[Dysphagia] off topic: aphasia

[lobsterpam at aol.com (lobsterpam at aol.com)]

 Constraint induced movement therapy! There are piles of articles on the approach for rehabilitation of affected limbs. 
 
 The approach involves something like 6 hours a day of exercise to the affected limb with the unaffected limb being immobilized during waking hours. Interesting approach, but if done as per the protocol, it does pretty much remove the whole idea of learning adaptive means for ADLs. 
 
 Here is something analogous (but only in terms of the intensive practice) for aphasia - and it focused on pragmatic manipulations without permitting any alternative types of responses to speech (so it didn't use writing). And there's free full text, which is always a wonderful thing. 
 http://stroke.ahajournals.org/cgi/reprint/32/7/1621
 
 Here's an abstract of a study showing evidence of cortical reorganization for motor functioning. Following THAT is an abstract providing evidence of cortical reorganization for language, but it wasn't facilitated through writing. 
 
  Functional MRI Evidence of Cortical Reorganization in Upper-Limb Stroke Hemiplegia Treated with Constraint-Induced Movement Therapy. 
 Research Article  American Journal of Physical Medicine & Rehabilitation. 80(1):4-12, January 2001.
  Levy, Charles E. MD; Nichols, Deborah S. PhD; Schmalbrock, Petra M. PhD; Keller, Paul PhD +; Chakeres, Donald W. MD     Abstract: 
 Levy CE, Nichols DS, Schmalbrock PM, Keller P, Chakeres DW: Functional MRI evidence of cortical reorganization in upper-limb stroke hemiparesis treated with constraint-induced movement therapy. Am J Phys Med Rehabil 2001;80:4-12. Objective: The purpose of this pilot study was to test constraint-induced movement therapy for chronic upper-limb stroke hemiparesis and to investigate the neural correlates of recovery with functional magnetic resonance imaging (MRI) in two subjects. Both subjects had been discharged from traditional therapy because no further improvement was anticipated. Design: Constraint-induced movement therapy consisted of 6 hr of daily upper-limb training for 2 wk; a restrictive mitt was worn on the nonparetic limb during waking hours. Functional MRI was performed on a 1.5-T MRI with echo-planar imaging; at the same time, the subjects attempted sequential finger-tapping. Results: Compared with baseline, performance time improved an average of 24% immediately after training and also continued to improve up to 33% 3 mo after training. Lift, grip strength, and Motor Activity Log scores likewise improved. Initially, on functional MRI, subject 1 activated scattered regions in the ipsilateral posterior parietal and occipital cortices. Subject 2 showed almost no areas of significant activation. After training, subject 1 showed activity bordering the lesion, bilateral activation in the association motor cortices, and ipsilateral activation in the primary motor cortex. Subject 2 showed activation near the lesion site. Conclusion: Constraint-induced movement therapy produced significant functional improvement and resulted in plasticity as demonstrated by functional MRI. 
 
   Language-related brain function during word repetition in post-stroke aphasics. 
 BRAIN IMAGING  Neuroreport. 15(12):1891-1894, August 26, 2004.
  Abo, Masahiro CA; Senoo, Atushi 1; Watanabe, Shu 1; Miyano, Satoshi; Doseki, Keiko; Sasaki, Nobuyuki; Kobayashi, Kazushige 2; Kikuchi, Yoshiaki 1; Yonemoto, Kyozo 1     Abstract: 
 We compared fMRI findings (using SPM99) obtained with repetition task in normal subjects with those of two patients with Broca's and Wernicke's aphasia who received speech therapy and showed complete recovery. Both aphasic patients with left hemisphere damage who showed complete recovery exhibited activation of only the compensatory area in the right hemisphere during the repetition task. Recovery from Broca's aphasia involves reorganization and neuromodulation between the external temporopolar area and the anterior superior temporal area of the superior temporal gyrus, putamen and the inferior frontal gyrus, while that from Wernicke's aphasia involves reorganization and neuromodulation between the superior temporal gyrus of the temporal region, the posterior supramarginal gyrus and inferior parietal lobule of the parietal region. 
 Pam Smith, Ph.D.
 Bloomsburg University
 Bloomsburg, PA
    
 -----Original Message-----
 From: sorriso at adelphia.net
 To: CASK51454 at aol.com
 Cc: dysphagia at b9.com
 Sent: Sun, 11 Feb 2007 6:54 AM
 Subject: Re: [Dysphagia] off topic: aphasia
 
  I don't know of a therapy but the idea may come from the book, "Drawing on the 
Right Side of the Brain" by Betty Edwards and the PT/OT technique of .... oh, 
what's it called? ... where the therapist immobilizes the good limb for use of 
the "bad."  I read a bit about this a few years ago (and obviously retained it 
quite well!).

Linda A. Zanchi, MA CCC-SLP

---- CASK51454 at aol.com wrote: 
> Is anyone familiar with an aphasia therapy that advocates pts using their  
> left (or alternate) hand to practice writing to stimulate language on the 
right  
> side of the brain?
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