RESOURCE and RESEARCH

Stroke Screening

2012-01-17T17:01:00.001-08:00

Willie Askew, 78, says the symptoms came on suddenly with blurry vision and weakness.

Askew was not too worried but went to the hospital after the urging of his family.

Sure enough, the doctors at Providence Hospital in Washington, D.C. found something very wrong. Askew was having a stroke.

Providence hospital neurologist Dr. Muneshwar Tiwari says Askew's stroke was caused by blocked arteries in his brain, the result of high cholesterol and hypertension, two risk factors that could have been treated early if he had just be........Next

High blood pressure, anemia put sickle cell kids at risk for strokes

2012-01-17T16:59:00.001-08:00

A team of researchers from the Johns Hopkins Children’s Center, Vanderbilt University and elsewhere have demonstrated that high blood pressure and anemia together put children with sickle cell disease at serious danger for symptomless, or “silent,” strokes, although either condition alone also signaled high risk.
The results are part of an ongoing National Institutes of Health–funded international multicenter trial, believed to be the largest study of its kind to date in children with sickle cell disease, or SCD. A report on the findings was published online Nov. 17 in the journal Blood.
In the study, brain MRI scans revealed that nearly a third (31 percent) of 814 children, ages 5 to 15, had suffered silent strokes. None of the children had a history of stroke or seizures, and none showed overt stroke signs at the time of the study.....Next

ESL instruction videos teaching more than English on YouTube

2012-01-12T19:16:00.000-08:00

Because the materials are available openly, that means there’s potential for unexpected repurposing of these lessons. One example is the story of Dave Valiulis, a technical writer and Ph.D who suffered a stroke in 2008 and has since been dealing with the effects of aphasia and apraxia, which damaged his ability to access words and manipulate his mouth to speak clearly.
After completing two years of professional speech therapy, Valiulis “graduated” and was left to improve his ability to talk on his own. Initially he went looking for things related to aphasia and apraxia, with little success — but when he discovered the amount of ESL material out there, he found his options widen dramatically. “I thought, ‘Of course — this is what I need! After all, English to a person with aphasia and apraxia is like a second language,’” Valiulis wrote via email....Next

Neurology Apples, Pears Linked to Reduced Stroke Risk

2011-09-27T11:09:00.000-07:00

September 15, 2011 — A new study shows an association between a high intake of fruits and vegetables with white flesh, in this research mainly apples and pears, and a reduced risk for stroke on the order of 50%.
In this large, population-based study, each 25 g/day increase in consumption of white fruits and vegetables was associated with a 9% decrease in stroke risk.
However, lead author Linda M. Oude Griep, MSc, from the Division of Human Nutrition at Wageningen University, the Netherlands, cautioned that as this is the first such study to look at color groups of fruits and vegetables in relation to stroke, no definite conclusions can be made.

Linda M. Oude Griep

"There are more studies needed to confirm these findings," Ms. Oude Griep told Medscape Medical News. "It's also the case that maybe other color groups of fruits and vegetables may protect against other chronic diseases, so it remains of importance that patients eat a variety of fruits and vegetables."
Their findings are published online September 15 and will appear in the November issue of Stroke.
Color Mirrors Content.................
In this study, the researchers investigated whether fruits and vegetables grouped into different colors were associated with incident stroke. Although studies have consistently shown that a high consumption of fruit and vegetables overall is associated with a lower stroke risk, the researchers note, few studies have examined the association between stroke risk and groups of fruit and vegetables grouped according to the color.
The color of the primary edible portion of fruits and vegetables reflects the presence or absence of particular pigmented bioactive compounds, such as carotenoids, anthocyanidins, and flavonoids, the authors write. Which fruits and vegetables in particular contribute most the reduction in stroke risk from overall high consumption is not known, and that was the primary aim of this study.
The researchers used data from the Monitoring Project on Risk Factors and Chronic Diseases in the Netherlands Study, a population-based cohort study including 20,069 men and women aged 20 to 65 years and free of cardiovascular disease at baseline.
Information on fruit and vegetable intake was taken from a validated, 178-item food frequency questionnaire that included juices and sauces.
Fruits and vegetables were classified into 4 color groups according to the edible portion: green included such items as broccoli, brussels sprouts, and kiwi fruit; orange/yellow included citrus fruits, carrots, and cantaloupe; red/purple encompassed things like cherries, grapes, red cabbage, and tomatoes; and white included the allium family of garlic and onion, hard fruits such as apples and pears, and bananas, cauliflower, or cucumber.
Potatoes and legumes were not included as vegetables, "because their nutritional value differs significantly from that of true vegetables," the researchers note.
The median consumption of white fruits and vegetables was highest in this population, and apples and pears were the most commonly consumed of these, making up 55% of intake.
Median Consumption of Fruits and Vegetables by Color Group

Color Group	G/Day
Green	62
Orange/Yellow	87
Red/Purple	57
White	118

During 10 years of follow-up, 233 incident cases of stroke were documented. Hazard ratios were calculated for incident stroke, adjusting for age, sex, lifestyle, and dietary factors.
The authors report that although no such relationship was seen with green, orange/yellow, or red/purple groups, there was a significant reduction of 52% in 10-year stroke incidence for those participants in the highest quartile for white fruit and vegetable consumption vs those in the lowest quartile.
Stroke Risk for Highest vs Lowest Intake of White Fruits and Vegetables

Comparison	Hazard Ratio	95% Confidence Interval
Quartile 4 vs quartile 1 (>171 g/day ≤78 g/day)	0.48	0.29 - 0.77

Each 25 g/day increase in white fruit and vegetable consumption was associated with a 9% lower risk for stroke (hazard ratio, 0.91; 95% confidence interval, 0.85 - 0.97).
Previous studies have suggested that apples and pears are inversely related to incident stroke, although the findings were not statistically significant in those studied, the researchers note. Apples are a rich source of dietary fiber and the flavonol quercetin, the authors note.
Another important contributor to white fruit consumption was bananas, they add. "To our knowledge, no previous prospective cohort studies have investigated the association between bananas and incident stroke."
"Apple a Day" Clinical Trial?
In an editorial accompanying the publication, Heike Wersching, MD, from the University of Muenster Institute of Epidemiology and Social Medicine, Germany, points out that this study focuses on the beneficial effects of food groups, allowing for the synergistic effects of different nutrients in whole fruits and vegetables to be evaluated.
"This approach is of particular importance in the active prevention of cerebrovascular disease, as it directly translates into healthy food choices," Dr. Wersching writes.
The adjustment in this large trial, however, still may not completely rule out the effects of a generally healthy lifestyle, she notes. "Thus, specific reduction in stroke risk for single subgroups of plant foods still needs to be interpreted with caution."
Nevertheless, "The work by Griep et al proposed an interesting and practical concept that calls for replication studies, ideally supported by analysis of corresponding biomarker profiles," she concludes. "If replication is successful in independent studies and countries, the time for an 'apple a day' clinical trial has come."
The Monitoring Project on Risk Factors and Chronic Diseases in the Netherlands Study was supported by the Ministry of Health, Welfare, and Sport of the Netherlands; the National Institute of Public Health and the Environment, Bilthoven, the Netherlands; and the Europe Against Cancer Program of the European Union. An unrestricted grant was obtained by one of the article coauthors from the Product Board for HorticuIture, Zoetermeer, the Netherlands, to cover the costs of data analysis for the present study. The other authors and the editorialist have disclosed no relevant financial relationships.
Stroke. Published online September 15, 2011.

Stroke Patients Get Robot Legs

2011-09-27T10:54:00.000-07:00

Stroke Patients Get Robot Legs

What's the Latest Development?
A powerful exoskeleton is helping stroke patients and victims of spinal cord injuries to walk again. "The prototype device is called the Lower-extremity Powered ExoSkeleton, or LOPES, and works by training the body and mind of a patient to recover a more natural step." Developed over the last several years at the University of Twente in Enschede in the Netherlands, the device "can do all the walking for the patient, or it can offer targeted support in either one leg or with one element of the walking process."
What's the Big Idea?
Commercial versions of the product could be developed as early as next year. Beyond victims of medical injuries, the lower-extremity exoskeleton is being designed with military function in mind. A California company is developing an exoskeleton that "enables infantry soldiers to lift and carry weights of up to 90kg in the field, and consists of a hydraulic-powered frame which straps around the soldier's body." In the future, exoskeleton devices may be used by aging individuals to keep pace with younger ones when families are out and about. .......
http://bit.ly/qwbIKr

Can eating fish save you from getting a stroke?

2011-09-27T10:50:00.000-07:00

Vitamin D, selenium and certain types of proteins in fish may also have stroke-related benefits, Mozaffarian added.

NEW YORK: People who eat fish a few times each week are slightly less likely to suffer a stroke than those who only eat a little or none at all.
That’s the conclusion of an analysis of 15 studies, each of which asked people how frequently they ate fish, then followed them for between four and 30 years to see who suffered a stroke.
“I think overall, fish does provide a beneficial package of nutrients, in particular the omega-3s, that could explain this lower risk,” said Dr. Dariush Mozaffarian, a Harvard School of Public Health epidemiologist whose research was included in the analysis.
“A lot of the evidence comes together suggesting that about two to three servings per week is enough to get the benefit.”......
http://bit.ly/oNRcbv

Study reveals natural protection mechanism during stroke

2011-09-27T10:05:00.000-07:00

Last updated 17 August 2011
Scientists have discovered how some nerve cells in the brain are resistant to damage during a stroke - a finding that could one day pave the way for new therapies to protect other types of nerve cells.

A research team at the University of Bristol examined two types of nerve cell in the hippocampus - part of the brain that is involved in memory and navigation.

One of the cell types, the CA1 cell, is highly susceptible to stroke-related damage, while the other type, the CA3 cell, is much more resistant.

The researchers found that CA1 cells' susceptibility appears to be linked to the absence of adenosine A3 receptors, which are normally activated by high levels of adenosine during stroke conditions.

Dr Jake Mellor, senior lecturer in the university's School of Physiology and Pharmacology, said: 'We hope that if we can understand why some nerve cells are resistant to stroke damage we may be able to develop strategies to protect those cells that are sensitive.'

The scientist, whose findings are published in the Journal of Neuroscience, noted that stroke's unpredictability and the need to administer drugs within minutes of onset have historically made it difficult to treat.

'These problems will not be overcome by our research but our findings do reveal a natural protection mechanism in some nerve cells, which may be useful in developing treatments to protect other nerve cell types,' he added.

Around 150,000 people in the UK are affected by stroke each year, according to the Stroke Association........ http://bit.ly/qIIqXI

Life After Stroke Audiobook

2011-09-26T18:36:00.000-07:00

In this unique and gentle approach to Stroke, learn
everything there is to know about stroke whether a
survivor, friend, family member or caregiver.

This important guide contains information that will:

Educate you about the immediate aftereffects of stroke,
so you know what to expect and how to overcome setbacks
in the early weeks following a stroke.

Teach you how to set goals following a stroke that will
speed the progression of your healing.

Help you understand what rehabilitation is all about,
including what forms of rehabilitation are available
and how they can improve your quality of life and
standard of living,..... http://bit.ly/qsRgOm

Speaking and Listening Share Large Part of Brain Infrastructure

2011-09-18T17:35:00.000-07:00

ScienceDaily (Aug. 16, 2011) — What areas of the brain are involved in the linguistic processes underlying speech and listening and are there large differences between these? Neuroscientists from the Donders Institute for Brain, Cognition and Behaviour at Radboud University Nijmegen are the first to have successfully investigated this question using functional magnetic resonance imaging (fMRI). In what may come as a surprise to many scientists, the researchers have established that there is a large degree of overlap between the areas involved.

