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Muscat CC, McCabe SA, Morgan AT, Scratch SE, MacKay MT, Lewis I, Beal DS. Neural mechanisms driving speech and language recovery following childhood stroke: a scoping review. Disabil Rehabil 2024:1-15. [PMID: 39218014 DOI: 10.1080/09638288.2024.2390053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This scoping review aimed to inform future research priorities by collating evidence on neural correlates of speech and language recovery following childhood stroke. METHODS Neuroimaging, motor speech, or language outcomes following childhood stroke (28 days to 18 years age) in the subacute to chronic community stages (care occurring after acute medical management, including inpatient and outpatient rehabilitation, and community-based programs) were identified and extracted from Medline, Embase, PsycInfo, and Clinical databases. RESULTS Of the 3990 studies screened, 11 met the inclusion criteria. Of the included articles, no papers formally assessed speech outcomes, 11 articles reported language outcomes through standardized testing, 11 utilized structural imaging (CT, MRI), and four reported functional neuroimaging outcomes (fMRI). INTERPRETATION This review revealed a rudimentary accounting of speech and language profiles in children post-stroke; limited by the use of varied and incomplete speech and language assessment batteries, inconsistent reporting of lesion locations associated with speech and language outcomes, a dearth of functional neuroimaging studies, and lack of information about speech and language function throughout the rehabilitation period, a time when the brain is most plastic and receptive to therapy. Future research should provide complete and accurate accounts of speech and language function and their neural correlates throughout rehabilitation and recovery to inform care, education, and employment planning.
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Affiliation(s)
- Christine C Muscat
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Speech-Language Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah A McCabe
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Angela T Morgan
- University of Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Shannon E Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Speech-Language Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Mark T MacKay
- University of Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Iveta Lewis
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Deryk S Beal
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Speech-Language Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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2
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Rubi-Fessen I, Gerbershagen K, Stenneken P, Willmes K. Early Boost of Linguistic Skills? Individualized Non-Invasive Brain Stimulation in Early Postacute Aphasia. Brain Sci 2024; 14:789. [PMID: 39199482 PMCID: PMC11353206 DOI: 10.3390/brainsci14080789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 09/01/2024] Open
Abstract
Non-invasive brain stimulation, such as transcranial direct current stimulation (tDCS), has been shown to increase the outcome of speech and language therapy (SLT) in chronic aphasia. Only a few studies have investigated the effect of add-on tDCS on SLT in the early stage of aphasia; this may be due to methodological reasons, in particular the influence of spontaneous remission and the difficulty of establishing stimulation protocols in clinical routines. Thirty-seven participants with subacute aphasia (PwA) after stroke (23 men, 14 women; mean age 62 ± 12 years; mean duration 49 ± 28 days) were included in two consecutive periods of treatment lasting two weeks each. During the first period (P1) the participants received 10 sessions of SLT, during the second period (P2) the aphasia therapy was supplemented by anodal left hemispheric 2 mA tDCS over the left hemisphere. Severity-specific language tests (Aachen Aphasia Test (AAT), n = 27 and Bielefeld Aphasia Screening-Reha (BIAS-R), n = 10) were administered before P1, between P1 and P2, and after P2. Where information was available, the results were corrected for spontaneous remission (AAT sample), and the therapy outcomes of P1 and P2 were compared. Participants' overall language abilities improved significantly during P1 and P2. However, improvement-as measured by the AAT profile level or the BIAS-R mean percentage value-during P2 (with tDCS) was significantly higher than during P1 (p < 0.001; AAT sample and p = 0.005; BIAS-R sample). Thus, tDCS protocols can be implemented in early aphasia rehabilitation. Despite the limitations of the research design, which are also discussed from an implementation science perspective, this is preliminary evidence that an individually tailored anodal tDCS can have a significant add-on effect on the outcome of behavioral aphasia therapy in subacute aphasia.
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Affiliation(s)
- Ilona Rubi-Fessen
- Neurological Rehabilitation Hospital, RehaNova Köln, 51109 Cologne, Germany;
- Department of Rehabilitation and Special Education, Faculty of Human Sciences, University of Cologne, 50931 Cologne, Germany;
| | | | - Prisca Stenneken
- Department of Rehabilitation and Special Education, Faculty of Human Sciences, University of Cologne, 50931 Cologne, Germany;
| | - Klaus Willmes
- Department of Neurology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
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3
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Mendes AJ, Lema A, Soares JM, Sampaio A, Leite J, Carvalho S. Functional neuroimaging and behavioral correlates of multisite tDCS as an add-on to language training in a person with post-stroke non-fluent aphasia: a year-long case study. Neurocase 2024; 30:8-17. [PMID: 38700140 DOI: 10.1080/13554794.2024.2349327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
Mary, who experienced non-fluent aphasia as a result of an ischemic stroke, received 10 years of personalized language training (LT), resulting in transient enhancements in speech and comprehension. To enhance these effects, multisite transcranial Direct Current Stimulation (tDCS) was added to her LT regimen for 15 sessions. Assessment using the Reliable Change Index showed that this combination improved her left inferior frontal connectivity and speech production for two months and significantly improved comprehension after one month. The results indicate that using multisite transcranial direct current stimulation (tDCS) can improve the effectiveness of language therapy (LT) for individuals with non-fluent aphasia.
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Affiliation(s)
- Augusto J Mendes
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Braga, Portugal
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Alberto Lema
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - José Miguel Soares
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Adriana Sampaio
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Jorge Leite
- CINTESIS@RISE, CINTESIS.UPT, Portucalense University, Porto, Portugal
| | - Sandra Carvalho
- Translational Neuropsychology Lab, Department of Education and Psychology, William James Center for Research (WJCR), University of Aveiro, Aveiro, Portugal
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
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4
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Shekari E, Seyfi M, Modarres Zadeh A, Batouli SA, Valinejad V, Goudarzi S, Joghataei MT. Mechanisms of brain activation following naming therapy in aphasia: A systematic review on task-based fMRI studies. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:780-801. [PMID: 35666667 DOI: 10.1080/23279095.2022.2074849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The pattern of brain neuroplasticity after naming therapies in patients with aphasia can be evaluated using task-based fMRI. This article aims to review studies investigating brain reorganization after semantic and phonological-based anomia therapy that used picture-naming fMRI tasks. We searched for those articles that compared the activation of brain areas before and after aphasia therapies in the PubMed and the EMBASE databases from 1993 up to April 2020. All studies (single-cases or group designs) on anomia treatment in individuals with acquired aphasia were reviewed. Data were synthesized descriptively through tables to allow the facilitated comparison of the studies. A total of 14 studies were selected and reviewed. The results of the reviewed studies demonstrated that the naming improvement is associated with changes in the activation of cortical and subcortical brain areas. This review highlights the need for a more systematic investigation of the association between decreased and increased activation of brain areas related to anomia therapy. Also, more detailed information about factors influencing brain reorganization is required to elucidate the neural mechanisms of anomia therapy. Overall, regarding the theoretical and clinical aspects, the number of studies that used intensive protocol is growing, and based on the positive potential of these treatments, they could be suitable for the rehabilitation of people with aphasia.
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Affiliation(s)
- Ehsan Shekari
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Seyfi
- Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Modarres Zadeh
- Department of Speech Therapy, Faculty of Rehabilitation, Tehran University of Medical science, Tehran, Iran
| | - Seyed Amirhossein Batouli
- Neuroimaging and Analysis Group, Tehran University of Medical Sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Valinejad
- Department of Speech Therapy, Faculty of Rehabilitation, Tehran University of Medical science, Tehran, Iran
| | - Sepideh Goudarzi
- Department of Pharmacology and Toxicology, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
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Low TA, Lindland K, Kirton A, Carlson HL, Harris AD, Goodyear BG, Monchi O, Hill MD, Dukelow SP. Repetitive transcranial magnetic stimulation (rTMS) combined with multi-modality aphasia therapy for chronic post-stroke non-fluent aphasia: A pilot randomized sham-controlled trial. BRAIN AND LANGUAGE 2023; 236:105216. [PMID: 36525719 DOI: 10.1016/j.bandl.2022.105216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/22/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) shows promise in improving speech production in post-stroke aphasia. Limited evidence suggests pairing rTMS with speech therapy may result in greater improvements. Twenty stroke survivors (>6 months post-stroke) were randomized to receive either sham rTMS plus multi-modality aphasia therapy (M-MAT) or rTMS plus M-MAT. For the first time, we demonstrate that rTMS combined with M-MAT is feasible, with zero adverse events and minimal attrition. Both groups improved significantly over time on all speech and language outcomes. However, improvements did not differ between rTMS or sham. We found that rTMS and sham groups differed in lesion location, which may explain speech and language outcomes as well as unique patterns of BOLD signal change within each group. We offer practical considerations for future studies and conclude that while combination therapy of rTMS plus M-MAT in chronic post-stroke aphasia is safe and feasible, personalized intervention may be necessary.
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Affiliation(s)
- Trevor A Low
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Lindland
- Department of Allied Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Adam Kirton
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Helen L Carlson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ashley D Harris
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, Alberta, Canada.
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6
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Ulanov M, Shtyrov Y. Oscillatory beta/alpha band modulations: A potential biomarker of functional language and motor recovery in chronic stroke? Front Hum Neurosci 2022; 16:940845. [PMID: 36226263 PMCID: PMC9549964 DOI: 10.3389/fnhum.2022.940845] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke remains one of the leading causes of various disabilities, including debilitating motor and language impairments. Though various treatments exist, post-stroke impairments frequently become chronic, dramatically reducing daily life quality, and requiring specific rehabilitation. A critical goal of chronic stroke rehabilitation is to induce, usually through behavioral training, experience-dependent plasticity processes in order to promote functional recovery. However, the efficiency of such interventions is typically modest, and very little is known regarding the neural dynamics underpinning recovery processes and possible biomarkers of their efficiency. Some studies have emphasized specific alterations of excitatory–inhibitory balance within distributed neural networks as an important recovery correlate. Neural processes sensitive to these alterations, such as task-dependent oscillatory activity in beta as well as alpha bands, may be candidate biomarkers of chronic stroke functional recovery. In this review, we discuss the results of studies on motor and language recovery with a focus on oscillatory processes centered around the beta band and their modulations during functional recovery in chronic stroke. The discussion is based on a framework where task-dependent modulations of beta and alpha oscillatory activity, generated by the deep cortical excitatory–inhibitory microcircuits, serve as a neural mechanism of domain-general top-down control processes. We discuss the findings, their limitations, and possible directions for future research.
