotomy with verbs significantly more difficult to retrieve than nouns. These findings lend support for the growing body of evidence showing a specific verb impairment in fluent anomic individuals as well as Broca's patients. Given the prevailing view, that anomic patients experience difficulty retrieving the morpho-phonological form of the target word, the results show that specific information of the grammatical category is also important during word form retrieval. LEARNER OUTCOMES: The reader will become familiar with (i) studies investigating grammatical word class breakdown in individuals with aphasia who speak different languages, (ii) the application of the serial model to word production breakdown in aphasia and (iii) the characteristics of verbs and nouns in Greek. It will be concluded that successful verb retrieval for fluent aphasic individuals who speak Greek is dependant on the retrieval of the morpho-phonological information of the target verb.     

Word fluency generation skills of head-injured patients in an acute trauma center

Two hundred-eighteen acutely brain-injured trauma patients with confirmed diagnosis of initial closed head injury completed two types of word fluency generation tasks, animal naming and single-letter-based word generation. Numbers of responses and inferred strategy utilizations were examined and compared with established norms for non-brain-injured individuals using frequency counts and chi 2 analyses. Significant differences were noted in response quantity and quality between closed head-injury patients and normals. A positive relationship was noted between level of cognitive functioning and number of word associates generated. Same initial consonant-vowel syllable (see-seed), semantic association (ship-sail), and same initial consonant-consonant blend (tree-trick) strategies were used by all subjects regardless of severity of injury. Quantitative and qualitative differences were noted as a function of severity of cognitive disruption.     

Outcome of intensive language treatment in aphasia

Sixty-eight aphasic inpatients received intensive language treatment (9 hr per week over a period of 6-8 weeks). Outcome was assessed by means of the Aachen Aphasia Test (AAT), a standardized test battery for the German language. For patients with duration of aphasia up to 12 months, amount of improvement was corrected by the expected rate of spontaneous recovery as determined by a previous multicenter follow-up study. About two thirds of the patients showed significant improvement in AAT performance according to psychometric single case analysis procedures. A similar rate of improvement was found for individuals with chronic aphasia beyond the stage of spontaneous recovery.     

Long-term hearing results in gamma knife radiosurgery for acoustic neuromas

Objectives: There are many studies that have examined functional outcomes following Gamma Knife treatment; however, few have reported long‐term audiometric data. This study analyzed the long‐term hearing results of Gamma Knife radiosurgery in the treatment of acoustic neuromas. Study Design: Retrospective cohort study. Methods: Seventeen patients were selected from our acoustic neuroma Gamma Knife registry of 113 patients treated from 1991 to 2005. Pretreatment audiograms were analyzed for pure‐tone average and word recognition scores and assigned a Gardner‐Robertson classification score (GRC). Either a current audiogram was obtained or the most recent audiogram (if the patient was lost to follow‐up) was reviewed from clinic charts and these were compared with the preoperative results. Audiometric data of the pre‐ and posttreatment normal ear were obtained and used as the patient's own control. Results: The tumor size ranged from 0.5 to 2.8 cm (mean, 1.33 cm) and patients received a range of 12.5–16 Gy (mean, 13.82 Gy) to 50% isodose line. Patient follow‐up ranged from 3 to 82 months with a mean of 33.6 months. Pretreatment pure‐tone average for the involved side group was 30.6 dB HL with a word recognition score of 74%. Pretreatment mean GRC was 1.76. posttreatment pure‐tone average for the group was 59.7 dB HL with a word recognition score of 37%. posttreatment mean GRC was 3.29. Comparing pre‐ versus post‐Gamma Knife radiosurgery results on the treatment ear, means were statistically significantly different for both pure‐tone average and word recognition scores, based on a paired‐samples t test (P < .001 for both). The group “normal” ear pure‐tone average was 14 dB HL and 17.75 dB HL pre‐ and posttreat‐ment, respectively. Normal ear pre‐ and posttreatment word recognition score and GRC were 93% and 98%, and 1.13 and 1.31, respectively. Conclusion: Gamma Knife radiosurgery remains a noninvasive treatment option for patients with acoustic neuromas; however, they may experience a delayed hearing loss. Of those patients with useful audition pretreatment, 42% maintained useful hearing posttreatment.     

Stuttering: An evaluation of follow-up procedures for syllable-timed speech / token system therapy

A token system was designed (Ingham, Andrews and Winkler 1972) to improve the results of treatment with Syllable-Timed speech. The outcome after nine months is reported for 58 adult stutterers. One group received Syllable-Timed speech alone, other groups were assisted by the Token System. After the intensive treatment phase (Ingham et al. 1972) three different follow-up procedures were utilized - weekly Group Psychotherapy and speech therapy, monthly sessions utilizing the Token System and no treatment at all. A group which was not treated by the Token System took nine months to approximate the performance level which was reached by Token System treated groups after two weeks of intensive treatment. However, regardless of whether the Token System groups received weekly, monthly or even no follow-up treatment, their performance at the end of nine months was not significantly different from their performance at the beginning of the follow-up period. The usefulness of Syllable-Timed speech as a therapeutic technique and the economy in treatment time effected by the Token System are discussed.     

