Patterns of language improvement in adults with non‐chronic non‐fluent aphasia after specific therapies

Background: Recent years have seen a growing number of dysgraphia therapy studies informed by models of the normal writing mechanism (see Beeson &; Rapcsak, 2002 Beeson, P. and Rapcsak, S. 2002. “Clinical diagnosis and treatment of spelling disorders.”. In The handbook of adult language disorders, Edited by: Hillis, A. New York: Psychology Press.  [Google Scholar], for review). Although outcomes from these studies have been encouraging, measures are often confined to clinical tests, leaving it unclear whether everyday writing activities have benefited. This study similarly applied a processing model but was driven from the outset by the everyday writing goal of the aphasic participant.

Aims: The study aimed to explore whether therapy could improve the note‐taking abilities of an aphasic individual. Evaluations aimed to determine whether gains reflected improvements to the writing mechanism and/or the application of writing strategies.

Methods &; Procedures: This is a single‐case therapy study of “Ray”, an individual with chronic aphasia and dysgraphia. Ray's priority for therapy was writing, with the goal of improving his note‐taking abilities for work. Ray's dysgraphia seemed due to a buffer‐level impairment, with length effects and errors of letter deletion, addition, transposition, and substitution. Therapy involved spelling practice and work on writing strategies. The outcome measures showed improvements both in note taking and in writing to dictation.

Conclusions: The results suggested that therapy reduced the effects of Ray's buffer impairment and improved his use of writing strategies. The study demonstrates how model‐based thinking can be integrated with a functional approach in intervention.     

The processing of compounds in bilingual aphasia: A multiple‐case study

Background: While converging evidence has led to the view that people with aphasia exploit compositional procedures when producing compound words, the issue of what compound‐internal characteristics are at play during these procedures is still under debate. It has been argued that constituent position and/or morphosyntactic prominence, i.e., being the head constituent of a compound, may influence the manner in which compounds are accessed. However, findings obtained from patient performances are thus far inconclusive, because positional and headedness effects are frequently confounded in a language.

Aims: In order to disentangle position‐in‐the‐string and headedness effects in compound production in aphasia, the main objective of this study is to investigate the performance of bilingual patients speaking languages in which these effects can be teased apart. Our secondary goal is to probe the roles of grammatical category (adjectives vs nouns) and of between‐language phonological similarity, as both these factors have been demonstrated to influence compound processing.

Methods & Procedures: Three English–French bilingual persons with aphasia participated in the study. Three experimental tasks, reading, repetition, and translation of isolated compound words, were administrated in each language. We contrasted French and English compounds that differ in the position of the head constituent: left for French and right for English.

Outcomes & Results: Two participants showed a similar pattern—a significantly reduced number of errors for the head (or first) constituent as compared to the non‐head (or second) constituent in French and an equivalent number of errors for both constituents in English—pointing to the cumulative effects of headedness and first‐position‐in‐the‐string in French, and to the mutual cancelling out of these effects in English. The third participant exhibited a non‐head constituent advantage in both languages, indicating that semantic modification of the head constituent by the non‐head constituent plays a prominent role in her accessing procedures. For all three participants phonological similarity influenced production, while grammatical category did not.

Conclusions: Our results reveal that headedness and position interact in the processing of compounds. They also demonstrate that compound constituents are processed asymmetrically across and within languages, thus confirming that people with aphasia are sensitive to compound‐internal structure. Moreover, they show that patients rely on varying structural information when accessing compounds.     

