A new article posted in Advance Magazine on a new method to analyze brain imaging data may paint a clearer picture of language production.

Although some brain regions are known to be associated with language, neuroscientists have had a surprisingly difficult time using brain imaging technology to understand exactly what these ‘language areas’ are doing. In a new study MIT neuroscientists report on a new method to analyze brain imaging data – one that may paint a clearer picture of how our brain produces and understands language [Journal of Neurophysiology Online, April 21, 2010].

Research with patients who developed specific language deficits (such as the inability to comprehend passive sentences) following brain injury suggest that different aspects of language may reside in different parts of the brain. But attempts to find these functionally specific regions of the brain with current neuroimaging technologies have been inconsistent and controversial.

One reason for this inconsistency may be due to the fact that most previous studies relied on group analyses in which brain imaging data were averaged across multiple subjects – a computation that could introduce statistical noise and bias into the analyses.

“Because brains differ in their folding patterns and in how functional areas map onto these folds, activations obtained in functional MRI studies often do not precisely ‘line up’ across brains,” explained Evelina Fedorenko, first author of the study and a postdoctoral associate in the lab of Nancy Kanwisher, PhD, at the McGovern Institute for Brain Research at MIT. ” Some regions of the brain thought to be involved in language are also geographically close to regions that support other cognitive processes like music, arithmetic, or general working memory. By spatially averaging brain data across subjects you may see an activation ‘blob’ that looks like it supports both language and, say, arithmetic, even in cases where in every single subject these two processes are supported by non-overlapping nearby bits of cortex.”

The only way to get around this problem, according to Fedorenko, is to first define “regions of interest” in each individual subject and then investigate those regions by examining their responses to various new tasks. To do this, they developed a “localizer” task where subjects read either sentences or sequences of pronounceable nonwords.

Sample sentence: THE DOG CHASED THE CAT ALL DAY LONG

Sample nonword sequence: BOKER DESH HE THE DRILES LER CICE FRISTY’S

By subtracting the nonword-activated regions from the sentence-activated regions, the researchers found a number of language regions that were quickly and reliably identified in individual brains. Their new method revealed higher selectivity for sentences compared to nonwords than a traditional group analysis applied to the same data.

“This new, more sensitive method allows us now to investigate questions of functional specificity between language and other cognitive functions, as well as between different aspects of language,” Fedorenko concluded. “We’re more likely to discover which patches of cortex are specialized for language and which also support other cognitive functions like music and working memory. Understanding the relationship between language and the rest of condition is one of key questions in cognitive neuroscience.”

Fedorenko published the tools used in this study on her website: http://web.mit.edu/evelina9/www/funcloc.html . The goal for the future, she says, is to adopt a common standard for identifying language-sensitive areas so that knowledge about their functions can be accumulated across studies and across labs. “The eventual goal is of course to understand the precise nature of the computations each brain region performs,” Fedorenko says, “but that’s a tall order.”

The research was funded by Ellison Medical Foundation, Eunice Kennedy Shriver National Institute of Child Health and Human Development, McGovern Institute for Brain Research.

To read, print or email this article click on Advance Magazine

Sound-wave powered clot busters safe for draining bleeding in brain

Dissolving clot-causing strokes with ultrasound can safely drain bleeding in the brain, according to a new study. Researchers tested the safety and efficacy of combining the use of ultrasound with clotbusters delivered precisely into bleeding areas during an intraventricular (IVH) bleed (bleeding inside fluid-filled spaces of the brain) and intracerebral (ICH) bleed (bleeding in brain tissue).

Nine ICH and IVH patients (average age 63) underwent treatment with the clot-busting drug tPA in conjunction with 24 hours of continuous ultrasound applied at the end of the probe placed directly in the blood clot. The liquefied blood clots were drained through a tube.

