Time for a quick word? The striking benefits of training



Time for a quick word? The striking benefits of training speed and accuracy of word retrieval in post-stroke aphasia.Paul Conroy *, Christina Sotiropoulou Drosopoulou*, Gina F. Humphreys, Ajay D. Halai, & Matthew A. Lambon RalphNeuroscience & Aphasia Research Unit, Division of Neuroscience & Experimental Psychology, School of Biological SciencesUniversity of Manchester UKAddress correspondence to: Dr. Paul Conroy or Prof. Matt Lambon Ralph, Neuroscience and Aphasia Research Unit (NARU), School of Biological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK. E-mail: paul.conroy@manchester.ac.uk or matt.lambon-ralph@manchester.ac.uk* - Joint first authorsORCiD:Conroy:0000-0003-2189-4149Sotiropoulou Drosopoulou:0000-0002-7237-3514Humphreys:0000-0002-4157-3409Halai:0000-0003-1725-7948Lambon Ralph:0000-0001-5907-2488Running title: speed + accuracy of word retrieval in aphasiaAcknowledgements: We would like to thank the participants with aphasia who took part in this study. This research was supported by grants from the Rosetrees Foundation, the MRC (MR/J004146/1) and ERC (GAP: 670428 - BRAIN2MIND_NEUROCOMP).Abstract One third of stroke survivors experience deficits in word retrieval as a core characteristic of their aphasia, which is frustrating, socially-limiting and disabling for their professional and everyday lives. The, as yet undiscovered, “holy grail” of clinical practice is to establish a treatment that not only improves item naming but also generalizes to patients’ connected speech. Speech production in healthy participants is a remarkable feat of cognitive processing being both rapid (at least 120 words per minute) and accurate (~one error per 1000 words). Accordingly, we tested the hypothesis that word-finding treatment will only be successful and generalize to connected speech if word retrieval is both accurate and quick. This study compared a novel combined speed- and accuracy-focused intervention - ‘repeated, increasingly-speeded production’ - to standard accuracy-focused treatment. Both treatments were evaluated for naming, connected speech outcomes, and related to participants’ neuropsychological and lesion profiles. Twenty participants with post-stroke chronic aphasia of varying severity and subtype took part in 12 computer-based treatment sessions over 6 weeks. Four carefully-matched word-sets were randomly allocated either to the speed- and accuracy-focused treatment, standard accuracy-only treatment, or untreated (two control sets). In the standard treatment, sound-based naming cues facilitated naming accuracy. The speed- and accuracy-focused treatment encouraged naming to become gradually quicker, aiming towards the naming time of age-matched controls. The novel treatment was significantly more effective in improving and maintaining picture naming accuracy and speed (reduced latencies). Generalization of treated vocabulary to connected speech was significantly increased for all items relative to the baseline. The speed- and accuracy-focused treatment generated substantial and significantly greater deployment of targeted items in connected speech. These gains were maintained at one-month post intervention. There was a significant negative correlation for the speed- and accuracy-focused treatment between the patients’ phonological scores and the magnitude of the therapy effect, which may have reflected the fact that the substantial, beneficial effect of the novel treatment generated a ceiling effect in the milder patients. Maintenance of the speed- and accuracy-treatment effect correlated positively with executive skills. The neural correlate analyses revealed that participants with the greatest damage to the posterior superior temporal gyrus extending into the white matter of the inferior longitudinal fasciculus, showed the greatest speed- and accuracy treatment benefit. The novel treatment was well tolerated by participants across the range of severity and aphasia subtype, indicating that this type of intervention has considerable clinical utility and broad applicability. Keywords: aphasia, word retrieval, speed, naming, treatment, stroke.Introduction Fluent speech requires rapid, errorless retrieval of vocabulary, which occurs at a rate of at least two words per second and less than one error per 1000 words ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2f5i4iqjb4","properties":{"formattedCitation":"(Bird et al., 2000; Levelt, 1989)","plainCitation":"(Bird et al., 2000; Levelt, 1989)"},"citationItems":[{"id":20,"uris":[""],"uri":[""],"itemData":{"id":20,"type":"article-journal","title":"The rise and fall of frequency and imageability: noun and verb production in semantic dementia","container-title":"Brain and Language","page":"17-49","volume":"73","issue":"1","source":"PubMed","abstract":"This study examines the impact of progressive degeneration of conceptual knowledge on the content words used in connected speech elicited using the Cookie Theft picture description (Goodglass & Kaplan. 1983). We began with an analysis of control subjects' descriptions with regard to word types and their frequency and imageability. Because the impairment of conceptual knowledge in semantic dementia is graded by concept familiarity, we created a model of a standardized normal Cookie Theft description that was then progressively degraded by the systematic removal of lower bands of word frequency. We drew two main predictions from this model: reduced availability of the lower bands of word frequency should result in (a) an apparent deficit for noun retrieval in relation to verb retrieval and (b) an apparent reverse imageability effect. Results from a longitudinal study. in which three patients with semantic dementia each described the Cookie Theft picture on three occasions during the progression of their disease, confirmed these predictions. An additional cross-sectional analysis, adding narratives from a larger number of cases, demonstrated that the decline in ability to produce suitable words for the picture description is closely related to the extent of semantic impairment as measured in tests of word comprehension and production. Both verbs and nouns are affected by the degradation of semantic memory; the fact that the impairment to noun production is manifested earlier and more catastrophically may be attributed to the relatively lower frequency of these terms.","DOI":"10.1006/brln.2000.2293","ISSN":"0093-934X","note":"PMID: 10872636","shortTitle":"The rise and fall of frequency and imageability","journalAbbreviation":"Brain Lang","language":"eng","author":[{"family":"Bird","given":"H."},{"family":"Lambon Ralph","given":"M. A."},{"family":"Patterson","given":"K."},{"family":"Hodges","given":"J. R."}],"issued":{"date-parts":[["2000",6,1]]},"PMID":"10872636"}},{"id":18,"uris":[""],"uri":[""],"itemData":{"id":18,"type":"book","title":"Speaking: from intention to articulation","publisher":"MIT Press","publisher-place":"Cambridge, Mass.","event-place":"Cambridge, Mass.","shortTitle":"Speaking","author":[{"family":"Levelt","given":"Willem"}],"issued":{"date-parts":[["1989"]]}}}],"schema":""} (Bird et al., 2000; Levelt, 1989). Aphasia occurs in at least one third of stroke survivors ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"liugcka5f","properties":{"formattedCitation":"(The Stroke Association (UK), 2016)","plainCitation":"(The Stroke Association (UK), 2016)"},"citationItems":[{"id":22,"uris":[""],"uri":[""],"itemData":{"id":22,"type":"post","title":"State of the Nation Stroke statistics January 2016","author":[{"family":"The Stroke Association (UK)","given":""}],"issued":{"date-parts":[["2016"]]}}}],"schema":""} (The Stroke Association (UK), 2016). Failures, errors or delays in word retrieval (anomia) are the most pervasive aphasic symptoms ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1r0cla2vk5","properties":{"formattedCitation":"(Laine and Martin, 2006)","plainCitation":"(Laine and Martin, 2006)"},"citationItems":[{"id":17,"uris":[""],"uri":[""],"itemData":{"id":17,"type":"book","title":"Anomia: Theoretical and clinical aspects.","publisher":"Psychology Press","publisher-place":"Hove, England","event-place":"Hove, England","author":[{"family":"Laine","given":"Matti"},{"family":"Martin","given":"Nadine"}],"issued":{"date-parts":[["2006"]]}}}],"schema":""} (Laine and Martin, 2006). Anomia treatment typically involves single-item picture naming. There is a strong clinical belief that there is a lack of generalization to connected speech for standard naming therapies ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"TcHBy3KM","properties":{"formattedCitation":"(Nickels, 2002; Wisenburn and Mahoney, 2009)","plainCitation":"(Nickels, 2002; Wisenburn and Mahoney, 2009)"},"citationItems":[{"id":47,"uris":[""],"uri":[""],"itemData":{"id":47,"type":"article-journal","title":"Therapy for naming disorders: Revisiting, revising, and reviewing","container-title":"Aphasiology","page":"935-979","volume":"16","issue":"10-11","source":"Taylor and Francis+NEJM","abstract":"Background: Impairments of word retrieval and production are a common and distressing feature of aphasia, and much clinical time is devoted to attempts at their remediation. There are now many research papers devoted to case studies examining treatments for word-retrieval impairments using a wide range of tasks with individuals who have varying levels of impairment. Aims: This paper aims to continue the selective review of this literature carried out by Nickels and Best (1996a). It summarises in table form those published papers since 1980 which present single case studies of treatment for word-retrieval impairments and which satisfy minimal methodological criteria. Main Contribution: Several main themes are derived from the literature and discussed in more detail, these include strategic approaches and facilitative or repair approaches to remediation, the contrast between semantic and phonological tasks in therapy, generalisation in therapy tasks and the relationship between impairment, therapy task, and outcome. Further discussion relates to the relationship between impairment level treatments, and measures of disability and handicap, and between therapy research and therapy practice. Conclusions: There are now many research papers devoted to impairments of word retrieval, and there can be no doubt that therapy for word-retrieval impairments can be highly successful, resulting in long-term improvements which can be of great communicative significance for the individual with aphasia. However, predicting the precise result of a specific treatment task with a specific individual with certainty is still not possible. For clinicians the recommendation is to use analyses of functional impairments to guide the choice of task, but to ensure that efficacy is tested and not assumed. Furthermore, structured multi-modal and multicomponent tasks (e.g., “semantic” or “phonological” cueing hierarchies) may hold the most promise for many individuals. For researchers, there remains a need to further dissect tasks, impairments, and their interactions across series of single cases.","DOI":"10.1080/02687030244000563","ISSN":"0268-7038","shortTitle":"Therapy for naming disorders","author":[{"family":"Nickels","given":"Lyndsey"}],"issued":{"date-parts":[["2002",10,1]]}}},{"id":50,"uris":[""],"uri":[""],"itemData":{"id":50,"type":"article-journal","title":"A meta-analysis of word-finding treatments for aphasia","container-title":"Aphasiology","page":"1338-1352","volume":"23","issue":"11","source":"Taylor and Francis+NEJM","abstract":"Background: The research literature on treatment methods for word-finding deficits in aphasia is extensive. A meta-analysis of studies for word-finding therapy was conducted in order to objectively synthesise this information to answer large-scale questions of treatment efficacy. Aims: The purpose of this study was to examine the efficacy of various treatment approaches for word-finding deficits for individuals with aphasia. This analysis also examined gains made to trained and untrained words, the level of maintenance after therapy, and the effect of the time post-onset of aphasia on the recovery of language function. Methods & Procedures: Various search methods were used to gather anomia treatment studies for this analysis. From 44 studies, 107 effect sizes were calculated for the final analysis. These data were sorted according to the following moderator variables: treatment category (semantic, phonological, or mixed), word set (trained, exposed-related, exposed-unrelated, unexposed-unrelated, and unexposed-related), follow-up measures, and median number of months post-onset. Outcomes & Results: All therapy approaches showed evidence of efficacy, although the variance between studies was large. Strong gains were seen for trained and exposed words, but only minor gains for unexposed words. Large effects were seen for up to 2 months post-therapy, with lingering effects at 3 months post-therapy. Treatment appeared efficacious even for individuals that were years post-onset. Conclusions: An objective synthesis of the literature shows that intervention for word-finding deficits is efficacious. However, the level of gains varied widely across studies and therapy approaches. As expected, little generalisation was found for untrained-unexposed words.","DOI":"10.1080/02687030902732745","ISSN":"0268-7038","author":[{"family":"Wisenburn","given":"Bruce"},{"family":"Mahoney","given":"Kate"}],"issued":{"date-parts":[["2009",10,15]]}}}],"schema":""} (Nickels, 2002; Wisenburn and Mahoney, 2009), yet typically studies (a) have lacked a systematic method for assessing generalization and (b) have been underpowered. Given that connected speech is highly demanding in terms of speed and accuracy, we hypothesised that retrained vocabulary will only generalise if it can be retrieved within the demanding time window required by connected speech ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"p6g8l2lrc","properties":{"formattedCitation":"(Conroy et al., 2009; Crerar, 2004)","plainCitation":"(Conroy et al., 2009; Crerar, 2004)"},"citationItems":[{"id":56,"uris":[""],"uri":[""],"itemData":{"id":56,"type":"article-journal","title":"The effects of decreasing and increasing cue therapy on improving naming speed and accuracy for verbs and nouns in aphasia","container-title":"Aphasiology","page":"707-730","volume":"23","issue":"6","source":"Taylor and Francis+NEJM","abstract":"Background: Verb impairments in aphasia have generated considerable theoretical interest in the literature (Druks, 2002; Druks & Masterson, 2003; Marshall, 2003) but this is not reflected in the number of studies investigating therapies for verb impairments (Conroy, Sage, & Lambon Ralph, 2006). Recent anomia therapy studies have compared errorless and errorful techniques (Abel, Schultz, Radermacher, Willmes, & Huber, 2005; Fillingham, Hodgson, Sage, & Lambon Ralph, 2003; Fillingham, Sage, & Lambon Ralph, 2005a, 2005b, 2006). Decreasing cues have been proposed as the optimal interaction of low error and sustained effort in therapy in the amnesia literature (Komatsu, Mimura, Kato, Wakamatsu, & Kashima, 2000). Following on from Conroy, Sage, and Lambon Ralph (2008), we predicted that decreasing cue therapy would result in greater effects in terms of both naming accuracy and speed relative to increasing cues. Aims: The present study aimed to answer the following questions: (1) Would naming therapy consisting of decreasing cues result in greater naming accuracy for verb and noun targets than therapy consisting of increasing cues? (2) Would decreasing cues result in speedier naming responses to verb and noun targets than increasing cues? Methods & Procedures: A case‐series study that utilised decreasing versus increasing cues as naming therapy for verbs and nouns was implemented with seven participants with aphasia of various sub‐types and degrees of severity. A total of 120 target words were collated for each participant, divided into three sets, each consisting of 20 verbs and 20 nouns. Set A was used in decreasing cues therapy, set B in increasing cues therapy, and set C served as control items. Ten sessions of therapy were delivered to each therapy set concurrently. The speed of post‐therapy naming responses as well as accuracy was recorded. Outcomes & Results: All participants showed significant therapy gains after both decreasing and increasing cue therapies, with little or no change in naming of control sets. The two therapies were equivalent in the degree to which participants improved in naming accuracy and yielded almost identical overall speed of naming responses. Naming speeds for successfully named items, post‐therapy, were faster for nouns than verbs (perhaps reflecting their shorter length), and faster at immediate than follow‐up assessment. Conclusions: Decreasing cues are as effective in naming therapy as increasing cues, in terms of both accuracy and speed of naming for verbs and nouns.","DOI":"10.1080/02687030802165574","ISSN":"0268-7038","author":[{"family":"Conroy","given":"Paul"},{"family":"Sage","given":"Karen"},{"family":"Lambon Ralph","given":"Matthew A. Lambon"}],"issued":{"date-parts":[["2009",6,1]]}}},{"id":53,"uris":[""],"uri":[""],"itemData":{"id":53,"type":"article-journal","title":"Aphasia rehabilitation and the strange neglect of speed","container-title":"Neuropsychological Rehabilitation","page":"173-206","volume":"14","issue":"1-2","source":"Taylor and Francis+NEJM","abstract":"Timing data is infrequently reported in aphasiological literature and time taken is only a minor factor, where it is considered at all, in existing aphasia assessments. This is not surprising because reaction times are difficult to obtain manually, but it is a pity, because speed data should be indispensable in assessing the severity of language processing disorders and in evaluating the effects of treatment. This paper argues that reporting accuracy data without discussing speed of performance gives an incomplete and potentially misleading picture of any cognitive function. Moreover, in