Crossed Aphasia after Intracranial Hematoma in the Right Temporoparietal Lobe: A Case Report

Purpose: Aphasia in a dextral after right hemisphere injury is called crossed aphasia (CA). We are reporting a first case of transformation of motor aphasia to conduction aphasia after right hemisphere intracerebral hemorrhage (ICH) associated with arteriovenous malformation (AVM) with literature reviews.Methods: A case of a man in his 30s with CA following right hemisphere ICH in the temporal-parietal lobe associated with AVM was reviewed. We analyzed his brain images, initial linguistic characteristics, and changes in aphasia for 8 weeks of follow-up.Results: The initial Paradise Korean Western Aphasia Battery Revised (PK-WAB-R) was evaluated as aphasia quotient (AQ) 72, 64%ile; post evaluation was evaluated AQ 95, 98.9%ile after 8 weeks. The post-test repetition score was the patient score range, which can be attributed to impairment in phonological short-term memory. The patient is diagnosed anomalous CA based on Alexander et al., and we could predict that the language ability originates from both hemispheres based on Nagaraja et al. Considering the appearance of Gerstmann syndrome at the beginning of the onset, we could expect that the function of the dominant parietal lobe is partially crossed as well.Conclusion: Changes in aphasia were reported throughout the initial stage to the end of speech therapy. It is also important to note that literature review of Korean studies was analyzed in this study. It will be necessary to conduct a cognitive test in the early stage of onset to understand the language problems of crossed conduction aphasia to know the characteristics of the cognitive process.

Priftis et al_Alexia without agraphia_COVID_2021

SARS-CoV-2 resulting in COVID-19 can affect the brain and cause neuropsychological disorders (e.g., executive dysfunction and memory difficulties). Recently the presence of more focal and isolated neuropsychological signs has been also reported, in the domain of language disorders (e.g., alexia without agraphia, conduction aphasia). We reported on patient LM affected by a left occipito-temporal ischemic stroke after SARS-CoV-2. LM had a largely preserved overall cognitive profile, but he presented with severe alexia without agraphia. We suggest that focal and isolated neuropsychological dysfunction can be observed in patients with stroke after SARS-CoV-2. Neuropsychological assessment and rehabilitation should be promptly provided to these patients.

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

COVID-19 presenting with agraphia and conduction aphasia in a patient with left-hemisphere ischemic stroke

COVID-19 following infection by SARS-CoV-2 can affect the brain causing confusion, depression and dementia-like signs. Nonetheless, the presence of more specific neuropsychological signs because of COVID-19 remains unexplored. We report on LA, a patient who was affected by a left-hemisphere ischemic stroke, probably because of SARS-CoV-2. The patient showed a highly specific neuropsychological profile characterized by severe agraphia and some signs of conduction aphasia. All other cognitive and sensori-motor functions remained intact. We sustain that specific neuropsychological signs can be observed in patients with COVID-19. Therefore, in-depth and comprehensive neuropsychological assessment should be included to better explore and qualify the neuropsychological consequences of COVID-19. This is a new challenge for diagnosis and rehabilitation, with important consequences for the involved neuropsychological services.

Cortical Reorganization after Rehabilitation in a Patient with Conduction Aphasia Using High-Density EEG

Conduction aphasia is a language disorder occurred after a left-brain injury. It is characterized by fluent speech production, reading, writing and normal comprehension, while speech repetition is impaired. The aim of this study is to investigate the cortical responses, induced by language activities, in a sub-acute stroke patient affected by conduction aphasia before and after an intensive speech therapy training. The patient was examined by using High-Density Electroencephalogram (HD-EEG) examination, while was performing language tasks. the patient was evaluated at baseline and after two months after rehabilitative treatment. Our results showed that an intensive rehabilitative process, in sub-acute stroke, could be useful for a good outcome of language deficits. HD-EEG results showed that left parieto-temporol-frontal areas were more activated after 2 months of rehabilitation training compared with baseline. Our results provided evidence that an intensive rehabilitation process could contribute to an inter- and intra-hemispheric reorganization.

Targeting Complex Orthography in the Treatment of a Bilingual Aphasia with Acquired Dysgraphia: The Case of a Malay/English Speaker with Conduction Aphasia

Background: Disruption of spoken language in people with aphasia tends to interfere with the ability to write, which is referred to as dysgraphia. This study examined the effectiveness of the anagram and copy treatment (ACT), administered in English on a bilingual Malay/English patient with conduction aphasia (GM). ACT is the arrangement of component letters presented in scrambled order (i.e., an anagram) so that the patient could use the letters to form target words, followed by repeated copying of the word. Methods: A single-subject multiple-baseline design was used with sets of English words (both nouns and verbs) sequentially targeted for treatment. Prior to the treatment, a series of single word writing and reading baselines were conducted in two languages: English and Malay. The ACT treatment was done in English, the language reported as more dominant for reading by the patient. Probes assessing generalizations to untrained pictures were presented at 8th, 13th, and 18th sessions. Results: GM showed steady and incremental improvement in the writing of trained nouns and verbs, with generalizations to untrained English nouns and verbs. Conclusions: Single word writing treatment in a non-transparent language may improve dysgraphia among adults with bilingual aphasia through the administration of a structured and systematic treatment.