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Acute stroke aphasia therapy

Karen H Mallet, Rany M Shamloul, Dale Corbett, Hillel M Finestone, Simon Hatcher, Jim Lumsden, Franco Momoli, Michel C F Shamy, Grant Stotts, Richard H Swartz, Christine Yang, Dar Dowlatshahi
BACKGROUND: Approximately 40% of patients diagnosed with stroke experience some degree of aphasia. With limited health care resources, patients' access to speech and language therapies is often delayed. We propose using mobile-platform technology to initiate early speech-language therapy in the acute care setting. For this pilot, our objective was to assess the feasibility of a tablet-based speech-language therapy for patients with communication deficits following acute stroke. METHODS: We enrolled consecutive patients admitted with a stroke and communication deficits with NIHSS score ≥1 on the best language and/or dysarthria parameters...
2016: PloS One
Julie Bernhardt, Erin Godecke, Liam Johnson, Peter Langhorne
PURPOSE OF REVIEW: Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions. RECENT FINDINGS: Trials in this early time window are few...
February 2017: Current Opinion in Neurology
Sari Numminen, Anna-Maija Korpijaakko-Huuhka, Anna-Kaisa Parkkila, Teija Kulkas, Heikki Numminen, Prasun Dastidar, Mervi Jehkonen
OBJECTIVE: This prospective follow-up study aimed to identify sociodemographic and clinical factors that may affect the quality of life (QoL) of patients with acute ischemic stroke during a 6-month follow-up. PATIENTS AND METHODS: In the acute phase, sociodemographic and clinical data were collected using the National Institute of Health Stroke Scale, Barthel Index, and modified Rankin Scale. QoL was assessed with the Stroke and Aphasia Quality of Life Scale-39 6 months after stroke...
September 30, 2016: Folia Phoniatrica et Logopaedica
Christophe Duret, Anne Gaelle Grosmaire, Ophélie Courtial
OBJECTIVE: In stroke patients, motor impairments evaluated during the first few weeks usually predict upper limb motor outcomes after rehabilitation. However, a recent growing literature suggests that severe patients might not follow this principle [1]. This study aimed at exploring predictors of motor recovery after intensive training in that sub population of stroke patients. MATERIAL/PATIENTS AND METHODS: Thirty-eight patients with sub-acute hemiparesis (19 females, age 56±17 [19-87] years; time from stroke, 55±22 days) carried out 16 sessions (33±12 days) of robot-assisted adaptive training using a shoulder/elbow device integrated into conventional care...
September 2016: Annals of Physical and Rehabilitation Medicine
Shin Saito, Seigo Shindo, Shun Tsudaka, Kazutaka Uchida, Manabu Shirakawa, Shinichi Yoshimura
Here we report first 2 cases of patients with nonvalvular atrial fibrillation with acute cardioembolic stroke in whom thrombi in the left atrial appendage (LAA) were resolved by edoxaban administration. Case 1 reports an 86-year-old woman who suddenly showed right hemiparesis and aphasia due to occlusion of the left middle cerebral artery. She received mechanical thrombectomy and recovered neurologically. Transesophageal echocardiography (TEE) performed on day 1 demonstrated thrombus in the LAA. The thrombus was resolved on day 13 after initiation of edoxaban (30 mg once daily) instead of warfarin, which was administered before stroke onset...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Hartwig Woldag, Nancy Voigt, Maria Bley, Horst Hummelsheim
BACKGROUND: Constraint-induced aphasia therapy (CIAT) has proven effective in patients with subacute and chronic forms of aphasia. It has remained unclear, however, whether intensity of therapy or constraint is the relevant factor. Data about intensive speech and language therapy (SLT) are conflicting. OBJECTIVE: To identify the effective component of CIAT and assess the feasibility of SLT in the acute stage after stroke. METHOD: A total of 60 patients with aphasia (68...
January 2017: Neurorehabilitation and Neural Repair
Kerstin Spielmann, W Mieke E van de Sandt-Koenderman, Majanka H Heijenbrok-Kal, Gerard M Ribbers
BACKGROUND: Transcranial direct current stimulation (tDCS) is a promising new technique to optimize the effect of regular Speech and Language Therapy (SLT) in the context of aphasia rehabilitation. The present study focuses on the effect of tDCS provided during SLT in the sub-acute stage after stroke. The primary aim is to evaluate the potential effect of tDCS on language functioning, specifically on word-finding, as well as generalization effects to verbal communication. The secondary aim is to evaluate its effect on social participation and quality of life, and its cost-effectiveness...
