SALT Speech Current Awareness Bulletin 25th August 2021

SALT Speech Current Awareness Bulletin
                                  25th August 2021

1. Prevalence of aphasia and dysarthria among inpatient stroke survivors: describing the
population, therapy provision and outcomes on discharge.
Author(s): Mitchell ; Gittins, Matthew; Tyson, Sarah; Vail, Andy; Conroy, Paul; Paley, Lizz; Bowen,
Audrey
Source: Aphasiology; Jul 2021; vol. 35 (no. 7); p. 950-960
Publication Date: Jul 2021
Publication Type(s): Academic Journal
Available at Aphasiology - from Unpaywall
Abstract: Background: Stroke causes communication impairments but we lack the real-world
population-level data needed to inform inpatient and community services. Aims: To establish
prevalence of aphasia and dysarthria within inpatient stroke survivors, describe those affected, the
amount of therapy they receive and their outcomes. Methods & Procedures: Secondary analysis of
data from the Sentinel Stroke National Audit Programme, England, Wales and Norther Ireland,
including inpatient stroke survivors after 72 hours, with completed National Institute of Health
Stroke Scale data (communication items), excluding those already discharged, not conscious or with
incomplete data. Outcomes & Results: 64% of the 88,974 stroke survivors meeting our criteria were
communication impaired: 28% had both aphasia and dysarthria, 24% had dysarthria only and 12%
had aphasia only. Those in the older age range and with more severe stroke were more likely to have
a communication impairment and had a worse outcome than those without communication
impairment. On average, those with both communication impairments had a 21 day length of stay
and 10 minutes of speech and language therapy for communication and/or dysphagia per day of
stay. Conclusions: Communication impairment is common during the inpatient phase of stroke care
yet average therapy provision is below the recommended levels and is likely to include dysphagia
assessment and intervention. Dysarthria is reported as more prevalent than aphasia at this early
stage, although this is not necessarily diagnosed by a speech and language therapist. The most
common presentation is to have a combination of aphasia and dysarthria for which there is limited
clinical guidance.
Database: CINAHL

2. Naming gains and within-intervention progression following semantic feature analysis (SFA) and
phonological components analysis (PCA) in adults with chronic post-stroke aphasia.
Author(s): Haentjens ; Auclair-Ouellet, Noémie
Source: Aphasiology; Aug 2021; vol. 35 (no. 8); p. 1024-1047
Publication Date: Aug 2021
Publication Type(s): Academic Journal
Abstract: Background: Up to 60% of people with aphasia experience persistent word-finding
difficulties into the chronic stage, starting six months after the stroke. Semantic Feature Analysis

(SFA) and Phonological Components Analysis (PCA) are two common word-finding interventions that
use the generation of semantic features for SFA (e.g. category) and phonological features for PCA
(e.g. first sound) to improve naming. Despite inconsistent support for the generalization to
untreated items, studies have shown improvements on probe word naming for treated items.
However, research concerning within-intervention effects and generalization to alternative contexts
has been limited. Aim: This study investigated the effect of treatment for SFA and PCA probe word
naming as well as their within-intervention effects in four individuals with chronic post-stroke
aphasia. Methods & Procedures: Baseline and follow-up measures included standardized
assessments and image naming tasks. The image naming task was used to generate three lists: an
SFA treated list, a PCA treated list, and an untreated list. One SFA session and one PCA session per
week were then provided concurrently to each participant for a period of six weeks. Outcomes &
Results: While only one participant experienced significant gains on treated probe word naming,
these gains were maintained four weeks after the intervention. Exploratory results suggested that
effects could transfer to two types of generalization items: different pictures of the same items and
pictures of items shown in a natural context. Furthermore, while generalization to untreated items
did not reach significance for any participant, some generalization of gains to standardized
assessments was observed. Although rarely equivalent for SFA and PCA interventions, all
participants also experienced some degree of within-intervention improvement over the progression
of sessions. These improvements included a reduction in the number of forced choices required for
feature generation and/or a reduction in the number of words never named during intervention
sessions. Conclusion: The results support additional avenues of investigation for SFA and PCA
therapies for individuals with post-stroke aphasia, namely within intervention effects and the
potential for generalization to different contexts.
Database: CINAHL

