Photobiomodulation with Super-Pulsed Laser Shows Efficacy for Stroke and Aphasia: Case Studies

Background: Brain disorders have become more and more common today, due to both the aging population and the ever-expanding sports community. However, a new therapeutic technology called photobiomodulation (PBM) is giving hope to thousands of individuals in need. Traumatic brain injury (TBI), dementia, post traumatic stress (PTSD) and attention deficit (ADD) disorders are in many cases quickly and safely improved by PBM. PBM employs red or near-infrared (NIR) light (600 - 1100 nm) to stimulate healing, protect tissue from dying, increase mitochondrial function, improve blood flow, and tissue oxygenation. PBM can also act to reduce edema, increase antioxidants, decrease inflammation, protect against apoptosis, and modulate the microglial activation state. All these effects can occur when light is delivered to the head, and can be beneficial in both acute and chronic brain conditions. Methods: In this case series, we used a high power, FDA-approved superpulsed laser system applied to the head to treat four chronic stroke patients. Patients received as few as three 6 - 9 minute treatments over a one-week period. The follow up time varied, but in one case was two years. Results: Patients showed significant improvement in their speech and verbal skills. Improvements were also noticed in walking ability, limb movement, less numbness, and better vision. Conclusion: The use of PBM in stroke rehabilitation deserves to be tested in controlled clinical trials, because this common condition has no approved pharmaceutical treatment at present.

Effect of scalp acupuncture combined with language rehabilitation training in treating post-stroke motor aphasia:A systematic review and meta-analysis

Objective:To evaluate the efficacy of scalp acupuncture combined with language rehabilitation training in the treatment of motor aphasia.Methods:CNKI,VIP,Wan Fang Database,MEDLINE,Embase,Web of Science and Cochrane Library were searched for published researches up to March,2021.Randomized controlled trials RCTs that focused on scalp acupuncture combined with language rehabilitation training in the treatment of motor aphasia were included.We managed the data analysis with RevMan 5.3 software.Results:A total of 16 RCTs with 1323 patients were involved.The results of meta-analysis showed that:①The effective rate of scalp acupuncture combined with language rehabilitation training in the treatment of motor aphasia after stroke was significantly better than that of simple language rehabilitation training[OR=3.94,95%CI(2.73,5.68),P<0.00001];②In the evaluation of language function,compared with the language rehabilitation training,the scalp acupuncture combined with language rehabilitation training can significantly improve the reading ability of the patients with motor aphasia after stroke[MD=7.22,95%CI(3.55,10.89),P=0.0001],writing ability[MD=6.51,95%CI(3.61,9.41),P<0.0001],expressive ability[MD=4.13,95%CI(2.37,5.89),P<0.0001],retelling ability[MD=5.00,95%CI(2.38,7.63),P=0.0002],listening comprehension ability[MD=5.36,95%CI(3.12,7.61),P<0.00001]and naming ability[MD=5.60,95%CI(4.20,7.00),P<0.00001];③Compared with simple language rehabilitation training,scalp acupuncture combined with language rehabilitation can significantly improve the daily life language communication ability of patients with motor aphasia,and the difference was statistically significant[MD=30.01,95%CI(11.30,48.72),P=0.002].Conclusion:Scalp acupuncture combined with language rehabilitation training has a significant effect on motor aphasia.However,due to the small sample size,more RCTs are needed to confirm that.

Study of Native Culture Aphasia and Compensation Strategies in English Education

English teaching in China has attached too much importance to the input of the target language culture,while neglecting our native culture.As a result,students cannot express Chinese culture in English,completely separating Chinese culture from English learning,leading to the serious native culture aphasia.This paper not only analyzes the reasons for this phenomenon from the aspects of curriculum setting,learning motivation,and teachers’quality,but also explains the necessity of integrating Chinese native culture in English teaching.On this basis,effective solutions are put forward from the perspective of classroom teaching,textbook compilation,curriculum arrangement,and so on.

Speech and language therapy for aphasia following subacute stroke

The aim of this study was to investigate the time window, duration and intensity of optimal speech and language therapy applied to aphasic patients with subacute stroke in our hospital. The study consisted of 33 patients being hospitalized for stroke rehabilitation in our hospital with first stroke but without previous history of speech and language therapy. Sixteen sessions of impairment-based speech and language therapy were applied to the patients, 30-60 minutes per day, 2 days a week, for 8 successive weeks. Aphasia assess- ment in stroke patients was performed with Giilhane Aphasia Test-2 before and after treatment. Compared with before treatment, fluency of speech, listening comprehension, reading comprehension, oral motor evaluation, automatic speech, repetition and naming were improved after treatment. This suggests that 16 seesions of speech and language therapy, 30-60 minutes per day, 2 days a week, for 8 successive weeks, are effective in the treatment of aphasic patients with subacute stroke.

