Cases reported "Aphasia"

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1/10. Written communication in undifferentiated jargon aphasia: a therapy study.

    A subject, R.M.M., with a 2-year history of jargon aphasia is described. At the beginning of this study she had minimal meaningful spoken output and showed little awareness of her speech despite having relatively well-preserved auditory comprehension. Her spoken output had proved resistant to earlier periods of therapy. In contrast, R.M.M.'s written output showed some ability to access orthographic information and monitoring of this modality was shown by an acute awareness of her errors. A 3-stage therapy programme is described. This was designed to improve R.M.M.'s writing of single words and to encourage use of writing as an alternative means of communication. The initial stage of therapy aimed to increase R.M.M.'s access to written word forms by use of picture stimuli. She showed significant improvement in writing treated items in response to pictures both immediately after therapy and at re-assessment 6 weeks later. Despite the acquisition of these skills, R.M.M. failed to use them in communicative contexts. A second stage of therapy replicated the results of the first and sought to facilitate R.M.M.'s functional use of her written vocabulary by asking her to write words to spoken questions. She again showed improved written naming of the treated items and could now produce written names appropriately in a questionnaire-type assessment. Generalization of this ability extended to items that had not been trained in this way. Functional use of writing in everyday communication remained absent, however. The final stage of therapy made explicit the potential links between items which R.M.M. could now write and functional messages which they might convey. She again showed significant changes in the acquisition of new vocabulary and, encouragingly, progress was also seen in her use of the strategy in functional communication. R.M.M.'s speech is almost entirely incomprehensible. It has remained unchanged for 2 years and has not responded to therapy. Relatively well-preserved auditory comprehension and good monitoring of written output allowed therapy to effectively target a small written vocabulary. Despite significant progress in the acquisition of new items, transfer of this skill to functional communication was initially absent. Further therapy which specifically targeted the impairment causing this failure was needed before functional use was seen. The potential for treating written output in cases of jargon aphasia which have been resistant to therapy for spoken language is discussed.
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2/10. Similarity and categorisation: neuropsychological evidence for a dissociation in explicit categorisation tasks.

    A series of experiments are reported on a patient (LEW) with difficulties in naming. Initial findings indicated severe impairments in his ability to freesort colours and facial expressions. However, LEW's performance on other tasks revealed that he was able to show implicit understanding of some of the classic hallmarks of categorical perception; for example, in experiments requiring the choice of an odd-one-out, the patient chose alternatives dictated by category rather than by perceptual distance. Thus, underlying categories appeared normal and boundaries appeared intact. Furthermore, in a two-alternative forced-choice recognition memory task, performance was worse for within-category decisions than for cross-category decisions. In a replication of the study of Kay and Kempton [Kay, P., Kempton, W., 1984. What is the Sapir-Whorf hypothesis? American Anthropologist 86, 65-78], LEW showed that his similarity judgements for colours could be based on perceptual or categorical similarity according to task demands. The consequences for issues concerned with perceptual categories and the relationship between perceptual similarity and explicit categorisation are considered; we argue for a dissociation between these kinds of judgements in the freesort tasks. LEW's inability to make explicit use of his intact (implicit) knowledge is seen as related to his language impairment.
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3/10. Global aphasia: an innovative assessment approach.

    OBJECTIVE: To provide an alternative language comprehension assessment strategy for patients unable to be tested with traditional verbally/behaviorally based methods. DESIGN: Event-related brain potentials were recorded from three midline scalp locations to visually and aurally computer-presented sentences, 50% of which were semantically appropriate and 50% semantically incongruous. SETTING: A rehabilitation hospital. PATIENT: A 21-year-old man with a traumatic brain injury. RESULTS: The patient exhibited brain response patterns to aurally presented congruous and incongruous sentences indicative of intact semantic processing capabilities. These findings resulted in reinstatement of individualized rehabilitative intervention, with a successful outcome. CONCLUSIONS: This innovative technique provides new opportunities for assessing intellectual function in noncommunicative patients who were patients previously unable to be tested.
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4/10. Treatment of acquired epileptic aphasia with the ketogenic diet.

    Acquired epileptic aphasia remains a poorly understood entity, which is frequently difficult to treat. Previously described treatment modalities have included antiepileptic drugs, corticosteroids, intravenous immunoglobulin, and multiple subpial transections. We describe three patients with acquired epileptic aphasia refractory to traditional treatments who were successfully treated with the ketogenic diet. All three patients had lasting improvement of their language, behavior, and seizures for 26, 24, and 12 months, respectively. This is the first reported series of patients with acquired epileptic aphasia successfully treated with the ketogenic diet, and suggests a new therapeutic alternative for patients with this often difficult-to-treat disorder.
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5/10. Patterns of phonological errors as a function of a phonological versus an articulatory locus of impairment.

