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Upton E, Doogan C, Fleming V, Leyton PQ, Barbera D, Zeidman P, Hope T, Latham W, Coley-Fisher H, Price C, Crinion J, Leff A. Efficacy of a gamified digital therapy for speech production in people with chronic aphasia (iTalkBetter): behavioural and imaging outcomes of a phase II item-randomised clinical trial. EClinicalMedicine 2024; 70:102483. [PMID: 38685927 PMCID: PMC11056404 DOI: 10.1016/j.eclinm.2024.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 05/02/2024] Open
Abstract
Background Aphasia is among the most debilitating of symptoms affecting stroke survivors. Speech and language therapy (SLT) is effective, but many hours of practice are required to make clinically meaningful gains. One solution to this 'dosage' problem is to automate therapeutic approaches via self-supporting apps so people with aphasia (PWA) can amass practice as it suits them. However, response to therapy is variable and no clinical trial has yet identified the key brain regions required to engage with word-retrieval therapy. Methods Between Sep 7, 2020 and Mar 1, 2022 at University College London in the UK, we carried out a phase II, item-randomised clinical trial in 27 PWA using a novel, self-led app, 'iTalkBetter', which utilises confrontation naming therapy. Unlike previously reported apps, it has a real-time utterance verification system that drives its adaptive therapy algorithm. Therapy items were individually randomised to provide balanced lists of 'trained' and 'untrained' items matched on key psycholinguistic variables and baseline performance. PWA practised with iTalkBetter over a 6-week therapy block. Structural and functional MRI data were collected to identify therapy-related changes in brain states. A repeated-measures design was employed. The trial was registered at ClinicalTrials.gov (NCT04566081). Findings iTalkBetter significantly improved naming ability by 13% for trained items compared with no change for untrained items, an average increase of 29 words (SD = 26) per person; beneficial effects persisted at three months. PWA's propositional speech also significantly improved. iTalkBetter use was associated with brain volume increases in right auditory and left anterior prefrontal cortices. Task-based fMRI identified dose-related activity in the right temporoparietal junction. Interpretation Our findings suggested that iTalkBetter significantly improves PWAs' naming ability on trained items. The effect size is similar to a previous RCT of computerised therapy, but this is the first study to show transfer to a naturalistic speaking task. iTalkBetter usage and dose caused observable changes in brain structure and function to key parts of the surviving language perception, production and control networks. iTalkBetter is being rolled-out as an app for all PWA and anomia: https://www.ucl.ac.uk/icn/research/research-groups/neurotherapeutics/projects/digital-interventions-neuro-rehabilitation-0 so that they can increase their dosage of practice-based SLT. Funding National Institute for Health and Care Research, Wellcome Centre for Human Neuroimaging.
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Affiliation(s)
- Emily Upton
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- Department of Psychology and Language Sciences, University College London, UK
| | - Catherine Doogan
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- St George’s, University of London, UK
| | - Victoria Fleming
- Department of Psychology and Language Sciences, University College London, UK
| | | | - David Barbera
- Institute of Cognitive Neuroscience, University College London, UK
| | - Peter Zeidman
- Wellcome Centre for Human Neuroimaging, University College London, UK
| | - Tom Hope
- Wellcome Centre for Human Neuroimaging, University College London, UK
- Department of Psychology and Social Science, John Cabot University, Rome, Italy
| | - William Latham
- Department of Computing, Goldsmiths, University of London, UK
| | | | - Cathy Price
- Wellcome Centre for Human Neuroimaging, University College London, UK
| | - Jennifer Crinion
- Institute of Cognitive Neuroscience, University College London, UK
- Department of Psychology and Language Sciences, University College London, UK
| | - Alex Leff
- UCL Queen Square Institute of Neurology, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
- University College London Hospitals NHS Trust, UK
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Shekari E, Seyfi M, Modarres Zadeh A, Batouli SA, Valinejad V, Goudarzi S, Joghataei MT. Mechanisms of brain activation following naming therapy in aphasia: A systematic review on task-based fMRI studies. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:780-801. [PMID: 35666667 DOI: 10.1080/23279095.2022.2074849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The pattern of brain neuroplasticity after naming therapies in patients with aphasia can be evaluated using task-based fMRI. This article aims to review studies investigating brain reorganization after semantic and phonological-based anomia therapy that used picture-naming fMRI tasks. We searched for those articles that compared the activation of brain areas before and after aphasia therapies in the PubMed and the EMBASE databases from 1993 up to April 2020. All studies (single-cases or group designs) on anomia treatment in individuals with acquired aphasia were reviewed. Data were synthesized descriptively through tables to allow the facilitated comparison of the studies. A total of 14 studies were selected and reviewed. The results of the reviewed studies demonstrated that the naming improvement is associated with changes in the activation of cortical and subcortical brain areas. This review highlights the need for a more systematic investigation of the association between decreased and increased activation of brain areas related to anomia therapy. Also, more detailed information about factors influencing brain reorganization is required to elucidate the neural mechanisms of anomia therapy. Overall, regarding the theoretical and clinical aspects, the number of studies that used intensive protocol is growing, and based on the positive potential of these treatments, they could be suitable for the rehabilitation of people with aphasia.
