Science.gov

Sample records for agrammatic aphasic patients

  1. Comprehension of Sentences with Stylistic Inversion by French Aphasic Patients

    ERIC Educational Resources Information Center

    Rigalleau, Francois; Baudiffier, Vanessa; Caplan, David

    2004-01-01

    Three French-speaking agrammatic aphasics and three French-speaking Conduction aphasics were tested for comprehension of Active, Passive, Cleft-Subject, Cleft-Object, and Cleft-Object sentences with Stylistic Inversion using an object manipulation test. The agrammatic patients consistently reversed thematic roles in the latter sentence type, and…

  2. Training and generalization of agrammatic aphasic adults' wh-interrogative productions.

    PubMed

    Wambaugh, J L; Thompson, C K

    1989-11-01

    The stimulus and response generalization effects of training wh-interrogative production were examined in 4 agrammatic Broca's aphasic subjects using a multiple baseline design across behaviors and subjects. Throughout treatment, response generalization to untrained questions and stimulus generalization to several nontraining conditions were assessed. Variable response generalization to untrained exemplars of trained wh-interrogative forms and little generalization to grammatically different wh constructions occurred. Stimulus generalization to only one of three conditions was noted. However, generalization treatment involving sequential modification of training across conditions was found to be effective in facilitating generalization to an additional stimulus condition for 2 of the 4 subjects.

  3. Idiom Comprehension in Aphasic Patients

    ERIC Educational Resources Information Center

    Papagno, Costanza; Tabossi, Patrizia; Colombo, Maria Rosa; Zampetti, Patrizia

    2004-01-01

    Idiom comprehension was assessed in 10 aphasic patients with semantic deficits by means of a string-to-picture matching task. Patients were also submitted to an oral explanation of the same idioms, and to a word comprehension task. The stimuli of this last task were the words following the verb in the idioms. Idiom comprehension was severely…

  4. Argument Structure Distribution of Predicates in Korean Agrammatic Speech.

    ERIC Educational Resources Information Center

    Kim, Young-Joo; Kim, Hyanghee; Song, Hong-Ki

    2003-01-01

    Examines production of predicates by Korean agrammatic aphasic patients with respect to argument structure distribution of predicates. Analyzed narrative production and picture/scene description data elicited from three Broca's aphasic patients compared with matched controls. Focused on whether subjects have the same type difficulties that Kegl's…

  5. Right unilateral spatial neglect in aphasic patients.

    PubMed

    Ihori, Nami; Kashiwagi, Asako; Kashiwagi, Toshihiro

    2015-08-01

    To investigate spatial responses by aphasic patients during language tasks, 63 aphasics (21 severe, 21 moderate, and 21 mild) were administered two kinds of auditory pointing tasks-word tasks and sentence tasks-in which the spatial conditions of the stimuli were controlled. There were significantly fewer correct responses on the right side of a space than on the left side in both the word and sentence tasks, but the left deviation of correct responses was more prominent in the sentence task than in the word task. Additionally, the severe aphasics exhibited a prominent leftward deviation that may have been the result of deficits in rightward attention controlled by the left hemisphere. This phenomenon also seems to reflect the directional attention that is subserved by the right hemisphere, which attends to the left side of a space and, less predominantly, the right side of a space.

  6. Audiological findings in aphasic patients after stroke

    PubMed Central

    Onoue, Solange Satie; Ortiz, Karin Zazo; Minett, Thaís Soares Cianciarullo; Borges, Alda Christina Lopes de Carvalho

    2014-01-01

    Objective To outline the audiological findings of aphasic patients after cerebrovascular accidents. Methods This is a cross-sectional study performed between March 2011 and August 2012 in the Speech, Language, and Hearing Pathology Department of the Universidade Federal de São Paulo. A total of 43 aphasic subjects (27 men) were referred for audiological evaluation after stroke, with mean age of 54.48 years. Basic audiological evaluation tests were performed, including pure tone audiometry, speech audiometry (speech recognition threshold and word recognition score), immittance measures (tympanometry and contralateral acoustic reflex), and transient otoacoustic emissions. Results Sensorineural hearing loss was prevalent (78.6%). Speech recognition threshold and word recognition score were not obtained in some patients because they were unable to perform the task. Hearing loss was a common finding in this population. Conclusion Comprehension and/or oral emission disruptions in aphasic patients after stroke compromised conventional speech audiometry, resulting in the need for changes in the evaluation procedures for these patients. PMID:25628193

  7. Binding in agrammatic aphasia: Processing to comprehension

    PubMed Central

    Janet Choy, Jungwon; Thompson, Cynthia K.

    2010-01-01

    Background Theories of comprehension deficits in Broca’s aphasia have largely been based on the pattern of deficit found with movement constructions. However, some studies have found comprehension deficits with binding constructions, which do not involve movement. Aims This study investigates online processing and offline comprehension of binding constructions, such as reflexive (e.g., himself) and pronoun (e.g., him) constructions in unimpaired and aphasic individuals in an attempt to evaluate theories of agrammatic comprehension. Methods & Procedures Participants were eight individuals with agrammatic Broca’s aphasia and eight age-matched unimpaired individuals. We used eyetracking to examine online processing of binding constructions while participants listened to stories. Offline comprehension was also tested. Outcomes & Results The eye movement data showed that individuals with Broca’s aphasia were able to automatically process the correct antecedent of reflexives and pronouns. In addition, their syntactic processing of binding was not delayed compared to normal controls. Nevertheless, offline comprehension of both pronouns and reflexives was significantly impaired compared to the control participants. This comprehension failure was reflected in the aphasic participants’ eye movements at sentence end, where fixations to the competitor increased. Conclusions These data suggest that comprehension difficulties with binding constructions seen in agrammatic aphasic patients are not due to a deficit in automatic syntactic processing or delayed processing. Rather, they point to a possible deficit in lexical integration. PMID:20535243

  8. Morphological and Phonological Factors in the Production of Verbal Inflection in Adult L2 Learners and Patients with Agrammatic Aphasia

    ERIC Educational Resources Information Center

    Szupica-Pyrzanowski, Malgorzata

    2009-01-01

    Failure to supply inflection is common in adult L2 learners of English and agrammatic aphasics (AAs), who are known to resort to bare verb forms. Among attempts to explain the absence of inflection are competing morphological and phonological explanations. In the L2 acquisition literature, omission of inflection is explained in terms of: mapping…

  9. Patterns of Comprehension Performance in Agrammatic Broca's Aphasia: A Test of the Trace Deletion Hypothesis

    ERIC Educational Resources Information Center

    Caramazza, A.; Capasso, R.; Capitani, E.; Miceli, G.

    2005-01-01

    We tested the core prediction of the Trace Deletion Hypothesis (TDH) of agrammatic Broca's aphasia, which contends that such patients' comprehension performance is normal for active reversible sentences but at chance level for passive reversible sentences. We analyzed the comprehension performance of 38 Italian Broca's aphasics with verified…

  10. A note on the "word-order problem" in agrammatism.

    PubMed

    Caplan, D

    1983-09-01

    This brief note has two parts. First, it presents an analysis of the ability of English agrammatic patients to assign the thematic roles of agent, instrument, theme, and locative to noun phrases in active and passive sentences and prepositional phrases. Data regarding this ability have been presented by Schwartz, Saffran, and Marin (Brain and Language, 10, 149-262 (1980) regarding comprehension, and by Saffran, Schwartz, and Marin (Brain and Language, 10, 263-280 (1980) regarding production. These authors claim their data show that English agrammatic aphasics do not map "word order" onto thematic information. However, a very simple set of principles accounts for all their results, including results which are discrepant in their treatment, but requires that English agrammatics assign thematic roles to NPs in part by virtue of the position of an NP in a sentence or a phrase. In the second part of this note, several issues raised by this re-analysis are briefly discussed.

  11. Processing of visual syntax in a globally aphasic patient.

    PubMed

    Weinrich, M; Steele, R D; Carlson, G S; Kleczewska, M; Wertz, R T; Baker, E

    1989-04-01

    A globally aphasic patient was trained on a computerized visual communication system. His ability to comprehend reversible locative prepositional phrases after training was studied and compared with the performance of Broca's aphasics on a similar task. This patient's ability to generalize symbols for actions was also investigated. The results demonstrate our patient's capacity to master a formal visual syntax in the absence of natural language and illustrate how this capacity may be used successfully in a visual communication system. A problem in generalizing symbols for actions is demonstrated, suggesting that certain heuristic and cueing capabilities in the approach may be helpful.

  12. Aphasic disorder in patients with closed head injury.

    PubMed Central

    Levin, H S; Grossman, R G; Kelly, P J

    1976-01-01

    Quantitative assessment of 50 patients with closed head injury disclosed that anomic errors and word finding difficulty were prominent sequelae as nearly half of the series had defective scores on tests of naming and/or word association. Aphasic disturbance was associated with severity of brain injury as reflected by prolonged coma and injury of the brain stem. PMID:1011017

  13. Testing Idiom Comprehension in Aphasic Patients: The Effects of Task and Idiom Type

    ERIC Educational Resources Information Center

    Papagno, C.; Caporali, A.

    2007-01-01

    Idiom comprehension in 15 aphasic patients was assessed with three tasks: a sentence-to-picture matching task, a sentence-to-word matching task and an oral definition task. The results of all three tasks showed that the idiom comprehension in aphasic patients was impaired compared to that of the control group, and was significantly affected by the…

  14. LANGUAGE DEFICITS, LOCALIZATION, AND GRAMMAR: EVIDENCE FOR A DISTRIBUTIVE MODEL OF LANGUAGE BREAKDOWN IN APHASIC PATIENTS AND NEUROLOGICALLY INTACT INDIVIDUALS

    PubMed Central

    Dick, Frederic; Bates, Elizabeth; Wulfeck, Beverly; Utman, Jennifer; Dronkers, Nina; Gernsbacher, Morton Ann

    2015-01-01

    Selective deficits in aphasics patients’ grammatical production and comprehension are often cited as evidence that syntactic processing is modular and localizable in discrete areas of the brain (e.g., Y. Grodzinsky, 2000). The authors review a large body of experimental evidence suggesting that morphosyntactic deficits can be observed in a number of aphasic and neurologically intact populations. They present new data showing that receptive agrammatism is found not only over a range of aphasic groups, but is also observed in neurologically intact individuals processing under stressful conditions. The authors suggest that these data are most compatible with a domain-general account of language, one that emphasizes the interaction of linguistic distributions with the properties of an associative processor working under normal or suboptimal conditions. PMID:11699116

  15. The comprehension of ambiguous idioms in aphasic patients.

    PubMed

    Cacciari, Cristina; Reati, Fabiola; Colombo, Maria Rosa; Padovani, Roberto; Rizzo, Silvia; Papagno, Costanza

    2006-01-01

    The ability to understand ambiguous idioms was assessed in 15 aphasic patients with preserved comprehension at a single word level. A string-to-word matching task was used. Patients were requested to choose one among four alternatives: a word associated with the figurative meaning of the idiom string; a word semantically associate with the last constituent of the idiom string; and two unrelated words. The results showed that patients' performance was impaired with respect to a group of matched controls, with patients showing a frontal and/or temporal lesion being the most impaired. A significant number of semantically associate errors were produced, suggesting an impairment of inhibition mechanisms and/or of recognition/activation of the idiomatic meaning.

  16. Time reference in agrammatic aphasia: A cross-linguistic study

    PubMed Central

    Bastiaanse, Roelien; Bamyaci, Elif; Hsu, Chien-Ju; Lee, Jiyeon; Duman, Tuba Yarbay; Thompson, Cynthia K.

    2015-01-01

    It has been shown across several languages that verb inflection is difficult for agrammatic aphasic speakers. In particular, Tense inflection is vulnerable. Several theoretical accounts for this have been posed, for example, a pure syntactic one suggesting that the Tense node is unavailable due to its position in the syntactic tree (Friedmann & Grodzinsky, 1997); one suggesting that the interpretable features of the Tense node are underspecified (Burchert, Swoboda-Moll, & De Bleser, 2005; Wenzlaff & Clahsen, 2004, 2005); and a morphosemantic one, arguing that the diacritic Tense features are affected in agrammatism (Faroqi–Shah & Dickey, 2009; Lee, Milman, & Thompson, 2008). However recent findings (Bastiaanse, 2008) and a reanalysis of some oral production studies (e.g. Lee et al., 2008; Nanousi, Masterson, Druks, & Atkinson, 2006) suggest that both Tense and Aspect are impaired and, most importantly, reference to the past is selectively impaired, both through simple verb forms (such as simple past in English) and through periphrastic verb forms (such as the present perfect, ‘has V-ed’, in English). It will be argued that reference to the past is discourse linked and reference to the present and future is not (Zagona, 2003, in press). In-line with Avrutin’s (2000) theory that suggests discourse linking is impaired in Broca’s aphasia, the PAst DIscourse LInking Hypothesis (PADILIH) has been formulated. Three predictions were tested: (1) patients with agrammatic aphasia are selectively impaired in use of grammatical morphology associated with reference to the past, whereas, inflected forms which refer to the present and future are relatively spared; (2) this impairment is language-independent; and (3) this impairment will occur in both production and comprehension. Agrammatic Chinese, English and Turkish speakers were tested with the Test for Assessing Reference of Time (TART; Bastiaanse, Jonkers, & Thompson, unpublished). Results showed that both the

  17. Psych verb production and comprehension in agrammatic Broca's aphasia.

    PubMed

    Thompson, Cynthia K; Lee, Miseon

    2009-07-01

    This study examined the factors that affect agrammatic sentence production by testing eight agrammatic aphasic participants' comprehension and production of active and passive sentences using two types of English psych verbs, those with an Experiencer-marked subject (Subject-Experiencer (SubExp)) and those with an Experiencer-marked object (Object-Experiencer (ObjExp)). The Argument Structure Complexity Hypothesis (ASCH, [J. Neuroling. 16 (2003) 151]) posits that the verb (and sentence) production difficulties observed in agrammatic aphasia can be attributed, at least in part, to the argument structure properties of verbs, with verbs that are marked for more complex argument structure (in terms of the number and type of arguments) presenting greater difficulty than those with less complex argument structure entries. Based on previous linguistic analyses of psych verbs, ObjExp psych verbs are more complex than SubjExp verbs. Therefore, we predicted that the former would present greater production (but not comprehension) difficulty than the latter. Results showed above chance comprehension of all sentence types, with the exception of SubjExp passive constructions, in which the subject position is occupied by a non-Experiencer argument. In active sentence production, ObjExp verbs were more impaired than SubjExp verbs. However, the opposite pattern was noted for passive sentence production. While all participants had difficulty producing passive sentences of both types, they showed better performance on ObjExp verbs, as compared to SubjExp verbs, in which the Experiencer is in the subject position. Further, agrammatic aphasic speakers showed a preference for producing actives for SubjExp verbs and passives for ObjExp verbs, indicating that the thematic role requirements of selected verbs (e.g., Experiencer, Theme) influence production patterns, as they do in normal speakers. These data, as well as the error patterns seen in our patients, support the ASCH and suggest

  18. On-Line Processing of Tense and Temporality in Agrammatic Aphasia

    ERIC Educational Resources Information Center

    Faroqi-Shah, Yasmeen; Dickey, Michael Walsh

    2009-01-01

    Agrammatic aphasic individuals exhibit marked production deficits for tense morphology. This paper presents three experiments examining whether a group of English-speaking agrammatic individuals (n = 10) exhibit parallel deficits in their comprehension of tense. Results from two comprehension experiments (on-line grammaticality judgment studies)…

  19. Parallel functional category deficits in clauses and nominal phrases: The case of English agrammatism.

    PubMed

    Wang, Honglei; Yoshida, Masaya; Thompson, Cynthia K

    2014-01-01

    Individuals with agrammatic aphasia exhibit restricted patterns of impairment of functional morphemes, however, syntactic characterization of the impairment is controversial. Previous studies have focused on functional morphology in clauses only. This study extends the empirical domain by testing functional morphemes in English nominal phrases in aphasia and comparing patients' impairment to their impairment of functional morphemes in English clauses. In the linguistics literature, it is assumed that clauses and nominal phrases are structurally parallel but exhibit inflectional differences. The results of the present study indicated that aphasic speakers evinced similar impairment patterns in clauses and nominal phrases. These findings are consistent with the Distributed Morphology Hypothesis (DMH), suggesting that the source of functional morphology deficits among agrammatics relates to difficulty implementing rules that convert inflectional features into morphemes. Our findings, however, are inconsistent with the Tree Pruning Hypothesis (TPH), which suggests that patients have difficulty building complex hierarchical structures.

  20. Comprehension of Co-Speech Gestures in Aphasic Patients: An Eye Movement Study

    PubMed Central

    Eggenberger, Noëmi; Preisig, Basil C.; Schumacher, Rahel; Hopfner, Simone; Vanbellingen, Tim; Nyffeler, Thomas; Gutbrod, Klemens; Annoni, Jean-Marie; Bohlhalter, Stephan; Cazzoli, Dario; Müri, René M.

    2016-01-01

    Background Co-speech gestures are omnipresent and a crucial element of human interaction by facilitating language comprehension. However, it is unclear whether gestures also support language comprehension in aphasic patients. Using visual exploration behavior analysis, the present study aimed to investigate the influence of congruence between speech and co-speech gestures on comprehension in terms of accuracy in a decision task. Method Twenty aphasic patients and 30 healthy controls watched videos in which speech was either combined with meaningless (baseline condition), congruent, or incongruent gestures. Comprehension was assessed with a decision task, while remote eye-tracking allowed analysis of visual exploration. Results In aphasic patients, the incongruent condition resulted in a significant decrease of accuracy, while the congruent condition led to a significant increase in accuracy compared to baseline accuracy. In the control group, the incongruent condition resulted in a decrease in accuracy, while the congruent condition did not significantly increase the accuracy. Visual exploration analysis showed that patients fixated significantly less on the face and tended to fixate more on the gesturing hands compared to controls. Conclusion Co-speech gestures play an important role for aphasic patients as they modulate comprehension. Incongruent gestures evoke significant interference and deteriorate patients’ comprehension. In contrast, congruent gestures enhance comprehension in aphasic patients, which might be valuable for clinical and therapeutic purposes. PMID:26735917

  1. Application of binaural beat phenomenon with aphasic patients.

    PubMed

    Barr, D F; Mullin, T A; Herbert, P S

    1977-04-01

    We investigated whether six aphasics and six normal subjects could binaurally fuse two slightly differing frequencies of constant amplitude. The aphasics were subdivided into two groups: (1) two men who had had mild cerebrovascular accidents (CVAs) during the past 15 months; (2) four men who had had severe CVAs during the last 15 months. Two tones of different frequency levels but equal in intensity were presented dichotically to the subjects at 40 dB sensation level. All subjects had normal hearing at 500 Hz (0 to 25 dB). All six normal subjects and the two aphasics who had had mild CVAs could hear the binaural beats. The four aphasics who had had severe CVAs could not hear them. A 2 X 2 design resulting from this study was compared using chi2 test with Yates correction and was found to be significantly different (P less than .05). Two theories are presented to explain these findings: the "depression theory" and the "temporal time-sequencing theory." Therapeutic implications are also discussed relative to cerebral and/or brain stem involvement in the fusion of binaural stimuli.

  2. Parallel functional category deficits in clauses and nominal phrases: The case of English agrammatism

    PubMed Central

    Wang, Honglei; Yoshida, Masaya; Thompson, Cynthia K.

    2015-01-01

    Individuals with agrammatic aphasia exhibit restricted patterns of impairment of functional morphemes, however, syntactic characterization of the impairment is controversial. Previous studies have focused on functional morphology in clauses only. This study extends the empirical domain by testing functional morphemes in English nominal phrases in aphasia and comparing patients’ impairment to their impairment of functional morphemes in English clauses. In the linguistics literature, it is assumed that clauses and nominal phrases are structurally parallel but exhibit inflectional differences. The results of the present study indicated that aphasic speakers evinced similar impairment patterns in clauses and nominal phrases. These findings are consistent with the Distributed Morphology Hypothesis (DMH), suggesting that the source of functional morphology deficits among agrammatics relates to difficulty implementing rules that convert inflectional features into morphemes. Our findings, however, are inconsistent with the Tree Pruning Hypothesis (TPH), which suggests that patients have difficulty building complex hierarchical structures. PMID:26379370

  3. Syllabic constraints in the phonological errors of an aphasic patient.

    PubMed

    Romani, C; Calabrese, A

    1998-08-01

    The Sonority Dispersion Principle (Clements, 1990) states that the sharper the rise in sonority between the beginning of the syllable and the nucleus, the better the syllable. So far evidence in favour of this principle has been derived mainly from the distributional properties of syllable types and, to a lesser extent, from language acquisition. The case of DB, presented in this study, provides strong evidence that the Sonority Dispersion Principle also applies to an explanation of aphasic errors and revives Jakobson's idea that the same principles of complexity can explain the distribution of syllables, language acquisition, and language loss (Jakobson, 1941, 1968). Although some evidence that sonority constraints aphasic errors has been presented before, this is the first study reporting systematic effects of sonority-based complexity in aphasia.

  4. Variable Solutions to the Same Problem: Aberrant Practice Effects in Object Naming by Three Aphasic Patients

    ERIC Educational Resources Information Center

    Wingfield, Arthur; Brownell, Hiram; Hoyte, Ken J.

    2006-01-01

    Although deficits in confrontation naming are a common consequence of damage to the language areas of the left cerebral hemisphere, some patients with aphasia show relatively good naming ability. We measured effects of repeated practice on naming latencies for a set of pictured objects by three aphasic patients with near-normal naming ability and…

  5. Why Reference to the Past Is Difficult for Agrammatic Speakers

    ERIC Educational Resources Information Center

    Bastiaanse, Roelien

    2013-01-01

    Many studies have shown that verb inflections are difficult to produce for agrammatic aphasic speakers: they are frequently omitted and substituted. The present article gives an overview of our search to understanding why this is the case. The hypothesis is that grammatical morphology referring to the past is selectively impaired in agrammatic…

  6. Training in rapid auditory processing ameliorates auditory comprehension in aphasic patients: a randomized controlled pilot study.

    PubMed

    Szelag, Elzbieta; Lewandowska, Monika; Wolak, Tomasz; Seniow, Joanna; Poniatowska, Renata; Pöppel, Ernst; Szymaszek, Aneta

    2014-03-15

    Experimental studies have often reported close associations between rapid auditory processing and language competency. The present study was aimed at improving auditory comprehension in aphasic patients following specific training in the perception of temporal order (TO) of events. We tested 18 aphasic patients showing both comprehension and TO perception deficits. Auditory comprehension was assessed by the Token Test, phonemic awareness and Voice-Onset-Time Test. The TO perception was assessed using auditory Temporal-Order-Threshold, defined as the shortest interval between two consecutive stimuli, necessary to report correctly their before-after relation. Aphasic patients participated in eight 45-minute sessions of either specific temporal training (TT, n=11) aimed to improve sequencing abilities, or control non-temporal training (NT, n=7) focussed on volume discrimination. The TT yielded improved TO perception; moreover, a transfer of improvement was observed from the time domain to the language domain, which was untrained during the training. The NT did not improve either the TO perception or comprehension in any language test. These results are in agreement with previous literature studies which proved ameliorated language competency following the TT in language-learning-impaired or dyslexic children. Our results indicated for the first time such benefits also in aphasic patients.

  7. The Development of More Efficient Measures for Evaluating Language Impairments in Aphasic Patients.

    ERIC Educational Resources Information Center

    Phillips, Phyllis P.; Halpin, Gerald

    Because it generally took over an hour to administer the Porch Index of Communicative Ability (PICA), a shorter but comparable version of the test was developed. The original test was designed to quantify aphasic patients' ability level on common communicative tasks and consisted of 18 ten-item subtests. Each item resulted in a proficiency rating,…

  8. EEG Delta Band as a Marker of Brain Damage in Aphasic Patients after Recovery of Language

    ERIC Educational Resources Information Center

    Spironelli, Chiara; Angrilli, Alessandro

    2009-01-01

    In this study spectral delta percentage was used to assess both brain dysfunction/inhibition and functional linguistic impairment during different phases of word processing. To this aim, EEG delta amplitude was measured in 17 chronic non-fluent aphasic patients while engaged in three linguistic tasks: Orthographic, Phonological and Semantic.…

  9. Analysis of Spoken Narratives in a Marathi-Hindi-English Multilingual Aphasic Patient

    ERIC Educational Resources Information Center

    Karbhari-Adhyaru, Medha

    2010-01-01

    In a multilingual country such as India, the probability that clinicians may not have command over different languages used by aphasic patients is very high. Since formal tests in different languages are limited, assessment of people from diverse linguistic backgrounds presents speech- language pathologists with many challenges. With a view to…

  10. Orthographic Effects in the Word Substitutions of Aphasic Patients: An Epidemic of Right Neglect Dyslexia?

    ERIC Educational Resources Information Center

    Berndt, Rita Sloan; Haendiges, Anne N.; Mitchum, Charlotte C.

    2005-01-01

    Aphasic patients with reading impairments frequently substitute incorrect real words for target words when reading aloud. Many of these word substitutions have substantial orthographic overlap with their targets and are classified as ''visual errors'' (i.e., sharing 50% of targets' letters in the same relative position). Fifteen chronic aphasic…

  11. Eye Gaze Behavior at Turn Transition: How Aphasic Patients Process Speakers' Turns during Video Observation.

    PubMed

    Preisig, Basil C; Eggenberger, Noëmi; Zito, Giuseppe; Vanbellingen, Tim; Schumacher, Rahel; Hopfner, Simone; Gutbrod, Klemens; Nyffeler, Thomas; Cazzoli, Dario; Annoni, Jean-Marie; Bohlhalter, Stephan; Müri, René M

    2016-10-01

    The human turn-taking system regulates the smooth and precise exchange of speaking turns during face-to-face interaction. Recent studies investigated the processing of ongoing turns during conversation by measuring the eye movements of noninvolved observers. The findings suggest that humans shift their gaze in anticipation to the next speaker before the start of the next turn. Moreover, there is evidence that the ability to timely detect turn transitions mainly relies on the lexico-syntactic content provided by the conversation. Consequently, patients with aphasia, who often experience deficits in both semantic and syntactic processing, might encounter difficulties to detect and timely shift their gaze at turn transitions. To test this assumption, we presented video vignettes of natural conversations to aphasic patients and healthy controls, while their eye movements were measured. The frequency and latency of event-related gaze shifts, with respect to the end of the current turn in the videos, were compared between the two groups. Our results suggest that, compared with healthy controls, aphasic patients have a reduced probability to shift their gaze at turn transitions but do not show significantly increased gaze shift latencies. In healthy controls, but not in aphasic patients, the probability to shift the gaze at turn transition was increased when the video content of the current turn had a higher lexico-syntactic complexity. Furthermore, the results from voxel-based lesion symptom mapping indicate that the association between lexico-syntactic complexity and gaze shift latency in aphasic patients is predicted by brain lesions located in the posterior branch of the left arcuate fasciculus. Higher lexico-syntactic processing demands seem to lead to a reduced gaze shift probability in aphasic patients. This finding may represent missed opportunities for patients to place their contributions during everyday conversation.

  12. Lack of Frank Agrammatism in the Nonfluent Agrammatic Variant of Primary Progressive Aphasia

    PubMed Central

    Graham, Naida L.; Leonard, Carol; Tang-Wai, David F.; Black, Sandra; Chow, Tiffany W.; Scott, Chris J.M.; McNeely, Alicia A.; Masellis, Mario; Rochon, Elizabeth

    2016-01-01

    Background/Aims Frank agrammatism, defined as the omission and/or substitution of grammatical morphemes with associated grammatical errors, is variably reported in patients with nonfluent variant primary progressive aphasia (nfPPA). This study addressed whether frank agrammatism is typical in agrammatic nfPPA patients when this feature is not required for diagnosis. Method We assessed grammatical production in 9 patients who satisfied current diagnostic criteria. Although the focus was agrammatism, motor speech skills were also evaluated to determine whether dysfluency arose primarily from apraxia of speech (AOS), instead of, or in addition to, agrammatism. Volumetric MRI analyses provided impartial imaging-supported diagnosis. Results The majority of cases exhibited neither frank agrammatism nor AOS. Conclusion There are nfPPA patients with imaging-supported diagnosis and preserved motor speech skills who do not exhibit frank agrammatism, and this may persist beyond the earliest stages of the illness. Because absence of frank agrammatism is a subsidiary diagnostic feature in the logopenic variant of PPA, this result has implications for differentiation of the nonfluent and logopenic variants, and indicates that PPA patients with nonfluent speech in the absence of frank agrammatism or AOS do not necessarily have the logopenic variant. PMID:27790240

  13. Old and recent approaches to the problem of non-verbal conceptual disorders in aphasic patients.

    PubMed

    Gainotti, Guido

    2014-04-01

    From the first research on aphasia, it has been shown that, in addition to verbal communication disorders, aphasic patients often have difficulty on non-verbal cognitive tasks, which can actually be solved without the use of language. In this survey, I will discuss in a historical perspective the different interpretations provided by classical and contemporary authors to explain this puzzling observation. First, I will take into account the different positions of classical authorities on this topic, starting from the first debates (mainly based on anatomo-clinical observations) on the organisation of language in the brain. Then, I will attempt to summarize the work of authors who have tackled this complex issue more recently, in systematic investigations using methods drawn from experimental psychology, to clarify the meaning of non-verbal cognitive disorders in aphasia. Finally, in the last part of the survey, I will discuss the interpretation of proponents of the 'semantic hub' hypothesis who have tried to analyse and explain the differences between the non-verbal semantic defects of patients with semantic dementia and aphasic stroke patients. The hypothesis which assumes that most non-verbal cognitive disorders observed in aphasic patients are due to a preverbal conceptual disorder, which cannot be attributed to a loss of semantic representations but rather to a defect in their controlled retrieval, seems substantially confirmed. Nevertheless, two main issues must still be clarified. The first is that some of the non-verbal cognitive defects of aphasic patients seem due to the negative influence of language disturbances on abstract non-verbal cognitive activities, rather than to a preverbal conceptual disorder. The second issue concerns the exact nature and the neuroanatomical correlates of the defective controlled retrieval of unimpaired conceptual representations, which should subsume most of the non-verbal cognitive disorders of aphasic patients.

  14. Verb inflections in agrammatic aphasia: Encoding of tense features ⋆

    PubMed Central

    Faroqi-Shah, Yasmeen; Thompson, Cynthia K.

    2008-01-01

    Across most languages, verbs produced by agrammatic aphasic individuals are frequently marked by syntactically and semantically inappropriate inflectional affixes, such as Last night, I walking home. As per language production models, verb inflection errors in English agrammatism could arise from three potential sources: encoding the verbs’ morphology based on temporal information at the conceptual level, accessing syntactic well-formedness constraints of verbal morphology, and encoding morphophonological form. We investigate these aspects of encoding verb inflections in agrammatic aphasia. Using three sentence completion experiments, it was demonstrated that production of verb inflections was impaired whenever temporal reference was involved; while morphological complexity and syntactic constraints were less likely to be the source of verb inflection errors in agrammatism. These findings are discussed in relation to current language production models. PMID:18392120

  15. Action Naming in Anomic Aphasic Speakers: Effects of Instrumentality and Name Relation

    ERIC Educational Resources Information Center

    Jonkers, Roel; Bastiaanse, Roelien

    2007-01-01

    Many studies reveal effects of verb type on verb retrieval, mainly in agrammatic aphasic speakers. In the current study, two factors that might play a role in action naming in anomic aphasic speakers were considered: the conceptual factor instrumentality and the lexical factor name relation to a noun. Instrumental verbs were shown to be better…

  16. Validity and reliability of a new test for Turkish-speaking aphasic patients: Ege Aphasia Test.

    PubMed

    Calis, Funda Atamaz; On, Arzu Yagiz; Durmaz, Berrin

    2013-01-01

    Due to the fact that the phonetic, morphological and syntactic structures of the Turkish language differ significantly from other European languages, the translated forms of the currently available aphasia assessment batteries are not adequate for Turkish-speaking aphasic patients. The aim of this study was to assess the validity and reliability of the Ege Aphasia Test that we have developed. The test, which includes the 8 subtests of praxia, spontaneous language, auditory and verbal comprehension, repetition, naming, reading, writing and calculating, was applied into 100 aphasic patients, 40 dysarthric patients and 40 healthy subjects. All test-retest intra-class correlation coefficients were found to be excellent (ICC = 0.99). The Cronbach's coefficients ranged from 0.71 to 0.91. All the subtests showed significantly greater scores in aphasic patients (p < 0.05). Significant correlations were found between the subtests and corrected total score (p < 0.05). Finally, the Ege Aphasia Test has an acceptable validity and reliability. It seems to be a promising battery for evaluation of aphasia in the Turkish language, which is spoken mainly in Turkey and in the surrounding regions. We believe that this study will pioneer the development of aphasia rehabilitation in these countries and contribute to future studies.

  17. Verbs: some properties and their consequences for agrammatic Broca's aphasia

    PubMed Central

    Bastiaanse, Roelien; Rispens, Judith; Ruigendijk, Esther; Rabadaán, Oneésimo Juncos; Thompson, Cynthia K.

    2011-01-01

    It has repeatedly been shown that agrammatic Broca's aphasics have serious problems with the retrieval of verbs on action naming tests (Miceli, Silveri, Villa & Caramazza, 1984; Kohn, Lorch & Pearson, 1989; Basso, Razzano, Faglioni & Zanobio, 1990; Jonkers, 1998; Kim & Thompson, 2000). Less attention has been paid to the production of verbs at the sentence level (but see Miceli, Mazzuchi, Menn & Goodglass, 1983; Thompson, Shapiro, Li & Schendel, 1995; Thompson, Lange, Schneider & Shapiro, 1997; Bastiaanse & Van Zonneveld, 1998; Bastiaanse, Rispens & Van Zonneveld, 2000; Friedmann, 2000), although it has been mentioned that in agrammatic spontaneous speech verbs are lacking (Saffran, Berndt & Schwartz, 1989; Thompson et al., 1995, but see Bastiaanse & Jonkers, 1998). In this paper, three cross-linguistic studies are discussed to show that these problems with verbs have consequences for other grammatical morphemes and structures that have been mentioned to be impaired in agrammatic speech and that these consequences are different per language, depending on linguistic characteristics. The first study focuses on finiteness and compares the production of finite verbs in matrix and embedded clauses in Dutch and English, showing that a linguistic rule in Dutch (Verb Second), which does not exist in English, can explain the different performance of Dutch and English agrammatic Broca's aphasics. The second study focuses on determiners and (finite) verbs in German and shows that poor determiner production is directly related to poor verb production. The last study demonstrates that the ability to construct negative sentences is dependent on the language specific relation between verb movement and negation: Dutch and Norwegian agrammatics perform equally well on affirmative and negative sentences, whereas English and Spanish agrammatics are more impaired on negative sentences. Overall, these studies show that the problems agrammatics encounter with verbs and their properties

  18. A Systematic Review on methods of evaluate sentence production deficits in agrammatic aphasia patients: Validity and Reliability issues

    PubMed Central

    Mehri, Azar; Jalaie, Shohreh

    2014-01-01

    Background: The grammar assessment in aphasia has been done by few standard tests, but today these tests cannot precise evaluate the sentence production in agrammatic patients. In this study, we review structures and contents of tests or tasks designed to find more frequent methods for sentence production ability in aphasia patients. Materials and Methods: We searched the Cochrane library, Medline by PubMed, Science Direct, Scopus, and Google Scholar from 1980 to October 1, 2013 and evaluated all of exist tests or tasks included in the articles and systematic reviews. The sentence production has been studied in three methods. It contains the use of sentence production in spontaneous speech, tasks designed and both methods. The quality of studies was assessed using Critical Appraisal Skills Program. Results: The 160 articles were reviewed and 38 articles were studied according to inclusion and exclusion criteria. They were classified into three categories based on assessment methods of sentence production. In 39.5% studies, researchers have used tasks designed, 7.9% articles have applied spontaneous speech and 52.6% articles have used both methods for evaluation production. Inter-rater reliability was between 90% and 100% and intra-rater reliability was between 96% and 98% in studied. Conclusion: Agrammatic aphasia has syntax disorders, especially in sentence production. Most researchers and clinicians used both methods for evaluation production. PMID:25535505

  19. Inflectional marking in Hungarian aphasics.

    PubMed

    MacWhinney, B; Osmán-Sági, J

    1991-08-01

    How do aphasics deal with the rich inflectional marking available in agglutinative languages like Hungarian? For the Hungarian noun alone, aphasics have to deal with over 15 basic case markings and dozens of possible combinations of these basic markings. Using the picture description task of MacWhinney and Bates (1978), this study examined the use of inflectional markings in nine Broca's and five Wernicke's aphasic speakers of Hungarian. The analysis focused on subject, direct object, indirect object, and locative nominal arguments. Compared to normals, both groups had a much higher rate of omission of all argument types. Subject ellipsis was particularly strong, as it is in normal Hungarian. There was a tendency for Broca's to omit the indirect object and for Wernicke's to omit the direct object. Across argument types, Wernicke's had a much higher level of pronoun usage than did Broca's. Broca's also showed a very high level of article omission. Compared to similar data reported by Slobin (this issue) for Turkish, the Hungarian aphasics showed an elevated level of omission of case markings. Addition errors were quite rare, but there were 14 substitutions of one case marking for another. These errors all involved the substitution of some close semantic competitor. There were no errors in the basic rules for vowel harmony or morpheme order. Overall the results paint a picture of a group of individuals whose grammatical abilities are damaged and noisy, but still largely functional. Neither the view of Broca's as agrammatic nor the view of Wernicke's as paragrammatic was strongly supported.

  20. Are aphasic patients who fail the GOAT in PTA? A modified Galveston Orientation and Amnesia Test for persons with aphasia.

    PubMed

    Jain, N S; Layton, B S; Murray, P K

    2000-02-01

    Because the Galveston Orientation and Amnesia Test (GOAT) requires oral or written response, it risks misclassifying as amnestic aphasic patients who are not, in fact, amnestic. To correct for possible classification errors due to anomia, a modified multiple-choice format of the GOAT (AGOAT) was developed. The average GOAT score of 10 control nonaphasic head-injured patients suggested that an AGOAT score of 90 corresponds to the standard GOAT cutoff of 75 for resolution of posttraumatic amnesia (PTA). Using this criterion, 8 of 15 aphasic head-injured patients who technically were classified as amnestic on the GOAT were classified as nonamnestic on the AGOAT.

  1. Wh interrogative production in agrammatic aphasia: an experimental analysis of auditory-visual stimulation and direct-production treatment.

    PubMed

    Thompson, C K; McReynolds, L V

    1986-06-01

    The effects of auditory-visual stimulation treatment derived from principles associated with a stimulation approach for aphasia treatment and direct-production treatment derived from a behavioral or learning approach were examined in 4 neurologically stable agrammatic aphasic subjects. Subjects were trained to produce selected exemplars of wh interrogative morphemes in complete sentence contexts, while the acquisition, response generalization (both within and across interrogative forms), stimulus generalization (to language samples), and maintenance effects of the two treatments were assessed. An alternating treatments design (ATD) in combination with a multiple-baseline design across behaviors and a multiple-baseline design across subjects was employed. Interrogative constructions were counterbalanced across subjects and treatments, and probes were administered daily to assess treatment effects. Results indicated that direct-production treatment was consistently more effective than auditory-visual stimulation treatment in facilitating acquisition of target responses for all subjects. Response generalization within interrogative forms paralleled acquisition regardless of treatment approach. Stimulus generalization to the elicited language-sample condition was not evident, however, trained responses were maintained subsequent to treatment. These data provided support for using direct-production treatment for interrogative intervention with agrammatic aphasic patients and indicated that training a selected number of exemplars of target interrogatives results in generalization of that question form to novel language responses. However, the lack of generalization across interrogatives indicated that wh interrogatives do not constitute a response class and, thus, pointed out a need for programming generalization to untrained members of that linguistic class and to spontaneous language.

  2. Thematic role assignment in two severely aphasic patients: associations and dissociations.

    PubMed

    Weinrich, M; McCall, D; Weber, C

    1995-02-01

    Two severely aphasic patients were compared in their abilities to comprehend and produce locative prepositional phrases and reversible S-V-O sentences using English and C-VIC, a computer-based iconographic communication system. One patient demonstrated a significant dissociation between his performance in interpreting symbol order in C-VIC prepositional phrases vs. S-V-O sentences. Patients were able to comprehend order in C-VIC S-V-O sentences significantly better than they were able to assign symbol order when they produced these sentences. These data suggest that the procedures for assigning thematic roles to nouns in sentences are at least partially distinct for comprehension and production and that the ordering of nouns around prepositions involves conceptual processes distinct from those involved in ordering nouns around verbs.

  3. Acquired Dyslexia in Three Writing Systems: Study of a Portuguese-Japanese Bilingual Aphasic Patient

    PubMed Central

    Senaha, Mirna Lie Hosogi; de Mattos Pimenta Parente, Maria Alice

    2012-01-01

    The Japanese language is represented by two different codes: syllabic and logographic while Portuguese employs an alphabetic writing system. Studies on bilingual Portuguese-Japanese individuals with acquired dyslexia therefore allow an investigation of the interaction between reading strategies and characteristics of three different writing codes. The aim of this study was to examine the differential impact of an acquired brain lesion on the reading of the logographic, syllabic and alphabetic writing systems of a bilingual Portuguese-Japanese aphasic patient (PF). Results showed impaired reading in the logographic system and when reading irregularly spelled Portuguese words but no effects on reading regular words and nonwords in syllabic and alphabetic writing systems. These dissociations are interpreted according to a multi-route cognitive model of reading assuming selective damage in the lexical route can result in acquired dyslexia across at least three different writing codes. PMID:22713387

  4. La perception des morphemes grammaticaux chez les aphasiques (The Perception of Grammatical Morphemes in Aphasics). Montreal Working Papers in Linguistics, Vol. 2.

    ERIC Educational Resources Information Center

    Goodenough, Cheryl; And Others

    Studies have indicated that agrammatical aphasics tend to better realize morphemes with a high level of semantic value. A study sought to examine the effect of the variation of the information content of the article on its comprehension by the aphasic. The appropriate and the significant nature of the function words "the" and "a" were varied with…

  5. Template construction grammar: from visual scene description to language comprehension and agrammatism.

    PubMed

    Barrès, Victor; Lee, Jinyong

    2014-01-01

    How does the language system coordinate with our visual system to yield flexible integration of linguistic, perceptual, and world-knowledge information when we communicate about the world we perceive? Schema theory is a computational framework that allows the simulation of perceptuo-motor coordination programs on the basis of known brain operating principles such as cooperative computation and distributed processing. We present first its application to a model of language production, SemRep/TCG, which combines a semantic representation of visual scenes (SemRep) with Template Construction Grammar (TCG) as a means to generate verbal descriptions of a scene from its associated SemRep graph. SemRep/TCG combines the neurocomputational framework of schema theory with the representational format of construction grammar in a model linking eye-tracking data to visual scene descriptions. We then offer a conceptual extension of TCG to include language comprehension and address data on the role of both world knowledge and grammatical semantics in the comprehension performances of agrammatic aphasic patients. This extension introduces a distinction between heavy and light semantics. The TCG model of language comprehension offers a computational framework to quantitatively analyze the distributed dynamics of language processes, focusing on the interactions between grammatical, world knowledge, and visual information. In particular, it reveals interesting implications for the understanding of the various patterns of comprehension performances of agrammatic aphasics measured using sentence-picture matching tasks. This new step in the life cycle of the model serves as a basis for exploring the specific challenges that neurolinguistic computational modeling poses to the neuroinformatics community.

  6. Agrammatism in aphasiology.

    PubMed

    Goodglass, H

    1997-01-01

    Agrammatism is a pattern of syntactically defective speech that is frequently observed as a prominent feature in Broca's aphasia. It may range in severity from one-word utterances, completely lacking in grammatical organization, to mildly 'telegraphic' speech. First described in the early 19th century, it was originally interpreted by Pick as being due to economy of effort in finding words. Beginning with Jakobson, in 1956, there have been a succession of efforts to give an account of it in terms of linguistic theory. While the theories are still controversial, they have led to much more detailed and systematic description of the linguistic output in agrammatic speech. Cross linguistic comparisons have revealed that the features of agrammatism are not fixed, but are conditioned by the grammatical structure of the speaker's language.

  7. Syntactic facilitation in agrammatic sentence production.

    PubMed

    Hartsuiker, R J; Kolk, H H

    1998-04-01

    Recently, proposals have been made to relate processing difficulties in aphasic language performance to limitations in resources for grammatical processing (Carpenter et al., 1994; Hagiwara, 1995; Kolk, 1995; Martin & Romani, 1994). Such proposals may account for a defining characteristic of agrammatic sentence production: reduced syntactic complexity. Syntactic structures that require deep hierarchical processing or reversals of canonical word order make demands exceeding limited resources. In the present study, we investigate the possibility of counteracting hypothesized resource limitations by increasing the availability of relatively complex sentences (i.e., datives and passives). The phenomenon of "syntactic priming" has been observed in a number of studies with healthy adults (e.g., Bock, 1986). With respect to Broca's aphasia, we hypothesized that increased availability of a syntactic structure, due to syntactic priming, results in a lesser demand on (limited) resources for sentence production. We elicited speech from 12 Broca's aphasics and 12 control subjects in three different conditions: spontaneous speech, picture description without priming, and picture description with priming. In addition, we varied instructions, in order to determine the role of strategies. The main findings were that (a) Brocas show stronger syntactic priming effects than controls; (b) the effects are automatic rather than strategic; and (c) in conditions with priming, Brocas produce relatively complex sentences (e.g., passives). We discuss these results in relation to capacity theories.

  8. Neural plasticity and treatment-induced recovery of sentence processing in agrammatism

    PubMed Central

    Thompson, Cynthia K.; Ouden, Dirk-Bart den; Bonakdarpour, Borna; Garibaldi, Kyla; Parrish, Todd B.

    2010-01-01

    This study examined patterns of neural activation associated with treatment-induced improvement of complex sentence production (and comprehension) in six individuals with stroke-induced agrammatic aphasia, taking into account possible alterations in blood flow often associated with stroke, including delayed time-to-peak of the hemodynamic response function (HRF) and hypoperfused tissue. Aphasic participants performed an auditory verification fMRI task, processing object cleft, subject cleft, and simple active sentences, prior to and following a course of Treatment of Underlying Forms (TUF; Thompson et al., 2003), a linguistically based approach for treating aphasic sentence deficits, which targeted object relative clause constructions. The patients also were scanned in a long-trials task to examine HRFs, to account for any local deviations resulting from stroke, and perfusion images were obtained to evaluate regions of hypoperfused tissue. Region-of-interest (ROI) analyses were conducted (bilaterally), modeling participant-specific local HRFs in left hemisphere areas activated by 12 healthy age-matched volunteers performing the same task, including the middle and inferior frontal gyri, precentral gyrus, middle and superior temporal gyri, and insula, and additional regions associated with complex syntactic processing, including the posterior perisylvian and superior parietal cortices. Results showed that, despite individual variation in activation differences from pre- to post-treatment scans in the aphasic participants, main-effects analyses revealed a general shift from left superior temporal activation to more posterior temporoparietal areas, bilaterally. Time-to-peak of these responses correlated negatively with blood flow, as measured with perfusion imaging. PMID:20603138

  9. Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series.

    PubMed

    Valiengo, Leandro; Casati, Roberta; Bolognini, Nadia; Lotufo, Paulo A; Benseñor, Isabela M; Goulart, Alessandra C; Brunoni, André R

    2016-01-01

    Aphasia is a common consequence of stroke; it is estimated that about two-thirds of aphasic patients will develop depression in the first year after the stroke. Treatment of post-stroke depression (PSD) is challenging due to the adverse effects of pharmacotherapy and difficulties in evaluating clinical outcomes, including aphasia. Transcranial direct current stimulation (tDCS) is a novel treatment that may improve clinical outcomes in the traditionally pharmacotherapy-refractory PSD. Our aim was to evaluate the safety and efficacy of tDCS for patients with PSD and with aphasia. The Stroke Aphasic Depression Questionnaire (SADQ) and the Aphasic Depression Rating Scale (ADRS) were used to evaluate the severity of PSD. The diagnoses of PSD and aphasia were confirmed by a psychiatrist and a speech-language pathologist, respectively. In this open case series, patients (n = 4) received 10 sessions (once a day) of bilateral tDCS to the dorsolateral prefrontal cortex (DLPFC) and two additional sessions after two and four weeks, for a total of 12 sessions. All patients exhibited improvement in depression after tDCS, as indicated by a decrease in SADQ (47.5%) and in ADRS (65.7%). This improvement was maintained four weeks after the treatment. In this preliminary, open-label study conducted in four PSD patients with aphasia, bilateral tDCS over the DLPFC was shown to induce a substantial mood improvement; tDCS was safe and well tolerated by every patient. Stroke patients with aphasia can be safely treated for PSD with tDCS. Sham-controlled studies are necessary to evaluate this technique further.

  10. Agraphia in patients with frontotemporal dementia and parkinsonism linked to chromosome 17 with P301L MAPT mutation: dysexecutive, aphasic, apraxic or spatial phenomenon?

    PubMed Central

    Sitek, Emilia J.; Narożańska, Ewa; Barczak, Anna; Jasińska-Myga, Barbara; Harciarek, Michał; Chodakowska-Żebrowska, Małgorzata; Kubiak, Małgorzata; Wieczorek, Dariusz; Konieczna, Seweryna; Rademakers, Rosa; Baker, Matt; Berdyński, Mariusz; Brockhuis, Bogna; Barcikowska, Maria; Żekanowski, Cezary; Heilman, Kenneth M.; Wszołek, Zbigniew K.; Sławek, Jarosław

    2013-01-01

    Objectives Patients with frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17) may be agraphic. The study aimed at characterizing agraphia in individuals with a P301L MAPT mutation. Methods Two pairs of siblings with FTDP-17 were longitudinally examined for agraphia in relation to language and cognitive deficits. Results All patients presented with dysexecutive agraphia. In addition, in the first pair of siblings one sibling demonstrated spatial agraphia with less pronounced allographic agraphia and the other sibling had aphasic agraphia. Aphasic agraphia was also present in one sibling from the second pair. Conclusion Agraphia associated with FTDP-17 is very heterogeneous. PMID:23121543

  11. Task-induced brain activity in aphasic stroke patients: what is driving recovery?

    PubMed

    Geranmayeh, Fatemeh; Brownsett, Sonia L E; Wise, Richard J S

    2014-10-01

    The estimated prevalence of aphasia in the UK and the USA is 250 000 and 1 000 000, respectively. The commonest aetiology is stroke. The impairment may improve with behavioural therapy, and trials using cortical stimulation or pharmacotherapy are undergoing proof-of-principle investigation, but with mixed results. Aphasia is a heterogeneous syndrome, and the simple classifications according to the Broca-Wernicke-Lichtheim model inadequately describe the diverse communication difficulties with which patients may present. Greater knowledge of how intact neural networks promote recovery after aphasic stroke, either spontaneously or in response to interventions, will result in clearer hypotheses about how to improve the treatment of aphasia. Twenty-five years ago, a pioneering study on healthy participants heralded the introduction of functional neuroimaging to the study of mechanisms of recovery from aphasia. Over the ensuing decades, such studies have been interpreted as supporting one of three hypotheses, which are not mutually exclusive. The first two predate the introduction of functional neuroimaging: that recovery is the consequence of the reconstitution of domain-specific language systems in tissue around the lesion (the 'perilesional' hypothesis), or by homotopic cortex in the contralateral hemisphere (the 'laterality-shift' hypothesis). The third is that loss of transcallosal inhibition to contralateral homotopic cortex hinders recovery (the 'disinhibition' hypothesis). These different hypotheses at times give conflicting views about rehabilitative intervention; for example, should one attempt to activate or inhibit a contralateral homotopic region with cortical stimulation techniques to promote recovery? This review proposes that although the functional imaging data are statistically valid in most cases, their interpretation has often favoured one explanation while ignoring plausible alternatives. In our view, this is particularly evident when recovery is

  12. Sonority Effects in Telugu Aphasics

    ERIC Educational Resources Information Center

    Vasanta, D.; Suvarna, A.; Sireesha, J.

    2010-01-01

    The focus of this paper is application of the concept of "sonority" to the study of aphasic speech. An assessment tool that is capable of examining sonority effects was developed and administered to a patient diagnosed to have progressive non-fluent aphasia. This tool successfully distinguished the performance of the patient from that of two…

  13. Electrophysiological responses to argument structure violations in healthy adults and individuals with agrammatic aphasia

    PubMed Central

    Kielar, Aneta; Meltzer-Asscher, Aya; Thompson, Cynthia

    2012-01-01

    Sentence comprehension requires processing of argument structure information associated with verbs, i.e. the number and type of arguments that they select. Many individuals with agrammatic aphasia show impaired production of verbs with greater argument structure density. The extent to which these participants also show argument structure deficits during comprehension, however, is unclear. Some studies find normal access to verb arguments, whereas others report impaired ability. The present study investigated verb argument structure processing in agrammatic aphasia by examining event-related potentials associated with argument structure violations in healthy young and older adults as well as aphasic individuals. A semantic violation condition was included to investigate possible differences in sensitivity to semantic and argument structure information during sentence processing. Results for the healthy control participants showed a negativity followed by a positive shift (N400-P600) in the argument structure violation condition, as found in previous ERP studies (Friederici & Frisch, 2000; Frisch, Hahne, & Friederici, 2004). In contrast, individuals with agrammatic aphasia showed a P600, but no N400, response to argument structure mismatches. Additionally, compared to the control groups, the agrammatic participants showed an attenuated, but relatively preserved, N400 response to semantic violations. These data show that agrammatic individuals do not demonstrate normal real-time sensitivity to verb argument structure requirements during sentence processing. PMID:23022079

  14. Automatic processing of wh- and NP-movement in agrammatic aphasia: Evidence from eyetracking

    PubMed Central

    Dickey, Michael Walsh; Thompson, Cynthia K.

    2009-01-01

    Individuals with agrammatic Broca’s aphasia show deficits in comprehension of non-canonical wh-movement and NP-movement sentences. Previous work using eyetracking has found that agrammatic and unimpaired listeners show very similar patterns of automatic processing for wh-movement sentences. The current study attempts to replicate this finding for sentences with wh-movement (in object relatives in the current study) and to extend it to sentences with NP movement (passives). For wh-movement sentences, aphasic and control participants’ eye-movements differed most dramatically in late regions of the sentence and post-offset, with aphasic participants exhibiting lingering attention to a salient but grammatically impermissible competitor. The eye-movement differences between correct and incorrect trials for wh-movement sentences were similar, with incorrect trials also exhibiting competition from an impermissible interpretation late in the sentence. Furthermore, the two groups exhibited similar eye-movement patterns in response to passive NP-movement sentences, but showed little evidence of gap-filling for passives. The results suggest that aphasic and unimpaired individuals may generate similar representations during comprehension, but that aphasics are highly vulnerable to interference from alternative interpretations (Ferreira, 2003). PMID:20161014

  15. Does agrammatic speech constitute a regression to child language? A three-way comparison between agrammatic, child, and normal ellipsis.

    PubMed

    Kolk, H

    2001-06-01

    When children are in the process of learning their mother tongue, they show frequent use of nonfinite clauses, even though they produce finite clauses at the same time, thereby demonstrating the availability of the functional domain associated with finiteness. In this study the hypothesis was tested that this behavior results from an overuse of the normal elliptical repertoire that has also been observed in agrammatic aphasia. The purpose of this overuse is prevention of computational overload. In support of the hypothesis it was found that children behaved very similar to aphasics and normal adults with respect to the following parameters: (a) distribution of types of ellipsis, (b) elaboration of ellipses, (c) word order, (d) subject omission, (e) frequency of weak subject pronouns, and (f) verb type (eventivity). The results also support the Jackson/Jakobson regression hypothesis, at least at the grammatical level.

  16. Parallel or serial activation of word forms in speech production? Neurolinguistic evidence from an aphasic patient.

    PubMed

    Blanken, Gerhard; Dittmann, Jürgen; Wallesch, Claus-W

    2002-05-31

    We report the oral picture naming performance of the German aphasic MW who presented with frequent meaning related word substitutions (e.g. tiger ==> lion) and word finding blockings (omissions) while his phonological capacities at the single word level were nearly preserved. Targets were controlled for their 'semantic competitiveness', that is, whether there exist closely meaning related lexical competitors or not. Semantic errors were far more numerous with the highly competitive targets than with the low competitive ones. However, omissions were more frequent with the low competitive items so that the sum of the semantic errors and of the omissions was comparable in both conditions. This inverse and compensatory relationship suggests that both error types are not mutually independent. The found pattern is at odds with serial psycholinguistic theories which locate word selection (and misselection) and word form access (and blockings) at different and serially connected stages of word production but supports theories which allow for a parallel architecture in lexical activation and selection involving the word form level.

