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Silva AB, Littlejohn KT, Liu JR, Moses DA, Chang EF. The speech neuroprosthesis. Nat Rev Neurosci 2024; 25:473-492. [PMID: 38745103 DOI: 10.1038/s41583-024-00819-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024]
Abstract
Loss of speech after paralysis is devastating, but circumventing motor-pathway injury by directly decoding speech from intact cortical activity has the potential to restore natural communication and self-expression. Recent discoveries have defined how key features of speech production are facilitated by the coordinated activity of vocal-tract articulatory and motor-planning cortical representations. In this Review, we highlight such progress and how it has led to successful speech decoding, first in individuals implanted with intracranial electrodes for clinical epilepsy monitoring and subsequently in individuals with paralysis as part of early feasibility clinical trials to restore speech. We discuss high-spatiotemporal-resolution neural interfaces and the adaptation of state-of-the-art speech computational algorithms that have driven rapid and substantial progress in decoding neural activity into text, audible speech, and facial movements. Although restoring natural speech is a long-term goal, speech neuroprostheses already have performance levels that surpass communication rates offered by current assistive-communication technology. Given this accelerated rate of progress in the field, we propose key evaluation metrics for speed and accuracy, among others, to help standardize across studies. We finish by highlighting several directions to more fully explore the multidimensional feature space of speech and language, which will continue to accelerate progress towards a clinically viable speech neuroprosthesis.
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Affiliation(s)
- Alexander B Silva
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - Kaylo T Littlejohn
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, USA
| | - Jessie R Liu
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - David A Moses
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA.
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2
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Latifi S, Carmichael ST. The emergence of multiscale connectomics-based approaches in stroke recovery. Trends Neurosci 2024; 47:303-318. [PMID: 38402008 DOI: 10.1016/j.tins.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/31/2023] [Accepted: 01/21/2024] [Indexed: 02/26/2024]
Abstract
Stroke is a leading cause of adult disability. Understanding stroke damage and recovery requires deciphering changes in complex brain networks across different spatiotemporal scales. While recent developments in brain readout technologies and progress in complex network modeling have revolutionized current understanding of the effects of stroke on brain networks at a macroscale, reorganization of smaller scale brain networks remains incompletely understood. In this review, we use a conceptual framework of graph theory to define brain networks from nano- to macroscales. Highlighting stroke-related brain connectivity studies at multiple scales, we argue that multiscale connectomics-based approaches may provide new routes to better evaluate brain structural and functional remapping after stroke and during recovery.
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Affiliation(s)
- Shahrzad Latifi
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA; Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
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3
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Harrington RM, Kristinsson S, Wilmskoetter J, Busby N, den Ouden D, Rorden C, Fridriksson J, Bonilha L. Dissociating reading and auditory comprehension in persons with aphasia. Brain Commun 2024; 6:fcae102. [PMID: 38585671 PMCID: PMC10998352 DOI: 10.1093/braincomms/fcae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/10/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
Language comprehension is often affected in individuals with post-stroke aphasia. However, deficits in auditory comprehension are not fully correlated with deficits in reading comprehension and the mechanisms underlying this dissociation remain unclear. This distinction is important for understanding language mechanisms, predicting long-term impairments and future development of treatment interventions. Using comprehensive auditory and reading measures from a large cohort of individuals with aphasia, we evaluated the relationship between aphasia type and reading comprehension impairments, the relationship between auditory versus reading comprehension deficits and the crucial neuroanatomy supporting the dissociation between post-stroke reading and auditory deficits. Scores from the Western Aphasia Battery-Revised from 70 participants with aphasia after a left-hemisphere stroke were utilized to evaluate both reading and auditory comprehension of linguistically equivalent stimuli. Repeated-measures and univariate ANOVA were used to assess the relationship between auditory comprehension and aphasia types and correlations were employed to test the relationship between reading and auditory comprehension deficits. Lesion-symptom mapping was used to determine the dissociation of crucial brain structures supporting reading comprehension deficits controlling for auditory deficits and vice versa. Participants with Broca's or global aphasia had the worst performance on reading comprehension. Auditory comprehension explained 26% of the variance in reading comprehension for sentence completion and 44% for following sequential commands. Controlling for auditory comprehension, worse reading comprehension performance was independently associated with damage to the inferior temporal gyrus, fusiform gyrus, posterior inferior temporal gyrus, inferior occipital gyrus, lingual gyrus and posterior thalamic radiation. Auditory and reading comprehension are only partly correlated in aphasia. Reading is an integral part of daily life and directly associated with quality of life and functional outcomes. This study demonstrated that reading performance is directly related to lesioned areas in the boundaries between visual association regions and ventral stream language areas. This behavioural and neuroanatomical dissociation provides information about the neurobiology of language and mechanisms for potential future treatment interventions.
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Affiliation(s)
- Rachael M Harrington
- Department of Communication Sciences and Disorders and Center for Research on the Challenges of Acquiring Language and Literacy, Georgia State University, Atlanta, GA 30310, USA
| | - Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Janina Wilmskoetter
- Department of Health and Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC 29464, USA
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Dirk den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Leonardo Bonilha
- School of Medicine Columbia, University of South Carolina, Columbia, SC 29208, USA
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4
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Lorca-Puls DL, Gajardo-Vidal A, Mandelli ML, Illán-Gala I, Ezzes Z, Wauters LD, Battistella G, Bogley R, Ratnasiri B, Licata AE, Battista P, García AM, Tee BL, Lukic S, Boxer AL, Rosen HJ, Seeley WW, Grinberg LT, Spina S, Miller BL, Miller ZA, Henry ML, Dronkers NF, Gorno-Tempini ML. Neural basis of speech and grammar symptoms in non-fluent variant primary progressive aphasia spectrum. Brain 2024; 147:607-626. [PMID: 37769652 PMCID: PMC10834255 DOI: 10.1093/brain/awad327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) is a neurodegenerative syndrome primarily defined by the presence of apraxia of speech (AoS) and/or expressive agrammatism. In addition, many patients exhibit dysarthria and/or receptive agrammatism. This leads to substantial phenotypic variation within the speech-language domain across individuals and time, in terms of both the specific combination of symptoms as well as their severity. How to resolve such phenotypic heterogeneity in nfvPPA is a matter of debate. 'Splitting' views propose separate clinical entities: 'primary progressive apraxia of speech' when AoS occurs in the absence of expressive agrammatism, 'progressive agrammatic aphasia' (PAA) in the opposite case, and 'AOS + PAA' when mixed motor speech and language symptoms are clearly present. While therapeutic interventions typically vary depending on the predominant symptom (e.g. AoS versus expressive agrammatism), the existence of behavioural, anatomical and pathological overlap across these phenotypes argues against drawing such clear-cut boundaries. In the current study, we contribute to this debate by mapping behaviour to brain in a large, prospective cohort of well characterized patients with nfvPPA (n = 104). We sought to advance scientific understanding of nfvPPA and the neural basis of speech-language by uncovering where in the brain the degree of MRI-based atrophy is associated with inter-patient variability in the presence and severity of AoS, dysarthria, expressive agrammatism or receptive agrammatism. Our cross-sectional examination of brain-behaviour relationships revealed three main observations. First, we found that the neural correlates of AoS and expressive agrammatism in nfvPPA lie side by side in the left posterior inferior frontal lobe, explaining their behavioural dissociation/association in previous reports. Second, we identified a 'left-right' and 'ventral-dorsal' neuroanatomical distinction between AoS versus dysarthria, highlighting (i) that dysarthria, but not AoS, is significantly influenced by tissue loss in right-hemisphere motor-speech regions; and (ii) that, within the left hemisphere, dysarthria and AoS map onto dorsally versus ventrally located motor-speech regions, respectively. Third, we confirmed that, within the large-scale grammar network, left frontal tissue loss is preferentially involved in expressive agrammatism and left temporal tissue loss in receptive agrammatism. Our findings thus contribute to define the function and location of the epicentres within the large-scale neural networks vulnerable to neurodegenerative changes in nfvPPA. We propose that nfvPPA be redefined as an umbrella term subsuming a spectrum of speech and/or language phenotypes that are closely linked by the underlying neuroanatomy and neuropathology.
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Affiliation(s)
- Diego L Lorca-Puls
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Sección de Neurología, Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Concepción, 4070105, Chile
| | - Andrea Gajardo-Vidal
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Centro de Investigación en Complejidad Social (CICS), Facultad de Gobierno, Universidad del Desarrollo, Santiago, 7590943, Chile
- Dirección de Investigación y Doctorados, Vicerrectoría de Investigación y Doctorados, Universidad del Desarrollo, Concepción, 4070001, Chile
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, 08025, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, 28029, Spain
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
| | - Zoe Ezzes
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Lisa D Wauters
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78712-0114, USA
| | - Giovanni Battistella
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA 02114, USA
| | - Rian Bogley
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Buddhika Ratnasiri
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Abigail E Licata
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Petronilla Battista
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Laboratory of Neuropsychology, Istituti Clinici Scientifici Maugeri IRCCS, Bari, 70124, Italy
| | - Adolfo M García
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Centro de Neurociencias Cognitivas, Universidad de San Andrés, Buenos Aires, B1644BID, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, 9160000, Chile
| | - Boon Lead Tee
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
| | - Sladjana Lukic
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Communication Sciences and Disorders, Ruth S. Ammon College of Education and Health Sciences, Adelphi University, Garden City, NY 11530-0701, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Maya L Henry
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78712-0114, USA
- Department of Neurology, Dell Medical School, University of Texas, Austin, TX 78712, USA
| | - Nina F Dronkers
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Department of Neurology, University of California, Davis, CA 95817, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
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5
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Swann Z, Tesman N, Rogalsky C, Honeycutt CF. Word Repetition Paired With Startling Stimuli Decreases Aphasia and Apraxia Severity in Severe-to-Moderate Stroke: A Stratified, Single-Blind, Randomized, Phase 1 Clinical Trial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2630-2653. [PMID: 37699161 DOI: 10.1044/2023_ajslp-22-00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
PURPOSE This prospective, single-blinded, parallel, stratified, randomized clinical trial via telehealth aimed to investigate the impact of Startle Adjuvant Rehabilitation Therapy (START) on aphasia, apraxia of speech (AOS), and quality of life in individuals with chronic stroke. The study hypothesized that START would have a greater effect on AOS-related measures and more severe individuals. METHOD Forty-two participants with poststroke aphasia, AOS, or both were randomly assigned to the START or control group. Both groups received 77-dB GET READY and GO cues during a word repetition task for three 1-hr sessions on consecutive days. The START group additionally received 105-dB white noise GO cues during one third of trials. The Western Aphasia Battery-Revised, Apraxia Battery for Adults, Stroke Impact Scale, and Communication Outcomes After Stroke scale were administered at Day 1, Day 5, and 1-month follow-up. RESULTS START improved performance on some subtests of the Western Aphasia Battery (Comprehension, Repetition, Reading) and measures of AOS (Diadochokinetic Rate, Increasing Word Length) in individuals with moderate/severe aphasia, whereas moderate/severe controls saw no changes. Individuals with mild aphasia receiving START had improved Reading, whereas mild controls saw improved Comprehension. The START group had increased mood and perceived communication recovery by Day 5, whereas controls saw no changes in quality of life. CONCLUSIONS This study is the first to evaluate the impact of training with startling acoustic stimuli on clinical measures of aphasia and AOS. Our findings suggest START can enhance both nontrained speech production and receptive speech tasks in moderate/severe aphasia, possibly by reducing poststroke cortical inhibition. Our findings should be considered carefully, as our limitations include small effect sizes, within-group variability, and low completion rates for quality-of-life assessments and follow-up visits. Future studies should explore a mechanism of action, conduct larger and longer Phase 2 clinical trials, and evaluate long-term retention. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24093519.
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Affiliation(s)
- Zoe Swann
- School of Life Sciences, Arizona State University, Tempe
| | - Nathan Tesman
- School of Biological and Health Science Engineering, Arizona State University, Tempe
| | | | - Claire F Honeycutt
- School of Biological and Health Science Engineering, Arizona State University, Tempe
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6
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Vasilopoulou ME, Triarhou LC. Neurobiological and pathophysiological concepts of Christfried Jakob (1866-1956) on language and aphasia: An English translation of two communications [1910,1932] and a modern perspective. J Chem Neuroanat 2023; 133:102341. [PMID: 37717828 DOI: 10.1016/j.jchemneu.2023.102341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/19/2023]
Abstract
The aim of the present article is to preserve, in English translation, two historical communications on aphasia and the pathophysiology of language by the neurobiologist Christfried Jakob (1866-1956) of Buenos Aires, and to place them in a modern perspective. The morphofunctional basis of human language and its pathology occupied Jakob's mind over three decades. His synthetic conclusions were based on the neuropathological examination of dozens of aphasic cases from the Hospital de Las Mercedes and the National Women's Psychiatric Hospital between 1906 and 1936. Special mention is made of the role of the cerebellum, the thalamus, and their connections with the cerebral cortex, and the language network. Current research and imaging studies support and elaborate that which Jacob presented so many years ago; many of his analyses and ideas are informative and remain relevant today.
