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Teghipco A, Newman-Norlund R, Fridriksson J, Rorden C, Bonilha L. Distinct brain morphometry patterns revealed by deep learning improve prediction of post-stroke aphasia severity. COMMUNICATIONS MEDICINE 2024; 4:115. [PMID: 38866977 PMCID: PMC11169346 DOI: 10.1038/s43856-024-00541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Emerging evidence suggests that post-stroke aphasia severity depends on the integrity of the brain beyond the lesion. While measures of lesion anatomy and brain integrity combine synergistically to explain aphasic symptoms, substantial interindividual variability remains unaccounted. One explanatory factor may be the spatial distribution of morphometry beyond the lesion (e.g., atrophy), including not just specific brain areas, but distinct three-dimensional patterns. METHODS Here, we test whether deep learning with Convolutional Neural Networks (CNNs) on whole brain morphometry (i.e., segmented tissue volumes) and lesion anatomy better predicts chronic stroke individuals with severe aphasia (N = 231) than classical machine learning (Support Vector Machines; SVMs), evaluating whether encoding spatial dependencies identifies uniquely predictive patterns. RESULTS CNNs achieve higher balanced accuracy and F1 scores, even when SVMs are nonlinear or integrate linear or nonlinear dimensionality reduction. Parity only occurs when SVMs access features learned by CNNs. Saliency maps demonstrate that CNNs leverage distributed morphometry patterns, whereas SVMs focus on the area around the lesion. Ensemble clustering of CNN saliencies reveals distinct morphometry patterns unrelated to lesion size, consistent across individuals, and which implicate unique networks associated with different cognitive processes as measured by the wider neuroimaging literature. Individualized predictions depend on both ipsilateral and contralateral features outside the lesion. CONCLUSIONS Three-dimensional network distributions of morphometry are directly associated with aphasia severity, underscoring the potential for CNNs to improve outcome prognostication from neuroimaging data, and highlighting the prospective benefits of interrogating spatial dependence at different scales in multivariate feature space.
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Affiliation(s)
- Alex Teghipco
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Roger Newman-Norlund
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Christopher Rorden
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, School of Medicine, University of South Carolina, Columbia, SC, USA
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2
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Hannan J, Busby N, Roth R, Wilmskoetter J, Newman-Norlund R, Rorden C, Bonilha L, Fridriksson J. Under pressure: the interplay of hypertension and white matter hyperintensities with cognition in chronic stroke aphasia. Brain Commun 2024; 6:fcae200. [PMID: 38894950 PMCID: PMC11184349 DOI: 10.1093/braincomms/fcae200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 05/08/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
While converging research suggests that increased white matter hyperintensity load is associated with poorer cognition, and the presence of hypertension is associated with increased white matter hyperintensity load, the relationship among hypertension, cognition and white matter hyperintensities is not well understood. We sought to determine the effect of white matter hyperintensity burden on the relationship between hypertension and cognition in individuals with post-stroke aphasia, with the hypothesis that white matter hyperintensity load moderates the relationship between history of hypertension and cognitive function. Health history, Fazekas scores for white matter hyperintensities and Wechsler Adult Intelligence Scale Matrix Reasoning subtest scores for 79 people with aphasia collected as part of the Predicting Outcomes of Language Rehabilitation study at the Center for the Study of Aphasia Recovery at the University of South Carolina and the Medical University of South Carolina were analysed retrospectively. We found that participants with a history of hypertension had increased deep white matter hyperintensity severity (P < 0.001), but not periventricular white matter hyperintensity severity (P = 0.116). Moderation analysis revealed that deep white matter hyperintensity load moderates the relationship between high blood pressure and Wechsler Adult Intelligence Scale scores when controlling for age, education, aphasia severity and lesion volume. The interaction is significant, showing that a history of high blood pressure and severe deep white matter hyperintensities together are associated with poorer Matrix Reasoning scores. The overall model explains 41.85% of the overall variation in Matrix Reasoning score in this group of participants. These findings underscore the importance of considering cardiovascular risk factors in aphasia treatment, specifically hypertension and its relationship to brain health in post-stroke cognitive function.