  17. Closed-class words as first syllables do interfere with lexical decisions for nonwords: implications for theories of agrammatism.

    PubMed

    Petocz, A; Oliphant, G

    1988-05-01

    It has been proposed that a principal cause of the agrammatism of some Broca's aphasics is that such patients, unlike normal subjects, are unable to make use of a special retrieval mechanism for closed-class ("function") words (D. C. Bradley, 1978, Computational distinctions of vocabulary type, Unpublished Ph.D. thesis; D. C. Bradley, M. F. Garrett, & E. B. Zurif, 1980. In D. Caplan (Ed.), Biological studies of mental processes). The main evidence for the existence of such a mechanism consisted of two observations: (1) the recognition of open-class words was observed to be frequency-sensitive, but that of closed-class words was not; and (2) lexical decisions for nonwords which began with open-class words were delayed, whereas there was no such interference for nonwords which began with closed-class words. However, the first of these observations has proved nonreplicable (e.g., B. Gordon & A. Caramazza, 1982, Brain and Language, 15, 143-160, 1983, Brain and Language, 19, 335-345; J. Segui, J. Mehler, W. Frauenfelder, & J. Morton, 1982, Neuropsychologia, 20, 615-627), and in the present paper, three lexical decision experiments are reported in which it is found that, when certain confounding variables are controlled, nonwords which begin with closed-class words are subject to interference. Moreover, contrary to a suggestion of Kolk and Blomert (1985, Brain and Language, 26, 94-105) the interference is independent of the presence of closed-class items in the lexical decision word list. It seems, then, that closed-class words are not qualitatively different from open-class words with respect either to frequency sensitivity or to nonword interference, and in consequence, the above proposed explanation of agrammatism is left without major empirical support.

  18. Effects of verb meaning on lexical integration in agrammatic aphasia: Evidence from eyetracking

    PubMed Central

    Mack, Jennifer E.; Ji, Woohyuk; Thompson, Cynthia K.

    2013-01-01

    Relatively little is known about the time course of access to the lexical representations of verbs in agrammatic aphasia and its effects on the prediction and integration of the verb’s arguments. The present study used visual-world eyetracking to test whether verb meaning can be used by agrammatic aphasic individuals to predict and facilitate the integration of a subsequent noun argument. Nine adults with agrammatic aphasia and ten age-matched controls participated in the study. In Experiment 1, participants viewed arrays of four objects (e.g., jar, plate, stick, pencil) while listening to sentences containing either a restrictive verb that was semantically compatible only with the target object or an unrestrictive verb compatible with all four objects (e.g., Susan will open/break the jar). For both participant groups, the restrictive condition elicited more fixations to the target object immediately after the verb. Experiment 2 differed from Experiment 1 in that the auditory sentences presented were incomplete (e.g., Susan will open/break the…). For controls, restrictive verbs elicited more target fixations immediately after the verb; however, the effects of verb type were noted downstream from the verb for the aphasic listeners. The results suggest that individuals with agrammatic aphasia have preserved ability to use verb information to facilitate integration of overt arguments, but prediction of upcoming arguments is impaired. Impaired lexical-semantic prediction processes may be caused by damage to the left inferior frontal gyrus, which has been argued to support higher-level lexical processes. PMID:24092952

  19. Processing ambiguity in a linguistic context: decision-making difficulties in non-aphasic patients with behavioral variant frontotemporal degeneration.

    PubMed

    Spotorno, Nicola; Healey, Meghan; McMillan, Corey T; Rascovsky, Katya; Irwin, David J; Clark, Robin; Grossman, Murray

    2015-01-01

    Some extent of ambiguity is ubiquitous in everyday conversations. For example, words have multiple meaning and very common pronouns, like "he" and "she" (anaphoric pronouns), have little meaning on their own and refer to a noun that has been previously introduced in the discourse. Ambiguity triggers a decision process that is not a subroutine of language processing but rather a more general domain resource. Therefore non-aphasic patients with limited decision-making capability can encounter severe limitation in language processing due to extra linguistic limitations. In the present study, we test patients with behavioral variant frontotemporal degeneration (bvFTD), focusing on anaphora as a paradigmatic example of ambiguity resolution in the linguistic domain. bvFTD is characterized by gray matter (GM) atrophy in prefrontal cortex, but relative sparing of peri-Sylvian cortex. A group of patients with parietal disease due to corticobasal syndrome (CBS) was also tested here in order to investigate the specific role of prefrontal cortex in the task employed in the current study. Participants were presented with a pair of sentences in which the first sentence contained two nouns while the second contained a pronoun. In the experimental (ambiguous) condition, both nouns are plausible referents of the pronoun, thus requiring decision-making resources. The results revealed that bvFTD patients are significantly less accurate than healthy seniors in identifying the correct referent of a pronoun in the ambiguous condition, although CBS patients were as accurate as healthy seniors. Imaging analyses related bvFTD patients' performance to GM atrophy in ventromedial prefrontal cortex (vmPFC). These results suggest that bvFTD patients have difficulties in decision processes that involve the resolution of an ambiguity.

  20. Processing ambiguity in a linguistic context: decision-making difficulties in non-aphasic patients with behavioral variant frontotemporal degeneration

    PubMed Central

    Spotorno, Nicola; Healey, Meghan; McMillan, Corey T.; Rascovsky, Katya; Irwin, David J.; Clark, Robin; Grossman, Murray

    2015-01-01

    Some extent of ambiguity is ubiquitous in everyday conversations. For example, words have multiple meaning and very common pronouns, like “he” and “she” (anaphoric pronouns), have little meaning on their own and refer to a noun that has been previously introduced in the discourse. Ambiguity triggers a decision process that is not a subroutine of language processing but rather a more general domain resource. Therefore non-aphasic patients with limited decision-making capability can encounter severe limitation in language processing due to extra linguistic limitations. In the present study, we test patients with behavioral variant frontotemporal degeneration (bvFTD), focusing on anaphora as a paradigmatic example of ambiguity resolution in the linguistic domain. bvFTD is characterized by gray matter (GM) atrophy in prefrontal cortex, but relative sparing of peri-Sylvian cortex. A group of patients with parietal disease due to corticobasal syndrome (CBS) was also tested here in order to investigate the specific role of prefrontal cortex in the task employed in the current study. Participants were presented with a pair of sentences in which the first sentence contained two nouns while the second contained a pronoun. In the experimental (ambiguous) condition, both nouns are plausible referents of the pronoun, thus requiring decision-making resources. The results revealed that bvFTD patients are significantly less accurate than healthy seniors in identifying the correct referent of a pronoun in the ambiguous condition, although CBS patients were as accurate as healthy seniors. Imaging analyses related bvFTD patients’ performance to GM atrophy in ventromedial prefrontal cortex (vmPFC). These results suggest that bvFTD patients have difficulties in decision processes that involve the resolution of an ambiguity. PMID:26578928

  1. Agrammatism in Jordanian-Arabic Speakers

    ERIC Educational Resources Information Center

    Albustanji, Yusuf M.; Milman, Lisa H.; Fox, Robert A.; Bourgeois, Michelle S.

    2013-01-01

    The studies of agrammatism show that not all morpho-syntactic elements are impaired to the same degree and that some of this variation may be due to language-specific differences. This study investigated the production of morpho-syntactic elements in 15 Jordanian-Arabic (JA) speaking individuals with agrammatism and 15 age-matched neurologically…

  2. Verb deficits in Alzheimer’s disease and agrammatism: Implications for lexical organization☆

    PubMed Central

    Kim, Mikyong; Thompson, Cynthia K.

    2011-01-01

    This study examined the nature of verb deficits in 14 individuals with probable Alzheimer’s Disease (PrAD) and nine with agrammatic aphasia. Production was tested, controlling both semantic and syntactic features of verbs, using noun and verb naming, sentence completion, and narrative tasks. Noun and verb comprehension and a grammaticality judgment task also were administered. Results showed that while both PrAD and agrammatic subjects showed impaired verb naming, the syntactic features of verbs (i.e., argument structure) influenced agrammatic, but not Alzheimer’s disease patients’ verb production ability. That is, agrammatic patients showed progressively greater difficulty with verbs associated with more arguments, as has been shown in previous studies (e.g., Kim & Thompson, 2000; Thompson, 2003; Thompson, Lange, Schneider, & Shapiro, 1997), and suggest a syntactic basis for verb production deficits in agrammatism. Conversely, the semantic complexity of verbs affected PrAD, but not agrammatic, patients’ performance, suggesting “bottom-up” breakdown in their verb lexicon, paralleling that of nouns, resulting from the degradation or loss of semantic features of verbs. PMID:14698726

  3. [Repetitive phenomenona in the spontaneous speech of aphasic patients: perseveration, stereotypy, echolalia, automatism and recurring utterance].

    PubMed

    Wallesch, C W; Brunner, R J; Seemüller, E

    1983-12-01

    Repetitive phenomena in spontaneous speech were investigated in 30 patients with chronic infarctions of the left hemisphere which included Broca's and/or Wernicke's area and/or the basal ganglia. Perseverations, stereotypies, and echolalias occurred with all types of brain lesions, automatisms and recurring utterances only with those patients, whose infarctions involved Wernicke's area and basal ganglia. These patients also showed more echolalic responses. The results are discussed in view of the role of the basal ganglia as motor program generators.

  4. Brain plasticity in aphasic patients: intra- and inter-hemispheric reorganisation of the whole linguistic network probed by N150 and N350 components.

    PubMed

    Spironelli, Chiara; Angrilli, Alessandro

    2015-07-28

    The present study examined linguistic plastic reorganization of language through Evoked Potentials in a group of 17 non-fluent aphasic patients who had suffered left perisylvian focal lesions, and showed a good linguistic recovery. Language reorganisation was probed with three linguistic tasks (Phonological, Semantic, Orthographic), the early word recognition potential (N150) and the later phonological-related component (N350). Results showed the typical left-lateralised posterior N150 in healthy controls (source: left Fusiform Gyrus), that was bilateral (Semantic) or right sided (Phonological task) in patients (sources: right Inferior/Middle Temporal and Fusiform Gyri). As regards N350, controls revealed different intra- and inter-hemispheric linguistic activation across linguistic tasks, whereas patients exhibited greater activity in left intact sites, anterior and posterior to the damaged area, in all tasks (sources: Superior Frontal Gyri). A comprehensive neurofunctional model is presented, describing how complete intra- and inter-hemispheric reorganisation of the linguistic networks occurs after aphasic damage in the strategically dominant left perisylvian linguistic centres.

  5. Brain plasticity in aphasic patients: intra- and inter-hemispheric reorganisation of the whole linguistic network probed by N150 and N350 components

    PubMed Central

    Spironelli, Chiara; Angrilli, Alessandro

    2015-01-01

    The present study examined linguistic plastic reorganization of language through Evoked Potentials in a group of 17 non-fluent aphasic patients who had suffered left perisylvian focal lesions, and showed a good linguistic recovery. Language reorganisation was probed with three linguistic tasks (Phonological, Semantic, Orthographic), the early word recognition potential (N150) and the later phonological-related component (N350). Results showed the typical left-lateralised posterior N150 in healthy controls (source: left Fusiform Gyrus), that was bilateral (Semantic) or right sided (Phonological task) in patients (sources: right Inferior/Middle Temporal and Fusiform Gyri). As regards N350, controls revealed different intra- and inter-hemispheric linguistic activation across linguistic tasks, whereas patients exhibited greater activity in left intact sites, anterior and posterior to the damaged area, in all tasks (sources: Superior Frontal Gyri). A comprehensive neurofunctional model is presented, describing how complete intra- and inter-hemispheric reorganisation of the linguistic networks occurs after aphasic damage in the strategically dominant left perisylvian linguistic centres. PMID:26217919

  6. [Evaluation of intelligence with non-verbal tests in aphasic patients].

    PubMed

    Ceschin, J S; Melaragno Filho, R; Brauer, M J; Parente, M A

    1979-09-01

    Eight patients with cerebral vascular disease and aphasia were studied just after the stroke. The clinical, neuropsychiatric, EEG and neuro-radiological aspects were evaluated. The patients were submitted to the psychological and phonoaudiological studies. The authors correlated the neurological lesions to the structural alteration of the intelligence, to the praxic and estheognostic alterations and also to the language disturbances. The criterions adopted by the World Health Organization and the genetics classification of Jean Piaget were used for the intellectual level classification. The results suggest that the intelligence evaluated through Leither's non-verbal test is better preserved in some asphasics.

  7. Linguistic Structures in Stereotyped Aphasic Speech

    ERIC Educational Resources Information Center

    Buckingham, Hugh W., Jr.; And Others

    1975-01-01

    The linguistic structure of specific introductory type clauses, which appear at a relatively high frequency in the utterances of a severely brain damaged fluent aphasic with neologistic jargon speech, is examined. The analysis is restricted to one fifty-six-year-old male patient who suffered massive subdural hematoma. (SCC)

  8. Aphasic Patients Exhibit a Reversal of Hemispheric Asymmetries in Categorical Color Discrimination

    PubMed Central

    Paluy, Yulia; Gilbert, Aubrey L.; Baldo, Juliana V.; Dronkers, Nina F.; Ivry, Richard B.

    2010-01-01

    Patients with left hemisphere (LH) or right hemisphere (RH) brain injury due to stroke were tested on a speeded, color discrimination task in which two factors were manipulated: 1) the categorical relationship between the target and the distracters and 2) the visual field in which the target was presented. Similar to controls, the RH patients were faster in detecting targets in the right visual field when the target and distracters had different color names compared to when their names were the same. This effect was absent in the LH patients, consistent with the hypothesis that injury to the left hemisphere handicaps the automatic activation of lexical codes. Moreover, the LH patients showed a reversed effect, such that the advantage of different target-distracter names was now evident for targets in the left visual field. This reversal may suggest a reorganization of the color lexicon in the right hemisphere following left hemisphere brain injury and/or the unmasking of a heightened right hemisphere sensitivity to color categories. PMID:21216454

  9. Aphasic Patients Exhibit a Reversal of Hemispheric Asymmetries in Categorical Color Discrimination

    ERIC Educational Resources Information Center

    Paluy, Yulia; Gilbert, Aubrey L.; Baldo, Juliana V.; Dronkers, Nina F.; Ivry, Richard B.

    2011-01-01

    Patients with left hemisphere (LH) or right hemisphere (RH) brain injury due to stroke were tested on a speeded, color discrimination task in which two factors were manipulated: (1) the categorical relationship between the target and the distracters and (2) the visual field in which the target was presented. Similar to controls, the RH patients…

  10. Extended turn construction and test question sequences in the conversations of three speakers with agrammatic aphasia

    PubMed Central

    Beckley, Firle; Best, Wendy; Johnson, Fiona; Edwards, Susan; Maxim, Jane

    2013-01-01

    The application of Conversation Analysis (CA) to the investigation of agrammatic aphasia reveals that utterances produced by speakers with agrammatism engaged in everyday conversation differ significantly from utterances produced in response to decontextualised assessment and therapy tasks. Early studies have demonstrated that speakers with agrammatism construct turns from sequences of nouns, adjectives, discourse markers and conjunctions, packaged by a distinct pattern of prosody. This article presents examples of turn construction methods deployed by three people with agrammatism as they take an extended turn, in order to recount a past event, initiate a discussion or have a disagreement. This is followed by examples of sequences occurring in the talk of two of these speakers that result in different, and more limited, turn construction opportunities, namely “test” questions asked in order to initiate a new topic of talk, despite the conversation partner knowing the answer. The contrast between extended turns and test question sequences illustrates the effect of interactional context on aphasic turn construction practices, and the potential of less than optimal sequences to mask turn construction skills. It is suggested that the interactional motivation for test question sequences in these data are to invite people with aphasia to contribute to conversation, rather than to practise saying words in an attempt to improve language skills. The idea that test question sequences may have their origins in early attempts to deal with acute aphasia, and the potential for conversation partnerships to become “stuck” in such interactional patterns after they may have outlived their usefulness, are discussed with a view to clinical implications. PMID:23848370

  11. Comparison of machine learning methods for classifying aphasic and non-aphasic speakers.

    PubMed

    Järvelin, Antti; Juhola, Martti

    2011-12-01

    The performance of eight machine learning classifiers were compared with three aphasia related classification problems. The first problem contained naming data of aphasic and non-aphasic speakers tested with the Philadelphia Naming Test. The second problem included the naming data of Alzheimer and vascular disease patients tested with Finnish version of the Boston Naming Test. The third problem included aphasia test data of patients suffering from four different aphasic syndromes tested with the Aachen Aphasia Test. The first two data sets were small. Therefore, the data used in the tests were artificially generated from the original confrontation naming data of 23 and 22 subjects, respectively. The third set contained aphasia test data of 146 aphasic speakers and was used as such in the experiments. With the first and the third data set the classifiers could successfully be used for the task, while the results with the second data set were less encouraging. However, based on the results, no single classifier performed exceptionally well with all data sets, suggesting that the selection of the classifier used for classification of aphasic data should be based on the experiments performed with the data set at hand.

  12. Different patterns of spoken and written word comprehension deficit in aphasic stroke patients.

    PubMed

    Crutch, Sebastian J; Warrington, Elizabeth K

    2011-09-01

    This study presents neuropsychological evidence for differences in the semantic representations underpinning spoken and written word comprehension. Potential modality-based discrepancies in the semantic system were examined by testing whether spoken word (auditory-verbal input) and written word (visual-verbal input) comprehension exhibited the same effect profile on variables typically used to distinguish so-called access and storage disorders (e.g., response consistency, sensitivity to item frequency). The study was based on the premise that damage to a common set of semantic representations should have an equivalent impact upon comprehension performance irrespective of input modality, whereas damage to partially dissociable semantic representations may give rise to different qualities of deficit (access/storage) in the comprehension of stimuli presented in different input modalities (spoken/written). The study involved two patients with global aphasia following left middle cerebral artery stroke (F.B.I. and H.O.P.). The two patients showed matched performance on conventional tests of single word comprehension with clear evidence of semantic impairment for stimuli presented in both the spoken and written input modalities. However, in H.O.P., spoken and written word comprehension was affected in the same way by variations in stimulus category, frequency, and multiple stimulus presentations, whilst in F.B.I., there were clear differences between input modalities with all three variables. More specifically, F.B.I.'s written word comprehension was significantly affected by category (living > nonliving) and frequency (high > low) but not multiple presentations (single = multiple), more consistent with degradation of stored representations (storage deficit). By contrast, his spoken word comprehension was unaffected by category (living = nonliving) and frequency (high = low) but was affected by multiple presentations (single > multiple; serial

  13. Neighbourhood Density Effects in Auditory Non-Word Processing in Aphasic Listeners

    ERIC Educational Resources Information Center

    Janse, Esther

    2009-01-01

    This study investigates neighbourhood density effects on lexical decision performance (both accuracy and response times) of aphasic patients. Given earlier results on lexical activation and deactivation in Broca's and Wernicke's aphasia, the prediction was that smaller neighbourhood density effects would be found for Broca's aphasic patients,…

  14. Agrammatism in Jordanian-Arabic Speakers

    ERIC Educational Resources Information Center

    Albustanji, Yusuf Mohammed

    2009-01-01

    Agrammatism is a frequent sequela of Broca's aphasia that manifests itself in omission and/or substitution of the grammatical morphemes in spontaneous and constrained speech. The hierarchical structure of syntactic trees has been proposed as an account for difficulty across grammatical morphemes (e.g., tense, agreement, and negation). Supporting…

  15. Making Non-Fluent Aphasics Speak: Sing along!

    ERIC Educational Resources Information Center

    Racette, Amelie; Bard, Celine; Peretz, Isabelle

    2006-01-01

    A classic observation in neurology is that aphasics can sing words they cannot pronounce otherwise. To further assess this claim, we investigated the production of sung and spoken utterances in eight brain-damaged patients suffering from a variety of speech disorders as a consequence of a left-hemisphere lesion. In Experiment 1, the patients were…

  16. Syllable structure and sonority in language inventory and aphasic neologisms.

    PubMed

    Stenneken, Prisca; Bastiaanse, Roelien; Huber, Walter; Jacobs, Arthur M

    2005-11-01

    Phonological theories have raised the notion of a universally preferred syllable type which is defined in terms of its sonority structure (e.g., ). Empirical evidence for this notion has been provided by distributional analyses of natural languages and of language acquisition data, and by aphasic speech error analyses. The present study investigates frequency distributions of syllable types in German, which allows for a rather complex syllable structure, and in neologistic utterances of a German speaking jargon aphasic. The findings suggest that the sonority structure of the patient's neologisms is generally in accordance with the notion of theoretically preferred syllables. Moreover, comparative analyses suggest that the predominance of the preferred syllable type is especially pronounced in the aphasic data. On the basis of these findings, the influence of sonority in impaired phonological lexical processing is discussed.

  17. Contrasting Effects of Phonological Priming in Aphasic Word Production

    ERIC Educational Resources Information Center

    Wilshire, Carolyn E.; Saffran, Eleanor M.

    2005-01-01

    Two fluent aphasics, IG and GL, performed a phonological priming task in which they repeated an auditory prime then named a target picture. The two patients both had selective deficits in word production: they were at or near ceiling on lexical comprehension tasks, but were significantly impaired in picture naming. IG's naming errors included both…

  18. Neural Mechanisms of Verb Argument Structure Processing in Agrammatic Aphasic and Healthy Age-Matched Listeners

    ERIC Educational Resources Information Center

    Thompson, Cynthia K.; Bonakdarpour, Borna; Fix, Stephen F.

    2010-01-01

    Processing of lexical verbs involves automatic access to argument structure entries entailed within the verb's representation. Recent neuroimaging studies with young normal listeners suggest that this involves bilateral posterior peri-sylvian tissue, with graded activation in these regions on the basis of argument structure complexity. The aim of…

  19. The phonology-morphosyntax interface: affixed words in agrammatism.

    PubMed

    Obler, L K; Harris, K; Meth, M; Centeno, J; Mathews, P

    In three experiments with nondysarthric agrammatics, we explored the association between phonology and morphosyntax. (1) Contrasting phonological and nonphonological factors on inflectional-affix production of English verbs across three tasks in eight agrammatics, longer stem-syllabic length and stem-final-CC status resulted in poorer affix-production. (2) Studying verb inflections in six agrammatic Spanish-speakers, affix-length and affix-stress correlated with poorer repetition, as did low affix frequency. (3) Four English-speaking agrammatics read aloud and repeated derived words varying in syllable-length and stem-stress reassignment; both contributed independently to word-production difficulty. Phonological complexity of affixes and stems appears to reduce resources for morphological processing in nondysarthric agrammatics.

  20. What Goes Wrong during Passive Sentence Production in Agrammatic Aphasia: An Eyetracking Study

    PubMed Central

    Cho, Soojin; Thompson, Cynthia K.

    2010-01-01

    Background Production of passive sentences is often impaired in agrammatic aphasia and has been attributed both to an underlying structural impairment (e.g., Schwartz, Saffran, Fink, Myers, & Martin, 1994) and to a morphological deficit (e.g., Caplan & Hanna, 1998; Faroqi-Shah & Thompson, 2003). However, the nature of the deficit in passive sentence production is not clear due to methodological issues present in previous studies. Aims This study examined active and passive sentence production in nine agrammatic aphasic speakers under conditions of structural priming using eyetracking to test whether structural impairments occur independently of morphological impairments and whether the underlying nature of error types is reflected in on-line measures, i.e., eye movements and speech onset latencies. Methods & Procedures Nine participants viewed and listened to a prime sentence in either active or passive voice, and then repeated it aloud. Next, a target picture appeared on the computer monitor and participants were instructed to describe it using the primed sentence structure. Outcomes & Results Participants made substantial errors in sentence structure, i.e., passives with role reversals (RRs) and actives-for-passives, but few errors in passive morphology. Longer gaze durations to the first-produced noun for passives with RRs as compared to correct passives were found before and during speech. For actives-for-passives, however, this pattern was found during speech, but not before speech. Conclusions The deficit in passive sentence production does not solely arise from a morphological deficit, rather it stems, at least in part, from a structural level impairment. The underlying nature of passives with RRs is qualitatively different from that of actives-for-passives, which cannot be clearly differentiated with off-line testing methodology. PMID:21188294

  1. Pragmatic-mode mediation of sentence comprehension among aphasic bilinguals and hispanophones.

    PubMed

    Schnitzer, M L

    1989-01-01

    A test of sentence comprehension administered in four input-output modality combinations to a group of aphasic bilinguals and monolingual hispanophones provides evidence that aphasics tend to use pragmatic-mode (in the sense of Givón, 1979, On understanding-grammar, New York, Academic Press) strategies in approaching this task. When five factors were identified and dichotomized with respect to the pragmatic-mode-syntactic-mode dimension, the patients performed significantly better on items classified as pragmatic than on those classified as syntactic, in both languages. The results support a vertical/hierarchical view of aphasic language dissolution.

  2. Contrasting patterns of comprehension for superordinate, basic-level, and subordinate names in semantic dementia and aphasic stroke patients.

    PubMed

    Crutch, Sebastian J; Warrington, Elizabeth K

    2008-06-01

    It is well established that patients with semantic memory impairment show a relative sparing of general superordinate information as compared with more detailed item-specific information. The objective of the current study was to examine whether or not this superordinate superiority effect is also reliably observed in individuals with stroke. The participants were 3 patients with a diagnosis of semantic dementia (SD) and 4 left middle cerebral artery stroke patients. In the first experiment, participants were administered a series of spoken-word-picture matching tasks, in which picture identity was probed under two conditions: item name (e.g., goose, beetle, shark, hedgehog) and superordinate name (e.g., bird, insect, fish, mammal). The SD patients showed the predicted pattern of performance, identifying stimuli significantly more accurately by their superordinate term than by their specific name. By contrast, the stroke patients showed the reverse pattern of inferior performance in the superordinate condition in all versions of the experimental task. In a second experiment comparing comprehension ofbasic-level names (e.g., dog, bird, fish) and subordinate-level names (e.g., Dalmatian, sparrow, trout), stroke patients also showed a reversal of the normal basic-level effect, showing less accurate comprehension of basic-level names. The pattern of results documented among the stroke patients cannot be accommodated obviously or readily by existing models of conceptual knowledge. These contrasting abilities of SD patients, stroke patients, and normal healthy participants to process subordinate, basic-level, and superordinate names are considered in relation to disorders of executive processing and taxonomic categorization.

  3. The forgotten grammatical category: Adjective use in agrammatic aphasia

    PubMed Central

    Meltzer-Asscher, Aya; Thompson, Cynthia K.

    2014-01-01

    Background In contrast to nouns and verbs, the use of adjectives in agrammatic aphasia has not been systematically studied. However, because of the linguistic and psycholinguistic attributes of adjectives, some of which overlap with nouns and some with verbs, analysis of adjective production is important for testing theories of word class production deficits in agrammatism. Aims The objective of the current study was to compare adjective use in agrammatic and healthy individuals, focusing on three factors: overall adjective production rate, production of predicative and attributive adjectives, and production of adjectives with complex argument structure. Method & Procedures Narratives elicited from 14 agrammatic and 14 control participants were coded for open class grammatical category production (i.e., nouns, verbs, adjectives), with each adjective also coded for its syntactic environment (attributive/predicative) and argument structure. Outcomes & Results Overall, agrammatic speakers used adjectives in proportions similar to that of cognitively healthy speakers. However, they exhibited a greater proportion of predicative adjectives and a lesser proportion of attributive adjectives, compared to controls. Additionally, agrammatic participants produced adjectives with less complex argument structure than controls. Conclusions The overall normal-like frequency of adjectives produced by agrammatic speakers suggests that agrammatism does not involve an inherent difficulty with adjectives as a word class or with predication, or that it entails a deficit in processing low imageability words. However, agrammatic individuals’ reduced production of attributive adjectives and adjectives with complements extends previous findings of an adjunction deficit and of impairment in complex argument structure processing, respectively, to the adjectival domain. The results suggest that these deficits are not tied to a specific grammatical category. PMID:24882945

  4. Assessing Spontaneous Language Abilities of Aphasic Speakers.

    ERIC Educational Resources Information Center

    Edwards, Susan; Knott, Raymond

    1994-01-01

    Reports on research to develop a descriptive framework capable of revealing relevant linguistic features of aphasic speech. Spontaneous speech samples collected from aphasic and normal speakers in dyadic conversational settings and from monologic picture descriptions are transcribed; lexical, phrasal and causal elements are coded and quantified.…

  5. Adaptive significance of right hemisphere activation in aphasic language comprehension

    PubMed Central

    Meltzer, Jed A.; Wagage, Suraji; Ryder, Jennifer; Solomon, Beth; Braun, Allen R.

    2013-01-01

    Aphasic patients often exhibit increased right hemisphere activity during language tasks. This may represent takeover of function by regions homologous to the left-hemisphere language networks, maladaptive interference, or adaptation of alternate compensatory strategies. To distinguish between these accounts, we tested language comprehension in 25 aphasic patients using an online sentence-picture matching paradigm while measuring brain activation with MEG. Linguistic conditions included semantically irreversible (“The boy is eating the apple”) and reversible (“The boy is pushing the girl”) sentences at three levels of syntactic complexity. As expected, patients performed well above chance on irreversible sentences, and at chance on reversible sentences of high complexity. Comprehension of reversible non-complex sentences ranged from nearly perfect to chance, and was highly correlated with offline measures of language comprehension. Lesion analysis revealed that comprehension deficits for reversible sentences were predicted by damage to the left temporal lobe. Although aphasic patients activated homologous areas in the right temporal lobe, such activation was not correlated with comprehension performance. Rather, patients with better comprehension exhibited increased activity in dorsal fronto-parietal regions. Correlations between performance and dorsal network activity occurred bilaterally during perception of sentences, and in the right hemisphere during a post-sentence memory delay. These results suggest that effortful reprocessing of perceived sentences in short-term memory can support improved comprehension in aphasia, and that strategic recruitment of alternative networks, rather than homologous takeover, may account for some findings of right hemisphere language activation in aphasia. PMID:23566891

  6. Adaptive significance of right hemisphere activation in aphasic language comprehension.

    PubMed

    Meltzer, Jed A; Wagage, Suraji; Ryder, Jennifer; Solomon, Beth; Braun, Allen R

    2013-06-01

    Aphasic patients often exhibit increased right hemisphere activity during language tasks. This may represent takeover of function by regions homologous to the left-hemisphere language networks, maladaptive interference, or adaptation of alternate compensatory strategies. To distinguish between these accounts, we tested language comprehension in 25 aphasic patients using an online sentence-picture matching paradigm while measuring brain activation with MEG. Linguistic conditions included semantically irreversible ("The boy is eating the apple") and reversible ("The boy is pushing the girl") sentences at three levels of syntactic complexity. As expected, patients performed well above chance on irreversible sentences, and at chance on reversible sentences of high complexity. Comprehension of reversible non-complex sentences ranged from nearly perfect to chance, and was highly correlated with offline measures of language comprehension. Lesion analysis revealed that comprehension deficits for reversible sentences were predicted by damage to the left temporal lobe. Although aphasic patients activated homologous areas in the right temporal lobe, such activation was not correlated with comprehension performance. Rather, patients with better comprehension exhibited increased activity in dorsal fronto-parietal regions. Correlations between performance and dorsal network activity occurred bilaterally during perception of sentences, and in the right hemisphere during a post-sentence memory delay. These results suggest that effortful reprocessing of perceived sentences in short-term memory can support improved comprehension in aphasia, and that strategic recruitment of alternative networks, rather than homologous takeover, may account for some findings of right hemisphere language activation in aphasia.

  7. [The significance of the Montessori method and phenomenon with a particular view to the therapy of the aphasics (author's transl)].

    PubMed

    Birchmeier-Nussbaumer, A K

    1980-05-01

    The methods of the Italian physician Maria Montessori influenced the development of modern learning practices. There is general agreement that the Montessori phenomenon is personality forming. Aspects of this method, which are relevant for the rehabilitation of the brain-damaged and, in particular, the aphasics are presented. Possible shifts of emphasis within the relationship therapist - method - patient are analysed. Examples are used to outline in how far an increasingly patient-oriented therapy can influence the development of the aphasic patient.

  8. MRI findings in aphasic status epilepticus.

    PubMed

    Toledo, Manuel; Munuera, Josep; Sueiras, Maria; Rovira, Rosa; Alvarez-Sabín, José; Rovira, Alex

    2008-08-01

    Ictal-MRI studies including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and MR-angiography (MRA) in patients with aphasic status epilepticus (ASE) are lacking. In this report, we aim to describe the consequences of the ASE on DWIs and its impact on cerebral circulation. We retrospectively studied eight patients with ASE confirmed by ictal-EEG, who underwent ictal-MRI shortly after well-documented onset (mean time delay 3 h). ASE consisted in fluctuating aphasia, mostly associated with other subtle contralateral neurological signs such as hemiparesia, hemianopia, or slight clonic jerks. In MRI, six patients showed cortical temporoparietal hyperintensity in DWI and four of them had also ipsilateral pulvinar lesions. Five patients showed close spatial hyperperfusion areas matching the DWI lesions and an enhanced blow flow in the middle cerebral artery. Parenchymal lesions and hemodynamic abnormalities were not associated with seizure duration or severity in any case. The resolution of DWI lesions at follow-up MRI depended on the length of the MRIs interval. In patients with ASE, lesions on DWI in the temporo-parietal cortex and pulvinar nucleus combined with local hyperperfusion can be observed, even when they appear distant from the epileptic focus or the language areas.

  9. The non-fluent/agrammatic variant of primary progressive aphasia.

    PubMed

    Grossman, Murray

    2012-06-01

    The non-fluent/agrammatic variant of primary progressive aphasia (naPPA) is a young-onset neurodegenerative disorder characterised by poor grammatical comprehension and expression and a disorder of speech sound production. In an era of disease-modifying treatments, the identification of naPPA might be an important step in establishing a specific cause of neurodegenerative disease. However, difficulties in defining the characteristic language deficits and heterogeneity in the anatomical distribution of disease in naPPA have led to controversy. Findings from imaging studies have linked an impairment of this uniquely human language capacity with disruption of large-scale neural networks centred in left inferior frontal and anterior superior temporal regions. Accordingly, the pathological burden of disease in naPPA is anatomically focused in these regions. Most cases of naPPA are associated with the spectrum of pathological changes found in frontotemporal lobar degeneration involving the microtubule-associated protein tau. Knowledge of these unique clinical-pathological associations should advance care for patients with this important class of neurodegenerative diseases while supplementing our knowledge of human cognitive neuroscience.

  10. Implicit and explicit learning in individuals with agrammatic aphasia.

    PubMed

    Schuchard, Julia; Thompson, Cynthia K

    2014-06-01

    Implicit learning is a process of acquiring knowledge that occurs without conscious awareness of learning, whereas explicit learning involves the use of overt strategies. To date, research related to implicit learning following stroke has been largely restricted to the motor domain and has rarely addressed implications for language. The present study investigated implicit and explicit learning of an auditory word sequence in 10 individuals with stroke-induced agrammatic aphasia and 18 healthy age-matched participants using an adaptation of the Serial Reaction Time task. Individuals with aphasia showed significant learning under implicit, but not explicit, conditions, whereas age-matched participants learned under both conditions. These results suggest significant implicit learning ability in agrammatic aphasia. Furthermore, results of an auditory sentence span task indicated working memory deficits in individuals with agrammatic aphasia, which are discussed in relation to explicit and implicit learning processes.

  11. Comparing the production of complex sentences in Persian patients with post-stroke aphasia and non-damaged people with normal speaking

    PubMed Central

    Mehri, Azar; Ghorbani, Askar; Darzi, Ali; Jalaie, Shohreh; Ashayeri, Hassan

    2016-01-01

    Background: Cerebrovascular disease leading to stroke is the most common cause of aphasia. Speakers with agrammatic non-fluent aphasia have difficulties in production of movement-derived sentences such as passive sentences, topicalized constituents, and Wh-questions. To assess the production of complex sentences, some passive, topicalized and focused sentences were designed for patients with non-fluent Persian aphasic. Afterwards, patients’ performance in sentence production was tested and compared with healthy non-damaged subjects. Methods: In this cross sectional study, a task was designed to assess the different types of sentences (active, passive, topicalized and focused) adapted to Persian structures. Seven Persian patients with post-stroke non-fluent agrammatic aphasia (5 men and 2 women) and seven healthy non-damaged subjects participated in this study. The computed tomography (CT) scan or magnetic resonance imaging (MRI) showed that all the patients had a single left hemisphere lesion involved middle cerebral artery (MCA), Broca`s area and in its white matter. In addition, based on Bedside version of Persian Western Aphasia Battery (P-WAB-1), all of them were diagnosed with moderate Broca aphasia. Then, the production task of Persian complex sentences was administered. Results: There was a significant difference between four types of sentences in patients with aphasia [Degree of freedom (df) = 3, P < 0.001]. All the patients showed worse performance than the healthy participants in all the four types of sentence production (P < 0.050). Conclusion: In general, it is concluded that topicalized and focused sentences as non-canonical complex sentences in Persian are very difficult to produce for patients with agrammatic non-fluent aphasia. It seems that sentences with A-movement are simpler for the patients than sentences involving A`-movement; since they include shorter movements in compare to topicalized and focused sentences. PMID:27141274

  12. Linguistic Complexity and Frequency in Agrammatic Speech Production

    ERIC Educational Resources Information Center

    Bastiaanse, Roelien; Bouma, Gosse; Post, Wendy

    2009-01-01

    There is a long standing debate between aphasiologists on the essential factor that constitutes the behavioral patterns of loss and preservation in agrammatic Broca's aphasia. It has been suggested that linguistic complexity plays a crucial role: linguistically complex structures are more difficult to produce than linguistically simple ones.…

  13. Sentence Comprehension in Swahili-English Bilingual Agrammatic Speakers

    ERIC Educational Resources Information Center

    Abuom, Tom O.; Shah, Emmah; Bastiaanse, Roelien

    2013-01-01

    For this study, sentence comprehension was tested in Swahili-English bilingual agrammatic speakers. The sentences were controlled for four factors: (1) order of the arguments (base vs. derived); (2) embedding (declarative vs. relative sentences); (3) overt use of the relative pronoun "who"; (4) language (English and Swahili). Two…

  14. The effects of single versus combined cue presentations on picture naming by aphasic adults.

    PubMed

    Weidner, W E; Jinks, A F

    1983-03-01

    Research has demonstrated that the presentation of auditory and visual cues is an effective clinical procedure for improving picture naming of nonfluent aphasic speakers. The effect of combined cue presentation, however, has not been clearly demonstrated. The present study investigated the effect of single and multiple cueing techniques used with nonfluent (Broca's) aphasic patients. The subjects were divided into a minimum or maximum error group based on their performance on a picture-naming task. Printed words (in either cursive or manuscript style), initial syllables, and sentence completion cues were presented independently and in combination. Discussion is directed toward the potential clinical application of multiple cueing techniques.

  15. Changes in Identity after Aphasic Stroke: Implications for Primary Care

    PubMed Central

    Gilbert, Thomas; Bokhour, Barbara G.

    2015-01-01

    Background. Stroke survivors with aphasia experience difficulty associated with their communication disorder. While much has been written about aphasia's impacts on partners/family, we lack data regarding the psychosocial adjustment of aphasic stroke survivors, with a paucity of data from the patients themselves. Methods. Qualitative study of lived experiences of individuals with poststroke aphasia. Each of the stroke survivors with aphasia completed 3-4 semistructured interviews. In most cases, patients' partners jointly participated in interviews, which were transcribed and analyzed using techniques derived from grounded theory. Results. 12 patients were interviewed, with the total of 45 interviews over 18 months. Themes included poststroke changes in patients' relationships and identities, which were altered across several domains including occupational identity, relationship and family roles, and social identity. While all these domains were impacted by aphasia, the impact varied over time. Conclusion. Despite the challenges of interviewing individuals with aphasia, we explored aphasia's impacts on how individuals experience their identity and develop new identities months and years after stroke. This data has important implications for primary care of patients with aphasia, including the importance of the long-term primary care relationship in supporting psychosocial adjustment to life after aphasic stroke. PMID:25685553

  16. Omissions and Semantic Errors in Aphasic Naming: Is There a Link?

    ERIC Educational Resources Information Center

    Bormann, Tobias; Kulke, Florian; Wallesch, Claus-W.; Blanken, Gerhard

    2008-01-01

    Within a discrete two-stage model of lexicalization, semantic errors and errors of omission are assumed to be independent events. In contrast, cascading and interactive models allow for an influence of word form on lexical selection and thus for an inherent relationship in accounting for both error types. A group of 17 aphasic patients was…

  17. The Effects of Homogeneous versus Heterogeneous Stimuli on the Confrontation-Naming Performance of Aphasics.

    ERIC Educational Resources Information Center

    Williams, Sarah E.; Wright, Judith M.

    1985-01-01

    The effect of semantic grouping on confrontation-naming performances of 16 fluent and 10 nonfluent aphasic adults was examined. Performances were not uniformly facilitated in one naming condition over the other. Some patients, however, did appear to display performance discrepancies between the two conditions. (Author/CL)

  18. Grammatical Planning Units during Real-Time Sentence Production in Speakers with Agrammatic Aphasia and Healthy Speakers

    ERIC Educational Resources Information Center

    Lee, Jiyeon; Yoshida, Masaya; Thompson, Cynthia K.

    2015-01-01

    Purpose: Grammatical encoding (GE) is impaired in agrammatic aphasia; however, the nature of such deficits remains unclear. We examined grammatical planning units during real-time sentence production in speakers with agrammatic aphasia and control speakers, testing two competing models of GE. We queried whether speakers with agrammatic aphasia…

  19. An Investigation of Luria's Hypothesis on Prompting in Aphasic Naming Disturbances.

    ERIC Educational Resources Information Center

    Li, Edith Chin; Canter, Gerald J.

    1987-01-01

    The study investigated A. R. Luria's hypothesis that aphasic subgroups (Broca's, conduction, Wernicke's, and anomic aphasics) would respond differentially to phonemic prompts. Results, with the exception of the anomic aphasic group, supported Luria's predictions. (Author/DB)

  20. A Psychometric Analysis of Functional Category Production in English Agrammatic Narratives

    ERIC Educational Resources Information Center

    Milman, Lisa H.; Dickey, Michael Walsh; Thompson, Cynthia K.

    2008-01-01

    Hierarchical models of agrammatism propose that sentence production deficits can be accounted for in terms of clausal syntactic structure [Friedmann, N., & Grodzinsky, Y. (1997). "Tense and agreement in agrammatic production: Pruning the syntactic tree." "Brain and Language, 56", 397-425; Hagiwara, H. (1995). "The breakdown of functional…

  1. Prosody as a Compensatory Strategy in the Conversations of People with Agrammatism

    ERIC Educational Resources Information Center

    Beeke, Suzanne; Wilkinson, Ray; Maxim, Jane

    2009-01-01

    Historically, agrammatism, a symptom of Broca's aphasia, has been associated with dysprosody, on account of speakers' slow, halting, and effortful speech. Almost all investigations of this phenomenon use experimental methods (reading, repetition). Thus, little is known about how prosody is used by speakers with agrammatism and understood by their…

  2. Training agrammatic subjects on passive sentences: implications for syntactic deficit theories.

    PubMed

    Weinrich, M; Boser, K I; McCall, D; Bishop, V

    2001-01-01

    We trained two subjects with chronic agrammatic aphasia on production of passive sentences using a computerized, iconic-based communication system. After training, one of the subjects demonstrated significant improvements in his abilities to comprehend and verbally produce English passive voiced sentences, including sentences with conjoined subjects and objects. These results suggest that agrammatism does not represent a fixed syntactic deficit.

  3. Tense and Agreement Dissociations in German Agrammatic Speakers: Underspecification Vs. Hierarchy

    ERIC Educational Resources Information Center

    Burchert, F.; Swoboda-Moll, M.; Bleser, R.D.

    2005-01-01

    The aim of the present paper was to investigate whether German agrammatic production data are compatible with the Tree-Pruning-Hypothesis (TPH; Friedmann & Grodzinsky, 1997). The theory predicts unidirectional patterns of dissociation in agrammatic production data with respect to Tense and Agreement. However, there was evidence of a double…

  4. Dissociations Between Fluency And Agrammatism In Primary Progressive Aphasia

    PubMed Central

    Thompson, Cynthia K.; Cho, Soojin; Hsu, Chien-Ju; Wieneke, Christina; Rademaker, Alfred; Weitner, Bing Bing; Mesulam, M-Marsel; Weintraub, Sandra

    2011-01-01

    Background Classical aphasiology, based on the study of stroke sequelae, fuses speech fluency and grammatical ability. Nonfluent (Broca's) aphasia often is accompanied by agrammatism; whereas in the fluent aphasias grammatical deficits are not typical. The assumption that a similar relationship exists in primary progressive aphasia (PPA) has led to the dichotomization of this syndrome into fluent and nonfluent subtypes. Aims This study compared elements of fluency and grammatical production in the narrative speech of individuals with PPA to determine if they can be dissociated from one another. Method Speech samples from 37 individuals with PPA, clinically assigned to agrammatic (N=11), logopenic (N=20) and semantic (N=6) subtypes, and 13 cognitively healthy control participants telling the “Cinderella Story” were analyzed for fluency (i.e., words per minute (WPM) and mean length of utterance in words (MLU-W)) and grammaticality (i.e., the proportion of grammatically correct sentences, open-to-closed-class word ratio, noun-to-verb ratio, and correct production of verb inflection, noun morphology, and verb argument structure.) Between group differences were analyzed for each variable. Correlational analyses examined the relation between WPM and each grammatical variable, and an off-line measure of sentence production. Outcomes And Results Agrammatic and logopenic groups both had lower scores on the fluency measures and produced significantly fewer grammatical sentences than did semantic and control groups. However, only the agrammatic group evinced significantly impaired production of verb inflection and verb argument structure. In addition, some semantic participants showed abnormal open-to-closed and noun-to-verb ratios in narrative speech. When the sample was divided on the basis of fluency, all the agrammatic participants fell in the nonfluent category. The logopenic participants varied in fluency but those with low fluency showed variable performance on

  5. [Thoughts on modern aphasic discourse studies].

    PubMed

    Wu, Ke-rong

    2006-04-01

    This article gives a brief introduction to the content of aphasic discourse analysis, the theoretical frameworks applied, and critical findings . It also points out the problem that faces the study, the variety of study methods that arises, and the future trend. The structuralists tend to focus on the micro aspects of the discourse while the functionalists on its general structure and the meaning. The study in the future shall address the connection of these two levels.

  6. Aphasic status epilepticus with periodic lateralized epileptiform discharges in a bilingual patient as a presenting sign of "AIDS-toxoplasmosis complex".

    PubMed

    Ozkaya, Gülşen; Kurne, Asli; Unal, Serhat; Oğuz, Kader Karli; Karabudak, Rana; Saygi, Serap

    2006-08-01

    We describe an HIV-infected, bilingual patient presenting with Wernicke's aphasia due to partial status epilepticus with periodic lateralized epileptiform discharges, as the first sign of AIDS-toxoplasmosis complex. The localization of the native and secondary language centers in the brain and the possible role of recurrent seizures in the fluctuating course of Wernicke's aphasia in this patient are discussed. The clinical course of this patient supports the belief that a second language area for a second language learned in the later stages of life is located in an area different from that for the native language but still in close proximity to it.

  7. Code Switching in Normal and Aphasic Kannada-English Bilinguals.

    ERIC Educational Resources Information Center

    Bhat, Sapna; Chengappa, Shyamala

    Patterns of code switching were studies from two aphasic and two neurologically normal Kannada-English bilinguals. Conversational analysis of the samples based on the Matrix Language Frame (MLF) model (Myers-Scotton, 1993) revealed consistent code switching between two languages by all the subjects. The aphasic subjects demonstrated a greater…

  8. Revisiting "The Influence of Literacy in Paraphasias of Aphasic Speakers"

    ERIC Educational Resources Information Center

    Colaco, Dora; Mineiro, Ana; Leal, Gabriela; Castro-Caldas, Alexandre

    2010-01-01

    Literature suggests that illiterate subjects are unaware of the phonological structure of language. This fact may influence the characteristics of aphasic speech, namely the structure of paraphasias. A battery of tests was developed for this study to be used with aphasic subjects (literate and illiterate), in order to explore this topic in more…

  9. Asyntactic Thematic Role Assignment by Mandarin Aphasics: A Test of the Trace-Deletion Hypothesis and the Double Dependency Hypothesis

    ERIC Educational Resources Information Center

    Su, Yi-ching.; Lee, Shu-er; Chung, Yuh-mei

    2007-01-01

    This study examines the comprehension patterns of various sentence types by Mandarin-speaking aphasic patients and evaluates the validity of the predictions from the Trace-Deletion Hypothesis (TDH) and the Double Dependency Hypothesis (DDH). Like English, the canonical word order in Mandarin is SVO, but the two languages differ in that the head…

  10. Advanced magnetic resonance neuroimaging of language function recovery after aphasic stroke: a technical review.

    PubMed

    Smits, Marion; Visch-Brink, Evy G; van de Sandt-Koenderman, Mieke E; van der Lugt, Aad

    2012-01-01

    Two advanced magnetic resonance neuroimaging techniques, functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), have recently made their way into clinically oriented research and hold great promise to study the brain's adaptive changes of function and structure after aphasic stroke, respectively. Such functional and structural neuroplasticity is thought to underlie the recovery of language function, occurring spontaneously and/or in the context of therapeutic intervention. With fMRI, brain activity can be visualized. Spontaneous brain activity, present in multiple brain networks, is measured with resting-state fMRI and language-related brain activity by having the subject perform a language task during scanning (task-based fMRI). With DTI the major white matter tracts, such as the dorsal and ventral language pathways and the commissural fibers, can be visualized and quantified. Both techniques are entirely noninvasive and thus offer the unique opportunity to perform multiple assessments within the same subject. To gain more insight in functional and structural neuroplasticity after aphasic stroke, advanced magnetic resonance neuroimaging studies in specific patient populations, at several stages after stroke and in the course of language recovery, are needed. Such studies will help to clarify the influence of the many factors that play a role in the recovery of language function and are thus vital to further the development of aphasia therapy. Application of these techniques in aphasic stroke patients, however, is not without challenge. The purpose of this article is to discuss the methodologic challenges of fMRI and DTI in the assessment of language recovery after aphasic stroke.

  11. Naming in aphasic children: analysis of paraphasic errors.

    PubMed

    van Dongen, H R; Visch-Brink, E G

    1988-01-01

    In the spontaneous speech of aphasic children paraphasias have been described. This analysis of naming errors during recovery showed that neologisms, literal and verbal paraphasias occurred. The etiology affected the recovery course of neologisms, but not other errors.

  12. Two insular regions are differentially involved in behavioral variant FTD and nonfluent/agrammatic variant PPA.

    PubMed

    Mandelli, Maria Luisa; Vitali, Paolo; Santos, Miguel; Henry, Maya; Gola, Kelly; Rosenberg, Lynne; Dronkers, Nina; Miller, Bruce; Seeley, William W; Gorno-Tempini, Maria Luisa

    2016-01-01

    The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) and the behavioral variant frontotemporal dementia (bvFTD) are focal neurodegenerative disorders belonging to the FTD-spectrum clinical syndromes. NfvPPA is characterized by effortful speech and/or agrammatism and left frontal atrophy, while bvFTD is characterized by social-emotional dysfunction often accompanied by right-lateralized frontal damage. Despite their contrasting clinical presentations, both disorders show prominent left anterior insula atrophy. We investigated differential patterns of insular sub-region atrophy in nfvPPA and bvFTD. Based on knowledge of insular connectivity and physiology, we hypothesized that the left superior precentral region of the dorsal anterior insula (SPGI) would be more atrophic in nvfPPA due to its critical role in motor speech, whereas the ventral anterior region would be more atrophied in bvFTD reflecting its known role in social-emotional-autonomic functions. Early stage nfvPPA and bvFTD patients matched for disease severity, age, gender and education and healthy controls participated in the study. Detailed clinical history, neurological examination, neuropsychological screening evaluation, and high-resolution T1-weighted brain magnetic resonance imaging (MRI) were collected. Voxel-based morphometry (VBM) was applied to perform group comparisons across the whole brain and in bilateral insula region of interest (ROI). Correlation analyses between insular sub-region atrophy and relevant clinical features were performed. Whole brain group comparisons between nfvPPA and bvFTD showed the expected predominantly left or right anterior insular atrophy pattern. ROI analysis of bilateral insula showed that the left SPGI was significantly more atrophied in nfvPPA compared to bvFTD, while the bilateral ventral anterior and right dorsal anterior insula sub-regions were more atrophied in bvFTD than nfvPPA. Only left SPGI volume correlated with speech production

  13. Two insular regions are differentially involved in behavioral variant FTD and nonfluent/agrammatic variant PPA

    PubMed Central

    Mandelli, Maria Luisa; Vitali, Paolo; Santos, Miguel; Henry, Maya; Gola, Kelly; Rosenberg, Lynne; Dronkers, Nina; Miller, Bruce; Seeley, William W.; Gorno-Tempini, Maria Luisa

    2016-01-01

    The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) and the behavioral variant frontotemporal dementia (bvFTD) are focal neurodegenerative disorders belonging to the FTD-spectrum clinical syndromes. NfvPPA is characterized by effortful speech and/or agrammatism and left frontal atrophy, while bvFTD is characterized by social-emotional dysfunction often accompanied by right-lateralized frontal damage. Despite their contrasting clinical presentations, both disorders show prominent left anterior insula atrophy. We investigated differential patterns of insular subregion atrophy in nfvPPA and bvFTD. Based on knowledge of insular connectivity and physiology, we hypothesized that the left superior precentral region of the dorsal anterior insula (SPGI) would be more atrophic in nvfPPA due to its critical role in motor speech, whereas the ventral anterior region would be more atrophied in bvFTD reflecting its known role in social-emotional-autonomic functions. Early stage nfvPPA and bvFTD patients matched for disease severity, age, gender and education and healthy controls participated in the study. Detailed clinical history, neurological examination, neuropsychological screening evaluation, and high-resolution T1-weighted brain magnetic resonance images (MRI) were collected. Voxel-based morphometry (VBM) was applied to perform group comparisons across the whole brain and in bilateral insula region of interest (ROI). Correlation analyses between insular subregion atrophy and relevant clinical features were performed. Whole brain group comparisons between nfvPPA and bvFTD showed the expected predominantly left or right anterior insular atrophy pattern. ROI analysis of bilateral insula showed that the left SPGI was significantly more atrophied in nfvPPA compared to bvFTD, while the bilateral ventral anterior and right dorsal anterior insula subregions were more atrophied in bvFTD than nfvPPA. Only left SPGI volume correlated with speech production

  14. The production of semantic paralexias in a Spanish-speaking aphasic.

    PubMed

    Ferreres, A R; Miravalles, G

    1995-05-01

    A case of a Spanish-speaking aphasic patient who produced a great number of semantic paralexias in reading aloud and who showed other symptoms consistent with the diagnosis of deep dyslexia is presented. In this study, (a) the production of semantic paralexias and the features of the deep dyslexia syndrome which have only recently begun to be studied in Spanish-speaking patients, are analyzed; and (b) the "obligatory character of phonological mediation in the reading of Spanish proposed by some authors is discussed.

  15. Nasal Consonant Production in Broca's and Wernicke's Aphasics: Speech Deficits and Neuroanatomical Correlates

    ERIC Educational Resources Information Center

    Kurowski, Kathleen M.; Blumstein, Sheila E.; Palumbo, Carole L.; Waldstein, Robin S.; Burton, Martha W.

