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Aphasia is a general language disorder resulting from brain damage, and alexia and agraphia are specific impairments in reading and writing, respectively. This article describes the symptoms associated with each disorder, the subtypes of each impairment, and the common causes. Assessment and management approaches consistent with the World Health Organization International Classification of Functioning (WHO-ICF) are briefly reviewed. © 2016 Elsevier Inc. All rights reserved.

Rehabilitation programs strive to help patients become more independent in all aspects of daily living. Therefore, management of a patient's healthcare requirements should be an integral part of the rehabilitation program, including management of medications. Some rehabilitation programs implement self-medication programs (SMP); however, patients with cognitive deficits are often excluded. This study explored whether patients with cognitive deficits due to stroke could successfully complete an SMP using an interdisciplinary cognitive rehabilitation approach. Twenty-seven stroke patients and 36 debilitated patients with cognitive deficits participated in an SMP. A nurse and a pharmacist educated patients on their medications, and a speech-language pathologist provided cognitive rehabilitation to the stroke patients, which incorporated information from the SMP. Eighty-one percent of the stroke patients successfully completed the SMP, compared to 36% of the debilitated patients. Thus, an interdisciplinary approach to medication management for cognitively impaired stroke patients holds promise.

Aphasia is a language disorder that occurs as a result of brain damage. It affects auditory comprehension, verbal expression, reading, and writing due to the disruption of specific language components such as phonology, semantics, and/or syntax. A hallmark characteristic of aphasia is anomia, or impaired word retrieval. This may occur in the context of fluent speech (normal rate, rhythm and prosody) or nonfluent speech (hesitant and agrammatic verbal output). Other characteristics of aphasia vary depending on the specific location and extent of brain damage. Alexia and agraphia are acquired impairments in reading and writing, respectively. These deficits may occur in isolation but more commonly co-occur with aphasia. Assessment and treatment of aphasia, alexia, and agraphia focuses on identifying and restoring impaired function as well as determining the impact of the impairment of quality of life and developing compensatory strategies to manage persisting deficits. This article describes the symptoms associated with aphasia, alexia, and agraphia, the subtypes and neurological correlates of each impairment, the general trajectory of recovery, and assessment and treatment approaches. © 2023 Elsevier Inc. All rights reserved.

Purpose: Injury to the dominant left brain hemisphere can lead to specific language deficits such as aphasia, or to the cognitive processes that support language such as attention and working memory. Language is heavily supported through the auditory modality, which is a key area of deficit in acquired language disorders, and recovery of auditory processing is a prerequisite to recovery of other language modalities. A specific auditory processing deficit that has been identified following neurologic injury is dichotic listening. Some researchers have suggested that dichotic listening can be strengthened through the use of a dichotic listening training paradigm, although the impact of this training for adults with neurological injury is unknown. The purpose of this study was to determine whether dichotic listening training improved dichotic listening performance as well as auditory comprehension in individuals with neurological injuries.Method: Five individuals with a history of acquired language deficits who met specific inclusion and exclusion criteria participated in the dichotic listening training for four to six weeks. Dichotic listening and language comprehension skills were evaluated pre- and post-training.Results: Results indicated all participants progressed through a range of dichotic listening tasks during training, and four of the five individuals improved on at least one of the dichotic listening tests post-treatment. All of the participants demonstrated some improvement in auditory processing/comprehension of complex commands.Conclusions: Dichotic listening training has the potential to positively influence dichotic listening and auditory comprehension skills in adults with neurological injury.

