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.An article in Medical News Today, 18 Feb 2022

When ABC journalist Bob Woodruff was injured while reporting in Iraq in 2006, he suffered severe head injuries that caused him to lose his ability to recall and produce common words - a condition called aphasia. Today, Woodruff has recovered most of his language skills thanks to intensive behavioral therapy - reading and repeating words and sounds.

“The standard of care for patients with aphasia has always been and will always be speech/language therapy, but a new area is opening up that looks at what drugs can be used in combination with therapy to enhance recovery from brain damage and help the brain repair itself,” said Gerry Stefanatos, D.Phil., an associate professor of communication sciences and disorders in the College of Health Professions. “We’re looking at the mechanism of how this combination works - it’s underlying effect on patients with aphasia.”

In research presented at the International Neurological Society this month, Stefanatos found that dextroamphetamine (D-AMPH), a drug commonly used to treat attention deficit hyperactivity disorder, improved the processing of speech among those suffering from Broca’s aphasia and the similar Anomic aphasia.

“Improving a patient’s attention and working memory may allow them to better focus and process information during therapy sessions,” said Stefanatos. “Attention is critically important for learning and relearning skills, and could be helpful in forging new neural pathways in the brain.”

The National Aphasia Association estimates some one million people in the United States live with aphasia, which is caused by lesions to the language centers of the brain. These lesions are often due to stroke or brain injury, but can also be the result of a brain tumor or progressive disease such as Parkinson’s or Alzheimer’s. Types of aphasia can range from a patient having difficulty finding and producing a word to a patient having no ability at all to speak or understand language.

Stefanatos’ study looked at the use of D-AMPH in ten aphasia patients. All were also given a placebo for comparison purposes. In each condition, participants were asked to make decisions about different types of speech sounds (vowels, consonant-vowels) and complex tones. Their brain’s electrical response to each was recorded via an electroencephalogram (EEG).

Those who took the D-AMPH had a strong reaction to the sounds - even to consonant-vowel sounds, which are more often difficult for individuals with aphasia to process.

“This tells us that D-AMPH may help the left hemisphere of the brain regain the ability to perform its functions,” said Stefanatos. “Understanding why the drug is having this effect allows us to start to think about how to tailor treatments to make them more effective or explore alternative drugs or drug combinations.”

Stefanatos said he and his team chose to look at this particular drug because in patients with ADHD it has been shown to stimulate the release of dopamine and epinephrine, which help in attention and learning. But he notes that some people aren’t good candidates for this particular drug.

“Now that we have a rudimentary understanding of why the drug may work to enhance the results of therapy, our next step is to look at dose effects and perhaps other drugs with more favorable side effect profiles,” said Stefanatos.

With collaborators from the departments of Radiology and Physical Medicine and Rehabilitation, Stefanatos will next study functional magnetic resonance imaging to explore the effects of D-AMPH on cerebral metabolism and where in the brain of individuals with aphasia it has the greatest effect.

Article adapted by Medical News Today from original press release.

Other authors on this study are Andrew DeMarco at Temple University, Robert Segal at McGill University in Quebec, and Arthur Gershoff, M.D. and Y. Ieuji of the Moss Rehab Stroke and Neurological Diseases Program, part of the Albert Einstein Healthcare Network in Philadelphia. This work was funded by grants from the National Institute of Health and the Pennsylvania Department of Health.

Published 10/17/10

WASHINGTON, D. C. When her stroke hit, Edna Wooten somehow stopped her car. Then her grown daughter ignored her slurred protests and raced her to the hospital - in time for a drug to dissolve the blood clot causing her stroke.

Wooten was lucky: Too few stroke sufferers get that clot-busting treatment, especially black and Hispanic patients who are at highest risk of having a stroke and also may be particularly hesitant to seek fast care.
New research is targeting those underserved populations to better spread the word that “time is brain” - the faster you move the more brain you save.

“We basically scare people so much about stroke, it motivates them to denial,” says Dr. Lewis Morganstern of the University of Michigan, an expert on stroke disparities. “What we haven’t done a good job of is telling people there is an effective treatment, that people are in control of their own destiny.”

That was the message stroke educator Shauna St. Clair of Georgetown University took to a senior center in a predominantly black neighborhood in the nation’s capital last week, part of a project funded by the National Institutes of Health.

