Drawing and writing are complex processes that require the synchronization of cognition, language, and perceptual-motor skills. Drawing and writing have both been utilized in the treatment of aphasia to improve communication. Recent research suggests that the act of drawing an object facilitated naming, whereas writing the word diminished accurate naming in individuals with aphasia. However, the relationship between object drawing and subsequent phonological output is unclear. Although the right hemisphere is characteristically mute, there is evidence from split-brain research that the right hemisphere can integrate pictures and words, likely via a semantic network. We hypothesized that drawing activates right hemispheric and left perilesional regions that are spared in aphasic individuals and may contribute to semantic activation that supports naming. Eleven right-handed subjects participated in a functional MRI (fMRI) experiment involving imagined drawing and writing and 6 of the 11 subjects participated in a second fMRI experiment involving actual writing and drawing. Drawing and writing produced very similar group activation maps including activation bilaterally in the premotor, inferior frontal, posterior inferior temporal, and parietal areas. The comparison of drawing vs. writing revealed significant differences between the conditions in areas of the brain known for language processing. The direct comparison between drawing and writing revealed greater right hemisphere activation for drawing in language areas such as Brodmann area (BA) 46 and BA 37.

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Background: Apraxia of speech (AOS) is a disorder of expressive speech attributed to an impairment at the motor planning and programming phases of speech production. AOS is treated in different ways but the articulatory kinematic approach is usually followed. The intervention described in this study introduces a new approach toward treatment of AOS with aphasia through the use of implicit manipulation of phonemes via rhyming, deletion and alliteration tasks. Theoretical models propose that during lexical retrieval, associated areas responsible for motor planning and the preparation of the utterance are activated. In a similar way, our tasks require a phoneme manipulation that is hypothesised to activate motor planning. The repeated implicit practice of retrieving and internally monitoring sounds in various phonetic contexts may improve the efficiency of the transition between phonological plans and the initial phase of motor planning and the monitoring of that plan. Therefore, if AOS is due to a dysfunction of motor planning, an implicit intervention targeting this phase may improve speech production without the need for overt practice. Methods and Procedures: This single-subject multiple baseline intervention used implicit phoneme manipulation tasks in a subject with AOS and mild aphasia. The therapistdesigned computerised program required the subject to perform the implicit practice of rhyming, deletion, and alliteration of phonemes in three sound classes: /s/, /dz/, and /s/ clusters in various phonetic contexts. Stimuli were presented on computerised templates requiring the subject to select the target among 3 foils. No overt speech was required however probe word repetitions were necessary to monitor treatment effects. Outcomes and Results: The effect sizes for the trained words were: /s/ probes d 5 4.46, /dz/ probes d 5 6.02, and /s/ clusters d 5 2.54 which represents a small to medium effect for /s/ and /dz/. T-MAC results of 59/87 (68%) at pre-testing improved to 75/87 (87%) at post-test (z 5 3.08, binomial p , .01, two-tailed) which suggest generalisation to nontreatment words. Patterns of change in three probe words over the course of treatment suggest an improvement in speech production. Distortions, disturbed prosody and phonological errors were resolved in these probes by the maintenance session as judged by 5 SLPs. Conclusions: We conclude that in this participant (1) implicit phoneme manipulation training improved overt speech production; (2) accuracy of trained words, specifically a

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