Annals of Indian Academy of Neurology
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   Table of Contents - Current issue
September 2020
Volume 23 | Issue 8 (Supplement)
Page Nos. 45-177

Online since Friday, September 25, 2020

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APHASIA: Not yet at the high table [In the comity of neurology sub-specialities] Highly accessed article p. 45
Apoorva Pauranik
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Clinical trials for treatment of aphasia: Some issues to consider Highly accessed article p. 48
Kameshwar Prasad
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“Rights of persons with disability” act: A boon for persons with aphasia p. 51
SP Goswami
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Design considerations for clinical trials in aphasia p. 52
Rebecca Palmer
The use of the randomised controlled trial (RCT) design to evaluate the effectiveness of new interventions in aphasia has increased in recent years in response to calls for high quality evidence of the effectiveness of interventions for this population. This view-point article highlights some of the important considerations when designing a trial for an aphasia intervention, illustrated with decisions made when designing the Big CACTUS RCT for self-managed computer-based word finding therapy in aphasia. Considerations outlined include whether an RCT is needed, readiness for conducting an RCT, choice of comparators, randomisation options, blinding/masking, selection of outcome measures, pragmatic versus explanatory approaches, and fidelity measurement.
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Where are we now with aphasia after stroke? p. 57
Pam Enderby, Laura Sutton
Objective: To provide a brief review of research literature relating to the current state of knowledge regarding speech and language therapy for people with aphasia and place these research findings within the context of outcome data of non-selected patients receiving usual therapy in the UK. Methods: Part 1 presents a literature search aimed at exploring up-to-date information related to the nature and evolution of aphasia, the impact of therapy and the changing nature of therapy. This provides the context of what may be achieved in rehabilitation. Part 2 examines of the impact of speech and language therapy on 1664 prospective patients receiving therapy for aphasia after stroke by 3 different types of service provision was collected and statistically analysed. The Therapy Outcome Measure was used to identify change in impairment, activity, participation and well-being at the beginning and end of therapy. Results: The findings from the non-selected group of patients supports the conclusions of the reported randomised control trials in that speech and language therapy for post stroke aphasia is associated with gains in one or more of the domains of the International Classification of Functioning.
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From aphasia and allied disorders to autism spectrum disorders - A mutualistic symbiotic relationship. (A five decade long journey in neuro-communication disorders) p. 63
Prathibha Karanth
The study of aphasia and the range of allied disorders, that accompany it has provided a rich source of clinical information providing insights in to the complexities of the human brain and how it affects the functioning of the individual, as well as how it influences his experiencing of the world; subsequently verified by more rigorous scientific research. An attempt is made here to document similar clinical insights in to the experiences of children with autism spectrum disorders (ASD), now known to have atypical neuro development; on the basis of clinical observations and self-reports of these children, vetted by the author's long standing experience of working with those with neurogenic communication disorders, both adult and child. As with the aphasias, these clinical documentations and insights could lead to more carefully controlled research, paving the way for better understanding and interventional support for those with ASD.
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Language breakdown in primary progressive aphasias p. 67
Amitabha Ghosh
Dementias with predominant language involvement, called primary progressive aphasias provide us with unique insight into systematic breakdown of language in neurodegenerative diseases and the structures and networks involved. Clinical and neuroimaging models quite distinct from those seen in stroke aphasias have evolved. In this short overview, we will discuss the cognitive processes involved in expressive and receptive verbal communication and how these processes are affected in the different variants of primary progressive aphasia producing distinctive clinical patterns. We will also discuss the brain's language network and how different components of the network break down in each of the primary progressive aphasia variants.
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Newer paradigms in language neurobiology p. 73
Anu Gupta, MV Padma Srivastava
The field of language research has seen tremendous progress in the last two decades. Advances in neuro-imaging and stimulation mapping have changed the way we conceive the neural basis of speech and language processing. In the past, the Wernicke-Lichtheim model was the most influential model explaining the neuro-anatomical basis of language. More recently, the concept of dual stream language processing has emerged, wherein separate dorsal and ventral networks are synergistically involved in phonological (sound to articulation) and semantic (sound to meaning) processing respectively. In this review article, we highlight new insights and approaches to the neurobiology of language, across different aspects of language processing like perception, comprehension, production, hemisphere lateralization, role of subcortical structures and effect of damage to language networks.