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Affiliation(s)
- Jade Hannan
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Rebecca Roth
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
| | - Janina Wilmskoetter
- Department of Health and Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | | | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Leonardo Bonilha
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
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3
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Busby N, Newman-Norlund S, Sayers S, Rorden C, Newman-Norlund R, Wilmskoetter J, Roth R, Wilson S, Schwen-Blackett D, Kristinsson S, Teghipco A, Fridriksson J, Bonilha L. Regional brain aging: premature aging of the domain general system predicts aphasia severity. Commun Biol 2024; 7:718. [PMID: 38862747 PMCID: PMC11167062 DOI: 10.1038/s42003-024-06211-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
Premature brain aging is associated with poorer cognitive reserve and lower resilience to injury. When there are focal brain lesions, brain regions may age at different rates within the same individual. Therefore, we hypothesize that reduced gray matter volume within specific brain systems commonly associated with language recovery may be important for long-term aphasia severity. Here we show that individuals with stroke aphasia have a premature brain aging in intact regions of the lesioned hemisphere. In left domain-general regions, premature brain aging, gray matter volume, lesion volume and age were all significant predictors of aphasia severity. Increased brain age following a stroke is driven by the lesioned hemisphere. The relationship between brain age in left domain-general regions and aphasia severity suggests that degradation is possible to specific brain regions and isolated aging matters for behavior.
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Affiliation(s)
- Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Sarah Newman-Norlund
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Sara Sayers
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | - Janina Wilmskoetter
- Department of Health and Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Rebecca Roth
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Sarah Wilson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Deena Schwen-Blackett
- Department of Health and Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Alex Teghipco
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Leonardo Bonilha
- School of Medicine, University of South Carolina, Columbia, SC, USA
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4
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Hildesheim FE, Ophey A, Zumbansen A, Funck T, Schuster T, Jamison KW, Kuceyeski A, Thiel A. Predicting Language Function Post-Stroke: A Model-Based Structural Connectivity Approach. Neurorehabil Neural Repair 2024; 38:447-459. [PMID: 38602161 PMCID: PMC11097606 DOI: 10.1177/15459683241245410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND The prediction of post-stroke language function is essential for the development of individualized treatment plans based on the personal recovery potential of aphasic stroke patients. OBJECTIVE To establish a framework for integrating information on connectivity disruption of the language network based on routinely collected clinical magnetic resonance (MR) images into Random Forest modeling to predict post-stroke language function. METHODS Language function was assessed in 76 stroke patients from the Non-Invasive Repeated Therapeutic Stimulation for Aphasia Recovery trial, using the Token Test (TT), Boston Naming Test (BNT), and Semantic Verbal Fluency (sVF) Test as primary outcome measures. Individual infarct masks were superimposed onto a diffusion tensor imaging tractogram reference set to calculate Change in Connectivity scores of language-relevant gray matter regions as estimates of structural connectivity disruption. Multivariable Random Forest models were derived to predict language function. RESULTS Random Forest models explained moderate to high amount of variance at baseline and follow-up for the TT (62.7% and 76.2%), BNT (47.0% and 84.3%), and sVF (52.2% and 61.1%). Initial language function and non-verbal cognitive ability were the most important variables to predict language function. Connectivity disruption explained additional variance, resulting in a prediction error increase of up to 12.8% with variable omission. Left middle temporal gyrus (12.8%) and supramarginal gyrus (9.8%) were identified as among the most important network nodes. CONCLUSION Connectivity disruption of the language network adds predictive value beyond lesion volume, initial language function, and non-verbal cognitive ability. Obtaining information on connectivity disruption based on routine clinical MR images constitutes a significant advancement toward practical clinical application.
