Though the current understanding of language processing is incomplete, it has been established that the left hemisphere is dominant for language in the majority of the population. Damage to language centers of the brain and to white matter tracts connecting these language centers results in a language deficit known as aphasia. Neuroplasticity in the brain can often compensate for these language deficits by strengthening neuronal connections between the right and left hemisphere, or by enhancing the neuronal connectivity of undamaged areas in the left hemisphere. Thus the brain can compensate for damaged language centers by using alternative cortical areas. These compensatory language areas may be homologous areas of the right hemisphere, or other undamaged portions of the left hemisphere. Various imaging techniques have been used to demonstrate this phenomenon. The current neuroimaging technique known as quantitative electroencephalographic brain imaging allows investigators to evaluate the functional anatomical location of language processing. When this mapping is overlaid on a magnetic resonance image, investigators are able to locate areas in the brain of the participant that are electrically activated during elicited speech tasks. This method was used in a single case study to examine the brain of an individual with a unique traumatic brain injury in which the anterior portion of the individual's left temporal lobe was surgically removed and considerable recovery of language subsequently occurred. The stimulus for the quantitative electroencephalography included identifying syntactically incorrect sentences. Imaging results from the participant with traumatic brain injury were compared to imaging results obtained from an age-matched control. Differences in quantitative electroencephalography between the two participants included a delayed P1-N1-P2 response and an absent P600 in the participant with traumatic brain injury. Behavioral results include an increased number of incorrect responses from the participant with traumatic brain injury as compared to the control participant. These results imply an interesting cortical distribution of language processing that could be further assessed by functional magnetic resonance imaging.

The purpose of this study was to contribute to the understanding of the effects of aphasia couples therapy (ACT) in a person with conduction aphasia. ACT is a social therapeutic approach that involves facilitating conversations between the person with aphasia (PWA) and their spouse, or caregiver. The participants in this study involved one pair. The dependent variables included conveyance of main concepts, use of intentional gestures, reflections and summary statements per conversation. Miscellaneous measures were also counted and analyzed including the PWA’s frequency of paraphasias, fillers (e.g. um, uh), and disfluencies. Baseline sessions involved the PWA watching a video clip, and then providing a verbal summary of the main concept of the clip to his non-aphasic spouse within a 10-minute conversation. Therapy treatment sessions followed the same format as the baseline sessions, however, therapy sessions also included the aide of the researcher to coach the participants to use their pre-selected communication strategies to improve the balance in their conversations. The ability to accurately convey the main concept of a video clip in conversation served as the primary dependent variable in this study. Follow-up sessions were also conducted in similar fashion to baseline and probe sessions to determine maintenance and validity of results by dividing the total number of main concepts by the total number of utterances per conversation. Furthermore, ratings of the PWA’s quality of life and confidence in his ability to communicate were gathered and compared. The results of this study indicated that ACT yielded improved effects for the couple with regards to the communication of main concepts per conversation. A decrease in the use of all included miscellaneous measures were also observed. However, no significant changes were noted with regards to use of intentional gestures, reflections, and summary statements.

