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Namjong Paik - One of the best experts on this subject based on the ideXlab platform.
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a telerehabilitation approach for chronic Aphasia following stroke
Telemedicine Journal and E-health, 2016Co-Authors: Yoon Hee Choi, Hae Kyung Park, Namjong PaikAbstract:Abstract Background: Intensive speech therapy improves language function in patients with chronic Aphasia, although treatment in the acute phase is more effective than in the chronic phase. Unfortunately, most patients with stroke go untreated due to socioeconomic problems. This study was performed to develop and test a speech therapy–based telerehabilitation program (iAphasia), suitable for use on a mobile device platform, which would expand access to therapy to patients who frequently go untreated. Subjects and Methods: We enrolled 8 patients with chronic poststroke Aphasia to receive therapy via our iPad® (Apple, Cupertino, CA)-based telespeech therapy program, iAphasia. Participants received 4 weeks of telespeech therapy using iAphasia, which generates six domains with six levels of difficulty. We compared pre- and posttreatment scores on the Korean version of the Western Aphasia Battery (K-WAB) to evaluate effectiveness. Additionally, a 1-month follow-up assessment was performed. Results: We investig...
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Severity of Post-stroke Aphasia According to Aphasia Type and Lesion Location in Koreans
2013Co-Authors: Eun Kyoung Kang, Hae Min Sohn, Moon-ku Han, Won Kim, Tai Ryoon Han, Namjong PaikAbstract:To determine the relations between post-stroke Aphasia severity and Aphasia type and lesion location, a retrospective review was undertaken using the medical records of 97 Korean patients, treated within 90 days of onset, for Aphasia caused by unilateral left hemispheric stroke. Types of Aphasia were classified according to the validated Korean version of the Western Aphasia Battery (K-WAB), and severities of Aphasia were quantified using WAB Aphasia Quotients (AQ). Lesion locations were classified as cortical or subcortical, and were determined by magnetic resonance imaging. Two-step cluster analysis was performed using AQ values to classify Aphasia severity by Aphasia type and lesion location. Cluster analysis resulted in four severity clusters: 1) mild; anomic type, 2) moderate; Wernicke’s, transcortical motor, transcortical sensory, conduction, and mixed transcortical types, 3) moderately severe; Broca’s Aphasia, and 4) severe; global Aphasia, and also in three lesion location clusters: 1) mild; subcortical 2) moderate; cortical lesions involving Broca’s and/or Wernicke’s areas, and 3) severe; insular and cortical lesions not in Broca’s or Wernicke’s areas. These results revealed that within 3 months of stroke, global Aphasia was the more severely affected type and cortical lesions were more likely to affect language function than subcortical lesions
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the factors associated with good responses to speech therapy combined with transcranial direct current stimulation in post stroke aphasic patients
Annals of Rehabilitation Medicine, 2011Co-Authors: Ilyoung Jung, Eun Kyoung Kang, Jong Youb Lim, Hae Min Sohn, Namjong PaikAbstract:OBJECTIVE To determine factors associated with good responses to speech therapy combined with transcranial direct current stimulation (tDCS) in aphasic patients after stroke. METHOD The language function was evaluated using Korean version of Western Aphasia Battery (K-WAB) before and after speech therapy with tDCS in 37 stroke patients. Patients received speech therapy for 30 minutes over 2 to 3 weeks (10 sessions) while the cathodal tDCS was performed to the Brodmann area 45 with 1 mA for 20 minutes. We compared the improvement of Aphasia quotient % (AQ%) between two evaluation times according to age, sex, days after onset, stroke type, Aphasia type, brain lesion confirmed by magnetic resonance image and initial severity of Aphasia. The factors related with good responses were also checked. RESULTS AQ% improved from pre- to post-therapy (14.94±6.73%, p<0.001). AQ% improvement was greater in patients with less severe, fluent type of Aphasia who received treatment before 30 days since stroke was developed (p<0.05). The adjusted logistic regression model revealed that patients with hemorrhagic stroke were more likely to achieve good responses (odds ratio=4.897, p<0.05) relative to infarction. Initial severity over 10% in AQ% was also found to be significantly associated with good improvement (odds ratio=8.618, p<0.05). CONCLUSION Speech therapy with tDCS was established as a treatment tool for aphasic patients after stroke. Lower initial severity was associated with good responses.