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Affiliation(s)
- Maria E Vasilopoulou
- Graduate Program in Neuroscience and Education, University of Macedonia School of Social Sciences, Humanities and Arts, Thessalonica 54636, Greece
| | - Lazaros C Triarhou
- Graduate Program in Neuroscience and Education, University of Macedonia School of Social Sciences, Humanities and Arts, Thessalonica 54636, Greece; Department of Psychology, Division of Brain, Behavior and Cognition, Aristotelian University Faculty of Philosophy, Thessalonica 54124, Greece.
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7
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Sen S, Newman-Norlund R, Riccardi N, Rorden C, Newman-Norlund S, Sayers S, Fridriksson J, Logue M. Cerebral blood flow in patients recovered from mild COVID-19. J Neuroimaging 2023; 33:764-772. [PMID: 37265421 PMCID: PMC11205277 DOI: 10.1111/jon.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Cerebral hypoperfusion has been described in both severe and mild forms of symptomatic Coronavirus Disease 2019 (COVID-19) infection. The purpose of this study was to investigate global and regional cerebral blood flow (CBF) in asymptomatic COVID-19 patients. METHODS Cases with mild COVID-19 infection and age-, sex-, and race-matched healthy controls were drawn from the Aging Brain Consortium at The University of South Carolina data repository. Demographics, risk factors, and data from the Montreal Cognitive Assessment were collected. Mean CBF values for gray matter (GM), white matter (WM), and the whole brain were calculated by averaging CBF values of standard space-normalized CBF image values falling within GM and WM masks. Whole brain region of interest-based analyses were used to create standardized CBF maps and explore differences between groups. RESULTS Twenty-eight cases with prior mild COVID-19 infection were compared with 28 controls. Whole-brain CBF (46.7 ± 5.6 vs. 49.3 ± 3.7, p = .05) and WM CBF (29.3 ± 2.6 vs. 31.0 ± 1.6, p = .03) were noted to be significantly lower in COVID-19 cases as compared to controls. Predictive models based on these data predicted COVID-19 group membership with a high degree of accuracy (85.2%, p < .001), suggesting CBF patterns are an imaging marker of mild COVID-19 infection. CONCLUSION In this study, lower WM CBF, as well as widespread regional CBF changes identified using quantitative MRI, was found in mild COVID-19 patients. Further studies are needed to determine the reliability of this newly identified COVID-19 brain imaging marker and determine what drives these CBF changes.
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Affiliation(s)
- Souvik Sen
- Department of Neurology, University of South Carolina, Columbia, South Carolina, USA
| | - Roger Newman-Norlund
- Department of Neurology, University of South Carolina, Columbia, South Carolina, USA
| | - Nicholas Riccardi
- Department of Neurology, University of South Carolina, Columbia, South Carolina, USA
| | - Christopher Rorden
- Department of Neurology, University of South Carolina, Columbia, South Carolina, USA
| | - Sarah Newman-Norlund
- Department of Neurology, University of South Carolina, Columbia, South Carolina, USA
| | - Sara Sayers
- Department of Neurology, University of South Carolina, Columbia, South Carolina, USA
| | - Julius Fridriksson
- Department of Neurology, University of South Carolina, Columbia, South Carolina, USA
| | - Makenzie Logue
- Department of Neurology, University of South Carolina, Columbia, South Carolina, USA
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8
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McCall JD, DeMarco AT, Mandal AS, Fama ME, van der Stelt CM, Lacey EH, Laks AB, Snider SF, Friedman RB, Turkeltaub PE. Listening to Yourself and Watching Your Tongue: Distinct Abilities and Brain Regions for Monitoring Semantic and Phonological Speech Errors. J Cogn Neurosci 2023; 35:1169-1194. [PMID: 37159232 PMCID: PMC10273223 DOI: 10.1162/jocn_a_02000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Despite the many mistakes we make while speaking, people can effectively communicate because we monitor our speech errors. However, the cognitive abilities and brain structures that support speech error monitoring are unclear. There may be different abilities and brain regions that support monitoring phonological speech errors versus monitoring semantic speech errors. We investigated speech, language, and cognitive control abilities that relate to detecting phonological and semantic speech errors in 41 individuals with aphasia who underwent detailed cognitive testing. Then, we used support vector regression lesion symptom mapping to identify brain regions supporting detection of phonological versus semantic errors in a group of 76 individuals with aphasia. The results revealed that motor speech deficits as well as lesions to the ventral motor cortex were related to reduced detection of phonological errors relative to semantic errors. Detection of semantic errors selectively related to auditory word comprehension deficits. Across all error types, poor cognitive control related to reduced detection. We conclude that monitoring of phonological and semantic errors relies on distinct cognitive abilities and brain regions. Furthermore, we identified cognitive control as a shared cognitive basis for monitoring all types of speech errors. These findings refine and expand our understanding of the neurocognitive basis of speech error monitoring.
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Affiliation(s)
- Joshua D McCall
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC
| | - Andrew T DeMarco
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC
- Rehabilitation Medicine Department, Georgetown University Medical Center, Washington, DC
| | - Ayan S Mandal
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC
- Brain-Gene Development Lab, Psychiatry Department, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mackenzie E Fama
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC
| | - Candace M van der Stelt
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC
- Research Division, MedStar National Rehabilitation Hospital, Washington, DC
| | - Elizabeth H Lacey
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC
- Research Division, MedStar National Rehabilitation Hospital, Washington, DC
| | - Alycia B Laks
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC
| | - Sarah F Snider
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC
| | - Rhonda B Friedman
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC
| | - Peter E Turkeltaub
- Center for Brain Plasticity and Recovery, Neurology Department, Georgetown University Medical Center, Washington, DC
- Rehabilitation Medicine Department, Georgetown University Medical Center, Washington, DC
- Research Division, MedStar National Rehabilitation Hospital, Washington, DC
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC
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9
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Roth R, Busby N, Wilmskoetter J, Schwen Blackett D, Gleichgerrcht E, Johnson L, Rorden C, Newman-Norlund R, Hillis AE, den Ouden DB, Fridriksson J, Bonilha L. Diabetes, brain health, and treatment gains in post-stroke aphasia. Cereb Cortex 2023; 33:8557-8564. [PMID: 37139636 PMCID: PMC10321080 DOI: 10.1093/cercor/bhad140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 05/05/2023] Open
Abstract
In post-stroke aphasia, language improvements following speech therapy are variable and can only be partially explained by the lesion. Brain tissue integrity beyond the lesion (brain health) may influence language recovery and can be impacted by cardiovascular risk factors, notably diabetes. We examined the impact of diabetes on structural network integrity and language recovery. Seventy-eight participants with chronic post-stroke aphasia underwent six weeks of semantic and phonological language therapy. To quantify structural network integrity, we evaluated the ratio of long-to-short-range white matter fibers within each participant's whole brain connectome, as long-range fibers are more susceptible to vascular injury and have been linked to high level cognitive processing. We found that diabetes moderated the relationship between structural network integrity and naming improvement at 1 month post treatment. For participants without diabetes (n = 59), there was a positive relationship between structural network integrity and naming improvement (t = 2.19, p = 0.032). Among individuals with diabetes (n = 19), there were fewer treatment gains and virtually no association between structural network integrity and naming improvement. Our results indicate that structural network integrity is associated with treatment gains in aphasia for those without diabetes. These results highlight the importance of post-stroke structural white matter architectural integrity in aphasia recovery.
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Affiliation(s)
- Rebecca Roth
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Janina Wilmskoetter
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Deena Schwen Blackett
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Ezequiel Gleichgerrcht
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Lisa Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | | | - Argye E Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Dirk B den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Leonardo Bonilha
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
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10
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Chen X, Affourtit J, Ryskin R, Regev TI, Norman-Haignere S, Jouravlev O, Malik-Moraleda S, Kean H, Varley R, Fedorenko E. The human language system, including its inferior frontal component in "Broca's area," does not support music perception. Cereb Cortex 2023; 33:7904-7929. [PMID: 37005063 PMCID: PMC10505454 DOI: 10.1093/cercor/bhad087] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 04/04/2023] Open
Abstract
Language and music are two human-unique capacities whose relationship remains debated. Some have argued for overlap in processing mechanisms, especially for structure processing. Such claims often concern the inferior frontal component of the language system located within "Broca's area." However, others have failed to find overlap. Using a robust individual-subject fMRI approach, we examined the responses of language brain regions to music stimuli, and probed the musical abilities of individuals with severe aphasia. Across 4 experiments, we obtained a clear answer: music perception does not engage the language system, and judgments about music structure are possible even in the presence of severe damage to the language network. In particular, the language regions' responses to music are generally low, often below the fixation baseline, and never exceed responses elicited by nonmusic auditory conditions, like animal sounds. Furthermore, the language regions are not sensitive to music structure: they show low responses to both intact and structure-scrambled music, and to melodies with vs. without structural violations. Finally, in line with past patient investigations, individuals with aphasia, who cannot judge sentence grammaticality, perform well on melody well-formedness judgments. Thus, the mechanisms that process structure in language do not appear to process music, including music syntax.
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Affiliation(s)
- Xuanyi Chen
- Department of Cognitive Sciences, Rice University, TX 77005, United States
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, United States
- McGovern Institute for Brain Research, MIT, Cambridge, MA 02139, United States
| | - Josef Affourtit
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, United States
- McGovern Institute for Brain Research, MIT, Cambridge, MA 02139, United States
| | - Rachel Ryskin
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, United States
- McGovern Institute for Brain Research, MIT, Cambridge, MA 02139, United States
- Department of Cognitive & Information Sciences, University of California, Merced, Merced, CA 95343, United States
| | - Tamar I Regev
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, United States
- McGovern Institute for Brain Research, MIT, Cambridge, MA 02139, United States
| | - Samuel Norman-Haignere
- Department of Biostatistics & Computational Biology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States
| | - Olessia Jouravlev
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, United States
- McGovern Institute for Brain Research, MIT, Cambridge, MA 02139, United States
- Department of Cognitive Science, Carleton University, Ottawa, ON, Canada
| | - Saima Malik-Moraleda
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, United States
- McGovern Institute for Brain Research, MIT, Cambridge, MA 02139, United States
- The Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA 02138, United States
| | - Hope Kean
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, United States
- McGovern Institute for Brain Research, MIT, Cambridge, MA 02139, United States
| | - Rosemary Varley
- Psychology & Language Sciences, UCL, London, WCN1 1PF, United Kingdom
| | - Evelina Fedorenko
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, United States
- McGovern Institute for Brain Research, MIT, Cambridge, MA 02139, United States
- The Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA 02138, United States
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11
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Kernbach JM, Hartwigsen G, Lim JS, Bae HJ, Yu KH, Schlaug G, Bonkhoff A, Rost NS, Bzdok D. Bayesian stroke modeling details sex biases in the white matter substrates of aphasia. Commun Biol 2023; 6:354. [PMID: 37002267 PMCID: PMC10066402 DOI: 10.1038/s42003-023-04733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Ischemic cerebrovascular events often lead to aphasia. Previous work provided hints that such strokes may affect women and men in distinct ways. Women tend to suffer strokes with more disabling language impairment, even if the lesion size is comparable to men. In 1401 patients, we isolate data-led representations of anatomical lesion patterns and hand-tailor a Bayesian analytical solution to carefully model the degree of sex divergence in predicting language outcomes ~3 months after stroke. We locate lesion-outcome effects in the left-dominant language network that highlight the ventral pathway as a core lesion focus across different tests of language performance. We provide detailed evidence for sex-specific brain-behavior associations in the domain-general networks associated with cortico-subcortical pathways, with unique contributions of the fornix in women and cingular fiber bundles in men. Our collective findings suggest diverging white matter substrates in how stroke causes language deficits in women and men. Clinically acknowledging such sex disparities has the potential to improve personalized treatment for stroke patients worldwide.
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Affiliation(s)
- Julius M Kernbach
- Neurosurgical Artificial Intelligence Laboratory Aachen (NAILA), RWTH Aachen University Hospital, Aachen, Germany
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Music, Neuroimaging, and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Lise Meitner Research Group Cognition and Plasticity, Leipzig, Germany
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Gottfried Schlaug
- Music, Neuroimaging, and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Anna Bonkhoff
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Danilo Bzdok
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, Faculty of Medicine, School of Computer Science, McGill University, Montreal, QC, Canada.
- Mila - Quebec Artificial Intelligence Institute, Montreal, QC, Canada.