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Affiliation(s)
- Ehsan Shekari
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Seyfi
- Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Modarres Zadeh
- Department of Speech Therapy, Faculty of Rehabilitation, Tehran University of Medical science, Tehran, Iran
| | - Seyed Amirhossein Batouli
- Neuroimaging and Analysis Group, Tehran University of Medical Sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Valinejad
- Department of Speech Therapy, Faculty of Rehabilitation, Tehran University of Medical science, Tehran, Iran
| | - Sepideh Goudarzi
- Department of Pharmacology and Toxicology, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
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Papageorgiou G, Kasselimis D, Laskaris N, Potagas C. Unraveling the Thread of Aphasia Rehabilitation: A Translational Cognitive Perspective. Biomedicines 2023; 11:2856. [PMID: 37893229 PMCID: PMC10604624 DOI: 10.3390/biomedicines11102856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Translational neuroscience is a multidisciplinary field that aims to bridge the gap between basic science and clinical practice. Regarding aphasia rehabilitation, there are still several unresolved issues related to the neural mechanisms that optimize language treatment. Although there are studies providing indications toward a translational approach to the remediation of acquired language disorders, the incorporation of fundamental neuroplasticity principles into this field is still in progress. From that aspect, in this narrative review, we discuss some key neuroplasticity principles, which have been elucidated through animal studies and which could eventually be applied in the context of aphasia treatment. This translational approach could be further strengthened by the implementation of intervention strategies that incorporate the idea that language is supported by domain-general mechanisms, which highlights the impact of non-linguistic factors in post-stroke language recovery. Here, we highlight that translational research in aphasia has the potential to advance our knowledge of brain-language relationships. We further argue that advances in this field could lead to improvement in the remediation of acquired language disturbances by remodeling the rationale of aphasia-therapy approaches. Arguably, the complex anatomy and phenomenology of aphasia dictate the need for a multidisciplinary approach with one of its main pillars being translational research.
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Affiliation(s)
- Georgios Papageorgiou
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Dimitrios Kasselimis
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Department of Psychology, Panteion University of Social and Political Sciences, 17671 Athens, Greece
| | - Nikolaos Laskaris
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Department of Industrial Design and Production Engineering, School of Engineering, University of West Attica, 12241 Athens, Greece
| | - Constantin Potagas
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Simic T, Desjardins MÈ, Courson M, Bedetti C, Houzé B, Brambati SM. Treatment-induced neuroplasticity after anomia therapy in post-stroke aphasia: A systematic review of neuroimaging studies. BRAIN AND LANGUAGE 2023; 244:105300. [PMID: 37633250 DOI: 10.1016/j.bandl.2023.105300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 05/02/2023] [Accepted: 06/21/2023] [Indexed: 08/28/2023]
Abstract
We systematically reviewed the literature on neural changes following anomia treatment post-stroke. We conducted electronic searches of CINAHL, Cochrane Trials, Embase, Ovid MEDLINE, MEDLINE-in-Process and PsycINFO databases; two independent raters assessed all abstracts and full texts. Accepted studies reported original data on adults with post-stroke aphasia, who received behavioural treatment for anomia, and magnetic resonance brain imaging (MRI) pre- and post-treatment. Search results yielded 2481 citations; 33 studies were accepted. Most studies employed functional MRI and the quality of reporting neuroimaging methodology was variable, particularly for pre-processing steps and statistical analyses. The most methodologically robust data were synthesized, focusing on pre- versus post-treatment contrasts. Studies more commonly reported increases (versus decreases) in activation following naming therapy, primarily in the left supramarginal gyrus, and left/bilateral precunei. Our findings highlight the methodological heterogeneity across MRI studies, and the paucity of robust evidence demonstrating direct links between brain and behaviour in anomia rehabilitation.
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Affiliation(s)
- Tijana Simic
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada; Département de Psychologie, Université de Montréal, 90 Vincent-d'Indy Avenue, Montréal, QC H2V 2S9, Canada; Hôpital du Sacré-Cœur de Montréal (HSCM), 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada.
