Aphasia Research & Therapies with Details on Major
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SUMMARY REPORT ON: APHASIA RESEARCH & THERAPIES WITH DETAILS ON MAJOR INSTITUTIONS & RESEARCHERS By Constance Lee Menefee PO Box 24133 Cincinnati OH 45224-0133 [email protected] http://www.selfcraft.net February 2001 [email protected] CONTENTS RESEARCH SUMMARY Aphasia overview RS-1 Recovery RS-2 Who speaks for the voiceless RS-3 Aphasia therapy RS-4 What is good enough? RS-6 What do we know? RS-9 Summary of current treatment approaches RS-11 About dysarthria RS-15 Clinical guidelines for treatment of aphasia RS-16 Glossary of terms RS-18 APPENDIX MAJOR APHASIA RESEARCH CENTERS Brown University A-5 Sheila Blumstein A-6 Center for Cognitive Braining Imaging A-9 Patricia Carpenter A-11 Marcel A. Just A-12 Malcolm McNeil A-14 Keith Thulborn A-23 Harold Goodglass Aphasia Research Center A-27 Martin L. Albert A-31 Harold Goodglass A-33 Nancy Helm-Estabrooks A-34 William Milberg A-35 Margaret Naeser A-36 National Center for Neurogenic Communication Disorders A-38 Thomas J. Hixon A-40 Kathryn A. Bayles A-41 Audrey L. Holland A-41 Pelagie Beeson A-41 Gary Weismer A-42 Elena Plante A-42 Cyma Van Petten A-42 National Institutes of Health A-43, A-44 TREATMENT PROGRAMS & OTHER RESEARCH CENTERS A-45 University of Michigan: Communicative Disorder Clinic & Residential Aphasia Program A-45 Aphasia Center of California A-45 Aphasia Institute: Pat Arato Aphasia Centre A-45 University of California State, Hayward: Department of Communicative Sciences and Disorders A-46 Dalhousie University: Intensive Residential Aphasia Communication [email protected] Therapy Program (InteRACT) A-46 MossRehab Aphasia Center A-47 Vanderbilt Bill Wilkerson Center A-47 Wendell Johnson Speech and Hearing Clinic (U Iowa) A-47 Memphis Speech & Hearing Center A-48 Callier Center for Communication Disorders A-48 University of Maryland Department of Neurology & Kernan Hospital A-48 The University of Florida Speech and Hearing Clinic & McKnight Brain Institute A-49 Veterans Adminstration Medical Center: Brain Rehabilitation Center A-49 PROMPT Institute A-50 TOP 15 U.S. SPEECH/LANGUAGE PATHOLOGY GRADUATE PROGRAMS A-51 ASSOCIATIONS A-55 Academy of Aphasia A-55 Aphasia Hope Foundation A-56 National Aphasia Association A-57 American Speech-Hearing-Language Association A-57 ASHA Foundation A-58 Other Associations A-59 INTERNET-BASED INTERACTIVE EFFORTS A-60 EXAMPLES OF ASSISTIVE TECHNOLOGIES A-63 Author: Constance Lee Menefee [email protected] damage to cranial nerves or the frontal RESEARCH SUMMARY lobe (motor cortex). When motor speech disorders Aphasia overview causing difficulty with articulation, speech speed and evenness occur concomitant Aphasia is an “acquired disorder with aphasia after strokes and brain injury, of previously intact language ability it creates a more complex language secondary to brain disease.” 1 Aphasia problem than aphasia alone. may affect the production of, or com- prehension of, speech, as well as the Most current research has ability to read or write. centered on aphasia as the result of stroke According to current accepted because these lesions can be mapped estimates, one million people in the more readily. Disorders such as brain United States and an additional one tumors or injuries tend to be less well million in the rest of the world have localized in the brain, with remote aphasia. Most of these people have pressure effects that are difficult to acquired aphasia as a result of a stroke, identify and isolate.5 although head injury, brain tumor and Currently, no steps can be taken to other neurological trauma may also result prevent the onset of aphasia following in aphasia.2 stroke or head injury. 6 Of the approximately half-million The prevailing thought is that the stroke victims each year in the US, about severity of aphasic condition is 40 % of patients will have some kind of determined by the location and size of speech and language disorders,3 and, of damaged area in the brain, 7so therapies those, half will have been rendered that offset stroke damage may also aphasic.4 mitigate the degree of aphasia. Rapid spontaneous language Other speech disorders, such as improvement may be seen in many cases. dysarthria, arise as a result of stroke and And it appears that some degree of other neurological damage. These are improvement can continue for a long motor speech problems resulting from period. Problems persist, however, even 1 Kirshner HS. “Introduction to aphasia.” In: in patients who recover partial speech. Handbook of Neurological Speech and Language Loss of familiar employment, social Disorders. Ed. Howard S. Kirshner. New York isolation, disruption of family roles, and Marcel Dekker. 1995. 