BACKGROUND:The application of non-invasive brain stimulation in the rehabilitation of bilingual individuals with aphasia following a stroke is understudied. Recent studies show benefits of anodal cerebellar transcranial Direct Current Stimulation in bilinguals, while in monolinguals, repetitive Transcranial Magnetic Stimulation (rTMS) targeting the motor cortex of the lips seems to be effective in aphasia recovery. OBJECTIVE:We aimed to investigate the effects of inhibitory continuous theta burst rTMS stimulation targeting the right motor cortex of the lips during picture naming task in the second language of a French-English post-stroke bilingual individual. METHODS:We enrolled a single bilingual (PR) exhibiting chronic post-stroke aphasia in both her second language (L2), and first language (L1). In the present study PR engaged in naming tasks three times a week for six weeks, including 2-week baseline, 2-week intervention and 2-week follow-up. RESULTS:The results demonstrated a statistically significant improvement in naming accuracy in the second language of the patient, as evidenced by visual analysis in both cognate and non-cognate words, as well as, overall language accuracy. Visual analysis revealed a positive improvement in all variables, with the greatest improvements observed in phonology, overall accuracy, and pathological language switching. CONCLUSION:The stimulation of the motor cortex of the lips resulted in an improvement in naming accuracy in both the first and second language of the participant, despite the possible varying language recovery after stroke. This suggests the possible existence of shared representations of language in the brain, which is likely due to the similarities between the languages. Further studies are required to confirm the efficacy of non-invasive brain stimulation in bilingual individuals with aphasia for deeper understanding of the underlying mechanisms influencing these outcomes. WHAT THIS PAPER ADDS:What is already known on this subject The application of non-invasive brain stimulation in bilinguals with post-stroke aphasia is understudied. Studies have indicated that the cortical organization of each language in bilingual individuals may exhibit overlap particularly in the case of similar languages, leading to a pathological language switching following cerebral lesions. A study by Coemans et al. (2023) demonstrated the efficacy of cerebellar transcranial direct current stimulation in bilingual individuals. The objective of this study is to investigate the effects of transcranial magnetic stimulation during a naming task on the second language of a post-stroke bilingual aphasia individual and to gain insight into the cortical organisation of each language. What this study adds to existing knowledge The present study demonstrates the potential of inhibitory repetitive transcranial magnetic stimulation (rTMS) targeting the right motor cortex of the lips to enhance picture naming accuracy in both languages and reduce pathological language switching in bilingual individuals with aphasia. The results demonstrate that rTMS not only facilitates recovery in each language but also has a beneficial impact on the cognitive control mechanisms involved in language switching, particularly for cognate words. That suggests that rTMS impacts both the targeted motor areas and broader cognitive networks, thereby providing insights into the bilingual language recovery process and highlighting the benefits of rTMS in bilingual aphasia. What are the clinical implications of this study? The clinical implications of this study indicate that rTMS may serve as a valuable tool for enhancing naming abilities and, consequently, language abilities in bilingual patients, particularly when the two languages exhibit similarities. The results suggest that rTMS targeting the motor cortex of the lip has the potential to simultaneously address linguistic and cognitive aspects of bilingual aphasia by targeting the phonological pathway and brain regions involved in cognitive control and language selection. These findings may assist clinicians in the development of personalized rehabilitation strategies for bilingual individuals with post-stroke aphasia.

The aim of this position article is to establish the state of affairs in aphasia assessment and treatment in individuals who speak minority languages. This article reports on recommendations from a panel of experts working with individuals with aphasia in a variety of languages to develop a research agenda for aphasia assessment and treatment in minority languages. Members of Working Group 2 (Aphasia Assessment and Outcomes) of the Collaboration of Aphasia Trialists (CATs) were invited to respond to a short online agenda-setting questionnaire and to discuss issues regarding this topic. The panel of experts then refined the responses and recommendations into future research themes and objectives. Seven priority themes were identified: Definitions, Tools, Research Practices, Treatment, Speech and language pathology (SLP) Training, Societal Impact, and Norms. In the EU alone, about 60 minority/regional languages are spoken by around 40 million people. Considering increasing caseloads and a lack of clinical tools for speakers of minority languages, this research agenda has an important impact for future research and clinical advancements.