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Affiliation(s)
- Franziska E. Hildesheim
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Department of Neurology & Neurosurgery, McGill University, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
| | - Anja Ophey
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention, University Hospital Cologne, Medical Faculty of the University of Cologne, Cologne, Germany
| | - Anna Zumbansen
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- Music and Health Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Thomas Funck
- Institute of Neurosciences and Medicine INM-1, Research Centre Jülich, Jülich, Germany
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Keith W. Jamison
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Alexander Thiel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Department of Neurology & Neurosurgery, McGill University, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
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Riccardi N, Nelakuditi S, den Ouden DB, Rorden C, Fridriksson J, Desai RH. Discourse- and lesion-based aphasia quotient estimation using machine learning. Neuroimage Clin 2024; 42:103602. [PMID: 38593534 PMCID: PMC11016805 DOI: 10.1016/j.nicl.2024.103602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
Discourse is a fundamentally important aspect of communication, and discourse production provides a wealth of information about linguistic ability. Aphasia commonly affects, in multiple ways, the ability to produce discourse. Comprehensive aphasia assessments such as the Western Aphasia Battery-Revised (WAB-R) are time- and resource-intensive. We examined whether discourse measures can be used to estimate WAB-R Aphasia Quotient (AQ), and whether this can serve as an ecologically valid, less resource-intensive measure. We used features extracted from discourse tasks using three AphasiaBank prompts involving expositional (picture description), story narrative, and procedural discourse. These features were used to train a machine learning model to predict the WAB-R AQ. We also compared and supplemented the model with lesion location information from structural neuroimaging. We found that discourse-based models could estimate AQ well, and that they outperformed models based on lesion features. Addition of lesion features to the discourse features did not improve the performance of the discourse model substantially. Inspection of the most informative discourse features revealed that different prompt types taxed different aspects of language. These findings suggest that discourse can be used to estimate aphasia severity, and provide insight into the linguistic content elicited by different types of discourse prompts.
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Affiliation(s)
- Nicholas Riccardi
- Department of Communication Sciences and Disorders, University of South Carolina, United States.
| | | | - Dirk B den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, United States
| | - Chris Rorden
- Department of Psychology, University of South Carolina, United States
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, United States
| | - Rutvik H Desai
- Department of Psychology, University of South Carolina, United States
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6
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O'Halloran R, Renton J, Harvey S, McSween MP, Wallace SJ. Do social determinants influence post-stroke aphasia outcomes? A scoping review. Disabil Rehabil 2024; 46:1274-1287. [PMID: 37010112 DOI: 10.1080/09638288.2023.2193760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To conduct a scoping review on five individual social determinants of health (SDOHs): gender, education, ethnicity, socioeconomic status, and social support, in relation to post-stroke aphasia outcomes. MATERIALS AND METHODS A comprehensive search across five databases was conducted in 2020 and updated in 2022. Twenty-five studies (3363 participants) met the inclusion criteria. Data on SDOHs and aphasia outcomes were extracted and analysed descriptively. RESULTS Twenty studies provide information on SDOH and aphasia recovery outcomes. Five studies provide insights on SDOH and response to aphasia intervention. Research on SDOH and aphasia recovery has predominantly focussed solely on language outcomes (14 studies), with less research on the role of SDOH on activity, participation, and quality of life outcomes (6 studies). There is no evidence to support a role for gender or education on language outcomes in the first 3 months post stroke. SDOHs may influence aphasia outcomes at or beyond 12 months post onset. CONCLUSIONS Research on SDOHs and aphasia outcomes is in its infancy. Given SDOHs are modifiable and operate over a lifetime, and aphasia is a chronic condition, there is a pressing need to understand the role of SDOHs on aphasia outcomes in the long term.
