SenseCam improves memory for recent events and quality of life in a patient with memory retrieval difficulties

A wearable camera that takes pictures automatically, SenseCam, was used to generate images for rehearsal, promoting consolidation and retrieval of memories for significant events in a patient with memory retrieval deficits. SenseCam images of recent events were systematically reviewed over a 2-week period. Memory for these events was assessed throughout and longer-term recall was tested up to 6 months later. A written diary control condition followed the same procedure. The SenseCam review procedure resulted in significantly more details of an event being recalled, with twice as many details recalled at 6 months follow up compared to the written diary method. Self-report measures suggested autobiographical recollection was triggered by the SenseCam condition but not by reviewing the written diary. Emotional and social wellbeing questionnaires indicated improved confidence and decreased anxiety as a result of memory rehearsal using SenseCam images. We propose that SenseCam images provide a powerful boost to autobiographical recall, with secondary benefits for quality of life.     

Gender differences in autobiographical memory for everyday events: retrieval elicited by SenseCam images versus verbal cues

Gender differences are frequently observed in autobiographical memory (AM). However, few studies have investigated the neural basis of potential gender differences in AM. In the present functional MRI (fMRI) study we investigated gender differences in AMs elicited using dynamic visual images vs verbal cues. We used a novel technology called a SenseCam, a wearable device that automatically takes thousands of photographs. SenseCam differs considerably from other prospective methods of generating retrieval cues because it does not disrupt the ongoing experience. This allowed us to control for potential gender differences in emotional processing and elaborative rehearsal, while manipulating how the AMs were elicited. We predicted that males would retrieve more richly experienced AMs elicited by the SenseCam images vs the verbal cues, whereas females would show equal sensitivity to both cues. The behavioural results indicated that there were no gender differences in subjective ratings of reliving, importance, vividness, emotion, and uniqueness, suggesting that gender differences in brain activity were not due to differences in these measures of phenomenological experience. Consistent with our predictions, the fMRI results revealed that males showed a greater difference in functional activity associated with the rich experience of SenseCam vs verbal cues, than did females.     

The use of a wearable camera improves autobiographical memory in patients with Alzheimer's disease

Despite the marked impairment of recent episodic memories in Alzheimer's disease, there have been few attempts to rehabilitate these deficits. We used a novel external memory aid to promote recall of episodic memories in patients with mild to moderate Alzheimer's disease. SenseCam, a small wearable camera, recorded significant events in the lives of six Alzheimer's disease patients. Every two days for two weeks each patient's memory for an event was assessed, followed by a structured review of the SenseCam images. Longer-term recall was tested one and three months later. A written diary control condition followed the same procedure. Across 40 events the SenseCam review method resulted in significantly more details of an event being recalled over two weeks than the written diary method in five out of the six patients. At three months post event, four out of five patients (one had dropped out) recalled significantly more details of events in the SenseCam condition while the other patient showed no significant difference. Viewing SenseCam images of personally experienced events may significantly improve autobiographical memory in patients with even moderate Alzheimer's disease.     

SenseCam reminiscence and action recall in memory-unimpaired people

Case studies of memory-impaired individuals consistently show that reminiscing with SenseCam images enhances event recall. This exploratory study examined whether a similar benefit would occur for the consolidation of memories in memory-unimpaired people. We tested delayed recall for atypical actions observed on a lengthy walk. Participants used SenseCam, a diary, or no external memory aid while walking, followed by reminiscence with SenseCam images, diary entries, or no aid, either alone (self-reminiscence) or with the experimenter (social reminiscence). One week later, when tested without SenseCam images or diary entries, prior social reminiscence produced greater recall than self-reminiscence, but there were no differences between memory aid conditions for action free recall or action order recall. When methodological variables were controlled, there was no recall advantage for SenseCam reminiscence with memory-unimpaired participants. The case studies and present study differ in multiple ways, making direct comparisons problematic. SenseCam is a valuable aid to the memory impaired, but its mnemonic value for non-clinical populations remains to be determined.     

