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Crosson B, McGregor KM, Nocera JR, Drucker JH, Tran SM, Butler AJ. The relevance of aging-related changes in brain function to rehabilitation in aging-related disease. Front Hum Neurosci 2015; 9:307. [PMID: 26074807 PMCID: PMC4444823 DOI: 10.3389/fnhum.2015.00307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/12/2015] [Indexed: 12/29/2022] Open
Abstract
The effects of aging on rehabilitation of aging-related diseases are rarely a design consideration in rehabilitation research. In this brief review we present strong coincidental evidence from these two fields suggesting that deficits in aging-related disease or injury are compounded by the interaction between aging-related brain changes and disease-related brain changes. Specifically, we hypothesize that some aphasia, motor, and neglect treatments using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) in stroke patients may address the aging side of this interaction. The importance of testing this hypothesis and addressing the larger aging by aging-related disease interaction is discussed. Underlying mechanisms in aging that most likely are relevant to rehabilitation of aging-related diseases also are covered.
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Affiliation(s)
- Bruce Crosson
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Neurology, Emory University Atlanta, GA, USA ; Department of Psychology, Georgia State University Atlanta, GA, USA ; School of Health and Rehabilitation Sciences, University of Queensland Brisbane, Qld, Australia
| | - Keith M McGregor
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Neurology, Emory University Atlanta, GA, USA
| | - Joe R Nocera
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Neurology, Emory University Atlanta, GA, USA
| | - Jonathan H Drucker
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Neurology, Emory University Atlanta, GA, USA ; Department of Psychology, Emory University Atlanta, GA, USA
| | - Stella M Tran
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Psychology, Georgia State University Atlanta, GA, USA
| | - Andrew J Butler
- Department of Veterans Affairs Rehabilitation Research and Development Center of Excellence for Visual and Neurocognitive Rehabilitation (151R), Atlanta VA Medical Center Decatur, GA, USA ; Department of Physical Therapy and School of Nursing and Health Professionals, Georgia State University Atlanta, GA, USA
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Neuroscience of Aphasia Recovery: the Concept of Neural Multifunctionality. Curr Neurol Neurosci Rep 2015; 15:41. [DOI: 10.1007/s11910-015-0568-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Heath S, McMahon KL, Nickels LA, Angwin A, MacDonald AD, van Hees S, McKinnon E, Johnson K, Copland DA. An fMRI investigation of the effects of attempted naming on word retrieval in aphasia. Front Hum Neurosci 2015; 9:291. [PMID: 26074801 PMCID: PMC4443028 DOI: 10.3389/fnhum.2015.00291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/06/2015] [Indexed: 11/13/2022] Open
Abstract
In healthy controls, picture naming performance can be facilitated by a single prior exposure to the same picture (“priming”). This priming phenomenon is utilized in the treatment of aphasia, which often includes repeated picture naming as part of a therapeutic task. The current study sought to determine whether single and/or multiple exposures facilitate subsequent naming in aphasia and whether such facilitatory effects act through normal priming mechanisms. A functional magnetic resonance imaging paradigm was employed to explore the beneficial effects of attempted naming in two individuals with aphasia and a control group. The timing and number of prior exposures was manipulated, with investigation of both short-term effects (single prior exposure over a period of minutes) and long-term effects (multiple presentations over a period of days). Following attempted naming, both short-term and long-term facilitated items showed improvement for controls, while only the long-term condition showed benefits at a behavioral level for the participants with aphasia. At a neural level, effects of long-term facilitation were noted in the left precuneus for one participant with aphasia, a result also identified for the equivalent contrast in controls. It appears that multiple attempts are required to improve naming performance in the presence of anomia and that for some individuals with aphasia the source of facilitation may be similar to unimpaired mechanisms engaged outside the language network.
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Affiliation(s)
- Shiree Heath
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney NSW, Australia ; Language Neuroscience Laboratory, University of Queensland Centre for Clinical Research, St Lucia QLD, Australia
| | - Katie L McMahon
- Centre for Advanced Imaging, University of Queensland, St Lucia QLD, Australia
| | - Lyndsey A Nickels
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney NSW, Australia ; NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation, St Lucia QLD, Australia
| | - Anthony Angwin
- NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation, St Lucia QLD, Australia ; School of Health and Rehabilitation Sciences, University of Queensland, St Lucia QLD, Australia
| | - Anna D MacDonald
- Language Neuroscience Laboratory, University of Queensland Centre for Clinical Research, St Lucia QLD, Australia ; NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation, St Lucia QLD, Australia
| | - Sophia van Hees
- Language Neuroscience Laboratory, University of Queensland Centre for Clinical Research, St Lucia QLD, Australia ; NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation, St Lucia QLD, Australia
| | - Eril McKinnon
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia QLD, Australia
| | - Kori Johnson
- Centre for Advanced Imaging, University of Queensland, St Lucia QLD, Australia
| | - David A Copland
- Language Neuroscience Laboratory, University of Queensland Centre for Clinical Research, St Lucia QLD, Australia ; NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation, St Lucia QLD, Australia ; School of Health and Rehabilitation Sciences, University of Queensland, St Lucia QLD, Australia
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Ullman MT, Pullman MY. A compensatory role for declarative memory in neurodevelopmental disorders. Neurosci Biobehav Rev 2015; 51:205-22. [PMID: 25597655 PMCID: PMC4359651 DOI: 10.1016/j.neubiorev.2015.01.008] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 12/17/2014] [Accepted: 01/08/2015] [Indexed: 11/20/2022]
Abstract
Most research on neurodevelopmental disorders has focused on their abnormalities. However, what remains intact may also be important. Increasing evidence suggests that declarative memory, a critical learning and memory system in the brain, remains largely functional in a number of neurodevelopmental disorders. Because declarative memory remains functional in these disorders, and because it can learn and retain numerous types of information, functions, and tasks, this system should be able to play compensatory roles for multiple types of impairments across the disorders. Here, we examine this hypothesis for specific language impairment, dyslexia, autism spectrum disorder, Tourette syndrome, and obsessive-compulsive disorder. We lay out specific predictions for the hypothesis and review existing behavioral, electrophysiological, and neuroimaging evidence. Overall, the evidence suggests that declarative memory indeed plays compensatory roles for a range of impairments across all five disorders. Finally, we discuss diagnostic, therapeutic and other implications.