deciding how to treat, when to continue treatment and when to cease therapy, clinicians should have regard to both parameters: Speed and accuracy of performance. Crerar, Ellis and Dean (1996) reported a study in which the written sentence comprehension of 14 long-term agrammatic subjects was assessed and treated using a computer-based microworld. Some statistically significant and durable treatment effects were obtained after a short amount of focused therapy. Only accuracy data were reported in that (already long) paper, and interestingly, although it has been a widely read study, neither referees nor subsequent readers seemed to miss “the other side of the coin”: How these participants compared with controls for their speed of processing and what effect treatment had on speed. This paper considers both aspects of the data and presents a tentative way of combining treatment effects on both accuracy and speed of performance in a single indicator. Looking at rehabilitation this way gives us a rather different perspective on which individuals benefited most from the intervention. It also demonstrates that while some subjects are capable of utilising metalinguistic skills to achieve normal accuracy scores even many years post-stroke, there is little prospect of reducing the time taken to within the normal range. Without considering speed of processing, the extent of this residual functional impairment can be overlooked.","DOI":"10.1080/09602010343000174","ISSN":"0960-2011","author":[{"family":"Crerar","given":"M. Alison"}],"issued":{"date-parts":[["2004",3,1]]}}}],"schema":""} (Conroy et al., 2009; Crerar, 2004). This hypothesis aligns with the broader observations that (a) naming speed is an important variable for both assessment and treatment tasks ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aq5pg8ocv","properties":{"formattedCitation":"(McCall et al., 1997)","plainCitation":"(McCall et al., 1997)"},"citationItems":[{"id":61,"uris":[""],"uri":[""],"itemData":{"id":61,"type":"article-journal","title":"The influence of syntactic and semantic information on picture-naming performance in aphasic patients","container-title":"Aphasiology","page":"581-600","volume":"11","issue":"6","source":"Taylor and Francis+NEJM","abstract":"Two experiments are described investigating which aspects of the sentence completion prompt are requisite for enhancing the ability of aphasic subjects to retrieve picture names. Naming performance of eight aphasic subjects is assessed in response to sentence frames containing a semantically related word (sentence completions), semantically empty sentence frames (carrier phrases) and provision of semantic information alone (associate verbs). It was shown that, as a group, subjects demonstrated better naming performance in response to sentence completions containing a semantically related word than to semantically empty sentence frames or to verb associates. Consideration of response times provides evidence that the sentence completion condition facilitates subjects' access to picture names. Our results support the notion that it is the combination of syntactic and semantic variables that enhances naming.","DOI":"10.1080/02687039708248491","ISSN":"0268-7038","author":[{"family":"McCall","given":"D."},{"family":"Cox","given":"D. M."},{"family":"Shelton","given":"J. R."},{"family":"Weinrich","given":"M."}],"issued":{"date-parts":[["1997",6,1]]}}}],"schema":""} (McCall et al., 1997) and (b) in mild aphasia, expressive vocabulary may be largely recovered except for delayed naming latencies (Crerar, 2004). To tackle this critical clinical need, we developed a novel treatment to reduce speed and increase picture naming accuracy, simultaneously (‘repeated, increasingly-speeded production’: RISP). This intervention was directly compared to (a) a standard treatment that targeted accuracy alone and (b) no treatment. We hypothesized that (i) RISP would generate greater improvements in both naming speed and accuracy, and (ii) speedier naming would increase production of treated words in connected speech (evaluated through a newly-developed, systematic method). Finally, we related the patients’ variable therapy outcomes to both their background neuropsychological profiles and the distributions of the underlying lesions. Materials and methods ParticipantsThe participants were recruited from a post-stroke database within the Neuroscience and Aphasia Research Unit. The database consisted of seventy participants with chronic aphasia following cerebrovascular accident (CVA). All were recruited from aphasia support groups or speech therapy services in Greater Manchester and North-West England. Participants covered the full-range of aphasia severity and multiple subtypes. All were right handed, native English speakers, who had sustained one left hemisphere stroke at least one year prior to recruitment, had normal or corrected-to-normal hearing and vision, had no co-existing neurological impairments and had no contradistinctions for MRI scanning. Nineteen participants had no contradistinctions to MRI scanning (i.e. no pacemakers, metal implants, claustrophobia, etc.), however one patient had a metal implant. This meant that neuroimaging data was collected only from nineteen patients. Neuroimaging data from a healthy age and education matched control group (8 female, 11 male) was used to determine abnormal voxels using the automated lesion identification procedure ADDIN EN.CITE <EndNote><Cite><Author>Seghier</Author><Year>2008</Year><RecNum>516</RecNum><DisplayText>(Seghier et al., 2008)</DisplayText><record><rec-number>516</rec-number><foreign-keys><key app="EN" db-id="sxf5tzfs1easwyerxe450eahwxeef52eww2r" timestamp="1412954958">516</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Seghier, M.L.</author><author>Ramlackhansingh, A.</author><author>Crinion, J. T.</author><author>Leff, Alex P.</author><author>Price, C.J.</author></authors></contributors><titles><title>Lesion identification using unified segmentation-normalisation models and fuzzy clustering.</title><secondary-title>NeuroImage</secondary-title></titles><periodical><full-title>NeuroImage</full-title></periodical><pages>1253-1266</pages><volume>41</volume><dates><year>2008</year></dates><urls></urls></record></Cite></EndNote>(Seghier et al., 2008). All participants gave written informed consent with approval from the local ethics committee.From the full database, twenty participants (11 males, 9 females; mean age 65.2 years, SD = 11.7) took part in the study. Prerequisites for participating were to have minimal repetition skills (>40% on an immediate word repetition test: ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"14uujltk73","properties":{"formattedCitation":"(Kay et al., 1996)","plainCitation":"(Kay et al., 1996)"},"citationItems":[{"id":69,"uris":[""],"uri":[""],"itemData":{"id":69,"type":"article-journal","title":"Psycholinguistic assessments of language processing in aphasia (PALPA): An introduction","container-title":"Aphasiology","page":"159-180","volume":"10","issue":"2","source":"Taylor and Francis+NEJM","abstract":"PALPA is designed to be a resource for speech and language therapists and cognitive and clinical neuropsychologists who wish to assess language processing skills in people with aphasia. We believe that PALPA can make a substantial contribution to the investigator/therapist's resources for examining people with aphasia. The comments made by a large number of aphasia therapists throughout the UK, other parts of Europe, and Australia and Canada—some of whom have been using research versions of the battery—have been encouraging. PALPA already seems to have brought a new approach to the clinical examination of individual patients with dysphasia, one which is in tune with the philosophy of considering language assessment as an iterative procedure of hypothesis testing.","DOI":"10.1080/02687039608248403","ISSN":"0268-7038","shortTitle":"Psycholinguistic assessments of language processing in aphasia (PALPA)","author":[{"family":"Kay","given":"Janice"},{"family":"Lesser","given":"Ruth"},{"family":"Coltheart","given":"Max"}],"issued":{"date-parts":[["1996",2,1]]}}}],"schema":""} (Kay et al., 1996). Participants with global aphasia, severe perceptual problems or with very severe naming difficulties (below 8% or 5/60 on the Boston Naming Test: ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"100kslm048","properties":{"formattedCitation":"(Goodglass et al., 2000)","plainCitation":"(Goodglass et al., 2000)"},"citationItems":[{"id":77,"uris":[""],"uri":[""],"itemData":{"id":77,"type":"book","title":"Boston Diagnostic Aphasia Examination - Third Edition (BDAE-3)","publisher":"Pearsons","author":[{"family":"Goodglass","given":"Harold"},{"family":"Kaplan","given":"Edith"},{"family":"Barresi","given":"Barbara"}],"issued":{"date-parts":[["2000"]]}}}],"schema":""} (Goodglass et al., 2000), were excluded from the study. All other levels and types were included so that the newly-developed therapy could be trialled across a full range of patients. Demographic details of the participants are given in Supplementary Table 1 together with baseline picture naming accuracy and speed, and production of the same vocabulary items in connected speech (with participants ordered according to their BNT naming accuracy).Background assessmentsBefore taking part in this study, participants also completed extensive linguistic and cognitive assessment. The results are summarised in Supplementary Tables 2 and 3. The background assessment battery included the following specific tests. The Boston Naming Test (BNT) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"lajmu7t99","properties":{"formattedCitation":"(Goodglass et al., 2000)","plainCitation":"(Goodglass et al., 2000)"},"citationItems":[{"id":77,"uris":[""],"uri":[""],"itemData":{"id":77,"type":"book","title":"Boston Diagnostic Aphasia Examination - Third Edition (BDAE-3)","publisher":"Pearsons","author":[{"family":"Goodglass","given":"Harold"},{"family":"Kaplan","given":"Edith"},{"family":"Barresi","given":"Barbara"}],"issued":{"date-parts":[["2000"]]}}}],"schema":""} (Goodglass et al., 2000) was used to assess word-finding difficultes. Four repetition tasks were used (from Kay et al., 1996): (a) word repetition immediate; (b) word repetition delayed; (c) non-word repetition immediate; (d) non-word repetition delayed. Two other phonological tasks included word and non-word minimal pairs (Kay et al., 1996). Participants also completed six tests of comprehension and semantic memory: (a) spoken sentence comprehension from the Comprehensive Aphasia Test (CAT: ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2iec1sdkct","properties":{"formattedCitation":"(Swinburn et al., 2004)","plainCitation":"(Swinburn et al., 2004)"},"citationItems":[{"id":78,"uris":[""],"uri":[""],"itemData":{"id":78,"type":"book","title":"Comprehensive Aphasia Test","publisher":"Psychology Press","publisher-place":"Hove, England","event-place":"Hove, England","author":[{"family":"Swinburn","given":"Kate"},{"family":"Porter","given":"Gillian"},{"family":"Howard","given":"David"}],"issued":{"date-parts":[["2004"]]}}}],"schema":""} (Swinburn et al., 2004); (b) Synonym Judgement Test ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2hb1b5oisj","properties":{"formattedCitation":"(Jefferies et al., 2009)","plainCitation":"(Jefferies et al., 2009)"},"citationItems":[{"id":81,"uris":[""],"uri":[""],"itemData":{"id":81,"type":"article-journal","title":"Comprehension of concrete and abstract words in semantic dementia","container-title":"Neuropsychology","page":"492-499","volume":"23","issue":"4","source":"PubMed Central","abstract":"The vast majority of brain-injured patients with semantic impairment have better comprehension of concrete than abstract words. In contrast, several patients with semantic dementia (SD), who show circumscribed atrophy of the anterior temporal lobes bilaterally, have been reported to show reverse imageability effects, i.e., relative preservation of abstract knowledge. Although these reports largely concern individual patients, some researchers have recently proposed that superior comprehension of abstract concepts is a characteristic feature of SD. This would imply that the anterior temporal lobes are particularly crucial for processing sensory aspects of semantic knowledge, which are associated with concrete not abstract concepts. However, functional neuroimaging studies of healthy participants do not unequivocally predict reverse imageability effects in SD because the temporal poles sometimes show greater activation for more abstract concepts. We examined a case-series of eleven SD patients on a synonym judgement test that orthogonally varied the frequency and imageability of the items. All patients had higher success rates for more imageable as well as more frequent words, suggesting that (a) the anterior temporal lobes underpin semantic knowledge for both concrete and abstract concepts, (b) more imageable items – perhaps due to their richer multimodal representations – are typically more robust in the face of global semantic degradation and (c) reverse imageability effects are not a characteristic feature of SD.","DOI":"10.1037/a0015452","ISSN":"0894-4105","note":"PMID: 19586212\nPMCID: PMC2801065","journalAbbreviation":"Neuropsychology","author":[{"family":"Jefferies","given":"Elizabeth"},{"family":"Patterson","given":"Karalyn"},{"family":"Jones","given":"Roy W."},{"family":"Lambon Ralph","given":"Matthew A."}],"issued":{"date-parts":[["2009",7]]},"PMID":"19586212","PMCID":"PMC2801065"}}],"schema":""} (Jefferies et al., 2009); and from the Cambridge Semantic Battery ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"19r17nstdf","properties":{"formattedCitation":"(Bozeat et al., 2000)","plainCitation":"(Bozeat et al., 2000)"},"citationItems":[{"id":79,"uris":[""],"uri":[""],"itemData":{"id":79,"type":"article-journal","title":"Non-verbal semantic impairment in semantic dementia","container-title":"Neuropsychologia","page":"1207-1215","volume":"38","issue":"9","source":"ScienceDirect","abstract":"The clinical presentation of patients with semantic dementia is dominated by anomia and poor verbal comprehension. Although a number of researchers have argued that these patients have impaired comprehension of non-verbal as well as verbal stimuli, the evidence for semantic deterioration is mainly derived from tasks that include some form of verbal input or output. Few studies have investigated semantic impairment using entirely non-verbal assessments and the few exceptions have been based on results from single cases ([3]: Breedin SD, Saffran EM, Coslett HB. Reversal of the concreteness effect in a patient with semantic dementia. Cognitive Neuropsychology 1994;11:617–660, [12]: Graham KS, Becker JT, Patterson K, Hodges JR. Lost for words: a case of primary progressive aphasia? In: Parkin A, editor. Case studies in the neuropsychology of memory, East Sussex: Lawrence Erlbaum, 1997. pp. 83–110, [21]: Lambon Ralph MA, Howard D. Gogi aphasia or semantic dementia? Simulating and assessing poor verbal comprehension in a case of progressive fluent aphasia. Cognitive Neuropsychology, (in-press).\nThis study employed sound recognition and semantic association tasks to investigate the nature of the verbal and non-verbal comprehension deficit in 10 patients with semantic dementia. The patients were impaired on both verbal and non-verbal conditions of the assessments, and their accuracy on these tasks was directly related to their scores on a range of other tests requiring access to semantic memory. Further analyses revealed that performance was graded by concept and sound familiarity and, in addition, identified significant item consistency across the different conditions of the tasks. These results support the notion that the patients’ deficits across all modalities were due to degradation within a single, central network of conceptual knowledge. There were also reliable differences between conditions. The sound-picture matching task proved to be more sensitive to semantic impairment than the word-picture matching equivalent, and the patients performed significantly better on the picture than word version of a semantic association test. We propose that these differences arise directly from the nature of the mapping between input modality and semantic memory. Words and sounds have an arbitrary relationship with meaning while pictures benefit from a degree of systematicity with conceptual knowledge about the object.","DOI":"10.1016/S0028-3932(00)00034-8","ISSN":"0028-3932","journalAbbreviation":"Neuropsychologia","author":[{"family":"Bozeat","given":"Sasha"},{"family":"Lambon Ralph","given":"Matthew A."},{"family":"Patterson","given":"Karalyn"},{"family":"Garrard","given":"Peter"},{"family":"Hodges","given":"John R."