Activation of intentional mechanisms through utilization of nonsymbolic movements in aphasia rehabilitation

Abstract—Intentional mechanisms play an important role in complex self-initiated actions, such as language and gesturing. Deficits demonstrated in nonfluent aphasia may be a result of a disconnection between or damage to the initiation (intention) and production mechanisms in the left hemisphere. In chronic nonfluent aphasias, damaged language production mechanisms in the left hemisphere may switch to homologous regions in the right hemisphere while the initiation mechanisms remain active in the left hemisphere. A treatment was developed to prime right-hemisphere initiation mechanisms with move-ments of the nondominant hand, thereby bringing initiation into the right hemisphere where the language production mech-anisms have been shifted. Three subjects with stable, chronic nonfluent aphasias were trained in daily sessions with a thera-pist to perform a complex nonsymbolic movement sequence with their nondominant hand to initiate naming trials of simple line drawings. Naming probes were administered during pre-treatment baseline sessions and before each treatment session. All three subjects demonstrated a stable baseline and a signifi-cant increase over baseline performance in the percentage correct on naming probes during the treatment. Findings indi-cate that more extensive investigations of this newly developed treatment are justified and suggest that activation of right-hemisphere initiation mechanisms may enhance word produc-tion accuracy in stable, chronic nonfluent aphasias. Key words: aphasia, initiation, intention, rehabilitation