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      Individualized response to semantic versus phonological aphasia therapies in stroke


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          Attempts to personalize aphasia treatment to the extent where it is possible to reliably predict individual response to a particular treatment have yielded inconclusive results. The current study aimed to (i) compare the effects of phonologically versus semantically focussed naming treatment and (ii) examine biographical and neuropsychological baseline factors predictive of response to each treatment. One hundred and four individuals with chronic post-stroke aphasia underwent 3 weeks of phonologically focussed treatment and 3 weeks of semantically focussed treatment in an unblinded cross-over design. A linear mixed-effects model was used to compare the effects of treatment type on proportional change in correct naming across groups. Correlational analysis and stepwise regression models were used to examine biographical and neuropsychological predictors of response to phonological and semantic treatment across all participants. Last, chi-square tests were used to explore the association between treatment response and phonological and semantic deficit profiles. Semantically focussed treatment was found to be more effective at the group-level, independently of treatment order ( P = 0.041). Overall, milder speech and language impairment predicted good response to semantic treatment ( r range: 0.256–0.373) across neuropsychological tasks. The Western Aphasia Battery-Revised Spontaneous Speech score emerged as the strongest predictor of semantic treatment response ( R 2 = 0.188). Severity of stroke symptoms emerged as the strongest predictor of phonological treatment response ( R 2 = 0.103). Participants who showed a good response to semantic treatment were more likely to present with fluent speech compared to poor responders ( P = 0.005), whereas participants who showed a good response to phonological treatment were more likely to present with apraxia of speech ( P = 0.020). These results suggest that semantic treatment may be more beneficial to the improvement of naming performance in aphasia than phonological treatment, at the group-level. In terms of personalized predictors, participants with relatively mild impairments and fluent speech responded better to semantic treatment, while phonological treatment benefitted participants with more severe impairments and apraxia of speech.


          Kristinsson et al. found superior effects of semantic versus phonological therapy in a group of 104 participants with chronic aphasia. Personalized predictors of semantic therapy response included mild language impairment and fluent speech, whereas more severe language impairment and presence of apraxia of speech predicted response to phonological therapy.

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          Measurements of acute cerebral infarction: a clinical examination scale.

          We designed a 15-item neurologic examination stroke scale for use in acute stroke therapy trials. In a study of 24 stroke patients, interrater reliability for the scale was found to be high (mean kappa = 0.69), and test-retest reliability was also high (mean kappa = 0.66-0.77). Test-retest reliability did not differ significantly among a neurologist, a neurology house officer, a neurology nurse, or an emergency department nurse. The stroke scale validity was assessed by comparing the scale scores obtained prospectively on 65 acute stroke patients to the patients' infarction size as measured by computed tomography scan at 1 week and to the patients' clinical outcome as determined at 3 months. These correlations (scale-lesion size r = 0.68, scale-outcome r = 0.79) suggested acceptable examination and scale validity. Of the 15 test items, the most interrater reliable item (pupillary response) had low validity. Less reliable items such as upper or lower extremity motor function were more valid. We discuss methods for improving the reliability and validity of brief examination scales to be used in stroke therapy trials.
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            Speech and language therapy for aphasia following stroke.

            Aphasia is an acquired language impairment following brain damage that affects some or all language modalities: expression and understanding of speech, reading, and writing. Approximately one third of people who have a stroke experience aphasia.
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              Aphasia in acute stroke: incidence, determinants, and recovery.

              Knowledge of the frequency and remission of aphasia is essential for the rehabilitation of stroke patients and provides insight into the brain organization of language. We studied prospectively and consecutively an unselected and community-based sample of 881 patients with acute stroke. Assessment of aphasia was done at admission, weekly during the hospital stay, and at a 6-month follow-up using the aphasia score of the Scandinavian Stroke Scale. Thirty-eight percent had aphasia at the time of admission; at discharge 18% had aphasia. Sex was not a determinant of aphasia in stroke, and no sex difference in the anterior-posterior distribution of lesions was found. The remission curve was steep: Stationary language function in 95% was reached within 2 weeks in those with initial mild aphasia, within 6 weeks in those with moderate, and within 10 weeks in those with severe aphasia. A valid prognosis of aphasia could be made within 1 to 4 weeks after the stroke depending on the initial severity of aphasia. Initial severity of aphasia was the only clinically relevant predictor of aphasia outcome. Sex, handedness, and side of stroke lesion were not independent outcome predictors, and the influence of age was minimal.

                Author and article information

                Brain Commun
                Brain Commun
                Brain Communications
                Oxford University Press
                05 August 2021
                05 August 2021
                : 3
                : 3
                : fcab174
                [1 ]Department of Communication Sciences and Disorders, University of South Carolina , Columbia, SC 29208, USA
                [2 ]Center for the Study of Aphasia Recovery, University of South Carolina , Columbia, SC 29208, USA
                [3 ]Department of Public Health Sciences, Medical University of South Carolina , Charleston, SC 29425, USA
                [4 ]Department of Neurology, Medical University of South Carolina , Charleston, SC 29425, USA
                [5 ]Department of Psychology, University of South Carolina , Columbia, SC 29208, USA
                [6 ]Department of Neurology, University of South Carolina , Columbia, SC 29208, USA
                [7 ]Department of Neurology and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine , Baltimore, MD 21218, USA
                [8 ]Department of Cognitive Science, Johns Hopkins University , Baltimore, MD 21218, USA
                [9 ]Department of Cognitive Sciences and Language Science, University of California , Irvine, CA 92697, USA
                Author notes
                Correspondence to: Sigfus Kristinsson, MSc SLP Department of Communication Sciences and Disorders, University of South Carolina 915 Greene Street, Columbia, SC 29209, USA E-mail: sigfus@ 123456email.sc.edu
                Author information
                © The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 13 January 2021
                : 23 April 2021
                : 28 May 2021
                : 17 August 2021
                Page count
                Pages: 18
                Funded by: The National Institute on Deafness and Other Communication Disorders, DOI 10.13039/100000055;
                Award ID: P50 DC014664
                Original Article

                stroke,aphasia,aphasia therapy,phonological therapy,semantic therapy


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