| | - Marie-Ève Desjardins
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada; Département de Psychologie, Université de Montréal, 90 Vincent-d'Indy Avenue, Montréal, QC H2V 2S9, Canada; Hôpital du Sacré-Cœur de Montréal (HSCM), 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada
| | - Melody Courson
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada; Département de Psychologie, Université de Montréal, 90 Vincent-d'Indy Avenue, Montréal, QC H2V 2S9, Canada
| | - Christophe Bedetti
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada
| | - Bérengère Houzé
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada; Département de Psychologie, Université de Montréal, 90 Vincent-d'Indy Avenue, Montréal, QC H2V 2S9, Canada
| | - Simona Maria Brambati
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Queen Mary R.d., Montréal, QC H3W 1W4, Canada; Département de Psychologie, Université de Montréal, 90 Vincent-d'Indy Avenue, Montréal, QC H2V 2S9, Canada; Hôpital du Sacré-Cœur de Montréal (HSCM), 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada
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Shekari E, Mehrpour M, Joghataei MT, Modarres Zadeh A, Valinejad V, Adineh HA, Seyfi M, Goudarzi S. Focusing on the locus of the breakdown for treatment of anomia: a pilot study. CLINICAL LINGUISTICS & PHONETICS 2023:1-31. [PMID: 37303193 DOI: 10.1080/02699206.2023.2221374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
The primary goal of this study was to evaluate the treatment effects of semantic feature analysis (SFA) and phonological components analysis (PCA) on word retrieval processing in persons with aphasia (PWAs). After identifying the locus of the breakdown in lexical retrieval processing, 15 monolingual native Persian speakers with aphasia were divided into two groups. After three naming trials, participants with dominant semantic deficits received SFA, and participants with primary phonological deficits were provided with PCA three times a week for eight weeks. Both approaches improved participants' naming and performance on language tests, including spontaneous speech, repetition, comprehension, and semantic processing. However, the correct naming of treated and untreated items was higher in mild-to-moderate participants, with mostly circumlocution and semantic paraphasias in the SFA group. The same holds for mild-to-moderate participants with mostly phonemic paraphasia who received PCA therapy. Moreover, the results showed that participants' baseline naming performance and semantic abilities could be associated with the treatment outcomes. Although limited by a lack of a control group, this study provided evidence supporting the possible benefits of focusing on the locus of the breakdown for treating anomia through SFA and PCA approaches, specifically in participants with mild to moderate aphasia. However, for those with severe aphasia, the treatment choice may not be as straightforward because several variables are likely to contribute to this population's word-finding difficulties. Replication with larger, well-stratified samples, use of a within-subjects alternating treatment design and consideration of treatments' long-term effects are required to better ascertain the effects of focusing on the locus of breakdown for treatment of anomia.
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Affiliation(s)
- Ehsan Shekari
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Mehrpour
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Modarres Zadeh
- Department of Speech-Language Pathology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Valinejad
- Department of Speech-Language Pathology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossain Ali Adineh
- Department of Epidemiology and Biostatistics, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Milad Seyfi
- Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Goudarzi
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
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Ivanova MV, Pappas I. Understanding recovery of language after stroke: insights from neurovascular MRI studies. FRONTIERS IN LANGUAGE SCIENCES 2023; 2:1163547. [PMID: 38162928 PMCID: PMC10757818 DOI: 10.3389/flang.2023.1163547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Stroke causes a disruption in blood flow to the brain that can lead to profound language impairments. Understanding the mechanisms of language recovery after stroke is crucial for the prognosis and effective rehabilitation of people with aphasia. While the role of injured brain structures and disruptions in functional connectivity have been extensively explored, the relationship between neurovascular measures and language recovery in both early and later stages has not received sufficient attention in the field. Fully functioning healthy brain tissue requires oxygen and nutrients to be delivered promptly via its blood supply. Persistent decreases in blood flow after a stroke to the remaining non-lesioned tissue have been shown to contribute to poor language recovery. The goal of the current paper is to critically examine stroke studies looking at the relationship between different neurovascular measures and language deficits and mechanisms of language recovery via changes in neurovascular metrics. Measures of perfusion or cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) provide complementary approaches to understanding neurovascular mechanisms post stroke by capturing both cerebral metabolic demands and mechanical vascular properties. While CBF measures indicate the amount of blood delivered to a certain region and serve as a proxy for metabolic demands of that area, CVR indices reflect the ability of the vasculature to recruit blood flow in response to a shortage of oxygen, such as when one is holding their breath. Increases in CBF during recovery beyond the site of the lesion have been shown to promote language gains. Similarly, CVR changes, when collateral vessels are recruited to help reorganize the flow of blood in hypoperfused regions, have been related to functional recovery post stroke. In the current review, we highlight the main findings in the literature investigating neurovascular changes in stroke recovery with a particular emphasis on how language abilities can be affected by changes in CBF and CVR. We conclude by summarizing existing methodological challenges and knowledge gaps that need to be addressed in future work in this area, outlining a promising avenue of research.
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Affiliation(s)
- Maria V. Ivanova
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Ioannis Pappas
- USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
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Arheix-Parras S, Glize B, Guehl D, Python G. Electrophysiological Changes in Patients with Post-stroke Aphasia: A Systematic Review. Brain Topogr 2023; 36:135-171. [PMID: 36749552 DOI: 10.1007/s10548-023-00941-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023]
Abstract
Background Magnetoencephalography (MEG) and electroencephalography (EEG) record two main types of data: continuous measurements at rest or during sleep, and event-related potentials/evoked magnetic fields (ERPs/EMFs) that involve specific and repetitive tasks. In this systematic review, we summarized longitudinal studies on recovery from post-stroke aphasia that used continuous or event-related temporal imaging (EEG or MEG). Methods We searched PubMed and Scopus for English articles published from 1950 to May 31, 2022. Results 34 studies were included in this review: 11 were non-interventional studies and 23 were clinical trials that used specific rehabilitation methods, neuromodulation, or drugs. The results of the non-interventional studies suggested that poor language recovery was associated with slow-wave activity persisting over time. The results of some clinical trials indicated that behavioral improvements were correlated with significant modulation of the N400 component. Discussion Compared with continuous EEG, ERP/EMF may more reliably identify biomarkers of therapy-induced effects. Electrophysiology should be used more often to explore language processes that are impaired after a stroke, as it may highlight treatment challenges for patients with post-stroke aphasia.