}],"issued":{"date-parts":[["2000",8,1]]}}}],"schema":""} (Bozeat et al., 2000): (c) picture naming; (d) spoken word-to-picture matching; (d) written word-to-picture matching; and (e) the picture-version of the Camel and Cactus Test (CCT) of semantic association knowledge. To test short-term memory skills, the forward and backward memory span assessments were administered ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ekaaggdqs","properties":{"formattedCitation":"(Wechsler, 1945)","plainCitation":"(Wechsler, 1945)"},"citationItems":[{"id":84,"uris":[""],"uri":[""],"itemData":{"id":84,"type":"article-journal","title":"A Standardized Memory Scale for Clinical Use","container-title":"The Journal of Psychology","page":"87-95","volume":"19","issue":"1","source":"Taylor and Francis+NEJM","DOI":"10.1080/00223980.1945.9917223","ISSN":"0022-3980","author":[{"family":"Wechsler","given":"David"}],"issued":{"date-parts":[["1945",1,1]]}}}],"schema":""} (Wechsler, 1945). Two executive tests were completed: (a) Brixton Spatial Rule Anticipation Test ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1pfm8ngakg","properties":{"formattedCitation":"(Burgess and Shallice, 1997)","plainCitation":"(Burgess and Shallice, 1997)"},"citationItems":[{"id":87,"uris":[""],"uri":[""],"itemData":{"id":87,"type":"book","title":"Hayling and Brixton Tests","publisher":"Pearson","publisher-place":"Oxford, England","event-place":"Oxford, England","author":[{"family":"Burgess","given":"Paul"},{"family":"Shallice","given":"Tim"}],"issued":{"date-parts":[["1997"]]}}}],"schema":""} (Burgess and Shallice, 1997) and Raven’s Coloured Progressive Matrices ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1e2arjqcvr","properties":{"formattedCitation":"(Raven, 1962)","plainCitation":"(Raven, 1962)"},"citationItems":[{"id":88,"uris":[""],"uri":[""],"itemData":{"id":88,"type":"book","title":"Raven's Coloured Progressive Matrices (CPM)","publisher":"Pearson","publisher-place":"Oxford, England","event-place":"Oxford, England","author":[{"family":"Raven","given":"John"}],"issued":{"date-parts":[["1962"]]}}}],"schema":""} (Raven, 1962). Speech production deficits were assessed by coding responses to the ‘Cookie theft’ picture in the BDAE, which included tokens (TOK), mean length of utterance (MLU), type/token ratio (TTR) and words-per-minute (WPM). All scores were converted into percentages; if no maximum was available we used the maximum score across the participants. Following previous studies, we utilised principal component analysis (PCA; SPSS v.22) to express the underling dimensions of performance variation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1h62UUYA","properties":{"formattedCitation":"(Butler et al., 2014; Halai et al., 2017)","plainCitation":"(Butler et al., 2014; Halai et al., 2017)"},"citationItems":[{"id":126,"uris":[""],"uri":[""],"itemData":{"id":126,"type":"article-journal","title":"Capturing multidimensionality in stroke aphasia: mapping principal behavioural components to neural structures","container-title":"Brain: A Journal of Neurology","page":"3248-3266","volume":"137","issue":"Pt 12","source":"PubMed","abstract":"Stroke aphasia is a multidimensional disorder in which patient profiles reflect variation along multiple behavioural continua. We present a novel approach to separating the principal aspects of chronic aphasic performance and isolating their neural bases. Principal components analysis was used to extract core factors underlying performance of 31 participants with chronic stroke aphasia on a large, detailed battery of behavioural assessments. The rotated principle components analysis revealed three key factors, which we labelled as phonology, semantic and executive/cognition on the basis of the common elements in the tests that loaded most strongly on each component. The phonology factor explained the most variance, followed by the semantic factor and then the executive-cognition factor. The use of principle components analysis rendered participants' scores on these three factors orthogonal and therefore ideal for use as simultaneous continuous predictors in a voxel-based correlational methodology analysis of high resolution structural scans. Phonological processing ability was uniquely related to left posterior perisylvian regions including Heschl's gyrus, posterior middle and superior temporal gyri and superior temporal sulcus, as well as the white matter underlying the posterior superior temporal gyrus. The semantic factor was uniquely related to left anterior middle temporal gyrus and the underlying temporal stem. The executive-cognition factor was not correlated selectively with the structural integrity of any particular region, as might be expected in light of the widely-distributed and multi-functional nature of the regions that support executive functions. The identified phonological and semantic areas align well with those highlighted by other methodologies such as functional neuroimaging and neurostimulation. The use of principle components analysis allowed us to characterize the neural bases of participants' behavioural performance more robustly and selectively than the use of raw assessment scores or diagnostic classifications because principle components analysis extracts statistically unique, orthogonal behavioural components of interest. As such, in addition to improving our understanding of lesion-symptom mapping in stroke aphasia, the same approach could be used to clarify brain-behaviour relationships in other neurological disorders.","DOI":"10.1093/brain/awu286","ISSN":"1460-2156","note":"PMID: 25348632\nPMCID: PMC4240295","shortTitle":"Capturing multidimensionality in stroke aphasia","journalAbbreviation":"Brain","language":"eng","author":[{"family":"Butler","given":"Rebecca A."},{"family":"Lambon Ralph","given":"Matthew A."},{"family":"Woollams","given":"Anna M."}],"issued":{"date-parts":[["2014",12]]},"PMID":"25348632","PMCID":"PMC4240295"}},{"id":117,"uris":[""],"uri":[""],"itemData":{"id":117,"type":"article-journal","title":"Using principal component analysis to capture individual differences within a unified neuropsychological model of chronic post-stroke aphasia: Revealing the unique neural correlates of speech fluency, phonology and semantics","container-title":"Cortex","collection-title":"Is a \"single\" brain model sufficient?","page":"275-289","volume":"86","source":"ScienceDirect","abstract":"Individual differences in the performance profiles of neuropsychologically-impaired patients are pervasive yet there is still no resolution on the best way to model and account for the variation in their behavioural impairments and the associated neural correlates. To date, researchers have generally taken one of three different approaches: a single-case study methodology in which each case is considered separately; a case-series design in which all individual patients from a small coherent group are examined and directly compared; or, group studies, in which a sample of cases are investigated as one group with the assumption that they are drawn from a homogenous category and that performance differences are of no interest. In recent research, we have developed a complementary alternative through the use of principal component analysis (PCA) of individual data from large patient cohorts. This data-driven approach not only generates a single unified model for the group as a whole (expressed in terms of the emergent principal components) but is also able to capture the individual differences between patients (in terms of their relative positions along the principal behavioural axes). We demonstrate the use of this approach by considering speech fluency, phonology and semantics in aphasia diagnosis and classification, as well as their unique neural correlates. PCA of the behavioural data from 31 patients with chronic post-stroke aphasia resulted in four statistically-independent behavioural components reflecting phonological, semantic, executive–cognitive and fluency abilities. Even after accounting for lesion volume, entering the four behavioural components simultaneously into a voxel-based correlational methodology (VBCM) analysis revealed that speech fluency (speech quanta) was uniquely correlated with left motor cortex and underlying white matter (including the anterior section of the arcuate fasciculus and the frontal aslant tract), phonological skills with regions in the superior temporal gyrus and pars opercularis, and semantics with the anterior temporal stem.","DOI":"10.1016/j.cortex.2016.04.016","ISSN":"0010-9452","shortTitle":"Using principal component analysis to capture individual differences within a unified neuropsychological model of chronic post-stroke aphasia","journalAbbreviation":"Cortex","author":[{"family":"Halai","given":"Ajay D."},{"family":"Woollams","given":"Anna M."},{"family":"Lambon Ralph","given":"Matthew A."}],"issued":{"date-parts":[["2017",1]]}}}],"schema":""} (Butler et al., 2014; Halai et al., 2017). A PCA with varimax rotation was calculated for these behavioural measures for our full N=70 chronic aphasia patient dataset. We performed the PCA on the full available dataset in order to: 1) maximise coverage of the multidimensional space and 2) achieve robust weighted-averages for the scores of the patients on the extracted PCA components. Four principal components with an eigenvalue>1 were extracted; these corresponded to phonological, semantic, executive and speech quanta dimensions (see Halai et al., 2017 for the details of these principal components and their lesion correlates). Patients’ component scores on the four extracted components were reconstucted using regression for the entire dataset (N=70). To explore the relationship between therapy outcome and background language-cognitive skills, the component scores for the subset of 20 patients included in the therapy (one did not have a factor score as we did not have full background neuropsychological data) were correlated with their therapy outcomes (1 week vs. baseline and 1 month vs. baseline). We note here that it is preferable to compute the PCA and resultant component scores on the full patient dataset as this ensures that (a) the PCA is as robust as possible and (b) places the scores for the therapy subgroup in relation to the full range of aphasia severity (as shown in Supplementary Figure 1). Acquisition of Neuroimaging dataHigh resolution structural T1-weighted MRI scans were acquired on a 3.0 Tesla Philips Achieva scanner using an 8-element SENSE head coil. A T1-weighted inversion recovery sequence with 3D acquisition was employed, with the following parameters: TR (repetition time) = 9.0 ms, TE (echo time) = 3.93 ms, flip angle = 8°, 150 contiguous slices, slice thickness = 1 mm, acquired voxel size 1.0 x 1.0 x 1.0 mm3, matrix size 256 x 256, FOV = 256 mm, TI (inversion time) = 1150 ms, SENSE acceleration factor 2.5, total scan acquisition time =575 s.Analysis of Neuroimaging dataStructural MRI scans were pre-processed with Statistical Parametric Mapping software (SPM8: ). The images were normalised into standard Montreal Neurological Institute (MNI) space using a modified unified segmentation-normalisation procedure optimised for focal lesioned brains ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1k98v413hi","properties":{"formattedCitation":"(Seghier et al., 2008)","plainCitation":"(Seghier et al., 2008)"},"citationItems":[{"id":103,"uris":[""],"uri":[""],"itemData":{"id":103,"type":"article-journal","title":"Lesion identification using unified segmentation-normalisation models and fuzzy clustering","container-title":"Neuroimage","page":"1253-1266","volume":"41","issue":"4-3","source":"PubMed Central","abstract":"In this paper, we propose a new automated procedure for lesion identification from single images based on the detection of outlier voxels. We demonstrate the utility of this procedure using artificial and real lesions. The scheme rests on two innovations: First, we augment the generative model used for combined segmentation and normalization of images, with an empirical prior for an atypical tissue class, which can be optimised iteratively. Second, we adopt a fuzzy clustering procedure to identify outlier voxels in normalised gray and white matter segments. These two advances suppress misclassification of voxels and restrict lesion identification to gray/white matter lesions respectively. Our analyses show a high sensitivity for detecting and delineating brain lesions with different sizes, locations, and textures. Our approach has important implications for the generation of lesion overlap maps of a given population and the assessment of lesion-deficit mappings. From a clinical perspective, our method should help to compute the total volume of lesion or to trace precisely lesion boundaries that might be pertinent for surgical or diagnostic purposes.","DOI":"10.1016/j.neuroimage.2008.03.028","ISSN":"1053-8119","note":"PMID: 18482850\nPMCID: PMC2724121","journalAbbreviation":"Neuroimage","author":[{"family":"Seghier","given":"Mohamed L."},{"family":"Ramlackhansingh","given":"Anil"},{"family":"Crinion","given":"Jenny"},{"family":"Leff","given":"Alexander P."},{"family":"Price","given":"Cathy J."}],"issued":{"date-parts":[["2008",7,15]]},"PMID":"18482850","PMCID":"PMC2724121"}}],"schema":""} (Seghier et al., 2008). Data from all participants with stroke aphasia and healthy controls were entered into the segmentation-normalisation that combines segmentation, bias correction and spatial normalisation through the inversion of a single unified model ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"o417hhoio","properties":{"formattedCitation":"(Ashburner and Friston, 2005)","plainCitation":"(Ashburner and Friston, 2005)"},"citationItems":[{"id":105,"uris":[""],"uri":[""],"itemData":{"id":105,"type":"article-journal","title":"Unified segmentation","container-title":"NeuroImage","page":"839-851","volume":"26","issue":"3","source":"PubMed","abstract":"A probabilistic framework is presented that enables image registration, tissue classification, and bias correction to be combined within the same generative model. A derivation of a log-likelihood objective function for the unified model is provided. The model is based on a mixture of Gaussians and is extended to incorporate a smooth intensity variation and nonlinear registration with tissue probability maps. A strategy for optimising the model parameters is described, along with the requisite partial derivatives of the objective function.","DOI":"10.1016/j.neuroimage.2005.02.018","ISSN":"1053-8119","note":"PMID: 15955494","journalAbbreviation":"Neuroimage","language":"eng","author":[{"family":"Ashburner","given":"John"},{"family":"Friston","given":"Karl J."}],"issued":{"date-parts":[["2005",7,1]]},"PMID":"15955494"}}],"schema":""} (Ashburner and Friston, 2005). Each patient’s lesion was identified using an outlier detection algorithm based on fuzzy clustering. The default parameters were used except we modified the U-threshold from 0.3 to 0.5 after comparing sample results to those from an expert neurologist. The images were individually, visually inspected with respect to the original scan, and were used to create the lesion overlay map in Figure 1. We note that although referred to as an automated ‘lesion’ segmentation method, the technique detects areas of unexpected tissue class; thus identifying missing grey and white matter but also augmented CSF space. We then smoothed the T1-weighted images (8mm full width half maximum Gaussian kernel) and created separate models where we correlated with magnitude of the RISP effect to the signal intensity for each voxel in the whole brain using a voxel-based correlational methodology (VBCM) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"as0u4fevo","properties":{"formattedCitation":"(Tyler et al., 2005)","plainCitation":"(Tyler et al., 2005)"},"citationItems":[{"id":110,"uris":[""],"uri":[""],"itemData":{"id":110,"type":"article-journal","title":"Dissociating neuro-cognitive component processes: voxel-based correlational methodology","container-title":"Neuropsychologia","page":"771-778","volume":"43","issue":"5","source":"ScienceDirect","abstract":"Relating behavioural deficits to lesion site has long been an important tool for localising the brain bases of cognitive function. Voxel-based methods, based on statistical analyses of structural brain images, allow a major step forward in the effectiveness of this approach. These methods provide a fine-grained assessment of damaged tissue by assigning a continuous value to each voxel over the entire brain. This information, correlated with continuous behavioural data reflecting specific aspects of cognition, offers new opportunities for identifying the neural organisation underlying cognitive function. The research reported here demonstrates the ability of this correlational methodology to differentiate between the neuro-cognitive components involved in word recognition and lexical decision, providing an important new tool for directly linking brain areas to specific aspects of psychological performance.","DOI":"10.1016/j.neuropsychologia.2004.07.020","ISSN":"0028-3932","shortTitle":"Dissociating neuro-cognitive component processes","journalAbbreviation":"Neuropsychologia","author":[{"family":"Tyler","given":"Lorraine K."},{"family":"Marslen-Wilson","given":"William"},{"family":"Stamatakis","given":"Emmanuel A."}],"issued":{"date-parts":[["2005"]]}}}],"schema":""} (Tyler et al., 2005), a variant of voxel symptom lesion mapping (VSLM) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ek0tqhj3o","properties":{"formattedCitation":"(Bates et al., 2003)","plainCitation":"(Bates et al., 2003)"},"citationItems":[{"id":114,"uris":[""],"uri":[""],"itemData":{"id":114,"type":"article-journal","title":"Voxel-based lesion-symptom mapping","container-title":"Nature Neuroscience","page":"448-450","volume":"6","issue":"5","source":"PubMed","DOI":"10.1038/nn1050","ISSN":"1097-6256","note":"PMID: 12704393","journalAbbreviation":"Nat. Neurosci.","language":"eng","author":[{"family":"Bates","given":"Elizabeth"},{"family":"Wilson","given":"Stephen M."},{"family":"Saygin","given":"Ayse Pinar"},{"family":"Dick","given":"Frederic"},{"family":"Sereno","given":"Martin I."},{"family":"Knight","given":"Robert T."},{"family":"Dronkers","given":"Nina F."