COGNITIVE REHABILITATION OF LANGUAGE AND SPEECH DEFICITS IN A CASE OF HERPES ENCEPHALITIS SEQUELAE
Keywords:
Acute encephalitis, cognitive rehabilitation, Aphasia, Multimodel InterventionAbstract
Acute encephalitis is a debilitating syndrome of global brain dysfunction that develops as a rapidly progressive encephalopathy (usually in less than 6 weeks) which can be caused by brain inflammation, both systemic, secondarily affecting the brain, and primary in the brain itself. Patients of all ages may get affected by encephalitis which represents a significant burden to self, family, and society as they usually follow a more chronic course. Initial or predominant symptoms consist of cognitive deficits as well as behavioral changes, emotional dysregulation, and reduction of self-awareness. A 32-year-old, right-handed married female, belonging to MSES was brought for consultation in the post-acute phase after around one and a half years of treatment for Herpes Encephalitis. After further stabilization of her complaints of pain in her right side, tremors in her hands and seizures; was referred to the neuropsychology unit for rehabilitation in December 2014. The clinical presentation revealed a loss of expressive language skills, significant deficits in memory, regression in terms of behavioral changes, and seizures controlled with medicine. Based on the findings of the neuropsychological assessment, an individualized tailored rehabilitation plan was formulated using a multidimensional rehabilitative approach with the aim to promote language reconstruction to integrate the training into daily life communication and enhance the recovery of the patient. The patient received intensive cognitive remediation training for initial 6 months followed by spaced sessions for the next year. Neuropsychological and functional assessments were performed again after six months and the next one-year rehabilitative training showed an improvement in different cognitive functions specifically speech and language, and overall behavioral aspects. Also, maintenance of these treatment effects at around 5-year follow-ups is extremely encouraging.
References
Andrew, Kertesz. (2020).The Western Aphasia Battery: a systematic review of research and clinical applications. Aphasiology.36(4):1-30. DOI: 10.1080/02687038.2020.1852002
Baddeley, A. D. (2021). Developing the concept of working memory: The role of neuropsychology. Arch Clin Neuropsychol. (2021) 36:861–73. doi: 10.1093/arclin/acab060
Brownsett, S.L., Warren, J.E., Geranmayeh, F., Woodhead, Z. (2014). Cognitive control and its impact on recovery from aphasic stroke. Brain. 137:242–54. doi: 10.1093/brain/awt289
Carragher, M., Conroy, P., Sage, K., & Wilkinson, R. (2012). Can impairment-focused therapy change the everyday conversations of people with aphasia? A review of the literature and future directions. Aphasiology, 26(7), 895–916.
Emslie, H., Wilson, B.A., Quir, K., et al. (2007) Using a paging system in the rehabilitation of encephalitic patients. Neuropsychol Rehabil. 17:567–81. [11]
Guevara-Silva, E., Castro-Suarez, S., Caparó-Zamalloa, C., Cortez-Escalante, J., Meza-Vega, M. (2022). Cognitive impairment in adults with autoimmune encephalitis: experience from the Peruvian National Institute of Neurological Sciences. Neurology Perspectives vol 2 (2): 61-66, DOI: 10.1016/ j.neurop.2022.01.004
Hickok, G. & Poeppel, D. (2007).The cortical organization of speech processing. Nat Rev Neurosci. 8:393–402.
Jmor, F., Emsley, H.C., Fischer, M., Solomon, T., Lewthwaite, P. (2008). The incidence of acute encephalitis syndrome in Western industrialised and tropical countries. Virology Journal.5:134–46.
Kaplan, E., Goodglass, H. & Weintraub, S. ((2000). The Boston Naming Test - Second Edition (2nd ed.)
Lambon Ralph, M.A., Snell, C., Fillingham, J.K., Conroy, P., Sage, K. (2010). Predicting the outcome of anomia therapy for people with aphasia post-CVA: both language and cognitive status are key predictors. Neuropsychol Rehabil. Apr;20(2):289-305. doi 10.1080/09602010903237875. Epub 2010 Jan 1. PMID: 20077315.