3. The Communicative Participation Item Bank: Evaluating, and Reevaluating, Its Use across
Communication Disorders in Adults.
Author(s): Baylor ; Eadie, Tanya; Yorkston, Kathryn
Source: Seminars in Speech & Language; Jun 2021; vol. 42 (no. 3); p. 225-239
Publication Date: Jun 2021
Publication Type(s): Academic Journal
Abstract: Patient-reported outcomes (PROs) are essential in patient-centered, evidence-based
practice in speech-language pathology. PROs respect individuals who live with communication
disorders as key stakeholders providing a critically unique perspective on consequences of
communication disorders, and whether interventions bring about meaningful changes. Some PROs
focus on specific communication symptoms such as voice or language symptom severity, while
others focus on broader constructs such as quality of life. Many PROs target specific diagnostic
groups. This article presents the Communicative Participation Item Bank (CPIB), a PRO that measures
communicative participation restrictions. The CPIB was based on the concept of participation, or
engagement in life situations, as defined in the World Health Organization's International
Classification of Functioning, Disability, and Health. It was designed to be relevant for adults across
different communication disorders to facilitate clinical and research activities that may involve either
comparing or aggregating data across communication disorders. The CPIB follows current PRO
development protocols including systematic guidance from stakeholders through cognitive
interviews, and the measurement methods of Item Response Theory that allow precise and adaptive
assessment. This article reviews use of the CPIB across different diagnostic groups, and identifies
needs for future efforts to expand the relevance of the CPIB further.
Database: CINAHL

4. Controlling the past, owning the present, and future: cholinergic modulation decreases
semantic perseverations in a person with post-stroke aphasia
Author(s): Berthier M.L.; Edelkraut L.; Lopez-Barroso D.; Davila G.; Torres-Prioris M.J.; Santana-
Moreno D.; Beltran-Corbellini A.; Criado-Alamo J.C.
Source: Aphasiology; 2021
Publication Date: 2021
Publication Type(s): Article
Abstract: Background: Perseverations in speech production tasks represent a pervasive symptom of
chronic aphasia. Semantic perseverations (SPs) are defined as repetitive and unconscious production
of specific linguistic forms previously produced, heard, or seen which share semantic relatedness
with the target word. Neurochemically, SPs have been attributed to weakened activation of the
target word due to the depletion of neurotransmitter systems (acetylcholine and dopamine)
occurring in the context of activation of semantic competitors. Aim(s): The present pilot study seeks
to evaluate the effectiveness of a cholinergic enhancing drug combined with speech language
therapy in reducing SPs and other non-perseverative semantic errors in a person with chronic post-
stroke aphasia. Methods & Procedures: Combined therapy of the cholinesterase inhibitor donepezil
and conventional speech-language therapy (SLT) (2 hours/week) over 16 weeks was administered to
a woman with chronic fluent post-stroke aphasia showing high rate of semantic errors. Aphasia and
SPs assessments were performed at four different time-points across the study: at baseline, after
donepezil 5 mg, donepezil 10 mg, and after 4-weeks of washout. The changes induced by the
treatments on the occurrence of SPs and semantic paraphasias during a picture naming task were
evaluated. By using a specific statistical methodology, we performed a fine-grained analysis of the
frequency of SPs and their temporal course at the different time-points to dissect changes induced
by the treatment. Result(s): At baseline, there were significantly more SPs than expected by a
random distribution, whereas a marked reduction of these errors was found in the three following
evaluations. A significant reduction in aphasia severity was also found with high donepezil doses and
this improvement maintained after a 4-week washout period. Everyday communication improved
with low doses of donepezil. Conclusion(s): Our findings suggest that decreased activity of the
cholinergic system may exert a permissive role for the production of SPs and highlight the
importance of combining cholinergic agents with speech-language therapy to reduce SPs in aphasia
at the time that other language deficits are also improved.Copyright © 2021 Informa UK Limited,
trading as Taylor & Francis Group.
Database: EMBASE