Background: Management of aphasia often focuses on training augmentative communication strategies such as communication books, computerised systems, gestures, writing, or drawing. Although many individuals are able to acquire a targeted skill in a structured format, many do not successfully use the trained skill in more functional situations. Training alternative communication strategies can be a time-consuming project; thus, it would be beneficial if speech-language pathologists could predict, a priori, how a patient may respond to this type of treatment approach. It has been hypothesised that use of augmentative communication strategies requires executive functioning, specifically cognitive flexibility, which may be impaired following brain damage. Therefore, assessment of cognitive flexibility may help clinicians determine which persons with aphasia would most likely benefit from training of augmentative communication strategies. Aims: The purpose of this study was to develop a measure of cognitive flexibility and to determine whether this measure predicted strategy usage during a functional communication task. Methods and Procedures: A novel scoring system for the Communicative Abilities in Daily Living (CADL) was developed to capture the degree of participants' cognitive flexibility. This score was correlated with the Wisconsin Card Sorting Test (WCST), to determine the validity of the scoring system. The CADL cognitive flexibility score was then correlated with performance on a referential communication task. A multiple regression analysis was conducted with severity of aphasia as an additional predictor variable. Outcomes and Results: There was a significant correlation between the cognitive flexibility score from the CADL and the WCST, confirming the validity of the scoring system as a measure of cognitive flexibility. Results of the regression analysis demonstrated a significant relationship between the cognitive flexibility score and strategy usage on a functional communication task. This relationship remained significant when the overall severity of aphasia was added to the regression analysis, suggesting that cognitive flexibility is a stronger predictor of strategy usage than severity of aphasia. These results may provide clinicians insight into which individuals would benefit most from the training of compensatory strategies, leading to the development of more appropriate goals and treatment methods.

Background: Because communication deficits caused by aphasia affect both persons with aphasia and their communication partners, most speech-language pathologists are aware of the importance of client and caregiver education. To maximise the effectiveness of their communicative interactions, training should be conducted for both the aphasic clients and their caregivers. Training conducted in group environments offers peer support through shared learning experiences and joint problem solving. Aims: The purpose of this study was to explore the benefits of a caregiver education and training programme in improving communication between caregivers and their aphasic partners using didactic and experiential approaches in a group setting. Methods & procedures: Ten caregivers and their aphasic partners, ranging from 4 to 130 months post-stroke, participated in a 12-week group training and education programme. Information about stroke and aphasia was provided in a didactic format, and facilitative communication strategies were discussed and practised using Kolb's (1984) experiential learning cycle model. The experiential learning cycle involved drawing on concrete experiences, engaging in reflective observation and abstract conceptualisation, and practising what was learned through active experimentation. Outcomes & results: Analysis of communicative performance on transactional and interactional tasks demonstrated increased communicative success. Responses on a questionnaire indicated that participants had a better understanding of aphasia and were more confident using facilitating strategies. Conclusions: Group education and training for caregivers and their aphasic partners can be beneficial, even after the couple has been living with aphasia for a number of years. Having an opportunity to practise, observe, and reflect on their performances facilitated participants' learning, and there were observed and reported positive alterations in interactions. © 2005 Psychology Press Ltd.

Background: Clinicians often teach persons with aphasia (PWA) non-verbal strategies to compensate for reduced verbal communication. The manner in which they teach the strategies may have an impact on how well PWA generalise and use the strategies. Previously, multimodal communication treatment (MCT) taught multiple modalities simultaneously. While participants demonstrated some increase in the flexible use of strategies, many communication breakdowns continued to occur. Recent research suggests that intensive treatment protocols result in the greatest increase in skills.Aims: The purpose of this study was to determine whether intensive (2-3hours/day, 5 days/week, for 2 weeks) multimodality communication training for aphasia resulted in increased successful use of verbal and non-verbal communication modalities as well as increased successful communicative repairs during structured communication tasks.Methods & Procedures: Three participants with chronic aphasia completed four baseline sessions, 10 treatment sessions across two phases (i.e., five sessions per phase), and three post-treatment sessions.Outcomes & Results: Two of the three participants demonstrated gains in the acquisition of non-verbal strategies during training and increased use of strategies on a referential communication task.Conclusions: Although MCT delivered intensely resulted in increased use of non-verbal modalities for two out of three participants, the results were similar to that achieved through the use of a non-intensive treatment protocol. Therefore, future research is needed to examine other potential modifications to maximise the gains people with aphasia receive from multimodal interventions.

BACKGROUND: Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes., OBJECTIVE: The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns., METHODS: Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy., RESULTS: Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant., CONCLUSIONS: Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting.