All nine patients had significant reductions in bleeding. Twenty-four hours after treatment, volume was reduced an average 59 percent for ICM patients and 45 percent in IVH patients. There were no significant instances of re-bleeding. Functional outcomes improved in seven of the nine patients at 30 days. One patient died. Compared to previous studies that did not use ultrasound with tPA, blood clots appeared to resolve faster in this study.  Sign up for this free publication. Stroke Connection Magazine

Author: Alyssa Banotai

Ahierarchical treatment process that incorporates elements of phonological processing and motor speech targets has evolved to become an effective tool for treating patients with apraxia of speech (AOS).

Sound Production Treatment (SPT) is a five-step approach developed by Julie Wambaugh, PhD, CCC-SLP, and colleagues at the VA Salt Lake City Healthcare System and VA Pittsburgh Healthcare System.1-3It was based on an earlier eight-step continuum developed by John Rosenbek, PhD, CCC-SLP, of the University of Florida in Gainesville and colleagues.4Dr. Wambaugh’s interest in phonological processing led her to incorporate minimal pair treatment into the hierarchy she and her colleagues developed in the early 1990s.

“We used integral stimulation, modeling and articulatory placement instructions and combined it with minimal pairs treatment,” she told ADVANCE. “At the time we still weren’t quite clear as a research discipline whether apraxia of speech was only a motor speech disorder or if there were some phonological aspects to it.”

Since that time, research has indicated that AOS is a motoric, phonetic-level disorder.

The therapy model is response-contingent, so not every patient will complete each step of the hierarchy. “You only use the steps as you need them,” said Dr. Wambaugh, an associate professor at the University of Utah in Salt Lake City and Research Career Scientist with the VA Salt Lake City Healthcare System. “You don’t use every step with every single person with every single attempt.”

The first step of the hierarchy incorporates minimal pairs contrast. If the target sound is produced incorrectly after a verbal model, then the clinician also asks the patient to produce a contrasting minimal pair word. Patients who are unable to complete the first step move onto the second step using a visual cue. The therapist uses a depiction of the written letter to facilitate the patient’s production of a target sound, again in a repetition-modeling paradigm.

The third step incorporates an integral stimulation approach of “watch me, listen to me, say it with me” that was based on Dr. Rosenbek’s research. In the fourth step articulatory placement cueing is used along with modeling. Dr. Wambaugh’s early research sought to determine whether work on one sound through the hierarchy would result in the generalization of improved sound production and articulatory skills as a whole.

“We treated just one sound at a time using single subject experimental designs so we could control the behavior, see the variability, understand what we were doing, and see if there was any generalization,” she explained. The researchers found little generalization across sounds, unless they were closely related to each other, such as /s/ and /sh/.

To Read, Print or Email this article click on AdvanceWeb

Author: Susan Payne, GUMC Communications

Millions of Americans suffer from a disorder known as aphasia, the root of which comes from the Greek aphatos, or “speechless.” Rhonda Friedman, PhD, professor of Neurology, believes it is important that those afflicted with the disorder—who number greater than those with Parkinson’s disease, cerebral palsy, or muscular dystrophy—are given hope.

Friedman directs Georgetown University Medical Center’s Center for Aphasia Research and Rehabilitation (CARR), which works to find new treatment options for patients with aphasia, in order to optimize and lengthen their lives with their families and loved ones.

Although not a result of cognitive or intellectual impairment, aphasia severely limits a person’s ability to speak and understand others, and most people experience difficulty reading and writing. It is most often caused by a stroke or other brain injury. Dr. Friedman’s research explores how language is processed in a healthy brain, how language breaks down in a brain damaged by stroke, head injury, or dementia, and how the brain recovers language functions.

Friedman and her CARR colleagues’ understanding of the neuropsychological and neural mechanisms of aphasia and normal cognition have led to increased successes in the treatment of the loss of language functions from stroke, head injury, or dementia. Friedman’s lab uses techniques such as behavioral studies, treatment studies, functional magnetic resonance imaging (fMRI), event-related potentials (ERP), and eye-tracking.

