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.