2016: Trials
M Koenig-Bruhin, T Vanbellingen, R Schumacher, T Pflugshaupt, J M Annoni, R M Müri, S Bohlhalter, T Nyffeler
BACKGROUND: Screening of aphasia in acute stroke is crucial for directing patients to early language therapy. The Language Screening Test (LAST), originally developed in French, is a validated language screening test that allows detection of a language deficit within a few minutes. The aim of the present study was to develop and validate two parallel German versions of the LAST. METHODS: The LAST includes subtests for naming, repetition, automatic speech, and comprehension...
January 2016: Cerebrovascular Diseases Extra
Erin Godecke, Elizabeth A Armstrong, Tapan Rai, Sandy Middleton, Natalie Ciccone, Anne Whitworth, Miranda Rose, Audrey Holland, Fiona Ellery, Graeme J Hankey, Dominique A Cadilhac, Julie Bernhardt
RATIONALE: The efficacy of rehabilitation therapy for aphasia caused by stroke is uncertain. AIMS AND HYPOTHESIS: The Very Early Rehabilitation of Speech (VERSE) trial aims to determine if intensive prescribed aphasia therapy (VERSE) is more effective and cost saving than non-prescribed, intensive (usual care-plus) and non-intensive usual care (UC) therapy when started within 15 days of stroke onset and continued daily over four weeks. We hypothesize that aphasia therapy when started very early after stroke and delivered daily could enhance recovery of communication compared with UC...
July 2016: International Journal of Stroke: Official Journal of the International Stroke Society
M Guillan, A DeFelipe-Mimbrera, A Alonso-Canovas, M C Matute, R Vera, A Cruz-Culebras, N Garcia-Barragan, J Masjuan
BACKGROUND AND PURPOSE: The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) can present as sudden onset of focal neurological deficits which are clinically and radiologically indistinguishable from an ischaemic stroke. Its diagnosis requires a lumbar puncture (LP), which contraindicates intravenous thrombolytic therapy (IV-tPA). METHODS: All patients referred to our stroke centre as a stroke code resulting in a final diagnosis of HaNDL syndrome from June 2005 to June 2015 were retrospectively analysed...
July 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Simon Horton, Allan Clark, Garry Barton, Kathleen Lane, Valerie M Pomeroy
OBJECTIVE: To assess the feasibility and acceptability of training stroke service staff to provide supported communication for people with moderate-severe aphasia in the acute phase; assess the suitability of outcome measures; collect data to inform sample size and Health Economic evaluation in a definitive trial. DESIGN: Phase II cluster-controlled, observer-blinded feasibility study. SETTINGS: In-patient stroke rehabilitation units in the UK matched for bed numbers and staffing were assigned to control and intervention conditions...
April 18, 2016: BMJ Open
N Bel Feki, L Dieudonné
Sneddon's syndrome is a rare vascular disease affecting mainly skin and brain arterioles leading to their occlusion. The two main features of this syndrome are livedo racemosa and ischemic stroke. Here, we describe the case of a 37-year-old woman with a past medical history of Moskowitz's syndrome and migraine, and a 2-year history of livedo racemosa and Raynaud's phenomenon. She presented with acute aphasia related to cortical ischemic stroke. Extensive diagnostic workup allowed to diagnose a Sneddon's syndrome...
November 2015: Revue Médicale de Liège
Guillermo Enrique Vergara, Natalia Roura, Marcelo Del Castillo, Andrea Mora, Santiago Condomi Alcorta, Rubén Mormandi, Andrés Cervio, Jorge Salvat
BACKGROUND: Invasive aspergillosis (IA) of the central nervous system (CNS) is an uncommon condition that usually occurs in immunocompromised patients. This illness can manifest as meningitis, or as a micotic aneurism, stroke or abscess. The infection affects the CNS either primarily or, more often, secondarily via blood dissemination from a distant focus, and has a poor prognosis. We present a patient with IA primarily affecting the cervical bones, with later spread into the brain. CASE DESCRIPTION: A 25-year old male was receiving chemotherapy for acute lymphocytic leukemia when he developed pneumonitis secondary to methotrexate and was started on corticosteroids...