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Affiliation(s)
- Sophie Arheix-Parras
- ACTIVE team, Bordeaux Population Health, INSERM UMR 1219, university of Bordeaux, 33000, Bordeaux, France. .,Institut Universitaire des Sciences de la Réadaptation, University of Bordeaux, 33000, Bordeaux, France. .,Department of physical medicine and rehabilitation, CHU de Bordeaux, 33000, Bordeaux, France.
| | - Bertrand Glize
- ACTIVE team, Bordeaux Population Health, INSERM UMR 1219, university of Bordeaux, 33000, Bordeaux, France.,Institut Universitaire des Sciences de la Réadaptation, University of Bordeaux, 33000, Bordeaux, France.,Department of physical medicine and rehabilitation, CHU de Bordeaux, 33000, Bordeaux, France
| | - Dominique Guehl
- Pole des neurosciences cliniques, CHU de Bordeaux, 33000, Bordeaux, France.,IMN CNRS UMR 5293, CNRS, University of Bordeaux, 33000, Bordeaux, France
| | - Grégoire Python
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Barbieri E, Thompson CK, Higgins J, Caplan D, Kiran S, Rapp B, Parrish T. Treatment-induced neural reorganization in aphasia is language-domain specific: Evidence from a large-scale fMRI study. Cortex 2023; 159:75-100. [PMID: 36610109 PMCID: PMC9931666 DOI: 10.1016/j.cortex.2022.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 08/14/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
Studies investigating the effects of language intervention on the re-organization of language networks in chronic aphasia have resulted in mixed findings, likely related to-among other factors-the language function targeted during treatment. The present study investigated the effects of the type of treatment provided on neural reorganization. Seventy individuals with chronic stroke-induced aphasia, recruited from three research laboratories and meeting criteria for agrammatism, anomia or dysgraphia were assigned to either treatment (N = 51) or control (N = 19) groups. Participants in the treatment group received 12-weeks of language intervention targeting sentence comprehension/production, naming, or spelling. At baseline and post-testing, all participants performed an fMRI story comprehension task, with blocks of auditorily-presented stories alternated with blocks of reversed speech. Participants in the treatment, but not control, group significantly improved in the treated language domain. FMRI region-of-interest (ROI) analyses, conducted within regions that were either active (or homologous to active) regions in a group of 22 healthy participants on the story comprehension task, revealed a significant increase in activation from pre-to post-treatment in right-hemisphere homologues of these regions for participants in the sentence and spelling, but not naming, treatment groups, not predicted by left-hemisphere lesion size. For the sentence (but not the spelling) treatment group, activation changes within right-hemisphere homologues of language regions were positively associated with changes in measures of verb and sentence comprehension. These findings support previous research pointing to recruitment of right hemisphere tissue as a viable route for language recovery and suggest that sentence-level treatment may promote greater neuroplasticity on naturalistic, language comprehension tasks, compared to word-level treatment.
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Affiliation(s)
- Elena Barbieri
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL 60208, USA.
| | - Cynthia K Thompson
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL 60208, USA; Department of Neurology, Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA
| | - James Higgins
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Chicago, IL 60611, USA
| | - David Caplan
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA 02114, USA
| | - Swathi Kiran
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Speech, Language, And Hearing, College of Health & Rehabilitation, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA
| | - Brenda Rapp
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Cognitive Science, Krieger School of Arts & Sciences, Johns Hopkins Univeristy, 3400 N Charles Street, Baltimore, MD 21218, USA
| | - Todd Parrish
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Chicago, IL 60611, USA
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9
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Masson-Trottier M, Dash T, Berroir P, Ansaldo AI. French Phonological Component Analysis and aphasia recovery: A bilingual perspective on behavioral and structural data. Front Hum Neurosci 2022; 16:752121. [PMID: 36211123 PMCID: PMC9535680 DOI: 10.3389/fnhum.2022.752121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Studies show bilingualism entails an advantage in cognitive control tasks. There is evidence of a bilingual advantage in the context of aphasia, resulting in better cognitive outcomes and recovery in bilingual persons with aphasia compared to monolingual peers. This bilingual advantage also results in structural changes in the right hemisphere gray matter. Very few studies have examined the so-called bilingual advantage by reference to specific anomia therapy efficacy. This study aims to compare the effect of French-Phonological Component Analysis (Fr-PCA) in monolinguals and bilingual persons with aphasia, both at the linguistic and cognitive control level, and to examine the structural impact of left hemisphere lesion location and right hemisphere structural data. Eight participants with chronic aphasia received Fr-PCA for a total of 15 h over 5 weeks. The results showed improved accuracy for treated words and generalization to untreated items and discourse in both groups, and improved Flanker task performance for some participants. Bilingual participants improved more than monolinguals for picture-naming tasks and narrative discourse. Damage to the left postcentral gyrus and the middle frontal gyrus was associated with less therapy-induced improvement. Additionally, left hemisphere damage to the inferior parietal gyrus and postcentral gyrus was associated with reduced cognitive control pre-therapy. Undamaged right hemisphere cortical thicknesses were significantly different between groups; the inferior frontal gyrus and the middle frontal gyrus were greater for the bilingual participants and correlated with cognitive control skills. These results suggest a bilingual advantage in anomia recovery following Fr-PCA, potentially resulting from enhanced cognitive control abilities that could be supported by right hemisphere neural reserve.
