Category: Neuroplasticity (includes neuroscience); Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Stroke
Objective :
The purpose of this case report is to document a protracted course of recovery and the deficits exhibited by a person with SMART syndrome.
Design : Case report.
Setting : Post-hospital residential rehabilitation and outpatient services at a hospital-based rehabilitation facility.
Participants (or Animals, Specimens, Cadavers) : 39-year-old male (GB) with protracted language and cognitive recovery from SMART syndrome.
Interventions : Speech-language therapy from two weeks to ten months post-onset.
Main Outcome Measure(s) : This case report does not emphasize planned outcomes. Standardized measures serving to characterize recovery included: Western Aphasia Battery – Revised (WAB-R); line bisection; Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Cancellation and Block Design subtests; computerized modification of Benton Facial Recognition Test, and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Written and spoken language samples collected throughout recovery substantiate standardized test findings.
Results :
GB's symptoms persisted beyond those reported in extant literature. Initial testing revealed severe expressive and receptive aphasia, severe alexia and agraphia, relatively intact visuoperceptual and visuoconstruction abilities but substantially disorganized and impaired retrieval of visual information and impaired facial recognition, decreased speed of processing, and poor deficit awareness. At ten-months post-onset, he displayed moderate receptive and mild expressive aphasia, mild alexia, moderate agraphia, intact visual processing, and good deficit awareness.
Conclusions : This case illustrates a protracted course of recovery from SMART syndrome. Extant literature documents approximately 40 cases of SMART syndrome for which recovery occurred within hours to weeks; longer recovery periods have never exceeded six months. However, greater variability in recovery appears to exist than previously documented, and researchers have yet to monitor change systematically. Additional investigation of recovery extent and variability is needed.
Cyrielle Andrew
– Neuropsychology Postdoctoral Fellow, VA Maryland Health Care System, Baltimore, Maryland
Karen Hux
– Director of Research, Quality Living, Inc., Omaha, Nebraska