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12
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Levy DF, Silva AB, Scott TL, Liu JR, Harper S, Zhao L, Hullett PW, Kurteff G, Wilson SM, Leonard MK, Chang EF. Apraxia of speech with phonological alexia and agraphia following resection of the left middle precentral gyrus: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22504. [PMID: 37014023 PMCID: PMC10550577 DOI: 10.3171/case22504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/23/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Apraxia of speech is a disorder of speech-motor planning in which articulation is effortful and error-prone despite normal strength of the articulators. Phonological alexia and agraphia are disorders of reading and writing disproportionately affecting unfamiliar words. These disorders are almost always accompanied by aphasia. OBSERVATIONS A 36-year-old woman underwent resection of a grade IV astrocytoma based in the left middle precentral gyrus, including a cortical site associated with speech arrest during electrocortical stimulation mapping. Following surgery, she exhibited moderate apraxia of speech and difficulty with reading and spelling, both of which improved but persisted 6 months after surgery. A battery of speech and language assessments was administered, revealing preserved comprehension, naming, cognition, and orofacial praxis, with largely isolated deficits in speech-motor planning and the spelling and reading of nonwords. LESSONS This case describes a specific constellation of speech-motor and written language symptoms-apraxia of speech, phonological agraphia, and phonological alexia in the absence of aphasia-which the authors theorize may be attributable to disruption of a single process of "motor-phonological sequencing." The middle precentral gyrus may play an important role in the planning of motorically complex phonological sequences for production, independent of output modality.
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Affiliation(s)
- Deborah F. Levy
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
| | - Alexander B. Silva
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
- University of California Berkeley - University of California San Francisco Graduate Program in Bioengineering, Berkeley, California
- Medical Scientist Training Program, University of California, San Francisco, California
| | - Terri L. Scott
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
| | - Jessie R. Liu
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
- University of California Berkeley - University of California San Francisco Graduate Program in Bioengineering, Berkeley, California
| | - Sarah Harper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
| | - Lingyun Zhao
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
| | - Patrick W. Hullett
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
| | - Garret Kurteff
- Department of Speech, Language, and Hearing Sciences, University of Texas Austin, Austin, Texas; and
| | - Stephen M. Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tennessee
| | - Matthew K. Leonard
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
| | - Edward F. Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
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13
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Duffy JR, Martin PR, Clark HM, Utianski RL, Strand EA, Whitwell JL, Josephs KA. The Apraxia of Speech Rating Scale: Reliability, Validity, and Utility. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:469-491. [PMID: 36630926 PMCID: PMC10171845 DOI: 10.1044/2022_ajslp-22-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/17/2022] [Accepted: 10/11/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE The purpose of this study was to examine the interrater reliability and validity of the Apraxia of Speech Rating Scale (ASRS-3.5) as an index of the presence and severity of apraxia of speech (AOS) and the prominence of several of its important features. METHOD Interrater reliability was assessed for 27 participants. Validity was examined in a cohort of 308 participants (120 with and 188 without progressive AOS) through item analysis; item-Total score correlations; correlations among ASRS Total score and component subscores and independent clinical ratings of AOS, dysarthria and aphasia severity, intelligibility, and articulatory errors, as well as years postonset and age; and regression models assessing item and Total score prediction of AOS presence. RESULTS Interrater reliability was good or excellent for most items and excellent for the Total score. Item and Total score analyses revealed good separation of participants with versus without AOS. Inter-item and item-Total score correlations were generally moderately high as were correlations between the ASRS Total score and independent ratings of AOS severity, intelligibility, and articulatory errors. The Total score was not meaningfully correlated with ratings of aphasia and dysarthria severity, years postonset, or age. Total scores below 7 and above 10 revealed excellent diagnostic sensitivity and specificity for AOS. The presence of eight or more abnormal features was also highly predictive of AOS presence. CONCLUSIONS The ASRS-3.5 is a reliable and valid scale for identifying the presence and severity of AOS and its predominant features. It has excellent sensitivity to AOS presence and excellent specificity relative to aphasia and dysarthria in patients with neurodegenerative disease. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21817584.
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Affiliation(s)
| | - Peter R. Martin
- Department of Quantitative Health Sciences (Biostatistics), Mayo Clinic, Rochester, MN
| | | | | | - Edythe A. Strand
- Department of Neurology, Mayo Clinic, Rochester, MN
- Department of Speech & Hearing Sciences, University of Washington, Seattle
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14
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Andrews JP, Cahn N, Speidel BA, Chung JE, Levy DF, Wilson SM, Berger MS, Chang EF. Dissociation of Broca's area from Broca's aphasia in patients undergoing neurosurgical resections. J Neurosurg 2023; 138:847-857. [PMID: 35932264 PMCID: PMC9899289 DOI: 10.3171/2022.6.jns2297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/15/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Broca's aphasia is a syndrome of impaired fluency with retained comprehension. The authors used an unbiased algorithm to examine which neuroanatomical areas are most likely to result in Broca's aphasia following surgical lesions. METHODS Patients were prospectively evaluated with standardized language batteries before and after surgery. Broca's area was defined anatomically as the pars opercularis and triangularis of the inferior frontal gyrus. Broca's aphasia was defined by the Western Aphasia Battery language assessment. Resections were outlined from MRI scans to construct 3D volumes of interest. These were aligned using a nonlinear transformation to Montreal Neurological Institute brain space. A voxel-based lesion-symptom mapping (VLSM) algorithm was used to test for areas statistically associated with Broca's aphasia when incorporated into a resection, as well as areas associated with deficits in fluency independent of Western Aphasia Battery classification. Postoperative MRI scans were reviewed in blinded fashion to estimate the percentage resection of Broca's area compared to areas identified using the VLSM algorithm. RESULTS A total of 289 patients had early language evaluations, of whom 19 had postoperative Broca's aphasia. VLSM analysis revealed an area that was highly correlated (p < 0.001) with Broca's aphasia, spanning ventral sensorimotor cortex and supramarginal gyri, as well as extending into subcortical white matter tracts. Reduced fluency scores were significantly associated with an overlapping region of interest. The fluency score was negatively correlated with fraction of resected precentral, postcentral, and supramarginal components of the VLSM area. CONCLUSIONS Broca's aphasia does not typically arise from neurosurgical resections in Broca's area. When Broca's aphasia does occur after surgery, it is typically in the early postoperative period, improves by 1 month, and is associated with resections of ventral sensorimotor cortex and supramarginal gyri.
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Affiliation(s)
- John P. Andrews
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California; and
| | - Nathan Cahn
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California; and
| | - Benjamin A. Speidel
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California; and
| | - Jason E. Chung
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California; and
| | - Deborah F. Levy
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California; and
| | - Stephen M. Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California; and
| | - Edward F. Chang
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California; and
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15
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Zevgolatakou E, Thye M, Mirman D. Behavioural and neural structure of fluent speech production deficits in aphasia. Brain Commun 2022; 5:fcac327. [PMID: 36601623 PMCID: PMC9798301 DOI: 10.1093/braincomms/fcac327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/03/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Deficits in fluent speech production following left hemisphere stroke are a central concern because of their impact on patients' lives and the insight they provide about the neural organization of language processing. Fluent speech production requires the rapid coordination of phonological, semantic, and syntactic processing, so this study examined how deficits in connected speech relate to these language sub-systems. Behavioural data (N = 69 participants with aphasia following left hemisphere stroke) consisted of a diverse and comprehensive set of narrative speech production measures and measures of overall severity, semantic deficits, and phonological deficits. These measures were entered into a principal component analysis with bifactor rotation-a latent structure model where each item loads on a general factor that reflects what is common among the items, and orthogonal factors that explain variance not accounted for by the general factor. Lesion data were available for 58 of the participants, and each factor score was analysed with multivariate lesion-symptom mapping. Effects of connectivity disruption were evaluated using robust regression with tract disconnection or graph theoretic measures of connectivity as predictors. The principal component analysis produced a four-factor solution that accounted for 70.6% of the variance in the data, with a general factor corresponding to the overall severity and length and complexity of speech output (complexity factor), a lexical syntax factor, and independent factors for Semantics and Phonology. Deficits in the complexity of speech output were associated with a large temporo-parietal region, similar to overall aphasia severity. The lexical syntax factor was associated with damage in a relatively small set of fronto-parietal regions which may reflect the recruitment of control systems to support retrieval and correct usage of lexical items that primarily serve a syntactic rather than semantic function. Tract-based measures of connectivity disruption were not statistically associated with the deficit scores after controlling for overall lesion volume. Language network efficiency and average clustering coefficient within the language network were significantly associated with deficit scores after controlling for overall lesion volume. These results highlight overall severity as the critical contributor to fluent speech in post-stroke aphasia, with a dissociable factor corresponding to lexical syntax.
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Affiliation(s)
- Eleni Zevgolatakou
- Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK
| | - Melissa Thye
- Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK
| | - Daniel Mirman
- Correspondence to: Daniel Mirman Department of Psychology, 7 George Square Edinburgh EH8 9JZ, UK E-mail:
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16
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Silva AB, Liu JR, Zhao L, Levy DF, Scott TL, Chang EF. A Neurosurgical Functional Dissection of the Middle Precentral Gyrus during Speech Production. J Neurosci 2022; 42:8416-8426. [PMID: 36351829 PMCID: PMC9665919 DOI: 10.1523/jneurosci.1614-22.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
Classical models have traditionally focused on the left posterior inferior frontal gyrus (Broca's area) as a key region for motor planning of speech production. However, converging evidence suggests that it is not critical for either speech motor planning or execution. Alternative cortical areas supporting high-level speech motor planning have yet to be defined. In this review, we focus on the precentral gyrus, whose role in speech production is often thought to be limited to lower-level articulatory muscle control. In particular, we highlight neurosurgical investigations that have shed light on a cortical region anatomically located near the midpoint of the precentral gyrus, hence called the middle precentral gyrus (midPrCG). The midPrCG is functionally located between dorsal hand and ventral orofacial cortical representations and exhibits unique sensorimotor and multisensory functions relevant for speech processing. This includes motor control of the larynx, auditory processing, as well as a role in reading and writing. Furthermore, direct electrical stimulation of midPrCG can evoke complex movements, such as vocalization, and selective injury can cause deficits in verbal fluency, such as pure apraxia of speech. Based on these findings, we propose that midPrCG is essential to phonological-motoric aspects of speech production, especially syllabic-level speech sequencing, a role traditionally ascribed to Broca's area. The midPrCG is a cortical brain area that should be included in contemporary models of speech production with a unique role in speech motor planning and execution.
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Affiliation(s)
- Alexander B Silva
- Department of Neurological Surgery, University of California, San Francisco, California, 94158
- Weill Institute for Neurosciences, University of California, San Francisco, California, 94158
- Medical Scientist Training Program, University of California, San Francisco, California, 94158
- Graduate Program in Bioengineering, University of California, Berkeley, California 94720, & University of California, San Francisco, California, 94158
| | - Jessie R Liu
- Department of Neurological Surgery, University of California, San Francisco, California, 94158
- Weill Institute for Neurosciences, University of California, San Francisco, California, 94158
- Graduate Program in Bioengineering, University of California, Berkeley, California 94720, & University of California, San Francisco, California, 94158
| | - Lingyun Zhao
- Department of Neurological Surgery, University of California, San Francisco, California, 94158
- Weill Institute for Neurosciences, University of California, San Francisco, California, 94158
| | - Deborah F Levy
- Department of Neurological Surgery, University of California, San Francisco, California, 94158
- Weill Institute for Neurosciences, University of California, San Francisco, California, 94158
| | - Terri L Scott
- Department of Neurological Surgery, University of California, San Francisco, California, 94158
- Weill Institute for Neurosciences, University of California, San Francisco, California, 94158
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, California, 94158
- Weill Institute for Neurosciences, University of California, San Francisco, California, 94158
- Graduate Program in Bioengineering, University of California, Berkeley, California 94720, & University of California, San Francisco, California, 94158
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17
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Zhao J, Li Y, Zhang X, Yuan Y, Cheng Y, Hou J, Duan G, Liu B, Wang J, Wu D. Alteration of network connectivity in stroke patients with apraxia of speech after tDCS: A randomized controlled study. Front Neurol 2022; 13:969786. [PMID: 36188376 PMCID: PMC9521848 DOI: 10.3389/fneur.2022.969786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed to examine the changes in the functional connectivity of the cortical speech articulation network after anodal transcranial direct current stimulation (A-tDCS) over the left lip region of the primary motor cortex (M1) in subacute post-stroke patients with apraxia of speech (AoS), and the effect of A-tDCS on AoS. Methods A total of 24 patients with post-stroke AoS were randomized into two groups and received A-tDCS over the left lip region of M1 (tDCS group)/ sham tDCS (control group) as well as speech and language therapy two times per day for 5 days. Before and after the treatment, the AoS assessments and electroencephalogram (EEG) were evaluated. The cortical interconnections were measured using the EEG non-linear index of cross approximate entropy (C-ApEn). Results The analysis of EEG showed that, after the treatment, the activated connectivity was all in the left hemisphere, and not only regions in the speech articulation network but also in the dorsal lateral prefrontal cortex (DLPFC) in the domain-general network were activated in the tDCS group. In contrast, the connectivity was confined to the right hemisphere and between bilateral DLPFC and bilateral inferior frontal gyrus (IFG) in the control group. In AoS assessments, the tDCS group improved significantly more than the control group in four of the five subtests. The results of multivariate linear regression analyses showed that only the group was significantly associated with the improvement of word repetition (P = 0.002). Conclusion A-tDCS over the left lip region of M1 coupled with speech therapy could upregulate the connectivity of both speech-specific and domain-general networks in the left hemisphere. The improved articulation performance in patients with post-stroke AoS might be related to the enhanced connectivity of networks in the left hemisphere induced by tDCS. Clinical trial registration ChiCTR-TRC-14005072.
