March 2025
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Publications (246)
September 2024
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47 Reads
Journal of Neurology
![Differential effects between groups of chronicity for the AAT profile level after individual correction for spontaneous recovery. Mean AAT profile level from pre-treatment to post-treatment assessment in the early subacute, late subacute and chronic group. Error bars represent 95% CI for the variation in intraindividual changes [35]](https://www.researchgate.net/publication/380729341/figure/fig2/AS:11431281290240676@1731553865134/Differential-effects-between-groups-of-chronicity-for-the-AAT-profile-level-after_Q320.jpg)
May 2024
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199 Reads
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2 Citations
Journal of Neurology
Background Aphasia is a devastating consequence after stroke, affecting millions of patients each year. Studies have shown that intensive speech and language therapy (SLT) is effective in the chronic phase of aphasia. Leveraging a large single-center cohort of persons with aphasia (PWA) including patients also in the subacute phase, we assessed treatment effects of intensive aphasia therapy in a real-world setting. Methods Data were collected at the Aachen aphasia ward in Germany between 2003 and 2020. Immediate treatment responses across different language domains were assessed with the Aachen Aphasia Test (AAT) using single-case psychometrics, conducted before and after 6–7 weeks of intensive SLT (10 h per week, median (IQR) dosage = 68 (61–76)). We adjusted for spontaneous recovery in subacute patients. Differential treatment effects between subgroups of chronicity and predictors of therapy response were investigated. Results A total of 448 PWA were included (29% female, median (IQR) age = 54 (46–62) years, median (IQR) time post-onset = 11 (6–20) months) with 12% in the early subacute, 15% in the late subacute and 74% in the chronic phase of aphasia. The immediate responder rate was 59%. Significant improvements in all AAT subtests und subscales were observed hinting at broad effectiveness across language domains. The degree of therapy-induced improvement did not differ between the chronicity groups. Time post-onset, dosage of therapy and aphasia severity at the beginning of treatment were predictors of immediate treatment response. Discussion Intensive therapy protocols for aphasia after stroke are yielding substantial responder rates in a routine clinical setting including a wide range of patients.
August 2022
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210 Reads
A 3-step hierarchical Bayes analysis of the frequency of apraxia of speech in patients with chronic post-stroke aphasia. Step 1: meta-analysis of published frequency data; step 2: survey of expert opinions; step 3: secondary auditory-perceptual analysis of speech samples from a representative sample of patients with post-stroke aphasia, > 6 months post-onset (n=156).
March 2022
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161 Reads
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19 Citations
Cortex
Apraxia of speech is a motor speech disorder that occurs after lesions to the left cerebral hemisphere, most often concomitant with aphasia. It requires specific approaches in the study of its physiological and neuroanatomical basis and special expertise in clinical care. Knowing its prevalence in patients with aphasia after stroke is therefore relevant for planning specific resources in clinical research and in health care provision. Systematic studies of the frequency of this condition are lacking. We examined the frequency of apraxia of speech in a representative sample of 156 patients with chronic post-stroke aphasia. Three experts classified the patients’ speech by best-practice auditory-perceptual methods. Bayesian hierarchical models were fitted to obtain probability distributions for prevalence estimates. A prior distribution was calculated in two steps, including Bayesian models for published frequency data (step 1) and prevalence estimates from experienced clinicians (step 2). Separate models were fitted for different severity ranges. Overall, a prevalence rate of 0.44 [0.30, 0.58] was obtained. When only moderate and severe cases were taken into account, the rate was 0.35 [0.23, 0.49]. After a further restriction to only severe impairment, prevalence dropped to 0.22 [0.12, 0.34]. Patients identified with apraxia of speech had suffered more severe strokes according to clinical criteria and had more severe aphasias. The presence of apraxia of speech was predicted by the articulation/prosody and syntax rating scales of the Aachen Aphasia Test. Lower prevalence estimates published earlier are probably biased by low sensitivity of assessment instruments for mild speech impairment.
November 2021
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40 Reads
September 2020
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167 Reads
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3 Citations
Cortex
Over a period of five years, three severely impaired chronic non-fluent aphasia patients with concomitant apraxia of speech (AOS) received annual treatment periods of specific rhythmic-melodic voice training SIPARI. This therapy concept focusses on improving planning, programming, and sequencing of speech movements emphasizing specifically the training of cognitive capabilities such as executive functions. Behavioral and neural data were assessed at the start of the therapy and continuously after each treatment period. As previously reported, a first major finding was that after the first treatment period, significant improvements in language and speech motor performance were measured going hand in hand with significant additional peri-lesional activation in all patients particularly in the posterior part of the left superior temporal gyrus. This activation pattern was continuously confirmed by each subsequent scan. However, assessments after the third treatment period yielded additional significant activations in dorsolateral prefrontal cortex regions, namely in the left middle and superior frontal gyri, and anterior cingulate gyrus resulting in a further statistically significant increase in speech profile level, an overall and clinically relevant measure of the severity of aphasia. On the basis of our results, we assume that even in long-term rehabilitation of severely impaired non-fluent aphasia patients the applied treatment may support coactivation with dorsolateral prefrontal regions, suggested to be particularly involved in cognitive processing. This left-lateralized dorsolateral prefrontal-parietal network is supposed to be engaged in domain-general aspects of active phonological memory. To the best of our knowledge, no comparable studies are available as yet. Therefore, we hope that our study may serve to attract more attention for the late stages of long-term rehabilitation, not at least as a challenge for therapists and researchers alike.
