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Han Y, Jing Y, Li X, Zhou H, Deng F. Clinical characteristics of post-stroke basal ganglia aphasia and the study of language-related white matter tracts based on diffusion spectrum imaging. Neuroimage 2024; 295:120664. [PMID: 38825217 DOI: 10.1016/j.neuroimage.2024.120664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/12/2024] [Accepted: 05/30/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Stroke often damages the basal ganglia, leading to atypical and transient aphasia, indicating that post-stroke basal ganglia aphasia (PSBGA) may be related to different anatomical structural damage and functional remodeling rehabilitation mechanisms. The basal ganglia contain dense white matter tracts (WMTs). Hence, damage to the functional tract may be an essential anatomical structural basis for the development of PSBGA. METHODS We first analyzed the clinical characteristics of PSBGA in 28 patients and 15 healthy controls (HCs) using the Western Aphasia Battery and neuropsychological test batteries. Moreover, we investigated white matter injury during the acute stage using diffusion magnetic resonance imaging scans for differential tractography. Finally, we used multiple regression models in correlation tractography to analyze the relationship between various language functions and quantitative anisotropy (QA) of WMTs. RESULTS Compared with HCs, patients with PSBGA showed lower scores for fluency, comprehension (auditory word recognition and sequential commands), naming (object naming and word fluency), reading comprehension of sentences, Mini-Mental State Examination, and Montreal Cognitive Assessment, along with increased scores in Hamilton Anxiety Scale-17 and Hamilton Depression Scale-17 within 7 days after stroke onset (P < 0.05). Differential tractography revealed that patients with PSBGA had damaged fibers, including in the body fibers of the corpus callosum, left cingulum bundles, left parietal aslant tracts, bilateral superior longitudinal fasciculus II, bilateral thalamic radiation tracts, left fornix, corpus callosum tapetum, and forceps major, compared with HCs (FDR < 0.02). Correlation tractography highlighted that better comprehension was correlated with a higher QA of the left inferior fronto-occipital fasciculus (IFOF), corpus callosum forceps minor, and left extreme capsule (FDR < 0.0083). Naming was positively associated with the QA of the left IFOF, forceps minor, left arcuate fasciculus, and uncinate fasciculus (UF) (FDR < 0.0083). Word fluency of naming was also positively associated with the QA of the forceps minor, left IFOF, and thalamic radiation tracts (FDR < 0.0083). Furthermore, reading was positively correlated with the QA of the forceps minor, left IFOF, and UF (FDR < 0.0083). CONCLUSION PSBGA is primarily characterized by significantly impaired word fluency of naming and preserved repetition abilities, as well as emotional and cognitive dysfunction. Damaged limbic pathways, dorsally located tracts in the left hemisphere, and left basal ganglia pathways are involved in PSBGA pathogenesis. The results of connectometry analysis further refine the current functional localization model of higher-order neural networks associated with language functions.
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Affiliation(s)
- Yue Han
- Department of Neurology, The First Hospital of Jilin University, Changchun, PR China
| | - Yuanyuan Jing
- Department of Neurology, The First Hospital of Jilin University, Changchun, PR China
| | - Xuewei Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, PR China
| | - Hongwei Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, PR China.
| | - Fang Deng
- Department of Neurology, The First Hospital of Jilin University, Changchun, PR China.
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Georgiou AM, Kambanaros M. Therapies and Challenges in the Post-Stroke Aphasia Rehabilitation Arena: Current and Future Prospects. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1674. [PMID: 37763793 PMCID: PMC10537631 DOI: 10.3390/medicina59091674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Aphasia is a serious consequence of stroke that results in a breakdown in communication. The course of aphasia recovery differs between afflicted individuals, and responsiveness to treatment cannot be predicted. Aphasiologists continue to investigate numerous behavioral treatment protocols that have shifted their focus to complimentary rehabilitation strategies. The aim of this study is threefold. First, to summarize the different categories of aphasia interventions post-stroke, considering their respective protocols, and present available evidence on the effectiveness of those protocols. Second, to document the challenges regarding the prediction of aphasia treatment response post-stroke in individual patients. Third, to report the challenges faced by researchers in recruiting people with aphasia (PWA) for treatment studies, and provide recommendations on how to increase participant recruitment and retention. This study provides up-to-date information on (i) effective therapies and aphasia recovery processes, and (ii) research recruitment hurdles together with potential strategies for overcoming them.
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Affiliation(s)
- Anastasios M. Georgiou
- The Brain and Neurorehabilitation Lab, Department of Rehabilitation Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus;
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Kristinsson S, den Ouden DB, Rorden C, Newman-Norlund R, Neils-Strunjas J, Fridriksson J. Predictors of Therapy Response in Chronic Aphasia: Building a Foundation for Personalized Aphasia Therapy. J Stroke 2022; 24:189-206. [PMID: 35677975 PMCID: PMC9194549 DOI: 10.5853/jos.2022.01102] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic aphasia, a devastating impairment of language, affects up to a third of stroke survivors. Speech and language therapy has consistently been shown to improve language function in prior clinical trials, but few clinicially applicable predictors of individual therapy response have been identified to date. Consequently, clinicians struggle substantially with prognostication in the clinical management of aphasia. A rising prevalence of aphasia, in particular in younger populations, has emphasized the increasing demand for a personalized approach to aphasia therapy, that is, therapy aimed at maximizing language recovery of each individual with reference to evidence-based clinical recommendations. In this narrative review, we discuss the current state of the literature with respect to commonly studied predictors of therapy response in aphasia. In particular, we focus our discussion on biographical, neuropsychological, and neurobiological predictors, and emphasize limitations of the literature, summarize consistent findings, and consider how the research field can better support the development of personalized aphasia therapy. In conclusion, a review of the literature indicates that future research efforts should aim to recruit larger samples of people with aphasia, including by establishing multisite aphasia research centers.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
- Correspondence: Sigfus Kristinsson Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, SC 29209, USA Tel: +1-803-553-4689 Fax: +1-803-777-9547 E-mail:
| | - Dirk B. den Ouden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Roger Newman-Norlund
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
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de Aguiar V, Rofes A. The noun-verb distinction. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:245-262. [PMID: 35964975 DOI: 10.1016/b978-0-12-823493-8.00006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The comparison between nouns and verbs has been a topic of interest for many researchers over the last 50 years. This comparison, and subsequent behavioral and (partly) anatomic dissociation, has allowed researchers to delve into many topics including the behavioral architecture of the language system and its neural correlates, the underlying nature of the linguistic impairment in individuals with different neurologic disorders, the assessment of language treatment protocols, and the proposal of new protocols aimed to protect the language system of individuals undergoing surgery for brain tumors and epilepsy. Specific to the left temporal lobe, classic accounts have shown its relevance for the processing of nouns and less for the processing of verbs. Nonetheless, more recent accounts indicate that different areas in the left temporal lobe can subserve different functions for the processing of both nouns and verbs. In this chapter, we outlined an overview of key findings of the study of nouns and verbs, with a particular focus on the left temporal lobe. This chapter contextualizes the literature on category-specific impairments and neural correlates of nouns and verbs with linguistic and psycholinguistic theories, and provides new ways to investigate and understand the intricacies of this comparison.
