Self-Reported Emotional Health and Social Support but not Executive Function Predict Participation After Mild Stroke

Date Presented 03/31/2022

Stroke rehabilitation prioritizes restoring basic self-care functions. Yet, community-dwelling survivors of mild stroke report persistent participation restrictions. This study examined the extent to which executive function, emotional health, and social support contribute to poststroke participation. We discuss how targeted interventions to address emotional health and social support may enable meaningful participation.

Primary Author and Speaker: Corinne Ianni

Additional Authors and Speakers: Laura Magee, Lisa Connor

Contributing Authors: Marjorie Nicholas

Outcomes of an interprofessional intensive comprehensive aphasia program's first five years

BACKGROUND AND OBJECTIVES

This ICAP program is a collaboration between an institute of health professions and a rehabilitation hospital. It was a 6-week intensive treatment program for people with post-stroke aphasia designed to maximize recovery and return to activities. This retrospective study investigated outcomes of this program offered annually from 2015 to 2019.

METHODS

This is an analysis of existing data collected for other purposes. While conducting a therapeutic program for people with aphasia, data were not collected for the purpose of conducting research. The treatment components addressed the activity participation goals of 35 participants. Programming consisted of individual and group speech-language and occupational therapy, adaptive sports, swimming, music therapy, and a wellness mindfulness group.. Participants received a comprehensive evaluation and a treatment plan addressing their individual participation goals, delivered primarily by SLP and OT graduate students under faculty supervision. Pre- and post-treatment outcomes were measured within four WHO ICF domains: impairment, participation, environment, person. Each cohort consisted of seven or eight community-dwelling participants seen four days/week.

RESULTS

Significant post-treatment changes were observed on measures within the impairment domain and on self-perception measures of participation, functional communication, and communication confidence. Subsequent analyses found a subset of 15 responders (WAB Aphasia Quotient change of ≥5) drove most significant effects seen on performance-based impairment measures, but that patient-reported self-perception measures showed significant changes in both responders and non-responders.

CONCLUSIONS

Results support research indicating that short-term intensive, interprofessional comprehensive aphasia programs (ICAPs) are effective treatment options for people with moderate-to-severe aphasia.

Do Fatigue, Apathy, and ADL and IADL Participation Influence Social Participation Poststroke? A Mediational Analysis

Date Presented 04/21/21

This research explores the correlations between fatigue, apathy, and activities of daily living (ADLs) and instrumental activities of daily living (IADLs) participation with social participation after chronic stroke for persons with and without aphasia. Combined, these factors significantly relate to social participation, which emphasizes the complex nature of social participation. The implications of the moderate mediation effects of perceived ADL and IADL participation on the relationships between fatigue and apathy and social participation is discussed.

Primary Author and Speaker: Anna Hausermann

Additional Authors and Speakers: Orley Templeton, Jennifer Rugletic Washko, Carolyn Maguire, Erin Onoshko, Katherine Schmitter, Martina Sledziewski, and Michael Floren

Contributing Authors: Casey Beichler, Kristen Skoff, Kristin Kern, Michelle Marchetti, and Krista A. Pasko

Cognitive Ability, Apathy, and Depression Influence Social Participation Poststroke

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

The purpose of this study is to investigate the extent to which cognitive ability and emotional health predict social participation poststroke for people with and without aphasia. Apathy was found to be an independent predictor of social participation. The results of this study indicate that apathy ought to be further investigated as its own, stand-alone predictor of social participation among the population with stroke and should be recognized and addressed in rehabilitation.

Primary Author and Speaker: Laura Magee

Contributing Authors: Laura Magee, Marjorie Nicholas, and Lisa Connor

Participation Assessment Post-Stroke: Do Measures Represent the Same Underlying Construct?

Date Presented 03/28/20

Confirmatory factor analyses were performed on models of participation depicting multiple assessments of poststroke participation as measuring the same construct. Results suggest that the Activity Card Sort, Reintegration to Normal Living Index, and Stroke Impact Scale–Participation subscale are tapping the same construct. A professional assumption is highlighted, and similar studies are encouraged to strengthen the profession’s ability to validly demonstrate its impact on participation.

