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The diploma thesis is devided into two parts - the theoretical and the practical one. The theoretical part deal with contemporary issues of aphasia in the context of various scientifics discipline and aphasia access. I analyze aphasia classifications, diagnostics, therapy and using of the aids in aphasia therapy. The practical part describes my work - project and realisation of reeducational aid for people with aphasia, which name is Soubor sekvencí dějových obrázků. I devote to detailed describtion of this aid in the final chapter. The aim of the diploma thesis was to widen offer reeducational materiál for people with aphasia in our conditions. Powered by TCPDF (www.tcpdf.org)

Cette recherche s'intéresse au fonctionnement des mécanismes de catégorisation orale de haut niveau dans l'aphasie. Elle s'inscrit dans le cadre théorique de la catégorisation cognitive, pierre angulaire de la cognition humaine, notamment en ce qui concerne la théorie du prototype. Le logiciel utilisé (TCL-Lab, 0.25) permet d'observer les stratégies de catégorisation implicite et explicite de manière graduelle : une tâche de catégorisation libre, suivie d'une tâche induite, et pour finir, une tâche de catégorisation guidée. Les stimuli sont composés de phrases partageant des traits linguistiques communs aux niveaux sémantique, prosodique et syntaxique. Les expériences ont été menées auprès d'une population de trente sujets sains et de vingt-et-un patients aphasiques. Au total, sept expériences ont été proposées : une tâche de catégorisation libre, trois tâches de catégorisation induites et trois tâches de catégorisation guidées, chacune correspondant à l'une des composantes langagières évaluées. Les résultats ont été analysés pour chaque composante et comparés aux données psycholinguistiques et démographiques complémentaires. Des données procédurales ont été également prises en compte dans l'analyse. Globalement, les résultats favorisent l'hypothèse d'une distinction entre les mécanismes déclenchés pour la catégorisation dans les pour la catégorisation dans les trois domaines : sémantique, prosodie et syntaxe. Des différences importantes, qui se dégagent de la comparaison des résultats inter-tâches, font également partie de la discussion. Les résultats sont interprétés à partir des postulats théoriques des travaux récents dans le domaine. / This investigation assesses higher-order auditory categorization mechanisms in aphasia. The theoretical background builds upon the basic premises of the prototype theory and on recent studies on cognitive categorization, considered to be one of the core mechanisms of human cognition. A computer program interface (TCL-lab.025) was used to observe categorization in a graded manner, ranging from unrestricted to guided tasks, as a means to explore implicit vs. explicit categorization mechanisms. The stimuli consisted of sentences displaying multidimensional commonalities across three linguistic components: semantics, prosody and syntax. The experiments were conducted on a population of thirty healthy controls and twenty-one aphasia patients. In total, seven experiments were designed as follows: one free sorting task, three induced categorization tasks and three guided tasks, each concerning one of the above mentioned linguistic components. Results were analyzed for each component and compared to complementary psycholinguistic and demography data collected. Procedural results were also included in the analysis. Global results point to a distinction between the mechanisms engaged for categorizing through meaning, form and structure. Important differences across tasks are also discussed. Results are interpreted according to the theoretical premises emanating from previous investigations in the field.

Background: Being close to a person who suffers from a disease can mean a burden, as these tends to disregard own needs in favor of the person who is sick. Aphasia is a disorder that affects communication skills and is one of the most common complications due to brain damage. Aim: The main purpose of this literature study was to illuminate relatives experiences of living with a person with aphasia. Method: Nine scientific articles were analyzed with a qualitative manifest content analysis which resulted in three themes with subthemes: Emotional reactions: The impact on well-being, Changing social and emotional relationships; A changed everyday life: Obstacles in communication, Decreased social interaction, Being able to handle everyday; Increased need for support: To get information about the aphasia; Deterioration of the economy and the need for financial support. Result: It was revealed that relatives felt left aside in the care of their relative with aphasia, resulting in an increased need for information, support and relief. Conclusion: Therefore conclusion was that relatives should be asked by nurses of how much involved in the care of their sick relative they want to be or can be and how much support they need to be able to handle that.

