Friday, September 26, 2008

Musicophilia by Dr. Sacks

Monday, September 1, 2008


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Saturday, June 28, 2008

National Aphasia Association

NEW YORK, June 17 /PRNewswire-USNewswire/ -- In recognition of the urgent
need for more public awareness about aphasia Senate Resolution 566 (sponsored
by Senator Tim Johnson, D-SD) and House Resolution 1188 (sponsored by
Representative Edward Markey, D-Mass), declare June as National Aphasia
Awareness Month. Aphasia is the sudden inability to communicate, speak, read,
write or understand language, usually as a result of stroke or traumatic brain
injury. It is estimated that over 1 million Americans have aphasia, and the
number of new aphasia cases is estimated to be as high as over 200,000 per

"I was proud to introduce a resolution recognizing National Aphasia
Awareness Month, which passed the Senate unanimously. During my recovery, I
was blessed to work with professional and talented speech-language
pathologists whose confidence was infectious and who motivated me to work
harder than I thought possible," said Sen. Johnson, who suffered the effects
of an arterio-venous malformation (AVM) in December 2006 and also credits the
love and support of his wife, family and friends for making an important
difference in his recovery.

According to National Aphasia Association Executive Director Ellayne
Ganzfried, "there is no cure for aphasia, but speech-language therapy and
constant social interaction is essential for recovery and maintaining a
meaningful life. Because of their difficulty in communicating, over 70% of
people with aphasia report that people avoided contact with them and 90
percent felt isolated, left out, ignored and lonely. This isolation, coupled
with the fact that intellect remains intact, makes depression another serious
result of aphasia."

Representative Edward Markey, whose resolution is expected to get
unanimous support, says, "Aphasia is a 'silent' disability because it quiets
people and causes them to withdraw from life. My hope is that National Aphasia
Awareness Month will help give a voice to people with aphasia so that their
needs and concerns can be heard. Aphasia is a condition that has affected a
number of my friends and colleagues, so I know from personal experience it is
an issue that deserves a lot of acknowledgement and attention."

"Aphasia is more common than cerebral palsy, muscular dystrophy, spinal
cord injuries, multiple sclerosis or Parkinson's disease, yet it is relatively
unknown by the general public," says Ganzfried, who is grateful to Sen.
Johnson, Rep. Markey and other legislators for helping to raise awareness for

"Among those who have heard of aphasia, there are serious misconceptions
about the mental condition of people with aphasia. We are trying to make it
absolutely clear that aphasia does not affect a person's intellect. Aphasia
does not make someone mentally ill. It only challenges their ability to
communicate," explains Ganzfried. To further help raise awareness, the Sixth
National NAA Conference -- Speaking Out! 2008 -- will be held June 19-21, 2008
at NYU's Kimmel Center. The conference brings together medical/rehabilitation
professionals, people with aphasia, family members, caregivers and the general

Aphasia can occur in people of all ages, nationalities, socio-economic
backgrounds and equally among men and women. Understanding, patience and a few
commonsense strategies will help family, friends, caregivers and the public
communicate with people with aphasia:

1) Have the person's attention before you speak.
2) Minimize or eliminate background noise (TV, radio, other people).
3) Keep your own voice at a normal level.
4) Keep communication simple, but adult.
5) Give them time to speak, resist the urge to finish sentences or offer
6) Communicate with drawings, gestures, writing and facial expressions.
7) Confirm that you are communicating successfully with "yes" and "no"
8) Praise all attempts to speak and downplay any errors.
9) Engage in normal activities whenever possible.
10) Encourage independence, avoid being overprotective.

National Aphasia Association

NAA is a consumer-focused, not-for-profit organization that was founded in
1987 as the first national organization dedicated to advocating for persons
with aphasia and their families. Resources include:

The Aphasia Quiz on

NAA Hotline (800-922-4622) helps over 4,000 families a year.

NAA National Registry links to over 440 aphasia US support groups and 210
state representatives. receives over 9,000 hits per month, helping an estimated
100,000 families a year.

The Aphasia Handbook: A Guide for Stroke and Brain Injury Survivors and
Their Families -- with its simple, illustrated design and practical,
non-technical content -- this award-winning, internationally acclaimed book is
a user-friendly, easy-to-understand resource.