}],"issued":{"date-parts":[["2003",5]]},"PMID":"12704393"}}],"schema":""} (Bates et al., 2003). An additional covariate was added to each model to account for lesion volume. Overlays were thresholded at p<0.005 voxel height and cluster corrected at familywise error of p<0.05, while?including?additional covariates of age, years of education, months post onset and lesion volume. All anatomical labels were based on the Harvard-Oxford atlas in MNI space.Figure 1 about hereTherapy MethodsStimuli One reason for the dearth of information with regard to generalization from naming therapy to connected speech, is the lack of a systematic assessment method ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"cet26ru02","properties":{"formattedCitation":"(Maendl, 1998)","plainCitation":"(Maendl, 1998)"},"citationItems":[{"id":185,"uris":[""],"uri":[""],"itemData":{"id":185,"type":"thesis","title":"Word finding difficulties in aphasia.","publisher":"University of York","author":[{"family":"Maendl","given":"Lisa"}],"issued":{"date-parts":[["1998"]]}}}],"schema":""} (Maendl, 1998). In order to measure word retrieval in both picture naming and connected speech, four detailed multi-event pictures were selected (from the “Where’s Wally/Waldo?” publications). These contained detailed depictions of hundreds of items and events (e.g., animals, objects and events at a busy zoo or fairground) from which a small minority of target items were selected. To assess and treat confrontational naming for these targets, we selected new pictures of the same exemplars (presenting each exemplar singly and without any background). The 120 target stimuli were all nouns, selected to meet the following criteria: (a) named spontaneously in control participants’ scene descriptions by more than 3/10 participants (participants and patients were asked to describe freely and were not directed to any areas or items within the scene); (b) targets could be depicted singly in a new picture with 100% name agreement (thus pictureable nouns such as bench rather than water or actions were selected); and (c), items did not have alternative names (e.g., dodgems and bumper cars). From these 120 nouns, four matched sets of 20 items were selected; two sets were allocated to the treatment conditions, (described below). The remaining two sets served as untreated control items (thus controlling for any non-specific effects, including the small boost in performance that can result from repeated assessment (Nickels, 2002)). One treatment set and its paired untreated set related to two of the four composite pictures. The other treatment set and its paired control related to the remaining two composite pictures. This allowed us to separate the effects of each therapy by avoiding target vocabulary for the two treatments appearing in the same composite picture. The allocation of picture sets to the two treatments was counterbalanced across participants. The word sets were matched ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"d1pfb6g6n","properties":{"formattedCitation":"(Van Casteren and Davis, 2007)","plainCitation":"(Van Casteren and Davis, 2007)"},"citationItems":[{"id":89,"uris":[""],"uri":[""],"itemData":{"id":89,"type":"article-journal","title":"Match: a program to assist in matching the conditions of factorial experiments","container-title":"Behavior Research Methods","page":"973-978","volume":"39","issue":"4","source":"PubMed","abstract":"In most experiments that involve between-subjects or between-items factorial designs, the items and/or the participants in the various experimental groups differ on one or more variables, but need to be matched on all other factors that can affect the outcome measure. Matching large groups of items or participants on multiple dimensions is a difficult and time-consuming task, yet failure to match conditions will lead to suboptimal experiments. We describe a computer program, \"Match\", that automates this process by selecting the best-matching items from larger sets of candidate items. In most cases, the program produces near-optimal solutions in amatter of minutes and selects matches that are typically superior to those obtained using hand matching or other semiautomated processes. We report the results of a case study in which Match was used to generate matched sets of experimental items (words varying in length and frequency) for a published study on language processing. The program was able to come up with better-matching item sets than those hand-selected by the authors of the original study, and in a fraction of the time originally taken up with stimulus matching.","ISSN":"1554-351X","note":"PMID: 18183914","shortTitle":"Match","journalAbbreviation":"Behav Res Methods","language":"eng","author":[{"family":"Van Casteren","given":"Maarten"},{"family":"Davis","given":"Matthew H."}],"issued":{"date-parts":[["2007",11]]},"PMID":"18183914"}}],"schema":""} (Van Casteren and Davis, 2007) for (a) the likelihood of retrieval in the spontaneous picture descriptions by the control participants; (b) frequency from the British National Corpus ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"8n93j4tec","properties":{"formattedCitation":"(BNC Consortium, 2007)","plainCitation":"(BNC Consortium, 2007)"},"citationItems":[{"id":91,"uris":[""],"uri":[""],"itemData":{"id":91,"type":"book","title":"The British National Corpus, version 3 (BNC XML Edition)","publisher":"Oxford University Computing Services","publisher-place":"Oxford, England","event-place":"Oxford, England","author":[{"family":"BNC Consortium","given":""}],"issued":{"date-parts":[["2007"]]}}}],"schema":""} (BNC Consortium, 2007); and (c) phoneme length.Baseline and post-therapy assessmentBaseline performance for the four composite picture descriptions and 80-item confrontational naming test were assessed twice before therapy commenced (across four separate assessment sessions with composite description assessed before the confrontational naming). There was no significant change in performance across the two baseline assessments (confirming a stable baseline) and thus we compared the post-therapy results to the first assessment. Post-therapy performance was assessed at one-week and again at one-month to establish the longer-term benefits of the therapy (no maintenance or practice regimes were used post therapy). An additional, fifth composite picture description was assessed before and after therapy. No vocabulary from this fifth picture was included in the therapy as treated or untreated items. The fifth picture acted as a control for the target composite pictures in order to control for non-specific improvements that might arise simply from repeated assessment.For the picture naming assessment, participants were presented with all 80 items in random order. Each picture was presented simultaneously with an auditory beep and remained on the screen for a maximum of ten seconds (using E-Prime software ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2ctifuo8dh","properties":{"formattedCitation":"(Schneider et al., 2002)","plainCitation":"(Schneider et al., 2002)"},"citationItems":[{"id":93,"uris":[""],"uri":[""],"itemData":{"id":93,"type":"book","title":"E-Prime Computer Software and Manual","publisher":"Psychology Software Tools Inc.","publisher-place":"Pittsburg, PA","event-place":"Pittsburg, PA","author":[{"family":"Schneider","given":"Walter"},{"family":"Eschman","given":"Amy"},{"family":"Zuccolotto","given":"Anthony"}],"issued":{"date-parts":[["2002"]]}}}],"schema":""} (Schneider et al., 2002). Audacity software was used to measure naming latencies by calculating the time elapsed from the beep to the onset of the participant’s correct response. When no correct name was produced, the reaction time for that trial was treated as missing data. To elicit connected speech samples, participants were informed that they were going to see four ‘busy’ pictures, one at a time on a computer screen. They were asked to describe what they saw in each picture in as much detail as they could for about 5-10 minutes. Participants’ responses were digitally audio-recorded. The order of presentation was randomised across participants, thus counterbalancing any effect of relative difficulty. TreatmentsFigure 2 about hereThe treatments were delivered in two phases (see Figure 2), each containing two sessions per week for three weeks (six treatment sessions per phase). In the first phase, only standard therapy was administered for all items (n=40) in order to boost naming accuracy before introducing any speed requirement. In the second phase, standard (accuracy-only) treatment was continued for one set, whilst the other was treated with RISP (see below). In both phases, stimuli in each set were randomised and the order of sets was counterbalanced across sessions. Please see Table 1 for treatment protocols for SP and RISP. Treatment sessions lasted between 30 and 50 minutes dependant on participant need for comfort breaks. Table 1 about hereStandard production (SP): This was a standard, increasing cues, naming therapy, which aimed to improve participants’ picture naming accuracy only. Participants were asked to name each picture, presented on a computer screen, in 10 seconds without support, i.e. with no cues. After each naming attempt, feedback was provided both verbally by the experimenter and presented in writing on the screen. Initially, minimal cues were provided (the initial consonant and vowel of the target word, e.g., “wi” for ‘window’) but the cues were increased if naming was not achieved (e.g., “wind” for ‘window’, and then the whole word ‘window’). Participants worked through all therapy items three times per session. There were no auditory cues presented in this standard therapy to indicate any type of time pressure.Repeated, Increasingly-Speeded Production (RISP treatment): This treatment was a hybrid intervention that combined cued naming with the deadline naming method used in experimental psycholinguistics ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"nRzuQA25","properties":{"formattedCitation":"(Hodgson and Lambon Ralph, 2008; Vitkovitch and Humphreys, 1991)","plainCitation":"(Hodgson and Lambon Ralph, 2008; Vitkovitch and Humphreys, 1991)"},"citationItems":[{"id":96,"uris":[""],"uri":[""],"itemData":{"id":96,"type":"article-journal","title":"Mimicking aphasic semantic errors in normal speech production: Evidence from a novel experimental paradigm","container-title":"Brain and Language","page":"89-101","volume":"104","issue":"1","author":[{"family":"Hodgson","given":"Catherine"},{"family":"Lambon Ralph","given":"Matthew"}],"issued":{"date-parts":[["2008"]]}}},{"id":131,"uris":[""],"uri":[""],"itemData":{"id":131,"type":"article-journal","title":"Perseverant responding in speeded naming of pictures: It's in the links","container-title":"Journal of Experimental Psychology: Learning, Memory, and Cognition","page":"664-680","volume":"17","issue":"4","source":"APA PsycNET","abstract":"Data are reported on picture naming under speeded deadline conditions. In Exp 1, more errors were made in response to pictures with low- relative to high-frequency names, indicating that the deadline constrained name selection. In addition, Ss often made prime-related perseverative errors, in which they misnamed target pictures by giving them the names of related pictures that had been named previously (primes). In Exp 2, prime-related perseverative errors did not occur at a greater than chance level when Ss categorized rather than named prime pictures. In Exp 3, these errors did not occur at a greater than chance level when Ss first named related prime words. It is concluded that prime-related perseverative errors reflect persistent activation in the mappings connecting semantic representations of pictures to name representations. The relevance of the findings for models of picture naming and the use of the deadline technique for decomposing the picture-naming process are discussed.","DOI":"10.1037/0278-7393.17.4.664","ISSN":"1939-1285 0278-7393","shortTitle":"Perseverant responding in speeded naming of pictures","language":"English","author":[{"family":"Vitkovitch","given":"Melanie"},{"family":"Humphreys","given":"Glyn W."}],"issued":{"date-parts":[["1991"]]}}}],"schema":""} (Hodgson and Lambon Ralph, 2008; Vitkovitch and Humphreys, 1991). Participants were instructed that the computer would present the picture for a limited time and their task was to try to name the picture before the beep at the end of the stimulus presentation. In each therapy session, the presentation duration/time-to-the-beep was reduced (see below). During each trial, the target picture was presented on the computer screen. At the end of the allotted time, the picture disappeared and a beep sound was produced by the computer. A blank screen was displayed for 1000msec. Participants were then presented with the written target word on the screen and the correct spoken name of the picture was played by the computer. Following an incorrect response, participants were asked to repeat the correct name three times. Participants cycled through all therapy items three times per session. This matched the number of item exposures between RISP and SP within each treatment session. The naming deadline was shortened systematically across the six RISP sessions. The initial picture exposure time was set to the mean of all patients’ baseline picture naming speed (3 seconds). This ensured that each participant’s first ‘speeded’ naming attempt would feel reasonably natural. The ultimate target deadline in the 6th RISP session was 1 second, which matched the mean naming speed of elderly neurotypical participants (mean naming time: 1002 msec). The target naming speed was reduced in a systematic way: session 1 = 3 seconds, session 2 = 2.5 seconds, session 3 = 2 seconds, session 4 = 1.6 seconds, session 5 = 1.3 seconds, and session 6 = 1 second. The same target naming speed was used for the three cycles within each session and only reduced on the start of the next session. It was not necessary for participants to actually ‘beat the beep’; rather the attempt to do so was expected and did reduce naming latencies over the course of the treatment.ScoringParticipant’s performance was scored based on their first response for all picture naming. Self-corrections were considered correct if the correct name was produced immediately after the first response.Analysis of the main therapy dataFor the three sets of target data (picture naming accuracy, picture naming speed, and word retrieval accuracy in the composite pictures), we carried out the same set of hierarchically-structure analyses. First, we conducted a global ANOVA with picture set (the treated and untreated items) and time (pre- vs. immediately post therapy vs. one month follow up) as main factors – which allows us to specify if there were changes in performance before and after intervention, and if these varied for treated and untreated sets. We then unpicked the nature of the significant interactions with planned ANOVA and t-tests: before and after intervention, each treated set was compared to its matched untreated set, and the two treated sets were compared to each other. Our a priori expectations were that performance on the therapy sets would be significantly improved after therapy and better than that observed for the untreated items. Analyses were run in SPSS v22.0. ResultsPicture naming accuracy after 1st treatment phaseIn the first phase, the standard therapy (SP) was administered for all items (n=40). Naming accuracy at the end of this phase are reported in Table 2. Set A progressed to be treated with SP in the 2nd phase of treatment, and set B with RISP. The mean accuracy for set A was 78.0, and set B 81.25 (a non-significant difference: two-tailed t= -0.43, p=0.66). Thus the main study comparison ANOVAs carried out at the end of the 2nd treatment phase were not biased by the (equivalent) performance on the sets after the initial treatment phase. Table 2 about herePicture naming accuracy after 2nd treatment phaseA global 3×4 ANOVA was conducted with the factor of time and treatment. These analyses were concerned with the cumulative effects of SP alone (phases 1+2 – i.e., Set A) versus SP followed by RISP (phases 1+2 – i.e., Set B). The three time-points were: baseline (pre-1st phase of treatment), one week post-2nd phase of treatment, one month post-2nd phase of treatment. The four treatment conditions were: SP, RISP, untreated SP, and untreated RISP. This 3x4 ANOVA indicated that there was a main effect of time (F(2,38) = 55.6, p < .0005), a main effect of treatments (F(3,57) = 35.7, p < .0005), and a significant interaction between time and treatments (F(6,114) = 18.0, p < .0005; see Figure 3a) – indicating very different effects of therapy on the treated and untreated items. We explored the nature of this interaction through three follow-up ANOVAs. First, we compared each treatment condition to its matched control set across the three time-points, (through two 2×3 ANOVAs where the first factor compared each treatment type to its own control: i.e., SP vs. untreated SP; RISP vs. untreated RISP). These ANOVAs showed that both therapies generated significantly improved accuracy scores relative to their control sets (significant interaction: p < .0005 for both therapies). For RISP, a significant interaction between ‘Time Point’ and ‘Treatment’ was found: (F(2,38) = 34.643, p < .0005, partial η2 = .65). For SP, a similarly robust significant interaction between ‘Time Point’ and ‘Treatment’ was evident: F(2,38) = 14.935, p < .0005, partial η2 = .44).Direct comparison of the two treatments, through another 2×3 ANOVA (SP vs. RISP; over the three time points), indicated that there was a trend towards a borderline interaction between time and treatment: F(2,38) = 2.3, p = .117. Planned t-tests showed that both therapies significantly increased picture naming accuracy between the baseline and post-treatment assessments (p < .0005), and that the RISP therapy effect was significantly greater than SP not only at the 1week post-treatment assessment (p < .0005), but also at the follow-up (1 month) assessment (p = .001). Figure 3 about herePicture naming speed after 2nd treatment phaseExactly the same set of planned ANOVAs and t-tests were used to examine the naming speed for correctly named items (the overall results are shown in Figure 3b). In the global 3 (time point) × 4 (picture sets) ANOVA, there was a main effect of ‘Time Point’: F(2,36) = 21.1, p < .0005, no main effect of ‘Treatment’ factor [F(3,54) = 1.7, p = .174], but a significant interaction between ‘Time Point’ and ‘Treatment’ [F(6,108) = 5.7, p < 0.0005] – indicating significantly different changes in naming speed for the treated vs. untreated sets. The follow-up 2×3 ANOVAs confirmed that the effect of each therapy was significantly different from its control [Time Point × Set interactions were significant: RISP F(2,36)=8.6, p=0.001; SP F(2,36)=3.9, p=0.03]. A 2×3 ANOVA comparing the two treated sets indicated that there was a significant interaction between ‘Time Point’ and ‘Treatment’ [F(2,36) = 3.2, p = .05]. Whilst both treatments significantly reduced