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ABILITY OF READING COMPREHENSION IN PATIENTS WITH SPEECH AND LANGUAGE IMPAIRMENTS AFTER STROKE Goran Savić, Department of Neurorehabilitation, Institute of Physical Medicine and Rehabilitation Dr Miroslav Zotović Banja Luka, Republic of Srpska, Bosnia and Herzegovina The work was presented at the XXI World Congress of Neurology in Vienna, Austria, 21-26 September 2013. Abstract Background: Impairments of speaking caused by stroke decreases ability to express and comprehend speaking, reading and writing. Aim is to examine relation between locations lesion of the brain and neurological deficit side of the body with the ability to read and reading comprehension word, sentences and paragraphs in patients damaged communication. Patients and Methods: Research is cross-sectional studies. During the period of six months, 135 patients with speech and language disorders after stroke were tested subtests of Boston Diagnostic Aphasia Examination test's. Results: Brain lesions were distributed on 35 different locations. The most numerous were multifocal lesions, than left sided lesions of parietal, front-parietal, temporal, parietal temporal, front-parietaltemporal and other brain regions. Low results were found on subtests: word- picture matching and comprehension sentences and paragraphs. Understanding of red materials was lower at left sided compared to right sided brain impairments. Conclusion: Ability of reading comprehension in patients with speech and language impairments after stroke is low. Key words: alexia, stroke, aphasia, comprehension reading, brain lesion Introduction The World Health Organization defines stroke as rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or more, or lead to death, without other apparent cause, than signs of blood vessel damage. Raičević R. (2009) showed that epidemiological studies indicate a rising incidence of stroke and its consequences for the overall somatic, social and psychological health with the prevalence of 518 per 100 000 population. Stroke occurs in 75 % of persons older than 65 years; stroke is 12-14 % of the causes of mortality of the population; 33 % of patients with stroke die within the first year after 1 stroke; 22% requires care and assistance, and 20% stay in stationary institutions. The findings of studies (Davidson et al. 2008; Parr, 2007) showed that aphasia is the most widely used neuropsychological consequences of stroke, with a prevalence of about one-third of all patients in the acute phase, and there is also a higher incidence data. Aphasia has far reaching consequences: it is reported to have an adverse effect on mood, 2,3 functional outcomes, social outcomes and quality of life. Aphasic patients may get a different role in their relationship and family, are often unable to maintain their job or education, experience a reduction of their social contacts and activities, and often suffer 4 from depression (Marjolein de Jong-Hagelstein, 2011). Current statistics indicate that in the coming period, the number of people with stroke will increase and within that the number of people with impaired speech and language communication. The writing and reading disorders in patients with stroke (alexias, agraphias and acalculias) are more frequent than verified in routine examination, not only in the less developed but also in large neurological departments. Alexia is an acquired type of sensory aphasia where damage to
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the brain causes a patient to lose the ability to read (Sinanovic, Mrkonjic 2013). It is also called word 5 blindness, text blindness or visual aphasia. Alexia is an acquired type of sensory aphasia where damage to the brain causes the patient to lose the ability to read. Alexia refers to an acquired inability to read due to brain damage and must be distinguished from dyslexia, a developmental abnormality in which the individual is unable to learn to read, and from illiteracy, which reflects a poor educational background. Most aphasics are also alexic, but alexia may occur in the absence of aphasia and may occasionally be the sole disability resulting from 6 specific brain lesions (Sinanović, 2011). There are different classifications of alexias. Reading is a complex skill which requires coordination of various cognitive processes. An efficient reading skill is necessary for the successful acquisition of knowledge at all educational levels. The efficiency of the processes involved in word recognition plays a major role in reading comprehension during the first few years of learning to read. In skilled reading, the efficient use of other processes, such as the use of metacognitive strategies during reading, becomes a more important factor in differences in reading comprehension. Working memory span, vocabulary and domain knowledge are important determinants of individual differences in reading comprehension in both beginning and skilled reader 7 (Rončević, 2005). The ability to accurately evaluate one's comprehension of what is heard or what is read is critical not only for optimum understanding in everyday life but also for optimum learning and acquiring of new 8 information to take place (Moskovljević-Popović Jasmina, Plut 2011). There are two major components of reading - understanding and decoding. Understanding relates to the comprehension of semantic and syntactic meanings of words. Decoding the grapheme-phoneme conversion relates to