Browsing by Subject "anomia"

Aphasia is often a chronic impairment. Regaining the premorbid language function is rare. Anomia is the most common residual disorder once the aphasia has stabilized. Earlier studies indicate that transcranial magnetic stimulation (rTMS, repetitive Transcranial Magnetic Stimulation) together with intensive speech therapy improves the outcome of the language rehabilitation. The aim of the current study was to find out what kinds of quantitative and qualitative changes occur in the participants' ability to name noun and verb pictures that were shown during the rTMS/sham-rTMS protocol. All of the participants received two weeks of either rTMS or sham-rTMS treatment and after a one-week break another two weeks of either rTMS or sham- rTMS treatment together with intensive group speech therapy (ILAT, Intensive Language Action Therapy). This is a multiple case study with six participants that have chronic expressive aphasia. The first two groups of a larger study were selected into this study. Group 1 (n=3) received 1Hz- rTMS therapy and group 2 (n=3) received sham-rTMS. rTMS was given to the right hemisphere on the pars triangularis area. Every participant named the same amount of action and object pictures during the rTMS/sham-rTMS treatment. Namings were analysed with a rating system derived for the current study. Each participant received intensive group speech therapy in the latter two-week part of the intervention. Language testing was conducted before, during and three months after the intervention. The naming abilities in all participants seemed to improve in both noun and verb series during the rTMS/sham-rTMS treatment and language tests. Results of the follow-up testing suggest that the positive results are long lasting. The results of this study are promising, even though the amount of participants is too small to draw further conclusions. This study brings positive evidence and reason for further research on the effectiveness of aphasia therapy.

Background and aims. The most common and persistent symptom of aphasia is word retrieval deficit, anomia. There is evidence of selective verb retrieval problems amongst non-fluent aphasic speakers. Training verbs in sentence context increases verb naming accuracy in naming tests and enhances verb usage and the use of well-formed syntactic structures in connected speech. Especially intensive interventions in which training takes place in communicative contexts may be beneficial. The aim of this study was to investigate whether a sentence-level verb intervention affects verb naming and the structures and vocabulary of the connected speech of Finnish non-fluent aphasic speakers. Methods. Two speakers with chronic Broca's aphasia participated in this study. Markku, a 35-year-old man, and Annikki, a 72-year-old woman, had both become aphasic due to a single stroke in the left hemisphere. The intervention programme lasted 6–7 weeks and consisted of 15 training sessions of 90 minutes (a total of 22,5 hours). In six different speech production tasks the participants were trained to place obligatory and optional sentence elements around a verb. The target was to promote verb usage in narratives. The effects of the intervention were evaluated by examining verb naming accuracy and speed in a naming test, by calculating the mean length of utterances and the proportion of empty speech in connected speech, and analysing the syntax and the vocabulary of narratives. Results. Markku’s aphasia quotient (WAB) increased by 20 points after the intervention as his speech became more fluent and informative. There were no changes in Annikki’s aphasia quotient. The intervention had no effect on verb naming in a verb naming test. Both participants produced longer narratives after the intervention, but at the same time the proportion of empty speech increased in Annikki's speech. The mean lengths of utterances didn't change after the intervention. The proportion of utterances including a finite verb increased slightly in Markku's narratives. Simultaneously, the proportion of clauses with an incomplete verb phrase or no verb phrase decreased slightly. The intervention had no effect on syntactic structures in Annikki's case. The number of different verbs increased in both participants' picture description narratives, although the change was much smaller in Annikki's case. There was some evidence in Markku's case that the intervention had a small effect on the vocabulary of personal narratives and descriptions of event sequences. Discussion. The results of this study provide preliminary support for the usefulness of sentence-level verb interventions in aphasia rehabilitation in Finland. The results indicate that this intervention can have a positive effect on the number of different verbs and the number of finite verbs used in non-fluent narratives. However, the response to the intervention seems to be highly individual. The next step would be to examine the efficacy of the intervention method in a larger scale study. The intervention could be modified by increasing the intensity of training and increasing the amount of training without picture support. The intervention method is applicable in the clinical world. In addition, an aphasic speaker and their significant other can train at home using the intervention tasks, so that possible intervention results could be better maintained after the intervention is withdrawn.

Tavoitteet. Anomiaa eli sananlöytämisen vaikeutta ilmenee lähestulkoon kaikilla afaattisilla henkilöillä ja se on afasian pysyvin oire. Nimeämisen kuntoutuksen taustalla tiedetään olevan monimutkainen molemmat aivopuoliskot käsittävä hermoverkosto. Kuntoutuksen hermostolliset mekanismit ovat kuitenkin monelta osin vielä epäselviä ja saadut tulokset osin ristiriitaisia. Tämän integroidun kirjallisuuskatsauksen tavoitteena on kartoittaa, miten nimeämisen kuntoutus näkyy aivotasolla kroonisessa afasiassa ja millaiset hermostolliset tekijät ovat yhteydessä kuntoutuksen vaikuttavuuteen. Menetelmä. Kandidaatintutkielman menetelmänä oli integroiva kirjallisuuskatsaus. Artikkelit haettiin Ovid Medline -tietokannasta. Hakusanoina käytettiin englanninkielisiä termejä aphasi* (afasia), treatment (hoito), therap* (terapia), rehabilitation (kuntoutus), anomia, naming (nimeäminen), "word-finding" (sanan löytäminen), neural (hermostollinen), neuroimaging (aivokuvantaminen), plasticity (muovautuvuus), reorganization (uudelleen järjestäytyminen). Rajausten jälkeen tutkimusaineistoon valikoitui seitsemän tutkimusartikkelia. Tulokset ja johtopäätökset. Tämän kirjallisuuskatsauksen perusteella kroonisessa afasiassa voidaan saavuttaa merkittäviä tuloksia nimeämisen kuntoutuksella. Tulosten perusteella kummankin aivopuoliskon alueilla on keskeinen rooli nimeämisen kuntoutuksessa. Kuntoutuksen seurauksena on havaittavissa paljon yksilöiden välistä vaihtelua aivojen hermostollisissa muutoksissa. Kuntoutuksen seurauksena voidaan havaita vasemman ja oikean aivopuoliskon aktivaation kasvua, joka viittaa aivojen toiminnalliseen uudelleen aktivaatioon ja uudelleen järjestäytymiseen. Toisaalta osalla kuntoutujista on havaittavissa vasemman ja/tai oikean aivopuoliskon aktivaation laskua, joka näyttäisi viittaavan tehostuneeseen tiedonkäsittelyyn. Saatujen tulosten perusteella vasemman ja oikean puolen alin otsalohkopoimu (inferior frontal gyrus, IFG) on keskeinen aivoalue nimeämisen kuntoutuksessa. Kuntoutuksen aikana voidaan havaita aktivaatiomuutoksia kummankin aivopuoliskon IFG-alueella. Lisäksi ennen kuntoutusta havaittu vasemman puolen IFG-alueen aktivaatiotaso ja alueen mahdollinen vaurio näyttävät olevan keskeisiä tekijöitä kuntoutusennusteen kannalta.