We describe the case of a 61-year-old right-handed male who developed global language deficits an... more We describe the case of a 61-year-old right-handed male who developed global language deficits and muteness following a right hemisphere middle cerebral artery distribution infarct involving the frontal, inferior parietal and superior temporal lobes. Language was evaluated serially during the early stages of recovery in order to document the evolution of this syndrome with regard to the observed areas of linguistic change. Auditory comprehension and information content were the areas showing the greatest change during the early stages of recovery, while gains influency were limited. By 48 days post-onset, this patient's linguistic profile was behaviourally compatible with the Broca's aphasia seen with left hemisphere lesions.
Liepmann postulated that the left hemisphere of right-handed persons contains the "movement formu... more Liepmann postulated that the left hemisphere of right-handed persons contains the "movement formulas" that control purposeful skilled movements of the limbs on both sides of the body. Accordingly, in right-handers apraxia should follow damage to the left hemisphere, whereas right hemisphere damage should not lead to apraxia. Although this is generally true, we recently examined a righthanded man who after a right hemispheric stroke became aphasic and apraxic with his nonparalyzed right hand. Our observations suggest that the right hemisphere of this right-handed man made a critical contribution to the planning and execution of skilled movements. This case provides evidence that right-handers should not be considered a homogeneous group in terms of cerebral motor dominance and that contrary to Liepmann's postulate, hemispheric dominance for the control of skilled movements does not entirely determine handedness.
Patients with transcortical sensory aphasia have relatively preserved repetition ability but have... more Patients with transcortical sensory aphasia have relatively preserved repetition ability but have poor comprehension and naming ability. Their spontaneous speech contains paraphasic errors and lacks content. We describe a patient with a left parietal lesion who had poor comprehension but who was able to repeat. However, unlike previously reported cases of transcortical aphasia, the patient had relatively normal naming and spontaneous speech. We believe that this distinct and previously unreported form of transcortical aphasia is induced by a one-way dissociation between phonemic and semantic processors.
For normal writing it is essential that both motoric and linguistic competence be present; disrup... more For normal writing it is essential that both motoric and linguistic competence be present; disruption of one or the other of these faculties may result in qualitatively different types of agraphia. Two right-handed patients became agraphic after left hemisphere lesions; pure apraxic agraphia in the absence of limb apraxia developed in one patient and pure linguistic agraphia in association with severe ideomotor limb apraxia in the other. The performance of these patients not only serves to illustrate the dissociation between the motoric and linguistic faculties that underlie writing but also confirms that ideomotor limb apraxia and apraxic agraphia are distinct and dissociable entities.
... Amy D. Rodriguez VA Brain Rehabilitation Research Center, and University of Florida, Gainesvi... more ... Amy D. Rodriguez VA Brain Rehabilitation Research Center, and University of Florida, Gainesville, FL, USA Anastasia M. Raymer Old Dominion University, Norfolk, VA, and VA Brain Rehabilitation Research Center, Gainesville, FL, USA Leslie J. Gonzalez Rothi ...
Journal of The International Neuropsychological Society, Nov 1, 2002
Patients with apraxia are more impaired when performing transitive pantomimes than intransitive g... more Patients with apraxia are more impaired when performing transitive pantomimes than intransitive gestures. This dissociation might be related to the differences in movement complexity. Alternatively, the programs for intransitive gestures might be better defined, more widely distributed, or easier to activate than are those for transitive pantomimes. The purpose of this study was to test the complexity versus representational hypotheses. Twenty right-handed normal subjects both performed and discriminated correct from incorrect transitive pantomimes and intransitive gestures. The discrimination was performed by having subjects point at illustrations of hand postures. The subjects performed better when discriminating postures than when performing gestures or pantomimes. On both the production and discrimination tests, subjects performed better with intransitive gestures than transitive pantomimes. Although the finding that even normal subjects had more difficulty performing transitive pantomimes than intransitive gestures might appear to support the complexity hypothesis, that subjects also had more difficulty discriminating transitive than intransitive postures supports the representational activation hypothesis.
