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Szaflarski JP, Allendorfer JB, Byars AW, Vannest J, Dietz A, Hernando KA, Holland SK. Age at stroke determines post-stroke language lateralization. Restor Neurol Neurosci 2015; 32:733-42. [PMID: 25159870 DOI: 10.3233/rnn-140402] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine how age at the time of left middle cerebral artery stroke affects language lateralization in a combined sample of subjects with perinatal, childhood, and adult stroke. METHODS 19 participants who had perinatal stroke (<1 month of age), 32 with later stroke, and 51 sex-/age-matched healthy controls (HCs) received fMRI of language using verb generation task (VGT). RESULTS Percent lesion volumes were not different between groups (perinatal vs. late stroke) when taking brain volume into account (p = 0.084). Perinatal stroke group showed bilateral signal increases compared to more left-lateralized signals in matched HCs; late stroke group and HCs both showed left-hemispheric signal increases. LIs in the stroke groups were consistently more bilateral than in HCs (all p < 0.008) except for the late group's posterior LI (p = 0.080). There was greater proportion of leftward language lateralization in HCs compared to their respective stroke groups (78.9% vs. 31.6% in perinatal; 87.5% vs. 59.4% in late stroke; p = 0.004) and a larger proportion of leftward lateralization in late compared to perinatal stroke (p = 0.039). The age of stroke occurrence showed significant positive associations with global and frontal LI (both p ≤ 0.007). CONCLUSION As expected, the age of stroke occurrence affects subsequent verb generation lateralization. Greater cortical plasticity is observed in earlier stroke while later stroke is associated with reliance on the repair of the previously damaged left-hemispheric networks.
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Affiliation(s)
- J P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A W Byars
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Vannest
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - A Dietz
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - K A Hernando
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - S K Holland
- Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Vannest J, Maloney T, Kay B, Siegel M, Allendorfer JB, Banks C, Altaye M, Szaflarski JP. Age related-changes in the neural basis of self-generation in verbal paired associate learning. NEUROIMAGE-CLINICAL 2015; 7:537-46. [PMID: 25844310 PMCID: PMC4375642 DOI: 10.1016/j.nicl.2015.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/26/2014] [Accepted: 02/17/2015] [Indexed: 12/04/2022]
Abstract
Verbal information is better retained when it is self-generated rather than when it is received passively. The application of self-generation procedures has been found to improve memory in healthy elderly and in individuals with impaired cognition. Overall, the available studies support the notion that active participation in verbal encoding engages memory mechanisms that supplement those used during passive observation. Thus, the objective of this study was to investigate the age-related changes in the neural mechanisms involved in the encoding of paired-associates using a self-generation method that has been shown to improve memory performance across the lifespan. Subjects were 113 healthy right-handed adults (Edinburgh Handedness Inventory >50; 67 females) ages 18–76, native speakers of English with no history of neurological or psychiatric disorders. Subjects underwent fMRI at 3 T while performing didactic learning (“read”) or self-generation learning (“generate”) of 30 word pairs per condition. After fMRI, recognition memory for the second word in each pair was evaluated outside of the scanner. On the post-fMRI testing more “generate” words were correctly recognized than “read” words (p < 0.001) with older adults recognizing the “generated” words less accurately (p < 0.05). Independent component analysis of fMRI data identified task-related brain networks. Several components were positively correlated with the task reflecting multiple cognitive processes involved in self-generated encoding; other components correlated negatively with the task, including components of the default-mode network. Overall, memory performance on generated words decreased with age, but the benefit from self-generation remained consistently significant across ages. Independent component analysis of the neuroimaging data revealed an extensive set of components engaged in self-generation learning compared with didactic learning, and identified areas that were associated with age-related changes independent of performance. Verbal information is better retained when self-generated vs. received passively. Application of self-generation is associated with better retention across ages. Generated words were retained better than read words. Several components of network for word generation were identified. Age-associated changes within the network are discussed.