Most strokes are like a clogged pipe, St. Clair explained: Break up the clog and blood can resume feeding starving brain cells on the other side, which is what happened when Wooten, 61, was treated at a nearby hospital.

“Damaged brain cells we can fix. That’s why we want you to get treatment as soon as possible,” St. Clair told the rapt group. “If they stay damaged, they die.”

About 795,000 Americans have a stroke every year. It is the nation’s leading cause of disability and the No. 3 killer. Symptoms include: sudden numbness or weakness in the face, arm or leg, especially on one side; sudden trouble speaking or understanding speech, seeing or walking; a sudden super-severe headache.
While some strokes are caused by bleeding in the brain, the vast majority are ischemic strokes, the clot kind that the drug TPA can help treat — but only if it’s given within a few hours of the first symptom.
Yet 14 years after TPA hit the market, overall only about 5 percent of U.S. patients get it. That’s partly due to problems within the health care system — but also partly because only about a third of stroke sufferers get to the hospital in time for testing to tell if they’re a good candidate.

Everyone needs to know to act fast if they experience or witness stroke symptoms. The new research comes because African-Americans have strokes at twice the rate of whites and are more likely to die. Hispanics are at increased risk of stroke as well. Worse, both populations tend to have strokes at much younger ages than whites.

Georgetown researchers tracked ischemic strokes for a year in Washington, and found black patients received TPA less often than whites in part because of slower hospital arrival — despite community surveys that found widespread knowledge about stroke symptoms.

“No, you can’t wait to see if your symptoms go away,” says Dr. Chelsea Kidwell, a Georgetown neurologist who heads the project. “No, you should not call your relative or friend. … You’ve got to call 911.”
The findings echo a major study that Morganstern leads in Corpus Christi, Texas, where Mexican-Americans were 40 percent less likely than whites to call 911 for a stroke.

The disconnect isn’t surprising, says Dr. Walter Koroshetz, deputy director of the NIH’s National Institute of Neurological Disorders and Stroke. The most common mistake among all populations when feeling a stroke symptom is to go rest.

Adding to the confusion are so-called ministrokes, a TIA or “transient ischemic attack” where an artery is blocked for a few minutes, leaving no permanent damage. But it’s a warning sign that a major stroke may be imminent, something prompt care to treat risk factors like high blood pressure might avert. Other studies have found half of people who have a TIA never tell a health provider.

It takes community-specific research to learn what act-fast messages work, Morgenstern says. His Corpus Christi project recently taught middle-school students to call 911 if they witness someone having stroke symptoms, with homework assignments to teach their parents, too — thus reaching a hard-to-target population. Next, the project is designing ways that local Catholic churches can help with stroke education.
In Washington, Kidwell is working with ambulances to bypass the closest hospital for one of three certified “stroke centers” — hospitals with 24-hour special capabilities to give TPA. The community education won’t just target seniors but younger people who may witness a stroke, like the woman who told St. Clair she’d noticed her mother leaving church looking drunk — a loss of balance caused by a stroke. And it will stress happy endings like Wooten’s. She slept off a TIA two weeks earlier, and credits her daughter’s love of TV hospital shows for recognizing the major stroke. About an hour after getting the clot-buster, “it was like it never happened,” says Wooten, who says her only lingering problem is a slight shake when her right hand holds something heavy. “I’m driving my car, I’m messing with my grandkids. Thank God I’m doing OK.” ___ EDITOR’S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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A stroke, the medical term for when blood and nutrients are cut off from the brain, can have a devastating effect on a person’s ability to communicate. Words that once came naturally for even simple objects before the stroke—such as a chair, a pen, or an apple—are suddenly difficult if not impossible to retrieve. Although some people may recover their language skills in time, for others, the effects can be chronically debilitating.

Such differences in patient outcomes have scientists from the University of South Carolina delving deeper into this language disorder—called aphasia—which results when language centers of the brain are damaged by stroke, head injury, or other causes. In new NIDCD-funded research, they’ve demonstrated not only how important the location of the brain damage is in predicting how well a person will respond to aphasia therapy, they are also investigating a new method for stimulating brain-damaged regions in people with aphasia, in hopes of increasing brain plasticity and perhaps improving word recall.