sound analysis and synthesis and the conversion of written words into their 9 respective phonological representations (Golubovic, 2003). In our region has a small number of studies regarding reading skills in aphasic patients. Ćulafić J. et al 2011 in a preliminary research on the topic Forms of manifestation alexias in aphasic patients, found that alexia present in all types of aphasia. Deficits were expressed in reading aloud and in reading 10 comprehension. Speech and language impairments (SLI) result damage to the parts of the brain responsible for speech and language function, and in majority of people this parts are in the left brain hemisphere. The disorder impairs ability of expression and understanding of speech and language function as well as reading and writing. Aphasia is SLI that can occur with speech disorders such as dysarthria or apraxia occurring also as a result of brain damage. Aphasia is a language processing disorder that is caused by dysfunction of damaged parts of the brain which leads to the interruption of the process of two-way communication between thought and language. Patients are not able to convert non-verbal images (thoughts) in linguistic symbols and grammatical relations that make up language. In most cases, the reverse process is damaged; the patient hears the word but cannot make it out of the non-verbal image that is adequate to the meaning 11
of the word (Vuković, 2011). Damage to the lower left frontal region of the brain, are correlated with difficulties linguistic fluency, grammar and syntax. The difficulty of understanding the words correlate with damage to the temporal region of the left hemisphere. The neuroanatomic substrate of language comprehension and production is complex, including auditory input and language decoding in the superior temporal lobe, analysis in the parietal lobe, and expression in the frontal lobe, descending via the corticobulbar tracts to the internal capsule and brainstem, with 12 modulators effects of the basal ganglia and the cerebellum (Kirshner, 2013). The term alexia means the loss or impairment of reading or acquired reading disorder, caused by brain damage, in the aphasic syndrome or other cognitive disorders of neurogenic origin, as well, but very rarely, isolated language deficit.
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The reading is the psycholinguistic process in which reconstructs the text message. It is based on the recognition of acquired skills and grapheme inner speech that achieves translating graphemes into phonemes. For this activity are required preserved connections between secondary gnostic and praxia cortical areas and intersensory smooth functioning at the level of tertiary cortical structures. Improvements in reading and writing skills, kinesthetic activity of writing became independent without the need to constantly sustaining the lexical form of control (Golubovic 2011; Golubovic 2007). Thus lexical function becomes independent, based on the gnostic capabilities tertiary areas (temporal-parietal13,14 occipital triangle between the dominant hemisphere). Damage of these parts of the brain who are responsible for recognition of graphemes, their translation at the level of auditory image of a word and its meaning, is disturbed to a greater or lesser extent, reading ability and reading comprehension. Reading is an active process that depends not only on the semantic and syntactic competencies but also the reader's initiative and problem solving skills. If you do not recognize most of the words is not possible to understand the text message. We can recognize the word but not understand its significance 13,14 (Golubovic 2011; Golubovic 2007). Phonological awareness is the ability to voice segmentation and understanding relation of letter - sound (awareness of a sound of a word), phonological decoding or recognizing the meaning of a linguistic expression and phonological encoding or the process of selection and producing phonemes that form the essence of language expression, and phonological processing information. Impaired ability of previously acquired skills, phonological processing information lead to disorders previously acquired reading and 15 writing skills (Golubović, 2007). The aim is to examine age, sex, educational level, type of stroke, and comorbidities. The special purpose is to examination the relation between the localization of brain damage after stroke identified CT or NMR, and the relationship of neurological deficit side of the body with the ability to read and reading comprehension word, sentences and paragraphs in patients after stroke with verbal communication damages, addressed to the speech-language therapy's assessment and treatment. Methodology Research is cross -sectional studies. We analyzed the results of tests of reading comprehension word, sentences and paragraphs groups of patients with speech and language impairments (SLI) after stroke. The sample size of 135 patients involved in speech therapy assessment during the first 60 days of the occurrence of the stroke in Department of Neurorehabilitation, Institute of Physical Medicine and Rehabilitation Dr Miroslav Zotovic, Banja Luka , Republic of Srpska, Bosnia and Herzegovina during 6 months in the period March, 01. to August, 31. 