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Affiliation(s)
- Michael T Ullman
- Brain and Language Laboratory, Department of Neuroscience, Georgetown University, Box 571464, Washington, DC 20057-1464, United States.
| | - Mariel Y Pullman
- Brain and Language Laboratory, Department of Neuroscience, Georgetown University, Box 571464, Washington, DC 20057-1464, United States
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Abel S, Weiller C, Huber W, Willmes K, Specht K. Therapy-induced brain reorganization patterns in aphasia. ACTA ACUST UNITED AC 2015; 138:1097-112. [PMID: 25688082 DOI: 10.1093/brain/awv022] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Both hemispheres are engaged in recovery from word production deficits in aphasia. Lexical therapy has been shown to induce brain reorganization even in patients with chronic aphasia. However, the interplay of factors influencing reorganization patterns still remains unresolved. We were especially interested in the relation between lesion site, therapy-induced recovery, and beneficial reorganization patterns. Thus, we applied intensive lexical therapy, which was evaluated with functional magnetic resonance imaging, to 14 chronic patients with aphasic word retrieval deficits. In a group study, we aimed to illuminate brain reorganization of the naming network in comparison with healthy controls. Moreover, we intended to analyse the data with joint independent component analysis to relate lesion sites to therapy-induced brain reorganization, and to correlate resulting components with therapy gain. As a result, we found peri-lesional and contralateral activations basically overlapping with premorbid naming networks observed in healthy subjects. Reduced activation patterns for patients compared to controls before training comprised damaged left hemisphere language areas, right precentral and superior temporal gyrus, as well as left caudate and anterior cingulate cortex. There were decreasing activations of bilateral visuo-cognitive, articulatory, attention, and language areas due to therapy, with stronger decreases for patients in right middle temporal gyrus/superior temporal sulcus, bilateral precuneus as well as left anterior cingulate cortex and caudate. The joint independent component analysis revealed three components indexing lesion subtypes that were associated with patient-specific recovery patterns. Activation decreases (i) of an extended frontal lesion disconnecting language pathways occurred in left inferior frontal gyrus; (ii) of a small frontal lesion were found in bilateral inferior frontal gyrus; and (iii) of a large temporo-parietal lesion occurred in bilateral inferior frontal gyrus and contralateral superior temporal gyrus. All components revealed increases in prefrontal areas. One component was negatively correlated with therapy gain. Therapy was associated exclusively with activation decreases, which could mainly be attributed to higher processing efficiency within the naming network. In our joint independent component analysis, all three lesion patterns disclosed involved deactivation of left inferior frontal gyrus. Moreover, we found evidence for increased demands on control processes. As expected, we saw partly differential reorganization profiles depending on lesion patterns. There was no compensatory deactivation for the large left inferior frontal lesion, with its less advantageous outcome probably being related to its disconnection from crucial language processing pathways.
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Affiliation(s)
- Stefanie Abel
- 1 Department of Neurology, Section Neuropsychology, RWTH Aachen, Germany 2 School of Psychological Sciences, Faculty of Medical and Human Sciences, University of Manchester, UK 3 SRH University of Applied Sciences, Gera, Germany 4 JARA-BRAIN, Aachen Juelich Research Alliance, Translational Brain Medicine, Germany
| | - Cornelius Weiller
- 5 Department of Neurology, University Medical Centre Freiburg, Germany
| | - Walter Huber
- 4 JARA-BRAIN, Aachen Juelich Research Alliance, Translational Brain Medicine, Germany
| | - Klaus Willmes
- 1 Department of Neurology, Section Neuropsychology, RWTH Aachen, Germany 4 JARA-BRAIN, Aachen Juelich Research Alliance, Translational Brain Medicine, Germany 6 Interdisciplinary Centre for Clinical Research, RWTH Aachen, Germany
| | - Karsten Specht
- 7 Department of Biological and Medical Psychology, University of Bergen, and Department of Clinical Engineering, Haukeland University Hospital Bergen, Norway
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56
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Neural underpinnings for model-oriented therapy of aphasic word production. Neuropsychologia 2014; 57:154-65. [DOI: 10.1016/j.neuropsychologia.2014.03.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/03/2014] [Accepted: 03/20/2014] [Indexed: 11/23/2022]
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van Hees S, McMahon K, Angwin A, de Zubicaray G, Copland DA. Neural activity associated with semantic versus phonological anomia treatments in aphasia. BRAIN AND LANGUAGE 2014; 129:47-57. [PMID: 24556337 DOI: 10.1016/j.bandl.2013.12.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 12/20/2013] [Accepted: 12/30/2013] [Indexed: 06/03/2023]
Abstract
Naming impairments in aphasia are typically targeted using semantic and/or phonologically based tasks. However, it is not known whether these treatments have different neural mechanisms. Eight participants with aphasia received twelve treatment sessions using an alternating treatment design, with fMRI scans pre- and post-treatment. Half the sessions employed Phonological Components Analysis (PCA), and half the sessions employed Semantic Feature Analysis (SFA). Pre-treatment activity in the left caudate correlated with greater immediate treatment success for items treated with SFA, whereas recruitment of the left supramarginal gyrus and right precuneus post-treatment correlated with greater immediate treatment success for items treated with PCA. The results support previous studies that have found greater treatment outcome to be associated with activity in predominantly left hemisphere regions, and suggest that different mechanisms may be engaged dependent on the type of treatment employed.