Sung Ho Jang - One of the best experts on this subject based on the ideXlab platform.
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recovery of Aphasia and change of injured arcuate fasciculus in the dominant hemisphere in stroke patients
NeuroRehabilitation, 2017Co-Authors: Sung Ho Jang, Ik Tae Cho, Ji Woon LimAbstract:OBJECTIVES We investigated the relation between recovery of Aphasia and change of injured fasciculus (AF) in the dominant hemisphere using diffusion tensor tractography (DTT) in stroke patients with Aphasia. METHODS Sixteen consecutive right-handed stroke patients with Aphasia with injury of the left AF were recruited for this study. The Western Aphasia Battery for assessment of Aphasia and DTTs of the AF were used within 30 days of stroke onset and again three months after. DTTs of both AFs were reconstructed, and fractional anisotropy (FA) and voxel number of the AF were measured. RESULTS A moderate positive correlation was observed between Aphasia quotient (AQ) and voxel number of the left AF (r = 0.626, p < 0.01). However, no correlation was observed between AQ and FA of the left AF, and voxel number and FA of the right AF. In addition, the language quotient (LQ) of WAB was not correlated with FA and voxel number of the both AFs. CONCLUSIONS We found a relation between recovery of Aphasia from early to chronic stage of stroke and recovery of the injured AF in the dominant hemisphere irrespective of change of the AF in the non-dominant hemisphere. Our results suggest that facilitation of the injured AF in the dominant hemisphere could be an important strategy in neuro-rehabilitation for stroke patients with Aphasia.
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recovery of injured arcuate fasciculus in the dominant hemisphere in a patient with an intracerebral hemorrhage
American Journal of Physical Medicine & Rehabilitation, 2014Co-Authors: Sung Ho Jang, Han Do LeeAbstract:This study reports on a patient with an intracerebral hemorrhage who showed recovery of an injured arcuate fasciculus (AF) in the dominant hemisphere, using follow-up diffusion tensor tractography. A 43-year-old right-handed man presented with severe Aphasia and hemiparesis resulting from a spontaneous intracerebral hemorrhage in the left parietotemporal lobes. The patient showed severe Aphasia at 1 month after onset, with an Aphasia quotient of 5% on the Korean-Western Aphasia Battery. He underwent comprehensive rehabilitative therapy until 22 months after onset and his Aphasia showed improvement, with an Aphasia quotient of 58% on the Korean-Western Aphasia Battery. On 1-month diffusion tensor tractography, only the thin ascending part of the left AF from the Wernicke area remained. In contrast, on 16-month diffusion tensor tractography, the injured left AF was thickened and elongated to around the left Broca area; however, discontinuation of the left AF was observed around the left Broca area, and this continuation was elongated to the left Broca area on 22-month diffusion tensor tractography. This study reports on a patient who showed recovery from injury of the left AF along with improvement of Aphasia. Recovery of the injured AF in the dominant hemisphere appears to be one of the mechanisms for recovery from Aphasia.
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relation between Aphasia and arcuate fasciculus in chronic stroke patients
BMC Neurology, 2014Co-Authors: Hyung Jun Tak, Sung Ho JangAbstract:The role of the arcuate fasciculus (AF) in the dominant hemisphere in stroke patients with Aphasia has not been clearly elucidated. We investigated the relation between language function and diffusion tensor tractography (DTT) findings for the left AF in chronic stroke patients with Aphasia. Twenty five consecutive right-handed stroke patients with Aphasia following lesions in the left hemisphere were recruited for this study. The Aphasia quotient (AQ) of Korean-Western Aphasia Battery was used for assessment of language function. We measured values of fractional anisotropy (FA), apparent diffusion coefficient (ADC), voxel number of the left AF. We classified patients into three groups: type A - the left AF was not reconstructed, type B - the left AF was discontinued between Wernicke’s and Broca’s areas, and type C – the left AF was preserved around the stroke lesion. Moderate positive correlation was observed between AQ and voxel number of the left AF (r = 0.471, p 0.05) and ADC values (r = -0.286, p > 0.05). Significant differences in AQ scores were observed between the three types (p < 0.05); the AQ score of type C was higher than those of type A and B, and that of type B was also higher than that of type A (p < 0.05). According to our findings, the remaining volume of the left AF, irrespective of directionality and diffusivity, showed moderate positive correlation with language function in chronic stroke patients with Aphasia. Discontinuation or non-construction of the left AF was also an important factor for language function.