5. Behavioural and neurophysiological responses to written naming treatment and high definition
tDCS: a case study in advanced primary progressive aphasia
Author(s): Shah-Basak P.; Jokel R.; Meltzer J.A.; Fernandez A.; Armstrong S.E.M.; Hodzic-Santor B.H.;
Lavoie M.
Source: Aphasiology; 2021
Publication Date: 2021
Publication Type(s): Article
Abstract: Background: Primary progressive aphasia (PPA) is associated with progressive loss of
language functions in the context of irreversible neurodegeneration, for which there is no cure.
Speech-language therapy can help preserve language abilities, and most promisingly, interventions
like transcranial direct current stimulation (tDCS) have been shown to augment the effectiveness of
therapy. However, the underlying mechanism for this enhancement is unknown. Objective(s): We
evaluated the behavioural and physiological (using resting-state magnetoencephalography [rsMEG])

effects of contemporary naming treatment provided with tDCS in a patient with an advanced case of
nonfluent variant PPA (P01; 67 year old male). P01 was mute but had preserved written abilities,
which we aimed to enhance with written naming therapy and excitatory or anodal-tDCS. We
hypothesized greater improvement in written performance, particularly immediate gains,
maintenance, and generalization, after anodal- than sham-tDCS. Additionally, reductions in
oscillatory abnormal activity, as indicated by rsMEG, were expected after repeated sessions of
anodal-tDCS with the naming treatment. Method(s): A written picture naming therapy was paired
with five sessions of anodal and five sessions of sham high-definition tDCS over two weeks.
Anatomical and neurophysiological abnormalities were mapped with structural-MRI and rsMEG,
respectively. TDCS was targeted towards an anatomically intact left supramarginal gyrus. The
therapy-induced changes in written performance were evaluated on both trained and untrained
pictures using Levenshtein Distances (LD). The neurophysiological changes were evaluated by
comparing spectral relative power estimates in frequency bands ranging from delta to low-gamma
(1-50 Hz), before and after therapy. All evaluations were completed immediately after therapy with
sham- and anodal-tDCS, and at a 3-month follow-up. Result(s): Compared to sham-tDCS, anodal-
tDCS augmented the immediate therapy-induced gains on trained items, as indicated by reductions
in LD scores, reflecting improvement in written performance, particularly for more difficult target
words. Neural activity at the stimulation spot and in surrounding and remote regions exhibited
reduced oscillatory slowing, both immediately after one session (short-term) and after completion of
five sessions (long-term) of anodal-tDCS compared to sham-tDCS. This is manifested as decreased
theta (1-4 Hz) and increased beta and low-gamma (15-50 Hz) power. No additional gains with
anodal-tDCS were found on untrained items (generalization) or at 3-month follow-up (maintenance).
Conclusion(s): Our findings suggest that five sessions of anodal-tDCS can improve written
performance by partially reversing abnormal neural activity and thus boosting the functional
capacity of the structurally intact cortex. Longer duration of treatment may be needed for additional
gains in maintenance and generalization with anodal-tDCS.Copyright © 2021 Informa UK Limited,
trading as Taylor & Francis Group.
Database: EMBASE

