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Fusco A, Giovannini S, Castelli L, Coraci D, Gatto DM, Reale G, Pastorino R, Padua L. Virtual Reality and Lower Limb Rehabilitation: Effects on Motor and Cognitive Outcome-A Crossover Pilot Study. J Clin Med 2022; 11:jcm11092300. [PMID: 35566424 PMCID: PMC9103855 DOI: 10.3390/jcm11092300] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 02/07/2023] Open
Abstract
The effectiveness of virtual reality (VR) in the motor and cognitive rehabilitation of patients with severe acquired brain injury (sABI) is unclear. This randomized, controlled, crossover, single-blinded, pilot study investigates the cognitive and motor effects of lower limb robotic therapy with and without VR visual feedback in a group of patients with ABI. A total of 23 patients with ABI were randomized into two groups: one group (VR-NVR) underwent a 2-week rehabilitation for the lower limbs training with a robotic device (Omego®) with VR feedback, followed by 2 weeks without VR; the other group (NVR-VR) performed the protocol in the opposite order. Patients were evaluated at baseline, after two and four weeks of treatment using the Level of Cognitive Functioning scale (LCF), Disability Rating Scale (DRS), and Motricity Index for Lower Limb (MI-LL) in the most affected limb. At the end of the intervention, both groups significantly improved in all the outcomes. A significant difference was found between VR treatment versus non-VR treatment for LCF (p = 0.024) and for DRS (p = 0.043) after the second week, while no significant differences were found in the group NVR-VR at T1. Our study indicates how the combination of robotic treatment with VR is effective in enhancing the recovery of cognitive function in patients with ABI, also improving disability and muscular function. Further, VR seems to enhance the early recovery process of motor and cognitive functions.
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Affiliation(s)
- Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Letizia Castelli
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-4382
| | - Daniele Coraci
- Dipartimento di Neuroscienze, Università di Padova, 35128 Padova, Italy;
| | - Dario Mattia Gatto
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giuseppe Reale
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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Gilmore N, Mirman D, Kiran S. Young Adults With Acquired Brain Injury Show Longitudinal Improvements in Cognition After Intensive Cognitive Rehabilitation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1494-1520. [PMID: 35290740 PMCID: PMC9499382 DOI: 10.1044/2021_jslhr-21-00324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE The aim of this study was to assess the effect of an intensive cognitive and communication rehabilitation (ICCR) program on language and other cognitive performance in young adults with acquired brain injury (ABI). METHOD Thirty young adults with chronic ABI participated in this study. Treatment participants (n = 22) attended ICCR 6 hours/day, 4 days/week for at least one 12-week semester. Deferred treatment/usual care control participants (n = 14) were evaluated before and after at least one 12-week semester. Pre- and postsemester standardized cognitive assessment items were assigned to subdomains. Between-groups and within-group generalized linear mixed-effects models assessed the effect of time point on overall item accuracy and differences by item subdomain. Subdomain analyses were adjusted for multiple comparisons. RESULTS Between-groups analyses revealed that treatment participants improved significantly faster over time than deferred treatment/usual care participants in overall item accuracy and specifically on items in the verbal expression subdomain. Investigating the three-way interaction between time point, group, and etiology revealed that the overall effects of the treatment were similar for individuals with nontraumatic and traumatic brain injuries. The treatment group showed an overall effect of treatment and significant gains over time in the verbal expression, written expression, memory, and problem solving subdomains. The control group did not significantly improve over time on overall item accuracy and showed significant subdomain-level gains in auditory comprehension, which did not survive correction. CONCLUSIONS Sustaining an ABI in young adulthood can significantly disrupt key developmental milestones, such as attending college and launching a career. This study provides strong evidence that integrating impairment-based retraining of language and other cognitive skills with "real-world" application in academically focused activities promotes gains in underlying cognitive processes that are important for academic success as measured by standardized assessment items. These findings may prompt a revision to the current continuum of rehabilitative care for young adults with ABI. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19320068.
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Affiliation(s)
- Natalie Gilmore
- Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences: Sargent College, Boston University, MA
| | - Daniel Mirman
- Department of Psychology, School of Philosophy, Psychology & Language Sciences, The University of Edinburgh, United Kingdom
| | - Swathi Kiran
- Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences: Sargent College, Boston University, MA
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Pasquini L, Di Napoli A, Rossi-Espagnet MC, Visconti E, Napolitano A, Romano A, Bozzao A, Peck KK, Holodny AI. Understanding Language Reorganization With Neuroimaging: How Language Adapts to Different Focal Lesions and Insights Into Clinical Applications. Front Hum Neurosci 2022; 16:747215. [PMID: 35250510 PMCID: PMC8895248 DOI: 10.3389/fnhum.2022.747215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
When the language-dominant hemisphere is damaged by a focal lesion, the brain may reorganize the language network through functional and structural changes known as adaptive plasticity. Adaptive plasticity is documented for triggers including ischemic, tumoral, and epileptic focal lesions, with effects in clinical practice. Many questions remain regarding language plasticity. Different lesions may induce different patterns of reorganization depending on pathologic features, location in the brain, and timing of onset. Neuroimaging provides insights into language plasticity due to its non-invasiveness, ability to image the whole brain, and large-scale implementation. This review provides an overview of language plasticity on MRI with insights for patient care. First, we describe the structural and functional language network as depicted by neuroimaging. Second, we explore language reorganization triggered by stroke, brain tumors, and epileptic lesions and analyze applications in clinical diagnosis and treatment planning. By comparing different focal lesions, we investigate determinants of language plasticity including lesion location and timing of onset, longitudinal evolution of reorganization, and the relationship between structural and functional changes.
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Affiliation(s)
- Luca Pasquini
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
- Radiology Department, Castelli Hospital, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Emiliano Visconti
- Neuroradiology Unit, Cesena Surgery and Trauma Department, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Kyung K. Peck
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrei I. Holodny
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
- Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, New York, NY, United States
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Gilbert C, Mooradian G, Citorik A, Gilmore N, Kiran S. Multi-level outcomes for young adults with acquired brain injury through a remote intensive cognitive rehabilitation approach: a pilot intervention study. Brain Inj 2022; 36:206-220. [PMID: 35188029 PMCID: PMC9124694 DOI: 10.1080/02699052.2022.2034961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate the effects of the Intensive Cognitive and Communication Rehabilitation (ICCR) program for young adults with acquired brain injury (ABI) using a quasi-experimental pilot intervention study design while transitioning to remote implementation. METHOD Twelve young adults with chronic ABI (treatment n = 7; control n = 5) participated in ICCR (i.e., lectures, seminars, individual cognitive rehabilitation (CR), technology training) for six hours/day, four days/week, for one or two 12-week semesters. Outcomes included classroom metrics, individual therapy performance, including Goal Attainment Scaling (GAS), standardized cognitive-linguistic assessments, and participation and health-related quality of life (QOL) measures. RESULTS In the first semester (in-person and remote), treatment participants significantly improved in classroom exams; individual therapy (i.e., memory, writing, GAS); executive function and participation measures, but not QOL. In the second semester (remote), treatment participants significantly improved in classroom exams; essay writing; individual therapy (i.e., writing and GAS); and memory assessment, but not in participation or QOL. Treatment participants enrolled in consecutive semesters significantly improved in classroom exams, individual therapy (i.e., memory), participation and QOL, but not on standardized cognitive assessments. Controls demonstrated no significant group-level gains. CONCLUSION These preliminary results highlight the benefit of intensive, integrated, and contextualized CR for this population and show promise for its remote delivery.
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Affiliation(s)
| | - Grace Mooradian
- Aphasia Research Laboratory, Boston University, Boston, Massachusetts, USA
| | - Anne Citorik
- Aphasia Research Laboratory, Boston University, Boston, Massachusetts, USA
| | - Natalie Gilmore
- Aphasia Research Laboratory, Boston University, Boston, Massachusetts, USA
| | - Swathi Kiran
- Aphasia Research Laboratory, Boston University, Boston, Massachusetts, USA
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Li R, Mukadam N, Kiran S. Functional MRI evidence for reorganization of language networks after stroke. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:131-150. [PMID: 35078595 DOI: 10.1016/b978-0-12-823384-9.00007-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this chapter, we review fMRI evidence for language reorganization in individuals with poststroke aphasia. Several studies in the current literature have utilized fMRI as a tool to understand patterns of functional reorganization in poststroke aphasia. Consistent with previous models that have been proposed to explain the trajectory of language recovery, differential patterns of language processing and language recovery have been identified across individuals with poststroke aphasia in different stages of recovery. Overall, a global network breakdown typically occurs in the early stages of aphasia recovery, followed by normalization in "traditional" left hemisphere language networks. Depending on individual characteristics, right hemisphere regions and bilateral domain-general regions may be further recruited. The main takeaway of this chapter is that poststroke aphasia recovery does not depend on individual neural regions, but rather involves a complex interaction among regions in larger networks. Many of the unresolved issues and contrastive findings in the literature warrant further research with larger groups of participants and standard protocols of fMRI implementation.
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Affiliation(s)
- Ran Li
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Nishaat Mukadam
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Swathi Kiran
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States.
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Cherney LR, Carpenter J. Behavioral interventions for poststroke aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:197-220. [PMID: 35078599 DOI: 10.1016/b978-0-12-823384-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a long history of behavioral interventions for poststroke aphasia with hundreds of studies supporting the benefits of aphasia treatment. However, interventions for aphasia are complex with many interacting components, and no one treatment is appropriate for all persons with aphasia. We present a novel, simple framework for classifying aphasia interventions. The framework is incorporated within the overarching International Classification of Functioning, Disability, and Health (ICF) model and is consistent with the commonly-held definition that aphasia is a multimodality disorder that impairs, in varying degrees, the understanding and expression of both oral and written language modalities. Furthermore, within the language impairment level, it distinguishes between the linguistic areas of phonology, semantics, and syntax that may be impaired individually or in combination. We define the terminology of the proposed framework and then categorize some common examples of behavioral interventions for post-stroke aphasia. We describe some of these interventions in greater detail to illustrate the extensive toolbox of evidence-based treatments for aphasia. We address some key issues that clinicians, usually speech-language pathologists, consider when selecting interventions for their specific patients with aphasia, including dose. Finally, we address various models of service delivery for persons with aphasia such as Intensive Comprehensive Aphasia Programs (ICAPs) and Aphasia Centers.
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Affiliation(s)
- Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States; Department of Communication Sciences & Disorders, Northwestern University, Chicago, IL, United States.
| | - Julia Carpenter
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, United States
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Harvey DY, Hamilton R. Noninvasive brain stimulation to augment language therapy for poststroke aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:241-250. [PMID: 35078601 DOI: 10.1016/b978-0-12-823384-9.00012-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral language treatment approaches represent the standard of care for persons with aphasia (PWA), but the benefits of these treatments are variable. Moreover, due to the logistic and financial limitations on the amount of behavioral therapy available to patients, it is often infeasible for PWA to receive behavioral interventions with the level of frequency, intensity, or duration that would provide significant and lasting benefit, underscoring the need for novel, effective treatment approaches. Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), have emerged as promising neurally-based tools to enhance language abilities for PWA following stroke. This chapter first provides an overview of the methods and physiologic basis motivating the use of NIBS to enhance aphasia recovery followed by a selective review of the growing evidence of its potential as a novel therapeutic tool. Subsequent sections discuss some of the principles that may prove most useful in guiding and optimizing the effects of NIBS on aphasia recovery, focusing on how the functional state of the brain at the time of stimulation interacts with the behavioral aftereffects of neuromodulation. We conclude with a discussion of current challenges and future directions for NIBS in aphasia treatment.