SenseCam: a wearable camera that stimulates and rehabilitates autobiographical memory

SenseCam is a wearable digital camera that captures an electronic record of the wearer's day. It does this by automatically recording a series of still images through its wide-angle lens, and simultaneously capturing a log of data from a number of built-in electronic sensors. Subsequently reviewing a sequence of images appears to provide a powerful autobiographical memory cue. A preliminary evaluation of SenseCam with a patient diagnosed with severe memory impairment was extremely positive; periodic review of images of events recorded by SenseCam resulted in significant recall of those events. Following this, a great deal of work has been undertaken to explore this phenomenon and there are early indications that SenseCam technology may be beneficial to a variety of patients with physical and mental health problems, and is valuable as a tool for investigating normal memory through behavioural and neuroimaging means. Elsewhere, it is becoming clear that judicious use of SenseCam could significantly impact the study of human behaviour. Meanwhile, research and development of the technology itself continues with the aim of providing robust hardware and software tools to meet the needs of clinicians, patients, carers, and researchers. In this paper we describe the history of SenseCam, and the design and operation of the SenseCam device and the associated viewing software, and we discuss some of the ongoing research questions being addressed with the help of SenseCam.     

Supporting older and younger adults’ memory for recent everyday events: A prospective sampling study using SenseCam

This study measured the effect of a wearable camera, SenseCam, on older and younger adults’ memories of recently experienced everyday events. Participants used SenseCam to prospectively sample events from a typical week, which they recalled two weeks later. Recall was cued by a self-generated title only (control condition), by the title and forward-order SenseCam images, or by the title and random-order SenseCam images. In the control condition, older and younger adults’ memories were comparably episodic, but older adults recalled more semantic details. Both forward- and random-order SenseCam images were associated with increased episodic and semantic recall in both groups, and there was a small but significant effect of temporal order favouring the forward-order condition. These findings suggest that SenseCam is effective in supporting retrieval of memory for recent events, and the results of the temporal order manipulation also shed light on the mechanism of SenseCam’s effect.     

Functional MRI of Language in Aphasia: A Review of the Literature and the Methodological Challenges

Animal analogue studies show that damaged adult brains reorganize to accommodate compromised functions. In the human arena, functional magnetic resonance imaging (fMRI) and other functional neuroimaging techniques have been used to study reorganization of language substrates in aphasia. The resulting controversy regarding whether the right or the left hemisphere supports language recovery and treatment progress must be reframed. A more appropriate question is when left-hemisphere mechanisms and when right-hemisphere mechanisms support recovery of language functions. Small lesions generally lead to good recoveries supported by left-hemisphere mechanisms. However, when too much language eloquent cortex is damaged, right-hemisphere structures may provide the better substrate for recovery of language. Some studies suggest that recovery is particularly supported by homologues of damaged left-hemisphere structures. Evidence also suggests that under some circumstances, activity in both the left and right hemispheres can interfere with recovery of function. Further research will be needed to address these issues. However, daunting methodological problems must be managed to maximize the yield of future fMRI research in aphasia, especially in the area of language production. In this review, we cover six challenges for imaging language functions in aphasia with fMRI, with an emphasis on language production: (1) selection of a baseline task, (2) structure of language production trials, (3) mitigation of motion-related artifacts, (4) the use of stimulus onset versus response onset in fMRI analyses, (5) use of trials with correct responses and errors in analyses, and (6) reliability and stability of fMRI images across sessions. However, this list of methodological challenges is not exhaustive. Once methodology is advanced, knowledge from conceptually driven fMRI studies can be used to develop theoretically driven, mechanism-based treatments that will result in more effective therapy and to identify the best patient candidates for specific treatments. While the promise of fMRI in the study of aphasia is great, there is much work to be done before this technique will be a useful clinical tool.     