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Affiliation(s)
- Sophia van Hees
- University of Queensland Centre for Clinical Research, Herston, QLD 4029, Australia; School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, QLD 4072, Australia; Centre for Advanced Imaging, University of Queensland, St. Lucia, QLD 4072, Australia.
| | - Katie McMahon
- Centre for Advanced Imaging, University of Queensland, St. Lucia, QLD 4072, Australia; Wesley Hospital, Auchenflower, QLD 4066, Australia.
| | - Anthony Angwin
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, QLD 4072, Australia.
| | - Greig de Zubicaray
- School of Psychology, University of Queensland, St. Lucia, QLD 4072, Australia.
| | - David A Copland
- University of Queensland Centre for Clinical Research, Herston, QLD 4029, Australia; School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, QLD 4072, Australia; Clinical Centre for Research Excellence in Aphasia Rehabilitation, Australia.
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Benjamin ML, Towler S, Garcia A, Park H, Sudhyadhom A, Harnish S, McGregor KM, Zlatar Z, Reilly JJ, Rosenbek JC, Gonzalez Rothi LJ, Crosson B. A Behavioral Manipulation Engages Right Frontal Cortex During Aphasia Therapy. Neurorehabil Neural Repair 2014; 28:545-53. [PMID: 24407914 DOI: 10.1177/1545968313517754] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background An aphasia treatment was designed to shift laterality from the left to right lateral frontal lobe during word production by initiating word-finding trials with complex left-hand movements. Previous findings indicated successful relateralization. Objective The current study was designed to ascertain whether the shift was attributable to the left-hand movement. Methods Using stratified random sampling, 14 subjects were equally divided between Intention (IT) and Control (CT) treatments. CT was identical to IT, except with no left-hand movements. Both treatments trained picture naming (phases 1 and 2) and category-member generation (phase 3), each phase lasting 10 sessions. Functional magnetic resonance imaging of category member generation occurred at pretreatment, posttreatment, and 3-month follow-up. Results IT shifted lateral frontal activity rightward compared with pretreatment both at posttreatment (t = -2.602, df = 6, P < .05) and 3-month follow-up (t = -2.332, df = 5, P < .05), but CT did not. IT and CT yielded similar changes for all picture-naming and category probes. However, IT patients showed gains for untrained category (t = 3.33, df = 6, P < .01) and picture-naming probes (t = 3.77, df = 5, P < .01), but CT patients did not. Conclusions The rightward shift in lateral frontal activity for IT was because of the left-hand movements. IT evoked greater generalization than CT.
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Affiliation(s)
| | | | | | | | | | | | - Keith M McGregor
- Atlanta VA RR&D Center of Excellence, Decatur, GA, USA Emory University, Atlanta, GA, USA
| | | | | | - John C Rosenbek
- University of Florida, Gainesville, FL, USA Gainesville VA RR&D Center of Excellence, Gainesville, FL, USA
| | - Leslie J Gonzalez Rothi
- University of Florida, Gainesville, FL, USA Gainesville VA RR&D Center of Excellence, Gainesville, FL, USA
| | - Bruce Crosson
- Atlanta VA RR&D Center of Excellence, Decatur, GA, USA Emory University, Atlanta, GA, USA Georgia State University, Atlanta, GA, USA
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Satoer D, Visch-Brink E, Smits M, Kloet A, Looman C, Dirven C, Vincent A. Long-term evaluation of cognition after glioma surgery in eloquent areas. J Neurooncol 2013; 116:153-60. [PMID: 24173681 DOI: 10.1007/s11060-013-1275-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/09/2013] [Indexed: 11/24/2022]
Abstract
Preservation of cognition is an important outcome measure in eloquent area glioma surgery. Glioma patients may have pre-operative deficits in one or more cognitive domains which could deteriorate post-operatively. It is assumed that these impairments recover within 3 months; some studies however, still detected cognitive decline. Longer follow-up is necessary to elucidate the conclusive effects of surgery. 45 patients with gliomas (low- and high-grade, but without contrast enhancement at diagnosis) in eloquent areas were assessed pre-operatively, 3 months and 1 year post-operatively with a neuropsychological test-protocol. Patients' performance was compared to normal population and between test-moments. Univariate analyses were performed between cognitive change and tumor-characteristics (localization, grade, volume, extent of resection [EOR]) and treatment-related factors (radio-/chemotherapy). Pre- and post-operatively, impairments were found in all cognitive domains; language, memory, attention and executive functions (p < 0.05). Post-operatively, permanent improvement was observed on a memory test (verbal recall: t = -1.931, p = 0.034), whereas deterioration was found on a language test (category fluency: t = 2.517, p = 0.030). Between 3 months and 1 year, patients improved on 2 language tests (naming: t = -2.781, p = 0.026 and letter fluency: t = -1.975, p = 0.047). There was no influence of tumor- or treatment-related factors on cognitive change. The findings underline the importance of cognitive testing at longer term post-operatively, as cognitive recovery took longer than 3 months, especially within the language domain. However, this longitudinal follow-up study showed that glioma surgery is possible without major long-term damage of cognitive functions. Tumor characteristics and EOR are no additional risk factors for cognitive outcome.
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Affiliation(s)
- Djaina Satoer
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Dr. Molewaterplein 50, Room EE220, 3015 GE, Rotterdam, The Netherlands,
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60
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Basso G, Magon S, Reggiani F, Capasso R, Monittola G, Yang FJ, Miceli G. Distinguishable neurofunctional effects of task practice and item practice in picture naming: a BOLD fMRI study in healthy subjects. BRAIN AND LANGUAGE 2013; 126:302-313. [PMID: 23933470 DOI: 10.1016/j.bandl.2013.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 07/03/2013] [Accepted: 07/08/2013] [Indexed: 06/02/2023]
Abstract
Practice of language tasks results in improved performance and BOLD signal changes. We distinguish changes correlated with repeated exposure to a picture naming task, from changes associated with naming specific items trained during practice. Task practice affected trained and untrained items, yielding left-sided BOLD deactivations in extrastriate, prefrontal and superior temporal areas (consistent with their putative role in perceptual priming, articulatory planning and phonological lexical retrieval, respectively). Item practice effects were restricted to trained words. There was deactivation in left posterior fusiform (supporting its role in accessing structural object representations), anterior cingulate and left insular/inferior frontal cortices (consistent with their role in processing low-frequency words). Central precuneus and posterior cingulate were hyperactivated (consistent with their putative role in episodic memory for trained items, probably due to functional connections with language areas). In healthy subjects, naming practice modifies stored linguistic representations, but mostly affects ease of access to trained words.
