The aim of the study was to evaluate the efficacy of the treatment for language and calculation disorders and for speech apraxia in vascular subjects. Only therapeutic methods that could be qualified as neuropsychological were taken into account. For language disorders, we searched the pertinent literature published from 1950 to August 31, 2007 by means of electronic data banks and we took into consideration the Cochrane review, and papers in Cicerone et al. and Cappa et al. systematic reviews. For acalculia we examined the literature from 1980 by carrying out research on electronic data banks; for speech apraxia, studies emerged from a search of PUBMED. Aphasia therapy has been clearly demonstrated efficacious in groups of subjects if sufficiently prolonged/intensive. Treatment for specific disorders (words and sentences processing, reading, writing) studied in series of single patients, though always efficacious, reaches a lower level of recommendation due to the lack of RCT. Only a few studies tackled the problem of efficacy in case of speech apraxia and calculation disorders. Results are positive but data are scanty. Efficacy of aphasia therapy seems well established in group of subjects and well-promising for speech apraxia and calculation disorders. It is suggested, however, that the term "aphasia" covers widely different impairments and that RCT are not the best instrument to evaluate efficacy; the importance of chronicity is underlined.

A topic much considered in research on acalculia was its relationship with aphasia. Far less attention has been given to the natural Course of acalculia. In this retrospective study, we examined the relationship between aphasia and acalculia in an unselected series of 98 left-brain-damaged patients and the spontaneous recovery from acalculia in 92 acalculic patients with follow-up. There was a significant association between aphasia and acalculia although 19 participants exhibited aphasia with no acalculia and six acalculia with no aphasia. We observed significant improvement between a first examination carried out between 1 and 5 months post-onset and a second examination carried out between 3 and 11 months later (mean: 5 months). The mechanisms of spontaneous recovery are discussed.

The neural mechanisms underlying recovery of cognitive functions are incompletely understood. Aim of this study was to assess, using functional magnetic resonance (fMRI), the pattern of brain activity during covert word retrieval to letter and semantic cues in five aphasic patients after stroke, in order to assess the modifications of brain function which may be related to recovery. Four out of five patients had undergone language recovery, according to standard testing, after at least 6 months of rehabilitation. The cerebral activation of each patient was evaluated and compared with the activation pattern of normal controls studied with the same fMRI paradigm. In the patients, the pattern of brain activation was influenced by the site and extent of the lesion, by the degree of recovery of language, as reflected by task performance outside the scanner, and by task requirements. In the case of word retrieval to letter cues, a good performance was directly related to the activation in Broca's area, or in the right-sided homologue. On the other hand, in the case of semantic fluency, the relationship between performance level and activation was less clear-cut, because of extensive recruitment of frontal areas in patients with defective performance. These findings suggest that the performance in letter fluency is dependent on the integrity of the left inferior frontal cortex, with the participation of the homologous right hemispheric region when the left inferior frontal cortex is entirely of partially damaged. Semantic fluency, which engages the distributed network of semantic memory, is also associated with more extensive patterns of cerebral activation, which however appear to reflect retrieval effort rather than retrieval success.

Background : Recovery from aphasia in the first 12 months post-onset has been extensively studied. However, far less research effort has been directed towards documenting the course of long-term aphasia. The few existing studies indicate a trend towards a decline in the long term.Aims : Aims of the present research were: (1) to investigate the long-term course of aphasia, and (2) to collect data about the occupational status of individuals with aphasia.Methods & Procedures : We present data from 52 left-hemisphere-damaged vascular aphasic individuals who underwent three aphasia examinations and had a mean post-onset time of 5 years. All subjects were treated between the first and second examination and none received treatment between the second and the final examination. At final examination the aphasic individuals and/or an important other were asked to respond to a questionnaire about the aphasic individuals' use of language, social life, and employment status.Outcomes & Results : Subjects significantly recovered between the first and second examination but there were no further significant changes between the second and the final examination. Only one subject showed a very mild general decline. Nine subjects were still gainfully employed at the time of the last evaluation and their working status is described.Conclusions : From our data it may be concluded that the passing of time has no negative effect on chronic aphasia. In view of the many variables involved, no general conclusion can be drawn concerning aphasic individuals' chances of gainful employment or their social life.

