Understanding 'not': neuropsychological dissociations between hand and head markers of negation in BSL

Simple negation in natural languages represents a complex interrelationship of syntax, prosody, semantics and pragmatics, and may be realised in various ways: lexically, morphologically and prosodically. In almost all spoken languages, the first two of these are the primary realisations of syntactic negation. In contrast, in many signed languages negation can occur without lexical or morphological marking. Thus, in British Sign Language (BSL), negation is obligatorily expressed using face-head actions alone (facial negation) with the option of articulating a manual form alongside the required face-head actions (lexical negation). What are the processes underlying facial negation? Here, we explore this question neuropsychologically. If facial negation reflects lexico-syntactic processing in BSL, it may be relatively spared in people with unilateral right hemisphere (RH) lesions, as has been suggested for other 'grammatical facial actions' [Language and Speech 42 (1999) 307; Emmorey, K. (2002). Language, cognition and the brain: Insights from sign language research. Mahwah, NJ: Erlbaum (Lawrence)]. Three BSL users with RH lesions were specifically impaired in perceiving facial compared with manual (lexical and morphological) negation. This dissociation was absent in three users of BSL with left hemisphere lesions and different degrees of language disorder, who also showed relative sparing of negation comprehension. We conclude that, in contrast to some analyses [Applied Psycholinguistics 18 (1997) 411; Emmorey, K. (2002). Language, cognition and the brain: Insights from sign language research. Mahwah, NJ: Erlbaum (Lawrence); Archives of Neurology 36 (1979) 837], non-manual negation in sign may not be a direct surface realisation of syntax [Language and Speech 42 (1999) 143; Language and Speech 42 (1999) 127]. Difficulties with facial negation in the RH-lesion group were associated with specific impairments in processing facial images, including facial expressions. However, they did not reflect generalised 'face-blindness', since the reading of (English) speech patterns from faces was spared in this group. We propose that some aspects of the linguistic analysis of sign language are achieved by prosodic analysis systems (analysis of face and head gestures), which are lateralised to the minor hemisphere.     

Vocational and social outcomes of adults with chronic aphasia

Vocational and social outcomes of rehabilitation, such as employment, Social Integration, and life satisfaction, are critical determinants of the usefulness of rehabilitation. The purpose of this study was to describe the employment status, Social Integration, and perceived life satisfaction of adults with chronic aphasia 2 years after discharge from an intensive treatment program. Among the 20 survey respondents, 62% of those who had been working prior to aphasia onset were also working at the time of follow-up. Those who were working before but not after onset had higher Home Integration scores. There was a relatively large perceived change in communication from clinic discharge to the 2-year follow-up. Eighty-five percent of the respondents indicated a positive life satisfaction rating. There was a significant positive relationship between Home Integration and life satisfaction ratings. The results are discussed in relation to other reports of employment and social outcomes for stroke and aphasia.

Learning outcomes

As a result of this activity, the participant will be able to: (1) identify factors that may contribute to the successful return to work for adults with chronic aphasia; (2) describe the vocational and social outcomes of a select group of adults with chronic aphasia after participation in an intensive treatment program; and (3) discuss future need areas in understanding vocational and social participation for adults with chronic aphasia after intervention.     

Modern concepts of normal language and impairments

Language is a primary factor in comprehending the functional organization of the brain. Starting with the static anatomoclinical model, followed by the limited aphasiological model, functional imaging techniques have allowed a more dynamic approach that adds complexity to the study of the interaction between brain and language, and bespeak the influence of parameters such as age, sex, motivation, and stress.     

Speech pathologists’ experience of involving people with stroke-induced aphasia in clinical decision making during rehabilitation

Purpose: Although client participation has been part of legislation and clinical guidelines for several years, the evidence of these recommendations being implemented into clinical practice is scarce, especially for people with communication disorders. The aim of this study was to investigate how speech pathologists experienced client participation during the process of goal-setting and clinical decision making for people with aphasia. Methods: Twenty speech pathologists participated in four focus group interviews. A qualitative analysis using Systematic Text Condensation was undertaken. Results: Analysis revealed three different approaches to client participation: (1) client-oriented, (2) next of kin-oriented and (3) professional-oriented participation. Participants perceived client-oriented participation as the gold standard. The three approaches were described as overlapping, with each having individual characteristics incorporating different facilitators and barriers. Conclusions: There is a need for greater emphasis on how to involve people with severe aphasia in goal setting and treatment planning, and frameworks made to enhance collaboration could preferably be used. Participants reported use of next of kin as proxies in goal-setting and clinical decision making for people with moderate-to-severe aphasia, indicating the need for awareness towards maintaining the clients’ autonomy and addressing the goals of next of kin.

• Implications for Rehabilitation

• Speech pathologists, and most likely other professionals, should place greater emphasis on client participation to ensure active involvement of people with severe aphasia.

• To achieve this, existing tools and techniques made to enhance collaborative goal setting and clinical decision making have to be better incorporated into clinical rehabilitation practice.

• To ensure the autonomy of the person with aphasia, as well as to respect next of kin's own goals, professionals need to make ethical considerations when next of kin are used as proxies in collaborative goal setting and clinical decision making.

