Abstract-Patients with chronic aphasia were assigned randomly to a group to receive either conventional aphasia therapy or constraint-induced (CI) aphasia therapy, a new therapeutic technique requiring intense practice over a relatively short period of consecutive days. CI aphasia therapy is realized in a communicative therapeutic environment constraining patients to practice systematically speech acts with which they have difficulty. Patients in both groups received the same amount of treatment (30 to 35 hours) as 10 days of massed-practice language exercises for the CI aphasia therapy group (3 hours per day minimum; 10 patients) or over a longer period of Ϸ4 weeks for the conventional therapy group (7 patients). CI aphasia therapy led to significant and pronounced improvements on several standard clinical tests, on self-ratings, and on blinded-observer ratings of the patients' communicative effectiveness in everyday life. Patients who received the control intervention failed to achieve comparable improvements. Data suggest that the language skills of patients with chronic aphasia can be improved in a short period by use of an appropriate massed-practice technique that focuses on the patients' communicative needs. (Stroke. 2001;32:1621-1626.)

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A speeded lexical decision task was used to investigate word-category deficits in patients suffering from lesions in the right hemisphere and in neurological controls without cortical lesion. In all patients from one group (n = 12), the right frontal lobe was affected causing a left-sided hemiparesis. In the second group (n = 6), lesions primarily affected areas in the right inferior temporo-occipital lobes. Patients with motor deficits due to lesions in the spinal cord or in the periphery served as neurological controls (n = 9). Processing of three categories of words was investigated: verbs referring to actions (action verbs (acVs)); nouns with strong visual associations (visually-related nouns (viNs)); and nouns with both strong action and visual associations (bimodal nouns (biNs)). Stimulus categories were matched for word length and normalized lexical frequency. Error scores revealed a significant word category by patient group interaction. Patients with lesions in the right frontal lobe showed most severe deficits in processing action verbs, whereas those with lesions in their right temporo-occipital areas showed most severe deficits in processing visually-related nouns. Neurological controls did not show any differences between word categories. The double dissociation of the processing impairments seen in frontal versus temporo-occipital patients demonstrates that specific word-category deficits can arise from lesions in the right non-dominant hemisphere. An account for these results in terms of distributed neuronal systems representing words is offered.

Word category-specific deficits were investigated in two patients with right hemispheric lesions and hemiparesis affecting the left extremities. Words from three categories, action verbs, nouns with strong visual associations and nouns with both strong action and visual associations, were presented in a lexical decision task. The stimulus categories were matched for word length and frequency. In both patients, responses to action verbs were slowed and/or less accurate compared with the other word categories. This was so even in the patient with a minor lesion in the motor, pre-motor and somatosensory areas of the hand representation. Control subjects did not show category differences when tested with the same stimulus materials. These results are consistent with the view that the cortical areas involved in the programming of body movements, even those in the hemisphere not dominant for language, specifically contribute to and are necessary for the processing of words referring to such movements. As an alternative, the affected brain areas may be of particular relevance for the processing of words from the lexical category of verbs. The results are consistent with a brain model of language based on Hebb's cell assembly concept.