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A review of biological interventions in chronic aphasia p. 82
E Susan Duncan, Aswathy Anakkathil Pradeep, Steven L Small
Aphasia is a common and debilitating condition following stroke. While the gold standard for aphasia treatment is behavioral speech-language therapy, benefits remain modest in chronic stages of recovery. This limitation motivates the pursuit of novel interventions for chronic aphasia. Here, we review biological approaches that have been used (or proposed for use, in the case of regenerative and genetic therapies) to treat chronic aphasia. These techniques aim to ameliorate the deficits of aphasia by directly manipulating brain function, rather than training lost or compensatory functions, although many have been used to augment effects of behavioral therapy. Specifically, we explore the most robust designs of transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and pharmacotherapy that have been applied in chronic (≥6 months) post-stroke aphasia. We also consider less investigated approaches including epidural cortical stimulation and photobiomodulation. All methods are currently in nascent phases and restricted to experimental studies and clinical trials. Although the evidence base remains limited, such interventions may ultimately improve language function and quality of life for those living with chronic aphasia. However, it is crucial that application of these methods consider the effects of concomitant speech-language therapy, as biological interventions combined with behaviorally induced experience-dependent plasticity will likely yield the most beneficial and durable outcomes.
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The implications of public awareness and knowledge of aphasia around the world p. 95
Chris Code
Background: The services provided and the financial support for research into a health condition is influenced by public awareness of a health condition. There has been a wide range of surveys of the public's and health professional's awareness of aphasia throughout the world to gauge levels of awareness. Findings confirm that awareness of aphasia is universally lower than comparable conditions. Objective: To provide a review of international public and health workers' awareness and knowledge of aphasia. Materials and Methods: A narrative review examining known telephone, internet and face-to-face surveys of aphasia to determine international levels of awareness, knowledge and attempts to raise the awareness of aphasia. Results: Awareness is internationally low and actual knowledge is even lower: 1%-66% for awareness and 5%-17% for actual knowledge. While higher than the public, levels of awareness and knowledge are also low among health professionals. A range of demographic variables, like age, sex and socio-economic status, are significantly associated with levels of awareness. People who have some awareness or knowledge of aphasia have gained it from the media or personal and professional contact with aphasia. Discussion and Conclusion: Awareness and knowledge of aphasia are low when compared to other communication disorders and comparable neurological conditions, for example, Parkinson's disease. The implications of results for service provision, research funding and awareness-raising programmes are reviewed and further suggestions for awareness-raising are discussed.
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Clinical feasibility of combining transcranial direct current stimulation with standard aphasia therapy p. 102
E Susan Duncan, Surani G Nakkawita
Background: Transcranial direct current stimulation (tDCS) is a safe, portable, and inexpensive form of noninvasive brain stimulation that appears to augment the effects of concurrent therapy. However, several methodological issues in existing studies distance tDCS from current clinical practice. In this study, we offered (and administered) tDCS to individuals seeking typical behavioral aphasia therapy on an outpatient basis. Methods: We approached clients (n = 10) planning to receive standard aphasia therapy at a university clinic. Following a brief description of tDCS, we offered to provide stimulation during their therapy. Those interested and without contraindications participated in a double-blind, sham-controlled crossover study of tDCS paired with speech-language therapy provided twice weekly. Participants received active (2 mA) or sham tDCS during two eight-week therapy phases (separated by ten weeks) with the anode over Broca's area and the cathode on the contralateral forehead. Stimulation was provided for the first 20 minutes of each one-hour session. Prior to and following each phase, participants were video recorded telling the Cinderella narrative. Recordings were transcribed and analyzed for correct information units (CIUs). Results: Seven individuals (70%) were interested in and eligible for tDCS. Data from four participants who completed the study indicated a large effect size favoring active over sham tDCS (Cohen's d = 1.32). The participant with the most severe deficits did not benefit from therapy in either condition. Conclusion: There is potential for tDCS to enhance meaningful communication outcomes in standard clinical practice. Further investigation is needed to replicate findings and determine individual characteristics predictive of treatment response.
