<p> Purpose: Non-verbal cognition and language functions were examined in adult stroke survivors with aphasia. The specific purpose of the study was twofold: 1) to examine the relationship between self-reported outcomes from people with aphasia (PwA), measures of non-verbal cognition (Delis-Kaplan Executive Function Systems Test (D-KEFS), Delis, Kaplan, &amp; Kramer, 2001) and measures of language (Western Aphasia Battery-Revised (WAB-R), Kertesz, 2007; Boston Naming Test Second Edition (BNT-2), Kaplan, Goodglass, &amp; Weintraub, 2001) and 2) to examine these same relationships using partner-reported outcomes for that same group of PwA. This study used the Aphasia Communication Outcome Measure (ACOM, Doyle et al., 2013) to gather both self-reported ACOM data and partner-reported ACOM data (ratings of the person with aphasia&rsquo;s communication made by a regular conversation partner). </p><p> Method: Seventeen participants with aphasia underwent examination with an extensive test battery including measures of functional communication, non-verbal cognition, and language impairment. In addition, 16 of their regular communication partners rated functional communication performance. </p><p> Results: Self-reported functional communication is strongly related to the number of errors committed on the D-KEFS design fluency test (r = .81, p = .001). Furthermore, a modified form of the D-KEFS design fluency test (in which the examinee is allowed unlimited time) shows that the proportion of errors contributes significantly to a two- predictor linear regression model. These two predictors account for 66% of the variance in self-reported functional communication ratings. These results suggest that non-verbal cognition for people with mild to moderate aphasia may serve an important role in functional communication. By contrast, self-reported functional communication was uncorrelated with aphasia severity (r = .04, p = .88), naming performance on either the WAB-R (r=.059, p=.823) or the BNT-2 (r=.097, p=.713), and category fluency (r=.086, p=.741). Partner-reported functional communication was highly correlated to the naming subtest on Western Aphasia Battery-Revised (WAB-R) scores (r=.71, p=.02) and to performance on the Boston Naming Test (BNT-2; r=.56, p=.026). </p><p> Partner-reported functional communication was also strongly predicted based on the number of animals named during the category fluency task on the WAB-R (r=.782, p=.000). A linear regression model including WAB-R category fluency accounted for 61.1% of the variance in partner-reported ratings. A second linear regression adding naming as a predictor was not significant (F_change = 2.18, p=.163). By contrast, none of the non-verbal cognition measures were useful predictors of partner-reported functional communication. These results suggest that aphasia severity serves an important role in partner ratings of functional communication whereas non-verbal cognition does not. </p><p> Taken together, these results suggest that PwA and their partners rely on different aspects of communication when judging functional communication. </p><p> Further work to explore the use of patient-reported outcome (PRO) measures and to identify factors that contribute to self-reported functional communication is needed. The discussion addresses the appropriateness of using PRO measures in aphasia and the use of surrogate reports.</p>