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Affiliation(s)
- Robyn O'Halloran
- NHMRC Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Australia
| | - Joanne Renton
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sam Harvey
- NHMRC Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Marie-Pier McSween
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
| | - Sarah J Wallace
- NHMRC Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
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7
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Harrington RM, Kristinsson S, Wilmskoetter J, Busby N, den Ouden D, Rorden C, Fridriksson J, Bonilha L. Dissociating reading and auditory comprehension in persons with aphasia. Brain Commun 2024; 6:fcae102. [PMID: 38585671 PMCID: PMC10998352 DOI: 10.1093/braincomms/fcae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/10/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
Language comprehension is often affected in individuals with post-stroke aphasia. However, deficits in auditory comprehension are not fully correlated with deficits in reading comprehension and the mechanisms underlying this dissociation remain unclear. This distinction is important for understanding language mechanisms, predicting long-term impairments and future development of treatment interventions. Using comprehensive auditory and reading measures from a large cohort of individuals with aphasia, we evaluated the relationship between aphasia type and reading comprehension impairments, the relationship between auditory versus reading comprehension deficits and the crucial neuroanatomy supporting the dissociation between post-stroke reading and auditory deficits. Scores from the Western Aphasia Battery-Revised from 70 participants with aphasia after a left-hemisphere stroke were utilized to evaluate both reading and auditory comprehension of linguistically equivalent stimuli. Repeated-measures and univariate ANOVA were used to assess the relationship between auditory comprehension and aphasia types and correlations were employed to test the relationship between reading and auditory comprehension deficits. Lesion-symptom mapping was used to determine the dissociation of crucial brain structures supporting reading comprehension deficits controlling for auditory deficits and vice versa. Participants with Broca's or global aphasia had the worst performance on reading comprehension. Auditory comprehension explained 26% of the variance in reading comprehension for sentence completion and 44% for following sequential commands. Controlling for auditory comprehension, worse reading comprehension performance was independently associated with damage to the inferior temporal gyrus, fusiform gyrus, posterior inferior temporal gyrus, inferior occipital gyrus, lingual gyrus and posterior thalamic radiation. Auditory and reading comprehension are only partly correlated in aphasia. Reading is an integral part of daily life and directly associated with quality of life and functional outcomes. This study demonstrated that reading performance is directly related to lesioned areas in the boundaries between visual association regions and ventral stream language areas. This behavioural and neuroanatomical dissociation provides information about the neurobiology of language and mechanisms for potential future treatment interventions.
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Affiliation(s)
- Rachael M Harrington
- Department of Communication Sciences and Disorders and Center for Research on the Challenges of Acquiring Language and Literacy, Georgia State University, Atlanta, GA 30310, USA
| | - Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Janina Wilmskoetter
- Department of Health and Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC 29464, USA
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Dirk den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Leonardo Bonilha
- School of Medicine Columbia, University of South Carolina, Columbia, SC 29208, USA
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8
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Johnson L, Newman-Norlund R, Teghipco A, Rorden C, Bonilha L, Fridriksson J. Progressive lesion necrosis is related to increasing aphasia severity in chronic stroke. Neuroimage Clin 2024; 41:103566. [PMID: 38280310 PMCID: PMC10835598 DOI: 10.1016/j.nicl.2024.103566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Volumetric investigations of cortical damage resulting from stroke indicate that lesion size and shape continue to change even in the chronic stage of recovery. However, the potential clinical relevance of continued lesion growth has yet to be examined. In the present study, we investigated the prevalence of lesion expansion and the relationship between expansion and changes in aphasia severity in a large sample of individuals in the chronic stage of aphasia recovery. METHODS Retrospective structural MRI scans from 104 S survivors with at least 2 observations (k = 301 observations; mean time between scans = 31 months) were included. Lesion demarcation was performed using an automated lesion segmentation software and lesion volumes at each timepoint were subsequently calculated. A linear mixed effects model was conducted to investigate the effect of days between scan on lesion expansion. Finally, we investigated the association between lesion expansion and changes on the Western Aphasia Battery (WAB) in a group of participants assessed and scanned at 2 timepoints (N = 54) using a GLM. RESULTS Most participants (81 %) showed evidence of lesion expansion. The mixed effects model revealed lesion volumes significantly increase, on average, by 0.02 cc each day (7.3 cc per year) following a scan (p < 0.0001). Change on language performance was significantly associated with change in lesion volume (p = 0.025) and age at stroke (p = 0.031). The results suggest that with every 10 cc increase in lesion size, language performance decreases by 0.9 points, and for every 10-year increase in age at stroke, language performance decreases by 1.9 points. CONCLUSIONS The present study confirms and extends prior reports that lesion expansion occurs well into the chronic stage of stroke. For the first time, we present evidence that expansion is predictive of longitudinal changes in language performance in individuals with aphasia. Future research should focus on the potential mechanisms that may lead to necrosis in areas surrounding the chronic stroke lesion.
