Response of an agrammatic patient to a syntax stimulation program for aphasia

German Language Adaptation of the NAVS (NAVS-G) and of the NAT (NAT-G): Testing Grammar in Aphasia

Grammar provides the framework for understanding and producing language. In aphasia, an acquired language disorder, grammatical deficits are diversified and widespread. However, the few assessments for testing grammar in the German language do not consider current linguistic, psycholinguistic, and functional imaging data, which have been shown to be crucial for effective treatment. This study developed German language versions of the Northwestern Assessment of Verbs and Sentences (NAVS-G) and the Northwestern Anagram Test (NAT-G) to examine comprehension and production of verbs, controlling for the number and optionality of verb arguments, and sentences with increasing syntactic complexity. The NAVS-G and NAT-G were tested in 27 healthy participants, 15 right hemispheric stroke patients without aphasia, and 15 stroke patients with mild to residual aphasia. Participants without aphasia showed near-perfect performance, with the exception of (object) relative sentences, where accuracy was associated with educational level. In each patient with aphasia, deficits in more than one subtest were observed. The within and between population-groups logistic mixed regression analyses identified significant impairments in processing syntactic complexity at the verb and sentence levels. These findings indicate that the NAVS-G and NAT-G have potential for testing grammatical competence in (German) stroke patients.

Retraining speech production and fluency in non-fluent/agrammatic primary progressive aphasia

The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) presents with a gradual decline in grammar and motor speech resulting from selective degeneration of speech-language regions in the brain. There has been considerable progress in identifying treatment approaches to remediate language deficits in other primary progressive aphasia variants; however, interventions for the core deficits in nfvPPA have yet to be systematically investigated. Further, the neural mechanisms that support behavioural restitution in the context of neurodegeneration are not well understood. We examined the immediate and long-term benefits of video implemented script training for aphasia (VISTA) in 10 individuals with nfvPPA. The treatment approach involved repeated rehearsal of individualized scripts via structured treatment with a clinician as well as intensive home practice with an audiovisual model using 'speech entrainment'. We evaluated accuracy of script production as well as overall intelligibility and grammaticality for trained and untrained scripts. These measures and standardized test scores were collected at post-treatment and 3-, 6-, and 12-month follow-up visits. Treatment resulted in significant improvement in production of correct, intelligible scripted words for trained topics, a reduction in grammatical errors for trained topics, and an overall increase in intelligibility for trained as well as untrained topics at post-treatment. Follow-up testing revealed maintenance of gains for trained scripts up to 1 year post-treatment on the primary outcome measure. Performance on untrained scripts and standardized tests remained relatively stable during the follow-up period, indicating that treatment helped to stabilize speech and language despite disease progression. To identify neural predictors of responsiveness to intervention, we examined treatment effect sizes relative to grey matter volumes in regions of interest derived from a previously identified speech production network. Regions of significant atrophy within this network included bilateral inferior frontal cortices and supplementary motor area as well as left striatum. Volumes in a left middle/inferior temporal region of interest were significantly correlated with the magnitude of treatment effects. This region, which was relatively spared anatomically in nfvPPA patients, has been implicated in syntactic production as well as visuo-motor facilitation of speech. This is the first group study to document the benefits of behavioural intervention that targets both linguistic and motoric deficits in nfvPPA. Findings indicate that behavioural intervention may result in lasting and generalized improvement of communicative function in individuals with neurodegenerative disease and that the integrity of spared regions within the speech-language network may be an important predictor of treatment response.

Recovery from moderate aphasia in the first year poststroke: effect of type of therapy

OBJECTIVES

(1) To determine whether 2 model-based remediation programs affect writing performance in unselected subjects with moderate aphasia and whether there is consequent improvement in everyday life, and (2) to interpret the potential changes observed by recourse to a theoretical model.

DESIGN

Consecutive sample, multiple baseline, within subject crossover study.

SETTING

Ambulatory care units.

PARTICIPANTS

Eight subjects with moderate aphasia from 6 to 12 months postonset.

INTERVENTION

A standardized test for reading and writing skills was given at the beginning and the end of each therapy program and 1 month after therapy stopped.

MAIN OUTCOME MEASURES

Functional outcome measures were the Communicative Abilities in Daily Living (CADL) test and subtests from standardized aphasia assessment.