Globally, there is still limited understanding of how Speech-Language Pathologists (SLPs) assess and treat multilingual people with aphasia (MPWA). This article presents results from the Multilingual Aphasia Practices (MAP) survey-an extensive international study involving 407 SLPs working across 60 countries. The MAP survey explored: 1) the multilingual background of SLPs and the languages they incorporate into service delivery, 2) their knowledge and professional training related to multilingualism and multilingual aphasia, and 3) their workplace contexts and client profiles. A large proportion of respondents (79.7%) identified as multilingual and reported using numerous languages in their practice. However, formal training in multilingualism was often minimal. Only 25.06% had completed a course focused on multilingualism, and just 10.07% took a full course specific to multilingual aphasia. Most participants (87.2%) reported major gaps in knowledge and training, particularly regarding best-practice recommendations, supervised clinical experience, and guidance on assessment and intervention for MPWA. Many expressed a strong desire for additional professional development in these areas. Clinical exposure to MPWA varied widely. While 27% of respondents reported daily contact, 26.1% encountered MPWA once or twice per week, and 22.8% indicated that they worked with MPWA only a few days per month. Overall, our findings point to persistent and widespread global gaps in training, resources, and clinical readiness for working with MPWA. The results underscore an urgent need to enhance multilingualism-focused education in SLP programs, establish international best-practice frameworks, develop and disseminate culturally and linguistically appropriate assessment and treatment materials.

BackgroundQuality of life measures related to health issues such as aphasia are essential to perform a comprehensive assessment of each individual situation and provide adequate care. The Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) is a tool internationally recognized covering three domains: communication, physical and psychosocial. Currently, the SAQOL-39 is not validated in French.AimsThree experiments were conducted to: 1) adapt the SAQOL-39 in French, 2) validate the scale in persons with aphasia, 3) explore the responses given by neurotypical persons to this self-questionnaire.Methods and proceduresIn Experiment 1, guidelines were used for the cross-cultural adaptation of the SAQOL-39 in French. Preliminary testing of the scale was conducted in six persons with aphasia. In Experiment 2, twenty-two persons with chronic aphasia were recruited in Switzerland and in France. Participants completed the SAQOL-39F twice, as well as the Sickness Impact Profile 65 (SIP-65). Acceptability, reliability and validity were analyzed. In Experiment 3, twenty-two matched neurotypical controls completed the SAQOL-39F. We explored the specificity of the overall scale, of each domain and of each item.Outcomes and resultsThe SAQOL-39 was successfully adapted in French following a forward-backward translation procedure. The validation in persons with aphasia revealed good acceptability, validity and reliability of the scale. The exploration in a matched group of neurotypical individuals showed a good specificity of the overall scale and of the three domains assessed by the SAQOL-39, whereas a few individual items were not particularly discriminant.ConclusionThe present findings support the use of the SAQOL-39F in the assessment of French-speaking persons with aphasia.

Among the wide range of anomia treatments for persons with aphasia (PWA), Phonological Components Analysis (PCA) is a well-known alternative. A systematic review of PCA efficacy studies for PWA was conducted to extract treatment-related and participant-related characteristics, to synthesise immediate and long-term outcomes and to assess the methodological quality of PCA studies (PROSPERO pre-registration CRD42024552047). Experimental studies on adults with post-stroke aphasia focusing on the efficacy of PCA published in English were included. Studies combining PCA with other treatment approaches, involving people with neurodegenerative disorders, without efficacy measures, or in dissertations, theses, and conference papers were excluded. The EBSCOhost platform and citations of the original PCA paper were last searched in November 2024. In total, thirteen studies were selected involving 89 PWA. Participants were at least 6 months post-stroke, and 75 % of them presented with Broca's or anomic aphasia. The quality of PCA efficacy studies was relatively high according to the Single Case Experimental Design scale (mean 8.6 ± 1.0, range 7-10). Picture naming improved to reach at least a small effect size in 74 % of PWA (58/85) for trained items immediately after PCA and in 55 % of PWA (38/71) in the maintenance phase. Generalisation to untrained items occurred in 37 % of participants (22/59). Overall, PCA led to positive outcomes in the majority of PWA, which were often item-specific. As experimental designs were highly heterogeneous, further research is needed to better understand the optimal target population for PCA, the ideal dosage distribution, the key ingredients driving the improvement, and their neural correlates.