The effectiveness of aphasia‐friendly principles for printed health education materials for people with aphasia following stroke

Background: Provision of health information to people with aphasia is inadequate. Current practice in providing printed health education materials to people with aphasia does not routinely take into consideration their language and associated reading difficulties. Aims: This study aimed to investigate if people with aphasia can comprehend health information contained in printed health education materials and if the application of aphasia‐friendly principles is effective in assisting them to comprehend health information. It was hypothesised that participants with aphasia would comprehend significantly more information from aphasia‐friendly materials than from existing materials. Other aims included investigating if the effectiveness of the aphasia‐friendly principles is related to aphasia severity, if people with aphasia are more confident in responding to health information questions after they have read the aphasia‐friendly material, if they prefer to read the aphasia‐friendly brochures, and if they prefer to read the brochure type that resulted in the greatest increase in their knowledge. Methods & Procedures: Twelve participants with mild to moderately severe aphasia were matched according to their reading abilities. A pre and post experimental design was employed with repeated measures ANOVA (p <. 05) used to investigate the effectiveness of the aphasia‐friendly principles. Outcomes & Results: While participants with aphasia comprehended health information from the existing printed education materials, participants comprehended 11.2% more information from materials that had an aphasia‐friendly format. No significant correlation between aphasia severity and aphasia‐friendly effectiveness was found. Participants were more confident in answering questions after they had read the aphasia‐friendly brochures. A clear preference for aphasia‐friendly brochures was not found and participants did not consistently select the brochure type that resulted in the greatest increase in their health knowledge. Conclusions: This preliminary investigation has found that aphasia‐friendly material does assist people with aphasia to comprehend health information. The benefits of providing aphasia‐friendly information have many clinical applications that extend beyond the provision of health information. The application of aphasia‐friendly principles to all written materials could prove beneficial in removing some of the barriers people with aphasia face in trying to comprehend written materials. In addition, this research has highlighted that a greater understanding of people with aphasia's reactions to aphasia‐friendly materials and also the social impact of providing aphasia‐friendly information is required. Future research, that incorporates a qualitative research approach, will add valuable insight to these topics.     

People with severe and moderate aphasia and their partners as estimators of communicative skills: A client‐centred evaluation

Background: According to the philosophy of the social model of disability, clients are the best estimators of their own life situation. Eliciting the experiences of people with severe aphasia is demanding because of their language and possible other cognitive problems. They are therefore usually excluded from the studies. However, there is evidence that modified assessment tools are accessible for them and help them to give self‐reports.

Aims: The aim of the present study was to ascertain how people with aphasia evaluate their own communicative skills during rehabilitation by means of modified assessment tools. In addition, their answers were compared with the estimations of their significant others or other partners.

Methods & Procedures: The data were collected during regular rehabilitation courses, which were carried out in two parts (8 + 4 days) with 3 months in between. Participants were 35 respondents with aphasia, aged 26 to 65 years, and 35 of their significant others or other partners, aged 29 to 71 years. The study was completed according to an initial, interim, and delayed post‐test questionnaire design. Two measures were used: the Finnish version of the Communicative Effectiveness Index (CETI) (Lomas et al., 1989 Lomas, J., Pickard, L., Bester, S., Elbard, H., Finlayson, A. and Zoghaib, C. 1989. The Communicative Effectiveness Index. Development and psychometric evaluation of a functional communicative measure for adult aphasia.. Journal of Speech and Hearing Disorders, 54: 113–124. [PubMed] , [Google Scholar]) and an investigator‐constructed questionnaire, the Use of Different Communication Methods (UDCM). The questionnaires for the people with aphasia were made more accessible by pictures.

Outcomes & Results: The self‐assessments of the participants with aphasia indicated that their functional communication skills did not change, but that the use of different communication methods improved slightly during the intervention. The significant others' and other partners' estimations showed that their communication skills improved significantly. Ratings of the two groups in functional communication skills differed significantly from each other before the intervention but thereafter the estimates correlated. There were no significant differences in the ratings of the use of different communication methods at any phase of the follow‐up study. However, the ratings correlated significantly only at the last assessment.

Conclusions: The results of the present study indicate that people with severe and moderate aphasia are able to assess their communication skills with modified, aphasia‐friendly self‐assessment tools. The results also indicate that people with aphasia and their partners perceive the communicative skills quite similarly, especially after the intervention has begun. The use of accessible measures enables people with severe aphasia to participate in the evaluation of therapy outcomes, as suggested by the philosophies of the social model of rehabilitation.     