    2007-01-01

    The present study investigated the articulatory implementation deficits of Broca's and Wernicke's aphasics and their potential neuroanatomical correlates. Five Broca's aphasics, two Wernicke's aphasics, and four age-matched normal speakers produced consonant-vowel-(consonant) real word tokens consisting of [m, n] followed by [i, e, a, o, u]. Three…

  16. Nonfluent/agrammatic PPA with in-vivo cortical amyloidosis and Pick's disease pathology.

    PubMed

    Caso, Francesca; Gesierich, Benno; Henry, Maya; Sidhu, Manu; LaMarre, Amanda; Babiak, Miranda; Miller, Bruce L; Rabinovici, Gil D; Huang, Eric J; Magnani, Giuseppe; Filippi, Massimo; Comi, Giancarlo; Seeley, William W; Gorno-Tempini, Maria Luisa

    2013-01-01

    The role of biomarkers in predicting pathological findings in the frontotemporal dementia (FTD) clinical spectrum disorders is still being explored. We present comprehensive, prospective longitudinal data for a 66 year old, right-handed female who met current criteria for the nonfluent/agrammatic variant of primary progressive aphasia (nfvPPA). She first presented with a 3-year history of progressive speech and language impairment mainly characterized by severe apraxia of speech. Neuropsychological and general motor functions remained relatively spared throughout the clinical course. Voxel-based morphometry (VBM) showed selective cortical atrophy of the left posterior inferior frontal gyrus (IFG) and underlying insula that worsened over time, extending along the left premotor strip. Five years after her first evaluation, she developed mild memory impairment and underwent PET-FDG and PiB scans that showed left frontal hypometabolism and cortical amyloidosis. Three years later (11 years from first symptom), post-mortem histopathological evaluation revealed Pick's disease, with severe degeneration of left IFG, mid-insula, and precentral gyrus. Alzheimer's disease (AD) (CERAD frequent/Braak Stage V) was also detected. This patient demonstrates that biomarkers indicating brain amyloidosis should not be considered conclusive evidence that AD pathology accounts for a typical FTD clinical/anatomical syndrome.

  17. Bilingualism delays the onset of behavioral but not aphasic forms of frontotemporal dementia.

    PubMed

    Alladi, Suvarna; Bak, Thomas H; Shailaja, Mekala; Gollahalli, Divyaraj; Rajan, Amulya; Surampudi, Bapiraju; Hornberger, Michael; Duggirala, Vasanta; Chaudhuri, Jaydip Ray; Kaul, Subhash

    2017-03-18

    Bilingualism has been found to delay onset of dementia and this has been attributed to an advantage in executive control in bilinguals. However, the relationship between bilingualism and cognition is complex, with costs as well as benefits to language functions. To further explore the cognitive consequences of bilingualism, the study used Frontotemporal dementia (FTD) syndromes, to examine whether bilingualism modifies the age at onset of behavioral and language variants of Frontotemporal dementia (FTD) differently. Case records of 193 patients presenting with FTD (121 of them bilingual) were examined and the age at onset of the first symptoms were compared between monolinguals and bilinguals. A significant effect of bilingualism delaying the age at onset of dementia was found in behavioral variant FTD (5.7 years) but not in progressive nonfluent aphasia (0.7 years), semantic dementia (0.5 years), corticobasal syndrome (0.4 years), progressive supranuclear palsy (4.3 years) and FTD-motor neuron disease (3 years). On dividing all patients predominantly behavioral and predominantly aphasic groups, age at onset in the bilingual behavioral group (62.6) was over 6 years higher than in the monolingual patients (56.5, p=0.006), while there was no difference in the aphasic FTD group (60.9 vs. 60.6 years, p=0.851). The bilingual effect on age of bvFTD onset was shown independently of other potential confounding factors such as education, gender, occupation, and urban vs rural dwelling of subjects. To conclude, bilingualism delays the age at onset in the behavioral but not in the aphasic variants of FTD. The results are in line with similar findings based on research in stroke and with the current views of the interaction between bilingualism and cognition, pointing to advantages in executive functions and disadvantages in lexical tasks.

  18. A new test battery to assess aphasic disturbances and associated cognitive dysfunctions -- German normative data on the aphasia check list.

    PubMed

    Kalbe, Elke; Reinhold, Nadine; Brand, Matthias; Markowitsch, Hans J; Kessler, Josef

    2005-10-01

    Aphasia, defined as an acquired impairment of linguistic abilities, can be accompanied by a diversity of neuropsychological dysfunction. Accordingly, the necessity to include cognitive testing in the diagnosis of aphasia is increasingly recognized. Here we present the Aphasia Check List (ACL), a new test battery for the assessment of aphasic and associated cognitive disorders. The language part of the battery provides a differentiated profile of important linguistic abilities. In addition, the ACL includes nonverbal screening tests for three neuropsychological domains: memory, attention, and reasoning. Dysfunctions in these domains have been observed in aphasic patients and can have an impact on language function. The ACL is applicable to patients with language disturbances of different etiologies, different stages of disease, and to patients with mild to severe aphasia. As the entire test duration is only about 30 minutes, the ACL is also economically valuable. It thus presents an adequate starting point in aphasia diagnosis for a wide range of patients. Here we describe the construction of the ACL, and the normative study of its original German version with 154 aphasic patients and 106 healthy comparison subjects. The ACL cognition part revealed additional neuropsychological dysfunction in the aphasia group. We present the patterns of these dysfunctions and their correlations with language deficits.

  19. The Production of Turkish Relative Clauses in Agrammatism: Verb Inflection and Constituent Order

    ERIC Educational Resources Information Center

    Duman, Tuba Yarbay; Aygen, Gulsat; Bastiaanse, Roelien

    2008-01-01

    This study presents results from a sentence completion test that examines the production of finite main clauses and non-finite relative clauses in Turkish agrammatic speech. In main clauses, the verb is finite and all its constituents are in their base positions. In relative clauses, the verb is a participle and the NP undergoes overt movement to…

  20. Training and Generalized Production of wh- and NP-Movement Structures in Agrammatic Aphasia.

    ERIC Educational Resources Information Center

    Thompson, Cynthia K.; And Others

    1997-01-01

    Production of complex sentences was studied in two men with agrammatic aphasia. The influence of training question production (wh)-movement structures on untrained wh-movement structures and on noun phrases (NP)-movement structures was investigated. Results indicate that movement to an argument position, as in NP-movement, is distinct from a…

  1. Pronominal Resolution and Gap Filling in Agrammatic Aphasia: Evidence from Eye Movements

    ERIC Educational Resources Information Center

    Thompson, Cynthia K.; Choy, Jungwon Janet

    2009-01-01

    This paper reports the results of three studies examining comprehension and real-time processing of pronominal (Experiment 1) and Wh-movement (Experiments 2 and 3) structures in agrammatic and unimpaired speakers using eyetracking. We asked the following questions: (a) Is off-line comprehension of these constructions impaired in agrammatic…

  2. Semantic Interference during Object Naming in Agrammatic and Logopenic Primary Progressive Aphasia (PPA)

    ERIC Educational Resources Information Center

    Thompson, Cynthia K.; Cho, Soojin; Price, Charis; Wieneke, Christina; Bonakdarpour, Borna; Rogalski, Emily; Weintraub, Sandra; Mesulam, M-Marsel

    2012-01-01

    This study examined the time course of object naming in 21 individuals with primary progressive aphasia (PPA) (8 agrammatic (PPA-G); 13 logopenic (PPA-L)) and healthy age-matched speakers (n=17) using a semantic interference paradigm with related and unrelated interfering stimuli presented at stimulus onset asynchronies (SOAs) of -1000, -500, -100…

  3. Verb Deficits in Alzheimer's Disease and Agrammatism: Implications for Lexical Organization

    ERIC Educational Resources Information Center

    Kim, Mikyong; Thompson, Cynthia K.

    2004-01-01

    This study examined the nature of verb deficits in 14 individuals with probable Alzheimer's Disease (PrAD) and nine with agrammatic aphasia. Production was tested, controlling both semantic and syntactic features of verbs, using noun and verb naming, sentence completion, and narrative tasks. Noun and verb comprehension and a grammaticality…

  4. APHASIC CHILDREN, IDENTIFICATION AND EDUCATION BY THE ASSOCIATION METHOD.

    ERIC Educational Resources Information Center

    MCGINNIS, MILDRED A.

    THIS BOOK IS DESIGNED TO DEFINE APHASIA AND ITS CHARACTERISTICS, TO PRESENT A PROCEDURE FOR TEACHING LANGUAGE TO APHASIC CHILDREN, AND TO APPLY THIS PROCEDURE TO ELEMENTARY SCHOOL SUBJECTS. OTHER HANDICAPPING CONDITIONS WHICH COMPLICATE THE DIAGNOSIS OF APHASIA ARE PRESENTED BY MEANS OF CASE STUDIES. CHARACTERISTICS OF TWO TYPES OF…

  5. Unsolicited Nominalizations by Aphasics: The Plausibility of the Lexicalist Model.

    ERIC Educational Resources Information Center

    Whitaker, Harry A.

    This paper uses a discussion of experiments with aphasics' use of verbally derived nouns to illustrate how one linguistic model may be superior to another in accounting for the facts of verbal behavior. The models involved are the transformational, which relates derived nominals to their source verb and lists only the verb in the lexicon, and the…

  6. Syllable Structure and Sonority in Language Inventory and Aphasic Neologisms

    ERIC Educational Resources Information Center

    Stenneken, Prisca; Bastiaanse, Roelien; Huber, Walter; Jacobs, Arthur M.

    2005-01-01

    Phonological theories have raised the notion of a universally preferred syllable type which is defined in terms of its sonority structure (e.g., Clements, 1990). Empirical evidence for this notion has been provided by distributional analyses of natural languages and of language acquisition data, and by aphasic speech error analyses. The present…

  7. L'adaptation langagiere de differents intervenants en interaction avec un aphasique (Linguistic Adaptation of Different Therapists in Interaction with an Aphasic).

    ERIC Educational Resources Information Center

    Perren, Helene

    1998-01-01

    The nature of research on speech communication in asymmetrical interactions, such as those between a speech therapist and patient, is discussed and some general approaches to therapy are noted. The situation of the aphasic is then considered, in which intervention is particularly difficult due to the lack of some important aspects of interpersonal…

  8. Strategy and impairment in sentence understanding by Broca's and Wernicke's aphasics.

    PubMed

    Kolk, H H; Friederici, A D

    1985-03-01

    15 Broca's aphasics and 14 Wernicke's aphasics, both German and Dutch speaking patients, were presented with a sentence-picture matching task. Both syntactic and semantic distractor pictures were used. Sentences were either reversible or non-reversible, had a topicalized or a non-topicalized word order and contained either of three types of prepositions that were labelled 'syntactic' (case-marking), 'obligatory' (subcategorized) and 'lexical' (locative). Results indicated (a) a significant difference between reversible and non reversible sentences for both Broca's and Wernicke's; (b) no significant differences between these two groups in the differences scores reversible minus non-reversible; (c) an above-chance performance on reversible sentences for both groups. To explain the pattern of differences between the various types of sentences, two schemes of interpretation are presented. The first scheme assumes that both Broca's and Wernicke's have lost basic (but different) syntactic abilities and that they can understand reversible sentences by non-syntactic strategies only. The second scheme assumes that there is no such loss, but that the impairment in Broca's and Wernicke's aphasia is such that the more syntactic analysis is required, the more errors are made. Patients are assumed to approach this task by trying to limit their syntactic analysis to the beginning of the sentence.

  9. Where is the effect of frequency in word production? Insights from aphasic picture naming errors

    PubMed Central

    Kittredge, Audrey K.; Dell, Gary S.; Verkuilen, Jay; Schwartz, Myrna F.

    2010-01-01

    Some theories of lexical access in production locate the effect of lexical frequency at the retrieval of a word’s phonological characteristics, as opposed to the prior retrieval of a holistic representation of the word from its meaning. Yet there is evidence from both normal and aphasic individuals that frequency may influence both of these retrieval processes. This inconsistency is especially relevant in light of recent attempts to determine the representation of another lexical property, age of acquisition or AoA, whose effect is similar to that of frequency. To further explore the representations of these lexical variables in the word retrieval system, we performed hierarchical, multinomial logistic regression analyses of 50 aphasic patients’ picture-naming responses. While both log frequency and AoA had a significant influence on patient accuracy and led to fewer phonologically related errors and omissions, only log frequency had an effect on semantically related errors. These results provide evidence for a lexical access process sensitive to frequency at all stages, but with AoA having a more limited effect. PMID:18704797

  10. Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language.

    PubMed

    Salisbury, Laura; Code, Chris

    2016-06-01

    This article explores the relationship between automatic and involuntary language in the work of Samuel Beckett and late nineteenth-century neurological conceptions of language that emerged from aphasiology. Using the work of John Hughlings Jackson alongside contemporary neuroscientific research, we explore the significance of the lexical and affective symmetries between Beckett's compulsive and profoundly embodied language and aphasic speech automatisms. The interdisciplinary work in this article explores the paradox of how and why Beckett was able to search out a longed-for language of feeling that might disarticulate the classical bond between the language, intention, rationality and the human, in forms of expression that seem automatic and "readymade".

  11. Cerebrolysin adjuvant treatment in Broca's aphasics following first acute ischemic stroke of the left middle cerebral artery

    PubMed Central

    Muresanu, DF; Bajenaru, O; Popescu, BO; Deme, SM; Moessler, H; Meinzingen, SZ; Petrica, L; Serpe, M; Ursoniu, S

    2010-01-01

    Background: The aim of our study was to assess the efficacy of Cerebrolysin administration in Broca's aphasics with acute ischemic stroke. Methods: We registered 2,212 consecutive Broca's aphasics following an acute ischemic stroke admitted in four departments of neurology in Romania, between September 2005 and September 2009. Language was evaluated with the Romanian version of the Western Aphasia Battery (WAB). The following inclusion criteria were used for this study: age 20%75 years, admission in the hospital within 12 hours from the onset of the symptoms, diagnosis of first acute left middle cerebral artery (MCA) ischemic stroke, presence of large artery disease (LAD) stroke, a NIHSS score of 5%22 points, and a therapeutic time window within 72 h. Fifty two patients were treated with Cerebrolysin (Cerebrolysin group) as an adjunctive treatment. A placebo group, which received saline infusions (n=104 patients) were matched to the NIHSS and WAB scores, gender and age of the Cerebrolysin group at baseline. We assessed spontaneous speech (SS), comprehension (C), repetition (R), naming (N), and Aphasia Quotient (AQ) scores of the two groups in an open label design, over 90 days, the mRS scores and mortality. Results: The Cerebrolysin and the placebo groups had similar age (66+/%8 versus 65+/%8 years) and sex ratio (14/38 versus 30/74). The mean AQ scores and the mean subscores for 3 subtests of WAB (SS, R, N) were similar at baseline and improved in the Cerebrolysin group significantly (p<0.05) over placebo group at all study time points. The mRS score at 90 days was also lower in the Cerebrolysin group than in the placebo group. Cerebrolysin and placebo were both tolerated and safe, and no difference in the mortality rate was seen (3.8% in each group). Conclusion: Cerebrolysin is effective for the treatment of Broca's aphasics with a first acute ischemic stroke of the left MCA territory. PMID:20945821

  12. Behavior Modification with an Aphasic Man

    ERIC Educational Resources Information Center

    Ince, Laurence P.

    1973-01-01

    Techniques based upon operant conditioning were employed with a male patient who had sustained a cerebrovascular accident with consequent right hemiplegia and expressive asphasia. A combination of positive verbal reinforcement and feedback of progress were utilized to improve language fluency and speed of typing. (Author)

  13. On separability of A-phases during the cyclic alternating pattern.

    PubMed

    Mendez, M O; Alba, A; Chouvarda, I; Milioli, G; Grassi, A; Terzano, M G; Parrino, L

    2014-01-01

    A statistical analysis of the separability of EEG A-phases, with respect to basal activity, is presented in this study. A-phases are short central events that build up the Cyclic Alternating Pattern (CAP) during sleep. The CAP is a brain phenomenon which is thought to be related to the construction, destruction and instability of sleep stages dynamics. From the EEG signals, segments obtained around the onset and offset of the A-phases were used to evaluate the separability between A-phases and basal sleep stage oscillations. In addition, a classifier was trained to separate the different A-phase types (A1, A2 and A3). Temporal, energy and complexity measures were used as descriptors for the classifier. The results show a percentage of separation between onset and preceding basal oscillations higher than 85 % for all A-phases types. For Offset separation from following baseline, the accuracy is higher than 80 % but specificity is around 75%. Concerning to A-phase type separation, A1-phase and A3-phase are well separated with accuracy higher than 80, while A1 and A2-phases show a separation lower than 50%. These results encourage the design of automatic classifiers for Onset detection and for separating among A-phases type A1 and A3. On the other hand, the A-phase Offsets present a smooth transition towards the basal sleep stage oscillations, and A2-phases are very similar to A1-phases, suggesting that a high uncertainty may exist during CAP annotation.

  14. Apraxia of Speech and Phonological Errors in the Diagnosis of Nonfluent/Agrammatic and Logopenic Variants of Primary Progressive Aphasia

    ERIC Educational Resources Information Center

    Croot, Karen; Ballard, Kirrie; Leyton, Cristian E.; Hodges, John R.

    2012-01-01

    Purpose: The International Consensus Criteria for the diagnosis of primary progressive aphasia (PPA; Gorno-Tempini et al., 2011) propose apraxia of speech (AOS) as 1 of 2 core features of nonfluent/agrammatic PPA and propose phonological errors or absence of motor speech disorder as features of logopenic PPA. We investigated the sensitivity and…

  15. Unambiguous generalization effects after treatment of non-canonical sentence production in German agrammatism.

    PubMed

    Stadie, Nicole; Schröder, Astrid; Postler, Jenny; Lorenz, Antje; Swoboda-Moll, Maria; Burchert, Frank; De Bleser, Ria

    2008-03-01

    Agrammatism is-among others, characterized by a deficit in producing grammatical structures. Of specific difficulty is the utilization of complex, non-canonical sentence structures (e.g. object-questions, passives, object-clefts). Several studies have documented positive effects when applying a specific treatment protocol in terms of increasingly correct production of target complex sentence structures with some variance in generalization patterns noted across individuals. The objective of this intervention study was to evaluate an intervention program focussing on the production of non-canonical sentences. Hypotheses about the occurrence of treatment effects were formulated on the basis of syntactic complexity, referring to the amount of syntactic phrase structures necessary to generate specific German sentence structures. A multiple single case study with seven agrammatic participants was applied, each participant receiving training in the production of object-relative-clauses and who-questions. The investigation was designed to unambiguously evaluate for each individual, structure specific and generalized learning effects with respect to the production of object-relative-clauses, who-questions and passive sentences. Results showed significant improvements for all sentences types. This outcome is considered within methodological issues of treatment studies. Theoretical and clinical implications are discussed.

  16. The Effect of Redundant Cues on Comprehension of Spoken Messages by Aphasic Adults.

    ERIC Educational Resources Information Center

    Venus, Carol A.; Canter, Gerald J.

    1987-01-01

    Aphasic adults (N=16) with severe auditory comprehension impairment were evaluated for comprehension of redundant and nonredundant spoken and/or gestured messages. Results indicated redundancy was not reliably superior to spoken messages alone. (Author/DB)

  17. Analysis of A-phase transitions during the cyclic alternating pattern under normal sleep.

    PubMed

    Mendez, Martin Oswaldo; Chouvarda, Ioanna; Alba, Alfonso; Bianchi, Anna Maria; Grassi, Andrea; Arce-Santana, Edgar; Milioli, Guilia; Terzano, Mario Giovanni; Parrino, Liborio

    2016-01-01

    An analysis of the EEG signal during the B-phase and A-phases transitions of the cyclic alternating pattern (CAP) during sleep is presented. CAP is a sleep phenomenon composed by consecutive sequences of A-phases (each A-phase could belong to a possible group A1, A2 or A3) observed during the non-REM sleep. Each A-phase is separated by a B-phase which has the basal frequency of the EEG during a specific sleep stage. The patterns formed by these sequences reflect the sleep instability and consequently help to understand the sleep process. Ten recordings from healthy good sleepers were included in this study. The current study investigates complexity, statistical and frequency signal properties of electroencephalography (EEG) recordings at the transitions: B-phase--A-phase. In addition, classification between the onset-offset of the A-phases and B-phase was carried out with a kNN classifier. The results showed that EEG signal presents significant differences (p < 0.05) between A-phases and B-phase for the standard deviation, energy, sample entropy, Tsallis entropy and frequency band indices. The A-phase onset showed values of energy three times higher than B-phase at all the sleep stages. The statistical analysis of variance shows that more than 80% of the A-phase onset and offset is significantly different from the B-phase. The classification performance between onset or offset of A-phases and background showed classification values over 80% for specificity and accuracy and 70% for sensitivity. Only during the A3-phase, the classification was lower. The results suggest that neural assembles that generate the basal EEG oscillations during sleep present an over-imposed coordination for a few seconds due to the A-phases. The main characteristics for automatic separation between the onset-offset A-phase and the B-phase are the energy at the different frequency bands.

  18. Production of modal and negative particles in Greek aphasia.

    PubMed

    Koukoulioti, Vasiliki

    2010-08-01

    This study aims at investigating the production of the Greek modal and negative particles by non-fluent aphasic patients. These particles belong to the highest part of the verb periphrasis, so they are likely to be impaired in non-fluent aphasia, according to some hypotheses about agrammatic language. Moreover, there is an agreement relation between modality and negation, allowing the examination of agreement relationships in the clause domain. The data are compared to the predictions of recent theories on agrammatic language. The data provide evidence that modality is impaired in agrammatic aphasia, whilst agreement relations between clausal elements are spared.

  19. [Disturbances of word finding of compound nouns (nomina composita) in aphasics (author's transl)].

    PubMed

    Ahrens, R

    1977-09-14

    The faulty use of compound nouns by aphasics is of practical and theoretical significance. Defects in the finding and using of compound nouns were investigated with respect to the following parameters: the importance of the frequency with which compounds and compound parts are used in normal speech, the influence of grammatical and psycholinguistic peculiarities on aphasic dysfunction, and the handling of compounds in individual aphasic syndromes. The distinctly poorer recall of compound nouns compared with simple nouns was found to be due mainly to their less frequent use in normal speech. In word-finding the grammatical unit of the compound noun was not very stable patholinguistically. If one part of the compound noun was commoner and more usual in normal speech than the other it was usually better recalled. However, some remarkable deviations from this were due to semantic functional value, vividness, morphologic peculiarities, and linguistic form. The wider meaning-range of the second part of the compound noun had no positive mnemonic effect, despite the propensity of the aphasic for the general. In naming tests the first part of the compound noun was preferred on average. Certain differences in the defective use of compound nouns were observed between the individual aphasic syndromes.

  20. Neural underpinnings for model-oriented therapy of aphasic word production.

    PubMed

    Abel, Stefanie; Weiller, Cornelius; Huber, Walter; Willmes, Klaus

    2014-05-01

    Model-oriented therapies of aphasic word production have been shown to be effective, with item-specific therapy effects being larger than generalisation effects for untrained items. However, it remains unclear whether semantic versus phonological therapy lead to differential effects, depending on type of lexical impairment. Functional imaging studies revealed that mainly left-hemisphere, perisylvian brain areas were involved in successful therapy-induced recovery of aphasic word production. However, the neural underpinnings for model-oriented therapy effects have not received much attention yet. We aimed at identifying brain areas indicating (1) general therapy effects using a naming task measured by functional magnetic resonance imaging (fMRI) in 14 patients before and after a 4-week naming therapy, which comprised increasing semantic and phonological cueing-hierarchies. We also intended to reveal differential effects (2) of training versus generalisation, (3) of therapy methods, and (4) of type of impairment as assessed by the connectionist Dell model. Training effects were stronger than generalisation effects, even though both were significant. Furthermore, significant impairment-specific therapy effects were observed for patients with phonological disorders (P-patients). (1) Left inferior frontal gyrus, pars opercularis (IFGoper), was a positive predictor of therapy gains while the right caudate was a negative predictor. Moreover, less activation decrease due to therapy in left-hemisphere temporo-parietal language areas was positively correlated with therapy gains. (2) Naming of trained compared to untrained words yielded less activation decrease in left superior temporal gyrus (STG) and precuneus, bilateral thalamus, and right caudate due to therapy. (3) Differential therapy effects could be detected in the right superior parietal lobule for the semantic method, and in regions involving bilateral anterior and mid cingulate, right precuneus, and left middle

  1. Production of Modal and Negative Particles in Greek Aphasia

    ERIC Educational Resources Information Center

    Koukoulioti, Vasiliki

    2010-01-01

    This study aims at investigating the production of the Greek modal and negative particles by non-fluent aphasic patients. These particles belong to the highest part of the verb periphrasis, so they are likely to be impaired in non-fluent aphasia, according to some hypotheses about agrammatic language. Moreover, there is an agreement relation…

  2. A Taiwanese Mandarin Main Concept Analysis (TM-MCA) for Quantification of Aphasic Oral Discourse

    ERIC Educational Resources Information Center

    Kong, Anthony Pak-Hin; Yeh, Chun-Chih

    2015-01-01

    Background: Various quantitative systems have been proposed to examine aphasic oral narratives in English. A clinical tool for assessing discourse produced by Cantonese-speaking persons with aphasia (PWA), namely Main Concept Analysis (MCA), was developed recently for quantifying the presence, accuracy and completeness of a narrative. Similar…

  3. Getting It Right? Using Aphasic Naming Errors to Evaluate Theoretical Models of Spoken Word Recognition.

    ERIC Educational Resources Information Center

    Nickels, Lyndsey

    1995-01-01

    Different models of spoken word production make different predictions regarding the extent of effects of certain word properties on the output of that model. This article examines these predictions with regard to the effect of these variables on the production of semantic and phonological errors by aphasic subjects. (60 references) (Author/CK)

  4. Effects of Nonlinguistic Auditory Variations on Lexical Processing in Broca's Aphasics

    ERIC Educational Resources Information Center

    Kittredge, Audrey; Davis, Lissa; Blumstein, Sheila E.

    2006-01-01

    In a series of experiments, the effect of white noise distortion and talker variation on lexical access in normal and Broca's aphasic participants was examined using an auditory lexical decision paradigm. Masking the prime stimulus in white noise resulted in reduced semantic priming for both groups, indicating that lexical access is degraded by…

  5. Mimicking Aphasic Semantic Errors in Normal Speech Production: Evidence from a Novel Experimental Paradigm

    ERIC Educational Resources Information Center

    Hodgson, Catherine; Lambon Ralph, Matthew A.

    2008-01-01

    Semantic errors are commonly found in semantic dementia (SD) and some forms of stroke aphasia and provide insights into semantic processing and speech production. Low error rates are found in standard picture naming tasks in normal controls. In order to increase error rates and thus provide an experimental model of aphasic performance, this study…

  6. Phonological facilitation of object naming in agrammatic and logopenic primary progressive aphasia (PPA)

    PubMed Central

    Mack, Jennifer E.; Cho-Reyes, Soojin; Kloet, James D.; Weintraub, Sandra; Mesulam, M-Marsel; Thompson, Cynthia K.

    2013-01-01

    Phonological processing deficits are characteristic of both the agrammatic and logopenic subtypes of primary progressive aphasia (PPA-G and PPA-L). However, it is an open question which substages of phonological processing (i.e., phonological word form retrieval, phonological encoding) are impaired in these subtypes of PPA, as well as how phonological processing deficits contribute to anomia. In the present study, participants with PPA-G (n=7), PPA-L (n=7), and unimpaired controls (n=17) named objects as interfering written words (phonologically related/unrelated) were presented at different stimulus onset asynchronies (SOAs) of 0, +100, +300, and +500 ms. Phonological facilitation (PF) effects (faster naming times with phonologically related interfering words) were found for the controls and PPA-L group only at SOA=0 and +100 ms. However, the PPA-G group exhibited protracted PF effects (PF at SOA=0, +100, and +300 ms). These results may reflect deficits in phonological encoding in PPA-G, but not in PPA-L, supporting the neuropsychological reality of this substage of phonological processing and the distinction between these two PPA subtypes. PMID:24070176

  7. Nasal Consonant Production in Broca’s and Wernicke’s Aphasics: Speech Deficits and Neuroanatomical Correlates

    PubMed Central

    Kurowski, Kathleen M.; Blumstein, Sheila E.; Palumbo, Carole L.; Waldstein, Robin; Burton, Martha W.

    2007-01-01

    The present study investigated the articulatory implementation deficits of Broca’s and Wernicke’s aphasics and their potential neuroanatomical correlates. Five Broca’s aphasics, two Wernicke’s aphasics, and four age-matched normal speakers produced consonant-vowel-(consonant) real word tokens consisting of [m, n] followed by [i, e, a, o, u]. Three acoustic measures were analyzed corresponding to different properties of articulatory implementation: murmur duration (a measure of timing), amplitude of the first harmonic at consonantal release (a measure of articulatory coordination), and murmur amplitude over time (a measure of laryngeal control). Results showed that Broca’s aphasics displayed impairments in all of these parameters, whereas Wernicke’s aphasics only exhibited greater variability in the production of two of the parameters. The lesion extent data showed that damage in either Broca’s area or the insula cortex was not predictive of the severity of the speech output impairment. Instead, lesions in the upper and lower motor face areas and the supplementary motor area resulted in the most severe implementation impairments. For the Wernicke’s aphasics, the posterior areas (superior marginal gyrus, parietal, and sensory) appear to be involved in the retrieval and encoding of lexical forms for speech production, resulting in increased variability in speech production. PMID:17145076

  8. Mn vacancy defects, grain boundaries, and A-phase stability of helimagnet MnSi.

    PubMed

    Ou-Yang, T Y; Shu, G J; Lin, J-Y; Hu, C D; Chou, F C

    2016-01-20

    Mn vacancy defect and grain size are shown to modify the magnetic phase diagram of MnSi significantly, especially near the critical regime of A-phase (skyrmion lattice) formation and the helimagnetic phase transition. Crystals grown using controlled nonstoichiometric initial precursors creates both grain boundaries and intrinsic Mn vacancy defect of various levels in MnSi. The results of combined transport, specific heat, and AC spin susceptibility measurements are compared for MnSi single crystal samples of various manganese deficiency levels and grain sizes. The finite-size effect and Mn vacancy level dependent helical phase transition temperature T(c) have been identified and verified. The stability of A-phase in H-T phase space has been examined through AC spin susceptibility data analysis.

  9. How to engage the right brain hemisphere in aphasics without even singing: evidence for two paths of speech recovery

    PubMed Central

    Stahl, Benjamin; Henseler, Ilona; Turner, Robert; Geyer, Stefan; Kotz, Sonja A.

    2012-01-01

    There is an ongoing debate as to whether singing helps left-hemispheric stroke patients recover from non-fluent aphasia through stimulation of the right hemisphere. According to recent work, it may not be singing itself that aids speech production in non-fluent aphasic patients, but rhythm and lyric type. However, the long-term effects of melody and rhythm on speech recovery are largely unknown. In the current experiment, we tested 15 patients with chronic non-fluent aphasia who underwent either singing therapy, rhythmic therapy, or standard speech therapy. The experiment controlled for phonatory quality, vocal frequency variability, pitch accuracy, syllable duration, phonetic complexity and other influences, such as the acoustic setting and learning effects induced by the testing itself. The results provide the first evidence that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia. This finding may challenge the view that singing causes a transfer of language function from the left to the right hemisphere. Instead, both singing and rhythmic therapy patients made good progress in the production of common, formulaic phrases—known to be supported by right corticostriatal brain areas. This progress occurred at an early stage of both therapies and was stable over time. Conversely, patients receiving standard therapy made less progress in the production of formulaic phrases. They did, however, improve their production of non-formulaic speech, in contrast to singing and rhythmic therapy patients, who did not. In light of these results, it may be worth considering the combined use of standard therapy and the training of formulaic phrases, whether sung or rhythmically spoken. Standard therapy may engage, in particular, left perilesional brain regions, while training of formulaic phrases may open new ways of tapping into right-hemisphere language resources—even without singing. PMID:23450277

  10. How to engage the right brain hemisphere in aphasics without even singing: evidence for two paths of speech recovery.

    PubMed

    Stahl, Benjamin; Henseler, Ilona; Turner, Robert; Geyer, Stefan; Kotz, Sonja A

    2013-01-01

    There is an ongoing debate as to whether singing helps left-hemispheric stroke patients recover from non-fluent aphasia through stimulation of the right hemisphere. According to recent work, it may not be singing itself that aids speech production in non-fluent aphasic patients, but rhythm and lyric type. However, the long-term effects of melody and rhythm on speech recovery are largely unknown. In the current experiment, we tested 15 patients with chronic non-fluent aphasia who underwent either singing therapy, rhythmic therapy, or standard speech therapy. The experiment controlled for phonatory quality, vocal frequency variability, pitch accuracy, syllable duration, phonetic complexity and other influences, such as the acoustic setting and learning effects induced by the testing itself. The results provide the first evidence that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia. This finding may challenge the view that singing causes a transfer of language function from the left to the right hemisphere. Instead, both singing and rhythmic therapy patients made good progress in the production of common, formulaic phrases-known to be supported by right corticostriatal brain areas. This progress occurred at an early stage of both therapies and was stable over time. Conversely, patients receiving standard therapy made less progress in the production of formulaic phrases. They did, however, improve their production of non-formulaic speech, in contrast to singing and rhythmic therapy patients, who did not. In light of these results, it may be worth considering the combined use of standard therapy and the training of formulaic phrases, whether sung or rhythmically spoken. Standard therapy may engage, in particular, left perilesional brain regions, while training of formulaic phrases may open new ways of tapping into right-hemisphere language resources-even without singing.

  11. Semantic contributions to immediate serial recall: evidence from two contrasting aphasic individuals.

    PubMed

    Wilshire, Carolyn E; Keall, Leonie M; O'Donnell, Debra J

    2010-08-01

    This paper examines the effect of semantic variables on serial recall in two contrasting aphasic cases and a group of controls. Experiment 1 manipulates word imageability and Experiment 2 manipulates semantic similarity. Controls not only showed better recall of imageable/semantically grouped lists, but under some conditions they also produced proportionately fewer phonological errors. These findings suggest that increasing the effectiveness of lexical/semantic support reduces reliance on phonological support. Consistent with this proposal, case TV, whose phonological impairment should increase his reliance on lexical/semantic support, produced abnormally low rates of phonological errors under some conditions. Conversely, case NP, who had a lexical/semantic impairment, produced abnormally high rates of phonological errors under some conditions. Analysis of serial recall curves in both aphasics and controls support the hypothesis that phonological processes are particularly critical for the recall of list-final items. However, there was no evidence that semantic support is especially crucial for list-initial recall. Controls did not exhibit stronger effects of semantic variables at list-initial position. Case NP (lexical/semantic impairment) performed disproportionately poorly on these items, but only under certain conditions.

  12. Automated Classification of Phonological Errors in Aphasic Language

    PubMed Central

    Ahuja, Sanjeev B.; Reggia, James A.; Berndt, Rita S.

    1984-01-01

    Using heuristically-guided state space search, a prototype program has been developed to simulate and classify phonemic errors occurring in the speech of neurologically-impaired patients. Simulations are based on an interchangeable rule/operator set of elementary errors which represent a theory of phonemic processing faults. This work introduces and evaluates a novel approach to error simulation and classification, it provides a prototype simulation tool for neurolinguistic research, and it forms the initial phase of a larger research effort involving computer modelling of neurolinguistic processes.

  13. Density Pervades: An Analysis of Phonological Neighborhood Density Effects in Aphasic Speakers with Different Types of Naming Impairment

    PubMed Central

    Middleton, Erica L.; Schwartz, Myrna F.

    2011-01-01

    We investigated the influence of phonological neighborhood density (PND) on the performance of aphasic speakers whose naming impairments differentially implicate phonological or semantic stages of lexical access. A word comes from a dense phonological neighborhood if many words sound like it. Limited evidence suggests that higher density facilitates naming in aphasic speakers, as it does in healthy speakers. Using well controlled stimuli, Experiment 1 confirmed the influence of PND on accuracy and phonological error rates in two aphasic speakers with phonological processing deficits. In Experiments 2 and 3, we extended the investigation to an aphasic speaker who is prone to semantic errors, indicating a semantic deficit and/or a deficit in the mapping from semantics to words. This individual had higher accuracy, and fewer semantic errors, in naming targets from high versus low density neighborhoods. It is argued that the results provide strong support for interactive approaches to lexical access, where reverberatory feedback between word- and phoneme-level lexical representations not only facilitates phonological level processes but also privileges the selection of a target word over its semantic competitors. PMID:21718214

  14. [An aphasic man with high fever; difficulty with diagnostic procedure].

    PubMed

    Potjewijd, J; Buijs, J

    2008-07-12

    A 73-year-old man, with known motor aphasia presented with high fever, dyspnoea, and vomiting. Only after several days it appeared that these signs were due to a sepsis as a consequence of a phlegmon of the neck, caused by an aspired part of his set of false teeth. The delay before diagnosis was due to the fact that adequate medical history taking was difficult because of the aphasia and attempts at non-verbal communication were poorly understood. The localization of the corpus alienum was a second pitfall, because it could not be visualized during physical examination or on the initial chest X-ray. The increased risk of colonization of dentures with pathogenic micro-organisms in nursing home residents may have played a role in the severe course of this infection. This case illustrates the diagnostic problems that may exist in patients who are unable to communicate adequately.

  15. [Comparison of the Aachen Aphasia Test, clinical study and Aachen Aphasia Beside Test in brain tumor patients].

    PubMed

    Wacker, A; Holder, M; Will, B E; Winkler, P A; Ilmberger, J

    2002-08-01

    In the clinical routine examination of patients with brain tumors, aphasic symptoms are often not recognized. In order to document the incidence of such symptoms, three diagnostic methods of testing for aphasia were compared: the Aachen aphasia test (AAT), which is the German standard aphasia test, clinical examination, and the Aachen aphasia bedside test (AABT), which was designed to test patients in the acute phases of illness. In the AAT, 50% of patients with left-sided tumors and 36% of those with right-sided tumors showed aphasic disturbances. The AAT results were defined as the gold standard. Clinical examination showed only low sensitivity; less than half of the aphasic patients were diagnosed as such. The AABT also detected only about half of the patients with aphasic disturbances. The low sensitivity is caused mainly by the results of the patients with right-hemisphere tumors, in which the mental set of the examiner during clinical examination (aphasic symptoms are not expected in patients with right-hemisphere lesions) and the pattern of disturbances in the AABT (deficits may be less severe and different in nature) may prevent detection of aphasic symptoms. Both clinical examination and AABT are thus not suitable for aphasia diagnostics in brain tumor patients. As the AAT is very time-consuming in everyday clinical routine, however, the development of an aphasia screening test seems desirable.

  16. Singing can improve speech function in aphasics associated with intact right basal ganglia and preserve right temporal glucose metabolism: Implications for singing therapy indication.

    PubMed

    Akanuma, Kyoko; Meguro, Kenichi; Satoh, Masayuki; Tashiro, Manabu; Itoh, Masatoshi

    2016-01-01

    Clinically, we know that some aphasic patients can sing well despite their speech disturbances. Herein, we report 10 patients with non-fluent aphasia, of which half of the patients improved their speech function after singing training. We studied ten patients with non-fluent aphasia complaining of difficulty finding words. All had lesions in the left basal ganglia or temporal lobe. They selected the melodies they knew well, but which they could not sing. We made a new lyric with a familiar melody using words they could not name. The singing training using these new lyrics was performed for 30 minutes once a week for 10 weeks. Before and after the training, their speech functions were assessed by language tests. At baseline, 6 of them received positron emission tomography to evaluate glucose metabolism. Five patients exhibited improvements after intervention; all but one exhibited intact right basal ganglia and left temporal lobes, but all exhibited left basal ganglia lesions. Among them, three subjects exhibited preserved glucose metabolism in the right temporal lobe. We considered that patients who exhibit intact right basal ganglia and left temporal lobes, together with preserved right hemispheric glucose metabolism, might be an indication of the effectiveness of singing therapy.

  17. Clause Structure and Verb Movement in a Greek-English Speaking Bilingual Patient with Broca's Aphasia: Evidence from Adverb Placement

    ERIC Educational Resources Information Center

    Alexiadou, Artemis; Stavrakaki, Stavroula

    2006-01-01

    In this paper, we investigate the performance of a Greek-English bilingual patient with Broca's aphasia and mild agrammatism on the placement of CP, MoodP, AspectP, and NegP-related adverbs, labeled specifier-type adverbs, and VP-related adverbs, labeled complement-type adverbs, by means of a constituent ordering task and a grammaticality judgment…

  18. Stendhal's aphasic spells: the first report of transient ischemic attacks followed by stroke.

    PubMed

    Bogousslavsky, Julien; Assal, Gil

    2010-01-01

    In March 1841, the year before he died of acute stroke, Stendhal, one of the most famous French novelists of the 19th century, developed a series of short-lived speech impairments which he precisely reported in his correspondence. His reports suggest that these spells were aphasic transient ischemic attacks (TIAs). The accuracy and precision of Stendhal's description exactly 20 years before Broca's presentation at the Société d'Anthropologie is remarkable since it occurred at a time when TIAs had not been studied in the medical literature and aphasia was still in its 'prehistory'. Stendhal's TIAs a few months before his fatal stroke constitute the first historical report of the warning nature of TIAs, which would be emphasized only over 100 years later.

  19. Jargonagraphia in Kanji and Kana in a Japanese crossed Wernicke's aphasic.

    PubMed

    Ihori, N; Kashiwagi, T; Kashiwagi, A; Tanabe, H

    1994-08-01

    A right-handed Japanese crossed Wernicke's aphasic showed complete neologistic jargonagraphia in kanji and kana with anosognosia of his writing deficits. Prominent jargonagraphia in kanji is quite rare and has not been previously described in the literature. Marked dissociation between speaking and writing during the course suggested that his jargonagraphia might be unique to crossed aphasia. His condition was interpreted for the main part by Yokoyama, Okubo, Doseki, and Yamadori's hypothesis (1981) that free-running on of motor engrams of characters stored in the left hemisphere caused jargonagraphia in crossed aphasia. This case of jargonagraphia in kanji suggests that this hypothesis should be supplemented by the following points: (1) in kanji, not necessarily a character as a whole, but radicals or parts of radicals, function as motor units, which may be released to produce jargonagraphia in kanji; (2) free-running on of visual images as well as of kinesthetic images should be considered especially in written jargon in kanji.

  20. Acquisition of adjectives and adverbs in sentences written by hearing impaired and aphasic children.

    PubMed

    Heward, W L; Eachus, H T

    1979-01-01

    The effect of an instructional package, which included modeling, reinforcement, and remedial feedback on the rate, accuracy, and topography of sentences composed by four hearing impaired and aphasic children, was examined. In a specially designed classroom, students wrote sentences describing a stimulus picture on acetate sheets placed on the stage of an overhead projector which was built into each student's desk. This arrangement provided the teacher and other students immediate and continuous visual access to each student's sentences. In a multiple baseline design across behaviors, model sentences were projected and token reinforcment and remedial feedback were made contingent upon writing correct sentences containing prenominal adjectives only, then adverbs only, then prenomial adjectives plus adverbs. During baseline all student displayed poor written language skills and seldom wrote sentences containing modifiers. When the instructional package was implemented, all students demonstrated significant increases in response rate, accuracy, and percentage of correct sentences including prenominal adjectives and adverbs.

  1. Aphasic and non-brain-damaged adults' descriptions of aphasia test pictures and gender-biased pictures.

    PubMed

    Correia, L; Brookshire, R H; Nicholas, L E

    1990-11-01

    Twelve aphasic and 12 non-brain-damaged adult males described the speech elicitation pictures from the Boston Diagnostic Aphasia Examination (BDAE), the Minnesota Test for Differential Diagnosis of Aphasia (MTDDA), the Western Aphasia Battery (WAB), and six pictures representing male-biased or female-biased daily-life situations. For each speech sample we calculated number of words, words per minute, number of correct information units, percentage of words that were correct information units, and percentage of correct information units that were nouns or adjectives (amount of enumeration or naming). The WAB picture elicited more enumeration than the BDAE or MTDDA pictures, and information was produced at a slower rate in response to the WAB picture than the other two pictures. These differences were statistically significant and appear to be clinically important. Gender bias had statistically significant effects on two measures. Male-biased pictures elicited significantly more words and significantly more correct information units than female-biased pictures. However, these differences were small and do not appear to be clinically important. Two of the five measures (words per minute and percentage of words that were correct information units) differentiated non-brain-damaged speakers from aphasic speakers. The magnitude of these differences suggests that these measures provide clinically important information about the problems aphasic adults may have when they produce narrative discourse.

  2. Aphasic speech with and without SentenceShaper: Two methods for assessing informativeness.

    PubMed

    Fink, Ruth B; Bartlett, Megan R; Lowery, Jennifer S; Linebarger, Marcia C; Schwartz, Myrna F

    2008-01-01

    BACKGROUND: SentenceShaper((R)) (SSR) is a computer program that is for speech what a word-processing program is for written text; it allows the user to record words and phrases, play them back, and manipulate them on-screen to build sentences and narratives. A recent study demonstrated that when listeners rated the informativeness of functional narratives produced by chronic aphasic speakers with and without the program they gave higher informativeness ratings to the language produced with the aid of the program (Bartlett, Fink, Schwartz, & Linebarger, 2007). Bartlett et al. (2007) also compared unaided (spontaneous) narratives produced before and after the aided version of the narrative was obtained. In a subset of comparisons, the sample created after was judged to be more informative; they called this "topic-specific carryover". AIMS: (1) To determine whether differences in informativeness that Bartlett et al.'s listeners perceived are also revealed by Correct Information Unit (CIU) analysis (Nicholas & Brookshire, 1993)-a well studied, objective method for measuring informativeness-and (2) to demonstrate the usefulness of CIU analysis for samples of this type. METHODS #ENTITYSTARTX00026; PROCEDURES: A modified version of the CIU analysis was applied to the speech samples obtained by Bartlett et al. (2007). They had asked five individuals with chronic aphasia to create functional narratives on two topics, under three conditions: Unaided ("U"), Aided ("SSR"), & Post-SSR Unaided ("Post-U"). Here, these samples were analysed for differences in % CIUs across conditions. Linear associations between listener judgements and CIU measures were evaluated with bivariate correlations and multiple regression analysis. OUTCOMES #ENTITYSTARTX00026; RESULTS: (1) The aided effect was confirmed: samples produced with SentenceShaper had higher % CIUs, in most cases exceeding 90%. (2) There was little CONCLUSIONS: That the percentage of CIUs was higher in SSR-aided samples than in

  3. An Exploratory Investigation of E-Rest: Teletherapy for Chronically Aphasic Speakers.

    PubMed

    Ruiter, Marina B; Rietveld, Toni C M; Hoskam, Vera; VAN Beers, Marijn M A

    2016-01-01

    Delivering aphasia therapy via telecommunication may provide a means to deliver intensive therapy in a cost-effective way. Teletherapy, remotely-administered (language) treatment, may support the repetitive drill practices that people with chronic aphasia need to perform when learning to compensate for their lasting language difficulties. The use of teletherapy may allow speech and language pathologists (SLPs) to focus in-person sessions more strongly on the generalisation of therapy effects to daily life. This single subject study is an investigation whether a teletherapy application called e-REST meets the criteria of accessibility, user-friendliness, as well as effectiveness. e-REST, the teletherapy version of the Dutch and adapted Reduced Syntax Therapy, teaches chronically aphasic speakers of Dutch who experience difficulties in sentence production to convey their messages in a kind of telegraphic style. The results obtained suggest that it is reasonable to conduct a larger study into the user-friendliness, accessibility, effectiveness, and cost-effectiveness of e-REST.

  4. An Exploratory Investigation of E-Rest: Teletherapy for Chronically Aphasic Speakers

    PubMed Central

    RUITER, MARINA B.; RIETVELD, TONI C.M.; HOSKAM, VERA; VAN BEERS, MARIJN M.A.

    2016-01-01

    Delivering aphasia therapy via telecommunication may provide a means to deliver intensive therapy in a cost-effective way. Teletherapy, remotely-administered (language) treatment, may support the repetitive drill practices that people with chronic aphasia need to perform when learning to compensate for their lasting language difficulties. The use of teletherapy may allow speech and language pathologists (SLPs) to focus in-person sessions more strongly on the generalisation of therapy effects to daily life. This single subject study is an investigation whether a teletherapy application called e-REST meets the criteria of accessibility, user-friendliness, as well as effectiveness. e-REST, the teletherapy version of the Dutch and adapted Reduced Syntax Therapy, teaches chronically aphasic speakers of Dutch who experience difficulties in sentence production to convey their messages in a kind of telegraphic style. The results obtained suggest that it is reasonable to conduct a larger study into the user-friendliness, accessibility, effectiveness, and cost-effectiveness of e-REST. PMID:27563388

  5. The classifier problem in Chinese aphasia.

    PubMed

    Tzeng, O J; Chen, S; Hung, D L

    1991-08-01

    In recent years, research on the relationship between brain organization and language processing has benefited tremendously from cross-linguistic comparisons of language disorders among different types of aphasic patients. Results from these cross-linguistic studies have shown that the same aphasic syndromes often look very different from one language to another, suggesting that language-specific knowledge is largely preserved in Broca's and Wernicke's aphasics. In this paper, Chinese aphasic patients were examined with respect to their (in)ability to use classifiers in a noun phrase. The Chinese language, in addition to its lack of verb conjugation and an absence of noun declension, is exceptional in yet another respect: articles, numerals, and other such modifiers cannot directly precede their associated nouns, there has to be an intervening morpheme called a classifier. The appropriate usage of nominal classifiers is considered to be one of the most difficult aspects of Chinese grammar. Our examination of Chinese aphasic patients revealed two essential points. First, Chinese aphasic patients experience difficulty in the production of nominal classifiers, committing a significant number of errors of omission and/or substitution. Second, two different kinds of substitution errors are observed in Broca's and Wernicke's patients, and the detailed analysis of the difference demands a rethinking of the distinction between agrammatism and paragrammatism. The result adds to a growing body of evidence suggesting that grammar is impaired in fluent as well as nonfluent aphasia.

  6. Temporal Information Processing as a Basis for Auditory Comprehension: Clinical Evidence from Aphasic Patients

    ERIC Educational Resources Information Center

    Oron, Anna; Szymaszek, Aneta; Szelag, Elzbieta

    2015-01-01

    Background: Temporal information processing (TIP) underlies many aspects of cognitive functions like language, motor control, learning, memory, attention, etc. Millisecond timing may be assessed by sequencing abilities, e.g. the perception of event order. It may be measured with auditory temporal-order-threshold (TOT), i.e. a minimum time gap…

  7. FMRI findings in an aphasic patient with reversed cerebral dominance for language.

    PubMed

    Vandervliet, Everhard J M; Verhoeven, Jo; Engelborghs, Sebastiaan; De Deyn, Peter Paul; Parizel, Paul M; Mariën, Peter

    2008-12-01

    An 80-year-old right-handed woman with no history of brain damage or familial strain of left-handedness acutely developed aphasia associated with a left hemiparesis following a right hemisphere stroke. Brain MRI showed a posterior insular ischemic infarction extending to the temporo-parietal region of the right hemisphere. Severe overall language disruption (global aphasia) in the acute phase of the stroke rapidly evolved into conduction aphasia, characterized by a neurolinguistic profile of disproportionately severe repetition deficits and markedly distorted phonological skills. In the lesion phase of the stroke, a functional MRI study using a word repetition task was conducted which revealed a consistent pattern of right hemisphere activations. For the first time, right hemisphere language dominance is demonstrated by fMRI in a clear instance of crossed aphasia in a dextral.

  8. Relation between heart beat fluctuations and cyclic alternating pattern during sleep in insomnia patients.

    PubMed

    de Leon-Lomeli, R; Murguia, J S; Chouvarda, I; Mendez, M O; Gonzalez-Galvan, E; Alba, A; Milioli, G; Grassi, A; Terzano, M G; Parrino, L

    2014-01-01

    Insomnia is a condition that affects the nervous and muscular system. Thirty percent of the population between 18 and 60 years suffers from insomnia. The effects of this disorder involve problems such as poor school or job performance and traffic accidents. In addition, patients with insomnia present changes in the cardiac function during sleep. Furthermore, the structure of electroencephalographic A-phases, which builds up the Cyclic Alternating Pattern during sleep, is related to the insomnia events. Therefore, the relationship between these brain activations (A-phases) and the autonomic nervous system would be of interest, revealing the interplay of central and autonomic activity during insomnia. With this goal, a study of the relationship between A-phases and heart rate fluctuations is presented. Polysomnography recording of five healthy subjects, five sleep misperception patients and five patients with psychophysiological insomnia were used in the study. Detrended Fluctuation Analysis (DFA) was used in order to evaluate the heart rate dynamics and this was correlated with the number of A-phases. The results suggest that pathological patients present changes in the dynamics of the heart rate. This is reflected in the modification of A-phases dynamics, which seems to modify of heart rate dynamics.

  9. Semantic Paralexias: A Group-Case Study on the Underlying Functional Mechanisms, Incidence and Clinical Features in a Consecutive Series of 340 Italian Aphasics

    ERIC Educational Resources Information Center

    Ciaghi, Maddalena; Pancheri, Elisa; Miceli, Gabriele

    2010-01-01

    We studied the reading performance of 340 consecutive, Italian-speaking aphasics in order to evaluate the clinical features of deep dyslexia, the functional impairments underlying semantic paralexias, and their neuranatomical correlates. Semantic paralexias were observed in 9/340 subjects (2.4%). Our data and a review of the literature show that…

  10. Characterization of the invasiveness of monophasic and aphasic Salmonella Typhimurium strains in 1-day-old and point-of-lay chickens.

    PubMed

    Martelli, Francesca; Gosling, Rebecca; Kennedy, Emma; Rabie, André; Reeves, Hannah; Clifton-Hadley, Felicity; Davies, Rob; La Ragione, Roberto

    2014-01-01

    Egg-related outbreaks of salmonellosis are a significant health concern. Although Salmonella Enteritidis (SE) is the major egg-associated serotype, Salmonella Typhimurium (ST) can also infect the hen's reproductive tract and contaminate eggs. Recently, monophasic and aphasic variants of ST have been reported with increased frequency in Europe, and the isolation of these variants from laying flocks triggers the same legislative restrictions associated with biphasic ST strains. However, little is known about the colonization, invasiveness and persistence of monophasic and aphasic ST strains in laying hens. In this study, seven groups of 1-day-old and point-of-lay commercial Hy-line chicken layers were separately challenged with four different strains of monophasic ST, one aphasic ST, one biphasic ST and one egg-invasive SE strain. Tissue samples and cloacal swabs (point-of-lay chickens only) were collected at regular intervals post challenge in order to recover the Salmonella challenge strains. In 1-day-old chicks, only the aphasic ST strain and the SE strain were recovered after direct plating, suggesting that the number of salmonellas colonizing the tissues of the chicks infected with the other strains was likely to be low. Interestingly, all of the strains colonized well in the point-of-lay chickens, and there was no statistical difference in the overall number of positive samples or Salmonella counts between the seven strains. Salmonella was recovered from the point-of-lay birds to the end of the study (20 days after challenge). Monophasic and aphasic ST strains colonized point-of-lay birds as efficiently as biphasic ST and SE strains. Further studies are necessary to estimate the invasiveness of these strains in naturally-infected vaccinated laying hens, and to assess the impact of natural infection on egg contamination.

  11. Word-Category Violations in Patients with Broca's Aphasia: An ERP Study

    ERIC Educational Resources Information Center

    Wassenaar, Marlies; Hagoort, Peter

    2005-01-01

    An event-related brain potential experiment was carried out to investigate on-line syntactic processing in patients with Broca's aphasia. Subjects were visually presented with sentences that were either syntactically correct or contained violations of word-category. Three groups of subjects were tested: Broca patients (N=11), non-aphasic patients…

  12. Heart rate variability in cyclic alternating pattern during sleep in healthy and Nocturnal Front Lobe Epilepsy patients.

    PubMed

    Dorantes, Guadalupe; Méndez, Martín; Alba, Alfonso; Gonzaáez, J S; Parrino, Liborio; Milioli, G

    2015-01-01

    The aim of this paper is to assess heart rate variability (HRV) during the cyclic alternating pattern, which is a sleep phenomenon, composed by cortical events that interrupt the basal oscillation of the NREM sleep stage. These cortical events are called A-phases and classified into three subtypes: A1, A2, A3. In addition, a comparison between healthy and Nocturnal Front Lobe Epilepsy (NFLE) patients was carried out. HRV was assessed by means of a time-varying autoregressive (TVAR) model with an adaptive filtering prediction scheme and by the time-varying square root of the mean of the sum of the squares of differences (RMSSD) of the RR intervals. For each A-phase, two signal segments were evaluated, the first one before the onset of the A-phase and the second one after the onset of the A-phase. An increase in the sympathetic outflow was suggested by higher values of low-frequency (LF) power in the three A-phases after the onset of A-phases, where A3-phases showed the largest changes. Increases in LF power were related with increases in heart rate in the same signal segments. These differences were found in both healthy and NFLE patients. LF/HF ratio and normalized LF power in A1-phases resulted significantly higher in NFLE patients in comparison with healthy subjects, which could suggest that there is a shift in the sympatho-vagal balance towards a more sympathetically mediated control of heart rate involving A1-phases in NFLE patients.