The efficacy of group communication treatment in adults with chronic aphasia.

We examined the effects of group communication treatment on linguistic and communicative performance in adults with chronic aphasia. Participants were randomly assigned to two treatment and two deferred treatment groups. Groups were balanced for age, education level, and initial aphasia severity. Twenty-four participants completed the 4-month treatment trial. While in the treatment condition, all participants received 5 hours of group communication treatment weekly, provided by a speech-language pathologist. The focus of treatment included increasing initiation of conversation and exchanging information using whatever communicative means possible. While awaiting group communication treatment, participants in the deferred treatment groups engaged in such activities as support, performance, or movement groups in order to control for the effects of social contact. Linguistic and communicative measures were administered to all participants at entry, after 2 and 4 months of treatment, and following 4 to 6 weeks of no treatment. In addition, participants in the deferred treatment groups received an additional administration of all measures just before their treatment trial. Results revealed that participants receiving group communication treatment had significantly higher scores on communicative and linguistic measures than participants not receiving treatment. In addition, significant increases were revealed after 2 months of treatment and after 4 months of treatment. No significant decline in performance occurred at time of follow-up.     

Effect of stimulus context and response coding variables on word retrieval performances in dysphasia

Quantitative and qualitative differences between two word retrieval tasks were examined using nonfluent and fluent dysphasic and nondysphasic subjects. Additional variables examined included scoring criteria, trial effects, response trends, and inaccurate responses. Results revealed that the word fluency task was significantly more sensitive than the picture-naming context. Similarly, the variable of response time was identified as the more discriminating response scoring procedure. In addition to these two variables, the data on response trends and inaccurate responses provided significant information for differentiating nonfluent and fluent dysphasias. Discussion relates to the implications of the obtained findings for differential diagnosis and measuring language recovery in dysphasia.     

Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part I: Speech characteristics

The speech characteristics of 29 patients with primary tracheoesophageal puncture who received either a pharyngeal constrictor myotomy, a unilateral pharyngeal plexus neurectomy, or a unilateral pharyngeal plexus neurectomy with drainage myotomy limited to the cricopharyngeus were studied. All patients used a Blom-Singer low-pressure voice prosthesis. Audio recordings of each patient speaking with both the Blom-Singer tracheostoma valve and manual occlusion of the tracheostoma were recorded at 3 weeks, 6 months, and 12 months after surgery. The three surgical variations were equally effective at preventing pharyngospasms; only 1 patient (10%) in each group had some loss of fluency during the 12 month study period. Neurectomized patients produced significantly higher fundamental frequencies during reading than did patients in the other groups. Residual resting tone in the neurectomized pharyngoesophageal segment may contribute to more favorable speaking frequencies in this group.     

Prognosis of nasopharyngeal carcinoma by Epstein-Barr virus antibody titer.

A total of 433 samples of serum were collected from 305 patients with histopathologically proved anaplastic nasopharyngeal carcinoma (NPC). Antibodies against viral capsid antigens (VCA) of Epstein-Barr (EB) virus were titrated by means of indirect fluorescent antibody technique, using P3HR-1 cells as the target. High anti-VCA antibody titer in patients with NPC was found beginning to decline at the end of radiotherapy. Most (66.7%) of the patients were found to have a detectable reduction in antibody titer within six months after radiotherapy. Persistent high antibody titer after treatment correlates to high risk of the recurrence of the disease. This prognostic importance of anti-VCA titer becomes apparent at the end of radiotherapy, significant (P less than .05) within one year after treatment, and highly significant (P less than .0005) over one year after treatment.     

From manual to artificial intelligence fitting: Two cochlear implant case studies

Objective: To assess whether CI programming by means of a software application using artificial intelligence (AI), FOX®, may improve cochlear implant (CI) performance.

Patients: Two adult CI recipients who had mixed auditory results with their manual fitting were selected for an AI-assisted fitting. Even after 17 months CI experience and 19 manual fitting sessions, the first subject hadn’t developed open set word recognition. The second subject, after 9 months of manual fitting, had developed good open set word recognition, but his scores remained poor at soft and loud presentation levels.

Main outcome measure(s): Cochlear implant fitting parameters, pure tone thresholds, bisyllabic word recognition, phonemic discrimination scores and loudness scaling curves.

Results: For subject 1, a first approach trying to optimize the home maps by means of AI-proposed adaptations was not successful whereas a second approach based on the use of Automaps (an AI approach based on universal, i.e. population based group statistics) during 3 months allowed the development of open set word recognition. For subject 2, the word recognition scores improved at soft and loud intensities with the AI suggestions. The AI-suggested modifications seem to be atypical.

Conclusions: The two case studies illustrate that adults implanted with manual CI fitting may experience an improvement in their auditory results with AI-assisted fitting.     