Speaking in Gibberish and Writing Constantly

10 June 2008

This article in Scientic American hints at some potential health-related impacts of blogging (all positive by the way). According to the article:

expressive writing produces many physiological benefits. Research shows that it improves memory and sleep, boosts immune cell activity and reduces viral load in AIDS patients, and even speeds healing after surgery.

Now, I’m not certain how “expressive” an article about VBA and VSTO can be… so it may not be helping me much at all, but it may help YOU to sleep.

Of course it may be possible to take a contrary view and suggest that people actually blog because they are ill. The article in describing the physiology of the brain related to writing suggest that the temporal lobes (which govern speech) may be involved as well. Then as proof cites Wernicke’s aphasia which appears to be rooted in the temporal lobes:

People with Wernicke’s aphasia speak in gibberish and often write constantly. In light of these traits, Flaherty speculates that some activity in this area could foster the urge to blog.

Uh huh, gibberish, constant writing, bloggers… all cut from the same cloth.

Relationships between behavior, brainstem and cortical encoding of seen and heard speech in musicians and non-musicians

from Hearing Research

Musicians have a variety of perceptual and cortical specializations compared to non-musicians. Recent studies have shown that potentials evoked from primarily brainstem structures are enhanced in musicians, compared to non-musicians. Specifically, musicians have more robust representations of pitch periodicity and faster neural timing to sound onset when listening to sounds or both listening to and viewing a speaker. However, it is not known whether musician-related enhancements at the subcortical level are correlated with specializations in the cortex. Does musical training shape the auditory system in a coordinated manner or in disparate ways at cortical and subcortical levels? To answer this question, we recorded simultaneous brainstem and cortical evoked responses in musician and non-musician subjects. Brainstem response periodicity was related to early cortical response timing across all subjects, and this relationship was stronger in musicians. Peaks of the brainstem response evoked by sound onset and timbre cues were also related to cortical timing. Neurophysiological measures at both levels correlated with musical skill scores across all subjects. In addition, brainstem and cortical measures correlated with the age musicians began their training and the years of musical practice. Taken together, these data imply that neural representations of pitch, timing and timbre cues and cortical response timing are shaped in a coordinated manner, and indicate corticofugal modulation of subcortical afferent circuitry.

Saturday, May 10, 2008


Babbel: Help Me, Help You Learn A New Language

babbel_logo.pngForeign languages are hard. There’s no shortage of expensive books and systems claiming to teach you how to gab like a native in only a few short lessons. But traditional methods don’t work for most people as well real world experience and continuous practice.

A young German startup is helping language students get that practice and experience through their new language learning community called Babbel. Babbel is an Adobe Flex application that combines a social network with a series of language learning tools for English, German, Spanish, Italian, and French. The language learning tools are currently fairly basic and come in the form of vocabulary quizzes that test you on words by matching a word’s sounds and spelling with pictures. The site tracks your progress and reminds you to continue training on new sets. Babbel leverages the social network by letting users message each other and work on forming lessons together. In the future you’ll be able to chat with each other as well. xLingo and LiveMocha are other language learning communities focused on matching up foreign language students...............

Sunday, March 16, 2008

Conceptualizing Functional Cognition in Stroke

Background. Up to 65% of individuals demonstrate poststroke cognitive impairments, which may increase hospital stay and caregiver burden. Randomized stroke clinical trials have emphasized physical recovery over cognition. Neuropsychological assessments have had limited utility in randomized clinical trials. These issues accentuate the need for a measure of functional cognition (the ability to accomplish everyday activities that rely on cognitive abilities, such as locating keys, conveying information, or planning activities). Objective. The aim of the study was to present the process used to establish domains of functional cognition for development of computer adaptive measure of functional cognition for stroke. Methods. Functional cognitive domains involved in identifying relevant neuropsychological constructs from the literature were conceptualized and finalized after advisory panel feedback from experts in neurology, neuropsychology, aphasiology, clinical trials

Saturday, March 15, 2008

Alexia and agraphia

Contrasting perspectives of J.-M. Charcot and J. Hughlings Jackson

Victor W. Henderson, MD, MS

From the Departments of Health Research and Policy (Epidemiology) and Neurology and Neurological Sciences, Stanford University, CA.

Address correspondence and reprint requests to Dr. Victor Henderson, Stanford University, 259 Campus Drive, mc 5405, Stanford, CA 94305-5405

Objective: To evaluate 19th-century concepts of cerebral localization for complex mental activities, focusing on alexia and agraphia in published writings of Jean-Martin Charcot (1825–1893) and John Hughlings Jackson (1835–1911).