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Affiliation(s)
- Denise Y Harvey
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Roy Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
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Leaman MC, Archer B, Edmonds LA. Toward Empowering Conversational Agency in Aphasia: Understanding Mechanisms of Topic Initiation in People With and Without Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:322-341. [PMID: 35007425 PMCID: PMC9135006 DOI: 10.1044/2021_ajslp-21-00049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/12/2021] [Accepted: 09/21/2021] [Indexed: 05/31/2023]
Abstract
PURPOSE This study examined topic initiation (TI) in conversations involving people with aphasia (PWA), matched people without aphasia (M-PWoA), and speech-language pathologists who were their conversation partners (SLP-Ps). For each speaker type, we analyzed patterns of distribution of typical mechanisms of TI and patterns of simultaneous use of multiple TI mechanisms. Lastly, we examined associations between use of simultaneous TI mechanisms and communicative success. METHOD Twenty PWA and 20 M-PWoA each participated in two conversations with SLP-Ps. Conversation samples were analyzed for TI locations and mechanisms, with results tallied for each speaker type following a published typology. A measure of communicative success was applied to TI utterances. Rank-order correlations were conducted to evaluate the patterns of distribution of the TI mechanisms between speaker types and the patterns of multiple mechanism usage between speaker types. Descriptive analysis was conducted to provide additional insight to the TI behaviors of each speaker type and to evaluate the relationship between multiple TI mechanisms and communicative success. RESULTS All speaker types used cohesion most often to achieve TI. PWA used an abrupt method of TI (noncoherent TI) more often than other speaker types. A single mechanism of TI was used most often by all speaker types, except for SLP-Ps when they were in conversations with PWA. In this case, SLP-Ps most often used two or more layered mechanisms of TI. SLP-Ps also used a highly salient TI mechanism with greater frequency when speaking with PWA than observed between other speaker types. When PWA layered mechanisms of TI, they appeared to be more likely to achieve better communicative success. CONCLUSIONS Specific, teachable behaviors such as favoring certain TI mechanisms and using multiple TI mechanisms may improve communicative success during TI for PWA. Furthermore, findings suggest that SLP-Ps modify their TI behaviors when speaking to PWA. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.17699423.
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Affiliation(s)
- Marion C. Leaman
- Department of Hearing and Speech, University of Kansas Medical Center, Kansas City
| | - Brent Archer
- Department of Communication Sciences and Disorders, Bowling Green State University, OH
| | - Lisa A. Edmonds
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Tabrizi R, Walton L, Simon E, Silkes JP. Repetition Priming in Treatment of Anomia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:48-66. [PMID: 34029115 DOI: 10.1044/2021_ajslp-20-00278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Repetition priming has been suggested as a method for targeting implicit processes in anomia treatment. Prior studies have used masked priming for this purpose. This study extends that work with visible primes, a more clinically feasible approach. METHOD This study used a single-subject design across three participants with aphasia. Treatment involved repeated exposure to identity primes (trained condition) or sham primes (untrained condition) paired with pictures. Analyses assessed acquisition effects for trained items and untrained items that were seen during the training period, generalization to untrained items that had not been seen, and generalization to broader language skills, immediately and 3 months post-treatment. RESULTS All participants improved in naming trained items immediately after treatment, with greater improvements for trained than for untrained items. All participants maintained some degree of improvement on trained items 3 months post-treatment, although the degree differed across participants. Inconsistent generalization occurred to unexposed items. Improvements were noted in some areas of broader language ability, although these varied. CONCLUSIONS These data suggest a repetition priming treatment paradigm may increase naming accuracy for individuals with anomia and may benefit other aspects of language. Participant factors may have influenced response to treatment. Directions for future investigation are discussed.
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Affiliation(s)
- Rana Tabrizi
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - Logan Walton
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Emily Simon
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - JoAnn P Silkes
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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The Effectiveness of Transcranial Magnetic Stimulation (TMS) Paradigms as Treatment Options for Recovery of Language Deficits in Chronic Poststroke Aphasia. Behav Neurol 2022; 2022:7274115. [PMID: 35069929 PMCID: PMC8767406 DOI: 10.1155/2022/7274115] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background In an effort to boost aphasia recovery, modern rehabilitation, in addition to speech and language therapy (SALT), is increasingly incorporating noninvasive methods of brain stimulation. The present study is aimed at investigating the effectiveness of two paradigms of neuronavigated repetitive transcranial magnetic stimulation (rTMS): (i) 1 Hz rTMS and (ii) continuous theta burst stimulation (cTBS) each as a standalone treatment for chronic aphasia poststroke. Methods A single subject experimental design (SSED) trial was carried out in which six people with aphasia (PWA) were recruited, following a single left hemispheric stroke more than six months prior to the study. Three individuals were treated with 1 Hz rTMS, and the remaining three were treated with cTBS. In all cases, TMS was applied over the right pars triangularis (pTr). Language assessment, with standardized and functional measures, and cognitive evaluations were carried out at four time points: twice prior to treatment (baseline), one day immediately posttreatment, and at follow-up two months after treatment was terminated. Quality of life (QoL) was also assessed at baseline and two months posttreatment. In addition, one of the participants with severe global aphasia was followed up again one and two years posttherapy. Results For all participants, both rTMS paradigms (1 Hz rTMS and cTBS) generated trends towards improvement in several language skills (i.e., verbal receptive language, expressive language, and naming and reading) one day after treatment and/or two months after therapy. Rated QoL remained stable in three individuals, but for the other three, the communication scores of the QoL were reduced, while two of them also showed a decline in the psychological scores. The participant that was treated with cTBS and followed for up to two years showed that the significant improvement she had initially exhibited in comprehension and reading skills two months after TMS (1st follow-up) was sustained for at least up to two years. Conclusion From the current findings, it is suggested that inhibitory TMS over the right pTr has the potential to drive neuroplastic changes as a standalone treatment that facilitates language recovery in poststroke aphasia.
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Chapman LR, Hallowell B. The Unfolding of Cognitive Effort During Sentence Processing: Pupillometric Evidence From People With and Without Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4900-4917. [PMID: 34763522 PMCID: PMC9150667 DOI: 10.1044/2021_jslhr-21-00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/18/2021] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Arousal and cognitive effort are relevant yet often overlooked components of attention during language processing. Pupillometry can be used to provide a psychophysiological index of arousal and cognitive effort. Given that much is unknown regarding the relationship between cognition and language deficits seen in people with aphasia (PWA), pupillometry may be uniquely suited to explore those relationships. The purpose of this study was to examine arousal and the time course of the allocation of cognitive effort related to sentence processing in people with and without aphasia. METHOD Nineteen PWA and age- and education-matched control participants listened to relatively easy (subject-relative) and relatively difficult (object-relative) sentences and were required to answer occasional comprehension questions. Tonic and phasic pupillary responses were used to index arousal and the unfolding of cognitive effort, respectively, while sentences were processed. Group differences in tonic and phasic responses were examined. RESULTS Group differences were observed for both tonic and phasic responses. PWA exhibited greater overall arousal throughout the task compared with controls, as evidenced by larger tonic pupil responses. Controls exhibited more effort (greater phasic responses) for difficult compared with easy sentences; PWA did not. Group differences in phasic responses were apparent during end-of-sentence and postsentence time windows. CONCLUSIONS Results indicate that the attentional state of PWA in this study was not consistently supportive of adequate task engagement. PWA in our sample may have relatively limited attentional capacity or may have challenges with allocating existing capacity in ways that support adequate task engagement and performance. This work adds to the body of evidence supporting the validity of pupillometric tasks for the study of aphasia and contributes to a better understanding of the nature of language deficits in aphasia. Supplemental Material https://doi.org/10.23641/asha.16959376.
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Affiliation(s)
- Laura Roche Chapman
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
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Hoover E, DeDe G, Maas E. A Randomized Controlled Trial of the Effects of Group Conversation Treatment on Monologic Discourse in Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4861-4875. [PMID: 34731574 PMCID: PMC10110355 DOI: 10.1044/2021_jslhr-21-00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/15/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Evidence has shown that group conversation treatment may improve communication and reduce social isolation for people with aphasia. However, little is known about the impact of conversation group treatment on measures of discourse. This project explored the impact of conversation treatment on measures of monologic discourse. METHOD In this randomized controlled trial, 48 participants with chronic aphasia were randomly assigned to dyadic, large group, or control conditions. Conversation group treatment was provided for 1 hr, twice per week, for 10 weeks. Discourse samples were collected and coded at pretreatment, posttreatment, and 6-week maintenance. There were three narrative tasks: (a) Comprehensive Aphasia Test (CAT) picture description, (b) Cat Rescue Picture, and (c) Cinderella retell. All narratives were coded using the percent correct information units (percent CIUs), the CAT standardized narrative analysis method, and the complete utterance (CU) method. RESULTS No significant changes were observed on percent CIU, which was the primary outcome measure. The treated groups demonstrated improvement on aspects of the CU method following treatment, whereas the control group did not. Significant changes were observed for other CIU measures and the CAT standardized narrative analysis in both the treated and control groups. CONCLUSIONS The results suggest that the CU measures were more sensitive to the effects of conversation treatment in monologic discourse compared to CIU and CAT measures. Changes were more common in absolute rather than relative values, suggesting that conversation treatment impacts the overall amount of language produced rather than efficiency of production.
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Affiliation(s)
- Elizabeth Hoover
- Department of Speech, Language & Hearing Sciences, Boston University, MA
| | - Gayle DeDe
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
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Evaluating Cognitive-Linguistic Approaches to Interventions for Aphasia Within the Rehabilitation Treatment Specification System. Arch Phys Med Rehabil 2021; 103:590-598. [PMID: 34822844 DOI: 10.1016/j.apmr.2021.07.816] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/26/2021] [Accepted: 07/07/2021] [Indexed: 11/20/2022]
Abstract
The Rehabilitation Treatment Specification System (RTSS) provides a framework to identify specific components of treatments developed within various rehabilitation disciplines (eg, physical, occupational, or speech-language therapy). Furthermore, this framework offers the opportunity to identify the target and active ingredients of a therapy approach as well as the mechanism of action by which it is hypothesized to effect change in abilities or functions. In this article, we apply the RTSS framework to the characterization of a sample of treatments for aphasia that are based on cognitive-linguistic models of language processing. Our discussion of these applications centers on the benefits of this classification system and additional criteria to consider when evaluating cognitive-linguistic treatments for aphasia.
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Gilmore N, Katz DI, Kiran S. Acquired Brain Injury in Adults: A Review of Pathophysiology, Recovery, and Rehabilitation. ACTA ACUST UNITED AC 2021; 6:714-727. [PMID: 34746412 DOI: 10.1044/2021_persp-21-00013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose To summarize existing literature from a range of fields (i.e., neurology, neuropsychology, neuroscience, neuroimaging, rehabilitation, speech-language pathology) that is relevant to the development and/or revision of cognitive rehabilitation programs for individuals with acquired brain injury (ABI) and in particular, for young adults. Method This paper reviews a range of ABI-associated topics including: 1) mechanisms of injury; 2) biological, individual-specific, and behavioral drivers of recovery; and 3) current methods of cognitive rehabilitation. It then narrows focus to young adults, a frequently affected and growing population to sustain ABI. The paper concludes by providing: 1) suggestions for key components of cognitive rehabilitation for young adults with ABI; 2) an example from our own research providing intensive academically-focused cognitive rehabilitation for young adults with ABI pursuing college; and 3) recommendations for future behavioral and neuroimaging studies in this area. Conclusions ABI is on the rise in the United States. Young adults have been sustaining ABI at higher rates over the past several decades. These injuries occur when they would otherwise be advancing their academic and career goals, making the cognitive deficits that often accompany ABI especially devastating for this group. Review of existing literature suggests cognitive rehabilitation programs that combine aspects of restorative, comprehensive, and contextualized approaches could promote recovery for young adults with ABI. Future intervention studies may benefit from including both behavioral and neural outcomes to best understand how principles of neuroplasticity- naturally embedded within many cognitive rehabilitation approaches-could be manipulated to promote cognitive recovery and long-lasting brain reorganization in this group.
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Affiliation(s)
- Natalie Gilmore
- Speech, Language and Hearing Sciences, Boston University, Boston, USA
| | - Douglas I Katz
- Neurology, Boston University School of Medicine, Boston, USA
| | - Swathi Kiran
- Speech, Language and Hearing Sciences, Boston University, Boston, USA
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Swiderski AM, Quique YM, Dickey MW, Hula WD. Treatment of Underlying Forms: A Bayesian Meta-Analysis of the Effects of Treatment and Person-Related Variables on Treatment Response. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4308-4328. [PMID: 34694908 DOI: 10.1044/2021_jslhr-21-00131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose This meta-analysis synthesizes published studies using "treatment of underlying forms" (TUF) for sentence-level deficits in people with aphasia (PWA). The study aims were to examine group-level evidence for TUF efficacy, to characterize the effects of treatment-related variables (sentence structural family and complexity; treatment dose) in relation to the Complexity Account of Treatment Efficacy (CATE) hypothesis, and to examine the effects of person-level variables (aphasia severity, sentence comprehension impairment, and time postonset of aphasia) on TUF response. Method Data from 13 single-subject, multiple-baseline TUF studies, including 46 PWA, were analyzed. Bayesian generalized linear mixed-effects interrupted time series models were used to assess the effect of treatment-related variables on probe accuracy during baseline and treatment. The moderating influence of person-level variables on TUF response was also investigated. Results The results provide group-level evidence for TUF efficacy demonstrating increased probe accuracy during treatment compared with baseline phases. Greater amounts of TUF were associated with larger increases in accuracy, with greater gains for treated than untreated sentences. The findings revealed generalization effects for sentences that were of the same family but less complex than treated sentences. Aphasia severity may moderate TUF response, with people with milder aphasia demonstrating greater gains compared with people with more severe aphasia. Sentence comprehension performance did not moderate TUF response. Greater time postonset of aphasia was associated with smaller improvements for treated sentences but not for untreated sentences. Conclusions Our results provide generalizable group-level evidence of TUF efficacy. Treatment and generalization responses were consistent with the CATE hypothesis. Model results also identified person-level moderators of TUF (aphasia severity, time postonset of aphasia) and preliminary estimates of the effects of varying amounts of TUF for treated and untreated sentences. Taken together, these findings add to the TUF evidence and may guide future TUF treatment-candidate selection. Supplemental Material https://doi.org/10.23641/asha.16828630.