Os idosos representam um grupo crescente na população e algumas alterações importantes de saúde dessa população advêm de acidentes vasculares cerebrais, que podem deixar sequelas como as afasias. A despeito de resultados positivos obtidos por áreas tradicionais do tratamento das afasias, analistas do comportamento têm desenvolvido procedimentos de ensino bem-sucedidos com populações clínicas de não idosos, empregando procedimentos de exclusão e de ensino de repertórios de discriminação condicional para formação de classes de equivalência entre estímulos verbais. Os objetivos gerais deste trabalho foram: a) verificar a efetividade de um procedimento de ensino por exclusão de substantivos e de verbos para afásicos fluentes e não fluentes, a partir do ensino de discriminações condicionais com estímulos auditivos e visuais, e b) verificar a emergência de repertórios não diretamente ensinados (relações transitivas entre estímulos, nomeação e leitura). Participaram do estudo 14 idosos com afasia. Foram conduzidos dois estudos, nos quais os participantes foram expostos às avaliações iniciais de repertório verbal e foram submetidos ao procedimento de ensino de relações entre palavras ditadas, figuras ou vídeos, e palavras impressas, com sondas posteriores de formação de equivalência, nomeação e leitura, além de pós-testes. Foi utilizado um delineamento de múltiplas sondagens. Resultados gerais indicaram que o procedimento foi efetivo para ensinar novas relações aos participantes, porém não foi suficiente para sustentar a formação de classes de equivalência entre estímulos para a maioria das relações ensinadas, e nem para a emergência de nomeação desses estímulos. Não houve diferenças entre a aprendizagem de substantivos e verbos. O procedimento estudado, com adaptações, pode ser uma alternativa terapêutica para recuperação de repertórios verbais em afásicos. / The elderly represents a growing group in the population and some important changes in the health of this population come from strokes, which can leave sequels such as aphasias. Despite positive results from traditional areas of aphasia treatment, behavioral analysts have developed successful teaching procedures with non-elderly clinical populations, employing exclusion procedures and teaching conditional discrimination to form equivalence classes between verbal stimuli. The general objectives were: a) to verify the effectiveness of a teaching by exclusion nouns and verbs for fluent and non-fluent aphasics, from teaching conditional discriminations with auditory and visual stimuli, and b) verify the emergence of repertoires not directly taught (transitive relations between stimuli, naming and reading). A total of 14 elderly people with aphasia participated in the study. Two studies were conducted, in which the participants were exposed to the initial verbal repertoire evaluations and were submitted to the procedure of teaching relationships between dictated words, figures or videos, and printed words, with subsequent probes of formation of equivalence, naming and reading, besides post-tests. A multiple probe design was used. Overall results indicate that the procedure was effective to teach new relationships to the participants, but it was not enough to sustain the formation of equivalence classes between stimuli for most of the relationships taught, and the emergence of naming these stimuli. There were no differences between the learning of nouns and verbs. The procedure studied, with adaptations, may be a therapeutic alternative for the recovery of verbal repertoires in aphasics.

Os idosos representam um grupo crescente na população e algumas alterações importantes de saúde dessa população advêm de acidentes vasculares cerebrais, que podem deixar sequelas como as afasias. A despeito de resultados positivos obtidos por áreas tradicionais do tratamento das afasias, analistas do comportamento têm desenvolvido procedimentos de ensino bem-sucedidos com populações clínicas de não idosos, empregando procedimentos de exclusão e de ensino de repertórios de discriminação condicional para formação de classes de equivalência entre estímulos verbais. Os objetivos gerais deste trabalho foram: a) verificar a efetividade de um procedimento de ensino por exclusão de substantivos e de verbos para afásicos fluentes e não fluentes, a partir do ensino de discriminações condicionais com estímulos auditivos e visuais, e b) verificar a emergência de repertórios não diretamente ensinados (relações transitivas entre estímulos, nomeação e leitura). Participaram do estudo 14 idosos com afasia. Foram conduzidos dois estudos, nos quais os participantes foram expostos às avaliações iniciais de repertório verbal e foram submetidos ao procedimento de ensino de relações entre palavras ditadas, figuras ou vídeos, e palavras impressas, com sondas posteriores de formação de equivalência, nomeação e leitura, além de pós-testes. Foi utilizado um delineamento de múltiplas sondagens. Resultados gerais indicaram que o procedimento foi efetivo para ensinar novas relações aos participantes, porém não foi suficiente para sustentar a formação de classes de equivalência entre estímulos para a maioria das relações ensinadas, e nem para a emergência de nomeação desses estímulos. Não houve diferenças entre a aprendizagem de substantivos e verbos. O procedimento estudado, com adaptações, pode ser uma alternativa terapêutica para recuperação de repertórios verbais em afásicos. / The elderly represents a growing group in the population and some important changes in the health of this population come from strokes, which can leave sequels such as aphasias. Despite positive results from traditional areas of aphasia treatment, behavioral analysts have developed successful teaching procedures with non-elderly clinical populations, employing exclusion procedures and teaching conditional discrimination to form equivalence classes between verbal stimuli. The general objectives were: a) to verify the effectiveness of a teaching by exclusion nouns and verbs for fluent and non-fluent aphasics, from teaching conditional discriminations with auditory and visual stimuli, and b) verify the emergence of repertoires not directly taught (transitive relations between stimuli, naming and reading). A total of 14 elderly people with aphasia participated in the study. Two studies were conducted, in which the participants were exposed to the initial verbal repertoire evaluations and were submitted to the procedure of teaching relationships between dictated words, figures or videos, and printed words, with subsequent probes of formation of equivalence, naming and reading, besides post-tests. A multiple probe design was used. Overall results indicate that the procedure was effective to teach new relationships to the participants, but it was not enough to sustain the formation of equivalence classes between stimuli for most of the relationships taught, and the emergence of naming these stimuli. There were no differences between the learning of nouns and verbs. The procedure studied, with adaptations, may be a therapeutic alternative for the recovery of verbal repertoires in aphasics.