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A longitudinal study of aphasia due to pure sub-cortical strokes p. 109
Durjoy Lahiri, Alfredo Ardila, Souvik Dubey, Biman Kanti Ray
Introduction: Contemporary neuro-imaging techniques have significantly advanced our understanding of the brain organization of language and the involvement of subcortical areas in aphasia. However, articles on sub-cortical aphasia, particularly in non-western languages, remain to be few and far between. We set out to explore aphasia typology in sub-cortical strokes among Bengali-speaking population with a focus towards providing a longitudinal view over a period of 3 months post-stroke. Methods: Bengali version of Western Aphasia Battery (BWAB) was used to assess and classify language dysfunction in our study participants. Conventional brain imaging techniques (CT scan & MRI) were used to detect and localize strokes. Uni-variate analysis for categorical variable (location versus aphasia typology) was performed using Chi square and Fischer's exact test (as applicable). Directional measures were calculated using lambda and Goodman-Kruskal tau (Range of -1 to + 1). Boot strapping was applied while calculating the directional measures because of inadequate numbers in some sub-sections the sample. Results: Frequency of sub-cortical aphasia was observed to be 29.80% (62/208) in the index study. Four location of strokes were associated with language dysfunction, of which putamen (53.23%) was the commonest followed by striato-capsular region (33.87%). Thalamus and peri-ventricular white matter (PVWM) strokes (6.45% each) were infrequent in our sample of sub-cortical aphasia. Global aphasia (30/62, 48.38%) was the most frequent type observed in acute phase while Broca's aphasia (23/53, 43.39%) dominated among the follow up cases. Aphasia recovery (with follow up AQ of 90.0 or more) was observed in 12 (22.64%) patients of whom majority (8/12) had striato-capsular strokes. Conclusion: The present paper illustrates the epidemiological aspects as well as longitudinal course aphasia following pure sub-cortical strokes.
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Development and validation of a comprehensive neuropsychological and language rehabilitation for stroke survivors: A home-based caregiver-delivered intervention program p. 116
Harsimarpreet Kaur, Ashima Nehra, Sakshi Chopra, Hemchandra Sati, Rohit Bhatia, Senthil S Kumaran, RM Pandey, MV Padma Srivastava
Context: Aphasia is a major disabling condition after a stroke that profoundly affects the quality of life of stroke survivors (SS) and their caregivers. Comprehensive neuropsychological rehabilitation has emerged as a complementary intervention that helps in improving the associated cognitive and psychological deficits and quality of life following a brain injury. A standardized, simple, and easy to administer intervention that can be delivered as a home-based intervention can assist in faster recovery. Aims: To describe the development, validation, and feasibility of a home-based, caregiver-delivered comprehensive neuropsychological and language rehabilitation for SS. Methods and Material: A culture-specific picture and task-based 8-week training workbook and manual were developed based on extensive review and focused group discussions. This intervention targeted areas of language (comprehension, fluency, and naming) and cognition (working memory, attention and concentration, executive functioning, and response inhibition). It was standardized on 40 healthy controls (HC) and 15 SS. Before recruitment, written informed consent was obtained from each patient, their primary caregiver, and the HCs. Results: All tasks were found to be effective in discriminating the performance of SS from the HC. The performance of the HC with respect to the errors and the time taken for each task was used for the hierarchical arrangement of the tasks. The developed intervention was later validated on 15 SS where they significantly improved in the pre-post assessment of language functioning (P < 0.001), quality of life (P < 0.001), and depression (P < 0.001). Conclusions: This intervention can be feasible to administer as a home-based intervention and may help to alleviate language and neuropsychological complaints after stroke in low-literate or mixed-cultural populations. Further, large sample size studies are recommended.
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Effectiveness of semantic-based treatment in persons with aphasia p. 123
P Deepak, SP Goswami
Background: Semantic-based treatment is the salient approach used to remediate word retrieval deficits in persons with aphasia (PWAs). It is deemed to improve semantic attributes around the target word, thus aids in restoring word retrieval abilities. Hence, the present study has developed a semantic-based therapy named semantic cueing of verbs and its thematic role (SCVTr). Also, this therapy uses verbs as a core element accompanied by graded levels of semantic cues. Aim: The current study Semantic Cueing of Verbs and its Thematic role (SCVTr) aimed to evaluate the effect of word retrieval abilities in PWAs. Methods and Procedure: Three participants (n = 3) with aphasia were recruited for the study. All the participants in the study received SCVTr therapy, and the responses were analyzed at three distinct time points. That is pre-therapy assessment (before initiation of therapy), mid-therapy assessment (10th session), and post-therapy assessment (20th session). Nouns, verbs, and discourse abilities of PWAs were evaluated using standardized test batteries. Outcomes and Results: The study results have discerned positive gains across trained conditions and discourse genres across all the participants. However, participants exhibited marginal gains with untrained stimuli. In addition, SCVTr therapy aids in modifying the error pattern exhibited by PWAs. Concurrently, researchers noted that all participants showed ameliorated performance on the standardized language test batteries during post-therapy evaluation. Conclusions: SCVTr therapy has found to be effective in remediating word retrieval deficits in PWAs. This study extends the knowledge about strengthening the semantic network associated with the target word and its effect on generalization.
