A case of unilateral opercular syndrome associated with a subcortical lesion

Summary A patient who developed a unilateral opercular syndrome following a cerebrovascular accident is described. Computed tomography showed that the lesion did not affect the opercular cortex, but involved deep white matter and the head of the caudate nucleus of the left hemisphere. Persistent hypophonia and transient aphasia were associated. Comparison with previous cases is discussed.     

Evaluation of stroke rehabilitation by randomized controlled studies: a review

In all, 22 reports of 20 randomized, controlled rehabilitation studies were evaluated. In 18 of these, the design of the trial was parallel, with a cross-over format being employed in the remaining 2 instances. Seven studies related to intensive rehabilitation during the early post-acute period. In six others, specific techniques--sometimes associated with traditional physiotherapy procedures--were compared: biofeedback, perceptual retraining, and amphetamine treatment. Eight experiments evaluated speech therapy in aphasia. Frequently, methodological considerations limited the interpretation of the results. The review showed that: 1) as regards activities of daily life and motor function, differences as between rehabilitation in stroke units on the one hand and non-rehabilitation or rehabilitation in medical wards on the other, were detected in relatively few quality studies and remained particularly inconclusive insofar as life in the home environment was concerned; 2) rehabilitation for aphasia and perceptual dysfunction proved effective for at least several months after acute stroke; 3) in general, examination of the reports cited revealed no differences in the effects of biofeedback and perceptual retraining vs conventional physiotherapy; 4) rehabilitation, whether administered by specialists or amateur caregivers purpose-trained by specialists, proved equally effective for aphasia. These conclusions constitute a valuable basis for the development and evaluation of modern rehabilitation programs for stroke patients.     

TIA磁共振弥散加权成像异常的相关因素分析

目的探讨短暂性脑缺血发作(TIA)磁共振弥散加权成像(DWI)异常的相关因素。方法对2006年1月～2006年12月临床诊断为TIA的住院患者45例进行回顾性分析,比较DWI异常组和正常组的临床特征,并采用Logistic回归分析判定与DWI异常有关的独立因素。结果DWI异常14例(31%);多元回归分析提示TIA症状持续时间≥1h(OR=2.5,95%CI:1.3～8.6)和症状表现为失语伴运动障碍(OR=8.9,95%CI:2.1～36.5)与DWI异常独立相关。结论TIA患者DWI异常与TIA症状持续时间和症状表现为失语伴运动障碍有关。     

Syntactic and semantic processing in the healthy and aphasic human brain

A syntactic and a semantic task were performed by German-speaking healthy subjects and aphasics with lesions in the dominant left hemisphere. In both tasks, pictures of objects were presented that had to be classified by pressing buttons. The classification was into grammatical gender in the syntactic task (masculine or feminine gender?) and into semantic category in the semantic task (man- or nature made?). Behavioral data revealed a significant Group by Task interaction, with aphasics showing most pronounced problems with syntax. Brain event-related potentials 300-600 ms following picture onset showed different task-dependent laterality patterns in the two groups. In controls, the syntax task induced a left-lateralized negative ERP, whereas the semantic task produced more symmetric responses over the hemispheres. The opposite was the case in the patients, where, paradoxically, stronger laterality of physiological brain responses emerged in the semantic task than in the syntactic task. We interpret these data based on neuro-psycholinguistic models of word processing and current theories about the roles of the hemispheres in language recovery.     

Crossed aphasia. An update

The aim of this article is to present an update of a rare but interesting problem: crossed aphasia. This term indicates the presence of aphasia after unilateral cerebral lesion of the hemisphere ipsilateral to the patient's dominant hand. We report two cases, review the most relevant literature, and analyze clinical, neuroanatomical, and neurophysiological aspects, taking in consideration the various interpretations proposed to explain this unusual language disorder.     