Primary Author and Speaker: Matthew Crowley

Contributing Authors: Annie Fox, Marjorie Nicholas, Lisa Connor

The Impact of Cognition and Communication on Participation for Individuals with Aphasia Poststroke

Date Presented 03/28/20

This study examines the impact of cognition and communication on participation for people with aphasia (PWA). For participation in communication and cognitive-intensive activities among PWA, a modest amount of variance is accounted for by cognition and communication ability. Cognition is a significant independent predictor of participation in communication and cognitive-intensive activities for PWA. To facilitate community re-integration for PWA, OTs must consider internal and external factors.

Primary Author and Speaker: Madelyn Girardi

Additional Authors and Speakers: Lisa Tabor Connor

Contributing Authors: Marjorie Nicholas

Do caregiver proxy reports and congruence of client-proxy activity participation goals relate to quality of life in people with aphasia?

BACKGROUND

Achieving activity participation goals is a key factor in quality of life (QOL) for people with aphasia (PWA), but expressing participation goals can be difficult for many of them. Proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, and discrepancies in these goals between PWA and their caregivers may affect QOL, based on the assumption that caregivers' awareness of their loved ones' unique participation goals may be important to increasing PWA activity participation.

AIMS

To examine everyday activities valued by PWA using the Life Interests and Values (LIV) Cards; to measure congruence between PWA and their caregivers on life participation goals; and to measure how congruence of PWA-caregiver participation goals related to QOL.

METHODS & PROCEDURES

A convenience sample of 25 PWA completed the LIV Card assessment and the Stroke Aphasia Quality of Life Scale-39 to assess participation goals and QOL. Participation goals were also evaluated with respect to age, time post-onset and aphasia severity. A total of 12 caregivers were administered the LIV Cards to calculate agreement between PWA-proxy activity reports and the relationship between agreement and QOL.

OUTCOMES & RESULTS

PWA endorsed wanting to participate more in a wide range of activities, with common interests in walking/running, going to the beach and eating out, among others. PWA-caregiver activity agreement was fair to moderate with point-to-point agreement averaging 70%. However, no relationship between degree of congruence in PWA-proxy pairs and QOL was found.

CONCLUSIONS & IMPLICATIONS

PWA have a variety of activity participation goals that can be integrated into intervention plans. Dependence on proxy respondents should be reduced as much as possible to support self-determination for PWA. What this paper adds What is already known on the subject Achieving activity participation goals is a key factor in QOL for PWA, but communicating about participation goals can be difficult for many of them. Because proxy reports by caregivers may not accurately reflect the interests and participation goals of PWA, this study examined how both PWA and their caregivers responded to an aphasia-friendly assessment for determining participation goals, and then compared level of agreement about these goals to QOL. Because activity participation is known to be an important factor in QOL, the reason for investigating how agreement relates to QOL is that caregivers' awareness of their loved ones' unique participation goals likely facilitates increased participation by PWA in their ongoing desired activities. The relationship between PWA-caregiver agreement regarding participation goals and QOL in PWA had not yet been investigated before this study. What this paper adds to existing knowledge This study adds additional as well as confirmatory information to the existing literature about life participation goals of community-dwelling individuals with chronic aphasia. Top activities endorsed by a group of 25 PWA are reported within four activity domains (home and community activities, creative and relaxing activities, physical activities, and social activities). Results indicated that agreement between PWA and their caregiver proxies on PWA's most desired activities was < 50%. However, the level of agreement between caregivers and proxies on participation goals was not significantly related to QOL in this sample. What are the potential or actual clinical implications of this work? PWA have a variety of participation goals that can be integrated into intervention plans to be carried out with clinicians, caregivers and family members. The use of proxy respondents when determining participation goals should be reduced as much as possible to support self-determination for PWA. Use of the LIV Cards, a picture-based sorting-task assessment, reduces the need for proxy responders and guesswork about the specific participation goals of PWA.