  13. Reading and Writing Skills in Multilingual/Multiliterate Aphasics: Two Case Studies

    ERIC Educational Resources Information Center

    Chengappa, Shyamala; Bhat, Sapna; Padakannaya, Prakash

    2004-01-01

    Reading and writing deficits in two multilingual speakers of Kannada, Hindi and English are described. Disorders of the two patients (Mr G and Ms S) had different etiologies. Mr G had severe alexia with agraphia in English as well as in Kannada and Hindi. Ms S exhibited dissociation across the languages, showing symptoms of surface dyslexia in…

  14. The right hemisphere supports but does not replace left hemisphere auditory function in patients with persisting aphasia.

    PubMed

    Teki, Sundeep; Barnes, Gareth R; Penny, William D; Iverson, Paul; Woodhead, Zoe V J; Griffiths, Timothy D; Leff, Alexander P

    2013-06-01

    In this study, we used magnetoencephalography and a mismatch paradigm to investigate speech processing in stroke patients with auditory comprehension deficits and age-matched control subjects. We probed connectivity within and between the two temporal lobes in response to phonemic (different word) and acoustic (same word) oddballs using dynamic causal modelling. We found stronger modulation of self-connections as a function of phonemic differences for control subjects versus aphasics in left primary auditory cortex and bilateral superior temporal gyrus. The patients showed stronger modulation of connections from right primary auditory cortex to right superior temporal gyrus (feed-forward) and from left primary auditory cortex to right primary auditory cortex (interhemispheric). This differential connectivity can be explained on the basis of a predictive coding theory which suggests increased prediction error and decreased sensitivity to phonemic boundaries in the aphasics' speech network in both hemispheres. Within the aphasics, we also found behavioural correlates with connection strengths: a negative correlation between phonemic perception and an inter-hemispheric connection (left superior temporal gyrus to right superior temporal gyrus), and positive correlation between semantic performance and a feedback connection (right superior temporal gyrus to right primary auditory cortex). Our results suggest that aphasics with impaired speech comprehension have less veridical speech representations in both temporal lobes, and rely more on the right hemisphere auditory regions, particularly right superior temporal gyrus, for processing speech. Despite this presumed compensatory shift in network connectivity, the patients remain significantly impaired.

  15. How to improve repetition ability in patients with Wernicke's aphasia: the effect of a disguised task.

    PubMed

    Otsuki, M; Soma, Y; Yoshimura, N; Miyashita, K; Nagatsuka, K; Naritomi, H

    2005-05-01

    Dissociation "automatico-voluntaire" is a symptom observed in aphasic patients. We elucidated the difference between voluntary and involuntary speech output in a quantitative manner using the same task materials in nine patients with Wernicke's aphasia. All the patients exhibited better ability and less paraphasias in a repetition task elicited in a disguised condition than in an ordinary repetition condition. This result indicates that the output difficulty in Wernicke's aphasia might be a disability of volitional control over the language system.

  16. The writing of arabic numerals, kanji, and kana in brain-damaged patients.

    PubMed

    Tamura, Itaru; Kikuchi, Seiji; Otsuki, Mika; Tashiro, Kunio

    2003-05-06

    This study investigated the neural mechanisms involved in the writing of Arabic numerals, kanji, and kana. Tasks involving writing numerals in Arabic, kanji, and, kana were administered to four patients with Gerstmann's syndrome and to five Wernicke aphasics. The results indicated that the ability to write Arabic numerals was well preserved in the Wernicke aphasics despite their serious phonological disturbances. The patients with Gerstmann's syndrome, who have a deficit with the concept of number, could write kanji numerals better than Arabic and kana numerals. Unlike Arabic numerals (ideogram) and kana (syllabogram), kanji (morphogram) have both semantic and phonetic values. The results suggested that Arabic numerals may be somesthetic and linked directly to the concept of number bypassing phonological analysis.

  17. Effects of transcranial direct current stimulation on naming and cortical excitability in stroke patients with aphasia.

    PubMed

    Wu, Dongyu; Wang, Jie; Yuan, Ying

    2015-03-04

    This study aimed to investigate the effects of anodal transcranial direct current stimulation (A-tDCS) over the left posterior perisylvian region (PPR) on picture naming and cortical excitability measured with electroencephalography (EEG) nonlinear dynamics analysis (NDA) in aphasic patients. Twelve aphasic patients received 20 sessions of speech-language therapy during each of three phases: sham tDCS (Phase A1); A-tDCS to the left PPR (Phase B); and sham tDCS (Phase A2). Picture naming and auditory word-picture identification were measured before and after each phase. The EEG nonlinear index of approximate entropy (ApEn) was calculated for all subjects and 12 normal controls. Picture naming and auditory word-picture identification was significantly improved after phase B. The EEG ApEn analysis indicated that improved picture naming correlated with a higher activation level in wide areas of the left hemisphere and in isolated areas of the right hemisphere after phase B. These results revealed that A-tDCS over the left PPR coupled with speech-language therapy can improve picture naming and auditory comprehension in aphasic patients. tDCS not only modulates activity in the brain region directly underlying the stimulating electrode but also in a network of brain regions that are function-related.

  18. Improved Neural Processing Efficiency in a Chronic Aphasia Patient Following Melodic Intonation Therapy: A Neuropsychological and Functional MRI Study

    PubMed Central

    Tabei, Ken-ichi; Satoh, Masayuki; Nakano, Chizuru; Ito, Ai; Shimoji, Yasuo; Kida, Hirotaka; Sakuma, Hajime; Tomimoto, Hidekazu

    2016-01-01

    Melodic intonation therapy (MIT) is a treatment program for the rehabilitation of aphasic patients with speech production disorders. We report a case of severe chronic non-fluent aphasia unresponsive to several years of conventional therapy that showed a marked improvement following intensive 9-day training on the Japanese version of MIT (MIT-J). The purpose of this study was to verify the efficacy of MIT-J by functional assessment and examine associated changes in neural processing by functional magnetic resonance imaging. MIT improved language output and auditory comprehension, and decreased the response time for picture naming. Following MIT-J, an area of the right hemisphere was less activated on correct naming trials than compared with before training but similarly activated on incorrect trials. These results suggest that the aphasic symptoms of our patient were improved by increased neural processing efficiency and a concomitant decrease in cognitive load. PMID:27698650

  19. Cathodal transcranial direct current stimulation of the right Wernicke's area improves comprehension in subacute stroke patients.

    PubMed

    You, Dae Sang; Kim, Dae-Yul; Chun, Min Ho; Jung, Seung Eun; Park, Sung Jong

    2011-10-01

    Previous studies have shown the appearance of right-sided language-related brain activity in right-handed patients after a stroke. Non-invasive brain stimulation such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) have been shown to modulate excitability in the brain. Moreover, rTMS and tDCS have been found to improve naming in non-fluent post-stroke aphasic patients. Here, we investigated the effect of tDCS on the comprehension of aphasic patients with subacute stroke. We hypothesized that tDCS applied to the left superior temporal gyrus (Wernicke's area) or the right Wernicke's area might be associated with recovery of comprehension ability in aphasic patients with subacute stroke. Participants included right-handed subacute stroke patients with global aphasia due to ischemic infarct of the left M1 or M2 middle cerebral artery. Patients were randomly divided into three groups: patients who received anodal tDCS applied to the left superior temporal gyrus, patients who received cathodal tDCS applied to the right superior temporal gyrus, and patients who received sham tDCS. All patients received conventional speech and language therapy during each period of tDCS application. The Korean-Western Aphasia Battery (K-WAB) was used to assess all patients before and after tDCS sessions. After intervention, all patients had significant improvements in aphasia quotients, spontaneous speech, and auditory verbal comprehension. However, auditory verbal comprehension improved significantly more in patients treated with a cathode, as compared to patients in the other groups. These results are consistent with the role of Wernicke's area in language comprehension and the therapeutic effect that cathodal tDCS has on aphasia patients with subacute stroke, suggesting that tDCS may be an adjuvant treatment approach for aphasia rehabilitation therapy in patients in an early stage of stroke.

  20. A large, searchable, web-based database of aphasic performance on picture naming and other tests of cognitive function.

    PubMed

    Mirman, Daniel; Strauss, Ted J; Brecher, Adelyn; Walker, Grant M; Sobel, Paula; Dell, Gary S; Schwartz, Myrna F

    2010-09-01

    Many research questions in aphasia can only be answered through access to substantial numbers of patients and to their responses on individual test items. Since such data are often unavailable to individual researchers and institutions, we have developed and made available the Moss Aphasia Psycholinguistics Project Database: a large, searchable, web-based database of patient performance on psycholinguistic and neuropsychological tests. The database contains data from over 240 patients covering a wide range of aphasia subtypes and severity, some of whom were tested multiple times. The core of the archive consists of a detailed record of individual-trial performance on the Philadelphia (picture) Naming Test. The database also contains basic demographic information about the patients and patients' overall performance on neuropsychological assessments as well as tests of speech perception, semantics, short-term memory, and sentence comprehension. The database is available at http://www.mappd.org/ .

  1. The right hemisphere supports but does not replace left hemisphere auditory function in patients with persisting aphasia

    PubMed Central

    Barnes, Gareth R.; Penny, William D.; Iverson, Paul; Woodhead, Zoe V. J.; Griffiths, Timothy D.; Leff, Alexander P.

    2013-01-01

    In this study, we used magnetoencephalography and a mismatch paradigm to investigate speech processing in stroke patients with auditory comprehension deficits and age-matched control subjects. We probed connectivity within and between the two temporal lobes in response to phonemic (different word) and acoustic (same word) oddballs using dynamic causal modelling. We found stronger modulation of self-connections as a function of phonemic differences for control subjects versus aphasics in left primary auditory cortex and bilateral superior temporal gyrus. The patients showed stronger modulation of connections from right primary auditory cortex to right superior temporal gyrus (feed-forward) and from left primary auditory cortex to right primary auditory cortex (interhemispheric). This differential connectivity can be explained on the basis of a predictive coding theory which suggests increased prediction error and decreased sensitivity to phonemic boundaries in the aphasics’ speech network in both hemispheres. Within the aphasics, we also found behavioural correlates with connection strengths: a negative correlation between phonemic perception and an inter-hemispheric connection (left superior temporal gyrus to right superior temporal gyrus), and positive correlation between semantic performance and a feedback connection (right superior temporal gyrus to right primary auditory cortex). Our results suggest that aphasics with impaired speech comprehension have less veridical speech representations in both temporal lobes, and rely more on the right hemisphere auditory regions, particularly right superior temporal gyrus, for processing speech. Despite this presumed compensatory shift in network connectivity, the patients remain significantly impaired. PMID:23715097

  2. Comprehension of emotional information in patients with aphasia.

    PubMed

    Hielscher, Martina

    2004-01-01

    Comprehension of emotional information has traditionally been attributed to right hemispheric processing. Especially nonverbal emotional communication seems to be much better than verbal competence in aphasics. Yet evidence stressing the importance of the left hemisphere for an adequate interpretation of emotional information has been reported. This article reports data on two experiments primarily aimed at emotional inferences in text comprehension. Patients with cortical lesions in their left vs. right hemisphere showed similar deficits in perceiving both verbal and nonverbal emotion tasks. The question arises, which underlying deficits may result in these similar comprehension patterns. Best predictors in regression analyses differed for patients with left hemisphere and right hemisphere lesions.

  3. Effects of Syntactic Features on Sentence-Picture Matching in Broca's Aphasics: A Reply to Drai and Grodzinksy (2005)

    ERIC Educational Resources Information Center

    Caplan, David; DeDe, Gayle; Brownell, Hiram

    2006-01-01

    We reanalyzed the data in Drai and Grodzinksy (2005), considering individual patients' responses to different sentence types to be non-independent events. The analyses revealed effects of two of the three factors identified by Drai and Grodzinsky-constituent movement and passive mood. The result is inconsistent with the trace deletion hypothesis;…

  4. Interpretation of Pronouns in VP-Ellipsis Constructions in Dutch Broca's and Wernicke's Aphasia

    ERIC Educational Resources Information Center

    Vasic, Nada; Avrutin, Sergey; Ruigendijk, Esther

    2006-01-01

    In this paper, we investigate the ability of Dutch agrammatic Broca's and Wernicke's aphasics to assign reference to possessive pronouns in elided VP constructions. The assumption is that the comprehension problems in these two populations have different sources that are revealed in distinct patterns of responses. The focus is primarily on the…

  5. Reference Assignment: Using Language Breakdown to Choose between Theoretical Approaches

    ERIC Educational Resources Information Center

    Ruigendijk, Esther; Vasic, Nada; Avrutin, Sergey

    2006-01-01

    We report results of an experimental study with Dutch agrammatic aphasics that investigated their ability to interpret pronominal elements in transitive clauses and Exceptional Case Marking constructions (ECM). Using the obtained experimental results as a tool, we distinguish between three competing linguistic theories that aim at determining…

  6. Influence of contextual complexity on the processing of cartoons by patients with unilateral lesions.

    PubMed

    Dagge, M; Hartje, W

    1985-12-01

    It was examined whether the performance of right hemisphere patients in the comprehension of cartoons is predominantly influenced by disturbed processing of affective material or by cognitive deficits. Cartoons differing in their cognitive demand were presented to groups of right hemisphere patients, aphasics and normal controls. Subjects were required to identify the cartoon in a multiple choice set of four pictures. Additionally, subjects were asked to rate the funniness on a three-point scale. The results indicate that the impairment of right hemisphere patients is caused by a combination of visuo-perceptive and cognitive deficits rather than by an inability to identify the affective component of cartoons.

  7. Therapy-Induced Neuroplasticity of Language in Chronic Post Stroke Aphasia: A Mismatch Negativity Study of (A)Grammatical and Meaningful/less Mini-Constructions

    PubMed Central

    Lucchese, Guglielmo; Pulvermüller, Friedemann; Stahl, Benjamin; Dreyer, Felix R.; Mohr, Bettina

    2017-01-01

    Clinical language performance and neurophysiological correlates of language processing were measured before and after intensive language therapy in patients with chronic (time post stroke >1 year) post stroke aphasia (PSA). As event-related potential (ERP) measure, the mismatch negativity (MMN) was recorded in a distracted oddball paradigm to short spoken sentences. Critical ‘deviant’ sentence stimuli where either well-formed and meaningful, or syntactically, or lexico-semantically incorrect. After 4 weeks of speech-language therapy (SLT) delivered with high intensity (10.5 h per week), clinical language assessment with the Aachen Aphasia Test battery demonstrated significant linguistic improvements, which were accompanied by enhanced MMN responses. More specifically, MMN amplitudes to grammatically correct and meaningful mini-constructions and to ‘jabberwocky’ sentences containing a pseudoword significantly increased after therapy. However, no therapy-related changes in MMN responses to syntactically incorrect strings including agreement violations were observed. While MMN increases to well-formed meaningful strings can be explained both at the word and construction levels, the neuroplastic change seen for ‘jabberwocky’ sentences suggests an explanation in terms of constructions. The results confirm previous reports that intensive SLT leads to improvements of linguistic skills in chronic aphasia patients and now demonstrate that this clinical improvement is associated with enhanced automatic brain indexes of construction processing, although no comparable change is present for ungrammatical strings. Furthermore, the data confirm that the language-induced MMN is a useful tool to map functional language recovery in PSA. PMID:28111545

  8. Differentiating core and co-opted mechanisms in calculation: the neuroimaging of calculation in aphasia.

    PubMed

    Benn, Yael; Wilkinson, Iain D; Zheng, Ying; Cohen Kadosh, Kathrin; Romanowski, Charles A J; Siegal, Michael; Varley, Rosemary

    2013-08-01

    The role of language in exact calculation is the subject of debate. Some behavioral and functional neuroimaging investigations of healthy participants suggest that calculation requires language resources. However, there are also reports of individuals with severe aphasic language impairment who retain calculation ability. One possibility in resolving these discordant findings is that the neural basis of calculation has undergone significant reorganization in aphasic calculators. Using fMRI, we examined brain activations associated with exact addition and subtraction in two patients with severe agrammatic aphasia and retained calculation ability. Behavior and brain activations during two-digit addition and subtraction were compared to those of a group of 11 healthy, age-matched controls. Behavioral results confirmed that both patients retained calculation ability. Imaging findings revealed individual differences in processing, but also a similar activation pattern across patients and controls in bilateral parietal cortices. Patients differed from controls in small areas of increased activation in peri-lesional regions, a shift from left fronto-temporal activation to the contralateral region, and increased activations in bilateral superior parietal regions. Our results suggest that bilateral parietal cortex represents the core of the calculation network and, while healthy controls may recruit language resources to support calculation, these mechanisms are not mandatory in adult cognition.

  9. Primary progressive aphasia and the evolving neurology of the language network

    PubMed Central

    Mesulam, M.-Marsel; Rogalski, Emily J.; Wieneke, Christina; Hurley, Robert S.; Geula, Changiz; Bigio, Eileen H.; Thompson, Cynthia K.; Weintraub, Sandra

    2014-01-01

    Primary progressive aphasia (PPA) is caused by selective neurodegeneration of the language-dominant cerebral hemisphere; a language deficit initially arises as the only consequential impairment and remains predominant throughout most of the course of the disease. Agrammatic, logopenic and semantic subtypes, each reflecting a characteristic pattern of language impairment and corresponding anatomical distribution of cortical atrophy, represent the most frequent presentations of PPA. Such associations between clinical features and the sites of atrophy have provided new insights into the neurology of fluency, grammar, word retrieval, and word comprehension, and have necessitated modification of concepts related to the functions of the anterior temporal lobe and Wernicke’s area. The underlying neuropathology of PPA is, most commonly, frontotemporal lobar degeneration in the agrammatic and semantic forms, and Alzheimer disease (AD) pathology in the logopenic form; the AD pathology often displays atypical and asymmetrical anatomical features consistent with the aphasic phenotype. The PPA syndrome reflects complex interactions between disease-specific neuropathological features and patient-specific vulnerability. A better understanding of these interactions might help us to elucidate the biology of the language network and the principles of selective vulnerability in neurodegenerative diseases. We review these aspects of PPA, focusing on advances in our understanding of the clinical features and neuropathology of PPA and what they have taught us about the neural substrates of the language network. PMID:25179257

  10. Cognitive grammar and aphasic discourse.

    PubMed

    Manning, Molly; Franklin, Sue

    2016-01-01

    In cognitive grammar (CG), there is no clear division between language and other cognitive processes; all linguistic form is conceptually meaningful. In this pilot study, a CG approach was applied to investigate whether people with aphasia (PWA) have cognitive linguistic difficulty not predicted from traditional, componential models of aphasia. Narrative samples from 22 PWA (6 fluent, 16 non-fluent) were compared with samples from 10 participants without aphasia. Between-group differences were tested statistically. PWA had significant difficulty with temporal sequencing, suggesting problems that are not uniquely linguistic. For some, these problems were doubly dissociated with naming, used as a general measure of severity, which indicates that cognitive linguistic difficulties are not linked with more widespread brain damage. Further investigation may lead to a richer account of aphasia in line with contemporary linguistics and cognitive science approaches.

  11. Screening tests for aphasia in patients with stroke: a systematic review.

    PubMed

    El Hachioui, Hanane; Visch-Brink, Evy G; de Lau, Lonneke M L; van de Sandt-Koenderman, Mieke W M E; Nouwens, Femke; Koudstaal, Peter J; Dippel, Diederik W J

    2017-02-01

    Aphasia has a large impact on the quality of life and adds significantly to the costs of stroke care. Early recognition of aphasia in stroke patients is important for prognostication and well-timed treatment planning. We aimed to identify available screening tests for differentiating between aphasic and non-aphasic stroke patients, and to evaluate test accuracy, reliability, and feasibility. We searched PubMed, EMbase, Web of Science, and PsycINFO for published studies on screening tests aimed at assessing aphasia in stroke patients. The reference lists of the selected articles were scanned, and several experts were contacted to detect additional references. Of each screening test, we estimated the sensitivity, specificity, likelihood ratio of a positive test, likelihood ratio of a negative test, and diagnostic odds ratio (DOR), and rated the degree of bias of the validation method. We included ten studies evaluating eight screening tests. There was a large variation across studies regarding sample size, patient characteristics, and reference tests used for validation. Many papers failed to report on the consecutiveness of patient inclusion, time between aphasia onset and administration of the screening test, and blinding. Of the three studies that were rated as having an intermediate or low risk of bias, the DOR was highest for the Language Screening Test and ScreeLing. Several screening tools for aphasia in stroke are available, but many tests have not been verified properly. Methodologically sound validation studies of aphasia screening tests are needed to determine their usefulness in clinical practice.

  12. Asymmetry and heterogeneity of Alzheimer’s and frontotemporal pathology in primary progressive aphasia

    PubMed Central

    Weintraub, Sandra; Rogalski, Emily J.; Wieneke, Christina; Geula, Changiz; Bigio, Eileen H.

    2014-01-01

    Fifty-eight autopsies of patients with primary progressive aphasia are reported. Twenty-three of these were previously described (Mesulam et al., 2008) but had their neuropathological diagnoses updated to fit current criteria. Thirty-five of the cases are new. Their clinical classification was guided as closely as possible by the 2011 consensus guidelines (Gorno-Tempini et al., 2011). Tissue diagnoses included Alzheimer’s disease in 45% and frontotemporal lobar degeneration (FTLD) in the others, with an approximately equal split between TAR DNA binding protein 43 proteinopathies and tauopathies. The most common and distinctive feature for all pathologies associated with primary progressive aphasia was the asymmetric prominence of atrophy, neuronal loss, and disease-specific proteinopathy in the language-dominant (mostly left) hemisphere. The Alzheimer’s disease pathology in primary progressive aphasia displayed multiple atypical features. Males tended to predominate, the neurofibrillary pathology was more intense in the language-dominant hemisphere, the Braak pattern of hippocampo-entorhinal prominence was tilted in favour of the neocortex, and the APOE e4 allele was not a risk factor. Mean onset age was under 65 in the FTLD as well as Alzheimer’s disease groups. The FTLD-TAR DNA binding protein 43 group had the youngest onset and fastest progression whereas the Alzheimer’s disease and FTLD-tau groups did not differ from each other in either onset age or progression rate. Each cellular pathology type had a preferred but not invariant clinical presentation. The most common aphasic manifestation was of the logopenic type for Alzheimer pathology and of the agrammatic type for FTLD-tau. The progressive supranuclear palsy subtype of FTLD-tau consistently caused prominent speech abnormality together with agrammatism whereas FTLD-TAR DNA binding protein 43 of type C consistently led to semantic primary progressive aphasia. The presence of agrammatism made

  13. Real-time comprehension of wh- movement in aphasia: Evidence from eyetracking while listening

    PubMed Central

    Dickey, Michael Walsh; Choy, JungWon Janet; Thompson, Cynthia K.

    2007-01-01

    Sentences with non-canonical wh- movement are often difficult for individuals with agrammatic Broca's aphasia to understand (Caramazza & Zurif, 1976, inter alia). However, the explanation of this difficulty remains controversial, and little is known about how individuals with aphasia try to understand such sentences in real time. This study uses an eyetracking while listening paradigm (Tanenhaus, et al., 1995) to examine agrammatic aphasic individuals' on-line comprehension of movement sentences. Participants' eye-movements were monitored while they listened to brief stories. These stories were followed by comprehension probes involving wh- movement, and looked at visual displays depicting elements mentioned in the story. In line with previous results for young normal listeners (Sussman & Sedivy, 2003), the study finds that both older unimpaired control participants (n=8) and aphasic individuals (n=12) showed visual evidence of successful automatic comprehension of wh- questions (like “Who did the boy kiss that day at school?”). Specifically, both groups fixated on a picture corresponding to the moved element (“who,” the person kissed in the story) at the position of the verb. Interestingly, aphasic participants showed qualitatively different fixation patterns for trials eliciting correct and incorrect responses. Aphasic individuals looked to first the moved-element picture and then to a competitor following the verb in the incorrect trials, indicating initially correct automatic processing. However, they only showed looks to the moved-element picture for the correct trials, parallel to control participants. Furthermore, aphasic individuals' fixations during movement sentences were just as fast as control participants' fixations. These results are unexpected under slowed-processing accounts of aphasic comprehension deficits, in which the source of failed comprehension should be delayed application of the same processing routines used in successful

  14. Aphasic Communities of Learning on the Web

    ERIC Educational Resources Information Center

    Spaniol, Marc; Klamma, Ralf; Springer, Luise; Jarke, Matthias

    2006-01-01

    This article presents the case study of a cooperative Web-learning environment--SOCRATES--to foster barrier-free learning on the Web. While the growth of the Internet was exponential in the last years, still many communities don't benefit from Web-learning technology due to improper tools and constricted communication processes. These problems…

  15. Caloric vestibular stimulation in aphasic syndrome

    PubMed Central

    Wilkinson, David; Morris, Rachael; Milberg, William; Sakel, Mohamed

    2013-01-01

    Caloric vestibular stimulation (CVS) is commonly used to diagnose brainstem disorder but its therapeutic application is much less established. Based on the finding that CVS increases blood flow to brain structures associated with language and communication, we assessed whether the procedure has potential to relieve symptoms of post-stroke aphasia. Three participants, each presenting with chronic, unilateral lesions to the left hemisphere, were administered daily CVS for four consecutive weeks. Relative to their pre-treatment baseline scores, two of the three participants showed significant improvement on both picture and responsive naming at immediate and 1-week follow-up. One of these participants also showed improved sentence repetition, and another showed improved auditory word discrimination. No adverse reactions were reported. These data provide the first, albeit tentative, evidence that CVS may relieve expressive and receptive symptoms of aphasia. A larger, sham-controlled study is now needed to further assess efficacy. PMID:24391559

  16. Communication in conversation in stroke patients.

    PubMed

    Rousseaux, Marc; Daveluy, Walter; Kozlowski, Odile

    2010-07-01

    In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication difficulties at the rehabilitation phase (1-6 months) post-stroke, in order to define the main mechanisms of verbal and non-verbal communication (VC, NVC) disorders and their relationship with aphasic disorders. Sixty-three patients were recruited, who belonged to six groups, with left or right cortico-sub-cortical (L-CSC, R-CSC) or sub-cortical (L-SC, R-SC), frontal (Fro) or posterior fossa (PF) lesions. They were compared with an equivalent control group (gender, age, education level). We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). We also used the Functional Communication Profile and the Boston Diagnostic Aphasia Examination (BDAE). Decrease in participation was found in L-CSC, R-CSC and Fro patients. Verbal communication was essentially disrupted in L-SCS and L-SC groups, including by verbal pragmatic disorders, and to a lesser degree in frontal patients. Nonverbal communication was mainly affected in R-CSC patients, especially by pragmatic difficulties. L-CSC patients showed an increase in gesture production, compensating for aphasia. In conclusion, communication disorders were relatively complex and could not be summarised by syntactical and lexical difficulties in left stroke and pragmatic problems in right stroke. The former also showed severe

  17. The On-Line Processing of Unaccusativity in Greek Agrammatism

    ERIC Educational Resources Information Center

    Peristeri, Eleni; Tsimpli, Ianthi-Maria; Tsapkini, Kyrana

    2013-01-01

    We investigated the on-line processing of unaccusative and unergative sentences in a group of eight Greek-speaking individuals diagnosed with Broca aphasia and a group of language-unimpaired subjects used as the baseline. The processing of unaccusativity refers to the reactivation of the postverbal trace by retrieving the mnemonic representation…

  18. Implicit and Explicit Learning in Individuals with Agrammatic Aphasia

    ERIC Educational Resources Information Center

    Schuchard, Julia; Thompson, Cynthia K.

    2014-01-01

    Implicit learning is a process of acquiring knowledge that occurs without conscious awareness of learning, whereas explicit learning involves the use of overt strategies. To date, research related to implicit learning following stroke has been largely restricted to the motor domain and has rarely addressed implications for language. The present…

  19. A Comparison of the BAT and BDAE-SF Batteries in Determining the Linguistic Ability in Greek-Speaking Patients with Broca's Aphasia

    ERIC Educational Resources Information Center

    Peristeri, Eleni; Tsapkini, Kyrana

    2011-01-01

    The aim of this study is to test the validity and reliability of the Bilingual Aphasia Test as a measure of language impairment in a Greek-speaking Broca's aphasic population and to investigate relationships with the same aphasic group's performance on the Greek version of the short form of the Boston Diagnostic Aphasia Examination battery, mainly…

  20. Diagnostic work up for language testing in patients undergoing awake craniotomy for brain lesions in language areas.

    PubMed

    Bilotta, Federico; Stazi, Elisabetta; Titi, Luca; Lalli, Diana; Delfini, Roberto; Santoro, Antonio; Rosa, Giovanni

    2014-06-01

    Awake craniotomy is the technique of choice in patients with brain tumours adjacent to primary and accessory language areas (Broca's and Wernicke's areas). Language testing should be aimed to detect preoperative deficits, to promptly identify the occurrence of new intraoperative impairments and to establish the course of postoperative language status. Aim of this case series is to describe our experience with a dedicated language testing work up to evaluate patients with or at risk for language disturbances undergoing awake craniotomy for brain tumour resection. Pre- and intra operative testing was accomplished with 8 tests. Intraoperative evaluation was accomplished when patients were fully cooperative (Ramsey < 3). Postoperative evaluation was scheduled at early (within 21 days) and long-term follow-up (3-6 months). Twenty consecutive patients were prospectively recruited. Preoperative language testings were normal in 9 patients (45%), showed mild to moderate language deficit in 8 (40%) and severe language deficit or aphasic disorders in 3 (15%). Broca's area was identified in 15 patients, in all cases by counting arrest during stimulation and in 12 cases by naming arrest. In this article we describe our experience using a language testing work up to evaluate - pre, intra and postoperatively - patients undergoing awake craniotomy for brain tumour resection with preoperative language disturbances or at risk for postoperative language deficits. This approach allows a systematic evaluation and recording of language function status and can be accomplished even when a neuropsychologist or speech therapist are not involved in the operation crew.

  1. A case for conflict across multiple domains: Memory and language impairments following damage to ventrolateral prefrontal cortex

    PubMed Central

    Novick, Jared M.; Kan, Irene P.; Trueswell, John C.; Thompson-Schill, Sharon L.

    2013-01-01

    Patients with focal lesions to the left inferior frontal gyrus (LIFG; BA 44/45) exhibit difficulty with language production and comprehension tasks, although the nature of their impairments has been somewhat difficult to characterize. No reported cases suggest that these patients are Broca's aphasics in the classic agrammatic sense. Recent case studies, however, do reveal a consistent pattern of deficit regarding their general cognitive processes: They are reliably impaired on tasks in which conflicting representations must be resolved by implementing top-down cognitive control (e.g., Stroop; memory tasks involving proactive interference). In the present study, we ask whether the language production and comprehension impairments displayed by a patient with circumscribed LIFG damage can best be understood within a general conflict resolution deficit account. We focus on one patient in particular—patient I.G.—and discuss the implications for language processing abilities as a consequence of a general cognitive control disorder. We compared I.G. and other frontal patients to age-matched control participants across four experiments. Experiment 1 tested participants’ general conflict resolution abilities within a modified working memory paradigm in an attempt to replicate prior case study findings. We then tested language production abilities on tasks of picture naming (Experiment 2) and verbal fluency (Experiment 3), tasks that generated conflict at the semantic and/or conceptual levels. Experiment 4 tested participants’ sentence processing and comprehension abilities using both online (eye movement) and offline measures. In this task, participants carried out spoken instructions containing a syntactic ambiguity, in which early interpretation commitments had to be overridden in order to recover an alternative, intended analysis of sentence meaning. Comparisons of I.G.'s performance with frontal and healthy control participants supported the following claim: I

  2. Selective deficit of second language: a case study of a brain-damaged Arabic-Hebrew bilingual patient

    PubMed Central

    Ibrahim, Raphiq

    2009-01-01

    Background An understanding of how two languages are represented in the human brain is best obtained from studies of bilingual patients who have sustained brain damage. The primary goal of the present study was to determine whether one or both languages of an Arabic-Hebrew bilingual individual are disrupted following brain damage. I present a case study of a bilingual patient, proficient in Arabic and Hebrew, who had sustained brain damage as a result of an intracranial hemorrhage related to herpes encephalitis. Methods The patient's performance on several linguistic tasks carried out in the first language (Arabic) and in the second language (Hebrew) was assessed, and his performance in the two languages was compared. Results The patient displayed somewhat different symptomatologies in the two languages. The results revealed dissociation between the two languages in terms of both the types and the magnitude of errors, pointing to aphasic symptoms in both languages, with Hebrew being the more impaired. Further analysis disclosed that this dissociation was apparently caused not by damage to his semantic system, but rather by damage at the lexical level. Conclusion The results suggest that the principles governing the organization of lexical representations in the brain are not similar for the two languages. PMID:19284632

  3. Verb and sentence production and comprehension in aphasia: Northwestern Assessment of Verbs and Sentences (NAVS)

    PubMed Central

    Cho-Reyes, Soojin; Thompson, Cynthia K.

    2015-01-01

    Background Verbs and sentences are often impaired in individuals with aphasia, and differential impairment patterns are associated with different types of aphasia. With currently available test batteries, however, it is challenging to provide a comprehensive profile of aphasic language impairments because they do not examine syntactically important properties of verbs and sentences. Aims This study presents data derived from the Northwestern Assessment of Verbs and Sentences (NAVS; Thompson, 2011), a new test battery designed to examine syntactic deficits in aphasia. The NAVS includes tests for verb naming and comprehension, and production of verb argument structure in simple active sentences, with each examining the effects of the number and optionality of arguments. The NAVS also tests production and comprehension of canonical and non-canonical sentences. Methods & Procedures A total of 59 aphasic participants (35 agrammatic and 24 anomic) were tested using a set of action pictures. Participants produced verbs or sentences for the production subtests and identified pictures corresponding to auditorily provided verbs or sentences for the comprehension subtests. Outcomes & Results The agrammatic group, compared to the anomic group, performed significantly more poorly on all subtests except verb comprehension, and for both groups comprehension was less impaired than production. On verb naming and argument structure production tests both groups exhibited difficulty with three-argument verbs, affected by the number and optionality of arguments. However, production of sentences using three-argument verbs was more impaired in the agrammatic, compared to the anomic, group. On sentence production and comprehension tests, the agrammatic group showed impairments in all types of non-canonical sentences, whereas the anomic group exhibited difficulty primarily with the most difficult, object relative, structures. Conclusions Results show that verb and sentence deficits seen in

  4. Lexical Competition Effects in Aphasia: Deactivation of Lexical Candidates in Spoken Word Processing

    ERIC Educational Resources Information Center

    Janse, Esther

    2006-01-01

    Research has shown that Broca's and Wernicke's aphasic patients show different impairments in auditory lexical processing. The results of an experiment with form-overlapping primes showed an inhibitory effect of form-overlap for control adults and a weak inhibition trend for Broca's aphasic patients, but a facilitatory effect of form-overlap was…

  5. Association between Therapy Outcome and Right-Hemispheric Activation in Chronic Aphasia

    ERIC Educational Resources Information Center

    Richter, Maria; Miltner, Wolfgang H. R.; Straube, Thomas

    2008-01-01

    The role of the right hemisphere for language processing and successful therapeutic interventions in aphasic patients is a matter of debate. This study explored brain activation in right-hemispheric areas and left-hemispheric perilesional areas in response to language tasks in chronic non-fluent aphasic patients before and after constraint-induced…

  6. Speculation about Behavior, Brain Damage, and Self-Organization: The Other Way to Herd a Cat

    ERIC Educational Resources Information Center

    Colangelo, Annette; Holden, John G.; Buchanan, Lori; Van Orden, Guy C.

    2004-01-01

    This article contrasts aphasic patients' performance of word naming and lexical decision with that of intact college-aged readers. We discuss this contrast within a framework of self-organization; word recognition by aphasic patients is destabilized relative to intact performance. Less stable performance shows itself as an increase in the…

  7. Stress Assignment in Aphasia: Word and Non-Word Reading and Non-Word Repetition

    ERIC Educational Resources Information Center

    de Bree, Elise; Janse, Esther; van de Zande, Anne Marie

    2007-01-01

    This paper investigates stress assignment in Dutch aphasic patients in non-word repetition, as well as in real-word and non-word reading. Performance on the non-word reading task was similar for the aphasic patients and the control group, as mainly regular stress was assigned to the targets. However, there were group differences on the real-word…

  8. Mild developmental delay and obesity in two patients with mosaic 1p36 deletion syndrome.

    PubMed

    Shimada, Shino; Maegaki, Yoshihiro; Osawa, Makiko; Yamamoto, Toshiyuki

    2014-02-01

    We identified mosaic 1p36 deletions in two patients with developmental delay, distinctive features, and obesity, who can walk alone and communicate with others. Thus, their neurological defects are milder than those in typical patients with 1p36 deletion syndrome because most patients with 1p36 deletion cannot acquire expressive language. Chromosomal microarray testing revealed 3.0 and 4.5 Mb aberrations in the subtelomeric region of the short arm of chromosome 1. Mean signal ratios of the identified aberrations were -0.4 and -0.5, indicating mosaicism, which was confirmed by fluorescence in situ hybridization analysis with a mosaic ratio of 70% and 77%, respectively. Previous studies demonstrated that deletion of the distal 2-3 Mb region would be responsible for hyperphagia and obesity seen in patients. On the other hand, the severity of the neurological defect often correlates with the size of the terminal deletion of 1p36, and patients with larger deletions of 1p36 would usually show severely impaired developmental milestones and be immobile and aphasic. In such cases, hyperphagia and obesity could be clinically masked. In this study, two patients with mosaic deletions of 1p36 showed obesity as a consequence of hyperphagia. This study suggests that patients with 1p36 deletion would be at risk for hyperphagia and obesity when they have both risk factors, that is, (1) deletions including the 2-3 Mb critical region and (2) milder phenotypes that allow them to reach food on their own and to overeat.

  9. Evolution of oral and written confrontation naming errors in aphasia. A retrospective study on vascular patients.

    PubMed

    Basso, A; Corno, M; Marangolo, P

    1996-02-01

    Impaired naming is a common finding in aphasia but while it is known that naming errors diminish over time, longitudinal studies are rare. In this retrospective study, naming errors of 84 vascular aphasic patients are studied. Errors in oral and written confrontation naming tasks in two successive evaluations are tabulated and coded into one of 10 error types. No Response, Word-Finding Difficulty, Semantic Paraphasia, Unrelated Paraphasia, Phonemic/Orthographic Paraphasia, Neologism, Paraphasic Jargon, Phonemic/Neologistic Jargon, Stereotypy, and Other. All analyses were carried out on the difference scores, that is, the score in the second examination minus the score in the first examination. Results indicate that there is a significant decrease of No Responses (in oral and written naming) and Neologisms (in oral naming), and a significant increase of Orthographic Paraphasias in written naming. Moreover, the difference score for Phonemic/Orthographic Paraphasias was higher in written than oral naming. The difference scores for the other types of error were not statistically significant.

  10. Deformation Mechanisms is a-Phase Silicon Nitride Ceramics

    SciTech Connect

    J. A. Schneider; A. K. Mukherjee

    1998-08-12

    Changes of phase composition and morphology were investigated in Si{sub 3}N{sub 4} both before and after compressive deformation testing. Si{sub 3}N{sub 4} specimens, with 5 wt% Y{sub 2}O{sub 3} and 5 wt% MgAl{sub 2}O{sub 4} additives, were rapidly consolidated to preserve the initial, metastable {alpha}-phase present in the Si{sub 3}N{sub 4} starting powders. Constant strain rate compression tests were used to evaluate the strain rate dependency of the flow stress. At 1723 K, a flow stress dependency value of n = 2 was observed.

  11. Singing by speechless (aphasic) children: Victorian medical observations.

    PubMed

    Lorch, Marjorie Perlman; Greenblatt, Samuel H

    2015-01-01

    In the second half of the nineteenth century, British clinicians made observations regarding the ability of individuals with impaired language abilities to sing or hum. One notable publication was of two cases of children briefly observed by John Hughlings Jackson (1835-1911) in 1871. These children were speechless but could produce some musical expression. Other such cases attracted the attention of Victorian clinicians who were actively pursuing theoretical questions regarding the organization of brain function and laterality. The presence of musical expression in children who failed to develop spoken language was seen as a notable symptom for early practitioners of pediatric neurology.

  12. The negotiation of intelligibility in an aphasic dyad.

    PubMed

    Damico, Jack S; Simmons-Mackie, Nina; Wilson, Brent

    2006-01-01

    Employing conversation analysis as a research technique, this study investigates the ways that unintelligibility is accounted for and overcome within a therapeutic encounter between an individual with aphasia and dysarthria and his clinician. The results emphasize the collaborative nature of intelligibility negotiation and demonstrate how both the individual with the impairment and his clinician employ various interactional strategies and knowledge resources to turn unintelligibility into intelligibility so that the therapeutic encounter may continue.

  13. Test-Retest Stability of Word Retrieval in Aphasic Discourse

    ERIC Educational Resources Information Center

    Boyle, Mary

    2014-01-01

    Purpose: This study examined the test-retest stability of select word-retrieval measures in the discourses of people with aphasia who completed a 5-stimulus discourse task. Method: Discourse samples across 3 sessions from 12 individuals with aphasia were analyzed for the stability of measures of informativeness, efficiency, main concepts, noun and…

  14. Language and Syntactic Impairment Following Stroke in Late Bilingual Aphasics

    ERIC Educational Resources Information Center

    Tschirren, Muriel; Laganaro, Marina; Michel, Patrik; Martory, Marie-Dominique; Di Pietro, Marie; Abutalebi, Jubin; Annoni, Jean-Marie

    2011-01-01

    Purpose: Bilingual aphasia generally affects both languages. However, the age of acquisition of the second language (L2) seems to play a role in the anatomo-functional correlation of the syntactical/grammatical processes, thus potentially influencing the L2 syntactic impairment following a stroke. The present study aims to analyze the influence of…

  15. Supporting Aphasics for Capturing, Organizing and Sharing Personal Experiences

    NASA Astrophysics Data System (ADS)

    Al Mahmud, Abdullah

    When a person, due to brain injury or another disease, suffers in his or her ability to speak, it becomes inherently cumbersome to share needs, emotions, and experiences through personal stories and social interaction. This paper describes the aim and progress of the author’s dissertation, which focuses on designing a support system to share daily experiences for people suffering from expressive aphasia.

  16. Psychometric properties of the Behavioural Outcomes of Anxiety questionnaire in stroke patients with aphasia

    PubMed Central

    Eccles, Alicia; Morris, Reg; Kneebone, Ian

    2016-01-01

    Objective: To evaluate the psychometric properties of an observational, carer-completed anxiety screen for aphasic stroke patients. Design: Phase 1: A cross-sectional questionnaire design to establish psychometric properties. Phase 2: A randomized longitudinal design with treatment and control to evaluate sensitivity to change and repeatability/reliability. Subjects: Phase 1: 111 patient-carer dyads were recruited through stroke charities: patient mean age 69.7(10. 7), 6.2(5. 2) years since stroke, 76 male; carer mean age 64.7(12. 2), 27 male. Phase 2. A subsample of 50 dyads (29 completed). Measures: All patients completed the Tension Rating Circles and the Frenchay Aphasia Screening Test. Carers completed the Behavioural Outcomes of Anxiety questionnaire, observational versions of the Hospital Anxiety and Depression Scale (HADS-A) and the Generalised Anxiety Disorder-7, and a feedback questionnaire. Intervention: Phase 2: 25 dyads were offered relaxation training and 25 acted as controls. Results: The Behavioural Outcomes of Anxiety questionnaire correlated .77 with the HADS-A and Cronbach’s Alpha was .82 demonstrating validity and internal consistency. Using HADS-A cut-off > 7 as criterion the area under the curve was 0.90 and at cut-off of > 16 sensitivity (0.85) and specificity (0.85) were both good. Scores declined significantly more in a group given anxiety training (n = 12) than in a control group (n = 17), demonstrating sensitivity to change and construct validity. Two-week repeatability/reliability was .92. Feedback suggested the scale was acceptable. Conclusions: The Behavioural Outcomes of Anxiety questionnaire shows promise as an anxiety screen for stroke patients with aphasia and is sensitive to change. Further analysis of dimensionality and discriminant validity is needed. PMID:27121863

  17. Individualized treatment with transcranial direct current stimulation in patients with chronic non-fluent aphasia due to stroke.

    PubMed

    Shah-Basak, Priyanka P; Norise, Catherine; Garcia, Gabriella; Torres, Jose; Faseyitan, Olufunsho; Hamilton, Roy H

    2015-01-01

    While evidence suggests that transcranial direct current stimulation (tDCS) may facilitate language recovery in chronic post-stroke aphasia, individual variability in patient response to different patterns of stimulation remains largely unexplored. We sought to characterize this variability among chronic aphasic individuals, and to explore whether repeated stimulation with an individualized optimal montage could lead to persistent reduction of aphasia severity. In a two-phase study, we first stimulated patients with four active montages (left hemispheric anode or cathode; right hemispheric anode or cathode) and one sham montage (Phase 1). We examined changes in picture naming ability to address (1) variability in response to different montages among our patients, and (2) whether individual patients responded optimally to at least one montage. During Phase 2, subjects who responded in Phase 1 were randomized to receive either real-tDCS or to receive sham stimulation (10 days); patients who were randomized to receive sham stimulation first were then crossed over to receive real-tDCS (10 days). In both phases, 2 mA tDCS was administered for 20 min per real-tDCS sessions and patients performed a picture naming task during stimulation. Patients' language ability was re-tested after 2-weeks and 2-months following real and sham tDCS in Phase 2. In Phase 1, despite considerable individual variability, the greatest average improvement was observed after left-cathodal stimulation. Seven out of 12 subjects responded optimally to at least one montage as demonstrated by transient improvement in picture-naming. In Phase 2, aphasia severity improved at 2-weeks and 2-months following real-tDCS but not sham. Despite individual variability with respect to optimal tDCS approach, certain montages result in consistent transient improvement in persons with chronic post-stroke aphasia. This preliminary study supports the notion that individualized tDCS treatment may enhance aphasia

  18. Comparison of emotional and non-emotional word repetitions in patients with aphasia

    PubMed Central

    Bakhtiyari, Jalal; Khatoonabadi, Seyyed Ahmad Reza; Dadgar, Hooshang; Bakhtiari, Behrooz Mahmoodi; Khosravizadeh, Parvaneh; Shaygannejad, Vahid

    2015-01-01

    Background: Aphasia is a language disorder caused by left hemisphere damage. For treatment of aphasia, in some of therapeutic approaches, the right hemisphere (RH) abilities, such as, emotional perception, is used for stimulation of the language process in the left hemisphere. The aim of this study is to investigate emotional word repetition in aphasia after a stroke, in Persian language patients. Materials and Methods: Fifteen aphasic patients (eleven male and four female) between 45 and 65 (58/4 ± 7/8) years of age, participated in this cross-sectional study. A list of 20 emotional words and a list of 20 neutral words as stimuli were prepared and the patients were asked to repeat each word after five seconds; if a patient needed to repeat a word again, it was repeated for him/her again, and the total score for each subject was calculated. The paired t-test was used to test group mean differences and the significant level was 0.05. Results: The mean and standard deviation for emotional word repetitions were 6.93 ± 1.72 and for non-emotional word repetition was 7.10 ± 2.23, and the P value = 0.892, thus, no significant difference between emotional and non-emotional word repetitions was noticed. The mean and standard deviation for the positive emotional word repetitions were 3.53 ± 3.29 and for negative word repetitions were 3.40 ± 3.56, (P = 0.751), with no significant difference between positive and negative emotional word repetitions. Conclusion: Despite the main hypothesis that the right hemisphere is involved in the processing of emotions, it can be stated that both hemispheres are involved in the processing of emotional words, albeit in a different and probably complementary manner. PMID:26436078

  19. Characterization of the autonomic system during the cyclic alternating pattern of sleep.

    PubMed

    Gonzalez-Salazar, J S; Alba, A; Mendez, M O; Luna-Rivera, J M; Parrino, L; Grassi, A; Terzano, M; Milioli, G

    2014-01-01

    Evaluation of the RR variability was carried out during the Cyclic Alternating Pattern (CAP) in sleep. CAP is a central phenomenon formed by short events called A-phases that break basal electroencephalogram (EEG) oscillations of the sleep stages. A-phases are classified in three types (A1, A2 and A3) based on the EEG desynchronization during A-phase. However, the relation of A-phases with other systems, such as cardiovascular system, is unclear and a deep analysis is required. For the study, six patients with Nocturnal Front Lobe Epilepsy (NFLE) and other six healthy controls patients underwent whole night polysomnographic recordings with CAP and hypnogram annotations. Amplitude reduction and time delay of the RR intervals minimum with respect to A-phases onset were computed. In addition, the same process was computed over randomly chosen RR interval segments during the NREM sleep for further comparison. The results suggest that the onset of the A-phases is correlated with a significative increase of the heart rate that peaks at around 4s after the Aphase onset, independently of the A-phase subtype.

  20. Screening LGI1 in a cohort of 26 lateral temporal lobe epilepsy patients with auditory aura from Turkey detects a novel de novo mutation.

    PubMed

    Kesim, Yesim F; Uzun, Gunes Altiokka; Yucesan, Emrah; Tuncer, Feyza N; Ozdemir, Ozkan; Bebek, Nerses; Ozbek, Ugur; Iseri, Sibel A Ugur; Baykan, Betul

    2016-02-01

    Autosomal dominant lateral temporal lobe epilepsy (ADLTE) is an autosomal dominant epileptic syndrome characterized by focal seizures with auditory or aphasic symptoms. The same phenotype is also observed in a sporadic form of lateral temporal lobe epilepsy (LTLE), namely idiopathic partial epilepsy with auditory features (IPEAF). Heterozygous mutations in LGI1 account for up to 50% of ADLTE families and only rarely observed in IPEAF cases. In this study, we analysed a cohort of 26 individuals with LTLE diagnosed according to the following criteria: focal epilepsy with auditory aura and absence of cerebral lesions on brain MRI. All patients underwent clinical, neuroradiological and electroencephalography examinations and afterwards they were screened for mutations in LGI1 gene. The single LGI1 mutation identified in this study is a novel missense variant (NM_005097.2: c.1013T>C; p.Phe338Ser) observed de novo in a sporadic patient. This is the first study involving clinical analysis of a LTLE cohort from Turkey and genetic contribution of LGI1 to ADLTE phenotype. Identification of rare LGI1 gene mutations in sporadic cases supports diagnosis as ADTLE and draws attention to potential familial clustering of ADTLE in suggestive generations, which is especially important for genetic counselling.

  1. Locative prepositional phrases in severe aphasia.

    PubMed

    Weinrich, M; McCall, D; Shoosmith, L; Thomas, K; Katzenberger, K; Weber, C

    1993-07-01

    Six severely aphasic patients were trained on C-VIC, a computerized alternative communication system. Patients with both global and Broca's aphasia were able to produce and comprehend locative prepositions using C-VIC. The Broca's aphasic patients were able to produce and interpret symbol order correctly in C-VIC locative prepositional phrases, despite their difficulties in performing the same tasks using English. One patient's verbal production of locative prepositional phrases improved markedly after C-VIC training. These results suggest that the "mapping" impairment suffered by some Broca's aphasics may be ameliorated by use of alternative communication system, such as C-VIC.

  2. The Comprehension of Turkish Relative Clauses in Second Language Acquisition and Agrammatism

    ERIC Educational Resources Information Center

    Aydin, Ozgur

    2007-01-01

    The purposes of this study are to test whether the processing of subject relative (SR) clauses is easier than that of object relative (OR) clauses in Turkish and to investigate whether the comprehension of SRs can be better explained by the linear distance hypothesis or structural distance hypothesis (SDH). The question is examined in two groups…

  3. Agrammatic Comprehension Caused by a Glioma in the Left Frontal Cortex

    ERIC Educational Resources Information Center

    Kinno, Ryuta; Muragaki, Yoshihiro; Hori, Tomokatsu; Maruyama, Takashi; Kawamura, Mitsuru; Sakai, Kuniyoshi L.

    2009-01-01

    It has been known that lesions in the left inferior frontal gyrus (L. IFG) do not always cause Broca's aphasia, casting doubt upon the specificity of this region. We have previously devised a picture-sentence matching task for a functional magnetic resonance imaging (fMRI) study, and observed that both pars triangularis (L. F3t) of L. IFG…

  4. Sentence Comprehension in Agrammatic Aphasia: History and Variability to Clinical Implications

    ERIC Educational Resources Information Center

    Johnson, Danielle; Cannizzaro, Michael S.

    2009-01-01

    Individuals with Broca's aphasia often present with deficits in their ability to comprehend non-canonical sentences. This has been contrastingly characterized as a systematic loss of specific grammatical abilities or as individual variability in the dynamics between processing load and resource availability. The present study investigated sentence…

  5. Discourse functions and hemispheric asymmetry.

    PubMed

    Osiejuk, E

    1993-01-01

    This paper presents a review of the main results of an application of discourse analysis in aphasics with the left hemisphere damages and in the right hemisphere damaged (RHD) patients. Research findings indicate that aphasics have marked deficits on the level of microstructure, especially cohesion of discourse, whereas the coherence and superstructure of their texts are relatively well preserved. RHD patients show difficulties at the microstructure of discourse but not so marked as that of aphasic subjects. The main impairments of RHD patients' discourse can be observed at the level of text coherence. The both populations have also preserved cognitive representation concerned with script knowledge. Discourse processing at macrostructural level of discourse is affected in aphasics as well as in RHD patients. These results suggest that both hemispheres are necessary for normal discourse processes.

  6. The Thai version of Aachen aphasia test (THAI-AAT).

    PubMed

    Pracharitpukdee, N; Phanthumchinda, K; Huber, W; Willmes, K

    2000-06-01

    The lack of a standardized Thai Language aphasia test raises difficulties not only with the assessment and treatment planning for the clinical but also with the accurate diagnosis and the reliable incidence for research on aphasiology in Thailand. This study aimed to use the Thai version of German Aachen aphasia (THAI-AAT), which is systematically adapted according to well-defined linguistic criteria and psychometric requirement, to assess the language deficit of Thai aphasic patients. The subjects participating in this study were 125 aphasia patients, 60 non-aphasic brain damaged patients and 120 normal subjects. The result revealed that the THAI-AAT is linguistically parallel in test design and fulfills the same psychometric properties as the original. The THAI-AAT obtains the goals: to differential diagnosis of aphasia distinguishing it from non-aphasic disturbance and to identify the type of aphasic syndrome.

  7. Anatomic, Clinical, and Neuropsychological Correlates of Spelling Errors in Primary Progressive Aphasia

    ERIC Educational Resources Information Center

    Shim, HyungSub; Hurley, Robert S.; Rogalski, Emily; Mesulam, M.-Marsel

    2012-01-01

    This study evaluates spelling errors in the three subtypes of primary progressive aphasia (PPA): agrammatic (PPA-G), logopenic (PPA-L), and semantic (PPA-S). Forty-one PPA patients and 36 age-matched healthy controls were administered a test of spelling. The total number of errors and types of errors in spelling to dictation of regular words,…

  8. Patient Rights

    MedlinePlus

    ... have a patient bill of rights. An important patient right is informed consent. This means that if you need a treatment, your health care provider must give you the information you need to make a decision. Many hospitals have patient advocates who can help you if you have ...

  9. Organization of and access to semantic memory in aphasia.

    PubMed

    Koemeda-Lutz, M; Cohen, R; Meier, E

    1987-03-01

    Previous experiments with picture sorting and matching tasks have shown aphasics to give more deviant responses than controls when decisions require the identification of single features of concepts, whereas their responses are close to normal whenever decisions have to be based on the relative overlap of broad associative fields. The present experiment was designed to compare picture matching based on single features (property verification) with picture matching based on category membership (category verification). Fifty-five aphasics (14 amnesics, 18 Brocas, 13 Wernickes, 10 global aphasics) and 29 right-brain-damaged control patients served as subjects. Aphasics were poorer than right hemisphere controls on property as well as on category sortings, especially when the sorting criterion was not a dominant property of the object or when the object in question was not a typical member of the criterion category. Contrary to other studies, the "semantic distance" variable did not differentially affect Brocas as compared to Wernickes aphasics. Verbal labels denoting the sorting criterion and added to the picture presentation did not affect the performance of the right hemisphere controls but significantly improved that of the aphasics.

  10. PATIENT NAVIGATION

    PubMed Central

    Wells, Kristen J.; Battaglia, Tracy A.; Dudley, Donald J.; Garcia, Roland; Greene, Amanda; Calhoun, Elizabeth; Mandelblatt, Jeanne S.; Paskett, Electra D.; Raich, Peter C.