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Affiliation(s)
- Michèle Masson-Trottier
- Laboratoire de Plasticité Cérébrale, Communication et Vieillissement, Centre de Recherche de l’Institut de Gériatrie de Montréal, Montréal, QC, Canada
- École d’Orthophonie et d’Audiologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Tanya Dash
- Laboratoire de Plasticité Cérébrale, Communication et Vieillissement, Centre de Recherche de l’Institut de Gériatrie de Montréal, Montréal, QC, Canada
| | - Pierre Berroir
- Laboratoire de Plasticité Cérébrale, Communication et Vieillissement, Centre de Recherche de l’Institut de Gériatrie de Montréal, Montréal, QC, Canada
| | - Ana Inés Ansaldo
- Laboratoire de Plasticité Cérébrale, Communication et Vieillissement, Centre de Recherche de l’Institut de Gériatrie de Montréal, Montréal, QC, Canada
- École d’Orthophonie et d’Audiologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- *Correspondence: Ana Inés Ansaldo,
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Pasquini L, Di Napoli A, Rossi-Espagnet MC, Visconti E, Napolitano A, Romano A, Bozzao A, Peck KK, Holodny AI. Understanding Language Reorganization With Neuroimaging: How Language Adapts to Different Focal Lesions and Insights Into Clinical Applications. Front Hum Neurosci 2022; 16:747215. [PMID: 35250510 PMCID: PMC8895248 DOI: 10.3389/fnhum.2022.747215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
When the language-dominant hemisphere is damaged by a focal lesion, the brain may reorganize the language network through functional and structural changes known as adaptive plasticity. Adaptive plasticity is documented for triggers including ischemic, tumoral, and epileptic focal lesions, with effects in clinical practice. Many questions remain regarding language plasticity. Different lesions may induce different patterns of reorganization depending on pathologic features, location in the brain, and timing of onset. Neuroimaging provides insights into language plasticity due to its non-invasiveness, ability to image the whole brain, and large-scale implementation. This review provides an overview of language plasticity on MRI with insights for patient care. First, we describe the structural and functional language network as depicted by neuroimaging. Second, we explore language reorganization triggered by stroke, brain tumors, and epileptic lesions and analyze applications in clinical diagnosis and treatment planning. By comparing different focal lesions, we investigate determinants of language plasticity including lesion location and timing of onset, longitudinal evolution of reorganization, and the relationship between structural and functional changes.
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Affiliation(s)
- Luca Pasquini
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
- Radiology Department, Castelli Hospital, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Emiliano Visconti
- Neuroradiology Unit, Cesena Surgery and Trauma Department, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Kyung K. Peck
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrei I. Holodny
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
- Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, New York, NY, United States
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11
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Li R, Mukadam N, Kiran S. Functional MRI evidence for reorganization of language networks after stroke. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:131-150. [PMID: 35078595 DOI: 10.1016/b978-0-12-823384-9.00007-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this chapter, we review fMRI evidence for language reorganization in individuals with poststroke aphasia. Several studies in the current literature have utilized fMRI as a tool to understand patterns of functional reorganization in poststroke aphasia. Consistent with previous models that have been proposed to explain the trajectory of language recovery, differential patterns of language processing and language recovery have been identified across individuals with poststroke aphasia in different stages of recovery. Overall, a global network breakdown typically occurs in the early stages of aphasia recovery, followed by normalization in "traditional" left hemisphere language networks. Depending on individual characteristics, right hemisphere regions and bilateral domain-general regions may be further recruited. The main takeaway of this chapter is that poststroke aphasia recovery does not depend on individual neural regions, but rather involves a complex interaction among regions in larger networks. Many of the unresolved issues and contrastive findings in the literature warrant further research with larger groups of participants and standard protocols of fMRI implementation.
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Affiliation(s)
- Ran Li
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Nishaat Mukadam
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States
| | - Swathi Kiran
- Department of Speech, Language and Hearing Sciences, Boston University, Boston, MA, United States.
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12
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Masson-Trottier M, Sontheimer A, Durand E, Ansaldo AI. Resting-State Functional Connectivity following Phonological Component Analysis: The Combined Action of Phonology and Visual Orthographic Cues. Brain Sci 2021; 11:1458. [PMID: 34827457 PMCID: PMC8615968 DOI: 10.3390/brainsci11111458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Anomia is the most frequent and pervasive symptom for people with aphasia (PWA). Phonological component analysis (PCA) is a therapy incorporating phonological cues to treat anomia. Investigations of neural correlates supporting improvements following PCA remain scarce. Resting-state functional connectivity (rsFC) as a marker of therapy-induced neuroplasticity has been reported by our team. The present study explores the efficacy of PCA in French and associated therapy-induced neuroplasticity using whole-brain rsFC analysis. Ten PWA participated in a pre-/post-PCA fMRI study with cognitive linguistic assessments. PCA was delivered in French following the standard procedure. PCA led to significant improvement with trained and untrained items. PCA also led to changes in rsFC between distributed ROIs in the semantic network, visual network, and sub-cortical areas. Changes in rsFC can be interpreted within the frame of the visual and phonological nature of PCA. Behavioral and rsFC data changes associated with PCA in French highlight its efficacy and point to the importance of phonological and orthographic cues to consolidate the word-retrieval strategy, contributing to generalization to untrained words.
