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Background and Purpose— Evidence suggests that therapy can be effective in recovering from aphasia, provided that it consists of socially embedded, intensive training of behaviorally relevant tasks. However, the resources of healthcare systems are often too limited to provide such treatment at sufficient dosage. Hence, there is a need for evidence-based, cost-effective rehabilitation methods. Here, we asked whether virtual reality-based treatment grounded in the principles of use-dependent learning, behavioral relevance, and intensity positively impacts recovery from nonfluent aphasia. Methods— Seventeen patients with chronic nonfluent aphasia underwent intensive therapy in a randomized, controlled, parallel-group trial. Participants were assigned to the control group (N=8) receiving standard treatment or to the experimental group (N=9) receiving augmented embodied therapy with the Rehabilitation Gaming System for aphasia. All Rehabilitation Gaming System for aphasia sessions were supervised by an assistant who monitored the patients but did not offer any elements of standard therapy. Both interventions were matched for intensity and materials. Results— Our results revealed that at the end of the treatment both groups significantly improved on the primary outcome measure (Boston Diagnostic Aphasia Examination: control group, P =0.04; experimental group, P =0.01), and the secondary outcome measure (lexical access—vocabulary test: control group, P =0.01; experimental group, P =0.007). However, only the Rehabilitation Gaming System for aphasia group improved on the Communicative Aphasia Log ( P =0.01). The follow-up assessment (week 16) demonstrated that while both groups retained vocabulary-related changes (control group, P =0.01; experimental group, P =0.007), only the Rehabilitation Gaming System for aphasia group showed therapy-induced improvements in language ( P =0.01) and communication ( P =0.05). Conclusions— Our results demonstrate the effectiveness of Rehabilitation Gaming System for aphasia for improving language and communication in patients with chronic aphasia suggesting that current challenges faced by the healthcare system in the treatment of stroke might be effectively addressed by augmenting traditional therapy with computer-based methods. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT02928822.

Background Impaired naming is a ubiquitous symptom in all types of aphasia, which often adversely impacts independence, quality of life, and recovery of affected individuals. Previous research has demonstrated that naming can be facilitated by phonological and semantic cueing strategies that are largely incorporated into the treatment of anomic disturbances. Beneficial effects of cueing, whereby naming becomes faster and more accurate, are often attributed to the priming mechanisms occurring within the distributed language network. Objective We proposed and explored two novel cueing techniques: (1) Silent Visuomotor Cues (SVC), which provided articulatory information of target words presented in the form of silent videos, and (2) Semantic Auditory Cues (SAC), which consisted of acoustic information semantically relevant to target words (ringing for “telephone”). Grounded in neurophysiological evidence, we hypothesized that both SVC and SAC might aid communicative effectiveness possibly by triggering activity in perceptual and semantic language regions, respectively. Methods Ten participants with chronic non-fluent aphasia were recruited for a longitudinal clinical intervention. Participants were split into dyads (i.e., five pairs of two participants) and required to engage in a turn-based peer-to-peer language game using the Rehabilitation Gaming System for aphasia (RGSa). The objective of the RGSa sessions was to practice communicative acts, such as making a request. We administered SVCs and SACs in a pseudorandomized manner at the moment when the active player selected the object to be requested from the interlocutor. For the analysis, we compared the times from selection to the reception of the desired object between cued and non-cued trials. Results Naming accuracy, as measured by a standard clinical scale, significantly improved for all stimuli at each evaluation point, including the follow-up. Moreover, the results yielded beneficial effects of both SVC and SAC cues on word naming, especially at the early intervention sessions when the exposure to the target lexicon was infrequent. Conclusions This study supports the efficacy of the proposed cueing strategies which could be integrated into the clinic or mobile technology to aid naming even at the chronic stages of aphasia. These findings are consistent with sensorimotor accounts of language processing, suggesting a coupling between language, motor, and semantic brain regions. Trial registration NCT02928822. Registered 30 May 2016.

Background: Stroke mimic (SM) is a common diagnosis in stroke assessment in our medical emergency systems. The diagnosis of SM requires an expertise neurological exam and probably support it by radiological tests. Different frequency of SM could be reported according to different epidemiological or clinical values. The rate of stroke mimic could be different between primary telestroke exam and face-to-face evaluation in comprehensive stroke center, and also chameleon syndromes (false SM) could present differences in percentage of diagnosis. Methods: A total of 3876 stroke codes were evaluated by our team of vascular neurologist in our comprehensive stroke center (CSC) and 415 patients were evaluated by telestroke with our referenced county hospitals between January 2014 to March 2019. We analyzed the percentage of SM in this period in both types of assessment: face-to-face or telemedicine. We analyze if there are any differences in percentage of SM diagnosis, frequency of SM subtypes or delay in diagnosis according to the evaluation method. Results: The percentage of SM diagnosis was 12% in our CSC and 11.1% by telemedicine assessment. Patients with SM were significantly younger than radiological confirmed stroke (63 vs 74 years; p:0.001) and had lower NIHSS (7 vs 9; p:0.003). We found significant differences between age and main subtypes of SM (conversion, brain tumor, confusional disorders). However they didn’t present any significant differences according to evaluation method (face-to-face in CSC or telestroke). Besides, there was difference in percentage of chameleon syndrome (3,2% and 2,2% respectively) but it was no significant. Conclusions: The percentage of SM diagnosis by vascular neurologist is similar with independence of method of evaluation: on-site or telemedicine. However the percentage of chameleon syndrome could be lower by telestroke assessment.

