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Objective . One out of three stroke-patients develop language processing impairment known as aphasia. The need for ecological validity of the existing diagnostic tools motivates research on biomarkers, such as stimulus-evoked brain responses. With the aim of enhancing the physiological interpretation of the latter, we used EEG to investigate how functional brain network patterns associated with the neural response to natural speech are affected in persons with post-stroke chronic aphasia. Approach . EEG was recorded from 24 healthy controls and 40 persons with aphasia while they listened to a story. Stimulus-evoked brain responses at all scalp regions were measured as neural envelope tracking in the delta (0.5-4 Hz), theta (4-8 Hz) and low-gamma bands (30-49 Hz) using mutual information. Functional connectivity between neural-tracking signals was measured, and the Network-Based Statistics toolbox was used to: (1) assess the added value of the neural tracking vs EEG time series, (2) test between-group differences and (3) investigate any association with language performance in aphasia. Graph theory was also used to investigate topological alterations in aphasia. Main results . Functional connectivity was higher when assessed from neural tracking compared to EEG time series. Persons with aphasia showed weaker low-gamma-band left-hemispheric connectivity, and graph theory-based results showed a greater network segregation and higher region-specific node strength. Aphasia also exhibited a correlation between delta-band connectivity within the left pre-frontal region and language performance. Significance. We demonstrated the added value of combining brain connectomics with neural-tracking measurement when investigating natural speech processing in post-stroke aphasia. The higher sensitivity to language-related brain circuits of this approach favors its use as informative biomarker for the assessment of aphasia., (© 2024 IOP Publishing Ltd. All rights, including for text and data mining, AI training, and similar technologies, are reserved.)

Background: The abbreviated version of the Token Test (aTT) is widely used to assess language comprehension deficits in stroke patients (SPs). However, aTT has not been validated for Latin American Spanish speakers, so clinicians tend to use cut-off scores for aTT validated in developed countries., Aims: To provide normative data for the Spanish aTT (Sp-aTT) in healthy Chilean Spanish-speaking and SP, determining the influence of sociodemographic variables such as gender, age and education on Sp-aTT performance., Methods & Procedures: A total of 210 healthy volunteers (age range = 18-88 years) and 197 SPs (age range = 23-94 years), all native speakers of Chilean Spanish, were recruited. The association of age, gender and years of education on the Sp-aTT performance was analysed. Specificity and sensibility analyses of the Sp-aTT to diagnose language comprehension deficits were completed., Outcomes & Results: Only age (p < 0.001) and years of education (p < 0.001) impacted the total score of Sp-aTT. Gender did not show an association with Sp-aTT performance (p = 0.181). For SPs, the Sp-aTT score showed a significant positive correlation (rho = 0.4, p < 0.001) with the aphasia severity rating scale (ASRS) score. For Sp-aTT, the area under the curve was 0.97, and the optimal cut-off score for the Sp-aTT was 30 (0.73 of sensitivity, 0.92 of specificity and a Youden index of 0.644)., Conclusions & Implications: Age and years of education are two key factors to be controlled for when determining the optimal cut-off points for the Sp-aTT. Our results also highlight the need for language-specific norms in stroke and aphasia research., What This Paper Adds: What is already known on the subject The aTT has been validated and adapted in several countries. Its properties in screening and detecting comprehensive deficits in SPs highlight its potential as a screening tool in clinical practice. Moreover, considering that stroke is the third largest cause of death worldwide, research and clinical practice have focused on how to improve early detection of deficits in these people, especially those related to cognition, language and functionality in SPs. Therefore, counting with validated and adapted tools is essential for clinicians because it could contribute to accurate intervention and classification of language disorders. What this paper adds to the existing knowledge The main contribution of this study is to provide normative data for the aTT in Latin American Spanish speakers. No previous studies have focused on validating this test and analysing the influence of three critical variables (age, gender and years of education) on its performance in SPs from Latin America. In addition, we propose a classification of the severity of comprehension deficits in SPs. Finally, we found comprehension deficits in patients with right and left hemisphere stroke, which would imply that these deficits would not be exclusive to left hemisphere stroke. What are the potential or actual clinical implications of this work? Contribute with validation of language comprehension tools, such as the aTT, could improve early diagnosis of patients with language disorders. This validation provides a test based on the sociodemographic characteristics of Latin American Speakers, which has yet to be established. Due to this, normative data considering the sociodemographic characteristics of the target population is crucial for accurately classifying comprehension deficits after brain damage., (© 2024 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Purpose: The purpose of this study was to examine the cognitive functions of Mandarin speakers with poststroke aphasia and to investigate the relationship between nonlinguistic cognitive deficits and the severity of aphasia., Method: Twenty-three adults with aphasia resulting from left-hemispheric stroke and 23 adults matched for age and educational level completed a series of six nonlinguistic cognitive tests measuring nonverbal intelligence, short-term memory, visual selective attention, visual alternating attention, auditory selective attention, and auditory alternating attention. A standardized aphasia assessment (Concise Chinese Aphasia Test [CCAT]) was also conducted to evaluate the severity of aphasia. Data analyses examined cognitive functions by comparing task performance of the two groups and examining the relationship between scores on the cognitive tasks and aphasia severity based on a hierarchical regression analysis., Results: The aphasia group scored significantly lower than the control group on all nonlinguistic cognitive tasks with large effect sizes ( d = 0.95 ~ 1.54). Significant associations between different nonlinguistic cognitive tasks and CCAT subtests were observed. Results from the hierarchical regression analysis showed that auditory alternating attention was the only factor that significantly predicted aphasia severity based on CCAT overall scores after age and education level were taken into account., Conclusions: The findings align with prior research observing deficits in nonlinguistic cognition in individuals with aphasia. Implications for clinical practice and future research are discussed.

Objective: To analyse and discuss the association of gender differences with the risk and incidence of poststroke aphasia (PSA) and its types, and to provide evidence-based guidance for the prevention and treatment of poststroke aphasia in clinical practice., Data Sources: Embase, PubMed, Cochrane Library and Web of Science were searched from January 1, 2002, to December 1, 2023., Study Selection: Including the total number of strokes, aphasia, the number of different sexes or the number of PSA corresponding to different sex., Data Extraction: Studies with missing data, aphasia caused by nonstroke and noncompliance with the requirements of literature types were excluded., Data Synthesis: 36 papers were included, from 19 countries. The analysis of 168,259 patients with stroke and 31,058 patients with PSA showed that the risk of PSA was 1.23 times higher in female than in male (OR = 1.23, 95% CI = 1.19-1.29, P < 0.001), with a prevalence of PSA of 31% in men and 36% in women, and an overall prevalence of 34% (P < 0.001). Analysis of the risk of the different types of aphasia in 1,048 patients with PSA showed a high risk in females for global, broca and Wenicke aphasia, and a high risk in males for anomic, conductive and transcortical aphasia, which was not statistically significant by meta-analysis. The incidence of global aphasia (males vs. females, 29% vs. 32%) and broca aphasia (17% vs 19%) were higher in females, and anomic aphasia (19% vs 14%) was higher in males, which was statistically significant (P < 0.05)., Conclusions: There are gender differences in the incidence and types of PSA. The risk of PSA in female is higher than that in male., (© 2024. The Author(s).)