“Speaking for” behaviours in spouses of people with aphasia: A descriptive study of six couples in an interview situation

Background: People with aphasia and their spouses frequently meet professionals to discuss health‐related issues. In this situation, which is often in an interview form, various strategies may be employed by spouses to facilitate communication. One of these strategies is “speaking for” the person with aphasia. Aims: (1) To identify the presence of “speaking for” behaviour, to measure the frequency of the spouses' “speaking for” and “rapid speaking for” behaviours, and to describe what preceded and followed these behaviours for all participating couples. (2) To describe each individual couple's patterns of “speaking for” in relationship to the members' perceptions of conversations before and after the onset of aphasia. Methods & Procedures: Six couples were studied in an interactive situation. Both the spouse with aphasia and the non‐aphasic spouse took turns being asked questions in a systematic way. Each member also participated individually in a semi‐structured interview aiming to obtain information on perceptions of communication before and since the aphasia. Outcomes & Results: Analysis of three‐way conversations revealed that all of the spouses without aphasia in this study used some “speaking for” behaviours. However, there was great variability in the frequency of the behaviours within couples. For some couples, “speaking for” the person with aphasia may reduce that person's ability or willingness to participate in conversations. The findings from the semi‐structured interviews suggest that “speaking for” a person with aphasia may be an integral behaviour for some couples that is consistent with pre‐stroke interaction patterns. Conclusions: It is important to consider the “speaking for” behaviour, the impact of this behaviour, and the pre‐stroke interaction pattern when helping couples adjust to the consequences of aphasia.     

How little is enough? The feasibility of conducting a dose-escalation study for exercise training in people with stroke

QuestionIs it feasible and safe to conduct an exercise dose-finding study in people with stroke? Is it possible to determine a minimal dose of exercise required to see clinically meaningful improvements in cardiorespiratory fitness?MethodsDose-escalation study. Twenty people with stroke (n=5 per cohort) who were able to walk independently participated in home-based, telehealth-supervised aerobic exercise sessions 3 d/week at moderate-vigorous intensity for 8 weeks. Dose parameters of frequency (3 d/week), intensity (55-85% of heart rate peak) and program length (8 weeks) were kept constant. The duration of exercise sessions was increased by 5 min per session from Dose 1 (10 min/session) to Dose 4 (25 min/session). Doses were escalated if safe and tolerable (< 33% of a cohort reaching a dose-limiting threshold). Doses were efficacious if ≥ 67% of a cohort increased peak oxygen consumption ≥ 2mL/kg/min.ResultsTarget exercise doses were well adhered to, and the intervention was safe (480 exercise sessions delivered; one fall resulting in minor laceration) and tolerable (no participants met the dose-limiting threshold). None of the exercise doses met our criterion for efficacy.ConclusionsIt is possible to conduct a dose-escalation trial for people with stroke. The small cohort sizes may have limited the ability to determine an efficacious minimum dose of exercise. Providing supervised exercise session at these prescribed doses via telehealth was safe.RegistrationThe study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000460303).     

Can 'football-team color-code' compensate for anomia? The case study of FN, a patient with color anomia

A case study is reported on large ischemic infracts involving cortical and subcortical areas of the parietal lobes bilaterally, especially left temporo-parietal and right parietal. On examination, the diagnosis of vascular dementia with color anomia, optic aphasia for colors, was established. The patient (FN) showed great difficulty in understanding a scene as a whole and in describing complex scenes. FN's oral comprehension skills at word and sentence level were satisfactory and he exhibited communicative effectiveness during conversation. He could read letter by letter, but could not make simple judgments of shapes. FN exhibited a marked inability to name colors presented to him visually and to indicate or point to the color requested from the examiner. The most interesting of all the patient's characteristics was the strategy--a football-team color-code--he had developed for compensating for his inability to name colors.     