    We present the case of two aphasic patients: one with fluent speech, MM, and one with dysfluent speech, DB. Both patients make similar proportions of phonological errors in speech production and the errors have similar characteristics. A closer analysis, however, shows a number of differences. DB's phonological errors involve, for the most part, simplifications of syllabic structure; they affect consonants more than vowels; and, among vowels, they show effects of sonority/complexity. This error pattern may reflect articulatory difficulties. MM's errors, instead, show little effect of syllable structure, affect vowels at least as much as consonants and, and affect all different vowels to a similar extent. This pattern is consistent with a more central impairment involving the selection of the right phoneme among competing alternatives. We propose that, at this level, vowel selection may be more difficult than consonant selection because vowels belong to a smaller set of repeatedly activated units.
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6/10. aphasia and its relation to language and thinking. Finding alternative ways for communication.

    A pictorial computerized communication aid for aphasic patients, PicBox, (12) has been developed by a group in sweden. During the technical and clinical work with the PicBox program we have had the reason and possibility to reflect on the relation between aphasia, language and thinking. From linguistic and neuropsychological research it has been claimed that in aphasia there is often a general cognitive impairment. Preliminary results from three patients' use of PicBox show that aphasic disturbances can, to some extent, be compensated for by pictorial communication, thus indicating an underlying cognitive competence. There are, however, also data indicating a deeper disturbance leading to an inability to fully use alternatives for spoken or written language.
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7/10. Morphological units in the Arabic mental lexicon: evidence from an individual with deep dyslexia.

    An ongoing debate in Arabic morphology concerns the nature of the smallest unit governing lexical organization and representation in this language. A standard model maintains that Arabic words are typically analyzable into a three-consonantal root morpheme carrying the core meaning of words and a prosodic template responsible mostly for grammatical information. This view has been largely supported by research in both theoretical linguistics and psycholinguistics. An alternative theory holds that the meaning of words in Arabic is, rather, encoded in the 'etymon' comprising two unordered consonants of the root only. Results from a recent priming experiment have shown that the etymon induces strong morphological priming effects, supporting its morphological/lexical status. In this paper we present data from a patient with deep dyslexia questioning the role of the etymon as a psychologically real representational unit in Arabic and arguing, instead, for the central role of the root in both morphological and lexical representation in this language.
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8/10. Psychogenic seizures in brain injury: diagnosis, treatment and case study.

    Psychogenic seizures are a functional phenomena in which a person experiences a paroxysmal event that may be interpreted as epileptiform in nature. By definition, psychogenic seizures imply a sudden episode of change in behaviour or psychic state that is not associated with an identifiable process, either vasculogenic or neurogenic, and during which there is an absence of characteristic epileptiform changes on the electroencephalogram. prevalence rates range from 5% to 50% in outpatient populations seen in epilepsy clinics. However, approximately 20% of true seizure patients also have psychogenic seizures. As psychogenic seizures are not a pathophysiological phenomena, pharmacological interventions do not alter their aetiology and can cloud the cognitive skills necessary to ameliorate the psychogenic seizure behaviour. In non-aphasic true seizure patients, as well as psychogenic seizure patients, self-control relaxation paradigms have been successful where pharmacological intervention has failed. This case involved an aphasic brain-injured patient who had both psychogenic and true seizures. For this patient, the self-control paradigm was modified to include use of gesture and prosody to achieve similar psychotherapeutic effects. Additionally, family therapy was instituted to provide a constructive means for the patient's family to participate in the reduction of psychogenic seizures. As seizures are a common sequelae of brain injury, the differential diagnosis of seizures and knowledge of standard and alternative treatment is essential for rehabilitation professionals.
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9/10. Progressive neuropsychological and extrapyramidal deterioration resembling progressive supranuclear palsy: is aphasia relevant for correct diagnosis?

    We describe the case of a woman presenting with a clinical syndrome closely resembling progressive supranuclear palsy, who also showed some progressive neuropsychological defects (aphasia and apraxia) not consistent with a simple loss of timing and activation as is generally postulated in this pathology. The case is discussed with regard to the definition of subcortical dementia and the possible alternative diagnosis of corticobasal degeneration.
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10/10. Drawing to communicate: a case report of an adult with global aphasia.

    Treatment for adults with global aphasia has typically involved the use of verbal treatment methods or alternative communication techniques including communication boards, word lists and notebooks. However, many adults with aphasia are unable to communicate verbally and alternative communication techniques can be limited, as a result of the restricted number and type of concepts that can be adequately depicted and expressed. Another viable means of communication for the globally aphasic adult is drawing. However, few individuals with severe aphasia initiate communication through this modality without specific training. In this case report we present several successful treatment methods that were used to train an adult with global aphasia to communicate more effectively through drawing. Several of his drawings are presented to illustrate the results of training in the use of drawing as an alternative means of communication.
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