Rapid advances in neural imaging, particularly in regard to neural plasticity and brain changes, have resulted in an evolving neurorehabilitation paradigm for aphasia and related language disorders. Aphasia and Related Neurogenic Language Disorders has been adopted worldwide as a text for aphasia courses. This new 5th edition by Leonard LaPointe and Julie Stierwalt encompasses state-of-the-art concepts and approaches from an impressive cadre of experts who work in research labs, classrooms, clinics, and hospitals-including the world-renowned Mayo Clinic.As in previous editions, this book embraces a humanistic approach to treatment, addressing multicultural and multilinguistic considerations and social model interventions. The text encompasses a full continuum of cognitive-language disorder management-from everyday practicalities, assessment, and treatment to disorder-specific cases with evidence-based data. Additions to the 5th edition include chapters on pragmatics and discourse, telepractice, digital and electronic advances, funding and reimbursement, and comprehension, syntax, and linguistic based disorders.Key Features:A new chapter on neuroanatomical basics features exquisite illustrationsAn in-depth look at neurogenic communication disorders from Mayo Clinic provides firsthand insights on treating patients in an acute care hospital settingDiscussion and test questions, case studies, and clinical pearls offer invaluable didactic guidanceA chapter on expanded traumatic brain injury covers blast injuries and multisystem injuriesThis is the most comprehensive yet concise resource on aphasia and related disorders available today. New legions of speech language pathology students, residents, course directors, and practitioners will discover a remarkable guide on the treatment of communication disorders.

Background: Reading difficulties often present as a consequence of aphasia. The specific nature of reading deficits varies widely in manifestation, and the cause of these deficits may be the result of a phonological, lexical semantic, or cognitive impairment. Several treatments have been developed to address a range of impairments underlying reading difficulty.Aims: The purpose of this review is to describe the current research on reading comprehension treatments for persons with aphasia, assess the quality of the research, and summarize treatment outcomes.Methods & Procedures: A systematic review of the literature was conducted based on a set of a priori questions, inclusion/exclusion criteria, and pre-determined search parameters. Results were summarized according to treatment type, methodologic rigor, and outcomes.Outcomes & Results: Fifteen studies meeting criteria were identified. A variety of reading comprehension treatments was implemented including: oral reading, strategy-based, cognitive treatment, and hierarchical reading treatments. Quality ratings were highly variable, ranging from 3 to 9 (on a 12-point scale). Overall, 14 of the 18 individuals for whom individual data were provided demonstrated some degree of improvement (oral reading 4/5 participants, strategy based 4/6, and cognitive treatment 6/7). Gains were also evident for hierarchical reading treatment administered to participant groups via computer; however, the degree to which improvement reached statistical significance varied among studies.Conclusions: Reading comprehension treatments have the potential to improve reading comprehension ability in persons with aphasia; however, outcomes were variable within and among treatment methods. We suggest focusing future research on factors such as participant candidacy and treatment intensity using increased methodological rigor.

Purpose: Generalization has been defined and instantiated in a variety of ways over the last half-century, and this lack of consistency has created challenges for speech-language pathologists to plan for, implement, and measure generalization in aphasia treatment protocols. This tutorial provides an overview of generalization with a focus on how it relates to aphasia intervention, including a synthesis of existing principles of generalization and examples of how these can be embedded in approaches to aphasia treatment in clinical and research settings. Method: Three articles collectively listing 20 principles of generalization formed the foundation for this tutorial. The seminal work of Stokes and Baer (1977) focused attention on generalization in behavioral change following treatment. Two aphasia-specific resources identified principles of generalization in relation to aphasia treatment (Coppens & Patterson, 2018; Thompson, 1989). A selective literature review was conducted to identify evidence-based examples of each of these 20 principles from the extant literature. Results: Five principles of generalization were synthesized from the original list of 20. Each principle was supported by studies drawn from the aphasia treatment literature to exemplify its application. Conclusions: Generalization is an essential aspect of meaningful aphasia intervention. Successful generalization requires the same dedication to strategic planning and outcome measurement as the direct training aspect of intervention. Although not all people with aphasia are likely to benefit equally from each of the principles reviewed herein, our synthesis provides information to consider for maximizing generalization of aphasia treatment outcomes. Supplemental Material: https://doi.org/10.23641/asha.24714399