2011. A sample of 135 patients with present SLI after stroke had age structure in the range of 35-85 years. Education level of patients are: Without primary education had 7 patients (5.18 % of the sample); 50 patients had primary education (37.03% of the sample); 52 patients had Secondary education (38.51% of the sample); 13 patients had College, Faculty, master’s or equivalent level (9.62% of the sample) and 13 patients was unknown education level (9.62% of the sample). Patients without primary education had literacy course. Their, the earlier (premorbid) weaker reading skills could affect the ability of reading and reading comprehension, especially for more complex texts. Patients were tested subtests: Word - picture matching and Comprehension read sentences and paragraphs of Boston Diagnostic Aphasia Examination test (BDAE). Subtest BDAE "Word-picture matching'' consisted in the fact that the patient after reading the test words with the same card should read, recognize, understand, and show a picture that is adequate write word. Previously, he is offered a few cards with pictures of which he needs to find the one to which the written word corresponds. Subtest BDAE "Comprehension read sentences and Paragraphs" consisted of reading sentences and paragraphs, and comprehension read. After reading the text the patient should choose one of the four written responses that are logical connection with the content and thus demonstrate the level of understanding of the contents of the text read. Understanding is required a preserved ability to string functions of reading skills, the presence of attention, short-term memory and the logical linking of answers with the content of the text. The obtained test results are put in relation with the localization of brain lesions determined CT and NMR, and the relationship with neurologically impaired side of the body after stroke. CT and NMR data we had in the medical history of the patients. In the processing, analysis and interpretation of the data, the methods of descriptive statistics software package SPSS for Windows.
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Results Average age of the sample is 66.77(± 8.93). The gender structure was 59.30% : 40.70% in favor of males. Discussion In our study we tried to find out to what extent the function of reading comprehension of written material was impaired, among patients with speech and language impairments (SLI) after stroke. All patients were referred for speech and language assessment due to present SLI. Patients have tested BDAE subtests: Word-picture matching and Comprehension read sentences and Paragraphs. The test results are put in relation with the localization of brain damage established CT and NMR, and the relation with neurological deficits side of the body as a result of a stroke. Patients were included in the assessment of speech therapy during the first 60 days after the stroke. The average number of days when we tested patients was 29 days onset the stroke. Length of time from onset of the stroke until testing is likely to have some impact on the results. Our experience shows that the length of recovery time leads to spontaneous restitution in patient's abilities; affect the improvement of attention, concentration, coordination and other factors that affect the test result. The results of the present comorbidity and type of stroke in our sample are similar with our previous 16,17,18 studies (Savic et al. 2013; Savic et al. 2012; Savic, Iriskic, 2011). Bugarski Vojislava et al. (2009) examined the connection location of brain lesions and cognitive status in acute ischemic stroke in a sample of 40 patients in the acute phase of the stroke. It was found that executive function and speech are strongly associated with a set of predictors that are related to lesion location. Global brain atrophy was a significant partial predictor of achievement in all aspects of cognitive status, a higher degree of global brain atrophy is associated with poorer performance in each of the tested domains. Mixed (cortical- sub cortical lesions) and unilateral lesions are significant partial predictors in the domain of speech, where a higher level of mixed and 19 unilateral lesions associated with poorer performance in the field of speech. Our previous study on a sample of patients, with or without speech and language impairments, we found that the location of brain damage, are topographically arranged in different parts of the brain. Damages are approximately equally represented on the left and right sides of the brain, partly both sided. The 18 presences of speech and language impairment were at 37% of the sample (Savic, Iriskic, 2011). Found results of brain damages (Table 2) confirm our previous research, as well as studies by other authors, that most often damage the left hemisphere of the brain leading to speech and language 20-22 impairments ( Savic, 2014; Sinanovic et al. 2006; Sinanovic, 2010) . In group with lesions on the right side of the brain we found generally, patients with mild speech and language impairments (table no 3). These patients achieve better results during testing compared to the other two groups. Among them are preserved cortical and subcortical regions of the dominant hemisphere (left hemisphere in most cases) so the test results were better than in the other two categories of patients. The results confirm that the vascular damage to left hemisphere of the brain that cause speech and language impairments, mainly include peri Silvio cortex and subcortical structures, paraventricular white mass, internal capsule and basal ganglia, which is supplies Arteria cerebri media. In testing patients, we