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Affiliation(s)
- Vânia de Aguiar
- Center for Language and Cognition Groningen, Groningen, The Netherlands; Department of Neurolinguistics and Language Development, University of Groningen, Groningen, The Netherlands
| | - Adrià Rofes
- Center for Language and Cognition Groningen, Groningen, The Netherlands; Department of Neurolinguistics and Language Development, University of Groningen, Groningen, The Netherlands.
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Kristinsson S, Basilakos A, Elm J, Spell LA, Bonilha L, Rorden C, den Ouden DB, Cassarly C, Sen S, Hillis A, Hickok G, Fridriksson J. Individualized response to semantic versus phonological aphasia therapies in stroke. Brain Commun 2021; 3:fcab174. [PMID: 34423302 PMCID: PMC8376685 DOI: 10.1093/braincomms/fcab174] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/23/2021] [Accepted: 05/28/2021] [Indexed: 11/12/2022] Open
Abstract
Attempts to personalize aphasia treatment to the extent where it is possible to reliably predict individual response to a particular treatment have yielded inconclusive results. The current study aimed to (i) compare the effects of phonologically versus semantically focussed naming treatment and (ii) examine biographical and neuropsychological baseline factors predictive of response to each treatment. One hundred and four individuals with chronic post-stroke aphasia underwent 3 weeks of phonologically focussed treatment and 3 weeks of semantically focussed treatment in an unblinded cross-over design. A linear mixed-effects model was used to compare the effects of treatment type on proportional change in correct naming across groups. Correlational analysis and stepwise regression models were used to examine biographical and neuropsychological predictors of response to phonological and semantic treatment across all participants. Last, chi-square tests were used to explore the association between treatment response and phonological and semantic deficit profiles. Semantically focussed treatment was found to be more effective at the group-level, independently of treatment order (P = 0.041). Overall, milder speech and language impairment predicted good response to semantic treatment (r range: 0.256-0.373) across neuropsychological tasks. The Western Aphasia Battery-Revised Spontaneous Speech score emerged as the strongest predictor of semantic treatment response (R 2 = 0.188). Severity of stroke symptoms emerged as the strongest predictor of phonological treatment response (R 2 = 0.103). Participants who showed a good response to semantic treatment were more likely to present with fluent speech compared to poor responders (P = 0.005), whereas participants who showed a good response to phonological treatment were more likely to present with apraxia of speech (P = 0.020). These results suggest that semantic treatment may be more beneficial to the improvement of naming performance in aphasia than phonological treatment, at the group-level. In terms of personalized predictors, participants with relatively mild impairments and fluent speech responded better to semantic treatment, while phonological treatment benefitted participants with more severe impairments and apraxia of speech.
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Affiliation(s)
- Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA.,Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA
| | - Alexandra Basilakos
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA
| | - Jordan Elm
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Leigh Ann Spell
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA.,Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA
| | - Leonardo Bonilha
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Chris Rorden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Dirk B den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA.,Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA
| | - Christy Cassarly
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Souvik Sen
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Neurology, University of South Carolina, Columbia, SC 29208, USA
| | - Argye Hillis
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Neurology and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21218, USA.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Gregory Hickok
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA.,Department of Cognitive Sciences and Language Science, University of California, Irvine, CA 92697, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA.,Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC 29208, USA
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Breining BL, Faria AV, Caffo B, Meier EL, Sheppard SM, Sebastian R, Tippett DC, Hillis AE. Neural regions underlying object and action naming: Complementary evidence from acute stroke and primary progressive aphasia. APHASIOLOGY 2021; 36:732-760. [PMID: 35832655 PMCID: PMC9272983 DOI: 10.1080/02687038.2021.1907291] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Naming impairment is commonly noted in individuals with aphasia. However, object naming receives more attention than action naming. Furthermore, most studies include participants with aphasia due to only one aetiology, commonly stroke. We developed a new assessment, the Hopkins Action Naming Assessment (HANA), to evaluate action naming impairments. AIMS Our aims were to show that the HANA is a useful tool that can (1) identify action naming impairments and (2) be used to investigate the neural substrates underlying naming. We paired the HANA with the Boston Naming Test (BNT) to compare action and object naming. We considered participants with aphasia due to primary progressive aphasia (PPA) or acute left hemisphere stroke to provide a more comprehensive picture of brain-behaviour relationships critical for naming. Behaviourally, we hypothesised that there would be a double dissociation between object and action naming performance. Neuroanatomically, we hypothesised that different neural substrates would be implicated in object vs. action naming and that different lesion-deficit associations would be identified in participants with PPA vs. acute stroke. METHODS & PROCEDURES Participants (N=138 with PPA, N=37 with acute stroke) completed the BNT and HANA. Behavioural performance was compared. A subset of participants (N=31 with PPA, N=37 with acute stroke) provided neuroimaging data. The whole brain was automatically segmented into regions of interest (ROIs). For participants with PPA, the image variables were the ROI volumes, normalised by the brain volume. For participants with acute stroke, the image variables were the percentage of each ROI affected by the lesion. The relationship between ROIs likely to be involved in naming performance was modelled with LASSO regression. OUTCOMES & RESULTS Behavioural results showed a double dissociation in performance: in each group, some participants displayed intact performance relative to healthy controls on actions but not objects and/or significantly better performance on actions than objects, while others showed the opposite pattern. These results support the need to assess both objects and actions when evaluating naming deficits. Neuroimaging results identified different regions associated with object vs. action naming, implicating overlapping but distinct networks of regions. Furthermore, results differed for participants with PPA vs. acute stroke, indicating that critical information may be missed when only one aetiology is considered. CONCLUSIONS Overall, the study provides a more comprehensive picture of the neural bases of naming, underscoring the importance of assessing both objects and actions and considering different aetiologies of damage. It demonstrates the utility of the HANA.