See Also:

Mind & Brain

Reference

The results are published in the journal Psychological Science.
Within the scientific community there is a lot of discussion about whether the brain functions involved in speech production are also involved in the comprehension of speech. In the area of mirror neuron research in particular (a hot topic for the past 15 years), research has viewed the overlap between the areas of the brain involved in speech and listening as reaction and observed action, says neuroscientist Laura Menenti, who is currently working at the University of Glasgow. However, speaking and listening are more than just action and observation. They also involve linguistic processing. Menenti and her colleagues mainly focused on this last aspect:..... http://bit.ly/nXC6tn

FDA panel votes 9-2 in favor of new blood thinner drug

2011-09-11T11:56:00.000-07:00

By Dr Ananya Mandal, MD
A new stroke preventer from Bayer and Johnson & Johnson – Xarelto moved one step closer to U.S. approval, but questions remained about restrictions on labeling and the need for more studies.
An Food and Drug Administration (FDA) panel advisory looked at the effectiveness and safety of blood thinner Xarelto compared to standard warfarin in the ROCKET-AF trial. They voted 9-2 on Thursday to recommend approval of the once-a-day anti-clotting pill, called Xarelto. They asked for further studies on how to transition off of Xarelto. FDA decision on the drug is expected by Nov. 4
Xarelto is one of several promising entrants angling to replace warfarin for people with dangerously irregular heart rhythms, called atrial fibrillation (AF). Warfarin is a problematic decades-old clot preventer originally developed as rat poison. AF patients' irregular heartbeats can cause blood to pool, increasing their risk of blood clots and strokes . But many are unwilling to take warfarin , which requires regular blood tests, or are unable to tolerate it.
The study involved 14,264 patients across 1,178 sites in 45 countries. Patients were diagnosed with persistent or paroxysmal AF with additional risk factors for stroke , and were randomly assigned to warfarin (Coumadin, Bristol-Meyers Squibb) or rivaroxaban (Xarelto, Johnson & Johnson). Patients who were assigned to rivaroxaban received a 20mg dose once daily, and warfarin was titrated to a target range of two to three.
Overall, a decreased rate of stroke and non-CNS embolism events were associated with rivaroxaban during treatments vs. warfarin (P=.015). In the intention-to-treat analysis, rivaroxaban was non-inferior to warfarin (P=.117). The rate of bleeding and adverse events was similar between the rivaroxaban and warfarin arms, but rivaroxaban was associated with less intercranial hemorrhage and fatal bleeding.
“I've seen the problems many patients face with warfarin ,” said Dr. Philip Sager, a panel member and executive committee member of the Cardiac Safety Research Consortium in San Francisco. “I think there's a tremendous unmet medical need for new therapies.”
Panelists were divided on whether Xarelto, with the clinical name rivaroxaban, was as effective as warfarin . In clinical trials that compared Xarelto to warfarin , panelists and the FDA said the older drug was not always given in the proper dosing, making it more difficult to determine if Xarelto was just as good.
“I've heard nothing that convinces me that rivaroxaban should be first-line treatment for many patients,” said Allan Coukell, the patient representative on the panel and director for medical safety at Pew Health Group, adding that Xarelto's label should reflect that......

http://bit.ly/n2z5qA

Interfacing Your Brain with Computers

2011-04-17T18:46:00.000-07:00

What's the Most Recent Development?
Renowned scientist and professor of neurology at Brown University, John Donoghue has made incredible advances in interfacing the human brain with computers, allowing paralyzed people to move objects by simply using their imagination. A small chip implanted in the brain picks up the right neural signals and beams them into a computer where they are translated into moving a cursor or controlling a computer keyboard. "By this means, paralysed people can move a robot arm or drive their own wheelchair, just by thinking about it."
What's the Big Idea?
The implications of a brain-computer interface are formidable, from transferring human consciousness onto a computer—in other words, immortality—to using the technology to read people's minds. Military establishments are interested in Dr. Donoghue's research in order to enhance interrogations methods. Were interrogators able to interface the mind of a prisoner with a computer, perhaps information could be extracted they could use to prevent criminal acts and save lives. It seems the next phase of evolution will be synthetic, rather than purely biological. more read...

Connectomics: Mapping The Brain's Complexity

2011-04-17T18:43:00.000-07:00

Connectomics: Mapping The Brain's Complexity

Scientists say they have moved a step closer to developing a computer model of the brain after finding a way to map both the connections and functions of nerve cells in the brain together for the first time.
In a study in the journal Nature on Sunday, researchers from Britain's University College London (UCL) described a technique developed in mice which enabled them to combine information about the function of neurons with details of their connections.
The study is part of an emerging area of neuroscience research known as 'connectomics'. A little like genomics, which maps our genetic make-up, connectomics aims to map the brain's connections, known as synapses.
By untangling and being able to map these connections -- and deciphering how information flows through the brain's circuits -- scientists hope to understand how thoughts and perceptions are generated in the brain and how these functions go wrong in diseases such as Alzheimer's, schizophrenia and stroke.
"We are beginning to untangle the complexity of the brain," said Tom Mrsic-Flogel, who led the study.
"Once we understand the function and connectivity of nerve cells spanning different layers of the brain, we can begin to develop a computer simulation of how this remarkable organ works."

But he said would take many years of work among scientists and huge computer processing power before that could be done.
In a report of his research, Mrsic-Flogel explained how mapping the brain's connections is no small feat: There are an estimated one hundred billion nerve cells, or neurons, in the brain, each connected to thousands of other nerve cells, he said, making an estimated 150 trillion synapses.
"How do we figure out how the brain's neural circuitry works? We first need to understand the function of each neuron and find out to which other brain cells it connects," he said.
In this study, Mrsic-Flogel's team focused on vision and looked into the visual cortex of the mouse brain, which contains thousands of neurons and millions of different connections.
Using high resolution imaging, they were able to detect which of these neurons responded to a particular stimulus.
Taking a slice of the same tissue, the scientists then applied small currents to subsets of neurons to see which other neurons responded and which of them were synaptically connected.
By repeating this technique many times, they were able to trace the function and connectivity of hundreds of nerve cells in visual cortex.
Using this method, the team hopes to begin generating a wiring diagram of a brain area with a particular function, such as the visual cortex. The technique should also help them map the wiring of regions that underpin touch, hearing and movement.
John Williams, head of neuroscience and mental health at the Wellcome Trust medical charity, which helped fund the study, said understanding the brain's inner workings was one of science's "ultimate goals."
"This important study presents neuroscientists with one of the key tools that will help them begin to navigate and survey the landscape of the brain," he said. more read....

Brain boffins in cortex mapping breakthrough

2011-04-17T18:37:00.000-07:00

Brain boffins at University College London have made a major breakthrough in the ongoing effort to bridge the gap between man and machine.
The UCL research team has developed a technique for mapping both the connections and functions of nerve cells in the brain, as revealed by UCL News.

"We are beginning to untangle the complexity of the brain," reads a statement from UCL research fellow Tom Mrsic-Flogel. "Once we understand the function and connectivity of nerve cells spanning different layers of the brain, we can begin to develop a computer simulation of how this remarkable organ works." more read...

State Proclamation Coincides with Brain Health Fair and American Academy of Neurology’s Annual Meeting.

2011-04-17T18:12:00.000-07:00

Hawaii Governor Neil Abercrombie has issued a state proclamation declaring the week of April 9-16, 2011, as “Brain Health Awareness Week” in the Aloha state. The proclamation coincides with two large events in Honolulu; the Brain Health Fair Saturday, April 9, and the American Academy of Neurology’s Annual Meeting at the Hawaii Convention Center April 9-16, which is the world’s largest meeting of neurologists with more than 9,000 attendees.

“Brain Health Awareness Week” aims to help the American Academy of Neurology and its Foundation raise awareness about the vital need for more research into the prevention, treatment and cure of brain disorders, which currently affect one in six people worldwide. Common brain disorders include Alzheimer’s disease, stroke, migraine, multiple sclerosis, autism and brain cancer.
“We are thankful for the Governor’s support in raising awareness about the vital need for everyone to have a healthier brain through the support of research into the prevention, treatment and cure of brain disorders,” said Christine E. Phelps, Deputy Executive Director of the American Academy of Neurology Foundation. “Please visit our website, BuyaBrain.org, to learn more about how you can help and honor your family and friends who are living with brain disorders. What makes the American Academy of Neurology Foundation so special is the fact that 100% of your donation will go directly toward research.”
“Brain Health Awareness Week” will kick off at 10:00 a.m. on Saturday, April 9, 2011, with the Brain Health Fair presented by the American Academy of Neurology Foundation at the Hilton Hawaiian Village in Honolulu. The Brain Health Fair is a free event for the public to learn from some of the best and brightest neurologists in the world about the latest advances in managing neurologic disorders as well as how to maintain a healthy brain. Brain health classes will be offered along with a kids zone and an exhibit hall with more than 30 exhibitors. Free registration is open at www.brainhealthfair.com.

Should Patients With Stroke Wear Compression Stockings?

2011-04-17T18:07:00.001-07:00

Dr. Sprigg and colleagues note that they “do not believe that low-dose heparin should be used routinely for the prevention of VTE in most patients with stroke.” We agree that low-dose heparin should not be used routinely in patients with ischemic stroke and did not make such a suggestion (1). As Dr. Sprigg and colleagues also note, “Prophylactic low-dose anticoagulation may help to treat patients at high risk for VTE in whom the risk for VTE is likely to outweigh the risk for SICH.”

If CLOTS (Clots in Legs Or sTtockings after Stroke) Trial 1 (2) had found that graduated compression stockings were very effective at preventing VTE, we would recommend this intervention over low-dose heparin in all patients with stroke, including those at highest risk for VTE. However, it found that graduated compression stockings did not work (2), and therefore, an effective alternative to low-dose anticoagulation to prevent VTE in patients with ischemic stroke does not currently exist. Lack of an alternative to prevent VTE does not mean that low-dose anticoagulation should be used routinely but does strengthen the argument for, as we suggested, “the cautious use of these agents” in patients with acute ischemic stroke and immobility without additional contraindications to anticoagulant therapy.

We propose that the findings of the IST (3) and TAIST (4) are mostly of indirect relevance to this discussion and, indeed, are consistent with our position. TAIST compared high- and intermediate-dose tinzaparin with aspirin in the acute treatment of ischemic stroke (4). This trial did not evaluate whether low-dose tinzaparin, as used to prevent VTE, was beneficial.

The IST compared high-dose unfractionated heparin (12 500 U twice daily) and low-dose unfractionated heparin (5000 U twice daily) with no anticoagulation (3). High-dose therapy was associated with greater harm than benefit. Low-dose therapy was associated with greater benefit than harm; however, we agree that the findings of this subgroup analysis are not definitive. An additional consideration is that if the IST had enrolled only participants with stroke and immobility—that is, persons with a high risk for VTE, a population group similar to those who are the focus of this discussion and that were enrolled in the CLOT Trials—the balance of benefit (reduction in VTE) to harm (increased intracranial bleeding) may have further favored low-dose heparin.

Finally, both of these trials evaluated the use of heparin in the acute phase of stroke (within 48 hours of onset), when the risk for hemorrhagic transformation is greatest. In patients at increased risk for intracerebral hemorrhage, delayed introduction of low-dose heparin may further alter the balance of benefit to harm. It is hoped that the ongoing CLOTS Trial 3, which is comparing intermittent pneumatic compression with a control group, will identify an effective way to prevent VTE in patients with acute stroke and immobility without increasing the risk for bleeding. more read....

Lacunar stroke is small but significant

2011-04-17T17:48:00.000-07:00

Lacunar stroke is small but significant

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By Paul G. Donohue M.D.

To Your Good Health

April 17, 2011 12:00 AM

DEAR DR. DONOHUE: I am a 66-year-old man who thought he was in good shape except for a touch of high blood pressure. About a week ago, I suddenly noticed that my left arm and left leg had gone limp. I had to be careful how I walked, and I couldn't hold on to anything. My wife said the left side of my face looked funny, too. The next day, everything was back to normal. My wife insisted that I see the doctor, and he insisted that I have a brain scan. The report said, "Compatible with a lacunar stroke." What is that? The doctor has me taking aspirin and has changed my blood pressure medicine. How serious is this?

— L.R.

The Latin word "lacuna" is "a small cavity or a hole." A lacunar stroke is one due to occlusion of a tiny brain artery that causes a similarly tiny hole in brain tissue. Blood supply to that part of the brain has been cut off.

Yours is the typical story told by those who have had such a stroke. Up to 60 percent of such patients complain of the sudden onset of arm and leg weakness on one side. The face on that side is weakened, too, and looks odd. People who have this kind of stroke never have trouble expressing themselves, as do people who suffer the more common and larger strokes.

Lacunar strokes don't leaving a lasting deficit. People regain what they lost, and usually do so in quick order.

MRI brain scans shows lacunar strokes clearly. A CT brain scan also can spot them.

Almost always, high blood pressure is involved. Just how high is "a touch of high blood pressure"? You have to take blood pressure control most seriously. Get a home blood pressure kit and take your pressure twice a day. You must take the same preventive steps that people who have had a major stroke take: weight reduction if that applies, limitation of salt, daily exercise within the limits prescribed by your doctor and a diet change to include much more fruits, vegetables and grains and much less meat and fats.

DEAR DR. DONOHUE: I am a female in my 80s and have had one child.

I have hair growing on the small of my back, just above the buttocks in the middle. All these years, a doctor has never explained why this is, and I have been too shy to ask. Can you enlighten me on this?

— Anon.

One possible explanation is spina bifida occulta, a malformation of one or two of the lower backbones.

During fetal development, those bones grow from their sides and form an arch over the spinal cord. In spina bifida occulta, there's a gap at the top of the arch. A sign that this has happened is hair growing on the lower back in the place where you indicate. For most with this defect, no symptoms arise. It causes no trouble to the spine or nerves.

If I am right about this, you're an example of one who hasn't suffered any disturbance from this slight abnormality that has been present all your life. The only way to know for sure is to have an X-ray. I don't recommend you do that.

DEAR DR. DONOHUE: Quite often, I go to bed with my hair up in rollers and fasten them with metal clips. Is this harmful in any way? Could it cause ringing in the ears upon arising from sleep? I'd appreciate your thoughts on the above.

— A.F.

It sounds painful to me. Don't the rollers dig into your scalp? If they don't hurt and they aren't cutting you, I can't see how this does you any harm.

It is not the cause of ringing in your ears.

Readers may write to Dr. Donohue or request an order form of available health newsletters at P.O. Box 536475, Orlando FL 32853-6475.