The left cerebral hemisphere in man contains anatomical structures specialized not only for langu... more The left cerebral hemisphere in man contains anatomical structures specialized not only for language but also for higher-order motor programming. One method of studying the nature of these motor programs is by observing the type of errors made by patients who have left hemisphere damage. A major problem, however, in investigating the disorders that result from failure of this specialized left hemisphere system (the apraxias) has been the difficulty in obtaining objective measurement of movement in three-dimensional space. To this end, we provide the first three-dimensional analysis of the nature of movement errors in apraxia. Two apraxic subjects with lesions to the left hemisphere and 5 matched control subjects were studied. The apraxic subjects showed impairments in the control of movement timing and spatial relations, as well as decoupling in the normally tight relation between certain spatial and temporal aspects of their movement trajectories. Further, the use of the distal musculature by apraxic subjects was more impaired than their use of the proximal musculature, suggesting more distal representation in any space-time maps of learned movement. These data provide further insight into the nature of the representations of learned skilled movements in the left cerebral hemisphere.
Theoretical models of praxis have two major components, a praxis conceptual system that includes ... more Theoretical models of praxis have two major components, a praxis conceptual system that includes knowledge of tool use and mechanical knowledge and a praxis production system that includes the information needed to program skilled motor acts. Because patients with Alzheimer's disease may have an impairment of the central conceptual system, we wanted to learn if they had a conceptual apraxia by testing their knowledge of the type of actions associated with tool use, their ability to associate tools with objects that receive their action, their ability to understand the mechanical nature of problems and the mechanical advantages tools may afford. We studied 32 subjects with probable Alzheimer's disease and 32 controls by examining tool-action relationships and tool-object associations. We tested mechanical knowledge by having subjects select alternative tools and solve mechanical puzzles by developing new tools. The Alzheimer's group was subdivided into four groups based on the presence or absence of ideomotor apraxia and a lexical-semantic deficit. Results indicated that each of the four Alzheimer's groups differed from normal controls on at least some measures of conceptual apraxia, suggesting that Alzheimer's patients do have a disturbance of the praxis conceptual system and that impairment of this system is not directly related to language impairment or ideomotor apraxia.
Destruction of parietal areas containing visuokinesthetic motor engrams, where motor acts may be ... more Destruction of parietal areas containing visuokinesthetic motor engrams, where motor acts may be programmed, should be distinguishable from apraxia induced by disconnection of these parietal areas from frontal motor areas. Destruction should result in inability to distinguish well-performed from poorly performed movements, whereas disconnection should not. We gave movement and act-discrimination tasks to apraxic and nonapraxic patients with anterior lesions or nonfluent aphasia, and to patients with posterior lesions or fluent aphasia. On both tasks, the performance of posteriorifluent patients was worse than that of all other patients. Our results suggest that there are two types of patients with ideomotor apraxia.
Background-Attention, the processing of one source of information to the exclusion of others, is ... more Background-Attention, the processing of one source of information to the exclusion of others, is important for most cognitive processes, including language. Evidence suggests not only that dysfunctional attention mechanisms contribute to language deficits after stroke, but also that orienting attention to a patient's ipsilesional hemispace recruits attention mechanisms in the intact hemisphere and improves language functions in some persons with aphasia. Aims-The aim of the current research was to offer proof of concept for the strategy of improving picture-naming performance in fluent aphasia by moving stimuli into the left hemispace. It was hypothesised that repeated orientation of attention to the ipsilesional hemispace during picture naming would lead to improved naming accuracy for participants with fluent aphasia. Methods & Procedures-Three participants with stable fluent aphasia received daily treatment sessions that consisted of naming simple line drawings presented 45 degrees to the left of body midline on a computer monitor. Naming probes were administered before initiation of the treatment protocol to establish a baseline, and before each treatment session to measure change during treatment. The C statistic was used to establish the stability of baseline performance and to determine whether the slope of the treatment phases differed significantly from the slope of the baseline. Outcomes & Results-Two of the three participants showed significant improvement over baseline performance in the percent correct of naming probes. One participant showed no improvement over baseline accuracy.