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Affiliation(s)
- Bonnie L. Breining
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Andreia V. Faria
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Erin L. Meier
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Shannon M. Sheppard
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Communication Sciences & Disorders, Chapman University, Irvine, CA 92618, USA
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Donna C. Tippett
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA
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Jarret T, Stockert A, Kotz SA, Tillmann B. Implicit learning of artificial grammatical structures after inferior frontal cortex lesions. PLoS One 2019; 14:e0222385. [PMID: 31539390 PMCID: PMC6754135 DOI: 10.1371/journal.pone.0222385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/29/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Previous research associated the left inferior frontal cortex with implicit structure learning. The present study tested patients with lesions encompassing the left inferior frontal gyrus (LIFG; including Brodmann areas 44 and 45) to further investigate this cognitive function, notably by using non-verbal material, implicit investigation methods, and by enhancing potential remaining function via dynamic attending. Patients and healthy matched controls were exposed to an artificial pitch grammar in an implicit learning paradigm to circumvent the potential influence of impaired language processing. METHODS Patients and healthy controls listened to pitch sequences generated within a finite-state grammar (exposure phase) and then performed a categorization task on new pitch sequences (test phase). Participants were not informed about the underlying grammar in either the exposure phase or the test phase. Furthermore, the pitch structures were presented in a highly regular temporal context as the beneficial impact of temporal regularity (e.g. meter) in learning and perception has been previously reported. Based on the Dynamic Attending Theory (DAT), we hypothesized that a temporally regular context helps developing temporal expectations that, in turn, facilitate event perception, and thus benefit artificial grammar learning. RESULTS Electroencephalography results suggest preserved artificial grammar learning of pitch structures in patients and healthy controls. For both groups, analyses of event-related potentials revealed a larger early negativity (100-200 msec post-stimulus onset) in response to ungrammatical than grammatical pitch sequence events. CONCLUSIONS These findings suggest that (i) the LIFG does not play an exclusive role in the implicit learning of artificial pitch grammars, and (ii) the use of non-verbal material and an implicit task reveals cognitive capacities that remain intact despite lesions to the LIFG. These results provide grounds for training and rehabilitation, that is, learning of non-verbal grammars that may impact the relearning of verbal grammars.
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Affiliation(s)
- Tatiana Jarret
- CNRS, UMR5292, INSERM, U1028, Lyon Neuroscience Research Center, Auditory Cognition and Psychoacoustics Team, Lyon, France
- University Lyon 1, Villeurbanne, France
| | - Anika Stockert
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Sonja A. Kotz
- Dept. of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Faculty of Psychology and Neuroscience, Dept. of Neuropsychology, Maastricht University, Maastricht, The Netherlands
- Faculty of Psychology and Neuroscience, Dept. of Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Barbara Tillmann
- CNRS, UMR5292, INSERM, U1028, Lyon Neuroscience Research Center, Auditory Cognition and Psychoacoustics Team, Lyon, France
- University Lyon 1, Villeurbanne, France
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Alferova VV, Shklovskij VM, Ivanova EG, Ivanov GV, Mayorova LA, Petrushevsky AG, Kuptsova SV, Guekht AB. [The prognosis for post-stroke aphasia]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:20-29. [PMID: 29863688 DOI: 10.17116/jnevro20181184120-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To determine risk factors and factors of favorable prognosis for regression of post-stroke aphasia in the early recovery period of ischemic stroke (IS). MATERIAL AND METHODS A cohort study was undertaken with 40 patients with different clinical forms of aphasia. The duration of study was 3-4 months of the disease. The regression of speech and non-speech cognitive impairment was assessed by the Method of a 10-point evaluation of higher mental functions. The method involves a comprehensive assessment of all mental functions with more than 90 subtests at the beginning and at the end of rehabilitation course and the calculation of the difference in the scoring of each mental function as a measure of treatment efficacy. Using logistic regression and odds ratio estimation, significance of the influence and the prognostic relationship of symptoms related to IS, and a number of biological and social factors (sex, age, and education) were studied. RESULTS An independent prognostic value for the aphasia regression on the third month of disease has the severity of neurologic symptomatology (NIHSS score) for the first day of stroke (OR 3,27 95% CI 1,02-9,77) and the third month of the disease (p=0,005, OR 4,6, 95% CI [1,39-15,11]) and the decrease in daily activity assessed by the total score of the Barthel index (p=0,004, OR 3,92, 95% CI [1,01-15,21]). A number of MRI signs (localization of post-stroke changes in the left angular gyrus, frontal-temporal region and focal volume) had a significant effect on the dynamics of non-verbal cognitive impairment. Neuropsychological examination revealed a significant improvement of speech in patients with initially severe forms of aphasias, in particular, sensory and sensorimotor. A direct relationship between age and certain clinical forms of aphasia as well as a significant positive effect of duration (β=1,91, p≤0,01) and level of education (β=1,68, p≤0,007) on aphasia regression were determined. CONCLUSION The severity of neurologic symptoms, in particular motor and sensory deficits, both in the acute and in the recovery period of the disease is one of the pathogenetic factors worsening the processes of functional reorganization of neuronal speech networks. The positive dynamics of the recovery of speech function is associated with the initial severity and clinical form of aphasia. The level and duration of education are related to factors positively affecting post-stroke neuroplasticity.