6. Selective Functional Network Changes Following tDCS-Augmented Language Treatment in
Primary Progressive Aphasia
Author(s): Tao Y.; Rapp B.; Ficek B.; Tsapkini K.; Wang Z.
Source: Frontiers in Aging Neuroscience; Jul 2021; vol. 13
Publication Date: Jul 2021
Publication Type(s): Article
Available at Frontiers in Aging Neuroscience - from Europe PubMed Central - Open Access
Available at Frontiers in Aging Neuroscience - from Unpaywall
Abstract:Objective: Transcranial direct current stimulation (tDCS) has shown promising results when
used as an adjunct to behavioral training in neurodegenerative diseases. However, the underlying
neural mechanisms are not understood and neuroimaging evidence from pre/post treatment has
been sparse. In this study, we examined tDCS-induced neural changes in a language intervention
study for primary progressive aphasia (PPA), a neurodegenerative syndrome with language
impairment as the primary clinical presentation. Anodal tDCS was applied to the left inferior frontal
gyrus (LIFG). To evaluate the hypothesis that tDCS promotes system segregation, analysis focused on
understanding tDCS-induced changes in the brain-wide functional network connectivity of the
targeted LIFG. Method(s): Resting-state fMRI data were obtained from 32 participants with PPA
before and after receiving a written naming therapy, accompanied either by tDCS or sham
stimulation. We focused on evaluating changes in the global connectivity of the stimulated LIFG-

triangularis (LIFG-tri) region given its important role in lexical processing. Global connectivity was
indexed by the graph-theoretic measure participation coefficient (PC) which quantifies a region's
level of system segregation. The values before and after treatment were compared for each
condition (tDCS or Sham) as well as with age-matched healthy controls (n = 19). Result(s): Higher
global connectivity of the LIFG-tri before treatment was associated with greater dementia severity.
After treatment, the tDCS group showed a significant decrease in global connectivity whereas the
Sham group's did not change, suggesting specific neural effects induced by tDCS. Further
examination revealed that the decrease was driven by reduced connectivity between the LIFG-tri
and regions outside the perisylvian language area, consistent with the hypothesis that tDCS
enhances the segregation of the language system and improves processing efficiency. Additionally,
we found that these effects were specific to the LIFG-tri and not observed in other control regions.
Conclusion(s): TDCS-augmented language therapy in PPA increased the functional segregation of the
language system, a normalization of the hyper-connectivity observed before treatment. These
findings add to our understanding of the nature of tDCS-induced neural changes in disease
treatment and have applications for validating treatment efficacy and designing future tDCS and
other non-invasive brain stimulation (NIBS) treatments.© Copyright © 2021 Tao, Ficek, Wang, Rapp
and Tsapkini.
Database: EMBASE

7. Parkinson's disease impacts feedback production during verbal communication
Author(s): Basirat A.; Knutsen D.; Moreau C.
Source: International journal of language & communication disorders; Jul 2021; vol. 56 (no. 4); p.
826-840
Publication Date: Jul 2021
Publication Type(s): Article
PubMedID: 34227719
Available at International journal of language & communication disorders - from Unpaywall
Abstract:BACKGROUND: Parkinson's disease (PD) leads to changes in verbal communications. The
focus of most studies to date has been on speech impairment, which is specifically referred to as
dysarthria. Although these studies are crucial to understanding the impact of PD on verbal
communication, they do not focus on the features of dialogues between people with PD (PwPD) and
other people in communicative contexts. AIMS: To investigate whether PwPD produce less feedback
than typical people during dialogue, thus potentially making it more difficult for them to reach
mutual comprehension (i.e., common ground) with their conversational partner. METHODS &
PROCEDURES: A matching task experiment was conducted during which an experimenter described
abstract pictures to a participant, who was either a PwPD or a typical participant, so that he or she
could organize these pictures in a grid. The participants could produce as much feedback as they
liked. OUTCOMES & RESULTS: PwPD were less likely to produce feedback than typical participants.
This effect was mainly driven by two specific types of feedback: acknowledgment tokens and
hesitations. CONCLUSIONS & IMPLICATIONS: The results suggest that PD impacts feedback
production. This could decrease the communicative abilities of PwPD in interactive contexts by
affecting grounding, that is, the ability to build common ground with others. This paper is one of the
first to specifically document the production of feedback markers in PwPD. Future studies should
examine the extent to which our results, which were obtained in a controlled dialogue task, may be
generalized to daily-life conversions. From a clinical perspective, our study points to the necessity of
assessing feedback production, and more generally abilities related to common ground construction
and use, during PD progression. WHAT IS ALREADY KNOWN ON THE SUBJECT: A few studies to date
have analyzed conversational interactions between people with Parkinson's disease (PwPD) and