RESULTS

After the 2 programs, there was improved writing performance, which was maintained after therapy stopped. Patterns of improvement corresponded to each of the 2 programs. Learning transfer was observed on the CADL test and functional writing, but gains on oral language were limited. Only 1 program was effective for 6 of the 8 patients.

CONCLUSION

Specific rehabilitation programs aid recovery from aphasic symptoms from 6 to 12 months postonset. Individual response is linked to type of treatment. The interpretation is linked to a model-based description of aphasic symptoms and mechanisms of functional recovery.

A comparison of relaxation training and syntax stimulation for chronic nonfluent aphasia

This study examined the effects of relaxation training and syntax stimulation on the spoken language abilities of a 59-year-old male with chronic, nonfluent aphasia of moderate severity. Relaxation training consisted of progressive muscle relaxation (PMR) and guided imagery (GI), whereas the syntax stimulation was a modified version of the Helm Elicited Program for Syntax Stimulation (HELPSS) [(1981). Helm Elicited Language Program for Syntax Stimulation. Austin, TX: Pro-Ed.]. These treatments were applied in the context of a single-subject alternating treatments plus baseline design. Results indicated that although both treatments produced improvements in spoken language, syntax stimulation was associated with larger improvements, particularly in terms of the proportions of grammatical utterances, correct information units (CIUs), and successful utterances produced by the participant. Analysis of treatment order, however, indicated that the participant's best performances of the syntax treatment and of the probe tasks occurred when relaxation training preceded syntax stimulation. These findings suggest that the simplicity and psychological benefits of relaxation training make it a complementary component to traditional linguistic programs for aphasia.

EDUCATIONAL OBJECTIVES

(1) The reader will understand how psychological responses to stress may affect the language processing abilities of adults with aphasia. (2) The reader will be able to describe how relaxation training complements a traditional language treatment approach for remediating spoken language abilities of adults with chronic nonfluent aphasia.

Treatment and generalization of complex sentence production in agrammatism

The present study applies single-subject experimental design to examine (a) the acquisition and generalization of complex sentence production in agrammatism using Linguistic Specific Treatment (LST) and (b) the utility of syntactic theory in guiding hypotheses of treatment effects. LST trains construction and production of complex sentence structures. Four sentence types were selected for study: object clefts and object-extracted matrix and embedded questions (which are noncanonical with wh-movement), and embedded actives (which are canonical with no overt movement). All sentences contain overt material in the complementizer phrase (CP) of the syntactic tree. Three of five participants (1, 2, and 3) demonstrated generalization from object cleft treatment to production of matrix questions. Thus, LST was effective in improving their ability to generate less complex sentences with wh-movement. Once production of object clefts and matrix questions was acquired, all 5 participants demonstrated generalization from treatment to improved production of embedded questions and/or embedded actives. This generalization involved improved ability to generate embedded clausal structure to form complex sentences but continuing inability to express overt material in CP. Finally, direct treatment for embedded questions did not result in accurate production of embedded actives or vice versa. There were no trends across participants toward improved production of morphosyntactic behaviors in narrative. Persons 1, 2, and 3 showed generalization to increased informativeness and efficiency of expression and were judged by independent listeners to improve in content, coherence, and fluency of spontaneous production. The remaining two participants showed no change or a decline in performance in narrative language production (4 and 5, respectively). These participants demonstrated more severe Broca's aphasia at pretesting compared to Persons 1, 2, and 3, with greater impairments in auditory comprehension, naming, and reading. Etiology and size of lesion did not appear to account for the different behavioral patterns. This study supports the use of LST, which applies syntactic theory to predict patterns of generalization, as an effective treatment approach.

Restitution and substitution: two theories of recovery with application to neurobehavioral treatment

This article reviews two theories regarding recovery from brain damage in adulthood. The notion of restitution of function assumes that behavioral improvement results from the increasing integrity of the injured functional system. In contrast, the theory of substitution of function assumes that improvement results from system reorganization or compensation. Both these processes take place during the course of neurologic recovery. The ability of the clinical neuropsychologist to maximize behavioral changes in the brain-damaged patient during the recovery period requires an appreciation for these recovery mechanisms. Treatment decisions can be enhanced by knowledge of the time course, degree of recovery potential, and behavioral constraints of these complementary recovery processes.