One aspect of Broca's aphasia, induced by anterior perisylvian lesions, is an inability t... more One aspect of Broca's aphasia, induced by anterior perisylvian lesions, is an inability to read closed-class words (eg, articles, prepositions) with a preserved ability to read open-class words (eg, nouns, verbs). We examined a man with profound Wernicke's aphasia induced by an infarct of the posterior portion of the superior temporal gyrus (Wernicke's area). He could not read substantive words or pronounceable nonwords but could read closed-class words. These observations suggest that the reading of closed- and open-class words is mediated by separable systems. Whereas the anterior perisylvian region appears to be important in reading functional words, the posterior perisylvian region is important in reading substantive words.
Syntactic alexia is the inability to comprehend graphically presented sentences when the meaning ... more Syntactic alexia is the inability to comprehend graphically presented sentences when the meaning depends on syntax. Although previously described in association with Broca's aphasia and attributed solely to the frontal lobe portion of the lesions, syntactic alexia has not been reported to accompany conduction aphasia. We studied three patients who had conduction aphasia from temporoparietal lesions and syntactic alexia. None of them had lesions in Broca's area. Broca's aphasics and our patients with conduction aphasia have a syntactic comprehension disturbance. Since Broca's aphasics and our patients have lesions that may extend into the supramarginal gyrus, we postulate that this area may be critical for comprehending syntax.
It has been proposed that the comprehension of written language requires transcoding from the vis... more It has been proposed that the comprehension of written language requires transcoding from the visual (grapheme) to the auditory (phoneme). It has also been proposed that visual word images can be comprehended without grapheme-phoneme transcoding. We describe three aphasic patients with left hemisphere impairment who had poor speech comprehension but could comprehend written language. One of these patients had a subsequent right hemisphere lesion and lost his ability to read. We propose that the right hemisphere in some individuals may be capable of extracting semantic information from iconic images (ideogram) without phonological processing.
This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed th... more This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed that if treatment were directed at the level of the phonologic processor, opportunities for naming via a phonological route, as opposed to a strictly whole word route, would be enhanced, thereby improving naming. The participants, ten people with anomia and aphasia due to left hemisphere stroke, received 96 h of phoneme based treatment in 12 weeks. To learn if treatment improved naming, a single-subject, repeated probe design with replication was employed. The primary outcome measure was confrontation naming. Secondary outcome measures included phonologic production, nonword repetition and discourse production. Results suggest a positive treatment effect (confrontation naming), improvements in phonologic production and nonword repetition, and generalization to discourse production. When tested 3 months after the completion of treatment the effects appeared to be maintained.
American Journal of Physical Medicine & Rehabilitation, Sep 1, 2007
Objective-To test the potential adjuvant effect of repetitive transcranial magnetic stimulation (... more Objective-To test the potential adjuvant effect of repetitive transcranial magnetic stimulation (rTMS) on motor learning in a group of stroke survivors undergoing constraint-induced therapy (CIT) for upper-limb hemiparesis. Design-This was a prospective randomized, double-blind, sham-controlled, parallel group study. Nineteen individuals, one or more years poststroke, were randomized to either a rTMS + CIT (n = 9) or a sham rTMS + CIT (n = 10) group and participated in the 2-wk intervention. Results-Regardless of group assignment, participants demonstrated significant gains on the primary outcome measures: the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL)-Amount of Use, and on secondary outcome measures including the Box and Block Test (BBT) and the MAL-How Well. Participants receiving rTMS failed to show differential improvement on either primary outcome measure. Conclusions-Although this study provided further evidence that even relatively brief sessions of CIT can have a substantial effect, it provided no support for adjuvant use of rTMS.