O diagnóstico de saúde, proporcionado pela epidemiologia, está inserido dentro das estratégias globais de planejamento e avaliação nos serviços de saúde. A aplicação de protocolos para o serviço público deve facilitar o gerenciamento das ações e resguardar os princípios de universalidade e eqüidade propostos pelo Sistema Único de Saúde. Os protocolos de avaliação podem traçar um plano exato e detalhado, permitindo fazer relações entre os achados fonoaudiológicos e seus constituintes. Desenvolver um protocolo de avaliação de motricidade orofacial, abrangendo as possíveis alterações motoras faciais, bem como, suas implicações nas funções estomatognáticas - para uso em pacientes adultos afásicos e/ou com possíveis alterações neurológicas - foi o objetivo desta pesquisa, já que as sequelas advindas de lesões cerebrais incluem distúrbios motores da face, distúrbios de fala e distúrbios de deglutição. Assim, a seleção de 8 (oito) artigos levou à criação do protocolo proposto para a avaliação de motricidade miofuncional orofacial de maneira fácil e padronizada. O protocolo proposto inclui a descrição de aspectos médicos e de saúde geral, além de a investigação das alterações posturais e dos aspectos morfológicos. Concluiu-se, pela importância da elaboração do protocolo, a preparação de um eficiente complemento terapêutico ao trabalho de estimulação da linguagem dos pacientes afásicos, bem como, pela sua utilidade como ferramenta na coleta epidemiológica de seus fatores de risco e os determinantes em saúde. / Health diagnosis, provided by epidemiology, is inserted into the global strategies for planning and evaluation in health services. The implementation of protocols for the public service should facilitate the management of actions and respect the principles of universality and equity proposed by Health System. Evaluation protocols can trace an exact and detailed plan, allowing making relations between speech-language findings and their constituents. Develop a protocol for evaluation of orofacial motor skills, including the possible changes in facial motor, as well as their implications for stomatognathic functions - for use in adult aphasic and/or with possible neurological disorders - was the aim of this study, as the consequences resulting brain injuries include motor disorders of the face, speech disorders and swallowing disorders. Therefore, the selection of eight articles led to the creation of the proposed protocol for the evaluation of orofacial myofunctional motor and easily standardized. It was described the medical and general health, besides having investigated postural changes and morphology. It was concluded that the develop the protocol was very important for the preparation of an efficient treatment plan to work with the concomitant stimulation of the language of aphasic patients, as well as for its usefulness as a tool in the collection of epidemiological risk factors and health determinants.

Esta pesquisa traz a análise de fenômenos linguísticos extraídos de entrevistas realizadas com seis sujeitos afásicos com diferentes graus de dificuldade de acesso lexical. Observamos a habilidade desses sujeitos em produzir e compreender nomes de animais utilizados em contexto não-literal. Desenvolvemos uma entrevista para determinar se os sujeitos em questão apresentavam dificuldade para acessar os nomes de animais escolhidos. Numa primeira etapa, os sujeitos tiveram de nomeá-los e descrevê-los e, posteriormente, utilizá-los dentro de um contexto provido pela entrevistadora. A hipótese é que possa haver diferença entre a habilidade do sujeito para produzir e compreender nomes de animais dependendo do contexto apresentado. Duas perspectivas de análise diferentes são apresentadas aqui: primeiro, temos as teorias baseadas em correlatos biológicos da linguagem e, em segundo, a teoria linguística de Roman Jakobson sobre o processamento da linguagem e a sua divisão em dois eixos principais, a metáfora e a metonímia (habilidades de abstração baseadas na similaridade e na contiguidade, respectivamente). Alguns sujeitos apresentam dificuldade para produzir formas de palavras no seu sentido literal, mas o mesmo não acontece quando as mesmas palavras são produzidas no seu sentido não-literal, sugerindo que nesses sujeitos o sistema semântico-lexical pode estar mais preservado do que se imagina, sendo que o tipo de entrada ou saída dessas formas lexicais pode ser o elemento prejudicado. A análise das entrevistas realizadas revela que a compreensão dessas mesmas metáforas foi uma tarefa mais laboriosa para os sujeitos, o que reforça nossa hipótese, uma vez que durante a tarefa de compreensão das metáforas os sujeitos não foram providos do contexto dado na tarefa de produção. / This research proposes the analysis of language phenomena taken from interviews made with six aphasic subjects presenting different degrees of lexical access deficits. The focus of this paper is the observation of the ability of these subjects to produce and comprehend names of animals used in a metaphorical context. We developed an interview in order to determine whether the subjects presented problems to access the chosen names of animals. In the first part of the interview, the subjects were asked to name and describe the animal pictures presented and, aftermost, they had to produce and comprehend those names in the context provided by the interviewer. Two distinct perspectives are presented in this paper: first, we have theories based on biological correlates of language, and in second, the linguistic theory by Roman Jakobson about the processing of language and its division in two main axis: metaphor and metonymy (modes of relation based on similarity and contiguity, respectively). Some subjects present distress to produce word forms in their literal meaning, whereas the same does not occur when those words are used in their nonliteral meaning. This suggests that these subjects present a better preservation of the semantic-lexical system than expected, and the only affected element can be the type of input or output of the lexical form. We can see in the interviews presented here that the comprehension of the mentioned metaphors was a more laborious task for the subjects, which reinforces our hypothesis, once during the comprehension part of the interview, the subjects were not provided with the context given previously, in the production task.