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Affiliation(s)
- Michèle Masson-Trottier
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada;
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Anna Sontheimer
- Centre National de la Recherche Scientifique, Institut National Polytechnique-Clermont, Institut Pascal, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
- Centre Hospitalier Universitaire de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Edith Durand
- U.F.R. Lettres, Cultures et Sciences Humaines, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
| | - Ana Inés Ansaldo
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada;
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada
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13
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Schevenels K, Price CJ, Zink I, De Smedt B, Vandermosten M. A Review on Treatment-Related Brain Changes in Aphasia. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2020; 1:402-433. [PMID: 37215585 PMCID: PMC10158631 DOI: 10.1162/nol_a_00019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 06/29/2020] [Indexed: 05/24/2023]
Abstract
Numerous studies have investigated brain changes associated with interventions targeting a range of language problems in patients with aphasia. We strive to integrate the results of these studies to examine (1) whether the focus of the intervention (i.e., phonology, semantics, orthography, syntax, or rhythmic-melodic) determines in which brain regions changes occur; and (2a) whether the most consistent changes occur within the language network or outside, and (2b) whether these are related to individual differences in language outcomes. The results of 32 studies with 204 unique patients were considered. Concerning (1), the location of treatment-related changes does not clearly depend on the type of language processing targeted. However, there is some support that rhythmic-melodic training has more impact on the right hemisphere than linguistic training. Concerning (2), we observed that language recovery is not only associated with changes in traditional language-related structures in the left hemisphere and homolog regions in the right hemisphere, but also with more medial and subcortical changes (e.g., precuneus and basal ganglia). Although it is difficult to draw strong conclusions, because there is a lack of systematic large-scale studies on this topic, this review highlights the need for an integrated approach to investigate how language interventions impact on the brain. Future studies need to focus on larger samples preserving subject-specific information (e.g., lesion effects) to cope with the inherent heterogeneity of stroke-induced aphasia. In addition, recovery-related changes in whole-brain connectivity patterns need more investigation to provide a comprehensive neural account of treatment-related brain plasticity and language recovery.
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Affiliation(s)
- Klara Schevenels
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Cathy J. Price
- Welcome Centre for Human Neuroimaging, Institute of Neurology, University College London, UK
| | - Inge Zink
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Bert De Smedt
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Maaike Vandermosten
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
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14
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Johnson JP, Meier EL, Pan Y, Kiran S. Pre-treatment graph measures of a functional semantic network are associated with naming therapy outcomes in chronic aphasia. BRAIN AND LANGUAGE 2020; 207:104809. [PMID: 32505940 PMCID: PMC7338231 DOI: 10.1016/j.bandl.2020.104809] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/28/2020] [Accepted: 04/17/2020] [Indexed: 05/29/2023]
Abstract
Naming treatment outcomes in post-stroke aphasia are variable and the factors underlying this variability are incompletely understood. In this study, 26 patients with chronic aphasia completed a semantic judgment fMRI task before receiving up to 12 weeks of naming treatment. Global (i.e., network-wide) and local (i.e., regional) graph theoretic measures of pre-treatment functional connectivity were analyzed to identify differences between patients who responded most and least favorably to treatment (i.e., responders and nonresponders) and determine if network measures predicted naming improvements. Responders had higher levels of global integration (i.e., average network strength and global efficiency) than nonresponders, and these measures predicted treatment effects after controlling for lesion volume and age. Group differences in local measures were identified in several regions associated with a variety of cognitive functions. These results suggest there is a meaningful and possibly prognostically-informative relationship between patients' functional network properties and their response to naming therapy.
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Affiliation(s)
- Jeffrey P Johnson
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, USA.
| | - Erin L Meier
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, USA.
| | - Yue Pan
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, USA.
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, USA.
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15
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Uscinska M, Polla Mattiot A, Bellino S. Treatment-Induced Brain Plasticity in Psychiatric Disorders. Behav Neurosci 2019. [DOI: 10.5772/intechopen.85448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Thompson CK. Neurocognitive Recovery of Sentence Processing in Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3947-3972. [PMID: 31756151 PMCID: PMC7203523 DOI: 10.1044/2019_jslhr-l-rsnp-19-0219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/20/2019] [Accepted: 09/09/2019] [Indexed: 05/04/2023]
Abstract
Purpose Reorganization of language networks in aphasia takes advantage of the facts that (a) the brain is an organ of plasticity, with neuronal changes occurring throughout the life span, including following brain damage; (b) plasticity is highly experience dependent; and (c) as with any learning system, language reorganization involves a synergistic interplay between organism-intrinsic (i.e., cognitive and brain) and organism-extrinsic (i.e., environmental) variables. A major goal for clinical treatment of aphasia is to be able to prescribe treatment and predict its outcome based on the neurocognitive deficit profiles of individual patients. This review article summarizes the results of research examining the neurocognitive effects of psycholinguistically based treatment (i.e., Treatment of Underlying Forms; Thompson & Shapiro, 2005) for sentence processing impairments in individuals with chronic agrammatic aphasia resulting from stroke and primary progressive aphasia and addresses both behavioral and brain variables related to successful treatment outcomes. The influences of lesion volume and location, perfusion (blood flow), and resting-state neural activity on language recovery are also discussed as related to recovery of agrammatism and other language impairments. Based on these and other data, principles for promoting neuroplasticity of language networks are presented. Conclusions Sentence processing treatment results in improved comprehension and production of complex syntactic structures in chronic agrammatism and generalization to less complex, linguistically related structures in chronic agrammatism. Patients also show treatment-induced shifts toward normal-like online sentence processing routines (based on eye movement data) and changes in neural recruitment patterns (based on functional neuroimaging), with posttreatment activation of regions overlapping with those within sentence processing and dorsal attention networks engaged by neurotypical adults performing the same task. These findings provide compelling evidence that treatment focused on principles of neuroplasticity promotes neurocognitive recovery in chronic agrammatic aphasia. Presentation Videohttps://doi.org/10.23641/asha.10257587.