Comparison of the recovery patterns of language and cognitive functions in patients with post-traumatic language processing deficits and in patients with aphasia following a stroke

In this study we investigated the recovery patterns of language and cognitive functions in patients with post-traumatic language processing deficits and in patients with aphasia following a stroke. The correlation of specific language functions and cognitive functions was analyzed in the acute phase and 6 months later.Significant recovery of the tested functions was observed in both groups. However, in patients with post-traumatic language processing deficits the degree of recovery of most language functions and some cognitive functions was higher. A significantly greater correlation was revealed within language and cognitive functions, as well as between language functions and other aspects of cognition in patients with post-traumatic language processing deficits than in patients with aphasia following a stroke.Our results show that patients with post-traumatic language processing deficits have a different recovery pattern and a different pattern of correlation between language and cognitive functions compared to patients with aphasia following a stroke.Learning outcomes: (1) Better understanding of the differences in recovery of language and cognitive functions in patients who have suffered strokes and those who have experienced traumatic brain injury. (2) Better understanding of the relationship between language and cognitive functions in patients with post-traumatic language processing deficits and in patients with aphasia following a stroke. (3) Better understanding of the factors influencing recovery.     

Performance over time of congenitally deaf and postlingually deafened children using a multichannel cochlear implant.

The speech perception performance of 10 congenitally deaf and 3 postlingually deafened children who received the Cochlear Corporation multichannel cochlear implant was examined and compared. The children were tested preimplant and at 6-month intervals up to 2 years using the Monosyllable-Trochee-Spondee test (MTS), the Word Intelligibility by Picture Identification test (WIPI), and Phonetically Balanced Kindergarten (PB-K) or Northwestern University List 6 (NU-6) word lists. The postlingually deafened children exhibited significantly improved performance on open- and closed-set tests of word recognition after 6 months of implant use, a pattern similar to that of postlingually deafened adult implant users. In contrast, the congenitally deaf children did not exhibit measurably improved performance on speech perception tests until after 12 months or more of implant use. With as much as 18-24 months of use, however, some congenitally deaf children demonstrated limited open-set word recognition.     

Home treatment for aphasic patients by trained nonprofessionals

Thirty-seven aphasic men received 8-10 hr of individual treatment each week for 12 weeks from a home therapist (wife, friend, relative) who was trained and directed by a speech pathologist. Treatment was followed by 12 weeks of no treatment. Patients were evaluated at entry and at 6, 12, 18, and 24 weeks after entry with a battery of speech and language measures. The group made substantial progress on all measures during the 12 weeks of treatment and ceased to progress when treatment was discontinued. Progress for the home treatment patients did not differ significantly from that of patients who received 12 weeks of individual treatment from speech pathologists or from that of patients for whom treatment was deferred for 12 weeks. Patient selection, training of the home therapists, and other methodological aspects are described to assist speech pathologists in making decisions about the use of trained volunteers in aphasia treatment.     

Children with a history of acquired aphasia: residual language and academic impairments

Fifteen children and adolescents with a history of acquired aphasia were administered a battery of language and academic tests, 1-10 years postonset. As a group, these children performed significantly more poorly than non-brain-injured subjects on the language measures, with deficits in word, sentence, and paragraph comprehension; naming; oral production of complex syntactic constructions; and word fluency. One particular language deficit or cluster of deficits did not characterize the group as a whole. For individual brain-injured subjects, language deficits ranged from no or only mild impairment to significant language deficits. All brain-injured subjects were functional verbal communicators at the time of the study; that is, all were oral and primarily used grammatical sentences as their means of communication. Academic difficulties were characteristic of this population. Two thirds of the brain-injured group were receiving academic assistance of some kind at the time of the study. Poor performance on arithmetic calculations was typical. The brain-injured group was heterogeneous with regard to age at onset, etiology, extent of damage, length of recovery, and outcome profiles. Careful and comprehensive assessment of a range of language and academic abilities is essential to adequately identify needs and appropriate intervention strategies for this population.     

内收型痉挛性发音障碍的语音特征

目的 探讨内收型痉挛性发音障碍的语音特征.方法 采用嗓音和语音的声信号和三维语图分析及主观评价的方法对1O例内收型痉挛性发音障碍患者(女7例,男3例)的语音特征与10例健康志愿者(男5例,女5例)进行对比.结果 内收型痉挛性发音障碍主要表现为音质、音韵及语音的流畅性改变,在朗读文章时出现紧张性发音困难,语音颤抖,频率及响度瞬间起伏,嗓音挤卡、中断,语音延长,失去正常韵律.10例患者中表现为轻度障碍者(异常音节数<25%)1例,中度障碍(异常音节数占25%～49%)6例,重度(异常音节数占50%～74%)1例,极重度(异常音节数≥75%)2例.10例患者朗读时间中位数为49 S,声信号中间断出现无音区,无音比率中位数为42%;而健康对照组朗读时间中位数为30 S,无声音中断.在三维语图中不同的患者在各自症状音节中可以看到嗓音起始时间延长,元音共振峰不规则、断裂甚至消失,症状音节的辅音缺失,或塞擦音的擦音成分延长等.结论 内收型痉挛性发音障碍语音特征为音质、音韵及语音的流畅性改变,在症状音节的三维语图中可以看到相应的元音或辅音音素的特征性改变.