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Affiliation(s)
- Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Thomas Maloney
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Benjamin Kay
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Miriam Siegel
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA ; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christi Banks
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Mekibib Altaye
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA ; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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The importance of premotor cortex for supporting speech production after left capsular-putaminal damage. J Neurosci 2015; 34:14338-48. [PMID: 25339747 DOI: 10.1523/jneurosci.1954-14.2014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The left putamen is known to be important for speech production, but some patients with left putamen damage can produce speech remarkably well. We investigated the neural mechanisms that support this recovery by using a combination of techniques to identify the neural regions and pathways that compensate for loss of the left putamen during speech production. First, we used fMRI to identify the brain regions that were activated during reading aloud and picture naming in a patient with left putamen damage. This revealed that the patient had abnormally high activity in the left premotor cortex. Second, we used dynamic causal modeling of the patient's fMRI data to understand how this premotor activity influenced other speech production regions and whether the same neural pathway was used by our 24 neurologically normal control subjects. Third, we validated the compensatory relationship between putamen and premotor cortex by showing, in the control subjects, that lower connectivity through the putamen increased connectivity through premotor cortex. Finally, in a lesion-deficit analysis, we demonstrate the explanatory power of our fMRI results in new patients who had damage to the left putamen, left premotor cortex, or both. Those with damage to both had worse reading and naming scores. The results of our four-pronged approach therefore have clinical implications for predicting which patients are more or less likely to recover their speech after left putaminal damage.
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Zweckberger K, Juettler E, Bösel J, Unterberg WA. Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review. Cerebrovasc Dis 2014; 38:313-23. [DOI: 10.1159/000365864] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/02/2014] [Indexed: 11/19/2022] Open
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Geranmayeh F, Brownsett SLE, Wise RJS. Task-induced brain activity in aphasic stroke patients: what is driving recovery? Brain 2014; 137:2632-48. [PMID: 24974382 PMCID: PMC4163030 DOI: 10.1093/brain/awu163] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/03/2014] [Accepted: 04/27/2014] [Indexed: 12/24/2022] Open
Abstract
The estimated prevalence of aphasia in the UK and the USA is 250 000 and 1 000 000, respectively. The commonest aetiology is stroke. The impairment may improve with behavioural therapy, and trials using cortical stimulation or pharmacotherapy are undergoing proof-of-principle investigation, but with mixed results. Aphasia is a heterogeneous syndrome, and the simple classifications according to the Broca-Wernicke-Lichtheim model inadequately describe the diverse communication difficulties with which patients may present. Greater knowledge of how intact neural networks promote recovery after aphasic stroke, either spontaneously or in response to interventions, will result in clearer hypotheses about how to improve the treatment of aphasia. Twenty-five years ago, a pioneering study on healthy participants heralded the introduction of functional neuroimaging to the study of mechanisms of recovery from aphasia. Over the ensuing decades, such studies have been interpreted as supporting one of three hypotheses, which are not mutually exclusive. The first two predate the introduction of functional neuroimaging: that recovery is the consequence of the reconstitution of domain-specific language systems in tissue around the lesion (the 'perilesional' hypothesis), or by homotopic cortex in the contralateral hemisphere (the 'laterality-shift' hypothesis). The third is that loss of transcallosal inhibition to contralateral homotopic cortex hinders recovery (the 'disinhibition' hypothesis). These different hypotheses at times give conflicting views about rehabilitative intervention; for example, should one attempt to activate or inhibit a contralateral homotopic region with cortical stimulation techniques to promote recovery? This review proposes that although the functional imaging data are statistically valid in most cases, their interpretation has often favoured one explanation while ignoring plausible alternatives. In our view, this is particularly evident when recovery is attributed to activity in 'language networks' occupying sites not observed in healthy participants. In this review we will argue that much of the distribution of what has often been interpreted as language-specific activity, particularly in midline and contralateral cortical regions, is an upregulation of activity in intact domain-general systems for cognitive control and attention, responding in a task-dependent manner to the increased 'effort' when damaged downstream domain-specific language networks are impaired. We further propose that it is an inability fully to activate these systems that may result in sub optimal recovery in some patients. Interpretation of the data in terms of activity in domain-general networks affords insights into novel approaches to rehabilitation.