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Affiliation(s)
- V V Alferova
- Center of Speech Pathology and Neurorehabilitation, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - V M Shklovskij
- Center of Speech Pathology and Neurorehabilitation, Moscow, Russia; Serbsky National Research Medical Center for Psychiatry and Narcology, Moscow, Russia
| | - E G Ivanova
- Center of Speech Pathology and Neurorehabilitation, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - L A Mayorova
- Center of Speech Pathology and Neurorehabilitation, Moscow, Russia; Institute of Higher Nervous Activity, Moscow, Russia
| | - A G Petrushevsky
- Center of Speech Pathology and Neurorehabilitation, Moscow, Russia
| | - S V Kuptsova
- Center of Speech Pathology and Neurorehabilitation, Moscow, Russia; Institute of Higher Nervous Activity, Moscow, Russia
| | - A B Guekht
- Pirogov Russian National Research Medical University, Moscow, Russia; Research and Clinical Center for Neuropsychiatry of Moscow, Moscow, Russia
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Abstract
Objective: To review the research literature pertaining to post-stroke language recovery, and to discuss neurocognitive assessment in patients in the context of aphasia, time course of language recovery, factors associated with language recovery, and therapeutic techniques designed to facilitate language recovery. Method: Articles were identified through PubMed, MEDLINE, PsychINFO, and Google Scholar searches. Examples of utilized keywords include "post-stroke aphasia," "post-stroke language recovery," "post-stroke neurocognitive assessment," and "neuropsychology and aphasia." Results: Most language recovery occurs in the first few weeks following stroke, but residual recovery may occur for many years. Although initial aphasia severity is the single largest determinant of post-stroke language recovery, a number of other variables also contribute. Several techniques have been developed to aid in the recovery process including speech-language therapy and noninvasive brain stimulation, although the effectiveness of acute and subacute treatment remains unclear. Some degree of valid neurocognitive assessment is possible in patients with aphasia, and the information gained from such an evaluation can aid the rehabilitative process Conclusions: Significant recovery of language function is possible following a stroke, but prediction of level of recovery in an individual patient is difficult. Information about initial aphasia severity and the integrity of cognitive domains other than language can help guide the rehabilitation team, as well as manage expectations for recovery.
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Affiliation(s)
- Adam Gerstenecker
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , AL, USA.,b Alzheimer's Disease Center , University of Alabama at Birmingham , Birmingham , AL, USA.,c Evelyn F. McKnight Brain Institute , University of Alabama at Birmingham , Birmingham , AL, USA
| | - Ronald M Lazar
- a Department of Neurology , University of Alabama at Birmingham , Birmingham , AL, USA.,c Evelyn F. McKnight Brain Institute , University of Alabama at Birmingham , Birmingham , AL, USA
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Abstract
BACKGROUND Post-stroke aphasia syndromes as a clinical entity arise from the disruption of brain networks specialized in language production and comprehension due to permanent focal ischemia. This approach to post-stroke aphasia is based on two pathophysiological concepts: 1) Understanding language processing in terms of distributed networks rather than language centers and 2) understanding the molecular pathophysiology of ischemic brain injury as a dynamic process beyond the direct destruction of network centers and their connections. While considerable progress has been made in the past 10 years to develop such models on a systems as well as a molecular level, the influence of these approaches on understanding and treating clinical aphasia syndromes has been limited. OBJECTIVE & METHODS In this article, we review current pathophysiological concepts of ischemic brain injury, their relationship to altered information processing in language networks after ischemic stroke and how these mechanisms may be influenced therapeutically to improve treatment of post-stroke aphasia. CONCLUSION Understanding the pathophysiological mechanism of post-stroke aphasia on a neurophysiological systems level as well as on the molecular level becomes more and more important for aphasia treatment, as the field moves from standardized therapies towards more targeted individualized treatment strategies comprising behavioural therapies as well as non-invasive brain stimulation (NIBS).
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Abstract
RESUMO O objetivo desta revisão foi identificar, avaliar e discutir artigos sobre intervenções e avanços terapêuticos em afasia, publicados periódicos científicos nos últimos cinco anos, em plataformas de livre acesso aos profissionais. Foi realizada uma revisão integrativa nas bases de dados SciELO, LILACS, Periódicos Capes e PubMed, com os descritores em português e inglês: afasia, reabilitação e tratamento. Foram incluídos artigos que descrevessem tratamentos para afasia ou histórias de reabilitação, publicados em inglês ou português. Os estudos que atenderam aos critérios foram lidos e analisados segundo instrumento para revisão integrativa, e posteriormente categorizada. Dos 96 artigos levantados 26 foram incluídos na revisão. Houve predominância de estudos quantitativos. De modo geral, diversas pesquisas que testavam terapias mostraram resultados positivos, confirmando que a afasia é uma condição que responde a uma ampla variedade de tratamentos. Nos estudos cujo foco foi a ativação cerebral, foram encontradas correlações importantes entre a melhora dos pacientes e a ativação de áreas cerebrais relacionadas à linguagem. A partir dos resultados, verificou-se que os tratamentos para afasia descritos não indicam a superioridade de uma abordagem terapêutica sobre outra. A maioria dos estudos revisados não apresentava bom grau de generalidade externa, indicando a necessidade de estudos controlados com amostras mais representativas. A literatura atualizada deve fundamentar as ações dos profissionais, porém esses devem estar atentos às características e limitações dos protocolos testados.