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Maintaining research fidelity: Remote training and monitoring of clinical assistants in aphasia research p. 130
Barnali Mazumdar, Neila J Donovan
Background: In aphasia research, to improve a study's reliability, the aphasia journals compel their authors to report fidelity. Aphasia researchers are mostly concerned about Type I and Type II errors to maintain the level of confidence. However, the third type (Type III error) can significantly affect the study outcomes and question the research fidelity. Objective: This study explains the methodology of how investigators maintained research fidelity in the context of hiring and training remote data collectors and conducted a multi-site data collection. Methods: The present study used a descriptive analysis design to explicate the three-step process of remote data collection: (1) remotely selecting and training data collectors, (2) remotely supervising data collection and data management, and (3) optimizing and monitoring screening/assessment fidelity. At the initial step, investigators interviewed seven candidates and short-listed four of them, who were trained using a standard training protocol and participated in a mock data collection. For the next two steps, data collectors video-recorded each study session and e-shared the data with the investigator, who watched all the video-recordings and provided necessary feedback with a focus on the screening sections. The screenings were a part of the inclusion-exclusion criteria. Results: Two data collectors (both clinical psychologists) with the highest scores were selected and received final training. One-to-one e-supervision by the investigator resulted in significant improvement in data collectors' performance. Only 4% of the total collected sample size was excluded, and 99 participants' data were analyzed. Conclusion: The present study adds information on maintaining research fidelity for remote data collection, where limited studies exist.
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Culturally appropriate stimuli for cognitive neuropsychology-based treatment “intensive language action therapy (ILAT)” p. 135
Pinki Singh, Nipun Pauranik, Apoorva Pauranik
Context: A standardized set of picture stimuli for neuro-language disorder has been long overdue. Aims: To develop a standardized set of 303 pictures for use in experiments of Intensive Language Action Therapy (ILAT). Methods and Material: Several sources with standardized picture stimuli having culturally unbiased features were studied. Among those studies two prime sources (1) Snodgrass & Vanderwart (1980), 127 (89+37) items and (2) Neininger & Pulvermuller (2002), 147 (89+56) items were used extensively. Out of 303 stimuli, 89 items were common to both principle sources. An Indian study by George & Mathuranath (2007) has also been taken as an additional source. Line drawing stimuli were standardized on four variables of central relevance to memory and cognitive processing: name agreement, image agreement, familiarity, and visual complexity. Statistical analysis used: All measures related to 303 concepts i.e. % correct, H statistics, familiarity, image agreement and visual complexity were analysed descriptively. Results: Low mean and positive skew on H statistics and visual complexity show that many concepts had a high name agreement (13 concepts have H values of .0, and 55 have H values of 0.68 or below, where 0.68 represents consensus among all but few of the subjects on a picture's name) and were visually simple line drawings. The intercorrelations among the four measures were low, suggesting that they are indices of different attributes of the pictures. Conclusions: Usage of appropriate items/stimuli has immense potential to influence aphasia therapy outcome. This set of pictures and its normative variable has enhanced the ILAT outcome. It could be generalised for other aphasia therapy too to understand its efficacy.