Introduction: Aphasia and neglect in combination with hemiparesis are reliable indicators of large anterior vessel occlusion (LAVO). Prehospital identification of these symptoms is generally considered difficult by emergency medical service (EMS) personnel. Therefore, we evaluated the simple non-paretic-hand-to-opposite-ear (NPE) test to identify aphasia and neglect with a single test. As the NPE test includes a test for arm paresis, we also evaluated the diagnostic ability of the NPE test to detect LAVO in patients with suspected stroke., Methods: In this prospective observational study, we performed the NPE test in 1042 patients with suspected acute stroke between May 2021 and May 2022. We analyzed the correlation between the NPE test and the aphasia/neglect items of the National Institutes of Health Stroke Scale. Additionally, the predictive values of the NPE test for LAVO detection were calculated., Results: The NPE test showed a strong, significant correlation with both aphasia and neglect. A positive NPE test result predicted LAVO with a sensitivity of 0.70, a specificity of 0.88, and an accuracy of 0.85. Logistic regression analysis showed an odds ratio of 16.14 (95% confidence interval 10.82-24.44) for predicting LAVO., Conclusion: The NPE test is a simple test for the detection of both aphasia and neglect. With its predictive values for LAVO detection being comparable to the results of LAVO scores in the prehospital setting, this simple test might be a promising test for prehospital LAVO detection by EMS personnel. Further prospective prehospital validation is needed., (© 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Background People with aphasia experience depression and anxiety associated with negative outcomes across a range of time post-stroke. Stroke clinicians are well-positioned to facilitate low-intensity psychotherapeutic interventions after aphasia (e.g. mood screening, behavioural activation, problem-solving therapy, relaxation therapy); however, they self-report a lack of knowledge, skills and confidence to do so. The Theoretical Domains Framework (TDF) provides a lens through which to view and target clinician behaviours and training needs in this area of practice. The aim of this study was to develop and gain consensus on items for a rating scale of clinical competencies in facilitating individual-based, low-intensity psychotherapeutic interventions for people with aphasia. Methods An e-Delphi methodology using focus groups and survey rounds was used to gain consensus on clinical competencies considered important. Results Eight stroke clinicians (speech pathologists and psychologists), two people with aphasia and three family members participated in one of four focus groups. Four themes were derived from the data: (1) Communication support, (2) Assessment and therapy structure, (3) Interpersonal skills, and (4) Needs of the significant other (family or friend). Themes informed an initial list of 23 self-rated and observer-rated competency items. Following two rounds of e-Delphi surveys, 11 stroke clinicians (six speech pathologists and five psychologists) reached consensus (80-100%) for 19 competencies. Conclusions The Psychological Care in Aphasia Rehabilitation Competency scale offers a preliminary list of items to guide and train clinicians to implement low-intensity psychotherapeutic interventions for people with aphasia.

Purpose: Behavioral intervention targeting speech, language, and communication concerns is an established therapeutic approach for patients with communication concerns across a range of acquired neurogenic disorders. The multidimensional factors that contribute to a person's self-identified communication challenges and strengths in their daily communication needs must be considered to provide functional and person-centered care. While assessments grounded in clinician observation or client self-report exist, there is a direct need for a screening tool that comprehensively evaluates the roles of modality (verbal, text, gesture) and environment (in-person, virtual) on self-reported success across communicative demands. In this study, we describe a preliminary approach to monitoring the progression of receptive and expressive communication skills in people with chronic poststroke aphasia in the context of communication practices of the 21st century, culminating in the development and exploratory implementation of a novel clinical instrument: the Communication Success Screener (COMSS)., Method: Thirty-three participants with aphasia due to stroke were recruited to complete and evaluate the COMSS via an online survey. Quantitative responses and open-ended participant feedback were collected to validate and propose adaptations to the COMSS. Group-level analyses and case presentations were used to highlight COMSS features and outcomes., Results: Participant responses to the COMSS questionnaire suggest that this screening tool creates differentiated communicative success profiles based on self-report. Participant feedback also indicated that the COMSS appropriately evaluates self-reported success across modalities of verbal, text, and gesture in the context of in-person and virtual environments., Conclusions: The communication concerns experienced by people with aphasia are often heterogeneous and vary as a function of their daily activities of living, preferred language modalities, and environmental supports. We present preliminary feasibility analyses of the COMSS as a potential tool to support the monitoring of functional change by evaluating self-reported communicative success across form, modality, environment, and task demand., Supplemental Material: https://doi.org/10.23641/asha.24521044.

Introduction: The quick aphasia battery (QAB), which assesses all areas of language in detail and quickly, was developed in English. It has been shown to be suitable for bedside patients. There is a need for a Turkish bedside test that allows for a comprehensive yet rapid assessment of stroke patients in terms of aphasia. The aim of this study was to create a Turkish version of QAB (QAB-TR) and to determine its validity and reliability in Turkish-speaking patients after a stroke., Materials and Methods: The study was conducted with 188 people aged 41-88 years. Of these, 37 (19.7%) had aphasia (12 chronic, 25 acute), 53 (28.2%) were acute stroke patients without aphasia, and 98 (52.1%) were healthy controls. Internal consistency and criterion validity, test-retest reliability, and inter-rater reliability of the QAB-TR were performed. The language assessment test for aphasia was used for criterion validity. For the inter-rater reliability of the test, two different speech language therapists (SLP) administered the QAB-TR. For test-retest reliability, 2 weeks later, the same SLP who filled out the QAB-TR the first time was administered the test again. To test the validity of the test, correlations between the items and subsections were determined. Receiver operating characteristic (ROC) analysis was performed to examine the sensitivity and selectivity of the QAB-TR score, and a cut-off value was determined to distinguish patients with aphasia., Results: The inter-rater Krippendorff's alpha value of the QAB-TR total was 0.6754. There was no statistically significant difference (p > .05) between the first and second QAB-TR total scores. The correlation analysis between the QAB-TR subsection scores and the total QAB-TR score (0.244-0.897) revealed statistically significant relationships. The area under the ROC curve was statistically significant and was found to be 0.853 (95% confidence interval: 0.799-0.906). The cut-off point for the QAB score to discriminate between patients with aphasia and those without aphasia was found to be 8.825, with 0.767 sensitivity and 0.765 selectivity (1-0.235)., Conclusion: All the study results show that QAB-TR has internal consistency, criterion validity, test-retest reliability, and inter-rater reliability. It can be administered in as little as 15 min and provides information about the multidimensional linguistic profiles of individuals. QAB-TR can be used for both clinical and study purposes as a language battery that allows for the measurement of the strengths and weaknesses of Turkish-speaking individuals who have suffered a stroke in basic language areas in acute and chronic periods. It can be easily administered at the bedside for individuals who have just suffered an acute stroke and can facilitate early assessment of individuals in terms of aphasia and early initiation of therapy, if necessary., (© 2023 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Purpose: Individuals with non-traumatic subarachnoid haemorrhage (SAH) are often excluded from studies of stroke populations due to differing pathophysiology and treatment pathways. Thus, aphasia presentation in the non-traumatic SAH population is potentially under-represented within existing research evidence., Materials and Methods: Five databases were systematically searched with terms related to "aphasia" and "subarachnoid haemorrhage." Studies were included if aphasia was attributed to non-traumatic SAH or its associated complications, and where at least one language assessment measure used determined the presence or absence of aphasia. Study quality was evaluated using the Mixed Methods Appraisal Tool (MMAT)., Results: Following deduplication, 2726 articles were identified for title and abstract screening. Full text screening for 162 articles occurred, with 18 articles selected for inclusion. Aphasia incidence ranged from 5 to 24%, and was influenced by assessment measure, timing of assessment, subgroup studied, and classifications of aphasia. Many studies excluded participants with poorer clinical outcome, intracerebral complications, or severe aphasia. Few studies used comprehensive language assessment measures to examine across language domains., Conclusions: Aphasia presentation is highly heterogenous following non-traumatic SAH. Future research using comprehensive language assessments at multiple time points post onset is required to better understand aphasia presentation and management needs for this population.

Aphasia is a systemic disorder of formed speech that develops as a result of local brain lesions. Most aphasias are characterized by damage to secondary cortical fields, which in turn are responsible for the performance of the functions of gnosis and praxis, which explains the variability in the manifestations of speech disorders in patients with acute cerebrovascular accidents. However, it is necessary in each case to diagnose the central pathological mechanism, which underlies the development of the entire syndrome and determines the entire clinical picture. The most important task of a speech therapist-aphasiologist is to qualify the defect, namely to isolate the mechanism and analyze the syndrome in order to select individual methods of corrective restoration. This article presents a case of a patient with an ischemic stroke in the left posterior cerebral artery with the development of amnestic aphasia in combination with alexia without agraphia.