A severe aphasia following a cerebral vascular accident is characterised by generalised deficits in most speech-language domains. The clinical dilemma remains focused on the extensive verbal speech impairment and in most cases little possibility of regaining verbal speech production. Many individuals living with severe aphasia use augmentative and alternative communication strategies to assist them in getting their communication needs met in their everyday lives. The Blissymbol system is one of the graphic symbol systems that can be used to supplement existing communication and speech strategies of the individual with little or no speech. Although the use of AAC strategies is gaining momentum in its application to severe aphasia, however, there still remain questions on how best to help these individuals learn and retain such strategies. Not only are individuals with severe aphasia faced with a memory task when learning AAC strategies such as Blissymbols, additional complexity to AAC interventions is derived from clinical presentation of severe aphasia. The presence of extensive damage to the neural centers responsible for linguistic processing and semantic retrieval makes learning of new AAC strategies all the more complicated. Research studies have looked at whether individuals with severe aphasia can learn to recognise and retain Blissymbols. Although these studies have successfully shown that individuals with severe aphasia can learn Blissymbols, there is little information available regarding how these symbols can best be taught and retained over time individuals with severe aphasia. Recently the research that has looked at the application of symbol learning with persons presenting with severe aphasia using computer technology and sophisticated application software has highlighted the importance of therapeutic methods that may enhance the learning of such software. This study looks at the application of the self-generation effect as a viable method for enhancing the recognition of Blissymbols in persons presenting with severe aphasia. The self-generation effect is the finding of superior retention and recall for stimuli constructed or generated by an individual. Memory for stimuli such as words, numbers and pictures were found to be enhanced by the extent to which the individual was involved in its construction. Using a 2X2X3 factorial design, this study compared the recognition levels for Blissymbols taught using two treatment approaches which was the self-generation condition and the non self-generation condition. During three experimental sessions which included two withdrawal periods participants were taught using both treatments to recognise a set of Blissymbols. Recognition levels were tested during recognition probes and retention probes. The results from these probes were compared in order to identify which treatment produced superior recognition levels. The data analysis conducted showed that although there was no recognition advantage for the self-generation effect seen during the three recognition probes some advantage for the self-generation effect was seen during the retention probes conducted. The self-generation effect began to emerge by the final retention probe following a withdrawal period of seven days. The self-generation treatment showed better retention of symbol recognition over time. Previous studies have shown that the self-generation effect failed to emerge with stimuli that were new or unfamiliar. This trend was also seen in this study. The results provide support for a semantic-association theory for the self-generation effect. / Thesis (PhD)--University of Pretoria, 2010. / Centre for Augmentative and Alternative Communication (CAAC) / unrestricted

With a large population of people who suffer from aphasia, it is imperative that an effective form of therapy is utilized. The purpose of this study was to investigate the effectiveness of augmentative and alternative communication (AAC) programs in improving the communication needs and lives of people affected by aphasia. Individuals (n = 20) suffering from aphasia for 3 months or more completed therapy sessions with speech and language pathologists and the AAC program. Pre- and post-intervention evaluations were administered, consisting of communication satisfaction and success questionnaires, the Western Aphasia Battery (WAB), and probing tests (prompt and response) with an EEG component. Only preliminary data analyses were completed, on three individuals, due to setbacks. All individuals improved on their post-WAB score and average scores on the questionnaires generally increased, but none were statistically significant. However, clinicians noted a clinical significance in improvements, which suggests that AACs are beneficial in aiding and improving people’s communicative functions and daily life. Resting state EEG data of one subject exhibited high mean power spectral densities (PSD) for delta and theta bands in the lobes before and after therapy, supporting previous literature. Mean PSDs of the left frontal lobe demonstrated a statistically significant decrease from pre- to post-, which in the case of the delta and theta bands may indicate possible recovery. More research is necessary to substantiate these conclusions and to explore the use of EEG in mapping brain lesions and tracking the brain’s rehabilitation, as well as the benefits of AACs.