2 Aphasia Fact Sheet. National Aphasia Association. http://www.aphasia.org/NAAfactsheet.html 5 Kirshner HS. “Introduction to aphasia.” In: 3 Gresham GE, Duncan PW, Stason WB, et al. Handbook of Neurological Speech and Language Post-Stroke Rehabilitation, Clinical Practice Disorders. Ed. Howard S. Kirshner. New York Guideline, No. 16. Rockville, MD: U.S. Marcel Dekker. 1995. Department of Health and Human Services, Public 6 Gonzalez Rothi LJ, Nadeau SE, Ennis MR. Health Service, Agency for Health Care Policy and “Aphasia treatment: a key issue for research into Research. AHCPR Publication No. 95-0662. May the twenty-first century.” Brain and Language. 71, 1995. 78-81 (2000). 4 Kirshner, HS. “Introduction to aphasia.” In: 7 Warburton E, Price CJ, Swinburn K, Wise RSJ. Handbook of Neurological Speech and Language “Mechanisms of recovery from aphasia: evidence Disorders. Ed. Howard S. Kirshner. New York from positron emission tomography studies.” J Marcel Dekker. 1995. Neurol Neurosurg Psychiatry. 1999; 66:155-161. RESEARCH SUMMARY - 1 Author: Constance Lee Menefee [email protected] depression create enormous barriers to motivation, pre-traumatic response to adequate recovery challenge, and other personality factors, In addition, there may be specific probably also modulate the effects of neurobehavioral correlates that can occur treatment for aphasia….no clear answer is with aphasia, corresponding to lesion available as to precisely which patient location.8 Not all patients will develop characteristics are consistently associated severe emotional reactions following with failure.” 11 stroke, however, the presence of neuro- psychiatric difficulties will impact treat- Although the effect of stress on ment efficacy and can delay or prevent stroke recovery isn’t widely discussed per recovery. se in the aphasia literature, it is important Depression is the most common to note that long term stress has del- mood disorder observed after depression. eterious effects on the brain and body. Some researchers report finding clinically Robert M. Sapolsky, Ph.D., significant depression in up to 50 % of professor of neuroscience at Stanford patients after acute stroke. University, notes that, “Westernized “Much work remains in the humans…are likely, to an unprecedented development of a comprehensive extent, to be made seriously ill by a stress- understanding of the neurobiological basis related disease.” 12 of neuropyschiatric syndromes associated He reports that recent evidence with local brain injury.” 9 demonstrates how prolonged stress damages the nervous system. ______________ Glucocorticoids that are released by the body as a result of stress reactions Recovery are neurotoxic and may accelerate the rate of neuron loss, resulting in memory There is no way to predict the degradation. Glucocorticoids can also outcome of post-stroke aphasia for an interfere with the ability of certain individual. A number of factors may come neurons important to memory function to into play: survive strokes, seizures or certain “Unique patterns of individual infections. emotional and psychosocial adjustment And to add to the difficulty of were found even in patients with similar endogenous stress, synthetic gluco- aphasia type and severity.” 10 corticoids such as prednisone or “Other factors, concerning dexamethasone are often given to stroke imprecise variables such as level of victims, with the belief that their action will reduce edema. Unfortunately, post- 8 Helm-Estabrooks N and Albert ML. Manual of stroke edema, unlike edema due to a brain Aphasia Therapy. Austin: Pro-Ed. 1991. tumor, is resistant to the action of these 9 Craig AH and Cummings JL. “Neuropsychiatric aspects of aphasia.” In: Handbook of Neurological Speech and Language Disorders. Ed. Howard S. 11 Holland AL, Beeson PM. “Aphasia therapy.” In: Kirshner. New York Marcel Dekker. 1995. Handbook of Neurological Speech and Language 10 Helmsley G, Code C. Abstract: “Interactions Disorders. Ed. Howard S. Kirshner. New York between recovery in aphasia, emotional and Marcel Dekker. 1995. psychosocial factors in subjects with aphasia, their 12 Margolis D. “Neuroscience 2000: a new era of significant others and speech pathologists.” discovery.” Annals of Internal Medicine. 1999; 131: Disability and Rehabilitation. 18 (11): 567-584. 318-320. RESEARCH SUMMARY - 2 Author: Constance Lee Menefee [email protected] steroids. But the brain is not resistant to studies are just beginning to test this the neurotoxicity of the synthetic hypothesis.” 14, 15 glucocorticoids either! 13 This could have less than happy ______________ consequences on the memory and cog- nition of stroke patients. In addition, chronic stress, even a Who speaks for the low levels, can contribute to depression, voiceless? lack of attention, lowered immunity to disease, increased difficulty handling pain, Seventy of those with