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Affiliation(s)
- Jiayi Zhao
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Yuanyuan Li
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Xu Zhang
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Ying Yuan
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yinan Cheng
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jun Hou
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Guoping Duan
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Baohu Liu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Jie Wang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
- Jie Wang
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
- *Correspondence: Dongyu Wu
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18
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Aberrant Beta-band Brain Connectivity Predicts Speech Motor Planning Deficits in Post-Stroke Aphasia. Cortex 2022; 155:75-89. [DOI: 10.1016/j.cortex.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/24/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022]
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19
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Ziegler W, Aichert I, Staiger A, Willmes K, Baumgaertner A, Grewe T, Flöel A, Huber W, Rocker R, Korsukewitz C, Breitenstein C. The prevalence of apraxia of speech in chronic aphasia after stroke: A Bayesian hierarchical analysis. Cortex 2022; 151:15-29. [DOI: 10.1016/j.cortex.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 01/24/2023]
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20
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Basilakos A, Fridriksson J. Types of motor speech impairments associated with neurologic diseases. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:71-79. [PMID: 35078611 DOI: 10.1016/b978-0-12-823384-9.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Speech disturbances are common consequences of acquired brain injury or neurodegenerative impairment. Although sudden difficulties with speech may signal acute pathologic conditions such as cerebrovascular accidents, determining the etiology of insidious disruptions in communication can be less straightforward. The identification of motor speech impairment, independent of difficulties with language, can be useful for diagnosis since there are subtle, albeit distinct, patterns of speech production impairments associated with different neurologic conditions. Furthermore, the identification of impairments specific to speech production can help elucidate the suspected pathologic mechanisms or even the neuroanatomic structures compromised. During a routine clinical evaluation, early warning signs of motor speech impairment may go undetected if a clinician is unaccustomed to examining motor speech or is unaware of its manifestations. Accordingly, this chapter provides clinicians with a concise yet thorough guide for the practical assessment and differential diagnosis of motor speech disorders (MSDs)-apraxia of speech and dysarthrias. This chapter is divided into neurologic conditions associated with disorders of speech planning/programming, execution, and articulatory control. The underlying mechanisms associated with these impairments are presented both from a clinical perspective as well as through a scientific discussion of recent research in the field on MSDs.
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Affiliation(s)
- Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States.
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21
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Roth R, Wilmskoetter J, Bonilha L. The role of disrupted structural connectivity in aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:121-127. [PMID: 35078594 DOI: 10.1016/b978-0-12-823384-9.00006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lesion-based studies are among the most informative approaches to determine a critical relationship between a particular brain region and specific function. Importantly, brain lesions cause disconnection of other brain areas that appear to be intact and may cause functional deficits in these regions due to a lack of afferent projections. If only the location of necrosis and gliosis after the stroke is considered to be the lesion, the full spectrum of brain dysfunction is only partly assessed, and there is a high probability that incomplete region-to-function inferences are made. In this chapter we (1) outline how structural connectivity can be measured in individuals with stroke, and (2) provide an overview of the importance of disrupted structural connectivity in aphasia. We conclude that connection-based and region/voxel-based symptom mapping yield complementary information and together provide an in-depth picture of brain and function relationships.
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Affiliation(s)
- Rebecca Roth
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Janina Wilmskoetter
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Leonardo Bonilha
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
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22
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Baboyan V, Basilakos A, Yourganov G, Rorden C, Bonilha L, Fridriksson J, Hickok G. Isolating the white matter circuitry of the dorsal language stream: Connectome-Symptom Mapping in stroke induced aphasia. Hum Brain Mapp 2021; 42:5689-5702. [PMID: 34469044 PMCID: PMC8559486 DOI: 10.1002/hbm.25647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/21/2021] [Indexed: 12/02/2022] Open
Abstract
The application of ℓ1-regularized machine learning models to high-dimensional connectomes offers a promising methodology to assess clinical-anatomical correlations in humans. Here, we integrate the connectome-based lesion-symptom mapping framework with sparse partial least squares regression (sPLS-R) to isolate elements of the connectome associated with speech repetition deficits. By mapping over 2,500 connections of the structural connectome in a cohort of 71 stroke-induced cases of aphasia presenting with varying left-hemisphere lesions and repetition impairment, sPLS-R was trained on 50 subjects to algorithmically identify connectomic features on the basis of their predictive value. The highest ranking features were subsequently used to generate a parsimonious predictive model for speech repetition whose predictions were evaluated on a held-out set of 21 subjects. A set of 10 short- and long-range parieto-temporal connections were identified, collectively delineating the broader circuitry of the dorsal white matter network of the language system. The strongest contributing feature was a short-range connection in the supramarginal gyrus, approximating the cortical localization of area Spt, with parallel long-range pathways interconnecting posterior nodes in supramarginal and superior temporal cortex with anterior nodes in both ventral and-notably-in dorsal premotor cortex, respectively. The collective disruption of these pathways indexed repetition performance in the held-out set of participants, suggesting that these impairments might be characterized as a parietotemporal disconnection syndrome impacting cortical area Spt and its associated white matter circuits of the frontal lobe as opposed to being purely a disconnection of the arcuate fasciculus.
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Affiliation(s)
- Vatche Baboyan
- Department of Cognitive ScienceUniversity of CaliforniaIrvineCaliforniaUSA
| | - Alexandra Basilakos
- Department of Communication Sciences and DisordersUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Grigori Yourganov
- Department of PsychologyUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Chris Rorden
- Department of PsychologyUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Leonardo Bonilha
- Department of NeurologyMedical University of South CarolinaColumbiaSouth CarolinaUSA
| | - Julius Fridriksson
- Department of Communication Sciences and DisordersUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Gregory Hickok
- Department of Cognitive ScienceUniversity of CaliforniaIrvineCaliforniaUSA
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23
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Alyahya RSW, Halai AD, Conroy P, Lambon Ralph MA. Content Word Production during Discourse in Aphasia: Deficits in Word Quantity, Not Lexical-Semantic Complexity. J Cogn Neurosci 2021; 33:2494-2511. [PMID: 34407196 DOI: 10.1162/jocn_a_01772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although limited and reduced connected speech production is one, if not the most, prominent feature of aphasia, few studies have examined the properties of content words produced during discourse in aphasia, in comparison to the many investigations of single-word production. In this study, we used a distributional analysis approach to investigate the properties of content word production during discourse by 46 participants spanning a wide range of chronic poststroke aphasia and 20 neurotypical adults, using different stimuli that elicited three discourse genres (descriptive, narrative, and procedural). Initially, we inspected the discourse data with respect to the quantity of production, lexical-semantic diversity, and psycholinguistic features (frequency and imageability) of content words. Subsequently, we created a "lexical-semantic landscape," which is sensitive to subtle changes and allowed us to evaluate the pattern of changes in discourse production across groups. Relative to neurotypical adults, all persons with aphasia (both fluent and nonfluent) showed significant reduction in the quantity and diversity of production, but the lexical-semantic complexity of word production directly mirrored neurotypical performance. Specifically, persons with aphasia produced the same rate of nouns/verbs, and their discourse samples covered the full range of word frequency and imageability, albeit with reduced word quantity. These findings provide novel evidence that, unlike in other disorders (e.g., semantic dementia), discourse production in poststroke aphasia has relatively preserved lexical-semantic complexity but demonstrates significantly compromised quantity of content word production. Voxel-wise lesion-symptom mapping using both univariate and multivariate approaches revealed left frontal regions particularly the pars opercularis, insular cortex, and central and frontal opercular cortices supporting word retrieval during connected speech, irrespective of their word class or lexical-semantic complexity.
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Affiliation(s)
- Reem S W Alyahya
- University of Cambridge.,King Fahad Medical City, Riyadh, Saudi Arabia.,Alfaisal University, Riyadh, Saudi Arabia
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24
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Conterno M, Kümmerer D, Dressing A, Glauche V, Urbach H, Weiller C, Rijntjes M. Speech apraxia and oral apraxia: association or dissociation? A multivariate lesion-symptom mapping study in acute stroke patients. Exp Brain Res 2021; 240:39-51. [PMID: 34652492 PMCID: PMC8803819 DOI: 10.1007/s00221-021-06224-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
The anatomical relationship between speech apraxia (SA) and oral apraxia (OA) is still unclear. To shed light on this matter we studied 137 patients with acute ischaemic left-hemisphere stroke and performed support vector regression-based, multivariate lesion–symptom mapping. Thirty-three patients presented with either SA or OA. These two symptoms mostly co-occurred (n = 28), except for few patients with isolated SA (n = 2) or OA (n = 3). All patient with either SA or OA presented with aphasia (p < 0.001) and these symptoms were highly associated with apraxia (p < 0.001). Co-occurring SA and OA were predominantly associated with insular lesions, while the insula was completely spared in the five patients with isolated SA or OA. Isolated SA occurred in case of frontal lesions (prefrontal gyrus and superior longitudinal fasciculus), while isolated OA occurred in case of either temporoparietal or striatocapsular lesions. Our study supports the notion of a predominant, but not exclusive, role of the insula in verbal and non-verbal oral praxis, and indicates that frontal regions may contribute exclusively to verbal oral praxis, while temporoparietal and striatocapsular regions contribute to non-verbal oral praxis. However, since tests for SA and OA so far intrinsically also investigate aphasia and apraxia, refined tests are warranted.
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Affiliation(s)
- Martina Conterno
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany. .,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany.
| | - Dorothee Kümmerer
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - Andrea Dressing
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, 79110, Freiburg im Breisgau, Germany
| | - Volkmar Glauche
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Cornelius Weiller
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany.,BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, 79110, Freiburg im Breisgau, Germany
| | - Michel Rijntjes
- Clinic of Neurology and Neurophysiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany.,Freiburg Brain Imaging Centre, University of Freiburg, 79106, Freiburg im Breisgau, Germany
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25
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Espinoza Bernal VC, Hiremath SV, Wolf B, Riley B, Mendonca RJ, Johnson MJ. Classifying and tracking rehabilitation interventions through machine-learning algorithms in individuals with stroke. J Rehabil Assist Technol Eng 2021; 8:20556683211044640. [PMID: 34646574 PMCID: PMC8504690 DOI: 10.1177/20556683211044640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Stroke is the leading cause of disability worldwide. It has been well-documented that rehabilitation (rehab) therapy can aid in regaining health and function for individuals with stroke. Yet, tracking in-home rehab continues to be a challenge because of a lack of resources and population-scale demands. In order to address this gap, we implemented a methodology to classify and track rehab interventions in individuals with stroke. Methods We developed personalized classification algorithms, including neural network-based algorithms, to classify four rehab exercises performed by two individuals with stroke who were part of a week-long therapy camp in Jamaica, a low- and middle-income country. Accelerometry-based wearable sensors were placed on each upper and lower limb to collect movement data during therapy. Results The classification accuracy for traditional and neural network-based algorithms utilizing feature data (e.g., number of peaks) from the sensors ranged from 64 to 94%, respectively. In addition, the study proposes a new method to assess change in bilateral mobility over the camp duration. Conclusion The results of this pilot study indicate that personalized supervised learning algorithms can be used to classify and track rehab activities and functional outcomes in resource limited settings such as LMICs.