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Campana S, Caltagirone C, Marangolo P. Combining Voxel-based Lesion-symptom Mapping (VLSM) With A-tDCS Language Treatment: Predicting Outcome of Recovery in Nonfluent Chronic Aphasia. Brain Stimul 2015; 8:769-76. [DOI: 10.1016/j.brs.2015.01.413] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/18/2015] [Accepted: 01/23/2015] [Indexed: 10/24/2022] Open
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13
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Factors predicting post-stroke aphasia recovery. J Neurol Sci 2015; 352:12-8. [DOI: 10.1016/j.jns.2015.03.020] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 11/21/2022]
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Anglade C, Thiel A, Ansaldo AI. The complementary role of the cerebral hemispheres in recovery from aphasia after stroke: a critical review of literature. Brain Inj 2014; 28:138-45. [PMID: 24456053 DOI: 10.3109/02699052.2013.859734] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To review the literature on the specific role of the right cerebral hemisphere during recovery from aphasia in order to address the lack of consensus among authors. To derive a theoretical model reconciling the controversial findings in the literature. METHODS Initial PubMed, MEDLINE (1946 to 5 May 2012) and PsycINFO (1806 to first week June 2012) searches on recovery mechanisms from aphasia, whether treatment-related or not, retrieved a total of 35 English language articles. Articles, cross-referenced in this initial set were also reviewed if they met the inclusion criteria, thus resulting in a total of 42 articles included in this review. MAIN OUTCOMES Recruitment of the right hemisphere during recovery from aphasia can be effective if it occurs during a critical time window post-stroke. The recruitment's effectiveness will depend on the lesion's location, extent and permanence. Preservation of core language processing areas will generate minimal right hemisphere recruitment and vice versa. Some experimental studies seem to suggest that the improvement linked to a particular hemisphere can be modulated by specific therapy methods. CONCLUSION The specific conditions in which effective right recruitment takes place may have important implications for rehabilitation treatment. These findings could lead to improved recovery in people suffering from aphasia. However, more research with non-invasive brain stimulation is needed.
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Affiliation(s)
- Carole Anglade
- Jewish General Hospital and Lady Davis Institute , Montréal, Quebec , Canada
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Henseler I, Regenbrecht F, Obrig H. Lesion correlates of patholinguistic profiles in chronic aphasia: comparisons of syndrome-, modality- and symptom-level assessment. ACTA ACUST UNITED AC 2014; 137:918-30. [PMID: 24525451 DOI: 10.1093/brain/awt374] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
One way to investigate the neuronal underpinnings of language competence is to correlate patholinguistic profiles of aphasic patients to corresponding lesion sites. Constituting the beginnings of aphasiology and neurolinguistics over a century ago, this approach has been revived and refined in the past decade by statistical approaches mapping continuous variables (providing metrics that are not simply categorical) on voxel-wise lesion information (voxel-based lesion-symptom mapping). Here we investigate whether and how voxel-based lesion-symptom mapping allows us to delineate specific lesion patterns for differentially fine-grained clinical classifications. The latter encompass 'classical' syndrome-based approaches (e.g. Broca's aphasia), more symptom-oriented descriptions (e.g. agrammatism) and further refinement to linguistic sub-functions (e.g. lexico-semantic deficits for inanimate versus animate items). From a large database of patients treated for aphasia of different aetiologies (n = 1167) a carefully selected group of 102 first ever ischaemic stroke patients with chronic aphasia (∅ 12 months) were included in a VLSM analysis. Specifically, we investigated how performance in the Aachen Aphasia Test-the standard clinical test battery for chronic aphasia in German-relates to distinct brain lesions. The Aachen Aphasia Test evaluates aphasia on different levels: a non-parametric discriminant procedure yields probabilities for the allocation to one of the four 'standard' syndromes (Broca, Wernicke, global and amnestic aphasia), whereas standardized subtests target linguistic modalities (e.g. repetition), or even more specific symptoms (e.g. phoneme repetition). Because some subtests of the Aachen Aphasia Test (e.g. for the linguistic level of lexico-semantics) rely on rather coarse and heterogeneous test items we complemented the analysis with a number of more detailed clinically used tests in selected mostly mildly affected subgroups of patients. Our results indicate that: (i) Aachen Aphasia Test-based syndrome allocation allows for an unexpectedly concise differentiation between 'Broca's' and 'Wernicke's' aphasia corresponding to non-overlapping anterior and posterior lesion sites; whereas (ii) analyses for modalities and specific symptoms yielded more circumscribed but partially overlapping lesion foci, often cutting across the above syndrome territories; and (iii) especially for lexico-semantic capacities more specialized clinical test-batteries are required to delineate precise lesion patterns at this linguistic level. In sum this is the first report on a successful lesion-delineation of syndrome-based aphasia classification highlighting the relevance of vascular distribution for the syndrome level while confirming and extending a number of more linguistically motivated differentiations, based on clinically used tests. We consider such a comprehensive view reaching from the syndrome to a fine-grained symptom-oriented assessment mandatory to converge neurolinguistic, patholinguistic and clinical-therapeutic knowledge on language-competence and impairment.
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Affiliation(s)
- Ilona Henseler
- 1 Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany
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van Hees S, McMahon K, Angwin A, de Zubicaray G, Copland DA. Neural activity associated with semantic versus phonological anomia treatments in aphasia. BRAIN AND LANGUAGE 2014; 129:47-57. [PMID: 24556337 DOI: 10.1016/j.bandl.2013.12.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 12/20/2013] [Accepted: 12/30/2013] [Indexed: 06/03/2023]
Abstract
Naming impairments in aphasia are typically targeted using semantic and/or phonologically based tasks. However, it is not known whether these treatments have different neural mechanisms. Eight participants with aphasia received twelve treatment sessions using an alternating treatment design, with fMRI scans pre- and post-treatment. Half the sessions employed Phonological Components Analysis (PCA), and half the sessions employed Semantic Feature Analysis (SFA). Pre-treatment activity in the left caudate correlated with greater immediate treatment success for items treated with SFA, whereas recruitment of the left supramarginal gyrus and right precuneus post-treatment correlated with greater immediate treatment success for items treated with PCA. The results support previous studies that have found greater treatment outcome to be associated with activity in predominantly left hemisphere regions, and suggest that different mechanisms may be engaged dependent on the type of treatment employed.
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Affiliation(s)
- Sophia van Hees
- University of Queensland Centre for Clinical Research, Herston, QLD 4029, Australia; School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, QLD 4072, Australia; Centre for Advanced Imaging, University of Queensland, St. Lucia, QLD 4072, Australia.
| | - Katie McMahon
- Centre for Advanced Imaging, University of Queensland, St. Lucia, QLD 4072, Australia; Wesley Hospital, Auchenflower, QLD 4066, Australia.
| | - Anthony Angwin
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, QLD 4072, Australia.
| | - Greig de Zubicaray
- School of Psychology, University of Queensland, St. Lucia, QLD 4072, Australia.
| | - David A Copland
- University of Queensland Centre for Clinical Research, Herston, QLD 4029, Australia; School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, QLD 4072, Australia; Clinical Centre for Research Excellence in Aphasia Rehabilitation, Australia.