Angioplasty Trial for Stroke Prevention Halted

2011-04-17T13:32:00.000-07:00

A higher rate of adverse events in the angioplasty/stenting arm of the randomized SAMMPRIS trial forced an early halt to the stroke prevention study, according to trial sponsor, the National Institute of Neurological Diseases and Stroke.
With just over half of the planned number of patients enrolled, 14% of those who underwent angioplasty had suffered a stroke or died within the first 30 days, compared with 5.8% of those treated with aggressive medical therapy alone, the NINDS said in a statement.
"The SAMMPRIS Executive Committee is in agreement with NINDS and the data safety and monitoring board that enrollment in the study should be stopped and that the trial data currently available indicate that aggressive medical management alone is superior to angioplasty combined with stenting in patients with recent symptoms and high grade intracranial arterial stenosis," the statement said.
The difference in event rates was "highly significant," according to the statement, which pointed out another surprise: The event rate in the medical-therapy arm was about half what has been observed in earlier studies.
According to NINDS, in historical controls the rate of strokes or death with aggressive medical therapy was 10.7%.
SAMMPRIS -- an acronym for Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis -- began enrolling patients in November 2008. It was halted last week after an interim review by the data safety and monitoring board.
A total of 451 of the planned 764 patients had been treated in the study, the first randomized trial to compare aggressive medical therapy alone with angioplasty and stenting plus aggressive medical management.
The medical therapy in both arms included aspirin at 325 mg/day for the entire follow-up; clopidogrel (Plavix) at 75mg/day for 90 days after enrollment; intensive management of vascular risk factors, including a systolic blood pressure target of less than 140 mm Hg and LDL cholesterol less than 70 mg/dL; and a lifestyle modification program.
The angioplasty arm used the Gateway-Wingspan system, according to NINDS.
Stroke physicians contacted by MedPage Today and ABC News expressed disappointment that the angioplasty-based treatment apparently failed so dismally.
"Obviously, this is not what the investigators or the stroke community at large was hoping for because medical management of this condition has not been very effective in the past," said Stanley Tuhrim, MD, of Mount Sinai Stroke Center in New York City, in an email.
Pierre Fayad, MD, of the University of Nebraska in Omaha, sounded a similar note. "This is, of course, a major disappointment for a novel treatment to improve the care of patients at risk for stroke with narrowing in the brain blood vessels inside the skull," he said in an email.
"At the same time, it is a relief and reassurance that with good medical treatment alone, patients with such disease can do okay," he added.
Joe Broderick, MD, of the University of Cincinnati, suggested that the findings "will change practice."
In an email, Broderick said the truncated trial had two important messages. One was that better outcomes in the control arm "likely reflects that aggressive medical therapy of current standards is an improvement over the past," he wrote.
The other, he said, was that the event rate with stenting was higher than previously reported in registries -- "not surprising [because] registries don't have the rigor of clinical trials."
"These two factors will result in intracranial stenting being used in very, very limited settings (patients with high grade stenoses who literally cannot sit up without becoming symptomatic and who have failed medical therapy)," Broderick wrote.
But Tuhrim suggested that the SAMMPRIS results may not tell the whole story. He pointed out that patients on medical therapy tend "to fall off the wagon over time," in which case the benefit would not be sustained.
"Stents, on the other hand, seem to be durable (and the argument [is] that the stents and the operators will get better over time), at least so far," Tuhrim wrote in the email.
"It remains an open question whether a study of longer duration would produce similar results or if a turning point would be reached down the road." more read...

Who Can Drive After a Stroke? Tests Can Help Decide

2011-04-09T15:29:00.001-07:00

The research analyzed all of the available studies on driving after a stroke. In all of the studies, participants' driving skills were tested in an on-road evaluation.
A total of 30 studies were analyzed. There were 1,728 participants with an average age of 61 in the studies. Of those, 938, or 54 percent, passed the on-road evaluation. The average amount of time between the stroke occurring and the on-road evaluation was about nine months.
Three tests can be used to identify those people who are most at risk of failing the on-road driving test.
"These are simple tests that can be done in the doctor's office, which is important because on-road tests are time-consuming and expensive," said study author Hannes Devos, MSc, of Catholic University of Leuven in Belgium. "These tests are readily available and can be administered within 15 minutes."
The tests are a Road Sign Recognition test that assesses traffic knowledge and visual comprehension, a Compass task that examines visual-perceptual and visual-spatial abilities and mental speed, and the Trail Making Test B, which measures visual-motor tracking and visual scanning abilities.
People who score below 8.5 out of 12 on the road sign test, below 25 out of 32 on the compass test and take more than 90 seconds to finish the trail making test are more likely to fail the on-road evaluation. The tests correctly classified 80 to 85 percent of the unsafe drivers. The results also showed that participants' fitness to drive could not be predicted by their motor symptoms. "This is not surprising considering the wide range of adaptive devices that are available, such as steering knobs that can be operated by one hand and left-foot accelerator pedals for people with limited use of the right leg," Devos said.
In addition, the analysis found that three out of four studies showed no increased risk of accidents for people cleared to drive after a stroke.

Are You Learning English? These Songs May Help

2011-03-05T18:43:00.000-08:00

Language bootstrapping the brain

2011-03-05T12:05:00.000-08:00

Marina Bedny and colleagues [1] show that, to a remarkable degree, the visual cortex of blind subjects takes on language-specific processing tasks.
I think the paper makes a nice occasion to consider just how language-specific areas of the left hemisphere may have evolved. The fact that one of the most domain-specific cortical regions of the brain can, to some degree, be reprogrammed to support language processing suggests that language itself is surprisingly voracious in its ability to consume brain resources and redirect development.
I'm a little surprised that we didn't already know that blind subjects use visual cortex in language. It has the ring of previous scholarship. And actually the authors discuss a boatload of previous studies that appear to show precisely that: blind subjects relying upon visual cortex for language processing. The visual cortex increases activity during language tasks in blind subjects; blind subjects who have their occipital lobes zapped with transcranial magnetic pulses have problems performing language tasks, and visual cortex activity in blind subjects appears to be correlated with verbal memory. But Bedny and colleagues discuss several reasons why the previous results were not fully convincing; the visual cortex might be taking on domain-general or sensory cognitive tasks instead of language processing proper.
Bedny and colleagues devised a series of tests involving different language tasks, showing that the visual cortex in blind subjects responded not merely to difficult or memory-intensive tasks, but specifically to those tasks that most tax the language regions of normal subjects. The simplest interpretation is that the visual cortex has indeed taken on language-specific functions in blind subjects.
Below: How language eats brains, and why it matters to language evolution.
Read More....

Inflammation Identified as New Therapeutic Target Years After Stroke

2011-02-28T15:30:00.000-08:00

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LOS ANGELES, Feb. 1, 2011 /PRNewswire/ -- A breakthrough in stroke research identifying the potential reversibility of chronic neurologic disability in stroke survivors has published today. In the February 1, 2011 issue of the journal CNS Drugs the first human results of a new method of targeting chronic brain inflammation years after stroke are reported. Rapid improvement in impaired motor function, gait, hand function, sensory deficits, spatial perception, speech, cognition and behavior were noted among the first three consecutive patients treated. All patients demonstrated improvement beginning within 10 minutes of drug administration(1).
The study utilized a new method of delivery of etanercept, a potent biotechnology anti-inflammatory therapeutic. Etanercept has been a breakthrough for rheumatoid arthritis and other inflammatory disorders. It works by neutralizing tumor necrosis factor (TNF), a cytokine that initiates and amplifies inflammation. The therapeutic potential of etanercept in Alzheimer's disease, traumatic brain injury, spinal cord injury, sciatica, and other neuroinflammatory disorders has attracted increasing attention(1).
Previous research had produced evidence of chronic brain inflammation following stroke. The CNS Drugs results provide, for the first time, proof-of-concept that targeting chronic brain inflammation is a viable therapeutic approach in humans years after stroke. The medical need is massive; in the United States alone approximately 795,000 individuals suffer a new or recurrent stroke each year. This calculates to a stroke happening every 40 seconds. At present, these patients lack treatment options to reverse the chronic disability that often results and many require full time care.
These new results provide a new direction for stroke research. In their most recent consensus statement, "Stroke: Working Towards a Prioritized World Agenda", leading stroke researchers recognized the need to "scan the scientific landscape to embrace new ideas and approaches ...[and] think outside the box ... could advances in the understanding of ... inflammation dramatically change our thinking about stroke pathogenesis?"
"The possibility of a leap in our understanding of brain dysfunction caused by stroke by exploring inflammatory pathways was anticipated by the forward-thinking stroke research community," said Edward Tobinick MD, the author of the study and inventor of the etanercept delivery method. "There is potential to address enormous unmet medical need."
1. "Rapid Improvement in Chronic Stroke Deficits after Perispinal Etanercept: Three Consecutive Cases". CNS Drugs 2011; 25 (2): 145-155. A video documenting the rapid effect of treatment accompanies the article at http://www.vimeo.com/18550399.
www.strokebreakthrough.com

Read More....

Pitt to test brain implants in paralyzed patients

2011-02-27T15:53:00.001-08:00

Pitt to test brain implants in paralyzed patients

Thursday, February 17, 2011

By Mark Roth, Pittsburgh Post-Gazette

The University of Pittsburgh will become one of the few places in the world to test brain implants in paralyzed patients in hopes of training them to move prosthetic arms with their thoughts.
The experimental work, involving two different kinds of electrode implants in the brain, is designed to interpret patients' brain signals, route them through a computer, and then control the movement of a prosthetic arm and hand, with a movable wrist and fingers.
If the research is successful, it could lead to implants that would allow patients to stimulate and control their own paralyzed arms, said Michael Boninger, director of the UPMC Rehabilitation Institute and a senior scientist on both projects.
The patients have not yet been chosen, Dr. Boninger said, but will probably be people with quadriplegia whose paralyses were caused by accidents.
The experiments build on the world-renowned work of Andrew Schwartz, a Pitt neurobiology professor, who has implanted electrodes in monkeys that have allowed them to control increasingly sophisticated prosthetic arms.
The projects are getting nearly $7 million over the next three years from the National Institutes of Health and the Defense Advanced Research Projects Agency.
The smaller of the two experiments will put an array of 16 electrodes on the surface of the brain in three patients for a month to test the concept of using brain-wave readings to move a cursor on a computer screen and then manipulate a prosthetic arm.
The other experiment will implant two sets of 100 electrodes each in the motor cortex of three paralyzed patients, Dr. Schwartz said in an interview Wednesday. The first patient, who will get the implants this summer, will have two small pedestals on the surface of the skull, from which wires will relay brain signals to a computer and then to a prosthetic arm.
One pedestal will channel signals from electrodes placed in an area that controls the arm, and the other from electrodes that control the wrist and hand.
The first patient's implants are scheduled to stay in place for a year. In 2012, a second patient would get implants that would also allow the patient to sense the movement of the arm and hand through a feedback circuit to the brain, he said.
A third patient in 2013 would get implants that would transmit signals wirelessly to control two prosthetic arms. Dr. Schwartz said.
In both projects, the patients start by observing the prosthetic arm's movements while the electrodes monitor signals from the motor control portions of their brains. Computer software can then use those patterns of signals to move the arm in the direction that the patient wants.
The longer project involving the implanted electrodes is being led by the Johns Hopkins University Applied Physics Laboratory in Laurel, Md., which oversaw development of the prosthetic arms and accompanying technology.
Other participants include Blackrock Microsystems in Utah, which makes the brain electrodes, and the California Institute of Technology, which is scheduled to try a different kind of brain implant in a patient in the future.
From a practical standpoint, Dr. Schwartz said, "we want to make this [prosthetic] arm perform as close to a real arm and hand as we can. When you ask these [paralyzed] subjects what they really want, they say they want to be able to use their hands to feed themselves and maintain themselves and do their buttons and zippers."
At a deeper level, he said, the researchers are learning how the brain carries out its plans. "We're trying to understand how the brain learns by watching the neurons fire, and that is very exciting."

Body and Brain Connection review

2011-02-27T15:50:00.000-08:00

y: Ryan Fleming •
February 14, 2011
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Review: Namaco Bandai’s Kinect title for the Xbox 360, Body and Brain Connection, is a great idea for the family that can help create real physical and mental benefits, but suffers from a lack of variety.

Let’s be honest, the Kinect is never going to have the same types of titles that the games using controllers have. There just isn’t the same level of depth that can be utilized when you can only mimic movement and all commands are done through time based highlighting of certain areas on the TV. If you want to select something, you hold your hand over the proper icon and wait until the bar fills up and the selection registers. You will never be able to pull off a satisfying 11-hit combo that finishes with a pile driver, nor will you ever be able to effectively use cover while under fire when you don’t have the ability to walk in the direction of your choice. It just isn’t going to happen.
Instead, clever developers are not trying to recreate the standard gaming experience without hands, they are coming up with new ideas that could only work on the Kinect, and adapting popular genres that wouldn’t typically appeal to the hardcore gamers. It is a push towards the casual gaming market, as well as move to specifically target the party game crowd. And that is exactly what Namaco Bandai has done with its new title Body and Brain Connection.
The game is designed to help people by offering simple mini-games that will help to exercise your brain and keeping you physically active. Body and Brain is also a game that parents should be able to quickly get behind. In fact, it is an easy fit for the home. If your kid likes video games, why not get them a video game designed by a “renowned neuroscientist” that can actually help them learn? The game sells itself like it is actually good for you, and it very well may be.
The idea of taking a game from the “brain training” genre is a natural fit for the Kinect. Adding physical movements to puzzles only further expands on what can be done. In fact, calling it a game is almost a misnomer because at its core, Body and Brain is a tool, albeit a fun one. When you first begin the “training”, it is fun and interesting. The more you play, the more difficult the problems become, and so the more benefit you reap from it. But behind the good idea that is Body and Brain Connection, lies the ugly specter of repetition. Even the most enticing mini-game can grow old quickly, and while Body and Brian is an impressive title at times, it could soon wear thin on all but the most resolute of players.