Purpose: Slow speech rate and abnormal temporal prosody are primary diagnostic criteria for differentiating between people with aphasia who do and do not have apraxia of speech. We sought to identify appropriate cutoff values for abnormal word syllable duration (WSD) in a word repetition task, interpret them relative to a data set of people with chronic aphasia, and evaluate the extent to which manually derived measures could be approximated through an automated process that relied on commercial speech recognition technology., Method: Fifty neurotypical participants produced 49 multisyllabic words during a repetition task. Audio recordings were submitted to an automated speech recognition (ASR) service (IBM Watson) to measure word duration and generate an orthographic transcription. The transcribed words were compared to a lexical database, and the number of syllables was identified. Automatic and manual measures were compared for 50% of the sample. Results were interpreted relative to WSD scores from an existing data set of 195 people with mostly chronic aphasia., Results: ASR correctly identified 83% of target words and 98% of target syllable counts. Automated word duration calculations were longer than manual measures due to imprecise cursor placement. Upon applying regression coefficients to the automated measures and examining the frequency distributions for both manual and estimated measures, a WSD of 303-316 ms was found to indicate longer-than-normal performance (corresponding to the 95th percentile). With this cutoff, 40%-45% of participants with aphasia in our comparison sample had an abnormally long WSD., Conclusions: We recommend using a rounded WSD cutoff score between 303 and 316 ms for manual measures. Future research will focus on customizing automated WSD methods to speech samples from people with aphasia, identifying target words that maximize production and measurement reliability, and developing WSD standard scores based on a large participant sample with and without aphasia.

Background: Care partners of people with aphasia after stroke need various informational supports, such as aphasia education and resources for psychosocial support. However, informational support may vary across clinicians, and access to these supports remains a persistent unmet need. Using implementation science frameworks can help to assess the gap between what is known about an issue and what is occurring in practice., Aim: The aim was to identify barriers to providing informational support for care partners of people with aphasia after stroke., Method and Procedure: We performed a secondary analysis of qualitative data collected from two of our previous studies. New themes were identified by comparing feedback from both speech-language pathologists and care partners, and previously assigned codes were interpreted relative to the Knowledge to Action (KTA) framework., Outcomes and Results: We identified four implementation themes that were specifically related to the action cycle of the KTA framework: (a) Aphasia rehabilitation tends to exclude care partners, (b) aphasia rehabilitation can be hard to understand, (c) structure is lacking for care partner check-ins, and (d) care partner informational support rarely extends beyond the acute phases of recovery., Conclusion: The results suggest that changes are needed at both systemic and care provider levels to ensure that tailored information is provided to care partners of people with aphasia.

Introduction: The National Institutes of Health Stroke Scale (NIHSS), originally designed in the United States of America, contains items on dysphasia and dysarthria that are deemed culturally unsuitable for the Singapore context. We compared the error rates of dysphasia objects, dysphasia phrases and dysarthria words between the original and alternative items in a cohort of Singaporean subjects without dysphasia or dysarthria., Methods: In this prospective study, 140 English-speaking Singaporean subjects without impairments of dysphasia or dysarthria had an assessment of NIHSS items 9 and 10 using the original and alternative items. Paired analyses were conducted for comparison of error rates., Results: The error rates were high for four original dysphasia objects (Hammock: 62.9%, Cactus: 38.6%, Feather: 23.6%, Glove: 20.7%) and significantly lower for alternative items (Snail: 5%, Horse: 1.4%, Hanger: 1.4%, Car: 0%) (P < 0.001). For dysphasia phrases and dysarthria words, the error rates were low and there were no differences in error rates between the original and alternative items., Conclusion: There are cultural issues with several dysphasia objects in the original NIHSS as evidenced by the high error rates, which were lowered with more culturally suitable alternatives. This study formed a basis to derive a more suitable version of the NIHSS for English-speaking subjects in Singapore., Competing Interests: None

Purpose: Behaviorally, acquired apraxia of speech (AOS) is a multidimensional syndrome that the experienced clinician recognizes based on impaired articulation and abnormal temporal prosody. We conducted this study to determine the extent to which three core features of AOS-when defined quantitatively-distinguish categorically among aphasia with no or minimal speech sound involvement, aphasia with AOS, and aphasia with phonemic paraphasia (APP)., Method: The study involved retrospective analysis of 195 participants with stroke-induced aphasia. We used three quantitative measures (phonemic error frequency, distortion error frequency, and word syllable duration [WSD]) to divide the sample into four participant groups according to the most likely speech diagnosis: aphasia with minimal speech sound errors, AOS, APP, and a borderline group with mixed profiles. We then conducted nonparametric comparisons across groups for which the measures were not defined and visualized all three measures in a three-dimensional graph., Results: The measures distributed as multidimensional spectra rather than discrete diagnostic entities, and there was considerable behavioral overlap among participant groups. Thirty percent of participants presented with aphasia with minimal sound production difficulties, and they were statistically indistinguishable from the APP group on distortion frequency and WSD. Distortion frequency and WSD were in a borderline region between AOS and APP for 29% of participants. Compared to all other groups, participants with AOS produced significantly more errors that affected listeners' phonemic perception., Conclusions: The results suggest that the current AOS-APP dichotomy has limited validity. We conclude that a continuous multidimensional view of speech variation would be a constructive perspective from which to understand how the left cerebral hemisphere produces speech and that quantitative and normed speech measures should be used to inform differential diagnosis in clinical settings., Supplemental Material: https://doi.org/10.23641/asha.21807609.

The Hungarian Aphasia Screening Test (HAST) is a newly developed diagnostic tool for detecting post-stroke aphasia in clinical settings, and for differentiating between stroke patients with and without aphasia. The HAST was developed by our team and has not been published in English yet. In Hungarian, to date, there is no aphasia screening test with reported psychometric properties available. This study aims to present the main characteristics of the HAST and to evaluate its validity, internal consistency, and diagnostic accuracy. The HAST comprises five subtests (maximum score: 20) and takes 5-10 minutes to administer. We administered the HAST to 40 stroke patients with aphasia, 26 stroke patients without aphasia, and 51 healthy control participants to evaluate the test's construct validity, convergent validity, and internal consistency, as well as its sensitivity and specificity. We used the Western Aphasia Battery (WAB) as a reference test. With a cut-off score of 17, the HAST showed high diagnostic accuracy (sensitivity: 92.5%, specificity: 88.5%). Its construct validity was good; we identified one component in the test, and moderate-to-strong positive correlations across most of its subtests (mean Spearman r = 0.56). Convergent validity of the HAST was satisfying, reflected by the moderate-to-strong positive correlations between subtests of the HAST and subtests of the WAB (Spearman r = 0.50-0.86). The correlation between the HAST total score and the WAB aphasia quotient was high (Spearman r = 0.86). Despite the small number of items within tasks, all subtests showed acceptable internal consistency (mean Cronbach's α = 0.74). Our preliminary results suggest that the HAST is a valid, accurate, and clinically feasible test to detect post-stroke aphasia and to identify patients who require a more detailed assessment of their language skills. In addition, it reliably identifies not only the presence but also the severity of aphasia, thus, it might be a good candidate for monitoring patient progress., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Zakariás, Lukács. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Brain structure deteriorates with aging and predisposes an individual to more severe language impairments (aphasia) after a stroke. However, the underlying mechanisms of this relation are not well understood. Here we use an approach to model brain network properties outside the stroke lesion, network controllability, to investigate relations among individualized structural brain connections, brain age, and aphasia severity in 93 participants with chronic post-stroke aphasia. Controlling for the stroke lesion size, we observe that lower average controllability of the posterior superior temporal gyrus (STG) mediates the relation between advanced brain aging and aphasia severity. Lower controllability of the left posterior STG signifies that activity in the left posterior STG is less likely to yield a response in other brain regions due to the topological properties of the structural brain networks. These results indicate that advanced brain aging among individuals with post-stroke aphasia is associated with disruption of dynamic properties of a critical language-related area, the STG, which contributes to worse aphasic symptoms. Because brain aging is variable among individuals with aphasia, our results provide further insight into the mechanisms underlying the variance in clinical trajectories in post-stroke aphasia., (© 2023. The Author(s).)