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Affiliation(s)
- Maxim Ulanov
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
- *Correspondence: Maxim Ulanov,
| | - Yury Shtyrov
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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7
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Kielar A, Patterson D, Chou YH. Efficacy of repetitive transcranial magnetic stimulation in treating stroke aphasia: Systematic review and meta-analysis. Clin Neurophysiol 2022; 140:196-227. [DOI: 10.1016/j.clinph.2022.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 12/12/2022]
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8
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Turker S, Hartwigsen G. The use of noninvasive brain stimulation techniques to improve reading difficulties in dyslexia: A systematic review. Hum Brain Mapp 2022; 43:1157-1173. [PMID: 34716977 PMCID: PMC8764483 DOI: 10.1002/hbm.25700] [Citation(s) in RCA: 10] [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: 07/24/2021] [Revised: 09/29/2021] [Accepted: 10/08/2021] [Indexed: 02/05/2023] Open
Abstract
Noninvasive brain stimulation (NIBS) allows to actively and noninvasively modulate brain function. Aside from inhibiting specific processes, NIBS may also enhance cognitive functions, which might be used for the prevention and intervention of learning disabilities such as dyslexia. However, despite the growing interest in modulating learning abilities, a comprehensive, up-to-date review synthesizing NIBS studies with dyslexics is missing. Here, we fill this gap and elucidate the potential of NIBS as treatment option in dyslexia. The findings of the 15 included studies suggest that repeated sessions of reading training combined with different NIBS protocols may induce long-lasting improvements of reading performance in child and adult dyslexics, opening promising avenues for future research. In particular, the "classical" reading areas seem to be most successfully modulated through NIBS, and facilitatory protocols can improve various reading-related subprocesses. Moreover, we emphasize the need to further explore the potential to modulate auditory cortex function as a preintervention and intervention approach for affected children, for example, to avoid the development of auditory and phonological difficulties at the core of dyslexia. Finally, we outline how future studies may increase our understanding of the neurobiological basis of NIBS-induced improvements in dyslexia.
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Affiliation(s)
- Sabrina Turker
- Lise Meitner Research Group Cognition and PlasticityMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
- Alexander von Humboldt FoundationBerlinGermany
| | - Gesa Hartwigsen
- Lise Meitner Research Group Cognition and PlasticityMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
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9
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Hartwigsen G, Bengio Y, Bzdok D. How does hemispheric specialization contribute to human-defining cognition? Neuron 2021; 109:2075-2090. [PMID: 34004139 PMCID: PMC8273110 DOI: 10.1016/j.neuron.2021.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/22/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022]
Abstract
Uniquely human cognitive faculties arise from flexible interplay between specific local neural modules, with hemispheric asymmetries in functional specialization. Here, we discuss how these computational design principles provide a scaffold that enables some of the most advanced cognitive operations, such as semantic understanding of world structure, logical reasoning, and communication via language. We draw parallels to dual-processing theories of cognition by placing a focus on Kahneman's System 1 and System 2. We propose integration of these ideas with the global workspace theory to explain dynamic relay of information products between both systems. Deepening the current understanding of how neurocognitive asymmetry makes humans special can ignite the next wave of neuroscience-inspired artificial intelligence.
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Affiliation(s)
- Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Lise Meitner Research Group Cognition and Plasticity, Leipzig, Germany.
| | - Yoshua Bengio
- Mila, Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - Danilo Bzdok
- Mila, Montreal, QC, Canada; Montreal Neurological Institute, McConnell Brain Imaging Centre, Faculty of Medicine, McGill University, Montreal, QC, Canada; Department of Biomedical Engineering, Faculty of Medicine, and School of Computer Science, McGill University, Montreal, QC, Canada.
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10
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Andreoli ML, Souza JTD, Ribeiro PW, Costa RDMD, Silva TRD, Winckler FC, Modolo GP, Alves KF, Hamamoto Filho PT, Garcia RD, Betting LEGG, Bazan SGZ, Bazan R, Luvizutto GJ. What are the barriers to participation in a neuromodulation pilot trial for aphasia after stroke? Codas 2021; 33:e20200019. [PMID: 34231751 DOI: 10.1590/2317-1782/20202020019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/13/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Aphasia is a common and debilitating manifestation of stroke. Transcranial electrical stimulation uses low-intensity electric currents to induce changes in neuronal activity. Recent evidence suggests that noninvasive techniques can be a valuable rehabilitation tool for patients with aphasia. However, it is difficult to recruit patients with aphasia for trials, and the reasons for this are not well understood. This study aimed to elucidate the main difficulties involved in patient's recruitment and inclusion in a randomized clinical study of neuromodulation in aphasia. METHODS We evaluated the reasons for the exclusion of patients in a pilot, randomized, double-blinded clinical trial in which patients diagnosed with motor aphasia after stroke were recruited from March to November 2018. A descriptive statistical analysis was performed. RESULTS Only 12.9% (4) of patients with ischemic stroke were included in the clinical trial. A total of 87.1% (27) of the 31 recruited patients were excluded for various reasons including: sensory aphasia (32.2%), dysarthria (25.8%), spontaneous clinical recovery (16.1%), previous stroke (6.4%), and death or mutism (3.2%). CONCLUSION The presence of other types of aphasia, dysarthria, spontaneous recovery, deaths, and mutism were barriers to recruiting patients evidenced in this neuromodulation study.
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Affiliation(s)
- Mariana Lopes Andreoli
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Juli Thomaz de Souza
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Priscila Watson Ribeiro
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Rafael Dalle Molle da Costa
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Taís Regina da Silva
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Fernanda Cristina Winckler
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Gabriel Pinheiro Modolo
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Karen Fernanda Alves
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Pedro Tadao Hamamoto Filho
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Rafael Delascio Garcia
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Luiz Eduardo Gomes Garcia Betting
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Silmeia Garcia Zanati Bazan
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Rodrigo Bazan
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP), Brasil
| | - Gustavo José Luvizutto
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triângulo Mineiro - UFTM - Uberaba (MG), Brasil
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11
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Szaflarski JP, Nenert R, Allendorfer JB, Martin AN, Amara AW, Griffis JC, Dietz A, Mark VW, Sung VW, Walker HC, Zhou X, Lindsell CJ. Intermittent Theta Burst Stimulation (iTBS) for Treatment of Chronic Post-Stroke Aphasia: Results of a Pilot Randomized, Double-Blind, Sham-Controlled Trial. Med Sci Monit 2021; 27:e931468. [PMID: 34183640 PMCID: PMC8254416 DOI: 10.12659/msm.931468] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Research indicates intermittent theta burst stimulation (iTBS) is a potential treatment of post-stroke aphasia. Material/Methods In this double-blind, sham-controlled trial (NCT 01512264) participants were randomized to receive 3 weeks of sham (G0), 1 week of iTBS/2 weeks of sham (G1), 2 weeks of iTBS/1 week of sham (G2), or 3 weeks of iTBS (G3). FMRI localized residual language function in the left hemisphere; iTBS was applied to the maximum fMRI activation in the residual language cortex in the left frontal lobe. FMRI and aphasia testing were conducted pre-treatment, at ≤1 week after completing treatment, and at 3 months follow-up. Results 27/36 participants completed the trial. We compared G0 to each of the individual treatment group and to all iTBS treatment groups combined (G1–3). In individual groups, participants gained (of moderate or large effect sizes; some significant at P<0.05) on the Boston Naming Test (BNT), the Semantic Fluency Test (SFT), and the Aphasia Quotient of the Western Aphasia Battery-Revised (WAB-R AQ). In G1–3, BNT, and SFT improved immediately after treatment, while the WAB-R AQ improved at 3 months. Compared to G0, the other groups showed greater fMRI activation in both hemispheres and non-significant increases in language lateralization to the left hemisphere. Changes in IFG connectivity were noted with iTBS, showing differences between time-points, with some of them correlating with the behavioral measures. Conclusions The results of this pilot trial support the hypothesis that iTBS applied to the ipsilesional hemisphere can improve aphasia and result in cortical plasticity.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber N Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph C Griffis
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aimee Dietz
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Victor W Mark
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victor W Sung
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harrison C Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xiaohua Zhou
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
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12
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Hong Z, Zheng H, Luo J, Yin M, Ai Y, Deng B, Feng W, Hu X. Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Language Recovery in Poststroke Survivors With Aphasia: An Updated Meta-analysis. Neurorehabil Neural Repair 2021; 35:680-691. [PMID: 34032160 DOI: 10.1177/15459683211011230] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) on treating poststroke aphasia (PSA) remain inconclusive. We aimed to evaluate the efficacy and safety of LF-rTMS on language function poststroke and determine potential factors that may affect treatment effects. Electronic databases, including MEDLINE, EMBASE, and Cochrane Library were searched to identify relevant randomized controlled trials (RCTs) concerning the effects of LF-rTMS on language performance poststroke. We adopted fixed- and random-effects models to estimate intervention effects, which were represented by the Hedges' g and 95% CIs. Subgroup analyses regarding several factors potentially influencing the effects of LF-rTMS on language recovery were also conducted. A total of 14 RCTs involving 374 participants were included in the meta-analysis. The pooled analysis showed the positive and significant effects of LF-rTMS on language function, both short-term (Hedges' g = 0.65; P < .05) and long-term (Hedges' g = 0.46; P < .05). Subgroup analyses demonstrated that LF-rTMS for 20 minutes per day over 10 days yielded the largest effect size (Hedges' g = 1.02; P < .05) and that LF-rTMS significantly improved language performance in the chronic stage after stroke (Hedges' g = 0.55; P < .05). Patients with different native languages might have diverse responses to LF-rTMS treatment efficacy. Additionally, there were significant improvements in language subtests, including naming, repetition, comprehension, and writing. Overall, this updated meta-analysis demonstrated that LF-rTMS has significant positive effects on PSA, with moderate treatment effects. It provides additional evidence to support LF-rTMS as a promising complementary therapy to promote language recovery in PSA.
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Affiliation(s)
- Zhongqiu Hong
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haiqing Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Luo
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingyu Yin
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinan Ai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baomei Deng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wuwei Feng
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Xiquan Hu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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13
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Pugh M, Olabarrieta‐Landa L, Chagualá AC, Perrin PB, Arango‐Lasprilla JC. Spontaneous Recovery of Executive Function, Attention, and Processing Speed in Stroke Patients in Colombia. PM R 2020; 13:674-682. [DOI: 10.1002/pmrj.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | - Juan Carlos Arango‐Lasprilla
- BioCruces Bizkaia Health Research Institute Cruces University Hospital Barakaldo, Barakaldo Spain
- IKERBASQUE, Basque Foundation for Science Plaza de Cruces s/n. 48903 Barakaldo, Bizkaia, Spain; and Department of Cell Biology and Histology, University of the Basque Country UPV/EHU Leioa Spain
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14
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Schevenels K, Price CJ, Zink I, De Smedt B, Vandermosten M. A Review on Treatment-Related Brain Changes in Aphasia. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2020; 1:402-433. [PMID: 37215585 PMCID: PMC10158631 DOI: 10.1162/nol_a_00019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 06/29/2020] [Indexed: 05/24/2023]
Abstract
Numerous studies have investigated brain changes associated with interventions targeting a range of language problems in patients with aphasia. We strive to integrate the results of these studies to examine (1) whether the focus of the intervention (i.e., phonology, semantics, orthography, syntax, or rhythmic-melodic) determines in which brain regions changes occur; and (2a) whether the most consistent changes occur within the language network or outside, and (2b) whether these are related to individual differences in language outcomes. The results of 32 studies with 204 unique patients were considered. Concerning (1), the location of treatment-related changes does not clearly depend on the type of language processing targeted. However, there is some support that rhythmic-melodic training has more impact on the right hemisphere than linguistic training. Concerning (2), we observed that language recovery is not only associated with changes in traditional language-related structures in the left hemisphere and homolog regions in the right hemisphere, but also with more medial and subcortical changes (e.g., precuneus and basal ganglia). Although it is difficult to draw strong conclusions, because there is a lack of systematic large-scale studies on this topic, this review highlights the need for an integrated approach to investigate how language interventions impact on the brain. Future studies need to focus on larger samples preserving subject-specific information (e.g., lesion effects) to cope with the inherent heterogeneity of stroke-induced aphasia. In addition, recovery-related changes in whole-brain connectivity patterns need more investigation to provide a comprehensive neural account of treatment-related brain plasticity and language recovery.