Journal of Rehabilitation Research and Development, 2006
In this phase I rehabilitation study, we investigated the effects of an intensive phonomotor reha... more In this phase I rehabilitation study, we investigated the effects of an intensive phonomotor rehabilitation program on verbal production in a 73-year-old male, 11 years postonset a left-hemisphere stroke, who exhibited apraxia of speech and aphasia. In the context of a single-subject design, we studied whether treatment would improve phoneme production and generalize to repetition of multisyllabic words, words of increasing length, discourse, and measures of self-report. We predicted that a predominant motor impairment would respond to intensive phonomotor rehabilitation. While able to learn to produce individual sounds, the subject did not exhibit generalization to other aspects of motor production. Discourse production was judged perceptually slower in rate and less effortful, but also less natural. Finally, self-report indicated less apprehension toward speaking with unfamiliar people, increased telephone use, and increased ease of communication.
Background: Models of basal ganglia (BG) function suggest that expressive language deficits will ... more Background: Models of basal ganglia (BG) function suggest that expressive language deficits will likely and consistently present in BG disease. Disparities currently exist between the predictions of models of BG function in expressive language and data from studies of BG disease. Traditional expressive language assessment methodologies that emphasize measures of language form (word and sentence productivity) while not carefully considering how language is used, may only partially account for these disparities. Objective: To use measures of cohesion to examine the use of cohesive markers in narrative discourse. Methods: Twelve individuals with idiopathic Parkinson's disease (PD) were compared to 12 matched neurologically intact controls on measures of discourse performance. Three discourse samples (typical day, memorable vacation and family) were analyzed for measures of narrative productivity, number of cohesive ties and cohesive adequacy. Mixed model analyses were completed for group comparisons. Results: Group differences were not observed on measures of language form as measured by narrative productivity, communication units, and number of cohesive ties produced. In contrast, group differences were observed in cohesive adequacy as individuals with PD produced a higher percentage of incomplete and erroneous cohesive ties relative the control subjects across narratives. Conclusions: These results support the conclusion that the BG in PD may have an executive role in expressive language use that can be disrupted without impacting language form.
We describe the case of a 61-year-old right-handed male who developed global language deficits an... more We describe the case of a 61-year-old right-handed male who developed global language deficits and muteness following a right hemisphere middle cerebral artery distribution infarct involving the frontal, inferior parietal and superior temporal lobes. Language was evaluated serially during the early stages of recovery in order to document the evolution of this syndrome with regard to the observed areas of linguistic change. Auditory comprehension and information content were the areas showing the greatest change during the early stages of recovery, while gains influency were limited. By 48 days post-onset, this patient's linguistic profile was behaviourally compatible with the Broca's aphasia seen with left hemisphere lesions.
Liepmann postulated that the left hemisphere of right-handed persons contains the "movement formu... more Liepmann postulated that the left hemisphere of right-handed persons contains the "movement formulas" that control purposeful skilled movements of the limbs on both sides of the body. Accordingly, in right-handers apraxia should follow damage to the left hemisphere, whereas right hemisphere damage should not lead to apraxia. Although this is generally true, we recently examined a righthanded man who after a right hemispheric stroke became aphasic and apraxic with his nonparalyzed right hand. Our observations suggest that the right hemisphere of this right-handed man made a critical contribution to the planning and execution of skilled movements. This case provides evidence that right-handers should not be considered a homogeneous group in terms of cerebral motor dominance and that contrary to Liepmann's postulate, hemispheric dominance for the control of skilled movements does not entirely determine handedness.
Patients with transcortical sensory aphasia have relatively preserved repetition ability but have... more Patients with transcortical sensory aphasia have relatively preserved repetition ability but have poor comprehension and naming ability. Their spontaneous speech contains paraphasic errors and lacks content. We describe a patient with a left parietal lesion who had poor comprehension but who was able to repeat. However, unlike previously reported cases of transcortical aphasia, the patient had relatively normal naming and spontaneous speech. We believe that this distinct and previously unreported form of transcortical aphasia is induced by a one-way dissociation between phonemic and semantic processors.