Brain Tumor (Primary

--An expanding, intracranial lesion that may be either benign or malignant. However, since both types can be lethal if inaccessible or left untreated, and since malignant tumors rarely metastasize beyond the central nervous system, the distinction serves mainly to describe the rate of growth and invasiveness. Tumors are divided into six classes, according to their origin: (1) skull, (2) meninges, (3) cranial nerves, (4) neuroglia, (5) pituitary/pineal body, and (6) congenital.

Right hemisphere activation in recovery from aphasia

Lesion effect or function recruitment?

G. Raboyeau, PhD, X. De Boissezon, MD, PhD, N. Marie, MD, S. Balduyck, MD, M. Puel, MD, C. Bézy, BA, J. F. Démonet, MD, PhD and D. Cardebat, PhD

From Pôle Neurosciences CHU Toulouse (G.R., X.D.B., N.M., M.P., C.B., J.F.D., D.C.), Inserm UMR S825, IFR 96, Universités de Toulouse; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (G.R.), Canada; and PET Center (S.B.), Purpan Hospital, Toulouse, France.

Address correspondence and reprint requests to Dr. G. Raboyeau, 4545 Chemin, Queen Mary Montréal (Québec) H3W 1W5, Canada

Background: Some neuroimaging studies have suggested that specific right hemispheric regions can compensate deficits induced by left hemispheric lesions in vascular aphasia. In particular, the right inferior frontal cortex might take part in lexical retrieval in patients presenting left-sided lesions involving the homologous area.

Objective: To address whether the involvement of the right inferior frontal cortex is either unique to recovering aphasic patients or present also in other circumstances of enrichment of lexical abilities, i.e., in non–brain-damaged subjects over learning of new vocabulary.

Long-Term Care

The number of older Americans is expected to rise from nearly 36 million in 2003 to an estimated 71.5 million in 2030, according to the Administration on Aging. One in four of us will need long-term care support some time in our lives. Therefore, the need for speech-language pathologists in the long-term care industry is expected to continue to grow.

Speech-language pathology in the long-term care setting has evolved considerably over the years. While nursing homes once were the only choice for the elderly, a variety of options now is available, such as subacute care, long-term care, assisted living and home health.

Furthermore, with the implementation of the Omnibus Reconciliation Act of 1987 (OBRA), the level of services in long-term care facilities has expanded dramatically. The regulations mandate that residents be maintained at their highest functional level and quality of life.

The speech-language pathologist is a vital part of the interdisciplinary team that determines the appropriate plan of care for each resident in long-term care. Other team members may include the resident and family, physicians, nurses, dietitians, physical and occupational therapists, and social service and recreational personnel.

Speech-language pathologists consult with team members and make recommendations regarding a resident's ability to communicate, including expressive and receptive language skills, cognitive-linguistic skills, voice and fluency.

More frequently, though, they are a critical part of the care planning process regarding the person's nutritional status, especially when dysphagia is present. Their recommendations focus not only on enhancing the communication and nutritional status of a resident but on the individual's quality of life.

Intervention begins with screening, a hands-off process that does not require a physician's order. A screen, which determines whether an assessment is warranted, includes a thorough review of the medical chart; interviews with staff, resident and family; and observation of the resident. If further assessment is needed, physician's orders should be obtained for a complete evaluation.

Evaluations should be comprehensive to ensure that all aspects of a resident's abilities and impairments are considered when developing a plan of care. The care plan should focus on what the resident wishes to achieve and be designed with success in mind.

Sunday, March 9, 2008

Speech therapy and feeding...geriatrics...occupational therapy...

We recently had a speech therapist who works at a local rehab hospital come in to talk to us about speech therapy and geriatrics. She talked about (and all the following is just my own, possibly wrong, understanding) how there are three major domains - cognition, communication, and dysphagia.

Cognition - a lot of overlap with OT
Communication - verbal expression, comprehension, voice, etc
Dysphagia - swallowing issues

Some of the cool things we learned

Neuropsychology Abstract of the Day: Aphasia

Baldo JV, Klostermann EC, & Dronkers NF. It's either a cook or a baker: Patients with conduction aphasia get the gist but lose the trace. Brain and Language. 2008 Feb 1 [Epub ahead of print]

VA Northern California Health Care System, Center for Aphasia and Related Disorders, 150 Muir Road (126s), Martinez, CA 94553, USA.