found that the average score subtests BDAE "Word-picture matching'' 4.54 points which meaning that in patients on average successfully solve 45.40% of the test. If we look at a sample without patients who had only literacy rate (7 patients without primary school) that average performance was slightly higher, was 47.81% of the test. It is interesting that even 43.70% of patients were completely unsuccessful in this subtest and the 23.00% was completely successful. All patients studied in the group had better success on this test compared to the subtest BDAE "Comprehension read sentences and Paragraphs" which is more complex to identify and understand written text. Poorest results had patients with lesions of the left hemisphere (Table 2). They had a below- average result compared to the whole group. They understood only 28.87% of test. Poor results are the result of brain damage to the primary and secondary area and the nerve pathways and networks responsible for character recognition, synthesis of letters in words, understanding the importance of words and recognition of the adequate image corresponding to written words. Fully unsuccessfully on this subtest BDAE were 19 patients (Table 3). 26 patients had a lesion in the left temporal area hemisphere, as an 416isolated lesion this location or in combination with neighboring regions. All patients
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location, except for one who had a success rate of 60% of the subtests, had a poor score that ranged from 0 to 16.00% success on the test. Patients with parietal lesions of the left hemisphere were significantly represented in the sample and small are poorly on this subtest. Patients with lesions of the right brain hemisphere had above-average scores in relation to the whole group. This group of patients had a successful understanding read the words on this subtest of 72.50%. On subtest BDAE "Comprehension read sentences and Paragraphs" tested group patients achieved lower scores in comparison to subtest Word-picture matching, understood, on average 27.55% of the test. If we look at a sample without patients who had only a literacy course, patients without a primary school (7 patients), the average performance was slightly higher, was 29.06% of the test. 54.10 % of the patients were unsuccessful on this test and only 10.8% were completely successful. Results of 50.00% efficiency or less had 74.10% of the patients.The poorest results achieved patients with left-sided brain lesions. They had half the average result over the entire study group. They understood only 13.54% test (Table 2). This information shows us how the process of reading and reading comprehension complex. Damage to any part of the brain responsible for this process (recognition of letters, convert a string of letters in a word, understanding words and their connection to a particular meaning and message) disrupts this process. On this subtest BDAE fully unsuccessfully were 32 patients (Table 3). Patients with lesions of the temporal and parietal regions have achieved poor results at subtest BDAE "Word-picture matching''. Of the 26 patients with a lesion temporal area of the left hemisphere, as well as isolated locations or in conjunction with neighboring regions, only one had a success rate of 60% of the subtests. All the others had a poor score that ranged from 0 to 8.3% of the success on the test. Patients with lesions of the left parietal hemisphere achieved poor results as shown in the Table 3. Success of patients with lesions located on both sides of the brain in this subtest was on average 38.66% of the test, depending on the localization of the damaged brain. Patients with lesions of the right side of the brain had an average score of 52.50% reading comprehension. A large number of patients in the group with right-sided and both sided brain lesions, understood shorter sentences and simple text. On the parts that contained more complex and more language sentences and which required a longer attention, concentration, short-term memory and understanding, read the words and connect their meaning, the results were weaker or patients were completely unsuccessful. Conclusion In the study group of patients with speech and language impairments after stroke are most often present left-sided, less both sided and rarest right-sided brain damage. Tested group has achieved poor results on tests of recognition and Reading Comprehension of tested materials. Better results are achieved on the subtest BDAE "Word-picture matching'', in relation to complex subtest "Comprehension read sentences and Paragraphs". Patients with lesions of the left hemisphere of cerebrum had below-average, and patients with lesions of the right hemisphere above-average results and recognition of reading comprehension in comparison to the average score of the whole group. Analogously, patients with right-sided neurological deficit of the body have achieved lower scores than patients with left-sided neurological deficits of the body after stroke. Poor test results show how the process of reading, recognizing and reading comprehension is complex and associated with a lots of functions (vision, speech and language, the thought). These functions are related to each cerebral area or their related activities. Damage to one or more locations responsible for these functions are being damaged in identifying, understanding and logical linking of meaning written word, sentences and paragraphs.