How It Works
With each category, the challenges offer puzzles and problems that typically require physical actions to solve. For example in the math sections, one of the first games you will play involves simple arithmetic. The problem is displayed above, and the answer is on one of two soccer balls displayed at your avatar’s feet. Once you have the answer, you then kick the corresponding ball into the net. Another puzzle has you watching the hands on a clock before they disappear. You follow the pattern and move your arms into the proper position where the hands should be before the timer runs out. Another game features arrows displayed in various places, and you must ignore where those arrows are, and instead you move your arms in the direction that the arrows are pointing as quickly as possible.
Once you have completed the game, you can go back and replay it on a harder level of difficulty. The arithmetic becomes algebra, the clock hands begin to move multiple spaces and disappear earlier, and the arrows appear in positions designed to try to fool you. As you complete each game, you are awarded a grade which you can accept or attempt to approve upon.
You track your progress primarily through the “age of your brain”. When you pop in the game for the first time, the game will run you through a few simple, time based problems. From that it will award you an age, and with each better score, and with each faster time, the age of your brain improves. Each day you will also find a new set of challenges which are offered based on previous results, in order to help you improve upon specific areas that you need help with.
The game claims to have been designed with the help of neuroscientist Dr. Ryuta Kawashima, one of the original people behind the brain-training genre, which is growing in America and is huge in Japan. The idea is that the games will help to train you mentally, while the physical nature is also beneficial to you.
The science behind it is no doubt sound, and the idea of using a video game to improve yourself is alluring. There is also a multiplayer which can make for some fun party games among people that enjoy brain-teaser based games. In that sense, Body and Brain is going right where the Kinect wants to—towards casual gamers.
Conclusion
The idea behind this game is both fun and appealing. Play a video game and get smarter—sounds good, right? But there is also the boredom factor that will soon descend upon players of any age as you quickly burn through the existing games and puzzles. There is always the potential of more games via DLC in the future, but that is a possibility not a certainty, and even if it were guaranteed the retail package is still a bit underwhelming.
All in all, Body and Brain Connection is a great idea that will keep gamers of all ages–from kids looking to learn to adults hoping for a bit of light stimulus—entertained for a while. It is something of a Catch-22. Many that play this game every now and then will probably find it interesting and a fun distraction, but to really benefit from it you must use it constantly, which will almost certainly chase people away once the tedium begins.
The concept of this title is impressive, and hopefully more games are on the way that can turn the Xbox 360 and the Kinect into something more than just a gaming system. Body and Brain is a tool that can be used to show real and practical benefits to the lives of gamers (at least to a small degree).
Body and Brain Connection is a good game/tool for those looking for something unique to do with their Kinect, and for people that enjoy brain teasers and puzzles which could offer real life benefits to the gamer. Odds are most won’t be able to continue to play the game for too long without getting bored, but in small doses, the game is solid. If you are a Kinect owner that is looking for something worthwhile to add to your collection, then Body and Brain Connection might be the game for you.
Read More....

Brain Scientists Create Illusion of Third Human Arm

2011-02-27T15:41:00.001-08:00

The human brain can be tricked into believing it has three arms, Swedish scientists said Thursday, giving hope to the advancement of prosthetic limbs for paralyzed stroke victims.

Scientists from the Karolinska Institute were able to convince 154 healthy volunteers that they owned multiple limbs -- to such an extent that participants broke out in a sweat when their fake limbs were threatened with a knife.

During the experiment, participants had a realistic prosthetic arm placed next to their right arm, and researchers stroked the real hand and fake hand with two small brushes in the same place. By synchronizing the strokes, the volunteers’ brains were tricked into feeling that the false arm was part of the body.

"A conflict arises in the brain concerning which of the right hands belongs to the participant's body," said researcher Dr. Arvid Guterstam. "What one could expect is that only one of the hands is experienced as one's own, presumably the real arm. But what we found, surprisingly, is that the brain solves this conflict by accepting both right hands as part of the body image, and the subjects experience having an extra third arm."

The scientists threatened either the prosthetic hand or the real hand with a kitchen knife while measuring the amount of sweating from the palm. They found results the participants had the same stress response when the prosthetic hand was threatened as when the real hand was in danger.

"It may be possible in the future to offer a stroke patient, who has become paralyzed on one side of the body, a prosthetic arm that can be used and experienced as his own, while the paralyzed arm remains within the patient's body image," said Dr. Henrik Ehrsson, who led the study.

Apoplexy

2010-11-23T10:38:00.000-08:00

Apoplexy is a medical term, which can be used to mean 'bleeding' in a cerebrovascular accident. However, without further specification it is rather outdated, and is today rather used for specific conditions, such as pituitary apoplexy and ovarian apoplexy. It can be used non-medically to mean a state of extreme rage or excitement. The word derives from the Greek word apoplēxia (ἀποπληξία).

Deaths attributed to apoplexy

Recognize the Common Types of Learning Disability

2010-11-20T18:34:00.000-08:00

The key to help learning disabled children cope with the disability is for parents to understand the type of problem. Identifying the problem will provide the various supports that parents will need to handle the difficulties of their child.
Furthermore, it is significant for parents to understand that learning disability is not a mental or emotional problem but rather, it affects the writing, speaking, listening and analytical skills of a child. Moreover, the symptoms and effects of learning disability may be different from one child to another.
Dyslexia is a reading disability wherein words and letters are mixed up.
The tendency of a dyslexic, an individual who suffers from dyslexia, is to reverse or invert letters in a word or words in a sentence thus affecting the reading skills. A dyslexic child may read or write the letter “d” as the letter “b” or may write the word “god” instead of “dog”. Moreover, a child with dyslexia may have trouble in following road directions since he or she may have difficulty distinguishing left from right. Experts advise that parents read patiently to a child with dyslexia and explain that words are supposed to be read from left to right.
Dyscalculia is a mathematical disability.
Dyscalculia is a learning disability in which a child experiences difficulty in analyzing numbers and mathematical symbols. A child may have problems in counting numbers, inability to tell time or failure to tell what number comes before or after another number.
Aphasia or Receptive Language Disability makes comprehension difficult.
Aphasia or receptive language disability is associated with the difficulty of a child to comprehend the meaning of words affecting his or her ability to follow verbal instructions. An aphasic child may show signs of helplessness in speaking or pronouncing words or even repeating short phrases. To help an aphasic child, it is important to talk using eye contact and always use simple words and short instructions...NEXT

Good Reads: Oliver Sacks' "Mind's Eye" and Simon Winchester's "Atlantic"

2010-11-16T17:41:00.000-08:00

About half of Oliver Sacks' The Mind's Eye is precisely what you've come to expect from the physician and professor of neurology and psychiatry: firsthand case studies of people facing unusual neurological obstacles, delivered by a kindly, curious observer.
A pianist has a degenerative condition that is slowly robbing her of the ability to read music (or anything else), another is stricken by aphasia following surgery to remove a blood clot. An author has a sudden stroke and loses his ability to read and remember much, but compensates by learning to read with his tongue; somehow, tracing the shape of letters with his tongue results in comprehension of the word he's spelled. If you're a long-time Sacks reader, you may find yourself learning less about neurology than the surprising amount of coping skills that people can marshal in these instances. ..Next

EBOOKEE

2010-11-16T17:03:00.001-08:00

Search results for "aphasia rehabilitation":

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Noun-verb dissociation in aphasia: The role of imageability and functional locus of the lesion [An article from: Neuropsychologia] No comments · Posted by Admin in Books Products

2010-08-16T19:17:00.000-07:00

Noun-verb dissociation in aphasia: The role of imageability and functional locus of the lesion [An article from: Neuropsychologia]

This digital document is a journal article from Neuropsychologia, published by Elsevier in . The article is delivered in HTML format and is available in your Amazon.com Media Library immediately after purchase. You can view it with any web browser. Description: Aphasic patients occasionally manifest a dissociated naming ability between objects and actions: this phenomenon has been interpreted as evidence of a separate organization for nouns and verbs in the mental lexicon. Nevertheless...next

Review: A Slender Thread by Katharine Davis

2010-08-16T12:28:00.000-07:00

Title: A Slender Thread

Author: Katharine Davis
Genre/Pages: Fiction/ 352
Publisher: NAL Trade; August 3, 2010
Rating: 3 Bookmarks
Source: Publisher
Nat’s One-Sentence Synopsis: A well-written novel that examines the impact that an illness has on a family.
With a single phone call or the results of a battery of medical testing, life can change in a moment. But a grim diagnosis is just the pebble dropping into the lake; author Katharine Davis examines the effects of the dropped pebble’s ripples.
50-year-old Lacey George’s diagnosis of aphasia , a rare and progressive disease that will rob her of speech, communication, and eventually her life, is not the crux of this novel. Instead, Davis uses the disease as a springboard to create a study of how a devastating illness changes the dynamic of a family.

Embolism of Left Middle Cerebral Artery with Aphasia and Agraphia

2010-08-16T11:52:00.001-07:00

Rehabilitation and cross-language transfer in bilingual aphasia: towards a computational model

2010-08-16T11:13:00.000-07:00

POSTER PRESENTATION Open Access
Rehabilitation and cross-language transfer in
bilingual aphasia: towards a computational model
Uli Grasemann1*, Chaleece Sandberg2, Swathi Kiran2, Risto Miikkulainen1
From Nineteenth Annual Computational Neuroscience Meeting: CNS*2010
San Antonio, TX, USA. 24-30 July 2010
Bilingual aphasia, defined as a loss of one or both languages
in bilingual individuals that results from left
hemisphere damage, is of increasing interest worldwide
premorbid
language proficiency, and post-morbid language
performance influence the nature and degree of crosslanguage
transfer...Next

Scoring Software for the Comprehensive Aphasia Test

2010-08-16T10:45:00.000-07:00

By Robin Keith, and Elise Croot.

The Scoring Software for the Comprehensive Aphasia Test makes scoring CAT assessments easy. Enter results from the CAT scoring book into the easy-to-use spreadsheet and the software instantly calculates totals and t-scores and produces three graphs that can be shared with clients and their families. Scoring sheets can be stored electronically, printed, or embedded into reports.
Benefits for therapists, their clients, and NHS departments include:

Experts develop unique metric to declare the possibility of aphasia after a stroke

2010-08-16T10:41:00.000-07:00

Aphasia is a language disorder that may occur after a brain injury especially stroke. Experts from the NewYork – Presbyterian Hospital / Columbia University Medical Center claim to have established a means to forecast post-stroke recovery of language by measuring the initial severity of impairment. Prediction of stroke recovery seems to be extremely beneficial for stroke survivors and their families .
Earlier scientists held the opinion that factors such as size of the stroke, patient age and education, and specific characteristics of the type of language deficit can determine recovery. But a definite metric predicting the precise recovery was not available. In the latest research, investigators employed Western Aphasia Battery (WAB) test for evaluating language function at 24 – 72 hours after the occurrence of a stroke. The researchers mentioned that the test was again used at 90 days.....Next

Language difficulty in adults (in plain English)

2010-08-16T10:23:00.000-07:00

What is language?

Language is the ability to understand words and to use them to make sentences.
What types of language difficulty affect adults?

A language difficulty can include problems with:

* comprehension (understanding what other people say)
* expression (putting words together in the right order to make sentences)

Some adults may have had a language difficulty since childhood. It may not have gone away.

Others might develop a language difficulty after a medical condition such as a stroke or a head injury.

When people develop language difficulties later in life, this is called an acquired disorder. ..Next....

Handwriting revisited

2010-03-13T17:29:00.000-08:00

he team of Jean-François Démonet was able to pinpoint this “channel” in the brain that connects orthographic information to the movements of handwriting.
This study is a first step towards understanding other contemporary forms of writing such as the use of keyboards, but also writing disorders in diseases as varied as Parkinson's disease, vascular aphasia or developmental dyslexia . Next ....

Aphasia Information and Treatment

2010-03-11T18:38:00.000-08:00

Aphasia is a neurological disorder. Aphasia caused from damage to the parts of the brain that hold language. The amount of disability rely on the location and the severity of the brain damage that is the cause. Aphasia is most common in adults who have had a stroke. Brain tumors, infections, injuries and dementia can also cause. Other causes of brain injury are stern blows to the head, brain tumors, brain infections, and other conditions of the brain. Certain chronic neurological disorders, such as the epilepsy or the migraine, can also include the aphasia transient like symptom prodromal or episodical. Next...

2 PhD positions in Language & Interaction: Daily Dutch and Aphasic Dutch

2010-03-10T16:04:00.000-08:00

The PhD positions are part of the NWO-funded Vidi research project “The Conversation Frame: Linguistic Forms and Communicative Functions in Discourse”, awarded to Dr. Esther Pascual. The program examines the relation between language, interaction and cognition, i.e. what Pascual calls ‘fictive interaction’. The main focus is on (intra-)sentential interactional structures –often expressed through direct speech– that reflect the conversational pattern of turn-taking. Examples are: “an attitude that says ‘what’s in it for me?’”, “a ‘what’s in it for me?’ attitude”. The language data will be daily and aphasic Dutch discourse from adult native speakers. The program is organized around two related PhD projects. We are inviting applications for one of these PhD projects.