The thesis with the topic of proposing new therapeutic materials for clients diagnosed with aphasia brings more profound understanding of separate field of speech therapy, which is aphasiology. The first part of the thesis introduces the theoretical basis to the issues of aphasia, concentrates on fundamental definition of aphasia, etiology and symptomatology. Moreover, the thesis describes the possibilities of aphasia therapy and lastly, it covers the differential diagnostics of aphasia. The second part of the thesis covers in detail the Boston Classification System of Aphasia, introduces to the reader the foundations that were the basis for the propositions of the therapeutic materials. The second part describes in detail the very process of designing therapeutic materials in general and it also provides concrete propositions of such materials with possible applications. The appendix includes examples of proposed materials, both theoretically explained and physically created for the reader to examine.

[pt] Inserida no quadro teórico-metodológico da Análise de Narrativa (cf. Riessman, 1993, 2008), esta pesquisa de natureza qualitativa e interpretativista tem o objetivo de investigar a performance de pessoas com afasia na construção de histórias de AVC, buscando compreender como se dá a construção colaborativa da narrativa e como as narradoras se constroem discursivamente, constroem o outro e as realidades que as cercam, diante (através) dos episódios de AVC por elas narrados. O alinhamento à concepção de linguagem como um sistema simbólico social e culturalmente construído (cf. Schiffrin, 1994), bem como a interface entre estudos de narrativa canônicos (cf. Labov e Waletzky, 1967; Labov, 1982) e interacionais (Sacks, [1968] 1992; Jefferson, 1978; Norrick, 2007; Garcez, 2001), no entendimento da narrativa como uma construção social, cultural e interacional, constituem o pano de fundo das análises empreendidas. Juntamente compondo o alicerce desta pesquisa, sobressaem estudos sobre performance e indentidade, orientando o entendimento de que narrar não se restringe a organizar eventos passados em uma ordem temporal e causal, mas, sobretudo, implica em construções identitárias e de relações com o outro (cf. Bruner, 1990; Bastos, 1999, 2004, 2005, 2008). Subsidiadas pelos referidos arcabouços teóricos e metodológicos, contando com o instrumental analítico do estudo de Ochs e Capps (2001) e com aproximadamente 15 horas de gravações em vídeo de interações face a face entre pessoas com e se afasia em grupo focal, das quais foram extraídas três narrativas de AVC para análise, nas investigações realizadas, foi possível observar: i) o engajamento ativo das narradoras afásicas no trabalho interacional de encaixe da narrativa na atividade discursiva circundante, bem como a colaboração substancial e indispensável da co-narradora não afásica nesse encaixe; ii) o turno a turno da estruturação das narrativas como um empreendimento inter-acional; iii) as ações das co-narradoras dando corpo à narrativa e possibilitando a manutenção da intersubjetividade da interação em curso; iv) a estruturação das histórias como narrativas que atendem aos requisitos de ordenação temporal e causal; v) a relevância do trabalho colaborativo na formatação da linearidade das narrativas; vi) a expertise altamente performática das narradoras afásicas na seleção de recursos utilizados na construção da historiabilidade; e vii) os modos distintos que as três narradoras elegeram para se construírem, construírem o outro e a realidade, diante dos episódios de AVC por elas narrados. Os resultados desta pesquisa iluminam que o encaixe da narrativa na atividade circundante, o envolvimento de múltiplos narradores na narração, a linearidade das histórias, a historiabilidade e a emergência de diferentes posturas morais consistem em negociações delegadas aos participantes da interação (narradores primários e co-narradores), ao invés de serem imposições a priori do contexto local (discursivo) e sociocultural, o que ressalta a tese de que narrativas são construções do aqui e agora da interação. Ademais, o fato de as narradoras apresentarem afasia coloca ainda mais em evidência o caráter inter-acional e colaborativo da narração, dada a frequente penetração das ações do outro no curso da construção da narrativa. / [en] Once embedded in the Narrative Analysis theoretical-methodological framework (cf. Riessman, 1993, 2008), the current qualitative and interpretative research aims to investigate performances from people with aphasia, regarding stroke stories construction, in order to understand how narratives are built in collaborative ways and how storytellers construct identities for themselves and the others, and how they build surrounding realities, throughout stroke episodes they have reported. The assumption of the concept of language as a social and cultural symbolic system (cf. Schiffrin, 1994), the interface between studies on canonic narratives (cf. Labov and Waletzky, 1967; Labov, 1982) and interactional ones (Sacks, [1968] 1992; Jefferson, 1978; Norrick, 2007; Garcez, 2001), and the sense of narratives as a social, cultural and interactional construction, constitute the background of the undertaken analysis. Along with it, comprising the basis