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Affiliation(s)
- Klara Schevenels
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Cathy J. Price
- Welcome Centre for Human Neuroimaging, Institute of Neurology, University College London, UK
| | - Inge Zink
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Bert De Smedt
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Maaike Vandermosten
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
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15
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Marangolo P. The potential effects of transcranial direct current stimulation (tDCS) on language functioning: Combining neuromodulation and behavioral intervention in aphasia. Neurosci Lett 2020; 719:133329. [DOI: 10.1016/j.neulet.2017.12.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 02/08/2023]
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16
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Impact of Combined Transcranial Direct Current Stimulation and Speech-language Therapy on Spontaneous Speech in Aphasia: A Randomized Controlled Double-blind Study. J Int Neuropsychol Soc 2020; 26:7-18. [PMID: 31983371 DOI: 10.1017/s1355617719001036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Aphasia recovery depends on neural reorganization, which can be enhanced by speech-language therapy and noninvasive brain stimulation. Several studies suggested that transcranial direct current stimulation (tDCS) associated with speech-language therapy may improve verbal performance evaluated by analytic tests, but none focused on spontaneous speech. We explored the effect of bihemispheric tDCS on spontaneous speech in patients with poststroke aphasia. METHODS In this multicentric controlled randomized cross-over double-blind study, we included 10 patients with poststroke aphasia (4 had aphasia >6 months and 6 with aphasia <6 months). We combined the sessions of speech-language therapy and bihemispheric tDCS (2 mA, 20 min). After three baseline speech evaluations (1/week), two different conditions were randomly consecutively proposed: active and sham tDCS over 3 weeks with 1 week of washout in between. The main outcome measure was the number of different nouns used in 2 min to answer the question "what is your job." RESULTS There was no significant difference between conditions concerning the main outcome measure (p = .47) nor in the number of verbs, adjectives, adverbs, pronouns, repetitions, blank ideas, ideas, utterances with grammatical errors or paraphasias used. Other cognitive functions (verbal working memory, neglect, or verbal fluency) were not significantly improved in the tDCS group. No adverse events occurred. CONCLUSION Our results differed from previous studies using tDCS to improve naming in patients with poststroke aphasia possibly due to bihemispheric stimulation, rarely used previously. The duration of the rehabilitation period was short given the linguistic complexity of the measure. This negative result should be confirmed by larger studies with ecological measures.
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17
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Dressing A, Kaller CP, Nitschke K, Beume LA, Kuemmerer D, Schmidt CS, Bormann T, Umarova RM, Egger K, Rijntjes M, Weiller C, Martin M. Neural correlates of acute apraxia: Evidence from lesion data and functional MRI in stroke patients. Cortex 2019; 120:1-21. [DOI: 10.1016/j.cortex.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/28/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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18
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Fisicaro F, Lanza G, Grasso AA, Pennisi G, Bella R, Paulus W, Pennisi M. Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls. Ther Adv Neurol Disord 2019. [PMID: 31598137 DOI: 10.1177/1756286419878317.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute brain ischemia causes changes in several neural networks and related cortico-subcortical excitability, both in the affected area and in the apparently spared contralateral hemisphere. The modulation of these processes through modern techniques of noninvasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), has been proposed as a viable intervention that could promote post-stroke clinical recovery and functional independence. This review provides a comprehensive summary of the current evidence from the literature on the efficacy of rTMS applied to different clinical and rehabilitative aspects of stroke patients. A total of 32 meta-analyses published until July 2019 were selected, focusing on the effects on motor function, manual dexterity, walking and balance, spasticity, dysphagia, aphasia, unilateral neglect, depression, and cognitive function after a stroke. Only conventional rTMS protocols were considered in this review, and meta-analyses focusing on theta burst stimulation only were excluded. Overall, both HF-rTMS and LF-rTMS have been shown to be safe and well-tolerated. In addition, the current literature converges on the positive effect of rTMS in the rehabilitation of all clinical manifestations of stroke, except for spasticity and cognitive impairment, where definitive evidence of efficacy cannot be drawn. However, routine use of a specific paradigm of stimulation cannot be recommended yet due to a significant level of heterogeneity of the studies in terms of protocols to be set and outcome measures that have to be used. Future studies need to preliminarily evaluate the most promising protocols before going on to multicenter studies with large cohorts of patients in order to achieve a definitive translation into daily clinical practice.
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Affiliation(s)
- Francesco Fisicaro
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Via Santa Sofia, 78, Catania, 95125, Italy
| | - Alfio Antonio Grasso
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg August University, Göttingen, Germany
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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19
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Fisicaro F, Lanza G, Grasso AA, Pennisi G, Bella R, Paulus W, Pennisi M. Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls. Ther Adv Neurol Disord 2019; 12:1756286419878317. [PMID: 31598137 PMCID: PMC6763938 DOI: 10.1177/1756286419878317] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023] Open
Abstract
Acute brain ischemia causes changes in several neural networks and related cortico-subcortical excitability, both in the affected area and in the apparently spared contralateral hemisphere. The modulation of these processes through modern techniques of noninvasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), has been proposed as a viable intervention that could promote post-stroke clinical recovery and functional independence. This review provides a comprehensive summary of the current evidence from the literature on the efficacy of rTMS applied to different clinical and rehabilitative aspects of stroke patients. A total of 32 meta-analyses published until July 2019 were selected, focusing on the effects on motor function, manual dexterity, walking and balance, spasticity, dysphagia, aphasia, unilateral neglect, depression, and cognitive function after a stroke. Only conventional rTMS protocols were considered in this review, and meta-analyses focusing on theta burst stimulation only were excluded. Overall, both HF-rTMS and LF-rTMS have been shown to be safe and well-tolerated. In addition, the current literature converges on the positive effect of rTMS in the rehabilitation of all clinical manifestations of stroke, except for spasticity and cognitive impairment, where definitive evidence of efficacy cannot be drawn. However, routine use of a specific paradigm of stimulation cannot be recommended yet due to a significant level of heterogeneity of the studies in terms of protocols to be set and outcome measures that have to be used. Future studies need to preliminarily evaluate the most promising protocols before going on to multicenter studies with large cohorts of patients in order to achieve a definitive translation into daily clinical practice.
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Affiliation(s)
- Francesco Fisicaro
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Via Santa Sofia, 78, Catania, 95125, Italy
- Department of Neurology IC, Oasi Research Institute – IRCCS, Troina, Italy
| | - Alfio Antonio Grasso
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg August University, Göttingen, Germany
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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20
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Bucur M, Papagno C. Are transcranial brain stimulation effects long-lasting in post-stroke aphasia? A comparative systematic review and meta-analysis on naming performance. Neurosci Biobehav Rev 2019; 102:264-289. [DOI: 10.1016/j.neubiorev.2019.04.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/12/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022]
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21
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Vandermosten M, Correia J, Vanderauwera J, Wouters J, Ghesquière P, Bonte M. Brain activity patterns of phonemic representations are atypical in beginning readers with family risk for dyslexia. Dev Sci 2019; 23:e12857. [PMID: 31090993 DOI: 10.1111/desc.12857] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/03/2019] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
Abstract
There is an ongoing debate whether phonological deficits in dyslexics should be attributed to (a) less specified representations of speech sounds, like suggested by studies in young children with a familial risk for dyslexia, or (b) to an impaired access to these phonemic representations, as suggested by studies in adults with dyslexia. These conflicting findings are rooted in between study differences in sample characteristics and/or testing techniques. The current study uses the same multivariate functional MRI (fMRI) approach as previously used in adults with dyslexia to investigate phonemic representations in 30 beginning readers with a familial risk and 24 beginning readers without a familial risk of dyslexia, of whom 20 were later retrospectively classified as dyslexic. Based on fMRI response patterns evoked by listening to different utterances of /bA/ and /dA/ sounds, multivoxel analyses indicate that the underlying activation patterns of the two phonemes were distinct in children with a low family risk but not in children with high family risk. However, no group differences were observed between children that were later classified as typical versus dyslexic readers, regardless of their family risk status, indicating that poor phonemic representations constitute a risk for dyslexia but are not sufficient to result in reading problems. We hypothesize that poor phonemic representations are trait (family risk) and not state (dyslexia) dependent, and that representational deficits only lead to reading difficulties when they are present in conjunction with other neuroanatomical or-functional deficits.
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Affiliation(s)
- Maaike Vandermosten
- Research Group ExpORL, Department of Neuroscience, KU Leuven, Leuven, Belgium.,Department of Cognitive Neuroscience and Maastricht Brain Imaging Center, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joao Correia
- Department of Cognitive Neuroscience and Maastricht Brain Imaging Center, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Basque Center on Cognition, Brain and Language, San Sebastian, Spain
| | - Jolijn Vanderauwera
- Research Group ExpORL, Department of Neuroscience, KU Leuven, Leuven, Belgium.,Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Jan Wouters
- Research Group ExpORL, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Pol Ghesquière
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Milene Bonte
- Department of Cognitive Neuroscience and Maastricht Brain Imaging Center, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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22
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Olabarrieta-Landa L, Pugh M, Calderón Chagualá A, Perrin PB, Arango-Lasprilla JC. Trajectories of memory, language, and visuoperceptual problems in people with stroke during the first year and controls in Colombia. Disabil Rehabil 2019; 43:324-330. [PMID: 31167580 DOI: 10.1080/09638288.2019.1622799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM Neuropsychological normative data for Latin America have been recently published, and for Colombia, in particular, but longitudinal neuropsychological outcomes after stroke have not yet been examined in this global region. The purpose of the current study was to compare functioning of individuals with stroke in Colombia, South America during the first year post-stroke to healthy controls across neuropsychological assessments of memory, language, and visuoperceptual impairments. METHOD A sample of 50 individuals with stroke (mean age = 51.58) and 50 matched healthy controls (mean age = 51.54) from Colombia were included in this study. Because of a lack of access to health services, individuals with stroke did not receive any inpatient or outpatient cognitive or behavioral rehabilitation. Participants were assessed on 10 visuoperceptual, language, and memory tasks at 3, 6, and 12 months. RESULTS Trajectories of neuropsychological performance were significantly worse among individuals with stroke than healthy controls across every index. Further, hierarchical linear models suggested that although both individuals with stroke and controls generally improved over time on these assessments, the improvements among individuals with stroke were often of no greater magnitude than the improvements seen in controls, suggesting extremely low levels of rehabilitation gains in Colombia. Only three of the 10 neuropsychological assessments did a significant time*group interaction occur, suggesting greater gains for the stroke group than controls. CONCLUSION These findings suggest profound disparities in post-stroke cognitive functioning in Colombia compared to other more developed global region and underscore the importance of comprehensive cognitive rehabilitation services for individuals with stroke in Colombia and other similar global regions. Implications for rehabilitation Because this study found only negligible cognitive improvements beyond practice effects over the first year after stroke in Colombia among individuals without access to acute rehabilitation, it is imperative that comprehensive cognitive rehabilitation services be implemented immediately during the acute rehabilitation period. Memory, language, and visuoperceptual training strategies can be implemented for people with stroke in underserved global regions as part of the standard of care for stroke rehabilitation. Cognitive rehabilitation strategies should be adapted into Spanish and pilot tested in Latin America to ensure cultural equivalence. Culturally competent cognitive rehabilitation strategies should be tailored based on varied educational and literacy levels.
