Afasi är ett samlingsbegrepp för förvärvade språkstörningar. Symptomen förekommer i högst utsträckning hos personer som drabbats av en stroke. Personer som drabbats av någon typ av afasi upplever ofta att deras kommunikativa förmåga i hög grad begränsats efter insjuknandet, vilket kan leda till stor eller mycket stor social inskränkning. De psykologiska faktorer som påverkas rör kognition och emotion, sociala strukturer och relationer, exempelvis personliga relationer, yrkesliv eller utbildning. Därmed relateras de psykosociala konsekvenserna av afasi till hur tillståndet påverkar vardagslivet och förmågan till att interagera med den sociala omgivningen. Idag sker intervention för personer med afasi individuellt och gruppintervention eller anhöriginkludering ses som sekundära komplement till den individuella behandlingen. I föreliggande studie undersöks en form av intervention där personer med afasi och deras anhöriga gemensamt får ta del av kommunikativa strategier och tilldelas individanpassade råd. Inspiration har hämtats från den befintliga anhöriginkluderande metoden SPPARC. Målet med interventionen var att den vardagliga kommunikationen skulle stärkas och effektiviseras. Interventionen skedde under en fem veckor lång period och utförts i två olika konstellationer; ett par och en mindre grupp. Gruppkonstellationerna har sedan jämförts med varandra. Båda koncepten utvärderades positivt av deltagarna. De förefaller därmed vara tillämpbara båda två, men beroende på deltagarnas förväntningar och psykosociala behov kan något av koncepten föredras på ett individuellt plan. Resultatet av föreliggande studie indikerar att det finns ett psykosocialt behov av att inkludera anhöriga till personer med afasi i intervention. En ökad medvetenhet hos deltagarna noterades gällande flera av de kommunikativa strategier som behandlades under interventionens gång, bland annat gestikulering och prompting. Deltagarnas utvärdering av perioden tyder på att interventionsperioden framför allt fungerat som ett forum för samtal kring afasi och kommunikation och att den har tjänat sitt syfte i psykosocial bemärkelse. Deltagarna uppgav dock under utvärderingen att interventionen är bäst lämpad som en tidig insats efter personen med afasis insjuknande.

Writing impairments are common as part of aphasia. To make qualified decisions regarding what intervention to provide, speech and language pathologists need easy access to the current knowledge base. The purpose of this study was to identify, describe and rate the level of evidence for interventions targeting writing impairments following aphasia. A systematic literature search procedure in six databases was performed during May 2020, which generated 1937 results. Based on criteria concerning inclusion and exclusion 26 articles were included in the review. 16 interventions were identified and their purpose, underlying theory, participants, execution and resulting effects were described. The methodological quality of the reviewed articles was assessed using validated rating scales and each identified intervention had their level of evidence graded according to GRADE (SBU, 2017). All of the reviewed articles were single- or multiple subject design studies, which resulted in an insufficient level of evidence. Improved writing abilities were noted for each intervention and most were deemed suitable for Swedish clinical conditions. The insufficient level of evidence accentuated the need for more research concerning interventions for acquired writing impairments. / Afasi är en förvärvad språkstörning där skrivsvårigheter är vanligt förekommande. En kartläggning av interventioner vid nedsatt skrivförmåga vid afasi behövs för att underlätta för logopeder vid val av intervention. Syftet med den här litteraturöversikten var att identifiera, beskriva och evidensgradera behandlingsmetoder för skrivsvårigheter vid afasi. En systematisk litteratursökning i sex databaser genomfördes i maj 2020, vilken resulterade i 1937 sökträffar. Efter jämförelse med inklusions- och exklusionskriterier inkluderades 26 artiklar i översikten. Vid granskningen identifierades 16 behandlingsmetoder, som beskrevs sett till syfte, bakomliggande teori, försöksgrupp, utförande och uppmätta resultat. Artiklarnas metodologiska kvalitet granskades och behandlingsmetoderna evidensgraderades. Samtliga granskade studier var av single- eller multiple subject design, vilket resulterade i otillräcklig evidensstyrka för samtliga interventioner. Förbättrad skrivförmåga noterades vid alla interventioner och de flesta bedömdes vara tillämpbara i svensk klinik sett till beskrivet utförande. Evidensgraderingen enligt GRADE (SBU, 2017) tydliggjorde behovet av mer forskning inom området.