Acknowledgements A special thanks to Zlatko Avdičević, St. Petersburg, Florida, USA for translating research from Serbian to English.
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L i t e r a t u r e: 1. Raičević R. (2009) Mozdani udar-epidemija koja traje. Vojnosanit Pregl; 10:777-8. 2. Davidson B, Howe T, Worrall L, Hickson L, Togher L. (2008) Social participation for older peoplewith aphasia: The impact of communication disability on friendships. Top Stroke Rehabil. 2008;15:325-340. 3. Parr S. (2007) Living with severe aphasia: Tracking social exclusion. Aphasiology;21:98-123 4. Marjolein de Jong-Hagelstein (2011) Word finding deficits in aphasia: diagnosis and treatment, Rotterdam Aphasia Therapy Study-2, dissertation, October 2011, Erasmus University Rotterdam. 5. Sinanovic O, Mrkonjic Z.(2013) Post-stroke writing and reading disorders. Sanamed; 8(1):55-63. 6. Sinanović O, Mrkonjić Z, Zukić S, Vidović M and Imamović K. (2011) Post-stroke language disorders, Acta Clin Croat 2011; 50:79-94. 7. Rončević B. (2005) Individual differences in reading comprehension, Psihologijske teme, Volumen 14 broj 2: 55-77. 8. Moskovljević-Popović Jasmina D, Plut D. (2011) The development of comprehension monitoring skills (I) Anali Filološkog fakulteta, 23(2) : 297-309. 9. Golubovic S.M. (2003) Jezicke sposobnosti i teskoce u citanju i pisanju, Nastava i vaspitanje, 52 (4) : 357-368. 10. Ćulafić, J., Vuković, M., & Vuković, I. (2011). Oblici ispoljavanja aleksije kod afazičnih pacijenata - preliminarno ispitivanje. Beogradska defektološka škola, 2011;2:259-270. 11. Vuković M. (2008) Tretman afazija, Univerzitet u Beogradu, Fakultet za specijalnu edukaciju i rehabilitaciju, Beograd. 12. Kirshner S. Howard, editor Howard A Crystal, Aphasia, Pathophysiology, [online] http://emedicine.medscape.com/article/1135944-overview. Update Aug 26, 2013, Accessed September 10, 2013. 13. Golubović S. (2011) Disleksija, disgrafija, dispraksija. Fakultet za specijalnu edukaciju i rehabilitaciju, Beograd, Merkur. 14. Golubović, S. (2007) Poremećaji fluentnosti govora. Društvo defektologa Srbije. Merkur, Beograd. 15. Golubović, S.(2007) Fonološki poremećaji. Društvo defektologa Srbije. Merkur, Beograd. 16. Savić G, Iriškić A, urić D, and Buzadžija V. (2013) Lesion location and speech understanding in stroke patients, Timočki medicinski glasnik; vol 38 (3):112-118. 17. Savić G, Iriškić A, urić D. (2012) Speech comprehension disturbance after stroke, Proceedings of the 18th European Congress of Physical and Rehabilitation Medicine (IPRM), Thessaloniki, Greece, Edizioni Minerva MedicaS.P.A.-Turin, Italy, ISBN: 978-88-7711-616-1, p. 77-81 18. Savić G, Iriškić A. (2011) Afazija kao posljedica moždanih oštećenja, Zbornik radova, 2. Kongres psihologa BiH sa me unarodnim učešćem, Banja Luka, p 295-309. 19. Bugarski V, Semnic M, Semnic R, Pavlović D. (2009) Relationship between lesion location and cognitive domains in acute ischemic stroke patients, Psihologija; 3:393 -410. 20. Savic G. (2014) Relationship of Speech and Language Disorders to Lateralization of Functional Impairments After Stroke, Global Journal of Human-Social Sciences: G, Vol 14, Issue 9, p 75-80. 21. Sinanović O, Vidović M, Smajlović Dž. (2006) Najčešći neuropsihološki poremećaji u akutnom cerebrovaskularnom inzultu. Liječ Vijesn; 128 (supl 6):20-1. 22. Sinanović O. (2010) Neuropsychology of acute stroke. Psychiatria Danubina;2:278-281.