ACUPUNCTURE COMBINED WITH LANGUAGE TRAINING FOR TREATMENT OF MOTOR APHASIA CAUSED BY ISCHEMIC APOPLEXY

Objective To observe therapeutic effects of acupuncture combined with language training on aphasia induced by ischemic apoplexy and investigate the mechanisms. Methods 60 patients were randomly divided into a treatment group treated by acupuncture associated with language training and a control group treated by simple language training. Tongue-acupuncture was applied as the main therapy, and language training included speech organ training, mouth-shape and voice training, spoken language expression training and practical communication ability training. According to Aphosio Bottery of Chinese （ABC）, language ex- amination evaluation was made, and event related potential （P300） was detected before and after treatment. Results The therapeutic effect in the treatment group was significantly better than that in the control group （P〈O. 05）, and the scores of ABC items including information content, speech fluency, repetition, vocabula- ry denomination, color naming, response denomination, confirmation or negation, acoustic recognition and carrying out instruction in the treatment group were obviously higher than those in the control group （P〈0.05）. After one course of treatment, the latencies of N2 and P3 waves in P300 were significantly short- ened and the amplitude of P3 was significantly elevated in the treatment group, compared with those in the control group （P〈0.05）. Conclusion Acupuncture combined with language training provided remarkable therapeutic effects in treating cerebral infarction-induced motor aphasia, and it was better than simple lan- guage training. The results of enhancing of the ABC scores including information content, speech fluency, repetition, vocabulary denomination, color naming, response denomination, confirmation or negation, acous- tic recognition and carrying out instruction, and shortening of the latencies of N2 and P3 waves in P300 and ele- vation of P3 amplitude may be taken as the indices for evaluating and anticipating clinical therapeutic effects of the therapy for treating the disease, which may also be some of the mechanisms.

Constraint-induced aphasia therapy for patients with aphasia: A systematic review

Objectives:This study aimed to systematically evaluate the effects of constraint-induced aphasia therapy(OAT)for aphasic patients reported by randomized controlled trials.Methods:Relevant randomized controlled trials were retrieved from 11 electronic databases.A methodological quality assessment was conducted in accordance with the Cochrane Handbook,and metaanalyses were performed by using RevMan 5.2.A descriptive analysis was conducted when the included trials were not suitable for a meta-analysis.Results:A total of 12 trials were included.A statistically significant group difference was shown from the meta-analysis in the results measured by the Western Aphasia Battery(random-effects model,MD=1.23,95%CI=0.31 to 2.14,P<0.01).However,there were no statistically significant differences shown in the results of the Boston Naming Test(fixed-effects model,MD=-1.79,95%CI=-11.19 to Z62,P>0.05)and Aachen Aphasia Test(fixed-effects model,MD=-1.11,95%CI=-4.49 to 2.27,P>0.05).The descriptive analysis showed positive results in language performances of naming,repetition,and comprehension.Conclusion:This systematic review indicated that CIAT was efficient for improving language performance with regard to naming,comprehension,repetition,written language,and oral language based on the current evidence.And this review provides some meaningful guides for clinical practice:expand the therapy duration to 2 or 3 h per day,focus on naming,and choose the best assessment tool.It also indicates a need for more rigorous,large-scale,and high-quality trials in the future.

Lesion localization of global aphasia without hemiparesis by overlapping of the brain magnetic resonance images

Global aphasia without hemiparesis is a striking stroke syndrome involving language impairment without the typically manifested contralateral hemiparesis, which is usually seen in patients with global aphasia following large left perisylvian lesions. The objective of this study is to elucidate the specific areas for lesion localization of global aphasia without hemiparesis by retrospectively studying the brain magnetic resonance images of six patients with global aphasia without hemiparesis to define global aphasia without hemiparesis-related stroke lesions before overlapping the images to visualize the most overlapped area. Talairach coordinates for the most overlapped areas were converted to corresponding anatomical regions. Lesions where the images of more than three patients overlapped were considered significant. The overlapped global aphasia without hemiparesis related stroke lesions of six patients revealed that the significantly involved anatomi- cal lesions were as follows： frontal lobe, sub-gyral, sub-lobar, extra-nuclear, corpus callosum, and inferior frontal gyrus, while caudate, claustrum, middle frontal gyrus, limbic lobe, temporal lobe, superior temporal gyrus, uncus, anterior cingulate, parahippocampal, amygdala, and subcallosal gyrus were seen less significantly involved. This study is the first to demonstrate the heterogeneous anatomical involvement in global aphasia without hemiparesis by overlapping of the brain magnetic resonance images.