others. The main focus is usually on potential difficulties of PwPD and their partners during the
interaction and the strategies adopted to "repair" these problems. Another important feature of any
interaction is the production of feedback. Feedback production plays a key role in building and using
common ground to ensure mutual comprehension between interlocutors. The impact of Parkinson's
disease on feedback production has received little attention in the literature to date. WHAT THIS
STUDY ADDS: The purpose of this study was to compare feedback production in a dialogue task (i.e.,
goal-oriented interaction) in PwPD versus typical controls. Our results revealed that PwPD produced
less feedback for their dialogue partners than did typical participants. This effect was mainly driven
by two specific types of feedback: acknowledgment tokens and hesitations. This paper is one of the
firsts to specifically document the production of feedback markers in PwPD and to illustrate that
PwPD and their dialogue partners may require more time and effort to establish common ground.
CLINICAL IMPLICATIONS OF THIS STUDY: Our findings suggest that an appropriate evaluation of
feedback production by speech and language therapists, as well the management of potential
deficits, would be beneficial. More broadly, we believe that the evaluation and management of
PwPD should take into account the theoretical framework used in this study, in particular the role of
common ground in communication.Copyright © 2021 Royal College of Speech and Language
Therapists.
Database: EMBASE

8. Treatment fidelity of technology-enhanced reading therapy (CommuniCATE) for people with
aphasia
Author(s): Bacon K.; Moutou C.; Marshall J.; Monnelly K.; Cruice M.; Woolf C.; Caute A.
Source: International journal of language & communication disorders; Jul 2021
Publication Date: Jul 2021
Publication Type(s): Article
PubMedID: 34260119
Available at International journal of language & communication disorders - from Unpaywall
Abstract: BACKGROUND: Treatment fidelity (TF), that is, the degree to which the treatment delivery
has adhered to protocol, is an important aspect of establishing treatment validity and reliability.
Research has shown that establishing TF is only done in a small percentage of aphasia treatment
studies. AIMS: This project supports the work of the CommuniCATE study, which explored the
benefits of technology-enhanced aphasia therapy on participants' reading, writing, speech and
conversation skills. It examines the TF of the Reading strand of the CommuniCATE project by
assessing whether the therapy adhered to the protocol. The following research questions were
asked: Does treatment delivery adhere to treatment protocol? Does the degree of TF vary according
to the person delivering the therapy (i.e. student therapist or qualified therapist)? Does the degree
of TF vary over time (early treatment sessions compared with later treatment sessions)? Was the
checklist tool reliable? METHODS & PROCEDURES: This study assessed the fidelity of 38
retrospective video recordings of therapy. It used a checklist measure of criteria to which the
delivery of the sessions should adhere, and against which the sessions were rated. Participants were
the people with aphasia receiving therapy, the students and qualified speech and language
therapists delivering therapy, and the independent raters assessing the sessions. A sample of
sessions was randomly chosen, including sessions delivered by qualified therapists and by students,
and sessions from different time points in the treatment process. The fidelity was rated by the first
author, and the fidelity rating calculated as a percentage. Comparisons in fidelity scores for the
different variables were drawn using Mann-Whitney tests. The reliability of the checklist was
assessed through inter and intra-rater reliability testing, and the results were analysed using Kappa
statistics. OUTCOMES & RESULTS: High fidelity was found across all therapy conditions with a mean