Evaluation of a Chemiluminescence Method for Measuring Alkaline Phosphatase Activity in WholeMilk of Multiple Species and Bovine Dairy Drinks: Interlaboratory Study

Alkaline phosphatase (ALP) is a ubiquitous enzyme in milk with timetemperature destruction similar to that of certain pathogens destroyed in pasteurization. Measurement of ALP to indicate proper pasteurization is a common practice. Recently the public health level for ALP was decreased to 350 mU/L, a level below the sensitivity of older colorimetric ALP methods. This study was conducted within the structure of the International Dairy Federation and the International Organization for Standardization to evaluate the reproducibility of the chemiluminescence method (Charm PasLite) for ALP at 50, 100, 350, and 500 mU/L in whole milk of multiple species to meet new regulations in the United States and proposed regulations in the European Union (EU). Fifteen laboratories from 8 countries evaluated bovine, goat, sheep, and buffalo milk, bovine skim milk, 20% fat cream, and 2% fat chocolate milk. At ALP levels of 350 and 500 mU/L, the average relative standard deviation for repeatability (RSDr) was 7.5%, and the average relative standard deviation of reproducibility was (RSDR) 15%. For ALP at 100 and 50 mU/L, the average RSDr values were 10.5 and 12.6%, respectively, and the average RSDR values were 18 and 25%, respectively. The limit of detection was 20 mU/L. Results are comparable to those obtained with other enzymatic photo-activated system methods such as the fluorometric method. Results indicate that the method is suitable for measuring ALP in the milk of multiple species and in dairy drinks at U.S. and proposed EU levels.

Influence of Environmental Factors on Social Participation Poststroke

Date Presented 04/06/19

This poster describes a study that examined the extent to which environmental factors affected participation in social activities for individuals at least six months poststroke. Results of the study provide OTs with a better understanding of important environmental factors to consider when addressing social participation after stroke and help to expand the focus of the rehabilitation literature beyond body functions and structures to participation in meaningful activities.

Primary Author and Speaker: Erin Foley

Additional Authors and Speakers: Lisa Connor

Contributing Authors: Marjorie Nicholas, Carolyn Baum

The Role of Fatigue in Limiting Cognitively and Physically Demanding Activities in Stroke Survivors

Date Presented 04/06/19

This study focused on the extent to which activity demands limit participation in high cognitively- and high physically-demanding activities. Various assessments of participation, fatigue, cognition, and motor ability were included. Results showed that perceived physical ability and cognitive ability were correlated with retention of these activities, but that fatigue had little effect. This study helps to better understand how activity demands relate of participation poststroke.

Primary Author and Speaker: Julianne Mitchell

Additional Authors and Speakers: Lisa Connor

Contributing Authors: Carolyn Baum, Marjorie Nicholas

A core outcome set for aphasia treatment research: The ROMA consensus statement

Background

A core outcome set (COS; an agreed, minimum set of outcomes) was needed to address the heterogeneous measurement of outcomes in aphasia treatment research and to facilitate the production of transparent, meaningful, and efficient outcome data.

Objective

The Research Outcome Measurement in Aphasia (ROMA) consensus statement provides evidence-based recommendations for the measurement of outcomes for adults with post-stroke aphasia within phases I–IV aphasia treatment studies.

Methods

This statement was informed by a four-year program of research, which comprised investigation of stakeholder-important outcomes using consensus processes, a scoping review of aphasia outcome measurement instruments, and an international consensus meeting. This paper provides an overview of this process and presents the results and recommendations arising from the international consensus meeting.

Results

Five essential outcome constructs were identified: Language, communication, patient-reported satisfaction with treatment and impact of treatment, emotional wellbeing, and quality of life. Consensus was reached for the following measurement instruments: Language: The Western Aphasia Battery Revised (WAB-R) (74% consensus); emotional wellbeing: General Health Questionnaire (GHQ)-12 (83% consensus); quality of life: Stroke and Aphasia Quality of Life Scale (SAQOL-39) (96% consensus). Consensus was unable to be reached for measures of communication (where multiple measures exist) or patient-reported satisfaction with treatment or impact of treatment (where no measures exist).