July 2018
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141 Reads
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4 Citations
July 2018
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156 Reads
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2 Citations
January 2018
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167 Reads
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12 Citations
Background: The logopenic variant of primary progressive aphasia (lvPPA) is the most recently identified subtype within the primary progressive aphasia spectrum. Data characterizing this subtype based on comprehensive testing and sophisticated error analyses over time are still rare. One of the two core features of this subtype is a deficit in sentence repetition. Aims: To provide a more fine-grained linguistic characterization of the sentence repetition deficit in lvPPA. Methods & Procedures: We longitudinally analyzed sentence repetition abilities of eight lvPPA patients (mean age 67.6 years; two women) and a group of seven healthy controls (mean age 66.7 years; three women) using a novel schema for the classification of linguistic errors. Outcomes & Results: At their first examination, patients with lvPPA showed an overall impaired repetition performance compared to controls with a variable degree of impairment on the first and all subsequent dates of measurement. Two patients presented with a steady, rather unimpaired profile, similar to the control group. In progression, however, five patients showed an increase of errors especially in the categories omissions and phonological errors, occasionally resulting in violation of syntactic rules. Conclusions: These results expand existing descriptions of repetition abilities in lvPPA patients. The paper thus provides a more fine-grained classification scheme for sentence repetition performance and emphasizes the role of omissions and phonological errors in lvPPA. This, in turn, offers new insights into the linguistic nature of sentence repetition deficits in lvPPA beyond the application of mere correctness judgments.
Citations (64)
... Based on the Schuell therapy technique, the principles of Schuell guided us to utilize the strong auditory stimulus, appropriate, multichannel language stimulation, and emphasized the importance of reinforcing correct response in time. The speech and language therapy protocol sessions were led by speech therapists and were tailored to subacute aphasia patient needs and abilities (38), including listening comprehension training, auditory memory span training, naming training, oral expression training, practical communication training, etc. (39). After rTMS treatment, patients rested for 5-10 min and received subsequent speech and language therapy. ...
- Citing Article
- Full-text available
May 2024
Journal of Neurology
... Although advances in medical technology have reduced the mortality rate of stroke, they have also resulted in a growing number of individuals suffering from permanent post-stroke sequelae. It is estimated that nearly 1% of the global population experiences post-stroke consequences [1], which can manifest as motor control disorders [2], speech generation or processing difficulties [3], and general cognitive deficits [4]. Similar challenges are also faced by patients with other neurological conditions such as amyotrophic lateral sclerosis (ALS) and traumatic brain injury, where neuroplasticity-based rehabilitation strategies show comparable potential. ...
- Citing Article
March 2022
Cortex
... We performed several studies with patients suffering from chronic aphasia, which demonstrated that especially nonfluent aphasia patients could benefit remarkably from the SIPARI treatment [9,[24][25][26]. This refers also to patients with concomitant apraxia of speech (AOS), a dysfunction of higher-order aspects of speech motor control characterized by deficits in programming or planning of articulatory gestures [27][28][29][30][31][32][33]. ...
- Citing Article
- Full-text available
September 2020
Cortex
... A total of 13 NIBS studies were included (Table 1). Among them, 7 studies have investigated the application of repetitive Transcranial Magnetic Stimulation (rTMS), an approach that utilized a magnetic coil over the targeted area, creating either an excitatory or inhibitory modulation effect according to the treatment intensity, frequency, and duration Khedr et al., 2014;Ren et al., 2019;Rubi-Fessen et al., 2018;Seniów et al., 2013;Thiel et al., 2013;Zumbansen et al., 2022). There are 4 studies examining the usage of transcranial Direct Current Stimulation (tDCS) (Campanella et al., 2020;Msigwa et al., 2022;Spielmann et al., 2018;You et al., 2011), which employed weak current to modulate the cortical excitability for long term synaptic plasticity (Fritsch et al., 2010). ...