2015: Surgical Neurology International
Yoon-Hee Choi, Hae Kyung Park, Nam-Jong Paik
BACKGROUND: Intensive speech therapy improves language function in patients with chronic aphasia, although treatment in the acute phase is more effective than in the chronic phase. Unfortunately, most patients with stroke go untreated due to socioeconomic problems. This study was performed to develop and test a speech therapy-based telerehabilitation program (iAphasia), suitable for use on a mobile device platform, which would expand access to therapy to patients who frequently go untreated...
May 2016: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
G N Belskaya, L G Krilova, M A Sokolov, I A Izmailov
AIM: To estimate an effect of cellex on the dynamics and time of speech functions recovery in the acute stage of ischemic stroke. MATERIAL AND METHODS: A multicenter, randomized, double-blind, placebo controlled clinical study included 8 Russian clinical sites. Four hundred eighty patients were involved. During the standard base therapy, cellex (or placebo) was introduced subcutaneously in dose 0,1 mg once a day in the first 10 days from the beginning of hospitalization...
2015: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
A V Blesneag, L Popa, A D Stan
The new tendency in rehabilitation involves non-invasive tools that, if applied early after stroke, promote neurorecovery. Repetitive transcranial magnetic stimulation and transcranial direct current stimulation may correct the disruption of cortical excitability and effectively contribute to the restoration of movement and speech. The present paper analyses the results of non-invasive brain stimulation (NIBS) trials, highlighting different aspects related to the repetitive transcranial magnetic stimulation frequency, transcranial direct current stimulation polarity, the period and stimulation places in acute and subacute ischemic strokes...
2015: Journal of Medicine and Life
Ann-Christin Ostwaldt, Tatiana Usnich, Christian H Nolte, Kersten Villringer, Jochen B Fiebach
BACKGROUND: In acute ischemic stroke, diffusion weighted imaging (DWI) shows hyperintensities and is considered to indicate irreversibly damaged tissue. We present the case of a young stroke patient with unusual variability in the development of signal intensities within the same vessel territory. CASE PRESENTATION: A 35-year-old patient presented with symptoms of global aphasia and hypesthesia of the left hand. MRI demonstrated a scattered lesion in the MCA territory...
August 25, 2015: BMC Medical Imaging
Dominique Flügel, Olaf Chan-Hi Kim, Ansgar Felbecker, Barbara Tettenborn
BACKGROUND: Sudden onset of aphasia is usually due to stroke. Rapid diagnostic workup is necessary if reperfusion therapy is considered. Ictal aphasia is a rare condition but has to be excluded. Perfusion imaging may differentiate acute ischemia from other causes. In dubious cases, EEG is required but is time-consuming and laborious. We report a case where we considered de novo status epilepticus as a cause of aphasia without any lesion even at follow-up. A 62-year-old right-handed woman presented to the emergency department after nurses found her aphasic...
August 2015: Epilepsy & Behavior: E&B
Inimioara Mihaela Cojocaru, M Cojocaru, Ana-Maria Petrescu, Daniela Traşcă, Adelina Simona Serban-Pereţeanu, V Stefănescu, V Ionescu
A 44-year-old right-handed Caucasian male was initialy diagnosed in 2007 with dermatomyositis (DM) and in 2009 with systemic lupus erythematosus (SLE) (overlap syndrome). He was treated with Methylprednisolone and Hydroxychloroquine. He interrupted the treatment in the last three years. The patient presented with fever (39.8 degrees C), left zoster ophthalmicus, headache and psychomotor agitation. The cerebral CT scan showed left hemispheric hypodense lesions. Herpetic encephalitis was suspected. The patient was referred to the Institute of Infectious Diseases...
2014: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
Jukka T Saarinen, Niko Sillanpää, Ilkka Kantola
The use of intravenous thrombolytic therapy for acute ischemic stroke is associated with improved outcomes. Fabry disease is an X-linked glycosphingolipid storage disease with vascular endothelial deposits. Affected males with the classic phenotype develop renal, cardiac, and cerebrovascular disease and die prematurely. However, Fabry disease is rare in young men with first ischemic stroke of undetermined cause. We report a 38-year-old man with acute aphasia and a left M2 segment of the middle cerebral artery thrombus with no recanalization who was finally diagnosed with Fabry disease after left ventricular hypertrophy of undetermined cause had been identified...
February 2015: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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