picture naming latencies between the baseline and both post-treatment assessments (1 week and 1 month), the pairwise t-tests showed that there was a trend for the RISP treatment to reduce RTs more than SP from baseline to the immediate assessment at Week 1 (p = .101) and, most strikingly, RISP was significantly more effective in maintaining the treatment effect in terms of quicker naming responses at the one month follow-up assessment (p = .001). In comparing the two untreated conditions, only the main effect of the ‘Time Point’ factor was significant (F(2,36) = 3.23, p = .05) – reflecting a small reduction in naming latencies across repeated assessments (presumably reflecting repetition priming). The main effect of ‘Set’ was not significant (F(1,18) < 1), nor was the interaction between ‘Time Point’ and ‘Set’ (F(2,36) = 1.3, p = 0.28).Generalisation to connected speech: Word retrieval in composite picture descriptionsAgain, exactly the same set of analyses were conducted on the target word retrieval data in the composite picture descriptions. The global 3×4 ANOVA indicated that there was a significant effect of the ‘Time Point’ factor [F(2,38) = 87.8, p < .0005], a main effect of ‘Treatment’ factor [F(3,57) = 43.7, p < .0005] and a highly significant interaction between ‘Time Point’ and ‘Treatment’ [F(6,114) = 19.9, p < .0005; (Figure 3c)] – indicating very different production of the target vs. untreated vocabulary in the patients’ narratives before and after therapy. Directly comparing the two treatments (SP vs RISP), a 2×3 ANOVA indicated that there was a highly significant interaction between ‘Time Point’ and ‘Treatment’ [F(2,38) = 19.6, p < .0005]. The t-tests showed that the RISP effect on connected speech production was significantly stronger than SP both at the 1 week and 1 month post-treatment assessments (both p < .0005). Comparing each treatment to its control set, separately, we found significant ‘Time Point’ × ‘Set’ interactions for the RISP and SP sets [F(2,38)=19.6, p<0.0005; F(2,38)=5.2, p=0.01, respectively]. Thus, although there is a general clinical belief that standard therapy does not induce generalisation to connected speech, our newly-developed assessment was able to demonstrate that this is incorrect – there is, in fact, a small but significant generalisation to connected speech for SP both at one week and one month (though the effect was significantly smaller than for the RISP therapy – see above). Finally, the two untreated conditions were compared. The main effect of ‘Time Point’ was significant [F(2,36) = 3.2, p = .05], indicating a small improvement in target vocabulary production simply through repeated assessment, but neither the main effect of ‘Set’ [F(1,18) < 1] nor the interaction between ‘Time Point’ and ‘Set’ were significant [F(2,36) = 1.3, p = 0.28).Content analysis of the connected speech samplesAs well as exploring the generalization of trained vocabulary to the connected speech samples, it is also important to investigate the connected speech samples more generally. It is possible, for example, that improved vocabulary promotes connected speech more generally or that the improvement on the trained items comes at the cost of reduced performance on the untrained vocabulary. We examined the connected speech samples in terms of the total number of nouns produced (tokens), the number of unique nouns produced (types), nouns per minute, the type/token ratio (number of unique words divided by the total words), average word frequency and average imageability for the treated and untreated pictures. The overall secondary effects on the patients’ connected speech samples were entirely positive. Specifically, for the treated pictures, the speech samples including all items showed that significantly more unique items were produced after therapy compared to baseline (mean at 1 week = 103.6, mean at baseline = 85.4; t(18) = -2.30, p = 0.03). There was also a significant decrease in the average word frequency of the nouns used (mean at 1 week = 1.40, mean at baseline = 1.55; t(18) = 4.21, p < 0.001). There were no significant changes found in nouns per minute, type/token ratio, and average imageability rating. Importantly, there were no significant effects found in analyses of the untreated fifth picture, indicating that the improved connected speech samples did not reflect a non-specific effect of repeated assessment.This first analysis included all items, including the target therapy items. Accordingly, we repeated the analysis to remove these items from consideration. In this second analysis, the increase in unique items from baseline to post therapy was no longer significant (mean at 1 week = 84.8, mean at baseline = 77.8; t(18) = -0.95, p = 0.3). The reduction in mean word frequency, however, was still significant (mean at 1 week = 1.48, mean at baseline = 1.58; t(18) = 2.86, p < 0.01).Correlations with individual’s background neuropsychological profileTable 3 about hereAlthough there were significant and reliable therapy effects at the group level, the effect varied across individual patients. We performed correlations between the background neuropsychological profile (with respect to four principal neuropsychological components (see Table 3 for component loadings): phonological, semantic, executive, and speech quanta (fluency)) and the magnitude of the therapy effect (1 week vs. baseline performance, and 1 month (maintenance) vs. baseline performance) in order to reveal which aspects of the patients’ profile were related to the therapy outcome. The PCA identified four components including phonological skill (50.9% variance), semantic ability (11.28% variance), executive ability (8.18% variance) and speech quanta (6.42% variance). In general, the phonological component loaded with repetition, naming and digit span tests, whereas the semantic component loaded with picture matching, camel and cactus and synonym judgement tests. The executive component loaded with Ravens coloured progressive matrices, Brixton spatial rule anticipation test and minimal pairs all of which are demanding tests. Finally, the measures of the amount of speech output component loaded on the fourth factor speech quanta. Overall, no correlations were found between any of the components and the outcome on the standard therapy. For the RISP therapy, however, a significant negative correlation was found between the patients' phonological component score and the magnitude of their therapy effect, at both 1 week (r = -.55, p < .01) and 1 month (r = -.61, p < .005). This demonstrates that patients with the poorest phonological abilities showed the largest RISP benefit. As can be seen across the case-series (Figure 4), this negative correlation seems to reflect the fact that the RISP therapy was particularly beneficial leading to a ceiling effect for many of the milder patients (note that if patient JS with poor phonological abilities but a large therapy effect is removed, then the correlation is still significant).Figure 4 about hereIt was also possible to determine how each component correlated with the maintenance of the therapy effect (i.e., 1 month vs. 1 week performance). In this analysis, the maintenance of the RISP effect was found to correlate positively with performance on the executive tasks (r = .53, p < .01). Thus, the patients with better executive abilities exhibited the best therapy maintenance. No other correlations were significant.Neural correlates of RISPIn order to determine the neural correlates of the RISP effect, we correlated each patient's therapy effect (1 week vs. baseline performance, and 1 month vs. baseline performance) with their T1-weighted MRI using voxel-based correlational methodology (VBCM: Tyler et al., 2005). This analysis revealed that patients with the greatest damage to the posterior superior temporal gyrus extending into the white matter of the inferior longitudinal fasciculus, showed the greatest RISP benefit both at 1 week and 1 month (height threshold p < .001, cluster corrected using FWE p < .05). This region is known to play an important role in phonological performance, as illustrated in Figure 5 whereby the RISP effect overlaps closely with the area related to the lesion correlate for the patients’ phonological skill factor found previously by Halai et al. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PKHNZ0D0","properties":{"formattedCitation":"(2017)","plainCitation":"(2017)"},"citationItems":[{"id":117,"uris":[""],"uri":[""],"itemData":{"id":117,"type":"article-journal","title":"Using principal component analysis to capture individual differences within a unified neuropsychological model of chronic post-stroke aphasia: Revealing the unique neural correlates of speech fluency, phonology and semantics","container-title":"Cortex","collection-title":"Is a \"single\" brain model sufficient?","page":"275-289","volume":"86","source":"ScienceDirect","abstract":"Individual differences in the performance profiles of neuropsychologically-impaired patients are pervasive yet there is still no resolution on the best way to model and account for the variation in their behavioural impairments and the associated neural correlates. To date, researchers have generally taken one of three different approaches: a single-case study methodology in which each case is considered separately; a case-series design in which all individual patients from a small coherent group are examined and directly compared; or, group studies, in which a sample of cases are investigated as one group with the assumption that they are drawn from a homogenous category and that performance differences are of no interest. In recent research, we have developed a complementary alternative through the use of principal component analysis (PCA) of individual data from large patient cohorts. This data-driven approach not only generates a single unified model for the group as a whole (expressed in terms of the emergent principal components) but is also able to capture the individual differences between patients (in terms of their relative positions along the principal behavioural axes). We demonstrate the use of this approach by considering speech fluency, phonology and semantics in aphasia diagnosis and classification, as well as their unique neural correlates. PCA of the behavioural data from 31 patients with chronic post-stroke aphasia resulted in four statistically-independent behavioural components reflecting phonological, semantic, executive–cognitive and fluency abilities. Even after accounting for lesion volume, entering the four behavioural components simultaneously into a voxel-based correlational methodology (VBCM) analysis revealed that speech fluency (speech quanta) was uniquely correlated with left motor cortex and underlying white matter (including the anterior section of the arcuate fasciculus and the frontal aslant tract), phonological skills with regions in the superior temporal gyrus and pars opercularis, and semantics with the anterior temporal stem.","DOI":"10.1016/j.cortex.2016.04.016","ISSN":"0010-9452","shortTitle":"Using principal component analysis to capture individual differences within a unified neuropsychological model of chronic post-stroke aphasia","journalAbbreviation":"Cortex","author":[{"family":"Halai","given":"Ajay D."},{"family":"Woollams","given":"Anna M."},{"family":"Lambon Ralph","given":"Matthew A."}],"issued":{"date-parts":[["2017",1]]}},"suppress-author":true}],"schema":""} (2017) and thus aligns with the behavioural correlation between phonological ability and therapy effect noted above. It appears, therefore, that the RISP effect may relate particularly to the patients’ phonological abilities. Finally, no voxels were found to correlate significantly with the RISP maintenance effect (1 month vs. 1 week performance). Figure 5 about hereDiscussionAnomia is an immensely frustrating and disabling feature of aphasia, which is a common disorder post stroke (around 1/3 cases) and in other neurological conditions. Accordingly, it is important to establish effective interventions for remediating word-finding skills and generalising these improvements to patients’ connected speech. Given the observation that fluent speech requires both quick and accurate word retrieval, we investigated and confirmed the novel hypothesis that a behavioural treatment, focussing on both speed and accuracy rather than accuracy alone (as is the case in standard methods), would generate greater improvements in both confrontation naming and also generalisation of this improved vocabulary to connected speech. A second key, novel feature of this study was that the interventions were not examined in isolation but we also investigated the neuropsychological and lesion correlates of treatment responsiveness. Although such analyses are a rarity in the literature to date ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"29nvor3ge7","properties":{"formattedCitation":"(Abel et al., 2015)","plainCitation":"(Abel et al., 2015)"},"citationItems":[{"id":133,"uris":[""],"uri":[""],"itemData":{"id":133,"type":"article-journal","title":"Therapy-induced brain reorganization patterns in aphasia","container-title":"Brain","page":"1097-1112","volume":"138","issue":"4","source":"academic.","DOI":"10.1093/brain/awv022","ISSN":"0006-8950","journalAbbreviation":"Brain","author":[{"family":"Abel","given":"Stefanie"},{"family":"Weiller","given":"Cornelius"},{"family":"Huber","given":"Walter"},{"family":"Willmes","given":"Klaus"},{"family":"Specht","given":"Karsten"}],"issued":{"date-parts":[["2015",4,1]]}}}],"schema":""} (Abel et al., 2015), increasing our understanding about both the neuropsychological and lesion correlates of variable therapy success will be a critical step towards future neuroscience-led stratification of patients and choice of clinical pathways. To address these questions, we developed a novel naming treatment that focussed on both speed and accuracy (RISP), which we compared to a standard accuracy-only treatment (SP). As expected, both treatments increased picture naming accuracy (assessed one week following the end of the intervention), which was largely retained at the one-month follow-up assessment even without maintenance practice. RISP was, however, significantly more effective than SP in promoting increased accuracy particularly at the important long-term follow-up assessment. The same pattern was found in naming speed – as intended, RISP was much more effective in speeding successful name retrieval and maintaining these improvements at follow-up assessment. Perhaps most importantly, we found that RISP generalised from naming individual target items into the patients’ connected speech – a “holy grail” for speech and language therapy. With regard to neuropsychological and neural correlates of therapy effects, we found a significant negative correlation for the RISP therapy between the patients’ degree of phonological impairment and the magnitude of their therapy effect, both immediately after therapy and at follow up assessment. This initially somewhat counter-intuitive finding probably reflects that RISP appears to be an especially beneficial treatment, such that milder patients show a resultant ceiling effect in their speech production assessment whereas the more severe patients can exhibit a much more dramatic improvement on the target items. This finding may also be consistent with the observation from Best and colleagues’ ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XDgpWaW2","properties":{"formattedCitation":"(2013)","plainCitation":"(2013)"},"citationItems":[{"id":42,"uris":[""],"uri":[""],"itemData":{"id":42,"type":"article-journal","title":"Aphasia rehabilitation: Does generalisation from anomia therapy occur and is it predictable? A case series study","container-title":"Cortex","page":"2345-2357","volume":"49","issue":"9","source":"ScienceDirect","abstract":"Introduction\nThe majority of adults with acquired aphasia have anomia which can respond to rehabilitation with cues. However, the literature and clinical consensus suggest change is usually limited to treated items. We investigated the effect of an experimentally controlled intervention using progressive cues in the rehabilitation of noun retrieval/production in 16 participants with chronic aphasia.\nMethod\nParticipants were sub-divided relative to the group according to performance on semantic tasks (spoken/written word to picture matching) and phonological output processing (presence/absence of word length effect and proportion of phonological errors in picture naming) in order to investigate outcome in relation to language profile. Cueing therapy took place weekly for 8 weeks.\nResults\nIntervention resulted in significant improvement on naming treated items for 15/16 participants, with stable performance on control tasks. Change occurred at the point of intervention and not during pre-therapy assessments. We predicted particular patterns of generalisation which were upheld. Only participants classified as having relatively less of a semantic difficulty and more of a phonological output deficit demonstrated generalisation to untreated items. Outcome did not relate to traditional aphasia classification.