For normal writing it is essential that both motoric and linguistic competence be present; disrup... more For normal writing it is essential that both motoric and linguistic competence be present; disruption of one or the other of these faculties may result in qualitatively different types of agraphia. Two right-handed patients became agraphic after left hemisphere lesions; pure apraxic agraphia in the absence of limb apraxia developed in one patient and pure linguistic agraphia in association with severe ideomotor limb apraxia in the other. The performance of these patients not only serves to illustrate the dissociation between the motoric and linguistic faculties that underlie writing but also confirms that ideomotor limb apraxia and apraxic agraphia are distinct and dissociable entities.
... Amy D. Rodriguez VA Brain Rehabilitation Research Center, and University of Florida, Gainesvi... more ... Amy D. Rodriguez VA Brain Rehabilitation Research Center, and University of Florida, Gainesville, FL, USA Anastasia M. Raymer Old Dominion University, Norfolk, VA, and VA Brain Rehabilitation Research Center, Gainesville, FL, USA Leslie J. Gonzalez Rothi ...
Journal of The International Neuropsychological Society, Nov 1, 2002
Patients with apraxia are more impaired when performing transitive pantomimes than intransitive g... more Patients with apraxia are more impaired when performing transitive pantomimes than intransitive gestures. This dissociation might be related to the differences in movement complexity. Alternatively, the programs for intransitive gestures might be better defined, more widely distributed, or easier to activate than are those for transitive pantomimes. The purpose of this study was to test the complexity versus representational hypotheses. Twenty right-handed normal subjects both performed and discriminated correct from incorrect transitive pantomimes and intransitive gestures. The discrimination was performed by having subjects point at illustrations of hand postures. The subjects performed better when discriminating postures than when performing gestures or pantomimes. On both the production and discrimination tests, subjects performed better with intransitive gestures than transitive pantomimes. Although the finding that even normal subjects had more difficulty performing transitive pantomimes than intransitive gestures might appear to support the complexity hypothesis, that subjects also had more difficulty discriminating transitive than intransitive postures supports the representational activation hypothesis.
The left cerebral hemisphere in man contains anatomical structures specialized not only for langu... more The left cerebral hemisphere in man contains anatomical structures specialized not only for language but also for higher-order motor programming. One method of studying the nature of these motor programs is by observing the type of errors made by patients who have left hemisphere damage. A major problem, however, in investigating the disorders that result from failure of this specialized left hemisphere system (the apraxias) has been the difficulty in obtaining objective measurement of movement in three-dimensional space. To this end, we provide the first three-dimensional analysis of the nature of movement errors in apraxia. Two apraxic subjects with lesions to the left hemisphere and 5 matched control subjects were studied. The apraxic subjects showed impairments in the control of movement timing and spatial relations, as well as decoupling in the normally tight relation between certain spatial and temporal aspects of their movement trajectories. Further, the use of the distal musculature by apraxic subjects was more impaired than their use of the proximal musculature, suggesting more distal representation in any space-time maps of learned movement. These data provide further insight into the nature of the representations of learned skilled movements in the left cerebral hemisphere.
Theoretical models of praxis have two major components, a praxis conceptual system that includes ... more Theoretical models of praxis have two major components, a praxis conceptual system that includes knowledge of tool use and mechanical knowledge and a praxis production system that includes the information needed to program skilled motor acts. Because patients with Alzheimer's disease may have an impairment of the central conceptual system, we wanted to learn if they had a conceptual apraxia by testing their knowledge of the type of actions associated with tool use, their ability to associate tools with objects that receive their action, their ability to understand the mechanical nature of problems and the mechanical advantages tools may afford. We studied 32 subjects with probable Alzheimer's disease and 32 controls by examining tool-action relationships and tool-object associations. We tested mechanical knowledge by having subjects select alternative tools and solve mechanical puzzles by developing new tools. The Alzheimer's group was subdivided into four groups based on the presence or absence of ideomotor apraxia and a lexical-semantic deficit. Results indicated that each of the four Alzheimer's groups differed from normal controls on at least some measures of conceptual apraxia, suggesting that Alzheimer's patients do have a disturbance of the praxis conceptual system and that impairment of this system is not directly related to language impairment or ideomotor apraxia.