Her most recent research has involved the development of a paradigm designed to slow the word finding difficulties (anomia) of dementia non-pharmacologically. Since the ability to read words lasts longer than naming in dementia, the study pairs pictures of objects and family members with their written names, to strengthen the brain’s connections before they begin to weaken due to disease.

Friedman’s current clinical study involves patients with primary, progressive aphasia—which is caused by problems with language-processing mechanisms; the ultimate goal of her study is to evaluate whether a treatment may be beneficial for patients in the early stages of Alzheimer’s disease.

Aphasia’s impact on a person’s ability to communicate is often frustrating, and while treatment options are improving, effective therapies take time to develop.

Friedman states simply: “There is never a time to give up hope… in a patient’s recovery, you don’t tell them to give up. With the right intervention and appropriate targeting, the connections in the brain can be strengthened. We are moving closer to a cure.”

Read, print or email this article by Clicking Here .

For more information, please visit Friedman’s Lab online .

Author: Dr. Richard Steele

Language processing in Broca’s area during word comprehension tasks is both surprisingly rich in content and complex in operation, according to the newest research. Although historically Broca’s area has been associated with motor planning and execution for speech production, the new findings involve it in other types of linguistic processing: lexical (helping to identify words), grammatical (helping to identify forms, such as plurals or past tenses), and phonological (helping to identify pronunciations). Moreover, these three types of processing happen in rapid-fire sequence — three waves in succession that together span approximately one quarter of a second; they register at approximately 200 milliseconds, 320 milliseconds, and 450 milliseconds after the stimulus on probes in Broca’s area. Such tightly-clustered three-wave patterns of processing in response to linguistic stimuli have not appeared in probes outside of Broca’s area.
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Read More “Topics in Aphasia”.

Author: Joanne Marttila Pierson, PhD

INTENSIVE THERAPY
By Joanne Marttila Pierson, PhD
As seen in ADVANCE for Speech-Language Patahologists & Audiologists, September 19, 2005 issue, Vol. 15 •Issue 38 • Page 17

An intensive therapy protocol should be considered a primary objective for individuals with aphasia. Intensive therapy can achieve significant speech and communication improvements, and successful outcomes are realized regardless of the length of time post the aphasia-causing event.

Positive results are generating greater hope and optimism among people with aphasia, their families and caregivers.

Whether aphasia is caused by a stroke, closed-head injury or disease, outcomes often are tempered with bleak comments from medical professionals such as “This is as good as it is going to get,” “Don’t expect much change,” and “Your lives are going to change forever.” These words can be devastating for patients and caregivers and lead to feelings of hopelessness, despair and depression.

The greater difficulty created by negative perceptions is their impact on recovery efforts. Feelings of hopelessness have a direct connection to an individual’s motivation to put forth the effort necessary for recovery, including entering a therapy program.

Medical professionals and speech-language pathologists play a key role in helping to frame recovery options and generating hope and optimism for improvement. This is why information about the success of intensive therapy is essential for those with aphasia and their caregivers.

A recent study at the Universitat Konstanz, in Germany, demonstrated the success of intensive therapy. The study, while small, offers hope to individuals with aphasia and their families.

Researchers evaluated 27 stroke survivors16 men and 11 women, with an average age of 51who had lived with varying degrees of aphasia for about four years. Study participants were given 30 hours of speech training, three hours a day over a period of 10 days. Improvements were immediate, and they were sustained when reevaluated six months later. Language skills improved in 85 percent of the patients.

The study supports the results many professionals have observed in intensive therapy programs such as the Residential Aphasia Program (RAP) at the University of Michigan. The year-round program, the oldest in the nation, attracts people from across the United States and other countries. The intensive six-week therapy regimen includes 23 hours of therapy per week, with 15 hours of individual therapy, five hours of group therapy, and three hours of computer-assisted training.

Twelve to 15 individuals with aphasia attend each of the six-week RAP sessions, working individually and in group settings with speech-language pathologists. The program includes art and music therapy, as well as social programs such as dinners, theater outings and baseball games.