Aphasia nearly affects half of all poststroke patients. Furthermore, aphasia affects all language functions, well-being, and quality of life of patients. Therefore, rehabilitation of patients with aphasia requires an accurate assessment of language function and psychological aspects. However, assessment scales for language function and psychological aspects of patients with aphasia are said to be inaccurate. In Japan, this sign is more prominent than in English-speaking countries. Therefore, we are putting together a scoping review of research articles published in English and Japanese to date, with the aim of summarizing the accuracy of rating scales for language function and psychological aspects of people with aphasia. The scoping review was intended to be a comprehensive examination of the accuracy of rating scales for people with aphasia. We will search the article databases PubMed, MEDLINE, Embase, PsycINFO, Web of Science, and the Medical Journal Web (Japan). The observational studies that describe the reliability and validity of the rating scales in adult aphasic after stroke will be searched for. There will be no publication date for the articles that will be searched. We believe that this scoping review aims to assess the accuracy of rating scales used to measure different aspects of aphasia, with a focus on research conducted in English-speaking countries and Japan. By conducting this review, we believe to identify any problems with rating scales used in English and Japanese research and improve their accuracy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kodani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Individuals with aphasia may have impairments in cognition, higher incidences of depression, and a variety of post-stroke functional impairments. However, evaluating these issues is challenging since most assessments require some degree of linguistic processing and task instructions are often verbal. Heart rate variability has shown to be an objective marker for cognitive functioning in neurologically healthy individuals, depression and post-stroke depression, and post-stroke functional impairments. However, before the utility of heart rate variability is established in persons with aphasia, its test-retest reliability needs to be established. The purpose of this study was to assess test-retest reliability of heart rate variability metrics in persons with aphasia. Heart rate variability was recorded at rest while in a sitting position in twenty-one persons with aphasia at two time points. Heart rate variability metrics were mostly moderately reliable. The majority of participants had resting heart rate variability parasympathetic and sympathetic indexes similar to those of neurologically healthy individuals. Further research is needed to establish the test-retest reliability of heart rate variability metrics in different postures and breathing conditions in persons with aphasia.

Post-stroke aphasia recovery is multifactorial and results from a complex equation between four types of interrelated factors : a) neurobiological factors, such as lesion size and location, but also to some extent the neural reserve in undamaged brain areas ; b) behavioral factors, mostly related to the initial severity of stroke symptoms ; c) personal factors, such as age and gender, that remain however poorly investigated and debated and d) therapeutic factors, related to medical endovascular interventions and to speech and language therapy. Future studies are crucial to determine more precisely the weight and the interaction of these factors in the recovery process of post-stroke aphasia., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Aphasia is often accompanied by impairment of non-language cognitive functions. Assessment of cognitive capacity in people with aphasia (PWA) with standard neuropsychological methods may be problematic due to their language difficulties. Numerous experimental studies indicate that P300 may be considered as an index of cognitive capacity in both healthy and clinical samples. Accordingly, the measurement of event-related potentials enables the investigation of behaviourally non-observable mental processes underlying the cognitive functions that are assessed with neuropsychological tests., Aims: To investigate in PWA the relationship between P300 parameters and cognitive function efficiency measured with neuropsychological methods., Methods & Procedures: A total of 25 PWA after left-hemispheric stroke participated in the study. Electrophysiological (EEG) signals were recorded during the performance of a visual Go-No Go task. P300 was identified on nine electrodes, which were then pooled in three lines: left (F3, C3, P3), central (Fz, Cz, Pz) and right (F4, C4, P4). The neuropsychological assessment of cognitive functions included mental speed, short-term memory, divided attention, executive functions, auditory language comprehension and expression., Outcomes & Results: P300 latency correlated with indices of several cognitive functions: temporal resolution, psychomotor speed, spatial short-term memory, planning, word and sentence comprehension, as well as verbal fluency. Shorter P300 latencies were accompanied by greater efficiency of the abovementioned functions. In contrast, significant correlations between P300 amplitudes and cognitive measures were fragmentary., Conclusions & Implications: In PWA, P300 latency might be related to cognitive functioning, especially to measures that rely heavily on the speed of information processing. However, P300 seems to be unrelated to more complex cognitive functions. P300 latency may be used as a neurophysiological correlate of cognitive efficiency in PWA and might have potential applications in monitoring the effects of therapeutic interventions in this patient group., What This Paper Adds: What is already known on the subject P300 parameters have been reported to be associated with cognitive performance in both healthy individuals and clinical groups (e.g., patients with Alzheimer's disease). Previous studies show that the presence of P300 at the early post-stroke stage may be a predictor of better recovery of comprehension in PWA. What this paper adds to existing knowledge Our results show for the first time that P300 may be used as a neurophysiological correlate of cognitive efficiency in PWA. In our study, P300 latency was associated with several languages and non-language cognitive functions, especially with those whose effectiveness depends mainly on processing speed. In PWA, shorter latency corresponded to more efficient cognitive functioning. What are the potential or actual clinical implications of this work? P300 measurement may be potentially useful in assessing the efficiency of certain cognitive functions in PWA. It may be also used to monitor the recovery process of PWA and to verify the effects of therapeutic interventions., (© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

The rehabilitation of aphasics is fundamentally based on the assessment of speech impairment. Developing methods for assessing speech impairment automatically is important due to the growing number of stroke cases each year. Traditionally, aphasia is assessed manually using one of the well-known assessment batteries, such as the Western Aphasia Battery (WAB), the Chinese Rehabilitation Research Center Aphasia Examination (CRRCAE), and the Boston Diagnostic Aphasia Examination (BDAE). In aphasia testing, a speech-language pathologist (SLP) administers multiple subtests to assess people with aphasia (PWA). The traditional assessment is a resource-intensive process that requires the presence of an SLP. Thus, automating the assessment of aphasia is essential. This paper evaluated and compared custom machine learning (ML) speech recognition algorithms against off-the-shelf platforms using healthy and aphasic speech datasets on the naming and repetition subtests of the aphasia battery. Convolutional neural networks (CNN) and linear discriminant analysis (LDA) are the customized ML algorithms, while Microsoft Azure and Google speech recognition are off-the-shelf platforms. The results of this study demonstrated that CNN-based speech recognition algorithms outperform LDA and off-the-shelf platforms. The ResNet-50 architecture of CNN yielded an accuracy of 99.64 ± 0.26% on the healthy dataset. Even though Microsoft Azure was not trained on the same healthy dataset, it still generated comparable results to the LDA and superior results to Google's speech recognition platform.

Objective: To identify the features of the clinical picture and evaluate the dynamics of regression of neurodynamic speech disorders in comparison with cortical aphasia in patients with ischemic stroke (IS) in the carotid system., Material and Methods: We examined 268 patients with a median age of 59 (54; 70) years in the acute period of IS in the dominant hemisphere with the presence of cortical aphasia or neurodynamic speech disorders. The degree of speech recovery was characterized by an increase in the score on the Speech Questionnaire (ΔSQ) from 1 to 21 days after the development of IS. The patients were divided into group 1 ( n =148) with a low level of recovery (ΔSQ≤6) and group 2 ( n =120) with a high level (ΔSQ >6)., Results: Of the 268 patients, cortical aphasia was detected in 171 (63.8%) patients, and neurodynamic speech disorders characterized by significant variability of symptoms over the course of hours and days were detected in 97 (36.2%) patients. In patients with cortical aphasia, the majority of patients (63.2%) were classified into group 1, and among patients with neurodynamic speech disorders - into group 2 (58.8%), which showed the stability of the regression dynamics of speech disorders ( p =0.001). In patients with cortical lesions the impressive side of speech suffered more often - in this group patients with sensorimotor aphasia predominate. In the case of neurodynamic speech disorders, motor and sensorimotor disorders are observed with approximately the same frequency ( p =0.002)., Conclusion: In comparison with cortical aphasias, the sensory component of speech suffers to a lesser extent in neurodynamic speech disorders. Neurodynamic speech disorders generally recover faster and more fully.