PURPOSE:Repetitive transcranial magnetic stimulation (rTMS) can enhance aphasia recovery. Most studies have used inhibitory stimulation targeting the right inferior frontal gyrus. However, the motor cortex, observed to contribute to the prediction of aphasia recovery, is involved in word production and could be an appropriate target for rTMS. We aimed to observe behavioral changes in a picture naming task induced by inhibitory rTMS targeting the right motor cortex of the lips in people with poststroke aphasia. METHOD:Using a single-case experimental design, we included three participants with chronic poststroke aphasia who had phonological deficits. Each participant performed a verbal picture naming task 3 times a week for 2, 3, or 4 weeks (pseudorandom across participants) to establish a baseline naming ability for each participant. These were not therapy sessions, and no feedback was provided. Then, each participant received the intervention, inhibitory continuous theta burst stimulation targeting the right motor cortex of the lips, 3 times a week for 2 weeks. Naming testing continued 3 times a week, for these latter 2 weeks. No therapy was performed at any time during the study. RESULTS:Visual analysis of the graphs showed a positive effect of rTMS for P2 and P3 on picture naming accuracy and a tendency toward improvement for P1. Statistical analysis showed an improvement after rTMS for P1 (τ = 0.544, p = .013, SETau = 0.288) and P2 (τ = 0.708, p = .001, SETau = 0.235). For P3, even if the intervention allowed some improvement, this was statistically nonsignificant due to a learning effect during the baseline naming testing, which lasted the longest, 4 weeks. Regarding specific language features, phonological errors significantly decreased in all patients. CONCLUSIONS:The motor cortex of the lips could be an appropriate target for rTMS to improve naming in people with poststroke aphasia suffering from a phonological deficit. This suggests the possibility to individualize the target for rTMS, according to the patient's linguistic impairment.

BackgroundUtterance production is affected under dual-task conditions, but so far studies have shown an impact either on lexical or on phonological processes, but not on both simultaneously.AimsIn the present study, we aimed at investigating how interference on lexical and phonological encoding is modulated by the timing of the concurrent task and by the attentional requirement (divided vs focused attention).MethodsParticipants with aphasia (PWA) underwent a picture naming task and an auditory detection task, with auditory stimuli presented at different stimulus onset asynchronies (SOAs). The dual-task was performed under divided (Experiment 1) and focused attention (Experiment 2).Outcome & ResultsOmission errors increased under dual-task at early SOA only in Experiment 1 while phonological errors increased at later SOAs in both experiments.ConclusionThese patterns of errors indicate that lexical and phonological processes are impacted under dual-task conditions, giving rise to an increase of specific types of errors at specific SOAs. They also show that very mild anomia may be more severe when assessed under dual-task conditions.

Post-stroke aphasia recovery is multifactorial and results from a complex equation between four types of interrelated factors : a) neurobiological factors, such as lesion size and location, but also to some extent the neural reserve in undamaged brain areas ; b) behavioral factors, mostly related to the initial severity of stroke symptoms ; c) personal factors, such as age and gender, that remain however poorly investigated and debated and d) therapeutic factors, related to medical endovascular interventions and to speech and language therapy. Future studies are crucial to determine more precisely the weight and the interaction of these factors in the recovery process of post-stroke aphasia.