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Table 1 The presence of comorbidities, and type of stroke of the sample Comorbidity
N of patients 45 33
Percent
Arterial hypertension Diabetes mellitus Unknown Without risk factors Atherosclerosis
29 11 9 3 2
21,48 8,14 6,66 2,22 1,48
Brain tumor
2
1,48
Thrombosis Total
1 135
0,74 100,00
Two and more diseases Heart diseases
33,33 24,44
Type of stroke Ischemia Hemorrhage Intracerebral (HIC) Unknown Ischemia and HIC Atrophy Ischemia and atrophy Subarachnoid hemorrhage (SAH) HIC and cerebral tumor Ischemia and SAH Total
N of patients 94 20
Percen t 69,6 14,81
10 5 1 2 1
7,40 3,70 0,74 1,48 0,74
1
0,74
1 135
0,74 100,00
The most common comorbidities in patients of the sample referred mostly to the presence of two or more risk factors for stroke. It is usually a combination of arterial hypertension (HTA), heart disease and diabetes mellitus. The following isolated heart disease, arterial hypertension and other diseases (Table 1). Table 2 The success of the subtest BDAE in relation with damage of the side brain hemisphere Patients with damage of the Side of the brain hemisphere Left side of the brain hemisphere Right side of the brain hemisphere Booth side of the brain hemisphere Missing data The whole sample
N 62 16 45 12 135
Mean success of the Subtest 1 * Mean Std. Deviation 2,88 3,83 7,25 4,35 5,71 4,31 5,08 4,46 4,54 4,38
Mean success of the Subtest 2 † Mean Std. Deviation 1,35 2,49 5,25 3,78 3,86 3,88 2,50 3,34 2,75 3,51
Subtest 1 * - Word-picture matching (maximum of score = 10) Subtest 2 † - Comprehensions read Sentences and paragraphs (maximum of score = 10) Found brain damages are the most localized on the left, the less both side, at least on the right hemisphere. In our study, the significant presence of the both sided brain damage (left and right hemispheres of the brain). These defects were found in 45 patients of the sample. In patients with bilateral cerebral lesions are usually represented multifocal lesions (Table 2). Table 3 The success of the subtest BDAE in relation to the location of the cerebral lesion Mean success
Location of brain lesion Frontotemporal left Frontoparietotemporal left Area irrigation ACM left Basal ganglia booth side Frontal left Supratentorijal Supratentorijal right 419
Subtest 1* 0,00 0.00 0.00 0.00 0.00 0.00 0.00
Subtest 2† 0.00 0.00 0.00 0.00 0.00 0.00 0.00
N of patients with Success ≤ 50% of the subtet Subtest Subtest 1* 2† 2 2 5 5 3 3 2 2 2 2 1 1 1 1
N of patients with Success >50% of the subtet Subtest Subtest 1* 2†
N
2 5 3 2 2 1 1
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Cerebellum Parietal right Frontoparietal right Temporal left Frontoparietal left Temporooccipital left Parietotemporal left Para and Supraventric. left Basal ganglia left Insula left Multifocal hotspot Cerebellum right Unknown location Parietooccipital left Parietooccipitotemporal left Parietal left Parietal booth side Parietotemporal right Pons booth side Paraventricular booth side Hypertensive encephalopathy Frontoparietotemporal right Frontal right Para and Supraventric. right Pons left Putamen right Basal ganglia right Supratentorial left Medulla oblongata Total
0.00 0.00 0.00 1,37 1.22 1.50 1.66 2,80 3.50 3.50 5,63 5.00 5.08 6.00 6.00 6.72 8.00 8.00 8.50 9,00 9,00 9.00 9.00 10,00 10.00 10.00 10.00 10.00 10.00 4.54
0.00 0.00 0.00 0.87 0.00 0.00 0.83 1.80 1.50 0.00 3.90 2.50 2.50 0.00 6.00 3.27 4.00 6.00 5.00 5.50 6.00 4.00 10.00 7.50 5.50 6.50 8.00 7.00 8.00 2.75
1 1 1 7 9 1 5 4 1 1 14 1 5
1 1 1 7 9 1 6 4 2 2 20 2 9 1
3
9 1
1
1 1 1 1 19 1 7 1 1 8 1 1 2 2 2 1 1 4 2 2 2 1 1 64
1 1 1 1 1 1 1
71
100
1
1
13 3 1 2 1 1 1 1 1 3 1 1 2 1 1 35
1 1 1 8 9 1 6 5 2 2 33 2 12 1 1 11 1 1 2 2 2 1 1 4 2 2 2 1 1 135