score of 98.2%. Fidelity scores were not affected by the administrator of therapy; sessions delivered
by qualified and student therapists were rated equally highly. There was a small but significant effect
of time, with later treatment sessions scoring more highly than earlier sessions. However, scores
across both periods > 90%. Inter-rater reliability found a high percentage agreement of 93.3% and a
Poor Kappa agreement level. Intra-rater agreement found a high percentage agreement of 97.3%
and a Fair Kappa agreement level. CONCLUSIONS & IMPLICATIONS: The CommuniCATE reading
therapy was implemented as per the protocol across time points, and withstood delegation to
students. The high fidelity and good reliability scores have positive implications for the study's
validity and reliability, and for the study's replication. WHAT THIS PAPER ADDS: What is already
known on the subject TF refers to the degree to which the delivery of core components of a
treatment matches the implementation guidelines, that is, the adherence to protocol. Despite the
acknowledged importance of TF reporting, this is often neglected in the literature. What this paper
adds to existing knowledge This paper shows that the TF assessment of the CommuniCATE study
(reading strand) found a 98.2% fidelity score, and that high fidelity was not compromised across
treatment conditions. This paper outlines the principles of TF and highlights the need for measures
to be in place to establish TF, for example, manuals, training and supervision; and to monitor TF, for
example, via the use of checklists. This paper also underlines the scarcity of TF measures and checks
in aphasia research. This paper therefore serves as a model of TF practice in aphasia therapy
research. What are the potential or actual clinical implications of this work? This study contributes to
the findings of the CommuniCATE project (reading strand), and the high fidelity findings enhance the
validity of the project and indicate that the therapy manual and training enable accurate
implementation of delivery. This paper also contributes to the literature on TF evaluation in aphasia
studies, which is presently lacking, and highlights the need for increased focus on the optimum
strategies of TF reporting.Copyright © 2021 The Authors. International Journal of Language &
Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech
and Language Therapists.
Database: EMBASE

9. Effect of Anodic Transcranial Direct Current Stimulation Combined With Speech Language
Therapy on Nonfluent Poststroke Aphasia
Author(s): Zhao Q.; Wang J.; Li Z.; Li X.; Song L.
Source: Neuromodulation; Jul 2021; vol. 24 (no. 5); p. 923-929
Publication Date: Jul 2021
Publication Type(s): Article
PubMedID: 33624330
Abstract: Objectives: Transcranial direct current stimulation (tDCS) facilitates or inhibits
spontaneous neuronal activity by low-intensity current. In this study, we evaluated the effects of
tDCS and sham stimulation combined with speech language therapy (SLT) on nonfluent poststroke
aphasia (PSA) patients. Material(s) and Method(s): Patients with PSA were randomly divided into the
anode tDCS (A-tDCS) group (n = 8) and sham tDCS (S-tDCS) group (n = 10). The anodes and cathodes
were fixed over left inferior gyrus frontalis (L-IFG) and the deltoid muscle of the right shoulder. A-
tDCS consisted of 2 mA for 20 min, while S-tDCS current started at 2 mA but automatically decreased
to 0 mA after 30 sec. Stimulation was concurrent with 30 min of SLT. Stimulation + SLT sessions
occurred five times a week for four weeks. The Western Aphasia Battery (WAB) was given before
treatment to obtain the baseline score and once more after all sessions were completed, and the
Aphasia Quotient (AQ) was calculated. Result(s): After tDCS treatment, the AQ mean(SD) in both
groups was significantly higher than before treatment (p < 0.001) and the AQ of the A-tDCS group
72.99 (21.91) was significantly higher than that of the S-tDCS group 46.18 (19.29) (t = 2.760, p <

0.05). Upon further analysis of the WAB subscores, except for comprehension, all other items were
significantly higher in the A-tDCS group than in the S-tDCS group (p < 0.05). Conclusion(s): Our
results suggest that left inferior gyrus frontalis anodic transcranial direct current stimulation is an
effective adjuvant to conventional speech language therapy for patients with nonfluent
PSA.Copyright © 2021 International Neuromodulation Society.
Database: EMBASE