O diagnóstico de saúde, proporcionado pela epidemiologia, está inserido dentro das estratégias globais de planejamento e avaliação nos serviços de saúde. A aplicação de protocolos para o serviço público deve facilitar o gerenciamento das ações e resguardar os princípios de universalidade e eqüidade propostos pelo Sistema Único de Saúde. Os protocolos de avaliação podem traçar um plano exato e detalhado, permitindo fazer relações entre os achados fonoaudiológicos e seus constituintes. Desenvolver um protocolo de avaliação de motricidade orofacial, abrangendo as possíveis alterações motoras faciais, bem como, suas implicações nas funções estomatognáticas - para uso em pacientes adultos afásicos e/ou com possíveis alterações neurológicas - foi o objetivo desta pesquisa, já que as sequelas advindas de lesões cerebrais incluem distúrbios motores da face, distúrbios de fala e distúrbios de deglutição. Assim, a seleção de 8 (oito) artigos levou à criação do protocolo proposto para a avaliação de motricidade miofuncional orofacial de maneira fácil e padronizada. O protocolo proposto inclui a descrição de aspectos médicos e de saúde geral, além de a investigação das alterações posturais e dos aspectos morfológicos. Concluiu-se, pela importância da elaboração do protocolo, a preparação de um eficiente complemento terapêutico ao trabalho de estimulação da linguagem dos pacientes afásicos, bem como, pela sua utilidade como ferramenta na coleta epidemiológica de seus fatores de risco e os determinantes em saúde. / Health diagnosis, provided by epidemiology, is inserted into the global strategies for planning and evaluation in health services. The implementation of protocols for the public service should facilitate the management of actions and respect the principles of universality and equity proposed by Health System. Evaluation protocols can trace an exact and detailed plan, allowing making relations between speech-language findings and their constituents. Develop a protocol for evaluation of orofacial motor skills, including the possible changes in facial motor, as well as their implications for stomatognathic functions - for use in adult aphasic and/or with possible neurological disorders - was the aim of this study, as the consequences resulting brain injuries include motor disorders of the face, speech disorders and swallowing disorders. Therefore, the selection of eight articles led to the creation of the proposed protocol for the evaluation of orofacial myofunctional motor and easily standardized. It was described the medical and general health, besides having investigated postural changes and morphology. It was concluded that the develop the protocol was very important for the preparation of an efficient treatment plan to work with the concomitant stimulation of the language of aphasic patients, as well as for its usefulness as a tool in the collection of epidemiological risk factors and health determinants.