Patients with conduction aphasia have been characterized as having a short-term memory deficit that leads to relative difficulty on span and repetition tasks. It has also been observed that these same patients often get the gist of what is said to them, even if they are unable to repeat the information verbatim. To study this phenomenon experimentally, patients with conduction aphasia and left hemisphere-injured controls were tested on a repetition recognition task that required them to listen to a sentence and immediately point to one of three sentences that matched it. On some trials, the distractor sentences contained substituted words that were semantically-related to the target, and on other trials, the distractor sentences contained semantically-distinct words. Patients with conduction aphasia and controls performed well on the latter condition, when distractors were semantically-distinct. However, when the distractor sentences were semantically-related, the patients with conduction aphasia were impaired at identifying the target sentence, suggesting that these patients could not rely on the verbatim trace. To further understand these results, we also tested elderly controls on the same task, except that a delay was introduced between study and test. Like the patients with conduction aphasia, the elderly controls were worse at identifying target sentences when there were semantically-related distractors. Taken together, these results suggest that patients with conduction aphasia rely on non-phonologic cues, such as lexical-semantics, to support their short-term memory, just as normal participants must do in long-term memory tasks when the phonological trace is no longer present.


tDCS and aphasia after stroke

One of the most common effects of a stroke is aphasia or the loss of the ability to comprehend and/or produce language. This accounts for much of the morbidity related to strokes.
In a study published by a group in Italy there is some convincing evidence that using tDCS can improve a naming task by 33% +/- 13%. This means that patients could demonstrate twenty to almost fifty percent improvement in naming. When you translate this into real-world recovery from stroke, the results are impressive.

Thursday, January 17, 2008

Aphasia, Apraxia and Scotoma

In a recent posting in the migraine community, someone discussed experiencing Aphasia and Apraxia during migraines. I experience those during most moderate to severe migraines, as well as sensitivity to light and sound (in general I always have a low tolerance to light and sound), along with the normal pain, etc, etc. . I feel like the pain with migraines is the easiest to deal with. But not being able to "find words" in your brain and communicate like normal or pronounce words correctly etc. is devastating. I can often not do a simple addition problem during an attack. The sensitivity to light is a very tough one too because the light is blinding and your vision can literally change. The difference between a migraine and a normal headache is a migraine is absolutely debilitating and really is not so much about the overall pain, but is more like a mini stroke. Also, it can be life threatening when you look at the link between stroke and migraine. From what I have seen, even some cardiologists sometimes have a difficult time differentiating between a TIA and a bad migraine.

I also included the link for Scotoma, also discussed in the posting. That is basically a visual aura, as I discussed in my previous posting. My earliest visual aura that I remember was age 10.

The neurotoxicity and safety of treatment with cefepime in patients with renal failure

Background: Cases of cefepime neurotoxicity have been Sporadically reported in patients with renal failure. The neurotoxicity of cefepime might be underestimated and the frequency of its neurotoxic effects may be insufficiently recognized.

Methods: We retrospectively reviewed the files of patients with renal failure who were treated with cefepime and who developed neurological complications.

Results: All 8 patients developed decreased conscience, confusion, agitation, global aphasia, myoclonus, chorea-athetosis, convulsions and coma. The latency, the period between the start of treatment and neurologicaldeterioration, was 4,75 ± 2,55 days (range: 1–10 days). All patients died 17 ± 14,7 days (range: 1–42 days) after becoming symptomatic. Three of them died shortly after neurological deterioration. Five patients developed a neurological "tableau" with global aphasia. Three patients showed clinical improvement after the discontinuation of cefepime. Electroencephalography revealed diffuse slow-wave activity (delta) and triphasic sharp wave activity. These findings confirm the possible neurotoxicity of treatment with cefepime in patients with renal failure. In none of the deceased patients have we been able to directly demonstrate a causal relationship between neurotoxicity and mortality. However, when a patient treated with cefepime develops neurological deterioration or aphasia, one must be aware of cefepime's potential neurotoxicity and treatment should be stopped.

Conclusion: We recommend that, in view of the high and unexplained mortality, the use of cefepime in patients with kidney failure should be carefully considered.

