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Thesis (M.S.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Recovery from aphasia, loss of language following a cerebrovascular incident (stroke), is a complex process involving both left and right hemispheric regions. In our study, we analyzed the relationships between semantic processing behavioral data, lesion size and location, and functional signal change from functional magnetic resonance imaging (fMRI) data. Our study included 14 persons with aphasia in the chronic stage of recovery (six or more months post stroke) who performed semantic processing tasks of determining whether a written semantic feature matched a picture or whether two written words were related. Region of interest (ROI) analysis revealed that left inferior frontal gyrus pars opercularis and pars triangularis, despite significant damage, were the only regions to correlate with behavioral accuracy. Additionally, bilateral frontal regions including superior frontal gyrus, middle frontal gyrus, and anterior cingulate appear to serve as an assistive network in the case of damage to traditional language regions including inferior frontal gyrus, middle temporal gyrus, supramarginal gyrus, and angular gyrus. Contralesional posterior regions including right middle temporal gyrus, right supramarginal gyrus, and right angular gyrus are engaged in the case of complete damage to left hemisphere language regions. Additionally, right inferior frontal gyrus pars orbitalis is noted to be possibly serving a monitoring function. These results reinforce the importance of the left hemisphere in language processing in aphasia, as well as the nuanced relationships between lesion size, lesion location, and bilateral signal change in aphasia. / 2999-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Intensive Language Action Therapy (ILAT) is a short-term aphasia therapy that emphasises massed-practise of language, where communication is framed through language action games that approximate everyday interactions. Despite increasing interest in ILAT, a comprehensive description of its methods has thus far been missing. Furthermore due to inconsistent results, further exploration of cortical reorganisation of language functions following ILAT is warranted. The underlying principles and practical features of ILAT methods and of language-action games are fully described, including the structure and materials for two specific games. 14 English speaking patients with chronic aphasia underwent two weeks of ILAT utilising the methods outlined. Pre and post measures of language performance were collected through standardised clinical assessments, along with functional Magnetic Resonance Imaging scans from a subset of 8 patients. Accuracy and response times for speech output and comprehension during language-action games were also recorded to measure success during the therapy interval. Data analysis showed significant improvements in clinical assessments of naming and comprehension, but not in auditory or syntactic processing tasks. Significant increases were also seen in patients’ self-ratings of quality of communication following therapy. Video and voice recordings during therapy sessions demonstrated significantly faster response times in production and comprehension of language, alongside an increase in the complexity of patients’ spoken output. Cortical activation was recorded whilst patients heard low-level noise, sentences containing ambiguous words and low-ambiguity sentences. Although the results showed no changes in cortical activation in the group of patients whilst processing low-level noise or low ambiguity sentences, increases in language-induced activation were seen in single-subject analyses in both the left and right hemispheres. Furthermore the group of patients recruited the right hemisphere significantly more than the left hemisphere following ILAT when processing complex sentences containing ambiguous words. iii Clinical assessments and measures of everyday communication showed undergoing two weeks of ILAT significantly improved speech output and comprehension in patients with chronic aphasia. Gains made in communicative performance during therapy highlight the importance of recording therapy sessions for additional assessment of therapy efficacy. Although conclusions regarding cortical reorganisation are not entirely clear, they indicate the important role of the right hemisphere in reorganisation of language after stroke.

Background: The Samoan population is a growing population and one with an estimated high incidence of aphasia. Language assessment with bilingual individuals is said to be a challenging area of Speech-Language Therapy practice. Language assessment of bilingual Samoan-English speakers with aphasia is a field with limited research, and the specific experience of the individuals involved is an important factor to consider in improving SLT practice with this population. Aims: The current thesis aimed to explore the experience of language assessment of bilingual Samoan-English speakers with aphasia as perceived by those involved in the assessment process. Method: Two qualitative studies were utilised to address the aims, the first was a single case study observing the process of language assessment of a bilingual Samoan-English speaker with aphasia and follow-up interviews with other participants involved. The second study was a focus group with Speech-Language Therapists who had experience with language assessment of bilingual Samoan-English speakers with aphasia. Outcome and results: The results of the case study revealed eight themes: language assessment of bilingual Samoan-English speakers with aphasia is a hard process for the individuals involved; language assessment of bilingual Samoan-English speakers with aphasia is a team process; differences in understanding of communication impairments and the assessment process; time; preparation; appropriateness of assessment tasks, resources, and processes; uncertainty; and flexibility. The results of the focus group indicated eight categories: Speech-Language Therapists’ background, using interpreters, family involvement, Samoan language and culture, getting an initial impression of and building rapport with the individual with aphasia, assessment tasks and resources, determining which language(s) to assess and logistics of assessment. Conclusion: Language assessment of bilingual Samoan-English speakers with aphasia is a challenging area of Speech-Language Therapy practice. Challenges are multifaceted and although some challenges may be present in all language assessment with individuals with aphasia, they are further exacerbated by the addition of multiple languages, people, and culture. Helpful strategies identified in this study may aid in improving the overall experience.

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Call number: LD2668 .T4 1963 W68 / Master of Science