10. Better long-term speech outcomes in stroke survivors who received early clinical speech and
language therapy: What's driving recovery?
Author(s): Roberts S.; Bruce R.M.; Lim L.; Woodgate H.; Ledingham K.; Anderson S.; Lorca-Puls D.L.;
Gajardo-Vidal A.; Hope T.M.H.; Price C.J.; Leff A.P.; Crinion J.T.; Green D.W.
Source: Neuropsychological rehabilitation; Jul 2021 ; p. 1-23
Publication Date: Jul 2021
Publication Type(s): Article
PubMedID: 34210238
Available at Neuropsychological rehabilitation - from Unpaywall
Abstract: Establishing whether speech and language therapy after stroke has beneficial effects on
speaking ability is challenging because of the need to control for multiple non-therapy factors known
to influence recovery. We investigated how speaking ability at three time points post-stroke differed
in patients who received varying amounts of clinical therapy in the first month post-stroke. In
contrast to prior studies, we factored out variance from: initial severity of speaking impairment,
amount of later therapy, and left and right hemisphere lesion size and site. We found that speaking
ability at one month post-stroke was significantly better in patients who received early therapy
(n=79), versus those who did not (n=64), and the number of hours of early therapy was positively
related to recovery at one year post-stroke. We offer two non-mutually exclusive interpretations of
these data: (1) patients may benefit from the early provision of self-management strategies; (2)
therapy is more likely to be provided to patients who have a better chance of recovery (e.g., poor
physical and/or mental health may impact suitability for therapy and chance of recovery). Both
interpretations have implications for future studies aiming to predict individual patients' speech
outcomes after stroke, and their response to therapy.
Database: EMBASE

11. Levodopa-based changes on vocalic speech movements during prosodic prominence marking
Author(s): Thies T.; Barbe M.T.; Mucke D.; Dano R.
Source: Brain Sciences; May 2021; vol. 11 (no. 5)
Publication Date: May 2021
Publication Type(s): Article
Available at Brain Sciences - from Europe PubMed Central - Open Access
Available at Brain Sciences - from Unpaywall
Abstract: The present study investigates speech changes in Parkinson's disease on the acoustic and
articulatory level with respect to prosodic prominence marking. To display movements of the
underlying articulators, speech data from 16 patients with Parkinson's disease were recorded using
electromagnetic articulography. Speech tasks focused on strategies of prominence marking.
Patients' ability to encode prominence in the laryngeal and supra-laryngeal domain is tested in two

conditions to examine the influence of motor performance on speech production further: without
dopaminergic medication and with dopaminergic medication. The data reveal that patients with
Parkinson's disease are able to highlight important information in both conditions. They maintain
prominence relations across-and within-accentuation by adjusting prosodic markers, such as vowel
duration and pitch modulation, while the acoustic vowel space remains the same. For differentiating
across-accentuation, not only intensity but also all temporal and spatial parameters related to the
articulatory tongue body movements during the production of vowels are modulated to signal
prominence. In response to the levodopa intake, gross motor performance improved significantly by
42%. The improvement in gross motor performance was accompanied by an improvement in speech
motor performance in terms of louder speech and shorter, larger and faster tongue body
movements. The tongue body is more agile under levodopa increase, a fact that is not necessarily
detectable on the acoustic level but important for speech therapy.Copyright © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.
Database: EMBASE