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Affiliation(s)
- Gianpaolo Basso
- DiPSCo (Department of Psychology and Cognitive Sciences), Università di Trento, Rovereto, TN, Italy
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61
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Kiran S, Ansaldo A, Bastiaanse R, Cherney LR, Howard D, Faroqi-Shah Y, Meinzer M, Thompson CK. Neuroimaging in aphasia treatment research: standards for establishing the effects of treatment. Neuroimage 2013; 76:428-35. [PMID: 23063559 PMCID: PMC3552150 DOI: 10.1016/j.neuroimage.2012.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 07/06/2012] [Accepted: 10/05/2012] [Indexed: 11/29/2022] Open
Abstract
The goal of this paper is to discuss experimental design options available for establishing the effects of treatment in studies that aim to examine the neural mechanisms associated with treatment-induced language recovery in aphasia, using functional magnetic resonance imaging (fMRI). We present both group and single-subject experimental or case-series design options for doing this and address advantages and disadvantages of each. We also discuss general components of and requirements for treatment research studies, including operational definitions of variables, criteria for defining behavioral change and treatment efficacy, and reliability of measurement. Important considerations that are unique to neuroimaging-based treatment research are addressed, pertaining to the relation between the selected treatment approach and anticipated changes in language processes/functions and how such changes are hypothesized to map onto the brain.
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Affiliation(s)
- Swathi Kiran
- Boston University, Sargent College of Health and Rehabilitation Sciences, Boston, MA 02215, USA.
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Meinzer M, Beeson PM, Cappa S, Crinion J, Kiran S, Saur D, Parrish T, Crosson B, Thompson CK. Neuroimaging in aphasia treatment research: consensus and practical guidelines for data analysis. Neuroimage 2013. [PMID: 22387474 DOI: 10.1016/j.neuroimage.2012.02.058,pii:s1053-8119(12)00236-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Functional magnetic resonance imaging is the most widely used imaging technique to study treatment-induced recovery in post-stroke aphasia. The longitudinal design of such studies adds to the challenges researchers face when studying patient populations with brain damage in cross-sectional settings. The present review focuses on issues specifically relevant to neuroimaging data analysis in aphasia treatment research identified in discussions among international researchers at the Neuroimaging in Aphasia Treatment Research Workshop held at Northwestern University (Evanston, Illinois, USA). In particular, we aim to provide the reader with a critical review of unique problems related to the pre-processing, statistical modeling and interpretation of such data sets. Despite the fact that data analysis procedures critically depend on specific design features of a given study, we aim to discuss and communicate a basic set of practical guidelines that should be applicable to a wide range of studies and useful as a reference for researchers pursuing this line of research.
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Affiliation(s)
- Marcus Meinzer
- Charite Universitätsmedizin, Department of Neurology, Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Berlin, Germany.
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Meinzer M, Beeson PM, Cappa S, Crinion J, Kiran S, Saur D, Parrish T, Crosson B, Thompson CK. Neuroimaging in aphasia treatment research: consensus and practical guidelines for data analysis. Neuroimage 2013; 73:215-24. [PMID: 22387474 PMCID: PMC3416913 DOI: 10.1016/j.neuroimage.2012.02.058] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/19/2012] [Indexed: 11/19/2022] Open
Abstract
Functional magnetic resonance imaging is the most widely used imaging technique to study treatment-induced recovery in post-stroke aphasia. The longitudinal design of such studies adds to the challenges researchers face when studying patient populations with brain damage in cross-sectional settings. The present review focuses on issues specifically relevant to neuroimaging data analysis in aphasia treatment research identified in discussions among international researchers at the Neuroimaging in Aphasia Treatment Research Workshop held at Northwestern University (Evanston, Illinois, USA). In particular, we aim to provide the reader with a critical review of unique problems related to the pre-processing, statistical modeling and interpretation of such data sets. Despite the fact that data analysis procedures critically depend on specific design features of a given study, we aim to discuss and communicate a basic set of practical guidelines that should be applicable to a wide range of studies and useful as a reference for researchers pursuing this line of research.
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Affiliation(s)
- Marcus Meinzer
- Charite Universitätsmedizin, Department of Neurology, Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Berlin, Germany.
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64
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Heath S, McMahon KL, Nickels L, Angwin A, MacDonald AD, van Hees S, McKinnon E, Johnson K, Copland DA. Facilitation of naming in aphasia with auditory repetition: an investigation of neurocognitive mechanisms. Neuropsychologia 2013; 51:1534-48. [PMID: 23684849 DOI: 10.1016/j.neuropsychologia.2013.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 01/19/2013] [Accepted: 05/07/2013] [Indexed: 11/13/2022]
Abstract
Prior phonological processing can enhance subsequent picture naming performance in individuals with aphasia, yet the neurocognitive mechanisms underlying this effect and its longevity are unknown. This study used functional magnetic resonance imaging to examine the short-term (within minutes) and long-term (within days) facilitation effects from a phonological task in both participants with aphasia and age-matched controls. Results for control participants suggested that long-term facilitation of subsequent picture naming may be driven by a strengthening of semantic-phonological connections, while semantic and object recognition mechanisms underlie more short-term effects. All participants with aphasia significantly improved in naming accuracy following both short- and long-term facilitation. A descriptive comparison of the neuroimaging results identified different patterns of activation for each individual with aphasia. The exclusive engagement of a left hemisphere phonological network underlying facilitation was not revealed. The findings suggest that improved naming in aphasia with phonological tasks may be supported by changes in right hemisphere activity in some individuals and reveal the potential contribution of the cerebellum to improved naming following phonological facilitation. Conclusions must be interpreted with caution, however, due to the comparison of corrected group control results to that of individual participants with aphasia, which were not corrected for multiple comparisons.
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Affiliation(s)
- Shiree Heath
- University of Queensland, Language Neuroscience Laboratory, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Level 3, Building 71/918, Herston, Queensland 4029, Australia.