<p> <b><u>Objective:</u></b> This is a pilot study designed to assess speech and swallowing characteristics of participants with idiopathic Parkinson&rsquo;s disease (IPD) before deep brain stimulation surgery of the subthalamic nucleus (DBS-STN), after the DBS-STN surgery, and at follow up evaluation sessions.</p><p> <b><u>Method:</u></b> A within participant, single-subject experimental A-B-A-A design was used to measure changes in the dependent variables for each participant. The primary dependent variables were intelligibility scores of words and sentences, vowel space area (VSA), vocal sound pressure level (dB SPL) of sustained vowels, single words, and contextual speech, Multidimensional voice program (MDVP) analysis of phonatory stability of sustained vowel phonation, lip pressure, tongue tip to alveolar ridge pressure, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and diadochokinetic rate. The secondary dependent variables were: duration of sustained vowel phonation, Visual analog scales (VAS) for communicative difficulties and swallowing difficulties, the EAT-10 swallowing questionnaire, and the qualitative narrative of life with IPD before and after the DBS-STN surgery.</p><p> <b><u>Results:</u></b> DBS-01 had significant declines of intelligibility with individual words, but did not have statistically significant changes for complete sentences. The VSA declined over the course of the study. The MDVP analyses indicated general declines in phonatory stability, but not significantly. There was a statistically significant increase in dB SPL for sustained vowel phonation, but there were overall declines in loudness for connected speech. The duration of sustained vowel phonation increased and the DDK rate varied across the experiment. Left lip and tongue pressures had overall declines, but right and center lip pressures increased. The VAS for communicative difficulties revealed worsening of symptoms. The VAS and the EAT-10 questionnaire for swallowing difficulties both recorded worsening of symptoms after surgery, and symptom improvements later on. The timed swallow test did not show any meaningful impairment in drinking or eating.</p><p> DBS-02 had statistically significant gains of intelligibility with individual words after the DBS-STN surgery, but had statistically significantly declines later on. The changes in the intelligibility of complete sentences were not significant. The VSA contracted after the surgery, but it increased afterwards. The MDVP analyses indicated an overall significant increase of phonatory stability. The dB SPL had a statistically significant increase for sustained vowel phonation, but the connected speech loudness had mixed results. The duration of sustained vowel phonation increased after surgery, but then declined later on. The DDK rate varied across the experiment. Lip and tongue pressures had overall increases. The VAS for communication difficulties revealed an overall increase in communicative abilities. The VAS and the EAT-10 questionnaire for swallowing difficulties both recorded a decrease in symptoms after surgery, and an increase later on. The timed swallow test did not show any meaningful impairment in drinking or eating.</p><p> <b><u>Conclusions:</u></b> DBS-01 had an overall result that the DBS-STN surgery and electrode adjustments were not apparently beneficial to speech and swallowing symptoms, although the delay in assessment after the surgery made distinguishing the effects of the surgery from progressive IPD symptoms difficult. DBS-02 had an overall result that the DBS-STN surgery was beneficial to speech and swallowing symptoms in the short term, although later progression of IPD symptoms, as well as electrode adjustments likely caused later declines.</p>

<p> Aphasia is an acquired impairment of language secondary to neurological brain damage commonly seen in stroke, and is defined by impairment to communication through speech and language which can limit participation in work, family, and social settings. Standard aphasia treatment consists of behavioral therapy to restore or compensate for this impairment. Unfortunately, recovery is often incomplete with long-lasting residual communication deficits. </p><p> Enhancing the effects of behavioral therapy has long been a goal of aphasia researchers. Behavioral therapy takes advantage of neuroplasticity, the brain&rsquo;s ability to change, and a recent direction has been to use adjuvants to behavioral treatment to enhance these effects, even in the chronic stage of recovery. The two studies reported here use transcranial direct current stimulation (tDCS) for this purpose. tDCS provides low-level current that can hyper- or depolarize cortical neurons, to build on the neuroplastic capacity of the brain. In the studies reported here, the anode was placed over the left primary motor cortex, with the cathode over the right supraorbital region. Study one investigated whether tDCS administered prior to robotic motor therapy (36 sessions over 12 weeks) resulted in improvements in speech/language outcome measures, comparing a group receiving active tDCS with a group receiving sham tDCS. This study revealed some overall differences on selected speech and language measures from pre-test to post-test, although tDCS condition did not affect performance. One important finding this work revealed was a possible cross domain synergy between motor and speech-language therapy, even when no speech therapy was provided. </p><p> Study two examined whether the timing of tDCS relative to a speech/language treatment affects treatment outcomes. This study compared participants receiving tDCS immediately preceding computerized aphasia treatment to participants receiving tDCS and treatment simultaneously. A crossover design was employed so each participant also received sham tDCS for comparison. No interaction was found between stimulation type and timing (preceding or during) of aphasia treatment. Accordingly, the results were somewhat equivocal with respect to the best approach. Further investigation with larger sample sizes, longer times between tDCS conditions or multiple consecutive sessions may help clarify the role of tDCS timing in aphasia treatment.</p><p>

<p> Whether neural substrates underlying conflict resolution, or the ability to choose an appropriate response from number of alternate options, are shared across disparate domains is currently unclear. This thesis sought to extend previous studies examining this question by asking whether conflict adaptation occurs between Stroop (a non-syntactic task well-studied in the conflict resolution literature) and two different language tasks. Evidence for bidirectional behavioral interaction between processing of sentences with syntax-semantic conflict and Stroop was found in Experiment 1; however, there were no behavioral interactions between a multiword production task and Stroop in Experiment 2. The difference between these two studies could be consistent with either a domain-general or domain-specific model of conflict processing, as it is unclear whether interactions were not found due to differences in levels of conflict processing or differences in domains of conflict processing. Further research should focus on better distinguishing between these two possibilities. Finally, we also suggest that future research should better characterize the time course of conflict processing.</p>