Effectiveness of a vocabulary data file,encyclopaedia, and Internet homepages in a conversation‐support system for people with moderate‐to‐severe aphasia

Background: In order to facilitate conversation for people with moderate‐to‐severe aphasia, a conversation‐support system has been developed. This system consists of three electronic resources: a vocabulary data file, an encyclopaedia, and homepages on the Internet. The vocabulary data file we created contains approximately 50,000 words, mostly consisting of various proper names, which are classified into 10 categories. These words function as keywords in conversation.

Aims: To evaluate the effectiveness of the three resources in eliciting new information from people with aphasia.

Methods & Procedures: Fifteen people with non‐fluent and moderate‐to‐severe aphasia participated in the experiment. Participants conversed with their communication partners about four topics under use and non‐use conditions. Under the use condition, partners showed pages from one of the three resources on the screen of a personal computer. Participants were asked to select words on the pages, or use other modalities (verbal or nonverbal), to answer questions. Three evaluators gave points for information conveyed correctly.

Outcomes & Results: Comparison of the points between the use and non‐use conditions showed that significantly more information was conveyed when the vocabulary data file was used. On the other hand, the amount of points did not increase in the use condition using the encyclopaedia or homepages.

Conclusions: The vocabulary date file succeeded in eliciting more information from people with moderate‐to‐severe aphasia within a limited timeframe. Presentation of the keyword or proper name lists related to the topics was shown to be a useful conversation resource for people with moderate‐to‐severe aphasia. As for the encyclopaedia and homepages, further research is required to determine whether or not these resources in collaboration with the data file can further facilitate conversation.     

Can ‘Football-Team Color-Code’ Compensate for Anomia? The case study of FN,a patient with color anomia

A case study is reported on large ischemic infracts involving cortical and subcortical areas of the parietal lobes bilaterally, especially left temporo-parietal and right parietal. On examination, the diagnosis of vascular dementia with color anomia, optic aphasia for colors, was established. The patient (FN) showed great difficulty in understanding a scene as a whole and in describing complex scenes. FN’s oral comprehension skills at word and sentence level were satisfactory and he exhibited communicative effectiveness during conversation. He could read letter by letter, but could not make simple judgments of shapes. FN exhibited a marked inability to name colors presented to him visually and to indicate or point to the color requested from the examiner. The most interesting of all the patient’s characteristics was the strategy – a football-team color-code – he had developed for compensating for his inability to name colors.     

Family caregiver burden in mental illnesses: The case of affective disorders and schizophrenia – a qualitative exploratory study

Background: Caregivers of people with mental illnesses often experience a wide range of burdens. Although many studies have confirmed burdens among family caregivers of mentally ill relatives in general, specific knowledge regarding the concrete everyday hassle and existential sorrows from the caregiver? subjective reasoning perspective is lacking. Furthermore, there is little evidence on the possible different effects of affective disorders and schizophrenia on the quality of burden; this is also true with regard to the role of cultural traditions and lay beliefs. Aims: The aim of this study was to explore the specific burdens experienced by caregivers of patients with schizophrenia and affective disorders. Methods: A qualitative study was conducted by semi-structured interviews with 45 caregivers of patients with schizophrenia and affective disorders. Data were analysed by qualitative content analysis. Results: Eleven encumbering themes resulted from the interviews including incertitude, unawareness, emotional burden, stigma and blame, financial burden, physical burden, restriction in routine, disruption in routine, dissatisfaction with family, relatives, and acquaintances, troubles with patients’ adherence to medication, and problems with health services and governmental support. Conclusions: Caring for a person with mental illness affects caregivers emotionally, financially, physically, and it elicits some restrictions in their routine (daily hassles). Finally, it causes conflicts in family relationships. Despite some differences regarding perceived burden among caregivers of schizophrenia and affective disorders, a common pattern of burden could be identified. Thus, authorities should provide adequate financial, educational, and psychosocial supports for caregivers of mental illnesses.     