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van Hees S, McMahon K, Angwin A, de Zubicaray G, Read S, Copland DA. A functional MRI study of the relationship between naming treatment outcomes and resting state functional connectivity in post-stroke aphasia. Hum Brain Mapp 2014; 35:3919-31. [PMID: 24453137 DOI: 10.1002/hbm.22448] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/11/2013] [Accepted: 11/29/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The majority of studies investigating the neural mechanisms underlying treatment in people with aphasia have examined task-based brain activity. However, the use of resting-state fMRI may provide another method of examining the brain mechanisms responsible for treatment-induced recovery, and allows for investigation into connectivity within complex functional networks METHODS Eight people with aphasia underwent 12 treatment sessions that aimed to improve object naming. Half the sessions employed a phonologically-based task, and half the sessions employed a semantic-based task, with resting-state fMRI conducted pre- and post-treatment. Brain regions in which the amplitude of low frequency fluctuations (ALFF) correlated with treatment outcomes were used as seeds for functional connectivity (FC) analysis. FC maps were compared from pre- to post-treatment, as well as with a group of 12 healthy older controls RESULTS Pre-treatment ALFF in the right middle temporal gyrus (MTG) correlated with greater outcomes for the phonological treatment, with a shift to the left MTG and supramarginal gyrus, as well as the right inferior frontal gyrus, post-treatment. When compared to controls, participants with aphasia showed both normalization and up-regulation of connectivity within language networks post-treatment, predominantly in the left hemisphere CONCLUSIONS The results provide preliminary evidence that treatments for naming impairments affect the FC of language networks, and may aid in understanding the neural mechanisms underlying the rehabilitation of language post-stroke.
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Affiliation(s)
- Sophia van Hees
- Centre for Clinical Research, University of Queensland, Brisbane, Australia; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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van Hees S, McMahon K, Angwin A, de Zubicaray G, Read S, Copland DA. Changes in white matter connectivity following therapy for anomia post stroke. Neurorehabil Neural Repair 2013; 28:325-34. [PMID: 24297762 DOI: 10.1177/1545968313508654] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The majority of studies investigating the neural mechanisms underlying treatment-induced recovery in aphasia have focused on the cortical regions associated with language processing. However, the integrity of the white matter connecting these regions may also be crucial to understanding treatment mechanisms. OBJECTIVE This study investigated the integrity of the arcuate fasciculus (AF) and uncinate fasciculus (UF) before and after treatment for anomia in people with aphasia. METHOD Eight people with aphasia received 12 treatment sessions to improve naming; alternating between phonologically-based and semantic-based tasks, with high angular resolution diffusion imaging conducted pre and post treatment. The mean generalized fractional anisotropy (GFA), a measure of fiber integrity, and number of fibers in the AF and UF were compared pre and post treatment, as well as with a group of 14 healthy older controls. RESULTS Pre treatment, participants with aphasia had significantly fewer fibers and lower mean GFA in the left AF compared with controls. Post treatment, mean GFA increased in the left AF to be statistically equivalent to controls. Additionally, mean GFA in the left AF pre and post treatment positively correlated with maintenance of the phonologically based treatment. No differences were found in the right AF, or the UF in either hemisphere, between participants with aphasia and controls, and no changes were observed in these tracts following treatment. CONCLUSIONS Anomia treatments may improve the integrity of the white matter connecting cortical language regions. These preliminary results add to the understanding of the mechanisms underlying treatment outcomes in people with aphasia post stroke.
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Affiliation(s)
- Sophia van Hees
- 1University of Queensland Centre for Clinical Research, Brisbane, Australia
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da Fontoura DR, Rodrigues JDC, Carneiro LBDS, Monção AM, de Salles JF. Rehabilitation of language in expressive aphasias: a literature review. Dement Neuropsychol 2012; 6:223-235. [PMID: 29213802 PMCID: PMC5619334 DOI: 10.1590/s1980-57642012dn06040006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective This paper reviews the methodological characteristics of studies on
rehabilitation of expressive aphasia, describing the techniques of
rehabilitation used. Methods The databases Medline, Science Direct and PubMed were searched for relevant
articles (January 1999 to December 2011) using the keywords Expressive /
Broca / Nonfluent Aphasia, combined with Language or Speech Rehabilitation /
Therapy / Intervention. Results A total of 56 articles were retrieved describing rehabilitation techniques,
including 22 with a focus on lexical processing, 18 on syntax stimulation,
seven with the aim of developing speech and nine with multiple foci. Conclusion A variety of techniques and theoretical approaches are available,
highlighting the heterogeneity of research in this area. This diversity can
be justified by the uniqueness of patients' language deficits, making it
difficult to generalize. In addition, there is a need to combine the formal
measures of tests with measures of pragmatic and social skills of
communication to determine the effect of rehabilitation on the patient's
daily life.