12. Baseline Cortical Anatomy Predicts Response to Combined HD-tDCS and Speech Therapy
Intervention in Aphasia
Author(s): Nissim N.; Harvey D.; Haslam C.; Grossman M.; Hamilton R.
Source: Neuromodulation; Jun 2021; vol. 24 (no. 4)
Publication Date: Jun 2021
Publication Type(s): Conference Abstract
Abstract: Introduction: Primary progressive aphasia (PPA) is a debilitating syndrome marked by
progressive loss of language skills resulting from neurodegenerative disease. There are no current
effective PPA treatments. Noninvasive brain stimulation, such as transcranial direct current
stimulation (tDCS), when paired with language therapy, has demonstrated the ability to enhance
language outcomes in aphasia patients. However, the variability in tDCS response is not well
understood. Method(s): In a blinded, within-group crossover pilot study, PPA patients (N = 12)
underwent a two-week intervention of high-definition-tDCS (HD-tDCS) with constraint-induced
language therapy (CILT). Multi-level linear regression using backward-fitted models were performed
separately to assess whether baseline cortical thickness or volume of regions involved in language
function predict tDCS-induced naming improvements, measured by the Western Aphasia Battery-
naming subtest, at 0-weeks (immediate) and 6-weeks post-intervention. Result(s): Cortical thickness
of the pars opercularis explained 37.8% of the variance in performance at 0-weeks post-intervention
following stimulation (F(1,10) = 6.08, p = 0.03, R2Adjusted = 0.32), whereas greater thickness (beta =
0.62) predicted naming gains (p = 0.03). At 6-weeks post-intervention following stimulation,
thickness explained 83.3% of the variance in change in performance (F(4,6) = 7.46, p = 0.02,
R2Adjusted = 0.72), whereas greater thickness of the middle temporal gyrus (MTG; beta = 0.92) and
less thickness of the posterior superior temporal gyrus (pSTG; beta = -2.02) significantly predicted
maintenance of naming gains (p's < 0.02). Cortical thickness did not predict naming gains in sham
(p's > 0.05). Cortical volume did not predict 0-week performance for active stimulation (p > 0.05).
However, volume in sham explained 68.2% of the variance in 0-week performance (F(3,8) = 5.71, p =
0.02, R2Adjusted = 0.56), whereas greater volume of pars orbitalis and MTG, and less pSTG volume,
predicted immediate naming gains (p's < 0.03). Volume for 6-week active explained 84.2% of the
variance in performance (F(4, 6) = 8.01, p = 0.014, R2Adjusted = 0.74), whereas greater volume of
pars triangularis (beta = 0.76) and MTG (beta = 0.71), but less pSTG and anterior-STG volume (beta =
-0.57, beta = -0.70) significantly predicted naming gains (p's < 0.05). Volume did not predict 6-week
naming gains in sham (p > 0.05). Conclusion(s): The findings that frontal cortical thickness predicted
tDCS-induced naming gains at 0-weeks and temporal areas at 6-weeks (active, not sham) suggests a

broader network of regions may maintain treatment gains. Cortical volume predicting 0-week
naming performance in sham may indicate the behavioral therapy response for immediate gains.
Collectively, thickness and volume were predictive of treatment gains in active, not sham, suggesting
that pairing HD-tDCS with CILT may be important for maintaining treatment effects. These data
suggest tDCS-induced gains are influenced by degree and location of atrophy. Future research is
needed to make clearer inferences about the nature of these relationships.
Database: EMBASE

13. Using a multidisciplinary approach to reveal decision-making capacity within acute care for an
individual with aphasia
Author(s): Maxwell R.; O'Brien M.; O'Donnell D.; Kroll T.; Christophers L.
Source: SAGE Open Medical Case Reports; 2021; vol. 9
Publication Date: 2021
Publication Type(s): Article
Available at SAGE open medical case reports - from Europe PubMed Central - Open Access
Available at SAGE open medical case reports - from Unpaywall
Abstract: Formal assessments of cognition that rely on language may conceal the non-linguistic
cognitive function of people with aphasia. This may have detrimental consequences for how people
with aphasia are supported to reveal communicative and decision-making competence. This case
report demonstrates a multidisciplinary team approach to supporting the health and social care
decision-making of people with aphasia. The case is a 67-year-old woman with Wernicke's type
aphasia. As the issue of long-term care arose, the speech and language therapist used a supported
communication approach with the patient who expressed her wish to go home. A multidisciplinary
team functional assessment of capacity was undertaken which involved functional assessments and
observations of everyday tasks by allied health, nursing, catering and medical staff. In this way, the
patient's decision-making capacity was revealed and she was discharged home. A collaborative
multidisciplinary team approach using supported communication and functional capacity
assessments may be essential for scaffolding the decision-making capacity of people with
aphasia.Copyright © The Author(s) 2021.
Database: EMBASE