GENDER AND THE USE OF SEXUALLY DEGRADING LANGUAGE

Based on feminist social constructionist theory, it was proposed that the sexual language women and men used would reflect male sexual power over women through degradation and objectification. In the first study, 79 women and 88 men (36 of whom were fraternity members) reported anonymously on the sexual language they used. The strongest effects found were that men (particularly those in a fraternity) were likely to use sexually degrading terms to refer to female genitals. Men were more likely than women to use aggressive terms to refer to copulation. In a second study, 56 women and 47 men college participants listened to a conversation between either two women or two men in which they were talking about having sex with someone they just met the night before. The speaker either used more degrading or less degrading language. In general, people judged anyone who used degrading language negatively. The person who was the object in the more degrading conversation compared to the less degrading conversation was judged as less intelligent and less moral. The results suggest that gender is associated with the sexual language people use, and that the degradation and objectification present in the sexual language men sometimes use might have harmful consequences on the person being objectified.     

Improved picture naming in chronic aphasia after TMS to part of right Broca's area: an open-protocol study

Functional imaging studies with nonfluent aphasia patients have observed "over-activation" in right (R) language homologues. This may represent a maladaptive strategy; suppression may result in language improvement. We applied slow, 1 Hz repetitive transcranial magnetic stimulation (rTMS) to an anterior portion of R Broca's homologue daily, for 10 days in four aphasia patients who were 5-11 years poststroke. Significant improvement was observed in picture naming at 2 months post-rTMS, with lasting benefit at 8 months in three patients. This preliminary, open trial suggests that rTMS may provide a novel treatment approach for aphasia by possibly modulating the distributed, bi-hemispheric language network.     

The recovery processes of two English-Japanese bilingual aphasics

The recovery processes of two English-Japanese bilingual aphasics, one with Broca's aphasia and the other with Wernicke's aphasia, were investigated with special emphasis on the effect of language therapy. The degree of impairment initially manifested in English and Japanese was almost equivalent in each case, the pattern of impairment corresponding to the respective types of aphasia. In both cases, systematic, controlled language therapy was conducted. Analysis of the recovery courses revealed that language therapy was one decisive variable in the relative degree of recovery of a bilingual aphasic's two languages. The type of aphasia appeared to exert a crucial influence on the relative recovery rate of different modalities.     

Crossed aphasia in Chinese: a clinical survey.

According to our clinical observations from various aspects of stroke patients, such as the total incidence of aphasia, the incidence of aphasia after left brain damage of the dextrals, the aphasia that occurs in patients without hemiplegia, and the types of aphasia, a much higher incidence of crossed aphasia is seen among the stroke patients of the Han (the largest ethnic group in China) as compared with the Uighur-Kazaks (U-K) in China and the Occidentals documented in the literature. Motor aphasia is most common and pure sensory or posterior aphasia is rarely seen in Han patients. The distinct features of the Chinese language is a possible explanation for this difference. We suspect that language function of the Han is not localized in the left brain but in the right or both hemispheres. There is no definite Wernicke's area in the left brain of the Chinese people and the neural pathway of the language function in the brain of the Chinese people is not similar to people who speak phonetic languages. Consequently the universal applicability of the theories of cerebral laterality of the language function and dominant hemisphere established by Dax and Broca are questioned in this paper.     

Conversational perspective of therapeutic outcomes: The importance of preference in the development of discourse

Major theme: Evaluation of therapeutic outcome. Logical development of the theme: We suggest a way for practitioners and researchers to assess if they are on track in conversing towards client preferred goals. We offer a critique of more conventional approaches to studying therapeutic progress, suggesting how a discursive (i.e. focused on interaction and language use) lens can address these limitations. Through this lens we examine therapeutic progress evident in ‘preference work’, where clients demonstrably indicate, imply, agree and disagree with where the therapeutic conversation is heading. Such ‘preference work’ offers a form of evidence of within‐session outcomes in a process of reaching larger client preferred outcomes. Authors’ point of view: We present the results of conversation analysis – a qualitative approach to the study of therapy – to illustrate our discursive perspective on therapy progress and change. Implications: we suggest a way for practitioners to assess if they are on track in conversing towards client preferred goals. We propose that our interactional perspective may significantly contribute to bridging practice and research in therapy.     