In certain circumstances, speech and language therapy is proposed in telepractice as a practical alternative to in-person services. However, little is known about the minimum quality requirements of recordings in the teleassessment of motor speech disorders (MSD) utilizing validated tools. The aim here is to examine the comparability of offline analyses based on speech samples acquired from three sources: (1) in-person recordings with high quality material, serving as the baseline/gold standard; (2) in-person recordings with standard equipment; (3) online recordings from videoconferencing. Speech samples were recorded simultaneously from these three sources in fifteen neurotypical speakers performing a screening battery of MSD and analyzed by three speech and language therapists. Intersource and interrater agreements were estimated with intraclass correlation coefficients on seventeen perceptual and acoustic parameters. While the interrater agreement was excellent for most speech parameters, especially on high quality in-person recordings, it decreased in online recordings. The intersource agreement was excellent for speech rate and mean fundamental frequency measures when comparing high quality in-person recordings to the other conditions. The intersource agreement was poor for voice parameters, but also for perceptual measures of intelligibility and articulation. Clinicians who plan to teleassess MSD should adapt their recording setting to the parameters they want to reliably interpret.

Post-stroke aphasia recovery is multifactorial and results from a complex equation between four types of interrelated factors : a) neurobiological factors, such as lesion size and location, but also to some extent the neural reserve in undamaged brain areas ; b) behavioral factors, mostly related to the initial severity of stroke symptoms ; c) personal factors, such as age and gender, that remain however poorly investigated and debated and d) therapeutic factors, related to medical endovascular interventions and to speech and language therapy. Future studies are crucial to determine more precisely the weight and the interaction of these factors in the recovery process of post-stroke aphasia.La récupération de l’aphasie post-AVC est multifactorielle et fait l’objet d’une équation complexe entre quatre types de facteurs interreliés : a) des facteurs neurobiologiques, comme la taille et la localisation de la lésion cérébrale, ou encore la réserve neuronale dans les régions non lésées ; b) des facteurs comportementaux, principalement en lien avec la sévérité initiale de la symptomatologie ; c) des facteurs personnels, comme l’âge ou le genre, qui restent toutefois peu explorés et encore débattus à l’heure actuelle et d) des facteurs thérapeutiques, liés aux traitements médicaux endovasculaires et aux traitements logopédiques prodigués. Seuls des travaux de recherche supplémentaires permettront de déterminer plus précisément le poids et l’interaction de ces facteurs dans le processus de récupération de l’aphasie vasculaire.

Background Magnetoencephalography (MEG) and electroencephalography (EEG) record two main types of data: continuous measurements at rest or during sleep, and event-related potentials/evoked magnetic fields (ERPs/EMFs) that involve specific and repetitive tasks. In this systematic review, we summarized longitudinal studies on recovery from post-stroke aphasia that used continuous or event-related temporal imaging (EEG or MEG). Methods We searched PubMed and Scopus for English articles published from 1950 to May 31, 2022. Results 34 studies were included in this review: 11 were non-interventional studies and 23 were clinical trials that used specific rehabilitation methods, neuromodulation, or drugs. The results of the non-interventional studies suggested that poor language recovery was associated with slow-wave activity persisting over time. The results of some clinical trials indicated that behavioral improvements were correlated with significant modulation of the N400 component. Discussion Compared with continuous EEG, ERP/EMF may more reliably identify biomarkers of therapy-induced effects. Electrophysiology should be used more often to explore language processes that are impaired after a stroke, as it may highlight treatment challenges for patients with post-stroke aphasia.