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Affiliation(s)
| | - Shivayogi V Hiremath
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA.,Director of Personal Health Informatics & Rehabilitation Engineering Laboratory, Temple University, Philadelphia, PA, USA
| | - Bethany Wolf
- Friends of the Redeemer United, St Elizabeth, Jamaica
| | - Brooke Riley
- Friends of the Redeemer United, St Elizabeth, Jamaica
| | - Rochelle J Mendonca
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Michelle J Johnson
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA.,Director of Rehabilitation Robotics Lab, University of Pennsylvania, Philadelphia, PA, USA
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26
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Dickens JV, DeMarco AT, van der Stelt CM, Snider SF, Lacey EH, Medaglia JD, Friedman RB, Turkeltaub PE. Two types of phonological reading impairment in stroke aphasia. Brain Commun 2021; 3:fcab194. [PMID: 34522884 PMCID: PMC8432944 DOI: 10.1093/braincomms/fcab194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 11/12/2022] Open
Abstract
Alexia is common in the context of aphasia. It is widely agreed that damage to phonological and semantic systems not specific to reading causes co-morbid alexia and aphasia. Studies of alexia to date have only examined phonology and semantics as singular processes or axes of impairment, typically in the context of stereotyped alexia syndromes. However, phonology, in particular, is known to rely on subprocesses, including sensory-phonological processing, motor-phonological processing, and sensory-motor integration. Moreover, many people with stroke aphasia demonstrate mild or mixed patterns of reading impairment that do not fit neatly with one syndrome. This cross-sectional study tested whether the hallmark symptom of phonological reading impairment, the lexicality effect, emerges from damage to a specific subprocess of phonology in stroke patients not selected for alexia syndromes. Participants were 30 subjects with left-hemispheric stroke and 37 age- and education-matched controls. A logistic mixed-effects model tested whether post-stroke impairments in sensory phonology, motor phonology, or sensory-motor integration modulated the effect of item lexicality on patient accuracy in reading aloud. Support vector regression voxel-based lesion-symptom mapping localized brain regions necessary for reading and non-orthographic phonological processing. Additionally, a novel support vector regression structural connectome-symptom mapping method identified the contribution of both lesioned and spared but disconnected, brain regions to reading accuracy and non-orthographic phonological processing. Specifically, we derived whole-brain structural connectomes using constrained spherical deconvolution-based probabilistic tractography and identified lesioned connections based on comparisons between patients and controls. Logistic mixed-effects regression revealed that only greater motor-phonological impairment related to lower accuracy reading aloud pseudowords versus words. Impaired sensory-motor integration was related to lower overall accuracy in reading aloud. No relationship was identified between sensory-phonological impairment and reading accuracy. Voxel-based and structural connectome lesion-symptom mapping revealed that lesioned and disconnected left ventral precentral gyrus related to both greater motor-phonological impairment and lower sublexical reading accuracy. In contrast, lesioned and disconnected left temporoparietal cortex is related to both impaired sensory-motor integration and reduced overall reading accuracy. These results clarify that at least two dissociable phonological processes contribute to the pattern of reading impairment in aphasia. First, impaired sensory-motor integration, caused by lesions disrupting the left temporoparietal cortex and its structural connections, non-selectively reduces accuracy in reading aloud. Second, impaired motor-phonological processing, caused at least partially by lesions disrupting left ventral premotor cortex and structural connections, selectively reduces sublexical reading accuracy. These results motivate a revised cognitive model of reading aloud that incorporates a sensory-motor phonological circuit.
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Affiliation(s)
- Jonathan Vivian Dickens
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA.,Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC 20007, USA.,Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Andrew T DeMarco
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA.,Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC 20007, USA.,Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC 20007, USA.,Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Candace M van der Stelt
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA.,Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Sarah F Snider
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA.,Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Elizabeth H Lacey
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA.,Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC 20007, USA
| | - John D Medaglia
- Drexel University, Philadelphia, PA 19104, USA.,University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rhonda B Friedman
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA.,Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Peter E Turkeltaub
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20007, USA.,Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC 20007, USA.,Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC 20007, USA.,Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC 20007, USA.,Research Division, MedStar National Rehabilitation Hospital, Washington, DC 20001, USA
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27
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Gajardo-Vidal A, Lorca-Puls DL, Team P, Warner H, Pshdary B, Crinion JT, Leff AP, Hope TMH, Geva S, Seghier ML, Green DW, Bowman H, Price CJ. Damage to Broca's area does not contribute to long-term speech production outcome after stroke. Brain 2021; 144:817-832. [PMID: 33517378 PMCID: PMC8041045 DOI: 10.1093/brain/awaa460] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 02/03/2023] Open
Abstract
Broca's area in the posterior half of the left inferior frontal gyrus has long been thought to be critical for speech production. The current view is that long-term speech production outcome in patients with Broca's area damage is best explained by the combination of damage to Broca's area and neighbouring regions including the underlying white matter, which was also damaged in Paul Broca's two historic cases. Here, we dissociate the effect of damage to Broca's area from the effect of damage to surrounding areas by studying long-term speech production outcome in 134 stroke survivors with relatively circumscribed left frontal lobe lesions that spared posterior speech production areas in lateral inferior parietal and superior temporal association cortices. Collectively, these patients had varying degrees of damage to one or more of nine atlas-based grey or white matter regions: Brodmann areas 44 and 45 (together known as Broca's area), ventral premotor cortex, primary motor cortex, insula, putamen, the anterior segment of the arcuate fasciculus, uncinate fasciculus and frontal aslant tract. Spoken picture description scores from the Comprehensive Aphasia Test were used as the outcome measure. Multiple regression analyses allowed us to tease apart the contribution of other variables influencing speech production abilities such as total lesion volume and time post-stroke. We found that, in our sample of patients with left frontal damage, long-term speech production impairments (lasting beyond 3 months post-stroke) were solely predicted by the degree of damage to white matter, directly above the insula, in the vicinity of the anterior part of the arcuate fasciculus, with no contribution from the degree of damage to Broca's area (as confirmed with Bayesian statistics). The effect of white matter damage cannot be explained by a disconnection of Broca's area, because speech production scores were worse after damage to the anterior arcuate fasciculus with relative sparing of Broca's area than after damage to Broca's area with relative sparing of the anterior arcuate fasciculus. Our findings provide evidence for three novel conclusions: (i) Broca's area damage does not contribute to long-term speech production outcome after left frontal lobe strokes; (ii) persistent speech production impairments after damage to the anterior arcuate fasciculus cannot be explained by a disconnection of Broca's area; and (iii) the prior association between persistent speech production impairments and Broca's area damage can be explained by co-occurring white matter damage, above the insula, in the vicinity of the anterior part of the arcuate fasciculus.
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Affiliation(s)
- Andrea Gajardo-Vidal
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK.,Faculty of Health Sciences, Universidad del Desarrollo, Concepcion, Chile
| | - Diego L Lorca-Puls
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK.,Department of Speech, Language and Hearing Sciences, Faculty of Medicine, Universidad de Concepcion, Concepcion, Chile
| | - Ploras Team
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Holly Warner
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Bawan Pshdary
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Jennifer T Crinion
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Alexander P Leff
- Institute of Cognitive Neuroscience, University College London, London, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Thomas M H Hope
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Sharon Geva
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Mohamed L Seghier
- Cognitive Neuroimaging Unit, Emirates College for Advanced Education, Abu Dhabi, UAE.,Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, UAE
| | - David W Green
- Department of Experimental Psychology, University College London, London, UK
| | - Howard Bowman
- Centre for Cognitive Neuroscience and Cognitive Systems and the School of Computing, University of Kent, Canterbury, UK.,School of Psychology, University of Birmingham, Birmingham, UK
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
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28
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Clark HM, Utianski RL, Ali F, Botha H, Whitwell JL, Josephs KA. Motor Speech Disorders and Communication Limitations in Progressive Supranuclear Palsy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1361-1372. [PMID: 33719524 PMCID: PMC8702836 DOI: 10.1044/2020_ajslp-20-00126] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Purpose This study describes motor speech disorders and associated communication limitations in six variants of progressive supranuclear palsy (PSP). Method The presence, nature, and severity of dysarthria and apraxia of speech (AOS) were documented, along with scores on the Apraxia of Speech Rating Scale-Version 3 (ASRS-3) for 77 (40 male and 37 female) patients with PSP. Clinician-estimated and patient-estimated communication limitations were rated using the Motor Speech Disorders Severity Rating (MSDSR) Scale and the Communicative Effectiveness Survey (CES), respectively. Descriptive statistics were calculated for each of these dependent variables. One-tailed t tests were conducted to test mean differences in ASRS-3 and CES between participants with and without AOS and between participants with and without dysarthria. Spearman rank correlations were calculated between ASRS-3 scores and clinical judgments of AOS and dysarthria severity and between MSDSR and CES ratings. Results Nine participants (12%) had normal speech. Eighty-seven percent exhibited dysarthria; hypokinetic and mixed hypokinetic-spastic dysarthria were observed most frequently. AOS was observed in 19.5% of participants across all variants, but in only 10% exclusive of the PSP speech and language variant. Nearly half presented with AOS in which neither phonetic nor prosodic features clearly predominated. The mean ASRS-3 score for participants with AOS was significantly higher than for those without and correlated strongly with clinician judgment of AOS severity. Mean ASRS-3 was higher for participants with dysarthria than for those without but correlated weakly with dysarthria severity. Mean MSDSR and CES ratings were lower in participants with AOS compared to those without and moderately correlated with each other. Conclusions Motor speech disorders that negatively impact communicative effectiveness are common in PSP and occur in many variants. This is the first description of motor speech disorders across PSP variants, setting the stage for future research characterizing neuroanatomical correlates, progression of motor speech disorders, and benefits of targeted interventions. Supplemental Material https://doi.org/10.23641/asha.14111837.
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Affiliation(s)
| | | | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
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29
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A molecular pathology, neurobiology, biochemical, genetic and neuroimaging study of progressive apraxia of speech. Nat Commun 2021; 12:3452. [PMID: 34103532 PMCID: PMC8187627 DOI: 10.1038/s41467-021-23687-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
Progressive apraxia of speech is a neurodegenerative syndrome affecting spoken communication. Molecular pathology, biochemistry, genetics, and longitudinal imaging were investigated in 32 autopsy-confirmed patients with progressive apraxia of speech who were followed over 10 years. Corticobasal degeneration and progressive supranuclear palsy (4R-tauopathies) were the most common underlying pathologies. Perceptually distinct speech characteristics, combined with age-at-onset, predicted specific 4R-tauopathy; phonetic subtype and younger age predicted corticobasal degeneration, and prosodic subtype and older age predicted progressive supranuclear palsy. Phonetic and prosodic subtypes showed differing relationships within the cortico-striato-pallido-nigro-luysial network. Biochemical analysis revealed no distinct differences in aggregated 4R-tau while tau H1 haplotype frequency (69%) was lower compared to 1000+ autopsy-confirmed 4R-tauopathies. Corticobasal degeneration patients had faster rates of decline, greater cortical degeneration, and shorter illness duration than progressive supranuclear palsy. These findings help define the pathobiology of progressive apraxia of speech and may have consequences for development of 4R-tau targeting treatment. Progressive apraxia of speech (PAOS) is a neurodegenerative syndrome of multiple etiologies which affects spoken communication. Here, the authors characterized the molecular pathology, biochemistry, genetics and longitudinal neuroimaging of 32 autopsy-confirmed patients with PAOS who were followed over 10 years.
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30
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Zhao Z, Liu Y, Zhang J, Lu J, Wu J. Where is the speech production area? Evidence from direct cortical electrical stimulation mapping. Brain 2021; 144:e61. [PMID: 33978731 PMCID: PMC8370392 DOI: 10.1093/brain/awab178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Zehao Zhao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai 201100, China
| | - Yan Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai 201100, China
| | - Jie Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai 201100, China
| | - Junfeng Lu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai 201100, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200030, China
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.,Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai 201100, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200030, China.,Zhangjiang Lab, Institute of Brain-Intelligence Technology, Shanghai 201210, China
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31
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Mailend ML, Maas E, Story BH. Apraxia of speech and the study of speech production impairments: Can we avoid further confusion? Reply to Romani (2021). Cogn Neuropsychol 2021; 38:309-317. [PMID: 34881683 PMCID: PMC10011684 DOI: 10.1080/02643294.2021.2009790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We agree with Cristina Romani (CR) about reducing confusion and agree that the issues raised in her commentary are central to the study of apraxia of speech (AOS). However, CR critiques our approach from the perspective of basic cognitive neuropsychology. This is confusing and misleading because, contrary to CR's claim, we did not attempt to inform models of typical speech production. Instead, we relied on such models to study the impairment in the clinical category of AOS (translational cognitive neuropsychology). Thus, the approach along with the underlying assumptions is different. This response aims to clarify these assumptions, broaden the discussion regarding the methodological approach, and address CR's concerns. We argue that our approach is well-suited to meet the goals of our recent studies and is commensurate with the current state of the science of AOS. Ultimately, a plurality of approaches is needed to understand a phenomenon as complex as AOS.