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Affiliation(s)
- Fatemeh Geranmayeh
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Sonia L E Brownsett
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Richard J S Wise
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
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de Mendonça LIZ. Transcranial brain stimulation (TMS and tDCS) for post-stroke aphasia rehabilitation: Controversies. Dement Neuropsychol 2014; 8:207-215. [PMID: 29213905 PMCID: PMC5619396 DOI: 10.1590/s1980-57642014dn83000003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Transcranial brain stimulation (TS) techniques have been investigated for use in
the rehabilitation of post-stroke aphasia. According to previous reports,
functional recovery by the left hemisphere improves recovery from aphasia, when
compared with right hemisphere participation. TS has been applied to stimulate
the activity of the left hemisphere or to inhibit homotopic areas in the right
hemisphere. Various factors can interfere with the brain's response to TS,
including the size and location of the lesion, the time elapsed since the causal
event, and individual differences in the hemispheric language dominance pattern.
The following questions are discussed in the present article: [a] Is inhibition of the right hemisphere truly beneficial?; [b] Is the transference of the language network to the left
hemisphere truly desirable in all patients?; [c] Is the use of TS during the post-stroke subacute phase truly
appropriate? Different patterns of neuroplasticity must occur in
post-stroke aphasia.
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Schönberger E, Heim S, Meffert E, Pieperhoff P, da Costa Avelar P, Huber W, Binkofski F, Grande M. The neural correlates of agrammatism: Evidence from aphasic and healthy speakers performing an overt picture description task. Front Psychol 2014; 5:246. [PMID: 24711802 PMCID: PMC3968764 DOI: 10.3389/fpsyg.2014.00246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/05/2014] [Indexed: 11/22/2022] Open
Abstract
Functional brain imaging studies have improved our knowledge of the neural localization of language functions and the functional reorganization after a lesion. However, the neural correlates of agrammatic symptoms in aphasia remain largely unknown. The present fMRI study examined the neural correlates of morpho-syntactic encoding and agrammatic errors in continuous language production by combining three approaches. First, the neural mechanisms underlying natural morpho-syntactic processing in a picture description task were analyzed in 15 healthy speakers. Second, agrammatic-like speech behavior was induced in the same group of healthy speakers to study the underlying functional processes by limiting the utterance length. In a third approach, five agrammatic participants performed the picture description task to gain insights in the neural correlates of agrammatism and the functional reorganization of language processing after stroke. In all approaches, utterances were analyzed for syntactic completeness, complexity, and morphology. Event-related data analysis was conducted by defining every clause-like unit (CLU) as an event with its onset-time and duration. Agrammatic and correct CLUs were contrasted. Due to the small sample size as well as heterogeneous lesion sizes and sites with lesion foci in the insula lobe, inferior frontal, superior temporal and inferior parietal areas the activation patterns in the agrammatic speakers were analyzed on a single subject level. In the group of healthy speakers, posterior temporal and inferior parietal areas were associated with greater morpho-syntactic demands in complete and complex CLUs. The intentional manipulation of morpho-syntactic structures and the omission of function words were associated with additional inferior frontal activation. Overall, the results revealed that the investigation of the neural correlates of agrammatic language production can be reasonably conducted with an overt language production paradigm.
