scholarly journals Current Approaches to the Treatment of Post-Stroke Aphasia

2021 ◽  
Vol 23 (2) ◽  
pp. 183-201
Author(s):  
Julius Fridriksson ◽  
Argye Elizabeth Hillis
Keyword(s):  
Language Processing ◽  
Brain Stimulation ◽  
Behavioral Therapy ◽  
Social Activity ◽  
Phase Iii ◽  
Language Therapy ◽  
Phase Ii Trials ◽  
Post Stroke ◽  
Aphasia Therapy ◽  
Behavioral Therapies

Aphasia, impairment of language after stroke or other neurological insult, is a common and often devastating condition that affects nearly every social activity and interaction. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to augment the effects of the behavioral therapy. In this narrative review, we discuss advances in aphasia therapy in the last 5 years and focus primarily on properly powered, randomized, controlled trials of both behavioral therapies and interventions to augment therapy for post-stroke aphasia. These trials include evaluation of behavioral therapies and computer-delivered language therapies. We also discuss outcome prediction trials as well as interventional trials that have employed noninvasive brain stimulation, or medications to augment language therapy. Supported by evidence from Phase III trials and large meta-analyses, it is now generally accepted that aphasia therapy can improve language processing for many patients. Not all patients respond similarly to aphasia therapy with the most severe patients being the least likely responders. Nevertheless, it is imperative that all patients, regardless of severity, receive aphasia management focused on direct therapy of language deficits, counseling, or both. Emerging evidence from Phase II trials suggests transcranial brain stimulation is a promising method to boost aphasia therapy outcomes.

EXPRESS: Treatment of post-stroke aphasia: A Narrative Review for Stroke Neurologists

2021 ◽  
pp. 174749302110178
Author(s):  
Emilia Vitti ◽  
Argye E Hillis
Keyword(s):  
Brain Stimulation ◽  
Behavioral Therapy ◽  
Review Literature ◽  
Narrative Review ◽  
Optimal Management ◽  
Language Therapy ◽  
Post Stroke ◽  
Non Invasive ◽  
Aphasia Treatment

This review is intended to help physicians guide patients to optimal management of post-stroke aphasia. We review literature on post-stroke aphasia treatment, focusing on: (1) when and for whom language therapy is most effective, (2) the variety of approaches that can be effective for different individuals, and (3) the extent to which behavioral therapy might be augmented by non-invasive brain stimulation and/or medications.

Acquired disorders of language and their treatment

2020 ◽  
pp. 279-290
Author(s):  
Alex Leff ◽  
Jenny Crinion
Keyword(s):  
Drug Therapy ◽  
Brain Stimulation ◽  
Main Part ◽  
Evidence Base ◽  
Language Therapy ◽  
Stroke Patients ◽  
Speech And Language Therapy ◽  
Non Invasive ◽  
Aphasia Therapy

This chapter covers the classification of acquired aphasic syndromes. It illustrates some of the speech errors aphasic stroke patients make with videos of a patient describing a picture and attempting to repeat words. The main part of the chapter assesses the evidence base for speech and language therapy (SALT) and answers the following questions: Does SALT work? What is the correct dose and intensity? And is it ever too late for SALT intervention? We then discuss two main adjuvants to SALT: one old—drug therapy; one new—non-invasive brain stimulation. Finally, we examine the role for e-rehabilitation and augmentative aids before asking what the future might hold for aphasia therapy, and wondering if it might already be here.

Acquired disorders of language and their treatment

2015 ◽  
pp. 251-261
Author(s):  
Alex Leff ◽  
Jenny Crinion
Keyword(s):  
Drug Therapy ◽  
Brain Stimulation ◽  
Main Part ◽  
Language Therapy ◽  
Stroke Patients ◽  
Speech And Language Therapy ◽  
Non Invasive ◽  
Correct Dose ◽  
Aphasia Therapy

This chapter covers the classification of acquired aphasic syndromes. It illustrates some of the speech errors aphasic stroke patients make with videos of a patient describing a picture and attempting to repeat words. The main part of the chapter assesses the evidencebase for speech and language therapy (SALT) and answers the following questions: Does SALT work? What is the correct dose and intensity? And is it ever too late for SALT intervention? We then discuss two main adjuvants to SALT:one old—drug therapy; one new—non-invasive brain stimulation. Finally, we examine the role for e-rehabilitation and augmentative aids before asking what the future might hold for aphasia therapy, and wondering if it might already be here.

scholarly journals Evaluating Cultural Impact in Discursive Space through Digital Footprints

2021 ◽  
Vol 13 (7) ◽  
pp. 4043 ◽  
Author(s):  
Jesús López Baeza ◽  
Jens Bley ◽  
Kay Hartkopf ◽  
Martin Niggemann ◽  
James Arias ◽  
...  
Keyword(s):  
Social Media ◽  
Language Processing ◽  
Social Activity ◽  
Test Site ◽  
Cultural Discourse ◽  
Discursive Space ◽  
Topic Identification ◽  
Small Test ◽  
The Impact ◽  
The City