Introduction: Although aphasia screening tools are widely used internationally, in Hungarian, to date, there have been no aphasia screening tests with reported psychometric properties available., Objective: (1) To provide an overview of the international practice and the tools of post-stroke aphasia screening. (2) To present a recently developed aphasia screening test in Hungarian., Method: The Hungarian Aphasia Screening Test comprises five tasks assessing speech comprehension and production, and takes 5-10 minutes to complete. The test is easy to score and needs little equipment, therefore it can be useful in any clinical setting that allows for quick test administration and diagnostics. Based on results of two studies, we evaluate the psychometric properties and the diagnostic accuracy of the test, and determine three impairment severity ranks (mild, moderate, severe aphasia) for the test. The severity ranks were defined based on results of 70 people with post-stroke aphasia (35 women; average age: 61.4 years; average postonset: 12.6 months)., Results: The test has high diagnostic accuracy, a sensitivity of 92.5% and a specificity of 88.5%. It shows acceptable structural and concurrent (MR = 0.68) validity as well as good internal consistency (Mα = 0.74). The cut-off score for diagnosing aphasia is 17., Discussion: The test can differentiate stroke patients with and without aphasia. With the use of the test, patients' aphasia can be rated as mild (score 14-17), moderate (score 9-13), or severe (score 0-8). Our results suggest that it is a reliable and valid screening tool., Conclusion: The test can detect the presence and quantify the severity of aphasia. We discuss the importance of aphasia screening in clinical settings and of the use of the Hungarian Aphasia Screening Test in the context of the international practices. Orv Hetil. 2022; 163(50): 2000-2008.

Patients with semantic aphasia have impaired control of semantic retrieval, often accompanied by executive dysfunction following left hemisphere stroke. Many but not all of these patients have damage to the left inferior frontal gyrus, important for semantic and cognitive control. Yet semantic and cognitive control networks are highly distributed, including posterior as well as anterior components. Accordingly, semantic aphasia might not only reflect local damage but also white matter structural and functional disconnection. Here, we characterise the lesions and predicted patterns of structural and functional disconnection in individuals with semantic aphasia and relate these effects to semantic and executive impairment. Impaired semantic cognition was associated with infarction in distributed left-hemisphere regions, including in the left anterior inferior frontal and posterior temporal cortex. Lesions were associated with executive dysfunction within a set of adjacent but distinct left frontoparietal clusters. Performance on executive tasks was also associated with interhemispheric structural disconnection across the corpus callosum. In contrast, poor semantic cognition was associated with small left-lateralized structurally disconnected clusters, including in the left posterior temporal cortex. Little insight was gained from functional disconnection symptom mapping. These results demonstrate that while left-lateralized semantic and executive control regions are often damaged together in stroke aphasia, these deficits are associated with distinct patterns of structural disconnection, consistent with the bilateral nature of executive control and the left-lateralized yet distributed semantic control network., (© 2022. The Author(s).)

Background and Purpose: Although findings from published studies suggest post-stroke aphasia is associated with an increased risk of dementia, few studies have evaluated its association in a nationally representative cohort with long-term follow-up. No studies have reported data by type of stroke. Therefore, we examined the association between post-stroke aphasia and the risk of developing dementia., Methods: Using claims data from Taiwan's universal health insurance program, a cohort of patients ≥18 years old with an initial hospitalization for stroke in 2002-2005 were identified and followed up until December 31, 2016. Patients with newly diagnosed aphasia during stroke hospitalization or within 6 months of discharge were defined as the aphasia group. Cox proportional hazards models were used to estimate hazard ratios (HRs) for developing overall, vascular, and non-vascular dementia in patients with and without post-stroke aphasia., Results: During a median follow-up period of 7.9 and 8.6 years for the aphasia (n=17063) and non-aphasia groups (n=105940), respectively, overall dementia incidence was similar, whereas vascular dementia incidence was higher in the aphasia group (7.52 vs. 5.52 per 1000 person-years). The adjusted HRs (95% confidence intervals) were 1.11 (1.06-1.17), 1.42 (1.31-1.53), and 0.94 (0.88-1.01) for overall, vascular, and non-vascular dementia, respectively. The association between aphasia and the risk of vascular dementia did not differ by stroke type (P for interaction=0.43). The analysis of 16856 propensity score-matched pairs revealed similar results., Conclusion: Patients with post-stroke aphasia have an increased risk of developing vascular dementia irrespective of the type of stroke., Competing Interests: Declaration of Competing Interest None to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: We present a 20-item naming test, the Severity-Calibrated Aphasia Naming Test (SCANT), that can serve as a proxy measure for an aphasia severity scale that is derived from a thorough test battery of connected speech production, single-word production, speech repetition, and auditory verbal comprehension., Method: We use lasso regression and cross-validation to identify an optimal subset from a set of 174 pictures to be named for prediction of aphasia severity, based on data from 200 participants with left-hemisphere stroke who were quasirandomly selected to represent the full impairment scale. Data from 20 healthy controls (i.e., participant caretakers/spouses) were also analyzed. We examine interrater reliability, test-retest reliability, sensitivity and specificity to the presence of aphasia, sensitivity to therapy gains, and external validity (i.e., correlation with aphasia severity measures) for the SCANT., Results: The SCANT has extremely high interrater reliability, and it is sensitive and specific to the presence of aphasia. We demonstrate the superiority of predictions based on the SCANT over those based on the full set of naming items. We estimate a 15% reduction in power when using the SCANT score versus the full test battery's aphasia severity score as an outcome measure; for example, to maintain the same power to detect a significant group average change in aphasia severity, a study with 25 participants using the full test battery to measure treatment effectiveness would require 30 participants if the SCANT were to be used as the testing instrument instead., Conclusion: We provide a linear model to convert SCANT scores to aphasia severity scores, and we identify a change score cutoff of four SCANT items to obtain a high degree of confidence based on test-retest SCANT data and the modeled relation between SCANT and aphasia severity scores., Supplemental Material: https://doi.org/10.23641/asha.21476871.

Background: Written communication has become an increasingly important part of everyday life in social, educational and professional spheres. The substantial increase in writing via the internet and mobile technologies provides both an opportunity for social engagement and distinct challenges for people with aphasia. Within the current literature there has been limited research into the lived experiences of people with aphasia of their writing difficulties and how these affect their ability to communicate., Aims: This qualitative study aimed to explore the experiences of people with aphasia of living with language-related writing difficulties and the impact of these on their lives., Methods & Procedures: Eight people with post-stroke aphasia and writing difficulties took part in semi-structured interviews. The interviews were analysed using inductive reflexive thematic analysis., Outcomes & Results: Two themes were found in the data. The first theme was a gradual and effortful improvement to writing: Participants described how writing had improved since their stroke due to strategies and support, but they still found writing to be difficult and frustrating and described many barriers to writing. The second theme was the importance of writing for fulfilling adult social roles: Participants found writing to be important for communicating with family, friends and organizations, but their participation in society and self-esteem and confidence were impacted by writing difficulties; reduced social roles meant reduced need for writing, but participants were still motivated to work towards writing goals., Conclusions & Implications: The findings demonstrate the emerging importance of writing skills for people with aphasia with respect to communication, well-being, participation and inclusion in society, and carrying out social roles. They provide an insight into the process of improvement, including the difficulties, facilitators and barriers. Implications for speech and language therapy assessment and management are discussed., What This Paper Adds: What is already known on the subject People with aphasia have difficulties with writing that can affect their ability to communicate. A small body of qualitative research has provided insights into individuals' experiences of literacy difficulties. More research is needed to understand the writing experiences of people with aphasia to help design appropriate assessments and interventions. What this paper adds to existing knowledge Participants experienced gradual and effortful improvement since their stroke. They felt negative about aspects of their writing, including speed, accuracy and range of vocabulary. Writing was facilitated through assistive technologies, spelling practice and support from others; barriers included technology, lack of time, stroke-related symptoms and others' lack of awareness about aphasia. Participants considered writing skills to be important, particularly for communication, carrying out adult social roles and participating in society, and were therefore still working towards goals related to everyday writing activities. What are the potential or actual clinical implications of this work? This study suggests that speech and language therapy assessment should include interviewing participants about their activities, strengths, difficulties, facilitators and barriers in writing, and informal assessment of a range of functional writing tasks. Intervention should be tailored to the individual's needs. This should include meaningful activities that relate to functional everyday writing and, where appropriate, self-management, compensatory technologies and group approaches, while making use of existing strategies identified by the individual., (© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

A rapid evidence review (RER) of empirical literature was conducted to explore aphasic stroke survivors' mental health outcomes and lived experiences, as well as the screening instruments for this cohort. The RER was informed by a critical disability theory approach and synthesised qualitative and quantitative evidence within and across 29 studies, published between 2000 and 2021, from a systematic search of three databases. Understanding the relationship between post-stroke aphasia and mental health outcomes is essential for developing comprehensive treatment strategies and designing appropriate long-term care. Available screening instruments currently only detect depression and anxiety, which are then used to detect further mental health issues. The RER revealed that the current screening instruments demonstrate reliability; however, research remains limited regarding their validity. Furthermore, limited studies include aphasic patients as participants and decision-makers in stroke research. Methodological limitations across studies include comparators and small sample sizes. Importantly, across the studies, there is a lack of representation of culturally diverse and minority participants. Overall, the RER results found a high prevalence of aphasic stroke survivors experiencing depression and other mental health outcomes, indicating that implementing mood screening in a timely manner is essential. In addition, the results support that psychological care pathways must be developed and evaluated in consultation with aphasic patients' and carers' lived experiences to identify stepped levels of care and establish appropriate screening instruments. Furthermore, the health system requires consistency, which would ideally be achieved by establishing staff roles and responsibilities regarding mood screening and supportive care in these psychological care pathways. Including mental health specialists such as social workers and establishing specialist training in the multidisciplinary team would support this endeavour. There is a need for further research regarding mood screening instruments, a diversity of aphasic stroke survivors' lived experiences and the clinical expertise of those providing psychological support., (© 2021 John Wiley & Sons Ltd.)