Langenbahn, D.M., Ashman, T., Cantor, J., et al. (2013). An evidence-based review of cognitive rehabilitation in medical conditions affecting cognitive function. Arch Phys Med Rehabi.94:271–86.
Lee, E.Y., Sohn, M.K., Lee, J.M., Kim, D.Y. (2022). Changes in Long-Term Functional Independence in Patients with Moderate and Severe Ischemic Stroke: Comparison of the Responsiveness of the Modified Barthel Index and the Functional Independence Measure. Int J Environ Res Public Health. Aug 4; 19(15):9612. doi: 10.3390/ijerph19159612. PMID: 35954971; PMCID: PMC9367998.
Leśniak, M., Bak, T., Czepiel, W., Seniów, J., Członkowska, A. (2008). Frequency and prognostic value of cognitive disorders in stroke patients. Dement Geriatr Cogn Disord. 26:356–63. doi: 10.1159/000162262
Lin, M., Jinxin, R., Jingsong, W.,Jia H.( 2022).The Prognostic Value of Domain-Specific Cognitive Abilities Assessed by Chinese Version of Oxford Cognitive Screen on Determining ADLs Recovery in Patients with Post-Stroke Cognitive Impairment. Evidence Based Complementary and Alternative Medicine. https://doi.org/10.1155/2022/1084901
Luria, A. R. (1970). Traumatic aphasia: Its syndromes, psychology and treatment. Trans. M. Critchley. Mouton. https://doi.org/10.1515/9783110816297
Mätzig, S., Druks, J., Masterson, J., Vigliocco, G. (2009). Noun and verb differences in picture naming: past studies and new evidence. Cortex. 45(6):738-58. doi: 10.1016/j.cortex.2008.10.003. Epub 2008 Nov 1. PMID: 19027106.
Pennington, B.F., Bishop, D.V. (2009). Relations among speech, language, and reading disorders. Annu Rev Psychol. 60:283-306. doi: 10.1146/annurev.psych. 60.110707.163548. PMID: 18652545.
Pershad, D., & Wig, N. N. (1977). P.G.I. Memory Scale: A normative study on elderly subjects. Indian Journal of Clinical Psychology, 4(1), 6–8.
Raphiq, I. (2011). Language and Cognitive Impairments Associated with Encephalitis. In Pathogenesis of Encephalitis
Rey, A. & Osterrieth, P. (1993). Translations of excerpts from Andre Rey’s ’psychological examination of traumatic encephalopathy’ and osterrieth’s ’the complex figure test’ . Clinical Neuropsychologist, 7 (1993), pp. 2-21, 10.1080/13854049308401883
Rottschy, C., Langner R., Dogan I., Reetz K., et al. (2012). Modeling neural correlates of working memory: a coordinate-based meta-analysis. Neuroimage. 60:830–46. doi: 10.1016/j.neuroimage.2011.11.050
Simic, T., Laird, L., Brisson, N., Moretti, K. et al. (2022) Cognitive Training to Enhance Aphasia Therapy (Co-TrEAT): A Feasibility Study. Front. Rehabilit. Sci. 3:815780. doi: 10.3389/fresc.2022.815780
Sreedharan, S., Arun, K.M., Sylaja, P.N., et al. (2019). Functional connectivity of language regions of stroke patients with expressive aphasia during real-time functional magnetic resonance imaging-based neurofeedback. Brain Connect. 9(8): 613- 626.
Uniform Data System for Medical Rehabilitation 2009. The FIM System® Clinical Guide, Version 5.2. Buffalo: UDSMR.
Venkatesan, A., Tunkel, A.R., Bloch, K.C., et al. (2013). For the International Encephalitis Consortium. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clinical Infectious Disorder.57:1114–28.
Vora, N.M., Holman, R.C., Mehal, J.M., Steiner, C.A. et al. (2014) Burden of encephalitis-associated hospitalizations in the United States, 1998–2010. Neurology. 82:443–51.
Zakariás, L., Salis, C., Wartenburger, I. (2018). Transfer effects on spoken sentence comprehension and functional communication after working memory training in stroke aphasia. J Neurolinguist. 48:47–63. doi: 10.1016/j.jneuroling.2017.12.002
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Indian Journal of Clinical Psychology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