Singing Could Aid Stroke Recovery

2010-03-10T15:44:00.000-08:00

Stroke victims who can no longer speak may now be able to regain their ability to communicate through singing, according to a recent Harvard Medical School study.

HMS professor Gottfried Schlaug and his research team have seen promising signs in the preliminary results of their first clinical trial of melodic intonation therapy, which can circumvent the effects of aphasia, the loss of verbal communicati NEXT...

The retrieval and inflection of verbs in the spontaneous speech of fluent aphasic speakers

2010-03-10T15:40:00.000-08:00

Fluent aphasia of the anomic and Wernicke’s type is characterized by word retrieval difficulties. However, in fluent aphasic speech, grammatical deviations have been observed as well. There is debate as to whether these grammatical problems are caused by the word retrieval deficit, by an additional grammatical deficit, or by an integration deficit.

Verbs are an interesting word class in this respect, because they are among the words that are hardest to retrieve for many fluent aphasic speakers and some forms require a considerable amount of grammatical computation. For production of a finite lexical verb, the lexical form and inflection for tense and agreement need to be integrated. Next....

Comprehensive Aphasia Test

2009-12-19T13:03:00.000-08:00

The Comprehensive Aphasia Test (CAT) is a new test for people who have acquired aphasia and can be completed over one or two assessment sessions. The battery contains a cognitive screen, a language..more..

Dave Kekich: The Bridge to Longevity.

2009-12-19T11:35:00.000-08:00

Negative optical aphasia: How much semantics makes a name take?

2009-12-18T15:42:00.000-08:00

Background: A spectacular framework of semantic processing in modern cognitive psychology advises that semantic memory originates in quotidian life experience with concrete objects such as workses, brutes, and tools ( Martin & Chao, 2001 ). When the signification of a concrete open-class word is being gotten, the scholar is faced with stimuli..next...

Preventing a stroke

2009-12-09T09:47:00.000-08:00

This section tells you how you could reduce the risk of stroke for yourself or

someone you care for.1000 people under 30 have a stroke each year

Some people are more at risk of stroke than others. Some factors can't be changed -

like your genes or your age. However, simple lifestyle changes may prevent you

from having a stroke. If you have already had a stroke, such changes may help

prevent stroke happening again. >Next...

WordCount

2009-11-22T10:04:00.000-08:00

WordCount

psych exam 3

2009-11-15T14:46:00.000-08:00

Created By
rhoppe
13 days ago

for my third psych exam


Shuffle Cards :	Yes	No

Sample flash cards from this set:

	Side A	Side B			Side A	Side B
1.	language	largely arbitrary system of communication...		11.	phonemes	sounds of our language (atoms)

2009-10-21T17:04:00.000-07:00

Only great minds can read this
This is weird, but interesting!
fi yuo cna raed tihs, yuo hvae a sgtrane mnid too

Cna yuo raed tihs? Olny 55 plepoe out of 100 can.

i cdnuolt blveiee taht I cluod aulaclty uesdnatnrd waht I was rdanieg. The phaonmneal pweor of the hmuan mnid, aoccdrnig to a rscheearch at Cmabrigde Uinervtisy, it dseno't mtaetr in waht oerdr the ltteres in a wrod are, the olny iproamtnt tihng is taht the frsit and lsat ltteer be in the rghit pclae. The rset can be a taotl mses and you can sitll raed it whotuit a pboerlm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Azanmig huh? yaeh and I awlyas tghuhot slpeling was ipmorantt! if you can raed tihs forwrad it

Traumatic Brain Injury Victims Studied Further at University

2009-09-26T15:10:00.000-07:00

Traumatic brain injury (TBI) patients are receiving extra attention at the University of Arizona's Aphasia Research Project where researchers are studying improved methods of writing and reading therapies for victims.

The university has reportedly received a collective $1.5 million grant from the National Institute on Deafness and other Communications and the National Institutes of Health to assist patients in recovering from communications disorders that involve more than just language. "Aphasia rehabilitation is typically directed toward the improvement of spoken language, but reading and spelling are also affected," according to reports from the Aphasia Research Project and the university....next...

BPS - Neuropsychology shines torch through corridors of the mind

2009-09-26T14:50:00.000-07:00

Hit the TV. The way it breaks down offers clues as to how it works. For example, you'll never find that a thump causes the screen to selectively stop displaying women, because there's no mechanism in the machine that exclusively supports the transmission of female images. Cognitive neuropsychologists pursue a similar approach with the human brain, except of course they don't kick people, but rather they study patients with a brain damaged through some other misfortune....next...

Chris DeWald | Aphasia and apraxia: The same, but different

2009-09-26T14:33:00.000-07:00

September 22, 2009 by chrisgraham

Trying to decipher and also remembering the difference is close to knowing all the whos in Whoville. Yeah, I bet everyone remembers Cindy Lou Who. I have always thought that the speech therapist told me I had aphasia, but reviewing my notes the other day, I read “apraxia.” Gee Golly, what is the difference? I always used to say it’s a stroke thing. That covers it, huh? A little knowledge does not hurt, so here we go! ..next....

Imaging short- and long-term training success in chronic aphasia

2009-09-26T14:29:00.000-07:00

To date, functional imaging studies of treatment-induced recovery from chronic aphasia only assessed short-term treatment effects after intensive language training. In the present study, we show with functional magnetic resonance imaging (fMRI), that different brain regions may be involved in immediate versus long-term success of intensive language training in chronic post-stroke aphasia patients.

Results: Eight patients were trained daily for three hours over a period of two weeks in naming of concrete objects....next.....

iPod Touch/iPhone as a Communication Device

2009-09-26T14:04:00.000-07:00

iPod Touch/iPhone as a Communication Device

For those PALS (Patients with ALS) who have good hand function, but just have trouble speaking, this may be a solution for you.

If you already own an iPod Touch or iPhone, there are a host of applications that you can purchase to have your device speak out loud things that you type or select on a screen:

Proloquo2go: Fully featured communication software with over 7000 items. Good quality voices. www.proloquo2go.com . $189.99 on iTunes

Talk Assist: Speaks anything typed into the application. Phrases can be saved, and it also keeps a history of typed phrases. Free on iTunes

iSpeech – Text to Speech: Speaks anything typed into the application. Free on iTunes

Speak it! Text to Speech: Turns anything a user types into speech. Good voice synthesizer with very clear speech. $1.99 on iTunes

Talk to Me – Text to Speech: Speaks words as they are typed, and will speak whole phrases. $1.99 on iTunes

Locabulary: Speaks preprogrammed word/phrases. Free on iTunes

Small Talk to Aphasia: Designed for people with aphasia, Small Talk provides a vocabulary of pictures and videos that talk in a natural human voice. Free on iTunes

If you do not have an iPod Touch or iPhone, you may be interested in this option. You should go to a store that sells iPod Touches or iPhones to see how you like the touch screen before you purchase this device.

Other accessories that you may find helpful:

Ewest Super Mini Stereo Speaker

iMainGo 2 Handheld Speaker Case

If you have difficulty touching the screen, there is a stylus that you can purchase to help make selecting items easier called the Pogo Stylus.

Spring 2009 Classes Filed Under News

2009-07-19T14:19:00.001-07:00

The semester is over, so it’s time for my update of the semester. This semester was probably my busiest one so far with 4 classes and clinic. My classes this semester included Fluency, Traumatic Brain Injury, Aphasia, and Dysphagia. Technically I should have taken Aphasia and Dysphagia last year, but they had to be postponed due to schedule conflicts.

Traumatic Brain Injury (TBI) was a good class. Typically, students take a class in Childhood Apraxia of Speech, but because most of my classmates are interested in the medical setting and they did not get much of an aphasia class, Apraxia was replaced. TBI was taught by the director of the clinic who worked several years with this population. The teacher doesn’t have a doctorate, so she has to get special permission to teach. This is the same teacher we had for Motor Speech Disorders last year. She is still one of the best teacher’s I’ve had. In the class we learned about cognitive communication disorders (impairments in memory, executive functioning, and attention) that result from a TBI and how to treat people with these impairments. It is an interesting field, but very heartbreaking to see individuals with injuries that have caused such damage to the brain. Next....

How to help a loved one suffering from aphasia

2009-07-17T14:21:00.000-07:00

June is Aphasia Awareness Month. Aphasia is a loss of language skills, one of the disabilities that can result from a stroke. Language problems usually result from damage to the left temporal and parietal lobes of the brain. Next..

Bridging aphasia-based language gaps

2009-07-17T14:13:00.000-07:00

Sarah Campbell
Staff Writer

Nestled on the fourth floor of the East Carolina University Health Sciences Building is a room where those suffering from aphasia have found a safe haven.
http://www.blogger.com/adsense-overview.g?blogID=1910041388171028050
"(Aphasia's) an impairment of language, the ability to use and comprehend words, Sherri Winslow, clinical supervisor for the ECU's Department of Communication Sciences and Disorders, said. "It includes talking, listening, understanding, reading, writing and numbers - all of those things relate to language."

East Carolina University's Department of Communication Sciences and Disorders began hosting free aphasia support groups during March.

"One of the main purposes (of the group) is getting people together because some of those with aphasia may tend not to try to attempt to communicate out in public or with other people," Sherri Winslow, clinical supervisor for the departm Next..

communication disorders

2009-04-29T13:24:00.000-07:00

Definition: Aphasia is defined as an impairment that affects language, reading, and writing. This person may have trouble reading, writing, talking, listening, ect. Aphasia is caused by damage to the left hemisphere of the brain. This can be caused suddenly as result of a stroke or trauma, or it can occur slowly by tumors, infection, or dementia. Anyone can be diagnosed with aphasia; it affects men and women the same. Aphasia can be cured or it can be permanent. There are two types of aphasia: fluen...next....

Case 12-2009 — A 46-Year-Old Man with Migraine, Aphasia, and Hemiparesis and Similarly Affected Family Members

2009-04-29T13:06:00.000-07:00

Family Members
Steven D. Brass, M.D., M.P.H., Eric E. Smith, M.D., M.P.H., Joseph F. Arboleda-Velasquez, M.D., William A. Copen, M.D., and Matthew P. Frosch, M.D., Ph.D.

Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

Presentation of Case

A 46-year-old man was seen in the neurology clinic because ofhemiparesis, aphasia, and abnormalities on neuroimaging studies.

The patient had been well, except for migraine headaches, until4 years earlier, when right-sided weakness, clumsiness, andslurred speech developed during a period of 24 hours. A neurologistat another hospital found dysarthria and right central facialweakness; decreased muscle tone in the right arm, with strength4+/5; and normal muscle tone in the right leg, with strength4+/5. Strength on the left side was normal, with slightly increasedtone in the left arm and normal tone in the left leg. . . . next

Speeder XP

2009-04-27T20:13:00.001-07:00

Don't use SpeederXP for CHEAT! (Such as WOW)

SpeederXP Screenshot

Click and view more pictures of SpeederXP...

What's SpeederXP ?

SpeederXP is a powerful PC speed hack tool. You can speed up your computer, your internet access and your games. Make your old slow computer more efficient and run faster in games.Learn more...

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Full support Microsoft Windows^® 98, 98SE, 2000 ,XP ,2003 and Vista

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Game speed hack and game accelerator

Track bar control speed freely

Hotkey enabled, 6 custom hot keys can change speed at anytime

New York Relay

2009-04-22T18:54:00.000-07:00

People who are deaf, hard-of-hearing, deaf-blind, or have a speech disability enrich their independent lives by utilizing relay services. Traditional phones are not for everybody. Teletypewriters (TTY) and telecommunications devices for the deaf (TDD) have proven themselves to be useful and easy to use. The relay services take advantage of TTY/TDD devices that allow the user to communicate with friends, loved ones, business associates, and service providers so they may participate in daily community life.

New York Relay Service uses state-of-the-art technology to bring relay services to customers. Enrich your communications. With New York Relay, you can:

* Store and refer back to information such as frequently dialed numbers, preferred call type, and long distance carrier
* Utilize a wide array of technologies, such as teletypewriters (TTY), Voice Carry-Over (VCO) and Hearing Carry-Over (HCO)
* Retrieve voicemail and answering machine messages
* Redial last number called
* Work with sensitive and well-trained Relay Operators who handle each call with complete confidentiality

The Relay Service routinely monitors performance to ensure continuously high quality services.

For Deaf, Hard-of-Hearing, or Speech Disabled:
The most common device used to make a relay call is a TTY (text telephone device) that can be used together with a phone handset. However, the equipment you need may vary depending upon the type of relay service you use. For more information on how to obtain a device in your area for your specific needs, call New York Relay Service Customer Service at 1-800-676-3777.