Study on the Status Quo of Chinese Cultural Aphasia from the Perspective of Cultural Ecology

To some extent,the phenomenon of"Chinese Cultural Aphasia"is caused by the imbalance of ecological environment of culture in college English teaching.Through questionnaire survey and later interview,this paper further analyzes the status quo of this phenomenon.In order to change the current situation,this paper,from the perspective of cultural ecology,puts forward the countermeasures to solve this problem to vigorously promote our country’s"Culture Exporting"strategy.

Some Suggestions of Solving the Problem of Chinese Culture Aphasia of English Education in Vocational College

Nowadays,it cannot be denied that most educators constantly emphasize on target language culture teaching,which results in the phenomenon of Chinese Culture Aphasia.some feasible suggestions on how to achieve the integration of native culture with target culture and solve the problem of Chinese Culture Aphasia are put forward.The suggestions include some reforms in teaching syllabus,textbooks,test and curriculum.Besides,teachers' self-improvement and students' cultural awareness improvement are also very essential.

Comparison Between Jakobson’s and Grodzinsky’s Models of Aphasia

Aphasiology is the scientific study of aphasias.Many researchers tend to explore the symptoms and causes of different kinds of aphasias.Luria and Jakobson proposed their theories in Ciba Foundation Symposium in 1964.Then Jakobson classified the impairments of aphasias from a linguistic and structuralist point of view based on Luria’s study.By contrast,Grodzinsky proposed trace deletion theory in terms of a generative point of view.Jakobson’s model laid emphasis on the significance of linguistics methodology and knowledge in aphasia analysis and included all types of impairments of aphasias and provided a“clear-cut and symmetrical linguistic classification”with clear damaged areas in the brain.However,this classification which is based on the one-to-one relationship is not rigorous and cannot use some advanced technologies such as CT,MRI,MEG,and ERP method to explore patients’brains,leading to limited insight into possible brain regions affecting language abilities.By contrast,although Grodzinsky’s trace deletion hypothesis in generative model could explain the comprehension problems of non-fluent aphasics to some degree,its assumptions that they could perform well in understanding active and other canonical sentences and that they will have a distinct pattern of comprehension performance and perform in a relatively neat pattern in different tasks are proved to be wrong.This analysis could show that Jakobson’s model is more convincing.

Clinical observation of scalp acupuncture plus speech rehabilitation for Broca's aphasia after cerebral stroke

Objective：To explore the clinical efficacy of scalp acupuncture plus speech rehabilitation in treating Broca＆#39;s aphasia after cerebral stroke, for providing novel evidences for the treatment. Methods：Ninety-one eligible patients with Broca＆#39;s aphasia after cerebral stroke were randomized into an observation group and a control group. Forty-six cases in the observation group were intervened by scalp acupuncture plus speech rehabilitation, while 45 cases in the control group were treated by speech rehabilitation alone. The aphasia battery of Chinese （ABC） and Boston diagnostic aphasia examination （BDAE） were adopted to evaluate the clinical efficacy. Results：After the treatment, the scores of oral expression, reading and writing and global score in the observation group were significantly higher than those in the control group （allP〈0.05）. There was a significant difference in comparing the BDAE grading between the two groups after the treatment （P〈0.05）. After intervention, the basically-recovered plus markedly-effective rate was 45.7% in the observation group versus 24.4% in the control group, and the between-group difference was statistically significant （P〈0.05）. Conclusion：Scalp acupuncture plus speech rehabilitation is effective in treating Broca＆#39;s aphasia after cerebral stroke, and worth promoting.

Aphasia rehabilitation based on mirror neuron theory: a randomized-block-design study of neuropsychology and functional magnetic resonance imaging