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65
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Kiran S. What is the nature of poststroke language recovery and reorganization? ISRN NEUROLOGY 2012; 2012:786872. [PMID: 23320190 PMCID: PMC3540797 DOI: 10.5402/2012/786872] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/05/2012] [Indexed: 12/16/2022]
Abstract
This review focuses on three main topics related to the nature of poststroke language recovery and reorganization. The first topic pertains to the nature of anatomical and physiological substrates in the infarcted hemisphere in poststroke aphasia, including the nature of the hemodynamic response in patients with poststroke aphasia, the nature of the peri-infarct tissue, and the neuronal plasticity potential in the infarcted hemisphere. The second section of the paper reviews the current neuroimaging evidence for language recovery in the acute, subacute, and chronic stages of recovery. The third and final section examines changes in connectivity as a function of recovery in poststroke aphasia, specifically in terms of changes in white matter connectivity, changes in functional effective connectivity, and changes in resting state connectivity after stroke. While much progress has been made in our understanding of language recovery, more work needs to be done. Future studies will need to examine whether reorganization of language in poststroke aphasia corresponds to a tighter, more coherent, and efficient network of residual and new regions in the brain. Answering these questions will go a long way towards being able to predict which patients are likely to recover and may benefit from future rehabilitation.
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Affiliation(s)
- Swathi Kiran
- Department of Speech, Language, and Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA ; Massachusetts General Hospital, Boston, MA, USA
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Vallila-Rohter S, Kiran S. Non-linguistic learning and aphasia: evidence from a paired associate and feedback-based task. Neuropsychologia 2012; 51:79-90. [PMID: 23127795 DOI: 10.1016/j.neuropsychologia.2012.10.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
Abstract
Though aphasia is primarily characterized by impairments in the comprehension and/or expression of language, research has shown that patients with aphasia also show deficits in cognitive-linguistic domains such as attention, executive function, concept knowledge and memory. Research in aphasia suggests that cognitive impairments can impact the online construction of language, new verbal learning, and transactional success. In our research, we extend this hypothesis to suggest that general cognitive deficits influence progress with therapy. The aim of our study is to explore learning, a cognitive process that is integral to relearning language, yet underexplored in the field of aphasia rehabilitation. We examine non-linguistic category learning in patients with aphasia (n=19) and in healthy controls (n=12), comparing feedback and non-feedback based instruction. Participants complete two computer-based learning tasks that require them to categorize novel animals based on the percentage of features shared with one of two prototypes. As hypothesized, healthy controls showed successful category learning following both methods of instruction. In contrast, only 60% of our patient population demonstrated successful non-linguistic category learning. Patient performance was not predictable by standardized measures of cognitive ability. Results suggest that general learning is affected in aphasia and is a unique, important factor to consider in the field of aphasia rehabilitation.
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Affiliation(s)
- Sofia Vallila-Rohter
- Aphasia Research Laboratory, Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215, USA.
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67
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Wilson KR, O'Rourke H, Wozniak LA, Kostopoulos E, Marchand Y, Newman AJ. Changes in N400 topography following intensive speech language therapy for individuals with aphasia. BRAIN AND LANGUAGE 2012; 123:94-103. [PMID: 22944529 DOI: 10.1016/j.bandl.2012.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 06/18/2012] [Accepted: 06/23/2012] [Indexed: 06/01/2023]
Abstract
Our goal was to characterize the effects of intensive aphasia therapy on the N400, an electrophysiological index of lexical-semantic processing. Immediately before and after 4 weeks of intensive speech-language therapy, people with aphasia performed a task in which they had to determine whether spoken words were a 'match' or a 'mismatch' to pictures of objects. Pre-therapy, people with aphasia exhibited an N400 mismatch effect that started over right hemisphere electrodes. Post-therapy, gains were seen in clinical measures of language ability, and the onset of the N400 was left-lateralized. No changes in the scalp distribution of the N400 were observed in healthy controls tested twice over the same 4 week interval. Since the distribution of the N400 after aphasia therapy differed from that of healthy controls, we conclude that it reflects the engagement of compensatory neural mechanisms for language processing rather than a return to a "normal" pattern of brain activation.
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Affiliation(s)
- K Ryan Wilson
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
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68
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Rapp B, Caplan D, Edwards S, Visch-Brink E, Thompson CK. Neuroimaging in aphasia treatment research: issues of experimental design for relating cognitive to neural changes. Neuroimage 2012; 73:200-7. [PMID: 22974976 DOI: 10.1016/j.neuroimage.2012.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 07/31/2012] [Accepted: 09/05/2012] [Indexed: 11/16/2022] Open
Abstract
The design of functional neuroimaging studies investigating the neural changes that support treatment-based recovery of targeted language functions in acquired aphasia faces a number of challenges. In this paper, we discuss these challenges and focus on experimental tasks and experimental designs that can be used to address the challenges, facilitate the interpretation of results and promote integration of findings across studies.
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Affiliation(s)
- Brenda Rapp
- Johns Hopkins University, Department of Cognitive Science, Baltimore, MD, USA.
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69
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Heath S, McMahon KL, Nickels L, Angwin A, Macdonald AD, van Hees S, Johnson K, McKinnon E, Copland DA. Neural mechanisms underlying the facilitation of naming in aphasia using a semantic task: an fMRI study. BMC Neurosci 2012; 13:98. [PMID: 22882806 PMCID: PMC3477078 DOI: 10.1186/1471-2202-13-98] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/01/2012] [Indexed: 11/10/2022] Open
Abstract
Background Previous attempts to investigate the effects of semantic tasks on picture naming in both healthy controls and people with aphasia have typically been confounded by inclusion of the phonological word form of the target item. As a result, it is difficult to isolate any facilitatory effects of a semantically-focused task to either lexical-semantic or phonological processing. This functional magnetic resonance imaging (fMRI) study examined the neurological mechanisms underlying short-term (within minutes) and long-term (within days) facilitation of naming from a semantic task that did not include the phonological word form, in both participants with aphasia and age-matched controls. Results Behavioral results showed that a semantic task that did not include the phonological word form can successfully facilitate subsequent picture naming in both healthy controls and individuals with aphasia. The whole brain neuroimaging results for control participants identified a repetition enhancement effect in the short-term, with modulation of activity found in regions that have not traditionally been associated with semantic processing, such as the right lingual gyrus (extending to the precuneus) and the left inferior occipital gyrus (extending to the fusiform gyrus). In contrast, the participants with aphasia showed significant differences in activation over both the short- and the long-term for facilitated items, predominantly within either left hemisphere regions linked to semantic processing or their right hemisphere homologues. Conclusions For control participants in this study, the short-lived facilitation effects of a prior semantic task that did not include the phonological word form were primarily driven by object priming and episodic memory mechanisms. However, facilitation effects appeared to engage a predominantly semantic network in participants with aphasia over both the short- and the long-term. The findings of the present study also suggest that right hemisphere involvement may be supportive rather than maladaptive, and that a large distributed perisylvian network in both cerebral hemispheres supports the facilitation of naming in individuals with aphasia.