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Affiliation(s)
- Denise Ren da Fontoura
- Fonoaudióloga, Doutora em Ciências da Linguagem/Psicolinguística pela Universidade Nova de Lisboa (UNL), Mestre em Ciências da Saúde/Neurociências pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Especialista em Reabilitação Fonoaudiológica/ Voz pelo Instituto Metodista IPA e Pós Graduada em Neuropsicologia/ Linguagem pela PUCRS
| | - Jaqueline de Carvalho Rodrigues
- Psicóloga Clínica, Mestranda em Psicologia no Programa de Pós-Graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS
| | | | - Ana Maria Monção
- Professora Auxiliar do Departamento de Linguística da Universidade Nova de Lisboa, Doutora em Psicolinguística, Licenciada em Psicoterapia e Mestre em Neuropsicologia e Demências
| | - Jerusa Fumagalli de Salles
- Fonoaudióloga, Doutora em Psicologia, Professora Adjunta do Departamento de Psicologia do Desenvolvimento e da Personalidade, Instituto de Psicologia, Programa de Pós-Graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS, Coordenadora do Núcleo de estudos em Neuropsicologia Cognitiva - NEUROCOG
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Marcotte K, Adrover-Roig D, Damien B, de Préaumont M, Généreux S, Hubert M, Ansaldo AI. Therapy-induced neuroplasticity in chronic aphasia. Neuropsychologia 2012; 50:1776-86. [DOI: 10.1016/j.neuropsychologia.2012.04.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 03/20/2012] [Accepted: 04/04/2012] [Indexed: 11/25/2022]
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Kurland J, Pulvermüller F, Silva N, Burke K, Andrianopoulos M. Constrained versus unconstrained intensive language therapy in two individuals with chronic, moderate-to-severe aphasia and apraxia of speech: behavioral and fMRI outcomes. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2012; 21:S65-S87. [PMID: 22294409 DOI: 10.1044/1058-0360(2012/11-0113)] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE This Phase I study investigated behavioral and functional MRI (fMRI) outcomes of 2 intensive treatment programs to improve naming in 2 participants with chronic moderate-to-severe aphasia with comorbid apraxia of speech (AOS). Constraint-induced aphasia therapy (CIAT; Pulvermüller et al., 2001) has demonstrated positive outcomes in some individuals with chronic aphasia. Whether constraint to the speech modality or treatment intensity is responsible for such gains is still under investigation. Moreover, it remains to be seen whether CIAT is effective in individuals with persistent severe nonfluent speech and/or AOS. METHOD A single-subject multiple-baseline approach was used. Both participants were treated simultaneously, first with Promoting Aphasics' Communicative Effectiveness (PACE; Davis & Wilcox, 1985) and then with CIAT. Pre-/posttreatment testing included an overt naming fMRI protocol. Treatment effect sizes were calculated for changes in probe accuracy from baseline to posttreatment phases and maintenance where available. RESULTS Both participants made more and faster gains in naming following CIAT. Treatment-induced changes in BOLD activation suggested that better naming was correlated with the recruitment of perilesional tissue. CONCLUSION Participants produced more target words accurately following CIAT than following PACE. Behavioral and fMRI results support the notion that the intense and repetitive nature of obligatory speech production in CIAT has a positive effect on word retrieval, even in participants with chronic moderate-to-severe aphasia with comorbid AOS.
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Smith EJ, Stroemer RP, Gorenkova N, Nakajima M, Crum WR, Tang E, Stevanato L, Sinden JD, Modo M. Implantation Site and Lesion Topology Determine Efficacy of a Human Neural Stem Cell Line in a Rat Model of Chronic Stroke. Stem Cells 2012; 30:785-96. [DOI: 10.1002/stem.1024] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Harnish S, Meinzer M, Trinastic J, Fitzgerald D, Page S. Language changes coincide with motor and fMRI changes following upper extremity motor therapy for hemiparesis: a brief report. Brain Imaging Behav 2011; 8:370-7. [DOI: 10.1007/s11682-011-9139-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ifejika-Jones NL, Barrett AM. Rehabilitation--emerging technologies, innovative therapies, and future objectives. Neurotherapeutics 2011; 8:452-62. [PMID: 21706265 PMCID: PMC3148149 DOI: 10.1007/s13311-011-0057-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Stroke is the leading cause of long-term disability. The goal of stroke rehabilitation is to improve recovery in the years after a stroke and to decrease long-term disability. This article, titled "Rehabilitation--Emerging Technologies, Innovative Therapies, and Future Objectives" gives evidence-based information on the type of rehabilitation approaches that are effective to improve functional mobility and to address cognitive impairments. We review the importance of taking a translational approach to neurorehabilitation, considering the interaction of motor and cognitive systems, skilled learned purposeful limb movement, and spatial navigation ability. Known biologic mechanisms of neurorecovery are targeted in relation to technology implemented by members of the multidisciplinary team. Results from proof-of-concept, within subjects, and randomized controlled trials are presented, and the implications for optimal stroke rehabilitation strategies are discussed. Developing clinical practices are highlighted and future research directions are proposed with goals to provide insight on what the next steps are for this burgeoning discipline.
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Affiliation(s)
- Nneka L. Ifejika-Jones
- Departments of Neurology and Physical Medicine & Rehabilitation, University of Texas Medical School at Houston, Houston, TX 77030 USA
| | - Anna M. Barrett
- Departments of Physical Medicine & Rehabilitation and Neurology & Neurosciences, University of Medicine and Dentistry New Jersey - New Jersey Medical School, Newark, NJ 07101 USA
- Kessler Foundation Research Center, West Orange, NJ 07052 USA
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Marchina S, Zhu LL, Norton A, Zipse L, Wan CY, Schlaug G. Impairment of speech production predicted by lesion load of the left arcuate fasciculus. Stroke 2011; 42:2251-6. [PMID: 21719773 DOI: 10.1161/strokeaha.110.606103] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have suggested that patients' potential for poststroke language recovery is related to lesion size; however, lesion location may also be of importance, particularly when fiber tracts that are critical to the sensorimotor mapping of sounds for articulation (eg, the arcuate fasciculus) have been damaged. In this study, we tested the hypothesis that lesion loads of the arcuate fasciculus (ie, volume of arcuate fasciculus that is affected by a patient's lesion) and of 2 other tracts involved in language processing (the extreme capsule and the uncinate fasciculus) are inversely related to the severity of speech production impairments in patients with stroke with aphasia. METHODS Thirty patients with chronic stroke with residual impairments in speech production underwent high-resolution anatomic MRI and a battery of cognitive and language tests. Impairment was assessed using 3 functional measures of spontaneous speech (eg, rate, informativeness, and overall efficiency) as well as naming ability. To quantitatively analyze the relationship between impairment scores and lesion load along the 3 fiber tracts, we calculated tract-lesion overlap volumes for each patient using probabilistic maps of the tracts derived from diffusion tensor images of 10 age-matched healthy subjects. RESULTS Regression analyses showed that arcuate fasciculus lesion load, but not extreme capsule or uncinate fasciculus lesion load or overall lesion size, significantly predicted rate, informativeness, and overall efficiency of speech as well as naming ability. CONCLUSIONS A new variable, arcuate fasciculus lesion load, complements established voxel-based lesion mapping techniques and, in the future, may potentially be used to estimate impairment and recovery potential after stroke and refine inclusion criteria for experimental rehabilitation programs.