In research published in the September 15, 2010, issue of the Journal of Neuroscience, Julius Fridriksson, Ph.D., studied 26 patients who experienced chronic aphasia after suffering a stroke that damaged the brain’s left hemisphere, where the language centers are found. He wanted to observe whether treating patients for anomia, an impairment associated with aphasia in which a person has difficulty naming certain objects, can help increase neural activity in key regions of the brain. (Although there are several types of aphasia and each has a variety of symptoms, anomia is a symptom that all people with aphasia have in common.) He also wanted to learn if damage to certain regions of the brain had a particularly negative effect on the successfulness of a patient’s treatment.

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An Article By Mimi Block, MS, CCC-SLP

Posted in Advance Magazine, Vol. 20 • Issue 22 • Page 10  on  November 3, 2010

The field of speech-language pathology has known for some time that outcomes are improved for adults with chronic aphasia when therapy is intensive, typically defined in the research as nine or more hours per week. The University of Michigan Aphasia Program (UMAP) creates an environment of success for this patient population with a combination of individual and group therapy delivered on an intensive schedule targeting multimodal forms of communication that include training with assistive software, along with education and support for caregivers.

Beginning in January 2011, UMAP will build on its clinical experience, client feedback, and what the research says to maximize the therapeutic experience for clients and their families. Sessions will coincide with each month of the year, and clients can opt for additional weeks at any time.

A full-time client receives 25 hours of speech-language therapy each week. Music and art therapy, caregiver education seminars and support group, and social-recreational activities complete the weekly package of 30 hours of structured activities.

Each client is assigned to a team of speech-language pathologists. The client’s primary clinician coordinates the goals and serves as the point person for the family and client regarding questions, goals and progress.

Each day clients receive two hours of individual therapy designed to target their specific goals, which are developed from baseline testing and initial conversations with the client and family. As appropriate, goals target all areas of communication: listening, speaking, reading, writing, memory, cognition, and use of gestures.

Group therapy is an important component of the UMAP therapy regimen. As speech-language pathologists, we are well aware of the dynamic nature of communication. Clients receive two hours of group therapy daily to support the use of newly learned behaviors targeted during individual therapy into more naturalistic contexts.

This supportive context for communication is vitally important. Our client may be the only person in his or her community with aphasia. Re-learning communication skills in an environment with others who have aphasia helps reduce some of the stress and increases hope. Our clients push each other to try new ways of communicating, and they reinforce one another’s successes. The exuberance in the group when someone accomplishes a communicative task is uplifting for all involved! 

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ScienceDaily (Sep. 13, 2010) — Stroke patients who were left partially paralysed found that their condition improved after they received a simple and non-invasive method of brain stimulation, according to research in the September issue of the European Journal of NeurologyScienceDaily (Sep. 13, 2010) — Stroke patients who were left partially paralysed found that their condition improved after they received a simple and non-invasive method of brain stimulation, according to research in the September issue of the European Journal of Neurology

Researchers from the Ain Shams University in Cairo, Egypt, studied 60 patients with ischaemic stroke — where the blood supply is reduced to the brain — who had been left with mild to moderate muscle weakness down one side of their body.

Twenty of the randomly assigned treatment group received repetitive transcranial magnetic stimulation (rTMS) applied at 5-Hz over the brain hemisphere affected by the stroke and the other 20 received 1-Hz stimulation of the unaffected hemisphere. The remaining 20 formed the control group, receiving inactive placebo doses of the treatment. All patients received the same physical therapy.

“When we compared the results between the three groups, we found that both of the treatment groups showed significant motor function recovery” says co-author Anwar El Etribi, Professor of Neurology and Psychiatry at the University. “No improvements were seen in the control group who had received the placebo treatment and the same physical therapy protocol.”

The majority of the patients (95 per cent) had suffered their stroke in the last three years, having been enrolled in the study at least one month after their stroke. However, there was no difference between the level of clinical improvement and the interval since the patients’ strokes.

“We believe that people develop partial paralysis down one side after they have a stroke because the hemispheres of the brain become unbalanced” explains Professor Etribi. “The hemisphere that has not been affected can become over-active, while the damaged hemisphere can become inhibited.

“Our treatment worked on the theory that increasing the activity of the hemisphere affected by the stroke and reducing the activity of the unaffected hemisphere can reduce muscle weakness and improve overall motor function.” Read More .

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, 2021].

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.



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: . 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. 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/.

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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.”

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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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