Deficits in phonology are among the most common and persistent impairments in aphasia after left hemisphere stroke, and can have significant functional consequences for spoken and written language. While many individuals make considerable gains through physiological restitution and in response to treatment, the neural substrates supporting phonological performance in the face of damage to critical language regions is poorly understood. To address this issue, we used BOLD fMRI to measure regional brain activation in a case series of individuals with aphasia after left MCA stroke during a phonological task. The results of this study support the idea that damage to even a portion of the phonological network results in impaired phonological processing. We found that individuals with left perisylvian damage tend to rely on the residual left-hemisphere language network, and typically recruit regions associated with domain-general cognitive processing which fall outside of the left-hemisphere language network. However, recruitment of these regions did not necessarily enhance phonological processing. Rather, more successful phonological processing outside the scanner was associated with recruitment of a language region in right posterior middle temporal gyrus and a region in left occipital pole. More successful phonological processing inside the scanner was associated with additional recruitment of the left supramarginal gyrus within the healthy control network, engagement of bilateral intraparietal sulcus from the multi-demand network, and up-regulation of the right-hemisphere network of regions homotopic to the left-hemisphere language network seen in the healthy control group. These findings emphasize the contributions of residual components of the left-hemisphere language network, engagement of a non-linguistic domain-general multi-demand network, and the participation of the non-dominant right-hemisphere language network in successful phonological processing in chronic aphasia after stroke.

Faculty of Humanities; School of Human and Community development; MA Research Report / Social participation is one of the most debilitating effects of aphasia. Yet, to date no clear definitions or models of social participation have been developed that can be applied within aphasiology. In addition, generic stroke scales are still the outcome measures of choice within research. There is a need for patient-centred measures that accurately document and assess the experiences and perceptions of those with aphasia. Therefore, the current research aimed to investigate the social participation of adults with aphasia by extending patient-centred measures and encompassing the views of the families, particularly the spouses, of those with aphasia. Four crosssectional parallel single case studies were conducted that involved a protocol combining the quantitative measure of the ASHA FACS with the qualitative tools of semi-structured interviews and observations. In addition, social network analyses were completed for each participant. Overall, open coding of the individual participants’ results produced common themes among the people with aphasia and common themes among their spouses. Each participant reported significantly altered social participation, which permeated throughout the family unit and was felt considerably by the spouses of those with aphasia. The results are discussed in relation to current social models and approaches to intervention, while professional role expansion and the needs of the South African context are also considered. Furthermore, the concept of resilience and its implications for future research are discussed.

Speech and language impairments after left hemisphere stroke are life altering. Neuroprotective interventions, such as tissue plasminogen activator, or tPA, are utilized to diminish the impact of the stroke on functional ability. The purpose of this study was to examine speech and language recovery in the first three months after stroke in individuals with aphasia and to further investigate any differences between individuals who did and individuals who did not receive tPA, using objective speech and language measures. Twenty-six individuals, thirteen of whom received tPA and thirteen who did not, suffering from first-ever left hemisphere stroke with resulting aphasia were enrolled and completed repeated speech and language assessments within 24 hours after stroke, at one and two weeks after stroke. A three month assessment also included an additional quality of life measure. Findings indicate that both individuals who did and those who did not receive tPA demonstrated significant gains in language skills. Results also suggest that the individuals who received tPA have better outcomes at three months compared to those who did not. This is clinically significant as it helps provide prognostic information about the use of tPA and informs decision making for speech pathologists within the acute care hospital.

Background: A social network is made up of the people with whom individuals make communicative contact throughout their lives. The socioemotional selectivity theory predicts that older adults selectively prune their social networks to make them more intimate and satisfying (Carstensen, 1992). Aphasia, a disorder that affects mostly older adults, has been found to reduce social network size. Prior research does not adequately address satisfaction with that change. Aims: The current qualitative study investigates the hypothesis that aphasia reduces social participation and satisfaction with social participation. Methods: Four people with aphasia and five people without aphasia were interviewed about their social network size, frequency of communication, satisfaction of communication, frequency of activity participation, and satisfaction of activity participation. We investigated the impact of factors hypothesized to affect these indices of social participation: aphasia severity, hearing loss, mobility status, and communication modalities. Results: The aphasia group reported smaller social networks, and less frequent social communication and individual and social activity participation. Social isolation was also reported by the aphasia group. Satisfaction of communication was roughly the same between groups. The aphasia group was more dissatisfied with activity participation than the control group. Conclusions: Individuals with aphasia had smaller social networks and less frequent activity participation than controls. This contributed to a perception of social isolation. Socioemotional selectivity theory may apply to the social communication changes in people with aphasia because results indicated equal dissatisfaction when compared to the control group. However, alternative hypotheses cannot be discounted. The aphasia group’s increased dissatisfaction with activity participation indicates an undesired change.

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Thesis (Ph.D.)--Ohio University, June, 2009. / Release of full electronic text on OhioLINK has been delayed until June 1, 2011 Includes bibliographical references (leaves 165-181)

Thesis (Ph.D.)--Ohio University, June, 2009. / Title from PDF t.p. Release of full electronic text on OhioLINK has been delayed until June 1, 2011 Includes bibliographical references (leaves 165-181)

Neuroplasticity research yields mixed results for the differential contribution of perilesional and contralesional brain areas to language recovery in aphasia. This paper will outline variables that mediate the presence and degree of right hemisphere activity and may account for some of the inconsistent research findings. Factors include the site and size of left hemisphere lesions, the phase of recovery, and the language task type and complexity. The performance accuracy of tasks also will be explored to further qualify the nature of homologous activity. Results found right hemisphere activation to be modulated by the damage and preservation of specific brain areas as well as by the presence of large left hemisphere lesions. Right hemisphere activity also was more consistently evident in the acute phase of recovery and returned to the left hemisphere in the chronic stage. Additionally, homologous areas tended to be more active during comprehension-based language tasks and during tasks of greater difficulty. In qualifying the nature of contralesional mechanisms, the activity appears to be more linguistic-oriented in less-recovered individuals with aphasia and more related to cognitive effort in well-recovered individuals. The nature of homologous activation depends on the brain’s ability to reactivate left hemisphere language networks. / text

Constraint-induced (CI) therapy is an approach adapted from motor rehabilitation to treat language deficits in individuals with poststroke aphasia. The principles of CI therapy were established from behavioral research with animal models that were later applied to human neurorehabilitation. There is a substantial body of evidence to support CI therapy for the treatment of postroke motor deficits; however, evidence for CI aphasia therapy is less established. This report examines the history and current state of evidence for the use of CI-based therapy to treat adults with poststroke aphasia. / text

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