Background and Purpose- Evidence suggests that therapy can be effective in recovering from aphasia, provided that it consists of socially embedded, intensive training of behaviorally relevant tasks. However, the resources of healthcare systems are often too limited to provide such treatment at sufficient dosage. Hence, there is a need for evidence-based, cost-effective rehabilitation methods. Here, we asked whether virtual reality-based treatment grounded in the principles of use-dependent learning, behavioral relevance, and intensity positively impacts recovery from nonfluent aphasia. Methods- Seventeen patients with chronic nonfluent aphasia underwent intensive therapy in a randomized, controlled, parallel-group trial. Participants were assigned to the control group (N=8) receiving standard treatment or to the experimental group (N=9) receiving augmented embodied therapy with the Rehabilitation Gaming System for aphasia. All Rehabilitation Gaming System for aphasia sessions were supervised by an assistant who monitored the patients but did not offer any elements of standard therapy. Both interventions were matched for intensity and materials. Results- Our results revealed that at the end of the treatment both groups significantly improved on the primary outcome measure (Boston Diagnostic Aphasia Examination: control group, P=0.04; experimental group, P=0.01), and the secondary outcome measure (lexical access-vocabulary test: control group, P=0.01; experimental group, P=0.007). However, only the Rehabilitation Gaming System for aphasia group improved on the Communicative Aphasia Log ( P=0.01). The follow-up assessment (week 16) demonstrated that while both groups retained vocabulary-related changes (control group, P=0.01; experimental group, P=0.007), only the Rehabilitation Gaming System for aphasia group showed therapy-induced improvements in language ( P=0.01) and communication ( P=0.05). Conclusions- Our results demonstrate the effectiveness of Rehabilitation Gaming System for aphasia for improving language and communication in patients with chronic aphasia suggesting that current challenges faced by the healthcare system in the treatment of stroke might be effectively addressed by augmenting traditional therapy with computer-based methods. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02928822.

About a quarter of stroke patients worldwide suffer serious language disorders such as aphasias. Most common symptoms of Broca's aphasia are word naming disorders which highly impact verbal communication and the quality of life of aphasic patients. In order to recover disturbances in word retrieval, several cueing methods (i.e. phonemic and semantic) have been established to improve lexical access establishing effective language rehabilitation techniques. Based on recent evidence from action-perception theories, which postulate that neural circuits for speech perception and articulation are tightly coupled, in the present work, we propose and investigate an alternative type of cueing using silent articulation-related visual stimuli. We hypothesize that providing patients with primes in the form of silent videos showing lip motions representative of correct pronunciation of target words, will result in faster word retrieval than when no such cue is provided. To test our prediction, we realize a longitudinal clinical virtual reality-based trial with four post-stroke Broca's patients and compare the interaction times between the two conditions over the eight weeks of the therapy. Our results suggest that silent visuomotor cues indeed facilitate word retrieval and verbal execution, and might be beneficial in lexical relearning in chronic Broca's patients.

Background: Recent guidelines recommend thrombectomy to treat stroke due to large vessel occlusions within first six hours after onset stroke time. There is no age limit, however elderly patients (>=80 years old) transferred from community hospital (CH) to comprehensive stroke center (CSC) possibly present different radiological findings in comparison with younger patients, that finally exclude them of endovascular treatment and could avoid unnecessary transfers to CSC. Method: We reviewed consecutive patients transferred from five CH to our CSC from January 2012 to July 2016. We analyzed radiological findings in ASPECTS (Alberta Stroke Program Early CT Scale) and segment of occluded artery in NonContrastCT (NCCT) and CT-angiography, both realized in CH (pre-transfer) and CSC. We evaluated the changes in NCCT between both centers related to onset stroke time, time of transfer, vascular occlusion segment and other epidemiological variables. Results: A total of 3825 patients were evaluated in our CSC as stroke code (24% elderly and increasing annually); 21% were transferred from CH to CSC with large vessel occlusion diagnosis and NIHSS>8. Subgroup of elderly patients presented worse score in ASPECTS-NCCT evaluated at CSC previous to endovascular treatment than younger patients (mean 6.8 vs 8.4;p: 0.001). An ASPECT score 6) in NCCT at CSC (AUC: 0.69; S: 61%, E: 85%). Conclusions: Patients over 83 years old and low score in ASPECT (score

Background: Endovascular treatment (EVT) is an effective treatment in strokes with persistent large artery occlusion despite previous intravenous thrombolisis (IVT) as rescue treatment. Performing computer tomography angiography (CTA) before IVT could allow early activation of neurointerventional teams; however routine CTA could delay unnecessary door-to-needle time of IVT and may be infeasible. Methods: We reviewed stroke code activations between May 2011 and June 2015 in our comprehensive stroke center and divided into groups based on NIHSS and patency of arterial occlusion according to non-enhanced CT on admission (dense artery sign or dot sign) and baseline CTA. We assessed patients treated with IVT and selected to EVT according to results in CTA post-IVT. We analyze percentage of recanalization or migration of thrombus after IVT alone and variables associated to successful treatment. Results: Of 2856 stroke codes registered during the study period 1810 were diagnosis of ischemic strokes. We treated 520 patients with IVT, 202 had a radiological evidence of large artery occlusion (55%M1, 32% M2, 5%TICA, 5%ICA, 3% basilar). Thirty-two percent of patients showed changes in CTA carried out after IVT(17% successfully recanalized, 15% distal migration of thrombus) so they were not selected to endovascular treatment. There were significant difference between M1 and M2 occlusion regarding changes in CTA after IVT (23% vs 70%; p Conclusions: We consider defer CTA angiography until after IVT in stroke code patients with moderate clinical impairment (NIH