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Affiliation(s)
- Shiree Heath
- University of Queensland, Language Neuroscience Laboratory, Centre for Clinical Research, Brisbane, Queensland, Australia.
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70
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Kurland J, Pulvermüller F, Silva N, Burke K, Andrianopoulos M. Constrained versus unconstrained intensive language therapy in two individuals with chronic, moderate-to-severe aphasia and apraxia of speech: behavioral and fMRI outcomes. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2012; 21:S65-S87. [PMID: 22294409 DOI: 10.1044/1058-0360(2012/11-0113)] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE This Phase I study investigated behavioral and functional MRI (fMRI) outcomes of 2 intensive treatment programs to improve naming in 2 participants with chronic moderate-to-severe aphasia with comorbid apraxia of speech (AOS). Constraint-induced aphasia therapy (CIAT; Pulvermüller et al., 2001) has demonstrated positive outcomes in some individuals with chronic aphasia. Whether constraint to the speech modality or treatment intensity is responsible for such gains is still under investigation. Moreover, it remains to be seen whether CIAT is effective in individuals with persistent severe nonfluent speech and/or AOS. METHOD A single-subject multiple-baseline approach was used. Both participants were treated simultaneously, first with Promoting Aphasics' Communicative Effectiveness (PACE; Davis & Wilcox, 1985) and then with CIAT. Pre-/posttreatment testing included an overt naming fMRI protocol. Treatment effect sizes were calculated for changes in probe accuracy from baseline to posttreatment phases and maintenance where available. RESULTS Both participants made more and faster gains in naming following CIAT. Treatment-induced changes in BOLD activation suggested that better naming was correlated with the recruitment of perilesional tissue. CONCLUSION Participants produced more target words accurately following CIAT than following PACE. Behavioral and fMRI results support the notion that the intense and repetitive nature of obligatory speech production in CIAT has a positive effect on word retrieval, even in participants with chronic moderate-to-severe aphasia with comorbid AOS.
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71
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Shin J, Yang E, Cho K, Barcenas CL, Kim WJ, Min Y, Paik NJ. Clinical application of repetitive transcranial magnetic stimulation in stroke rehabilitation. Neural Regen Res 2012; 7:627-34. [PMID: 25745455 PMCID: PMC4346989 DOI: 10.3969/j.issn.1673-5374.2012.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 02/03/2012] [Indexed: 11/12/2022] Open
Abstract
Proper stimulation to affected cerebral hemisphere would promote the functional recovery of patients with stroke. Effects of repetitive transcranial magnetic stimulation on cortical excitability can be can be altered by the stimulation frequency, intensity and duration. There has been no consistent recognition regarding the best stimulation frequency and intensity. This study reviews the intervention effects of repetitive transcranial stimulation on motor impairment, dysphagia, visuospatial neglect and aphasia, and summarizes the stimulation frequency, intensity and area for repetitive transcranial magnetic stimulation to yield the best therapeutic effects.
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Affiliation(s)
- Joonho Shin
- Department of Rehabilitation Medicine, Bundang Hospital, College of Medicine, Seoul National University, Seongnam 463-707, Republic of Korea
| | - EunJoo Yang
- Department of Rehabilitation Medicine, Bundang Hospital, College of Medicine, Seoul National University, Seongnam 463-707, Republic of Korea
| | - KyeHee Cho
- Department of Rehabilitation Medicine, Bundang Hospital, College of Medicine, Seoul National University, Seongnam 463-707, Republic of Korea
| | - Carmelo L Barcenas
- Department of Rehabilitation Medicine, Bundang Hospital, College of Medicine, Seoul National University, Seongnam 463-707, Republic of Korea
| | - Woo Jin Kim
- Department of Rehabilitation Medicine, Bundang Hospital, College of Medicine, Seoul National University, Seongnam 463-707, Republic of Korea
| | - Yusun Min
- Department of Rehabilitation Medicine, Bundang Hospital, College of Medicine, Seoul National University, Seongnam 463-707, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Bundang Hospital, College of Medicine, Seoul National University, Seongnam 463-707, Republic of Korea,
Corresponding author: Nam-Jong Paik, Department of Rehabilitation Medicine, Bundang Hospital, College of Medicine, Seoul National University, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea (NY20111011004/H)
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72
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Meinzer M, Rodriguez AD, Gonzalez Rothi LJ. First decade of research on constrained-induced treatment approaches for aphasia rehabilitation. Arch Phys Med Rehabil 2012; 93:S35-45. [PMID: 22202189 DOI: 10.1016/j.apmr.2011.06.040] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 04/27/2011] [Accepted: 06/27/2011] [Indexed: 12/28/2022]
Abstract
Approaches for treating poststroke language impairments (aphasia) based on constraint-induced (CI) principles were first introduced in 2001. CI principles as previously applied to upper extremity and locomotor retraining in stroke survivors were derived from basic neuroscience. They comprise forced-use of the affected modality, a gradual rebuilding of targeted functions using a highly intensive treatment protocol, administered in a behaviorally relevant context. CI-based approaches have stimulated considerable neurorehabilitation research interest in the past decade. The original CI aphasia treatment protocol was tailored to improve functional communication in chronic aphasia (ie, 6-12mo after stroke) and more recently, it has been adapted to treat language impairments in acute stroke survivors as well. Moreover, CI therapy applied to aphasia has been used as a model to assess language network plasticity in response to treatment using functional imaging techniques. In the following article, we review the first 10 years of behavioral and functional brain imaging research on CI-based approaches for aphasia rehabilitation.