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Affiliation(s)
- Marja-Liisa Mailend
- Moss Rehabilitation Research Institute, Einstein Healthcare Network, Elkins Park, PA, USA.,Department of Special Education, University of Tartu, Tartu, Estonia
| | - Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA, USA
| | - Brad H Story
- Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, USA
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32
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Hybbinette H, Östberg P, Schalling E. Intra- and Interjudge Reliability of the Apraxia of Speech Rating Scale in Early Stroke Patients. JOURNAL OF COMMUNICATION DISORDERS 2021; 89:106076. [PMID: 33493822 DOI: 10.1016/j.jcomdis.2020.106076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 11/02/2020] [Accepted: 12/05/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE There is a recognized need for a reliable assessment instrument for apraxia of speech (AOS) diagnosis for post stroke patients. In 2014, Strand and colleagues reported high to excellent intra- and interjudge reliability of the Apraxia of Speech Rating Scale (ASRS) in neurodegenerative speech and language disorders. Excellent interjudge reliability of the ASRS total score has also recently been reported in another study of individuals with chronic AOS after stroke, where the ratings were carried out by two experienced researchers not involved in the development of the instrument. However, it is still not fully determined whether the ASRS is a reliable instrument in assessment of patients in an early phase after stroke, where severe AOS is not uncommon. It is also not determined whether ASRS ratings can be performed reliably by practicing speech-language pathologists (SLPs) without long common experience and joint training. This study therefore addresses these questions. METHOD The ASRS was administered to thirty-six individuals in the first six months after stroke. The assessment procedures were video recorded. Ten of the recordings were selected for the reliability study, representative of patients typically seen at the actual inpatient ward with varying degrees of AOS severity. Five SLPs from different hospital departments participated as raters. The raters viewed each video and independently rated the presence and severity of AOS using the ASRS. To study intrajudge reliability, a rescoring was performed after a minimum of three weeks. Reliability was calculated using the intraclass correlation coefficient (ICC). RESULTS Intrajudge agreement for the ASRS total score varied from moderate to excellent (mean ICC = 0.69, 95 % CI [0.60, 0.77]) with most of the mean item level agreements within the categories 'moderate' or 'good. Interjudge reliability was poor for the ASRS total score (ICC = 0.42, 95 % CI [0.35, 0.50]). The item level results varied between moderate and poor, with lack of agreement on several items. CONCLUSIONS For clinicians without expert knowledge of AOS and limited training using the ASRS, intra- and interjudge reliability of the ASRS is not satisfactory. Also, since some items in the protocol require a certain level of speech production to target the diagnostic marker, findings indicate that the ASRS in its present design has limitations in assessment of severe AOS. As suggested by Strand and colleagues, video examples that illustrate the ASRS characteristics could be one helpful alternative to support clinician training. A minor revision of response definitions of the scale may improve the applicability of the ASRS in severe AOS.
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Affiliation(s)
- Helena Hybbinette
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
| | - Per Östberg
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet and Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Ellika Schalling
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet and Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
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33
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Alyahya RSW, Halai AD, Conroy P, Lambon Ralph MA. A unified model of post-stroke language deficits including discourse production and their neural correlates. Brain 2020; 143:1541-1554. [PMID: 32330940 PMCID: PMC7241958 DOI: 10.1093/brain/awaa074] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/14/2020] [Accepted: 02/02/2020] [Indexed: 11/28/2022] Open
Abstract
The clinical profiles of individuals with post-stroke aphasia demonstrate considerable variation in the presentation of symptoms. Recent aphasiological studies have attempted to account for this individual variability using a multivariate data-driven approach (principal component analysis) on an extensive neuropsychological and aphasiological battery, to identify fundamental domains of post-stroke aphasia. These domains mainly reflect phonology, semantics and fluency; however, these studies did not account for variability in response to different forms of connected speech, i.e. discourse genres. In the current study, we initially examined differences in the quantity, diversity and informativeness between three different discourse genres, including a simple descriptive genre and two naturalistic forms of connected speech (storytelling narrative, and procedural discourse). Subsequently, we provided the first quantitative investigation on the multidimensionality of connected speech production at both behavioural and neural levels. Connected speech samples across descriptive, narrative, and procedural discourse genres were collected from 46 patients with chronic post-stroke aphasia and 20 neurotypical adults. Content analyses conducted on all connected speech samples indicated that performance differed across discourse genres and between groups. Specifically, storytelling narratives provided higher quantities of content words and lexical diversity compared to composite picture description and procedural discourse. The analyses further revealed that, relative to neurotypical adults, patients with aphasia, both fluent and non-fluent, showed reduction in the quantity of verbal production, lexical diversity, and informativeness across all discourses. Given the differences across the discourses, we submitted the connected speech metrics to principal component analysis alongside an extensive neuropsychological/aphasiological battery that assesses a wide range of language and cognitive skills. In contrast to previous research, three unique orthogonal connected speech components were extracted in a unified model, reflecting verbal quantity, verbal quality, and motor speech, alongside four core language and cognitive components: phonological production, semantic processing, phonological recognition, and executive functions. Voxel-wise lesion-symptom mapping using these components provided evidence on the involvement of widespread cortical regions and their white matter connections. Specifically, left frontal regions and their underlying white matter tracts corresponding to the frontal aslant tract and the anterior segment of the arcuate fasciculus were particularly engaged with the quantity and quality of fluent connected speech production while controlling for other co-factors. The neural correlates associated with the other language domains align with existing models on the ventral and dorsal pathways for language processing.
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Affiliation(s)
- Reem S W Alyahya
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.,King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Paul Conroy
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
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34
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Pisano F, Caltagirone C, Incoccia C, Marangolo P. Spinal or cortical direct current stimulation: Which is the best? Evidence from apraxia of speech in post-stroke aphasia. Behav Brain Res 2020; 399:113019. [PMID: 33207242 DOI: 10.1016/j.bbr.2020.113019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 09/04/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
To date, new advances in technology have already shown the effectiveness of non-invasive brain stimulation and, in particular, of transcranial direct current stimulation (tDCS), in enhancing language recovery in post-stroke aphasia. More recently, it has been suggested that the stimulation over the spinal cord improves the production of words associated to sensorimotor schemata, such as action verbs. Here, for the first time, we present evidence that transpinal direct current stimulation (tsDCS) combined with a language training is efficacious for the recovery from speech apraxia, a motor speech disorder which might co-occur with aphasia. In a randomized-double blind experiment, ten aphasics underwent five days of tsDCS with concomitant treatment for their articulatory deficits in two different conditions: anodal and sham. In all patients, language measures were collected before (T0), at the end (T5) and one week after the end of treatment (F/U). Results showed that only after anodal tsDCS patients exhibited a better accuracy in repeating the treated items. Moreover, these effects persisted at F/U and generalized to other oral language tasks (i.e. picture description, noun and verb naming, word repetition and reading). A further analysis, which compared the tsDCS results with those collected in a matched group of patients who underwent the same language treatment but combined with tDCS, revealed no differences between the two groups. Given the persistency and severity of articulatory deficits in aphasia and the ease of use of tsDCS, we believe that spinal stimulation might result a new innovative approach for language rehabilitation.
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Affiliation(s)
- Francesca Pisano
- Department of Humanities studies - University Federico II, Naples, Italy
| | | | | | - Paola Marangolo
- Department of Humanities studies - University Federico II, Naples, Italy; IRCCS Santa Lucia Foundation, Rome, Italy.
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35
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Johnson LP, Sangtian S, Johari K, Behroozmand R, Fridriksson J. Slowed Compensation Responses to Altered Auditory Feedback in Post-Stroke Aphasia: Implications for Speech Sensorimotor Integration. JOURNAL OF COMMUNICATION DISORDERS 2020; 88:106034. [PMID: 32919232 PMCID: PMC7736368 DOI: 10.1016/j.jcomdis.2020.106034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Developing a clearer understanding of impairments that underlie the behavioral characteristics of aphasia is essential for the development of targeted treatments and will help inform theories of speech motor control. Impairments in sensorimotor integration of speech in individuals with conduction aphasia have previously been implicated in their repetition deficits. However, much less is known about the extent to which these integrative deficits occur outside of conduction aphasia and how this manifests behaviorally in areas other than speech repetition. In this study, we aimed to address these issues by examining the behavioral correlates of speech sensorimotor impairment under altered auditory feedback (AAF) and their relationship with the impaired ability to independently correct for online errors during picture naming in people with aphasia. We found that people with aphasia generate slower vocal compensation response to pitch-shift AAF stimuli compared with controls. However, when the timing of responses was controlled for, no significant difference in the magnitude of vocal pitch compensation was observed between aphasia and control groups. Moreover, no relationship was found between self-correction of naming errors and the timing and magnitude of vocal compensation responses to AAF. These findings suggest that slowed compensation is a potential behavioral marker of impaired sensorimotor integration in aphasia.
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Affiliation(s)
- Lorelei Phillip Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, SC 29201, USA.
| | - Stacey Sangtian
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, SC 29201, USA
| | - Karim Johari
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, SC 29201, USA
| | - Roozbeh Behroozmand
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, SC 29201, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, SC 29201, USA
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36
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Allison KM, Cordella C, Iuzzini-Seigel J, Green JR. Differential Diagnosis of Apraxia of Speech in Children and Adults: A Scoping Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2952-2994. [PMID: 32783767 PMCID: PMC7890226 DOI: 10.1044/2020_jslhr-20-00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Purpose Despite having distinct etiologies, acquired apraxia of speech (AOS) and childhood apraxia of speech (CAS) share the same central diagnostic challenge (i.e., isolating markers specific to an impairment in speech motor planning/programming). The purpose of this review was to evaluate and compare the state of the evidence on approaches to differential diagnosis for AOS and CAS and to identify gaps in each literature that could provide directions for future research aimed to improve clinical diagnosis of these disorders. Method We conducted a scoping review of literature published between 1997 and 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. For both AOS and CAS, literature was charted and summarized around four main methodological approaches to diagnosis: speech symptoms, quantitative speech measures, impaired linguistic-motor processes, and neuroimaging. Results Results showed that similar methodological approaches have been used to study differential diagnosis of apraxia of speech in adults and children; however, the specific measures that have received the most research attention differ between AOS and CAS. Several promising candidate markers for AOS and CAS have been identified; however, few studies report metrics that can be used to assess their diagnostic accuracy. Conclusions Over the past two decades, there has been a proliferation of research identifying potential diagnostic markers of AOS and CAS. In order to improve clinical diagnosis of AOS and CAS, there is a need for studies testing the diagnostic accuracy of multiple candidate markers, better control over language impairment comorbidity, more inclusion of speech-disordered control groups, and an increased focus on translational work moving toward clinical implementation of promising measures.
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Affiliation(s)
- Kristen M. Allison
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Claire Cordella
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Boston
| | - Jenya Iuzzini-Seigel
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, MA
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37
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Mapping articulatory and grammatical subcomponents of fluency deficits in post-stroke aphasia. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 19:1286-1298. [PMID: 31240565 PMCID: PMC6786948 DOI: 10.3758/s13415-019-00729-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fluent speech production is a critical aspect of language processing and is central to aphasia diagnosis and treatment. Multiple cognitive processes and neural subsystems must be coordinated to produce fluent narrative speech. To refine the understanding of these systems, measures that minimize the influence of other cognitive processes were defined for articulatory deficits and grammatical deficits. Articulatory deficits were measured by the proportion of phonetic errors (articulatory and prosodic) in a word repetition task in 115 participants with aphasia following left hemisphere stroke. Grammatical deficits were assessed in 46 participants based on two measures-proportion of closed class words and proportion of words in sentences-generated during semistructured narrative speech production (telling the Cinderella story). These measures were used to identify brain regions critical for articulatory and grammatical aspects of speech production using a multivariate lesion-symptom mapping approach based on support vector regression. Phonetic error proportion was associated with damage to the postcentral gyrus and the inferior parietal lobule (particularly the supramarginal gyrus). Proportion of closed class words in narrative speech did not have consistent lesion correlates. Proportion of words in sentences was strongly associated with frontal lobe damage, particularly the inferior and middle frontal gyri. Grammatical sentence structuring relies on frontal regions, particularly the inferior and middle frontal gyri, whereas phonetic-articulatory planning and execution relies on parietal regions, particularly the postcentral and supramarginal gyri. These results clarify and extend current understanding of the functional components of the frontoparietal speech production system.