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Affiliation(s)
- Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Department of Neurology and Mesulam Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, Evanston/Chicago, IL
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17
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Purcell JJ, Wiley RW, Rapp B. Re-learning to be different: Increased neural differentiation supports post-stroke language recovery. Neuroimage 2019; 202:116145. [PMID: 31479754 DOI: 10.1016/j.neuroimage.2019.116145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/31/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022] Open
Abstract
Identifying the neural changes that support recovery of cognitive functions after a brain lesion is important to advance our understanding of human neuroplasticity, which, in turn, forms the basis for the development of effective treatments. To date, the preponderance of neuroimaging studies has focused on localizing changes in average brain activity associated with functional recovery. Here, we took a novel approach by evaluating whether cognitive recovery in chronic stroke is related to increases in the differentiation of local neural response patterns. This approach is supported by research indicating that, in the intact brain, local neural representations become more differentiated (dissimilar) with learning (Glezer et al., 2015). We acquired fMRI data before and after 21 individuals received approximately 12 weeks of behavioral treatment for written language impairment due to a left-hemisphere stroke. We used Local-Heterogeneity Regression Analysis (Purcell and Rapp, 2018) to measure local neural response differentiation associated with written language processing, assuming that greater heterogeneity in the pattern of activity across adjacent neural areas indicates more well-differentiated neural representations. First, we observed pre to post-treatment increases in local neural differentiation (Local-Hreg) in the ventral occipital-temporal cortex of the left hemisphere. Second, we found that, in this region, higher local neural response differentiation prior to treatment was associated with less severe written language impairment, and that it also predicted greater future responsiveness to treatment. Third, we observed that changes in neural differentiation were systematically related to performance changes for trained and untrained items. Fourth, we did not observe these brain-behavior relationships for mean BOLD responses, only for Local-Hreg. Thus, this is the first investigation to quantify changes in local neural differentiation in the recovery of a cognitive function and the first to demonstrate the clear behavioral relevance of these changes. We conclude that the findings provide strong support for the novel hypothesis that the local re-differentiation of neural representations can play a significant role in functional recovery after brain lesion.
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Affiliation(s)
- Jeremy J Purcell
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA; Maryland Neuroimaging Center, University of Maryland, College Park, MD, USA.
| | - Robert W Wiley
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA; Department of Psychology, University of North Carolina, Greensboro, NC, USA
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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18
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Naeser MA, Ho MD, Martin PI, Hamblin MR, Koo BB. Increased Functional Connectivity Within Intrinsic Neural Networks in Chronic Stroke Following Treatment with Red/Near-Infrared Transcranial Photobiomodulation: Case Series with Improved Naming in Aphasia. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 38:115-131. [PMID: 31621498 DOI: 10.1089/photob.2019.4630] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To examine effects of four different transcranial, red/near-infrared (NIR), light-emitting diode (tLED) protocols on naming ability in persons with aphasia (PWA) due to left hemisphere (LH) stroke. This is the first study to report beneficial effects from tLED therapy in chronic stroke, and parallel changes on functional magnetic resonance imaging (fMRI). Materials and methods: Six PWA, 2-18 years poststroke, in whom 18 tLED treatments were applied (3 × /week, 6 weeks) using LED cluster heads: 500 mW, red (633 nm) and NIR (870 nm), 22.48 cm2, 22.2 mW/cm2. Results: After Protocol A with bilateral LED placements, including midline, at scalp vertex over left and right supplementary motor areas (L and R SMAs), picture naming was not improved. P1 underwent pre-/postovert, picture-naming task-fMRI scans; P2 could not. After Protocol A, P1 showed increased activation in LH and right hemisphere, including L and R SMAs. After Protocol B with LEDs only on ipsilesional, LH side, naming ability significantly improved for P1 and P2; the fMRI scans for P1 then showed activation only on the ipsilesional LH side. After Protocol C with LED placements on ipsilesional LH side, plus one midline placement over mesial prefrontal cortex (mPFC) at front hairline, a cortical node of the default mode network (DMN), P3 and P4 had only moderate/poor response, and no increase in functional connectivity on resting-state functional-connectivity MRI. After Protocol D, however, with LED placements on ipsilesional LH side, plus over two midline nodes of DMN, mPFC, and precuneus (high parietal) simultaneously, P5 and P6 each had good response with significant increase in functional connectivity within DMN, p < 0.0005; salience network, p < 0.0005; and central executive network, p < 0.05. Conclusions: NIR photons can affect surface brain cortex areas subjacent to where LEDs are applied on the scalp. Improved naming ability was present with optimal Protocol D. Transcranial photobiomodulation may be an additional noninvasive therapy for stroke.