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Affiliation(s)
- Alexander M Swiderski
- University of Pittsburgh, PA
- Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA
- VA Healthcare System, Pittsburgh, PA
| | - Yina M Quique
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael Walsh Dickey
- University of Pittsburgh, PA
- Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA
- VA Healthcare System, Pittsburgh, PA
| | - William D Hula
- University of Pittsburgh, PA
- VA Healthcare System, Pittsburgh, PA
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Fridriksson J, Basilakos A, Boyle M, Cherney LR, DeDe G, Gordon JK, Harnish SM, Hoover EL, Hula WD, Pompon RH, Johnson LP, Kiran S, Murray LL, Rose ML, Obermeyer J, Salis C, Walker GM, Martin N. Demystifying the complexity of aphasia treatment: Application of the Rehabilitation Treatment Specification System (RTSS). Arch Phys Med Rehabil 2021; 103:574-580. [PMID: 34748758 DOI: 10.1016/j.apmr.2021.08.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/13/2021] [Accepted: 08/01/2021] [Indexed: 11/15/2022]
Abstract
A considerable body of research supports the use of behavioral communication treatment as the standard of care for aphasia. In spite of robust progress in clinical aphasiology, many questions regarding optimal care remain unanswered. One of the major challenges to progress in the field is the lack of a common framework to adequately describe individual treatments, which, if available, would allow comparisons across studies as well as improved communication among researchers, clinicians, and other stakeholders. Here, we describe how aphasia treatment approaches can be systematically characterized using the Rehabilitation Treatment Specification System (RTSS). At the core of the RTSS is a tripartite structure that focuses on targets (the behavior that is expected to change as a result of treatment), ingredients (what a clinician does to affect change in the target), and mechanism(s) of action (why a given treatment works by linking the ingredients to the target). Three separate papers in the current issue specifically describe how the RTSS can be used to describe different kinds of aphasia treatment approaches: functional approaches, cognitive-linguistic approaches, and biological approaches. It is our hope that the application of the RTSS in clinical aphasiology will improve communication in published studies, grant proposals, and in the clinical care of persons with aphasia.
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Affiliation(s)
- Julius Fridriksson
- Center for the Study of Aphasia Recovery (C-STAR), University of South Carolina.
| | - Alexandra Basilakos
- Center for the Study of Aphasia Recovery (C-STAR), University of South Carolina
| | - Mary Boyle
- Department of Communication Sciences and Disorders, Montclair State University, Montclair, NJ
| | - Leora R Cherney
- Think and Speak, Shirley Ryan Ability Lab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gayle DeDe
- Department of Communication Sciences and Disorders, Temple University
| | - Jean K Gordon
- Department of Communication Sciences and Disorders, University of Iowa
| | - Stacy M Harnish
- Department of Speech and Hearing Science, The Ohio State University
| | | | - William D Hula
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA; Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Swathi Kiran
- Department of Speech-Language and Hearing Sciences, Boston University
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, Canada
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Jessica Obermeyer
- Department of Communication Sciences and Disorders, University of North Carolina at Greensboro, Greensboro, NC
| | - Christos Salis
- Speech and Language Sciences, Newcastle University, Newcastle upon Tyne
| | - Grant M Walker
- Department of Cognitive Sciences, University of California, Irvine, Irvine, CA
| | - Nadine Martin
- Department of Communication Sciences and Disorders, Temple University
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Masson-Trottier M, Sontheimer A, Durand E, Ansaldo AI. Resting-State Functional Connectivity following Phonological Component Analysis: The Combined Action of Phonology and Visual Orthographic Cues. Brain Sci 2021; 11:1458. [PMID: 34827457 PMCID: PMC8615968 DOI: 10.3390/brainsci11111458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Anomia is the most frequent and pervasive symptom for people with aphasia (PWA). Phonological component analysis (PCA) is a therapy incorporating phonological cues to treat anomia. Investigations of neural correlates supporting improvements following PCA remain scarce. Resting-state functional connectivity (rsFC) as a marker of therapy-induced neuroplasticity has been reported by our team. The present study explores the efficacy of PCA in French and associated therapy-induced neuroplasticity using whole-brain rsFC analysis. Ten PWA participated in a pre-/post-PCA fMRI study with cognitive linguistic assessments. PCA was delivered in French following the standard procedure. PCA led to significant improvement with trained and untrained items. PCA also led to changes in rsFC between distributed ROIs in the semantic network, visual network, and sub-cortical areas. Changes in rsFC can be interpreted within the frame of the visual and phonological nature of PCA. Behavioral and rsFC data changes associated with PCA in French highlight its efficacy and point to the importance of phonological and orthographic cues to consolidate the word-retrieval strategy, contributing to generalization to untrained words.
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Affiliation(s)
- Michèle Masson-Trottier
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada;
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Anna Sontheimer
- Centre National de la Recherche Scientifique, Institut National Polytechnique-Clermont, Institut Pascal, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
- Centre Hospitalier Universitaire de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Edith Durand
- U.F.R. Lettres, Cultures et Sciences Humaines, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
| | - Ana Inés Ansaldo
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada;
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada
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Truzman T, Rochon E, Meltzer J, Leonard C, Bitan T. Simultaneous Normalization and Compensatory Changes in Right Hemisphere Connectivity during Aphasia Therapy. Brain Sci 2021; 11:1330. [PMID: 34679395 PMCID: PMC8534113 DOI: 10.3390/brainsci11101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
Changes in brain connectivity during language therapy were examined among participants with aphasia (PWA), aiming to shed light on neural reorganization in the language network. Four PWA with anomia following left hemisphere stroke and eight healthy controls (HC) participated in the study. Two fMRI scans were administered to all participants with a 3.5-month interval. The fMRI scans included phonological and semantic tasks, each consisting of linguistic and perceptual matching conditions. Between the two fMRI scans, PWA underwent Phonological Components Analysis treatment. Changes in effective connectivity during the treatment were examined within right hemisphere (RH) architecture. The results illustrate that following the treatment, the averaged connectivity of PWA across all perceptual and linguistic conditions in both tasks increased resemblance to HC, reflecting the normalization of neural processes associated with silent object name retrieval. In contrast, connections that were specifically enhanced by the phonological condition in PWA decreased in their resemblance to HC, reflecting emerging compensatory reorganization in RH connectivity to support phonological processing. These findings suggest that both normalization and compensation play a role in neural language reorganization at the chronic stage, occurring simultaneously in the same brain.
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Affiliation(s)
- Tammar Truzman
- Communication Sciences and Disorders Department and IIPDM, University of Haifa, Haifa 3498838, Israel
- The Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
| | - Elizabeth Rochon
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- KITE Research Institute, Toronto Rehab, University Health Network (UHN), Toronto, ON M5G 2A2, Canada
| | - Jed Meltzer
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- Psychology Department, University of Toronto, Toronto, ON M5S 1A1, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada
| | - Carol Leonard
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Tali Bitan
- The Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- Psychology Department and IIPDM, University of Haifa, Haifa 3498838, Israel
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Gilmore N, Yücel MA, Li X, Boas DA, Kiran S. Investigating Language and Domain-General Processing in Neurotypicals and Individuals With Aphasia - A Functional Near-Infrared Spectroscopy Pilot Study. Front Hum Neurosci 2021; 15:728151. [PMID: 34602997 PMCID: PMC8484538 DOI: 10.3389/fnhum.2021.728151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Brain reorganization patterns associated with language recovery after stroke have long been debated. Studying mechanisms of spontaneous and treatment-induced language recovery in post-stroke aphasia requires a network-based approach given the potential for recruitment of perilesional left hemisphere language regions, homologous right hemisphere language regions, and/or spared bilateral domain-general regions. Recent hardware, software, and methodological advances in functional near-infrared spectroscopy (fNIRS) make it well-suited to examine this question. fNIRS is cost-effective with minimal contraindications, making it a robust option to monitor treatment-related brain activation changes over time. Establishing clear activation patterns in neurotypical adults during language and domain-general cognitive processes via fNIRS is an important first step. Some fNIRS studies have investigated key language processes in healthy adults, yet findings are challenging to interpret in the context of methodological limitations. This pilot study used fNIRS to capture brain activation during language and domain-general processing in neurotypicals and individuals with aphasia. These findings will serve as a reference when interpreting treatment-related changes in brain activation patterns in post-stroke aphasia in the future. Twenty-four young healthy controls, seventeen older healthy controls, and six individuals with left hemisphere stroke-induced aphasia completed two language tasks (i.e., semantic feature, picture naming) and one domain-general cognitive task (i.e., arithmetic) twice during fNIRS. The probe covered bilateral frontal, parietal, and temporal lobes and included short-separation detectors for scalp signal nuisance regression. Younger and older healthy controls activated core language regions during semantic feature processing (e.g., left inferior frontal gyrus pars opercularis) and lexical retrieval (e.g., left inferior frontal gyrus pars triangularis) and domain-general regions (e.g., bilateral middle frontal gyri) during hard versus easy arithmetic as expected. Consistent with theories of post-stroke language recovery, individuals with aphasia activated areas outside the traditional networks: left superior frontal gyrus and left supramarginal gyrus during semantic feature judgment; left superior frontal gyrus and right precentral gyrus during picture naming; and left inferior frontal gyrus pars opercularis during arithmetic processing. The preliminary findings in the stroke group highlight the utility of using fNIRS to study language and domain-general processing in aphasia.
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Affiliation(s)
- Natalie Gilmore
- Department of Speech Language & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Meryem Ayse Yücel
- Neurophotonics Center, Biomedical Engineering, Boston University, Boston, MA, United States
| | - Xinge Li
- Neurophotonics Center, Biomedical Engineering, Boston University, Boston, MA, United States.,Department of Psychology, College of Liberal Arts and Social Sciences, University of Houston, Houston, TX, United States
| | - David A Boas
- Neurophotonics Center, Biomedical Engineering, Boston University, Boston, MA, United States
| | - Swathi Kiran
- Department of Speech Language & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
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Cichon N, Wlodarczyk L, Saluk-Bijak J, Bijak M, Redlicka J, Gorniak L, Miller E. Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation. J Clin Med 2021; 10:jcm10173778. [PMID: 34501229 PMCID: PMC8432240 DOI: 10.3390/jcm10173778] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/07/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022] Open
Abstract
Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21–40% of stroke patients sustain permanent aphasia, which progressively worsens one’s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.
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Affiliation(s)
- Natalia Cichon
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
- Correspondence:
| | - Lidia Wlodarczyk
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland;
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland;
| | - Michal Bijak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
| | - Justyna Redlicka
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa, 14, 93-113 Lodz, Poland; (J.R.); (E.M.)
| | - Leslaw Gorniak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
| | - Elzbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa, 14, 93-113 Lodz, Poland; (J.R.); (E.M.)
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Harvey DY, Parchure S, Hamilton RH. Factors predicting long-term recovery from post-stroke aphasia. APHASIOLOGY 2021; 36:1351-1372. [PMID: 36685216 PMCID: PMC9855303 DOI: 10.1080/02687038.2021.1966374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 08/05/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND It remains widely accepted that spontaneous recovery from aphasia is largely limited to the first related factors. This has direct implications for acute and chronic interventions for aphasia. few months following stroke. A few recent studies challenge this view, revealing that some individuals' language abilities improve even during the chronic stage. AIMS To identify prognostic indicators of long-term aphasia recovery. METHODS & PROCEDURES Eighteen people with aphasia initially evaluated in the chronic stage were retested at least one year later. The Western Aphasia Battery-Revised (WAB-R) Aphasia Quotient (AQ) was used to quantify changes in language impairment. Prognostic factors included those related to the patient (demographic, psychosocial), stroke (lesion volume and location), and treatment (medical, rehabilitative). OUTCOMES & RESULTS Twelve participants improved and 6 remained stable or declined. Linear regression analysis revealed that lesion volume predicted long-term language gains, with smaller lesions yielding greater improvements. Individuals who did not improve were more likely to have lesions encompassing critical frontal and temporoparietal cortical regions and interconnecting white matter pathways. Exploratory regression analysis of psychosocial and treatment-related factors revealed a positive relationship between improvement and satisfaction with life participation, and a negative relationship between improvement and perceived impairment severity. Critically, psychosocial and treatment-related factors significantly improved model fit over lesion volume, suggesting that these factors add predictive value to determining long-term aphasia prognosis. CONCLUSIONS Long-term aphasia recovery is multidetermined by a combination of stroke-, psychosocial-, and treatment-related factors. This has direct implications for acute and chronic interventions for aphasia.