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9
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Vadinova V, Sihvonen AJ, Wee F, Garden KL, Ziraldo L, Roxbury T, O'Brien K, Copland DA, McMahon KL, Brownsett SLE. The volume and the distribution of premorbid white matter hyperintensities: Impact on post-stroke aphasia. Hum Brain Mapp 2024; 45:e26568. [PMID: 38224539 PMCID: PMC10789210 DOI: 10.1002/hbm.26568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024] Open
Abstract
White matter hyperintensities (WMH) are a radiological manifestation of progressive white matter integrity loss. The total volume and distribution of WMH within the corpus callosum have been associated with pathological cognitive ageing processes but have not been considered in relation to post-stroke aphasia outcomes. We investigated the contribution of both the total volume of WMH, and the extent of WMH lesion load in the corpus callosum to the recovery of language after first-ever stroke. Behavioural and neuroimaging data from individuals (N = 37) with a left-hemisphere stroke were included at the early subacute stage of recovery. Spoken language comprehension and production abilities were assessed using word and sentence-level tasks. Neuroimaging data was used to derive stroke lesion variables (volume and lesion load to language critical regions) and WMH variables (WMH volume and lesion load to three callosal segments). WMH volume did not predict variance in language measures, when considered together with stroke lesion and demographic variables. However, WMH lesion load in the forceps minor segment of the corpus callosum explained variance in early subacute comprehension abilities (t = -2.59, p = .01) together with corrected stroke lesion volume and socio-demographic variables. Premorbid WMH lesions in the forceps minor were negatively associated with early subacute language comprehension after aphasic stroke. This negative impact of callosal WMH on language is consistent with converging evidence from pathological ageing suggesting that callosal WMH disrupt the neural networks supporting a range of cognitive functions.
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Affiliation(s)
- Veronika Vadinova
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
| | - A. J. Sihvonen
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
- Cognitive Brain Research Unit (CBRU)University of HelsinkiHelsinkiFinland
- Centre of Excellence in Music, Mind, Body and BrainUniversity of HelsinkiHelsinkiFinland
| | - F. Wee
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - K. L. Garden
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
| | - L. Ziraldo
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - T. Roxbury
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - K. O'Brien
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
| | - D. A. Copland
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
| | - K. L. McMahon
- School of Clinical Sciences, Centre for Biomedical TechnologiesQueensland University of TechnologyBrisbaneAustralia
| | - S. L. E. Brownsett
- Queensland Aphasia Research CentreUniversity of QueenslandBrisbaneAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneAustralia
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneAustralia
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10
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Brito AC, Levy DF, Schneck SM, Entrup JL, Onuscheck CF, Casilio M, de Riesthal M, Davis LT, Wilson SM. Leukoaraiosis Is Not Associated With Recovery From Aphasia in the First Year After Stroke. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2023; 4:536-549. [PMID: 37946731 PMCID: PMC10631799 DOI: 10.1162/nol_a_00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 06/28/2023] [Indexed: 11/12/2023]
Abstract
After a stroke, individuals with aphasia often recover to a certain extent over time. This recovery process may be dependent on the health of surviving brain regions. Leukoaraiosis (white matter hyperintensities on MRI reflecting cerebral small vessel disease) is one indication of compromised brain health and is associated with cognitive and motor impairment. Previous studies have suggested that leukoaraiosis may be a clinically relevant predictor of aphasia outcomes and recovery, although findings have been inconsistent. We investigated the relationship between leukoaraiosis and aphasia in the first year after stroke. We recruited 267 patients with acute left hemispheric stroke and coincident fluid attenuated inversion recovery MRI. Patients were evaluated for aphasia within 5 days of stroke, and 174 patients presented with aphasia acutely. Of these, 84 patients were evaluated at ∼3 months post-stroke or later to assess longer-term speech and language outcomes. Multivariable regression models were fit to the data to identify any relationships between leukoaraiosis and initial aphasia severity, extent of recovery, or longer-term aphasia severity. We found that leukoaraiosis was present to varying degrees in 90% of patients. However, leukoaraiosis did not predict initial aphasia severity, aphasia recovery, or longer-term aphasia severity. The lack of any relationship between leukoaraiosis severity and aphasia recovery may reflect the anatomical distribution of cerebral small vessel disease, which is largely medial to the white matter pathways that are critical for speech and language function.