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excellent recovery of Aphasia in a patient with complete injury of the arcuate fasciculus in the dominant hemisphere
NeuroRehabilitation, 2011Co-Authors: Hyeok Gyu Kwon, Sung Ho JangAbstract:Abstract The arcuate fasciculus (AF) is the neural tract that connects Wernicke's area and Broca's area. The main role of the AF is speech repetition; therefore, injury to the AF typically causes conduction Aphasia. We report on a patient who showed excellent recovery of Aphasia despite complete injury of the AF due to a cerebral infarct. A 54-year-old, right-handed male presented with Aphasia and right hemiparesis. Brain MRI showed an infarct in the left centrum semiovale and corona radiata. Diffusion tensor tractography for the AF was reconstructed using DTI-studio software. The Korean-Western Aphasia Battery (K-WAB) was used for measurement of language function. On K-WAB at 1 week after onset, his Aphasia type was compatible with global Aphasia (Aphasia quotient: 12‰, fluency: 5‰, comprehension: 24‰, repetition: 15‰, and naming: 31‰). The patient underwent rehabilitative therapy, including language therapy and medication, which is known to facilitate recovery from Aphasia, for a period of 24 months. His Aphasia had improved to a nearly normal state at 30 months after onset; Aphasia quotient: 93‰ (fluency: 91‰, comprehension: 92‰, repetition: 85‰, and naming: 96‰). The left AF showed a complete disruption on 27-month diffusion tensor tractography. Findings from this study suggest the possibility that Aphasia might show good recovery, even in cases of severe injury of the AF.
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the clinical application of the arcuate fasciculus for stroke patients with Aphasia a diffusion tensor tractography study
NeuroRehabilitation, 2011Co-Authors: Soohyun Kim, Su Min Son, Dong Gyu Lee, Hee You, Yun Woo Cho, Min Cheol Chang, Jun Lee, Sung Ho JangAbstract:Little is known about the clinical usefulness of diffusion tensor tractography (DTT) for the arcuate fasciculus (AF) in stroke patients with Aphasia. Using DTT, we attempted to investigate the clinical usefulness of the AF in patients with Aphasia. Five stroke patients and 7 age- and sex-matched normal subjects were recruited for this study. We recruited stroke patients with language dysfunction who had lesions in the left corona radiata and basal ganglia level. DTT for the AF was reconstructed using DTI-studio software. Korean-Western Aphasia Battery (K-WAB) was used for measurement of language function. Patient 1, who showed mild dysarthria, revealed a normal left AF in terms of integrity and DTT parameters. In patient 2, with conduction Aphasia, the left AF showed partial injury; however, the integrity of the left AF was spared. Patients 3 and 4, who had no brain lesions at Broca's area on conventional brain MRI, showed disruptions of the left AF over the stroke lesions after originating from Wernicke's area and they presented with Broca's Aphasia. Patient 5 revealed global Aphasia on K-WAB and the left AF was not reconstructed due to severe injury and Wallerian degeneration. We found that DTT for the AF could provide useful information on the presence or severity of injury of the AF, which could not be detected on conventional brain MRI in stoke patients. In addition, it could be helpful in classification of the Aphasia type of stroke patients.
Gerard E Francisco - One of the best experts on this subject based on the ideXlab platform.