Semantic errors in aphasic patients are frequent and their study has helped understanding the structure and processing of the lexical/semantic system. Most of the patients with semantic errors in reading and writing are English-speaking and it has been argued that this depends on the type of the orthographic systems: in opaque orthographies semantic errors are more frequent than in transparent orthographies. The paper reports the case of an Italian patient, AM, with semantic damage and semantic errors in comprehension and production tasks, except reading aloud. AM was also impaired in non-word repetition and writing but his reading of non-words was only mildly impaired. The absence of semantic errors in reading and the co-occurring absence of severe damage to the non-lexical reading route is consistent with interaction between lexical and non-lexical processing. The discussion addresses the question of the relative frequency of semantic errors in reading and writing tasks in languages with different types of orthographies.

Cauraugh (2002), taking as a starting point a paper by Basso, Burgio, Paulin, and Prandoni (2000), writes a stimulating lesson on statistical deontology, which we appreciate both for its purpose and its content. However, we feel it right and proper to add some considerations about the statistical strategy and the neuropsychological conclusions. In the original paper, Basso et al. (2000) reported results from 44 patients with ideomotor apraxia (IMA) who underwent three successive examinations and from two subgroups of patients with either anterior (n = 6) or posterior (n = 8) lesions. They reached three conclusions: (1) that in the whole group recovery was significant in the first time interval but did not reach significance in the second time interval; (2) that initial severity significantly differed between anterior (more severely apraxic) and posterior (less severely apraxic) lesions; and (3) that recovery in the two groups did not differ significantly. Cauraugh is concerned about the repeated use of t tests instead of ANOVA. In addition, he argues that Basso et al. did not address the study of interaction effects and of circularity assumptions. He therefore conducted two ANOVAs “to further clarify recovery from ideomotor apraxia”.

Effectiveness of aphasia therapy, at least for some patients, is no longer under discussion but the specific effect of most of the variables influencing recovery is unknown. In this paper we address a question relative to the therapeutic regimen. Three pairs of patients with similar age, educational level, sex, aetiology, lesion site, and type and severity of aphasia are compared. Except for one of the control patients who was 2 months post-onset, all patients were at least 6 months post-onset (range: 6-22 months) and had already been rehabilitated when they entered the study. The three experimental subjects underwent a very long and intensive therapeutic programme (2/3 hours per day, 7 days per week, for many months), with the help of the family and volunteers. The control patients were rehabilitated daily (1 hour, 5 days a week) for similar periods of time. It is argued that the intensive treatment achieved higher test scores and more prolonged recovery and that the experimental patients made better use of their recovered language in daily life.

The study explores the efficacy of three learning methods in normal controls. Thirty subjects, randomly assigned to the repetition, reading aloud, or orthographic cueing method, were asked to learn 30 new "words" (legal nonwords arbitrarily assigned to 30 different pictures); 30 further new "words" were used as controls. Number of trials to criterion was significantly lower, and number of words remembered at follow-up was significantly higher for the orthographic cueing method. Two aphasic patients with damage to the output lexicons were also rehabilitated with the same three methods. In both patients the orthographic cueing method was significantly more efficacious. The differences in learning efficacy of the three methods are discussed.

We present a patient with selective dyscalculia following left-hemisphere damage, GC was a cognitively unimpaired woman except for mild verbal and spatial learning disorders, Within the domain of cognitive numerical processing mechanisms, GC presented with multiple and severe disorders, the two most important being impaired number transcoding and impaired arithmetical fact retrieval, Compared to previously reported cases, GC's dissociation between preserved language and impaired mathematical skills is more marked. GC also committed many misspellings in writing number names, but only a few errors in writing words. This dissociation supports the hypothesis of categorical organization to a very peripheral level of language processing.

Signor Piazza, a patient with a left parieto-occipital haemorrhage and a right thalamic stroke, showed severe right personal neglect (e.g. touching own body parts) and right perceptual neglect in tasks with (e.g. cancelling tasks) or without (e.g. description of a complex picture) motor response. He had also right-sided neglect dyslexia (including single words), without language impairments. However, the patient also presented with a clear left-sided deficit in the representational domain (e.g. imagery tasks). Signor Piazza's pattern of performance suggests dissociation between imagery and perception within the neglect syndrome.

Acalculia is a frequent disorder in left-brain-damaged patients but nothing is known about its natural course. We report a study on 51 vascular acalculic patients examined at least twice. Our results indicate that recovery from acalculia is possible in the first months post-stroke, that initial severity does not significantly influence recovery, and that it correlates with recovery of auditory comprehension.