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Affiliation(s)
| | - Deborah F. Levy
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah M. Schneck
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jillian L. Entrup
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Caitlin F. Onuscheck
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marianne Casilio
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael de Riesthal
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L. Taylor Davis
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen M. Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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11
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Hannan J, Wilmskoetter J, Fridriksson J, Hillis AE, Bonilha L, Busby N. Brain health imaging markers, post-stroke aphasia and Cognition: A scoping review. Neuroimage Clin 2023; 39:103480. [PMID: 37536153 PMCID: PMC10412866 DOI: 10.1016/j.nicl.2023.103480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
For the past decade, brain health has been an emerging line of scientific inquiry assessing the impact of age-related neurostructural changes on cognitive decline and recovery from brain injury. Typically, compromised brain health is attributed to the presence of small vessel disease (SVD) and brain tissue atrophy, which are represented by various neuroimaging features. However, to date, the relationship between brain health markers and chronic aphasia severity remains unclear. Thus, the goal of this scoping review was to assess the current body of evidence regarding the relationship between SVD-related brain health biomarkers and post-stroke aphasia and cognition. In all, 187 articles were identified from 3 databases, of which 16 articles met the criteria for inclusion. Among these studies, 11 focused on cognition rather than aphasia, while 2 investigated both. Of the 10 studies that used white matter hyperintensities (WMHs) as an indicator of SVD severity, 8 studies (80%) demonstrated a relationship between WMH load and worse cognition in stroke patients. Interestingly, among the studies that specifically investigated aphasia, all 5 studies (100%) demonstrated a relationship between SVD and worse language performance. They also indicated that factors other than brain health (e.g., lesion, age, time post onset) played an important role in determining aphasia severity at a single timepoint. These findings suggest that brain health is likely a crucial factor in the context of aphasia recovery, possibly indicating the necessity of cognitive reserve thresholds for the multimodal cognitive demands associated with language recovery. While SVD and structural brain health are not commonly considered as predictors of aphasia severity, more comprehensive models incorporating brain health have the potential to improve prognosis of post-stroke cognitive and language deficits. Given the variability in the existing literature, a uniform grading system for overall SVD would be beneficial for future research on the mechanisms related to brain networks and neuroplasticity, and their translational impact.
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Affiliation(s)
- Jade Hannan
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Janina Wilmskoetter
- Department of Health and Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Physical Medicine, Rehabilitation, and Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | | | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
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Wilmskoetter J, Busby N, He X, Caciagli L, Roth R, Kristinsson S, Davis KA, Rorden C, Bassett DS, Fridriksson J, Bonilha L. Dynamic network properties of the superior temporal gyrus mediate the impact of brain age gap on chronic aphasia severity. Commun Biol 2023; 6:727. [PMID: 37452209 PMCID: PMC10349039 DOI: 10.1038/s42003-023-05119-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
Brain structure deteriorates with aging and predisposes an individual to more severe language impairments (aphasia) after a stroke. However, the underlying mechanisms of this relation are not well understood. Here we use an approach to model brain network properties outside the stroke lesion, network controllability, to investigate relations among individualized structural brain connections, brain age, and aphasia severity in 93 participants with chronic post-stroke aphasia. Controlling for the stroke lesion size, we observe that lower average controllability of the posterior superior temporal gyrus (STG) mediates the relation between advanced brain aging and aphasia severity. Lower controllability of the left posterior STG signifies that activity in the left posterior STG is less likely to yield a response in other brain regions due to the topological properties of the structural brain networks. These results indicate that advanced brain aging among individuals with post-stroke aphasia is associated with disruption of dynamic properties of a critical language-related area, the STG, which contributes to worse aphasic symptoms. Because brain aging is variable among individuals with aphasia, our results provide further insight into the mechanisms underlying the variance in clinical trajectories in post-stroke aphasia.