Destruction of parietal areas containing visuokinesthetic motor engrams, where motor acts may be ... more Destruction of parietal areas containing visuokinesthetic motor engrams, where motor acts may be programmed, should be distinguishable from apraxia induced by disconnection of these parietal areas from frontal motor areas. Destruction should result in inability to distinguish well-performed from poorly performed movements, whereas disconnection should not. We gave movement and act-discrimination tasks to apraxic and nonapraxic patients with anterior lesions or nonfluent aphasia, and to patients with posterior lesions or fluent aphasia. On both tasks, the performance of posteriorifluent patients was worse than that of all other patients. Our results suggest that there are two types of patients with ideomotor apraxia.
Background-Attention, the processing of one source of information to the exclusion of others, is ... more Background-Attention, the processing of one source of information to the exclusion of others, is important for most cognitive processes, including language. Evidence suggests not only that dysfunctional attention mechanisms contribute to language deficits after stroke, but also that orienting attention to a patient's ipsilesional hemispace recruits attention mechanisms in the intact hemisphere and improves language functions in some persons with aphasia. Aims-The aim of the current research was to offer proof of concept for the strategy of improving picture-naming performance in fluent aphasia by moving stimuli into the left hemispace. It was hypothesised that repeated orientation of attention to the ipsilesional hemispace during picture naming would lead to improved naming accuracy for participants with fluent aphasia. Methods & Procedures-Three participants with stable fluent aphasia received daily treatment sessions that consisted of naming simple line drawings presented 45 degrees to the left of body midline on a computer monitor. Naming probes were administered before initiation of the treatment protocol to establish a baseline, and before each treatment session to measure change during treatment. The C statistic was used to establish the stability of baseline performance and to determine whether the slope of the treatment phases differed significantly from the slope of the baseline. Outcomes & Results-Two of the three participants showed significant improvement over baseline performance in the percent correct of naming probes. One participant showed no improvement over baseline accuracy.
One aspect of Broca's aphasia, induced by anterior perisylvian lesions, is an inability t... more One aspect of Broca's aphasia, induced by anterior perisylvian lesions, is an inability to read closed-class words (eg, articles, prepositions) with a preserved ability to read open-class words (eg, nouns, verbs). We examined a man with profound Wernicke's aphasia induced by an infarct of the posterior portion of the superior temporal gyrus (Wernicke's area). He could not read substantive words or pronounceable nonwords but could read closed-class words. These observations suggest that the reading of closed- and open-class words is mediated by separable systems. Whereas the anterior perisylvian region appears to be important in reading functional words, the posterior perisylvian region is important in reading substantive words.
Syntactic alexia is the inability to comprehend graphically presented sentences when the meaning ... more Syntactic alexia is the inability to comprehend graphically presented sentences when the meaning depends on syntax. Although previously described in association with Broca's aphasia and attributed solely to the frontal lobe portion of the lesions, syntactic alexia has not been reported to accompany conduction aphasia. We studied three patients who had conduction aphasia from temporoparietal lesions and syntactic alexia. None of them had lesions in Broca's area. Broca's aphasics and our patients with conduction aphasia have a syntactic comprehension disturbance. Since Broca's aphasics and our patients have lesions that may extend into the supramarginal gyrus, we postulate that this area may be critical for comprehending syntax.
It has been proposed that the comprehension of written language requires transcoding from the vis... more It has been proposed that the comprehension of written language requires transcoding from the visual (grapheme) to the auditory (phoneme). It has also been proposed that visual word images can be comprehended without grapheme-phoneme transcoding. We describe three aphasic patients with left hemisphere impairment who had poor speech comprehension but could comprehend written language. One of these patients had a subsequent right hemisphere lesion and lost his ability to read. We propose that the right hemisphere in some individuals may be capable of extracting semantic information from iconic images (ideogram) without phonological processing.