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Affiliation(s)
- Laiene Olabarrieta-Landa
- BioCruces Bizkaia Health Research Institute, Cruces University Hospital Barakaldo, Bizkaia, Spain
| | - Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, Cruces University Hospital Barakaldo, Bizkaia, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
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23
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Nair VA, Dodd K, Rajan S, Santhanubosu A, Beniwal-Patel P, Saha S, Prabhakaran V. A Verbal Fluency Task-Based Brain Activation fMRI Study in Patients with Crohn's Disease in Remission. J Neuroimaging 2019; 29:630-639. [PMID: 31134699 DOI: 10.1111/jon.12634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND PURPOSE In this pilot study, we investigated functional brain activation changes in patients with Crohn's disease (CD) in remission compared to age and gender-matched healthy controls (HCs). METHODS Data from 20 patients with CD in remission (age range 19-63 years) and 20 HCs (matched in age and gender) were analyzed. Task functional MRI (fMRI) data were collected while participants performed a cognitive (phonemic verbal fluency) task in the scanner. All participants also performed the same task outside the scanner. RESULTS Task fMRI results showed greater bi-hemispheric activation in CD patients compared to controls. Because this pattern is commonly reported with normal aging, we performed further analyses to investigate fMRI responses in a subset of the younger CD patients (N = 12, age < = 35 years) compared to matched young HCs (age < = 35 years), and an older cohort of HCs (age > = 50 years). Results showed that task activation patterns were similar between young CD patients and older HCs, and that both groups differed significantly from younger HCs. Activation intensity in specific brain regions for patients was associated with disease duration. CONCLUSIONS These results suggest that CD patients in remission may show accelerated signs of aging in terms of brain responses to a typical cognitive task. Future work with larger sample size will need to replicate these results as well as investigate the influence of factors, such as chronicity of the disease and medication effects on task-associated brain activation patterns in this patient population.
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Affiliation(s)
- Veena A Nair
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Keith Dodd
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
| | - Shruti Rajan
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Anu Santhanubosu
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Poonam Beniwal-Patel
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin-Madison, Madison, WI
| | - Vivek Prabhakaran
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
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24
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Heikkinen PH, Pulvermüller F, Mäkelä JP, Ilmoniemi RJ, Lioumis P, Kujala T, Manninen RL, Ahvenainen A, Klippi A. Combining rTMS With Intensive Language-Action Therapy in Chronic Aphasia: A Randomized Controlled Trial. Front Neurosci 2019; 12:1036. [PMID: 30778280 PMCID: PMC6369187 DOI: 10.3389/fnins.2018.01036] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
Neuromodulation technologies, such as transcranial magnetic stimulation (TMS), are promising tools for neurorehabilitation, aphasia therapy included, but not yet in common clinical use. Combined with behavioral techniques, in particular treatment-efficient Intensive Language-Action Therapy (ILAT, previously CIAT or CILT), TMS could substantially amplify the beneficial effect of such behavioral therapy alone (Thiel et al., 2013; Martin et al., 2014; Mendoza et al., 2016; Kapoor, 2017). In this randomized study of 17 subjects with post-stroke aphasia in the chronic stage, we studied the combined effect of ILAT and 1-Hz placebo-controlled navigated repetitive TMS (rTMS) to the right-hemispheric inferior frontal cortex—that is, to the anterior part of the non-dominant hemisphere's homolog Broca's area (pars triangularis). Patients were randomized to groups A and B. Patients in group A received a 2-week period of rTMS during naming training where they named pictures displayed on the screen once every 10 s, followed by 2 weeks of rTMS and naming combined with ILAT. Patients in group B received the same behavioral therapy but TMS was replaced by sham stimulation. The primary outcome measures for changes in language performance were the Western Aphasia Battery's aphasia quotient AQ; the secondary outcome measures were the Boston naming test (BNT) and the Action naming test (Action BNT, ANT). All subjects completed the study. At baseline, no statistically significant group differences were discovered for age, post-stroke time or diagnosis. ILAT was associated with significant improvement across groups, as documented by both primary and secondary outcome measures. No significant effect of rTMS could be documented. Our results agree with previous results proving ILAT's ability to improve language in patients with chronic aphasia. In contrast with earlier claims, however, a beneficial effect of rTMS in chronic post-stroke aphasia rehabilitation was not detected in this study. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03629665
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Affiliation(s)
- Paula H Heikkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, WE4, Freie Universität Berlin, Berlin, Germany
| | - Jyrki P Mäkelä
- BioMag Laboratory, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Pantelis Lioumis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Teija Kujala
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Riitta-Leena Manninen
- BioMag Laboratory, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Ahvenainen
- BioMag Laboratory, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Klippi
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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25
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Meier EL, Johnson JP, Kiran S. Left frontotemporal effective connectivity during semantic feature judgments in patients with chronic aphasia and age-matched healthy controls. Cortex 2018; 108:173-192. [PMID: 30243049 PMCID: PMC6234086 DOI: 10.1016/j.cortex.2018.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 12/15/2022]
Abstract
Traditional models of neural reorganization of language skills in patients with chronic stroke-induced aphasia (PWA) propose activation of reperfused or spared left hemisphere tissue results in the most favorable language outcomes. However, these models do not fully explain variable behavioral recovery patterns observed in chronic patients. Instead, investigation of connectivity patterns of critical network nodes may elucidate better-informed recovery models. In the present study, we combined fMRI and dynamic causal modeling (DCM) to examine effective connectivity of a simple three-node left hemisphere network during a semantic feature decision task in 25 PWA and 18 age-matched neurologically intact healthy controls. The DCM model space utilized in Meier, Kapse, & Kiran (2016), which was organized according to exogenous input to one of three regions (i.e., left inferior frontal gyrus, pars triangularis [LIFGtri], left posterior middle temporal gyrus [LpMTG], or left middle frontal gyrus [LMFG]) implicated in various levels of lexical-semantic processing, was interrogated. This model space included all possible combinations of uni- and bidirectional task-modulated connections between LIFGtri, LMFG and LpMTG, resulting in 72 individual models that were partitioned into three separate families (i.e., Family #1: Input to LIFGtri, Family #2: Input to LMFG, Family #3: Input to LpMTG). Family-wise Bayesian model selection revealed Family #2: Input to LMFG best fit both patient and control data at a group level. Both groups relied heavily on LMFG's modulation of the other two model regions. By contrast, between-group differences in task-modulated coupling of LIFGtri and LpMTG were observed. Within the patient group, the strength of activity in LIFGtri and connectivity of LpMTG → LIFGtri were positively associated with lexical-semantic abilities inside and outside of the scanner, whereas greater recruitment of LpMTG was associated with poorer lexical-semantic skills.
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Affiliation(s)
- Erin L Meier
- Sargent College of Health & Rehabilitation Sciences, Boston University, United States.
| | - Jeffrey P Johnson
- Sargent College of Health & Rehabilitation Sciences, Boston University, United States
| | - Swathi Kiran
- Sargent College of Health & Rehabilitation Sciences, Boston University, United States
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26
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Nenert R, Allendorfer JB, Martin AM, Banks C, Vannest J, Holland SK, Hart KW, Lindsell CJ, Szaflarski JP. Longitudinal fMRI study of language recovery after a left hemispheric ischemic stroke. Restor Neurol Neurosci 2018; 36:359-385. [PMID: 29782329 DOI: 10.3233/rnn-170767] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recovery from stroke-induced aphasia is typically protracted and involves complex functional reorganization. The relative contributions of the lesioned and non-lesioned hemispheres to this process have been examined in several cross-sectional studies but longitudinal studies involving several time-points and large numbers of subjects are scarce. OBJECTIVE The aim of this study was to address the gaps in the literature by longitudinally studying the evolution of post-stroke lateralization and localization of language-related fMRI activation in the first year after single left hemispheric ischemic stroke. METHOD Seventeen patients with stroke-induced aphasia were enrolled to undergo detailed behavioral testing and fMRI at 2, 6, 12, 26, and 52 weeks post-stroke. Matched for age, handedness and sex participants were also enrolled to visualize canonical language regions. RESULTS Behavioral results showed improvements over time for all but one of the behavioral scores (Semantic Fluency Test). FMRI results showed that the left temporal area participates in compensation for language deficits in the first year after stroke, that there is a correlation between behavioral improvement and the left cerebellar activation over time, and that there is a shift towards stronger frontal left-lateralization of the fMRI activation over the first year post-stroke. Temporary compensation observed in the initial phases of post-stroke recovery that involves the non-lesioned hemisphere may not be as important as previously postulated, since in this study the recovery was driven by activations in the left fronto-temporal regions. CONCLUSION Language recovery after left hemispheric ischemic stroke is likely driven by the previously involved in language and attention left hemispheric networks.