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Affiliation(s)
- Sarah Marchina
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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Meinzer M, Harnish S, Conway T, Crosson B. Recent developments in functional and structural imaging of aphasia recovery after stroke. APHASIOLOGY 2011; 25:271-290. [PMID: 21532927 PMCID: PMC3083028 DOI: 10.1080/02687038.2010.530672] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND: Functional and structural neuroimaging techniques can increase our knowledge about the neural processes underlying recovery from post-stroke language impairments (aphasia). AIMS: In the present review we highlight recent developments in neuroimaging research of aphasia recovery. MAIN CONTRIBUTION: We review (a) cross-sectional findings in aphasia with regard to local brain functions and functional connectivity, (b) structural and functional imaging findings using longitudinal (intervention) paradigms, (c) new adjunct treatments that are guided by functional imaging techniques (e.g., electrical brain stimulation) and (d) studies related to the prognosis of language recovery and treatment responsiveness after stroke. CONCLUSIONS: More recent developments in data acquisition and analysis foster better understanding and more realistic modelling of the neural substrates of language recovery after stroke. Moreover, the combination of different neuroimaging protocols can provide converging evidence for neuroplastic brain remodelling during spontaneous and treatment-induced recovery. Researchers are also beginning to use sophisticated imaging analyses to improve accuracy of prognosis, which may eventually improve patient care by allowing for more efficient treatment planning. Brain stimulation techniques offer a new and exciting way to improve the recovery potential after stroke.
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Affiliation(s)
- Marcus Meinzer
- Department of Neurology, Center for Stroke Research Berlin & Cluster of Excellence NeuroCure, Charite, Universitätsmedizin Berlin, Berlin, Germany
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Stacy Harnish
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Tim Conway
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Bruce Crosson
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
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Weiduschat N, Thiel A, Rubi-Fessen I, Hartmann A, Kessler J, Merl P, Kracht L, Rommel T, Heiss WD. Effects of Repetitive Transcranial Magnetic Stimulation in Aphasic Stroke. Stroke 2011; 42:409-15. [PMID: 21164121 DOI: 10.1161/strokeaha.110.597864] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Nora Weiduschat
- From the Department of Neurology (N.W., J.K.), University of Cologne, Cologne, Germany; Max-Planck-Institute for Neurological Research (N.W., L.K., W.D.H.), Cologne, Germany; the Department of Neurology (A.T.), McGill University, Montreal, Canada; and RehaNova GmbH (I.R.-F., A.H., P.M., T.R.), Cologne, Germany
| | - Alexander Thiel
- From the Department of Neurology (N.W., J.K.), University of Cologne, Cologne, Germany; Max-Planck-Institute for Neurological Research (N.W., L.K., W.D.H.), Cologne, Germany; the Department of Neurology (A.T.), McGill University, Montreal, Canada; and RehaNova GmbH (I.R.-F., A.H., P.M., T.R.), Cologne, Germany
| | - Ilona Rubi-Fessen
- From the Department of Neurology (N.W., J.K.), University of Cologne, Cologne, Germany; Max-Planck-Institute for Neurological Research (N.W., L.K., W.D.H.), Cologne, Germany; the Department of Neurology (A.T.), McGill University, Montreal, Canada; and RehaNova GmbH (I.R.-F., A.H., P.M., T.R.), Cologne, Germany
| | - Alexander Hartmann
- From the Department of Neurology (N.W., J.K.), University of Cologne, Cologne, Germany; Max-Planck-Institute for Neurological Research (N.W., L.K., W.D.H.), Cologne, Germany; the Department of Neurology (A.T.), McGill University, Montreal, Canada; and RehaNova GmbH (I.R.-F., A.H., P.M., T.R.), Cologne, Germany
| | - Josef Kessler
- From the Department of Neurology (N.W., J.K.), University of Cologne, Cologne, Germany; Max-Planck-Institute for Neurological Research (N.W., L.K., W.D.H.), Cologne, Germany; the Department of Neurology (A.T.), McGill University, Montreal, Canada; and RehaNova GmbH (I.R.-F., A.H., P.M., T.R.), Cologne, Germany
| | - Patrick Merl
- From the Department of Neurology (N.W., J.K.), University of Cologne, Cologne, Germany; Max-Planck-Institute for Neurological Research (N.W., L.K., W.D.H.), Cologne, Germany; the Department of Neurology (A.T.), McGill University, Montreal, Canada; and RehaNova GmbH (I.R.-F., A.H., P.M., T.R.), Cologne, Germany
| | - Lutz Kracht
- From the Department of Neurology (N.W., J.K.), University of Cologne, Cologne, Germany; Max-Planck-Institute for Neurological Research (N.W., L.K., W.D.H.), Cologne, Germany; the Department of Neurology (A.T.), McGill University, Montreal, Canada; and RehaNova GmbH (I.R.-F., A.H., P.M., T.R.), Cologne, Germany
| | - Thomas Rommel
- From the Department of Neurology (N.W., J.K.), University of Cologne, Cologne, Germany; Max-Planck-Institute for Neurological Research (N.W., L.K., W.D.H.), Cologne, Germany; the Department of Neurology (A.T.), McGill University, Montreal, Canada; and RehaNova GmbH (I.R.-F., A.H., P.M., T.R.), Cologne, Germany
| | - Wolf Dieter Heiss
- From the Department of Neurology (N.W., J.K.), University of Cologne, Cologne, Germany; Max-Planck-Institute for Neurological Research (N.W., L.K., W.D.H.), Cologne, Germany; the Department of Neurology (A.T.), McGill University, Montreal, Canada; and RehaNova GmbH (I.R.-F., A.H., P.M., T.R.), Cologne, Germany
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