Discussion

Harmonization of the ROMA COS with other core outcome initiatives in stroke rehabilitation is discussed. Ongoing research and consensus processes are outlined.

Conclusion

The WAB-R, GHQ-12, and SAQOL-39 are recommended to be routinely included within phases I–IV aphasia treatment studies. This consensus statement has been endorsed by the Collaboration of Aphasia Trialists, the British Aphasiology Society, the German Society for Aphasia Research and Therapy, and the Royal College of Speech Language Therapists.

The psychological impact of traffic injuries sustained in a road crash by bicyclists: A prospective study

OBJECTIVE

The objective of this study was to investigate the psychological impact of traffic injuries in bicyclists (cyclists) in comparison to car occupants who also sustained traffic injuries. Factors predictive of elevated psychological distress were also investigated.

METHODS

An inception cohort prospective design was used. Participants included cyclists aged ≥17 years (mean age 41.7 years) who sustained a physical injury (n = 238) assessed within 28 days of the crash, following medical examination by a registered health care practitioner. Injury included musculoskeletal and soft tissue injuries and minor/moderate traumatic brain injury (TBI), excluding severe TBI, spinal cord injury, and severe multiple fractures. Assessment also occurred 6 months postinjury. Telephone-administered interviews assessed a suite of measures including sociodemographic, preinjury health and injury factors. Psychological impact was measured by pain catastrophization, trauma-related distress, and general psychological distress. The psychological health of the cyclists was compared to that of the car occupants (n = 234; mean age 43.1 years). A mixed model repeated measures analysis, adjusted for confounding factors, was used to determine differences between groups and regression analyses were used to determine contributors to psychological health in the cyclists 6 months postinjury.

RESULTS

Cyclists had significantly better psychological health (e.g., lower pain catastrophizing, lower rates of probable posttraumatic stress disorder [PTSD], and lower general distress levels) compared to car occupants at baseline and 6 months postinjury. Factors predictive of cyclists' psychological distress included younger age, greater perceived danger of death, poorer preinjury health, and greater amount of time in hospital after the injury.

CONCLUSIONS

These data provide insight into how cyclists perceive and adjust to their traffic injuries compared to drivers and passengers who sustain traffic injuries, as well as direction for preventing the development of severe psychological injury. Future research should examine the utility of predictors of psychological health to improve recovery.

Characterizing the Outcomes for Patients With Brain Injury in Acute Care Rehabilitation

Date Presented 4/16/2015

This study investigated the factors affecting functional outcomes in patients with brain injury, including the relationship between etiology, demographic variables, and recovery trajectory. It is critical to account for these factors to improve treatment interventions and discharge planning.

Modified Berg Balance Scale: making assessment appropriate for people with aphasia

OBJECTIVE

Modifying assessments for people with aphasia has the potential to increase the validity of healthcare assessments across professional domains. This pilot study addressed the challenges of giving people with aphasia the power to fully participate in the assessment process. The study aimed to investigate the feasibility of using an aphasia-modified version of the Berg Balance Scale (BBS), a physical therapy assessment tool to quantify dynamic sitting and standing balance.

METHOD

The study compared how people with aphasia performed on the original BBS to an aphasia-modified version (MBBS), created for this study. We examined the relationship between auditory comprehension scores and balance performance of 15 participants with chronic aphasia and three control participants. We tested the hypothesis that individuals with aphasia would perform higher on the MBBS rather than the BBS, thus more closely approaching a score reflective of their true physical abilities.

RESULTS

Overall people with aphasia performed significantly better on the MBBS than the BBS, indicating that at least some portion of their performance difficulty was likely due to poor auditory comprehension of test instructions rather than true balance difficulty.

CONCLUSION

Implications of this study suggest that modifying assessments, such as the BBS, by reducing linguistic complexity and adding visual and written cues along with modeling and repetition has the potential to increase the validity of healthcare assessments for individuals with aphasia.

Presence and predictors of persistent pain among persons who sustained an injury in a road traffic crash

BACKGROUND

There is a paucity of prospective studies with long follow-up that have examined a wide range of correlates associated with persistent pain outcomes in persons who sustained a mild or moderate injury in a road traffic crash. This study aimed to establish the independent predictors of pain severity over 24 months.