\nConclusion\nA cueing hierarchy can improve word retrieval/production for adults with aphasia. In some cases generalisation to untreated items also occurs. The study demonstrates that the results of behavioural testing can be used to guide predictions of recovery with intervention.","DOI":"10.1016/j.cortex.2013.01.005","ISSN":"0010-9452","shortTitle":"Aphasia rehabilitation","journalAbbreviation":"Cortex","author":[{"family":"Best","given":"Wendy"},{"family":"Greenwood","given":"Alison"},{"family":"Grassly","given":"Jennie"},{"family":"Herbert","given":"Ruth"},{"family":"Hickin","given":"Julie"},{"family":"Howard","given":"David"}],"issued":{"date-parts":[["2013",10]]}},"suppress-author":true}],"schema":""} (2013) meta-analysis that better treatment responsiveness was evident in participants classified as having relatively less semantic difficulties?and?greater phonological output deficits (note, our use of principal component analysis to extract the pattern of underlying language-cognitive deficits means that, over and above phonology per se, the potential additional influence of semantic, skills, speech fluency and cognitive-executive factors were already partialled out: see Butler et al., 2014; Halai et al., 2017). This behavioural correlate for the RISP therapy was also mirrored directly in the lesion correlate analysis: the RISP benefit was most evident in participants with the greatest damage to the posterior superior temporal gyrus extending into the white matter of the inferior longitudinal fasciculus. This region has been implicated in auditory-phonological processing not only through neuropsychological studies ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Pwe8abor","properties":{"formattedCitation":"(Baldo et al., 2012; Robson et al., 2013, 2012)","plainCitation":"(Baldo et al., 2012; Robson et al., 2013, 2012)"},"citationItems":[{"id":136,"uris":[""],"uri":[""],"itemData":{"id":136,"type":"article-journal","title":"Brain Regions Underlying Repetition and Auditory-Verbal Short-term Memory Deficits in Aphasia: Evidence from Voxel-based Lesion Symptom Mapping","container-title":"Aphasiology","page":"338-354","volume":"26","issue":"3-4","source":"PubMed","abstract":"BACKGROUND: A deficit in the ability to repeat auditory-verbal information is common among individuals with aphasia. The neural basis of this deficit has traditionally been attributed to the disconnection of left posterior and anterior language regions via damage to a white matter pathway, the arcuate fasciculus. However, a number of lesion and imaging studies have called this notion into question.\nAIMS: The goal of this study was to identify the neural correlates of repetition and a related process, auditory-verbal short-term memory (AVSTM). Both repetition and AVSTM involve common elements such as auditory and phonological analysis and translation to speech output processes. Based on previous studies, we predicted that both repetition and AVSTM would be most dependent on posterior language regions in left temporo-parietal cortex.\nMETHODS & PROCEDURES: We tested 84 individuals with left hemisphere lesions due to stroke on an experimental battery of repetition and AVSTM tasks. Participants were tested on word, pseudoword, and number-word repetition, as well as digit and word span tasks. Brain correlates of these processes were identified using a statistical, lesion analysis approach known as voxel-based lesion symptom mapping (VLSM). VLSM allows for a voxel-by-voxel analysis of brain areas most critical to performance on a given task, including both grey and white matter regions.\nOUTCOMES & RESULTS: The VLSM analyses showed that left posterior temporo-parietal cortex, not the arcuate fasciculus, was most critical for repetition as well as for AVSTM. The location of maximal foci, defined as the voxels with the highest t values, varied somewhat among measures: Word and pseudoword repetition had maximal foci in the left posterior superior temporal gyrus, on the border with inferior parietal cortex, while word and digit span, as well as number-word repetition, were centered on the border between the middle temporal and superior temporal gyri and the underlying white matter.\nCONCLUSIONS: Findings from the current study show that 1) repetition is most critically mediated by cortical regions in left posterior temporo-parietal cortex; 2) repetition and AVSTM are mediated by partially overlapping networks; and 3) repetition and AVSTM deficits can be observed in different types of aphasia, depending on the site and extent of the brain injury. These data have implications for the prognosis of chronic repetition and AVSTM deficits in individuals with aphasia when lesions involve critical regions in left temporo-parietal cortex.","DOI":"10.1080/02687038.2011.602391","ISSN":"0268-7038","note":"PMID: 24976669\nPMCID: PMC4070523","shortTitle":"Brain Regions Underlying Repetition and Auditory-Verbal Short-term Memory Deficits in Aphasia","journalAbbreviation":"Aphasiology","language":"eng","author":[{"family":"Baldo","given":"Juliana V."},{"family":"Katseff","given":"Shira"},{"family":"Dronkers","given":"Nina F."}],"issued":{"date-parts":[["2012"]]},"PMID":"24976669","PMCID":"PMC4070523"}},{"id":140,"uris":[""],"uri":[""],"itemData":{"id":140,"type":"article-journal","title":"Fundamental deficits of auditory perception in Wernicke's aphasia","container-title":"Cortex; a Journal Devoted to the Study of the Nervous System and Behavior","page":"1808-1822","volume":"49","issue":"7","source":"PubMed","abstract":"OBJECTIVE: This work investigates the nature of the comprehension impairment in Wernicke's aphasia (WA), by examining the relationship between deficits in auditory processing of fundamental, non-verbal acoustic stimuli and auditory comprehension. WA, a condition resulting in severely disrupted auditory comprehension, primarily occurs following a cerebrovascular accident (CVA) to the left temporo-parietal cortex. Whilst damage to posterior superior temporal areas is associated with auditory linguistic comprehension impairments, functional-imaging indicates that these areas may not be specific to speech processing but part of a network for generic auditory analysis.\nMETHODS: We examined analysis of basic acoustic stimuli in WA participants (n = 10) using auditory stimuli reflective of theories of cortical auditory processing and of speech cues. Auditory spectral, temporal and spectro-temporal analysis was assessed using pure-tone frequency discrimination, frequency modulation (FM) detection and the detection of dynamic modulation (DM) in \"moving ripple\" stimuli. All tasks used criterion-free, adaptive measures of threshold to ensure reliable results at the individual level.\nRESULTS: Participants with WA showed normal frequency discrimination but significant impairments in FM and DM detection, relative to age- and hearing-matched controls at the group level (n = 10). At the individual level, there was considerable variation in performance, and thresholds for both FM and DM detection correlated significantly with auditory comprehension abilities in the WA participants.\nCONCLUSION: These results demonstrate the co-occurrence of a deficit in fundamental auditory processing of temporal and spectro-temporal non-verbal stimuli in WA, which may have a causal contribution to the auditory language comprehension impairment. Results are discussed in the context of traditional neuropsychology and current models of cortical auditory processing.","DOI":"10.1016/j.cortex.2012.11.012","ISSN":"1973-8102","note":"PMID: 23351849","journalAbbreviation":"Cortex","language":"eng","author":[{"family":"Robson","given":"Holly"},{"family":"Grube","given":"Manon"},{"family":"Lambon Ralph","given":"Matthew A."},{"family":"Griffiths","given":"Timothy D."},{"family":"Sage","given":"Karen"}],"issued":{"date-parts":[["2013",8]]},"PMID":"23351849"}},{"id":138,"uris":[""],"uri":[""],"itemData":{"id":138,"type":"article-journal","title":"Wernicke's aphasia reflects a combination of acoustic-phonological and semantic control deficits: a case-series comparison of Wernicke's aphasia, semantic dementia and semantic aphasia","container-title":"Neuropsychologia","page":"266-275","volume":"50","issue":"2","source":"PubMed","abstract":"Wernicke's aphasia (WA) is the classical neurological model of comprehension impairment and, as a result, the posterior temporal lobe is assumed to be critical to semantic cognition. This conclusion is potentially confused by (a) the existence of patient groups with semantic impairment following damage to other brain regions (semantic dementia and semantic aphasia) and (b) an ongoing debate about the underlying causes of comprehension impairment in WA. By directly comparing these three patient groups for the first time, we demonstrate that the comprehension impairment in Wernicke's aphasia is best accounted for by dual deficits in acoustic-phonological analysis (associated with pSTG) and semantic cognition (associated with pMTG and angular gyrus). The WA group were impaired on both nonverbal and verbal comprehension assessments consistent with a generalised semantic impairment. This semantic deficit was most similar in nature to that of the semantic aphasia group suggestive of a disruption to semantic control processes. In addition, only the WA group showed a strong effect of input modality on comprehension, with accuracy decreasing considerably as acoustic-phonological requirements increased. These results deviate from traditional accounts which emphasise a single impairment and, instead, implicate two deficits underlying the comprehension disorder in WA.","DOI":"10.1016/j.neuropsychologia.2011.11.021","ISSN":"1873-3514","note":"PMID: 22178742","shortTitle":"Wernicke's aphasia reflects a combination of acoustic-phonological and semantic control deficits","journalAbbreviation":"Neuropsychologia","language":"eng","author":[{"family":"Robson","given":"Holly"},{"family":"Sage","given":"Karen"},{"family":"Ralph","given":"Matthew A. Lambon"}],"issued":{"date-parts":[["2012",1]]},"PMID":"22178742"}}],"schema":""} (Baldo et al., 2012; Robson et al., 2013, 2012) but also in fMRI explorations of healthy function ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"l1lp1mm0m","properties":{"formattedCitation":"(Hickok and Poeppel, 2004; Rauschecker and Scott, 2009; Warren and Griffiths, 2003)","plainCitation":"(Hickok and Poeppel, 2004; Rauschecker and Scott, 2009; Warren and Griffiths, 2003)"},"citationItems":[{"id":146,"uris":[""],"uri":[""],"itemData":{"id":146,"type":"article-journal","title":"Dorsal and ventral streams: a framework for understanding aspects of the functional anatomy of language","container-title":"Cognition","page":"67-99","volume":"92","issue":"1-2","source":"PubMed","abstract":"Despite intensive work on language-brain relations, and a fairly impressive accumulation of knowledge over the last several decades, there has been little progress in developing large-scale models of the functional anatomy of language that integrate neuropsychological, neuroimaging, and psycholinguistic data. Drawing on relatively recent developments in the cortical organization of vision, and on data from a variety of sources, we propose a new framework for understanding aspects of the functional anatomy of language which moves towards remedying this situation. The framework posits that early cortical stages of speech perception involve auditory fields in the superior temporal gyrus bilaterally (although asymmetrically). This cortical processing system then diverges into two broad processing streams, a ventral stream, which is involved in mapping sound onto meaning, and a dorsal stream, which is involved in mapping sound onto articulatory-based representations. The ventral stream projects ventro-laterally toward inferior posterior temporal cortex (posterior middle temporal gyrus) which serves as an interface between sound-based representations of speech in the superior temporal gyrus (again bilaterally) and widely distributed conceptual representations. The dorsal stream projects dorso-posteriorly involving a region in the posterior Sylvian fissure at the parietal-temporal boundary (area Spt), and ultimately projecting to frontal regions. This network provides a mechanism for the development and maintenance of \"parity\" between auditory and motor representations of speech. Although the proposed dorsal stream represents a very tight connection between processes involved in speech perception and speech production, it does not appear to be a critical component of the speech perception process under normal (ecologically natural) listening conditions, that is, when speech input is mapped onto a conceptual representation. We also propose some degree of bi-directionality in both the dorsal and ventral pathways. We discuss some recent empirical tests of this framework that utilize a range of methods. We also show how damage to different components of this framework can account for the major symptom clusters of the fluent aphasias, and discuss some recent evidence concerning how sentence-level processing might be integrated into the framework.","DOI":"10.1016/j.cognition.2003.10.011","ISSN":"0010-0277","note":"PMID: 15037127","shortTitle":"Dorsal and ventral streams","journalAbbreviation":"Cognition","language":"eng","author":[{"family":"Hickok","given":"Gregory"},{"family":"Poeppel","given":"David"}],"issued":{"date-parts":[["2004",6]]},"PMID":"15037127"}},{"id":150,"uris":[""],"uri":[""],"itemData":{"id":150,"type":"article-journal","title":"Maps and streams in the auditory cortex: nonhuman primates illuminate human speech processing","container-title":"Nature Neuroscience","page":"718-724","volume":"12","issue":"6","source":"PubMed","abstract":"Speech and language are considered uniquely human abilities: animals have communication systems, but they do not match human linguistic skills in terms of recursive structure and combinatorial power. Yet, in evolution, spoken language must have emerged from neural mechanisms at least partially available in animals. In this paper, we will demonstrate how our understanding of speech perception, one important facet of language, has profited from findings and theory in nonhuman primate studies. Chief among these are physiological and anatomical studies showing that primate auditory cortex, across species, shows patterns of hierarchical structure, topographic mapping and streams of functional processing. We will identify roles for different cortical areas in the perceptual processing of speech and review functional imaging work in humans that bears on our understanding of how the brain decodes and monitors speech. A new model connects structures in the temporal, frontal and parietal lobes linking speech perception and production.","DOI":"10.1038/nn.2331","ISSN":"1546-1726","note":"PMID: 19471271\nPMCID: PMC2846110","shortTitle":"Maps and streams in the auditory cortex","journalAbbreviation":"Nat. Neurosci.","language":"eng","author":[{"family":"Rauschecker","given":"Josef P."},{"family":"Scott","given":"Sophie K."}],"issued":{"date-parts":[["2009",6]]},"PMID":"19471271","PMCID":"PMC2846110"}},{"id":148,"uris":[""],"uri":[""],"itemData":{"id":148,"type":"article-journal","title":"Distinct mechanisms for processing spatial sequences and pitch sequences in the human auditory brain","container-title":"The Journal of Neuroscience: The Official Journal of the Society for Neuroscience","page":"5799-5804","volume":"23","issue":"13","source":"PubMed","abstract":"Perception of the acoustic world requires the simultaneous processing of the acoustic patterns associated with sound objects and their location in space. In this functional magnetic resonance experiment, we investigated the human brain areas engaged in the analysis of pitch sequences and sequences of acoustic spatial locations in a paradigm in which both could be varied independently. Subjects were presented with sequences of sounds in which the individual sounds were regular interval noises with variable pitch. Positions of individual sounds were varied using a virtual acoustic space paradigm during scanning. Sound sequences with changing pitch specifically activated lateral Heschl's gyrus (HG), anterior planum temporale (PT), planum polare, and superior temporal gyrus anterior to HG. Sound sequences with changing spatial locations specifically activated posteromedial PT. These results demonstrate directly that distinct mechanisms for the analysis of pitch sequences and acoustic spatial sequences exist in the human brain. This functional differentiation is evident as early as PT: within PT, pitch pattern is processed anterolaterally and spatial location is processed posteromedially. These areas may represent human homologs of macaque lateral and medial belt, respectively.","ISSN":"1529-2401","note":"PMID: 12843284","journalAbbreviation":"J. Neurosci.","language":"eng","author":[{"family":"Warren","given":"J. D."},{"family":"Griffiths","given":"T. D."}],"issued":{"date-parts":[["2003",7,2]]},"PMID":"12843284"}}],"schema":""} (Hickok and Poeppel, 2004; Rauschecker and Scott, 2009; Warren and Griffiths, 2003). Finally, with regard to the long-term maintenance of the RISP treatment, follow-up performance correlated positively with cognitive-executive skills. Specifically, strong performances on neuropsychological assessments like the Brixton Rule Anticipation Test ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"127renqmsf","properties":{"formattedCitation":"(Vordenberg et al., 2014)","plainCitation":"(Vordenberg et al., 2014)"},"citationItems":[{"id":188,"uris":[""],"uri":[""],"itemData":{"id":188,"type":"article-journal","title":"Application of the Brixton Spatial Anticipation Test in Stroke: Ecological Validity and Performance Characteristics","container-title":"The Clinical Neuropsychologist","page":"300-316","volume":"28","issue":"2","source":"Taylor and Francis+NEJM","abstract":"Executive dysfunction predicts functional recovery post-stroke. However, traditional neuropsychological tests have limitations with this population due to required verbal response, complex motor response, and lengthy administration time. This study examined the ecological validity and performance characteristics of a relatively new measure of executive function, the Brixton Spatial Anticipation Test, which does not place the aforementioned demands on these patients. A total of 57 ischemic stroke patients with frontal lobe and subcortical lesions were administered the Brixton, on average 2 weeks post-stroke, during inpatient rehabilitation and assessed using the Functional Independence Measure (FIM) upon discharge. Brixton performance was significantly correlated with the FIM Total and FIM Cognitive Subtotal at discharge but unrelated to FIM Motor Subtotal. After controlling for global ability measured by the RBANS, Brixton performance accounted for additional variance in predicting FIM Total score at discharge. Interestingly, patients with subcortical strokes in the thalamus and basal ganglia performed significantly worse than patients with strokes in the frontal cortex on the Brixton, supporting the role of subcortical structures in the frontal lobe circuitry and executive function. Based on the present findings, the Brixton is a sensitive measure conducive to the stroke population and has strong ecological validity for identifying cognitive functional outcomes post-stroke.","DOI":"10.1080/13854046.2014.881555","ISSN":"1385-4046","note":"PMID: 24528244","shortTitle":"Application of the Brixton Spatial Anticipation Test in Stroke","author":[{"family":"Vordenberg","given":"Jessica A."