Many who attend RAP come back several times for additional sessions due to their success and improvement. Some have been to as many as eight individual six-week sessions.

Intensive therapy generates positive outcomes for RAP participants. For example, Bob Virden, 77, now has the confidence to answer the phone, something he was reluctant to do before he entered the program. The Kansas City resident had his first stroke in 1998, followed by two strokes last year. He now speaks clearly, although he sometimes struggles to retrieve the exact words he wants to say.
“RAP is inspiring,” said Virden. “The one-to-one therapy sessions were helpful, and I liked music therapy.”

A retired attorney, Virden owns several buildings and likes to stay involved in supervising them. Because he was struggling with some of the terminology, therapists incorporated key words into his therapy. He now looks forward to being able to communicate more effectively with his business partner.

Considerable bonding occurs between clients and caregivers who attend the sessions, reported his wife, Dorrie Virden. “It was one of the most impressive and moving experiences I have ever had.”

Lindsay Rahl, of Chesapeake, VA, participated in two six-week sessions during 2004 and will participate in another six-week session this fall. Rahl, 50, had a stroke two years ago.

“It was during our first session at RAP that we recognized the significant progress she was making, far beyond what she was able to achieve at home in a traditional outpatient therapy setting,” her husband recalled. “During our second session, we saw even greater progress, with significant improvements in both comprehension and verbal ability.”

Sixteen-year-old Jacob Nettles, of Nederland, TX, just completed his second visit to RAP and is scheduled to return for additional sessions later this year.

“RAP’s intensive program gives Jacob more focus,” his father reported. “The variety of programs, including one-on-one therapy, group, music, art and computer sessions, provides a variety of therapies that keep him motivated.”
For people with aphasia and their families and caregivers, intensive therapy may be the most important step in achieving significantly improved communications skills.

For More Information
Residential Aphasia Program, University of Michigan, (734) 764-8440, online: Residential Aphasia Program (RAP) .

Joanne Marttila Pierson, PhD, is associate director of the Residential Aphasia Program at the University of Michigan.

Author: Adance for Speech-Language Pathologists & Audiologists

An experimental treatment that spares disability from acute stroke may be delivered much later than the current three-hour treatment standard. This potential advance is needed to benefit more patients.

Researchers at the University of South Florida (USF) found that human umbilical cord blood cells administered to rats two days following a stroke greatly curbed the inflammatory response of the brain, reducing the size of the stroke and resulting in greatly improved recovery. The inflammatory response to injury from stroke peaked 48 hours after the brain attack, which was when intravenous delivery of the cells appeared most beneficial.

“We were very surprised,” said principal investigator Alison Willing, PhD, a neuroscientist at the USF Center of Excellence for Aging and Brain Repair. “In some animals the stroke initially damaged half the brain, but they were functioning normally after treatment with the cord blood cells. These findings show we are able to rescue neurons at a time when most research suggests they are already dead.”

Dr. Willing presented the preliminary findings at the annual meeting of the Society for Neuroscience on Nov. 12 in Washington, DC.

The only drug currently approved for ischemic stroke treatment is tissue plasminogen activator (tPA), which breaks up blood clots. However, tPA must be given within three hours following a stroke to be effective, and few patients arrive at the hospital quickly enough to receive it. Even when patients meet this criteria, smaller hospitals often lack ready access to computed tomography (CT), which can rule out a hemorrhagic stroke. The drug can worsen this less common type of stroke.

“New and more flexible treatments are needed to help more patients,” Dr. Willing said. “Cord blood treatment in rats is successful in alleviating, even eliminating, the disabling effects of both ischemic and hemorrhagic stroke. What’s more, the treatment can be delivered much later than the current therapeutic window.”
The USF study challenges the notion that nerve cells inevitably die quickly in the core region of the brain most severely deprived of oxygen and nutrients during stroke. The researchers suggest that many succumb over several days through apoptosis.