The effect of aphasia varies across patients and consequently their rehabilitation needs may differ. Access to participation in today’s information society requires good reading skills and this should be considered in a patient's rehabilitation plan. However, there are currently no guidelines available regarding the treatment of acquired reading impairments following stroke. The national guidelines for stroke rehabilitation states that speech and language intervention should be given when necessary and requested. There are currently no national guidelines for aphasia treatment that target specific language functions. The current study aims to gather and review the evidence of reading interventions for people with aphasia. A systematic search was made in medical databases to gather relevant studies. A quality review was conducted for the 19 studies found and information about the different methods used for therapy was gathered. This was followed by an evidence evaluation of each method. Although most studies demonstrated positive results, only 3 out of 13 methods were found to have a moderate to high evidence base. The majority of the methods were supported by single-case studies or lacked in quality, making it difficult to draw any conclusion about whether those methods are suitable to use in the clinic. This result also reflects the focus of the evidence grading system (GRADE) on study design and questions arose of its suitability for this type of aphasia research. / Bakgrund: Afasi efter stroke är en symptomdiagnos som innebär språknedsättning av varierande grad och omfattning. Rehabiliteringen för personer med afasi (PMA) ska vara individanpassad och logopedisk intervention ska erbjudas vid behov.  Lässvårigheter är en begränsande nedsättning som kan bidra till att PMA blir mer beroende av sin omgivning. Idag saknas riktlinjer för läsbehandling vid afasi efter stroke och en översikt av existerande evidensbaserade metoder behövs för klinisk verksamhet. Syfte: Studiens syfte var att genom en systematisk litteraturöversikt sammanställa evidensen för behandlingsmetoder vid nedsatt läsförmåga och läsförståelse hos PMA efter stroke. Metod: En systematisk litteratursökning gjordes i utvalda databaser och 19 studier identifierades för kvalitetsgranskning. Metoderna som användes i studierna sammanställdes och en evidensgradering utifrån GRADE-systemet utfördes. Resultat: 13 metoder identifierades varav 3 metoder, Phonomotor Treatment (PMT), Semantic Feature Analysis (SFA) och tekniskt hjälpmedel som läsbehandling, ansågs ha måttligt till starkt vetenskapligt underlag. Resterande metoders vetenskapliga underlag bedömdes som otillräckliga. Slutsats: Positiv behandlingseffekt sågs överlag i samtliga metoder men begränsningar i antalet studier, deltagarantal och studiernas utförande sänkte evidensgraderna. Resultatet angående användning av metoderna PMT och SFA, med starkast evidensgradering, ifrågasätts då det präglats av evidensgraderingssystemets inriktning på studiers design.  Metoderna anses även behöva mer forskningsstöd för att kunna bedömas som lämpliga behandlingsmetoder i klinisk verksamhet.

Among Swedish speech and language pathologists there is a need for extended knowledge of existing treatment methods for aphasia. Currently, there is an ongoing process to develop clinical guidelines for aphasia rehabilitation. Therefore, a knowledge base is needed, including a description of existing treatment methods, their theoretical foundation and evidence base. The aim of the present study was to compose an evidence-based summation of treatment methods for auditory comprehension disorder in people with aphasia. A systematic literature search was conducted using the following databases: PubMed, PsycINFO, Cochrane Library, CINAHL and Speechbite. Additionally, several studies were found by manual searches. Twenty-three articles were chosen and assessed. A total of 13 different treatment methods were described. Most of the included studies had a poor quality and few participants. The majority of the treatment methods were found to have an insufficient evidence base, with the exception of CIAT and Hand-action observation treatment. They were found to have moderate and limited evidence. Most of the included studies have shown a significant improvement of auditory comprehension following speech and language therapy. Although, for speech and language pathologists to be able to choose a specific treatment method based on evidence, larger studies with higher quality will be needed. / Bland svenska logopeder finns behov av utökad kunskap om vilka specifika metoder som finns för behandling av afasi. För närvarande pågår ett arbete med att ta fram kliniska riktlinjer för afasi. Syftet med studien var att ta fram ett evidensbaserat kunskapsunderlag med en beskrivning av olika metoder för behandling av hörförståelse hos personer med afasi. Resultatet av den aktuella studien ämnas användas till arbetet med de kliniska riktlinjerna. En systematisk litteratursökning genomfördes i databaserna PubMed, PsycINFO, Cochrane Library, CINAHL samt Speechbite. Utöver detta handsöktes ytterligare artiklar. Sammanlagt 23 artiklar kvalitetsgranskades och evidensstyrkan för varje metod bedömdes enligt SBU:s beskrivning av GRADE-systemet. I kunskapsunderlaget presenteras sammanlagt 13 olika behandlingsmetoder för behandling av hörförståelse. De flesta av de ingående studierna hade en bristande studiekvalitet med lågt antal deltagare. Majoriteten av behandlingsmetoderna bedömdes ha otillräcklig evidens, med undantag för CIAT och Hand-action observation treatment som bedömdes ha måttlig respektive begränsad evidens. De ingående studierna har övervägande visat att logopedisk behandling ger ett signifikant förbättrat resultat på hörförståelse. Större behandlingsstudier med bättre kvalitet behövs dock för att kliniska logopeder ska kunna välja en behandlingsmetod framför en annan på en evidensbaserad grund.