Cognitive impairments of aphasics in picture sorting and matching tasks

On the basis of earlier experiments showing a differential deficit of aphasics in picture sorting and matching tasks, two experiments were conducted to test the conjecture of a specific deficit of aphasics in the analytical appraisal of individual features. Broca's and Wernicke's aphasics-according to clinical diagnoses and the Aachener Aphasie Test-were compared with patients having right-hemisphere lesions or left-hemisphere lesions without aphasia. Both groups of aphasics differed from the control groups in the sorting task, irrespective of the sorting criterion, but the differences were small. The picture matching task did not discriminate between groups. Obviously, the basic assumption has to be modified with respect to specific conditions of task requirements. The experimental literature is reviewed.This research was supported by a Research Grant from the Deutsche Forschungsgemeinschaft.The research was conducted at the following clinics and rehabilitation centers. We are grateful for their support: Abteilung Neurologie der Med. Fak., RWTH, Aachen. Poliklinik für Stimm-und Sprachkranke, Universitätsklinikum Steglitz, Freie Universität Berlin. Neurologisches Rehabilitationszentrum Godeshöhe e. V., Bonn. Rheinische Landesklinik für Sprachgestörte, Bonn. Neurologische Klinik der Universität Ulm, Dietenbronn. Kliniken Schmieder, Gailingen und Allensbach. Max-Planck-Institut für Psychiatrie, München. Neurologiches Krankenhaus, München. Neurologisches und Hirneverletzten-Versorgungskrankenhaus, Tübingen.We are also most grateful for the kind help of K. Willmes, Aachen, in carrying out the discriminant analyses to classify the aphasics on the basis of the Aachener Aphasie Test.     

针刺结合语言训练治疗脑卒中失语的临床研究(英文)

目的:观察针刺结合语言康复训练对脑卒中引起的失语的临床疗效。方法:将 60 例病人随机分成两组,每组 30 例。治疗组行针刺加语言康复训练。对照组单纯采用语言康复训练。治疗 30 天后观察疗效。结果:治疗组的总有效率和语言分明显高于对照组 (P<0.05)。结论:针刺加语言训练的综合康复对脑卒中引起的失语具有较好的治疗作用。     

针刺配合言语训练治疗失语症复述障碍疗效观察

目的观察针刺配合言语训练治疗汉语失语症复述障碍的疗效。方法将入选的60例汉语失语症复述障碍患者随机分为两组,每组30例。治疗组给予针刺配合言语训练治疗,对照组采用单纯言语训练治疗,治疗前后采用汉语失语成套检测（ABC）对两组疗效进行评定。结果对照组总有效率为73.3%,治疗组总有效率为96.7%,两组比较差异有统计学意义（P〈0.05）。结论针刺配合言语训练治疗汉语失语症复述障碍总有效率高于单纯言语训练。     

针灸结合西医常规疗法对脑卒中后运动性失语患者语言功能及血液流变学的影响

目的：探讨针灸结合西医常规疗法对脑卒中后运动性失语患者语言功能与血液流变学的影响。方法将符合入选标准的脑卒中后运动性失语患者160例,按随机数字表法分为2组,每组80例。对照组采用西医常规疗法配合语言康复训练,并控制血压、血糖及血脂等至正常水平;针联组在对照组基础上配合解语方针灸治疗。2组均治疗4周。采用LBY-N6A自清洗旋转式黏度计检测全血黏度及血浆黏度,采用温氏分血管法检测红细胞压积,评估患者治疗前后语言功能及神经功能缺损评分,评价临床疗效。结果针联组总有效率为88.8%(71/80)、对照组为70.0%(56/80),2组比较差异有统计学意义(χ2＝8.590,P＝0.003)。治疗后,针联组神经功能评分[(5.5±1.6)分比(7.5±1.5)分,t＝6.893]低于对照组(P＜0.01);针联组书写能力[(44.7±2.5)分比(39.1±2.4)分,t＝2.198]、复述能力[(47.1±4.4)分比(35.9±3.6)分, t＝4.433]、阅读能力[(77.2±7.6)分比(65.2±6.9)分,t＝3.677]及听理解能力[(45.2±2.4)分比(38.9±2.5)分, t＝2.150]评分均高于对照组(P＜0.05)。针联组全血黏度高切[(2.67±1.03)mPa?s比(4.12±1.13)mPa?s, t＝4.197]、全血黏度低切[(13.9±2.0)mPa?s比(20.1±2.1)mPa?s,t＝3.011]低于对照组(P＜0.01)。结论针灸结合常规疗法可改善脑卒中后运动性失语患者的语言功能,降低血液黏稠度,提高患者的生活质量。     

The bedside assessment practices of speech-language pathologists in adult dysphagia

Abstract

This study used a qualitative approach to describe the experience of the first 3 months post-stroke in order to identify factors which facilitate successfully living with aphasia. Fifteen participants completed semi-structured interviews and self-perceived ratings of how successfully he or she was living with aphasia. A number of themes were identified from the interviews, including: a need to do things in order to be actively engaged in rehabilitation; increase independence and have a purpose in life; the importance of social support; the value of rehabilitation; a need to adapt and make adjustments; and having a positive outlook. These results suggest that a range of service delivery models need to be considered during the early stages post-stroke in order to address individual needs and so that long-term outcomes of people with aphasia may be improved.