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Affiliation(s)
- Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber M Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christi Banks
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Jennifer Vannest
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott K Holland
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly W Hart
- Department of Emergency Medicine, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Christopher J Lindsell
- Department of Emergency Medicine, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.,currently at Department of Biostatistics, Vanderbilt University, Department of Biostatistics, Nashville, TN, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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27
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Wilson SM, Yen M, Eriksson DK. An adaptive semantic matching paradigm for reliable and valid language mapping in individuals with aphasia. Hum Brain Mapp 2018; 39:3285-3307. [PMID: 29665223 PMCID: PMC6045968 DOI: 10.1002/hbm.24077] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 11/08/2022] Open
Abstract
Research on neuroplasticity in recovery from aphasia depends on the ability to identify language areas of the brain in individuals with aphasia. However, tasks commonly used to engage language processing in people with aphasia, such as narrative comprehension and picture naming, are limited in terms of reliability (test-retest reproducibility) and validity (identification of language regions, and not other regions). On the other hand, paradigms such as semantic decision that are effective in identifying language regions in people without aphasia can be prohibitively challenging for people with aphasia. This paper describes a new semantic matching paradigm that uses an adaptive staircase procedure to present individuals with stimuli that are challenging yet within their competence, so that language processing can be fully engaged in people with and without language impairments. The feasibility, reliability and validity of the adaptive semantic matching paradigm were investigated in sixteen individuals with chronic post-stroke aphasia and fourteen neurologically normal participants, in comparison to narrative comprehension and picture naming paradigms. All participants succeeded in learning and performing the semantic paradigm. Test-retest reproducibility of the semantic paradigm in people with aphasia was good (Dice coefficient = 0.66), and was superior to the other two paradigms. The semantic paradigm revealed known features of typical language organization (lateralization; frontal and temporal regions) more consistently in neurologically normal individuals than the other two paradigms, constituting evidence for validity. In sum, the adaptive semantic matching paradigm is a feasible, reliable and valid method for mapping language regions in people with aphasia.
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Affiliation(s)
- Stephen M. Wilson
- Department of Hearing and Speech SciencesVanderbilt University Medical CenterNashvilleTennessee
| | - Melodie Yen
- Department of Hearing and Speech SciencesVanderbilt University Medical CenterNashvilleTennessee
| | - Dana K. Eriksson
- Department of SpeechLanguage, and Hearing Sciences, University of ArizonaTucsonArizona
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28
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Wright A, Saxena S, Sheppard SM, Hillis AE. Selective impairments in components of affective prosody in neurologically impaired individuals. Brain Cogn 2018; 124:29-36. [PMID: 29723680 DOI: 10.1016/j.bandc.2018.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/13/2018] [Accepted: 04/15/2018] [Indexed: 11/30/2022]
Abstract
The intent and feelings of the speaker are often conveyed less by what they say than by how they say it, in terms of the affective prosody - modulations in pitch, loudness, rate, and rhythm of the speech to convey emotion. Here we propose a cognitive architecture of the perceptual, cognitive, and motor processes underlying recognition and generation of affective prosody. We developed the architecture on the basis of the computational demands of the task, and obtained evidence for various components by identifying neurologically impaired patients with relatively specific deficits in one component. We report analysis of performance across tasks of recognizing and producing affective prosody by four patients (three with right hemisphere stroke and one with frontotemporal dementia). Their distinct patterns of performance across tasks and quality of their abnormal performance provides preliminary evidence that some of the components of the proposed architecture can be selectively impaired by focal brain damage.
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Affiliation(s)
- Amy Wright
- Johns Hopkins University School of Medicine, Department of Neurology, USA
| | - Sadhvi Saxena
- Johns Hopkins University School of Medicine, Department of Neurology, USA
| | - Shannon M Sheppard
- Johns Hopkins University School of Medicine, Department of Neurology, USA
| | - Argye E Hillis
- Johns Hopkins University School of Medicine, Department of Neurology, USA; Johns Hopkins University School of Medicine, Department of Physical and Medicine & Rehabilitation, USA; Johns Hopkins University, Department of Cognitive Science, USA.
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29
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Santhanam P, Duncan ES, Small SL. Therapy-Induced Plasticity in Chronic Aphasia Is Associated with Behavioral Improvement and Time Since Stroke. Brain Connect 2018; 8:179-188. [PMID: 29338310 PMCID: PMC5899281 DOI: 10.1089/brain.2017.0508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cortical reorganization after stroke is thought to underlie functional improvement. Patterns of reorganization may differ depending on the amount of time since the stroke or the degree of improvement. We investigated these issues in a study of brain connectivity changes with aphasia therapy. Twelve individuals with chronic aphasia participated in a 6-week trial of imitation-based speech therapy. We assessed improvement on a repetition test and analyzed effective connectivity during functional magnetic resonance imaging of a speech observation task before and after therapy. Using structural equation modeling, patient networks were compared with a model derived from healthy controls performing the same task. Independent of the amount of time since the stroke, patients demonstrating behavioral improvement had networks that reorganized to be more similar to controls in two functional pathways in the left hemisphere. Independent of behavioral improvement, patients with remote infarcts (2-7 years poststroke; n = 5) also reorganized to more closely resemble controls in one of these pathways. Patients with far removed injury (>10 years poststroke; n = 3) did not show behavioral improvement and, despite similarities to the normative model and overall network heterogeneity, reorganized to be less similar to controls following therapy in a distinct right-lateralized pathway. Behavioral improvement following aphasia therapy was associated with connectivity more closely approximating that of healthy controls. Individuals who had a stroke more than a decade before testing also showed plasticity, with a few pathways becoming less like controls, possibly representing compensation. Better understanding of these mechanisms may help direct targeted brain stimulation.
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Affiliation(s)
- Priya Santhanam
- Department of Neurology, The University of Chicago, Chicago, Illinois
| | - E. Susan Duncan
- Department of Neurology, University of California, Irvine, Orange, California
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge, Louisiana
| | - Steven L. Small
- Department of Neurology, The University of Chicago, Chicago, Illinois
- Department of Neurology, University of California, Irvine, Orange, California
- Department of Neurobiology and Behavior, University of California, Irvine, California
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30
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Long C, Sebastian R, Faria AV, Hillis AE. Longitudinal Imaging of Reading and Naming Recovery after Stroke. APHASIOLOGY 2018; 32:839-854. [PMID: 30127542 PMCID: PMC6097621 DOI: 10.1080/02687038.2017.1417538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Functional neuroimaging techniques can provide a unique window into the neural basis of language recovery after a stroke. The functional neuroimaging literature on post-stroke language recovery is complex; multiple factors such as the time post-stroke, degree of initial impairment, nature of the task, and lesion location and size, influence recovery patterns. Some of these factors may not be applicable across different stroke participants, and therefore, influence recovery trajectories in vastly different manners across patients. AIMS The aim of this paper is to examine longitudinal changes in brain activation patterns of reading and naming recovery in participants with posterior cerebral artery (PCA) strokes with varying degrees of initial language impairment. METHODS & PROCEDURES Five participants with PCA strokes and 5 healthy controls underwent language testing and functional MRI with a covert reading task and an overt picture-naming task. Stroke participants underwent language testing and scanning at the three time points: 2-5 weeks (T1, subacute phase), 4-7 months (T2, chronic phase), and 11-13 months (T3, chronic phase). Healthy controls underwent language testing and fMRI once. OUTCOMES & RESULTS Language testing indicated that there were varying degrees of reading and naming recovery or decline from the subacute to the chronic phase. With regard to task-based fMRI, we found that for most participants, naming consistently activated a diffuse bilateral network of frontal, temporal, parietal, and occipital regions across the three time points. In contrast, for the reading task, functional activation across the three time points was more left lateralized with a right to left shift in peak activation from the subacute to the chronic phase. CONCLUSIONS These results indicate that the patterns of activation during language processing is highly dependent on the task and phase of recovery, and these results may have implications for neurally targeted non-invasive brain stimulation techniques.
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Affiliation(s)
- Charltien Long
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD 21287, USA
| | - Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD 21287, USA
| | - Andreia V. Faria
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore MD 21287, USA
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD 21287, USA
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore MD 21287, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA
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31
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Hartwigsen G, Saur D. Neuroimaging of stroke recovery from aphasia - Insights into plasticity of the human language network. Neuroimage 2017; 190:14-31. [PMID: 29175498 DOI: 10.1016/j.neuroimage.2017.11.056] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
The role of left and right hemisphere brain regions in language recovery after stroke-induced aphasia remains controversial. Here, we summarize how neuroimaging studies increase the current understanding of functional interactions, reorganization and plasticity in the language network. We first discuss the temporal dynamics across the time course of language recovery, with a main focus on longitudinal studies from the acute to the chronic phase after stroke. These studies show that the functional contribution of perilesional and spared left hemisphere as well as contralesional right hemisphere regions to language recovery changes over time. The second section introduces critical variables and recent advances on early prediction of subsequent outcome. In the third section, we outline how multi-method approaches that combine neuroimaging techniques with non-invasive brain stimulation elucidate mechanisms of plasticity and reorganization in the language network. These approaches provide novel insights into general mechanisms of plasticity in the language network and might ultimately support recovery processes during speech and language therapy. Finally, the neurobiological correlates of therapy-induced plasticity are discussed. We argue that future studies should integrate individualized approaches that might vary the combination of language therapy with specific non-invasive brain stimulation protocols across the time course of recovery. The way forward will include the combination of such approaches with large data sets obtained from multicentre studies.
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Affiliation(s)
- Gesa Hartwigsen
- Research Group Modulation of Language Networks, Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Dorothee Saur
- Language & Aphasia Laboratory, Department of Neurology, University of Leipzig, Germany.
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32
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Griffis JC, Nenert R, Allendorfer JB, Szaflarski JP. Linking left hemispheric tissue preservation to fMRI language task activation in chronic stroke patients. Cortex 2017; 96:1-18. [PMID: 28961522 PMCID: PMC5675757 DOI: 10.1016/j.cortex.2017.08.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/09/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022]
Abstract
The preservation of near-typical function in distributed brain networks is associated with less severe deficits in chronic stroke patients. However, it remains unclear how task-evoked responses in networks that support complex cognitive functions such as semantic processing relate to the post-stroke brain anatomy. Here, we used recently developed methods for the analysis of multimodal MRI data to investigate the relationship between regional tissue concentration and functional MRI activation evoked during auditory semantic decisions in a sample of 43 chronic left hemispheric stroke patients and 43 age, handedness, and sex-matched controls. Our analyses revealed that closer-to-normal levels of tissue concentration in left temporo-parietal cortex and the underlying white matter correlated with the level of task-evoked activation in distributed regions associated with the semantic network. This association was not attributable to the effects of left hemispheric lesion or brain volumes, and similar results were obtained when using explicit lesion data. Left temporo-parietal tissue concentration and the associated task-evoked activations predicted patient performance on the in-scanner task, and also predicted patient performance on out-of-scanner naming and verbal fluency tasks. Exploratory analyses using the average HCP-842 tractography dataset revealed the presence of fronto-temporal, fronto-parietal, and temporo-parietal semantic network connections in the locations where tissue concentration was found to correlate with task-evoked activation in the semantic network. In summary, our results link the preservation of left posterior temporo-parietal structures with the preservation of task-evoked semantic network function in chronic left hemispheric stroke patients. Speculatively, this relationship may reflect the status of posterior temporo-parietal areas as cortical and white matter convergence zones that support coordinated processing in the distributed semantic network. Damage to these regions may contribute to atypical task-evoked responses during semantic processing in chronic stroke patients.