},{"family":"Barrett","given":"John J."},{"family":"Doninger","given":"Nicholas A."},{"family":"Contardo","given":"Christopher P."},{"family":"Ozoude","given":"Kingsley A."}],"issued":{"date-parts":[["2014",2,17]]},"PMID":"24528244"}}],"schema":""} (Vordenberg et al., 2014) predict good longer-term responsiveness to anomia treatment in general, and RISP in particular. This may reflect the enhanced demands that RISP placed on participants in terms of cognitive flexibility, planning, problem-solving and speed of processing – consistent with the suggestion that both patients’ degree of language impairment and remaining executive skill may be critical in recovery of function and therapy outcome ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"IK7TqPBn","properties":{"formattedCitation":"(Brownsett et al., 2014; Geranmayeh et al., 2014; Lambon Ralph et al., 2010; Sharp et al., 2010)","plainCitation":"(Brownsett et al., 2014; Geranmayeh et al., 2014; Lambon Ralph et al., 2010; Sharp et al., 2010)"},"citationItems":[{"id":162,"uris":[""],"uri":[""],"itemData":{"id":162,"type":"article-journal","title":"Cognitive control and its impact on recovery from aphasic stroke","container-title":"Brain","page":"242-254","volume":"137","issue":"1","source":"academic.","DOI":"10.1093/brain/awt289","ISSN":"0006-8950","journalAbbreviation":"Brain","author":[{"family":"Brownsett","given":"Sonia L. E."},{"family":"Warren","given":"Jane E."},{"family":"Geranmayeh","given":"Fatemeh"},{"family":"Woodhead","given":"Zoe"},{"family":"Leech","given":"Robert"},{"family":"Wise","given":"Richard J. S."}],"issued":{"date-parts":[["2014",1,1]]}}},{"id":169,"uris":[""],"uri":[""],"itemData":{"id":169,"type":"article-journal","title":"Task-induced brain activity in aphasic stroke patients: what is driving recovery?","container-title":"Brain","page":"2632-2648","volume":"137","issue":"10","source":"PubMed Central","abstract":"Based on the interpretation and reinterpretation of published functional neuroimaging and clinical neuropsychological data, Geranmayeh et al. argue that recovery from aphasic stroke may be due as much to the function of high-order, domain-general networks as to recovery of language-specific networks. This distinction has implications for rehabilitation., The estimated prevalence of aphasia in the UK and the USA is 250 000 and 1 000 000, respectively. The commonest aetiology is stroke. The impairment may improve with behavioural therapy, and trials using cortical stimulation or pharmacotherapy are undergoing proof-of-principle investigation, but with mixed results. Aphasia is a heterogeneous syndrome, and the simple classifications according to the Broca-Wernicke-Lichtheim model inadequately describe the diverse communication difficulties with which patients may present. Greater knowledge of how intact neural networks promote recovery after aphasic stroke, either spontaneously or in response to interventions, will result in clearer hypotheses about how to improve the treatment of aphasia. Twenty-five years ago, a pioneering study on healthy participants heralded the introduction of functional neuroimaging to the study of mechanisms of recovery from aphasia. Over the ensuing decades, such studies have been interpreted as supporting one of three hypotheses, which are not mutually exclusive. The first two predate the introduction of functional neuroimaging: that recovery is the consequence of the reconstitution of domain-specific language systems in tissue around the lesion (the ‘perilesional’ hypothesis), or by homotopic cortex in the contralateral hemisphere (the ‘laterality-shift’ hypothesis). The third is that loss of transcallosal inhibition to contralateral homotopic cortex hinders recovery (the ‘disinhibition’ hypothesis). These different hypotheses at times give conflicting views about rehabilitative intervention; for example, should one attempt to activate or inhibit a contralateral homotopic region with cortical stimulation techniques to promote recovery? This review proposes that although the functional imaging data are statistically valid in most cases, their interpretation has often favoured one explanation while ignoring plausible alternatives. In our view, this is particularly evident when recovery is attributed to activity in ‘language networks’ occupying sites not observed in healthy participants. In this review we will argue that much of the distribution of what has often been interpreted as language-specific activity, particularly in midline and contralateral cortical regions, is an upregulation of activity in intact domain-general systems for cognitive control and attention, responding in a task-dependent manner to the increased ‘effort’ when damaged downstream domain-specific language networks are impaired. We further propose that it is an inability fully to activate these systems that may result in sub optimal recovery in some patients. Interpretation of the data in terms of activity in domain-general networks affords insights into novel approaches to rehabilitation.","DOI":"10.1093/brain/awu163","ISSN":"0006-8950","note":"PMID: 24974382\nPMCID: PMC4163030","shortTitle":"Task-induced brain activity in aphasic stroke patients","journalAbbreviation":"Brain","author":[{"family":"Geranmayeh","given":"Fatemeh"},{"family":"Brownsett","given":"Sonia L. E."},{"family":"Wise","given":"Richard J. S."}],"issued":{"date-parts":[["2014",10]]},"PMID":"24974382","PMCID":"PMC4163030"}},{"id":160,"uris":[""],"uri":[""],"itemData":{"id":160,"type":"article-journal","title":"Predicting the outcome of anomia therapy for people with aphasia post CVA: both language and cognitive status are key predictors","container-title":"Neuropsychological Rehabilitation","page":"289-305","volume":"20","issue":"2","source":"PubMed","abstract":"The aim of this study was to determine whether it was possible to predict therapy gain from participants' performance on background tests of language and cognitive ability. To do this, we amalgamated the assessment and therapy results from 33 people with aphasia following cerebral vascular accident (CVA), all of whom had received the same anomia therapy (based on progressive phonemic and orthographic cueing). Previous studies with smaller numbers of participants had found a possible relationship between anomia therapy performance and some language and cognitive assessments. Because this study had access to a larger data set than previous studies, we were able to replicate the previous findings and also to verify two overarching factors which were predictive of therapy gain: a cognitive factor and a phonological factor. The status of these two domains was able to predict both immediate and longer-term therapy gain. Pre-treatment naming ability also predicted gain after the anomia therapy. When combined, both cognitive and language (naming or phonological) skills were found to be independent predictors of therapy outcome.","DOI":"10.1080/09602010903237875","ISSN":"1464-0694","note":"PMID: 20077315","shortTitle":"Predicting the outcome of anomia therapy for people with aphasia post CVA","journalAbbreviation":"Neuropsychol Rehabil","language":"eng","author":[{"family":"Lambon Ralph","given":"Matthew A."},{"family":"Snell","given":"Claerwen"},{"family":"Fillingham","given":"Joanne K."},{"family":"Conroy","given":"Paul"},{"family":"Sage","given":"Karen"}],"issued":{"date-parts":[["2010",4]]},"PMID":"20077315"}},{"id":157,"uris":[""],"uri":[""],"itemData":{"id":157,"type":"article-journal","title":"Increased frontoparietal integration after stroke and cognitive recovery","container-title":"Annals of Neurology","page":"753-756","volume":"68","issue":"5","source":"Wiley Online Library","abstract":"The neural mechanism by which patients spontaneously recover cognitive function after brain injury is not understood. Here we demonstrate for the first time that aphasic patients, who have largely recovered language function, show increased frontoparietal integration. A similar change in functional connectivity is also observed when normal subjects are exposed to adverse listening conditions. Thus, compensation for inefficient language processing is associated with increased integration between parts of the language network critical to language control. This change reflects greater top-down control of speech comprehension and provides a mechanism by which language impairments after stroke may be compensated for. ANN NEUROL 2010","DOI":"10.1002/ana.21866","ISSN":"1531-8249","journalAbbreviation":"Ann Neurol.","language":"en","author":[{"family":"Sharp","given":"David J."},{"family":"Turkheimer","given":"Federico E."},{"family":"Bose","given":"Subrata K."},{"family":"Scott","given":"Sophie K."},{"family":"Wise","given":"Richard J. S."}],"issued":{"date-parts":[["2010",11,1]]}}}],"schema":""} (Brownsett et al., 2014; Geranmayeh et al., 2014; Lambon Ralph et al., 2010; Sharp et al., 2010).Two different possible hypotheses can be made about the mechanisms underlying the speeded treatment effect, which can be tested in future investigations. The first, language-specific hypothesis is related to the aim of the RISP treatment to target both accuracy and speed. For optimally easy and efficient word retrieval, the language system requires precise representations that allow the target meaning to be converted to phonological and motor-speech representations ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2mmlp7uc6f","properties":{"formattedCitation":"(Lupker et al., 1997)","plainCitation":"(Lupker et al., 1997)"},"citationItems":[{"id":201,"uris":[""],"uri":[""],"itemData":{"id":201,"type":"article-journal","title":"Strategic control in a naming task: Changing routes or changing deadlines?","container-title":"Journal of Experimental Psychology: Learning, Memory, and Cognition","page":"570-590","volume":"23","issue":"3","author":[{"family":"Lupker","given":"Stephen J."},{"family":"Brown","given":"Patrick"},{"family":"Colombo","given":"Lucia"}],"issued":{"date-parts":[["1997",5]]}}}],"schema":""} (Lupker et al., 1997). Computational models of speech production and reading have repeatedly shown that as these representations and mappings are refined through learning, performance of models becomes both more accurate and more efficient ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1owLs0CF","properties":{"formattedCitation":"(Ellis and Lambon Ralph, 2000; Plaut et al., 1996)","plainCitation":"(Ellis and Lambon Ralph, 2000; Plaut et al., 1996)"},"citationItems":[{"id":168,"uris":[""],"uri":[""],"itemData":{"id":168,"type":"article-journal","title":"Age of Acquisition effects in adult lexical processing reflect loss of plasticity in maturing systems: Insights from connectionist networks.","container-title":"JEP:LMC","page":"1103-1123","volume":"26","issue":"5","author":[{"family":"Ellis","given":"Andrew"},{"family":"Lambon Ralph","given":"Matthew A."}],"issued":{"date-parts":[["2000"]]}}},{"id":166,"uris":[""],"uri":[""],"itemData":{"id":166,"type":"article-journal","title":"Understanding normal and impaired word reading: Computational principles in quasi-regular domains.","container-title":"Psychological Review","page":"56-115","volume":"103","author":[{"family":"Plaut","given":"David C."},{"family":"McClelland","given":"James L."},{"family":"Seidenberg","given":"Mark S."},{"family":"Patterson","given":"Karalyn"}],"issued":{"date-parts":[["1996"]]}}}],"schema":""} (Ellis and Lambon Ralph, 2000; Plaut et al., 1996). Accordingly, because the RISP treatment deliberately aims beyond accuracy to improve speed as well, the language representations and mappings may have been pressured not only to reform but also to be ‘sharpened up’ to become more precise. This also supports previous findings which indicated that naming speed is a significant yet often overlooked factor, not only in assessment but also in treatment tasks ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"SQz5igAz","properties":{"formattedCitation":"(McCall et al., 1997)","plainCitation":"(McCall et al., 1997)"},"citationItems":[{"id":61,"uris":[""],"uri":[""],"itemData":{"id":61,"type":"article-journal","title":"The influence of syntactic and semantic information on picture-naming performance in aphasic patients","container-title":"Aphasiology","page":"581-600","volume":"11","issue":"6","source":"Taylor and Francis+NEJM","abstract":"Two experiments are described investigating which aspects of the sentence completion prompt are requisite for enhancing the ability of aphasic subjects to retrieve picture names. Naming performance of eight aphasic subjects is assessed in response to sentence frames containing a semantically related word (sentence completions), semantically empty sentence frames (carrier phrases) and provision of semantic information alone (associate verbs). It was shown that, as a group, subjects demonstrated better naming performance in response to sentence completions containing a semantically related word than to semantically empty sentence frames or to verb associates. Consideration of response times provides evidence that the sentence completion condition facilitates subjects' access to picture names. Our results support the notion that it is the combination of syntactic and semantic variables that enhances naming.","DOI":"10.1080/02687039708248491","ISSN":"0268-7038","author":[{"family":"McCall","given":"D."},{"family":"Cox","given":"D. M."},{"family":"Shelton","given":"J. R."},{"family":"Weinrich","given":"M."}],"issued":{"date-parts":[["1997",6,1]]}}}],"schema":""} (McCall et al., 1997). Indeed, this hypothesis might also explain why, aside from speed, RISP led to significantly better naming accuracy than the accuracy-only focussed SP (following the fact that both speed and accuracy reflect the precision of the underlying language representations). Another possible hypothesis accounting for the RISP effect is related to a domain-general, cognitive-executive mechanism ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1q6o66r3tp","properties":{"formattedCitation":"(Geranmayeh et al., 2014; Lambon Ralph et al., 2010)","plainCitation":"(Geranmayeh et al., 2014; Lambon Ralph et al., 2010)"},"citationItems":[{"id":169,"uris":[""],"uri":[""],"itemData":{"id":169,"type":"article-journal","title":"Task-induced brain activity in aphasic stroke patients: what is driving recovery?","container-title":"Brain","page":"2632-2648","volume":"137","issue":"10","source":"PubMed Central","abstract":"Based on the interpretation and reinterpretation of published functional neuroimaging and clinical neuropsychological data, Geranmayeh et al. argue that recovery from aphasic stroke may be due as much to the function of high-order, domain-general networks as to recovery of language-specific networks. This distinction has implications for rehabilitation., The estimated prevalence of aphasia in the UK and the USA is 250 000 and 1 000 000, respectively. The commonest aetiology is stroke. The impairment may improve with behavioural therapy, and trials using cortical stimulation or pharmacotherapy are undergoing proof-of-principle investigation, but with mixed results. Aphasia is a heterogeneous syndrome, and the simple classifications according to the Broca-Wernicke-Lichtheim model inadequately describe the diverse communication difficulties with which patients may present. Greater knowledge of how intact neural networks promote recovery after aphasic stroke, either spontaneously or in response to interventions, will result in clearer hypotheses about how to improve the treatment of aphasia. Twenty-five years ago, a pioneering study on healthy participants heralded the introduction of functional neuroimaging to the study of mechanisms of recovery from aphasia. Over the ensuing decades, such studies have been interpreted as supporting one of three hypotheses, which are not mutually exclusive. The first two predate the introduction of functional neuroimaging: that recovery is the consequence of the reconstitution of domain-specific language systems in tissue around the lesion (the ‘perilesional’ hypothesis), or by homotopic cortex in the contralateral hemisphere (the ‘laterality-shift’ hypothesis). The third is that loss of transcallosal inhibition to contralateral homotopic cortex hinders recovery (the ‘disinhibition’ hypothesis). These different hypotheses at times give conflicting views about rehabilitative intervention; for example, should one attempt to activate or inhibit a contralateral homotopic region with cortical stimulation techniques to promote recovery? This review proposes that although the functional imaging data are statistically valid in most cases, their interpretation has often favoured one explanation while ignoring plausible alternatives. In our view, this is particularly evident when recovery is attributed to activity in ‘language networks’ occupying sites not observed in healthy participants. In this review we will argue that much of the distribution of what has often been interpreted as language-specific activity, particularly in midline and contralateral cortical regions, is an upregulation of activity in intact domain-general systems for cognitive control and attention, responding in a task-dependent manner to the increased ‘effort’ when damaged downstream domain-specific language networks are impaired. We further propose that it is an inability fully to activate these systems that may result in sub optimal recovery in some patients. Interpretation of the data in terms of activity in domain-general networks affords insights into novel approaches to rehabilitation.","DOI":"10.1093/brain/awu163","ISSN":"0006-8950","note":"PMID: 24974382\nPMCID: PMC4163030","shortTitle":"Task-induced brain activity in aphasic stroke patients","journalAbbreviation":"Brain","author":[{"family":"Geranmayeh","given":"Fatemeh"},{"family":"Brownsett","given":"Sonia L. E."