When watching someone performs an action, mirror neurons are activated in a way that is very similar to the activation that occurs when actually performing that action. Previous single-sample case studies indicate that hand-action observation training may lead to activation and remodeling of mirror neuron systems, which include important language centers, and may improve language function in aphasia patients. In this randomized-block-design experiment, we recruited 24 aphasia patients from, Zhongda Hospital, Southeast University, China. The patients were divided into three groups where they underwent hand-action observation and repetition, dynamic-object observation and repetition, or conventional speech therapy. Training took place 5 days per week, 35 minutes per day, for 2 weeks. We assessed language function via picture naming tests for objects and actions and the Western Aphasia Battery. Among the participants, one patient, his wife and four healthy student volunteers underwent functional magnetic resonance imaging to analyze changes in brain activation during hand-action observation and dynamic-object observation. Results demonstrated that, compared with dynamic-object observation, hand-action observation led to greater performance with respect to the aphasia quotient and affiliated naming sub-tests and a greater Western Aphasia Battery test score. The overall effect was similar to that of conventional aphasia training, yet hand-action observation had advantages compared with conventional training in terms of vocabulary extraction and spontaneous speech. Thus, hand-action observation appears to more strongly activate the mirror neuron system compared with dynamic-object observation. The activated areas included Broca's area, Wernicke's area, and the supramarginal gyrus. These results suggest that hand-action observation combined with repetition might better improve language function in aphasia patients compared with dynamic-object observation combined with repetition. The therapeutic mechanism of this intervention may be associated with activation of additional mirror neuron systems, and may have implications for the possible repair and remodeling of damaged nerve networks. The study protocol was approved by the Ethical Committee of Nanjing Medical University, China(approval number: 2011-SRFA-086) on March 11, 2011. This trial has been registered in the ISRCTN Registry(ISRCTN84827527).

Action observation as a tool for neurorehabilitation to moderate motor deficits and aphasia following stroke

The mirror neuron system consists of a set of brain areas capable of matching action observation with action execution. One core feature of the mirror neuron system is the activation of motor areas by action observation alone. This unique capacity of the mirror neuron system to match action perception and action execution stimulated the idea that mirror neuron system plays a crucial role in the understanding of the content of observed actions and may participate in procedural learning. These features bear a high potential for neurorehabilitation of motor deficits and of aphasia following stroke. Since the first articles exploring this principle were published, a growing number of follow-up studies have been conducted in the last decade. Though, the combination of action observation with practice of the observed actions seems to constitute the most powerful approach. In the present review, we present the existing studies analyzing the effects of this neurorehabJlitative approach in clinical settings especially in the rehabilitation of stroke associated motor deficits and give a perspective on the ongoing trials by our research group. The data obtained up to date showed significant positive effect of action observation on recovery of motor functions of the upper limbs even in the chronic state after stroke, indicating that our approach might become a new standardized add-on feature of modern neurorehabilitative treatment schemes.

Clinical Application of Loewenstein Occupational Therapy Cognitive Assessment Battery-Second Edition in Evaluating of Cognitive Function of Chinese Patients with Post-stroke Aphasia

Objective To investigate the clinical application value of Loewenstein Occupational Therapy Cognitive Assessment （LOTCA） battery in Chinese patients with post-stroke aphasia. Methods Cognitive fimctions of 59 Chinese patients with aphasia following a stroke were assessed with the Chinese version of the second edition of LOTCA battery and their linguistic functions were tested with the Western Aphasia Battery （WAB） Scale, respectively. The results of LOTCA were analyzed and compared across different groups, in the light of gender, age, educational background, the length of illness, and the degree of aphasia.

Special function of nestin^+ neurons in the medial septum-diagonal band of Broca in adult rats

Nestin＋ neurons have been shown to express choline acetyltransferase （CHAT） in the medial septum-diagonal band of Broca in adult rats. This study explored the projection of nestin＋ neu-rons to the olfactory bulb and the time course of nestin＋ neurons in the medial septum-diagonal band of Broca in adult rats during injury recovery after olfactory nerve transection. This study observed that all nestin＋ neurons were double-labeled with ChAT in the medial septum-diagonal band of Broca. Approximately 53.6% of nestin~ neurons were projected to the olfactory bulb and co-labeled with fast blue. A large number of nestin~ neurons were not present in each region of the medial septum-diagonal band of Broca. Nestin＋ neurons in the medial septum and vertical limb of the diagonal band of Broca showed obvious compensatory function. The number of nestin＋ neurons decreased to a minimum later than nestin/CHAT＋ neurons in the medial sep- turn-diagonal band of Broca. The results suggest that nestin＋ cholinergic neurons may have a closer connection to olfactory bulb neurons. Nestin＋ cholinergic neurons may have a stronger tolerance to injury than Nestin/CHAT＋ neurons. The difference between nestin＋ and nestin-/ ChAT＋ neurons during the recovery process requires further investigations.

A CONTROL STUDY OF SCALP ACUPUNCTURE IN TREATING APHASIA AFTER ACUTE CEREBROVASCULAR DISEASES

A control study of clinical therapeutic effects of scalp acupuncture was made onforty-four Patients suffering from aphasia caused by acute cerebrovascular diseases,and was observedfor 4 weeks.The results revealed that the therapeutic effect in the scalp acupuncture group was betterthan that in the controlgroup.Aphasia was cured more rapidly in the scalpacupuncturegroug than inhe control group.The difference was of significance statistically.