METHODS

A total of 364, 284 and 252 persons with mild/moderate musculoskeletal injuries sustained in a vehicle-related crash participated in telephone interviews in the subacute phase, and at 12 and 24 months, respectively. The numeric rating scale (NRS) assessed pain severity. Pain-Related Self-Statements Scale-Catastrophizing (PRSS-Catastrophizing) and the Short Form Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) were also administered.

RESULTS

After multivariable adjustment, each 1 SD increase in Short Form-12 Physical Component Score (SF-12 PCS) in the subacute phase was associated with 0.73 (p = 0.002) and 1.11 (p < 0.0001) decrease in NRS scores after 12 and 24 months, respectively. Each unit increase in the PRSS-Catastrophizing score in the subacute phase was associated with 0.54 (p = 0.001) and 0.43 (p = 0.03) increase in NRS scores 12 and 24 months later, respectively. Subacute phase OMPSQ scores were positively associated with NRS scores at 12- and 24-month follow-ups (p < 0.0001).

CONCLUSIONS

Self-perceived physical well-being, pain-related work disability and pain catastrophizing could play a role in determining long-term pain-related outcomes following traffic-related injuries.

A MEG investigation of single-word auditory comprehension in aphasia

PURPOSE

To explore whether individuals with aphasia exhibit differences in the M350, an electrophysiological marker of lexical activation, compared with healthy controls.

METHOD

Seven people with aphasia, 9 age-matched controls, and 10 younger controls completed an auditory lexical decision task while cortical activity was recorded with magnetoencephalography. There were 2 stimulus conditions of interest: identity primed (i.e., a word preceded by itself) and semantic primed (i.e., a word preceded by a semantically related word). Latency and amplitude of the M350 response as well as reaction time were measured.

RESULTS

Consistent with the age-matched control group, the group with aphasia showed both identity and semantic priming behaviorally. In contrast to the control groups, the group with aphasia did not show either semantic or identity priming of the M350 response. This group also demonstrated longer M350 latencies than either control group. Furthermore, within this group, M350 latency was positively correlated with a measure of semantic impairment.

CONCLUSIONS

These findings highlight the usefulness of temporally sensitive measures when studying aphasia and demonstrate that the latency of electrophysiological markers is of interest in this population. In particular, increased M350 latency appears to be indicative of a semantic processing impairment.

TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia

This study sought to discover if an optimum 1 cm(2) area in the non-damaged right hemisphere (RH) was present, which could temporarily improve naming in chronic, nonfluent aphasia patients when suppressed with repetitive transcranial magnetic stimulation (rTMS). Ten minutes of slow, 1Hz rTMS was applied to suppress different RH ROIs in eight aphasia cases. Picture naming and response time (RT) were examined before, and immediately after rTMS. In aphasia patients, suppression of right pars triangularis (PTr) led to significant increase in pictures named, and significant decrease in RT. Suppression of right pars opercularis (POp), however, led to significant increase in RT, but no change in number of pictures named. Eight normals named all pictures correctly; similar to aphasia patients, RT significantly decreased following rTMS to suppress right PTr, versus right POp. Differential effects following suppression of right PTr versus right POp suggest different functional roles for these regions.

C-Speak Aphasia alternative communication program for people with severe aphasia: importance of executive functioning and semantic knowledge

Learning how to use a computer-based communication system can be challenging for people with severe aphasia even if the system is not word-based. This study explored cognitive and linguistic factors relative to how they affected individual patients' ability to communicate expressively using C-Speak Aphasia (CSA), an alternative communication computer program that is primarily picture-based. Ten individuals with severe non-fluent aphasia received at least six months of training with CSA. To assess carryover of training, untrained functional communication tasks (i.e., answering autobiographical questions, describing pictures, making telephone calls, describing a short video, and two writing tasks) were repeatedly probed in two conditions: (1) using CSA in addition to natural forms of communication, and (2) using only natural forms of communication, e.g., speaking, writing, gesturing, drawing. Four of the 10 participants communicated more information on selected probe tasks using CSA than they did without the computer. Response to treatment was also examined in relation to baseline measures of non-linguistic executive function skills, pictorial semantic abilities, and auditory comprehension. Only nonlinguistic executive function skills were significantly correlated with treatment response.

Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS

Two chronic, nonfluent aphasia patients participated in overt naming fMRI scans, pre- and post-a series of repetitive transcranial magnetic stimulation (rTMS) treatments as part of a TMS study to improve naming. Each patient received 10, 1-Hz rTMS treatments to suppress a part of R pars triangularis. P1 was a 'good responder' with improved naming and phrase length; P2 was a 'poor responder' without improved naming. Pre-TMS (10 years poststroke), P1 had significant activation in R and L sensorimotor cortex, R IFG, and in both L and R SMA during overt naming fMRI (28% pictures named). At 3 mo. post-TMS (42% named), P1 showed continued activation in R and L sensorimotor cortex, R IFG, and in R and L SMA. At 16 mo. post-TMS (58% named), he also showed significant activation in R and L sensorimotor cortex mouth and R IFG. He now showed a significant increase in activation in the L SMA compared to pre-TMS and at 3 mo. post-TMS (p < .02; p < .05, respectively). At 16 mo. there was also greater activation in L than R SMA (p < .08). At 46 mo. post-TMS (42% named), this new LH pattern of activation continued. He improved on the Boston Naming Test from 11 pictures named pre-TMS, to scores ranging from 14 to 18 pictures, post-TMS (2-43 mo. post-TMS). His longest phrase length (Cookie Theft picture) improved from three words pre-TMS, to 5-6 words post-TMS. Pre-TMS (1.5 years poststroke), P2 had significant activation in R IFG (3% pictures named). At 3 and 6 mo. post-TMS, there was no longer significant activation in R IFG, but significant activation was present in R sensorimotor cortex. On all three fMRI scans, P2 had significant activation in both the L and R SMA. There was no new, lasting perilesional LH activation across sessions for this patient. Over time, there was little or no change in his activation. His naming remained only at 1-2 pictures during all three fMRI scans. His BNT score and longest phrase length remained at one word, post-TMS. Lesion site may play a role in each patient's fMRI activation pattern and response to TMS treatment. P2, the poor responder, had an atypical frontal lesion in the L motor and premotor cortex that extended high, near brain vertex, with deep white matter lesion near L SMA. P2 also had frontal lesion in the posterior middle frontal gyrus, an area important for naming (Duffau et al., 2003); P1 did not. Additionally, P2 had lesion inferior and posterior to Wernicke's area, in parts of BA 21 and 37, whereas P1 did not. The fMRI data of our patient who had good response following TMS support the notion that restoration of the LH language network is linked in part, to better recovery of naming and phrase length in nonfluent aphasia.

A fatal case of Lassa fever in London, January 2009

In January 2009, the eleventh case of Lassa fever imported to the United Kingdom was diagnosed in London. Risk assessment of 328 healthcare contacts with potential direct exposure to Lassa virus - through contact with the case or exposure to bodily fluids - was undertaken. No contacts were assessed to be at high risk of infection and no secondary clinical cases identified.

A fatal case of Lassa fever in London, January 2009

In January 2009, the eleventh [corrected] case of Lassa fever imported to the United Kingdom was diagnosed in London. Risk assessment of 328 healthcare contacts with potential direct exposure to Lassa virus - through contact with the case or exposure to bodily fluids - was undertaken. No contacts were assessed to be at high risk of infection and no secondary clinical cases identified.

The agistment market in the northern Australian rangelands: failings and opportunities

Agistment is the practice of temporarily moving stock between properties, and is used by pastoralists both to strategically develop their enterprises and as a response to environmental heterogeneities such as variation in rainfall. This paper considers the agistment market in the northern Australian rangelands using the ‘market failure framework’. This form of economic analysis identifies failings in a market, thus, provides a rigorous basis for designing interventions intended to improve market performance. Drawing on interviews with pastoralists from the Dalrymple Shire in Queensland we conclude that, although agistment is widely used, there are several failings in the existing market which are likely to result in overall agistment activity being far less than optimal. The market failure analysis indicates that key issues relate to the lack of a common marketplace, asymmetric information on the characteristics of the other party in an agreement, and a lack of mutual expectations at the outset. Innovations with the potential to overcome these failings, while minimising the transaction costs involved in entering an agistment agreement, are discussed.