    2008-01-01

    Background First implemented in 1990, patient navigation interventions are emerging as an approach to reduce cancer disparities. However, there is lack of consensus about how patient navigation is defined, what patient navigators do, and what their qualifications should be. Little is known about the efficacy and cost effectiveness of patient navigation. Methods We conducted a qualitative synthesis of published literature on cancer patient navigation. Using the keywords “navigator” or “navigation” and “cancer,” we identified 45 articles from Pubmed and reference searches that were published or in press through October 2007. 16 provided data on efficacy of navigation in improving timeliness and receipt of cancer screening, diagnostic follow-up care, and treatment. Patient navigation services are defined and differentiated from other outreach services. Results Overall there is evidence for some degree of efficacy for patient navigation in increasing participation in cancer screening and adherence to diagnostic follow-up care following an abnormality, with increases in screening ranging from 10.8% to 17.1% and increases in adherence to diagnostic follow-up care ranging from 21% to 29.2%, when compared to control patients. There is less evidence regarding efficacy of patient navigation in reducing either late stage cancer diagnosis or delays in initiation of cancer treatment or improving outcomes during cancer survivorship. There were methodological limitations in most studies, such as lack of control groups, small sample sizes, and contamination with other interventions. Conclusions Although cancer-related patient navigation interventions are being increasingly adopted across the U.S. and Canada, further research is necessary to evaluate their efficacy and cost-effectiveness in improving cancer care. PMID:18780320

  11. Elicitation of specific syntactic structures in primary progressive aphasia.

    PubMed

    Deleon, Jessica; Gesierich, Benno; Besbris, Max; Ogar, Jennifer; Henry, Maya L; Miller, Bruce L; Gorno-Tempini, Maria Luisa; Wilson, Stephen M

    2012-12-01

    Many patients with primary progressive aphasia (PPA) are impaired in syntactic production. Because most previous studies of expressive syntax in PPA have relied on quantitative analysis of connected speech samples, which is a relatively unconstrained task, it is not well understood which specific syntactic structures are most challenging for these patients. We used an elicited syntactic production task to identify which syntactic structures pose difficulties for 31 patients with three variants of PPA: non-fluent/agrammatic, semantic and logopenic. Neurodegenerative and healthy age-matched participants were included as controls. As expected, non-fluent/agrammatic patients made the most syntactic errors. The structures that resulted in the most errors were constructions involving third person singular present agreement, and constructions involving embedded clauses. Deficits on this elicited production task were associated with atrophy of the left posterior inferior frontal gyrus.

  12. Patient management.

    PubMed

    Guptill, Lynn

    2015-03-01

    Hospital-associated infections, including those caused by zoonotic agents, represent an increasing concern in veterinary practice. Veterinarians and hospital staff are obligated and expected to provide education about and protection from transmission of pathogens among animal patients and between animal patients and human beings (eg, veterinary staff, volunteers, owners) who come into contact with infected animals. Patient management involves assessing risks of pathogen transmission, identification of animals either suspected of or proved to be infected with a transmissible infectious disease agent, and the implementation of measures that minimize the likelihood of transmission of the infectious agent.

  13. Conversation Therapy for Agrammatism: Exploring the Therapeutic Process of Engagement and Learning by a Person with Aphasia

    ERIC Educational Resources Information Center

    Beckley, Firle; Best, Wendy; Johnson, Fiona; Edwards, Susan; Maxim, Jane; Beeke, Suzanne

    2013-01-01

    Background & Aims: A recent systematic review of conversation training for communication partners of people with aphasia has shown that it is effective, and improves participation in conversation for people with chronic aphasia. Other research suggests that people with aphasia are better able to learn communication strategies in an environment…

  14. Patient Empowerment

    MedlinePlus

    ... Chat Social Home FAQ Start Here Learn About Kidney Cancer Guidelines for Patients Statistics and Survival Data (NIH) Cancer Term Dictionary (NCI) Surgery for Kidney Cancer Print Surgery Information Therapies for Advanced Kidney Cancer ...

  15. An Analysis of Aphasic Naming Errors as an Indicator of Improved Linguistic Processing Following Phonomotor Treatment

    ERIC Educational Resources Information Center

    Kendall, Diane L.; Pompon, Rebecca Hunting; Brookshire, C. Elizabeth; Minkina, Irene; Bislick, Lauren

    2013-01-01

    Purpose: The aim of this study was to investigate the influence of phonomotor treatment on the types of errors produced during a confrontation naming task for people with aphasia (PWA). Method: Ten PWA received 60 hr of phonomotor treatment across 6 weeks. Confrontation naming abilities were measured before and after treatment, and responses were…

  16. Widening the Temporal Window: Processing Support in the Treatment of Aphasic Language Production

    ERIC Educational Resources Information Center

    Linebarger, Marcia; McCall, Denise; Virata, Telana; Berndt, Rita Sloan

    2007-01-01

    Investigations of language processing in aphasia have increasingly implicated performance factors such as slowed activation and/or rapid decay of linguistic information. This approach is supported by studies utilizing a communication system ("SentenceShaper"[TM]) which functions as a "processing prosthesis." The system may reduce the impact of…

  17. Computer-Assisted Analysis of Spontaneous Speech: Quantification of Basic Parameters in Aphasic and Unimpaired Language

    ERIC Educational Resources Information Center

    Hussmann, Katja; Grande, Marion; Meffert, Elisabeth; Christoph, Swetlana; Piefke, Martina; Willmes, Klaus; Huber, Walter

    2012-01-01

    Although generally accepted as an important part of aphasia assessment, detailed analysis of spontaneous speech is rarely carried out in clinical practice mostly due to time limitations. The Aachener Sprachanalyse (ASPA; Aachen Speech Analysis) is a computer-assisted method for the quantitative analysis of German spontaneous speech that allows for…

  18. Effects of Syllable Structure in Aphasic Errors: Implications for a New Model of Speech Production

    ERIC Educational Resources Information Center

    Romani, Cristina; Galluzzi, Claudia; Bureca, Ivana; Olson, Andrew

    2011-01-01

    Current models of word production assume that words are stored as linear sequences of phonemes which are structured into syllables only at the moment of production. This is because syllable structure is always recoverable from the sequence of phonemes. In contrast, we present theoretical and empirical evidence that syllable structure is lexically…

  19. The Main Concept Analysis in Cantonese Aphasic Oral Discourse: External Validation and Monitoring Chronic Aphasia

    ERIC Educational Resources Information Center

    Kong, Anthony Pak-Hin

    2011-01-01

    Purpose: The 1st aim of this study was to further establish the external validity of the main concept (MC) analysis by examining its relationship with the Cantonese Linguistic Communication Measure (CLCM; Kong, 2006; Kong & Law, 2004)--an established quantitative system for narrative production--and the Cantonese version of the Western Aphasia…

  20. Anterior Temporal Lobe Connectivity Correlates with Functional Outcome after Aphasic Stroke

    ERIC Educational Resources Information Center

    Warren, Jane E.; Crinion, Jennifer T.; Ralph, Matthew A. Lambon; Wise, Richard J. S.

    2009-01-01

    Focal brain lesions are assumed to produce language deficits by two basic mechanisms: local cortical dysfunction at the lesion site, and remote cortical dysfunction due to disruption of the transfer and integration of information between connected brain regions. However, functional imaging studies investigating language outcome after aphasic…

  1. Patient Monitoring

    NASA Technical Reports Server (NTRS)

    1978-01-01

    In photo above, the electrocardiogram of a hospitalized patient is being transmitted by telemetry. Widely employed in space operations, telemetry is a process wherein instrument data is converted to electrical signals and sent to a receiver where the signals are reconverted to usable information. In this instance, heart readings are picked up by the electrode attached to the patient's body and delivered by wire to the small box shown, which is a telemetry transmitter. The signals are relayed wirelessly to the console in the background, which converts them to EKG data. The data is displayed visually and recorded on a printout; at the same time, it is transmitted to a central control station (upper photo) where a nurse can monitor the condition of several patients simultaneously. The Patient Monitoring System was developed by SCI Systems, Inc., Huntsville, Alabama, in conjunction with Abbott Medical Electronics, Houston, Texas. In developing the system, SCI drew upon its extensive experience as a NASA contractor. The company applied telemetry technology developed for the Saturn launch vehicle and the Apollo spacecraft; instrumentation technology developed for heart, blood pressure and sleep monitoring of astronauts aboard NASA's Skylab long duration space station; and communications technology developed for the Space Shuttle.

  2. Speech and language in primary progressive anarthria.

    PubMed

    Silveri, Maria Caterina; Cappa, Antonella; Salvigni, Bruna Lorena

    2003-06-01

    We describe a patient with a progressive loss of speech up to muteness due to frontal atrophy. The clinical and neuropsychological examination documented a severe progressive articulatory disorder associated with a mild language deficit consisting of agrammatic production and spelling errors. Investigation of the patient's auditory-verbal short-term memory system revealed a selective impairment of the articulatory rehearsal system (covert re-circulation of verbal information), suggesting that not only overt but also covert articulation is impaired in this pathology. The conclusion is drawn that pure anarthria is a disorder of executive aspects of language. The hypothesis is advanced that language deficits such as spelling errors and agrammatic features might be due to ineffective covert articulation.

  3. Predicting primary progressive aphasias with support vector machine approaches in structural MRI data.

    PubMed

    Bisenius, Sandrine; Mueller, Karsten; Diehl-Schmid, Janine; Fassbender, Klaus; Grimmer, Timo; Jessen, Frank; Kassubek, Jan; Kornhuber, Johannes; Landwehrmeyer, Bernhard; Ludolph, Albert; Schneider, Anja; Anderl-Straub, Sarah; Stuke, Katharina; Danek, Adrian; Otto, Markus; Schroeter, Matthias L

    2017-01-01

    Primary progressive aphasia (PPA) encompasses the three subtypes nonfluent/agrammatic variant PPA, semantic variant PPA, and the logopenic variant PPA, which are characterized by distinct patterns of language difficulties and regional brain atrophy. To validate the potential of structural magnetic resonance imaging data for early individual diagnosis, we used support vector machine classification on grey matter density maps obtained by voxel-based morphometry analysis to discriminate PPA subtypes (44 patients: 16 nonfluent/agrammatic variant PPA, 17 semantic variant PPA, 11 logopenic variant PPA) from 20 healthy controls (matched for sample size, age, and gender) in the cohort of the multi-center study of the German consortium for frontotemporal lobar degeneration. Here, we compared a whole-brain with a meta-analysis-based disease-specific regions-of-interest approach for support vector machine classification. We also used support vector machine classification to discriminate the three PPA subtypes from each other. Whole brain support vector machine classification enabled a very high accuracy between 91 and 97% for identifying specific PPA subtypes vs. healthy controls, and 78/95% for the discrimination between semantic variant vs. nonfluent/agrammatic or logopenic PPA variants. Only for the discrimination between nonfluent/agrammatic and logopenic PPA variants accuracy was low with 55%. Interestingly, the regions that contributed the most to the support vector machine classification of patients corresponded largely to the regions that were atrophic in these patients as revealed by group comparisons. Although the whole brain approach took also into account regions that were not covered in the regions-of-interest approach, both approaches showed similar accuracies due to the disease-specificity of the selected networks. Conclusion, support vector machine classification of multi-center structural magnetic resonance imaging data enables prediction of PPA subtypes with

  4. [Crossed aphasia or dysexecutive syndrome? A case report].

    PubMed

    Tabeling, S; Kopp, B; Braun, M; Moschner, C; Wessel, K

    2007-08-01

    The case of a female dextral patient (MN) is reported. MN sustained a partial frontotemporal infarction in the right hemisphere. Clinically, MN presented herself mainly with aphasic symptoms. The dextrality of the patient and the laterality of the lesion as well as the nature of language deficits would legitimate the diagnosis of a crossed aphasia, implying paradoxical lateralization of language in MN. However, comprehensive neuropsychological assessment revealed the presence of a global dysexecutive syndrome in MN, suggesting a general cognitive impairment, part of which must be the aphasic symptoms. General issues regarding the relationship between language and cognition and the lateralization of cognitive functions are discussed.

  5. Lesion correlates of patholinguistic profiles in chronic aphasia: comparisons of syndrome-, modality- and symptom-level assessment.

    PubMed

    Henseler, Ilona; Regenbrecht, Frank; Obrig, Hellmuth

    2014-03-01

    One way to investigate the neuronal underpinnings of language competence is to correlate patholinguistic profiles of aphasic patients to corresponding lesion sites. Constituting the beginnings of aphasiology and neurolinguistics over a century ago, this approach has been revived and refined in the past decade by statistical approaches mapping continuous variables (providing metrics that are not simply categorical) on voxel-wise lesion information (voxel-based lesion-symptom mapping). Here we investigate whether and how voxel-based lesion-symptom mapping allows us to delineate specific lesion patterns for differentially fine-grained clinical classifications. The latter encompass 'classical' syndrome-based approaches (e.g. Broca's aphasia), more symptom-oriented descriptions (e.g. agrammatism) and further refinement to linguistic sub-functions (e.g. lexico-semantic deficits for inanimate versus animate items). From a large database of patients treated for aphasia of different aetiologies (n = 1167) a carefully selected group of 102 first ever ischaemic stroke patients with chronic aphasia (∅ 12 months) were included in a VLSM analysis. Specifically, we investigated how performance in the Aachen Aphasia Test-the standard clinical test battery for chronic aphasia in German-relates to distinct brain lesions. The Aachen Aphasia Test evaluates aphasia on different levels: a non-parametric discriminant procedure yields probabilities for the allocation to one of the four 'standard' syndromes (Broca, Wernicke, global and amnestic aphasia), whereas standardized subtests target linguistic modalities (e.g. repetition), or even more specific symptoms (e.g. phoneme repetition). Because some subtests of the Aachen Aphasia Test (e.g. for the linguistic level of lexico-semantics) rely on rather coarse and heterogeneous test items we complemented the analysis with a number of more detailed clinically used tests in selected mostly mildly affected subgroups of patients. Our results

  6. A Study of Syntactic Processing in Aphasia II: Neurological Aspects

    ERIC Educational Resources Information Center

    Caplan, David; Waters, Gloria; Kennedy, David; Alpert, Nathanial; Makris, Nikos; DeDe, Gayle; Michaud, Jennifer; Reddy, Amanda

    2007-01-01

    This paper presents the results of a study of the effects of left hemisphere strokes on syntactically-based comprehension in aphasic patients. We studied 42 patients with aphasia secondary to left hemisphere strokes and 25 control subjects for the ability to assign and interpret three syntactic structures (passives, object extracted relative…

  7. Oral Reading in Bilingual Aphasia: Evidence from Mongolian and Chinese

    ERIC Educational Resources Information Center

    Weekes, Brendan Stuart; Su, I. Fan; Yin, Wengang; Zhang, Xihong

    2007-01-01

    Cognitive neuropsychological studies of bilingual patients with aphasia have contributed to our understanding of how the brain processes different languages. The question we asked is whether differences in script have any impact on language processing in bilingual aphasic patients who speak languages with different writing systems: Chinese and…

  8. The Crucial Role of Tense for Verb Production

    ERIC Educational Resources Information Center

    Druks, J.; Carroll, E.

    2005-01-01

    The case of an aphasic patient whose spontaneous speech contains very few lexical verbs is reported. Instead of sentences with lexical verbs, the patient produces many (grammatical) copular constructions. He also substitutes lexical verbs with the copula. Although this results in ungrammatical utterances, by doing so, a resemblance of sentence…

  9. Semantic Aphasia and Luria's Neurolinguistic Model.

    ERIC Educational Resources Information Center

    Johnsen, Birgitta

    A study of eight adult chronic aphasic patients' comprehension of sentences and pictures in which comparisons of time and space were crucial was designed to assess A. R. Luria's approach to designing comprehension test tasks. The investigation required patients, with lesions of varying size and location, to determine whether a sentence expressing…

  10. How Left Inferior Frontal Cortex Participates in Syntactic Processing: Evidence from Aphasia

    ERIC Educational Resources Information Center

    Love, Tracy; Swinney, David; Walenski, Matthew; Zurif, Edgar

    2008-01-01

    We report on three experiments that provide a real-time processing perspective on the poor comprehension of Broca's aphasic patients for non-canonically structured sentences. In the first experiment we presented sentences (via a Cross Modal Lexical Priming (CMLP) paradigm) to Broca's patients at a normal rate of speech. Unlike the pattern found…

  11. The Variability Debate: More Statistics, More Linguistics

    ERIC Educational Resources Information Center

    Drai, Dan; Grodzinsky, Yosef

    2006-01-01

    We respond to critical comments and consider alternative statistical and syntactic analyses of our target paper which analyzed comprehension scores of Broca's aphasic patients from multiple sentence types in many languages, and showed that Movement but not Complexity or Mood are factors in the receptive deficit of these patients. Specifically, we…

  12. Gesture recognition in patients with aphasia.

    PubMed

    Daniloff, J K; Noll, J D; Fristoe, M; Lloyd, L L

    1982-02-01

    This study focuses on the controversial issue of the integrity of gestural communication abilities in subjects with aphasia. To define the ability of subjects to interpret symbolic gestures, an Amer-Ind Recognition Test (ART) was developed which required no verbal response from the examiner or the subject. The relationships between impairment of Amer-Ind signal recognition and (a) severity of aphasia, (b) listening and talking abilities and (c) the type of response picture used were investigated. Whether subjects more often chose related foils than unrelated foils in a forced-choice format was also examined. Two training tests and the ART are described. Results from administration to 15 aphasic subjects indicated that: (a) all subjects performed equally well, regardless of their aphasia severity classification; (b) action picture recognition was related to listening ability; (c) action pictures were easier to identify than object pictures; and (d) on error responses, subjects overwhelmingly chose related over unrelated foils. The possibility that gestural abilities were relatively well preserved among the subjects tested, in the presence of a wide range of listening and talking deficits, is also discussed.

  13. [Patient advice].

    PubMed

    Lucio-Villegas Menéndez, M Eulalia; González, Laura López; Gutiérrez Pérez, M Isabel; Lluch, Natalia Aresté; Morató Agustí, M Luisa; Cachafeiro, Santiago Pérez

    2014-05-01

    In wound care, knowing what to do is as important as knowing what not to do. The first step is to evaluate the severity of the lesion and to know whether it is necessary to attend a health center or not. If the wound is simple, the recommended course of action is cleansing with serum or water after washing one's hands, followed by wound disinfection with the most appropriate antiseptic. Antiseptics not should be used for wound cleansing (physiological serum or tap water should be used) or for wound healing with granulation tissue. Equally, antiseptics should not be used in the ear or near the eyes; if there is accidental application, the eye should be washed in abundant water. Povidone iodine should not be used in pregnant women, nor should iodine preparations be used in neonates, in patients with thyroid alterations or in those allergic to iodine. Currently, merbromine/mercurochrome is not used because of its mercury content. Before an antiseptic is applied, all inorganic residues (foreign bodies) and dead tissue should be removed; detritus, slough, purulent exudate, scabs… This will aid healing and the action of antiseptics, since they become inactive in the presence of organic material.

  14. Semantic field in aphasia: an experimental investigation on comprehension of the relations of class and property.

    PubMed

    Bisiacchi, P; Denes, G; Semenza, C

    1976-01-01

    A multiple choice test was devised in order to assess some aspects of the aphasic's semantic field; patient's task was to match a given picture with one out of three alternatives: one of them was linked by a class relationship, one was linked by a property relationship and the last was an unrelated item. Results clearly show that Broca's aphasics make their choice according to class criteria whereas Wernicke's and controls make their choice according to property criteria. Results are discussed in the light of Jakobson linguistic hypothesis which postulates that Broca's and Wernicke's aphasia are subdued by a contiguity and similarity disorder.

  15. Aphasia in Clinical Practice

    PubMed Central

    Kertesz, Andrew

    1983-01-01

    Aphasia is a central language impairment with word finding and comprehension deficit and paraphasias. The highlights of the essential language tests and the classification based on a scorable assessment are presented. The clinical syndromes of Broca's, global, Wernicke, conduction, anomic and transcortical aphasias are detailed with definition, localization, and prognosis. Modality specific disorders associated with aphasic syndromes are discussed. The management of the aphasic patient, consisting of informed support and coordination of available services, is often the responsibility of the family physician. ImagesFig. 1Fig. 2 PMID:21286589

  16. Achieving patient satisfaction: resolving patient complaints.

    PubMed

    Oxler, K F

    1997-07-01

    Patients demand to be active participants on and partners with the health care team to design their care regimen. Patients bring unique perceptions and expectations and use these to evaluate service quality and satisfaction. If customer satisfaction is not achieved and a patient complaint results, staff must have the skills to respond and launch a service recovery program. Service recovery, when done with style and panache, can retain loyal customers. Achieving patient satisfaction and resolving patient complaints require commitment from top leadership and commitment from providers to dedicate the time to understand their patients' needs.

  17. Patient-centered Radiology.

    PubMed

    Itri, Jason N

    2015-10-01

    Patient-centered care (ie, care organized around the patient) is a model in which health care providers partner with patients and families to identify and satisfy patients' needs and preferences. In this model, providers respect patients' values and preferences, address their emotional and social needs, and involve them and their families in decision making. Radiologists have traditionally been characterized as "doctor-to-doctor" consultants who are distanced from patients and work within a culture that does not value patient centeredness. As medicine becomes more patient driven and the trajectory of health care is toward increasing patient self-reliance, radiologists must change the perception that they are merely consultants and become more active participants in patient care by embracing greater patient interaction. The traditional business model for radiology practices, which devalues interaction between patients and radiologists, must be transformed into a patient-centered model in which radiologists are reintegrated into direct patient care and imaging processes are reorganized around patients' needs and preferences. Expanding radiology's core assets to include direct patient care may be the most effective deterrent to the threat of commoditization. As the assault on the growth of Medicare spending continues, with medical imaging as a highly visible target, radiologists must adapt to the changing landscape by focusing on their most important consumer: the patient. This may yield substantial benefits in the form of improved quality and patient safety, reduced costs, higher-value care, improved patient outcomes, and greater patient and provider satisfaction.

  18. Pharmacist-Patient Interaction and Patient Expectations

    ERIC Educational Resources Information Center

    DeSimone, Edward M.; And Others

    1977-01-01

    The nature of the professional interaction between the pharmacist and the patient was explored, with data collected from 3,743 questions asked of 16 pharmacists during an 8-week period. Factors that might affect the nature of the pharmacist-patient interaction are identified along with a cognitive-based profile of patient wants. (LBH)

  19. Healthy brain connectivity predicts atrophy progression in non-fluent variant of primary progressive aphasia.

    PubMed

    Mandelli, Maria Luisa; Vilaplana, Eduard; Brown, Jesse A; Hubbard, H Isabel; Binney, Richard J; Attygalle, Suneth; Santos-Santos, Miguel A; Miller, Zachary A; Pakvasa, Mikhail; Henry, Maya L; Rosen, Howard J; Henry, Roland G; Rabinovici, Gil D; Miller, Bruce L; Seeley, William W; Gorno-Tempini, Maria Luisa

    2016-10-01

    Neurodegeneration has been hypothesized to follow predetermined large-scale networks through the trans-synaptic spread of toxic proteins from a syndrome-specific epicentre. To date, no longitudinal neuroimaging study has tested this hypothesis in vivo in frontotemporal dementia spectrum disorders. The aim of this study was to demonstrate that longitudinal progression of atrophy in non-fluent/agrammatic variant primary progressive aphasia spreads over time from a syndrome-specific epicentre to additional regions, based on their connectivity to the epicentre in healthy control subjects. The syndrome-specific epicentre of the non-fluent/agrammatic variant of primary progressive aphasia was derived in a group of 10 mildly affected patients (clinical dementia rating equal to 0) using voxel-based morphometry. From this region, the inferior frontal gyrus (pars opercularis), we derived functional and structural connectivity maps in healthy controls (n = 30) using functional magnetic resonance imaging at rest and diffusion-weighted imaging tractography. Graph theory analysis was applied to derive functional network features. Atrophy progression was calculated using voxel-based morphometry longitudinal analysis on 34 non-fluent/agrammatic patients. Correlation analyses were performed to compare volume changes in patients with connectivity measures of the healthy functional and structural speech/language network. The default mode network was used as a control network. From the epicentre, the healthy functional connectivity network included the left supplementary motor area and the prefrontal, inferior parietal and temporal regions, which were connected through the aslant, superior longitudinal and arcuate fasciculi. Longitudinal grey and white matter changes were found in the left language-related regions and in the right inferior frontal gyrus. Functional connectivity strength in the healthy speech/language network, but not in the default network, correlated with

  20. Counseling the Coronary Patient

    ERIC Educational Resources Information Center

    Semmler, Caryl; Semmler, Maynard

    1974-01-01

    The article discusses counseling sessions designed to a) help the coronary patient adjust to cardiovascular disease, b) diminish patient anxieties and fears, and c) educate the patient and family members on controlling risk factors to deter another coronary attack. (JS)

  1. Physician accountability, patient safety and patient compensation.

    PubMed

    Gray, John E

    2006-01-01

    In Canada, the response to adverse medical events follows one or more of three main paths: patient safety, physician accountability and patient compensation. While their goals differ, each of these responses serves a valuable function. There are however competing imperatives inherent in each response, particularly in terms of information disclosure: Effective patient safety depends on the full and protected disclosure of all information relevant to an adverse event and requires a "no blame" environment. While natural justice demands that a physician be held accountable for his actions, the doctor should be accorded the right of due process and be judged against an established standard of care. This is necessarily a fault-finding activity. Patient compensation meets both accountability demands and the social justice imperatives of supporting a patient injured through physician negligence. The most effective approach is one that achieves balance between competing imperatives. With clear information disclosure rules, patient safety, physician accountability and patient compensation can operate synergistically.

  2. [Patient education in France].

    PubMed

    Bertrand, Dominique

    2011-10-01

    Patient education is an increasingly important component of therapeutic strategies, especially for chronic illnesses, which currently affect about 12% of the French population and will undoubtedly increase in coming years. Patient education aims to enhance patients' personal responsibility and participation in their therapeutic management and quality of life. Article 84 of French health legislation passed in 2009 inscribes patient education in the Public Health Code for the first time. It distinguishes personalized therapeutic education, patient accompaniment, and learning programs. Direct links between patients and drug companies are prohibited. However, the notion of patient accompaniment remains to be defined, along with the evaluation of patient education, funding sources and practical modalities.

  3. The Mental Representation of Verb-Noun Compounds in Italian: Evidence from a Multiple Single-Case Study in Aphasia

    ERIC Educational Resources Information Center

    Mondini, Sara; Luzzatti, Claudio; Zonca, Giusy; Pistarini, Caterina; Semenza, Carlo

    2004-01-01

    This study seeks information on the mental representation of Verb-Noun (VN) nominal compounds through neuropsychological methods. The lexical retrieval of compound nouns is tested in 30 aphasic patients using a visual confrontation naming task. The target names are VN compounds, Noun-Noun (NN) compounds, and long morphologically simple nouns…

  4. Bilateral Capacity for Speech Sound Processing in Auditory Comprehension: Evidence from Wada Procedures

    ERIC Educational Resources Information Center

    Hickok, G.; Okada, K.; Barr, W.; Pa, J.; Rogalsky, C.; Donnelly, K.; Barde, L.; Grant, A.

    2008-01-01

    Data from lesion studies suggest that the ability to perceive speech sounds, as measured by auditory comprehension tasks, is supported by temporal lobe systems in both the left and right hemisphere. For example, patients with left temporal lobe damage and auditory comprehension deficits (i.e., Wernicke's aphasics), nonetheless comprehend isolated…

  5. Does Long Term Use of Piracetam Improve Speech Disturbances Due to Ischemic Cerebrovascular Diseases?

    ERIC Educational Resources Information Center

    Gungor, Levent; Terzi, Murat; Onar, Musa Kazim

    2011-01-01

    Aphasia causes significant disability and handicap among stroke survivors. Language therapy is recommended for aphasic patients, but not always available. Piracetam, an old drug with novel properties, has been shown to have mild beneficial effects on post-stroke aphasia. In the current study, we investigated the effects of 6 months treatment with…

  6. A Computational Account of Bilingual Aphasia Rehabilitation

    ERIC Educational Resources Information Center

    Kiran, Swathi; Grasemann, Uli; Sandberg, Chaleece; Miikkulainen, Risto

    2013-01-01

    Current research on bilingual aphasia highlights the paucity in recommendations for optimal rehabilitation for bilingual aphasic patients (Edmonds & Kiran, 2006; Roberts & Kiran, 2007). In this paper, we have developed a computational model to simulate an English-Spanish bilingual language system in which language representations can vary by age…

  7. Treatment of Anomia Using Errorless Versus Errorful Learning: Are Frontal Executive Skills and Feedback Important?

    ERIC Educational Resources Information Center

    Fillingham, Joanne; Sage, Karen; Ralph, Matthew Lambon

    2005-01-01

    Background: Studies from the amnesia literature suggest that errorless learning can produce superior results to errorful learning. However, it was found in a previous investigation by the present authors that errorless and errorful therapy produced equivalent results for patients with aphasic word-finding difficulties. A study in the academic…

  8. The Neural Basis of Reversible Sentence Comprehension: Evidence from Voxel-Based Lesion Symptom Mapping in Aphasia

    ERIC Educational Resources Information Center

    Thothathiri, Malathi; Kimberg, Daniel Y.; Schwartz, Myrna F.

    2012-01-01

    We explored the neural basis of reversible sentence comprehension in a large group of aphasic patients (n = 79). Voxel-based lesion symptom mapping revealed a significant association between damage in temporo-parietal cortex and impaired sentence comprehension. This association remained after we controlled for phonological working memory. We…

  9. Mechanisms of Aphasia Recovery after Stroke and the Role of Noninvasive Brain Stimulation

    ERIC Educational Resources Information Center

    Hamilton, Roy H.; Chrysikou, Evangelia G.; Coslett, Branch

    2011-01-01

    One of the most frequent symptoms of unilateral stroke is aphasia, the impairment or loss of language functions. Over the past few years, behavioral and neuroimaging studies have shown that rehabilitation interventions can promote neuroplastic changes in aphasic patients that may be associated with the improvement of language functions. Following…

  10. Semantic Short-Term Memory and Its Role in Sentence Processing: A Replication

    ERIC Educational Resources Information Center

    Martin, Randi C.; He, Tao

    2004-01-01

    Previous studies have shown that an aphasic patient (AB) with a semantic short-term memory deficit (STM) had difficulties comprehending and producing sentences with structures that demanded the simultaneous retention of several individual word meanings (Martin & Freedman, 2001a, 2001b; Martin & Romani, 1994; Martin, Shelton, & Yaffee, 1994). The…

  11. Sparing of Written Production of Proper Nouns and Dates in Aphasia

    ERIC Educational Resources Information Center

    Schmidt, Darren; Buchanan, Lori

    2004-01-01

    Aphasia is a total or partial loss of the ability to produce or understand language, usually caused by brain disease or injury. In this case study, the aphasic patient (BMW) has a profound impairment of oral production and a very moderate impairment in comprehension. Several years of informal observation lead to the current study that contrasts…

  12. Alexia and agraphia in Wernicke's aphasia.

    PubMed Central

    Kirshner, H S; Webb, W G

    1982-01-01

    Three patients with otherwise typical Wernicke's aphasia showed consistently greater impairment of reading than auditory comprehension. While this syndrome resembles alexia with agraphia, the paraphasia of speech, repetition, and naming underline the aphasic nature of the disorder. Together with previous reports of isolated word deafness in Wernicke's aphasia, these cases suggest a relative independence of auditory and visual language processing. Images PMID:7130996

  13. Testing Predictions of the Interactive Activation Model in Recovery from Aphasia after Treatment

    ERIC Educational Resources Information Center

    Jokel, Regina; Rochon, Elizabeth; Leonard, Carol

    2004-01-01

    This paper presents preliminary results of pre- and post-treatment error analysis from an aphasic patient with anomia. The Interactive Activation (IA) model of word production (Dell, Schwartz, Martin, Saffran, & Gagnon, 1997) is utilized to make predictions about the anticipated changes on a picture naming task and to explain emerging patterns.…

  14. A Selective Deficit for Inflection Production

    ERIC Educational Resources Information Center

    Miozzo, Michele; Fischer-Baum, Simon; Postman, Jeffrey

    2010-01-01

    We report the case of an English-speaking aphasic patient (JP) with left posterior-frontal damage affecting the inferior frontal and precentral gyri. In speaking, JP was impaired with the regular inflections of nouns and pseudonouns, making errors like "pears" instead of "pear" or "door" for "doors", while the spoken production of noun stems and…

  15. Digging beneath the Surface Behavioral and Neural Indices of Lexical Access during Idiom Comprehension in Aphasia: A Multi-Modal Approach

    ERIC Educational Resources Information Center

    Brumm, Kathleen Patricia

    2011-01-01

    This project examines spoken language comprehension in Broca's aphasia, a non-fluent language disorder acquired subsequent to stroke. Broca's aphasics demonstrate impaired comprehension for complex sentence constructions. To account for this deficit, one current processing theory claims that Broca's patients retain intrinsic linguistic knowledge,…

  16. 'Patient satisfaction' in hospitalized cancer patients.

    PubMed

    Skarstein, Jon; Dahl, Alv A; Laading, Jacob; Fosså, Sophie D

    2002-01-01

    Predictors of 'patient satisfaction' with hospitalization at a specialized cancer hospital in Norway are examined in this study. Two weeks after their last hospitalization, 2021 consecutive cancer patients were invited to rate their satisfaction with hospitalization, quality of life, anxiety and depression. Compliance rate was 72% (n = 1453). Cut-off levels separating dissatisfied from satisfied patients were defined. It was found that 92% of the patients were satisfied with their stay in hospital, independent of cancer type and number of previous admissions. Performance of nurses and physicians, level of information perceived, outcome of health status, reception at the hospital and anxiety independently predicted 'patient satisfaction'. The model explained 35% of the variance with an area under the curve of 0.76 of the Receiver Operator Curve. Cancer patients' satisfaction with their hospital stay was high, and predicted by four independently predictive variables related to the performance of caregivers. These suggest areas for further improvement in the healthcare service.

  17. The functional connectivity of semantic task changes in the recovery from stroke aphasia

    NASA Astrophysics Data System (ADS)

    Lu, Jie; Wu, Xia; Yao, Li; Li, Kun-Cheng; Shu, Hua; Dong, Qi

    2007-03-01

    Little is known about the difference of functional connectivity of semantic task between the recovery aphasic patients and normal subject. In this paper, an fMRI experiment was performed in a patient with aphasia following a left-sided ischemic lesion and normal subject. Picture naming was used as semantic activation task in this study. We compared the preliminary functional connectivity results of the recovery aphasic patient with the normal subject. The fMRI data were separated by independent component analysis (ICA) into 90 components. According to our experience and other papers, we chose a region of interest (ROI) of semantic (x=-57, y=15, z=8, r=11mm). From the 90 components, we chose one component as the functional connectivity of the semantic ROI according to one criterion. The criterion is the mean value of the voxels in the ROI. So the component of the highest mean value of the ROI is the functional connectivity of the ROI. The voxel with its value higher than 2.4 was thought as activated (p<0.05). And the functional connectivity networks of the normal subjects were t-tested as group network. From the result, we can know the semantic functional connectivity of stroke aphasic patient and normal subjects are different. The activated areas of the left inferior frontal gyrus and inferior/middle temporal gyrus are larger than the ones of normal. The activated area of the right inferior frontal gyrus is smaller than the ones of normal. The functional connectivity of stroke aphasic patient under semantic condition is different with the normal one. The focus of the stroke aphasic patient can affect the functional connectivity.

  18. Patient Satisfaction by Design.

    PubMed

    Jacobs, Karen

    2016-11-01

    The concept of the patient experience as it relates to patient satisfaction is a complex dynamic. It is a dynamic that is becoming increasingly more important as patients are faced with multiple choices for their hearing and balance care. As reimbursement and performance policies have become more normative within health care, patient satisfaction has become a metric to measure quality. Patient satisfaction is no longer contained to just the interaction with the audiologist. It extends to the entire experience-the staff, the service, the product, and other factors. Many practices fail to capitalize on one of the primary components of the patient experience-office design. This article discusses the role of evidence-based design in facility planning as it relates to patient satisfaction. It will illustrate how design principles and ideal attributes may be used to send conscious and subconscious cues that will motivate staff, facilitate patient-centered care, and ultimately increase patient satisfaction.

  19. The Angry Dying Patient.

    PubMed

    Houston, Robert E.

    1999-02-01

    Over 25 years ago, Kubler-Ross identified anger as a predictable part of the dying process. When the dying patient becomes angry in the clinical setting, all types of communication become strained. Physicians can help the angry dying patient through this difficult time by using 10 rules of engagement. When physicians engage and empathize with these patients, they improve the patient's response to pain and they reduce patient suffering. When physicians educate patients on their normal responses to dying and enlist them in the process of family reconciliation, they can impact the end-of-life experience in a positive way.

  20. ''I'm Sitting Here Feeling Aphasic!'' A Study of Recurrent Perseverative Errors Elicited in Unimpaired Speakers

    ERIC Educational Resources Information Center

    Moses, Melanie S.; Nickels, Lyndsey A.; Sheard, Christine

    2004-01-01

    In this study, the recurrent perseverative errors produced by 44 speakers without impairment were examined in picture naming and reading aloud tasks under a fast response deadline. The proportion of perseverative relative to non-perseverative errors was greater in picture naming, the more error-prone task, than in reading aloud. Additionally,…

  1. Repositioning the Patient:

    PubMed Central

    Mold, Alex

    2013-01-01

    Summary This article explores how and why the patient came to be repositioned as a political actor within British health care during the 1960s and 1970s. Focusing on the role played by patient organizations, it is suggested that the repositioning of the patient needs to be seen in the light of growing demands for greater patient autonomy and the application of consumerist principles to health. Examining the activities of two patient groups—the National Association for the Welfare of Children in Hospital (NAWCH) and the Patients Association (PA)—indicates that while such groups undoubtedly placed more emphasis on individual autonomy, collective concerns did not entirely fall away. The voices of patients, as well as the patient, continued to matter within British health care. PMID:23811711

  2. Managing patients with encephalitis.

    PubMed

    Matata, Claire; Easton, Ava; Michael, Benedict; Evans, Becky; Ward, Deborah; Solomon, Tom; Kneen, Rachel

    2015-11-11

    This article provides an overview of encephalitis and addresses its diagnosis, some of the common presenting signs and symptoms, and the different aspects of nursing care required for these patients. In particular, it addresses how to explain encephalitis to the patient's relatives, the rehabilitation needs of these patients, and important aspects of discharge planning. Tests that are necessary for diagnosis in patients with suspected encephalitis and the importance of these are explained.

  3. Patient blood management equals patient safety.

    PubMed

    Zacharowski, Kai; Spahn, Donat R

    2016-06-01

    Patient blood management (PBM) can be defined in many ways and may consist of hundreds of single measures to improve patient safety. Traditionally, PBM is based on three pillars and defined as (i) optimization of the endogenous red blood cell (RBC) mass through the targeted stimulation of erythropoiesis and the treatment of modifiable underlying disorders; (ii) minimization of diagnostic, interventional, and surgical blood loss to preserve the patient's RBC mass; and (iii) optimization of the patient-specific tolerance to anemia through strict adherence to physiological transfusion thresholds [1-4]. However, for this review, we have chosen the following three peri-interventional parts: (1) diagnosis and therapy of anemia, (2) optimal hemotherapy, and (3) minimization of hospital-acquired anemia. PBM is an evidence-based, multidisciplinary preventive, and therapeutic approach focusing each patient. The PBM concept involves the use of safe and effective medical and surgical methods and techniques designed to prevent peri-interventional anemia, rationalize use of blood products, and set good blood management measures in an effort to improve patient safety and outcome.

  4. Using Lexical Familiarity Judgments to Assess Verbally-Mediated Intelligence in Aphasia

    PubMed Central

    Leritz, Elizabeth C.; McGlinchey, Regina E.; Lundgren, Kristine; Grande, Laura J.; Milberg, William P.

    2010-01-01

    In this study, a task using forced-choice lexical familiarity judgments of irregular versus archaic words (a newly developed measure called the Lexical Orthographic Familiarity Test; LOFT) was compared to a standardized oral word-reading measure (the Wechsler Test of Adult Reading; WTAR) in a group of 35 aphasic adults and a comparison group of 125 community dwelling, non-brain damaged adults. When compared to non-brain damaged adults, aphasics had significantly lower scores on the WTAR but not the LOFT. Although both the WTAR and LOFT were significantly correlated with education in the non-brain damaged group, only the LOFT was correlated with education and also with the Barona full scale IQ index in the aphasic group. Lastly, WTAR performance showed a significantly greater relationship to the severity of language disorder in the aphasic group than did the LOFT. These results have both theoretical and clinical implications for the assessment of language disordered adults, as they indicate that patients with aphasia may retain aspects of verbally mediated intelligence, and that the LOFT may provide a better estimate of premorbid functioning in aphasia than other currently available measures. PMID:18999341

  5. Patient-centered Communication

    PubMed Central

    Swenson, Sara L; Buell, Stephanie; Zettler, Patti; White, Martha; Ruston, Delaney C; Lo, Bernard

    2004-01-01

    OBJECTIVE To investigate patient preferences for a patient-centered or a biomedical communication style. DESIGN Randomized study. SETTING Urgent care and ambulatory medicine clinics in an academic medical center. PARTICIPANTS We recruited 250 English-speaking adult patients, excluding patients whose medical illnesses prevented evaluation of the study intervention. INTERVENTION Participants watched one of three videotaped scenarios of simulated patient-physician discussions of complementary and alternative medicine (CAM). Each participant watched two versions of the scenario (biomedical vs. patient-centered communication style) and completed written and oral questionnaires to assess outcome measurements. MEASUREMENTS AND MAIN RESULTS Main outcome measures were 1) preferences for a patient-centered versus a biomedical communication style; and 2) predictors of communication style preference. Participants who preferred the patient-centered style (69%; 95% confidence interval [CI], 63 to 75) tended to be younger (82%[51/62] for age < 30; 68%[100/148] for ages 30–59; 55%[21/38] for age > 59; P < .03), more educated (76%[54/71] for postcollege education; 73%[94/128] for some college; 49%[23/47] for high school only; P = .003), use CAM (75%[140/188] vs. 55%[33/60] for nonusers; P = .006), and have a patient-centered physician (88%[74/84] vs. 30%[16/54] for those with a biomedical physician; P < .0001). On multivariate analysis, factors independently associated with preferring the patient-centered style included younger age, use of herbal CAM, having a patient-centered physician, and rating a “doctor's interest in you as a person” as “very important.” CONCLUSIONS Given that a significant proportion of patients prefer a biomedical communication style, practicing physicians and medical educators should strive for flexible approaches to physician-patient communication. PMID:15566435

  6. Why measure patient satisfaction?

    PubMed

    Riskind, Patty; Fossey, Leslie; Brill, Kari

    2011-01-01

    A practice that consistently and continuously measures patient perceptions will be more efficient and effective in its daily operations. With pay-for-performance requirements on the horizon and consumer rating sites already publicizing impressions from physician encounters, a practice needs to know how it is performing through the eyes of the patients. Azalea Orthopedics has used patient feedback to coach its physicians on better patient communication. The Orthopaedic Institute has used patient satisfaction results to reduce wait times and measure the return on investment from its marketing efforts. Patient survey results that are put to work can enhance the efficiency and effectiveness of practice operations as well as position the practice for increased profitability.

  7. Patient Education: An Annotated Bibliography.

    ERIC Educational Resources Information Center

    Simmons, Jeannette

    Topics included in this annotated bibliography on patient education are (1) background on development of patient education programs, (2) patient education interventions, (3) references for health professionals, and (4) research and evaluation in patient education. (TA)

  8. Histoplasmosis in immunosuppressed patients.

    PubMed

    Kauffman, C A; Israel, K S; Smith, J W; White, A C; Schwarz, J; Brooks, G F

    1978-06-01

    Infection with Histoplasma capsulatum in 58 patients whose immune responses were suppressed (Immunosuppressed patients) (16 from the present series and 42 described previously) was analyzed. The most common underlying diseases were Hodgkin's disease (29 per cent), chronic lymphocytic leukemia (19 per cent) and acute lymphocytic leukemia (17 per cent). Sixty-three per cent of the patients had received cytotoxic drugs, and 57 per cent had taken corticosteroids. Widely disseminated infection occurred in 88 per cent of the patients, with predominant involvement of lungs and organs of the reticuloendothelial system. Localized pulmonary infection was present in the remaining patients. The most useful diagnostic method was bone marrow biopsy with microscopic examination for the intracellular yeast form of H. capsulatum. Biopsy of oral lesions, lung, liver and lymph node also proved diagnostically helpful. Growth of H. capsulatum in culture was frequently too slow to be beneficial in diagnosing histoplasmosis in ill patients. Serologic methods were of little diagnostic help in this population of immunosuppressed patients. The response to amphotericin B therapy was excellent (6.7 per cent mortality rate) in those patients in whom the diagnosis was established early and in whom a full course of antifungal therapy could be given. In contrast, the mortality rate in patients who received no antifungal therapy or less than 1 g of amphotericin B was 100 per cent.

  9. Speech and language therapy for aphasia following subacute stroke

    PubMed Central

    Koyuncu, Engin; Çam, Pınar; Altınok, Nermin; Çallı, Duygu Ekinci; Duman, Tuba Yarbay; Özgirgin, Neşe

    2016-01-01

    The aim of this study was to investigate the time window, duration and intensity of optimal speech and language therapy applied to aphasic patients with subacute stroke in our hospital. The study consisted of 33 patients being hospitalized for stroke rehabilitation in our hospital with first stroke but without previous history of speech and language therapy. Sixteen sessions of impairment-based speech and language therapy were applied to the patients, 30–60 minutes per day, 2 days a week, for 8 successive weeks. Aphasia assessment in stroke patients was performed with Gülhane Aphasia Test-2 before and after treatment. Compared with before treatment, fluency of speech, listening comprehension, reading comprehension, oral motor evaluation, automatic speech, repetition and naming were improved after treatment. This suggests that 16 seesions of speech and language therapy, 30–60 minutes per day, 2 days a week, for 8 successive weeks, are effective in the treatment of aphasic patients with subacute stroke. PMID:27904489

  10. The critically ill immunosuppressed patient

    SciTech Connect

    Parrillo, J.E.; Masur, H. )

    1987-01-01

    This book discusses the papers on the diagnosis and management of immunosuppressed patient. Some of the topics are: life-threatening organ failure in immunosuppressed patients; diagnosis and therapy of respiratory disease in the immunosuppressed patient; CNS complication of immunosuppression; infections; antineoplastic therapy of immunosuppressed patient; radiation therapy-issues in critically ill patient; AIDS; and management of bone marrow transplant patients.

  11. A Patient Assessment Guide

    ERIC Educational Resources Information Center

    Fuller, Dorothy; Rosenaur, Janet Allan

    1974-01-01

    Use of a nursing assessment/patient history tool developed by project faculty at the school of nursing, University of California, San Francisco and used in a primary care clinic assisted nursing students in collecting patient information, making home visits, functioning as team members, recording data, and in defining their nursing role. (EA)

  12. Patient Telmonitoring at Home

    DTIC Science & Technology

    2007-11-02

    Fraga , M. Lama and J. Vila. “Intelligent telemonitoring of critical care patients,” IEEE Eng. Med. & Biol. Mag., vol. 18, pp. 80-88, July/August...1999. [6] J. Presedo, D. Castro, J. Vila, M. Fernández-Delgado, S. Fraga , M. Lama and S. Barro. “Wireless interface for monitored patients in Coronary

  13. Patient Education Thesaurus.

    ERIC Educational Resources Information Center

    Cooper, Lynn

    This thesaurus was compiled to make the materials in the Patient Education Room of the Donald J. Vincent Medical Library at Riverside Methodist Hospital, Columbus, Ohio, more accessible to patients. Subjects are grouped in fairly broad categories (e.g., Aging & Problems of Aging; Alcohol & Alcohol Abuse; Careers in the Medical Field; Childhood and…

  14. Primary progressive aphasia: diagnosis, varieties, evolution.

    PubMed

    Kertesz, Andrew; Davidson, Wilda; McCabe, Patricia; Takagi, Kenji; Munoz, David

    2003-07-01

    A referred cohort of 67 clinically defined PPA patients were compared to 99 AD patients with formal language and nonverbal cognitive tests in a case control design. Language fluency was determined at the first and last follow up visits. Quantitation of sulcal and ventricular atrophy on MRI was carried out in 46 PPA and 53 AD patients. Most PPA patients (57%) are relatively fluent when first examined. Visuospatial and memory functions are initially preserved. Aphemic, stuttering, "pure motor" presentation, or agrammatic aphasia are seen less frequently. Later most PPAs become logopenic and nonfluent, even those with semantic aphasia (dementia). In contrast, AD patients were more fluent and had relatively lower comprehension, but better overall language performance. MRI showed significant left sided atrophy in most PPA patients. Subsequent to PPA, 25 patients developed behavioral manifestations of frontotemporal dementia and 15 the corticobasal degeneration syndrome, indicating the substantial clinical overlap of these conditions. Language testing, particularly fluency scores supported by neuroimaging are helpful differentiating PPA from AD. The fluent-nonfluent dichotomy in PPA is mostly stage related. The aphemic-logopenic-agrammatic and semantic distinction is useful, but the outcomes converge.

  15. [Physiotherapy of cancer patients].

    PubMed

    Gomez, Izabella; Szekanecz, Éva; Szekanecz, Zoltán; Bender, Tamás

    2016-07-01

    Physiotherapy of cancer patients is one of the most controversial issues in our country. Malignant diseases are firstly mentioned as a contraindication of physiotherapy. Until now, physiotherapy was not suggested (or only in limited accessibility) for those patients who had malignant disease in medical history. International medical practice was less restrictive in managing this topic. The development of imaging techniques put this question in a new light. On the basis of evidence, the majority of articles have reported beneficial effects of physiotherapy in cancer patients, and only few articles mentioned it as harmful. Of course, each patient requires an individual assessment, however, if we exclude the possibility of tumor recurrence and metastasis, most of physiotherapy procedures can be used safely. One of the aims of this review is to support the physicians' decisions when to prescribe treatments, in such a way, that more patients could receive physiotherapy. Orv. Hetil., 2016, 157(31), 1224-1231.

  16. Doctor-patient relationship

    PubMed Central

    Chamsi-Pasha, Hassan; Albar, Mohammed A.

    2016-01-01

    The doctor-patient relationship is an intricate concept in which patients voluntarily approach a doctor and become part of a contract by which they tend to abide by doctor’s instructions. Over recent decades, this relationship has changed dramatically due to privatization and commercialization of the health sector. A review of the relevant literature in the database of MEDLINE published in English between 1966 and August 2015 was performed with the following keywords: doctor-patient relationship, physician-patient relationship, ethics, and Islam. The Muslim doctor should be familiar with the Islamic teachings on the daily issues faced in his/her practice and the relationship with his/her patients. PMID:26837392

  17. Mirror neuron system based therapy for aphasia rehabilitation

    PubMed Central

    Chen, Wenli; Ye, Qian; Ji, Xiangtong; Zhang, Sicong; Yang, Xi; Zhou, Qiumin; Cong, Fang; Chen, Wei; Zhang, Xin; Zhang, Bing; Xia, Yang; Yuan, Ti-Fei; Shan, Chunlei

    2015-01-01

    Objective: To investigate the effect of hand action observation training, i.e., mirror neuron system (MNS) based training, on language function of aphasic patients after stroke. In addition, to reveal the tentative mechanism underlying this effect. Methods: Six aphasic patients after stroke, meeting the criteria, undergo 3 weeks' training protocol (30 min per day, 6 days per week). Among them, four patients accepted an ABA training design, i.e., they implemented Protocol A (hand action observation combined with repetition) in the first and third weeks and carried out Protocol B (static object observation combined with repetition) in the second week. Conversely, for the other two patients, BAB training design was adopted, i.e., patients took Protocol B in the first and third weeks and accepted Protocol A in the second week. Picture naming test, western aphasia battery (WAB) and Token Test were applied to evaluate the changes of language function before and after each week's training. Furthermore, two subjects (one aphasic patient and one healthy volunteer) attended a functional MRI (fMRI) experiment, by which we tried to reveal the mechanism underlying possible language function changes after training. Results: Compared with static object observation and repetition training (Protocol B), hand action observation and repetition training (Protocol A) effectively improved most aspects of the language function in all six patients, as demonstrated in the picture naming test, subtests of oral language and aphasia quotient (AQ) of WAB. In addition, the fMRI experiment showed that Protocol A induced more activations in the MNS of one patient and one healthy control when compared to Protocol B. Conclusion: The mirror neuron based therapy may facilitate the language recovery for aphasic patients and this, to some extent, provides a novel direction of rehabilitation for aphasia patients. PMID:26579046

  18. Patients living with disabilities

    PubMed Central

    Lofters, Aisha; Guilcher, Sara; Maulkhan, Niraj; Milligan, James; Lee, Joseph

    2016-01-01

    Objective To compare the potential risk factors for lower-quality primary care, the potential markers of unmet needs in primary care, and the willingness to participate in future research among primary care patients with versus without physical disabilities. Design A waiting room survey using a convenience sample. Setting A family health team (FHT) in Kitchener-Waterloo, Ont, with a designated Mobility Clinic. Participants A total of 40 patients seen at the FHT Mobility Clinic and 80 patients from the general patient population of the same FHT. Main outcome measures Socioeconomic status and social capital, number of self-reported emergency department visits and hospitalizations in the preceding year, and willingness of the patients in the 2 groups to participate in future research studies. Results Patients from the Mobility Clinic were more than twice as likely to be receiving benefits or social assistance (75.0% vs 32.1%, P < .001), were twice as likely to report an annual household income of less than $40000 (58.6% vs 29.2%, P = .006), and were more likely to report their health status to be fair or poor (42.5% vs 16.2%, P = .002). Half of Mobility Clinic patients had visited the emergency department at least once in the preceding year, compared with 29.7% in the general patient population (P = .027). When asked if they would be willing to provide their health card number in the future so that it could be linked to health care data for research, 82.5% of Mobility Clinic patients agreed versus 55.0% of those in the general patient population (P = .004). Conclusion In this study, patients with disabilities were at a social disadvantage compared with their peers without disabilities and were more likely to use the emergency department, suggesting that they had unmet health needs. Future research should continue to explore this patient population and to investigate if an interprofessional primary health care team approach focused on patients with disabilities can

  19. Patients with resistant hypertension.

    PubMed

    Amar, Jacques

    2007-06-01

    Hypertension remains uncontrolled in the majority of treated patients, especially those with multiple cardiovascular risk factors. This was demonstrated by a French study that showed that 70% of treated hypertensive patients are not controlled to the target level of 140/90 mmHg. This proportion reached 84% in hypertensive patients with diabetes (target level 130/85 mmHg). What are the reasons for this disappointing situation? Observational studies have shown that only a minority of patients with uncontrolled hypertension receive triple therapy including a diuretic. In this respect, self-measurement of blood pressure should improve the situation by allowing clinicians to base their decision to intensify hypertension treatment on more solid evidence than consultation blood pressure measurements alone. Patient-related factors may also contribute to this situation. Treated patients with uncontrolled hypertension often have multiple risk factors. This is associated with or is a source of poor treatment observance linked to patient psychological factors or a result of the increased consumption of medication. Finally, risk factors themselves may be responsible for problems with blood pressure control as a result of their detrimental effects on large arteries as well as the microvascular network. The early correction of such vascular anomalies is vital for medium and long-term blood pressure control.

  20. Bacteremia in hemodialysis patients

    PubMed Central

    Suzuki, Masashi; Satoh, Nobuhiko; Nakamura, Motonobu; Horita, Shoko; Seki, George; Moriya, Kyoji

    2016-01-01

    Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of the causative organisms of bacteremia in hemodialysis patients are Gram-positive bacteria. The ratio of resistant bacteria in hemodialysis patients compared to the general population is unclear. Several reports have indicated that hemodialysis patients have a higher risk of methicillin-resistant Staphylococcus aureus infection. The most common site of infection causing bacteremia is internal prostheses; the use of a hemodialysis catheter is the most important risk factor for bacteremia. Although antibiotic lock of hemodialysis catheters and topical antibiotic ointment can reduce catheter-related blood stream infection (CRBSI), their use should be limited to necessary cases because of the emergence of resistant organisms. Systemic antibiotic administration and catheter removal is recommended for treating CRBSI, although a study indicated the advantages of antibiotic lock and guidewire exchange of catheters over systemic antibiotic therapy. An infection control bundle recommended by the Center for Disease Control and Prevention succeeded in reducing bacteremia in hemodialysis patients with either a catheter or arteriovenous fistula. Appropriate infection control can reduce bacteremia in hemodialysis patients. PMID:27872830

  1. Nutrition in dialysis patients.

    PubMed

    Sen, D; Prakash, J

    2000-07-01

    Malnutrition is a common clinical problem in dialysis patients, which is multifactorial in origin. It is most often found in a patient of chronic renal failure (CRF) during the period when the glomerular filtration rate (GFR) falls below 10 ml/min, but dialysis is yet to be started. The loss of proteins, aminoacids and other essential nutrients during the procedure of dialysis may further aggravate the malnutrition. Poor nutrition in dialysis patients is associated with increased morbidity and mortality in the form of delayed wound healing, malaise, fatigue, increased susceptibility to infection and poor rehabilitation. In view of the above consequences, all patients on dialysis must undergo nutritional assessment. It is very vital to maintain good nutritional status in-patients on dialysis by adequate protein and calories intake, appropriate supplementation of iron, calcium, minerals and water-soluble vitamins and, of course, the supplementation should be individualised. Nutritional needs are enhanced in presence of stresses like infection or surgery to limit excessive tissue catabolism and therefore, these are the situations, which demand intensive nutrition therapy. Total parenteral nutrition (TPN) may be required for patients on dialysis in intensive care unit, using a central venous catheter. However, enteral route is always preferred to parenteral ones, whenever possible. Even after adequate dialysis has been given, dietary counselling is often required for both hemodialysis and peritoneal dialysis patients to ensure that they ingest the recommended amount of protein, calories and essential micronutrients.

