Within a dual-route neuropsychological model, two distinct but interrelated pathways are used to read and write, known as the lexical and sublexical routes. Individuals with reading and writing deficits often exhibit impairments in one or both of these routes, and therefore must rely on the combined power of the integrated system in print processing tasks. The resultant errors reflect varying degrees of lexical and sublexical accuracy in a single production. However, no system presently exists to analyze bimodal errors robustly in both routes. The goal of this project was to develop a system that simultaneously, quantitatively, and qualitatively captures lexical and sublexical errors for single-word reading and writing tasks. This system evaluates responses hierarchically in both routes according to proximity to a target. Each response earns a bivariate score [sublexical, lexical], which is plotted along x and y axes. This scoring system was developed using data from a novel treatment study for patients with acquired alexia/agraphia. Repeated-measures multivariate analyses of variance and post hoc analyses revealed a significant treatment effect in both the lexical and sublexical systems. Qualitative analyses were also conducted to evaluate patterns of change in both the trained and untrained modalities, in the sublexical and lexical systems. Overall, the results of this study indicate that treatment-induced evolution of reading/writing responses can be comprehensively represented by this novel scoring system. / 2018-07-07T00:00:00Z

abstract: Cognitive deficits often accompany language impairments post-stroke. Past research has focused on working memory in aphasia, but attention is largely underexplored. Therefore, this dissertation will first quantify attention deficits post-stroke before investigating whether preserved cognitive abilities, including attention, can improve auditory sentence comprehension post-stroke. In Experiment 1a, three components of attention (alerting, orienting, executive control) were measured in persons with aphasia and matched-controls using visual and auditory versions of the well-studied Attention Network Test. Experiment 1b then explored the neural resources supporting each component of attention in the visual and auditory modalities in chronic stroke participants. The results from Experiment 1a indicate that alerting, orienting, and executive control are uniquely affected by presentation modality. The lesion-symptom mapping results from Experiment 1b associated the left angular gyrus with visual executive control, the left supramarginal gyrus with auditory alerting, and Broca’s area (pars opercularis) with auditory orienting attention post-stroke. Overall, these findings indicate that perceptual modality may impact the lateralization of some aspects of attention, thus auditory attention may be more susceptible to impairment after a left hemisphere stroke. Prosody, rhythm and pitch changes associated with spoken language may improve spoken language comprehension in persons with aphasia by recruiting intact cognitive abilities (e.g., attention and working memory) and their associated non-lesioned brain regions post-stroke. Therefore, Experiment 2 explored the relationship between cognition, two unique prosody manipulations, lesion location, and auditory sentence comprehension in persons with chronic stroke and matched-controls. The combined results from Experiment 2a and 2b indicate that stroke participants with better auditory orienting attention and a specific left fronto-parietal network intact had greater comprehension of sentences spoken with sentence prosody. For list prosody, participants with deficits in auditory executive control and/or short-term memory and the left angular gyrus and globus pallidus relatively intact, demonstrated better comprehension of sentences spoken with list prosody. Overall, the results from Experiment 2 indicate that following a left hemisphere stroke, individuals need good auditory attention and an intact left fronto-parietal network to benefit from typical sentence prosody, yet when cognitive deficits are present and this fronto-parietal network is damaged, list prosody may be more beneficial. / Dissertation/Thesis / Doctoral Dissertation Speech and Hearing Science 2019

For many years, treatment for word retrieval deficits has involved the use of various cueing techniques to help trigger retrieval of target words. Research has shown that accuracy for future retrieval of target words is best achieved by training subjects with semantically based cues. Personalized cues that are created by the subjects themselves to help remember a target word have been shown to be the most effective of the semantically based cues. However, even with the use of personalized cues, accuracy for naming tasks has been found to decrease once training is completed. Current research in memory indicates that, for normal subjects, techniques that facilitate future recall of information include testing, additional study, overlearning, and distributed practice. This research examined the influence of posttraining maintenance sessions on the long term memory of subjects with aphasia. The goal was to compare the effect on naming accuracy for stimuli (a) presented in two additional training sessions (b) presented in one additional session, (c) not presented in any additional sessions. Additional sessions presented opportunities for testing, study, overlearning, and distributed practice for selected stimuli. Three adult male subjects with moderate aphasia created their own cues to help remember 30 pictures of famous characters. During training sessions, these cues were presented to trigger name recall. Following the end of the 3-week training period, the 30 pictures were divided into groups of 10 cards called, A, B, and C. There were two additional training sessions for A, one for B, and none for C. A probe following the last session showed that for two of the subjects, the addition of posttraining maintenance sessions acted to enhance naming accuracy, and two sessions resulted in much higher accuracy than one session. This is consistent with research with normal subjects and suggests that short intermittent training sessions can help maintain naming accuracy with subjects with aphasia.