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Affiliation(s)
- Denise Y. Harvey
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | - Shreya Parchure
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Roy H. Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
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Cotosck KR, Meltzer JA, Nucci MP, Lukasova K, Mansur LL, Amaro E. Engagement of Language and Domain General Networks during Word Monitoring in a Native and Unknown Language. Brain Sci 2021; 11:brainsci11081063. [PMID: 34439682 PMCID: PMC8393423 DOI: 10.3390/brainsci11081063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022] Open
Abstract
Functional neuroimaging studies have highlighted the roles of three networks in processing language, all of which are typically left-lateralized: a ventral stream involved in semantics, a dorsal stream involved in phonology and speech production, and a more dorsal "multiple demand" network involved in many effortful tasks. As lateralization in all networks may be affected by life factors such as age, literacy, education, and brain pathology, we sought to develop a task paradigm with which to investigate the engagement of these networks, including manipulations to selectively emphasize semantic and phonological processing within a single task performable by almost anyone regardless of literacy status. In young healthy participants, we administered an auditory word monitoring task, in which participants had to note the occurrence of a target word within a continuous story presented in either their native language, Portuguese, or the unknown language, Japanese. Native language task performance activated ventral stream language networks, left lateralized but bilateral in the anterior temporal lobe. Unfamiliar language performance, being more difficult, activated left hemisphere dorsal stream structures and the multiple demand network bilaterally, but predominantly in the right hemisphere. These findings suggest that increased demands on phonological processing to accomplish word monitoring in the absence of semantic support may result in the bilateral recruitment of networks involved in speech perception under more challenging conditions.
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Affiliation(s)
- Kelly R. Cotosck
- FNI–Functional Neuroimaging, LIM 4–Laboratório de Investigação Médica 44 (Laboratory of Medical Investigation 44), Department of Radiology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (M.P.N.); (K.L.); (E.A.J.)
- Correspondence: or ; Tel.: +55-11-95131-2225
| | | | - Mariana P. Nucci
- FNI–Functional Neuroimaging, LIM 4–Laboratório de Investigação Médica 44 (Laboratory of Medical Investigation 44), Department of Radiology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (M.P.N.); (K.L.); (E.A.J.)
| | - Katerina Lukasova
- FNI–Functional Neuroimaging, LIM 4–Laboratório de Investigação Médica 44 (Laboratory of Medical Investigation 44), Department of Radiology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (M.P.N.); (K.L.); (E.A.J.)
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Santo André 09210-580, Brazil
| | | | - Edson Amaro
- FNI–Functional Neuroimaging, LIM 4–Laboratório de Investigação Médica 44 (Laboratory of Medical Investigation 44), Department of Radiology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (M.P.N.); (K.L.); (E.A.J.)
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Fama ME, Hatfield B, Coyle S, Richman MS, Georgeadis AC. The Impact of the COVID-19 Public Health Crisis on Communication and Quality of Life: Insights From a Community of Stroke and Brain Trauma Survivors. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1805-1818. [PMID: 34233121 DOI: 10.1044/2021_ajslp-20-00297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The COVID-19 pandemic has led to stay-at-home orders and social distancing guidelines that have the potential to greatly impact individuals' behavior and social engagement. Adults recovering from stroke or other brain trauma, who often have communication difficulties and other long-term challenges, are a population already at risk of isolation and lower quality of life. We investigated the impact of public health guidelines and related behavioral changes on self-perceptions of communication abilities and psychosocial factors in this population. Method The Stroke Comeback Center, a community-based center for stroke and other brain trauma survivors with communication impairments, disseminated an online survey to current members to investigate changes in communication, social engagement, and quality of life. Results Participants (N = 50) reported a number of changes in their day-to-day activities that reflect the current social distancing guidelines, such as reduced outings into the community and fewer in-person conversations with those living outside one's home. Overall, feelings of connectedness to others and overall quality of life were reported to be decreased when compared to before the COVID-19 pandemic, whereas receptive language abilities and technology skills were reported to have improved. Perhaps most interestingly, certain behavioral changes (including healthy movement activities and participation in virtual programs) had specific relationships with perceived communication abilities and social engagement. Conclusions Changes in daily life resulting from the COVID-19 pandemic have had a tangible impact on self-perceived psychosocial elements (e.g., quality of life) and communication abilities among stroke and other brain trauma survivors. Clinicians and researchers may consider these perceived changes when engaging with this population as the effects of the pandemic continue and in the period of community re-entry that may follow. Supplemental Material https://doi.org/10.23641/asha.14830881.
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Affiliation(s)
- Mackenzie E Fama
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC
- Stroke Comeback Center, Vienna, VA
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Rose ML, Pierce JE, Scharp VL, Off CA, Babbitt EM, Griffin-Musick JR, Cherney LR. Developments in the application of Intensive Comprehensive Aphasia Programs: an international survey of practice. Disabil Rehabil 2021; 44:5863-5877. [PMID: 34251946 DOI: 10.1080/09638288.2021.1948621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Intensive Comprehensive Aphasia Programs (ICAPs) were first described in 2013 with an international survey documenting 12 unique programs. ICAPs involve high dose intervention delivered in both group and individual settings, targeting communication across impairment, functioning, participation, and contextual domains. In this study, we aimed to investigate international growth in ICAPs. MATERIALS AND METHODS We developed a 43-item questionnaire expanding on the original 2013 version to investigate program modifications, activities, protocolised therapies, software and apps, and family involvement. The survey was disseminated to aphasia clinicians and researchers internationally (November 2019-February 2020). RESULTS Thirty-nine unique respondents completed the survey from nine countries. Twenty-one met the criteria for an ICAP or modified ICAP (mICAP): 14 ICAPs; 7 mICAPs, and 13 of these were new programs. ICAPs differed from mICAPs with greater emphasis on group sessions, use of technology, total communication, advocacy, and art activities. A large range of protocolised therapies were used across programs. An increased focus on mood and psychosocial well-being was observed compared to the 2013 survey. CONCLUSIONS The number and comprehensiveness of ICAPs has grown since 2013 with development of modified versions. Future research should focus on comparative efficacy of ICAPs/mICAPs and other forms of aphasia interventions and factors underpinning growth and sustainability.Implications for RehabilitationClinicians who coordinate or are considering commencing an ICAP in future can use these results to consider the design of their program.Coordinators should carefully consider the components of their ICAPs and advise consumers whether they meet the definition of an ICAP or a mICAP.With the increasing number of ICAPs across the globe, clinicians commencing an ICAP may wish to contact existing ICAPs within their country for advice.Program sustainability may be challenging and these results provide an indication of some of the key challenges coordinators may face.
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Affiliation(s)
- Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - John E Pierce
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Victoria L Scharp
- School of Communication and Rehabilitation Sciences, College of Health, Idaho State University, Pocatello, ID, USA
| | - Catherine A Off
- School of Speech, Language, Hearing, & Occupational Sciences, College of Health, University of Montana, Missoula, MT, USA
| | - Edna M Babbitt
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jenna R Griffin-Musick
- School of Speech, Language, Hearing, & Occupational Sciences, College of Health, University of Montana, Missoula, MT, USA
| | - Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
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75
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Ivanova MV, Zhong A, Turken A, Baldo JV, Dronkers NF. Functional Contributions of the Arcuate Fasciculus to Language Processing. Front Hum Neurosci 2021; 15:672665. [PMID: 34248526 PMCID: PMC8267805 DOI: 10.3389/fnhum.2021.672665] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022] Open
Abstract
Current evidence strongly suggests that the arcuate fasciculus (AF) is critical for language, from spontaneous speech and word retrieval to repetition and comprehension abilities. However, to further pinpoint its unique and differential role in language, its anatomy needs to be explored in greater detail and its contribution to language processing beyond that of known cortical language areas must be established. We address this in a comprehensive evaluation of the specific functional role of the AF in a well-characterized cohort of individuals with chronic aphasia (n = 33) following left hemisphere stroke. To evaluate macro- and microstructural integrity of the AF, tractography based on the constrained spherical deconvolution model was performed. The AF in the left and right hemispheres were then manually reconstructed using a modified 3-segment model (Catani et al., 2005), and a modified 2-segment model (Glasser and Rilling, 2008). The normalized volume and a measure of microstructural integrity of the long and the posterior segments of the AF were significantly correlated with language indices while controlling for gender and lesion volume. Specific contributions of AF segments to language while accounting for the role of specific cortical language areas – inferior frontal, inferior parietal, and posterior temporal – were tested using multiple regression analyses. Involvement of the following tract segments in the left hemisphere in language processing beyond the contribution of cortical areas was demonstrated: the long segment of the AF contributed to naming abilities; anterior segment – to fluency and naming; the posterior segment – to comprehension. The results highlight the important contributions of the AF fiber pathways to language impairments beyond that of known cortical language areas. At the same time, no clear role of the right hemisphere AF tracts in language processing could be ascertained. In sum, our findings lend support to the broader role of the left AF in language processing, with particular emphasis on comprehension and naming, and point to the posterior segment of this tract as being most crucial for supporting residual language abilities.
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Affiliation(s)
- Maria V Ivanova
- Aphasia Recovery Lab, Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.,Center for Language, Imaging, Mind & Brain, VA Northern California Health Care System, Martinez, CA, United States
| | - Allison Zhong
- Center for Language, Imaging, Mind & Brain, VA Northern California Health Care System, Martinez, CA, United States.,School of Medicine, New York Medical College, Valhalla, NY, United States
| | - And Turken
- Center for Language, Imaging, Mind & Brain, VA Northern California Health Care System, Martinez, CA, United States
| | - Juliana V Baldo
- Center for Language, Imaging, Mind & Brain, VA Northern California Health Care System, Martinez, CA, United States
| | - Nina F Dronkers
- Aphasia Recovery Lab, Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.,Center for Language, Imaging, Mind & Brain, VA Northern California Health Care System, Martinez, CA, United States.,Department of Neurology, University of California, Davis, Davis, CA, United States
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76
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Goldberg EB, Meier EL, Sheppard SM, Breining BL, Hillis AE. Stroke Recurrence and Its Relationship With Language Abilities. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2022-2037. [PMID: 34043446 PMCID: PMC8740764 DOI: 10.1044/2021_jslhr-20-00347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/23/2020] [Accepted: 02/20/2021] [Indexed: 06/12/2023]
Abstract
Purpose Many factors influence poststroke language recovery, yet little is known about the influence of previous stroke(s) on language after left hemisphere stroke. In this prospective longitudinal study, we investigated the role of prior stroke on language abilities following an acute left hemisphere ischemic stroke, while controlling for demographic and stroke-related factors, and examined if earlier stroke impacted language recovery at a chronic time point. Method Participants (n = 122) with acute left hemisphere ischemic stroke completed language evaluation and clinical neuroimaging. They were divided into two groups: single stroke (SS; n = 79) or recurrent stroke (RS; n = 43). A subset of participants (n = 31) completed chronic-stage re-evaluation. Factors studied included age, education, diabetes and hypertension diagnoses, lesion volume and broad location, group status, aphasia prevalence, and language scores. Results Groups did not differ in language performance across time points. The only significant group differences were that participants with RS were older, had smaller acute lesions, and were less educated. Stroke group membership (SS vs. RS) was not associated with language performance at either time point. In patients with prior stroke, large acute lesion volumes were associated with acute language performance, whereas both large acute and chronic volumes influenced recovery. Conclusions History of prior stroke in itself may not significantly influence language impairment after an additional acute left hemisphere stroke, unless it contributes substantially to the total volume of infarcted brain tissue. Chronic and acute lesion volumes should be accounted for in studies investigating poststroke language performance and recovery. Supplemental Material https://doi.org/10.23641/asha.14669715.