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Affiliation(s)
- Janina Wilmskoetter
- Department of Health and Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Xiaosong He
- Department of Psychology, University of Science and Technology of China, Beijing, China
| | - Lorenzo Caciagli
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Roth
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Kathryn A Davis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Dani S Bassett
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Electrical and Systems Engineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Department of Physics & Astronomy, School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Santa Fe Institute, Santa Fe, New Mexico, NM, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
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Roth R, Busby N, Wilmskoetter J, Schwen Blackett D, Gleichgerrcht E, Johnson L, Rorden C, Newman-Norlund R, Hillis AE, den Ouden DB, Fridriksson J, Bonilha L. Diabetes, brain health, and treatment gains in post-stroke aphasia. Cereb Cortex 2023; 33:8557-8564. [PMID: 37139636 PMCID: PMC10321080 DOI: 10.1093/cercor/bhad140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 05/05/2023] Open
Abstract
In post-stroke aphasia, language improvements following speech therapy are variable and can only be partially explained by the lesion. Brain tissue integrity beyond the lesion (brain health) may influence language recovery and can be impacted by cardiovascular risk factors, notably diabetes. We examined the impact of diabetes on structural network integrity and language recovery. Seventy-eight participants with chronic post-stroke aphasia underwent six weeks of semantic and phonological language therapy. To quantify structural network integrity, we evaluated the ratio of long-to-short-range white matter fibers within each participant's whole brain connectome, as long-range fibers are more susceptible to vascular injury and have been linked to high level cognitive processing. We found that diabetes moderated the relationship between structural network integrity and naming improvement at 1 month post treatment. For participants without diabetes (n = 59), there was a positive relationship between structural network integrity and naming improvement (t = 2.19, p = 0.032). Among individuals with diabetes (n = 19), there were fewer treatment gains and virtually no association between structural network integrity and naming improvement. Our results indicate that structural network integrity is associated with treatment gains in aphasia for those without diabetes. These results highlight the importance of post-stroke structural white matter architectural integrity in aphasia recovery.
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Affiliation(s)
- Rebecca Roth
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Janina Wilmskoetter
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Deena Schwen Blackett
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Ezequiel Gleichgerrcht
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Lisa Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | | | - Argye E Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Dirk B den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Leonardo Bonilha
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
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Berthier ML, Dávila G. Pharmacotherapy for post-stroke aphasia: what are the options? Expert Opin Pharmacother 2023; 24:1221-1228. [PMID: 37263978 DOI: 10.1080/14656566.2023.2221382] [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: 03/07/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Aphasia is a common, long-lasting aftermath of stroke lesions. There is an increased integration of pharmacotherapy as an adjunctive strategy to speech and language therapy (SLT) for post-stroke aphasia (PSA). Nevertheless, more research in pharmacotherapy for acute and chronic PSA is necessary, including the election of drugs that target different neurotransmitter systems and deficits in specific language domains. AREAS COVERED This article updates the role of pharmacotherapy for PSA, focusing the spotlight on some already investigated drugs and candidate agents deserving of future research. Refining the precision of drug election would require using multimodal biomarkers to develop personalized treatment approaches. There is a solid need to devise feasible randomized controlled trials adapted to the particularities of the PSA population. The emergent role of multimodal interventions combining one or two drugs with noninvasive brain stimulation to augment SLT is emphasized. EXPERT OPINION Pharmacotherapy can improve language deficits not fully alleviated by SLT. In addition, the 'drug-only' approach can also be adopted when administering SLT is not possible. The primary goal of pharmacotherapy is reducing the overall aphasia severity, although targeting language-specific deficits (i.e. naming, spoken output) also contributes to improving functional communication. Unfortunately, there is still little information for recommending a drug for specific language deficits.
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Affiliation(s)
- Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga - IBIMA, Malaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Malaga - IBIMA, Malaga, Spain
- Language Neuroscience Research Laboratory, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioral Sciences, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
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Vadinova V, Sihvonen AJ, Garden KL, Ziraldo L, Roxbury T, O'Brien K, Copland DA, McMahon KL, Brownsett SLE. Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke. Neurorehabil Neural Repair 2023; 37:218-227. [PMID: 37083133 PMCID: PMC10152219 DOI: 10.1177/15459683231168384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated. OBJECTIVE To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables. METHODS Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating. RESULTS The presence of severe WMH explained an additional 18% and 25% variance in early subacute (t = -3.00, p = .004) and chronic (t = -3.60, P = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores. CONCLUSIONS Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.
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Affiliation(s)
- Veronika Vadinova
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Aleksi J Sihvonen
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
- Cognitive Brain Research Unit (CBRU), University of Helsinki, Helsinki, Finland
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland
| | - Kimberley L Garden
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Laura Ziraldo
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Tracy Roxbury
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Kate O'Brien
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - David A Copland
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Queensland, Australia
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
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