Word retrieval difficulties are experienced by almost all aphasic adults. Consequently, these problems receive a substantial amount of attention in aphasia treatment. Because of the methodological difficulties, few studies have examined WRBs in conversational speech, focusing instead on confrontational naming tasks in which the client is asked to retrieve a specific word. These studies have left unanswered questions about the WRB processes. The purposes of this study were to: (1) develop profiles of WRB for moderately impaired aphasic adult clients and examine these profiles for evidence that reflects the level of breakdown in the word retrieval process, and (2) determine potential treatment applications derived from the study of WRBs of moderately aphasic speakers.

The purpose of this study was to examine and compare inferential abilities on a reading comprehension task in two groups of adults who had suffered cerebrovascular accidents (CVA). Sixteen subjects with a CVA to the right hemisphere of the brain were compared to an equal number of left hemisphere damaged subjects. Subjects were selected after they had demonstrated an adequate level of functioning on the Short Porch Index of Communicative Ability (SPICA), a test which measures communicative efficiency, to perform the tasks required in this study. All subjects were administered the revised version of the Nelson Reading Skills Test (NRST). On the NRST, test questions can be grouped into three categories representing literal, translational and high levels of inference. Subjects were presented five reading paragraphs. They were asked to answer thirty-three questions pertaining to the reading material by pointing to the correct answer out of four choices. Subjects were allowed to refer back to the paragraphs when trying to answer the questions. Results revealed total NRST performance to be significantly better for RBD subjects. RBD subjects also performed significantly better than LBD subjects on translational inference items. The research data did not reflect the expected error pattern with most errors on questions requiring high inferential abilities followed by translational items and fewest errors on literal inferences for either group of subjects.

Verbal communication relies heavily on the ability to effortlessly produce intended words to express a meaning. This capacity is frequently impaired in individuals with aphasia, and impairment often lasts well into the chronic stages. However, the nature of anomia can vary. Phonological neighborhood density (PND) is one feature of words which has been shown to impact the ease of retrieval in speakers with aphasia; words with more similar-sounding neighbors are easier to retrieve because the neighbors help activate the target. However, it is unclear how different types of lexical access breakdowns affect the impact of PND. The aim of this project was to analyze the relationship between word retrieval accuracy, speech error patterns, and PND in individuals with aphasia. Twenty-two participants with various types and severities of aphasia named 200 single-syllable line drawings. WebFit, an online software program designed to fit naming data to a theoretical model of word retrieval, was used to characterize participants' error patterns by calculating the strength of connections within the lexicon, as well as the rate of decay. Analyses confirmed previous findings that participants with all types of breakdown achieved lower rates of overall accuracy. Weaker connections between semantic knowledge and words resulted in a more errors that were close to the target, relative to errors with no relationship to the target. Individuals with more severe impairments of the semantic-lexical connections and the lexical-phonological connections produced words with many neighbors more accurately than words with fewer neighbors. Implications for initial therapy target selection and directions for further research are discussed.