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38
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Chang EF, Kurteff G, Andrews JP, Briggs RG, Conner AK, Battiste JD, Sughrue ME. Pure Apraxia of Speech After Resection Based in the Posterior Middle Frontal Gyrus. Neurosurgery 2020; 87:E383-E389. [PMID: 32097489 PMCID: PMC7690655 DOI: 10.1093/neuros/nyaa002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 12/01/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Apraxia of speech is a disorder of articulatory coordination and planning in speech sound production. Its diagnosis is based on deficits in articulation, prosody, and fluency. It is often described concurrent with aphasia or dysarthria, while pure apraxia of speech is a rare entity. CLINICAL PRESENTATION A right-handed man underwent focal surgical resection of a recurrent grade III astrocytoma in the left hemisphere dorsal premotor cortex located in the posterior middle frontal gyrus. After the procedure, he experienced significant long-term speech production difficulties. A battery of standard and custom language and articulatory assessments were administered, revealing intact comprehension and naming abilities, and preserved strength in orofacial articulators, but considerable deficits in articulatory coordination, fluency, and prosody-consistent with diagnosis of pure apraxia of speech. Tractography and resection volumes compared with publicly available imaging data from the Human Connectome Project suggest possible overlap with area 55b, an under-recognized language area in the dorsal premotor cortex and has white matter connectivity with the superior longitudinal fasciculus. CONCLUSION The case reported here details a rare clinical entity, pure apraxia of speech resulting from resection of posterior middle frontal gyrus. While not a classical language area, emerging literature supports the role of this area in the production of fluent speech, and has implications for surgical planning and the general neurobiology of language.
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Affiliation(s)
- Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Garret Kurteff
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - John P Andrews
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrew K Conner
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - James D Battiste
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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39
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Li Z, Zhang W, Li C, Wang M, Wang S, Chen R, Zhang X. Articulation rehabilitation induces cortical plasticity in adults with non-syndromic cleft lip and palate. Aging (Albany NY) 2020; 12:13147-13159. [PMID: 32619200 PMCID: PMC7377881 DOI: 10.18632/aging.103402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
In this study, we investigated brain morphological changes in adults with non-syndromic cleft lip and palate (NSCLP) after articulation rehabilitation (AR). High-resolution T1 weighted brain magnetic resonance imaging data were analyzed from 45 adults with NSCLP after palatoplasty: 24 subjects were assessed before AR (bNSCLP) and 21 subjects were assessed after AR (aNSCLP). In addition, there were 24 age and sex matched controls. Intergroup differences of grey matter volume were evaluated as a comprehensive measure of the cortex; cortical thickness and cortical complexity (gyrification and fractal dimensions) were also analyzed. As compared to controls, the bNSCLP subjects exhibited altered indexes in frontal, temporal, and parietal lobes; these morphological changes are characteristic for adults with NSCLP. Importantly, as compared to the bNSCLP and control subjects, the aNSCLP subjects exhibited cortical plasticity in the regions involved in language, auditory, pronunciation planning, and execution functions. The AR-mediated cortical plasticity in aNSCLP subjects may be caused by AR-induced cortical neurogenesis, which might reflect the underlying neural mechanism during AR.
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Affiliation(s)
- Zhen Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Wenjing Zhang
- Department of Oral and Maxillofacial Plastic and Trauma Surgery, Center of Cleft Lip and Palate Treatment, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Chunlin Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Mengyue Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Songjian Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Renji Chen
- Department of Oral and Maxillofacial Plastic and Trauma Surgery, Center of Cleft Lip and Palate Treatment, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Xu Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
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40
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Archakov D, DeWitt I, Kuśmierek P, Ortiz-Rios M, Cameron D, Cui D, Morin EL, VanMeter JW, Sams M, Jääskeläinen IP, Rauschecker JP. Auditory representation of learned sound sequences in motor regions of the macaque brain. Proc Natl Acad Sci U S A 2020; 117:15242-15252. [PMID: 32541016 PMCID: PMC7334521 DOI: 10.1073/pnas.1915610117] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Human speech production requires the ability to couple motor actions with their auditory consequences. Nonhuman primates might not have speech because they lack this ability. To address this question, we trained macaques to perform an auditory-motor task producing sound sequences via hand presses on a newly designed device ("monkey piano"). Catch trials were interspersed to ascertain the monkeys were listening to the sounds they produced. Functional MRI was then used to map brain activity while the animals listened attentively to the sound sequences they had learned to produce and to two control sequences, which were either completely unfamiliar or familiar through passive exposure only. All sounds activated auditory midbrain and cortex, but listening to the sequences that were learned by self-production additionally activated the putamen and the hand and arm regions of motor cortex. These results indicate that, in principle, monkeys are capable of forming internal models linking sound perception and production in motor regions of the brain, so this ability is not special to speech in humans. However, the coupling of sounds and actions in nonhuman primates (and the availability of an internal model supporting it) seems not to extend to the upper vocal tract, that is, the supralaryngeal articulators, which are key for the production of speech sounds in humans. The origin of speech may have required the evolution of a "command apparatus" similar to the control of the hand, which was crucial for the evolution of tool use.
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Affiliation(s)
- Denis Archakov
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20057
- Brain and Mind Laboratory, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, FI-02150 Espoo, Finland
| | - Iain DeWitt
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20057
| | - Paweł Kuśmierek
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20057
| | - Michael Ortiz-Rios
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20057
| | - Daniel Cameron
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20057
| | - Ding Cui
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20057
| | - Elyse L Morin
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20057
| | - John W VanMeter
- Center for Functional and Molecular Imaging, Georgetown University Medical Center, Washington, DC 20057
| | - Mikko Sams
- Brain and Mind Laboratory, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, FI-02150 Espoo, Finland
| | - Iiro P Jääskeläinen
- Brain and Mind Laboratory, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, FI-02150 Espoo, Finland
| | - Josef P Rauschecker
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20057;
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Miller HE, Guenther FH. Modelling speech motor programming and apraxia of speech in the DIVA/GODIVA neurocomputational framework. APHASIOLOGY 2020; 35:424-441. [PMID: 34108793 PMCID: PMC8183977 DOI: 10.1080/02687038.2020.1765307] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND The Directions Into Velocities of Articulators (DIVA) model and its partner, the Gradient Order DIVA (GODIVA) model, provide neurobiologically grounded, computational accounts of speech motor control and motor sequencing, with applications for the study and treatment of neurological motor speech disorders. AIMS In this review, we provide an overview of the DIVA and GODIVA models and how they explain the interface between phonological and motor planning systems to build on previous models and provide a mechanistic accounting of apraxia of speech (AOS), a disorder of speech motor programming. MAIN CONTRIBUTION Combined, the DIVA and GODIVA models account for both the segmental and suprasegmental features that define AOS via damage to (i) a speech sound map, hypothesized to reside in left ventral premotor cortex, (ii) a phonological content buffer hypothesized to reside in left posterior inferior frontal sulcus, and/or (iii) the axonal projections between these regions. This account is in line with a large body of behavioural work, and it unifies several prior theoretical accounts of AOS. CONCLUSIONS The DIVA and GODIVA models provide an integrated framework for the generation and testing of both behavioural and neuroimaging hypotheses about the underlying neural mechanisms responsible for motor programming in typical speakers and in speakers with AOS.
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Affiliation(s)
- Hilary E. Miller
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA
| | - Frank H. Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA
- Department of Biomedical Engineering, Boston University, Boston, MA
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA
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42
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DeMarco AT, Turkeltaub PE. Functional anomaly mapping reveals local and distant dysfunction caused by brain lesions. Neuroimage 2020; 215:116806. [PMID: 32278896 DOI: 10.1016/j.neuroimage.2020.116806] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/16/2020] [Accepted: 03/21/2020] [Indexed: 01/28/2023] Open
Abstract
The lesion method has been important for understanding brain-behavior relationships in humans, but has previously used maps based on structural damage. Lesion measurement based on structural damage may label partly damaged but functional tissue as abnormal, and moreover, ignores distant dysfunction in structurally intact tissue caused by deafferentation, diaschisis, and other processes. A reliable method to map functional integrity of tissue throughout the brain would provide a valuable new approach to measuring lesions. Here, we use machine learning on four dimensional resting state fMRI data obtained from left-hemisphere stroke survivors in the chronic period of recovery and control subjects to generate graded maps of functional anomaly throughout the brain in individual patients. These functional anomaly maps identify areas of obvious structural lesions and are stable across multiple measurements taken months and even years apart. Moreover, the maps identify functionally anomalous regions in structurally intact tissue, providing a direct measure of remote effects of lesions on the function of distant brain structures. Multivariate lesion-behavior mapping using functional anomaly maps replicates classic behavioral localization, identifying inferior frontal regions related to speech fluency, lateral temporal regions related to auditory comprehension, parietal regions related to phonology, and the hand area of motor cortex and descending corticospinal pathways for hand motor function. Further, this approach identifies relationships between tissue function and behavior distant from the structural lesions, including right premotor dysfunction related to ipsilateral hand movement, and right cerebellar regions known to contribute to speech fluency. Brain-wide maps of the functional effects of focal lesions could have wide implications for lesion-behavior association studies and studies of recovery after brain injury.
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Affiliation(s)
- Andrew T DeMarco
- Department of Neurology, Georgetown University, Washington, DC, 20057, United States.
| | - Peter E Turkeltaub
- Department of Neurology, Georgetown University, Washington, DC, 20057, United States; MedStar National Rehabilitation Hospital, Washington, DC, 20010, United States
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Matchin W, Basilakos A, Stark BC, den Ouden DB, Fridriksson J, Hickok G. Agrammatism and Paragrammatism: A Cortical Double Dissociation Revealed by Lesion-Symptom Mapping. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2020; 1:208-225. [PMID: 34296193 PMCID: PMC8293792 DOI: 10.1162/nol_a_00010] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/27/2020] [Indexed: 05/21/2023]
Abstract
The fundamental distinction of grammatical deficits in aphasia, agrammatism and paragrammatism, was made over a century ago. However, the extent to which the agrammatism/paragrammatism distinction exists independently of differences in speech fluency has not clearly been investigated. Despite much research on agrammatism, the lesion correlates of paragrammatism are essentially unknown. Lesion-symptom mapping was used to investigate the degree to which the lesion correlates of agrammatism and paragrammatism overlap or dissociate. Four expert raters assessed videos of 53 right-handed patients with aphasia following chronic left-hemisphere stroke retelling the Cinderella story. Consensus discussion determined each subject's classification with respect to grammatical deficits as Agrammatic, Paragrammatic, Both, or No Grammatical Deficit. Each subject's lesion was manually drawn on a high-resolution MRI and warped to standard space for group analyses. Lesion-symptom mapping analyses were performed in NiiStat including lesion volume as a covariate. Secondary analyses included speech rate (words per minute) as an additional covariate. Region of interest analyses identified a double dissociation between these syndromes: damage to Broca's area was significantly associated with agrammatism, p = 0.001 (but not paragrammatism, p = 0.930), while damage to the left posterior superior and middle temporal gyri was significantly associated with paragrammatism, p < 0.001 (but not agrammatism, p = 0.873). The same results obtained when regressing out the effect of speech rate, and nonoverlapping lesion distributions between the syndromes were confirmed by uncorrected whole brain analyses. Our results support a fundamental distinction between agrammatism and paragrammatism.
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Affiliation(s)
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina
| | - Brielle C. Stark
- ISpeech and Hearing Sciences Department and Program in Neuroscience Faculty, Indiana University Bloomington
| | - Dirk-Bart den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina
| | - Gregory Hickok
- Department of Cognitive Sciences, Department of Language Sciences, University of California, Irvine
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Wang J, Wu D, Cheng Y, Song W, Yuan Y, Zhang X, Zhang D, Zhang T, Wang Z, Tang J, Yin L. Effects of Transcranial Direct Current Stimulation on Apraxia of Speech and Cortical Activation in Patients With Stroke: A Randomized Sham-Controlled Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1625-1637. [PMID: 31618056 DOI: 10.1044/2019_ajslp-19-0069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The study aims to investigate, using anodal transcranial direct current stimulation (A-tDCS), over which site, the left lip region of primary motor cortex (M1) or the Broca's area, there would be better recovery from apraxia of speech (AoS) in patients with poststroke aphasia and to examine for altered activation in speech-related areas after tDCS with nonlinear electroencephalography (EEG). Method Fifty-two patients with AoS were randomized into A-tDCS over the left M1 (A-tDCS-M1), Broca's area, and sham tDCS groups who underwent 10 sessions of tDCS and speech treatment for 5 days. The EEG nonlinear index of approximate entropy was calculated for 6 subjects in each group before and after treatment. Results After treatment, the change in speech-language performance improved more significantly in the A-tDCS-M1 group than the other 2 groups (p < .05). EEG approximate entropy indicated that both A-tDCS groups could activate the stimulated sites; the improvement in the A-tDCS-M1 group was correlated with high activation in the dorsal lateral prefrontal cortex and Broca's areas of the left hemisphere in addition to the stimulated site. Conclusion A-tDCS over the left M1 can improve the speech function in patients with poststroke aphasia and severe AoS and excite and recruit more areas in the motor speech network.