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Affiliation(s)
- Joseph C Griffis
- University of Alabama at Birmingham, Department of Psychology, USA.
| | - Rodolphe Nenert
- University of Alabama at Birmingham, Department of Neurology, USA
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33
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Nenert R, Allendorfer JB, Martin AM, Banks C, Ball A, Vannest J, Dietz AR, Szaflarski JP. Neuroimaging Correlates of Post-Stroke Aphasia Rehabilitation in a Pilot Randomized Trial of Constraint-Induced Aphasia Therapy. Med Sci Monit 2017; 23:3489-3507. [PMID: 28719572 PMCID: PMC5529460 DOI: 10.12659/msm.902301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Recovery from post-stroke aphasia is a long and complex process with an uncertain outcome. Various interventions have been proposed to augment the recovery, including constraint-induced aphasia therapy (CIAT). CIAT has been applied to patients suffering from post-stroke aphasia in several unblinded studies to show mild-to-moderate linguistic gains. The aim of the present study was to evaluate the neuroimaging correlates of CIAT in patients with chronic aphasia related to left middle cerebral artery stroke. Material/Methods Out of 24 patients recruited in a pilot randomized blinded trial of CIAT, 19 patients received fMRI of language. Eleven of them received CIAT (trained) and eight served as a control group (untrained). Each patient participated in three fMRI sessions (before training, after training, and 3 months later) that included semantic decision and verb generation fMRI tasks, and a battery of language tests. Matching healthy control participants were also included (N=38; matching based on age, handedness, and sex). Results Language testing showed significantly improved performance on Boston Naming Test (BNT; p<0.001) in both stroke groups over time and fMRI showed differences in the distribution of the areas involved in language production between groups that were not present at baseline. Further, regression analysis with BNT indicated changes in brain regions correlated with behavioral performance (temporal gyrus, postcentral gyrus, precentral gyrus, thalamus, left middle and superior frontal gyri). Conclusions Overall, our results suggest the possibility of language-related cortical plasticity following stroke-induced aphasia with no specific effect from CIAT training.
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Affiliation(s)
- Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber M Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christi Banks
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jennifer Vannest
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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34
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Nair VA, Raut RV, Prabhakaran V. Investigating the Blood Oxygenation Level-Dependent Functional MRI Response to a Verbal Fluency Task in Early Stroke before and after Hemodynamic Scaling. Front Neurol 2017; 8:283. [PMID: 28674515 PMCID: PMC5474460 DOI: 10.3389/fneur.2017.00283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022] Open
Abstract
Background and objective Blood oxygenation level-dependent (BOLD) functional MRI (fMRI) has been extensively used as a marker of brain dysfunction and subsequent recovery following stroke. However, growing evidence suggests that straightforward interpretation of BOLD fMRI changes with aging and disease is challenging. In this study, we investigated the effect of calibrating task fMRI data by applying a hemodynamic calibration method using the resting-state fluctuation amplitude (RSFA). Task fMRI responses were obtained during a covert verbal fluency task in a group of early stage stroke patients and matched healthy normal controls. Methods Fifteen acute left hemisphere stroke patients (less than 7 days from stroke; aged 44–84 years, average ~64 years) and 21 healthy controls (aged 55–77 years, average ~61 years) were prospectively studied. All subjects completed a 3-min covert verbal fluency task, and a 10-min eyes-closed resting-state fMRI scan, from which the calibration factor (RSFA) was computed. A behavioral measure on the verbal fluency task was also collected outside the scanner. Whole brain activation volumes and region-of-interest (ROI)-wise percent signal change and activation volumes before and after calibration were computed. Results Between-group differences in whole brain activation volumes, although statistically significant before calibration failed to be significant after calibration. There were significant within-group differences before and after calibration with RSFA. Statistically significant between-group differences on ROI-wise measures before calibration also significantly reduced after calibration. Exploratory brain-behavior correlations revealed a similar pattern: significant correlations before calibration failed to survive after calibration. Discussion and conclusion BOLD fMRI changes with aging and disease is confounded by changes in neurofunctional coupling leading to challenges in the straightforward interpretation of task fMRI results. Application of the hemodynamic calibration using the RSFA technique in the current study appeared to mitigate any differences between stroke and age-matched healthy controls. Our study indicates that estimating neural activity after applying hemodynamic scaling is important for studies of aging and for studies tracking post-stroke changes. We recommend that further investigation of hemodynamic calibration with RSFA in healthy subjects and in stroke in larger samples is necessary.
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Affiliation(s)
- Veena A Nair
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Ryan V Raut
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States.,Medical Scientist Training Program, University of Wisconsin-Madison, Madison, WI, United States
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35
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Mack JE, Thompson CK. Recovery of Online Sentence Processing in Aphasia: Eye Movement Changes Resulting From Treatment of Underlying Forms. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1299-1315. [PMID: 28474086 PMCID: PMC5755549 DOI: 10.1044/2016_jslhr-l-16-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/06/2016] [Accepted: 11/07/2016] [Indexed: 05/03/2023]
Abstract
Purpose The present study tested whether (and how) language treatment changed online sentence processing in individuals with aphasia. Method Participants with aphasia (n = 10) received a 12-week program of Treatment of Underlying Forms (Thompson & Shapiro, 2005) focused on production and comprehension of passive sentences. Before and after treatment, participants performed a sentence-picture matching task with active and passive sentences as eye movements were tracked. Twelve age-matched controls also performed the task once each. Results In the age-matched group, eye movements indicated agent-first predictive processing after hearing the subject noun, followed by rapid thematic reanalysis after hearing the verb form. Pretreatment eye movements in the participants with aphasia showed no predictive agent-first processing, and more accurate thematic analysis in active compared to passive sentences. After treatment, which resulted in improved offline passive sentence production and comprehension, participants were more likely to respond correctly when they made agent-first eye movements early in the sentence, showed equally reliable thematic analysis in active and passive sentences, and were less likely to use a spatially based alternative response strategy. Conclusions These findings suggest that treatment focused on improving sentence production and comprehension supports the emergence of more normal-like sentence comprehension processes.
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Affiliation(s)
- Jennifer E Mack
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Cynthia K Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, ILCognitive Neurology and Alzheimer's Disease Center, Northwestern University, Evanston, ILDepartment of Neurology, Northwestern University, Evanston, IL
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36
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Norise C, Hamilton RH. Non-invasive Brain Stimulation in the Treatment of Post-stroke and Neurodegenerative Aphasia: Parallels, Differences, and Lessons Learned. Front Hum Neurosci 2017; 10:675. [PMID: 28167904 PMCID: PMC5253356 DOI: 10.3389/fnhum.2016.00675] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/19/2016] [Indexed: 11/22/2022] Open
Abstract
Numerous studies over the span of more than a decade have shown that non-invasive brain stimulation (NIBS) techniques, namely transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), can facilitate language recovery for patients who have suffered from aphasia due to stroke. While stroke is the most common etiology of aphasia, neurodegenerative causes of language impairment—collectively termed primary progressive aphasia (PPA)—are increasingly being recognized as important clinical phenotypes in dementia. Very limited data now suggest that (NIBS) may have some benefit in treating PPAs. However, before applying the same approaches to patients with PPA as have previously been pursued in patients with post-stroke aphasia, it will be important for investigators to consider key similarities and differences between these aphasia etiologies that is likely to inform successful approaches to stimulation. While both post-stroke aphasia and the PPAs have clear overlaps in their clinical phenomenology, the mechanisms of injury and theorized neuroplastic changes associated with the two etiologies are notably different. Importantly, theories of plasticity in post-stroke aphasia are largely predicated on the notion that regions of the brain that had previously been uninvolved in language processing may take on new compensatory roles. PPAs, however, are characterized by slow distributed degeneration of cellular units within the language system; compensatory recruitment of brain regions to subserve language is not currently understood to be an important aspect of the condition. This review will survey differences in the mechanisms of language representation between the two etiologies of aphasia and evaluate properties that may define and limit the success of different neuromodulation approaches for these two disorders.
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Affiliation(s)
- Catherine Norise
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania Philadelphia, PA, USA
| | - Roy H Hamilton
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania Philadelphia, PA, USA
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37
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Griffis JC, Nenert R, Allendorfer JB, Vannest J, Holland S, Dietz A, Szaflarski JP. The canonical semantic network supports residual language function in chronic post-stroke aphasia. Hum Brain Mapp 2016; 38:1636-1658. [PMID: 27981674 DOI: 10.1002/hbm.23476] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/11/2016] [Accepted: 11/15/2016] [Indexed: 12/28/2022] Open
Abstract
Current theories of language recovery after stroke are limited by a reliance on small studies. Here, we aimed to test predictions of current theory and resolve inconsistencies regarding right hemispheric contributions to long-term recovery. We first defined the canonical semantic network in 43 healthy controls. Then, in a group of 43 patients with chronic post-stroke aphasia, we tested whether activity in this network predicted performance on measures of semantic comprehension, naming, and fluency while controlling for lesion volume effects. Canonical network activation accounted for 22%-33% of the variance in language test scores. Whole-brain analyses corroborated these findings, and revealed a core set of regions showing positive relationships to all language measures. We next evaluated the relationship between activation magnitudes in left and right hemispheric portions of the network, and characterized how right hemispheric activation related to the extent of left hemispheric damage. Activation magnitudes in each hemispheric network were strongly correlated, but four right frontal regions showed heightened activity in patients with large lesions. Activity in two of these regions (inferior frontal gyrus pars opercularis and supplementary motor area) was associated with better language abilities in patients with larger lesions, but poorer language abilities in patients with smaller lesions. Our results indicate that bilateral language networks support language processing after stroke, and that right hemispheric activations related to extensive left hemispheric damage occur outside of the canonical semantic network and differentially relate to behavior depending on the extent of left hemispheric damage. Hum Brain Mapp 38:1636-1658, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joseph C Griffis
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Scott Holland
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aimee Dietz
- University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
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Yang H, Bai L, Zhou Y, Kang S, Liang P, Wang L, Zhu Y. Increased inter-hemispheric resting-state functional connectivity in acute lacunar stroke patients with aphasia. Exp Brain Res 2016; 235:941-948. [PMID: 27942764 DOI: 10.1007/s00221-016-4851-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/30/2016] [Indexed: 12/18/2022]
Abstract
Aphasia is a devastating neurological condition affecting a person's ability to communicate and reintegrate into the society. It may occur in 20% or more of patients after stroke. The recovery of language function is accompanied by brain reorganization, and identifying the inter-hemispheric interaction post-stroke will conduce to more targeted treatments. Previous studies suggested that robust homotopic resting-state functional connectivity is a key characteristic of the brain's intrinsic functional architecture, and communication between the left and right cerebral hemispheres is important for language processing. In this study, voxel-mirrored homotopic connectivity (VMHC) was used to examine the inter-hemispheric resting-state functional connectivity (RSFC) differences between 37 patients with acute lacunar stroke in the left hemisphere and 28 healthy controls. Besides, correlation analyses were carried out to investigate the relationship between VMHC values of brain regions showing abnormal inter-hemispheric RSFC and clinical variables [i.e., aphasia quotient (AQ) scores, National Institutes of Health Stroke Scale (NIHSS) and Mini-Mental State Examination of patients]. Compared with healthy controls, patients showed significantly increased VMHC in the pars orbitalis of the inferior frontal gyrus, anterior part of the superior temporal gyrus (STG) and lingual gyrus. No brain region showed decreased VMHC in the patient group than in the healthy control group. The AQ scores were negatively correlated with VMHC values in the STG. NIHSS scores were positively correlated with VMHC values in the lingual gyrus. We hope these results could shed new insights into the pathology of aphasia in patients with acute lacunar stroke.