For Hearing (or Voice Caller):
You don't need any special devices for calling the Relay Service. When you plan to call a deaf, hard-of-hearing or speech-disabled individual, all you do is to simply dial 7-1-1 or 1-800-421-1220. You will hear a voice recording telling you to press "1" to make a relay call. Then you will give the Relay Operator the area code and telephone number you wish to call and any further instructions. The Relay Operator will process your call, relaying exactly what the TTY user is typing back to you. The Relay Operator will relay what you say back to the TTY user.

voice control

2009-04-20T19:27:00.000-07:00

http://www.sitepal.com/text-to-speech

http://arstechnica.com/apple/news/2009/04/iphone-os-30-to-feature-voice-control-and-feedback.ars

http://www.nch.com.au/verbose/index.html?gclid=CPaRo_fw65kCFWVM5QodtGBOQw

http://www.1st-dragon.com/?gclid=CIrjgfjx65kCFYZM5Qodo0qbSA

http://support.microsoft.com/kb/306901

http://www.microsoft.com/windowsxp/using/mce/expert/ballew_04dec13.mspx

http://www.supershareware.com/info/e-speaking-voice-and-speech-recognition.html

Musicophilia by Dr. Sacks

2008-09-26T14:11:00.000-07:00

http://www.diversityworld.com/Disability/newsletter.htm

2008-09-01T13:54:00.000-07:00

NEWSLETTER

D-NETPicture of DNET Newsletter
Disability Network Newsletter

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National Aphasia Association

2008-06-28T17:39:00.000-07:00

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
year.

"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
aphasia.

"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
public.

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
words.
6) Communicate with drawings, gestures, writing and facial expressions.
7) Confirm that you are communicating successfully with "yes" and "no"
questions.
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 www.aphasia.org

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.

www.aphasia.org 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

2008-06-28T17:22:00.000-07:00

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

2008-06-28T12:38:00.000-07:00

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.

Babbel

2008-05-10T14:19:00.000-07:00

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...............

Conceptualizing Functional Cognition in Stroke

2008-03-16T14:22:00.000-07:00

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

Alexia and agraphia

2008-03-15T19:28:00.000-07:00

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 vhenderson@stanford.edu.

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

Brain Tumor (Primary

2008-03-15T19:23:00.001-07:00

--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

2008-03-15T19:20:00.000-07:00

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 gaelle.raboyeau@criugm.rtss.qc.ca

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

Objective: To address whether the involvement of the rightinferior frontal cortex is either unique to recovering aphasicpatients or present also in other circumstances of enrichmentof lexical abilities, i.e., in non–brain-damaged subjectsover learning of new vocabulary.

Long-Term Care

2008-03-15T18:10:00.000-07:00

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.

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

2008-03-09T20:08:00.000-07:00

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 about..next..........

Neuropsychology Abstract of the Day: Aphasia

2008-03-09T20:00:00.000-07:00

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.

Next..........

tDCS and aphasia after stroke

2008-03-09T19:56:00.000-07:00

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.

Aphasia, Apraxia and Scotoma

2008-01-17T17:24:00.000-08:00

http://www.strokeassociation.org/presenter.jhtml?identifier=3030925

http://en.wikipedia.org/wiki/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

2008-01-17T17:21:00.000-08:00

Abstract
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?

2008-01-17T16:51:00.001-08:00

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

2008-01-17T15:31:00.000-08:00

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

2008-01-17T15:24:00.000-08:00

Abstract

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

Process skill rather than motor skill ..

2008-01-16T11:44:00.000-08:00

... 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)

Background

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

2008-01-16T11:30:00.000-08:00

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.

Next.........

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

2008-01-16T11:16:00.000-08:00

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, jason-osher@northwestern.edu

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

2008-01-16T10:54:00.001-08:00

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.

The autism 'epidemic', is there a sensory perceptual form of autism?

2007-11-21T12:08:00.000-08:00

Exploring agnosia, I found the context blindness of simultagnosia, and the object confusion of associative agnosia. So that’s why I still confuse the garlic crusher and the can opener and why I can’t tell people are talking because I just see someone’s mouth moving making noise, then someone else’s but don’t realise they are talking TO EACH OTHER!

And I learned of automobilia in which one can’t recognise vehicles and I remember my frustrated mother hitting me because she had this face blind kid who couldn’t recognise anyone so would treat all as strangers or friends, and couldn’t identify types of cars even though her father owned a car yard. There were drive ins then and my family would go to them. I’d go to the toilet and get into three cars before my parents would spot me running from each and beep the horn. My mother had been afraid I’d be taken by strangers and be unable to name the car. But being hit for something due to brain damage which could no more work than could I sprout a tail, is part of why I’m bothering to write this blog entry.

And I learned of integrative agnosia in Next.............

Musicophilia: Tales of Music and the Brain

2007-11-21T11:57:00.000-08:00

by Oliver Sacks
367pp, Picador, £17.99

It is a remarkable fact that if I merely type "the Mission: Impossible theme tune" or "Beethoven's Fifth", you will probably start humming to yourself. We take it for granted, but how is it possible? What is going on in our brains? Oliver Sacks, the neurologist author of The Man Who Mistook His Wife For a Hat, here devotes a book to the cognitive miracles of music. "It really is a very odd business," he muses, "that all of us, to varying degrees, have music in our heads."

The start of a new beginning.

2007-11-21T11:54:00.000-08:00

So I'm pretty much convinced that there is something slightly wrong with my Broca's area*. No, it isn't severe damage, I'm sure. But if you have tried to hold a conversation with me before, you probably know of my tendencies to 1) talk too fast for my own good, causing me to 2) stutter, and 3) have a constant misuse of and unnecessary use of (?) vocabulary words.

*Broca's area is a section of the brain that is involved inlanguage processing, speech production, and comprehension.

According to Wikipedia (aka my best friend):

People suffering from damage to this area may show a condition called Broca's aphasia (sometimes known as expressive aphasia, motor aphasia, or nonfluent aphasia), which makes them unable to create grammatically-complex sentences: their speech is often described as telegraphic and contains little but content words. Patients are usually aware that they cannot speak properly. Comprehension in Broca's aphasia is relatively normal, although many studies have demonstrated that Broca's aphasics have trouble understanding certain kinds of syntactically complex sentences.

Abstract

2007-11-21T08:59:00.000-08:00

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. next.

This is an excerpt from the paper...

2007-11-21T08:41:00.000-08:00

As early as 1836, Marc Dax found that patients who could not speak properly had damage to the left side of the brain, and in 1861 Paul Broca described a patient who could say only one word - Tan (The Brain, 2005). When the patient died, he carried out an autopsy and discovered damage to the patient's left frontal cortex, which became known as Broca's area. In 1876, Karl Wernicke found damage in the posterior temporal lobe (Wernicke's area), connected to Broca's area by a bundle of nerve fibers, the arcuate fasciculus, also caused speech problems. Damage to the arcuate fasciculus causes conduction aphasia, in which people can understand language but their speech does not make sense and they cannot repeat words.

To speak a word that is read, information must travel from the primary visual cortex to the posterior speech area, including Wernicke's area, and from here to Broca's area, and then to the primary motor cortex (The Brain, 2005). To speak a word that

Next..

Stroke Causing Aphasia

2007-11-21T08:37:00.000-08:00

A pattern of ensuing weeks of receptive aphasia is foreign language practice , in which individuals can understand what others say or write, but appropriate medical care much, if any, speech or writing of their own. Management of fundamental issues - like blood pressure, body temperature and blood sugar - can set the stage for the best possible outcome. It shows that there is a 6 types of chinese characters used to create Chinese characters. (The phrenologists believed otherwise, but that is a story of its own.) It is paramount that concepts and material be presented in a way most suitable for the learners. Can the company handle these requirements? I looked on the internet and found the best program out there. In cases of stroke due to hardening of the arteries (atherosclerosis) this often takes the form of ratcheting down blood pressure, blood sugar and cholesterol, along with elimination next..

Health: Aphasia impairs understanding of language

2007-10-19T20:35:00.000-07:00

Pam Ahlman
Special for The Republic
Sept. 26, 2007 10:49 AM

Question: I have a friend who was diagnosed with aphasia. What is this and what can I do to help her? NEXT...........

Speech-language Pathology and Audiology Titles from Delmar Learning

2007-09-27T13:31:00.000-07:00

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Complete Review for NCLEX-RN (Delmar's Complete Review for NCLEX-RN (W/CD))
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Language In Our Life And Its Role In Our Brain

2007-09-27T13:07:00.000-07:00

The early studies done in this area were by Broca (1861) and Wernicke
(1874). Broca's work included the patient, now known as "tan", who
could only say the word "tan", although his speech comprehension
stayed in tact. The patient died shortly afterwards and autopsy
revealed that he had been damaged in the lower part of the left
frontal lobe. Broca collected eight more cases and concluded that the
identified area was essential in the production and comprehension of
speech. The area is called Broca's area and the condition of damage to
it is called Broca's aphasia.

Wernicke reported a different aphasia. Patients could speak in
organized and grammatical sentences, although what they said seemed to
have little to do with the on going conversation. On the other hand
they seemed to have no understanding of what was spoken to them. On
autopsy, they all had damage to an area at the top of the left
temporal lobe, now known as Wernicke's area.

These speech zones also tally with the sensory and motor cortical
mechanisms. For example, Wernicke's aphasia represents a problem with
speech processing. The spoken word is a sound stimulus which enters
our ear and in transferred as an electrical signal through our nerves
until it reaches the primary auditory cortex in the temporal lobe.
This area is close to Wernicke's area which contains the "word
analyzer". The word analyzer contains the sound patterns of words
that are essential in converting speech into words. If Wernicke's are
damaged the sounds cannot be identified as speech and comprehended.

We humans have a wonderful opportunity to communicate with each other both spoken and written languages, unlike our "smaller brothers" from animal world who can only use some specific signals which are recognized by them only. Language is a very powerful tool that enables us not only to communicate, but also plays a vital part in our brain's development and simply "working'.

Broca's area is in the frontal lobe and contains the motor cortex.
Speech is a motor process requiring sophisticated control over muscles
of the throat, lips and mouth. Broca's area contains the motor plans
for words. When Broca's damaged the plans cannot be activated
even though the motor cortex is intact.

Speech, reading and writing are also language functions that have a
role in the human brain. Aphasia study showed that the condition was
more common in left hemisphere damage than in right. In contrast to
the symmetry of sensory and motor functions, language functions are
asymmetrical, being more dominant in the left hemisphere. Global
aphasia is when both Broca's and Wernicke's areas are damaged and
"shadowing" experiments in which words are spoken to a subject quickly
and they must repeat them back quickly suggest that a global aphasic
will be unable to "shadow". The accurate fasciculus's the direct
pathway from Wernicke's to Broca's area. If this is damaged then
conduction aphasia results, which is severe impairment of repetition or
"shadowing". However, normal speech production and comprehension are
less affected. This implies other less direct pathways exist apart
from the direct pathway of accurate fascicules.

Writing, as a motor process is produced from the motor cortex under
the control of the planning centre in Broca's area. The input system,
reading, involves the visual system and a region that contains the
visual pattern of words and is capable of converting visual input into
words. The key region for reading and writing is the angular gyros, on
the borders of the temporal and parietal lobes.

This region contains visual word patterns, the visual pattern is
transmitted to Wernicke's area, where it arouses the auditory form of
the word and comprehension occurs. Pure word blindness occurs when we
have someone able to write a page of coherent and fluent prose, but
who cannot read it back. This syndrome is known as alexia without

Dragon Naturally Speaking

2007-09-19T09:04:00.000-07:00

Speech Recognition Software Finally Works

By Lamont Wood, Special to LiveScience

posted: 16 July 2007 08:39 am ET

Surprisingly, the summer of 2007 will be remembered for something other than Paris Hilton’s incarceration: It’s also the 10th anniversary of continuous speech recognition (SR) technology for the PC. Dragon NaturallySpeaking 1.0 came out in the summer of 1997, and those who wanted to dictate to their computers no longer had to pause ... between ... words.

Originally, the user had to “train” the software for about 45 minutes by reading it a canned test, and the resulting accuracy of about 75 percent meant you couldn’t finish a short sentence without several glaring errors. Today, having changed hands twice before arriving at version 9.5, training takes only minutes and out-of-the-box accuracy is about 95 percent, meaning you can expect one error per run-on sentence. Dragon’s current vendor, Nuance Communications Inc. of Burlington, MA, reports that sales are booming.

Chris Strammiello, a spokesman for Dragon’s current vendor, Nuance Communications Inc. of Burlington, MA, told LiveScience that Dragon did not catch on with the mass market until Version 8.0 came out in June 2004, offering enough accuracy (thanks to improved algorithms and faster computers) to be truly useful. Sales have been increasing by 30 percent per year since then, he said. (Strammiello would not break out Dragon’s contribution to Nuance’s bottom line, but the firm’s gross sales rose from $130.9 million in 2004, to $232.4 million in 2005, to $388.5 in 2006.)

Up from 95 percent

Actually, my extensive personal use shows that 95 percent is about as accurate as typing, with the software’s chief advantage being that it can keep up with a conversational speed of 140 words per minute, which is easily three times faster than most people can type.

Proofreading is a strange experience, since you are seeing the text for the first time, and you can be confused between what you meant to say, what you really said, and what the computer heard. Long words are almost invariably correct, while short words sometimes seem interchangeable.

Getting to 99 percent accuracy is possible in several weeks using the software’s correction facilities, by which it gradually adjusts itself to your voice. But speaking clearly and consistently is all-important. The personal version of Dragon retails for about $200, while the professional version costs about $765.