  2. Respecting patient confidentiality.

    PubMed

    Price, Bob

    2015-02-03

    Nurses face a particular challenge in respecting the confidentiality of patients in a world where information is quickly shared and where information about illness can be sensitive. We have a duty of care towards patients. That duty includes maintaining privacy (protecting them from undue intrusion), and confidentiality (by the discreet management of information about themselves that they share with us). Legislation on confidentiality comes from different sources and should be interpreted in the clinical setting. This article summarises the principal requirements set out in the legislation and directs readers to questions and tools designed to help them explore the extent to which patient confidentiality is respected where they work.

  3. Evaluation of Patient Welfare

    PubMed Central

    Piedmont, Eugene B.; Dornblaser, Bright M.

    1970-01-01

    A multifaceted attempt is made to measure patients' well-being quantitatively in a complex interdisciplinary research and experimental construction project. Parallel studies were conducted in adjoining traditionally shaped and spoke-design hospital buildings. Major innovations were made, in both plants, in the organization of nursing staffs and in communications and logistical support. Smaller nursing staffs achieved significant increases in time spent in direct patient (“bedside”) care, without negative effects on patient welfare, in both buildings; but these effects were maximized in the spoke-design building. PMID:5494267

  4. The patient with ataxia.

    PubMed

    Maggs, F G

    2014-01-01

    In this article we look at the causes of ataxia, and how the patient presenting with ataxia should be managed. One of the difficulties in managing the patient with ataxia is that acute ataxia has many causes, but usually these can be teased out by means of a careful history and examination. Investigations can then be targeted at confirming or disproving the differential diagnosis. Some patients with ataxia need to be managed in hospital, but many can be investigated, and receive therapy, as an outpatient.

  5. MRSA Information for Patients

    MedlinePlus

    ... can be spread when patients contact contaminated bed linens, bed rails, and medical equipment. Top of Page ... razors. Wash and dry your clothes and bed linens in the warmest temperatures recommended on the labels. ...

  6. Patient Treatment Tracking Chart

    MedlinePlus

    ... Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival Golden Age Games Summer Sports Clinic ... Patient Treatment Tutorial return to top CONNECT Veterans Crisis Line: 1-800-273-8255 (Press 1) Social ...

  7. [Patient safety: Glossary].

    PubMed

    Sabio Paz, Verónica; Panattieri, Néstor D; Cristina Godio, Farmacéutica; Ratto, María E; Arpí, Lucrecia; Dackiewicz, Nora

    2015-10-01

    Patient safety and quality of care has become a challenge for health systems. Health care is an increasingly complex and risky activity, as it represents a combination of human, technological and organizational processes. It is necessary, therefore, to take effective actions to reduce the adverse events and mitigate its impact. This glossary is a local adaptation of key terms and concepts from the international bibliographic sources. The aim is providing a common language for assessing patient safety processes and compare them.

  8. Patient care in radiography

    SciTech Connect

    Ehrlich, R.A.; McCloskey, E.D.

    1989-01-01

    This book focuses on patient care procedures for radiographers. The authors focus on the role of the radiographer as a member of the health care team. The authors report on such topics as communication in patient care: safety, medico-legal considerations, transfer and positioning; physical needs; infection control; medication; CPR standards, acute situations; examination of the GI tract; contrast media; special imaging techniques and bedside radiography.

  9. Turning patients over in bed

    MedlinePlus

    Roll patients in bed ... following steps should be followed: Explain to the patient what you are planning to do so the ... Stand on the side of the bed the patient will be turning towards and lower the bed ...

  10. Preventing Infections in Cancer Patients

    MedlinePlus

    ... Caregivers Flu Treatment for Cancer Patients and Survivors Flu Publications Stay Informed Cancer Home Information for Patients and Caregivers Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir Cancer patients ...

  11. Cytomegalovirus Colitis in Immunocompetent Patients

    PubMed Central

    Hussain, Qulsoom; Shafique, Khurram; Tasleem, Syed H; Hurairah, Abu

    2016-01-01

    Cytomegalovirus colitis is common in immunocompromised patients, but rare in immunocompetent patients. The present study not only represents the colonoscopy and pathological findings, but also applies the method of diagnosing and treating cytomegalovirus colitis in immunocompetent patients. PMID:27980888

  12. [Urosepsis in Geriatric Patients].

    PubMed

    Heppner, H J; Yapan, F; Wiedemann, A

    2016-02-01

    Due to the demographic shift, increasing numbers of geriatric patients are admitted to acute care hospitals of all levels of care. This means that special challenges must be met in the medical care and management of these patients.Immunosenescence and multimorbidity make elderly patients vulnerable to infectious diseases. Urinary tract infections range from "simple" cystitis to pyelonephritis and urosepsis and, at 25%, are the second most common form of infection in geriatric patients. It is often difficult to make a diagnosis because typical symptoms do not always occur. Urosepsis, a hyperactive and uncontrolled immune response of the organism due to exogenous damage, is based on bacterial infection of the urogenital tract. Urinary retention, immunosuppressive medication, malignancy, diabetes mellitus and renal or prostatic processes promote the risk for urosepsis. Complicated urosepsis additionally comprises a structural or functional abnormality, including ureteral obstruction. Risk factors for urosepsis are urinary incontinence, an indwelling urinary catheter, hydronephrosis or ureteral calculi. Patients suffering from diabetes mellitus are also at a higher risk for urosepsis. When diagnosing elderly patients, one has to consider that the classic symptoms can be masked by multimorbidity, or septic encephalopathy and acute confusion (delirium) may be the only symptoms. Body temperature is lower in elderly patients and does not necessarily rise to 38°C or more in the acute phase. In patients older than 75 years who are suspicious for sepsis, temperatures as low as 37.4°C should be rated as fever. Treatment of urosepsis basically includes clearing the focus, antimicrobial treatment, stabilisation of circulation and replacement of failed organ functions. Initial empiric antibiotic treatment, depending on local resistance, should be done with acylaminopenicilline and beta-lactamase inhibitors (e. g. piperacillin/combactam or tazobactam or group 3 cephalosporins

  13. Mastocytosis among elderly patients

    PubMed Central

    Rouet, Audrey; Aouba, Achille; Damaj, Gandhi; Soucié, Erinn; Hanssens, Katia; Chandesris, Marie-Olivia; Livideanu, Cristina Bulai; Dutertre, Marine; Durieu, Isabelle; Grandpeix-Guyodo, Catherine; Barète, Stéphane; Bachmeyer, Claude; Soria, Angèle; Frenzel, Laurent; Fain, Olivier; Grosbois, Bernard; de Gennes, Christian; Hamidou, Mohamed; Arlet, Jean-Benoit; Launay, David; Lavigne, Christian; Arock, Michel; Lortholary, Olivier; Dubreuil, Patrice; Hermine, Olivier; Georgin-Lavialle, Sophie

    2016-01-01

    Abstract Mastocytosis is a heterogeneous group of diseases with a young median age at diagnosis. Usually indolent and self-limited in childhood, the disease can exhibit aggressive progression in mid-adulthood. Our objectives were to describe the characteristics of the disease when diagnosed among elderly patients, for which rare data are available. The French Reference Center conducted a retrospective multicenter study on 53 patients with mastocytosis >69 years of age, to describe their clinical, biological, and genetic features. The median age of our cohort of patients was 75 years. Mastocytosis variants included were cutaneous (n = 1), indolent systemic (n = 5), aggressive systemic (n = 11), associated with a hematological non-mast cell disease (n = 34), and mast cell leukemia (n = 2). Clinical manifestations were predominantly mast cell activation symptoms (75.5%), poor performance status (50.9%), hepatosplenomegaly (50.9%), skin involvement (49.1%), osteoporosis (47.2%), and portal hypertension and ascites (26.4%). The main biological features were anemia (79.2%), thrombocytopenia (50.9%), leucopenia (20.8%), and liver enzyme abnormalities (32.1%). Of the 40 patients tested, 34 (85%), 2 (5%), and 4 (10%) exhibited the KIT D816V mutant, other KIT mutations and the wild-type form of the KIT gene, respectively. Additional sequencing detected significant genetic defects in 17 of 26 (65.3%) of the patients with associated hematological non-mast cell disease, including TET2, SRSF2, IDH2, and ASLX1 mutations. Death occurred in 19 (35.8%) patients, within a median delay of 9 months, despite the different treatment options available. Mastocytosis among elderly patients has a challenging early detection, rare skin involvement, and/or limited skin disease; it is heterogeneous and has often an aggressive presentation with nonfortuitous associated myeloid lineage malignant clones, and thus a poor overall prognosis. PMID:27310990

  14. Thromboprophylaxis in nonsurgical patients.

    PubMed

    Streiff, Michael B; Lau, Brandyn D

    2012-01-01

    Venous thromboembolism (VTE) is an important cause of preventable morbidity and mortality in medically ill patients. Randomized controlled trials indicate that pharmacologic prophylaxis reduces deep venous thrombosis (relative risk [RR] = 0.46; 95% confidence interval [CI], 0.36-0.59) and pulmonary embolism (RR = 0.49; 95% CI, 0.33-0.72) with a nonsignificant trend toward more bleeding (RR = 1.36; 95% CI, 0.80-2.33]. Low-molecular-weight heparin (LMWH) and unfractionated heparin are equally efficacious in preventing deep venous thrombosis (RR = 0.85; 95% CI, 0.69-1.06) and pulmonary embolism (RR = 1.05; 95% CI, 0.47-2.38), but LMWH is associated with significantly less major bleeding (RR = 0.45; 95% CI, 0.23-0.85). LMWH is favored for VTE prophylaxis in critically ill patients. New VTE and bleeding risk stratification tools offer the potential to improve the risk-benefit ratio for VTE prophylaxis in medically ill patients. Intermittent pneumatic compression devices should be used for VTE prophylaxis in patients with contraindications to pharmacologic prophylaxis. Graduated compression stockings should be used with caution. VTE prevention in medically ill patients using extended-duration VTE prophylaxis and new oral anticoagulants warrant further investigation. VTE prophylaxis prescription and administration rates are suboptimal and warrant multidisciplinary performance improvement strategies.

  15. Childhood Aphasia and Brain Damage: Volume II, Differential Diagnosis.

    ERIC Educational Resources Information Center

    Rappaport, Sheldon R., Ed.

    Addressing itself to factors leading to the misdiagnosis of the brain damaged child and the aphasic child, the Pathway School's Second Annual Institute considered the differences between the following: the aphasic and the aphasoid child; the sensory aphasic and the deaf child; the psychotic and the psychotic aphasic child; childhood brain damage…

  16. The moderators of patient satisfaction.

    PubMed

    Tucker, Jessie L

    2002-01-01

    The purpose of this study was to determine which Department of Defense (DOD) active duty patient sociodemographic, health status, geographic location, and utilization factors, predict overall patient satisfaction with health care in military facilities. A theoretical framework developed from patient satisfaction and social identity theories and from previous empirical findings was used to develop a model to predict patient satisfaction and delineate moderating variables. The major finding indicated in this study was the significance of patients' characteristics in moderating their satisfaction. Principal components factor analysis and hierarchical linear regression revealed that patient specific factors predicted patients' satisfaction after controlling for factors depicting patients' evaluations of health system characteristics. Patient specific factors provided added, although very minimal, explanatory value to the determination of patients' satisfaction. The study findings can aid in the development of targeted, objectively prioritized programs of improvement and marketing by ranking variables using patients' passively derived importance schema.

  17. Phonological Processing in Primary Progressive Aphasia.

    PubMed

    Henry, Maya L; Wilson, Stephen M; Babiak, Miranda C; Mandelli, Maria Luisa; Beeson, Pelagie M; Miller, Zachary A; Gorno-Tempini, Maria Luisa

    2016-02-01

    Individuals with primary progressive aphasia (PPA) show selective breakdown in regions within the proposed dorsal (articulatory-phonological) and ventral (lexical-semantic) pathways involved in language processing. Phonological STM impairment, which has been attributed to selective damage to dorsal pathway structures, is considered to be a distinctive feature of the logopenic variant of PPA. By contrast, phonological abilities are considered to be relatively spared in the semantic variant and are largely unexplored in the nonfluent/agrammatic variant. Comprehensive assessment of phonological ability in the three variants of PPA has not been undertaken. We investigated phonological processing skills in a group of participants with PPA as well as healthy controls, with the goal of identifying whether patterns of performance support the dorsal versus ventral functional-anatomical framework and to discern whether phonological ability differs among PPA subtypes. We also explored the neural bases of phonological performance using voxel-based morphometry. Phonological performance was impaired in patients with damage to dorsal pathway structures (nonfluent/agrammatic and logopenic variants), with logopenic participants demonstrating particular difficulty on tasks involving nonwords. Binary logistic regression revealed that select phonological tasks predicted diagnostic group membership in the less fluent variants of PPA with a high degree of accuracy, particularly in conjunction with a motor speech measure. Brain-behavior correlations indicated a significant association between the integrity of gray matter in frontal and temporoparietal regions of the left hemisphere and phonological skill. Findings confirm the critical role of dorsal stream structures in phonological processing and demonstrate unique patterns of impaired phonological processing in logopenic and nonfluent/agrammatic variants of PPA.

  18. Phonological processing in primary progressive aphasia

    PubMed Central

    Henry, M.L.; Wilson, S.M.; Babiak, M.C.; Mandelli, M.L; Beeson, P.M.; Miller, Z.A.; Gorno-Tempini, M.L.

    2016-01-01

    Individuals with primary progressive aphasia (PPA) show selective breakdown in regions within the proposed dorsal (articulatory-phonological) and ventral (lexical-semantic) pathways involved in language processing. Phonological short-term memory impairment, which has been attributed to selective damage to dorsal pathway structures, is considered to be a distinctive feature of the logopenic variant of PPA. By contrast, phonological abilities are considered to be relatively spared in the semantic variant and are largely unexplored in the nonfluent/agrammatic variant. Comprehensive assessment of phonological ability in the three variants of PPA has not been undertaken. We investigated phonological processing skills in a group of participants with PPA as well as healthy controls, with the goal of identifying whether patterns of performance support the dorsal versus ventral functional-anatomical framework and to discern whether phonological ability differs amongst PPA subtypes. We also explored the neural bases of phonological performance using voxel-based morphometry (VBM). Phonological performance was impaired in patients with damage to dorsal pathway structures (nonfluent/agrammatic and logopenic variants), with logopenic participants demonstrating particular difficulty on tasks involving nonwords. Binary logistic regression revealed that select phonological tasks predicted diagnostic group membership in the less fluent variants of PPA with a high degree of accuracy, particularly in conjunction with a motor speech measure. Brain-behavior correlations indicated a significant association between the integrity of gray matter in frontal and temporoparietal regions of the left hemisphere and phonological skill. Findings confirm the critical role of dorsal stream structures in phonological processing and demonstrate unique patterns of impaired phonological processing in logopenic and nonfluent/agrammatic variants of PPA. PMID:26544920

  19. Hypertension in aging patients.

    PubMed

    Logan, Alexander G

    2011-01-01

    Hypertension, especially isolated systolic hypertension, is commonly found in older (60-79 years of age) and elderly (≥80 years of age) people. Antihypertensive drug therapy should be considered in all aging hypertensive patients, as treatment greatly reduces cardiovascular events. Most classes of antihypertensive medications may be used as first-line treatment with the possible exception of α- and β-blockers. An initial blood pressure treatment goal is less than 140/90 mmHg in all older patients and less than 150/80 mmHg in the nonfrail elderly. The current paradigm of delaying therapeutic interventions until people are at moderate or high cardiovascular risk, a universal feature of hypertensive patients over 60 years of age, leads to vascular injury or disease that is only partially reversible with treatment. Future management will likely focus on intervening earlier to prevent accelerated vascular aging and irreversible arterial damage.

  20. Patients' preferences for information

    PubMed Central

    Kindelan, K.; Kent, G.

    1986-01-01

    In a study of patients' views of the type of information they would like to receive from the doctor 265 patients from four general practices were given a list of five areas of information — diagnosis, prognosis, treatment, aetiology and social effects of their illness — and asked to rank these in order of importance for that visit. In general, information on diagnosis and prognosis was the most highly valued, while the ways the illness would affect daily activities was the least preferred. Although information on treatment was rarely selected as the first preference it was often the second or third preference. Conversely, diagnosis was the first choice of the largest proportion of patients and the least valued information for 26%. PMID:3440990

  1. Handedness in psychiatric patients.

    PubMed

    Fleminger, J J; Dalton, R; Standage, K F

    1977-11-01

    Eight hundred psychiatric patients and eight hundred controls completed a handedness preference questionnaire. There was no significant difference in handedness between the two samples, but, contrary to some previous reports, excess of sinistrality was not associated with male sex. The distribution of handedness was similar in neurotics and controls, but among psychotics in general there was a higher proportion of fully right-handed subjects. Among schizophrenics there was a significantly higher proportion of left-handed writers among males than females. There were relatively few left-handed writers of either sex among patients with affective psychosis. Female patients with personality disorders had a significantly higher proportion of mixed handedness than controls. The findings are considered in relation to suggestions that functional psychoses may be associated with asymmetrical cerebral dysfunction, and that poorly lateralized function may be related to anomalous psychological development.

  2. Creating virtual ARDS patients.

    PubMed

    Das, Anup; Haque, Mainul; Chikhani, Marc; Wenfei Wang; Hardman, Jonathan G; Bates, Declan G

    2016-08-01

    This paper presents the methodology used in patient-specific calibration of a novel highly integrated model of the cardiovascular and pulmonary pathophysiology associated with Acute Respiratory Distress Syndrome (ARDS). We focus on data from previously published clinical trials on the static and dynamic cardio-pulmonary responses of three ARDS patients to changes in ventilator settings. From this data, the parameters of the integrated model were identified using an optimization-based methodology in multiple stages. Computational simulations confirm that the resulting model outputs accurately reproduce the available clinical data. Our results open up the possibility of creating in silico a biobank of virtual ARDS patients that could be used to evaluate current, and investigate novel, therapeutic strategies.

  3. Online patient information.

    PubMed

    Oakley, Amanda

    2002-09-01

    Information appropriate for patients with skin diseases is readily available on the Internet. Patients primarily seek disease-related information, but may also search for a dermatologist, shop for skin care products, or look to a consumer organization for support. Authoritative educational material is supplied by academic dermatologic associations and institutions and distributed by independent websites, large health portals, and search directories. Interactive opportunities include bulletin boards, ask-an-expert forums, and live chat. Although it is easy to find excellent dermatological information, the Internet is dynamic and unmoderated and patients can be misled or exploited by inaccurate or fraudulent websites. Health on the Net and other organizations have developed ethical principles to aid consumers in evaluating the quality of health-related information.

  4. [Toxoplasmosis in immunocompromised patients].

    PubMed

    Machala, L; Kodym, P; Malý, M; Geleneky, M; Beran, O; Jilich, D

    2015-06-01

    In humans, toxoplasmosis mostly occurs as a latent infection, but in immunocompromised individuals, the agent may reactivate and cause severe to life-threatening disease. HIV positive individuals and transplant recipients, in particular hematopoietic stem cell transplant and heart transplant recipients, are at highest risk. The disease most often affects the central nervous system but can involve any organ. Because of the alteration of the immune response in these patients, the serodiagnosis is not reliable and direct detection of the causative agent is needed--namely by microscopy and DNA PCR. If inadequately treated or left untreated, toxoplasmosis generally has a fatal prognosis in immunocompromised patients and therefore, the treatment must be started as early and energetically as possible. The gold standard both in the treatment of reactivation and secondary prophylaxis is the pyrimethamine-sulfadiazine combination while co-trimoxazole can be used in the primary prophylaxis for high-risk patients.

  5. [Respecting patient intimacy].

    PubMed

    2014-04-01

    Transparency as a general rule for all our professional acts casts doubts about the statement of the Hippocratic Oath that says "Whatever I see or hear in the lives of my patients, I will keep secret, as considering all such things to be private". Medical secrecy protects the intimacy of patients, who reveal to their physicians their most hidden secrets aiming to recover their health. Therefore, physicians should receive those secrets with reverence and care, as servers and not as their owners. The values associated with the respect for personal intimacy are the anthropological basis of medical confidentiality. A medical act is performed by definition between two equally honorable individuals. Therefore, the professional honors the trust of his patient, maintaining strict confidence of what is revealed. Therefore, medical secrecy must be strengthened rather than weakened, pursuing common wealth and dignity.

  6. Thromboprophylaxis for trauma patients

    PubMed Central

    Lozano, Luis Manuel Barrera; Perel, Pablo; Ker, Katharine; Cirocchi, Roberto; Farinella, Eriberto; Morales, Carlos Hernando

    2014-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of thromboprophylaxis in trauma patients on mortality and incidence of DVT and PE. To compare the effects of different thromboprophylaxis interventions and their relative effects according to the type of trauma. PMID:25267908

  7. [Healthcare patient loyalty].

    PubMed

    Ameri, Cinzia; Fiorini, Fulvio

    2016-01-01

    If the "old economy" preached standardization of products/services in order to reduce costs, the "new economy" is based on the recognition of the needs and the management of information. It is aimed at providing better and more usable services. One scenario is a national health service with regional management but based on competition between hospitals/companies.This led to a different handling of the user/patient, which has become the center of the health system: marketing seeks to retain the patient, trying to push a client-patient to not change their healthcare service provider. In costs terms, it is more economical to retain a customer rather than acquire a new one: a satisfied customer is also the best sounding board for each company. Customer equity is the management of relations with patients which can result in a greater customer value: it is possible to recognize an equity of the value, of the brand and of the report. Loyalty uses various marketing activities (basic, responsive, responsible, proactive and collaborative): each hospital/company chooses different actions depending on how many resources it plans to invest in loyalty.

  8. The Adolescent Patient.

    ERIC Educational Resources Information Center

    Daniel, William A., Jr.

    Written to orient the physician and paramedical personnel to the adolescent patient, the book provides information concerning the changes of adolescence, and age-related problems and illnesses. Part 1 discusses the essence of adolescence by describing physical, mental, and emotional growth and development. Part 2, the major section, consists of 21…

  9. A Patient's Best Friend.

    ERIC Educational Resources Information Center

    Haggard, Ann

    1985-01-01

    The author describes the development of a pet therapy program at a rehabilitation unit of a hospital. She discusses documentation of the success of pet therapy programs, picking out the right pets, responsibilities of caring for the pet, training the pet, patient response, and program policies. (CT)

  10. Long-term effects of transcranial direct-current stimulation in chronic post-stroke aphasia: a pilot study.

    PubMed

    Vestito, Lucilla; Rosellini, Sara; Mantero, Massimo; Bandini, Fabio

    2014-01-01

    Transcranial direct-current stimulation (tDCS) has been suggested to improve language function in patients with post-stroke aphasia. Most studies on aphasic patients, however, were conducted with a very limited follow-up period, if any. In this pilot, single-blind study on chronic post-stroke aphasic patients, we aimed to verify whether or not tDCS is able to extend its beneficial effects for a longer period of time (21 weeks after the end of stimulation). Three aphasic patients underwent anodal tDCS (A-tDCS, 20 min, 1.5 mA) and sham stimulation (S-tDCS) over the left frontal (perilesional) region, coupled with a simultaneous naming training (on-line tDCS). Ten consecutive sessions (5 days per week for 2 weeks) were implemented. In the first five sessions, we used a list of 40 figures, while in the subsequent five sessions we utilized a second set of 40 figures differing in word difficulty. At the end of the stimulation period, we found a significant beneficial effect of A-tDCS (as compared to baseline and S-tDCS) in all our subjects, regardless of word difficulty, although with some inter-individual differences. In the follow-up period, the percentage of correct responses persisted significantly better until the 16th week, when an initial decline in naming performance was observed. Up to the 21st week, the number of correct responses, though no longer significant, was still above the baseline level. These results in a small group of aphasic patients suggest a long-term beneficial effect of on-line A-tDCS.

  11. Processing of disyllabic compound words in Chinese aphasia: evidence for the processing limitations account.

    PubMed

    Lee, Chia-Lin; Hung, Daisy L; Tse, John K-P; Lee, Chia-Ying; Tsai, Jie-Li; Tzeng, Ovid J-L

    2005-02-01

    The current study addresses the debate between so-called 'structural' and 'processing limitation' accounts of aphasia, i.e., whether language impairments reflect the 'loss' of linguistic knowledge or its representations, or instead reflect a limitation in processing resources. Confrontation-naming task and category-judgment tasks were used to examine and compare the performance of non-fluent and fluent aphasics on different compound types of nouns and verbs. We demonstrate that aphasic patients' performance is modulated by the canonicity of the particular compound type, a result that holds true even for the category in which patients show a 'selective category deficit.' These findings weigh against the 'loss' of linguistic representations as the underlying cause of noun-verb deficits, instead supporting a 'processing limitations' approach.

  12. Recovery from aphasia and neglect after subcortical stroke: neuropsychological and cerebral perfusion study.

    PubMed Central

    Vallar, G; Perani, D; Cappa, S F; Messa, C; Lenzi, G L; Fazio, F

    1988-01-01

    Cortical regional cerebral perfusion was assessed by N, N, N1-trimethyl-N1-(2)-hydroxy-3-methyl-5-(I-123) iodobenzyl-1, 3-propanediamine 2 HCl I-123 (HIPDM) and single photon emission computerised tomography (SPECT) in six aphasic and two neglect patients with unilateral subcortical vascular lesions. Assessments were carried out both in the acute phase and after a period ranging from 1 to 6 months after stroke onset. In all patients an almost complete spontaneous recovery occurred and was associated with a significant improvement of cortical perfusion. A relationship between severity of aphasia and degree of cortical hypoperfusion was found, in both the acute and the follow up assessments, in the aphasic subgroup. Images PMID:2465386

  13. Cue Recognition and Integration – Eye Tracking Evidence of Processing Differences in Sentence Comprehension in Aphasia

    PubMed Central

    Schumacher, Rahel; Cazzoli, Dario; Eggenberger, Noëmi; Preisig, Basil; Nef, Tobias; Nyffeler, Thomas; Gutbrod, Klemens; Annoni, Jean-Marie; Müri, René M.

    2015-01-01

    Purpose We aimed at further elucidating whether aphasic patients’ difficulties in understanding non-canonical sentence structures, such as Passive or Object-Verb-Subject sentences, can be attributed to impaired morphosyntactic cue recognition, and to problems in integrating competing interpretations. Methods A sentence-picture matching task with canonical and non-canonical spoken sentences was performed using concurrent eye tracking. Accuracy, reaction time, and eye tracking data (fixations) of 50 healthy subjects and 12 aphasic patients were analysed. Results Patients showed increased error rates and reaction times, as well as delayed fixation preferences for target pictures in non-canonical sentences. Patients’ fixation patterns differed from healthy controls and revealed deficits in recognizing and immediately integrating morphosyntactic cues. Conclusion Our study corroborates the notion that difficulties in understanding syntactically complex sentences are attributable to a processing deficit encompassing delayed and therefore impaired recognition and integration of cues, as well as increased competition between interpretations. PMID:26562795

  14. Cerebral glucose metabolism in Wernicke's, Broca's, and conduction aphasia

    SciTech Connect

    Metter, E.J.; Kempler, D.; Jackson, C.; Hanson, W.R.; Mazziotta, J.C.; Phelps, M.E.

    1989-01-01

    Cerebral glucose metabolism was evaluated in patients with either Wernicke's (N = 7), Broca's (N = 11), or conduction (N = 10) aphasia using /sup 18/F-2-fluoro-2-deoxy-D-glucose with positron emission tomography. The three aphasic syndromes differed in the degree of left-to-right frontal metabolic asymmetry, with Broca's aphasia showing severe asymmetry and Wernicke's aphasia mild-to-moderate metabolic asymmetry, while patients with conduction aphasia were metabolically symmetric. On the other hand, the three syndromes showed the same degree of metabolic decline in the left temporal region. The parietal region appeared to separate conduction aphasia from both Broca's and Wernicke's aphasias. Common aphasic features in the three syndromes appear to be due to common changes in the temporal region, while unique features were associated with frontal and parietal metabolic differences.

  15. The dichotomous view on IFG lesion and non-fluent aphasia.

    PubMed

    Kasselimis, Dimitrios; Chatziantoniou, Lina; Peppas, Christos; Evdokimidis, Ioannis; Potagas, Constantin

    2015-09-01

    A lesion in inferior frontal gyrus (IFG) is traditionally considered to be crucial for the occurrence of non-fluent aphasia. However, recent studies question the axiomatic causality between a lesion in this area and the expected non-fluent aphasic syndrome. The aim of the present study is to investigate the relationship between IFG lesions and non-fluent aphasia. To address this question, we present radiological and neuropsychological data of 49 chronic aphasic patients. Lesions were identified based on CT and/or MRI scans. Aphasia was assessed using the Boston Diagnostic Aphasia Examination-short form. Analysis indicated a statistically significant association between IFG lesion and non-fluent aphasic disturbances. Nevertheless, a large proportion of our patients did not confirm the traditional prediction, namely that non-fluent patients' lesions would include the inferior frontal gyrus and the opposite would be true for fluent patients. Our results stress the importance of taking into account the size of particular estimates when conducting group analyses. We also argue in favor of examining individual data in clinical practice, and further suggest that the traditional lesion to syndrome correspondence seems to be oversimplified and should be thoroughly revisited.

  16. Gastric Cancer in Young Patients

    PubMed Central

    Dhobi, Manzoor A.; Wani, Khursheed Alam; Parray, Fazl Qadir; Wani, Rouf A.; Peer, G. Q.; Abdullah, Safiya; Wani, Imtiyaz A.; Wani, Muneer A.; Shah, Mubashir A.; Thakur, Natasha

    2013-01-01

    Aim. The aim of this study was to see the clinical, pathological, and demographic profile of young patients with stomach carcinoma besides association with p53. Patients and Methods. Prospective study of young patients with stomach carcinoma from January 2005 to December 2009. A total of 50 patients with age less than 40 years were studied. Results. Male female ratio was 1 : 1.08 in young patients and 2.5 : 1 in older patients. A positive family history of stomach cancer in the first degree relatives was present in 10% of young patients. Resection was possible only in 50% young patients. 26% young patients underwent only palliative gastrojejunostomy. The most common operation was lower partial gastrectomy in 68%. Amongst the intraoperative findings peritoneal metastasis was seen in 17.4% in young patients. 50% young patients presented in stage IV as per AJCC classification (P value .004; sig.). None of the patients presented as stage 1 disease in young group. Conclusion. Early detection of stomach carcinoma is very important in all patients but in young patients it is of paramount importance. PMID:24381753

  17. Visualising patient flow.

    PubMed

    Jensen, Andrew; Boyle, Justin; Khanna, Sankalp

    2012-01-01

    We describe the development of a method to distil routinely collected clinical data into patient flow information to aid hospital bed management. Using data from state-wide emergency department and inpatient clinical information systems, a user-friendly interface was developed to visualise patient flow conditions for a particular hospital. The historical snapshots employ a variable time scale, allowing flow to be visualised across a day, week, month or year. Flow information includes occupancy, arrival and departure rates, length-of-stay and access block observations, which can be filtered by age, departure status, diagnosis, elective status, triage category, and admission unit. The tool may be helpful in supporting hospital bed managers in their daily decision making.

  18. Communicating with Latino patients.

    PubMed

    de Pheils, Pilar Bernal; Saul, Naledi Marie

    2009-09-01

    This article describes the efforts of the University of California, San Francisco, School of Nursing to develop the Spanish language and cultural competency skills of advanced practice nursing students by establishing an elective course, Communicating with the Latino Patient. The need for this training is reflected in the literature, which has shown that language barriers decrease patient satisfaction and quality of care and increase the likelihood of medical error. Fifty-seven first-year master's students participated in this course. The effectiveness of the training was monitored during and after each course by self-assessment surveys of the participants' language acquisition. The data suggest that the most successful outcomes result from limiting class size, emphasizing high interactivity, and incorporating clinical experiences in the instruction, as well as focusing exclusively on intermediate-level speakers when resources are limited. Training can be time consuming and costly, yet graduates agreed that the training was imperative and valuable.

  19. Teleophthalmology: improving patient outcomes?

    PubMed Central

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  20. The visually impaired patient.

    PubMed

    Rosenberg, Eric A; Sperazza, Laura C

    2008-05-15

    Blindness or low vision affects more than 3 million Americans 40 years and older, and this number is projected to reach 5.5 million by 2020. In addition to treating a patient's vision loss and comorbid medical issues, physicians must be aware of the physical limitations and social issues associated with vision loss to optimize health and independent living for the visually impaired patient. In the United States, the four most prevalent etiologies of vision loss in persons 40 years and older are age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy. Exudative macular degeneration is treated with laser therapy, and progression of nonexudative macular degeneration in its advanced stages may be slowed with high-dose antioxidant and zinc regimens. The value of screening for glaucoma is uncertain; management of this condition relies on topical ocular medications. Cataract symptoms include decreased visual acuity, decreased color perception, decreased contrast sensitivity, and glare disability. Lifestyle and environmental interventions can improve function in patients with cataracts, but surgery is commonly performed if the condition worsens. Diabetic retinopathy responds to tight glucose control, and severe cases marked by macular edema are treated with laser photocoagulation. Vision-enhancing devices can help magnify objects, and nonoptical interventions include special filters and enhanced lighting.

  1. "The impatient patient".

    PubMed

    Bos, Lodewijk; Carroll, Denis; Marsh, Andy

    2008-01-01

    Modern Healthcare Systems that have embraced ICT and Internet technologies (referred to as Health 1.0) are evolving towards self management but from a clinical knowledge perspective. In contrast, from a user experience perspective, and using the latest web 2.0 technologies, the developing healthcare social networking communities (referred to as Health 2.0) are evolving towards becoming online medical portals. The growing Grand Challenge for healthcare is therefore: how will health care services (Health 1.0) work together with user-generated health care (Health 2.0) in a consumer market place delivering self management services for a healthier lifestyle and medical compliance. What is foreseen is that the self care information tool of the future will be a combination between the patient's observation record and the Internet, with the doctor and the patient positioned together at the intersection but not having to pay attention to the technology. This article deals with various aspects related to this Grand Challenge like the paradigm shift towards a needs-led and consumer-oriented healthcare, the role, supply and quality of information and the changing doctor-patient relationship.

  2. Pain in burn patients.

    PubMed

    Latarjet, J; Choinère, M

    1995-08-01

    While severe pain is a constant component of the burn injury, inadequate pain management has been shown to be detrimental to burn patients. Pain-generating mechanisms in burns include nociception, primary and secondary hyperalgesia and neuropathy. The clinical studies of burn pain characteristics reveal very clear-cut differences between continuous pain and pain due to therapeutic procedures which have to be treated separately. Some of the main features of burn pain are: (1) its long-lasting course, often exceeding healing time, (2) the repetition of highly nociceptive procedures which can lead to severe psychological disturbances if pain control is inappropriate. Pharmaco-therapy with opioids is the mainstay for analgesia in burned patients, but non-pharmacological techniques may be useful adjuncts. Routine pain evaluation is mandatory for efficient and safe analgesia. Special attention must be given to pain in burned children which remains too often underestimated and undertreated. More educational efforts from physicians and nursing staff are necessary to improve pain management in burned patients.

  3. Angle closure in younger patients.

    PubMed Central

    Chang, Brian M; Liebmann, Jeffrey M; Ritch, Robert

    2002-01-01

    PURPOSE: Angle-closure glaucoma is rare in children and young adults. Only scattered cases associated with specific clinical entities have been reported. We evaluated the findings in patients in our database aged 40 or younger with angle closure. METHODS: Our database was searched for patients with angle closure who were 40 years old or younger. Data recorded included age at initial consultation; age at the time of diagnosis; gender; results of slit-lamp examination, gonioscopy, and ultrasound biomicroscopy (from 1993 onward); clinical diagnosis; and therapy. Patients with previous incisional surgery were excluded, as were patients with anterior chamber proliferative mechanisms leading to angle closure. RESULTS: Sixty-seven patients (49 females, 18 males) met entry criteria. Mean age (+/- SD) at the time of consultation was 34.4 +/- 9.4 years (range, 3-68 years). Diagnoses included plateau iris syndrome (35 patients), iridociliary cysts (8 patients), retinopathy of prematurity (7 patients), uveitis (5 patients), isolated nanophthalmos (3 patients), relative pupillary block (2 patients), Weill-Marchesani syndrome (3 patients), and 1 patient each with Marfan syndrome, miotic-induced angle closure, persistent hyperplastic primary vitreous, and idiopathic lens subluxation. CONCLUSION: The etiology of angle closure in young persons is different from that in the older population and is typically associated with structural or developmental ocular anomalies rather than relative pupillary block. Following laser iridotomy, these eyes should be monitored for recurrent angle closure and the need for additional laser or incisional surgical intervention. PMID:12545694

  4. The challenge of patient adherence

    PubMed Central

    Martin, Leslie R; Williams, Summer L; Haskard, Kelly B; DiMatteo, M Robin

    2005-01-01

    Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors. These include realistic assessment of patients' knowledge and understanding of the regimen, clear and effective communication between health professionals and their patients, and the nurturance of trust in the therapeutic relationship. Patients must be given the opportunity to tell the story of their unique illness experiences. Knowing the patient as a person allows the health professional to understand elements that are crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social supports, and emotional health challenges, particularly depression. Physician–patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence. Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and improves patients' healthcare outcomes. PMID:18360559

  5. Physician-Patient Communication and Patient Compliance: A Theoretical Orientation.

    ERIC Educational Resources Information Center

    Clampitt, Phillip G.; Williams, M. Lee

    This paper synthesizes much of the literature concerning physician/patient communication as it relates to patient compliance. Using the theoretical perspective that deals with belief, attitude, intention, and behavior (a perspective generated by Martin Fishbein and Icek Ajzen), a new theoretical orientation for predicting patient compliance is…

  6. Choosing effective patient education materials

    MedlinePlus

    ... education. Tell your patient what to pay special attention to. Be sure to review any materials you plan to use before sharing them with the patient. Keep in mind that no resource is a substitute ...

  7. Patient Safety: Do Your Homework

    MedlinePlus

    American Society of Plastic Surgeons Home Cosmetic Reconstructive Before & After Photos Find A Surgeon Patient Safety News Patients of Courage About ASPS Menu More Call for a nearby plastic surgeon you can trust | 1-800-514-5058 ...

  8. Rhythm in disguise: why singing may not hold the key to recovery from aphasia

    PubMed Central

    Kotz, Sonja A.; Henseler, Ilona; Turner, Robert; Geyer, Stefan

    2011-01-01

    The question of whether singing may be helpful for stroke patients with non-fluent aphasia has been debated for many years. However, the role of rhythm in speech recovery appears to have been neglected. In the current lesion study, we aimed to assess the relative importance of melody and rhythm for speech production in 17 non-fluent aphasics. Furthermore, we systematically alternated the lyrics to test for the influence of long-term memory and preserved motor automaticity in formulaic expressions. We controlled for vocal frequency variability, pitch accuracy, rhythmicity, syllable duration, phonetic complexity and other relevant factors, such as learning effects or the acoustic setting. Contrary to some opinion, our data suggest that singing may not be decisive for speech production in non-fluent aphasics. Instead, our results indicate that rhythm may be crucial, particularly for patients with lesions including the basal ganglia. Among the patients we studied, basal ganglia lesions accounted for more than 50% of the variance related to rhythmicity. Our findings therefore suggest that benefits typically attributed to melodic intoning in the past could actually have their roots in rhythm. Moreover, our data indicate that lyric production in non-fluent aphasics may be strongly mediated by long-term memory and motor automaticity, irrespective of whether lyrics are sung or spoken. PMID:21948939

  9. Aphasia in a prelingually deaf woman.

    PubMed

    Chiarello, C; Knight, R; Mandel, M

    1982-03-01

    A left parietal infarct in a prelingually deaf person resulted in an aphasia for both American Sign Language (ASL) and written and finger-spelled English. Originally the patient had a nearly global aphasia affecting all language systems. By five to seven weeks post-onset her symptoms resembled those of hearing aphasics with posterior lesions: fluent but paraphasic signing, anomia, impaired comprehension and repetition, alexia, and agraphia with elements of neologistic jargon. In addition, there was a pronounced sequential movement copying disorder, reduced short-term verbal memory and acalculia. In general, the patient's sign errors showed a consistent disruption in the structure of ASL signs which parallels the speech errors of oral aphasic patients. We conclude that most aphasic symptoms are not modality-dependent, but rather reflect a disruption of linguistic processes common to all human languages. This case confirms the importance of the left hemisphere in the processing of sign language. Furthermore, the results indicate that the left supramarginal and angular gyri are necessary substrates for the comprehension of visual/gestural languages.

  10. Nutritional screening in surgical patients.

    PubMed

    Thompson, J S; Burrough, C A; Green, J L; Brown, G L

    1984-03-01

    Routine nutritional screening of patients admitted to the surgical services confirms a substantial prevalence of malnutrition. Identification of the malnourished patient and the patient who is likely to become malnourished should be done as early as possible in the hospital stay and usually requires only simple, readily available parameters. Nutritional screening is only the first step in the optimal nutritional management of surgical patients. This information should be used to determine the need for further nutritional assessment, the appropriate consultation, and nutritional therapy.

  11. Profile of Your Geriatric Patient

    PubMed Central

    Longhurst, Mark F.; Slade, Debra

    1990-01-01

    The family doctor cares for many geriatric patients. Many of these patients enter the family practice for the first time, having either recently moved to the area or to a nearby long-term care facility. Obtaining a meaningful patient profile is essential to the physicians' care, allowing future medical decisions to be made in the best interest of that person. Patients' beliefs motivate their functioning in a system. Any system has its own history, structure, and function. PMID:21234029

  12. Systems Thinking and Patient Safety

    DTIC Science & Technology

    2005-01-01

    1 Prologue Systems Thinking and Patient Safety Paul M. Schyve Patient safety is a prominent theme in health care delivery today. This should...been “unenlightened,” to say the least; we would not have been able to apply systems thinking to patient safety. Even today, preventable patient...in the minds of many, to be met with blame and punishment. But systems thinking is now ubiquitous in health care—due, in large measure, to its

  13. The patient-friendly practice.

    PubMed

    Dooley, Sharon Kay

    2006-01-01

    In today's medical marketplace, patients see themselves as consumers of healthcare with certain customer-service expectations. The medical practice that is indifferent or resistant to these changes is at risk. Having a good understanding of patient-friendly changes can help a practice survive in a changing environment. A patient-friendly office will continue to meet the needs of the patient by adopting this new practice style.

  14. Patient-centered healthcare design.

    PubMed

    Stichler, Jaynelle F

    2011-12-01

    Patient-centered care focuses on the patient's and family's experience in the hospital, and the design of the healthcare environment should support the patient-centered care concept. The purpose of this facility design department is to expand nurse leaders' knowledge and competencies in health facility design and enable them to take leadership roles in design efforts. This article focuses on healthcare design guiding principles and features to support organizational cultural initiatives such as patient- and family-centered care and Planetree.

  15. Podcasting: contemporary patient education.

    PubMed

    Abreu, Daniel V; Tamura, Thomas K; Sipp, J Andrew; Keamy, Donald G; Eavey, Roland D

    2008-04-01

    Portable video technology is a widely available new tool with potential to be used by pediatric otolaryngology practices for patient and family education. Podcasts are media broadcasts that employ this new technology. They can be accessed via the Internet and viewed either on a personal computer or on a handheld device, such as an iPod or an MP3 player. We wished to examine the feasibility of establishing a podcast-hosting Web site. We digitally recorded pediatric otologic procedures in the operating room and saved the digital files to DVDs. We then edited the DVDs at home with video-editing software on a personal computer. Next, spoken narrative was recorded with audio-recording software and combined with the edited video clips. The final products were converted into the M4V file format, and the final versions were uploaded onto our hospital's Web site. We then downloaded the podcasts onto a high-quality portable media player so that we could evaluate their quality. All of the podcasts are now on the hospital Web site, where they can be downloaded by patients and families at no cost. The site includes instructions on how to download the appropriate free software for viewing the podcasts on a portable media player or on a computer. Using this technology for patient education expands the audience and permits portability of information. We conclude that a home computer can be used to inexpensively create informative surgery demonstrations that can be accessed via a Web site and transferred to portable viewing devices with excellent quality.

  16. Managing the chronically late patient.

    PubMed

    Baum, Neil

    2014-01-01

    Every practice has patients who are chronically late. This wrecks havoc with your schedule and makes you less productive. Patients can be trained to respect your time and arrive in the office on time. This article discusses several approaches to managing the chronically late patient.

  17. Dental problems in epileptic patients.

    PubMed

    Zioło, Anna; Mielnik-Błaszczak, Maria

    2004-01-01

    On the grounds of literature and own clinical experience, pathological changes in epilepitic patients have been described. Dental management procedures in these patients have also been presented. The unquestionable importance of prophylaxis, which may markedly minimize the impact of epilepsy on the incidence of mouth diseases, has been emphasised. It has also been stated that epileptic patients should receive specialised and integrated dental treatment.

  18. Medical Services: Patient Administration

    DTIC Science & Technology

    2007-11-02

    participants in Domestic Action Programs (formerly para 4-63). o Rescinds eligibility references to the Citizens Military Training Corps (formerly para 5...consolidated regulation p r e s c r i b e s p o l i c i e s a n d m a n d a t e d t a s k s governing the management and adminis- tration of patients...Security beneficiaries • 3–34, page 25 Micronesian citizens • 3–35, page 25 American Samoan citizens • 3–36, page 25 Section VIII Miscellaneous Categories

  19. Carctol: Profit before Patients?

    PubMed Central

    Ernst, Edzard

    2009-01-01

    Summary Background Carctol is a herbal remedy that recently was widely reported to offer a cure for a range of cancers. This article is aimed at evaluating the evidence that supports this claim. Methods In addition to numerous websites, we conducted systematic searches in six electronic databases. Any factual information relating to Carctol was considered. Results The websites provided the composition of the herbal mixture and numerous claims as to its effectiveness. However, not a single scientific study of any style was found. Conclusions The claim that Carctol is of any benefit to cancer patients is not supported by scientific evidence. PMID:20877681

  20. Caring for Latino patients.

    PubMed

    Juckett, Gregory

    2013-01-01

    Latinos comprise nearly 16 percent of the U.S. population, and this proportion is anticipated to increase to 30 percent by 2050. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. Barriers to care have resulted in striking disparities in quality of health care for these patients. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. The National Standards for Culturally and Linguistically Appropriate Services address these concerns with recommendations for culturally competent care, language services, and organizational support. Latinos have disproportionately higher rates of obesity and diabetes mellitus. Other health problems include stress, neurocysticercosis, and tuberculosis. It is important to explore the use of alternative therapies and belief in traditional folk illnesses, recognizing that health beliefs are dependent on education, socioeconomic status, and degree of acculturation. Many-but not all-folk and herbal treatments can be safely accommodated with conventional therapy. Physicians must be sensitive to Latino cultural values of simpatia (kindness), personalismo (relationship), respeto (respect), and modestia (modesty). The LEARN technique can facilitate cross-cultural interviews. Some cultural barriers may be overcome by using the "teach back" technique to ensure that directions are correctly understood and by creating a welcoming health care environment for Latino patients.

  1. Patient Zero”:

    PubMed Central

    McKay, Richard A.

    2014-01-01

    Summary This article contextualizes the production and reception of And the Band Played On, Randy Shilts’s popular history of the initial recognition of the American AIDS epidemic. Published over twenty-five years ago, the book and its most notorious character, “Patient Zero,” are in particular need of a critical historical treatment. The article presents a more balanced consideration—a “patient’s view”—of Gaétan Dugas’s experience of the early years of AIDS. I oppose the assertion that Dugas, the so-called Patient Zero, ignored incontrovertible information about the condition and was intent on spreading his infection. Instead I argue that scientific ideas in 1982 and 1983 about AIDS and the transmissibility of a causative agent were later portrayed to be more self-evident than they were at the time. The article also traces how Shilts’s highly selective—and highly readable—characterization of Dugas rapidly became embedded in discussions about the need to criminalize the reckless transmission of HIV. PMID:24769806

  2. The treatment of anomia in Sesotho: a case for parametric aphasiology.

    PubMed

    Penn, Claire; Archer, Brent

    2011-11-01

    South Africa, as a multilingual country, offers the opportunity for examining the interaction between aphasic symptomatology and the parameters of language. Effective intervention techniques depend on an understanding of clinical linguistics. This article describes an intervention study with two Sesotho-speaking individuals with anomia. Sesotho as a noun class and syllable-timed language offers the opportunity to study the influence of cueing techniques, which are based on such linguistic parameters. Word lists were designed using non-aphasic participants and three cueing techniques for anomia were evaluated over a period of 4 months. Findings suggested a positive response to the techniques of true phonemic cueing and prosodic cueing, whereas initial phonemic cueing (a technique commonly used for English-speaking anomic patients) had no impact. This supports the need for a parametrically informed approach to aphasia therapy and strengthens the recommendation that a linguistic basis is paramount in the training of effective clinicians.

  3. Phonemic carryover perseveration: word blends.

    PubMed

    Buckingham, Hugh W; Christman, Sarah S

    2004-11-01

    This article will outline and describe the aphasic disorder of recurrent perseveration and will demonstrate how it interacts with the retrieval and production of spoken words in the language of fluent aphasic patients who have sustained damage to the left (dominant) posterior temporoparietal lobe. We will concentrate on the various kinds of sublexical segmental perseverations (the so-called phonemic carryovers of Santo Pietro and Rigrodsky) that most often play a role in the generation of word blendings. We will show how perseverative blends allow the clinician to better understand the dynamics of word and syllable production in fluent aphasia by scrutinizing the "onset/rime" and "onset/superrime" constituents of monosyllabic and polysyllabic words, respectively. We will demonstrate to the speech language pathologist the importance of the trochee stress pattern and the possibility that its metrical template may constitute a structural unit that can be perseverated.

  4. [Neurological complications in cancer patients].

    PubMed

    Hundsberger, Thomas; Roth, Patrick; Roelcke, Ulrich

    2014-08-20

    Neurological symptoms in cancer patients have a great impact on quality of life and need an interdisciplinary approach. They lead to significant impairment in activities of daily living (gait disorders, dizziness), a loss of patients independency (vegetative disturbances, wheel-chair dependency) and interfere with social activities (ban of driving in case of epilepsy). In this article we describe three main and serious neurological problems in the context of oncological patients. These are chemotherapy-induced polyneuropathy, malignant spinal cord compression and epileptic seizures. Our aim is to increase the awareness of neurological complications in cancer patients to improve patients care.

  5. Financial Distress in Cancer Patients

    PubMed Central

    de Souza, Jonas A.; Wong, Yu-Ning

    2013-01-01

    Novel diagnostic and therapeutic options offer hope to cancer patients with both localized and advanced disease. However, many of these treatments are often costly and even well-insured patients can face high out-of-pocket costs. Families may also be at risk of financial distress due to lost wages and other treatment-related expenses. Research is needed to measure and characterize financial distress in cancer patients and understand how it affects their quality of life. In addition, health care providers need to be trained to counsel patients and their families so they can make patient-centered treatment decisions that reflect their preferences and values. PMID:24349677

  6. Bibliotherapy in a Patients' Library *

    PubMed Central

    McDowell, David J.

    1971-01-01

    This paper describes the involvement of patients in the Patients' Library at McLean Hospital, and the relationship between them and the librarian in library activities. The publication of a patients' magazine is discussed, with case histories of persons who had taken part in its production. The Patients' Librarian has a personal role in patient therapy, and accounts are given of various activities such as play-reading, poetry-reading, and the discussion of poems by established writers, with therapeutic aims in view. Actual clinical experiences are given. PMID:5146769

  7. [Treatment of patients with osteoarthritis].

    PubMed

    Vargas Negrín, Francisco; Medina Abellán, María D; Hermosa Hernán, Juan Carlos; de Felipe Medina, Ricardo

    2014-01-01

    The therapeutic management of patients with osteoarthritis aims to decrease pain and inflammation, improve physical function, and to apply safe and effective treatments. A patient-centered approach implies the active participation of the patient in the design of the treatment plan and in timely and informed decision-making at all stages of the disease. The nucleus of treatment is patient education, physical activity and therapeutic exercise, together with weight control in overweight or obese patients. Self-care by the individual and by the family is fundamental in day-to-day patient management. The use of physical therapies, technical aids (walking sticks, etc.) and simple analgesics, opium alkaloids, and antiinflammatory drugs have demonstrated effectiveness in controlling pain, improving physical function and quality of life and their use is clearly indicated in the treatment of osteoarthritis. Conservative surgery and joint replacement is indicated when treatment goals are not achieved in specific patients.

  8. Perseveration or the Tower of Babel.

    PubMed

    Basso, Anna

    2004-11-01

    The purpose of this article is twofold: (1) to present a study of perseveration in a continuous series of 50 left brain-damaged aphasic subjects and (2) to describe the treatment of 2 patients with high rates of perseveration. In the group of 50 subjects, 20 showed two or more perseverations in one or more language tasks. No difference in number of perseverations was found between fluent and nonfluent subjects, but perseverations in global aphasic subjects with stereotyped speech were less varied than they were in fluent aphasic subjects and were not unlike other types of recurrent utterances. Of the two patients who received treatment, subject 1 had severe semantic disruption and perseverated in all production and comprehension tasks, except in repetition, reading aloud, and writing to dictation, all of which could be performed by the undamaged sublexical routines. Treated subject 2 had writing disorders that were ascribed to damage to the output buffer. She perseverated in all writing tasks. Rehabilitation of the semantic system in subject 1 and of the output buffer in subject 2 greatly reduced the number of perseverations in both subjects. It is argued that recovery of the underlying functional damage reduces the perseverative behavior.

  9. [Autonomy of the patient with chronic diseases: from passive patient to active patient].

    PubMed

    González Mestre, Assumpció

    2014-01-01

    Due to social, economic and cultural changes, there has been a transformation of Health Services around the world. A new figure has emerged from this: the Active Patient, more responsible, with more information and willing to change his life as a chronic patient. In order to respond to this new situation, several countries have established initiatives such as self-reliance programmes for chronic patients. The aim of this article is to underline the Expert Patient Programme Catalonia(®) and to explain its operation and the results obtained up until now. The purpose of this program is to improve the experience of chronic disease by patients, from meetings in which an expert patient provides his knowledge and experiences to a group of patients with the same disease, with the aim of promoting changes in habits and lifestyles that improve the quality of life and the coexistence of the person with his chronic process.

  10. Improving emergency department patient flow.

    PubMed

    Jarvis, Paul Richard Edwin

    2016-06-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

  11. Creating the ideal patient experience.

    PubMed

    Purcărea, Th.V

    2016-01-01

    Healthcare industry continues to evolve under conditions of intense competition in approaching health prevention, protection, and promotion. Therefore, healthcare providers are challenged to always ensure better patient experience, winning patients' satisfaction, and loyalty and remain competitive on today's healthcare market. Healthcare markets bring together professionals and their patients into real collaborative relationships, which empower patients to contribute to the healthcare improvement. Within this competitive landscape, which is also characterized by digital health tools boosting patients' awareness and controlling their own health, medical providers need to be perceived as skilled and trustworthy in relying on patients' needs, expectations, and sacrifices are required in order to obtain the promised benefits. Moreover, while constantly providing a holistic assessment of the healthcare services' and experience attributes, acting on feedback and reaching healthcare service excellence, providing a better understanding of all the touch points with their patients and improving the quality and consistency of all these touch points, all these are achieved by employees, who are truly connected to the healthcare business. Today, patients are systematically becoming aware of the diversity of their choices, being increasingly involved in making better healthcare choices, and, so, more and more innovative products are introduced, targeting new patient segments. Findings from the last three years have shown that patients may achieve better outcomes due to the stakeholders' commitment to innovation within the context of the big-data revolution, by building new values.