     

脑损害的语言及吞咽障碍诊治新进展

失语症和吞咽障碍是目前临床上脑损害患者最常见的症状，严重影响患者的预后及生活质量，本文重点介绍国内外关于失语症的功能评估、影像学检查和治疗新进展，以及吞咽障碍的临床评估、功能检查和康复训练新进展，以便指导临床工作。     

Feature rich,but user-friendly: Speech pathologists’ preferences for computer-based aphasia therapy

Purpose: High-intensity language therapy has been shown to provide greater outcomes for people with aphasia (PWA). Unfortunately, a number of issues including the ageing population and a lack of rurally-based clinicians prevent high-intensity interventions. Computer-based therapies are a potential solution to the issues of intensity and accessibility; however, this service delivery model is not commonly used. A possible reason behind the poor uptake is that current computer-based aphasia therapy (CBAT) programs may not meet the needs of speech-language pathologists (SLPs). This study investigated the preferences of SLPs with regard to the features desired in their ideal CBAT program.

Method: Phenomenological research methodology was used to explore the preferences of 10 SLPs. Data were analysed using qualitative thematic analysis.

Result: Desired features were grouped into five themes: therapy activities, stimuli, cues, access and progress data. A range of sub-themes were also identified.

Conclusion: The wide range of desirable features found in this study may reflect the extent to which current CBAT programs are considered to be useful, but perhaps do not meet the needs of users. The study’s findings provide useful information for future CBAT developers to create programs with high clinician usability.     

81例丘脑出血急性期血肿定量与临床症状分析

目的：研究丘脑血肿与急性期主要临床症状的关系。方法：对原发性丘脑出血８１例患者的意识水平，头痛，失语症状与血肿ＣＴ表现进行统计分析。结果：经比较，有统计学差异的指标有（１）继发性脑室出血与单纯丘脑出血的昏迷发生率和头痛发生率；（２）不同意识水平病人组的丘脑出血量；（３）失语组与非失语组的血肿直径。结论：继发性脑室出血患者容易发生昏迷，而单纯组患者丘脑出血量１７￣２２ｍＬ者即可引起昏迷；血肿直径大于     

Poster 40: Comparison of constraint-induced language therapy and traditional therapy in the rehabilitation of chronic aphasia: preliminary findings

Objectives: To compare constraint-induced language therapy (CILT) to a more traditional multimodality intervention for rehabilitation of chronic aphasia. Design: Nonrandomized control trial, within-subject comparisons. Setting: Outpatient rehabilitation. Participants: 9 subjects with chronic nonfluent aphasia >2 years poststroke. Intervention: 2 groups (n=4) were treated using key CILT principles: massed practice, constraint of other communication modalities, and forced use of language through the application of visual barriers in a supported environment; 2 groups (n=5) were treated using a traditional approach, which encouraged all modes of communication: verbal and nonverbal. Both groups received treatment 3h/d, 4d/wk for 2 consecutive weeks. Main Outcomes Measures: Western Aphasia Battery, Boston Naming Test, Action Naming Test, and linguistic analyses. Results: Although participants in both groups evinced positive outcomes posttreatment, CILT subjects showed increased performance on more measures than the traditional subjects. Conclusions: Findings support the notion that persons with chronic nonfluent aphasia may make substantial, measurable change in language after intensive CILT. Progress observed in both groups suggests intensity may be an important factor in the positive outcome for both conditions.     

Benchmarks of Significant Change After Aphasia Rehabilitation

ObjectiveTo establish benchmarks of significant change for aphasia rehabilitation outcome measures (ie, Western Aphasia Battery-Aphasia Quotient [WAB-AQ], Communicative Effectiveness Index [CETI], Boston Naming Test [BNT]) and assess if those benchmarks significantly differ across subgroups (ie, time post onset, dose frequency, treatment type).Data SourcesA comprehensive literature search of 12 databases, reference lists of previous reviews, and evidence-based practice materials was conducted.Study SelectionRandomized controlled trials, quasi-experimental studies, single-subject design, and case studies that used a standardized outcome measure to assess change were included. Titles and full-text articles were screened using a dual review process. Seventy-eight studies met criteria for inclusion.Data ExtractionData were extracted independently, and 25% of extractions were checked for reliability. All included studies were assigned quality indicator ratings and an evidence level.Data SynthesisRandom-effects meta-analyses were conducted separately for each study design group (ie, within-/between-group comparisons). For within-group designs, the summary effect size after aphasia rehabilitation was 5.03 points (95% confidence interval, 3.95-6.10, P<.001) on the WAB-AQ, 10.37 points (6.08-14.66, P<.001) on the CETI, and 3.30 points (2.43-4.18, P<.001) on the BNT. For between-group designs, the summary effect size was 5.05 points (1.64-8.46, P=.004) on the WAB-AQ and 0.55 points (-1.33 to 2.43, P=.564) on the BNT, the latter of which was not significant. Subgroup analyses for the within-group designs showed no significant differences in the summary effect size as a function of dose frequency or treatment type.ConclusionsThis study established benchmarks of significant change on 3 standardized outcome measures used in aphasia rehabilitation.     

脑卒中失语症患者常见的心理特点及护理干预

目的探讨脑卒中失语病人的心理特点,采取适当的护理干预措施,观察对脑卒中失语患者康复疗效的改善。方法选取52例脑卒中后造成失语症的患者,随机分为干预组和对照组。对照组给予常规康复训练,干预组在常规训练的基础上给予个性化沟通、音乐治疗、强化支持系统等护理干预措施。疗程为2个月,在治疗前后分别用Zung氏抑郁自评量表、波士顿BDAE失语症诊断量表、Barthel指数、MMSE量表评估两组患者的抑郁程度、语言功能、日常生活活动能力及认知功能。结果干预组与对照组相比,除日常生活活动能力组间比较P〉0．05,其余3组均p〈0．05。结论通过有效的护理干预措施可以有效减轻脑卒中失语症患者的卒中后抑郁,改善其语言功能和认知功能。