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Affiliation(s)
- Emily B. Goldberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erin L. Meier
- Department of Communication Sciences and Disorders, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Shannon M. Sheppard
- Department of Communication Sciences and Disorders, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA
| | - Bonnie L. Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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77
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Kristinsson S, Zhang W, Rorden C, Newman‐Norlund R, Basilakos A, Bonilha L, Yourganov G, Xiao F, Hillis A, Fridriksson J. Machine learning-based multimodal prediction of language outcomes in chronic aphasia. Hum Brain Mapp 2021; 42:1682-1698. [PMID: 33377592 PMCID: PMC7978124 DOI: 10.1002/hbm.25321] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 12/26/2022] Open
Abstract
Recent studies have combined multiple neuroimaging modalities to gain further understanding of the neurobiological substrates of aphasia. Following this line of work, the current study uses machine learning approaches to predict aphasia severity and specific language measures based on a multimodal neuroimaging dataset. A total of 116 individuals with chronic left-hemisphere stroke were included in the study. Neuroimaging data included task-based functional magnetic resonance imaging (fMRI), diffusion-based fractional anisotropy (FA)-values, cerebral blood flow (CBF), and lesion-load data. The Western Aphasia Battery was used to measure aphasia severity and specific language functions. As a primary analysis, we constructed support vector regression (SVR) models predicting language measures based on (i) each neuroimaging modality separately, (ii) lesion volume alone, and (iii) a combination of all modalities. Prediction accuracy across models was subsequently statistically compared. Prediction accuracy across modalities and language measures varied substantially (predicted vs. empirical correlation range: r = .00-.67). The multimodal prediction model yielded the most accurate prediction in all cases (r = .53-.67). Statistical superiority in favor of the multimodal model was achieved in 28/30 model comparisons (p-value range: <.001-.046). Our results indicate that different neuroimaging modalities carry complementary information that can be integrated to more accurately depict how brain damage and remaining functionality of intact brain tissue translate into language function in aphasia.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia RecoveryUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Wanfang Zhang
- Department of Epidemiology and BiostatisticsUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Chris Rorden
- Department of PsychologyUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | | | - Alexandra Basilakos
- Center for the Study of Aphasia RecoveryUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Leonardo Bonilha
- Department of NeurologyMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Grigori Yourganov
- Advanced Computing and Data Science, Cyberinfrastructure and Technology IntegrationClemson UniversityClemsonSouth CarolinaUSA
| | - Feifei Xiao
- Department of Epidemiology and BiostatisticsUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Argye Hillis
- Department of Neurology and Physical Medicine and RehabilitationJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Cognitive ScienceJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Julius Fridriksson
- Center for the Study of Aphasia RecoveryUniversity of South CarolinaColumbiaSouth CarolinaUSA
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78
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Abbott NT, Baker CJ, Chen C, Liu TT, Love TE. Defining Hypoperfusion in Chronic Aphasia: An Individualized Thresholding Approach. Brain Sci 2021; 11:491. [PMID: 33924446 PMCID: PMC8070458 DOI: 10.3390/brainsci11040491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023] Open
Abstract
Within the aphasia literature, it is common to link location of lesioned brain tissue to specific patterns of language impairment. This has provided valuable insight into the relationship between brain structure and function, but it does not capture important underlying alterations in function of regions that remain structurally intact. Research has demonstrated that in the chronic stage of aphasia, variable patterns of reduced cerebral blood flow (CBF; hypoperfusion) in structurally intact regions of the brain contribute to persisting language impairments. However, one consistent issue in this literature is a lack of clear consensus on how to define hypoperfusion, which may lead to over- or underestimation of tissue functionality. In the current study, we conducted an exploratory analysis in six individuals with chronic aphasia (>1 year post-onset) using perfusion imaging to (1) suggest a new, individualized metric for defining hypoperfusion; (2) identify the extent of hypoperfused tissue in perilesional bands; and (3) explore the relationship between hypoperfusion and language impairment. Results indicated that our individualized metric for defining hypoperfusion provided greater precision when identifying functionally impaired tissue and its effects on language function in chronic aphasia. These results have important implications for intervention approaches that target intact (or impaired) brain tissue.
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Affiliation(s)
- Noelle T. Abbott
- San Diego State University and University of California San Diego Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA 92182, USA; (C.J.B.); (T.E.L.)
| | - Carolyn J. Baker
- San Diego State University and University of California San Diego Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA 92182, USA; (C.J.B.); (T.E.L.)
| | - Conan Chen
- Center for Functional MRI and Department of Radiology, University of California San Diego, San Diego, CA 92093, USA; (C.C.); (T.T.L.)
| | - Thomas T. Liu
- Center for Functional MRI and Department of Radiology, University of California San Diego, San Diego, CA 92093, USA; (C.C.); (T.T.L.)
| | - Tracy E. Love
- San Diego State University and University of California San Diego Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA 92182, USA; (C.J.B.); (T.E.L.)
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA 92182, USA
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79
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German Language Adaptation of the NAVS (NAVS-G) and of the NAT (NAT-G): Testing Grammar in Aphasia. Brain Sci 2021; 11:brainsci11040474. [PMID: 33918022 PMCID: PMC8069474 DOI: 10.3390/brainsci11040474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 11/17/2022] Open
Abstract
Grammar provides the framework for understanding and producing language. In aphasia, an acquired language disorder, grammatical deficits are diversified and widespread. However, the few assessments for testing grammar in the German language do not consider current linguistic, psycholinguistic, and functional imaging data, which have been shown to be crucial for effective treatment. This study developed German language versions of the Northwestern Assessment of Verbs and Sentences (NAVS-G) and the Northwestern Anagram Test (NAT-G) to examine comprehension and production of verbs, controlling for the number and optionality of verb arguments, and sentences with increasing syntactic complexity. The NAVS-G and NAT-G were tested in 27 healthy participants, 15 right hemispheric stroke patients without aphasia, and 15 stroke patients with mild to residual aphasia. Participants without aphasia showed near-perfect performance, with the exception of (object) relative sentences, where accuracy was associated with educational level. In each patient with aphasia, deficits in more than one subtest were observed. The within and between population-groups logistic mixed regression analyses identified significant impairments in processing syntactic complexity at the verb and sentence levels. These findings indicate that the NAVS-G and NAT-G have potential for testing grammatical competence in (German) stroke patients.
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80
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Hybbinette H, Schalling E, Plantin J, Nygren-Deboussard C, Schütz M, Östberg P, Lindberg PG. Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke. Front Neurol 2021; 12:634065. [PMID: 33868144 PMCID: PMC8044583 DOI: 10.3389/fneur.2021.634065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/03/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. In addition, we also explored factors predicting recovery from AOS. Methods: Seventy participants with mild to severe paresis in the upper extremity were assessed; 50% of these (n = 35) had left hemisphere (LH) lesions. Aphasia, AOS and hand motor assessments and magnetic resonance imaging were conducted at 4 weeks (A1) and at 6 months (A2) after stroke onset. Recovery was characterized in 15 participants showing initial aphasia that also had complete follow-up data at 6 months. Results: All participants with AOS and/or aphasia had LH lesions. In LH lesioned, the prevalence of aphasia was 71% and of AOS 57%. All participants with AOS had aphasia; 80% of the participants with aphasia also had AOS. Recovery in aphasia (n = 15) and AOS (n = 12) followed a parallel pattern to that observed in hand motor impairment and recovery correlated positively across speech-language and motor domains. The majority of participants with severe initial aphasia and AOS showed a limited but similar amount of recovery across domains. Lesion volume did not correlate with results from behavioral assessments, nor with recovery. The initial aphasia score was the strongest predictor of AOS recovery. Conclusion: Our findings confirm the common occurrence of AOS and aphasia in left hemisphere stroke patients with a hand motor impairment. Recovery was similar across speech-language and motor domains, even in patients with severe impairment, supporting the shared recovery hypothesis and that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. These observations contribute to the knowledge of AOS and its relation to motor and language functions and add information that may serve as a basis for future studies of post stroke recovery. Studies including neuroimaging and/or biological assays are required to gain further knowledge on shared brain recovery mechanisms.
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Affiliation(s)
- Helena Hybbinette
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Ellika Schalling
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette Plantin
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Catharina Nygren-Deboussard
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Marika Schütz
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Per Östberg
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Påvel G. Lindberg
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Institut de Psychiatrie et Neurosciences Paris, Inserm U1266, Université de Paris, Paris, France
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81
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Jin L, Li C, Zhang Y, Yuan T, Ying J, Zuo Z, Gui S. The Functional Reorganization of Language Network Modules in Glioma Patients: New Insights From Resting State fMRI Study. Front Oncol 2021; 11:617179. [PMID: 33718172 PMCID: PMC7953055 DOI: 10.3389/fonc.2021.617179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background Prior investigations of language functions have focused on the response profiles of particular brain regions. However, the specialized and static view of language processing does not explain numerous observations of functional recovery following brain surgery. To investigate the dynamic alterations of functional connectivity (FC) within language network (LN) in glioma patients, we explored a new flexible model based on the neuroscientific hypothesis of core-periphery organization in LN. Methods Group-level LN mapping was determined from 109 glioma patients and forty-two healthy controls (HCs) using independent component analysis (ICA). FC and mean network connectivity (mNC: l/rFCw, FCb, and FCg) were compared between patients and HCs. Correlations between mNC and tumor volume (TV) were calculated. Results We identified ten separate LN modules from ICA. Compared to HCs, glioma patients showed a significant reduction in language network functional connectivity (LNFC), with a distinct pattern modulated by tumor position. Left hemisphere gliomas had a broader impact on FC than right hemisphere gliomas, with more reduced edges away from tumor sites (p=0.011). mNC analysis revealed a significant reduction in all indicators of FC except for lFCw in right hemisphere gliomas. These alterations were associated with TV in a double correlative relationship depending on the tumor position across hemispheres. Conclusion Our findings emphasize the importance of considering the modulatory effects of core-periphery mechanisms from a network perspective. Preoperative evaluation of changes in LN caused by gliomas could provide the surgeon a reference to optimize resection while maintaining functional balance.
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Affiliation(s)
- Lu Jin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Taoyang Yuan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jianyou Ying
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Braley M, Pierce JS, Saxena S, De Oliveira E, Taraboanta L, Anantha V, Lakhan SE, Kiran S. A Virtual, Randomized, Control Trial of a Digital Therapeutic for Speech, Language, and Cognitive Intervention in Post-stroke Persons With Aphasia. Front Neurol 2021; 12:626780. [PMID: 33643204 PMCID: PMC7907641 DOI: 10.3389/fneur.2021.626780] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Post-stroke aphasia is a chronic condition that impacts people's daily functioning and communication for many years after a stroke. Even though these individuals require sustained rehabilitation, they face extra burdens to access care due to shortages in qualified clinicians, insurance limitations and geographic access. There is a need to research alternative means to access intervention remotely, such as in the case of this study using a digital therapeutic. Objective: To assess the feasibility and clinical efficacy of a virtual speech, language, and cognitive digital therapeutic for individuals with post-stroke aphasia relative to standard of care. Methods: Thirty two participants completed the study (experimental: average age 59.8 years, 7 female, 10 male, average education: 15.8 years, time post-stroke: 53 months, 15 right handed, 2 left handed; control: average age 64.2 years, 7 female, 8 male, average education: 15.3 years, time post-stroke: 36.1 months, 14 right handed, 1 left handed). Patients in the experimental group received 10 weeks of treatment using a digital therapeutic, Constant Therapy-Research (CT-R), for speech, language, and cognitive therapy, which provides evidence-based, targeted therapy with immediate feedback for users that adjusts therapy difficulty based on their performance. Patients in the control group completed standard of care (SOC) speech-language pathology workbook pages. Results: This study provides Class II evidence that with the starting baseline WAB-AQ score, adjusted by −0.69 for every year of age, and by 0.122 for every month since stroke, participants in the CT-R group had WAB-AQ scores 6.43 higher than the workbook group at the end of treatment. Additionally, secondary outcome measures included the WAB-Language Quotient, WAB-Cognitive Quotient, Brief Test of Adult Cognition by Telephone (BTACT), and Stroke and Aphasia Quality of Life Scale 39 (SAQOL-39), with significant changes in BTACT verbal fluency subtest and the SAQOL-39 communication and energy scores for both groups. Conclusions: Overall, this study demonstrates the feasibility of a fully virtual trial for patients with post-stroke aphasia, especially given the ongoing COVID19 pandemic, as well as a safe, tolerable, and efficacious digital therapeutic for language/cognitive rehabilitation. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT04488029.