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Affiliation(s)
- Marcus Meinzer
- Department of Neurology, Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite, Universitätsmedizin Berlin, Berlin, Germany.
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73
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Malá H, Rodríguez Castro M, Pearce H, Kingod SC, Nedergaard SK, Scharff Z, Zandersen M, Mogensen J. Delayed intensive acquisition training alleviates the lesion-induced place learning deficits after fimbria-fornix transection in the rat. Brain Res 2012; 1445:40-51. [PMID: 22322151 DOI: 10.1016/j.brainres.2012.01.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 01/03/2012] [Accepted: 01/14/2012] [Indexed: 10/14/2022]
Abstract
This study evaluates the effects of two learning paradigms, intensive vs. baseline, on the posttraumatic acquisition of a water maze based place learning task. Rats were subjected either to a control operation (Sham) or to a fimbria-fornix (FF) transection, which renders the hippocampus dysfunctional and disrupts the acquisition of allocentric place learning. All animals were administered 30 post-lesion acquisition sessions, which spanned either 10 or 30days. The acquisition period was followed by a 7day pause after which a retention probe was administered. The lesioned animals were divided into 3 groups: i) Baseline Acquisition Paradigm (BAP) once daily for 30days starting 1week post-surgery; ii) Early Intensive Acquisition Paradigm (EIAP) 3 times daily for 10days starting 1week post-surgery; and iii) Late Intensive Acquisition Paradigm (LIAP) 3 times daily for 10days starting 3weeks post-surgery. Within the control animals, one group followed the schedule of BAP, and one group followed the schedule of Intensive Acquisition Paradigm (IAP). All lesioned animals showed an impaired task acquisition. LIAP was beneficial in FF animals, in that it led to a better acquisition of the place learning task than the two other acquisition paradigms. The FF/EIAP group did not show improved acquisition compared to the FF/BAP group. The control animals were not differentially affected by the two learning schedules. The findings have implications for cognitive rehabilitation after brain injury and support the assumption that intensive treatment can lead to an improved learning, even when the neural structures underlying such a process are compromised. However, the timing of intensive treatment needs to be considered further.
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Affiliation(s)
- Hana Malá
- The Unit for Cognitive Neuroscience, Department of Psychology, University of Copenhagen, Denmark
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74
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Neurobiology of Language Recovery After Stroke: Lessons From Neuroimaging Studies. Arch Phys Med Rehabil 2012; 93:S15-25. [PMID: 22202187 DOI: 10.1016/j.apmr.2011.03.036] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 11/24/2022]
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75
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Pure left hippocampal stroke: a transient global amnesia-plus syndrome. J Neurol 2011; 259:989-92. [DOI: 10.1007/s00415-011-6296-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/12/2011] [Accepted: 10/15/2011] [Indexed: 11/27/2022]
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76
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Cappa SF. The neural basis of aphasia rehabilitation: Evidence from neuroimaging and neurostimulation. Neuropsychol Rehabil 2011; 21:742-54. [DOI: 10.1080/09602011.2011.614724] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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77
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Cherney LR, Patterson JP, Raymer AM. Intensity of Aphasia Therapy: Evidence and Efficacy. Curr Neurol Neurosci Rep 2011; 11:560-9. [DOI: 10.1007/s11910-011-0227-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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78
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Elkana O, Frost R, Kramer U, Ben-Bashat D, Schweiger A. Cerebral language reorganization in the chronic stage of recovery: a longitudinal fMRI study. Cortex 2011; 49:71-81. [PMID: 21983479 DOI: 10.1016/j.cortex.2011.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 05/14/2011] [Accepted: 08/19/2011] [Indexed: 11/18/2022]
Abstract
The goal of the present study was to investigate whether spontaneous functional recovery following insult to the language-dominant hemisphere continues in the so-called "chronic stage," and if so, to examine its neuro-functional correlates. We used a longitudinal functional magnetic resonance imaging (fMRI) block design, where each young patient served as his/her own control. Specifically, we examined whether language functions differed significantly in two monitoring sessions conducted years apart, both in the chronic stage, where almost no functional changes are expected. We focused on a unique cohort of young brain damaged patients with aphasiogenic lesions occurring after normal language acquisition, in order to maximize the potential of plasticity for language reorganization following brain damage. The most striking finding was that the linguistic recovery of our patients was significant not just relative to their linguistic scores on initial testing (T1), but also in absolute terms, relative to the respective age-matched normal population. Such improvement, therefore, cannot be simply attributed to the natural process of development. Overall, we found that right hemisphere (RH) activation was associated with better recovery in the chronic stage. Our longitudinal findings may challenge the view of recovery as ending within the first year following onset, suggesting that the RH may provide the substrate for ongoing plasticity in the damaged brain.
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Affiliation(s)
- Odelia Elkana
- Psychology Department, Hebrew University, Jerusalem, Israel.
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79
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Drug Therapy of Post-Stroke Aphasia: A Review of Current Evidence. Neuropsychol Rev 2011; 21:302-17. [DOI: 10.1007/s11065-011-9177-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/27/2011] [Indexed: 11/26/2022]
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80
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Flöel A, Meinzer M, Kirstein R, Nijhof S, Deppe M, Knecht S, Breitenstein C. Short-Term Anomia Training and Electrical Brain Stimulation. Stroke 2011; 42:2065-7. [PMID: 21636820 DOI: 10.1161/strokeaha.110.609032] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Language training success in chronic aphasia remains only moderate. Electric brain stimulation may be a viable way to enhance treatment efficacy.