Painful decade

Over the past decade and earlier, the history of SR has not been a continuous series of triumphs, as the technology was nearly sunk twice by rampant hucksterism. One of the pioneers in the SR field was Kurzweill Applied Intelligence, two of whose executives were sentenced to prison in 1993 for inventing sales. The remains of that firm were bought in 1997 by a Belgium-based SR firm, Lernout and Hauspie (L&H), which was then reporting steady sales growth.

Dragon’s original vendor, Dragon Systems, was not reporting much growth after releasing NaturallySpeaking in 1997, and in 2000 L&H stepped forward and bought the struggling firm in a stock deal. A few months later, L&H’s sales growth was exposed as fakery, and it collapsed.

ScanSoft Inc. bought the Dragon SR technology at a bankruptcy auction in late 2001 and has continued development through three upgrades since then, meanwhile changing its name to Nuance Communications.

SR elsewhere

SR facilities are also included in Microsoft Office XP, although the fact is apparently not known to most users. Industry observers considered it a test version, as it required a mouse for navigation and correction, unlike Dragon.

Microsoft Vista has an enhanced version of SR that, like Dragon, does not need a mouse.

IBM ViaVoice was also once a competitor of Dragon, but IBM has licensed the software to Nuance, which uses it as an entry-level product. No other large-vocabulary desktop SR products are being marketed in the United States.

Speech perception

2007-08-19T01:31:00.000-07:00

Speech perception in language or hearing impairment

Research in how people with language or hearing impairment perceive speech is not only intended to discover possible treatments. It can provide insight into what principles underlie non-impaired speech perception. Two areas of research can serve as an example:

Listeners with aphasia. Aphasia affects both the expression and reception of language. Both two most common types, Broca's and Wernike's aphasia , affect speech perception to some extent. Broca’s aphasia causes moderate difficulties for language understanding. The effect of Wernike’s aphasia on understanding is much more severe. It is agreed upon, that aphasics suffer from perceptual deficits. They are usually unable to fully distinguish place of articulation and voicing.^[22] As for other features, the difficulties vary. It has not yet been proven whether low-level speech-perception skills are affected in aphasia sufferers or whether their difficulties are caused by higher-level impairment alone.^[22]

Listeners with cochlear implants. Cochlear implantation allows partial restoration of hearing in deaf people. The acoustic information conveyed by an implant is usually sufficient for implant users to properly recognize speech of people they know even without visual clues.^[23] For cochlear implant users, it is more difficult to understand unknown speakers and sounds. The perceptual abilities of children that received an implant after the age of two are significantly better than of those who were implanted in adulthood. A number of factors have been shown to influence perceptual performance. These are especially duration of deafness prior to implantation, age of onset of deafness, age at implantation (such age affects may be related to the Critical period hypothesis ) and the duration of using an implant. There are differences between children with congenital and acquired deafness. Postlingually deaf children have better results than the prelingually deaf and adapt to a cochlear implant faster.^[23]

Doing More With Less for People With Aphasia: Creative Responses to Healthcare Change

2007-08-18T17:49:00.000-07:00

Candace Vickers, M.S.,CCC-SLP

Speech language pathologists providing therapy services to persons with aphasia in medical settings are confronted today with two seemingly incompatible grim realities: 1) Persons with aphasia often have limited access to rehabilitation due to limited visits allowed by managed care insurances and; 2) third party payers, supervisors and families of persons with aphasia expect ‘functional outcomes’ as a result of treatment regardless of the time frame allowed. At the same time ASHA’s revised Scope of Practice for Speech Language Pathology (May, 2001) now states that the ultimate goal of speech-language therapy intervention is to improve quality of life via increased participation in life.

The call to increasing ‘life participation in aphasia’ was initially sounded by some of the top aphasiologists in the country (Lyon, 1992; Chapey, et al, 2000). Increasing ‘participation in life’ may seem like a lofty task to the average clinician toiling away in a medical setting when, with shorter treatment sessions, the number of patients seen in a day has increased, paperwork has doubled, and obtaining even six to twelve consecutive visits for treatment can require a Herculean effort from clinicians already short on planning time.

Facing up to why it is important to "do more with less"

Doing "more with less" for people with aphasia begins with the SLP’s recognition that months and months of individual speech and language therapy possibly never has necessarily been the road to increased communication opportunities, communication success, and/or participation in life for persons who have aphasia. The profession shares some responsibility in not clearly demonstrating the functional effectiveness of therapy in the typical medical setting under typical conditions. How, for example, can it be suggested that twelve individual therapy sessions are too few, when it has not been fully demonstrated that 40 sessions produced real life meaningful changes in persons’ lives? (Threats, 2002)

One response to the constraints imposed by today’s healthcare system is to do as Roberta Elman has suggested (1999) and provide treatment "outside the box." The "box" that clinicians may need to step out of could be what Jon Lyon (1999) calls the box of ‘reimbursable care’. Both Elman and Lyon are dedicated aphasiologists who actually did step "out of the box" to forge new frontiers in meeting the communication needs of people with aphasia. Elman and her colleagues Bernstein-Ellis and Ewing, left paying jobs as speech language pathologists to begin the Aphasia Center of California in Oakland, which offers group therapy to people with aphasia five days a week without billing third party payers. Lyon partners with community agencies to train "communication partner volunteers" to provide services to people with aphasia through his nonprofit organization, Living with Aphasia. He also provides long term specialized services to couples coping with aphasia that would be unavailable in traditional treatment settings. ( Lyon, 1999) Providing services that empower couples coping with aphasia to learn more efficient communication strategies is to be applauded and hopefully taken up by more speech-language pathologists. For example, Boles (1998, 2000) has reported measurable changes in communicative success for couples who received Solution Focused Aphasia Therapy in the university setting. It is crucial, however, that clinicians in traditional medical settings are also able to show the effectiveness in facilitation of real life functional changes in the lives of those with aphasia. The current reduced treatment time situation for speech-language pathologists is precarious since not achieving functional goals with decreased therapy time could be used to declare that therapy does not really work. The continuing challenge for clinicians providing aphasia therapy in the medical arena will not only be to advocate for patients to receive the appropriate amount of treatment visits, but also to initiate at least beginning guidance for coping with the long term consequences of aphasia on daily life. This process can begin through family education and training in the initial stages of therapy, but will also need to address ensuring that persons with aphasia have access to meaningful communication opportunities such as that provided by participation in group conversation programs that focus on facilitating satisfying interactions with peers and trained volunteers.

Doing more for the person with aphasia during the inpatient phase

Part of ‘doing more with less’ for persons with aphasia who are inpatients in medical settings could be to do as Kagan has suggested, and create an "aphasia friendly infrastructure" (1998b). Actions such as presenting in-services to nursing staff or one’s colleagues in allied disciplines about effective communication skills to use with people with aphasia are a way to begin building this infrastructure. It is even more powerful when timed to coincide with National Aphasia Awareness Week in the month of June. Additional momentum can be gained by working with the volunteer services department of one’s hospital on ways to increase access to special services for inpatients with aphasia. For example, at some hospitals, there are special desks manned by volunteers that offer inpatients the chance to request items like VCR’s, talking books, or special food to be delivered to their hospital rooms. Clinicians can heighten awareness of the fact that hospitalized individuals with aphasia who have difficulty using the telephone or using interrogative questions to request items barely ever access this service due to communication difficulty. They can then work collaboratively with volunteers, nursing, and others to open new avenues of communication for these inpatients to be able to express more choices and access services.

Creative responses from "the trenches" for the outpatient phase

There is an old saying that a crisis is a time of "danger and opportunity" and that is certainly applicable to the situation faced by clinicians desiring to provide quality treatment for people with aphasia. The dangers may come in the form of limited access to treatment due to external forces, but it is the response of clinicians having a passion to make a difference anyway that presents the opportunity for growth and creativity by trying different avenues or methods of treatment or initiating new programs outside of reimbursable care. Although lobbying for adequate individual therapy time is part of what clinicians in medical settings will do out of necessity, proactive responses go beyond arranging for what can occur in the two or three times a week 45 minute therapy session. Clinicians in medical settings who want to help open doors for increased participation in life for people with aphasia, can make a powerful impact when they establish ways to respond to the ongoing communicative needs of persons with aphasia outside of the limited treatment time framework. This impact extends not only to the lives of the persons with aphasia whom they serve, but also on their local healthcare community, such as colleagues in other disciplines, management personnel, students who are provided with field study and service learning opportunities, and community agencies who interact with their facilities.

Tools for raising awareness of needs of persons with aphasia

Clinicians have some powerful tools for helping them to gain support for the notion that persons with aphasia want, need, and deserve ongoing communication participation opportunities. These tools can be found in two places: 1) the ICF framework for rehabilitation as described in the World Health Organization’s new classification system, (WHO, 2001); and: 2) the mission statement or core values of many healthcare institutions where clinicians work. Additional tools for education and advocacy are also available through the National Aphasia Association at www.aphasia.org.

Aphasia treatment in the ICF framework

People with aphasia need increased access to existing services, as well as the ability to receive adequate amounts of rehabilitation services. Clinicians advocating for both of these have a strong ally in the new concepts for rehabilitation provided by The International Classification of Functioning, Disability and Health (World Health Organization, 2001). ICF concepts such as targeting improved participation in life have now been embraced by ASHA in its revised Scope of Practice for Speech-Language Pathology, (ASHA, 2001) and the framework shows promise of inspiring research on all aspects of disability and the disablement process. One of the purposes of any scope of practice is for use with third party payers to demonstrate that services being provided fall within the breadth and recommended practices for a profession. Thus, if asked why spouses are being included in the treatment process for persons with aphasia, one could state that the scope of practice for the field recognizes the environment as an important component to the recovery process. According to Threats (2001), third party payers are studying possible use of the codes for their future healthcare determinations as well. For example, the National Committee of Vital and Health Statistics, a scholarly subcommittee of the Department of Health and Human Services, has made a recommendation to further study the use of the ICF for all federal health reporting forms, including those for Medicare reporting and reimbursement. They state in their report that the functional outcomes of all medical interventions is now considered the most important of all outcomes. Thus, even for something such as determining whether a medication is effective it would have to be shown that there is a functional improvement in patients’ lives, and not only a physiological appropriate reaction to the medication. (NCVHS, 2001)

The attention that will be given to ICF codes in the future has significant ramifications for speech language pathologists providing clinical services to people with aphasia. For example, the specialized codes for activity and participation codes in the ICF offer clinicians in medical settings a meaningful way to identify the range of impacts that aphasia has on participation in communication for virtually every area of life. The same codes can then be used to indicate the changes that have occurred in terms of activity and participation when therapy has ended.

Fulfilling the healthcare mission

Chapey (2001) has written that the ability to communicate through language is part of the ‘human essence’. By validating that a communication disorder can impact every aspect of life, the ICF presents an advocacy tool that clinicians can use to demonstrate that providing services such as conversation groups to persons with aphasia are consistent with the mission statements of the facilities in which they work. For example, this author’s healthcare setting embraces the core values of "dignity, service, justice, and excellence", and rewards its employees yearly for exemplifying those values in interactions with both patients and coworkers. Initiation of innovative programs that promote wellness while also decreasing length of stay and reducing costs are also valued and encouraged.

For example, at St. Jude’s Medical Center in Fullerton, California, the hospital conducts ongoing endeavors in its community to enhance "Healthy Communities". A Community Exercise Group offered five days a week to persons with disabilities, and a Mobile Health Van offering free pediatric services to economically disadvantaged groups are just two examples of these efforts. Ideas such as this may provide a beginning point that can help clinicians create new systems to help persons with aphasia. An illustration of this concept in action would be the founding of Communication Recovery, a group conversation program for persons with aphasia using volunteers in a medical setting. (Vickers, 1998) The author was able to gain support from hospital administration for operating this community group program for persons with aphasia by pointing out that participation in weekly conversation groups with peers is just as crucial for improved well being as physical exercise, and is an expression of the values espoused by the institution. (Vickers, 1999)

The fact that access to individual treatment time is more limited during this time of healthcare change accentuates the urgent need that persons with aphasia and their families learn to do what Lyon has termed "cope with aphasia", (1998) and that this learning to cope needs to occur sooner than later. Clinicians serving persons with aphasia are keenly aware that clients often view termination of individual therapy services as a devastating loss. Many may have been experiencing the most satisfying and least frustrating communication of their day with a therapist who used active listening and was able to follow their messages. When individual therapy cannot continue and this unique communication opportunity ceases, families are often hard pressed to help their loved one with aphasia find and successfully become involved with outlets for communication interaction, as there are many areas of the country where there are no community aphasia groups available. ASHA (1988) has stated that part of the SLP’s ethical responsibility is to offer communication opportunities to the isolated. This mandate also reinforces the need for clinicians to respond to the new curtailed treatment time scenario creatively, by finding ways to be a catalyst of change for the communication world of the person with aphasia. This author’s experience in a medical setting has demonstrated that one clinician can be an instrument of this change and make a difference, even while carrying a full caseload, with no budget for equipment of any kind, and with no outside funding.