O comprometimento da comunicação é uma das principais sequelas dos vitimados de acidente vascular encefálico. No Brasil, há extrema carência de instrumentos de avaliação da linguagem e comunicação de afásicos em beira de leito. A avaliação em beira de leito permite a obtenção de benefícios em relação a informações sobre prognóstico e reabilitação e constitui base na qual família, profissionais e serviços de saúde poderão se amparar. Neste estudo, buscou-se verificar a aplicabilidade de um teste de rastreio para detecção de alterações de linguagem decorrentes de acidentes vasculares encefálicos em duas unidades de cuidados específicos, geriatria e neurologia, em hospital destinado a atendimento de alta complexidade. Dessa forma, 108 participantes, divididos em dois grupos, controle (n= 32) e pesquisa (n= 76) foram submetidos à investigação de comunicação por meio da versão em Português do Brasil do Bedside Evaluation Screening Test -2a versão (BEST-2). Foi possível obter o ponto de corte para discriminar sujeitos com desempenho normal e alterado em comunicação. Ademais, este estudo disponibilizou um instrumento que cumpriu a função de ser abrangente incluindo a análise de aspectos preservados e comprometidos em vários subitens linguísticos. A versão em língua portuguesa do BEST-2 mostrou-se útil como rastreio de alterações comunicativas em pacientes com lesão neurológica. Dessa forma, contribuiu para preencher a lacuna de carência de instrumentos formais de avaliação de comunicação em fase aguda, a entender os pressupostos de cada cultura e incentivar o desenvolvimento procedimentos de avaliação corretamente modelados para cada uma delas. / The impairment of communication is one of the main sequelae in victims of stroke. In Brazil there is a vast shortage of instruments to do bedside evaluation of language and communication to aphasics. Bedside evaluation makes it possible to obtain the benefits related to prognosis and rehabilitation data and it constitutes a base in which the family, professionals and health services can rely. The aim of this study was to verify the suitability of a screening test to detect the language alterations resulting from encephalic vascular accidents, in two-specific care-units, geriatrics and neurology, in a hospital for highcomplexity attendance. Therefore, 108 individuals divided into two groups, control (n=32) and research (n=76) were subjected to communication tests through the Brazilian-Portuguese translation of the Bedside Evaluation Screening Test 2nd version (BEST 2). It was possible to attain a cut-off point to discriminate the subjects with normal or altered performance communication. Furthermore, this study provided an instrument that fulfilled the function of being comprehensive including the analysis of preserved and impaired aspects in various linguistic sub-items. The Portuguese language version of BEST 2 proved to be useful to screen communication alterations in patients with neurological lesion. Therefore, it contributed to fill the gap caused by the lack of formal instruments to assess acute-phase communication, to understand the underlying assumptions of each culture and to encourage the development of evaluation procedures correctly modeled for each of them.

Auditory comprehension, the ability to understand spoken language, consists of a number of different auditory processing skills. In the five studies presented in this thesis I investigated both intact and impaired auditory comprehension at different levels: voice versus phoneme perception, as well as single word auditory comprehension in terms of phonemic and semantic content. In the first study, using sounds from different continua of ‘male’-/pæ/ to ‘female’-/tæ/ and ‘male’-/tæ/ to ‘female’-/pæ/, healthy participants (n=18) showed that phonemes are categorised faster than voice, in contradistinction with the common hypothesis that voice information is stripped away (or normalised) to access phonemic content. Furthermore, reverse correlation analysis suggests that gender and phoneme are processed on the basis of different perceptual representations. A follow-up study (same paradigm) in stroke patients (n=25, right or left hemispheric brain lesions, both with and without aphasia) showed that lesions of the right frontal cortex (likely ventral inferior frontal gyrus) leads to systematic voice perception deficits while left hemispheric lesions can elicit both voice and phoneme deficits. Together these results show that phoneme processing is lateralized while voice information processing requires both hemispheres. Furthermore, this suggests that commencing Speech and Language Therapy at a low level of acoustic processing/voice perception may be an appropriate method in the treatment of phoneme perception impairments. A longitudinal case study (CF) of crossed aphasia (rare acquired communication impairment secondary to lesion ipsilateral to the dominant hand) is then presented alongside a mini-review of the literature. Extensive clinical investigation showed that CF presented with word-finding difficulties related to impaired auditory phonological analysis, while functional Magnetic Resonance Imaging (fMRI) analyses showed right hemispheric lateralization of language functions (reading, repetition and verb generation). These results, together with the co-morbidity analysis from the mini-review, suggest that crossed aphasia can be explained by