Keywords: cefepime; neurotoxicity; renal failure; kidney disease

Mirror Neurons -- Rock Stars or Backup Singers?

Greg Hickok
Center for Cognitive Neuroscience
University of California, Irvine

Mirror neurons are the rock stars of cognitive neuroscience. Discovered in the mid-1990s by Giacomo Rizzolatti and his colleagues at the University of Parma, these brain cells have been claimed to be the neural basis for a host of complex human behaviors including imitation, action understanding, language, empathy, and mind-reading – not psychic mind-reading, but our capacity to "get inside someone else's head" and imagine how they feel or what they might do. Meanwhile, dysfunction of the mirror neuron system has been linked to developmental disorders, such as autism. With that kind of explanatory range, it's no surprise that mirror neurons have headlined in all forms of news media. But is this rock star status deserved? Will mirror neurons have the star power longevity of Mick Jagger? Or are they just back up singers?

The hidden mirror

So what exactly are mirror neurons? While studying neurons in motor areas of the frontal lobe of the Rhesus monkey brain, Rizzolatti's team noticed that some cells were responsive not only when the monkey performed an action, such as grasping a raisin, but also when the monkey simply watched the experimenter perform the same action. It was as if these neurons were simulating, or mirroring, a perceived action in the motor system of the animal. This is a very interesting and important finding, showing that sensory and motor systems interact in the brain's cortex at the single cell level.

But the interpretation of mirror neurons since then has extended well beyond sensory-motor interaction. For example, some have speculated that mirror neurons are the basis for our ability to understand the actions of others: because we know the consequences of our own actions, we can understand and anticipate the intended consequences of others' actions by activating similar neural networks in our own motor system. This concept was quickly generalized to more complex functions: because we speak, feel emotion, and have a sense of our own intentions, the theory goes, we can understand the speech of others, empathize, and "mind-read" intentions by mapping other people's behaviors onto our own mirror neuron system.

What is really being reflected?

Is the speculation that mirror neurons are responsible for "understanding" the behavior of others justified? Or are mirror neurons involved in less lofty, but nonetheless important, mental functions? A new study -- "Sensosirmotor Leaning Configures the Human Mirror System," from Current Biology (abstract or pdf download -- suggests the latter. Carolyn Catmur, Vincent Walsh, and Cecilia Heyes, researchers at University College London's Institute of Cognitive Science, stimulated the hand-related portions of motor cortex of human volunteers while they watched videos of hands performing movements of the index or little finger. Stimulation was accomplished using "transcranial magnetic stimulation" (or TMS), in which magnetic pulses are passed through the skull to induce brief electrical currents in the underlying brain tissue. TMS of motor cortex hand areas results in electrical neural impulses being transmitted to the hand itself, where these impulses can be measured by placing electrodes over the finger muscles. The researchers found that when a volunteer watched index finger movement, motor-cortex stimulation by TMS led to stronger electrical signals in the participant's own index finger compared to the pinky, and vice-versa when watching pinky finger movement. This is a mirror-neuron-like effect. Watching a video of index finger movement induces activation of the observer's own motor system controlling index finger movement. This naturally induced activity then sums with the TMS-induced activity to produce stronger than normal neural signals in the index finger muscles.

The mirror neuron theorists would say that our "understanding" of this movement is a result of this heightened activation of our own motor system. But Catmur and colleagues went beyond this basic mirror neuron result. After their initial measurements, they trained the participants to make "counter-mirror" movements: that is, when you see the index finger move, move your own pinky finger, and vice-versa. After this training, the brain responses were reassessed -- and a reversal of the mirror effect was found: watching index-finger movement resulted in more electrical activity in the pinky, and watching pinky movement produced more activity in the index finger. The brain learned new sensory-motor associations, and it is these associations that underlie the mirror neuron-like effect.

Fodder for, not parent of

This is a very nice demonstration that mirror system-like activity is subject to sensory-motor learning, suggesting it is learned rather than hard-wired. But the real question for the mirror neuron theory of action understanding is what these newly trained volunteers "understand" about these movements. Since viewing index finger movement induces activity in the participants' pinky motor systems, do they now think they are viewing little finger movement? Of course not. They still understand that they are viewing index finger movement. Conclusion: mirror system activation is not necessarily correlated with "understanding" but rather with sensory-motor learning.