“This delayed death would permit more time to deliver neuron-sparing treatments than originally thought,” Dr. Willing said. Vol. 15 •Issue 47 • Page 5

For more information regarding the important research being done by the University of South Florida, please Click Here

Author: Eric Vohr

In the study, Daniel Hanley, a professor of neurology at the School of Medicine, demonstrated that rates of continued bleeding and subsequent death can be reduced if the tPA dosage is lowered to 1 milligram.

“We have good evidence that lower doses of tPA not only worked as well as the higher dose but also markedly reduced side effects in regard to bleeding,” Hanley said. “Ten years ago, the mortality rate for this type of stroke was at 80 percent. One year ago, it was 50 percent. In this study, it was 13 percent.”

Hanley presented the study Feb. 18 at the International Stroke Conference, held in Kissimmee, Fla.

An intracerebral hemorrhage — bleeding in the brain — is the only type of stroke without a clearly defined treatment. It occurs in more than 100,000 Americans each year. Up to half of patients die, and those who survive suffer significant disabilities. During such a stroke, blood often extends into the ventricles, small chambers in the brain where cerebrospinal fluid is made, increasing the chances of damage.

In a previous study by Hanley and his group of 26 patients, a 3 milligram dose of tPA could be used safely to treat this type of stroke, reducing the mortality rate to 19 percent. However, continued bleeding was observed in 23 percent of the patients. This new study was designed to find ways to reduce bleeding and further improve patient outcomes.

Researchers studied 16 patients who received either 0.3 milligram or 1 milligram of tPA every 12 hours through a catheter for up to four days or until the ventricles opened. The patient groups were balanced with respect to age, gender, initial stroke severity and demographic characteristics. Results from daily CT scans from this study and the previous study showed that blood clots broke up over the first three days at similar rates for all three doses. Similarly, compared with a placebo, all doses substantially accelerated clot removal. But unlike the patients who received 3 milligram doses, none of the patients who received either 1 or 0.3 milligram doses experienced continued bleeding as a clinically significant side effect. Also, there were fewer deaths in each of the lower-dose groups, suggesting that the lower doses are safer.

To read the complete article, go to John Hopkins University Gazette.

Author: Edward Tobinick, MD

Abstract:
Primary progressive aphasia (PPA) is an uncommon form of progressive dementia for which there exists no established treatment. The underlying pathology may be that of either frontotemporal dementia or Alzheimer’s disease. Increasing evidence suggests that excess tumor necrosis factor (TNF) may play a central role in Alzheimer’s disease. Additionally, excess TNF has been documented in patients with frontotemporal dementia. Excess TNF may therefore represent a therapeutic target in PPA. Etanercept, an anti-TNF fusion protein, binds to TNF, thereby reducing its biologic effect. Emerging evidence suggests that perispinal administration of etanercept may have therapeutic efficacy for Alzheimer’s disease. This evidence, in combination, supports a rationale for the use of perispinal etanercept for the treatment of PPA. This report documents rapid improvement in verbal abilities, beginning within 20 minutes of perispinal etanercept, in a patient with severe PPA. With repeated weekly dosing, sustained improvement at 1 month is documented, with a more than 10-point improvement in the patient’s abilities to perform activities of daily living as measured by a standardized instrument, the Alzheimer’s Disease Cooperative Study-Activities of Daily Living inventory. Rapid clinical improvement in PPA following perispinal etanercept administration may be related to TNF’s role as a gliotransmitter and modulator of synaptic communication in the brain. These results may provide insight into the basic pathophysiologic mechanisms underlying PPA and related forms of dementia and suggest the existence of novel, rapidly reversible, TNF-mediated pathophysiologic mechanisms in both PPA and Alzheimer’s disease. Further study of this therapeutic method is indicated.

