This study investigated participation, environmental factors and health-related quality of life (HRQOL) of people with aphasia. The subjects were 66 persons who had aphasia concomitant with cerebral injury one year or more before (aphasia group) and 51 persons without anamnesis of cerebral injury (general population group) . In this study, the Japanese version of the Community Integration Questionnaire (CIQ) , Japanese version 2 of the Craig Hospital Inventory of Environmental Factors (CHIEF) , the Japanese version of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) and other related rating scales were used. Regarding the CIQ, the total score, Home Integration score and Social Integration score were significantly lower in the aphasia group. Concerning the CHIEF, the total score, Physical/Structural score and Services/Assistance score were significantly higher in the aphasia group. Although a significant positive correlation between the CIQ total score and the CHIEF total score was found in the aphasia group, no significant correlation was found in the general population group. These observations suggest that participation correlates with barriers in people with aphasia, and a person with aphasia engaging in a higher degree of participation tends to feel barriers from aphasia. Multiple logistic regression analyses were used. The participation model included the variable of physical independence. The barriers model included the variable of participation. The HRQOL model included the variable of language functioning. Significant correlations were found between the CIQ total score and the Barthel Index, the CIQ total score and the modified Rankin Scale, the CHIEF total score and the CIQ total score, and the SAQOL-39 total score and the Boston Diagnostic Aphasia Examination Aphasia Severity Rating Scale. These results suggest that physical independence affects participation, participation affects barriers, and language functioning affects HRQOL in people with aphasia.
Backgrounds: There are various studies for the language areas in bilingual cases by neuroimaging or cortical mapping with direct stimulation. However, it is still unclear about the topography of functional cortices for each language. We report a bilingual patient in this article, who underwent brain tumor removal under awake craniotomy with language mapping. The results of mapping were suggestive of the roles for the language-specific areas and the common areas in bilingual patients. Case: A 48 year-old man, who was born in Brazil, and has been in Japan for 23 years, suffered from recurrent glioma in the left frontal lobe. Tumor removal was performed under awake craniotomy with language mapping. His native language was Portuguese, but Japanese was more frequently used in his daily life. Intraoperatively, language mapping showed positive responses to both Japanese and Portuguese in the triangle part of the inferior frontal gyrus, consistent with Brocaʼs area. The specific area was seen only to Portuguese in the part of the middle frontal gyrus. No specific area was seen to Japanese. The tumor was gross-totally removed, preserving those functional cortices. Neurological condition was not deteriorated postoperatively. Discussion and Conclusions: In this study, we identified the language-specific area to Portuguese, and the common area to both Portuguese and Japanese. Although Portuguese was native tongue for this patient, its responded-areas showed wider spread than those of Japanese. Moreover, the location of Portuguese-specific area identified during mapping was the middle frontal lobe, which was unusual as Brocaʼs area. This case suggests that the language functional cortices in bilingual cases are various, and when language mapping is performed to preserve language function in bilingual patients, not only the one language but also the other should be examined in various locations.
Here we report a case that showed disorder of new intentional motor initiation localized only in the fingers after resection of a brain tumor in the right frontal lobe. A right-handed 37-years-old male underwent a craniotomy, and a tumor located in the right superior frontal gyrus including the rostral pre-supplementary motor area (SMA) , middle frontal gyrus, cingulate gyrus and corpus callosum were resected. Postoperative magnetic resonance imaging showed an infarction in the non-tumor part of the caudal SMA-proper. Postoperatively, the patient was unable to release an object intentionally if he grasped it in his left hand. However, interestingly, in the case of extrinsic movement, when he was given a cue of movement initiation through somatic sensory stimulation, he was able to release the object easily. Moreover, paralysis, typical grasp reflex and apraxia were not observed in his left hand. The symptom recovered gradually and completely disappeared within five weeks after surgery. This symptom might be due to disorder of the inhibitory and/or promotive system of movement. However, clinical symptoms associated with disorder of the inhibitory and/or promotive system of movement are variable, and the relationship between the area of symptom manifestation and responsible lesions, as well as the neural networks related to motor symptoms, are not well known. Further studies are required with more patients with similar symptoms.
We report a patient with non-fluent conduction aphasia following a left parietal lesion. An 81-year-old right-handed male presented with aphasia and right-sided weakness in the upper limb following cerebral infarction. The neurological symptoms improved over the clinical course except for aphasia and construction apraxia. MRI revealed a lesion spanning the left supramarginal gyrus, superior temporal gyrus and postcentral gyrus. Phonological paraphasia was often seen-he tried to correct his errors but was mostly unsuccessful even with repeated efforts. Anomia and semantic paraphasia were rarely seen. As to the disturbance of repetition, the difficulty of repetition was directly proportional to the number of syllables. Repetition of nonsense syllables was more impaired compared with word repetition. Writing disturbance was frequently seen in the form of literal paragraphia when writing hiragana (phonogram) characters on both spontaneous writing and dictation. Based on these clinical features, we made a diagnosis conduction aphasia. We also noted that the patient showed dysprosody, characterized by a delay of speech, prolongation, and pitch abnormality and distortion, symptoms which are not typically seen in conduction aphasia. Phonemic and sub-phonemic analyses revealed that sound errors occurred mainly for consonants and that substitution was more frequent than transposition. These findings correspond with the characteristics of Brocaʼs aphasia. By contrast, analysis based on the distinctive feature framework revealed that consonant substitution errors were distributed almost at random in terms of feature distance, which is consistent with the characteristics of conduction aphasia. The present case suggests that patients with conduction aphasia with lesions encroaching into the postcentral gyrus show peculiar non-fluent speech production features.