Building momentum on behalf of persons with aphasia in the medical setting through use of volunteers

As specialists in the treatment of communicative disorders, speech language pathologists are also uniquely suited to help others such as colleagues in management and administrative positions, recognize the intrinsic value and importance of being able to communicate, and the devastating impact it can have on the individual when this ability is lost or impaired. Clinicians also possess strategic knowledge about how others without the same knowledge of aphasia may be able to engage in satisfying interactions with persons with aphasia when given appropriate training and guidance to do so. This concept was articulated by Lyon (1988) when he created the designation "communication partner" volunteer, and pointed out that the volunteer’s interaction with the person with aphasia has intrinsic value, because it is not seen as obligatory. Lyon trains volunteers to interact with persons with aphasia throughout the week as well as to accompany them in what he terms ‘activities of choice’ in the community. At the Aphasia Institute in Toronto, Kagan and colleagues are able to offer conversation groups and more, to people with aphasia throughout the week, with the help of volunteers who have received extensive training in Supportive Conversation. (Kagan, 1998; Kagan & Cohen-
Schneider, 1998a)

While it is true that most clinicians in medical settings may not be able to offer the variety of options or frequency of conversation groups described above, experience in working with volunteers in Communication Recovery Groups at St. Jude Medical Center since 1994 has shown that the "communication partner volunteer" can play a significant role in partnering with even one speech pathologist in the medical setting. When provided with special education and training in use of techniques such as Written Choice Communication (Garrett & Beukelman, 1992; 1998), volunteers can assist persons with aphasia by engaging them in meaningful interactions under the supervision of the speech language pathologist. While interactions with volunteers do not constitute the experience of having therapy, persons with aphasia can benefit greatly from being able to engage in frequent, enjoyable communication opportunities.

Communication groups for people coping with both recent and chronic aphasia

It is clear that persons with aphasia need ongoing access to participation in meaningful communication situations after discharge from individual therapy, just as they may need chances to perform supervised physical exercise regularly in order to prevent further strokes and rehospitalization due to other complications. It is also clear that clinicians are having to discharge persons with aphasia from individual therapy sooner than in the past due to current healthcare constraints with the result that many with aphasia, and their family members, do not have opportunities to learn to gradually adjust to life with aphasia or receive encouragement or tools to continue moving forward with their lives. By applying some of the ideas and principles described above, clinicians around the country may be able to raise awareness of the needs of people with aphasia in their own unique settings, and initiate communication group programs. By recruiting and training volunteers, as well as partnering with colleagues in other disciplines, it is possible to reach and help more individuals with aphasia than one clinician could do alone, thus making a significant impact on one’s local area.

Volunteerism as a path to involvement as well as increased life participation

The experience of using volunteers in Communication Recovery at St. Jude Medical Center has been found to benefit a wide range of individuals in addition to those with aphasia. The rehab center is strategically located only two miles from California State University, which also offers a master’s program in communicative disorders. Through the last nine years, a steady stream of both undergraduate and graduate students have invested their time and energy into helping persons with aphasia, often for as long as a year, while gaining valuable field experience prior to entering the field. Spouses of persons with aphasia have found meaningful tasks as volunteers in the group program that allowed them to use natural talents and abilities and move beyond the role of caregiver to mutual participant, making new friends and sharing enjoyable life experiences with their spouses with aphasia. Students in other disciplines have also become involved in meaningful ways. For example, recently a student majoring in human services took the author’s Communication and Aging class, decided to volunteer in the program and eventually initiated a bimonthly peer support group for spouses of group members that meets during group sessions.

Interacting with trained volunteers of all ages, both those with and without aphasia, also offers persons with aphasia the advantage of increased communication opportunities and interactions in a naturalistic context, and can provide the sense of belonging that is altered when aphasia makes communicating with one’s prior friends and peers difficult. The purpose of speech-language therapy is to facilitate meaningful verbal and/or nonverbal interactions with significant others rather than with therapists only. Thus, even though a speech-language pathologist may have excellent clinical and personal interaction abilities, he or she is not necessarily similar to a group member’s family and friends. For example, a typical 65-year man would not necessarily be expected to have 25-year old females in his closest circle of friends. In this context, both volunteers with and without aphasia, who share similar backgrounds, experiences and outlooks, and can relate to the current life situations of group members, provide an essential link to increasing the autonomy and communicative success of persons with aphasia. This type of empowerment may impact ability to accept the altered self that comes as a result of aphasia, which in turn can improve interaction in natural environments. (Coles and Eales, 1998) Volunteers who have some residual aphasia and have completed their course of therapy can be powerful role models, and provide valuable interaction for group members in that they demonstrate that: 1) one can live with less than perfect speech and language, 2) a person can still be helpful to others even with a disability, and 3) that people with aphasia can enjoy interaction with others.

Documenting improvement

As with a clinician’s individual therapy, it is important to document how the interventions suggested in this article, such as group therapy using volunteers, benefit the communication interactions of persons with aphasia. Theoretically based systematic documentation of improvement is important for two reasons. One, it can help justify the resources needed to support these activities to the administration at one’s facility. Secondly, the evidence gained from such documentation can contribute to the body of knowledge concerning the effectiveness of interventions for persons with aphasia.

Questionnaires, structured interviews, and systematic direct observation are three methods of obtaining the necessary baseline and subsequent data. The ICF is an excellent theoretical framework as well as a specific coding system to be used by clinicians to guide development of such assessments. The author is currently conducting a retrospective study of the improvement made by persons in her Communication Recovery groups.

Summary

There are several steps clinicians can take to create a positive momentum on behalf of persons with aphasia in medical settings, even in an atmosphere of limited individual clinical services. During the inpatient phase clinicians can raise awareness that persons with aphasia need what the ICF terms "environmental facilitators" (2001) in order to access needed services within the hospital. They can also train and educate families of persons with aphasia about effective communication skills and provide them with resources that they will possibly access once their loved one is out of the hospital.

In the outpatient phase, clinicians may be able to find support for establishing creative programs outside of billable care by showing how: 1) the health and well being of persons with aphasia is enhanced through access to the kind of meaningful communication interactions that can occur in a weekly group therapy program, and: 2) these methods help the clinician to actually "do more with less" and are needed to facilitate improved functional outcomes within the context of reduced individual sessions available.

The World Health Organization has stated that health involves more than the absence of disease (2001), which would suggest that health care institutions should recognize that supporting persons access to satisfying communicative experiences is as important as providing chances to engage in physical exercise, and fulfills the healthcare mission. Making participation in group an option for both discharged patients as well as those who are still attending individual therapy is not only a creative response to a curtailed treatment time scenario, but has even been shown to be efficacious bringing improved communication. (Elman & Bernstein-Ellis, 1999) While some may continue to prefer individual treatment to a group experience, there are many others that embrace the sense of community and camaraderie found in a group, and continue to move forward as communicators by learning to use a variety of communication strategies, even after individual therapy has ended.

Although conceptualizing and initiating the group program, group planning, and recruitment and training of volunteers may be time consuming initially, once the program is established, one may find that hospital administration takes pride in the program because it demonstrates the medical center’s commitment to quality patient outcomes and accomplishes this task with limited additional costs. A clinician’s own leadership skills are also enhanced by learning how to work collaboratively in the medical setting with persons in other disciplines, such as recreational therapy, or the volunteer services coordinator, or by delegating tasks and empowering others to develop their own ideas. These leadership and collaboration skills can then be applied to other strategies to enhance services for persons with aphasia in the medical setting, such as the establishment of a specialized partner and family training series through a hospital’s community education department.

Finally, clinicians should document the changes that occur in persons with aphasia in a systematic manner, starting with baseline data taken of the current situations. With appropriate baseline data, comparisons can then be documented of changes in the targeted areas.

References

American Speech Language and Hearing Association. (2001) Scope of Practice in Speech Language Pathology. ASHA: Rockville, MD

American Speech-Language Hearing Association Committee on Communication Problems of the Aging. 1988. The roles of speech-language pathologists and audiologists in working with older persons. ASHA, 33, 39-41.

Boles, L. (1998) Conducting conversation: a case study using the spouse in aphasia treatment. Special Interest Division 2 Newsletter: Neurophysiology and Neurogenic Speech and Language Disorders. 8:24-31.

Boles, L. (2000) Solution Focused Aphasia Therapy, CSHA Magazine, 29 (3): 8-12.

Chapey, R., Duchan, J., Elman, R., Garcia, L., Kagan, A., Lyon, L. and Simmons-Mackie, N.) (2000) Life participation approach to aphasia: a statement of values for the future. ASHA Leader, Feb. 13, 2000 edition.

Chapey, R. (ed.) (2001) Language Intervention strategies in aphasia and related neurogenic communication disorders (4^th ed.) Philadelphia: Lippincott Williams and Wilkins

Coles, R., and Eales, C. 1998. The Aphasia Self-Help Movement in Britain: A challenge and an opportunity. In Group treatment of neurogenic communication disorders: The expert clinician’s approach, edited by Roberta Elman. Boston: Butterworth Heinemann.

Elman, R. (1999) Group treatment of neurogenic communication disorders: the expert clinician’s approach, Butterworth-Heinemann, Boston.

Elman, R.. (1998) "Treating Outside the Box", ASHA presentation, November, 1998, San Antonio, Texas.

Elman, R. and Bernstein-Ellis, E. (1999) The Efficacy of Group Communication Treatment in Adults with Chronic Aphasia, Journal of Speech and Hearing Research, Vol. 42(2): 411-419.

Garrett K., and D. Beukelman. (1992). Augmentative communication approaches for persons with severe aphasia. In Augmentative communication in the medical setting, edited by Kathryn M. Yorkston. Tucson, Az: Communication Skill Builders

Garrett, K. (1998) Adults with severe aphasia. In Augmentative and alternative communication (2^nd edition) edited by David Beukelman & Pat Mirenda. Brookes Publishing Co.: Baltimore.

Kagan, A., Black, S., Felson Duchan, J., Simmons-Mackie, N. & Square, P. (2001) Training volunteers as conversation partners using Supported Conversation for Adults with Aphasia (SCA): A controlled clinical trial. Journal of Speech Language & Hearing Research (44) 624-638.

Kagan, A., (1998). Clinical Forum: Supported conversation for adults with aphasia: methods and resources for training conversation partners. Aphasiology, 12: 816-830.

Kagan, A., and Cohen-Schneider,R. (1998a). Groups in the introductory program at the Pat Arato Aphasia Centre. In Group treatment of neurogenic communication disorders: The expert clinician’s approach, edited by Roberta Elman. Boston: Butterworth Heinemann.

Kagan, A., (1998b) Presentation at Supported Conversation Workshop, Pat Arato Aphasia Centre, North York, Toronto, Canada.

Lyon, J. (1992) Communication use and participation in life for adults with aphasia in natural settings: The scope of the problem. American Journal of Speech-Language Pathology, 1 (3) (May) 7-14.

Lyon, J., (1988). Communicative Partners: Their value in reestablishing communication with aphasic adults. In Clinical Aphasiology 18, edited by T.E. Prescott. Boston: College Hill Press.

Lyon, J. (1999) ASHA Teleseminar : Continuum of Care for Aphasia: Long term management phase. American Speech Language and Hearing Association: Rockville, MD.

Lyon, J. (1998) Coping with aphasia. San Diego: Singular Publishing.

National Committee of Vital and Health Statistics (2001) Report posted on website at: www.ncvhs.hhs.gov/010716rp.htm.

Threats, T. (2001) New classification will aid assessment and intervention. The ASHA Leader, 6 (18) 12-13.

Threats, T. (2002) Evidence based practice research using the WHO framework. Journal of Medical Speech-Language Pathology, 10 (3), xvii-xxiv.

Vickers, Candace, (1998) Communication Recovery: Group conversation activities for adults, Communication Skill Builders, San Antonio, Texas.

Vickers, C. (1999) ASHA Teleseminar : Continuum of Care for Aphasia: Long term management phase (with Jon Lyon and GloriaJean Wallace) American Speech Language and Hearing Association: Rockville, MD.

World Health Organization. International Classification of Functioning, Disability and Health. (2001) World Health Organization: Geneva.

APHASIA

2007-07-22T07:05:00.000-07:00

APHASIA
The documents below are all in .PDF format. If you require a Microsoft document format, please contact me.
Initial proposal

Research Summary is the meat of the report

If You Build A Model, Will They Come? is an overview of my
impressions on aphasia research and therapy. It includes edited
interviews with some of the leading experts in the field.

COMPLETE REPORT:

Title page
Table of Contents
Research Summary
If You Build A Model, Will They Come?
Appendix: Researchers & Institutions

The Adler Aphasia Center in Maywood NJ used my research to design and establish an innovative program: http://www.adleraphasiacenter.org/.

Constance@Menefee.com

Aphasia In children

2007-07-15T10:02:00.000-07:00

Aphasia In Children

3 - aphasia in children
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WYNN Wizard

2007-07-01T10:10:00.000-07:00

WYNN Wizard by Freedom Scientific provides optical character recognition (OCR), the ability to scan a printed page and convert it into electronic text. Speech synthesis enables this scanned text to be read aloud. WYNN Wizard can scan and read word processing, text files, and the Internet.

WYNN is the innovative literacy software tool designed to enhance success for individuals with reading challenges and writing difficulties. WYNN was developed with the help of special educators and individuals with learning difficulties such as dyslexia, dysgraphia and aphasia.

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Actions Speak As Loud as Word

2007-03-23T22:16:00.000-07:00

Journal

2007-03-23T22:04:00.000-07:00