Introduction:

Primary progressive aphasia (PPA) is an uncommon form of progressive dementia without established treatment. One third of these patients have underlying Alzheimer’s disease pathology, and two thirds have pathology characteristic of frontotemporal dementia.[1] These patients characteristically present with progressive difficulty with language as the most prominent initial manifestation of the disease, which advances in an unrelenting fashion until all language abilities are lost.[2] No effective treatment has been established.[1,2]

Basic science and genetic, epidemiologic, and clinical evidence suggest that excess tumor necrosis factor-alpha (TNF-alpha) may play a central role in the pathogenesis of Alzheimer’s disease.[3-23] In addition, excess TNF has been documented in the cerebrospinal fluid of patients with frontotemporal dementia.[24] Excess TNF may, therefore, represent a therapeutic target in PPA. Etanercept, a recombinant dimeric anti-TNF fusion protein, binds to TNF and blocks its interaction with cell-surface TNF receptors, thereby reducing the biologic effect of excess TNF. Emerging evidence suggests that perispinal administration of etanercept may have therapeutic efficacy in Alzheimer’s disease.[25-29] This evidence, in combination, supports a rationale for the use of perispinal etanercept for the treatment of PPA.

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Author: Dr. Richard Steele

Aphasia in bilingual individuals is an area of growing importance to speech-language pathologists (SLPs) in the United States, according to a 2008 ASHA article by Lorenzen and Murray. Not only is the incidence of aphasia rising steadily — with prevalence projected to double over the next decade — but at the same time the number of bilingual Americans is growing. In the 2000 census, some 47 million persons over age five reported speaking a language other than English at home: English-Spanish bilingualism is most frequent, but sizable numbers of residents speak English as well as Chinese, French, or other languages. Feeding this growth in bilingual populations are both increases in family sizes and the arrival of new immigrants. As a consequence of these and additional factors, SLPs can expect to encounter ever-increasing numbers of bilingual clients with aphasia in their future caseloads.

Meeting the rehabilitation needs of bilingual clients with aphasia raises numerous challenging issues for SLPs:
• Assessing speech, language, and communication deficits in each of the languages
• Determining language-specific rehabilitation wants and needs of individual clients
• Understanding the contexts and purposes of different language uses
• Setting treatment goals appropriately
• Providing services effectively
• Identifying, understanding, and documenting improvements

Since a patient’s aphasic deficits frequently vary in different languages, language-specific responses to therapy can follow divergent paths, and the different languages can interact during treatment. As a result, the communication rehabilitation of bilingual persons is complex and not fully understood.
But while bilingual speech therapy presents fundamental challenges, it also provides important opportunities. Careful studies of rehabilitation in bilingual individuals with aphasia, for example, are helping us to refine our understanding of two crucial, basic issues: (1) whether different languages are represented in the same areas of the brain, and if not, then how; and (2) whether age of language acquisition in bilingualism influences the ways in which the languages are represented in the brain and how they interact. These are questions both of fundamental scientific import and of practical clinical significance. As we improve our understanding of these issues and are better able to characterize bilingual individuals with aphasia, then clinical personnel will be able to better assess deficits, determine needs, provide therapy, understand responses, and follow up after discharge.

Clinical studies to date have provided very preliminary answers. Different languages appear to draw on partially distinct, yet largely overlapping cerebral areas. As a consequence, overall aphasic severity may differ somewhat from language to language and two languages’ subsystems – such as their syntax or lexicon – may be affected somewhat differently. Age of acquisition also appears to influence how languages interact in bilingual individuals. A second language acquired in adulthood may be influenced by the speaker’s first language ¯ resulting, for example, in a foreign accent or unusual word usage ¯ in ways not observed in individuals whose two languages were both acquired during childhood. But work is still at an early stage, and much remains to be done to understand these phenomena in depth. Improved understandings of bilingual aphasia and its clinical management are matters of growing importance, both theoretically and clinically.
________________
For further reading: Bonnie Lorenzen, Laura Murray. “Bilingual aphasia: A theoretical and clinical review.” American Journal of Speech-Language Pathology, August 2008, vol. 17, no. 8, pp. 299–317.
doi: 10.1044/1058-0360(2008/026)

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