Background: Treatment fidelity is inconsistently reported in aphasia research, contributing to uncertainty about the effectiveness of types of aphasia therapy following stroke. We outline the processes and outcomes of treatment fidelity monitoring in a pre-specified secondary analysis of the VERSE trial., Methods: VERSE was a 3-arm, single-blinded RCT with a 12-week primary endpoint comparing Usual Care (UC) to two higher intensity treatments: Usual Care-Plus (UC-Plus) and VERSE, a prescribed intervention. Primary outcome results were previously reported. This secondary analysis focused on treatment fidelity. Video-recorded treatment sessions in the higher intensity study arms were evaluated for treatment adherence and treatment differentiation. Treatment components were evaluated using a pre-determined fidelity checklist., Primary Outcome: prescribed amount of therapy time (minutes); secondary outcomes: (i) adherence to therapy protocol (%) and (ii) treatment differentiation between control and high intensity groups., Results: Two hundred forty-six participants were randomised to Usual Care (n=81), Usual Care-Plus (n=82), and VERSE (n=83). One hundred thirty-five (82%) participants in higher intensity intervention arms received the minimum prescribed therapy minutes. From 10,805 (UC 7787; UC-Plus 1450; VERSE 1568) service events, 431 treatment protocol deviations were noted in 114 participants. Four hundred thirty-seven videos were evaluated. The VERSE therapists achieved over 84% adherence to key protocol elements. Higher stroke and aphasia severity, older age, and being in the UC-Plus group predicted more treatment deviations., Conclusions: We found high levels of treatment adherence and differentiation between the intervention arms, providing greater confidence interpreting our results. The comprehensive systems for intervention fidelity monitoring and reporting in this trial make an important contribution to aphasia research and, we argue, should set a new standard for future aphasia studies., Trial Registration: ACTRN 12613000776707., (© 2022. The Author(s).)

Introduction and Aims: As a critical form of stroke damage, aphasia negatively impacts stroke patients' return to society. Speech and language intervention has been found to assist in optimizing poststroke aphasia patient outcomes; consequently, early identification and diagnosis are vital for poststroke aphasia to ensure that patients receive the rehabilitation they require. This project aimed to promote evidence-based practice (EBP) in the assessment and screening of stroke patients with aphasia and to improve the clinical outcomes of patients who suffer from poststroke aphasia in a large tertiary hospital., Methods: The current evidence implementation project was conducted in the neurology and rehabilitation departments of a tertiary hospital in China. Six audit criteria were developed for the baseline and follow-up audits. The project used the JBI PACES software, as well as JBI's Getting Research into Practice audit and feedback tool, to foster evidence-based healthcare in practice., Results: Although the performance of all evidence-based criteria during the baseline audit was poor, barriers were identified through baseline, and the project team carried out and implemented developed strategies following Getting Research into Practice resources. All the criteria improved from baseline after the follow-up cycle, with four out of six criteria achieving a compliance rate of 100%, and two evidence-based criteria recorded at 73 and 80% compliance, respectively., Conclusion: The current project successfully increased EBP for the assessment and screening of stroke patients with aphasia. Further studies are needed to ensure the project's long-term sustainability., (Copyright © 2022 JBI. Unauthorized reproduction of this article is prohibited.)

Purpose : Individuals with stroke-related apraxia of speech (AOS) plus aphasia tend to produce more speech errors with increasing word length. The Words of Increasing Length task (WIL) uses a 3-point scale to score word accuracy but penalises for error types that can arise either from language or motor impairment, reducing the test's sensitivity and specificity. The purpose here was to identify error types explaining variance in the WIL score, and those associated with AOS and word length. Method : Speech errors were perceptually identified on the WIL task for 51 Australian English-speaking adults with stroke-related aphasia, 25 with concomitant AOS. Multiple regression and linear mixed effects modelling were applied. Result : Variance in WIL scores was best explained with four error types: consonant additions, incorrect number of syllables, false starts and consonant substitutions/distortions. False starts were significantly associated with AOS diagnosis. Incorrect number of syllables, consonant omissions, false starts, and lexical stress errors increased in frequency for longer words and, while the interaction with diagnosis did not reach significance, the effect appeared driven by the AOS group. Conclusion : Findings provide further support for using polysyllabic word production to assess apraxic speech. The WIL task has limitations that may bias patients' performance and clinicians' perceptual evaluation. Data provide valuable information for designing a more sensitive diagnostic protocol for AOS.

Purpose: The external validity of aphasia treatment research relies on diverse and representative participants. The purposes of this study were (a) to examine whether reporting of patient-reported age, sex, and race/ethnicity has improved since Ellis (2009) and (b) to evaluate whether these demographic variables were consistent with population-level estimates of stroke survivor demographics in the United States., Method: A scoping review examined U.S.-based aphasia treatment studies published between 2009 and 2019 and characterized the percentage of studies reporting age, sex, and race/ethnicity. Summary statistics for these variables were calculated and compared statistically with a population-based study of stroke survivors., Results: It was found out that 97.1% of studies reported age, 93.5% reported sex, and 28.1% reported race and/or ethnicity. Within reporting studies, participant mean age was 58.04 years, 61.6% of participants were men, and 38.4% were women; 86.5% of participants were White, 11.0% were Black, 2.0% were Hispanic/Latino, and 0.5% fell in other racial categories. All three variables were statistically different from the study of Kissela et al. (2012)., Discussion: Despite being highlighted as an issue by Ellis (2009), less than 30% of recent aphasia treatment studies reported race or ethnicity, and participants do not appear to be demographically representative compared with estimates of stroke survivors living in the United States. These issues may negatively impact the ecological validity of aphasia treatment research. Aphasia researchers should more consistently report participant race and ethnicity and follow current guidelines for increasing the demographic representation of women and minorities.

Background: The Aphasia Rapid Test (ART) is a short bedside aphasia screening test developed originally in French for use with post-stroke patients in the acute phase of recovery., Objectives: The purpose of this study was to assess the inter-rater reliability of the Turkish version of the ART in stroke patients (ICTRP ID: NCT04386837)., Methods: The French ART was translated into Turkish. Inter-rater reliability was assessed in 30 post-stroke patients with aphasia by two independent speech-language pathologists blind to each other's ratings., Results: 30 patients (18 men, 12 women; mean age 64.43 ± 16.60 years) were included within 10 days of stroke onset, as assessed by clinical examination and confirmed by CT and/or MRI. The mean (± SD) ART value was 16.26 (± 8.05) for rater 1 and 16.43 (±8.14) for rater 2. The inter-rater concordance coefficient was 0.997 (95% CI 0.994-0.999; p < .001)., Conclusions: Findings indicate that the Turkish version of the original ART was successfully administered in Turkish-speaking patients.