  12. Hallux ulceration in diabetic patients.

    PubMed

    ElMakki Ahmed, Mohamed; Tamimi, Abdulhakim O; Mahadi, Seif I; Widatalla, Abubakr H; Shawer, Mohamed A

    2010-01-01

    We undertook a prospective cohort study to assess risk factors associated with hallux ulceration, and to determine the incidence of healing or amputation, in consecutive patients with diabetes mellitus who were treated over the observation period extending from September 2004 to March 2005, at the Jabir Abu Eliz Diabetic Centre, Khartoum City, Sudan. There were 122 diabetic patients in the cohort (92 males and 30 females) with an overall mean age of 58 +/- 9 years. Fifty-three percent of patients had complete healing within 8 weeks and 43% healed within 20 weeks. The overall mean time to healing was 16 +/- 8 weeks. In 32 (26.2%) patients, osteomyelitic bone was removed, leaving a healed and boneless hallux. The hallux was amputated in 17 (13.9%) patients; in 2 (1.6%) patients it was followed by forefoot amputation and in 7 (5.7%) patients by below-the-knee amputation. In 90 (73.8%) patients the initial lesion was a blister. In conclusion, hallux ulceration is common in patients with diabetes mellitus and is usually preceded by a blister. Neuropathy, foot deformity, and wearing new shoes are common causative factors; and ischemia, osteomyelitis, any form of wound infection, and the size of the ulcer are main outcome determinants. Complete healing occurred in 103 (85%) of diabetic patients with a hallux ulcer. Vascular intervention is important relative to limb salvage when ischemia is the main cause of the ulcer.

  13. Improving emergency department patient flow

    PubMed Central

    Jarvis, Paul Richard Edwin

    2016-01-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED’s capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED. PMID:27752619

  14. Patient-Specific Orthopaedic Implants.

    PubMed

    Haglin, Jack M; Eltorai, Adam E M; Gil, Joseph A; Marcaccio, Stephen E; Botero-Hincapie, Juliana; Daniels, Alan H

    2016-11-01

    Patient-specific orthopaedic implants are emerging as a clinically promising treatment option for a growing number of conditions to better match an individual's anatomy. Patient-specific implant (PSI) technology aims to reduce overall procedural costs, minimize surgical time, and maximize patient outcomes by achieving better biomechanical implant fit. With this commercially-available technology, computed tomography or magnetic resonance images can be used in conjunction with specialized computer programs to create preoperative patient-specific surgical plans and to develop custom cutting guides from 3-D reconstructed images of patient anatomy. Surgeons can then place these temporary guides or "jigs" during the procedure, allowing them to better recreate the exact resections of the computer-generated surgical plan. Over the past decade, patient-specific implants have seen increased use in orthopaedics and they have been widely indicated in total knee arthroplasty, total hip arthroplasty, and corrective osteotomies. Patient-specific implants have also been explored for use in total shoulder arthroplasty and spinal surgery. Despite their increasing popularity, significant support for PSI use in orthopaedics has been lacking in the literature and it is currently uncertain whether the theoretical biomechanical advantages of patient-specific orthopaedic implants carry true advantages in surgical outcomes when compared to standard procedures. The purpose of this review was to assess the current status of patient-specific orthopaedic implants, to explore their future direction, and to summarize any comparative published studies that measure definitive surgical characteristics of patient-specific orthopaedic implant use such as patient outcomes, biomechanical implant alignment, surgical cost, patient blood loss, or patient recovery.

  15. Patient reported outcomes and patient empowerment in clinical genetics services.

    PubMed

    McAllister, M; Dearing, A

    2015-08-01

    Evaluation of clinical genetics services (CGS), including genetic counseling and genetic testing, has been problematic. Patient mortality and morbidity are unlikely to be directly improved by interventions offered in CGS. Patient-reported outcomes (PROs) are not routinely measured in CGS evaluation, but this may change as patient-reported outcome measures (PROMs) become a key part of how healthcare services are managed and funded across the world. However, there is no clear consensus about which PROMs are most useful for CGS evaluation. This review summarizes the published research on how PROs from CGS have been measured and how patients may benefit from using those services, with a focus on patient empowerment. Many patient benefits (PROs) identified repeatedly in the research literature can be re-interpreted within a patient empowerment framework. Other important PROs identified include family functioning, social functioning, altruism, sense of purpose, enabling development of future research and treatment/participating in research. Well-validated measures are available to capture (dimensions of) patient empowerment. Although generic measures of family functioning are available, suitable measures capturing social functioning, development of future treatments, and altruism were not identified in this review. Patient empowerment provides one useful approach to measuring PROs from CGS.

  16. [Anemia in peritoneal dialysis patients].

    PubMed

    Lausević, Mirjana; Nesić, Vidosava; Jovanović, Natasa; Stojimirović, Biljana

    2006-01-01

    A normocytic normochromic anemia is one of the first signs of renal failure. Since anemia increases morbidity and mortality, its elimination is one of the essential objectives of the treatment. Human recombinant erythropoietin (rHuEPO) has changed the therapeutical approach to anemia. The aim of the present study was to compare efficacy of anemia correction in peritoneal dialysis patients depending on treatment and dialysis modality. The study is the retrospective analysis of 64 patients who presented to our Clinic in 2003. Eighteen (28.13%) patients were treated with rHuEPO, 14 (28%) underwent continuous ambulatory peritoneal dialysis (CAPD), 2 (100%)--automated peritoneal dialysis (APD) and 2 (33.3%)--intermittent peritoneal dialysis (IPD). Mean hemoglobin level was 98.6 +/- 17.82 g/l in patients treated with rHuEPO versus 98.81 +/- 15.14 g/l in patients without rHuEPO treatment. Erythropoietin requirements were 3392.85 +/- 1211.77 IU/week All patients received iron supplementation during rHuEPO therapy. Mean serum ferritin levels were 463.41 +/- 360 ug/l. Transferrin saturation (TSAT) was 0.35 +/- 0.16%. No difference of serum iron and TSAT levels was found between CAPD and IPD patients. The degree of anemia significantly differed between CAPD and IPD patients. A total of 17.11% of PD patients were given blood transfusions, most frequently during the first three months after the onset of dialysis. Our conclusion is that the number of patients receiving rHuEPO should be increased, as 50% of our patients should be substituted, while only 28% are being treated. As 50% of patients receiving rHuEPO failed to reach target Hgb levels, higher EPO doses should be considered. Iron stores should be continuously monitored, particularly in patients receiving rHuEPO, since iron deficiency is an important problem for patients undergoing peritoneal dialysis, especially during erythropoietin therapy. Oral iron supplementation is satisfactory in the majority of patients, and iron

  17. Oral lesions in haemopathic patients.

    PubMed

    Grande, M; Milano, V; Desiate, A; Martinelli, A; Iaffaldano, B

    1990-03-01

    This paper deals with the oral manifestations observed in patients with haemolymphopathies and oral complications associated with systemic cytotoxic chemotherapy and/or radiation therapy. We report the percentage of oral manifestations observed in 30 patients treated with cytotoxic drugs for malignant haemolymphopathies or other tumors after 2-4 cycles of systemic combinations chemotherapy. No sex or age differences were recorded except for abnormalities of taste present only in 13% treated patients older than 50. Stomatitis was more frequent in patients with malignant haemolymphopathies than in patient with other neoplastic diseases, probably due to the fact that in the former group neutropenia and thrombocytopenia induced by bone marrow infiltration or by more aggressive combination chemotherapy are most frequent. An oral care protocol for these patients is suggested.

  18. Pneumonia in renal transplant patients.

    PubMed Central

    Bowie, D. M.; Marrie, T. J.; Janigan, D. T.; MacKeen, A. D.; Belitsky, P.; MacDonald, A. S.; Lannon, S. G.; Cohen, A. D.

    1983-01-01

    Between January 1976 and March 1982, 28 episodes of pneumonia occurred in 26 renal transplant patients. The overall mortality rate was 46%. Of the 16 patients with nosocomial pneumonia 9 (56%) died, whereas of the 12 patients with community-acquired pneumonia 4 (33%) died. In all 9 cases of unknown cause the response to empiric treatment was prompt, whereas in 4 of the 10 cases of monomicrobial pneumonia and 8 of the 9 cases of polymicrobial pneumonia the patient died. Cytomegalovirus was the sole cause of the pneumonia in two patients and a contributing cause, along with aerobic gram-negative bacteria, in another five, four of whom also had a fungal infection. Two patients, both of whom survived, had nosocomial Legionnaires' disease. PMID:6342741

  19. Prioritization strategies for patient evacuations.

    PubMed

    Childers, Ashley Kay; Mayorga, Maria E; Taaffe, Kevin M

    2014-03-01

    Evacuation from a health care facility is considered last resort, and in the event of a complete evacuation, a standard planning assumption is that all patients will be evacuated. A literature review of the suggested prioritization strategies for evacuation planning-as well as the transportation priorities used in actual facility evacuations-shows a lack of consensus about whether critical or non-critical care patients should be transferred first. In addition, it is implied that these policies are "greedy" in that one patient group is given priority, and patients from that group are chosen to be completely evacuated before any patients are evacuated from the other group. The purpose of this paper is to present a dynamic programming model for emergency patient evacuations and show that a greedy, "all-or-nothing" policy is not always optimal as well as discuss insights of the resulting optimal prioritization strategies for unit- or floor-level evacuations.

  20. Trading patients. Lessons from Scandinavia.

    PubMed

    Botten, Grete; Grepperud, Sverre; Nerland, Sölve Mikal

    2004-09-01

    The next few decades will bring about more trade in services, among them health care. This paper describes a recent project on cross-border trading of patients initiated by the Norwegian parliament (The Patient Bridge). This health policy reform met some resistance among hospital physicians. However, patients were willing to participate if being properly informed and supported by local health care workers. The Patient Bridge turned out to be a relatively expensive project partly because of the transaction costs involved (transportation and escort) and partly because of high treatment costs. Excessive treatment costs were a result of insufficient cost-consciousness in the purchasing organization. The Patient Bridge revealed large price differentials not only between Norwegian and foreign hospitals, but also between hospitals abroad, even within the same country. This finding points to the possibilities of reaching mutual gains from trading patients across borders.

  1. Sinusitis: Special Considerations for Aging Patients

    MedlinePlus

    ... ENT Doctor Near You Sinusitis: Special Considerations for Aging Patients Sinusitis: Special Considerations for Aging Patients Patient ... for evaluation and possible surgical management. Sources For Aging Patients: Administration on Aging (AoA), U.S. Department of ...

  2. [Pulmonary Rehabilitation for Cancer Patients].

    PubMed

    Yamamoto, Kazuo; Gemma, Akihiko

    2015-07-01

    Dyspnea occurs in most cancer patients and is often associated with severe pain. Pulmonary rehabilitation has become increasingly important to improve ADL and QOL and to relieve pain that results from dyspnea. Although pulmonary rehabilitation is now provided mainly during the perioperative period, it has been recognized as an effective procedure for patients before, during, or after chemotherapy or radiotherapy. It is also useful for patients with advanced or terminal cancer. However, an evidence-based cancer rehabilitation procedure has to be established.

  3. Scripting patienthood with patient clothing.

    PubMed

    Topo, Päivi; Iltanen-Tähkävuori, Sonja

    2010-06-01

    The potential of care environments to promote patient healing has gained increasing attention over the last decade, with evidence-based designs used to explore developments in this field. Medical textiles, such as clothes provided to patients, are part of the care environment in many countries. Our study focuses on patients' experiences of such clothing. The goal of this research is to understand how patienthood is constructed in relation to patient clothing and the practices around their use. The study is based on four group interviews involving a total of 12 people with experience of being patients in a hospital or of visiting residential care environments. We employed an active interview format, and the medical textiles currently used in Finnish hospitals and residential care facilities were available for scrutiny during the interviews. Content analyses were carried out on the interview transcripts. Patient clothing was critically evaluated by the participants; they experienced giving up their own clothes as akin to a rite of passage into their new role as a patient. The low status of a patient in a hospital environment was symbolised by the outworn appearance of patient clothing and the problems in protecting privacy. Patient clothing was also felt to provide limited possibilities for being active and in some cases was found to be annoying or even harmful and upsetting. For patients, being dressed in patient clothing may be symbolic of lower status and narrowed agency in everyday life. We can conclude that artefacts such as clothing worn in care environments need to be given attention when considering possibilities for improving care.

  4. Expert patients: learning from HIV.

    PubMed

    Cooke, Molly

    2011-04-01

    The outbreak of HIV in the early 1980s saw widespread activism among patients and community supporters. The author, a young physician in San Francisco at the time, describes how coming of age as a clinician in the midst of this activism affected her concept of the patient-physician relationship. The insistence of a particular patient, Robert, on specifying his treatment goals illustrates that even people with substantial cognitive challenges can participate in their own care in an egalitarian and active manner.

  5. Corneal Protection for Burn Patients

    DTIC Science & Technology

    2012-07-01

    cornea’s defense mechanisms and subsequent events that may lead to cornea opacification and the need for cornea transplant . Currently these patients...cornea’s defense mechanisms and subsequent events that may lead to cornea opacification and the need for cornea transplant . Currently these patients...resistant crosslinked amniotic membranes for treating cornea of burn patients that were produced in Years 1 and 2. Major findings: Identified

  6. Tempus Pro Patient Monitoring System

    DTIC Science & Technology

    2015-04-03

    AFRL-SA-WP-TR-2015-0006 Tempus Pro Patient Monitoring System Nigel D. Pritchard 3 April 2015 Final Report... System 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Nigel D. Pritchard 5e. TASK NUMBER...subsequent demonstration of the Tempus Pro patient monitoring system to include the AF3899L critical care patient movement record. 15. SUBJECT TERMS

  7. [Sophrology for patients in oncology].

    PubMed

    Barré, Chantal; Falcou, Marie-Christine; Mosseri, Véronique; Carrié, Sylvie; Dolbeault, Sylvie

    2015-11-01

    It is important to support patients with cancer during their care pathway and even beyond. They undergo long and difficult treatments, all anxiety-causing situations and sources of stress. Sophrological techniques help patients to find calm, lessen their fears and offer them the opportunity to work on themselves through simple easily reproducible exercises. This observation has been verified by a study carried out at the Institut Curie with patients undergoing chemotherapy.

  8. Implementing national patient safety alerts.

    PubMed

    Moore, Sally; Taylor, Natalie; Lawton, Rebecca; Slater, Beverley

    National patient safety alerts are sometimes difficult to implement in an effective way. All trusts have to declare compliance with alerts as part of a three-step process to improve patient safety. This article discusses an alternative way of implementing national patient safety alerts and describes how behaviour-change methods can be used to successfully implement lasting changes in practice at ward or departmental level.

  9. Nutritional assessment of surgical patients.

    PubMed

    Brown, C S; Stegman, M R

    1988-10-01

    In order to test the sensitivity and specificity of the East Orange Nutritional Screening Form (EONSF), nutritional assessments were performed on a random sample of 10% of general medical/surgical admissions at a large midwestern veteran's administration hospital. Patients were followed until discharge to determine if they met the standard criteria of additional nutritional support. The tool correctly identified patients at nutritional risk (sensitivity) 95% of the time and patients not at nutritional risk (specificity) 89% of the time. It proved to be an effective, low-cost tool for identifying patients at risk and for planning appropriate nutritional strategies.

  10. Strategies for improving patient compliance.

    PubMed

    Strand, J

    1994-01-01

    Achieving patient compliance in taking prescribed medications is a formidable challenge for all clinicians. As PAs, we have daily opportunities to communicate with patients and improve their compliance. An office-based compliance program, combining patient education and behavior-modification components, can be beneficial in this regard. Strategies for improving compliance include giving clear, concise, and logical instructions in familiar language, adapting drug regimens to daily routines, eliciting patient participation through self-monitoring, and providing educational materials that promote overall good health in connection with medical treatment.

  11. Orthodontic treatment in oncological patients.

    PubMed

    Mituś-Kenig, Maria; Łoboda, Magdalena; Marcinkowska-Mituś, Agata; Durka-Zajac, Magdalena; Pawłowska, Elzbieta

    2015-01-01

    The progress in oncological treatment has led to the current increase of childhood cancer survival rate to 80%. That is why orthodontists more and more frequently consult patients who had completed a successful anti-cancer therapy in childhood. Oncological treatments such as chemotherapy, radiotherapy or supportive immunosuppressive therapy cause numerous side effects in growing patients, connected i.a. with growth, the development of teeth or the viscerocranium. This is a special group of patients that needs an optimised plan of orthodontic treatment and often has to accept a compromise result. The purpose of the current work is to discuss the results of orthodontic treatment in patients after an anti-cancer therapy. Time of treatment was 12,5 months. In 6 patients (from 40 undergoing orthodontic therapy) we haven't reached a normocclusion, in 9 patients we should have stopped the therapy because of the recurrence. In 11 patients we found mucosa inflammation and in 1 patient the therapy stopped before the end because of very low oral hygiene level. Bearing in mind the limited number of original works on the above topic in Polish medical literature, the study has been carried out in order to make Polish orthodontists more acquainted with the topic and the standards of dealing with an oncological patient.

  12. Engaging patients through your website.

    PubMed

    Snyder, Kimberlee; Ornes, Lynne L; Paulson, Pat

    2014-01-01

    Legislation requires the healthcare industry to directly engage patients through technology. This paper proposes a model that can be used to review hospital websites for features that engage patients in their healthcare. The model describes four levels of patient engagement in website design. The sample consisted of 130 hospital websites from hospitals listed on 2010 and 2011 Most Wired Hospitals. Hospital websites were analyzed for features that encouraged patient interaction with their healthcare according to the levels in the model. Of the four levels identified in the model, websites ranged from "informing" to "collaborative" in website design. There was great variation of features offered on hospital websites with few being engaging and interactive.

  13. Effective writing that attracts patients.

    PubMed

    Baum, Neil

    2015-01-01

    Doctors today not only must communicate verbally, they must also realize that the written word is important to their ability to connect with the patients that they already have and also to attract new patients. Doctors will be expected to write blogs, to create content for their Web sites, to write articles for local publications, and even to learn to express themselves in 140 characters or less (i.e., Twitter). This article presents 10 rules for selecting the right words to enhance your communication with existing patients and potentially to attract new patients to your practice.

  14. Government influence on patient organizations.

    PubMed

    Van de Bovenkamp, Hester M; Trappenburg, Margo J

    2011-12-01

    Patient organizations increasingly play an important role in health care decision-making in Western countries. The Netherlands is one of the countries where this trend has gone furthest. In the literature some problems are identified, such as instrumental use of patient organizations by care providers, health insurers and the pharmaceutical industry. To strengthen the position of patient organizations government funding is often recommended as a solution. In this paper we analyze the ties between Dutch government and Dutch patient organizations to learn more about the effects of such a relationship between government and this part of civil society. Our study is based on official government documents and existing empirical research on patient organizations. We found that government influence on patient organizations has become quite substantial with government influencing the organizational structure of patient organizations, the activities these organizations perform and even their ideology. Financing patient organizations offers the government an important means to hold them accountable. Although the ties between patient organizations and the government enable the former to play a role that can be valued as positive by both parties, we argue that they raise problems as well which warrant a discussion on how much government influence on civil society is acceptable.

  15. Psychological distress and patient satisfaction.

    PubMed

    Greenley, J R; Young, T B; Schoenherr, R A

    1982-04-01

    Psychologically distressed patients and clients of health care and social service organizations are found to report somewhat more dissatisfaction with services than do the nondistressed. Four explanations for this relationship are examined: 1) the psychologically distressed are generally dissatisfied; 2) service providers react negatively to the psychologically distressed; 3) psychologically distressed patients are dissatisfied when service providers do not respond to their psychological needs; and 4) patients who deny their psychological distress tend to be dissatisfied. The results show that the psychologically distressed report more dissatisfaction because of the very high levels of dissatisfaction found among patients who deny having personal problems.

  16. Violent psychiatric patients: a study.

    PubMed

    Kermani, E J

    1981-04-01

    In a study of fifty-three violent psychiatric patients in a psychiatric hospital setting, it was found that there are two distinct major groups of violent patients--one of patients with a long history of antisocial behavior who are often chronically homicidal and suicidal, and another of patients who neither have a history of destructive behavior nor exhibit homicidal or suicidal tendencies. The latter become acutely assaultive only during the course of psychiatric illness. The personality traits and background associated with these two groups offer additional contrasts. Each group presents different problems and, of major importance to the psychiatric practioner, each group requires different management.

  17. Patients' responsibilities in medical ethics.

    PubMed

    Draper, Heather; Sorell, Tom

    2002-08-01

    Patients have not been entirely ignored in medical ethics. There has been a shift from the general presumption that 'doctor knows best' to a heightened respect for patient autonomy. Medical ethics remains one-sided, however. It tends (incorrectly) to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences. In this respect, medical ethics remains largely paternalistic, requiring doctors to protect patients from the consequences of their decisions. This is reflected in a one-sided account of duties in medical ethics. Duties fall mainly on doctors and only exceptionally on patients. Medical ethics may exempt patient from obligations because they are the weaker or more vulnerable party in the doctor-patient relationship. We argue that vulnerability does not exclude obligation. We also look at other ways in which patient responsibilities flow from general ethics: for instance, from responsibilities to others and to the self, from duties of citizens, and from the responsibilities of those who solicit advice. Finally, we argue that certain duties of patients counterbalance an otherwise unfair capacity of doctors as helpers.

  18. Patient Education Leads to Better Care for Heart Patients.

    ERIC Educational Resources Information Center

    Rosenberg, Stanley G.

    The staff of a heart and circulatory disease program of a State department of health conducted a special project at a city hospital which showed that a well-organized treatment and education program for patients with congestive heart failure increased the patient's knowledge of his disease, medication, and diet as well as his adherence to a…

  19. Patient or customer?

    PubMed

    Parker, J M

    1999-01-01

    This paper investigates caring in practice within the context of the global imperative of increasing rationalisation of care based on an economic ethic. The notion of the global marketplace has spread to the domain of health services, so that 'health' has come to be seen as a commodity, with the body as its site, and the 'patient' a customer; clinicians work to construct standard pathways through the healthcare supermarket. The challenge for nurses is to work within but also to challenge and resist the reductionist impetus of economically based and commercially driven approaches to health care. They must retain the sense of the value of the wholeness of the person, the deeply personal and profoundly significant professional-recipient relationship, and find ways of demonstrating their capacity to deliver high-quality care in a cost-effective way. Proper and appropriate accountability is a key strategy to maintaining quality nursing as a significant aspect of care. The expansion of the role of the advanced practice nurse is very useful in providing holistic and cost-effective care, though there are currently limitations to scope of practice that need to be removed. The metaphor of the marketplace, underpinned by powerful global economic forces, can draw us into unthinking compliance with its imperatives--but other metaphors are available. Metaphor and creativity are linked, and we need to consider how the creative use of language can facilitate the emergence of new ways of understanding in health care.

  20. Current status of patient-controlled analgesia in cancer patients.

    PubMed

    Ripamonti, C; Bruera, E

    1997-03-01

    Patient-controlled analgesia (PCA) is a relatively new technique in which patients are able to self-administer small doses of opioid analgesics when needed. Many different devices are available for opioid infusion, including a syringe pump, disposable plastic cylinder, and battery-operated computer-driven pump. These devices allow patients to choose an intermittent (demand) bolus, continuous infusion, or both modes of administration. Parameters, such as route, drug concentration dose, frequency, and maximum daily or hourly dose, are programmed by the physician. The patient decides whether or not to take a dose. Devices can be used to deliver the drug into a running intravenous infusion, the epidural space, or subcutaneously. Controlled trials indicate that PCA is probably superior to regular opioid administration in postoperative pain. Reported advantages include greater patient satisfaction, decreased sedation and anxiety, and reduced nursing time and hospitalization. Preliminary experience suggests that PCA is also useful and safe for cancer pain, but further research is greatly needed.

  1. Elderly patients also have rights

    PubMed Central

    Pérez‐Cárceles, M D; Lorenzo, M D; Luna, A; Osuna, E

    2007-01-01

    Background Sharing information with relatives of elderly patients in primary care and in hospital has to fit into the complex set of obligations, justifications and pressures concerning the provision of information, and the results of some studies point to the need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day‐to‐day care of older people. Objectives To know the frequency with which “capable” patients over 65 years of age receive information when admitted to hospital, the information offered to the families concerned, the person who gives consent for medical intervention, and the degree of satisfaction with the information received and the healthcare provided. Method A descriptive questionnaire given to 200 patients and 200 relatives during the patients' stay in hospital. Results Only 5% of patients confirmed that they had been asked whether information could be given to their relatives. A significantly higher proportion of relatives received information on the successive stages of the care offered than did patients themselves. As the age of the patients increased, so the number who were given information, understood the information and were asked for their consent for complementary tests decreased. The degree of satisfaction with the information offered was high for both patients and relatives (86.5% and 84%, respectively), despite the irregularities observed. Conclusions The capacity of elderly patients to participate in the decision‐making process is frequently doubted simply because they have reached a certain age and it is thought that relatives should act as their representatives. In Spain, the opinion of the family and doctors appears to play a larger role in making decisions than does the concept of patient autonomy. PMID:18055902

  2. National survey of hospital patients.

    PubMed Central

    Bruster, S.; Jarman, B.; Bosanquet, N.; Weston, D.; Erens, R.; Delbanco, T. L.

    1994-01-01

    OBJECTIVE--To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems. DESIGN--Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital. SUBJECTS--5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards. MAIN OUTCOME MEASURES--Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals. RESULTS--Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers. CONCLUSIONS--This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened

  3. Patient preference: a comparison of electronic patient-completed questionnaires with paper among cancer patients.

    PubMed

    Martin, P; Brown, M C; Espin-Garcia, O; Cuffe, S; Pringle, D; Mahler, M; Villeneuve, J; Niu, C; Charow, R; Lam, C; Shani, R M; Hon, H; Otsuka, M; Xu, W; Alibhai, S; Jenkinson, J; Liu, G

    2016-03-01

    In this study, we compared cancer patients preference for computerised (tablet/web-based) surveys versus paper. We also assessed whether the understanding of a cancer-related topic, pharmacogenomics is affected by the survey format, and examined differences in demographic and medical characteristics which may affect patient preference and understanding. Three hundred and four cancer patients completed a tablet-administered survey and another 153 patients completed a paper-based survey. Patients who participated in the tablet survey were questioned regarding their preference for survey format administration (paper, tablet and web-based). Understanding was assessed with a 'direct' method, by asking patients to assess their understanding of genetic testing, and with a 'composite' score. Patients preferred administration with tablet (71%) compared with web-based (12%) and paper (17%). Patients <65 years old, non-Caucasians and white-collar professionals significantly preferred the computerised format following multivariate analysis. There was no significant difference in understanding between the paper and tablet survey with direct questioning or composite score. Age (<65 years) and white-collar professionals were associated with increased understanding (both P = 0.03). There was no significant difference in understanding between the tablet and print survey in a multivariate analysis. Patients overwhelmingly preferred computerised surveys and understanding of pharmacogenomics was not affected by survey format.

  4. Changes in the Zero-Point Energy of the Protons as the Source of the Binding Energy of Water to A-Phase DNA

    SciTech Connect

    Reiter, G. F.; Senesi, R.; Mayers, J.

    2010-10-01

    The measured changes in the zero-point kinetic energy of the protons are entirely responsible for the binding energy of water molecules to A phase DNA at the concentration of 6 water molecules/base pair. The changes in kinetic energy can be expected to be a significant contribution to the energy balance in intracellular biological processes and the properties of nano-confined water. The shape of the momentum distribution in the dehydrated A phase is consistent with coherent delocalization of some of the protons in a double well potential, with a separation of the wells of 0.2 Angst .

  5. Changes in the zero-point energy of the protons as the source of the binding energy of water to A-phase DNA.

    PubMed

    Reiter, G F; Senesi, R; Mayers, J

    2010-10-01

    The measured changes in the zero-point kinetic energy of the protons are entirely responsible for the binding energy of water molecules to A phase DNA at the concentration of 6  water molecules/base pair. The changes in kinetic energy can be expected to be a significant contribution to the energy balance in intracellular biological processes and the properties of nano-confined water. The shape of the momentum distribution in the dehydrated A phase is consistent with coherent delocalization of some of the protons in a double well potential, with a separation of the wells of 0.2 Å.

  6. [Delirium in patients with cancer].

    PubMed

    Staniszewska, Agnieszka; Kłoszewska, Iwona

    2007-01-01

    Delirium is a frequent complication of cancer. It is the cause of patients' suffering and due to worsening of communication, the impediment to clinical assessment. It lowers the quality of life of family caregivers as well. Instant diagnosis and therapy of delirium are essential in clinical practice. In this review etiology, prevalence, clinical features and management of delirium in cancer patients are described.

  7. Viscoelastic cushion for patient support

    NASA Technical Reports Server (NTRS)

    Sauers, D. G.

    1971-01-01

    Flexible container, filled with liquid, provides supportive device which conforms to patient's anatomy. Uniform cushion pressure prevents formation of decubitus ulcers, while the porous sponge substructure damps fluid movement through cushion response so that patient is not dumped when his weight shifts.

  8. Art Therapy with Laryngectomy Patients.

    ERIC Educational Resources Information Center

    Anand, Susan Ainlay; Anand, Vinod K.

    1997-01-01

    Reports on the experiences of patients with laryngeal cancer who used art therapy. Drawing on 14 years of experience and 109 laryngeal cancer patients, describes treatment results and the case material substantiating the distinct role of art therapy. Provides an overview of the special medical and therapeutic needs of this group. (RJM)

  9. Corneal Protection for Burn Patients

    DTIC Science & Technology

    2012-07-01

    cornea transplant . Currently these patients receive frequent application of topical lubricants and anti-inflammatory medications, an imperfect solution...of the degradation-resistant crosslinked amniotic membranes for treating cornea of burn patients that were produced in Years 1 and 2. Major findings...Identified membrane stiffness as a critical parameter for a successful cornea -protective membrane and quantitatively assessed this parameter

  10. Corneal Protection for Burn Patients

    DTIC Science & Technology

    2011-07-01

    cornea transplant . Currently these patients receive frequent application of topical lubricants and anti-inflammatory medications, an imperfect... cornea as is done in amniotic membrane transplantation . However we proposed and, have now tested, an alternative method for securing the... cornea of burn patients that were produced in Year 1. Major findings: Established that 2 and 3 layer crosslinked amniotic membrane composites are more

  11. Burns in Morbidly Obese Patients,

    DTIC Science & Technology

    1992-12-01

    tract infection and one episode C obesity. The clinical records of these patients were reviewed in of sinusitis. Two patients had documented bacteremias...veloped pneumonia and two developed tracheobronchitis. 0 Research, seven of whom clearly fulfilled the criteria for morbid There were one urinary

  12. Virtual Patients in Geriatric Education

    ERIC Educational Resources Information Center

    Tan, Zaldy S.; Mulhausen, Paul L.; Smith, Stephen R.; Ruiz, Jorge G.

    2010-01-01

    The virtual patient is a case-based computer program that combines textual information with multimedia elements such as audio, graphics, and animation. It is increasingly being utilized as a teaching modality by medical educators in various fields of instruction. The inherent complexity of older patients and the shortage of geriatrics educators…

  13. Virtual Patients in Pharmacy Education

    PubMed Central

    Jabbur-Lopes, Monique O.; Mesquita, Alessandra R.; Silva, Leila M. A.; De Almeida Neto, Abilio

    2012-01-01

    A review of the literature relating to the use of virtual patients in teaching pharmaceutical care to pharmacy students was conducted. Only 7 articles met the inclusion criteria for the review and 4 of the studies were conducted in North America. Few articles identified by the review used virtual patient technology that was true-to-life and/or validated. PMID:22761533

  14. Gadobutrol in Renally Impaired Patients

    PubMed Central

    Michaely, Henrik J.; Aschauer, Manuela; Deutschmann, Hannes; Bongartz, Georg; Gutberlet, Matthias; Woitek, Ramona; Ertl-Wagner, Birgit; Kucharczyk, Walter; Hammerstingl, Renate; De Cobelli, Francesco; Rosenberg, Martin; Balzer, Thomas; Endrikat, Jan

    2017-01-01

    Objective The aim of this study was to assess the potential risk of gadobutrol-enhanced magnetic resonance imaging (MRI) in patients with moderate to severe renal impairment for the development of nephrogenic systemic fibrosis (NSF). Materials and Methods We performed a prospective, international, multicenter, open-label study in 55 centers. Patients with moderate to severe renal impairment scheduled for any gadobutrol-enhanced MRI were included. All patients received a single intravenous bolus injection of gadobutrol at a dose of 0.1 mmol/kg body weight. The primary target variable was the number of patients who develop NSF within a 2-year follow-up period. Results A total of 908 patients were enrolled, including 586 with moderate and 284 with severe renal impairment who are at highest risk for developing NSF. The mean time since renal disease diagnosis was 1.83 and 5.49 years in the moderate and severe renal impairment cohort, respectively. Overall, 184 patients (20.3%) underwent further contrast-enhanced MRI with other gadolinium-based contrast agents within the 2-year follow-up. No patient developed symptoms conclusive of NSF. Conclusions No safety concerns with gadobutrol in patients with moderate to severe renal impairment were identified. There were no NSF cases. PMID:27529464

  15. Pharmacotherapeutics for the AIDS Patient.

    ERIC Educational Resources Information Center

    Fife, Kenneth H.

    1991-01-01

    Anticipated shifts in the demographics of the Acquired Immune Deficiency Syndrome (AIDS) epidemic are examined, current state-of-the-art AIDS patient management is summarized, and some unique facets of drug therapy in the AIDS patient are discussed, including adverse reactions, complex drug interactions, use of investigational drugs, and…

  16. The Coronary Patient in Industry

    NASA Technical Reports Server (NTRS)

    Schuster, B.

    1971-01-01

    The coronary patient, as he pertains to industry particularly NASA, is discussed. Concepts of precoronary care, acute attacks which may develop while on the job, and the return of the cardiac patient to work are covered. Major emphasis was on the prevention of sudden death due to coronary disease.

  17. Patient Disclosure of Medical Misdeeds

    ERIC Educational Resources Information Center

    Bergen, Clara; Stivers, Tanya

    2013-01-01

    Modern patients walk a tightrope between respecting medical authority and acting as knowledgeable advocates regarding health issues, with the agency and responsibilities that come with this. This article uses conversation analysis to explore this balance in relation to patient disclosures of medical misdeeds in video-recorded primary care medical…

  18. Rhinoplasty in Middle Eastern Patients.

    PubMed

    Sajjadian, Ali

    2016-01-01

    Rhinoplasty in patients of Middle Eastern origin requires complete understanding of nasal morphology and an individualized approach to create a racially congruent and aesthetically pleasing outcome. In this article, common anatomic features and characteristics and detailed steps, surgical techniques, and operative maneuvers that can lead to predictable outcome in rhinoplasty of Middle Eastern patients are discussed.

  19. Patient safety: honoring advanced directives.

    PubMed

    Tice, Martha A

    2007-02-01

    Healthcare providers typically think of patient safety in the context of preventing iatrogenic injury. Prevention of falls and medication or treatment errors is the typical focus of adverse event analyses. If healthcare providers are committed to honoring the wishes of patients, then perhaps failures to honor advanced directives should be viewed as reportable medical errors.

  20. Patient's breath controls comfort devices

    NASA Technical Reports Server (NTRS)

    Schrader, M.; Carpenter, B.; Nichols, C. D.

    1972-01-01

    Patient assist system for totally disabled persons was developed which permits a person, so paralyzed as to be unable to move, to activate by breathing, a call system to summon assistance, turn the page of a book, ajust his bed, or do any one of a number of other things. System consists of patient assist control and breath actuated switch.

  1. Inflatable stretcher to transport patients

    NASA Technical Reports Server (NTRS)

    Clark, C. C.; Gordon, F. T., Jr.; Schmidt, C. B.

    1970-01-01

    Inflatable plastic bag inside strong, inflexible outer bag facilitates emergency transport of seriously burned or disabled patients. When the bag is inflated the patient is completely immobilized and cushioned from external shock. Air for breathing, temperature controls and communications may be provided by appropriate plug-in connections.

  2. Are rhinoplasty patients potentially mad?

    PubMed

    Slator, R; Harris, D L

    1992-01-01

    Rhinoplasty patients have long been considered to be psychologically unstable and therefore a "risky" group upon which to operate. Patients who had rhinoplastic operations more than 5 years ago were contacted by post and their psychological health assessed by the use of psychometric tests. The results show no evidence to support earlier suggestions that requests for rhinoplasty may be early symptoms of severe psychiatric disease. However, several points do emerge. Male patients show more symptoms of anxiety and depression than normal, and female patients who give no history of injury preceding their operation behave in a more extrovert and sociable manner than normal. Furthermore, patients of both sexes who give no history of injury before their operation, even though pleased with the operative results, are more self-conscious of their appearance than those who were injured prior to their rhinoplasty.

  3. Oocyte cryopreservation in oncological patients.

    PubMed

    Porcu, Eleonora; Fabbri, Raffaella; Damiano, Giuseppe; Fratto, Rosita; Giunchi, Susanna; Venturoli, Stefano

    2004-04-05

    The use of chemotherapy and radiotherapy in oncological patients may reduce their reproductive potential. Sperm cryopreservation has been already used in men affected by neoplastic disease. Oocyte cryopreservation might be an important solution for these patients at risk of losing ovarian function. A program of oocyte cryopreservation for oncological patients is also present in our center. From June 1996 to January 2000, 18 patients awaiting chemotherapy and radiotherapy for neoplastic disease were included in our oocyte cryopreservation program. Our experience documents that oocyte storage may be a concrete and pragmatic alternative for oncological patients. The duration of oocyte storage does not seem to interfere with oocyte survival as pregnancies occurred even after several years of gamete cryopreservation in liquid nitrogen.

  4. Endodontics and the ageing patient.

    PubMed

    Johnstone, M; Parashos, P

    2015-03-01

    Patients are living longer and the rate of edentulism is decreasing. Endodontic treatment is an essential part of maintaining the health and well-being of the elderly. Retention of natural teeth improves the quality of life and the overall health and longevity of ageing patients. Also, teeth that might be otherwise extracted may be strategically valuable to retain a prosthesis, and elderly patients are more likely to have medical complications that may prevent dental extractions from being safely performed. The technical goals of endodontic treatment in the elderly are the same as those for younger patients. However, the pulpo-dentinal complex undergoes calcific changes over time, which may pose challenges for the clinician. The purposes of this review are to discuss age changes in the pulp and the challenges posed by diagnosing, treatment planning and treating the elderly endodontic patient.

  5. Developing patient safety in dentistry.

    PubMed

    Pemberton, M N

    2014-10-01

    Patient safety has always been important and is a source of public concern. Recent high profile scandals and subsequent reports, such as the Francis report into the failings at Mid Staffordshire, have raised those concerns even higher. Mortality and significant morbidity associated with the practice of medicine has led to many strategies to help improve patient safety, however, with its lack of associated mortality and lower associated morbidity, dentistry has been slower at systematically considering how patient safety can be improved. Recently, several organisations, researchers and clinicians have discussed the need for a patient safety culture in dentistry. Strategies are available to help improve patient safety in healthcare and deserve further consideration in dentistry.

  6. Hormone therapy for transgender patients

    PubMed Central

    2016-01-01

    Many transgender men and women seek hormone therapy as part of the transition process. Exogenous testosterone is used in transgender men to induce virilization and suppress feminizing characteristics. In transgender women, exogenous estrogen is used to help feminize patients, and anti-androgens are used as adjuncts to help suppress masculinizing features. Guidelines exist to help providers choose appropriate candidates for hormone therapy, and act as a framework for choosing treatment regimens and managing surveillance in these patients. Cross-sex hormone therapy has been shown to have positive physical and psychological effects on the transitioning individual and is considered a mainstay treatment for many patients. Bone and cardiovascular health are important considerations in transgender patients on long-term hormones, and care should be taken to monitor certain metabolic indices while patients are on cross-sex hormone therapy. PMID:28078219

  7. Patient With Borderline Personality Disorder

    PubMed Central

    Griffiths, Dorothy E.

    1989-01-01

    Every family practice includes people who are difficult to manage. Persons with a borderline personality disorder can be the most difficult of all. They will trust no one, and consequently few, if any, others will be able to tolerate their profoundly difficult interpersonal communication style. These patients will present to their family physician more and more often with a variety of somatic and emotional symptoms. They will demand, either verbally or silently, that these symptoms be relieved immediately. This increasing demand for immediate response may eventually cause the physician to reject the patient. An understanding of this condition and how it develops in infancy may enable the physician to help the patient. A family physician who can set appropriate limits to the patient's demands may slowly convince the patient that he can trust and not be hurt. PMID:21248944

  8. Cross linguistic aphasia testing: the Portuguese version of the Aachen Aphasia Test (AAT).

    PubMed

    Lauterbach, Martin; Martins, Isabel Pavão; Garcia, Paula; Cabeça, Joana; Ferreira, Ana Cristina; Willmes, Klaus

    2008-11-01

    We report the adaptation of the Aachen Aphasia Test (AAT) to the Portuguese language (PAAT) and the results of its standardization in 125 persons with aphasia and 153 healthy controls. Patients with aphasia had a previous syndromic diagnosis, obtained through a Portuguese aphasia battery, which served as a reference. The control group was stratified by age and educational level. Hierarchical cluster analyses showed good construct validity. The increasing degree of difficulty and complexity throughout the item sets comprising subtests was confirmed. The discriminatory power of the PAAT for the selection of aphasic from non-aphasic persons proved to be as high as for the AAT versions in other languages. Classification of standard aphasic syndromes by means of discriminant analyses was good. Internal consistency, measured by means of Cronbach's alpha coefficient, was high to very high for the different PAAT subtests. Performance differences caused by age or educational level among the healthy control persons emphasized the need for correction factors. In conclusion, the PAAT showed robust psychometric properties, comparable to the original German and to adaptations to other languages. It constitutes a useful tool for cross-linguistic and multicenter studies.

  9. Artificial grammar learning in individuals with severe aphasia.

    PubMed

    Zimmerer, Vitor C; Cowell, Patricia E; Varley, Rosemary A

    2014-01-01

    One factor in syntactic impairment in aphasia might be damage to general structure processing systems. In such a case, deficits would be evident in the processing of syntactically structured non-linguistic information. To explore this hypothesis, we examined performances on artificial grammar learning (AGL) tasks in which the grammar was expressed in non-linguistic visual forms. In the first experiment, AGL behavior of four aphasic participants with severe syntactic impairment, five aphasic participants without syntactic impairment, and healthy controls was examined. Participants were trained on sequences of nonsense stimuli with the structure A(n)B(n). Data were analyzed at an individual level to identify different behavioral profiles and account for heterogeneity in aphasic as well as healthy groups. Healthy controls and patients without syntactic impairment were more likely to learn configurational (item order) than quantitative (counting) regularities. Quantitative regularities were only detected by individuals who also detected the configurational properties of the stimulus sequences. By contrast, two individuals with syntactic impairment learned quantitative regularities, but showed no sensitivity towards configurational structure. They also failed to detect configurational structure in a second experiment in which sequences were structured by the grammar A(+)B(+). We discuss the potential relationship between AGL and processing of word order as well as the potential of AGL in clinical practice.

  10. Longitudinal deteriorations in patient reported outcomes in patients with COPD.

    PubMed

    Oga, Toru; Nishimura, Koichi; Tsukino, Mitsuhiro; Sato, Susumu; Hajiro, Takashi; Mishima, Michiaki

    2007-01-01

    Goals of effective management of patients with chronic obstructive pulmonary disease (COPD) include relieving their symptoms and improving their health status. We examined how such patient reported outcomes would change longitudinally in comparison to physiological outcomes in COPD. One hundred thirty-seven male outpatients with stable COPD were recruited for the study. The subjects health status was evaluated using the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ). Their dyspnoea using the modified Medical Research Council (MRC) scale and their psychological status using the Hospital Anxiety and Depression Scale (HADS) were assessed upon entry and every 6 months thereafter over a 5-year period. Pulmonary function and exercise capacity as evaluated by peak oxygen uptake (VO2) on progressive cycle ergometry were also followed over the same time. Using mixed effects models to estimate the slopes for the changes, scores on the SGRQ, the CRQ, the MRC and the HADS worsened in a statistically significant manner over time. However, changes only weakly correlated with changes in forced expiratory volume in 1s (FEV(1)) and peak (VO2). We demonstrated that although changes in pulmonary function and exercise capacity are well known in patients with COPD, patient reported outcomes such as health status, dyspnoea and psychological status also deteriorated significantly over time. In addition, deteriorations in patient reported outcomes only weakly correlated to changes in physiological indices. To capture the overall deterioration of COPD from the subjective viewpoints of the patients, patient reported outcomes should be followed separately from physiological outcomes.

  11. Do patient assessments of primary care differ by patient ethnicity?

    PubMed Central

    Taira, D A; Safran, D G; Seto, T B; Rogers, W H; Inui, T S; Montgomery, J; Tarlov, A R

    2001-01-01

    OBJECTIVE: To determine if patient assessments (reports and ratings) of primary care differ by patient ethnicity. DATA SOURCES/STUDY DESIGN: A self-administered patient survey of 6,092 Massachusetts employees measured seven defining characteristics of primary care: (1) access (financial, organizational); (2) continuity (longitudinal, visit based); (3) comprehensiveness (knowledge of patient, preventive counseling); (4) integration; (5) clinical interaction (communication, thoroughness of physical examinations); (6) interpersonal treatment; and (7) trust. The study employed a cross-sectional observational design. PRINCIPAL FINDINGS: Asians had the lowest primary care performance assessments of any ethnic group after adjustment for socioeconomic and other factors. For example, compared to whites, Asians had lower scores for communication (69 vs. 79, p = .001) and comprehensive knowledge of patient (56 vs. 48, p = .002), African Americans and Latinos had less access to care, and African Americans had less longitudinal continuity than whites. CONCLUSIONS: We do not know what accounts for the observed differences in patient assessments of primary care. The fact that patient reports as well as the more subjective ratings of care differed by ethnicity suggests that quality differences might exist that need to be addressed. PMID:11775667

  12. Preoperative patient assessment: Identifying patients at high risk.

    PubMed

    Boehm, O; Baumgarten, G; Hoeft, A

    2016-06-01

    Postoperative mortality remains alarmingly high with a mortality rate ranging between 0.4% and 4%. A small subgroup of multimorbid and/or elderly patients undergoing different surgical procedures naturally confers the highest risk of complications and perioperative death. Therefore, preoperative assessment should identify these high-risk patients and stratify them to individualized monitoring and treatment throughout all phases of perioperative care. A "tailored" perioperative approach might help further reduce perioperative morbidity and mortality. This article aims to elucidate individual morbidity-specific risks. It further suggests approaches to detect patients at the risk of perioperative complications.

  13. HPV Carcinomas in Immunocompromised Patients

    PubMed Central

    Reusser, Nicole M.; Downing, Christopher; Guidry, Jacqueline; Tyring, Stephen K.

    2015-01-01

    Human papillomavirus (HPV) infection is the most common sexually transmitted disease worldwide and can result in pre-malignancies or overt malignancies of the skin and mucosal surfaces. HPV-related illnesses are an important personal and public health problem causing physical, mental, sexual and financial detriments. Moreover, this set of malignancies severely affects the immunosuppressed population, particularly HIV-positive patients and organ-transplant recipients. There is growing incidence of HPV-associated anogenital malignancies as well as a decrease in the average age of affected patients, likely related to the rising number of high-risk individuals. Squamous cell carcinoma is the most common type of HPV-related malignancy. Current treatment options for HPV infection and subsequent disease manifestations include imiquimod, retinoids, intralesional bleomycin, and cidofovir; however, primary prevention with HPV vaccination remains the most effective strategy. This review will discuss anogenital lesions in immunocompromised patients, cutaneous warts at nongenital sites, the association of HPV with skin cancer in immunocompromised patients, warts and carcinomas in organ-transplant patients, HIV-positive patients with HPV infections, and the management of cutaneous disease in the immunocompromised patient. PMID:26239127

  14. [The AIDS patient in anesthesia].

    PubMed

    Jalowy, A; Flesche, C W; Lorenz, C

    1997-02-01

    Treatment of a patient with Acquired Immune Deficiency Syndrome (AIDS) is very challenging, and makes great demands on the anaesthesiologist. Any of an AIDS patient's vital organ systems may be compromised, either by the human immunodeficiency virus (HIV) itself, opportunistic infections, by tumours, or as a result of AIDS-related drug therapies. Infections of the lungs (e.g., Pneumocystis carinii pneumonia) are prevalent, and cardiac impairment can be found in as many as 50% of AIDS patients. In addition, disorders of the central and peripheral nervous system and water and electrolyte imbalances are often seen. Perioperatively, the AIDS patient is especially prone to infections as a result of a compromised immune system. The choice of anaesthetic procedure for the AIDS patient-aside from the type of operation-depends on the severity of the illness and progression of organ impairment. All anaesthesia personnel must be careful to avoid infection, as they frequently come in contact with the blood or body fluids of their patients. However, the risk of being infected by an AIDS patient is very low, provided hygiene regulations are followed strictly. The rate of seroconversion after accidental needle-stick injury is below 1%. If exposure does occur, regular serologic controls should be continued for one year. Prophylactic treatment with azidothymidine after exposition to HIV is recommended.

  15. [Adrenal insufficiency in cirrhotic patients].

    PubMed

    Orozco, Federico; Anders, María; Mella, José; Antinucci, Florencia; Pagano, Patricia; Esteban, Paula; Cartier, Mariano; Romero, Gustavo; Francini, Bettina; Mastai, Ricardo

    Relative adrenal insufficiency (RAI) is a common finding in cirrhotic patients with severe sepsis, and increased mortality. Its significance is unknown in stable conditions. The aim of this study was to evaluate the prevalence of RAI in stable cirrhotic patients at different stages of the disease. Also, the impact of RAI on the survival was evaluated and basal cortisol levels between plasma and saliva was correlated in control subjects and cirrhotic patients. Forty seven ambulatory patients and 16 control subjects were studied. RAI was defined as a serum cortisol increase of less than 9 υg/dl from baseline after the stimulation with 250 mg of synthetic ACTH. Twenty two had Child-Pugh = 8 and 25 = 9. The prevalence of RAI in patients with stable cirrhosis was 22%. A higher incidence of RAI was observed in patients with a Child-Pugh = 9 (8/32) than in those with = 8 (3/13, p < 0.05). A correlation between salivary cortisol and basal plasma cortisol (r = 0.6, p < 0.0004) was observed. Finally, survival at 1 year (97%) and 3 years (91%) was significantly higher without RAI than those who developed this complication (79% and 51%, p < 0.05, respectively). In summary, the prevalence of RAI is frequent in patients with stable cirrhosis and that it is related to the severity of liver diseaseand increased mortality.

  16. Creating the ideal patient experience

    PubMed Central

    Purcărea, Th.V

    2016-01-01

    Healthcare industry continues to evolve under conditions of intense competition in approaching health prevention, protection, and promotion. Therefore, healthcare providers are challenged to always ensure better patient experience, winning patients’ satisfaction, and loyalty and remain competitive on today’s healthcare market. Healthcare markets bring together professionals and their patients into real collaborative relationships, which empower patients to contribute to the healthcare improvement. Within this competitive landscape, which is also characterized by digital health tools boosting patients’ awareness and controlling their own health, medical providers need to be perceived as skilled and trustworthy in relying on patients’ needs, expectations, and sacrifices are required in order to obtain the promised benefits. Moreover, while constantly providing a holistic assessment of the healthcare services’ and experience attributes, acting on feedback and reaching healthcare service excellence, providing a better understanding of all the touch points with their patients and improving the quality and consistency of all these touch points, all these are achieved by employees, who are truly connected to the healthcare business. Today, patients are systematically becoming aware of the diversity of their choices, being increasingly involved in making better healthcare choices, and, so, more and more innovative products are introduced, targeting new patient segments. Findings from the last three years have shown that patients may achieve better outcomes due to the stakeholders’ commitment to innovation within the context of the big-data revolution, by building new values. PMID:27928442

  17. Confabulations in alcoholic Korsakoff patients.

    PubMed

    Borsutzky, Sabine; Fujiwara, Esther; Brand, Matthias; Markowitsch, Hans J

    2008-11-01

    Besides forgetting, memory is also prone to distortions, errors and illusions. Confabulation is one type of memory distortion that may occur in cases of brain damage. Although confabulations are described anecdotally in patients with alcoholic Korsakoff syndrome (KS), there are few systematic investigations of the presence and nature of these types of false memories in KS. Moreover, it is unclear whether KS patients' confabulations evenly affect all types of memories, or whether certain memory domains are more susceptible. Our study attempted to clarify two questions: first, whether confabulations are a critical feature of the cognitive impairment associated with long-term KS in a large sample of patients (N=42). Second, we investigated which memory domain is most likely affected by confabulations in KS. To elicit confabulations, we used a Confabulation Interview containing questions from different memory domains. We found that KS patients overall confabulated more compared to a group of healthy subjects. Furthermore, we found that patients confabulated most within the episodic/autobiographical memory domain. Our results imply that besides pronounced memory deficits typically associated with KS, confabulation can also be regarded as a clinical feature of the disease. The preponderance of episodic confabulation obtained here by using a standardized test, confirms anecdotic reports that KS patients confabulate in everyday life mainly with respect to their personal past and present. Thus, for a detailed description of the memory profile of KS patients, the screening of confabulation tendencies may be a useful supplementary clinical tool.

  18. Psychological care in trauma patients.

    PubMed

    Mohta, Medha; Sethi, A K; Tyagi, Asha; Mohta, Anup

    2003-01-01

    The clinician manages trauma patients in the emergency room, operation theatre, intensive care unit and trauma ward with an endeavour to provide best possible treatment for physical injuries. At the same time, it is equally important to give adequate attention to behavioural and psychological aspects associated with the event. Knowledge of the predisposing factors and their management helps the clinician to prevent or manage these psychological problems. Various causes of psychological disturbances in trauma patients have been highlighted. These include pain, the sudden and unexpected nature of events and the procedures and interventions necessary to resuscitate and stabilise the patient. The ICU and trauma ward environment, sleep and sensory deprivation, impact of injury on CNS, medications and associated pre-morbid conditions are also significant factors. Specific problems that concern the traumatised patients are helplessness, humiliation, threat to body image and mental symptoms. The patients react to these stressors by various defence mechanisms like conservation withdrawal, denial, regression, anger, anxiety and depression. Some of them develop delirium or even more severe problems like acute stress disorder or post-traumatic stress disorder. Physical, pharmacological or psychological interventions can be performed to prevent or minimise these problems in trauma patients. These include adequate pain relief, prevention of sensory and sleep deprivation, providing familiar surroundings, careful explanations and reassurance to the patient, psychotherapy and pharmacological treatment whenever required.

  19. [Neurologically critical patient. Nurses' care].

    PubMed

    López Díaz, Cristina

    2009-12-01

    Handling a neurologically critical patient requires some necessary knowledge and aptitudes in order to avoid risks and complications which could worsen a patient's prognosis. To that end, in this article the author deals with two important points nursing personnel need to bear in mind: the distinct methods and catheters which can be used to monitor intracranial pressure, obtaining an important parameter for evaluation purposes and therapeutic follow-up on these patients, placing special emphasis on ventricular drainage and nursing care, and the operations nurses take when dealing with patients who present a risk of intracranial hypertension, setting up a protocol based on seven necessities in the Virginia Henderson model: breathing, elimination, temperature, hygiene and skin, feeding and hydration, mobility and safety. In each of these necessities, the author studies the problems these patients present, identifying them with a series of diagnoses according to NANDA (North American Nursing Diagnosis Association), and defining the care or nursing activities for each of them, which will prove essential to prevent cerebral ischemia after suffering a primary cerebral injury due to a "TCE"(Cranial Encephalic Trauma) hemorrhage, etc. Nurses' role in caring for neurologically critical patients proves to be of vital importance since these professionals must be capable of evaluating, preventing, controlling and identifying those risk situations which neurologically critical patients could present, avoiding possible complications, aiding their recuperation, and providing quality health care.