Language rehabilitation in chronic aphasia and time postonset: a review of single-subject data

BACKGROUND AND PURPOSE

This article is a comprehensive review of aphasia treatment studies for the purpose of investigating the relationship between time postonset of aphasia and response to treatment for aphasia in chronic patients at >/=1 year after symptom onset.

METHODS

Studies that demonstrated treatment response (defined as a measurable change in task performance compared with a control task performance) through the use of single-subject design methodologies on measures of verbal output or auditory comprehension were selected. Individual subject data were extracted from the 23 studies that met criteria identifying the subjects as those who received direct continuous therapy for spoken language deficits and whose changes in response to therapy were measurable. Percent of maximum possible change was used as a measurement of outcome.

RESULTS

Nonparametric correlation statistics (Spearman rho) and comparisons of group means (Kruskal-Wallis) were used to compare the relationship between time postonset and improvement. Time postonset at which treatment was initiated did not correlate with response to treatment. No significant differences in response to treatment were found between groups of patients according to times postonset.

CONCLUSIONS

Time postonset is not related to response to treatment for aphasia in patients >1 year postonset of aphasia.

Improved naming after TMS treatments in a chronic, global aphasia patient--case report

We report improved ability to name pictures at 2 and 8 months after repetitive transcranial magnetic stimulation (rTMS) treatments to the pars triangularis portion of right Broca's homologue in a 57 year-old woman with severe nonfluent/global aphasia (6.5 years post left basal ganglia bleed, subcortical lesion). TMS was applied at 1 Hz, 20 minutes a day, 10 days, over a two-week period. She received no speech therapy during the study. One year after her TMS treatments, she entered speech therapy with continued improvement. TMS may have modulated activity in the remaining left and right hemisphere neural network for naming.

Improved picture naming in chronic aphasia after TMS to part of right Broca's area: an open-protocol study

Functional imaging studies with nonfluent aphasia patients have observed "over-activation" in right (R) language homologues. This may represent a maladaptive strategy; suppression may result in language improvement. We applied slow, 1 Hz repetitive transcranial magnetic stimulation (rTMS) to an anterior portion of R Broca's homologue daily, for 10 days in four aphasia patients who were 5-11 years poststroke. Significant improvement was observed in picture naming at 2 months post-rTMS, with lasting benefit at 8 months in three patients. This preliminary, open trial suggests that rTMS may provide a novel treatment approach for aphasia by possibly modulating the distributed, bi-hemispheric language network.

Overt propositional speech in chronic nonfluent aphasia studied with the dynamic susceptibility contrast fMRI method

This study examined activation levels in the left (L) supplementary motor area (SMA) and the right (R) SMA (separately), and activation in nine R perisylvian language homologues during overt, propositional speech in chronic nonfluent aphasia patients. Previous functional imaging studies with a variety of chronic aphasia patients have reported activation in these regions during different language tasks, however, overt propositional speech has not been examined. In the present research, four nonfluent aphasia patients were studied during overt elicited propositional speech at 4-9 years post-single L hemisphere stroke, which spared the SMA. The dynamic susceptibility contrast (DSC) method of functional MRI was used to calculate relative cerebral blood volume (relCBV) for cortical regions of interest (ROIs) during the first-pass bolus of gadolinium during two conditions: (1) pattern (silent viewing of checkerboard patterns) and (2) story (overt, elicited propositional speech describing sequential pictures, which formed a story). During the story condition, controls had significantly higher relCBV in L SMA than in R SMA; aphasics, however, had significantly higher relCBV in R SMA than in L SMA. During the pattern condition, no significant differences were observed between the L SMA and the R SMA for either controls or aphasics. In addition, aphasics had significantly higher relCBV in the R sensorimotor mouth during story than pattern. This R sensorimotor mouth relCBV was also significantly higher in aphasics than controls during story, and the two groups did not differ during pattern. The overall mean relCBV for the nine R perisylvian ROIs was significantly higher for aphasics than controls during both story and pattern. These results suggest that poor modulation, including possible over-activation of R sensorimotor mouth and other R perisylvian language homologues may underlie in part, the hesitant, poorly articulated, agrammatic speech associated with nonfluent aphasia.