- Citing Article
July 2018
... This discrepancy was interpreted in terms of the linguistic demands imposed by sentence repetition and the fact that the ability to repeat sentences is also dependent on an individual's morphosyntactic knowledge, in the sense that linguistic structures of high structural complexity (like complex subordinate clauses) may increase the processing effort involved in sentence repetition. Studies with persons with PPA note that syntactically complex constructions add additional processing difficulties during the task of repeating sentence material (Arslan et al., 2022;Hohlbaum et al., 2018;Macoir et al., 2021). In the current study, the sentence repetition task included both structurally simple and complex sentences, which were matched for length and lexical frequency, to allow us to disentangle effects of parsing structural complex language and WM constraints on the repetition performance of the persons with nfaPPA. ...
- Citing Article
January 2018
... We found a general trend of studies reporting a higher dose of intervention reporting greater improvements. This is not surprising given that current evidence suggests that at least 10 hours per week for three weeks, alongside at least 5 hours per week of self-directed practice is required to improve outcomes in people with chronic aphasia (Breitenstein et al., 2017). Our findings suggest that further investigations are needed to determine the optimal and precise dose required for aphasia therapies. ...
- Citing Article
March 2017
The Lancet
... Especially the latter place high demands on inhibitory control as revealed by fMRI, and they activate specific language-related brain networks. Along the same lines, the blocked-cycled naming task induces competition by modulating the context in which the items to be named appear (e.g., Belke et al., 2005), robustly engaging semantic control, which is impaired when the inferior frontal gyrus (IFG) is affected in PWA (Schnur et al., 2009); the IFG was also shown to be involved in cued naming (Holland & Crinion, 2021) and the acquisition of new vocabulary (Pohl et al., 2017) in healthy persons. More rarely, interfered-naming has been investigated in PWA: In a behavioural single case with mild anomia, Wilshire et al. (2007) revealed that task processing was feasible but slowed, as revealed by response time analyses of correct responses (but see Hashimoto & Thompson, 2010). ...
- Citing Article
July 2016
... In der alphabetischen Phase des Schriftspracherwerbs basiert sowohl das Schreiben als auch das Lesen auf einem sequentiellen phonologischen Rekodierungsprozess. Beim dekodierenden Lesen müssen visuelle Reize (Grapheme) erkannt und in phonologische Informationen (Phoneme) übersetzt werden. Beim lautgetreuen Schreiben müssen phonologische Informationen wahrgenommen und in graphische Zeichen überführt werden (Berendes, Schnitzler, Willmes & Huber, 2010). Eine ausgeprägte Phonembewusstheit ermöglicht es Kindern, diesen regelhaften Zusammenhang von Graphemen und Phonemen zu begreifen und ein grundlegendes Verständnis des alphabetischen Prinzips der Schriftsprache zu erwerben (Muter, Hulme, Snowling & Taylor, 1998;Schnitzler, 2008;Berendes & Weinert, 2016). ...
- Citing Article
January 2010
Sprache · Stimme · Gehör
... The 44 studies applied 20 distinct therapy types, nine studies compared more than one therapy type [46,47,[49][50][51][52][53][54][55]: Constraint therapy (e.g., CILT, CIAT, CIAT-Plus, CILT-II) [26,47,[49][50][51][52][53][54][56][57][58][59][60][61][62][63][64]; Promoting Aphasics' Communication Effectiveness (PACE) [50,53,54]; Multi-Modality Aphasia Treatment (M-MAT) [51,52]; Model-Orientated Aphasia Therapy (MOAT) [49]; Phonomotor therapy [55,[65][66][67][68]; Naming treatments [46,69,70]; Intensive Comprehensive Aphasia Programs (ICAPs) [17,19,71]; Action Observation intervention [72,73]; Semantic Feature Analysis (SFA) [55,74]; Script training [75,76]. Eleven studies used a unique treatment method (e.g., Intensive Integrative Language Therapy [77], Listen-In [78], Phonological Components Analysis (PCA) [79], Word-picture verification treatment [80], Intensive impairmentbased treatment [81], Group aphasia therapy [45], Lexical retrieval [82], Individual and group treatment [18], Group language games [83], Dialogue skills [84], Conversational therapy [85]). Figure 3 presents the program intensities and durations. ...
- Citing Article
September 2010
Forum Logopadie
... Findings suggested that dysfunction in network-specific patterns, attributed to a specific behavioral deficit, and loss of interhemispheric communication across a group of areas was related to impairment across numerous behavioral domains (Siegel et al., 2016). Finally, adaptive interactions between language and motor functions occur without competition for resources in neuroplasticity maybe can allowing for synergistic recovery (Coppens, 2016;Harnish et al., 2014;Hartwigsen and Saur, 2019;Primaßin et al., 2015;Pulvermüller and Berthier, 2008). To support this perspective, Gentilucci and Dalla Volta (2008) discovered that language and arm movements are controlled by the same neural system, where grasping influences labial articulation. ...
- Citing Article
- Full-text available
October 2015