of the current research, studies on performance and identity are highlighted, guiding one to the understanding that story telling is not an act restricted to organizing past events in a temporal and causal order, but, above all, it applies identity and relationship construction (cf. Bruner, 1990; Bastos, 1999, 2004, 2005, 2008). Subsidized by the mentioned theoretical and methodological framework, counting on Ochs and Capps analytical tools (2001) and on approximately 15 hours of face to face interaction video recordings from people with and without aphasia in focal groups, from which 3 stroke narratives were extracted to be analyzed, the investigation led to the possibility of seeing: i) the active engagement of storytellers with aphasia to the interactional means of to embed narratives in surrounding discursive activities; ii) the turn to turn of narrative formation as an interactional enterprise; iii) co-storytellers actions to shape up the report, making it possible to keep a maintenance process over the ongoing interaction´s inter-subjectivity; iv) structuring stories as narratives that full fill temporal and causal organization requirements; v) the relevance of collaborative ways to the formation of narrative linearity; vi) storytellers with aphasia high performance expertise when selecting resources used to build tellability; and vii) distinct ways chosen by the three storytellers in order to construct themselves, others and reality, through stroke episodes they have reported. The current research outcomes show narratives embeddedness in surrounding discourse and social activity, the engagement of multiple storytellers to the narrative, linearity regarding stories, tellability and that different moral stances consist on interactional negotiations that participants are in charge of (primary storytellers and co-storytellers), instead of being an a priori imposition of local (discursive) and socio-cultural contexts. It highlights the theses that narratives are constructions related to here and now, throughout interaction processes. Besides, the fact that storytellers present aphasia underlines the interactional and collaborative features of storytelling, given the frequent penetration of somebody else´s actions in the course of narrative constructions.

This thesis is concerned with the experience of aphasia in Khayelitsha, a township on the outskirts of Cape Town characterised by poverty, violence, limited resources and a culture and language that differs from the setting of most speech and language services in South Africa. It is based on three years of intermittent fieldwork that entailed participant observation of the everyday life of five adults living with aphasia and interviews with participants, kin and healthcare workers in various settings. Grounded in sociocultural theory, this thesis has aimed to provide an ethnographic account of cultural frameworks of interpretation of communication impairment following stroke and of the daily reality of life for adults living with aphasia in this setting. An exploration of causal notions in this setting provided interesting commentary on social and cultural processes and how people, caught up in these processes, search for meaning and for cure. Participants entertained plural notions of causation of aphasia and explored numerous therapeutic avenues. The wide variation in causal notions included biomedical causes, social and behavioural determinants, and the influences of supernatural powers, such as witches and ancestors. Similarly participants experienced aphasia through multiple healing systems, including traditional, biomedical and religious therapy options. All however seemed to be ambiguous sources of help. Whilst encounters with the health system presented serious challenges to participants, traditional and religious avenues for help were obscured by a burgeoning and not always ethical open market offering miracle cures. An articulation of the circumstances of this group of adults provided further commentary on the influence of the social context on aphasia. In a context where sociopolitical processes have had a disintegrating effect on social cohesion, questions of support, care and security were of primary concern. Prejudices towards the elderly and women were more acutely felt and vulnerability, isolation, insecurity and fluidity of circumstance emerged as overarching themes. The central argument in this thesis is that the genesis of these experiences can be found in contextual factors in Khayelitsha, such as poverty, inequality, urbanisation and changing cultural paradigms. These emerging themes highlight the disjunctions between the medical alignment of the discipline of speech language therapy in South Africa and the capacity for socially-engaged practice. They also highlight the socio-cultural complexity of the experience of aphasia, specifically the influences of culture and poverty. There is thus theoretical and clinical relevance in using anthropological objectives to explore the world of the adult living with aphasia and the interface between context and service provision. Interventions and healthcare communications that will make a meaningful difference to adults with aphasia in a setting such as Khayelitsha are proposed.