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Affiliation(s)
- Haiqing Yang
- Department of Radiology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China
| | - Lin Bai
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China
| | - Yi Zhou
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China
| | - Shan Kang
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China
| | - Panpan Liang
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China
| | - Lihua Wang
- Department of Blood Purification, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China.
| | - Yifei Zhu
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China.
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Lee YS, Zreik JT, Hamilton RH. Patterns of neural activity predict picture-naming performance of a patient with chronic aphasia. Neuropsychologia 2016; 94:52-60. [PMID: 27864027 DOI: 10.1016/j.neuropsychologia.2016.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 10/06/2016] [Accepted: 11/13/2016] [Indexed: 10/20/2022]
Abstract
Naming objects represents a substantial challenge for patients with chronic aphasia. This could be in part because the reorganized compensatory language networks of persons with aphasia may be less stable than the intact language systems of healthy individuals. Here, we hypothesized that the degree of stability would be instantiated by spatially differential neural patterns rather than either increased or diminished amplitudes of neural activity within a putative compensatory language system. We recruited a chronic aphasic patient (KL; 66 year-old male) who exhibited a semantic deficit (e.g., often said "milk" for "cow" and "pillow" for "blanket"). Over the course of four behavioral sessions involving a naming task performed in a mock scanner, we identified visual objects that yielded an approximately 50% success rate. We then conducted two fMRI sessions in which the patient performed a naming task for multiple exemplars of those objects. Multivoxel pattern analysis (MVPA) searchlight revealed differential activity patterns associated with correct and incorrect trials throughout intact brain regions. The most robust and largest cluster was found in the right occipito-temporal cortex encompassing fusiform cortex, lateral occipital cortex (LOC), and middle occipital cortex, which may account for the patient's propensity for semantic naming errors. None of these areas were found by a conventional univariate analysis. By using an alternative approach, we extend current evidence for compensatory naming processes that operate through spatially differential patterns within the reorganized language system.
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Affiliation(s)
- Yune Sang Lee
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, USA.
| | - Jihad T Zreik
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Sul B, Kim JS, Hong BY, Lee KB, Hwang WS, Kim YK, Lim SH. The Prognosis and Recovery of Aphasia Related to Stroke Lesion. Ann Rehabil Med 2016; 40:786-793. [PMID: 27847708 PMCID: PMC5108705 DOI: 10.5535/arm.2016.40.5.786] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/07/2016] [Indexed: 11/10/2022] Open
Abstract
Objective To investigate the effects of specific brain lesions on prognosis and recovery of post-stroke aphasia, and to assess the characteristic pattern of recovery. Methods Total of 15 subjects with first-ever, left hemisphere stroke, who were right handed, and who completed language assessment using the Korean version of the Western Aphasia Battery (K-WAB) at least twice during the subacute and chronic stages of stroke, were included. The brain lesions of the participants were evaluated using MRI-cron, SPM8, and Talairach Daemon software. Results Subtraction of the lesion overlap map of the participants who showed more than 30% improvement in the aphasia quotient (AQ) by the time of their chronic stage (n=9) from the lesion overlap map of those who did not show more than 30% improvement in the AQ (n=6) revealed a strong relationship with Broca's area, inferior prefrontal gyrus, premotor cortex, and a less strong relationship with Wernicke's area and superior and middle temporal gyri. The culprit lesion related to poor prognosis, after grouping the subjects according to their AQ score in the chronic stage (a cut score of 50), revealed a strong relationship with Broca's area, superior temporal gyrus, and a less strong relationship with Wernicke's area, prefrontal cortex, and inferior frontal gyrus. Conclusion Brain lesions in the Broca's area, inferior prefrontal gyrus, and premotor cortex may be related to slow recovery of aphasia in patients with left hemisphere stroke. Furthermore, involvement of Broca's area and superior temporal gyrus may be associated with poor prognosis of post-stroke aphasia.
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Affiliation(s)
- Bomi Sul
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Joon Sung Kim
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Kyoung Bo Lee
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Woo Seop Hwang
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Young Kook Kim
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Adaptive Plasticity in the Healthy Language Network: Implications for Language Recovery after Stroke. Neural Plast 2016; 2016:9674790. [PMID: 27830094 PMCID: PMC5088318 DOI: 10.1155/2016/9674790] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/18/2016] [Accepted: 09/25/2016] [Indexed: 12/27/2022] Open
Abstract
Across the last three decades, the application of noninvasive brain stimulation (NIBS) has substantially increased the current knowledge of the brain's potential to undergo rapid short-term reorganization on the systems level. A large number of studies applied transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in the healthy brain to probe the functional relevance and interaction of specific areas for different cognitive processes. NIBS is also increasingly being used to induce adaptive plasticity in motor and cognitive networks and shape cognitive functions. Recently, NIBS has been combined with electrophysiological techniques to modulate neural oscillations of specific cortical networks. In this review, we will discuss recent advances in the use of NIBS to modulate neural activity and effective connectivity in the healthy language network, with a special focus on the combination of NIBS and neuroimaging or electrophysiological approaches. Moreover, we outline how these results can be transferred to the lesioned brain to unravel the dynamics of reorganization processes in poststroke aphasia. We conclude with a critical discussion on the potential of NIBS to facilitate language recovery after stroke and propose a phase-specific model for the application of NIBS in language rehabilitation.
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Oliveira FFD, Marin SDMC, Bertolucci PHF. Neurological impressions on the organization of language networks in the human brain. Brain Inj 2016; 31:140-150. [PMID: 27740867 DOI: 10.1080/02699052.2016.1199914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND More than 95% of right-handed individuals, as well as almost 80% of left-handed individuals, have left hemisphere dominance for language. The perisylvian networks of the dominant hemisphere tend to be the most important language systems in human brains, usually connected by bidirectional fibres originated from the superior longitudinal fascicle/arcuate fascicle system and potentially modifiable by learning. Neuroplasticity mechanisms take place to preserve neural functions after brain injuries. Language is dependent on a hierarchical interlinkage of serial and parallel processing areas in distinct brain regions considered to be elementary processing units. Whereas aphasic syndromes typically result from injuries to the dominant hemisphere, the extent of the distribution of language functions seems to be variable for each individual. METHOD Review of the literature Results: Several theories try to explain the organization of language networks in the human brain from a point of view that involves either modular or distributed processing or sometimes both. The most important evidence for each approach is discussed under the light of modern theories of organization of neural networks. CONCLUSIONS Understanding the connectivity patterns of language networks may provide deeper insights into language functions, supporting evidence-based rehabilitation strategies that focus on the enhancement of language organization for patients with aphasic syndromes.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- a Department of Neurology and Neurosurgery , Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) , São Paulo , SP , Brazil
| | - Sheilla de Medeiros Correia Marin
- a Department of Neurology and Neurosurgery , Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) , São Paulo , SP , Brazil
| | - Paulo Henrique Ferreira Bertolucci
- a Department of Neurology and Neurosurgery , Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) , São Paulo , SP , Brazil
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Marangolo P, Fiori V, Sabatini U, De Pasquale G, Razzano C, Caltagirone C, Gili T. Bilateral Transcranial Direct Current Stimulation Language Treatment Enhances Functional Connectivity in the Left Hemisphere: Preliminary Data from Aphasia. J Cogn Neurosci 2016; 28:724-38. [DOI: 10.1162/jocn_a_00927] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract
Several studies have already shown that transcranial direct current stimulation (tDCS) is a useful tool for enhancing recovery in aphasia. However, no reports to date have investigated functional connectivity changes on cortical activity because of tDCS language treatment. Here, nine aphasic persons with articulatory disorders underwent an intensive language therapy in two different conditions: bilateral anodic stimulation over the left Broca's area and cathodic contralesional stimulation over the right homologue of Broca's area and a sham condition. The language treatment lasted 3 weeks (Monday to Friday, 15 sessions). In all patients, language measures were collected before (T0) and at the end of treatment (T15). Before and after each treatment condition (real vs. sham), each participant underwent a resting-state fMRI study. Results showed that, after real stimulation, patients exhibited the greatest recovery not only in terms of better accuracy in articulating the treated stimuli but also for untreated items on different tasks of the language test. Moreover, although after the sham condition connectivity changes were confined to the right brain hemisphere, real stimulation yielded to stronger functional connectivity increase in the left hemisphere. In conclusion, our data provide converging evidence from behavioral and functional imaging data that bilateral tDCS determines functional connectivity changes within the lesioned hemisphere, enhancing the language recovery process in stroke patients.
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Affiliation(s)
- Paola Marangolo
- 1IRCCS Fondazione Santa Lucia, Rome, Italy
- 2Università Federico II, Naples, Italy
| | - Valentina Fiori
- 1IRCCS Fondazione Santa Lucia, Rome, Italy
- 3Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Umberto Sabatini
- 1IRCCS Fondazione Santa Lucia, Rome, Italy
- 4University of Magna Grecia, Catanzaro, Italy
| | | | | | - Carlo Caltagirone
- 1IRCCS Fondazione Santa Lucia, Rome, Italy
- 3Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Tommaso Gili
- 1IRCCS Fondazione Santa Lucia, Rome, Italy
- 5Museo Storico della Fiscia e Ricerche “Enrico Fermi”, Rome, Italy
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Dunn LE, Schweber AB, Manson DK, Lendaris A, Herber C, Marshall RS, Lazar RM. Variability in Motor and Language Recovery during the Acute Stroke Period. Cerebrovasc Dis Extra 2016; 6:12-21. [PMID: 27099611 PMCID: PMC4836126 DOI: 10.1159/000444149] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/18/2016] [Indexed: 11/19/2022] Open
Abstract
Background Most stroke recovery occurs by 90 days after onset, with proportional recovery models showing an achievement of about 70% of the maximal remaining recovery. Little is known about recovery during the acute stroke period. Moreover, data are described for groups, not for individuals. In this observational cohort study, we describe for the first time the daily changes of acute stroke patients with motor and/or language deficits over the first week after stroke onset. Methods Patients were enrolled within 24-72 h after stroke onset with upper extremity hemiparesis, aphasia, or both, and were tested daily until day 7 or discharge with the upper-extremity Fugl-Meyer Assessment of Motor Recovery after Stroke, the Boston Naming Test, and the comprehension domain from the Western Aphasia Battery. Discharge scores, and absolute and proportional changes were examined using t-tests for pairwise comparisons and linear regression to determine relative contributions of initial impairment, lesion volume, and age to recovery over this period. Results Thirty-four patients were enrolled: 19 had motor deficits alone, 8 had aphasia alone, and 7 had motor and language deficits. In a group analysis, statistically significant changes in absolute scores were found in the motor (p < 0.001) and comprehension (p < 0.001) domains but not in naming. Day-by-day recovery curves for individual patients displayed wide variation with comparable initial impairment. Proportional recovery calculations revealed that, on average, patients achieved less than 1/3 of their potential recovery by the time of discharge. Multivariate regression showed that the amount of variance accounted for by initial severity, age, and lesion volume in this early time period was not significant for motor or language domains. Conclusions Over the first week after stroke onset, recovery of upper extremity hemiparesis and aphasia were not predictable on the basis of initial impairment, lesion volume, or age. In addition, patients only achieved about 1/3 of their remaining possible recovery based on the anticipated 70% proportion found at 90 days. These findings suggest that the complex interaction between poststroke structural repair, regeneration, and functional reorganization during the first week after stroke has yet to be elucidated.