Subtest 1 * - Word-picture matching (maximum of score = 10) Subtest 2 † - Comprehensions read Sentences and paragraphs (maximum of score = 10) Analysis of the lateralization of brain lesions in patients of our study group, we found that the brain damage was distributed to 35 different locations. It incorporates and brain damage was appointed as multifocal hotspot, which include more than three damaged, topographically unrelated locations, or present many small lesions in specific areas of the brain. In 16 patients studied groups lesions were found on the right side of the brain. The most common were localized para and/or supraventricular, the basal ganglia, cerebellum and putamen and the 6 other locations right side of the brain as shown in the Table 3. Table 4 Success on the subtest BDAE word – picture matching in relation to neurological dysfunction side of the body
Subtest BDAE Word Picture Success ≤ 50 % of the test Success > 50% of the test Total
Right side of the body 60 40 100
N of patients with damage side of the body Left side of Booth side of No significant the body the body damage 8 3 19 3 2 27 6 2
Total 71 64 135
Analyzing the average success on the subtest BDAE "Word-picture matching'' in relation to neurological deficits of the body side (Table 4) shows that of the 100 patients with right-sided functional impairment of the body, 60.00% had an average success of 50% of the test, and 40.00% had a success more than 50% of the test. In part of the sample, with right-sided neurological deficits bodies were patients with bilateral brain damage who do not have significant neurological deficits left sides of the body. They had neurological deficits that were expressed on 420
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the right side of the body. Average score for the 100 patients with neurological deficit of the right body side, in this test was success 3.83 points (38.30% of the test). Two patients without significant functional impairment on either side of the body had an average success rate of 90.00% of the test. Patients with bilateral functional deficits of the body had average success 55.00% of the test. Half of this group had success up to 50% of the test and the other half over 50.00% of the test. Patients with functional impairments left side of the body had average success of 66.29% of the test. From this group, 19 patients had a score over 50.00% of the test, and 8 patients below the 50.00% of the test. Table 5 Success on the subtest BDAE Comprehension read sentences and paragraphs in relation to neurological dysfunction side of the body
Success on the subtest BDAE Comprehension read Sentences and Paragraphs Success ≤ 50 % of the test Success >50% of the test Total
Right side of the body 80 20 100
N of patients with damage side of the body Left side of Booth side No significant the body of the body damage 15 12 27
5 1 6
2 2
Total
100 35 135
Analyzing reading ability and reading comprehension in relation to functional damage to the body side at the subtest BDAE Comprehension subtest read sentences and Paragraphs, we find than 135 patients, 100 patients or 74.08 % of the sample had average success to 50 % of the test and 35 patients ( 25.92% of the sample) had success more than 50% of the test. We find that the worst results were obtained at patients with right-sided functional deficit of the body side (Table 5). The average success of this category of patients was only 2.13 points. They had, on average, success of 21.30% of the read test. This result is related to reading and understanding the most part, the first two or three simple sentences. This category of patients could not read and understand the complex paragraphs. Of the 100 patients in this category only 20% had success over 50.00% of the test. Two patients without significant functional impairment of any body side had average success on this test of 75.00%. Both patients had success over 50.00% of the test. Patients with left-sided functional impairments had twice better result as compared to patients with right-sided functional impairments of the body. On average, they had success of 45.55% of the test. 12 patients of this group had a score over 50.00% of the test, and 15 below the 50.00% of the test. Patients with bilateral functional impairments had an average success in the tests of 35.00%. Of these 5 patients had success under 50.00% and only one over 50.00% of the test.
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