For two decades, researchers and clinicians have been using the diagnostic criteria for FTD to generally diagnose a patient as suffering from PPA and the criteria of Neary et al. (1998) to further specify the diagnosis as progressive nonfluent aphasia or semantic dementia. However, there were a number of PPA cases that could not be classified according to the criteria of Neary and colleagues, which led to a revision of the diagnostic clinical and research criteria for PPA by Gorno-Tempini et al. (2011). The revised criteria encompass three PPA variants (svPPA, nfvPPA, and lvPPA) with three stages characterized by increasing evidence: clinical diagnosis, imaging-supported diagnosis, and diagnosis with definite pathology. As compared to the previous diagnostic criteria, more emphasis is placed on imaging markers as supportive features. These imaging criteria were however proposed based on a purely qualitative evaluation of the literature and have not been validated so far. The aim of this thesis was to quantitatively evaluate the validity of the new diagnostic imaging criteria for PPA variants using anatomical likelihood meta-analyses (study 1) and to investigate the usefulness of these imaging criteria for the individual diagnosis of PPA patients in clinical routine using support vector machine classification (study 2).

The Cremator: The Fetish as The Denial of Life and The Adoration of Death Summary The object of interest in the semiotic analysis of the literary work "The Cremator" by the Czech writer Ladislav Fuks are primarily the motifs of fetishism and the cult of death. This framework is examined in the relation to the specific "new" language of masochism and in the relation to the aphasic language disorder related to metonymy. The utterance of the main character Karl Kopfrkingel intermingles with the way he thinks and consequently acts, as he duplicates through his language a fictional world and obscures it with the fetishized descriptions adoring the death. In this case, the masochism is not manifested in a sexuality (as in the case with Masoch), but on the ethno-social level related to the personal myth crisis and the subsequent transformation of Kopfringel and the related environment of the fictional world. These aspects become to a murdering urges in the context of ethnic affiliation, which has become to an obstacle and the settlement with it demands the establishment of a new order. Keywords Ladislav Fuks, The Cremator, aphasia, metonymy, metaphor, fetishism, fiction worlds, identity, masochism, sadism

The diploma thesis deals with the issue of diagnosis of phatic disorders. The aim of this work is to provide insight into the topic of phatic disorders, especially by introducing diagnostic tests that are used in the Czech Republic and some available materials that are used in English- speaking countries. Individual diagnostic tests are processed on the basis of an analysis of professional literature in Czech and English. The diploma thesis is theoretical and is divided into four parts. The first chapter describes the impaired communication ability, aphasia in terms of definition, etiology, symptomatology and classification approaches. The second chapter presents diagnostic methods created and used in the Czech environment, which differ depending on the theoretical basis of individual experts, respectively. authors of test methods. The third chapter deals with diagnostic procedures abroad, specifically in English-speaking countries. The focus is on the presentation of the most important and available current methods, part of the chapter is a theoretical introduction to the history of aphasiology and fundamental paradigms that affect the form of the diagnostic process. The final part is devoted to the analysis and comparison of these methods. Both approaches agree on the goal of the diagnostic...