This dissociation between mirror neuron-like activity and understanding comes as no real surprise. We know from decades (centuries even) of research involving patients with aphasia (language deficits resulting from brain damage, typically stroke) that it is possible to lose virtually all ability to articulate words while retaining the ability to understand the meaning of spoken words. Loss of the motor system controlling speech production, which contains the mirror system for speech, does not result in loss of the ability to understand the speech actions of others. It is also possible for the reverse situation to happen: in some patients with damage that spares the mirror system, the ability to repeat the speech of others may be intact (indicating intact sensory-motor associations), and yet they fail to understand the words. As in the study described above, mirror system function and action understanding dissociate.

The implications are clear. The mirror neuron system is not the neural basis for action understanding. This is true for simple limb actions of the sort that led to the discovery of mirror neurons in the monkey, and it is true for the first complex human behavior that the mirror neuron theory was generalized to, namely speech. If the mirror neuron theory shatters for these behaviors, its generalization to abilities like empathy or "mind-reading" seems ridiculously overstated.

This is not to say that a neural network supporting sensory-motor associations isn't important, or even that such associations are irrelevant to action understanding, language and the like. It seems quite likely that these higher-level systems make use of information derived from sensory-motor linkages. But that mirror neurons provide information that gets used by this high-level understanding does not mean that mirror neurons encode and produce this high-level understanding. You might be able to train a parrot to say "I can't get no satisfaction" -- but that doesn't mean he understands the message. Despite the hype to the contrary, mirror neurons are not the Mick Jagger of cognitive neuroscience. But there's no shame in singing backup. After all, who would want to sit through two hours of Mick singing a cappella? You need a whole band to make good music. The brain works the same way.

Gregory Hickok is professor of cognitive neuroscience and the director of the Center for Cognitive Neuroscience at the University of California, Irvine. He blogs on the neural underpinnings of language at Talking Brains and contributes to a UC Irvine cog-sci group blog as well.

Spoken-word processing in aphasia

from Brain and Language

Two studies were carried out to investigate the effects of presentation of primes showing partial (word-initial) or full overlap on processing of spoken target words. The first study investigated whether time compression would interfere with lexical processing so as to elicit aphasic-like performance in non-brain-damaged subjects. The second study was designed to compare effects of item overlap and item repetition in aphasic patients of different diagnostic types. Time compression did not interfere with lexical deactivation for the non-brain-damaged subjects. Furthermore, all aphasic patients showed immediate inhibition of co-activated candidates. These combined results show that deactivation is a fast process. Repetition effects, however, seem to arise only at the longer term in aphasic patients. Importantly, poor performance on diagnostic verbal STM tasks was shown to be related to lexical decision performance in both overlap and repetition conditions, which suggests a common underlying deficit.

Are regular and irregular verbs dissociated in non-fluent aphasia? A meta-analysis


The cognitive mechanisms and neuroantomical substrates used by the brain to effortlessly generate morphologically complex words (write + ing → writing) are little understood. The left inferior frontal gyrus (LIFG, including Broca's area) is often implicated as being involved, although its specific role is unclear. Data from brain damaged individuals, particularly those with Broca's aphasia, are often used as evidence to support or refute various theoretical perspectives. Typically, performance on two types of morphologically complex verbs, regulars (walk-walked, slip-slipped) and irregulars (sing-sang, sleep-slept) is contrasted for evidence of single or double dissociations. The question of how Broca's aphasic individuals dissociate in their production of inflectional morphology is important to our understanding of how the brain is organized to compute morphologically complex words. This article is a synthesis of research studies investigating the production of morphologically complex regular and irregular verbs in individuals with Broca's aphasia. The question being asked is if there is a robust and consistent dissociation, and if this dissociation can be tied to lesions of the left frontal lobe. This meta-analysis of 75 patients failed to show a single consistent dissociation pattern and over half the datasets had no significant difference between regulars and irregulars. There was also no relationship of any performance pattern to frontal lobe lesions, highlighting the difficulty of identifying any single neuroanatomical lesion for regular–irregular verb production deficits. The implications for various theoretical and neuroanatomical hypotheses are discussed. The role of neuropsychological dissociations in constraining hypothesis of normal neuroanatomical organization is evaluated.

Keywords: Morphology; Broca's aphasia; Language production; Sentence completion; Repetition; Verb

Wednesday, January 16, 2008

Process skill rather than motor skill ..