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Affiliation(s)
- Michelle Braley
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Charlestown, MA, United States.,Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,The Learning Corp, Newton, MA, United States
| | - Jordyn Sims Pierce
- Constant Therapy Health, Lexington, MA, United States.,Pierce Health Consultants, Lenox, MA, United States
| | - Sadhvi Saxena
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Emily De Oliveira
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Definitive Healthcare, Boston, MA, United States
| | | | - Veera Anantha
- Constant Therapy Health, Lexington, MA, United States
| | - Shaheen E Lakhan
- The Learning Corp, Newton, MA, United States.,Global Neuroscience Initiative Foundation, Boston, MA, United States.,Virginia Tech, Blacksburg, VA, United States
| | - Swathi Kiran
- Constant Therapy Health, Lexington, MA, United States.,Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
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83
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Dreyer FR, Doppelbauer L, Büscher V, Arndt V, Stahl B, Lucchese G, Hauk O, Mohr B, Pulvermüller F. Increased Recruitment of Domain-General Neural Networks in Language Processing Following Intensive Language-Action Therapy: fMRI Evidence From People With Chronic Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:455-465. [PMID: 32830988 PMCID: PMC7613191 DOI: 10.1044/2020_ajslp-19-00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose This study aimed to provide novel insights into the neural correlates of language improvement following intensive language-action therapy (ILAT; also known as constraint-induced aphasia therapy). Method Sixteen people with chronic aphasia underwent clinical aphasia assessment (Aachen Aphasia Test [AAT]), as well as functional magnetic resonance imaging (fMRI), both administered before (T1) and after ILAT (T2). The fMRI task included passive reading of single written words, with hashmark strings as visual baseline. Results Behavioral results indicated significant improvements of AAT scores across therapy, and fMRI results showed T2-T1 blood oxygenation-level-dependent (BOLD) signal change in the left precuneus to be modulated by the degree of AAT score increase. Subsequent region-of-interest analysis of this precuneus cluster confirmed a positive correlation of T2-T1 BOLD signal change and improvement on the clinical aphasia test. Similarly, the entire default mode network revealed a positive correlation between T2-T1 BOLD signal change and clinical language improvement. Conclusion These results are consistent with a more efficient recruitment of domain-general neural networks in language processing, including those involved in attentional control, following aphasia therapy with ILAT. Supplemental Material https://doi.org/10.23641/asha.12765755.
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Affiliation(s)
- Felix R. Dreyer
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Germany
- Cluster of Excellence Matters of Activity, Image Space Material, Humboldt Universität zu Berlin, Germany
| | - Lea Doppelbauer
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Germany
- Einstein Center for Neurosciences Berlin, Germany
- Berlin School of Mind and Brain, Humboldt University Berlin, Germany
| | - Verena Büscher
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Germany
| | - Verena Arndt
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Germany
| | - Benjamin Stahl
- Department of Neurology, University Medicine Greifswald, Germany
- Department of Neurology, Charité Universitätsmedizin Berlin, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Psychologische Hochschule Berlin, Germany
| | | | - Olaf Hauk
- Medical Research Council Cognition and Brain Science Unit, Cambridge, United Kingdom
| | - Bettina Mohr
- ZeNIS-Centre for Neuropsychology and Intensive Language Therapy, Berlin, Germany
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Germany
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Germany
- Cluster of Excellence Matters of Activity, Image Space Material, Humboldt Universität zu Berlin, Germany
- Einstein Center for Neurosciences Berlin, Germany
- Berlin School of Mind and Brain, Humboldt University Berlin, Germany
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84
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Thompson CK, Barbieri E, Mack JE, Wilkins A, Xie KY. Plasticity of sentence processing networks: evidence from a patient with agrammatic variant of primary progressive aphasia (PPA). Neurocase 2021; 27:39-56. [PMID: 33378229 PMCID: PMC8026534 DOI: 10.1080/13554794.2020.1862241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
This study reports the results of a longitudinal study examining the effects of treatment for sentence processing deficits for a 70-year-old gentleman (DK) with the agrammatic variant of Primary Progressive Aphasia (PPA). On entry into the study, he presented with a 2-year history of impaired verb and sentence processing and concomitant neural atrophy in primarily subcortical regions. Spanning an 18-month period, treatment focused on improving comprehension and production of syntactically complex, passive and object cleft, structures, consecutively. Results, derived from extensive behavioral and neurocognitive testing, showed not only improved ability to comprehend and produce both trained and untrained, less complex, linguistically related structures in offline tasks, but also improved online sentence processing strategies as revealed by partially normalized eye movements in online comprehension (i.e., emergence of thematic prediction and thematic integration) and production (i.e., use of incremental processing) tasks. Changes in neural activation from pre- to post-treatment of both structures also were found, with upregulation of tissue in both the left and right hemispheres, overlapping with regions recruited by neurotypical adults performing the same task. These findings indicate that Treatment of Underlying Forms (TUF) is effective for treatment of patients with the agrammatic variant of PPA (as it is for those with stroke-induced agrammatism), and show that unaffected neural tissue in patients with PPA is malleable and may be recruited to support language, providing evidence of experience-based plasticity in neurodegenerative disease.
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Affiliation(s)
- Cynthia K. Thompson
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, Northwestern University, Chicago, IL, United States
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern University, Chicago, IL, United States
| | - Elena Barbieri
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Jennifer E. Mack
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Aaron Wilkins
- Center for Audiology, Speech, Language, and Learning, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Kathy Y. Xie
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
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85
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Increased links between language and motor areas: A proof-of-concept study on resting-state functional connectivity following Personalized Observation, Execution and Mental imagery therapy in chronic aphasia. Brain Cogn 2021; 148:105659. [PMID: 33485051 DOI: 10.1016/j.bandc.2020.105659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/02/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022]
Abstract
A tight coupling of language and motor processes has been established, which is consistent with embodied cognition theory. However, very few therapies have been designed to exploit the synergy between motor and language processes to help rehabilitate people with aphasia (PWA). Moreover, the underlying mechanisms supporting the efficacy of such approaches remain unknown. Previous work in our laboratory has demonstrated that personalized observation, execution, and mental imagery therapy (POEM)-a new therapy using three sensorimotor strategies to trigger action verb naming-leads to significant improvements in verb retrieval in PWA. Moreover, these improvements were supported by significant activations in language and sensorimotor processing areas, which further reinforce the role of both processes in language recovery (Durand et al., 2018). The present study investigates resting state functional connectivity (rsFC) changes following POEM in a pre-/post-POEM therapy design. A whole brain network functional connectivity approach was used to assess and describe changes in rsFC in a group of four PWA, who were matched and compared with four healthy controls (HC). Results showed increased rsFC in PWA within and between visuo-motor and language areas (right cuneal cortex-left supracalcarin (SCC) cortex/right precentral gyrus (PreCG)-left lingual gyrus (LG)) and between areas involved in action processing (right anterior parahippocampal gyrus (aPaHC)-left superior parietal lobule (SPL). In comparison to HC, the PWA group showed increased rsFC between the right inferior frontal gyrus (IFG) and left thalamus, which are areas involved in lexico-semantic processing. This proof-of-concept study suggests that the sensorimotor and language strategies used in POEM may induce modifications in large-scale networks, probably derived from the integration of visual and sensorimotor systems to sustain action naming, which is consistent with the embodied cognition theory.
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86
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Fan JM, Gorno-Tempini ML, Dronkers NF, Miller BL, Berger MS, Chang EF. Data-Driven, Visual Framework for the Characterization of Aphasias Across Stroke, Post-resective, and Neurodegenerative Disorders Over Time. Front Neurol 2020; 11:616764. [PMID: 33447252 PMCID: PMC7801263 DOI: 10.3389/fneur.2020.616764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/03/2020] [Indexed: 12/04/2022] Open
Abstract
Aphasia classifications and specialized language batteries differ across the fields of neurodegenerative disorders and lesional brain injuries, resulting in difficult comparisons of language deficits across etiologies. In this study, we present a simplified framework, in which a widely-used aphasia battery captures clinical clusters across disease etiologies and provides a quantitative and visual method to characterize and track patients over time. The framework is used to evaluate populations representing three disease etiologies: stroke, primary progressive aphasia (PPA), and post-operative aphasia. A total of 330 patients across three populations with cerebral injury leading to aphasia were investigated, including 76 patients with stroke, 107 patients meeting criteria for PPA, and 147 patients following left hemispheric resective surgery. Western Aphasia Battery (WAB) measures (Information Content, Fluency, answering Yes/No questions, Auditory Word Recognition, Sequential Commands, and Repetition) were collected across the three populations and analyzed to develop a multi-dimensional aphasia model using dimensionality reduction techniques. Two orthogonal dimensions were found to explain 87% of the variance across aphasia phenotypes and three disease etiologies. The first dimension reflects shared weighting across aphasia subscores and correlated with aphasia severity. The second dimension incorporates fluency and comprehension, thereby separating Wernicke's from Broca's aphasia, and the non-fluent/agrammatic from semantic PPA variants. Clusters representing clinical classifications, including late PPA presentations, were preserved within the two-dimensional space. Early PPA presentations were not classifiable, as specialized batteries are needed for phenotyping. Longitudinal data was further used to visualize the trajectory of aphasias during recovery or disease progression, including the rapid recovery of post-operative aphasic patients. This method has implications for the conceptualization of aphasia as a spectrum disorder across different disease etiology and may serve as a framework to track the trajectories of aphasia progression and recovery.
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Affiliation(s)
- Joline M Fan
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | | | - Nina F Dronkers
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.,Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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87
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Kaur H, Nehra A, Chopra S, Sati H, Bhatia R, Kumaran SS, Pandey RM, Padma Srivastava MV. Development and Validation of a Comprehensive Neuropsychological and Language Rehabilitation for Stroke Survivors: A Home-Based Caregiver-Delivered Intervention Program. Ann Indian Acad Neurol 2020; 23:S116-S122. [PMID: 33343135 PMCID: PMC7731686 DOI: 10.4103/aian.aian_500_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022] Open
Abstract
Context: Aphasia is a major disabling condition after a stroke that profoundly affects the quality of life of stroke survivors (SS) and their caregivers. Comprehensive neuropsychological rehabilitation has emerged as a complementary intervention that helps in improving the associated cognitive and psychological deficits and quality of life following a brain injury. A standardized, simple, and easy to administer intervention that can be delivered as a home-based intervention can assist in faster recovery. Aims: To describe the development, validation, and feasibility of a home-based, caregiver-delivered comprehensive neuropsychological and language rehabilitation for SS. Methods and Material: A culture-specific picture and task-based 8-week training workbook and manual were developed based on extensive review and focused group discussions. This intervention targeted areas of language (comprehension, fluency, and naming) and cognition (working memory, attention and concentration, executive functioning, and response inhibition). It was standardized on 40 healthy controls (HC) and 15 SS. Before recruitment, written informed consent was obtained from each patient, their primary caregiver, and the HCs. Results: All tasks were found to be effective in discriminating the performance of SS from the HC. The performance of the HC with respect to the errors and the time taken for each task was used for the hierarchical arrangement of the tasks. The developed intervention was later validated on 15 SS where they significantly improved in the pre-post assessment of language functioning (P < 0.001), quality of life (P < 0.001), and depression (P < 0.001). Conclusions: This intervention can be feasible to administer as a home-based intervention and may help to alleviate language and neuropsychological complaints after stroke in low-literate or mixed-cultural populations. Further, large sample size studies are recommended.
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Affiliation(s)
- Harsimarpreet Kaur
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashima Nehra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sakshi Chopra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Hemchandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Senthil S Kumaran
- Department of NMR, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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88
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Harvey S, Carragher M, Dickey MW, Pierce JE, Rose ML. Dose effects in behavioural treatment of post-stroke aphasia: a systematic review and meta-analysis. Disabil Rehabil 2020; 44:2548-2559. [PMID: 33164590 DOI: 10.1080/09638288.2020.1843079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Aphasia is a debilitating chronic acquired language disorder that impacts heavily on a person's life. Behavioural treatments aim to remediate language processing skills or to enhance communication between the person with aphasia and others, and a number of different treatments are efficacious. However, it is unclear how much of a particular treatment a person needs in order to optimise recovery of language and communication skills following stroke. MATERIALS AND METHODS Systematic search for and meta-analysis of experimental studies that directly compared different amounts of the same behavioural aphasia treatment, following PRISMA guidelines. RESULTS Treatment dose research in aphasia is an emerging area. Just six studies comparing different doses of the same intervention met all criteria for inclusion. Evidence from these studies was synthesised and meta-analysed, where possible. Meta-analyses were inconclusive due to limited data; however, there are indications that suggest increased dose may confer greater improvement on language and communication measures, but with diminishing returns over time. Aphasia severity and chronicity may affect dose-response relationships. CONCLUSIONS There is currently insufficient evidence to determine the effect of dose on treatment response. A dedicated and coordinated research agenda is required to systematically explore dose-response relationships in post-stroke aphasia interventions.A video abstract is available in the Supplementary Material.Implications for rehabilitationThe investigation of the effect of dose on treatment outcomes in post-stroke aphasia is an emerging research area with few studies reporting comparison of different amounts of the same intervention.In the acute phase of recovery following stroke, higher doses of treatment provided over short periods may not be preferable, tolerable, or superior to lower doses of the same treatment.In the chronic phase, providing additional blocks of treatment may confer additional benefit for some people with aphasia but with diminishing returns.People with chronic aphasia can achieve and maintain significant gains in picture naming after a relatively brief period of high-dose treatment.