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Affiliation(s)
- Jie Wang
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing, China
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing, China
| | - Yinan Cheng
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Ying Yuan
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xu Zhang
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing, China
| | - Dahua Zhang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Tiantian Zhang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zhuo Wang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jingwen Tang
- Department of Integrated Traditional Chinese and Western Medicine Oncology, Affiliated Tumor Hospital of Zhengzhou University, China
| | - Ling Yin
- Department of Health Care, Zunyi Academician Center, China
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Basilakos A, Smith KG, Fillmore P, Fridriksson J, Fedorenko E. Functional Characterization of the Human Speech Articulation Network. Cereb Cortex 2019; 28:1816-1830. [PMID: 28453613 DOI: 10.1093/cercor/bhx100] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 04/05/2017] [Indexed: 12/14/2022] Open
Abstract
A number of brain regions have been implicated in articulation, but their precise computations remain debated. Using functional magnetic resonance imaging, we examine the degree of functional specificity of articulation-responsive brain regions to constrain hypotheses about their contributions to speech production. We find that articulation-responsive regions (1) are sensitive to articulatory complexity, but (2) are largely nonoverlapping with nearby domain-general regions that support diverse goal-directed behaviors. Furthermore, premotor articulation regions show selectivity for speech production over some related tasks (respiration control), but not others (nonspeech oral-motor [NSO] movements). This overlap between speech and nonspeech movements concords with electrocorticographic evidence that these regions encode articulators and their states, and with patient evidence whereby articulatory deficits are often accompanied by oral-motor deficits. In contrast, the superior temporal regions show strong selectivity for articulation relative to nonspeech movements, suggesting that these regions play a specific role in speech planning/production. Finally, articulation-responsive portions of posterior inferior frontal gyrus show some selectivity for articulation, in line with the hypothesis that this region prepares an articulatory code that is passed to the premotor cortex. Taken together, these results inform the architecture of the human articulation system.
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Affiliation(s)
- Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Kimberly G Smith
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA.,Department of Speech Pathology and Audiology, University of South Alabama, Mobile, AL 36688, USA
| | - Paul Fillmore
- Department of Communication Sciences and Disorders, Baylor University, Waco, TX 76798, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Evelina Fedorenko
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Chenausky K, Paquette S, Norton A, Schlaug G. Apraxia of speech involves lesions of dorsal arcuate fasciculus and insula in patients with aphasia. Neurol Clin Pract 2019; 10:162-169. [PMID: 32309035 DOI: 10.1212/cpj.0000000000000699] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/29/2019] [Indexed: 11/15/2022]
Abstract
Objective To determine the contributions of apraxia of speech (AOS) and anomia to conversational dysfluency. Methods In this observational study of 52 patients with chronic aphasia, 47 with concomitant AOS, fluency was quantified using correct information units per minute (CIUs/min) from propositional speech tasks. Videos of patients performing conversational, how-to and picture-description tasks, word and sentence repetition, and diadochokinetic tasks were used to diagnose AOS using the Apraxia of Speech Rating Scale (ASRS). Anomia was quantified by patients' scores on the 30 even-numbered items from the Boston Naming Test (BNT). Results Together, ASRS and BNT scores accounted for 51.4% of the total variance in CIUs/min; the ASRS score accounted for the majority of that variance. The BNT score was associated with lesions in the left superior temporal gyrus, left inferior frontal gyrus, and large parts of the insula. The global ASRS score was associated with lesions in the left dorsal arcuate fasciculus (AF), pre- and post-central gyri, and both banks of the central sulcus of the insula. The ASRS score for the primary distinguishing features of AOS (no overlap with features of aphasia) was associated with less AF and more insular involvement. Only ∼27% of this apraxia-specific lesion overlapped with lesions associated with the BNT score. Lesions associated with AOS had minimal overlap with the frontal aslant tract (FAT) (<1%) or the extreme capsule fiber tract (1.4%). Finally, ASRS scores correlated significantly with damage to the insula but not to the AF, extreme capsule, or FAT. Conclusions Results are consistent with previous findings identifying lesions of the insula and AF in patients with AOS, damage to both of which may create dysfluency in patients with aphasia.
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Affiliation(s)
- Karen Chenausky
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
| | - Sébastien Paquette
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
| | - Andrea Norton
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
| | - Gottfried Schlaug
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
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47
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Wambaugh JL, Bailey DJ, Mauszycki SC, Bunker LD. Interrater Reliability and Concurrent Validity for the Apraxia of Speech Rating Scale 3.0: Application With Persons With Acquired Apraxia of Speech and Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:895-904. [PMID: 31306600 DOI: 10.1044/2018_ajslp-msc18-18-0099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose This investigation was designed to provide interrater reliability data for the Apraxia of Speech Rating Scale 3.0 (ASRS 3.0; Strand, Duffy, Clark, & Josephs, 2014 ). Importantly, ratings were completed by investigators who were not involved with the ASRS development. Another aim was to evaluate the relationship of the ASRS 3.0 total score to word intelligibility. Method Two investigators independently completed ASRS 3.0 ratings for 28 participants with chronic apraxia of speech and aphasia. Intelligibility scores were obtained for all participants. Results Consistency of ratings for each feature and total score of the ASRS 3.0 was measured using intraclass correlation coefficients. Twelve of 13 intraclass correlation coefficients for feature ratings reached significance; clinical meaningfulness ranged from poor to excellent. Interrater reliability for the total scores was excellent. Similarly, absolute difference of ratings was minimal for the total scores, but varied across the 13 feature ratings. Correlations between the intelligibility scores and ASRS 3.0 total score were moderate to strong. Conclusion The total ASRS 3.0 score may be viewed as a reliable indicator of prevalence of apraxia of speech features. Although there was good to acceptable correspondence in ratings of the majority of the individual features, additional operationalization of rating procedures may be needed to improve interrater reliability for a few features.
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Affiliation(s)
- Julie L Wambaugh
- Veterans Affairs Salt Lake City Health Care System, UT
- Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Dallin J Bailey
- Department of Communication Disorders, Auburn University, AL
| | - Shannon C Mauszycki
- Veterans Affairs Salt Lake City Health Care System, UT
- Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Lisa D Bunker
- Veterans Affairs Salt Lake City Health Care System, UT
- Communication Sciences and Disorders, University of Utah, Salt Lake City
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Harvey DY, Mass JA, Shah-Basak PP, Wurzman R, Faseyitan O, Sacchetti DL, DeLoretta L, Hamilton RH. Continuous theta burst stimulation over right pars triangularis facilitates naming abilities in chronic post-stroke aphasia by enhancing phonological access. BRAIN AND LANGUAGE 2019; 192:25-34. [PMID: 30870740 PMCID: PMC6503859 DOI: 10.1016/j.bandl.2019.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has been used experimentally to facilitate naming abilities in individuals with chronic post-stroke aphasia. However, little is known about how rTMS confers clinical improvement, hampering its therapeutic value. The present study investigated the characteristics of naming failure that improve following administration of continuous theta burst stimulation (cTBS)-an inhibitory form of rTMS-to the right pars triangularis (rPTr) in persons with chronic aphasia. METHODS Eleven participants with chronic aphasia following left hemisphere stroke named pictures prior to and immediately following cTBS of the rPTr and a control site (vertex) in separate sessions. Prior to stimulation, we obtained two baseline measurements of picture naming ability to determine the extent and type (i.e., phonological vs. semantic) of naming impairment. Items presented for naming during stimulation were those that were named incorrectly in one or both of the baseline sessions (i.e., inconsistent vs. wrong items, respectively). Analyses assessed whether cTBS effects differed depending on the severity and/or type of naming impairment. RESULTS Relative to vertex, cTBS of the rPTr improved naming of inconsistent, but not wrong, items for individuals with more severe baseline naming impairment. Critically, baseline phonological but not semantic naming impairment severity marginally correlated with improved accuracy overall, and significantly correlated with decreased phonological errors following rPTr stimulation. CONCLUSION CTBS of the rPTr enhances naming by facilitating phonological access during word retrieval, indicating that individuals whose naming impairment is localized to this stage of processing may be most likely to benefit from this rTMS approach.
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Affiliation(s)
- Denise Y Harvey
- Department of Neurology, University of Pennsylvania, 3710 Hamilton Walk, Philadelphia, PA 19104, USA; Research Department, Moss Rehabilitation Research Institute, 50 Township Line Road, Elkins Park, PA 19027, USA
| | - Joely A Mass
- Department of Neurology, University of Pennsylvania, 3710 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Priyanka P Shah-Basak
- Department of Neurology, University of Pennsylvania, 3710 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Rachel Wurzman
- Department of Neurology, University of Pennsylvania, 3710 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Olufunsho Faseyitan
- Department of Neurology, University of Pennsylvania, 3710 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Daniela L Sacchetti
- Department of Neurology, University of Pennsylvania, 3710 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Laura DeLoretta
- Department of Neurology, University of Pennsylvania, 3710 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania, 3710 Hamilton Walk, Philadelphia, PA 19104, USA.
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Cordella C, Quimby M, Touroutoglou A, Brickhouse M, Dickerson BC, Green JR. Quantification of motor speech impairment and its anatomic basis in primary progressive aphasia. Neurology 2019; 92:e1992-e2004. [PMID: 30944238 PMCID: PMC6511075 DOI: 10.1212/wnl.0000000000007367] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate whether a quantitative speech measure is effective in identifying and monitoring motor speech impairment (MSI) in patients with primary progressive aphasia (PPA) and to investigate the neuroanatomical basis of MSI in PPA. Methods Sixty-four patients with PPA were evaluated at baseline, with a subset (n = 39) evaluated longitudinally. Articulation rate (AR), a quantitative measure derived from spontaneous speech, was measured at each time point. MRI was collected at baseline. Differences in baseline AR were assessed across PPA subtypes, separated by severity level. Linear mixed-effects models were conducted to assess groups differences across PPA subtypes in rate of decline in AR over a 1-year period. Cortical thickness measured from baseline MRIs was used to test hypotheses about the relationship between cortical atrophy and MSI. Results Baseline AR was reduced for patients with nonfluent variant PPA (nfvPPA) compared to other PPA subtypes and controls, even in mild stages of disease. Longitudinal results showed a greater rate of decline in AR for the nfvPPA group over 1 year compared to the logopenic and semantic variant subgroups. Reduced baseline AR was associated with cortical atrophy in left-hemisphere premotor and supplementary motor cortices. Conclusions The AR measure is an effective quantitative index of MSI that detects MSI in mild disease stages and tracks decline in MSI longitudinally. The AR measure also demonstrates anatomic localization to motor speech–specific cortical regions. Our findings suggest that this quantitative measure of MSI might have utility in diagnostic evaluation and monitoring of MSI in PPA.
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Affiliation(s)
- Claire Cordella
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Megan Quimby
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Alexandra Touroutoglou
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Michael Brickhouse
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Bradford C Dickerson
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA
| | - Jordan R Green
- From the Program in Speech and Hearing Bioscience and Technology (C.C., J.R.G.), Division of Medical Sciences, Harvard University, Cambridge; Frontotemporal Disorders Unit (C.C., M.Q., A.T., M.B., B.C.D.), Massachusetts General Hospital; Department of Communication Sciences and Disorders (C.C., J.R.G.), MGH Institute of Health Professions; and Department of Neurology (B.C.D.), Harvard Medical School, Boston, MA.
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50
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Mailend ML, Maas E, Beeson PM, Story BH, Forster KI. Speech motor planning in the context of phonetically similar words: Evidence from apraxia of speech and aphasia. Neuropsychologia 2019; 127:171-184. [PMID: 30817912 PMCID: PMC6459184 DOI: 10.1016/j.neuropsychologia.2019.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/22/2019] [Accepted: 02/24/2019] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to test two competing hypotheses about the nature of the impairment in apraxia of speech (AOS). The Reduced Buffer Capacity Hypothesis argues that people with AOS can hold only one syllable at a time in the speech motor planning buffer. The Program Retrieval Deficit Hypothesis, states that people with AOS have difficulty accessing the intended motor program in the context where several motor programs are activated simultaneously. The participants included eight speakers with AOS, most of whom also had aphasia, nine speakers with aphasia without AOS, and 25 age-matched control speakers. The experimental paradigm prompted single word production following three types of primes. In most trials, prime and target were the same (e.g., bill-bill). On some trials, the initial consonant differed in one phonetic feature (e.g., bill-dill; Similar) or in all phonetic features (fill-bill; Different). The dependent measures were accuracy and reaction time. The results revealed a switch cost - longer reaction times in trials where the prime and target differed compared to trials where they were the same words - in all groups; however, the switch cost was significantly larger in the AOS group compared to the other two groups. These findings are in line with the prediction of the Program Retrieval Deficit Hypothesis and suggest that speakers with AOS have difficulty with selecting one program over another when several programs compete for selection.
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Affiliation(s)
| | - Edwin Maas
- The University of Arizona, United States
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