Little is known about the perceived changes in identity and sense of self in individuals with aphasia. Seminal research using qualitative methods and personal narratives has been conducted in England regarding the experience of living with aphasia (see for instance Parr, Byng, Gilpin & Ireland, 1999; Parr, Duchan & Pound, 2003; Byng, Pound & Hewitt, 2004), but the use of such methodologies is still emergent in the United States. In addition, despite the great achievements of the disabilities movement in countries such as the U.S. and the U.K., individuals with aphasia have remained largely at the margins due to the very nature of their impairment (Pound & Hewitt, 2004). How can one reflect upon and adjust to the changes brought about by a disability when one is devoid of words? According to Brumfitt (1993), individuals with aphasia, especially during the acute stages of recovery, have the tendency to idealize their "prior self." However are these identities transformed in relation to the acquired disability as individuals enter the chronic stages? If so, are these changes perceived in the same manner by survivors and caregivers? The purpose of the present study was to investigate these perceptual changes in identity using a qualitative ethnographic methodology. Seven individuals with aphasia and five caregivers participated in in-depth ethnographic interviews addressing perceived changes in sense of self after the onset of aphasia. Interview analysis resulted in ethnographic narratives in which participants and caregivers reflected on their perceptions of change and adaptation to disability. Common themes included the discovery of new identities, the gradual compromise between rehabilitation and adaptation, divergent perceptions of change, and the role of support groups during the rehabilitation process. The study was concluded with reflections from the investigator and the participants on how the results from this research could be used in our clinical practice.

BAKGRUND: Afasi är en komplikation efter stroke som kan drabba människor i allaåldrar men främst i hög ålder. Afasin finns av olika typer och har många olikasvårighetsgrader detta beror på vilken del av hjärnan som skadas. Vid lindrig afasi kanskadan läka eftersom hjärnan kan återfå sin funktion. En annan typ av afasi genererar i merallvarliga komplikationer där patienterna förlorar det mesta av språket. När den verbalakommunikationen försvinner är det viktigt att sjuksköterskor ser till den icke-verbalakommunikationen istället, där kroppsspråk, tonfall samt ansiktsuttryck är viktiga delar.SYFTE: Syftet med denna litteraturöversikt var att belysa kommunikationen mellanpatienter med afasi och sjuksköterskor ur både ett patientperspektiv och ettsjuksköterskeperspektiv.METOD: Litteraturöversikt Femton artiklar från tidigare forskning med kvalitativ ochkvantitativ ansats har inkluderats och analyserats.RESULTAT: Resultatet visar på fem områden av kommunikation icke-verbalkommunikation, brister vid kommunikation, samspel vid kommunikation, stöd vidkommunikation och omgivningens påverkan på kommunikation.DISKUSSION: Patienter med afasi upplever att sjuksköterskor saknar kunskap omkommunikation och vill ha mer stöd. Kommunikationshjälpmedel finns men används intetillräckligt. Mer forskning behövs kring patienters upplevelse då kommunikationen mellansjuksköterskor och patienter med afasi är en viktig faktor för en god omvårdnad. / CONTEXT: Aphasia is a complication after stroke that can affect people of all ages butmost elderly. Aphasia can be of various kinds and has many different degrees of severitythat depends on what part of the brain that is damaged. In mild aphasia the damage canheal because the brain can regain the function. While another type of aphasia produce moreserious adverse events in which patients lose most of the language. When the verbalcommunication is lost it’s important that nurses look to the non-verbal communicationinstead, where body language, intonation and facial expression are important parts.OBJECTIVE: The aim of this literature review is to highlight the communication betweenthe patients with aphasia and nurses from both a patient perspective and a nursingperspective.METHOD: Literature review. Fifteen articles from previous research with qualitative andquantitative approach has been included and analyzed.RESULTS: The result showed five areas of communication non-verbal communication,lack of communications, interaction of communications, support for communication andenvironmental effects on communication.DISCUSSION: Patients with aphasia experience that nurses don’t have the knowledgeabout communication and that they need more support. Communication facilities areavailable but not used enough. More research is needed on patients experience whencommunication between nurses and patients with aphasia is an important factor in goodcare.