},{"family":"Wise","given":"Richard J. S."}],"issued":{"date-parts":[["2014",10]]},"PMID":"24974382","PMCID":"PMC4163030"}},{"id":160,"uris":[""],"uri":[""],"itemData":{"id":160,"type":"article-journal","title":"Predicting the outcome of anomia therapy for people with aphasia post CVA: both language and cognitive status are key predictors","container-title":"Neuropsychological Rehabilitation","page":"289-305","volume":"20","issue":"2","source":"PubMed","abstract":"The aim of this study was to determine whether it was possible to predict therapy gain from participants' performance on background tests of language and cognitive ability. To do this, we amalgamated the assessment and therapy results from 33 people with aphasia following cerebral vascular accident (CVA), all of whom had received the same anomia therapy (based on progressive phonemic and orthographic cueing). Previous studies with smaller numbers of participants had found a possible relationship between anomia therapy performance and some language and cognitive assessments. Because this study had access to a larger data set than previous studies, we were able to replicate the previous findings and also to verify two overarching factors which were predictive of therapy gain: a cognitive factor and a phonological factor. The status of these two domains was able to predict both immediate and longer-term therapy gain. Pre-treatment naming ability also predicted gain after the anomia therapy. When combined, both cognitive and language (naming or phonological) skills were found to be independent predictors of therapy outcome.","DOI":"10.1080/09602010903237875","ISSN":"1464-0694","note":"PMID: 20077315","shortTitle":"Predicting the outcome of anomia therapy for people with aphasia post CVA","journalAbbreviation":"Neuropsychol Rehabil","language":"eng","author":[{"family":"Lambon Ralph","given":"Matthew A."},{"family":"Snell","given":"Claerwen"},{"family":"Fillingham","given":"Joanne K."},{"family":"Conroy","given":"Paul"},{"family":"Sage","given":"Karen"}],"issued":{"date-parts":[["2010",4]]},"PMID":"20077315"}}],"schema":""} (Geranmayeh et al., 2014; Lambon Ralph et al., 2010). Not only was the degree of treatment maintenance related to the patients’ cognitive-executive skills, but all participants (irrespective of severity) reported RISP to be especially engaging and motivating. Thus, RISP may be much better than SP in engaging patients’ executive and attentional skills, in addition to the speech production system, resulting in improved learning and retention. From a neurobiological perspective, increased motivation and reward-seeking behaviour has been being strongly associated with dopamine release ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"17kb0q1rcb","properties":{"formattedCitation":"(Fiorillo, 2013; Morita et al., 2013; Sharp et al., 2016)","plainCitation":"(Fiorillo, 2013; Morita et al., 2013; Sharp et al., 2016)"},"citationItems":[{"id":208,"uris":[""],"uri":[""],"itemData":{"id":208,"type":"article-journal","title":"Two dimensions of value: dopamine neurons represent reward but not aversiveness","container-title":"Science (New York, N.Y.)","page":"546-549","volume":"341","issue":"6145","source":"PubMed","abstract":"Whereas reward (appetitiveness) and aversiveness (punishment) have been distinguished as two discrete dimensions within psychology and behavior, physiological and computational models of their neural representation have treated them as opposite sides of a single continuous dimension of \"value.\" Here, I show that although dopamine neurons of the primate ventral midbrain are activated by evidence for reward and suppressed by evidence against reward, they are insensitive to aversiveness. This indicates that reward and aversiveness are represented independently as two dimensions, even by neurons that are closely related to motor function. Because theory and experiment support the existence of opponent neural representations for value, the present results imply four types of value-sensitive neurons corresponding to reward-ON (dopamine), reward-OFF, aversive-ON, and aversive-OFF.","DOI":"10.1126/science.1238699","ISSN":"1095-9203","note":"PMID: 23908236","shortTitle":"Two dimensions of value","journalAbbreviation":"Science","language":"eng","author":[{"family":"Fiorillo","given":"Christopher D."}],"issued":{"date-parts":[["2013",8,2]]},"PMID":"23908236"}},{"id":211,"uris":[""],"uri":[""],"itemData":{"id":211,"type":"article-journal","title":"Dopaminergic control of motivation and reinforcement learning: a closed-circuit account for reward-oriented behavior","container-title":"The Journal of Neuroscience: The Official Journal of the Society for Neuroscience","page":"8866-8890","volume":"33","issue":"20","source":"PubMed","abstract":"Humans and animals take actions quickly when they expect that the actions lead to reward, reflecting their motivation. Injection of dopamine receptor antagonists into the striatum has been shown to slow such reward-seeking behavior, suggesting that dopamine is involved in the control of motivational processes. Meanwhile, neurophysiological studies have revealed that phasic response of dopamine neurons appears to represent reward prediction error, indicating that dopamine plays central roles in reinforcement learning. However, previous attempts to elucidate the mechanisms of these dopaminergic controls have not fully explained how the motivational and learning aspects are related and whether they can be understood by the way the activity of dopamine neurons itself is controlled by their upstream circuitries. To address this issue, we constructed a closed-circuit model of the corticobasal ganglia system based on recent findings regarding intracortical and corticostriatal circuit architectures. Simulations show that the model could reproduce the observed distinct motivational effects of D1- and D2-type dopamine receptor antagonists. Simultaneously, our model successfully explains the dopaminergic representation of reward prediction error as observed in behaving animals during learning tasks and could also explain distinct choice biases induced by optogenetic stimulation of the D1 and D2 receptor-expressing striatal neurons. These results indicate that the suggested roles of dopamine in motivational control and reinforcement learning can be understood in a unified manner through a notion that the indirect pathway of the basal ganglia represents the value of states/actions at a previous time point, an empirically driven key assumption of our model.","DOI":"10.1523/JNEUROSCI.4614-12.2013","ISSN":"1529-2401","note":"PMID: 23678129","shortTitle":"Dopaminergic control of motivation and reinforcement learning","journalAbbreviation":"J. Neurosci.","language":"eng","author":[{"family":"Morita","given":"Kenji"},{"family":"Morishima","given":"Mieko"},{"family":"Sakai","given":"Katsuyuki"},{"family":"Kawaguchi","given":"Yasuo"}],"issued":{"date-parts":[["2013",5,15]]},"PMID":"23678129"}},{"id":213,"uris":[""],"uri":[""],"itemData":{"id":213,"type":"article-journal","title":"Dopamine selectively remediates ‘model-based’ reward learning: a computational approach","container-title":"Brain","page":"355-364","volume":"139","issue":"2","source":"academic.","abstract":"Patients with loss of dopamine due to Parkinson’s disease are impaired at learning from reward. However, it remains unknown precisely which aspect of learning is impaired. In particular, learning from reward, or reinforcement learning, can be driven by two distinct computational processes. One involves habitual stamping-in of stimulus-response associations, hypothesized to arise computationally from ‘model-free’ learning. The other, ‘model-based’ learning, involves learning a model of the world that is believed to support goal-directed behaviour. Much work has pointed to a role for dopamine in model-free learning. But recent work suggests model-based learning may also involve dopamine modulation, raising the possibility that model-based learning may contribute to the learning impairment in Parkinson’s disease. To directly test this, we used a two-step reward-learning task which dissociates model-free versus model-based learning. We evaluated learning in patients with Parkinson’s disease tested ON versus OFF their dopamine replacement medication and in healthy controls. Surprisingly, we found no effect of disease or medication on model-free learning. Instead, we found that patients tested OFF medication showed a marked impairment in model-based learning, and that this impairment was remediated by dopaminergic medication. Moreover, model-based learning was positively correlated with a separate measure of working memory performance, raising the possibility of common neural substrates. Our results suggest that some learning deficits in Parkinson’s disease may be related to an inability to pursue reward based on complete representations of the environment.","DOI":"10.1093/brain/awv347","ISSN":"0006-8950","shortTitle":"Dopamine selectively remediates ‘model-based’ reward learning","journalAbbreviation":"Brain","author":[{"family":"Sharp","given":"Madeleine E."},{"family":"Foerde","given":"Karin"},{"family":"Daw","given":"Nathaniel D."},{"family":"Shohamy","given":"Daphna"}],"issued":{"date-parts":[["2016",2,1]]}}}],"schema":""} (Fiorillo, 2013; Morita et al., 2013; Sharp et al., 2016) and dopamine has been associated with improved learning and therapy effects ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"7lojqr8m6","properties":{"formattedCitation":"{\\rtf (Berthier and Pulverm\\uc0\\u252{}ller, 2011; Gill and Leff, 2012)}","plainCitation":"(Berthier and Pulvermüller, 2011; Gill and Leff, 2012)"},"citationItems":[{"id":176,"uris":[""],"uri":[""],"itemData":{"id":176,"type":"article-journal","title":"Neuroscience insights improve neurorehabilitation of poststroke aphasia","container-title":"Nature Reviews. Neurology","page":"86-97","volume":"7","issue":"2","source":"PubMed","abstract":"The treatment of aphasias-acquired language disorders-caused by stroke and other neurological conditions has benefitted from insights from neuroscience and neuropsychology. Hebbian mechanisms suggest that massed practice and exploitation of residual neurological capacities can aid neurorehabilitation of patients with poststroke aphasia, and progress in basic neuroscience research indicates that the language system of the human brain is functionally interwoven with perceptual and motor systems. Intensive speech and language therapies, including constraint-induced aphasia therapy, that activate both the linguistic and concordant motor circuits utilize the knowledge gained from these advances in neuroscience research and can lead to surprisingly rapid improvements in language performance, even in patients with chronic aphasia. Drug-based therapies alone and in conjunction with behavioral language therapies also increase language performance in patients with aphasia. Furthermore, noninvasive transcranial magnetic stimulation and electrical stimulation techniques that target neuronal activity within perilesional areas might help patients with aphasia to regain lost language functions. Intensive language-action therapies that lead to rapid improvements in language skills might provide a new opportunity for investigating fast plastic neuronal changes in the areas of the brain associated with language processing. Here, we review progress in basic neuroscience research and its translational impact on the neurorehabilitation of language disorders after stroke.","DOI":"10.1038/nrneurol.2010.201","ISSN":"1759-4766","note":"PMID: 21297651","journalAbbreviation":"Nat Rev Neurol","language":"eng","author":[{"family":"Berthier","given":"Marcelo L."},{"family":"Pulvermüller","given":"Friedemann"}],"issued":{"date-parts":[["2011",2]]},"PMID":"21297651"}},{"id":181,"uris":[""],"uri":[""],"itemData":{"id":181,"type":"article-journal","title":"Dopaminergic therapy in aphasia","container-title":"Aphasiology","page":"155-170","volume":"28","issue":"2","source":"PubMed Central","abstract":"Background\nThe dopaminergic system is involved in a wide range of cognitive functions including motor control, reward, memory, attention, problem-solving and learning. This has stimulated interest in investigating the potential of dopaminergic drugs as cognitive enhancers in aphasic patients.\n\nAim\nTo discuss the evidence for the use of dopaminergic agents in patients with aphasia. Levodopa (L-dopa) and the dopamine agonist bromocriptine are the two drugs that have been trialled to date. We discuss, in some detail, the 15 studies that have been published on this topic from the first case report in 1988 to the present (2012), and assess the evidence from each.\n\nMain contribution\nIn addition to summarising the effectiveness of the drugs that have been tried, we examine the possible cognitive mechanisms by which dopaminergic drugs may act on language function and aphasia recovery. Given the wide range of dopaminergic drugs, it is surprising that such a narrow range has been trialled in aphasic patients. Important lessons are to be learned from published studies and we discuss optimal trial designs to help guide future work.\n\nConclusions\nThe evidence for the efficacy of dopaminergic agents in aphasia therapy is mixed. Further trials with better tolerated agents are required. Optimal trial designs with appropriate control groups or blocks should be used. The mechanism of action is unclear, but at the cognitive level the evidence points towards either (re)learning of word-forms or their improved retrieval.","DOI":"10.1080/02687038.2013.802286","ISSN":"0268-7038","note":"PMID: 25076804\nPMCID: PMC4095891","journalAbbreviation":"Aphasiology","author":[{"family":"Gill","given":"Sumanjit K."},{"family":"Leff","given":"Alexander P."}],"issued":{"date-parts":[["2012",2]]},"PMID":"25076804","PMCID":"PMC4095891"}}],"schema":""} (Berthier and Pulvermüller, 2011; Gill and Leff, 2012). This observation speaks to the wider potential of ‘gamification’, that is utilising the dynamic and engaging aspects of commercial gaming software to ramp up the engagement required for rehabilitation tasks ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"qv9tcsbiv","properties":{"formattedCitation":"(Ferreira et al., 2014)","plainCitation":"(Ferreira et al., 2014)"},"citationItems":[{"id":174,"uris":[""],"uri":[""],"itemData":{"id":174,"type":"paper-conference","title":"Gamification of Stroke Rehabilitation Exercises Using a Smartphone","container-title":"Proceedings of the 8th International Conference on Pervasive Computing Technologies for Healthcare","collection-title":"PervasiveHealth '14","publisher":"ICST (Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering)","publisher-place":"ICST, Brussels, Belgium, Belgium","page":"282–285","source":"ACM Digital Library","event-place":"ICST, Brussels, Belgium, Belgium","abstract":"Stroke is a disabling disease that requires extensive work of rehabilitation to improve the quality of life of patients. In order to increase the compliance and motivation of the patients, stroke rehabilitation exercises have been developed in a game-like structure using a smartphone. These games were designed to promote and evaluate different movements of the upper limbs and their level of difficulty is adaptable to each patient's impairment level. The feasibility of the use of smartphone built-in inertial sensors to monitor the execution of stroke rehabilitation exercises has been assessed. The accuracy of the angles measured decreased along time and for higher angles, nevertheless the differences between real and measured angles are within acceptable limits. The usability tests in a post-stroke patient case demonstrate the applicability and motivational potential of the developed games. Gamification of stroke rehabilitation exercises using a smartphone is feasible and may be valuable for stroke rehabilitation.","URL":"","DOI":"10.4108/icst.pervasivehealth.2014.255326","ISBN":"978-1-63190-011-2","author":[{"family":"Ferreira","given":"Carlos"},{"family":"Guimar?es","given":"V?nia"},{"family":"Santos","given":"António"},{"family":"Sousa","given":"Inês"}],"issued":{"date-parts":[["2014"]]}}}],"schema":""} (Ferreira et al., 2014). Although based on a limited number of items in each condition, the current results suggest that there might be clinically-notable differences between the two therapy approaches, particularly at longer-term follow up. These indications from the current experimental exploration will need to be confirmed in larger-scale studies, including formal clinical trials.References: ADDIN ZOTERO_BIBL {"custom":[]} CSL_BIBLIOGRAPHY Abel, S., Weiller, C., Huber, W., Willmes, K., Specht, K., 2015. Therapy-induced brain reorganization patterns in aphasia. 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Figure 5: Neural correlates of RISP - RISP Week 1 vs Baseline and Phonological ability; RISP Month 1 vs Baseline and Phonological ability. Supplementary FigureSupplementary Figure 1: Distribution of the PCA component scores for the therapy subgroup vs. the full patient sample. Tables Table 1: Treatment ProtocolsTable 2: Participant performance on naming accuracy as percentage for treated items at the mid-treatment point. Table 3: Factor loadings from the principal component analysis on the entire dataset (N=70). Supplementary TablesSupplementary Table 1: Participant Demographic Details including baseline scores and aphasia subtypesSupplementary Table 2: Participant performance on language, semantic and cognitive assessments converted into percentage.Supplementary Table 3: Participant performance on further language, semantic and cognitive assessments converted into percentage. ................
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