  20. Informational Needs of Postmastectomy Patients

    PubMed Central

    Yeşilyurt, Duygu Soydaş; Fındık, Ümmü Yıldız

    2016-01-01

    Objective The aim of this study was to determine informational needs of postmastectomy patients. Materials and Methods This descriptive study was conducted in the general surgery clinics of a university health center for medical research and practice with 72 voluntary patients. For data collection, a patient identification form was used, which was prepared by the researchers in accordance with the literature. Results The mean age of the patients was 52.66±13.39 years, 87% were married, 58% had primary school education, 76% had moderate economic status, and 53% had undergone simple mastectomy. It was determined that 83% of the patients wanted to be informed about hospital and home care interventions, 82% about symptoms and prevention of post-surgical problems, 76% regarding breast cancer and treatment options, and in the range of 54–68%, patients wanted information on the effects of surgery on the body, shoulder and arm exercises, breast self-examination, the effects of breast cancer on family and work life, lymphedema and prevention interventions. Conclusion We recommend that patients with mastectomy should be informed about topics including care interventions, breast cancer and treatment options, effects of surgery, and reducing these effects.

  1. Patient satisfaction: focusing on "excellent".

    PubMed

    Otani, Koichiro; Waterman, Brian; Faulkner, Kelly M; Boslaugh, Sarah; Burroughs, Thomas E; Dunagan, W Claiborne

    2009-01-01

    In an emerging competitive market such as healthcare, managers should focus on achieving excellent ratings to distinguish their organization from others. When it comes to customer loyalty, "excellent" has a different meaning. Customers who are merely satisfied often do not come back. The purpose of this study was to find out what influences adult patients to rate their overall experience as "excellent." The study used patient satisfaction data collected from one major academic hospital and four community hospitals. After conducting a multiple logistic regression analysis, certain attributes were shown to be more likely than others to influence patients to rate their experiences as excellent. The study revealed that staff care is the most influential attribute, followed by nursing care. These two attributes are distinctively stronger drivers of overall satisfaction than are the other attributes studied (i.e., physician care, admission process, room, and food). Staff care and nursing care are under the control of healthcare managers. If improvements are needed, they can be accomplished through training programs such as total quality management or continuous quality improvement, through which staff employees and nurses learn to be sensitive to patients' needs. Satisfying patients' needs is the first step toward having loyal patients, so hospitals that strive to ensure their patients are completely satisfied are more likely to prosper.

  2. Quality of Doctor-Patient Communication through the Eyes of the Patient: Variation According to the Patient's Educational Level

    ERIC Educational Resources Information Center

    Aelbrecht, Karolien; Rimondini, Michela; Bensing, Jozien; Moretti, Francesca; Willems, Sara; Mazzi, Mariangela; Fletcher, Ian; Deveugele, Myriam

    2015-01-01

    Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In…

  3. Contribution of patient and hospital characteristics to adverse patient incidents.

    PubMed Central

    Elnicki, R A; Schmitt, J P

    1980-01-01

    The 1974 medical malpractice "crisis" brought about extensive legislation and insurance regulation in the United States. Hospitals in many states are now required to support risk management programs that include investigation and systematic analyses of adverse patient incidents. However, no research supports the hypothesis that systematic analysis of adverse patient incidents can identify contributory factors. In this study, a simple prediction model was used to estimate relationships between adverse incidents and selected patient and environmental characteristics in a large hospital. While some of the incident-characteristic relationships were significant, none of the estimated equations yielded results that could be logically translated into policy recommendations for the hospital. These results point to the need for further research. The benefits that positive research results would have for patients, hospitals, an the bill-paying public are obvious. Additional negative results would suggest that many legislative bodies and regulatory agencies were presumptions in requiring hospitals to conduct analyses of incidents. PMID:7461973

  4. Maintaining primacy of the patient perspective in the development of patient-centered patient reported outcomes

    PubMed Central

    Garver, Amanda; Ljungberg, Inger H.; Schladen, Manon M.; Groah, Suzanne L.

    2017-01-01

    The objectives of this study were to describe and demonstrate a new model of developing patient reported outcomes (PROs) that are patient-centered, and to test the hypothesis that following this model would result in a qualitatively different PRO than if the typical PRO development model were followed. The typical process of developing PROs begins with an initial list of signs or symptoms originating from clinicians or PRO developers; patient validation of this list ensures that the list (i.e., the new PRO) is interpretable by patients, but not that patient perspectives are central or even represented. The new model begins with elicitation from clinicians and patients independently and separately. These perspectives are formally analyzed qualitatively, and the results are iteratively integrated by researchers, supporting clinical relevance and patient centeredness. We describe the application of this new model to the development of a PRO for urinary signs and symptoms in individuals with neuropathic bladder, and test the hypothesis that the two processes generate qualitatively different instruments using a national validation sample of 300 respondents. Of its 29 items, the new instrument included 13 signs/symptoms derived from existing clinical practice guidelines, with 16 others derived from the patient/focus groups. The three most-endorsed items came from the patients, and the three least-endorsed items came from clinical guidelines. Thematic qualitative analysis of the elicitation process, as well as the results from our national sample, support the conclusion that the new model yields an instrument that is clinically interpretable, but more patient-centered, than the typical model would have done in this context. PMID:28257414

  5. [Patients's with aphasia communication problems].

    PubMed

    Matuszak, Katarzyna; Bonikowska, Agata; Kuczma, Monika; Hagner, Wojciech

    2011-01-01

    Aphasia is a speech disorder caused by disorders of speech centre in brain cortex. Patient with aphasia compensates communication disorders by communication strategy, witch are spontaneous mechanisms, and uses individual rehabilitation methods. Compensation mechanisms are divided in to: phonetic, inflective, formative, semantic, discursive and structural. Patients with aphasia early therapy have to be individual and consists in not only articulation correction, but in establish over verbal contact or verbal, and improvement this contacts, to create patients ability of communication with society. Later therapy is oriented on improvement of cognitive functions for possibility of participation in social live and if it is possible for return to work.

  6. Diarrhea in the immunocompromised patient.

    PubMed

    Krones, Elisabeth; Högenauer, Christoph

    2012-09-01

    Diarrhea is a common problem in patients with immunocompromising conditions. The etiologic spectrum differs from patients with diarrhea who have a normal immune system. This article reviews the most important causes of diarrhea in immunocompromised patients, ranging from infectious causes to noninfectious causes of diarrhea in the setting of HIV infection as a model for other conditions of immunosuppression. It also deals with diarrhea in specific situations, eg, after hematopoietic stem cell or solid organ transplantation, diarrhea induced by immunosuppressive drugs, and diarrhea in congenital immunodeficiency syndromes.

  7. [The magnetotherapy of hypertension patients].

    PubMed

    Ivanov, S G; Smirnov, V V; Solov'eva, F V; Liashevskaia, S P; Selezneva, L Iu

    1990-01-01

    A study was made of the influence of the constant MKM2-1 magnets on patients suffering from essential hypertension. Continuous action of the magnetic field, created by such magnets, on the patients with stage II essential hypertension was noted to result in a decrease of arterial pressure without the occurrence of any side effects and in a simultaneous reduction of the scope of drug administration. Apart from that fact, magnetotherapy was discovered to produce a beneficial effect on the central hemodynamics and microcirculation. The use of the MKM2-1 magnets may be regarded as a feasible method of the treatment of essential hypertension patients at any medical institution.

  8. Improving oral hygiene for patients.

    PubMed

    Bonetti, Debbie; Hampson, Victoria; Queen, Kerry; Kirk, Donna; Clarkson, Jan; Young, Linda

    2015-01-13

    Systematic reviews and patient safety initiatives recommend that oral hygiene should be part of routine patient care. However, evidence suggests it is often neglected in hospitals and care homes. Research recommends encouraging beliefs that support oral hygiene, and teaching nurses appropriate skills, as necessary prerequisites to implementing best practice in hospital wards. This article describes a pilot study of an educational workshop on oral hygiene. Results from the pilot study suggest that this workshop is a feasible intervention for a service-wide trial. The literature suggests that other interventions are required to complement this approach if nurses are to make oral hygiene a priority in daily patient care.

  9. Erectile dysfunction in COPD patients.

    PubMed

    Turan, Onur; Ure, Iyimser; Turan, Pakize Ayse

    2016-02-01

    Sexual dysfunction is a common problem in chronic obstructive pulmonary disease (COPD). We aimed to assess the presence of erectile dysfunction (ED) in COPD patients. Ninety-three outpatients who had been diagnosed as COPD and followed in Bolvadin State Hospital, Afyon, Turkey, were included in the study. All patients underwent pulmonary function tests and arterial blood gas analysis. They completed International Physical Activity Questionnaire (IPAQ), Medical Research Council (MRC) Dyspnea Scale, Short Form 36-item Scale (SF-36), and International Index of Erectile Function (IIEF) Questionnaire. The mean age of 10 (10.8%) mild, 46 (49.5%) moderate, 28 (30.1%) severe, and 9 (9.7%) very severe COPD patients was 61.4 ± 9.8 years. Varying degrees of ED were detected in 67.7% of COPD patients. All patients with hypoxemia had ED. IPAQ score and all SF-36 parameters were low in patients with ED, while MRC score was high. Forced expiratory volume in one second, forced vital capacity, partial pressure of oxygen in blood, oxygen (O2) saturation, IPAQ score, and role-physical parameters were statistically low in ED patients (p = 0.04, 0.02, <0.01, <0.01, 0.02, and 0.04, respectively); MRC score was statistically higher in patients with ED (p = 0.02). Patients with moderate and severe ED had statistically lower score of mental health (p < 0.01 and p = 0.02, respectively). There was a positive correlation between IIEF score and IPAQ scores (p < 0.01), MRC scores (p = 0.01), general health (p < 0.01), role-physical (p < 0.01), role-emotional (p < 0.01), physical functioning (p < 0.01), and mental health (p < 0.01) parameters in SF-36. ED is frequently seen in COPD patients. Hypoxemia, smoking, and limitation of physical activity are thought to be associated with ED in COPD as mechanisms. Quality of life and the functional capacity are negatively affected with the presence of ED. It is important for a physician to question the sexual functions in patients with COPD. The

  10. Patient risk from interproximal radiography

    SciTech Connect

    Gibbs, S.J.; Pujol, A. Jr.; Chen, T.S.; Malcolm, A.W.; James, A.E. Jr.

    1984-09-01

    Computer simulation methods for determining patient dose from dental radiography have demonstrated that patient risk from a two-film interproximal examination ranges from 1.1 X 10(-8) to 3.4 X 10(-7) using 90-kVp beams, depending on film speed, projection technique, and age and sex of the patient. Further, changing from a short-cone round-beam to a long-cone technique with rectangular collimation reduces risk by a factor of 2.9, independent of other factors.

  11. How important is patient education?

    PubMed

    Ramos-Remus, C; Salcedo-Rocha, A L; Prieto-Parra, R E; Galvan-Villegas, F

    2000-12-01

    The prevalence and disability rate of rheumatic diseases are increasing. It seems that non-medical causes play an important role in the morbidity, disability and mortality of these patients. Efforts to reduce their impact are extremely important. Patient education is thought to be one way to limit disability in rheumatic diseases and to achieve an improvement in quality of life. In this chapter, we review the influence of non-medical causes of morbidity on disease outcome, some basic aspects of education and the evidence of the effectiveness of patient education in diseases such as ankylosing spondylitis, systemic lupus erythematosus, rheumatoid arthritis and fibromyalgia syndrome.

  12. With patient satisfaction under increasing scrutiny, consider patient callbacks.

    PubMed

    2011-07-01

    Under the final rules for Medicare's value-based purchasing program, one-third of the funding that is set aside to reward quality will be based on how patients rate their hospital experience. However, some EDs are already working to maximize patient satisfaction by implementing programs or policies whereby patients who have been discharged are routinely called to make sure their recovery is going well, as well as to intervene if there is an opportunity for service recovery. There are benefits to having ED clinicians make the follow-up calls themselves, but some health care organizations are also reaping benefits by having non-clinicians collect feedback on individual clinicians as well as specific facilities. In addition to potentially boosting quality and customer service, experts say callbacks are useful in curbing malpractice litigation. To avoid pushback among staff, consider beginning a program of patient callbacks by asking clinicians to call back just two patients per shift worked, and to share their experiences with colleagues. For maximum value, experts recommend that patient callbacks be made within one to four days of discharge.

  13. Simulated Patients vs. Standardized Patients in Objective Structured Clinical Examinations

    PubMed Central

    Austin, Zubin; Gregory, Paul; Tabak, Diana

    2006-01-01

    Objectives To describe the use of patient-actors as educators in a senior-level pharmacy practice course, and to contrast the value and application of “standardized patient” and “simulated patient” educational methodologies. Design The objective structured clinical examination (OSCE) of the licensing examination were utilized during and at the end of the course along with external assessment to determine the impact of this educational methodology. Interviews with a randomly selected cohort of 14 students were undertaken 3 years after graduation and licensure to evaluate long-term impact of this course. Assessment Overall, students responded positively to the shift from “standardized” patients to “simulated” patients, recognizing their value in teaching clinical and pharmaceutical care skills. Concerns were expressed regarding objectivity in assessment and individual grading. Over 98% of students successfully passed the OSCE component of the licensing examination. Long-term follow-up suggests students valued this approach to education and that it provided them with a foundation for better understanding of the psychosocial needs of patients in practice. Conclusions Simulated-patient educators can play an important role in the pharmacy curriculum, and can complement practitioner-educators in providing students with a real-world context for understanding complex patient care needs. PMID:17149448

  14. Implant rehabilitation in bruxism patient

    PubMed Central

    Goiato, Marcelo Coelho; Sonego, Mariana Vilela; dos Santos, Daniela Micheline; da Silva, Emily Vivianne Freitas

    2014-01-01

    A white female patient presented to the university clinic to obtain implant retained prostheses. She had an edentulous maxillary jaw and presented three teeth with poor prognosis (33, 34 and 43). The alveolar bone and the surrounding tissues were healthy. The patient did not report any relevant medical history contraindicating routine dental treatment or implant surgery, but self-reported a dental history of asymptomatic nocturnal bruxism. The treatment plan was set and two Branemark protocols supported by six implants in each arch were installed after a 6-month healing period. A soft occlusal splint was made due to the patient's history of bruxism, and the lack of its use by the patient resulted in an acrylic fracture. The prosthesis was repaired and the importance of using the occlusal splint was restated. In the 4-year follow-up no fractures were reported. PMID:24907215

  15. Transfusion medicine in trauma patients

    PubMed Central

    Murthi, Sarah B; Dutton, Richard P; Edelman, Bennett B; Scalea, Thomas M; Hess, John R

    2011-01-01

    Injured patients stress the transfusion service with frequent demands for uncrossmatched red cells and plasma, occasional requirements for large amounts of blood products and the need for new and better blood products. Transfusion services stress trauma centers with demands for strict accountability for individual blood component units and adherence to indications in a clinical field where research has been difficult, and guidance opinion-based. New data suggest that the most severely injured patients arrive at the trauma center already coagulopathic and that these patients benefit from prompt, specific, corrective treatment. This research is clarifying trauma system requirements for new blood products and blood-product usage patterns, but the inability to obtain informed consent from severely injured patients remains an obstacle to further research. PMID:21083009

  16. Connecting Patients With Specialty Products

    PubMed Central

    MCCAIN, JACK

    2012-01-01

    Previously, this series described distribution channels through which specialty drugs move to patients. This installment discusses changes and challenges that lie ahead, especially at the dispensing end. PMID:23091429

  17. The patient with daily headaches.

    PubMed

    Maizels, Morris

    2004-12-15

    The term "chronic daily headache" (CDH) describes a variety of headache types, of which chronic migraine is the most common. Daily headaches often are disabling and may be challenging to diagnose and treat. Medication overuse, or drug rebound headache, is the most treatable cause of refractory daily headache. A pathologic underlying cause should be considered in patients with recent-onset daily headache, a change from a previous headache pattern, or associated neurologic or systemic symptoms. Treatment of CDH focuses on reduction of headache triggers and use of preventive medication, most commonly anti-depressants, antiepileptic drugs, and beta blockers. Medication overuse must be treated with discontinuation of symptomatic medicines, a transitional therapy, and long-term prophylaxis. Anxiety and depression are common in patients with CDH and should be identified and treated. Although the condition is challenging, appropriate treatment of patients with CDH can bring about significant improvement in the patient's quality-of-life.

  18. Implant rehabilitation in bruxism patient.

    PubMed

    Goiato, Marcelo Coelho; Sonego, Mariana Vilela; dos Santos, Daniela Micheline; da Silva, Emily Vivianne Freitas

    2014-06-06

    A white female patient presented to the university clinic to obtain implant retained prostheses. She had an edentulous maxillary jaw and presented three teeth with poor prognosis (33, 34 and 43). The alveolar bone and the surrounding tissues were healthy. The patient did not report any relevant medical history contraindicating routine dental treatment or implant surgery, but self-reported a dental history of asymptomatic nocturnal bruxism. The treatment plan was set and two Branemark protocols supported by six implants in each arch were installed after a 6-month healing period. A soft occlusal splint was made due to the patient's history of bruxism, and the lack of its use by the patient resulted in an acrylic fracture. The prosthesis was repaired and the importance of using the occlusal splint was restated. In the 4-year follow-up no fractures were reported.

  19. Should Immunocompromised Patients Have Pets?

    PubMed Central

    Steele, Russell W.

    2008-01-01

    Purpose: To evaluate the risks and benefits of pet ownership by immunodeficient patients, focusing primarily on organisms that colonize animals and are transmitted to humans. Those diseases that are known to be progressive or more severe in patients with altered immune function are emphasized. Methods: A review of the medical and veterinary literature pertaining to zoonoses transmitted by domestic animals was completed. Information pertaining to issues involving immunosuppressed patients including AIDS was carefully evaluated and summarized for inclusion. Results: There are significant clinical and psychosocial benefits to pet ownership. However, numerous diseases can be acquired from these animals which may be more severe in immunocompromised individuals. Conclusion: Simple guidelines for pet ownership by immunosuppressed patients can be implemented to reduce their risk of disease and allow them to safely interchange with their pets. PMID:21603465

  20. Vaccines for Patients with COPD.

    PubMed

    Moreno, Dolores; Barroso, Judith; Garcia, Alexis

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic obstruction of lung airflow limitation. This disease is currently the fourth higher cause of death in the world, and it is predicted to be the third by the year 2020. Patients with COPD are frequently exposed to Human Rhinovirus, Respiratory Syncytial and Influenza Virus, as well as to Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. These infectious agents are responsible for exacerbations increasing morbidity and mortality in COPD patients. Prevention of infectious exacerbations by vaccination would improve quality of life and patient survival. A literature search: "vaccination of COPD patients" was performed using Medline, the Cochrane Library and other Non-Indexed Citations for this review. This article presents a brief overview of the different studies found, on the new patents, and the future strategies on the field.

  1. Fluconazole Pharmacokinetics in Burn Patients

    PubMed Central

    Boucher, Bradley A.; King, Stephen R.; Wandschneider, Heidi L.; Hickerson, William L.; Hanes, Scott D.; Herring, Vanessa L.; Canada, Todd W.; Hess, Mary M.

    1998-01-01

    The pharmacokinetics of fluconazole in nine adult patients with severe (30 to 95% total body surface area) burns were studied. There was no significant difference in half-life (t1/2), clearance (CL), or volume of distribution (V) over time in five patients on days 3 and 8 of the study (P > 0.05). Combined parameter estimates (means ± standard deviations) for all nine patients for the two study periods were as follows: t1/2, 24.4 ± 5.8 h; CL, 0.36 ± 0.09 ml/min/kg; and V, 0.72 ± 0.12 liters/kg. These estimates of t1/2 and CL in burn patients were approximately 13% shorter and 30% more rapid, respectively, than the most extreme estimates reported for other populations. PMID:9559811

  2. [Food habits among HIV patients].

    PubMed

    Parrilla Saldaña, Josefa; Muñoz Sánchez, Isabel; Peñalver Jiménez, Carmen; Castro Rodríguez, Encarnación; Quero Haro, Antonia; Largo García, Esperanza

    2003-01-01

    The authors analyze the eating habits of a group of 108 patients suffering from HIV. The authors elaborate a chart about the composition and distribution of foods which contains all the required food groups necessary for a complete diet. This food chart lists the variable of this study as well as the frequency of their consummation. Once this chart was drawn up, it was approved by the Nutrition and Dietetic Unit at the Virgen de Valma University Hospital. Among the results obtained, there is a relationship between the necessity these patients have regarding eating a complete diet and diverse nutrients that are easy to chew as well as an abundance of liquids. The article "Nutrition for Patients suffering from HIV" written by the same authors published in the Revista ROL de Enfermera 2002; 25(12):816-820, is recommended in order to have a more complete understanding of this topic, nutrition for patients suffering from HIV.

  3. Cockroach hypersensitivity in asthmatic patients.

    PubMed

    Pola, J; Valdivieso, R; Zapata, C; Moneo, I; Duce, F; Larrad, L; Losada, E

    1988-01-01

    Hypersensitivity to cockroach antigen has been recognized as an important cause of perennial allergic rhinitis and asthma. To assess the frequency of cockroach hypersensitivity in our country, 150 asthmatic atopic subjects were studied using skin testing and in vitro assays for cockroach-specific IgE antibodies (Oriental and German cockroaches). Twenty-two of 61 patients who had a positive history of cockroach exposure had positive skin tests, and only 3 of 89 patients who had no history of exposure had positive skin reactions. Of 25 patients with positive skin tests, 23 showed specific IgE antibodies against oriental and German cockroaches using RAST and EIA techniques. In summary, approximately 15% of asthmatic atopics in Madrid area are sensitive to cockroaches (positive skin test + specific IgE antibodies). These results indicate that cockroach hypersensitivity should be considered in every patient with perennial asthma.

  4. Bathing a patient in bed

    MedlinePlus

    You will need: Large bowl of warm water Soap (regular or non-rinse soap) Two washcloths or sponges Dry towel Lotion Shaving ... skin, then gently apply a small amount of soap. Check with the patient to make sure you ...

  5. CCCT - Patient Advocate Steering Committee

    Cancer.gov

    The Patient Advocate Steering Committee (PASC) works to ensure advocates involved with the Scientific Steering Committees (SSCs) are completely integrated in the development, implementation, and monitoring of clinical trials within those groups.

  6. Dealing with the difficult patient.

    PubMed Central

    Smith, S.

    1995-01-01

    Dealing with difficult patients can represent a significant burden in the life of doctors. It is more productive, however, to view this burden as a product of the interaction between doctor and patient, for which both have a responsibility, rather than attributing any problems encountered to shortcomings of the patient alone. There is a significant risk in such situations of potentially harmful over-medicalisation. It behoves doctors, therefore, to try to prevent such problems becoming established, or make some attempt to rectify matters if they have already become so. Much is known about the factors that contribute to successful and unsuccessful clinical transactions. The awareness of what doctors bring both as professionals and as individual people to this interaction, will count as much as the practical clinical efforts made towards helping patients. PMID:7494768

  7. Helping Patients To Quit Smoking

    PubMed Central

    Bass, Frederic

    1989-01-01

    Years ago, the tobacco leaf offered its users many social and ceremonial benefits. But today, throughout the world, the manufactured cigarette wreaks biological havoc. Clinically, physicians can make a small, but significant, contribution to their patients' stopping smoking. Family physicians who want to offer systematic aid to their smoking patients should assess the amount of time and energy they are willing to invest in patients' smoking and the probable rewards of such efforts. Behavioural change comprises four stages: a pre-motivational phase, a motivational phase, a behavioural-change phase, and a maintenance phase. Anyone who has ever smoked belongs to one of these phases and should be treated accordingly. Paradoxically, the physician should support consonant smoking (the patient freely choosing to smoke) except when the smoker is actively engaged in changing behaviour. PMID:21248907

  8. 'The patient is medically cleared'.

    PubMed

    Beale, Chloe; Turner, Trevor

    2013-09-01

    It is standard practice for psychiatric nurses and junior doctors working in emergency departments to ask that patients be 'medically cleared' before psychiatric admission or even assessment. However, there is a lack of agreement over what this process should entail.

  9. Corneal temperature in schizophrenia patients.

    PubMed

    Shiloh, Roni; Munitz, Hanan; Portuguese, Shirley; Gross-Isseroff, Ruth; Sigler, Mayanit; Bodinger, Liron; Katz, Nachum; Stryjer, Rafael; Hermesh, Haggai; Weizman, Abraham

    2005-12-01

    Most data imply that dopaminergic transmission is essential for proper hypothalamic-mediated core temperature regulation. Altered central dopaminergic transmission is suggested to be involved in the pathophysiology of schizophrenia. Thus, hypothetically, schizophrenia patients might be at increased risk of developing thermoregulatory dysregulation manifested by alterations in core temperature, as well as in peripheral tissue, the temperature of which has been shown to correlate with core temperature (e.g. cornea). Previous small pilot studies of ours showed that schizophrenia patients may exhibit corneal temperature abnormalities. Hence, we assessed corneal temperature in a controlled sample of drug-free ( n =11) and medicated ( n =28) schizophrenia patients compared to healthy comparison subjects ( n =9), using a FLIR thermal imaging camera. Drug-free schizophrenia patients exhibited significantly higher corneal temperature compared to healthy subjects, typical antipsychotic drug (APD)-treated patients ( n =16) and atypical APD-treated patients ( n =12) (37.08+/-1.46 degrees C vs. 33.37+/-2.51 degrees C, 31.08+/-1.43 degrees C and 31.67+/-0.44 degrees C respectively, p <0.0001; p <0.001 vs. each group separately). The healthy comparison subjects and the atypical APD-treated patients exhibited comparable corneal temperatures and these two groups exhibited higher corneal temperatures compared to the typical APD-treated patients ( p <0.01 and p =0.051 respectively). In conclusion, this study indicates that drug-free schizophrenia patients exhibit substantially higher corneal temperature compared to healthy comparison subjects or medicated patients, and that APDs may decrease corneal temperature either to normal (atypical APD) or to subnormal (typical APD) values. The relevance of these phenomena to the pathophysiology of schizophrenia, the biological mechanism underlying drug-induced corneal temperature alterations, the possible role of temperature-lowering drugs

  10. [Ocular changes in dialysis patients].

    PubMed

    Popa, M; Nicoară, S

    2000-01-01

    The study analyzes the ocular aspects in patients receiving hemodialysis, in order to define the importance of the ophthalmological exam as prognosis and follow-up parameter. The prospective study includes 84 patients with renal insufficiency who received hemodialysis between 1994-1998. The ocular aspects and their connection with the dialysis and the basic disease are described and analyzed. The most important were the retinal vascular complications: hypertensive retinopathy, anterior optic ischaemic neuropathy, central retinal artery occlusion, diabetic retinopathy.

  11. Seeing Patients Through Genetic Lenses

    PubMed Central

    FELCONE, LINDA HULL

    2005-01-01

    Biotechnology is changing how doctors ‘see’ patients and disease processes. Optical probes and computer-assisted genetic screening tools let researchers peer into the structure and functions of cellular proteins on a molecular level. Soon, this clearer vision of individual patients will be available in the clinic, making drug and biologic treatments safer. These new lenses will push medicine toward risk prediction and away from acute intervention. PMID:23393472

  12. Nutritional Considerations for Cancer Patients

    PubMed Central

    Chen, Angela

    1985-01-01

    Although weight loss is a frequent, though not invariable, component of the cancer syndrome, the associated malnutrition is a poor prognostic sign among both children and adults. This article describes the possible mechanisms of cancer cachexia; reviews the present state of nutritional support in cancer patients; identifies nutritional problems and workable approaches during the pre- and post-treatment periods; discusses the unconventional nutritional practices commonly encountered and lists resource materials for patients and families. PMID:21274086

  13. Dental management of anticoagulated patients.

    PubMed

    Carr, M M; Mason, R B

    1992-10-01

    Today's trend toward ambulatory medical care will bring more pharmacological problems into the dental office. While the dental management of patients taking oral anticoagulants is controversial, current research supports the contention that they can be safely treated on an outpatient basis. The use of the International Normalized Ratio (INR) has made better estimates of prothrombin time possible, and patients can be maintained in a narrow therapeutic range. Postoperative hemorrhage can be avoided or controlled with local hemostatic agents.

  14. Intragastric Balloon for Overweight Patients

    PubMed Central

    Martins Fernandes, Flavio Augusto; Lima, Diego L.; Rao, Prashanth; Shadduck, Phillip P.; Montandon, Isabelle D.; de Souza Barros, Juscielle; Rodrigues, Ingrid Lais Vieira

    2016-01-01

    Background and Objectives: Current treatments for overweight adults include reduced-calorie diet, exercise, behavior modification, and selective use of medications. Many achieve suboptimal results with these measures and progress to obesity. Whether the intragastric balloon (IGB), a reversible device approved for treatment of obesity, is a safe and effective option in overweight adults is less well studied. We conducted a study to prospectively analyze the safety and effectiveness of IGB in overweight adults, to compare the results to a simultaneously studied cohort of obese patients, and to share procedural tips for safe IGB placement and removal. Methods: One hundred thirty-nine patients were evaluated in this prospective, nonrandomized study. Twenty-six overweight [body mass index (BMI), 26–30)] and 113 obese (BMI > 30) patients underwent outpatient, endoscopic IGB placement under intravenous sedation. The IGB was filled with a 550–900 mL (average, 640 mL) solution of saline, radiological contrast, and methylene blue, with an approximate final proportion of 65:2:1. The patients were followed up at 1–2 weeks and then monthly for 6 months. At 6 months, they underwent IGB removal via an esophageal overtube to optimize safety, and then they were observed for 6 more months. Results: IGB time was 190 ± 36 d in the overweight patients and 192 ± 43 d in the obese patients. Symptoms of IGB intolerance included nausea and pain, which were transiently present in 50–95% of patients for several days, and necessitated early IGB removal in 6% of patients. There were no procedure-related complications and no IGB-related esophagitis, erosion, perforation, or obstruction. The percentage of excess weight loss (EWL%) was 96 ± 54% in the overweight group and 41 ± 26% in the obese group (P < 0.001). Conclusion: In overweight adults failing standard treatments, IGB placement for 6 months had an acceptable safety profile and excellent weight loss. PMID:26955259

  15. [Orthodontic treatment in periodontal patients].

    PubMed

    Krausz, E; Einy, S; Aizenbud, D; Levin, L

    2011-07-01

    Orthodontic treatment poses a significant challenge in patients suffering from periodontal disease. Providing orthodontic treatment to periodontal patients should be carefully planned and performed in a tight collaboration between the orthodontist and periodontist. Resolution and stabilization of the periodontal condition is a pre-requisite for orthodontic treatment initiation. Careful oral hygiene performance and highly frequent recall periodontal visits are also crucial. Pre- or post- orthodontic periodontal surgery might help providing better treatment outcomes.

  16. Depression and the Suicidal Patient.

    PubMed

    Kuo, Dick C; Tran, Mina; Shah, Asim A; Matorin, Anu

    2015-11-01

    Depression is the most common psychiatric illness in the general community, with 3% to 4% of depressives dying by suicide today. Studies have shown that depression has considerable morbidity and mortality. This article focuses on depressed patients and their management within the emergency department. Understanding the intricacies of the interview process and identifying which patients need immediate attention are important skills for the emergency physician.

  17. [Risk management and patient safety].

    PubMed

    Lessing, C

    2009-06-01

    Risk management and patient safety are of indisputable importance for the quality of health care. At the same time they confront all professional groups in the health system with high demands. The Action Alliance for Patient Safety inc. wants to demonstrate ways in which measures for avoiding errors and improving safety can reach the healthcare practice. Interdisciplinary cooperation and the availability of mutually developed materials are the maxims of the work of the society.

  18. Paradoxical emboli in elderly patients.

    PubMed

    Vella, M; McNabb, R; Lewis, R; Sulke, N; Poston, R; Lugon, M

    1992-01-01

    We report two elderly patients who each had a patent foramen ovale (PFO) and were considered to have had paradoxical emboli. In one patient the PFO was detected by contrast two-dimensional echocardiography, whereas in the other it was demonstrated at post-mortem examination. This is an unusual but treatable condition, particularly difficult to diagnose in older people and probably occurring more frequently than is generally suspected.

  19. Information technologies and patient safety.

    PubMed

    Ellner, Scott J; Joyner, Paul W

    2012-02-01

    Advances in health information technology provide significant opportunities for improvements in surgical patient safety. The adoption and use of electronic health records can enhance communication along the surgical spectrum of care. Bar coding and radiofrequency identification technology are strategies to prevent retained surgical sponges and for tracking the operating room supply chain. Computerized intraoperative monitoring systems can improve the performance of the operating room team. Automated data registries collect patient information to be analyzed and used for surgical quality improvement.

  20. Patient Simulators Train Emergency Caregivers

    NASA Technical Reports Server (NTRS)

    2014-01-01

    Johnson Space Center teamed up with Sarasota, Florida-based METI (now CAE Healthcare) through the STTR program to ruggedize the company’s patient simulators for training astronauts in microgravity environments. The design modifications were implemented in future patient simulators that are now used to train first responders in the US military as well as fire departments and other agencies that work in disaster zones.

  1. Establishing an active patient partnership.

    PubMed

    Herrier, R N; Boyce, R W

    1995-04-01

    Pharmacists face many changes in the coming decade, some of which threaten their professional survival. Although uncertainty may currently prevail, one of these changes, the shift in the patient-health care professional relationship from the patient taking a passive role to an active partnering role, provides pharmacists with many opportunities to realize the vision of patient-centered care that has been advocated by pharmacy innovators and leaders for almost three decades. To take advantage of these changes, pharmacists must modify their practice paradigms and use their existing strengths, such as easy patient access and high levels of patient trust, to help develop a new model of pharmaceutical care. The concern that the magnitude of these changes will prevent successful practice transformations may be exaggerated. In reality, these proposed "new" roles have been in existence for much of this century. Most pharmacists can expand and enhance their traditional roles as self-care advisors and patient educators simply by incremental improvements in interpersonal and clinical skills. Rather than a Star Trek approach to "go where no man has gone before," the profession needs only a pharmaceutical sequel to Back to the Future.

  2. Toothbrush pressures of orthodontic patients.

    PubMed

    White, L

    1983-02-01

    The intention of this study was to determine whether toothbrushing pressures varied significantly between groups of orthodontic patients who were good toothbrushers and those who were poor toothbrushers. Seventy-two patients undergoing full-banded orthodontic treatment were selected from the author's practice and were subjectively paired by him according to their habitual oral hygiene. One group of thirty-six patients who habitually displayed poor oral hygiene was compared to a group of thirty-six patients who habitually displayed good oral hygiene. A specially designed strain gauge with a force-averaging feedback mechanism was attached to each patient's manual toothbrush, and the force with which that patient brushed was averaged and recorded in pounds. The poor brushers averaged 0.20 pound, whereas the average pressure of the good brushers was 0.89 pound. The statistical evidence indicates that the difference between the two groups is highly significant and is unlikely to be due to chance alone. This study has shown that toothbrush pressures can be easily and accurately measured. The attempt to objectify a single characteristic of toothbrushing behavior in an orthodontic population is an effort to avoid the medical model explanation of behavior vis-a-vis the nonspecific and subjective word attitude. Future studies will determine whether poor toothbrushers can be changed into good toothbrushers through the progressive acquisition of greater toothbrushing forces.

  3. Cancer patient satisfaction with care.

    PubMed

    Wiggers, J H; Donovan, K O; Redman, S; Sanson-Fisher, R W

    1990-08-01

    A diagnosis of cancer places considerable stress on patients and requires them to make major adjustments in many areas of their lives. As a consequence, considerable demands are placed on health care providers to satisfy the complex care needs of cancer patients. Currently, there is little available information to indicate the extent to which cancer patients are satisfied with the quality of care they receive. The present study assessed the perceptions of 232 ambulatory cancer patients about the importance of and satisfaction with the following aspects of care: doctors technical competence and interpersonal and communication skills, accessibility and continuity of care, hospital and clinic care, nonmedical care, family care, and finances. The results indicate that all 60 questionnaire items used were considered to reflect important aspects of care, but that greater importance was given to the technical quality of medical care, the interpersonal and communication skills of doctors, and the accessibility of care. Most patients were satisfied with the opportunities provided to discuss their needs with doctors, the interpersonal support of doctors, and the technical competence of doctors. However, few patients were satisfied with the provision of information concerning their disease, treatment, and symptom control and the provision of care in the home and to family and friends.

  4. [Orthodontics for mentally handicapped patients].

    PubMed

    Remmelink, H J

    2006-12-01

    The mentally handicapped exhibit a 3 times higher incidence of malocclusions and related functional problems than the general population. In contrast there is little available literature relating to the orthodontic treatment of handicapped patients. Based on published articles on orthodontic treatment of disabled patients the following recommendations can be given. First of all for each patient a 'problem list' should be drawn up, based on the diagnosis. In this list the orthodontic problems are formulated. Additionally, the list makes clear who is responsible for providing services related to orthodontic care, such as oral hygiene and transportation of the patient to the orthodontist. When deciding whether or not orthodontic treatment should be administered to a patient with a mental handicap the same functional and aesthetic considerations as with any other orthodontic case must be taken into account. Furthermore, the severity of the handicap and possible associated psychosocial and medical limitations as well as the extent to which it will be possible to treat the patient have to be considered. Contraindications are a severe mental handicap, inability to remain still in the dental chair, insufficient co-operation of parents/carers, open bite resulting from abnormal oral function, and a mild malocclusion. The orthodontic treatment should aim for an acceptable result, and not for orthodontic perfection.

  5. [Fertility in testicular cancer patients].

    PubMed

    Shin, Takeshi; Miyata, Akane; Arai, Gaku; Okada, Hiroshi

    2015-03-01

    Testicular cancer(TC)is the most common and curable cancer affecting men of reproductive age. Successful treatment approaches have resulted in longer life expectancy in TC survivors. The most frequently used treatment for TC is a combination of inguinal orchiectomy, and either radiotherapy or cisplatin-based chemotherapy. In many TC patients, sperm quality is already abnormal and there may even be a lack of viable spermatozoa at the time of diagnosis. Therefore, the effect of cancer treatment on fertility is a potentially significant issue. Fertility preservation in these men has become essential and needs to be discussed prior to the start of cancer treatment. The only currently established fertility preservation method is the cryopreservation of sperm before therapy. For most patients seeking cryopreservation, the semen sample is collected via masturbation. If the patient is unable to ejaculate for any reason, other techniques such as vibratory stimulation and electroejaculation can be performed. In azoospermic or severely oligozoospermic patients, testicular sperm extraction at the time of the inguinal orchiectomy is a useful technique for obtaining spermatozoa before cytotoxic therapy. We herein present an overview of the current topics on fertility in TC patients, including the effects of surgery, chemotherapy, and radiation therapy. We also describe the strategy for fertility preservation in these patients.

  6. The Zest for Patient Empowerment

    PubMed Central

    Thawani, Vijay

    2016-01-01

    Patient Empowerment (PE) can be considered as an active and self-determining role of patient than a passive recipient of health related services. It encourages the provider–patient relationship to blossom and helps in clearing patients’ doubts, confusion and fears to bring in clarity, relief and assurance. For the active involvement of the patient’s in own health management they need to be awakened, motivated, educated and enlightened to enable them to exercise their rights. Active patient involvement in the decision-making achieves favourable health outcome. In an empowerment based approach, the focus is not on defining a particular type of behaviour, but on how the behaviour is defined as a goal to be achieved by a particular individual. As a result of their empowerment process, the patients can better self-manage their illness and their lives. Thus empowerment of the patients will positively help medical uprising of the community by creating an educated, health aware, informed and health conscious mass. PMID:27504307

  7. Peripapillary Retinoschisis in Glaucoma Patients

    PubMed Central

    Bayraktar, Serife; Cebeci, Zafer; Kabaalioglu, Melis; Ciloglu, Serife; Kir, Nur; Izgi, Belgin

    2016-01-01

    Purpose. To investigate peripapillary retinoschisis and its effect on retinal nerve fiber layer (RNFL) thickness measurements by using spectral-domain optical coherence tomography (SD-OCT) in glaucomatous eyes. Methods. Circumpapillary RNFL (cpRNFL) B-scan images of 940 glaucoma patients (Group 1) and 801 glaucoma-suspect patients (Group 2) obtained by SD-OCT were reviewed. The structural and clinical characteristics of the retinoschisis were investigated. The RNFL thickness measurements taken at the time of retinoschisis diagnosis and at the follow-up visits were also compared. Results. Twenty-nine retinoschisis areas were found in 26 of the 940 glaucoma patients (3.1%) in Group 1 and seven areas were found in 801 patients (0.87%) in Group 2. In glaucomatous eyes, the retinoschisis was attached to the optic disc and overlapped with the RNFL defect. At the time of retinoschisis, the RNFL thickness was statistically greater in the inferior temporal quadrant when compared with the follow-up scans (p < 0.001). No macular involvement or retinal detachment was observed. Conclusion. The present study investigated 33 peripapillary retinoschisis patients. Increase in RNFL thickness measurements was observed at the time of retinoschisis. It is important to examine the cpRNFL B-scan images of glaucoma patients so that the RNFL thickness is not overestimated. PMID:27069674

  8. Hypothermia and the trauma patient

    PubMed Central

    Kirkpatrick, Andrew W.; Chun, Rosaleen; Brown, Ross; Simons, Richard K.

    Hypothermia has profound effects on every system in the body, causing an overall slowing of enzymatic reactions and reduced metabolic requirements. Hypothermic, acutely injured patients with multisystem trauma have adverse outcomes when compared with normothermic control patients. Trauma patients are inherently predisposed to hypothermia from a variety of intrinsic and iatrogenic causes. Coagulation and cardiac sequelae are the most pertinent physiological concerns. Hypothermia and coagulopathy often mandate a simplified approach to complex surgical problems. A modification of traditional classification systems of hypothermia, applicable to trauma patients is suggested. There are few controlled investigations, but clinical opinion strongly supports the active prevention of hypothermia in the acutely traumatized patient. Preventive measures are simple and inexpensive, but the active reversal of hypothermia is much more complicated, often invasive and controversial. The ideal method of rewarming is unclear but must be individualized to the patient and is institution specific. An algorithm reflecting newer approaches to traumatic injury and technical advances in equipment and techniques is suggested. Conversely, hypothermia has selected clinical benefits when appropriately used in cases of trauma. Severe hypothermia has allowed remarkable survivals in the course of accidental circulatory arrest. The selective application of mild hypothermia in severe traumatic brain injury is an area with promise. Deliberate circulatory arrest with hypothermic cerebral protection has also been used for seemingly unrepairable injuries and is the focus of ongoing research. PMID:10526517

  9. ETHICAL MODELS OF PHYSICIAN--PATIENT RELATIONSHIP REVISITED WITH REGARD TO PATIENT AUTONOMY, VALUES AND PATIENT EDUCATION.

    PubMed

    Borza, Liana Rada; Gavrilovici, Cristina; Stockman, René

    2015-01-01

    The present paper revisits the ethical models of patient--physician relationship from the perspective of patient autonomy and values. It seems that the four traditional models of physician--patient relationship proposed by Emanuel & Emanuel in 1992 closely link patient values and patient autonomy. On the other hand, their reinterpretation provided by Agarwal & Murinson twenty years later emphasizes the independent expression of values and autonomy in individual patients. Additionally, patient education has been assumed to join patient values and patient autonomy. Moreover, several authors have noted that, over the past few decades, patient autonomy has gradually replaced the paternalistic approach based on the premise that the physician knows what is best for the patient. Neither the paternalistic model of physician-patient relationship, nor the informative model is considered to be satisfactory, as the paternalistic model excludes patient values from decision making, while the informative model excludes physician values from decision making. However, the deliberative model of patient-physician interaction represents an adequate alternative to the two unsatisfactory approaches by promoting shared decision making between the physician and the patient. It has also been suggested that the deliberative model would be ideal for exercising patient autonomy in chronic care and that the ethical role of patient education would be to make the deliberative model applicable to chronic care. In this regard, studies have indicated that the use of decision support interventions might increase the deliberative capacity of chronic patients.

  10. A Patient Safety Dilemma: Obesity in the Surgical Patient.

    PubMed

    Goode, Victoria; Phillips, Elayne; DeGuzman, Pamela; Hinton, Ivora; Rovnyak, Virginia; Scully, Kenneth; Merwin, Elizabeth

    2016-12-01

    Patient safety and the delivery of quality care are major concerns for healthcare in the United States. Special populations (eg, obese patients) need study in order to support patient safety, quantify risks, advance education for healthcare-workers, and establish healthcare policy. Obesity is a complex chronic disease and is considered the second leading cause of preventable death in the United States with approximately 300,000 deaths per year. Obesity is recognized by the Agency for Healthcare Research and Quality (AHRQ) as a comorbid condition. These concerns emphasize the need to focus further research on the obese patient. Through the use of clinical and administrative data, this study examines the incidence of adverse outcomes in the obese surgical population through AHRQ Patient Safety Indicators (PSI) and allows for the engagement PSIs as measures to guide and improve performance. In this study, the surgical population was overwhelmingly positive for obesity. Body mass index (BMI) was also a significant positive predictor for 2 of 3 postoperative outcomes. This finding suggests that as BMI reaches the classification of obesity, the risk of these adverse outcomes increases. It further suggests there exists a threshold BMI that requires anticipation of alterations to systems and processes to revise outcomes.

  11. Supporting patient autonomy: the importance of clinician-patient relationships.

    PubMed

    Entwistle, Vikki A; Carter, Stacy M; Cribb, Alan; McCaffery, Kirsten

    2010-07-01

    Personal autonomy is widely valued. Recognition of its vulnerability in health care contexts led to the inclusion of respect for autonomy as a key concern in biomedical ethics. The principle of respect for autonomy is usually associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive. In this paper, we suggest that a strong focus on decision situations is problematic, especially when combined with a tendency to stress the importance of patients' independence in choosing. It distracts attention from other important aspects of and challenges to autonomy in health care. Relational understandings of autonomy attempt to explain both the positive and negative implications of social relationships for individuals' autonomy. They suggest that many health care practices can affect autonomy by virtue of their effects not only on patients' treatment preferences and choices, but also on their self-identities, self-evaluations and capabilities for autonomy. Relational understandings de-emphasise independence and facilitate well-nuanced distinctions between forms of clinical communication that support and that undermine patients' autonomy. These understandings support recognition of the value of good patient-professional relationships and can enrich the specification of the principle of respect for autonomy.

  12. [Nutritional support in stroke patients].

    PubMed

    Burgos Peláez, Rosa; Segurola Gurrutxaga, Hegoi; Bretón Lesmes, Irene

    2014-01-01

    Stroke is a public health problem of the first order. In developed countries is one of the leading causes of death, along with cardiovascular disease and cancer. In addition, stroke is the leading cause of permanent disability in adulthood. Many of the patients who survive do so with significant sequelae that limit them in their activities of daily living. Most strokes (80-85%) are due to ischemia, while the rest are hemorrhagic. We have identified many modifiable risk factors, some with an important relationship with dietary factors or comorbidities in wich the diet has a significant impact. The incidence of malnutrition in stroke patients is not well known, but most likely impacts on patient prognosis. Furthermore, the nutritional status of patients admitted for stroke often deteriorates during hospitalization. It is necessary to perform a nutritional assessment of the patient in the early hours of admission, to determine both the nutritional status and the presence of dysphagia. Dysphagia, through alteration of the safety and efficacy of swallowing, is a complication that has an implication for nutritional support, and must be treated to prevent aspiration pneumonia, which is the leading cause of mortality in the stroke patient. Nutritional support should begin in the early hours. In patients with no or mild dysphagia that can be controlled by modifying the texture of the diet, they will start oral diet and oral nutritional supplementation will be used if the patient does not meet their nutritional requirements. There is no evidence to support the use of nutritional supplements routinely. Patients with severe dysphagia, or decreased level of consciousness will require enteral nutrition. Current evidence indicates that early nutrition should be initiated through a nasogastric tube, with any advantages of early feeding gastrostomy. Gastrostomy will be planned when the enteral nutrition support will be expected for long-term (4 weeks). Much evidence points to the

  13. Antimicrobial Dose in Obese Patient

    PubMed Central

    Kassab, Sawsan; Syed Sulaiman, Syed Azhar; Abdul Aziz, Noorizan

    2007-01-01

    Introduction Obesity is a chronic disease that has become one of major public health issue in Malaysia because of its association with other disease states including cardiovascular disease and diabetes. Despite continuous efforts to educate the public about the health risks associated with obesity, prevalence of the disease continues to increase. Dosing of many medications are based on weight, limited data are available on how antimicrobial agents should be dosed in obesity. The aim of this case presentation is to discuss dose of antibiotic in obese patient. Case report: Patient: GMN, Malay, Female, 45 year old, 150kg, transferred from medical ward to ICU with problems of fever, orthopnea, sepsis secondary to nosocomial pneumonia. She was admitted to hospital a week ago for SOB on exertion, cyanosis, mildly dyspneic, somasthenia, bilateral ankle swelling. There was no fever, cough, chest pain, clubbing, flapping tremor. Her grand father has pre-morbid history of obesity, HPT, DM and asthma. She was non alcoholic, smoker, and not on diet control. The diagnosis Pickwickian syndrome was made. Patient was treated with IV Dopamine 11mcg/kg/min, IV Morphine 4mg/h. IV GTN 15mcg/min, IV Ca gluconate 10g/24h for 3/7, IV Zantac 50mg tds, IV Augmentin 1.2g tds, IV Lasix 40mg od, IV Plasil 10mg tds, S.c heparin 5000IU bd. patient become stable and moved to medical ward to continue her treatment. Discussion: The altered physiologic function seen in obese patients is a concern in patients receiving antimicrobial agents because therapeutic outcomes depend on achieving a minimum inhibitory concentration (MIC). The therapeutic effect of any drug can be altered when any of the 4 pharmacokinetic processes (absorption, distribution, metabolism, or elimination) are altered. Decreased blood flow rates and increased renal clearance in obese patients can affect drug distribution and elimination. Changes in serum protein levels can change the metabolism and distribution of drugs that are

  14. Mycoses in the transplanted patient.

    PubMed

    Dictar, M O; Maiolo, E; Alexander, B; Jacob, N; Verón, M T

    2000-01-01

    The incidence of invasive fungal infection (IFI) has increased considerably over the past 20 years, and transplant recipients are at especially high risk for fungal infections owing to their overall immunosuppressed condition. Organ transplantation procedures were incorporated as a therapeutic option for many patients who lacked the normal functions of organs such as the heart, liver, kidney, lung, pancreas and small bowel. The prevalence of IFI in solid organ transplant (SOTR) patients ranges from 5 to 50% in kidney and liver transplants, respectively. In bone marrow transplant (BMT) patients, IFI are major causes of morbidity and mortality due to the protracted neutropenic period and graft-versus-host disease. Candida spp. and Aspergillus spp. account for >80% of fungal episodes in both SOTR and BMT. The development of new immunosuppressive agents, new prophylaxis strategies (as pre-emptive therapy) and the improvement in surgical techniques led to increase survival of transplant recipients. In this session, a clear and concise update of the recent advances in the laboratory diagnosis of candidiasis and aspergillosis in this kind of patients was presented. However, we still need to establish more rapid, sensitive and specific methods for IFI diagnosis. Representatives of the 'Subcomision de Infecciones en el Paciente Neutropenico y Transplantado (SIPNYT)' de la Sociedad Argentina de Infectologia (SADI), presented the results of an unusual multicenter study both retrospective and descriptive studies of IFI in SOTR and BMT patients in Argentina. In addition, a study of IFI in 1,861 SOTR patients from four centers and the analysis of IFI in 2,066 BMT patients from all 12 BMT centers from Argentina was presented. From these studies it can be concluded that 'all transplant recipients are not the same' and that they should be stratified according to their different risk degrees in order to determine the best prophylaxis and treatment strategies.

  15. Managing diabetes in dialysis patients.

    PubMed

    O'Toole, Sam M; Fan, Stanley L; Yaqoob, M Magdi; Chowdhury, Tahseen A

    2012-03-01

    Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with

  16. Patient Informatics: Technology in the Service of Patient Care

    PubMed Central

    Brennan, Patricia Flatley

    1990-01-01

    Care of the patient at home challenges the health care system with both the quantity and diversity of services required. Informatics technologies may provide mechanisms to relieve the burden of traditional services while meeting the unique needs of home-based patients in a timely and effective manner. Capitalizing on an existing, free, public-access computer network we developed the COMPUTERLINK, a set of utilities designed to provide home-care support to persons living with AIDS/ARC (PLWA) in the community. The pilot study presented here we demonstrate the feasibility of using home-based computer networks to provide information, communication and decision assistance to PLWA. The success experienced with this particular group provides sufficient encouragement to extend this intervention to other groups of community-based patients.

  17. [Tracheotomy in brain injured patients: which patients? Why? When? How?].

    PubMed

    Richard, I; Hamon, M-A; Ferrapie, A-L; Rome, J; Brunel, P; Mathé, J-F

    2005-06-01

    The aim of this study is to determine, from the data available in the literature, the indications of tracheostomy in brain injured patients, the incidence and risk factors for complications and the follow-up required until decannulation. The incidence of tracheostomy is 10% in TBI and 50 to 70% in subpopulations with a Glasgow Coma Scale (GCS) below 9. Early complications are not specific. The most frequent late complication is laryngotracheal stenosis, which occurs in 15% and is more frequently observed in the most severe patients with major hypertonia. It is likely that tracheostomy, if needed, should be performed early and the prognosis as to whether it will be required, can be made at the end of the first week. The follow-up of these patients includes surveillance of multiresistant colonisations and systematic performance of fibroscopy before decannulation. Cuffless, small diameters, soft tracheostomy tubes, are preferred on the long-term unless the risk of aspiration remains high.

  18. Research without informed patient consent in incompetent patients.

    PubMed

    Dobb, G J

    2015-05-01

    Most patients needing intensive care cannot give informed consent to participation in research. This includes the most acutely and severely ill, with the highest mortality and morbidity where research has the greatest potential to improve patient outcomes. In these circumstances consent is usually sought from a substitute decision maker, but while survivors of intensive care believe substitute decision makers will look after their interests, evidence suggests substitute decision makers are poorly equipped for this task. Various models have been suggested for research without patient informed consent when intervention is urgent and cannot wait until first person consent is possible, including a waiver of consent if conditions are met. A nationally consistent model is proposed for Australia with a robust process for initial waiver of consent followed by first person consent to further research-related procedures or ongoing follow-up when this can be competently provided.

  19. Verbal hallucinations in psychotic patients.

    PubMed

    Ettinger, B; Telerand, A; Kronenberg, Y; Gaoni, B

    1991-01-01

    "Verbal hallucinations" are sentences that psychotic patients may say repeatedly throughout a conversation which are out of context or unconnected to the topic of conversation. These hallucinations are not the outcome of a remembrance of an experience or an event and do not bring about any emotional relief or catharsis, but they supply valuable information. They resemble Jacques Lacan's description of the psychotic mechanism "Forclusion." This mechanism relates to experiences that did not undergo the process of primary symbolization through language, and experiences where words were attached but were not bound to the language structure. The result being that these experiences did not enter into the unconscious discourse of the subject. This information can reappear as verbal hallucinations in the psychotic patient. In such cases, the therapist, with the assistance of the patient's family, must investigate the meaning of the verbal hallucinations through research into the patient's and family's history in the phase prior to language development. When such a connection is discovered, the therapist must then bridge the hallucinations with the events unknown to the patient but contained in his subconscious. The therapist's role in such cases resembles that of a parent with a child: To translate the subject's experience through language from the physical schema to the body image and symbolic plane and in so doing, give meaning to meaninglessness. In our paper three short clinical cases are presented.

  20. Creating Simulated Microgravity Patient Models

    NASA Technical Reports Server (NTRS)

    Hurst, Victor; Doerr, Harold K.; Bacal, Kira

    2004-01-01

    The Medical Operational Support Team (MOST) has been tasked by the Space and Life Sciences Directorate (SLSD) at the NASA Johnson Space Center (JSC) to integrate medical simulation into 1) medical training for ground and flight crews and into 2) evaluations of medical procedures and equipment for the International Space Station (ISS). To do this, the MOST requires patient models that represent the physiological changes observed during spaceflight. Despite the presence of physiological data collected during spaceflight, there is no defined set of parameters that illustrate or mimic a 'space normal' patient. Methods: The MOST culled space-relevant medical literature and data from clinical studies performed in microgravity environments. The areas of focus for data collection were in the fields of cardiovascular, respiratory and renal physiology. Results: The MOST developed evidence-based patient models that mimic the physiology believed to be induced by human exposure to a microgravity environment. These models have been integrated into space-relevant scenarios using a human patient simulator and ISS medical resources. Discussion: Despite the lack of a set of physiological parameters representing 'space normal,' the MOST developed space-relevant patient models that mimic microgravity-induced changes in terrestrial physiology. These models are used in clinical scenarios that will medically train flight surgeons, biomedical flight controllers (biomedical engineers; BME) and, eventually, astronaut-crew medical officers (CMO).