Methods—
In a randomized, double-blind, sham-controlled crossover trial, we assessed if anodal transcranial direct current stimulation compared to cathodal transcranial direct current stimulation and sham stimulation over the right temporo-parietal cortex would improve the success of short-term high-frequency anomia training. Twelve chronic poststroke aphasia patients were studied. Naming outcome was assessed after training and 2 weeks later.
Results—
All training conditions led to a significant increase in naming ability, which was retained for at least 2 weeks after the end of the training. Application of anodal transcranial direct current stimulation significantly enhanced the overall training effect compared to sham stimulation. Baseline naming ability significantly predicted anodal transcranial direct current stimulation effects.
Conclusions—
Anodal transcranial direct current stimulation applied over the nonlanguage dominant hemisphere can enhance language training outcome in chronic aphasia.
Clinical Trial Registration—
URL:
www.clinicaltrials.gov/
. Unique identifier: NCT00822068.
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Affiliation(s)
- Agnes Flöel
- From the Department of Neurology (A.F., M.M.), Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite Universitätsmedizin, Berlin, Germany; Department of Neurology (A.F., R.K., S.N., M.D., S.K., C.B.), University of Münster, Münster, Germany
| | - Marcus Meinzer
- From the Department of Neurology (A.F., M.M.), Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite Universitätsmedizin, Berlin, Germany; Department of Neurology (A.F., R.K., S.N., M.D., S.K., C.B.), University of Münster, Münster, Germany
| | - Robert Kirstein
- From the Department of Neurology (A.F., M.M.), Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite Universitätsmedizin, Berlin, Germany; Department of Neurology (A.F., R.K., S.N., M.D., S.K., C.B.), University of Münster, Münster, Germany
| | - Sarah Nijhof
- From the Department of Neurology (A.F., M.M.), Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite Universitätsmedizin, Berlin, Germany; Department of Neurology (A.F., R.K., S.N., M.D., S.K., C.B.), University of Münster, Münster, Germany
| | - Michael Deppe
- From the Department of Neurology (A.F., M.M.), Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite Universitätsmedizin, Berlin, Germany; Department of Neurology (A.F., R.K., S.N., M.D., S.K., C.B.), University of Münster, Münster, Germany
| | - Stefan Knecht
- From the Department of Neurology (A.F., M.M.), Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite Universitätsmedizin, Berlin, Germany; Department of Neurology (A.F., R.K., S.N., M.D., S.K., C.B.), University of Münster, Münster, Germany
| | - Caterina Breitenstein
- From the Department of Neurology (A.F., M.M.), Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite Universitätsmedizin, Berlin, Germany; Department of Neurology (A.F., R.K., S.N., M.D., S.K., C.B.), University of Münster, Münster, Germany
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81
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Meinzer M, Harnish S, Conway T, Crosson B. Recent developments in functional and structural imaging of aphasia recovery after stroke. APHASIOLOGY 2011; 25:271-290. [PMID: 21532927 PMCID: PMC3083028 DOI: 10.1080/02687038.2010.530672] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND: Functional and structural neuroimaging techniques can increase our knowledge about the neural processes underlying recovery from post-stroke language impairments (aphasia). AIMS: In the present review we highlight recent developments in neuroimaging research of aphasia recovery. MAIN CONTRIBUTION: We review (a) cross-sectional findings in aphasia with regard to local brain functions and functional connectivity, (b) structural and functional imaging findings using longitudinal (intervention) paradigms, (c) new adjunct treatments that are guided by functional imaging techniques (e.g., electrical brain stimulation) and (d) studies related to the prognosis of language recovery and treatment responsiveness after stroke. CONCLUSIONS: More recent developments in data acquisition and analysis foster better understanding and more realistic modelling of the neural substrates of language recovery after stroke. Moreover, the combination of different neuroimaging protocols can provide converging evidence for neuroplastic brain remodelling during spontaneous and treatment-induced recovery. Researchers are also beginning to use sophisticated imaging analyses to improve accuracy of prognosis, which may eventually improve patient care by allowing for more efficient treatment planning. Brain stimulation techniques offer a new and exciting way to improve the recovery potential after stroke.
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Affiliation(s)
- Marcus Meinzer
- Department of Neurology, Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite, Universitätsmedizin Berlin, Berlin, Germany
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Stacy Harnish
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Tim Conway
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Bruce Crosson
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
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82
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Berthier ML, Pulvermüller F. Neuroscience insights improve neurorehabilitation of poststroke aphasia. Nat Rev Neurol 2011; 7:86-97. [PMID: 21297651 DOI: 10.1038/nrneurol.2010.201] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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83
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Integrity of the hippocampus and surrounding white matter is correlated with language training success in aphasia. Neuroimage 2010; 53:283-90. [PMID: 20541018 DOI: 10.1016/j.neuroimage.2010.06.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 05/29/2010] [Accepted: 06/03/2010] [Indexed: 11/22/2022] Open
Abstract
Aphasia after middle cerebral artery (MCA) stroke shows highly variable degrees of recovery. One possible explanation may be offered by the variability of the occlusion location. Branches from the proximal portion of the MCA often supply the mesial temporal lobe including parts of the hippocampus, a structure known to be involved in language learning. Therefore, we assessed whether language recovery in chronic aphasia is dependent on the proximity of the MCA infarct and correlated with the integrity of the hippocampus and its surrounding white matter. Language reacquisition capability was determined after 2weeks of intensive language therapy and 8months after treatment in ten chronic aphasia patients. Proximity of MCA occlusion relative to the internal carotid artery was determined by magnetic resonance imaging (MRI) based on the most proximal anatomical region infarcted. Structural damage to the hippocampus was assessed by MRI-based volumetry, regional microstructural integrity of hippocampus adjacent white matter by fractional anisotropy. Language learning success for trained materials was correlated with the proximity of MCA occlusion, microstructural integrity of the left hippocampus and its surrounding white matter, but not with lesion size, overall microstructural brain integrity and a control region outside of the MCA territory. No correlations were found for untrained language materials, underlining the specificity of our results for training-induced recovery. Our results suggest that intensive language therapy success in chronic aphasia after MCA stroke is critically dependent on damage to the hippocampus and its surrounding structures.
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