Default-mode network functional connectivity in aphasia: Therapy-induced neuroplasticity

Previous research on participants with aphasia has mainly been based on standard functional neuroimaging analysis. Recent studies have shown that functional connectivity analysis can detect compensatory activity, not revealed by standard analysis. Little is known, however, about the default-mode network in aphasia. In the current study, we studied changes in the default-mode network in subjects with aphasia who underwent semantic feature analysis therapy. We studied nine participants with chronic aphasia and compared them to 10 control participants. For the first time, we identified the default-mode network using spatial independent component analysis, in participants with aphasia. Intensive therapy improved integration in the posterior areas of the default-mode network concurrent with language improvement. Correlations between integration and improvement did not reach significance, but the trend suggests that pre-therapy integration of the default-mode network may predict therapy outcomes. Functional connectivity allows a better understanding of the impact of semantic feature analysis in aphasia.     

Variability in subcortical aphasia is due to variable sites of cortical hypoperfusion

A variety of fluent and nonfluent aphasias have been reported after left basal ganglia stroke. It has been speculated that this heterogeneity may reflect variations in cortical hypoperfusion resulting from large vessel stenosis. To test this hypothesis, a consecutive series of 24 patients with left caudate infarct identified with diffusion-weighted imaging underwent language testing and perfusion-weighted imaging < 24h from onset of symptoms. Specific regions in perisylvian cortex were rated for the percentage of the region that was hypoperfused. Aphasia type was determined on the basis of speech fluency, comprehension, and repetition performance on the language tests. Association between aphasia type/language impairment and regions of hypoperfusion were identified with Fisher's exact tests. Results demonstrated that in patients with acute left caudate infarct, the presence and type of aphasia reflected regions of hypoperfusion, and generally followed predictions based on chronic lesion studies, regarding anatomical lesions associated with classic aphasia types.     

Evaluating Models of Gesture and Speech Production for People With Aphasia

People with aphasia use gestures not only to communicate relevant content but also to compensate for their verbal limitations. The Sketch Model (De Ruiter, 2000) assumes a flexible relationship between gesture and speech with the possibility of a compensatory use of the two modalities. In the successor of the Sketch Model, the AR-Sketch Model (De Ruiter, 2017), the relationship between iconic gestures and speech is no longer assumed to be flexible and compensatory, but instead iconic gestures are assumed to express information that is redundant to speech. In this study, we evaluated the contradictory predictions of the Sketch Model and the AR-Sketch Model using data collected from people with aphasia as well as a group of people without language impairment. We only found compensatory use of gesture in the people with aphasia, whereas the people without language impairments made very little compensatory use of gestures. Hence, the people with aphasia gestured according to the prediction of the Sketch Model, whereas the people without language impairment did not. We conclude that aphasia fundamentally changes the relationship of gesture and speech.     

Cathodal transcranial direct current stimulation of the right Wernicke's area improves comprehension in subacute stroke patients