Transcranial Magnetic Stimulation as a Complementary Treatment for Aphasia

Functional brain imaging with nonfluent aphasia patients has shown increased cortical activation (perhaps "overactivation") in right (R) hemisphere language homologues. These areas of overactivation may represent a maladaptive strategy that interferes with, rather than promotes, aphasia recovery. Repetitive transcranial magnetic stimulation (rTMS) is a painless, noninvasive procedure that utilizes magnetic fields to create electric currents in discrete brain areas affecting about a 1-cm square area of cortex. Slow frequency, 1 Hz rTMS reduces cortical excitability. When rTMS is applied to an appropriate cortical region, it may suppress the possible overactivation and thus modulate a distributed neural network for language. We provide information on rTMS and report preliminary results following rTMS application to R Broca's area (posterior, R pars triangularis) in four stroke patients with nonfluent aphasia (5-11 years after left hemisphere stroke). Following 10 rTMS treatments, significant improvement in naming pictures was observed. This form of rTMS may provide a novel, complementary treatment for aphasia.

The matched-phase coherent multi-frequency matched-field processor

Coherent multi-frequency matched-field processing is investigated using a matched-phase coherent matched-field processor. Its main difference from previous coherent processors is that the relative phases of the Fourier components contained within the recorded signal are not assumed to be known a priori. Rather they are considered free parameters that can be determined using a global functional minimization algorithm. Additionally, this processor uses only the cross-frequency terms, making it less susceptible to the detrimental effects of ambient noise; in one example, this processor shows a five decibel improvement over a similar coherent processor. Along with its increased sensitivity with respect to the broadcast source levels, this coherent processor exhibits superior range resolution as compared with multi-frequency incoherent processors, due to the cross-frequency interference of the vertical eigenmodes. Within this work we explore the efficacy of the algorithms used to determine the relative phases along with the performance of the matched-phase coherent processor itself, performed within the context of data collected during an event from the SWellEx-96 experiment. Performance comparisons between this processor, an incoherent processor, and another coherent processor are demonstrated using this data set.

Collective oscillations of fresh and salt water bubble plumes

Bubble plumes of various void fractions and sizes were produced by varying the flow velocity of a water jet impinging normally on a water surface. The bubbles entrained at the surface were carried downwards by the fluid flow to depths ranging from 33 to 65 cm, and formed roughly cylindrical plumes with diameters ranging from 12 to 27 cm. The acoustic emissions from the plumes were recorded onto digital audio tape using a hydrophone placed outside the cloud at distances ranging from 50 cm to 16.0 m. Closeup video images of the individual bubbles within the plume were also taken in order to gain knowledge of the bubble size distributions. The experiments were performed in both fresh-water and salt-water environments. The fresh-water clouds emitted sounds with a modal structure that was significantly different from that produced by the salt-water clouds. Furthermore, the smaller bubbles present in the salt-water clouds have a fundamental effect on the amplification of turbulence noise, generating sound at significant levels for frequencies up to several hundred Hertz.

Advantages of heterogeneous therapy groups in the psychotherapy of the traumatically abused: treating the problem as well as the person

The authors combine a social-constructionist perspective with a psychodynamic one in discussing the problem of trauma and its treatment. They argue that effective treatment of traumatic physical, sexual, and psychological abuse must do more than alleviate the pain of the sufferer. Factors that cause and perpetuate abuse must be addressed by the abused person in conjunction with other nontraumatized persons who may have been abusive or passive in the face of abuse. An argument is made for heterogeneous therapy groups as a context for this to occur.