L’aphasie est un trouble acquis du langage survenant suite à une lésion cérébrale, le plus souvent suite à un accident vasculaire cérébral. Les conséquences des troubles du langage sont multiples et diminuent de manière importante la qualité de vie des personnes avec aphasie. L’anomie ou manque du mot en est la manifestation la plus fréquente et persistante, et ce, quel que soit le type d’aphasie. Le manque du mot peut porter sur les noms, mais aussi sur les verbes. Ces derniers jouent d’ailleurs un rôle central dans la construction des énoncés. Alors que l’anomie des verbes est plus fréquente que celle des noms, les thérapies les ciblant restent moins nombreuses que celles pour les noms. En accord avec la cognition incarnée et située, l’usage de stratégies sensorimotrices telles que l’exécution du geste ou l’observation de l’action semble pouvoir faciliter la dénomination de verbes. Cependant, les travaux publiés jusqu’à présent ne montrent que très peu d’effet de généralisation aux items non entraînés, qui est pourtant l’objectif clinique à atteindre par excellence. Ces études n’ont utilisé en général qu’une seule de ces stratégies, ne considérant pas l’imagerie mentale pourtant en lien avec le traitement de l’action. De plus, ces études incluent rarement les recommandations issues des neurosciences. L’objectif de ce travail doctoral fut alors (1) d’élaborer une nouvelle thérapie à partir de ces constats théoriques et méthodologiques, (2) d’évaluer son « efficacité » au niveau comportemental et enfin (3) de rechercher les substrats neurofonctionnels associés à la thérapie. Les résultats indiquent une amélioration significative de la dénomination d’actions auprès des 10 participants inclus. Plus important, cette amélioration est également valable pour les verbes non entraînés traduisant un effet de généralisation. De plus, cette amélioration se maintient à deux mois et à six mois après la thérapie. Les analyses neurofonctionnelles, conduites auprès de deux patients, montrent une implication des aires appartenant aux réseaux langagier et sensorimoteur lors de la dénomination d’actions. Enfin, les analyses de connectivité au repos, auprès de quatre participants, suggèrent une meilleure intégration dans les réseaux visuomoteurs et moteurs associés à la dénomination de l’action. Ces données préliminaires indiquent que les changements neurofonctionnels sont associés à la nature de la thérapie combinant des stratégies sensorimotrices pour faciliter la dénomination des verbes. Prises ensemble, ces données s’avèrent très prometteuses quant à l’efficacité de POEM, en particulier à travers l’effet de généralisation. Bien que les échantillons soient modestes, la robustesse des analyses employées et la convergence des résultats avec les données existantes dans la littérature et à travers les modalités d’études (niveau comportemental et neurofonctionnel) permettent d’être optimiste quant aux applications cliniques possibles de cette thérapie. Enfin, les perspectives théoriques, à travers la cognition incarnée, et pratiques, avec les limites et travaux toujours en cours sont discutées au regard de la littérature existante. / Aphasia is a language impairment due to a brain lesion, most often following a stroke. Language impairments lead to multiple negative outcomes and significantly impoverish the quality of life of persons living with aphasia. Anomia is the most frequent and persistent symptom across all kinds of aphasia. Anomia can be observed for nouns, but also for verbs. Moreover, the latter are at the core of the sentences. Despite the fact that verb anomia is more frequent than anomia with nouns, there is much less interventions available to treat verbs’ anomia. Accordingly, with embodied cognition theory, sensorimotor strategies, such as action execution and action observation seem to improve verb naming. However, published studied show only a very limited generalization effect when this effect is the gold standard of clinical practice. These studies are generally based on only one strategy and did not use mental imagery which was found to be related with action processing. Moreover, these studies rarely include recommendations from the work in neuroscience. The present PhD project aims to (1) develop a new sensorimotor therapy taking into account these theoretical and methodological points, (2) evaluate its « efficacy » at a behavioural level, and (3) seek its neurofunctional underpinning functioning. The results reveal a significant improvement of the verb naming performance for the 10 persons with aphasia. More importantly, this improvement is also observed for the untrained verbs signalling a generalization effect. In addition, the effects are still present after two and six months following the end of the therapy. The neurofunctional results, for the two participants included, confirm the involvement of language and sensorimotor areas during action naming. Finally, resting state connectivity analyses performed with four participants suggest higher integration in the visuomotor and motor networks involved in action naming. These preliminary data support the idea that neurofonctional changes are associated with the nature of the therapy combining different sensorimotor strategies to improve verb naming. Taken together, these results are very promising regarding the efficacy of this new therapy, mainly through the generalization effect. Even if the sample size is limited, the robustness of the analyses and the convergence of the results with the existing data of the literature and through the different modalities of the studies (behavioural and neurofunctional) allow to be optimistic for the clinical applications of the therapy. Finally, the theoretical perspectives, with the embodied cognition theory, as well as the practical ones, with the limits of the projects and the ongoing work, are discussed in light of the existing literature.

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The submitted diploma thesis deals with the topic of diagnostic and therapeutic procedures in speech therapy intervention for people with aphasia. The work is divided into four chapters, while the first three chapters are theoretically oriented the fourth chapter represents the empirical part of the work. In the first chapters, the diploma thesis deals with the theoretical definition of individual areas which are needed to understand the researched issues, specifically focuses on the concept of communication, explains the connection between brain and speech and, last but not least, defines the period of adulthood and old age. Concurrently this chapter presents the principles of speech therapy intervention with a focus on providing speech therapy intervention in the Czech Republic. The focus of the theoretical part of the thesis is the second chapter, which provides a direct (detailed) insight into the issue of aphasia as a neurogenic disorder of speech communication. The chapter deals with aphasia in terms of definition, etiology, symptomatology and classification approaches. Withal it represents a speech therapy intervention for people with a neurogenic speech disorder, aimed at diagnosis, therapy and prevention. The third theoretical chapter introduces the psychological and social aspects related...