Previous studies have shown the appearance of right-sided language-related brain activity in right-handed patients after a stroke. Non-invasive brain stimulation such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) have been shown to modulate excitability in the brain. Moreover, rTMS and tDCS have been found to improve naming in non-fluent post-stroke aphasic patients. Here, we investigated the effect of tDCS on the comprehension of aphasic patients with subacute stroke. We hypothesized that tDCS applied to the left superior temporal gyrus (Wernicke’s area) or the right Wernicke’s area might be associated with recovery of comprehension ability in aphasic patients with subacute stroke. Participants included right-handed subacute stroke patients with global aphasia due to ischemic infarct of the left M1 or M2 middle cerebral artery. Patients were randomly divided into three groups: patients who received anodal tDCS applied to the left superior temporal gyrus, patients who received cathodal tDCS applied to the right superior temporal gyrus, and patients who received sham tDCS. All patients received conventional speech and language therapy during each period of tDCS application. The Korean-Western Aphasia Battery (K-WAB) was used to assess all patients before and after tDCS sessions. After intervention, all patients had significant improvements in aphasia quotients, spontaneous speech, and auditory verbal comprehension. However, auditory verbal comprehension improved significantly more in patients treated with a cathode, as compared to patients in the other groups. These results are consistent with the role of Wernicke’s area in language comprehension and the therapeutic effect that cathodal tDCS has on aphasia patients with subacute stroke, suggesting that tDCS may be an adjuvant treatment approach for aphasia rehabilitation therapy in patients in an early stage of stroke.     

Cerebral dominance in aphasia recovery.

This investigation studied the patterns of ear preference of a group of 25 aphasic adults through the administration of two verbal dichotic tests and retests over a 2-month interval of time. These dichotic tests were a Dichotic Digits Test (DDT) and a Dichotic Animal Names Test (DANT). Schuell's short test of aphasia was given twice over this interval to assess language recovery. Results indicated that as aphasics improve in language, cerebral dominance becomes more firmly established in the right cerebral hemisphere. The data in this study tend to support a dominance shift hypothesis in the recovery of language after aphasia.     

The Contribution of Neuroimaging to the Study of Language and Aphasia

New structural and functional imaging methods continue to be developed at a rapid pace. In the last 25 years, advanced imaging techniques have provided insights into how language is represented and processed in the brain and how it can be disrupted by damage to, or dysfunction of, various parts of the brain. Imaging studies have also yielded new information regarding how individuals recover language after stroke. We briefly review the strengths and weaknesses of the various radiological methods currently used to study language and aphasia.     

Gestural impairment and gestural ability in aphasia: A review

Studies of gestural ability in aphasic subjects have found impairment of gestural expression and comprehension, with a close relationship between severity of aphasia and degree of gestural impairment. A few investigators have correlated gestural ability with specific language functions or subcategories of aphasia. Reading appears to correlate better with gestural recognition than does auditory comprehension. Despite the general findings of gestural impairment in aphasia, successes have been reported with gestural training including artificial language techniques, pantomime, Amerind, and American Sign Language. Future studies of gestural therapy in aphasia should examine specific language deficits in order to identify those aphasic individuals who can benefit from gestural training.     

PET activation studies comparing two speech tasks widely used in surgical mapping

"Automatic" speech, especially counting, is frequently preserved in aphasia, even when word production is severely impaired. Although brain sites and processes for automatic speech are not well understood, counting is frequently used to elicit fluent speech during preoperative and intraoperative cortical mapping for language. Obtaining both behavioral and functional brain imaging measures, this study compared counting with a word production task (generation of animal names), including non-verbal vocalizations and quiet rest as control states, in normal and aphasic subjects. Behavioral data indicated that normal and aphasic groups did not differ in counting or non-verbal vocalizations, but did differ significantly in word production ("naming" animals). Functional brain imaging results on normal subjects using partial least squares analysis of PET rCBF images revealed three significant latent variables (LVs): one for naming and vocalizing, identifying bilateral anterior areas, with left predominating over right; a second LV for naming, identifying left and right frontal and temporal areas. For the third, only marginally significant LV, which was associated with automatic speech alone (counting), right and subcortical sites predominated. For patients, two LVs emerged, identified with naming and vocalization, and corresponding to a variety of cerebral sites; the analysis failed to find a specific latent variable for counting. A comparison between group data for normal subjects and patients suggested that the naming, counting, and vocalization tasks were performed differently by the two groups. These results suggest that word generation as a verbal task is more likely to elicit activity in classical language areas than counting. Further studies are suggested to better understand differences between neurological substrates for non-propositional and automatic speech.