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A screening tool to detect stroke aphasia: Adaptation of frenchay aphasia screening test (FAST) to the Indian context p. 143
Avanthi Paplikar, Gowri K Iyer, Feba Varghese, Suvarna Alladi, Apoorva Pauranik, Shailaja Mekala, Subhash Kaul, Meenakshi Sharma, RS Dhaliwal, Aralikatte Onkarappa Saroja, Santosh Dharamkar, Aparna Dutt, Gollahalli Divyaraj, Amitabha Ghosh, Rajmohan Kandukuri, Robert Mathew, Ramshekhar Menon, Jwala Narayanan, Ashima Nehra, MV Padma, Subasree Ramakrishnan, Sunil Kumar Ravi, Urvashi Shah, Manjari Tripathi, PN Sylaja, Ravi Prasad Varma, ICMR Neuro-Cognitive Tool Box Consortium
Background: Aphasia is a common consequence of stroke. To optimize recovery, it becomes critical as there are early identification and treatment of language deficits. The rising burden of stroke aphasia and lack of screening tools in the Indian context necessitates the need for a screening tool. Objective: We aimed to adapt and validate the Frenchay Aphasia Screening Test (FAST) to the Indian context in two widely spoken Indian languages, Telugu and Kannada, for the literate and illiterate population. Methods: A systematic process of adaptation and culturally appropriate modifications of the original FAST were done in 116 healthy controls and 115 patients. The validity of the adapted test was established. Results: The optimum cut-off values for detecting aphasia in our sample ranged from 25 to 25.5 (literate) and 13.5 to 15.5 (illiterate) with high sensitivity and specificity. There was also a significant correlation between aphasia scores for adapted FAST and the Western Aphasia Battery (WAB), establishing good convergent validity. Discussion: Results of the adaptation and validation of two Indian versions of FAST, suggest that it is an easy-to-use screening measure for detecting stroke-related language disabilities. The psychometric properties of the Indian version of FAST met the standardised requirements for adaptation and validation. Conclusions: The Indian version of FAST was found to be a reliable and valid bedside screening tool for aphasia in stroke patients. We aim that this study will facilitate the use of the test across other Indian languages and a large clinical population in the future.
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Effect of distance between marker agreement dependencies on sentence comprehension in persons with aphasia p. 149
HS Darshan, SP Goswami
Background: Rules and regularities are embedded in all the language structures. Extracting these helps in speech-language acquisition and processing. Sentence processing relies on transitional probability of the dependencies and its distance which are present within the sentence. Aim: To investigate the effect of distance between marker agreement dependencies on sentence comprehension in Persons with Aphasia (PWA) and Neuro- Typical Individuals (NTI). Methods: Ten PWA and Ten NTI were recruited for the study. Participants whose native language was Kannada (a South Indian Language) and received formal education of minimum 10th grade were selected. Materials: A total of 60 Kannada sentences were used and grouped into three categories i.e., short sentence (had short distance between dependencies) (SSD); Longer sentences (had long distance between dependencies) (LLD) and longer sentences (had short distance between dependencies) (LSD). The agreement markers in the sentence were manipulated w.r.t distance among them and grouped it as adjacent (short distance) and non-adjacent (long distance) type of sentences. Procedure: The participants were instructed to read the sentence and judge whether it is grammatically correct or not by pressing the key corresponding to 'yes' or 'no' on the keyboard. In addition, modified N-back task was administered. Results and Discussion: Accuracy and reaction time measures were derived for each sentence types. NTI showed better performance than PWA in sentence judgment task. Both the groups, performed poorly on LSD type of sentence when compared to other sentence types. LSD type was more complex due to the syntactic demands placed by the antecedent preposition, pronoun and adverb placed nearer to the verb and also longer distance between subject agreement to the verb.
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Quality of communication life in people with aphasia: Implications for intervention p. 156
Grama N Rangamani, Hannah M Judovsky
Background and Aims: The main goals were to determine the effectiveness of two commonly used communication-related Quality of Life (QoCL) measures, and the impact of aphasia-related factors on quality of life (QoL) and QoCL in persons with aphasia (PWAs). Method: Twenty-one PWAs ranging from 47 to 91 years of age with post-onset periods of 2 months to 14 years were tested using standardized and criterion-measure tools to assess their language and cognitive functions, QoL, and QoCL. Additionally, participants completed a demographics questionnaire, which also included information on their stroke and the kinds of therapies they had received. Assessments were conducted over two sessions with randomized order of test administrations to control fatigue and order effects. Results and Discussions: Correlation-matrix was used to determine the strength of relations between test measures. The impact of QoL related factors (viz., aphasia severity, cognitive functioning, time post-onset, and therapy received) on QoCL was examined using ANOVAs. The ASHA Quality of Communication Life Scale (ASHA-QCL) had more significant correlations with other QoL measures than the ASHA-Functional Assessment of Communication Skills (ASHA-FACS). Aphasia severity, cognitive deficits, and therapy received contributed significantly to QoL and QoCL in PWAs. Conclusions: Evaluating overall QoL may not fully reveal the QoCL in PWAs. Measuring QoCL specifically is crucial in aphasia interventions, and it is equally important to use sensitive tools that can capture the QoCL effectively. ASHA-QCL was more effective than ASHA-FACS in capturing the QoCL. QoCL must be considered even when working with PWAs with severe aphasias and/or mild cognitive deficits.