Transcranial direct current stimulation (tDCS), together with speech therapy, is known to relieve the symptoms of aphasia. Knowledge about amount of current to apply and stimulation location is needed to ensure the best result possible. Segmented tissues are used in a finite element method (FEM) simulation and by creating a mesh, information to guide the stimulation is gained. Thus, correct segmentation is crucial. Manual segmentation is known to produce the most accurate result, although it is not useful in the clinical setting since it currently takes weeks to manually segment one image volume. Automatic segmentation is faster, although both acute stroke lesions and nectrotic stroke lesions are known to cause problems. Three automatic segmentation routines are evaluated using default settings and two sets of tissue probability maps (TPMs). Two sets of stroke patients are used; one set with acute stroke lesions (which can only be seen as a change in image intensity) and one set with necrotic stroke lesions (which are cleared out and filled with cerebrospinal fluid (CSF)). The original segmentation routine in SPM8 does not produce correct segmentation result having problems with lesion and paralesional areas. Mohamed Seghier’s ALI, an automatic segmentation routine developed to handle lesions as an own tissue class, does not produce satisfactory result. The new segmentation routine in SPM8 produces the best results, especially if Chris Rorden’s (professor at The Georgia Institute of Technology) improved TPMs are used. Unfortunately, the layer of CSF is not continuous. The segmentation result can still be used in a FEM simulation, although the result from the simulatation will not be ideal. Neither of the automatic segmentation routines evaluated produce an acceptable result (see Figure 5.7) for stroke patients. Necrotic stroke lesions does not affect the segmentation result as much as the acute dito, especially if there is only a small amount of scar tissue present at the lesion site. The new segmentation routine in SPM8 has the brightest future, although changes need to be made to ensure anatomically correct segmentation results. Post-processing algorithms, relying on morphological prior constraints, can improve the segmentation result further.

<p>BAKGRUND: Afasi är en komplikation efter stroke som kan drabba människor i allaåldrar men främst i hög ålder. Afasin finns av olika typer och har många olikasvårighetsgrader detta beror på vilken del av hjärnan som skadas. Vid lindrig afasi kanskadan läka eftersom hjärnan kan återfå sin funktion. En annan typ av afasi genererar i merallvarliga komplikationer där patienterna förlorar det mesta av språket. När den verbalakommunikationen försvinner är det viktigt att sjuksköterskor ser till den icke-verbalakommunikationen istället, där kroppsspråk, tonfall samt ansiktsuttryck är viktiga delar.SYFTE: Syftet med denna litteraturöversikt var att belysa kommunikationen mellanpatienter med afasi och sjuksköterskor ur både ett patientperspektiv och ettsjuksköterskeperspektiv.METOD: Litteraturöversikt Femton artiklar från tidigare forskning med kvalitativ ochkvantitativ ansats har inkluderats och analyserats.RESULTAT: Resultatet visar på fem områden av kommunikation icke-verbalkommunikation, brister vid kommunikation, samspel vid kommunikation, stöd vidkommunikation och omgivningens påverkan på kommunikation.DISKUSSION: Patienter med afasi upplever att sjuksköterskor saknar kunskap omkommunikation och vill ha mer stöd. Kommunikationshjälpmedel finns men används intetillräckligt. Mer forskning behövs kring patienters upplevelse då kommunikationen mellansjuksköterskor och patienter med afasi är en viktig faktor för en god omvårdnad.</p> / <p>CONTEXT: Aphasia is a complication after stroke that can affect people of all ages butmost elderly. Aphasia can be of various kinds and has many different degrees of severitythat depends on what part of the brain that is damaged. In mild aphasia the damage canheal because the brain can regain the function. While another type of aphasia produce moreserious adverse events in which patients lose most of the language. When the verbalcommunication is lost it’s important that nurses look to the non-verbal communicationinstead, where body language, intonation and facial expression are important parts.OBJECTIVE: The aim of this literature review is to highlight the communication betweenthe patients with aphasia and nurses from both a patient perspective and a nursingperspective.METHOD: Literature review. Fifteen articles from previous research with qualitative andquantitative approach has been included and analyzed.RESULTS: The result showed five areas of communication non-verbal communication,lack of communications, interaction of communications, support for communication andenvironmental effects on communication.DISCUSSION: Patients with aphasia experience that nurses don’t have the knowledgeabout communication and that they need more support. Communication facilities areavailable but not used enough. More research is needed on patients experience whencommunication between nurses and patients with aphasia is an important factor in goodcare.</p>