Treating Visual Speech Perception to Improve Speech Production in Nonfluent Aphasia

Abstract

Background and Purpose-Several recent studies have revealed modulation of the left frontal lobe speech areas not only during speech production but also for speech perception. Crucially, the frontal lobe areas highlighted in these studies are the same ones that are involved in nonfluent aphasia. Based on these findings, this study examined the utility of targeting visual speech perception to improve speech production in nonfluent aphasia. Methods-Ten patients with chronic nonfluent aphasia underwent computerized language treatment utilizing picture-word matching. To examine the effect of visual speech perception on picture naming, 2 treatment phases were comparedone that included matching pictures to heard words and another in which pictures were matched to heard words accompanied by a video of the speaker's mouth presented on the computer screen. Results-The results revealed significantly improved picture naming of both trained and untrained items after treatment when it included a visual speech component (ie, seeing the speaker's mouth). In contrast, the treatment phase in which pictures were only matched to heard words did not result in statistically significant improvement of picture naming. Conclusions-The findings suggest that focusing on visual speech perception can significantly improve speech production in nonfluent aphasia and may provide an alternative approach to treat a disorder in which speech production seldom improves much in the chronic phase of stroke.

Transcranial Direct Current Stimulation Improves Naming Reaction Time in Fluent Aphasia

“…Beginning 5 minutes before the start of tDCS, this treatment was modeled after tasks used in previous studies that have resulted in improved naming accuracy in participants with aphasia. 1,5 Separate word lists were used for each treatment phase. 1…”

The impact of phonological versus semantic repetition training on generalisation in chronic stroke aphasia reflects differences in dorsal pathway connectivity

“…In the phonological condition, ` each heard word was accompanied by a video of a mouth saying the same word simultaneously. Such audio-visual integration has been shown to not only improve picture naming performance in aphasic speakers on both trained and untrained items but also created an "errorless learning" environment which patients found particularly enjoyable (Fridriksson, et al, 2009). Fridriksson and colleagues (2009) demonstrated that treatment of speech production in non-fluent aphasic patients can make use of motor speech perception, even though this process is also somewhat impaired in aphasia (Schmid & Ziegler, 2006).…”

“…A number of studies have identified that both phonological therapies that engage the dorsal route and semantic therapies that engage the ventral route can produce appreciable improvements in aphasic individuals (e.g., Barthel, Meinzer, Djundja, & Rockstroh, 2008;Bruce & Howard, 1987;Coelho, McHugh, & Boyle, 2000;Fridriksson et al, 2009;Lorenz & Ziegler, 2009;Nettleton & Lesser, 1991;Raymer, Thompson, Jacobs, & Le Grand, 1993). There are however, mixed opinions as to which types of therapy are superior.…”

“…Yet if brain damage does affect one pathway more than the other, then the question becomes whether therapy should focus on rebuilding the function associated with that pathway (e.g., a phonological therapy for a patient with dorsal damage) or rather enhance the ` use of relatively intact pathways (e.g., a semantic therapy for a patient with dorsal damage). The general issue as to whether therapy should be impairment-focused (e.g., Coelho, et al, 2000;Fridriksson, et al, 2009;Louis et al, 2001;Nettleton & Lesser, 1991) or draw upon intact processing abilities (Yampolsky & Wayers, 2002) is a matter of ongoing debate in the literature.…”

The Promising Role of Neuromodulation in Improving Ischemic Stroke Recovery

“…Furthermore, a recent meta-analysis studied the effects of TMS on neuropathic pain, including post-stroke supra-spinal related pain, and concluded that TMS provides a significant reduction invarious neuropathic pain conditions [21][22][23][24][25]. There are three main proposed mechanisms for this: 1) induction of neuroplasticity can allow for the brain to simply reorganize itself in a way that reverses the plasticity induced with neuropathic pain, 2) direct stimulation of descending inhibitory pathways to decrease the response to painful stimuli, 3) direct stimulation of endogenous opioid secretions [19].…”