There has been little research on recovery from ideomotor apraxia (IMA). We undertook a long-term follow-up study in a group of ideomotor apraxic patients (n = 44). The duration of follow-up ranged from 1.5 years to 7.2 :years. The patients' ability to imitate gestures was evaluated three times (1.6 months, 9.4 months, and 27.9 months mean time post-onset). All but one patient made an important recovery from IMA in the period between the first and second examinations. Subsequently, very few of the patients showed further recovery and six patients worsened. In three cases deterioration was global; while in three it was confined to IMA.The performance of patients with anterior (n = 6) and posterior (n = 8) lesions was also compared. At all three examinations, patients with anterior lesions had more severe apraxia however, the degree of recovery was not significantly different in the two groups.

The paper reports the performance of 50 left- and 26 vascular right-brain-damaged (LBD, RBD) patients in the EC301 Calculation Battery, which explores different aspects of number and calculation processing. All patients underwent a comprehensive neuropsychological testing that also included evaluation for the presence and type of aphasia in LBD patients, and of spatial disorders in RBD patients. LBD were subdivided in three groups: non-aphasic (NA), Broca and Wernicke aphasics. Results indicate that language and calculation disorders can dissociate. The relationship between spatial and calculation disorders in RBD patients is less clear. No significant difference was found between Broca and Wernicke aphasics, nor between NA and RBD patients. In the transcoding tasks (reading or writing to dictation numbers and number words, for instance) syntactic errors were the most frequent type of errors in all groups. They were also present when neither the input nor the required response was in the Arabic code, and a word-by-word strategy could have been used to read the number word or write a spoken number in the orthographic code.

Twenty normal controls without previous knowledge of French were asked to learn 12 French words that could not be written by Italian correspondence rules. After acquisition of the phonological representations, participants were presented the pictures and asked to write the corresponding words (baseline). They were then presented 3 times with the pictures and the corresponding written words. After a filled delay of 10 min, they were re-presented the pictures and asked to write the corresponding words (testing). A week later, participants were again requested to write the words (follow-up). Number of words correctly written at testing and at follow-up significantly differs from baseline, as well as number of words correctly written at testing and at follow-up. These results are discussed and it is suggested that acquisition of irregular output orthographic representations can be supported by knowledge of orthographic representations for reading and that rehabilitation of patients with damage to output orthographic representations can utilize input orthographic representations.

We report the case of an aphasic patient whose speech was sparse and agrammatic in spontaneous production and in sentence generation. His confrontation naming abilities were well preserved for both nouns and verbs. This capacity to retrieve a noun in a visual confrontation task contrasted markedly with his difficulty in retrieving the same name in a sentence-completion task. One patient has been previously described with the same dissociation and three with the opposite dissociation. In all four cases, there was a grammatical class effect, with better preserved noun than action naming in the patient whose confrontation naming was significantly better than his sentence completion, and better preserved verb than noun retrieval in the three patients with better preserved sentence completion. In contrast with these reports, our patient did not show a grammatical class effect. Furthermore, despite his difficulty in generating sentences, his ability to process verb syntax was fairly preserved. Results are discussed in terms of two language routes activated in producing isolated words: the nominal route, which is utilized on a visual confrontation task, and the propositional route, which is active in a sentence-completion task.

Five-hundred and three normal subjects were given a phonetically cued word-fluency task in order to investigate the controversial issue of the influence of gender and aging on this task. Subjects were requested to say in one minute all the words that occurred to them, beginning with a given letter (F, P and L). Besides the expected significance of education, we observed a female advantage, but not a significant decline in the performance with aging. However, the slope of the line expressing word fluency as a function of age was different between females and males, indicating a greater sensitivity to aging for males. We provide inner and outer tolerance limits for this test in the normal population and give a formula useful for adjusting the raw scores on the basis of gender and education. The results are discussed with reference to previous findings and some hypotheses about the origins of the female advantage in PWF.

This retrospective study investigated whether there is evidence of a 3rd reading mechanism in a transparent orthography such as Italian, where (nearly) all words can be read through the sublexical route but stress cannot always be assigned by orthography-to-phonology rules. The presence and frequency of stress errors in lexically stressed words in 16 aphasic patients with impaired reading comprehension of those same words was checked. Nine patients were reexamined months later. Notwithstanding impaired reading comprehension, none of the patients made stress errors at first examination. At follow-up, all patients showed improvement of reading comprehension and only 2 patients still had better preserved oral reading. The authors concluded that even in transparent orthographies such as Italian, the noninteractive dual-route model is inadequate for explaining all patterns of reading performances. In nonprogressive aphasias, reading comprehension can recover in a larger number of patients, reducing the amplitude of the dissociation between reading aloud and reading comprehension and reducing the number of patients showing this dissociation.