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Affiliation(s)
- Sam Harvey
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Marcella Carragher
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Michael Walsh Dickey
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia.,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - John E Pierce
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Miranda L Rose
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
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89
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Fabian R, Bunker L, Hillis AE. Is Aphasia Treatment Beneficial for the Elderly? A Review of Recent Evidence. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:478-492. [PMID: 33777504 DOI: 10.1007/s40141-020-00287-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose We review recent literature regarding aphasia therapy in the elderly. Relevant articles from the last 5 years were identified to determine whether or not there is evidence to support that various therapeutic approaches can have a positive effect on post-stroke aphasia in the elderly. Recent findings There were no studies examining the effects of aphasia therapy specifically in the elderly within the timeframe searched. Therefore, we briefly summarize findings from 50 relevant studies that included large proportions of participants with post-stroke aphasia above the age of 65. A variety of behavioral and neuromodulation therapies are reported. Summary We found ample evidence suggesting that a variety of behavioral and neuromodulatory therapeutic approaches can benefit elderly individuals with post-stroke aphasia.
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Affiliation(s)
- Rachel Fabian
- Department of Neurology, Johns Hopkins University School of Medicine
| | - Lisa Bunker
- Department of Neurology, Johns Hopkins University School of Medicine
| | - Argye E Hillis
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine.,Department of Neurology, Johns Hopkins University School of Medicine
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90
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Ramage AE, Aytur S, Ballard KJ. Resting-State Functional Magnetic Resonance Imaging Connectivity Between Semantic and Phonological Regions of Interest May Inform Language Targets in Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3051-3067. [PMID: 32755498 PMCID: PMC7890222 DOI: 10.1044/2020_jslhr-19-00117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 03/16/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
Purpose Brain imaging has provided puzzle pieces in the understanding of language. In neurologically healthy populations, the structure of certain brain regions is associated with particular language functions (e.g., semantics, phonology). In studies on focal brain damage, certain brain regions or connections are considered sufficient or necessary for a given language function. However, few of these account for the effects of lesioned tissue on the "functional" dynamics of the brain for language processing. Here, functional connectivity (FC) among semantic-phonological regions of interest (ROIs) is assessed to fill a gap in our understanding about the neural substrates of impaired language and whether connectivity strength can predict language performance on a clinical tool in individuals with aphasia. Method Clinical assessment of language, using the Western Aphasia Battery-Revised, and resting-state functional magnetic resonance imaging data were obtained for 30 individuals with chronic aphasia secondary to left-hemisphere stroke and 18 age-matched healthy controls. FC between bilateral ROIs was contrasted by group and used to predict Western Aphasia Battery-Revised scores. Results Network coherence was observed in healthy controls and participants with stroke. The left-right premotor cortex connection was stronger in healthy controls, as reported by New et al. (2015) in the same data set. FC of (a) connections between temporal regions, in the left hemisphere and bilaterally, predicted lexical-semantic processing for auditory comprehension and (b) ipsilateral connections between temporal and frontal regions in both hemispheres predicted access to semantic-phonological representations and processing for verbal production. Conclusions Network connectivity of brain regions associated with semantic-phonological processing is predictive of language performance in poststroke aphasia. The most predictive connections involved right-hemisphere ROIs-particularly those for which structural adaptions are known to associate with recovered word retrieval performance. Predictions may be made, based on these findings, about which connections have potential as targets for neuroplastic functional changes with intervention in aphasia. Supplemental Material https://doi.org/10.23641/asha.12735785.
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Affiliation(s)
- Amy E. Ramage
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham
| | - Semra Aytur
- Department of Health Policy and Management, University of New Hampshire, Durham
| | - Kirrie J. Ballard
- Faculty of Medicine and Health and the Brain and Mind Centre, The University of Sydney, New South Wales, Australia
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91
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Monroy-Sosa A, Chakravarthi SS, Cortes-Contreras AP, Hernandez-Varela M, Andres-Arrieta V, Epping A, Rovin RA. The Evolution of Cerebral Language Localization: Historical Analysis and Current Trends. World Neurosurg 2020; 145:89-97. [PMID: 32916360 DOI: 10.1016/j.wneu.2020.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/05/2020] [Accepted: 09/05/2020] [Indexed: 01/08/2023]
Abstract
Language localization has been an evolving concept over the past 150 years, with the emergence of several important yet conflicting ideologies. The classical theory, starting from the phrenologic work of Gall to the identification of specific regions of language function by Broca, Wernicke, and others, proposed that discrete subcomponents of language were organized into separate anatomic structural regions. The holism theory was postulated in an attempt to disclose that language function was instead attributed to a larger region of the cortex, in which cerebral regions may have the capability of assuming the function of damaged areas. However, this theory was largely abandoned in favor of discrete structural localizationist viewpoints. The subsequent cortical stimulatory work of Penfield led to the development of maps of localization, assigning an eloquent designation to specific regions. The expanding knowledge of cortical and subcortical anatomy allowed for the development of anatomically and functionally integrative language models. In particular, the dual stream model revisited the concept of regional interconnectivity and expanded the concept of eloquence. Advancements in cortical-subcortical stimulation, neurophysiologic monitoring, magnetic resonance diffusion tensor imaging/functional magnetic resonance imaging, awake neurosurgical technique, and knowledge gained by white matter tract anatomy and the Human Connectome Project, shed new light on the dynamic interconnectivity of the cerebrum. New studies are progressively opening doors to this paradigm, showing the dynamic and interdependent nature of language function. In this review, the evolution of language toward the evolving paradigm of dynamic language function and interconnectivity and its impact on shaping the neurosurgical paradigm are outlined.
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Affiliation(s)
- Alejandro Monroy-Sosa
- Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin; Skull Base, Brain & Cerebrovascular Laboratory, Advocate Aurora Research Health Institute, Milwaukee, Wisconsin.
| | - Srikant S Chakravarthi
- Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin; Skull Base, Brain & Cerebrovascular Laboratory, Advocate Aurora Research Health Institute, Milwaukee, Wisconsin
| | | | | | - Victor Andres-Arrieta
- Faculty of Medicine, PECEM, Universidad Nacional Autonónoma de México, Mexico City, Mexico
| | - Austin Epping
- Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin; Skull Base, Brain & Cerebrovascular Laboratory, Advocate Aurora Research Health Institute, Milwaukee, Wisconsin
| | - Richard A Rovin
- Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
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92
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Msigwa SS, Cheng X. The management of subacute and chronic vascular aphasia: an updated review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00224-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Post-stroke aphasia (PSA) is an impairment of the generation or comprehension of language due to acute cerebrovascular lesions. Subacute phase span the 7th day to 24 weeks post-onset while > 6 months is termed chronic phase. Language recovery does not arise immediately in chronic PSA, unlike the acute phase. The majority of the treatment modalities in these two PSA phases are still in the infancy stage, facing dilemmas and considered experimental requiring constant updates. Hence, we aimed to upgrade the existing literature regarding available PSA management options, advances, and drawbacks pertaining to subacute and chronic phases.
Main text
In this review, we analyzed the management options for subacute and chronic vascular aphasia. MEDLINE, through PubMed, ScienceDirect, and Google Scholar were explored for English studies by utilizing the terms “stroke aphasia” Plus “vascular aphasia”; 160,753 articles were retrieved. The latest studies, published from 2016 to July 2020, were selected. Article headings and abstracts were analyzed for relevance and filtered; eventually, 92 articles were included in this review. Various management options were extracted as follows: noninvasive brain stimulation (NIBS), technology-based therapies, speech-language therapy (SLT), pharmacotherapy, music-based therapies, and psychosocial interventions.
Conclusion
The PSA therapy evolves towards more intense SLT therapy, yet the optimal dosage of the emerging high-intensity therapies is controversial. As spinal and cerebellar NIBS, Telespeech, and E-mental health mark PSA's future, distinct pharmacological options remain a dilemma. Across the continuum of care, PSA–depression comorbidity and inadequate PSA post-discharge education to patient’s families are the significant therapeutic challenges. Future therapeutic mechanisms, optimal dose/timing, and tolerability/safety exploration are obliged.
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93
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Butler LK, Kiran S, Tager-Flusberg H. Functional Near-Infrared Spectroscopy in the Study of Speech and Language Impairment Across the Life Span: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1674-1701. [PMID: 32640168 PMCID: PMC7893520 DOI: 10.1044/2020_ajslp-19-00050] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Purpose Functional brain imaging is playing an increasingly important role in the diagnosis and treatment of communication disorders, yet many populations and settings are incompatible with functional magnetic resonance imaging and other commonly used techniques. We conducted a systematic review of neuroimaging studies using functional near-infrared spectroscopy (fNIRS) with individuals with speech or language impairment across the life span. We aimed to answer the following question: To what extent has fNIRS been used to investigate the neural correlates of speech-language impairment? Method This systematic review was preregistered with PROSPERO, the international prospective register of systematic reviews (CRD42019136464). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol for preferred reporting items for systematic reviews. The database searches were conducted between February and March of 2019 with the following search terms: (a) fNIRS or functional near-infrared spectroscopy or NIRS or near-infrared spectroscopy, (b) speech or language, and (c) disorder or impairment or delay. Results We found 34 fNIRS studies that involved individuals with speech or language impairment across nine categories: (a) autism spectrum disorders; (b) developmental speech and language disorders; (c) cochlear implantation and deafness; (d) dementia, dementia of the Alzheimer's type, and mild cognitive impairment; (e) locked-in syndrome; (f) neurologic speech disorders/dysarthria; (g) stroke/aphasia; (h) stuttering; and (i) traumatic brain injury. Conclusions Though it is not without inherent challenges, fNIRS may have advantages over other neuroimaging techniques in the areas of speech and language impairment. fNIRS has clinical applications that may lead to improved early and differential diagnosis, increase our understanding of response to treatment, improve neuroprosthetic functioning, and advance neurofeedback.
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Affiliation(s)
- Lindsay K. Butler
- Sargent College of Health and Rehabilitation Sciences, Boston University, MA
| | - Swathi Kiran
- Sargent College of Health and Rehabilitation Sciences, Boston University, MA
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94
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Altmann RF, Ortiz KZ, Benfica TR, de Oliveira EP, Pagliarin KC. Brief Montreal-Toulouse Language Assessment Battery: adaptation and content validity. PSICOLOGIA-REFLEXAO E CRITICA 2020; 33:18. [PMID: 32734309 PMCID: PMC7392960 DOI: 10.1186/s41155-020-00157-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evaluating patients in the acute phase of brain damage allows for the early detection of cognitive and linguistic impairments and the implementation of more effective interventions. However, few cross-cultural instruments are available for the bedside assessment of language abilities. The aim of this study was to develop a brief assessment instrument and evaluate its content validity. METHODS Stimuli for the new assessment instrument were selected from the M1-Alpha and MTL-BR batteries (Stage 1). Sixty-five images were redesigned and analyzed by non-expert judges (Stage 2). This was followed by the analysis of expert judges (Stage 3), where nine speech pathologists with doctoral training and experience in aphasiology and/or linguistics evaluated the images, words, nonwords, and phrases for inclusion in the instrument. Two pilot studies (Stage 4) were then conducted in order to identify any remaining errors in the instrument and scoring instructions. RESULTS Sixty of the 65 figures examined by the judges achieved inter-rater agreement rates of at least 80%. Modifications were suggested to 22 images, which were therefore reanalyzed by the judges, who reached high levels of inter-rater agreement (AC1 = 0.98 [CI = 0.96-1]). New types of stimuli such as nonwords and irregular words were also inserted in the Brief Battery and favorably evaluated by the expert judges. Optional tasks were also developed for specific diagnostic situations. After the correction of errors detected in Stage 4, the final version of the instrument was obtained. CONCLUSION This study confirmed the content validity of the Brief MTL-BR Battery. The method used in this investigation was effective and can be used in future studies to develop brief instruments based on preexisting assessment batteries.