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Aphasia in neurology practice: A survey about perceptions and practices p. 162
Apoorva Pauranik, Nipun Pauranik, Pinki Singh, Durjoy Lahiri, Gopee Krishnan
Background: Aphasia is one of those clinical conditions, where the role of affiliated professionals, mainly speech language pathologists (SLPs) is substantial in diagnostic assessments, therapy, and rehabilitation. There is no study to focus on neurologists, with respect to their perceptions and practices about aphasia, the disease, as well as the profession of SLP. Objective: To reach out to the neurologist community in India and learn about their perceptions and practices about the nature of the ailment and role of speech language therapy (SLT). Our premise was that observations and inferences from a questionnaire-based survey will be subsequently helpful in planning educational activities targeted to neurologists with more focus on specific gaps in perceptions and practices. Material and Methods: Three neurologists and two SLPs collaboratively developed the questionnaire. The aim was to probe the issues which were likely to have a bearing upon optimum service delivery to persons with aphasia by a dyad of neurologist and SLP. The survey was set in “Google Forms” and sent by “WhatsApp” and email to approximately 500 practicing neurologists in India. We employed a nonprobability sampling design for ease of administration with a combination of “chunk sampling” and “snowball sampling.” Telephonic reminders were made to almost all. Results and Discussion: We received 100 responses. The mean age of respondents was 50.64 (SD +/− 12.60) with a range of 28–78 years. The mean number of years of experience as a neurophysician was 19.88 (SD. +/− 12.72) with range of 1–47 years. Females were only 8%. Apparently, the proportion of neurologists working in large corporate and large public sector institutions from tier one and tier two cities was higher, who are more likely to have SLP and related rehabilitation facilities in their institutions and hence harbor more conducive attitudes to SLT in aphasia. The ground reality from tier three cities and small private and public sector hospital and solo practitioners may be somewhat worse than this. Many responses were in conformity with facts and in tune with desirable attitudes as per guidelines like aphasia being a detrimental factor in stroke recovery, doing assessment of handedness, paying attention to neuroimaging correlations and associated cognitive functions, not resorting to unnecessary pharmacotherapy, being aware about efficacy of SLT, and fairly good chances of recovery. However, many more answers highlighted a need for emphasis in Continuing Medical Education like not being aware about community burden of aphasia in comparison to a few better known neurological diseases, not paying attention to psychosocial aspects apart from biological ones in assessment and rehabilitation, not using a standardized and validated battery, not confidant about role of SLT in chronic stable aphasia and need for longer and intensive therapy, and being unconcerned for the value of advocacy for aphasia, like the role of Self-Help Groups. Conclusion: The thrust areas, pertaining to gaps in perception and practices identified through this study, can be viewed as “an in-time input.” We hope that changes in some of the perceptions and practices can be attained through an emphasis on education and training at multiple levels right from the undergraduate to the practicing physicians. A few more themes and domains will need advocacy actions targeted to different stakeholders.
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Literacy-based normative data for elderly adults on linguistic profile test in kannada and malayalam p. 171
Gopee Krishnan, Reema Pujari, Kiran Roy
Objectives: Literacy is an important variable that can influence the performance of persons with aphasia on language tasks. This study aimed to generate the literacy-based normative data in two Indian languages (Kannada and Malayalam) for a linguistic tool originally designed for adults with acquired language impairment following brain damage—the Linguistic Profile Test (LPT). Methods: The Kannada and Malayalam versions of LPT were administered on 134 and 127 normal speakers of these languages, respectively. The participants were divided into three literacy groups (nonliterates, semiliterates, and literates). The scores on each section of the test as well as the overall scores were determined, as per the instructions provided in the test material. Results: The influence of literacy was apparent in semantic and syntax sections of the LPT. Participants from nonliterate group performed notably poorly on these two tasks compared to other two groups. Literacy, however, did not show an effect on the “phonology” section of LPT. Conclusion: The literacy-based norms of LPT developed here could improve the sensitivity of clinical evaluation by reducing the “false positives,” especially while evaluating the language skills of nonliterate persons with brain damage.
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Aboulia: Where there is a will there is a way p. 176
Srimathy Narasimhan, Shankar Balakrishnan
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