Background: There is limited evidence on the performance of emergent large-vessel occlusion (LVO) stroke screening tools when used by emergency medical services (EMS) and emergency department (ED) providers. We assessed the validity and predictive value of the vision, aphasia, neglect (VAN) assessment when completed by EMS and in the ED among suspected stroke patients., Methods: We conducted a retrospective study of VAN performed by EMS providers and VAN inferred from the National Institutes of Health Stroke Scale performed by ED nurses at a single hospital. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VAN by EMS and in the ED for LVO and a combined LVO and intracerebral hemorrhage (ICH) outcome., Results: From January 2018 to June 2020, 1,547 eligible patients were identified. Sensitivity and specificity of ED VAN were similar for LVO (72% and 74%, respectively), whereas EMS VAN was more sensitive (84%) than specific (68%). PPVs were low for both EMS VAN (26%) and ED VAN (21%) to detect LVO. Due to several VAN-positive ICHs, PPVs were substantially higher for both EMS VAN (44%) and ED VAN (39%) to detect LVO or ICH. EMS and ED VAN had high NPVs (97% and 96%, respectively)., Conclusions: Among suspected stroke patients, we found modest sensitivity and specificity of VAN to detect LVO for both EMS and ED providers. Moreover, the low PPV in our study suggests a significant number of patients with non-LVO ischemic stroke or ICH could be over-triaged with VAN., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To describe the development and determine the diagnostic accuracy of the Brisbane Evidence-Based Language Test in detecting aphasia., Methods: Consecutive acute stroke admissions ( n  = 100; mean = 66.49y) participated in a single (assessor) blinded cross-sectional study. Index assessment was the ∼45 min Brisbane Evidence-Based Language Test. The Brisbane Evidence-Based Language Test is further divided into four 15-25 min Short Tests: two Foundation Tests (severe impairment), Standard (moderate) and High Level Test (mild). Independent reference standard included the Language Screening Test, Aphasia Screening Test, Comprehensive Aphasia Test and/or Measure for Cognitive-Linguistic Abilities, treating team diagnosis and aphasia referral post-ward discharge., Results: Brisbane Evidence-Based Language Test cut-off score of ≤157 demonstrated 80.8% (LR+ =10.9) sensitivity and 92.6% (LR- =0.21) specificity. All Short Tests reported specificities of ≥92.6%. Foundation Tests I (cut-off ≤61) and II (cut-off ≤51) reported lower sensitivity (≥57.5%) given their focus on severe conditions. The Standard (cut-off ≤90) and High Level Test (cut-off ≤78) reported sensitivities of ≥72.6%., Conclusion: The Brisbane Evidence-Based Language Test is a sensitive assessment of aphasia. Diagnostically, the High Level Test recorded the highest psychometric capabilities of the Short Tests, equivalent to the full Brisbane Evidence-Based Language Test. The test is available for download from brisbanetest.org.Implications for rehabilitationAphasia is a debilitating condition and accurate identification of language disorders is important in healthcare.Language assessment is complex and the accuracy of assessment procedures is dependent upon a variety of factors.The Brisbane Evidence-Based Language Test is a new evidence-based language test specifically designed to adapt to varying patient need, clinical contexts and co-occurring conditions.In this cross-sectional validation study, the Brisbane Evidence-Based Language Test was found to be a sensitive measure for identifying aphasia in stroke.

Background: Language tests are important in the assessment and follow up of people with aphasia (PWA). However, language assessment in the low literacy population is still a challenge., Objective: To investigate whether a formal evaluation of aphasia is able to distinguish the neurological effect from the effect of low educational level in people with post-stroke aphasia., Methods: The sample consisted of a group of 30 aphasic subjects (AG) and a control group (CG) of 36 individuals, both with an educational level of 1-4 years. The Brazilian Montreal-Toulouse Language Assessment battery was applied to all subjects., Results: There were statistically significant differences between the groups in 19 out of the 20 tasks analyzed., Conclusions: These results suggest that formal evaluation procedures are able to detect language disorders resulting from stroke, even in subjects with low educational level.

Introduction: A decrease in ischemic stroke (IS) incidence has been observed in high income countries during the last decades. Whether this has influenced the occurrence of aphasia in IS is uncertain. We therefore examined the incidence rate and potentially related determinants of aphasia in IS., Methods: We prospectively examined consecutive patients admitted to hospital with first-ever acute IS between March 1, 2017, and February 28, 2018, as part of the Lund Stroke Register (LSR) Study, comprising patients from the uptake area of Skåne University Hospital, Lund, Sweden. Patients were assessed with National Institutes of Health Stroke Scale (NIHSS) at stroke onset. Presence of aphasia was evaluated with NIHSS item 9 (language). We registered IS subtypes and risk factors. To investigate possible temporal changes in aphasia incidence, we made comparisons with corresponding LSR data from 2005 to 2006. Incidence rates were calculated and adjusted to the European Standard Population (ESP) and to the Swedish population., Results: Among 308 included IS patients, 30% presented with aphasia (n = 91; 95% CI: 25-35), a proportion of aphasia in IS that was similar to 2005-2006. The incidence rate of aphasia was 31 per 100,000 person-years adjusted to the ESP (95% CI: 25-38 per 100,000 person-years) corresponding to a significant decrease of 30% between 2005-2006 and 2017-2018. The decrease was significantly more pronounced in men. The initial severity of aphasia remained unchanged, with the majority of patients having severe to global aphasia. No significant differences between vascular stroke risk factors were noted among stroke patients with or without aphasia., Conclusion: Even though the overall IS incidence rate has decreased during the first decades of the 21st century, the proportion of IS patients with aphasia at stroke onset remains stable at 30%. Aphasia continues to be an important symptom that needs to be considered in stroke care and rehabilitation., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

In stroke units, diagnosing seizures may be difficult, especially in aphasic patients. We discuss herein our systematic 4-hour video EEG monitoring of 61 patients with aphasia within the first 72hours after the onset of ischaemic stroke. Five electrographic seizures were identified in 3 patients, with no clinical signs apparent on the video and no symptoms reported by patients. We did not record status epilepticus nor generalized seizure. Comparative analyses disclosed a higher risk of early seizures in patients with haemorrhagic transformation. Video EEG monitoring detected electrographic seizures in 5% of stroke patients with aphasia. This monitoring could be useful for selected patients, especially those with haemorrhagic transformation., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Typical lacunar syndromes do not include aphasia but aphasia has been reported in rare atypical lacunar syndromes., Objective: Description of the phenomenology and of affected fiber tracts., Material and Methods: Case series of three patients with lacunar stroke as evidenced by magnetic resonance imaging. Identification of affected fiber tracts via fiber tracking from coregistered lesion sites in brains of two healthy participants., Results: The lacunar strokes that produced aphasia were located in the very lateral territory of perforating branches of the middle cerebral artery and extended along the external capsule into its most rostrodorsal aspect. Even though the cortex, thalamus and most parts of the basal ganglia were unaffected, patients exhibited a mild to moderate nonfluent aphasia with syntactic deficits. Fiber tracking revealed that in contrast to the nonaphasic control patient with a neighboring lacunar stroke, the aphasic patient strokes involved particularly fibers of the left arcuate fascicle as well as fibers of the frontostriatal and frontal aslant tracts., Conclusion: Left lateral lacunar stroke can cause clinically relevant aphasia through disruption of speech-relevant fiber tracts., (© 2021. The Author(s).)

Electroencephalographic synchrony can help assess brain network status; however, its usefulness has not yet been fully proven. We developed a clinically feasible method that combines the phase synchrony index (PSI) with resting-state 19-channel electroencephalography (EEG) to evaluate post-stroke motor impairment. In this study, we investigated whether our method could be applied to aphasia, a common post-stroke cognitive impairment. This study included 31 patients with subacute aphasia and 24 healthy controls. We assessed the expressive function of patients and calculated the PSIs of three motor language-related regions: frontofrontal, left frontotemporal, and right frontotemporal. Then, we evaluated post-stroke network alterations by comparing PSIs of the patients and controls and by analyzing the correlations between PSIs and aphasia scores. The frontofrontal PSI (beta band) was lower in patients than in controls and positively correlated with aphasia scores, whereas the right frontotemporal PSI (delta band) was higher in patients than in controls and negatively correlated with aphasia scores. Evaluation of artifacts suggests that this association is attributed to true synchrony rather than spurious synchrony. These findings suggest that post-stroke aphasia is associated with alternations of two different networks and point to the usefulness of EEG PSI in understanding the pathophysiology of aphasia.