Afin d'évaluer finement les mécanismes de sélection lexicale et notamment le contrôle nécessaire à la résolution de la compétition lexicale en production orale, le paradigme de dénomination par blocs cycliques a été beaucoup utilisé en recherche (ex. Anders et al., 2017 ; Harvey et Schnur, 2015 ; Ries et al., 2014 ; Schnur et al., 2006). Dans ce paradigme, on répète plusieurs fois les mêmes images au sein d'une catégorie sémantique, dans le but de créer un contexte hautement compétitif et d'accroître la demande exécutive. Nous présenterons ici une épreuve qui comprend 16 images répétées trois fois dans un bloc sémantiquement homogène (même catégorie sémantique) et trois fois dans un bloc sémantiquement hétérogène (catégories mélangées), pour un total de 96 items. Des données normatives ont été récoltées auprès de 46 personnes sans lésion cérébrale et une validation a été effectuée auprès de 16 personnes présentant une anomie légère post-AVC en phase post-aiguë. Alors que les personnes sans lésion cérébrale ont produit 3 % d'erreurs au maximum, les personnes avec aphasie ont produit jusqu'à 11 % d'erreurs, malgré une familiarisation avec toutes les images avant l'épreuve. La majorité des erreurs produites par les personnes cérébro-lésées consistent en paraphasies sémantiques de type coordonné/persévératif portant sur un autre item de l'épreuve, parlant en faveur d'une difficulté à contrôler/réguler la sélection lexicale en contexte hautement compétitif ou/et à inhiber les mots précédemment activés. Des analyses statistiques ont montré que la meilleure spécificité et la meilleure sensibilité sont atteintes avec un cutoff de deux erreurs maximum dans cette épreuve. Le but de ce travail est de pouvoir utiliser en pratique clinique un paradigme de dénomination largement utilisé en recherche pour mieux comprendre les mécanismes de contrôle exécutif impliqués dans la régulation de l'activation/inhibition des compétiteurs sémantiques en dénomination.

Digital treatments on tablet computers have become increasingly popular to deliver speech and language therapy. Practice guidelines have been proposed to successfully integrate non-aphasia-specific apps into rehabilitation, but few evidence-based reports are available yet. Three individuals with acquired language disorders trained at home with a mainstream app containing personalized material. The treatment plan was specific to each individual and supervised by a speech and language therapist. All three participants showed significant improvements in picture naming that were specific to the treated items and treatment gains were overall maintained after a couple of months. Treatments carefully designed and delivered in an app led to specific language improvements similar to those previously reported in the literature with or without technology. There is presently no proof that ready-to-go dedicated apps are more effective than this kind of mainstream app allowing the creation and adaptation of materials and tasks to evidence-based knowledge.

Background: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool that induces neuro -modulation in the brain. Several studies have shown that rTMS improves language recovery in patients with post-stroke aphasia. Objective: This systematic review summarizes the role of rTMS in aphasia rehabilitation. Methods: We searched MEDLINE via PubMed and Scopus on 30October, 2020, for English articles (1996-2020). Eligible studies involved post-stroke aphasia rehabilitation with rTMS. In some of these studies, rTMS was also combined with speech therapy. Results: In total, seven meta-analyses and 59studies (23randomized clinical trials) were included in this sys-tematic review. The methods used in these studies were heterogeneous. Only six studies did not find that rTMS had a significant effect on language performance. Conclusions: The evidence from the peer-reviewed literature suggests that rTMS is an effective tool in post-stroke aphasia rehabilitation. However, the precise mechanisms that underlie the effects of rTMS and the reorganization of language networks in patients who have had a stroke remain unclear. We discuss these crucial challenges in the context of future studies.

Background: Even if both phonological and semantic cues can facilitate word retrieval in aphasia, it remains unclear if their respective effectiveness varies according to the underlying anomic profile. Aim: The aim of the present facilitation study is to compare the effect of phonological and semantic cues on picture naming accuracy and speed in different types of anomia. Methods: In the present within-subject design study, 15 aphasic persons following brain damage underwent picture naming paradigms with semantic cues (categorically- or associatively related) and phonological cues (initial phoneme presented auditorily, visually or both). Results: At the group level, semantic cueing was as effective as phonological cueing to significantly speed up picture naming. However, while phonological cues were effective regardless of the anomic profile, semantic cueing effects varied depending on the type of anomia. Participants with mixed anomia showed facilitation after both semantic categorical and associative cues, but individuals with lexical-phonological anomia only after categorical cues. Crucially, semantic cues were ineffective for participants with lexical-semantic anomia. These disparities were confirmed by categorical semantic facilitation decreasing when semantic/omission errors prevailed in the anomic profile, but increasing alongside phonological errors. Conclusion: The effectiveness of phonological vs semantic cues seems related to the underlying anomic profile: phonological cues benefit any type of anomia, but semantic cues only lexical-phonological or mixed anomia.