developmental disorders which cause partial right lateralization shift of language processes. Interestingly, in CF this process did not affect voice lateralization and information processing, suggesting partial segregation of voice and speech processing. In the last two studies, auditory comprehension was examined at the single word level using a word-picture matching task with congruent (correct target) and incongruent (semantic, phonological and unrelated foils) conditions. fMRI in healthy participants (n=16) revealed a key role of the pars triangularis (phonological processing), the left angular gyrus (semantic incongruency) and the left precuneus (semantic relatedness) in this task – regions typically associated via the arcuate fasciculus and often impaired in aphasia. Further investigation of stroke patients on the same task (n=15) suggested that the connections between the angular gyrus and the pars triangularis serve a fundamental role in semantic processing. The quality of a published word-picture matching task was also investigated, with results questioning the clinical relevance of this task as an assessment tool. Finally, a pilot study looking at the effect of a computer-assisted auditory comprehension therapy (React2©) in 6 stroke patients (vs. 6 healthy controls and 6 stroke patients without therapy) is presented. Results show that the more therapy patients carry out the more improvement is seen in the semantic processing of single nouns. However, these results need to be reproduced on a larger scale in order to generalise any outcomes. Overall, the findings from these studies present new insight into, as well as extending on, current cognitive and neuroanatomical models of voice perception, speech perception and single word auditory comprehension. A combinatorial approach to cognitive and neuroanatomical models is proposed in order to further research, and thus improve clinical care, into impaired auditory comprehension.

Esta pesquisa traz a análise de fenômenos linguísticos extraídos de entrevistas realizadas com seis sujeitos afásicos com diferentes graus de dificuldade de acesso lexical. Observamos a habilidade desses sujeitos em produzir e compreender nomes de animais utilizados em contexto não-literal. Desenvolvemos uma entrevista para determinar se os sujeitos em questão apresentavam dificuldade para acessar os nomes de animais escolhidos. Numa primeira etapa, os sujeitos tiveram de nomeá-los e descrevê-los e, posteriormente, utilizá-los dentro de um contexto provido pela entrevistadora. A hipótese é que possa haver diferença entre a habilidade do sujeito para produzir e compreender nomes de animais dependendo do contexto apresentado. Duas perspectivas de análise diferentes são apresentadas aqui: primeiro, temos as teorias baseadas em correlatos biológicos da linguagem e, em segundo, a teoria linguística de Roman Jakobson sobre o processamento da linguagem e a sua divisão em dois eixos principais, a metáfora e a metonímia (habilidades de abstração baseadas na similaridade e na contiguidade, respectivamente). Alguns sujeitos apresentam dificuldade para produzir formas de palavras no seu sentido literal, mas o mesmo não acontece quando as mesmas palavras são produzidas no seu sentido não-literal, sugerindo que nesses sujeitos o sistema semântico-lexical pode estar mais preservado do que se imagina, sendo que o tipo de entrada ou saída dessas formas lexicais pode ser o elemento prejudicado. A análise das entrevistas realizadas revela que a compreensão dessas mesmas metáforas foi uma tarefa mais laboriosa para os sujeitos, o que reforça nossa hipótese, uma vez que durante a tarefa de compreensão das metáforas os sujeitos não foram providos do contexto dado na tarefa de produção. / This research proposes the analysis of language phenomena taken from interviews made with six aphasic subjects presenting different degrees of lexical access deficits. The focus of this paper is the observation of the ability of these subjects to produce and comprehend names of animals used in a metaphorical context. We developed an interview in order to determine whether the subjects presented problems to access the chosen names of animals. In the first part of the interview, the subjects were asked to name and describe the animal pictures presented and, aftermost, they had to produce and comprehend those names in the context provided by the interviewer. Two distinct perspectives are presented in this paper: first, we have theories based on biological correlates of language, and in second, the linguistic theory by Roman Jakobson about the processing of language and its division in two main axis: metaphor and metonymy (modes of relation based on similarity and contiguity, respectively). Some subjects present distress to produce word forms in their literal meaning, whereas the same does not occur when those words are used in their nonliteral meaning. This suggests that these subjects present a better preservation of the semantic-lexical system than expected, and the only affected element can be the type of input or output of the lexical form. We can see in the interviews presented here that the comprehension of the mentioned metaphors was a more laborious task for the subjects, which reinforces our hypothesis, once during the comprehension part of the interview, the subjects were not provided with the context given previously, in the production task.