Abstract: The current status of the diagnosis and management of poststroke aphasia (PSA) in China is unknown.To analyze the physicians' strategy and knowledge about the management of PSA in clinical practice and the needs for standardization of diagnosis and treatment.This survey was conducted in March-August 2019 at 32 tertiary hospitals in 16 provinces/municipalities in China. The attending physicians from the Neurology and Neuro-rehabilitation/Rehabilitation Departments were included. The online questionnaire inquired about patient information, physicians' diagnosis and treatment behavior for PSA, and physicians' understanding of PSA.A total of 236 physicians completed the survey. Regarding PSA assessment, 99.2% of the physicians reported using medical history and physical examination, 93.2% reported using neuroimaging, and 76.3% reported using dedicated scales. Most physicians used a combination of drug and non-drug treatment. Neuro-regenerators/cerebral activators and anti-dementia drugs were the most common pharmacotherapies; butylphthalide, edaravone, and memantine were most frequently prescribed. Six months poststroke was rendered as a spontaneous language recovery period, and a ≥6-month treatment for PSA was suggested by many physicians. The lack of standardized treatment regimen/clinical guidelines and the limited number of approved drugs for PSA were the primary challenges encountered by physicians during practice. The majority of the physicians agreed with the necessity of guidelines or consensus for the diagnosis and treatment of PSA.The knowledge gaps exist among physicians in China regarding the assessment and management of PSA. The improved awareness of the available guidelines/consensus could improve the performance of the physicians., Competing Interests: The authors have no funding and conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Common assessment tools for aphasia evaluate single language impairments but not their functional impact on patient's communication skills in daily life. The lack of tools focused on ecological aspects might affect the choice of rehabilitative trainings. The Communicative Effectiveness Index (CETI) represents an attempt to assess the communicative abilities in "ecologic" context. This study aimed to explore psychometrics properties of the Italian translation and adaptation of CETI (I-CETI)., Methods: Sixty-eight patients with aphasia due to left hemispheric stroke admitted to post-acute rehabilitation units and their relatives were included in the study. Data were collected in three different sessions. At study entry, patients were assessed for language, depression, and functional abilities, while their caregivers and speech therapists independently completed the I-CETI to assess inter-rater agreement (baseline). One week later, caregivers and speech therapists completed again I-CETI, to assess test-retest reliability (T1). Last, at discharge, patients completed again the evaluation protocol, and caregivers and speech therapists completed I-CETI (T2)., Results: I-CETI showed high internal validity, excellent reliability, and good correlation between scores obtained by speech therapists and caregivers. Moreover, scores of I-CETI had quite good correlations with a traditional tool to assess language, and with measures of functional independence both at study entry and at discharge., Discussion: I-CETI showed good psychometric proprieties. These results allowed considering I-CETI as a reliable tool to assess effects of speech treatments on the communicative abilities in patients with aphasia. Furthermore, I-CETI might help clinicians to develop treatments more tailored on the "ecologic" difficulties of patients.

The Aphasia Communication Outcome Measure (ACOM) is a patient-reported measure of communicative functioning developed for persons with stroke-induced aphasia. It was motivated by the desire to include the perspective of persons with aphasia in the measurement of treatment outcomes and to apply newly accessible psychometric tools to improve the quality and usefulness of available outcome measures for aphasia. The ACOM was developed within an item response theory framework, and the validity of the score estimates it provides is supported by evidence based on its content, internal structure, relationships with other variables, stability over time, and responsiveness to treatment. This article summarizes the background and motivation for the ACOM, the steps in its initial development, evidence supporting its validity as a measure of patient-reported communication functioning, and current recommendations for interpreting change scores., Competing Interests: P.J.D. and W.D.H. report Grants from the Veterans Affairs Rehabilitation Research and Development Service, during the conduct of the study. W.D.H. reports consulting fees from the University of Delaware and a speaking fee from Twin Cities Speech-Language Pathologists associated with the work., (Thieme. All rights reserved.)

Purpose This study aimed to provide novel insights into the neural correlates of language improvement following intensive language-action therapy (ILAT; also known as constraint-induced aphasia therapy). Method Sixteen people with chronic aphasia underwent clinical aphasia assessment (Aachen Aphasia Test [AAT]), as well as functional magnetic resonance imaging (fMRI), both administered before (T1) and after ILAT (T2). The fMRI task included passive reading of single written words, with hashmark strings as visual baseline. Results Behavioral results indicated significant improvements of AAT scores across therapy, and fMRI results showed T2-T1 blood oxygenation-level-dependent (BOLD) signal change in the left precuneus to be modulated by the degree of AAT score increase. Subsequent region-of-interest analysis of this precuneus cluster confirmed a positive correlation of T2-T1 BOLD signal change and improvement on the clinical aphasia test. Similarly, the entire default mode network revealed a positive correlation between T2-T1 BOLD signal change and clinical language improvement. Conclusion These results are consistent with a more efficient recruitment of domain-general neural networks in language processing, including those involved in attentional control, following aphasia therapy with ILAT. Supplemental Material https://doi.org/10.23641/asha.12765755.

Assessment of mood is critical in determining rehabilitation outcomes for stroke and other acquired brain injury, yet a common consequence of such injuries is aphasia, where language is impaired. Consequently, the use of language-based measures in this population is often not possible. Following a critical review of the neuropsychological aspects of self-reported mood, this paper evaluates the problems in reporting mood after stroke due to aphasia, and discusses implications for the design of adapted instruments. The paper then appraises the construction and psychometric properties of existing, adapted self-report measures developed to try and address these problems, and evaluates their utility and limitations. This includes a focus on the recently validated tablet-based Dynamic Visual Analog Mood Scales (D-VAMS), which uses innovative non-verbal assessment methods based on facial expression modulated via a slider control on a touchscreen interface. Currently, most studies evaluating recovery interventions simply omit individuals with aphasia because of the difficulty of assessing mood and quality of life in this population. However, adapted scales such as the D-VAMS appear to represent an important step forward in assessing mood in people with language impairments, with the use of interactive modulated imagery having wider applications for nonverbal communication as well as the quantification of subjective phenomena., Competing Interests: Declaration of Competing Interest The authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Recent findings indicate that measures derived from resting-state magnetoencephalography (rsMEG) are sensitive to cortical dysfunction in post-stroke aphasia. Spectral power and multiscale entropy (MSE) measures show that left-hemispheric areas surrounding the stroke lesion (perilesional) exhibit pathological oscillatory slowing and alterations in signal complexity. In the current study, we tested whether individually-targeted high-definition transcranial direct current stimulation (HD-tDCS) can reduce MEG abnormalities and transiently improve language performance. In eleven chronic aphasia survivors, we devised a method to localize perilesional areas exhibiting peak MSE abnormalities, and subsequently targeted these areas with excitatory/anodal-tDCS, or targeted the contralateral homolog areas with inhibitory/cathodal-tDCS, based on prominent theories of stroke recovery. Pathological MEG slowing in these patients was correlated with aphasia severity. Sentence/phrase repetition accuracy was assessed before and after tDCS. A delayed word reading task was administered inside MEG to assess tDCS-induced neurophysiological changes in relative power and MSE computed on the pre-stimulus and delay task time windows. Results indicated increases in repetition accuracy, decreases in contralateral theta (4-7 Hz) and coarse-scale MSE (slow activity), and increases in perilesional low-gamma (25-50 Hz) and fine-scale MSE (fast activity) after anodal-tDCS, indicating reversal of pathological abnormalities. RsMEG may be a sensitive measure for guiding therapeutic tDCS.

Purpose The aim of this tutorial is to provide speech-language pathologists with foundational knowledge of poststroke depression comorbidly occurring with aphasia. Given the negative effect of depression on functional outcomes and mortality, it is crucial that speech-language pathologists possess this knowledge in order to better advocate for and treat their patients. Method and Results Three areas of complementary expertise (speech-language pathology, psychology, and neurology) collaborated on this tutorial to address the following areas: (a) provide terminology associated with depression and related mood disorders, (b) describe the potential underlying pathophysiology of depression in the general population, (c) provide an overview of our existing understanding of comorbid poststroke depression and aphasia, and (d) summarize current assessment methods and interventions for poststroke depression in adults with aphasia. Conclusion Given the compounding impact aphasia and depression have on rehabilitation outcomes, it is imperative that speech-language pathologists understand terminology, assessment, and treatment practices for depression.