This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed th... more This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed that if treatment were directed at the level of the phonologic processor, opportunities for naming via a phonological route, as opposed to a strictly whole word route, would be enhanced, thereby improving naming. The participants, ten people with anomia and aphasia due to left hemisphere stroke, received 96 h of phoneme based treatment in 12 weeks. To learn if treatment improved naming, a single-subject, repeated probe design with replication was employed. The primary outcome measure was confrontation naming. Secondary outcome measures included phonologic production, nonword repetition and discourse production. Results suggest a positive treatment effect (confrontation naming), improvements in phonologic production and nonword repetition, and generalization to discourse production. When tested 3 months after the completion of treatment the effects appeared to be maintained.
American Journal of Physical Medicine & Rehabilitation, Sep 1, 2007
Objective-To test the potential adjuvant effect of repetitive transcranial magnetic stimulation (... more Objective-To test the potential adjuvant effect of repetitive transcranial magnetic stimulation (rTMS) on motor learning in a group of stroke survivors undergoing constraint-induced therapy (CIT) for upper-limb hemiparesis. Design-This was a prospective randomized, double-blind, sham-controlled, parallel group study. Nineteen individuals, one or more years poststroke, were randomized to either a rTMS + CIT (n = 9) or a sham rTMS + CIT (n = 10) group and participated in the 2-wk intervention. Results-Regardless of group assignment, participants demonstrated significant gains on the primary outcome measures: the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL)-Amount of Use, and on secondary outcome measures including the Box and Block Test (BBT) and the MAL-How Well. Participants receiving rTMS failed to show differential improvement on either primary outcome measure. Conclusions-Although this study provided further evidence that even relatively brief sessions of CIT can have a substantial effect, it provided no support for adjuvant use of rTMS.
Journal of Rehabilitation Research and Development, 2006
In this phase I rehabilitation study, we investigated the effects of an intensive phonomotor reha... more In this phase I rehabilitation study, we investigated the effects of an intensive phonomotor rehabilitation program on verbal production in a 73-year-old male, 11 years postonset a left-hemisphere stroke, who exhibited apraxia of speech and aphasia. In the context of a single-subject design, we studied whether treatment would improve phoneme production and generalize to repetition of multisyllabic words, words of increasing length, discourse, and measures of self-report. We predicted that a predominant motor impairment would respond to intensive phonomotor rehabilitation. While able to learn to produce individual sounds, the subject did not exhibit generalization to other aspects of motor production. Discourse production was judged perceptually slower in rate and less effortful, but also less natural. Finally, self-report indicated less apprehension toward speaking with unfamiliar people, increased telephone use, and increased ease of communication.
Background: Models of basal ganglia (BG) function suggest that expressive language deficits will ... more Background: Models of basal ganglia (BG) function suggest that expressive language deficits will likely and consistently present in BG disease. Disparities currently exist between the predictions of models of BG function in expressive language and data from studies of BG disease. Traditional expressive language assessment methodologies that emphasize measures of language form (word and sentence productivity) while not carefully considering how language is used, may only partially account for these disparities. Objective: To use measures of cohesion to examine the use of cohesive markers in narrative discourse. Methods: Twelve individuals with idiopathic Parkinson's disease (PD) were compared to 12 matched neurologically intact controls on measures of discourse performance. Three discourse samples (typical day, memorable vacation and family) were analyzed for measures of narrative productivity, number of cohesive ties and cohesive adequacy. Mixed model analyses were completed for group comparisons. Results: Group differences were not observed on measures of language form as measured by narrative productivity, communication units, and number of cohesive ties produced. In contrast, group differences were observed in cohesive adequacy as individuals with PD produced a higher percentage of incomplete and erroneous cohesive ties relative the control subjects across narratives. Conclusions: These results support the conclusion that the BG in PD may have an executive role in expressive language use that can be disrupted without impacting language form.
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Papers by Leslie Rothi