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combined dextroamphetamine and transcranial direct current stimulation in poststroke Aphasia
American Journal of Physical Medicine & Rehabilitation, 2017Co-Authors: Zafer Keser, Michelle Weber Dehgan, Shaparak Shadravan, Nuray Yozbatiran, Lynn M Maher, Gerard E FranciscoAbstract:There is a growing need for various effective adjunctive treatment options for speech recovery after stroke. A pharmacological agent combined with noninvasive brain stimulation has not been previously reported for poststroke Aphasia recovery. In this "proof of concept" study, we aimed to test the safety of a combined intervention consisting of dextroamphetamine, transcranial direct current stimulation, and speech and language therapy in subjects with nonfluent Aphasia. Ten subjects with chronic nonfluent Aphasia underwent two experiments where they received dextroamphetamine or placebo along with transcranial direct current stimulation and speech and language therapy on two separate days. The Western Aphasia Battery-Revised was used to monitor changes in speech performance. No serious adverse events were observed. There was no significant increase in blood pressure with amphetamine or deterioration in speech and language performance. Western Aphasia Battery-Revised Aphasia quotient and language quotient showed a statistically significant increase in the active experiment. Comparison of proportional changes of Aphasia quotient and language quotient in active experiment with those in placebo experiment showed significant difference. We showed that the triple combination therapy is safe and implementable and seems to induce positive changes in speech and language performance in the patients with chronic nonfluent Aphasia due to stroke.
K Searle - One of the best experts on this subject based on the ideXlab platform.
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a prospective randomized parallel group controlled study of the effect of intensity of speech and language therapy on early recovery from poststroke Aphasia
Clinical Rehabilitation, 2007Co-Authors: A M O Bakheit, Steve Shaw, Louise Barrett, J Wood, Suzanne Carrington, Sarah Griffiths, K Searle, F KoutsiAbstract:Objective: To examine whether the amount of speech and language therapy influences the recovery from poststroke Aphasia.Setting: A hospital stroke unit and community.Design: A prospective, randomized controlled trial.Intervention: Aphasic stroke patients were randomly allocated to receive 5 hours (intensive therapy group, n=51) or 2 hours (standard therapy group) of speech and language therapy per week for 12 consecutive weeks starting as soon as practicable after the stroke. Another 19 patients were recruited for 2 hours per week of therapy and were treated by National Health Service (NHS) staff (NHS group).Outcome measure and assessment: The Western Aphasia Battery. Assessments were made blind to randomization at baseline and 4, 8, 12 and 24 weeks after the start of therapy. Data were analysed by intention to treat.Results: The mean (SD) Western Aphasia Battery score at week 12 for the intensive, standard and NHS groups was 70.3 (26.9), 66.2 (26.2) and 58.1 (33.7), respectively. There was no treatment e...
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high scores on the Western Aphasia Battery correlate with good functional communication skills as measured with the communicative effectiveness index in aphasic stroke patients
Disability and Rehabilitation, 2005Co-Authors: A M O Bakheit, Suzanne Carrington, Sarah Griffiths, K SearleAbstract:Objective. To examine the correlation between an impairment-level and a functional-level assessment scale of Aphasia.Design. Prospective, longitudinal study.Setting. A stroke rehabilitation unit.Subjects. Sixty-seven aphasic acute stroke patients who were undergoing a multi-disciplinary rehabilitation programme, including conventional speech and language therapy (SLT).Intervention. Patients were assessed on study entry and 4, 8, 12 and 24 weeks after the start of SLT. The language impairment was assessed with the Western Aphasia Battery (WAB) and the communicative functional limitation associated with Aphasia was measured with the Communicative Effectiveness Index (CETI).Results. There was a statistically significant correlation between the two scales for all assessment periods (Pearson's r = 0.71; P < 0.01).Conclusion. The study suggests that in the acute and subacute stages of stroke the scores of WAB and CETI can be surmised from one another.
Eun Kyoung Kang - One of the best experts on this subject based on the ideXlab platform.