Verifying the hypothesis of disconnection syndrome in patients with conduction aphasia using diffusion tensor imaging

BACKGROUND： It is thought in disconnection theory that connection of anterior and posterior language function areas, i.e. the lesion of arcuate fasciculus causes conduction aphasia. OBJECTIVE： To verify the theory of disconnection elicited by repetition disorder in patients with conduction aphasia by comparing the characteristics of diffusion tensor imaging between healthy persons and patients with conduction aphasia. DESIGN： Case-control observation. SETTING： Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical College. PARTICIPANTS： Five male patients with cerebral infarction-involved arcuate fasciculus conduction aphasia, averaged （43±2） years, who hospitalized in the Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical College from February 2004 to February 2005 were involved in this experiment. The involved patients were all confirmed as cerebral infarction by skull CT and MRI, and met the diagnosis criteria revised in 1995 4^th Cerebrovascular Conference. They were examined by the method of Aphasia Battery of Chinese （ABC） edited by Surong Gao. The results were poorer than auditory comprehension disproportionately, and consistented with the mode of conduction aphasia. Another 5 male healthy persons, averaged （43 ± 1 ） years, who were physicians receiving further training in the Department of Neurology, Beijing Tiantan Hospital were also involved in this experiment. Informed consents of detected items were obtained from all the subjects. METHODS： All the subjects were performed handedness assessment with assessment criteria of handedness formulated by Department of Neurology, First Hospital Affiliated to Beijing Medical University. Arcuate fasciculus of involved patients and health controls were analyzed with diffusion tensor imaging （DTI） and divided into 3 parts （anterior, middle and posterior segments） for determining FA value （mean value was obtained after three times of measurements）, and a comparison of FA value was made between two sides. MAIN OUTCOME MEASURES： Analysis results of arcuate fasciculus DTI of healthy controls and patients with conduction aphasia. RESULTS： Five patients with conduction aphasia and 5 healthy controls participated in the final analysis. ①All the subjects were right-handedness.② The left FA value of anterior, middle and posterior segments of arcuate fasciculus was larger than the right one in most normal volunteers, i.e. arcuate fasciculus with normal function on the left side was more than that on the right side. Because the amount of healthy controls was small, so positive conclusion has not been obtained, and only above-mentioned tendency was demonstrated. Healthy controls had good bilateral arcuate fasciculus; Three patients with conduction aphasia presented left FA value of anterior segment of arcuate fasciculus smaller than the right one, and two patients presented the left FA value larger than the right one. Four patients presented the left FA value of middle segment of arcuate fasciculus smaller than the right one, and one patient presented the left FA value larger than the right one, i.e. middle segment of arcuate fasciculus of 5 patients with conduction aphasia was all involved in at different degrees. Four patients with conduction aphasia presented the left FA value of posterior segment of arcuate fasciculus smaller than the right one, and one patient presented the left FA value larger than the right one, i.e. posterior segment of arcuate fasciculus of 5 patients was all injured at different degrees. CONCLUSION： Arcuate fasciculus of patients with conduction aphasia all is involved in at different degrees, which verifies the theory of disconnection of repetition disorder in patients with conduction aphasia.

Recent advances in the treatment of post-stroke aphasia

Aphasia is an impairment of language use following brain damage. There is no consensual definition of aphasia beyond this general description （Code and Petheram, 2011）. In a more restricted defini- tion, however, aphasia is an impairment of linguistic processing at the phonological, morphological, lexical semantic or syntactic level which is usually caused by lesions of the left cerebral hemisphere. This impairment can affect language reception and expression depending on the various aphasic syndromes （McNeil and Pratt, 2001）. Aphasia results in restrictions in those activities of daily living which rely on communication.

The Evidence of Interdisciplinary Teamwork in the Rehabilitation of Stroke Patients with Aphasia

The aim of this review was to investigate the evidence of interdisciplinary teamwork in the rehabilitation of stroke patients with aphasia. A total of 248 studies were read and nine included. The papers were analysed and data were extracted by categorizing the four components of rehabilitation: assessment, goal setting, intervention and reassessment. The results revealed that interdisciplinary teamwork was a prerequisite for rehabilitation and that nurses’ position in post-stroke care was unclear and limited. In addition, rehabilitation strategies, interdisciplinary cooperation, education and training are important aspects of the rehabilitation process. This study highlights the need for one valid and reliable assessment tool that incorporates communication problems. In conclusion, persons with aphasia should be more involved in their own rehabilitation, which means that the interdisciplinary team members must be educated to communicate appropriately with them.