... seems to be a predictor of costs for rehabilitation after a stroke in working age; a longitudinal study with a 1 year follow up post discharge

Ann Bjorkdahl email and Katharina S Sunnerhagen email

BMC Health Services Research 2007, 7:209doi:10.1186/1472-6963-7-209
Published: 21 December 2007
Abstract (provisional)


In recent years a number of costs of stroke studies have been conducted based on incidence or prevalence and estimating costs at a given time. As there still is a need for a deeper understanding of factors influencing these costs the aim of this study was to calculate the direct and indirect costs in a "young" (<65) sample of stroke patients and to explore factors affecting the costs.

Information about Cerebrovascular Disease

By Robert Baird
January 16, 2008

The signs and symptoms of cerebrovascular disease depend on the location of the hemorrhage, thrombus, or embolus and the extent of cerebral tissue affected. General signs and symptoms of a hemorrhagic or ischemic event include motor dysfunction, such as hemiplegia and hemiparesis.

Early in a CVA, the patient may experience flaccid paralysis, followed by increased muscle tone and spasticity. He may lose his gag reflex and ability to cough. He may have communication deficits, such as dysphagia, receptive or expressive aphasia, dysarthria, and apraxia. He also may develop spatial and perceptual deficits, such as the loss of half of his visual field (homonymous hemianopia) and the inability to recognize an object (agnosia).

Other signs and symptoms of a CVA include vomiting, seizures, fever, ECG abnormalities, confusion that leads to a complete loss of consciousness, labored or irregular respirations, apneic periods, increased blood pressure, and bowel and bladder incontinence.

Signs and symptoms specific to a hemorrhagic CVA include abrupt onset of a severe headache, nuchal rigidity, and rapid onset of complete hemiplegia. As the hematoma enlarges, the patient's neurologic deficits worsen from gradual loss of consciousness to coma.

Signs and symptoms of a thrombotic CVA follow the "stroke in evolution" pattern and include the progressive deterioration of motor and sensory function, slow deterioration of speech, and lethargy. These signs and symptoms peak when edema develops, usually about 72 hours after the onset of the thrombotic event.


The Mini-Mental State Examination in Behavioral Variant Frontotemporal Dementia and Primary Progressive Aphasia

The Mini-Mental State Examination in Behavioral Variant Frontotemporal Dementia and Primary Progressive Aphasia
Jason E. Osher, MS

Cognitive Neurology and Alzheimer's Disease Center, Nowrthwestern University Feinberg School of Medicine, Chicago, Illinois, Department of Psychiatry and Behavioral Sciences, Nowrthwestern Universtiy Feinberg School of Medicine, Chicago, Illinois,

Alissa H. Wicklund, PhD

Cognitive Neurology and Alzheimer's Disease Center, Nowrthwestern University Feinberg School of Medicine, Chicago, Illinois

American Journal of Alzheimer's Disease and Other Dementias®, Vol. 22, No. 6, 468-473 (2008)
DOI: 10.1177/1533317507307173
© 2008 SAGE Publications

How left inferior frontal cortex participates in syntactic processing: Evidence from aphasia

from Brain and Language

We report on three experiments that provide a real-time processing perspective on the poor comprehension of Broca’s aphasic patients for non-canonically structured sentences. In the first experiment we presented sentences (via a Cross Modal Lexical Priming (CMLP) paradigm) to Broca’s patients at a normal rate of speech. Unlike the pattern found with unimpaired control participants, we observed a general slowing of lexical activation and a concomitant delay in the formation of syntactic dependencies involving “moved” constituents and empty elements. Our second experiment presented these same sentences at a slower rate of speech. In this circumstance, Broca’s patients formed syntactic dependencies as soon as they were structurally licensed (again, a different pattern from that demonstrated by the unimpaired control group). The third experiment used a sentence-picture matching paradigm to chart Broca’s comprehension for non-canonically structured sentences (presented at both normal and slow rates). Here we observed significantly better scores in the slow rate condition. We discuss these findings in terms of the functional commitment of the left anterior cortical region implicated in Broca’s aphasia and conclude that this region is crucially involved in the formation of syntactically-governed dependency relations, not because it supports knowledge of syntactic dependencies, but rather because it supports the real-time implementation of these specific representations by sustaining, at the least, a lexical activation rise-time parameter.