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Affiliation(s)
- Eva Schönberger
- Section Neurological Cognition Research, Department of Neurology, Uniklinik RWTH Aachen Aachen, Germany
| | - Stefan Heim
- Section Neurological Cognition Research, Department of Neurology, Uniklinik RWTH Aachen Aachen, Germany ; Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen Aachen, Germany ; Research Centre Juelich, Institute of Neuroscience and Medicine (INM-1) Juelich, Germany
| | - Elisabeth Meffert
- Section Neurological Cognition Research, Department of Neurology, Uniklinik RWTH Aachen Aachen, Germany ; Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen Aachen, Germany
| | - Peter Pieperhoff
- Research Centre Juelich, Institute of Neuroscience and Medicine (INM-1) Juelich, Germany
| | - Patricia da Costa Avelar
- Section Neurological Cognition Research, Department of Neurology, Uniklinik RWTH Aachen Aachen, Germany
| | - Walter Huber
- Section Neurological Cognition Research, Department of Neurology, Uniklinik RWTH Aachen Aachen, Germany
| | - Ferdinand Binkofski
- Section Neurological Cognition Research, Department of Neurology, Uniklinik RWTH Aachen Aachen, Germany
| | - Marion Grande
- Section Neurological Cognition Research, Department of Neurology, Uniklinik RWTH Aachen Aachen, Germany
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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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Jarso S, Li M, Faria A, Davis C, Leigh R, Sebastian R, Tsapkini K, Mori S, Hillis AE. Distinct mechanisms and timing of language recovery after stroke. Cogn Neuropsychol 2014; 30:454-75. [PMID: 24472056 PMCID: PMC3979443 DOI: 10.1080/02643294.2013.875467] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The "language network" is remarkably stable across language tasks but changes in response to injury to specific components or in response to "disconnection" of input to one component. We investigated network changes during language recovery, hypothesizing that language recovery takes place through distinct mechanisms: (a) reperfusion; (b) recovery from diaschisis; (c) recovery from structural disconnection; and (d) "reorganization" of language, whereby various components assume function of a damaged component. We also tested the hypothesis that "reorganization" depends on: the language task, level of performance, size and site of stroke, and time post onset. We tested these hypotheses in five participants who had structural, perfusion, and functional imaging utilizing spelling, reading, word generation, and picture naming tasks at acute and subsequent stages after ischaemic stroke. These cases illustrate different mechanisms of aphasia recovery or illustrate that reorganization of language acutely depends on individual variables in addition to size and site of stroke.
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Affiliation(s)
- Samson Jarso
- a Russell H. Morgan Department of Radiology and Radiological Science , The Johns Hopkins University School of Medicine , Baltimore , MA , USA
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Shah PP, Szaflarski JP, Allendorfer J, Hamilton RH. Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation. Front Hum Neurosci 2013; 7:888. [PMID: 24399952 PMCID: PMC3870921 DOI: 10.3389/fnhum.2013.00888] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/05/2013] [Indexed: 11/13/2022] Open
Abstract
Stroke victims tend to prioritize speaking, writing, and walking as the three most important rehabilitation goals. Of note is that two of these goals involve communication. This underscores the significance of developing successful approaches to aphasia treatment for the several hundred thousand new aphasia patients each year and over 1 million stroke survivors with chronic aphasia in the U.S. alone. After several years of growth as a research tool, non-invasive brain stimulation (NBS) is gradually entering the arena of clinical aphasiology. In this review, we first examine the current state of knowledge of post-stroke language recovery including the contributions from the dominant and non-dominant hemispheres. Next, we briefly discuss the methods and the physiologic basis of the use of inhibitory and excitatory repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) as research tools in patients who experience post-stroke aphasia. Finally, we provide a critical review of the most influential evidence behind the potential use of these two brain stimulation methods as clinical rehabilitative tools.
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Affiliation(s)
- Priyanka P Shah
- Department of Neurology, University of Pennsylvania Philadelphia, PA, USA ; Laboratory for Cognition and Neural Stimulation, Center for Cognitive Neuroscience, University of Pennsylvania Philadelphia, PA, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Jane Allendorfer
- Department of Neurology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania Philadelphia, PA, USA ; Laboratory for Cognition and Neural Stimulation, Center for Cognitive Neuroscience, University of Pennsylvania Philadelphia, PA, USA
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Beisteiner R. Improving clinical fMRI: better paradigms or higher field strength? AJNR Am J Neuroradiol 2013; 34:1972-3. [PMID: 23928135 PMCID: PMC7965422 DOI: 10.3174/ajnr.a3722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- R Beisteiner
- Study Group Clinical fMRIDepartment of NeurologyHigh Field MR CenterMedical University of ViennaVienna, Austria
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Heiss WD, Hartmann A, Rubi-Fessen I, Anglade C, Kracht L, Kessler J, Weiduschat N, Rommel T, Thiel A. Noninvasive Brain Stimulation for Treatment of Right- and Left-Handed Poststroke Aphasics. Cerebrovasc Dis 2013; 36:363-72. [PMID: 24217362 DOI: 10.1159/000355499] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/05/2013] [Indexed: 11/19/2022] Open
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