The research presented in this paper describes an evaluation of the impact of spatial interventions in public spaces, measured by social media data. This contribution aims at observing the way a spatial intervention in an urban location can affect what people talk about on social media. The test site for our research is Domplatz in the center of Hamburg, Germany. In recent years, several actions have taken place there, intending to attract social activity and spotlight the square as a landmark of cultural discourse in the city of Hamburg. To evaluate the impact of this strategy, textual data from the social networks Twitter and Instagram (i.e., tweets and image captions) are collected and analyzed using Natural Language Processing intelligence. These analyses identify and track the cultural topic or “people talking about culture” in the city of Hamburg. We observe the evolution of the cultural topic, and its potential correspondence in levels of activity, with certain intervention actions carried out in Domplatz. Two analytic methods of topic clustering and tracking are tested. The results show a successful topic identification and tracking with both methods, the second one being more accurate. This means that it is possible to isolate and observe the evolution of the city’s cultural discourse using NLP. However, it is shown that the effects of spatial interventions in our small test square have a limited local scale, rather than a city-wide relevance.

scholarly journals Unconventional Anticancer Agents: A Systematic Review of Clinical Trials

2006 ◽  
Vol 24 (1) ◽  
pp. 136-140 ◽  
Author(s):  
Andrew J. Vickers ◽  
Joyce Kuo ◽  
Barrie R. Cassileth
Keyword(s):  
Clinical Trials ◽  
Phase I ◽  
Cancer Patients ◽  
Phase Ii ◽  
Dose Finding ◽  
Phase Iii ◽  
High Dose ◽  
Free Text ◽  
Phase Ii Trials ◽  
Off Label

Purpose A substantial number of cancer patients turn to treatments other than those recommended by mainstream oncologists in an effort to sustain tumor remission or halt the spread of cancer. These unconventional approaches include botanicals, high-dose nutritional supplementation, off-label pharmaceuticals, and animal products. The objective of this study was to review systematically the methodologies applied in clinical trials of unconventional treatments specifically for cancer. Methods MEDLINE 1966 to 2005 was searched using approximately 200 different medical subject heading terms (eg, alternative medicine) and free text words (eg, laetrile). We sought prospective clinical trials of unconventional treatments in cancer patients, excluding studies with only symptom control or nonclinical (eg, immune) end points. Trial data were extracted by two reviewers using a standardized protocol. Results We identified 14,735 articles, of which 214, describing 198 different clinical trials, were included. Twenty trials were phase I, three were phase I and II, 70 were phase II, and 105 were phase III. Approximately half of the trials investigated fungal products, 20% investigated other botanicals, 10% investigated vitamins and supplements, and 10% investigated off-label pharmaceuticals. Only eight of the phase I trials were dose-finding trials, and a mere 20% of phase II trials reported a statistical design. Of the 27 different agents tested in phase III, only one agent had a prior dose-finding trial, and only for three agents was the definitive study initiated after the publication of phase II data. Conclusion Unconventional cancer treatments have not been subject to appropriate early-phase trial development. Future research on unconventional therapies should involve dose-finding and phase II studies to determine the suitability of definitive trials.

Design Issues of Randomized Phase II Trials and a Proposal for Phase II Screening Trials

2005 ◽  
Vol 23 (28) ◽  
pp. 7199-7206 ◽  
Author(s):  
Lawrence V. Rubinstein ◽  
Edward L. Korn ◽  
Boris Freidlin ◽  
Sally Hunsberger ◽  
S. Percy Ivy ◽  
...  
Keyword(s):  
Phase Ii ◽  
False Positive ◽  
Standard Treatment ◽  
False Negative ◽  
Error Rates ◽  
Targeted Treatment ◽  
Phase Iii ◽  
Phase Ii Trials ◽  
Treatment Control ◽  
Randomized Phase Ii

Future progress in improving cancer therapy can be expedited by better prioritization of new treatments for phase III evaluation. Historically, phase II trials have been key components in the prioritization process. There has been a long-standing interest in using phase II trials with randomization against a standard-treatment control arm or an additional experimental arm to provide greater assurance than afforded by comparison to historic controls that the new agent or regimen is promising and warrants further evaluation. Relevant trial designs that have been developed and utilized include phase II selection designs, randomized phase II designs that include a reference standard-treatment control arm, and phase II/III designs. We present our own explorations into the possibilities of developing “phase II screening trials,” in which preliminary and nondefinitive randomized comparisons of experimental regimens to standard treatments are made (preferably using an intermediate end point) by carefully adjusting the false-positive error rates (α or type I error) and false-negative error rates (β or type II error), so that the targeted treatment benefit may be appropriate while the sample size remains restricted. If the ability to conduct a definitive phase III trial can be protected, and if investigators feel that by judicious choice of false-positive probability and false-negative probability and magnitude of targeted treatment effect they can appropriately balance the conflicting demands of screening out useless regimens versus reliably detecting useful ones, the phase II screening trial design may be appropriate to apply.

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