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Affiliation(s)
| | - Adam B Schweber
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Daniel K Manson
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Andrea Lendaris
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Charlotte Herber
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Randolph S Marshall
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
| | - Ronald M Lazar
- The Richard and Jenny Levine Cerebral Localization Laboratory, Department of Neurology, Columbia University Medical Center, New York, N.Y., USA
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Interhemispheric Plasticity following Intermittent Theta Burst Stimulation in Chronic Poststroke Aphasia. Neural Plast 2016; 2016:4796906. [PMID: 26881111 PMCID: PMC4736997 DOI: 10.1155/2016/4796906] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/01/2015] [Accepted: 11/10/2015] [Indexed: 12/31/2022] Open
Abstract
The effects of noninvasive neurostimulation on brain structure and function in chronic poststroke aphasia are poorly understood. We investigated the effects of intermittent theta burst stimulation (iTBS) applied to residual language-responsive cortex in chronic patients using functional and anatomical MRI data acquired before and after iTBS. Lateralization index (LI) analyses, along with comparisons of inferior frontal gyrus (IFG) activation and connectivity during covert verb generation, were used to assess changes in cortical language function. Voxel-based morphometry (VBM) was used to assess effects on regional grey matter (GM). LI analyses revealed a leftward shift in IFG activity after treatment. While left IFG activation increased, right IFG activation decreased. Changes in right to left IFG connectivity during covert verb generation also decreased after iTBS. Behavioral correlations revealed a negative relationship between changes in right IFG activation and improvements in fluency. While anatomical analyses did not reveal statistically significant changes in grey matter volume, the fMRI results provide evidence for changes in right and left IFG function after iTBS. The negative relationship between post-iTBS changes in right IFG activity during covert verb generation and improvements in fluency suggests that iTBS applied to residual left-hemispheric language areas may reduce contralateral responses related to language production and facilitate recruitment of residual language areas after stroke.
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Wilson SM. Lesion-symptom mapping in the study of spoken language understanding. LANGUAGE, COGNITION AND NEUROSCIENCE 2016; 32:891-899. [PMID: 29051908 PMCID: PMC5642290 DOI: 10.1080/23273798.2016.1248984] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Lesion-symptom mapping studies aim to make inferences about the functional neuroanatomy of spoken language understanding by investigating relationships between damage to different brain regions and the various speech perception and comprehension deficits that result. Voxel-based lesion-symptom mapping (VLSM), voxel-based morphometry (VBM), and studies focused on specific cortical regions of interest or fiber pathways have all yielded insights regarding the localization of different components of spoken language processing. Major challenges include the fact that brain damage rarely impacts just a single brain region or just a single processing component, and that neuroplasticity and recovery can complicate the interpretation of lesion-deficit correlations. Future studies involving large patient cohorts derived from multi-center projects, and multivariate approaches to quantifying patterns of brain damage and patterns of linguistic deficits, will continue to yield new insights into the neural basis of spoken language understanding.
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Affiliation(s)
- Stephen M Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
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Crinion JT. Transcranial Direct Current Stimulation as a Novel Method for Enhancing Aphasia Treatment Effects. EUROPEAN PSYCHOLOGIST 2016. [DOI: 10.1027/1016-9040/a000254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Neuromodulation is an exciting area of development. Currently, there is significant interest in academia, industry, and clinical practice where an effective and acceptable transcranial direct current stimulation (tDCS) kit for use in clinical rehabilitation would offer much benefit to patients’ treatment. In this review, I discuss the latest group studies investigating current tDCS methods for enhancing aphasia treatment effects in post-stroke (sub-acute and chronic) and primary progressive aphasia (PPA) patient populations. This field is still new, and many more investigations with larger samples of patients are needed. Nevertheless, in the studies completed to date, on-line tDCS paired with language rehabilitation was feasible, safe, well tolerated, and sham controlled. Results on the effectiveness of tDCS at boosting recovery outcomes are preliminary but promising with a number of themes emerging. I highlight some of these themes and future directions toward identifying those patients who are likely to respond to specific tDCS and behavioral therapies. This would provide an empirical basis from which to investigate specific aphasia interventions in future multicenter clinical trials and could greatly improve the quality of aphasia treatment for stroke and PPA patients.
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Paiva S, Magalhães R, Alves J, Sampaio A. Efficacy of cognitive intervention in stroke: A long road ahead. Restor Neurol Neurosci 2015; 34:139-52. [PMID: 26684266 DOI: 10.3233/rnn-150590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Eigsti IM, Stevens MC, Schultz RT, Barton M, Kelley E, Naigles L, Orinstein A, Troyb E, Fein DA. Language comprehension and brain function in individuals with an optimal outcome from autism. NEUROIMAGE-CLINICAL 2015; 10:182-91. [PMID: 26862477 PMCID: PMC4707189 DOI: 10.1016/j.nicl.2015.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/23/2015] [Accepted: 11/16/2015] [Indexed: 11/30/2022]
Abstract
Although Autism Spectrum Disorder (ASD) is generally a lifelong disability, a minority of individuals with ASD overcome their symptoms to such a degree that they are generally indistinguishable from their typically-developing peers. That is, they have achieved an Optimal Outcome (OO). The question addressed by the current study is whether this normalized behavior reflects normalized brain functioning, or alternatively, the action of compensatory systems. Either possibility is plausible, as most participants with OO received years of intensive therapy that could alter brain networks to align with typical function or work around ASD-related neural dysfunction. Individuals ages 8 to 21 years with high-functioning ASD (n = 23), OO (n = 16), or typical development (TD; n = 20) completed a functional MRI scan while performing a sentence comprehension task. Results indicated similar activations in frontal and temporal regions (left middle frontal, left supramarginal, and right superior temporal gyri) and posterior cingulate in OO and ASD groups, where both differed from the TD group. Furthermore, the OO group showed heightened “compensatory” activation in numerous left- and right-lateralized regions (left precentral/postcentral gyri, right precentral gyrus, left inferior parietal lobule, right supramarginal gyrus, left superior temporal/parahippocampal gyrus, left middle occipital gyrus) and cerebellum, relative to both ASD and TD groups. Behaviorally normalized language abilities in OO individuals appear to utilize atypical brain networks, with increased recruitment of language-specific as well as right homologue and other systems. Early intensive learning and experience may normalize behavioral language performance in OO, but some brain regions involved in language processing may continue to display characteristics that are more similar to ASD than typical development, while others show characteristics not like ASD or typical development. fMRI study of "optimal outcome" (OO) youth with no symptoms of autism spectrum disorder. Results show “compensatory” language activation in some areas in OO. OO youth also had some “residual ASD” patterns of activation (OO, ASD > TD). There was no evidence of areas of normalized brain function (OO, TD ≠ ASD). Early treatment may normalize behavior but not brain in some individuals with ASD.
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Affiliation(s)
- Inge-Marie Eigsti
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | | | - Robert T Schultz
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marianne Barton
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Elizabeth Kelley
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Letitia Naigles
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Alyssa Orinstein
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Eva Troyb
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Deborah A Fein
- Department of Psychology, University of Connecticut, Storrs, CT, USA; Department of Pediatrics, University of Connecticut, Farmington, CT, USA
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Primaßin A, Scholtes N, Heim S, Huber W, Neuschäfer M, Binkofski F, Werner CJ. Determinants of Concurrent Motor and Language Recovery during Intensive Therapy in Chronic Stroke Patients: Four Single-Case Studies. Front Neurol 2015; 6:215. [PMID: 26500606 PMCID: PMC4598579 DOI: 10.3389/fneur.2015.00215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/22/2015] [Indexed: 01/12/2023] Open
Abstract
Despite intensive research on mechanisms of recovery of function after stroke, surprisingly little is known about determinants of concurrent recovery of language and motor functions in single patients. The alternative hypotheses are that the two functions might either “fight for resources” or use the same mechanisms in the recovery process. Here, we present follow-up data of four exemplary patients with different base levels of motor and language abilities. We assessed functional scales and performed exact lesion analysis to examine the connection between lesion parameters and recovery potential in each domain. Results confirm that preservation of the corticospinal tracts (CSTs) is a neural predictor for good motor recovery while preservation of the arcuate fasciculus (AF) is important for a good language recovery. However, results further indicate that even patients with large lesions in CST, AF, and superior longitudinal fasciculus, respectively, are able to recover their motor/language abilities during intensive therapy. We further found some indicators of a facilitating interaction between motor and language recovery. Patients with positive improvement of motor skills after therapy also improved in language skills, while the patients with no motor improvements were not able to gain any language recovery.
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Affiliation(s)
- Annika Primaßin
- Section Clinical-Cognitive Sciences, Department of Neurology, Uniklinik RWTH Aachen , Aachen , Germany ; Department of Clinical Neurophysiology, University Medical Center , Göttingen , Germany
| | - Nina Scholtes
- Section Clinical-Cognitive Sciences, Department of Neurology, Uniklinik RWTH Aachen , Aachen , Germany
| | - Stefan Heim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen , Aachen , Germany ; JARA - Translational Brain Medicine , Aachen , Germany ; Department of Neurology, Medical Faculty, Uniklinik RWTH Aachen , Aachen , Germany ; Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich , Jülich , Germany
| | - Walter Huber
- Section Clinical-Cognitive Sciences, Department of Neurology, Uniklinik RWTH Aachen , Aachen , Germany
| | | | - Ferdinand Binkofski
- Section Clinical-Cognitive Sciences, Department of Neurology, Uniklinik RWTH Aachen , Aachen , Germany ; Institute of Neuroscience and Medicine (INM-4), Research Centre Jülich , Jülich , Germany
| | - Cornelius J Werner
- Department of Neurology, Medical Faculty, Uniklinik RWTH Aachen , Aachen , Germany
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