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Affiliation(s)
- Raira Fernanda Altmann
- Department of Speech-Language Pathology, Universidade Federal de Santa Maria, Santa Maria/RS, Brazil.
| | - Karin Zazo Ortiz
- Department of Speech-Language Pathology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tainá Rossato Benfica
- Department of Speech-Language Pathology, Universidade Federal de Santa Maria, Santa Maria/RS, Brazil
| | | | - Karina Carlesso Pagliarin
- Department of Speech-Language Pathology, Universidade Federal de Santa Maria, Santa Maria/RS, Brazil
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95
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Harvey SR, Carragher M, Dickey MW, Pierce JE, Rose ML. Treatment dose in post-stroke aphasia: A systematic scoping review. Neuropsychol Rehabil 2020; 31:1629-1660. [PMID: 32631143 DOI: 10.1080/09602011.2020.1786412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Little is known about how the amount of treatment a person with aphasia receives impacts aphasia recovery following stroke, yet this information is vital to ensure effective treatments are delivered efficiently. Furthermore, there is no standard dose terminology in the stroke rehabilitation or aphasia literature. This scoping review aims to systematically map the evidence regarding dose in treatments for post-stroke aphasia and to explore how treatment dose is conceptualized, measured and reported in the literature. A comprehensive search was undertaken in June 2019. One hundred and twelve intervention studies were reviewed. Treatment dose (amount of treatment) has been conceptualized as both a measure of time and a count of discrete therapeutic elements. Doses ranged from one to 100 hours, while some studies reported session doses of up to 420 therapeutic inputs per session. Studies employ a wide variety of treatment schedules (i.e., session dose, session frequency, and intervention duration) and the interaction of dose parameters may impact the dose-response relationship. High dose interventions delivered over short periods may improve treatment efficiency while maintaining efficacy. Person- and treatment-level factors that mediate tolerance of high dose interventions require further investigation. Systematic exploration of dose-response relationships in post-stroke aphasia treatment is required.
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Affiliation(s)
- Sam R Harvey
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Marcella Carragher
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Michael Walsh Dickey
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia.,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - John E Pierce
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Miranda L Rose
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
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96
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Pierce JE, O'Halloran R, Menahemi-Falkov M, Togher L, Rose ML. Comparing higher and lower weekly treatment intensity for chronic aphasia: A systematic review and meta-analysis. Neuropsychol Rehabil 2020; 31:1289-1313. [PMID: 32496963 DOI: 10.1080/09602011.2020.1768127] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Optimizing intensity for aphasia treatment is a high priority research issue for people with aphasia, their families and clinicians, and could result in healthcare cost savings. An important aspect of intensity is the frequency of intervention, or how regularly treatment should be provided each week. While principles of neuroplasticity endorse massed practice, cognitive psychology has established superiority of distributed practice within normal learning. Neither concept has been conclusively tested in aphasia. There have been many literature reviews of intensity in aphasia intervention, but most have not investigated treatment intensity whilst also ensuring that therapy dose and treatment type are identical between study groups. Some have also combined studies across acute, subacute and chronic aphasia. We searched systematically for studies directly comparing higher and lower weekly treatment frequency in chronic aphasia. Eight studies were retrieved and rated for methodological quality. Meta-analysis was completed for group and single case experimental designs. Results showed that there are few studies investigating treatment frequency in chronic aphasia and their quality is low-moderate. Meta-analyses were inconclusive due to limited data, but there was no indication of either schedule being superior. Further research directly comparing treatment schedules is needed.
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Affiliation(s)
- John E Pierce
- School of Allied Health, La Trobe University, Melbourne, Australia.,Speech Pathology, Cabrini Health, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Robyn O'Halloran
- School of Allied Health, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Maya Menahemi-Falkov
- School of Allied Health, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
| | - Leanne Togher
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia.,Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Miranda L Rose
- School of Allied Health, La Trobe University, Melbourne, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
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97
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Copland DA. Elizabeth Usher Memorial Lecture: Lost in Translation? Challenges and future prospects for a neurobiological approach to aphasia rehabilitation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:270-280. [PMID: 32686593 DOI: 10.1080/17549507.2020.1768287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While there has been considerable progress in conducting trials of aphasia therapy, there is no consistent evidence for long-term benefits of aphasia treatment, suggesting the need to reconsider current approaches. There are also no accurate methods for determining the amount, type and timing of aphasia therapy that should be provided for an individual. At the same time, there has been increasing interest in applying various principles of neuroplasticity to aphasia treatment and using measures of brain structure and function to predict recovery. This article will consider the potential of neuroplasticity principles and neurobiological predictors to improve our current approach to aphasia rehabilitation and optimise outcomes. Reviewing these principles highlights some of the challenges of translating animal model-based principles and emphases the need to also consider relevant theories of human learning. While considerable progress has been made in considering neurobiological principles and using measures of brain structure and function to predict recovery, there is significant work required to achieve the full potential of this neurobiological approach to aphasia management.
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Affiliation(s)
- David A Copland
- School of Health and Rehabilitation Sciences, Centre for Clinical Research, Queensland Aphasia Rehabilitation Centre, The University of Queensland, St Lucia, Australia
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98
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Ginex V, Gilardone G, Viganò M, Monti A, Judica E, Passaro I, Gilardone M, Vanacore N, Corbo M. Interaction Between Recovery of Motor and Language Abilities After Stroke. Arch Phys Med Rehabil 2020; 101:1367-1376. [PMID: 32417441 DOI: 10.1016/j.apmr.2020.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/27/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze the nature of the interaction between motor and language recovery in patients with motor impairment and aphasia following left hemispheric stroke and to investigate prognostic factors of best recovery, that is, the significant recovery of both functions simultaneously. DESIGN Retrospective cohort study. SETTING Specialized inpatient rehabilitation facility. PARTICIPANTS Patients (N=435) with left hemispheric stroke in the postacute phase with motor impairment and aphasia. INTERVENTION Not applicable. MAIN OUTCOME MEASURE Patients who reached the minimal clinically important difference in the motor-FIM (M-FIM) were classified as motor responders, patients who reached a significant change in Aachen Aphasia Test were classified as language responders, and patients who reached a simultaneous and significant improvement in both functions were classified as motor and language responders. RESULTS Of the sample 45% were motor responders, 58% were language responders, and 35% were motor and language responders. Responder groups showed lower motor impairment and less severe aphasia at admission and greater improvement in both functions at discharge compared with nonresponder groups. Premorbid autonomy, dysphagia, apraxia, and number of rehabilitative sessions were also significantly different between groups. A logistic regression model identified M-FIM, repetition abilities, and number of sessions of speech and language therapy as independent predictors of best response (ie, motor and language responders). CONCLUSIONS This study provides evidence about a possible interaction between motor and language recovery after stroke. The improvement in one function was never associated with deterioration in the other. The results actually suggest a synergic effect between the amelioration of the 2 functions, with an overall increased efficiency when the 2 recovery pathways are combined.
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Affiliation(s)
- Valeria Ginex
- Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy.
| | - Giulia Gilardone
- Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy
| | - Mauro Viganò
- Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy
| | - Alessia Monti
- Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy
| | - Elda Judica
- Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy
| | - Ilaria Passaro
- Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy
| | - Marco Gilardone
- Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy
| | - Nicola Vanacore
- National Institute of Health, National Centre for Epidemiology, Surveillance, and Health Promotion Italian, Rome, Italy
| | - Massimo Corbo
- Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy
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Higgins J, Barbieri E, Wang X, Mack J, Caplan D, Kiran S, Rapp B, Thompson C, Zinbarg R, Parrish T. Reliability of BOLD signals in chronic stroke-induced aphasia. Eur J Neurosci 2020; 52:3963-3978. [PMID: 32282965 DOI: 10.1111/ejn.14739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
Abstract
Investigating the neurobiology of language impairment and treatment in chronic stroke aphasia using fMRI requires an understanding of measurement variability within and between participants. In this multicenter study, we evaluated the scan-rescan reliability of an auditory and visual (written) story comprehension paradigm in stroke participants with aphasia (N = 65) and healthy controls (N = 22). The multi-modal task was conducted twice (~1 week apart) on separate visits upon study enrolment and twice again at completion three months later. A non-language visuomotor task was studied in the aphasia group only, which was conducted once per time point (3 months apart). While participants were asked to make responses during the comprehension task, these in-scanner responses were not recorded. Reliability was assessed using intraclass correlation coefficient (ICC) at both group and individual participant levels. The visual story comprehension condition had higher reliability than the auditory condition in both groups, with participants with aphasia exhibiting lower reliability than controls in both conditions (stroke ICC = .43, healthy ICC = .81). Differences in reliability within the group of participants with aphasia were found to be partially explained by overall language impairment as well as greater head motion. In the participants with aphasia, the visuomotor paradigm was found to have greater reliability than the story comprehension task at equivalent interscan intervals (visuomotor = 0.50, comprehension = 0.34), and its reliability was not associated with language impairment. This work highlights the importance of considering the reliability of fMRI tasks in aphasia research, provides strategies to improve reliability and has potential implications for the field of clinical neuroimaging in general.
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Affiliation(s)
- James Higgins
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elena Barbieri
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.,Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Xue Wang
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jennifer Mack
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.,Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - David Caplan
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Swathi Kiran
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.,Department of Speech, Language, and Hearing, College of Health & Rehabilitation, Boston University, Boston, MA, USA
| | - Brenda Rapp
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.,Department of Cognitive Science, Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia Thompson
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.,Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA.,Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Richard Zinbarg
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.,Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, USA.,The Family Institute at Northwestern University, Evanston, IL, USA
| | - Todd Parrish
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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100
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Beuter A, Balossier A, Vassal F, Hemm S, Volpert V. Cortical stimulation in aphasia following ischemic stroke: toward model-guided electrical neuromodulation. BIOLOGICAL CYBERNETICS 2020; 114:5-21. [PMID: 32020368 DOI: 10.1007/s00422-020-00818-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
The aim of this paper is to integrate different bodies of research including brain traveling waves, brain neuromodulation, neural field modeling and post-stroke language disorders in order to explore the opportunity of implementing model-guided, cortical neuromodulation for the treatment of post-stroke aphasia. Worldwide according to WHO, strokes are the second leading cause of death and the third leading cause of disability. In ischemic stroke, there is not enough blood supply to provide enough oxygen and nutrients to parts of the brain, while in hemorrhagic stroke, there is bleeding within the enclosed cranial cavity. The present paper focuses on ischemic stroke. We first review accumulating observations of traveling waves occurring spontaneously or triggered by external stimuli in healthy subjects as well as in patients with brain disorders. We examine the putative functions of these waves and focus on post-stroke aphasia observed when brain language networks become fragmented and/or partly silent, thus perturbing the progression of traveling waves across perilesional areas. Secondly, we focus on a simplified model based on the current literature in the field and describe cortical traveling wave dynamics and their modulation. This model uses a biophysically realistic integro-differential equation describing spatially distributed and synaptically coupled neural networks producing traveling wave solutions. The model is used to calculate wave parameters (speed, amplitude and/or frequency) and to guide the reconstruction of the perturbed wave. A stimulation term is included in the model to restore wave propagation to a reasonably good level. Thirdly, we examine various issues related to the implementation model-guided neuromodulation in the treatment of post-stroke aphasia given that closed-loop invasive brain stimulation studies have recently produced encouraging results. Finally, we suggest that modulating traveling waves by acting selectively and dynamically across space and time to facilitate wave propagation is a promising therapeutic strategy especially at a time when a new generation of closed-loop cortical stimulation systems is about to arrive on the market.
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Affiliation(s)
- Anne Beuter
- Bordeaux INP, University of Bordeaux, Bordeaux, France.
| | - Anne Balossier
- Service de neurochirurgie fonctionnelle et stéréotaxique, AP-HM La Timone, Aix-Marseille University, Marseille, France
| | - François Vassal
- INSERM U1028 Neuropain, UMR 5292, Centre de Recherche en Neurosciences, Universités Lyon 1 et Saint-Etienne, Saint-Étienne, France
- Service de Neurochirurgie, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Étienne, France
| | - Simone Hemm
- School of Life Sciences, Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts Northwestern Switzerland, 4132, Muttenz, Switzerland
| | - Vitaly Volpert
- Institut Camille Jordan, UMR 5208 CNRS, University Lyon 1, 69622, Villeurbanne, France
- INRIA Team Dracula, INRIA Lyon La Doua, 69603, Villeurbanne, France
- People's Friendship University of Russia (RUDN University), Miklukho-Maklaya St, Moscow, Russian Federation, 117198
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