Considerando a família como instituição primária a qual se tem acesso, e a sua relevância nos diversos processos os quais o ser humano passa durante a vida, um resultado desse movimento são as mudanças na dinâmica familiar, quando há, por exemplo, o adoecimento de algum dos membros e um familiar torna-se cuidador. , atentando-se para as necessidades de cada sistema familiar. O objetivo deste estudo foi descrever a qualidade da relação entre o cuidador familiar e adulto ou idoso pós-Acidente Vascular Cerebral, que se encontram no processo de reabilitação. Participaram deste estudo, familiares de 11 pacientes que se encontram em atendimento na Clínica de Fonoaudiologia da Faculdade de Odontologia de Bauru FOB/USP. Para a coleta de dados foram agendadas entrevistas com a aplicação de questionários para caracterizar os aspectos interacionais entre o cuidador familiar e a pessoa cuidada, avaliar o nível de dependência na realização de atividades básicas e instrumentais diárias e como esses fatores podem influenciar na sobrecarga do cuidador, considerando o tempo do Acidente Vascular Cerebral (tAVC) e tempo de convivência diária (tCD) e, consequentemente, oferecer uma qualidade da relação insatisfatória. A média de idade dos participantes foi de 49 anos, houve predominância do sexo feminino (63,6%), a média de tAVC de 44 meses e a média de tCD foi de 19 horas. Para a análise dos dados optou-se por uma análise descritiva e abordagem quantitativa para a apresentação dos dados, para determinar a correlação entre as variáveis foi utilizado o Coeficiente de Correlação de Spearman e adotado nível de significância de 5% (p<0,05). Os resultados oferecem subsídios para estudos complementares direcionados ao desenvolvimento de intervenções no âmbito familiar. A psicologia pode auxiliar nessa tarefa de observar os comportamentos e as interações dos indivíduos, além de avaliar o contexto desse paciente, em especial, na descrição da qualidade da relação entre paciente-familiar, partindo da atual situação vivenciada. / Considering the family as the primary institution to have access, and its relevance among different processes which the human being goes through the life, as result of this reality there are changes in family dynamics such as illness of a member and a family member becomes a caregiver. Changes in roles and family dynamics suggest that the services and health professionals are prepared to meet the patient and families, paying attention to the needs of each family system and each person. The objective of this study was to describe the quality of the relationship between family members / caregivers and adults and elderly poststroke, who are attending a rehabilitation program. In this study, 11 family members of patients who are in attendance at the Clinic of Speech Language Pathology Dentistry School - FOB / USP participated. For data collection interviews with questionnaires were scheduled to characterize the interactional aspects between the family / caregiver and the cared person, assess the level of dependency in carrying out daily basic and instrumental activities and how these factors may influence the overload caregiver, considering the time of stroke and time of daily living together and thus it will all provide a quality unsatisfactory relationship. The average age of participants was 49 years, there was a predominance of females (63.6%), the average when stroke happened was 44 months and the average of being together was 19 hours. For data analysis it was chosen a descriptive analysis and quantitative approach to the presentation of data to determine the correlation between the variables we used the Spearman correlation coefficient and adopted a significance level of 5% (p <0.05 ). The results provide input for further studies directed to development interventions within the family. Psychology can help in this task of observing the behavior and interactions of individuals, as well as evaluating the context of this patient , in particular in describing the quality of the relationship between patient - family, from the current situation experienced.