‘Getting to Know Me’: the development and evaluation of a training programme for enhancing skills in the care of people with dementia in general hospital settings

Objective: The aims of the study were to report on the development and evaluation of a staff training intervention in dementia care designed for use in the general hospital setting: the ‘Getting to Know Me’ training programme. The study also aimed to undertake initial psychometric analysis on two new outcome scales designed to measure knowledge and confidence in dementia care.Methods: The study comprised two phases. The first phase comprised the design of two questionnaires which are shared within this paper: Confidence in Dementia (CODE) Scale and Knowledge in Dementia (KIDE) Scale. In phase two, staff undertook the ‘Getting to Know Me’ training programme (n = 71). The impact of the programme was evaluated using a pre–post design which explored: (1) changes in confidence in dementia; (2) changes in knowledge in dementia; and (3) changes in beliefs about challenging behaviour.Results: The psychometric properties of the CODE and KIDE scales are reported. Statistically significant change was identified pre–post training on all outcome measures. Clinically meaningful change was demonstrated on the CODE scale.Conclusions: The ‘Getting to Know Me’ programme was well received and had a significant impact on staff knowledge and confidence. Our findings add to a growing evidence base which will be strengthened by further robust studies, the exploration of the impact of staff training on direct patient outcomes, and further identification of ways in which to transfer principles of care from specialist dementia environments into general hospital settings.     

“The Castle of Remembrance”: New insights from a cognitive training programme for autobiographical memory in Alzheimer's disease

Autobiographical memory deficits are prominent from the early stages of Alzheimer's disease (AD) and result in a loss of personal identity. Nevertheless, standardised methods of autobiographical memory stimulation for the neuropsychological rehabilitation of patients with AD remain underdeveloped. Our aim was to evaluate the impact of a new cognitive training programme for autobiographical memory (REMau) on both the episodic and semantic components of autobiographical memory performance across lifetime periods, as well as on mood. Pre/post evaluations were conducted on two groups of patients with early to moderate AD, assigned to one of two different training activities: either the REMau or a cognitive training programme focused on collective semantic memory. Statistical comparisons showed significant improvement of episodic and semantic autobiographical memory performance in the REMau group, which was more pronounced for the semantic component, as well as improved mood. By contrast, deleterious pre/post differences were observed in the other group. Most interestingly, this study showed that the REMau programme boosted autobiographical memory from the reminiscence bump period, which is considered crucial for the construction and maintenance of personal identity. We discuss the theoretical and practical implications of these results for the reduction of autobiographical memory deficits in AD.     

“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.     

‘Accepting where I'm at’ – a qualitative study of the mechanisms,benefits, and impact of a behavioral memory intervention for community-dwelling older adults

Objective: Gain novel, in-depth insight into therapeutic mechanisms, benefits, and impact of a multi-modal behavioral memory intervention for older adults with concerns about memory.

Methods: Participants were11 community-dwelling older adults (aged 63–88) who completed the Memory and Aging Program, an evidence-based multi-modal group intervention for normal age-related memory change. Semi-structured interviews were administered post-intervention. Responses were analyzed using qualitative content analysis until meaningful themes were agreed upon.

Results: Analyses revealed a main theme of normalization as the overarching benefit of participation. The mechanism for this comprised both specific intervention content and the process of participating with others. A positive impact of the intervention was demonstrated at emotional (feelings of reassurance, hope, and confidence) and functional (increasing motivation for lifestyle change) levels; for some, there was a direct link between emotion and function.

Conclusion: This study highlighted a single, prominent therapeutic benefit of normalization, illustrated a dual mechanism for achieving this, and characterized a nuanced inter-relationship of the emotional and functional impact of the intervention for participants. Results support the notion that group behavioral interventions can educate, empower, and promote psychological well-being in older adults and may be an effective avenue to reduce risk of disease and promote sustained functional independence.     

The study of social cognition with neuroimaging methods as a means to explore future directions of deficit evaluation in schizophrenia?