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cognitive and language function in aphasic patients assessed with the korean version of mini mental status examination
Annals of Rehabilitation Medicine, 2016Co-Authors: Eun Kyoung Kang, Hyun Sun Jeong, Eun Rhan Moon, Joo Young Lee, Kun Jai LeeAbstract:OBJECTIVE To assess the clinical usefulness of the relatively short instrument, the Korean version of the Mini-Mental State Examination (MMSE-K), for testing the association between cognition and language function in subacute post-stroke Aphasia patients. METHODS Medical charts of 111 post-stroke patients (65 men; age 69.6±10.0 years; 124.6±80.6 days post-onset) were reviewed retrospectively. All patients were assessed longitudinally for Aphasia using the validated Korean version of the Western Aphasia Battery (K-WAB) and for cognition using the MMSE-K. Patients were categorized and analyzed according to 3 Aphasia-severity clusters. RESULTS All subscales of the K-WAB showed significant improvement in follow-up assessments in all groups (p<0.05 or p<0.01). Only the scores of orientation, language function, and total score of MMSE-K showed significant improvement in all groups (p<0.01). The more severely impaired group showed stronger Pearson correlation coefficients between cognition and language function. Additionally, comparisons between correlation coefficients showed that the association of improvement in orientation with that of fluency and AQ% (Aphasia quotient %) was significant in the more severely impaired group. CONCLUSION Among subacute post-stroke aphasic patients, patients with more severe Aphasia showed greater impairments to cognitive function; in addition, recovery of orientation may be related to recovery of language function.
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Severity of Post-stroke Aphasia According to Aphasia Type and Lesion Location in Koreans
2013Co-Authors: Eun Kyoung Kang, Hae Min Sohn, Moon-ku Han, Won Kim, Tai Ryoon Han, Namjong PaikAbstract:To determine the relations between post-stroke Aphasia severity and Aphasia type and lesion location, a retrospective review was undertaken using the medical records of 97 Korean patients, treated within 90 days of onset, for Aphasia caused by unilateral left hemispheric stroke. Types of Aphasia were classified according to the validated Korean version of the Western Aphasia Battery (K-WAB), and severities of Aphasia were quantified using WAB Aphasia Quotients (AQ). Lesion locations were classified as cortical or subcortical, and were determined by magnetic resonance imaging. Two-step cluster analysis was performed using AQ values to classify Aphasia severity by Aphasia type and lesion location. Cluster analysis resulted in four severity clusters: 1) mild; anomic type, 2) moderate; Wernicke’s, transcortical motor, transcortical sensory, conduction, and mixed transcortical types, 3) moderately severe; Broca’s Aphasia, and 4) severe; global Aphasia, and also in three lesion location clusters: 1) mild; subcortical 2) moderate; cortical lesions involving Broca’s and/or Wernicke’s areas, and 3) severe; insular and cortical lesions not in Broca’s or Wernicke’s areas. These results revealed that within 3 months of stroke, global Aphasia was the more severely affected type and cortical lesions were more likely to affect language function than subcortical lesions
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the factors associated with good responses to speech therapy combined with transcranial direct current stimulation in post stroke aphasic patients
Annals of Rehabilitation Medicine, 2011Co-Authors: Ilyoung Jung, Eun Kyoung Kang, Jong Youb Lim, Hae Min Sohn, Namjong PaikAbstract:OBJECTIVE To determine factors associated with good responses to speech therapy combined with transcranial direct current stimulation (tDCS) in aphasic patients after stroke. METHOD The language function was evaluated using Korean version of Western Aphasia Battery (K-WAB) before and after speech therapy with tDCS in 37 stroke patients. Patients received speech therapy for 30 minutes over 2 to 3 weeks (10 sessions) while the cathodal tDCS was performed to the Brodmann area 45 with 1 mA for 20 minutes. We compared the improvement of Aphasia quotient % (AQ%) between two evaluation times according to age, sex, days after onset, stroke type, Aphasia type, brain lesion confirmed by magnetic resonance image and initial severity of Aphasia. The factors related with good responses were also checked. RESULTS AQ% improved from pre- to post-therapy (14.94±6.73%, p<0.001). AQ% improvement was greater in patients with less severe, fluent type of Aphasia who received treatment before 30 days since stroke was developed (p<0.05). The adjusted logistic regression model revealed that patients with hemorrhagic stroke were more likely to achieve good responses (odds ratio=4.897, p<0.05) relative to infarction. Initial severity over 10% in AQ% was also found to be significantly associated with good improvement (odds ratio=8.618, p<0.05). CONCLUSION Speech therapy with tDCS was established as a treatment tool for aphasic patients after stroke. Lower initial severity was associated with good responses.