This article discusses the important advances in a recent field of science dealing with the brain processes implicated in understanding social situations and interacting with others. Many behavioral studies on schizophrenia have shown the impairment of these processes and their preferential relation with disorganization and negative syndromes. Brain imaging is a powerful method to identify brain systems participating in these processes in healthy subjects and will be used increasingly to study mental disorders such as schizophrenia. A few preliminary studies have opened this field of research and allowed for the drawing of some limited conclusions. We emphasize the importance of developing an integrated neurocognitive framework to account for the multifaceted nature of social cognition deficits in schizophrenia. Inspired by contemporary models of empathy and social cognition that identify different components such as shared representation, mentalizing, self/other distinction, we show how schizophrenia affects these components at the behavioral and functional levels. We also outline the interest of this model to understand putative abnormalities of contextual integration within the area of mentalization. Finally, we discuss how specialized measures of brain functions during the performance of these precisely defined mental processes might be used as outcome predictors.     

Online help for people with suicidal thoughts provided by charities and healthcare organisations: a qualitative study of users’ perceptions

Purpose

Internet use is common among people with suicidal feelings and a considerable amount of suicide help material is available online. Despite attempts to promote formal help sites (e.g. governmental and charity sector) in internet search results, users’ evaluation of these sites is lacking. This study, therefore, aimed to explore distressed users’ perceptions of formal online help and their experiences of using this in times of crisis.

Methods

In-depth interview study of 53 adults reporting suicide-related internet use.

Results

While highly valued in relation to general mental health problems, formal sites were not perceived to meet the different needs of those experiencing suicidal thoughts, and did not engage individuals in crisis. Sites were criticised for being impersonal, dispassionate, too focused on information-giving, and lacking solutions that were novel or sensitive to reasons why an individual may choose to seek help online. Most participants criticised the tendency for sites to signpost to offline services as their primary response. Participants desired immediacy and responsive online help incorporating ‘live chat’, self-help tools, opportunities to interact with others and lived-experience content. Positive accounts of seeking online help described sites incorporating these features.

Conclusions

Formal online help services should be reappraised to ensure they meet users’ needs for immediacy and responsive help to capitalise upon the opportunity available for suicide prevention.

     

Beneficial effect of repetitive transcranial magnetic stimulation combined with cognitive training for the treatment of Alzheimer��s disease: a proof of concept study

The current drug treatment for Alzheimer's disease (AD) is only partially and temporary effective. Transcranial magnetic stimulation (TMS) is a non-invasive technique that generates an electric current inducing modulation in cortical excitability. In addition, cognitive training (COG) may improve cognitive functions in AD. Our aim was to treat AD patients combining high-frequency repetitive TMS interlaced with COG (rTMS-COG). Eight patients with probable AD, treated for more than 2 months with cholinesterase inhibitors, were subjected to daily rTMS-COG sessions (5/week) for 6 weeks, followed by maintenance sessions (2/week) for an additional 3 months. Six brain regions, located individually by MRI, were stimulated. COG tasks were developed to fit these regions. Primary objectives were average improvement of Alzheimer Disease Assessment Scale-Cognitive (ADAS-cog) and Clinical Global Impression of Change (CGIC) (after 6 weeks and 4.5 months, compared to baseline). Secondary objectives were average improvement of MMSE, ADAS-ADL, Hamilton Depression Scale (HAMILTON) and Neuropsychiatric Inventory (NPI). One patient abandoned the study after 2 months (severe urinary sepsis). ADAS-cog (average) improved by approximately 4 points after both 6 weeks and 4.5 months of treatment (P < 0.01 and P < 0.05) and CGIC by 1.0 and 1.6 points, respectively. MMSE, ADAS-ADL and HAMILTON improved, but without statistical significance. NPI did not change. No side effects were recorded. In this study, rTMS-COG (provided by Neuronix Ltd., Yokneam, Israel) seems a promising effective and safe modality for AD treatment, possibly as good as cholinesterase inhibitors. A European double blind study is underway.