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Affiliation(s)
- Margaret A Naeser
- VA Boston Healthcare System (12-A), Boston, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael D Ho
- VA Boston Healthcare System (12-A), Boston, Massachusetts
| | - Paula I Martin
- VA Boston Healthcare System (12-A), Boston, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
| | - Bang-Bon Koo
- Brain-Imaging and Informatics Lab (BIL), Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
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19
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O'Sullivan M, Brownsett S, Copland D. Language and language disorders: neuroscience to clinical practice. Pract Neurol 2019; 19:380-388. [PMID: 31350297 PMCID: PMC6839799 DOI: 10.1136/practneurol-2018-001961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 12/21/2022]
Abstract
Language disorders are common in neurological practice but their accurate recognition and description can be challenging. In this review, we summarise the major landmarks in the understanding of language disorders and the organisation of language in the brain. We describe approaches to assessing language disorders at the bedside or in the clinic as well as the treatment and rehabilitation of aphasia. Finally, we describe how the field of neuroscience is providing new computational and neuroscientific approaches to study the mechanisms of recovery and rehabilitation of aphasia.
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Affiliation(s)
- Michael O'Sullivan
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Sonia Brownsett
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Copland
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
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20
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Johnson JP, Meier EL, Pan Y, Kiran S. Treatment-related changes in neural activation vary according to treatment response and extent of spared tissue in patients with chronic aphasia. Cortex 2019; 121:147-168. [PMID: 31627014 DOI: 10.1016/j.cortex.2019.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 06/21/2019] [Accepted: 08/23/2019] [Indexed: 11/25/2022]
Abstract
Neuroimaging studies of aphasia recovery have linked treatment-related improvements in language processing to changes in functional brain activation in left hemisphere language regions and their right hemisphere homologues. Although there is some consensus that better behavioral outcomes are achieved when activation is restored to the left hemisphere, the circumstances that dictate how and why regions in both hemispheres respond to naming therapy are still unclear. In this study, an fMRI picture-naming task was used to examine 16 regions of interest in 26 patients with chronic aphasia before and after 12 weeks of semantic naming treatment. Ten control patients who did not receive treatment and 17 healthy controls were also scanned. Naming therapy resulted in a significant increase in cortical activation, an effect that was largely driven by patients who responded most favorably to treatment, as patients who responded less favorably (as well as those who did not receive treatment) had little change in activation over time. Relative to healthy controls, patients had higher pre-treatment activation in the bilateral inferior frontal gyri (IFG) and lower activation in the bilateral angular gyri; after treatment, they had higher activation in bilateral IFG, as well as in the right middle frontal gyrus. These results suggest that the predominant effect of beneficial naming treatment was an upregulation of traditional language areas and their right hemisphere homologues and, in particular, regions associated with phonological and semantic/executive semantic processing, as well as broader domain general functions. Additionally, in some left hemisphere regions, post-treatment changes in activation were greater when there was more damage than when there was less damage, indicating that spared tissue in otherwise highly damaged regions can be modulated by treatment.
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Affiliation(s)
- Jeffrey P Johnson
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA.
| | - Erin L Meier
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Yue Pan
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
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21
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Gilmore N, Dwyer M, Kiran S. Benchmarks of Significant Change After Aphasia Rehabilitation. Arch Phys Med Rehabil 2019; 100:1131-1139.e87. [PMID: 30240594 PMCID: PMC6422764 DOI: 10.1016/j.apmr.2018.08.177] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/30/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To establish benchmarks of significant change for aphasia rehabilitation outcome measures (ie, Western Aphasia Battery-Aphasia Quotient [WAB-AQ], Communicative Effectiveness Index [CETI], Boston Naming Test [BNT]) and assess if those benchmarks significantly differ across subgroups (ie, time post onset, dose frequency, treatment type). DATA SOURCES A comprehensive literature search of 12 databases, reference lists of previous reviews, and evidence-based practice materials was conducted. STUDY SELECTION Randomized controlled trials, quasi-experimental studies, single-subject design, and case studies that used a standardized outcome measure to assess change were included. Titles and full-text articles were screened using a dual review process. Seventy-eight studies met criteria for inclusion. DATA EXTRACTION Data were extracted independently, and 25% of extractions were checked for reliability. All included studies were assigned quality indicator ratings and an evidence level. DATA SYNTHESIS Random-effects meta-analyses were conducted separately for each study design group (ie, within-/between-group comparisons). For within-group designs, the summary effect size after aphasia rehabilitation was 5.03 points (95% confidence interval, 3.95-6.10, P<.001) on the WAB-AQ, 10.37 points (6.08-14.66, P<.001) on the CETI, and 3.30 points (2.43-4.18, P<.001) on the BNT. For between-group designs, the summary effect size was 5.05 points (1.64-8.46, P=.004) on the WAB-AQ and 0.55 points (-1.33 to 2.43, P=.564) on the BNT, the latter of which was not significant. Subgroup analyses for the within-group designs showed no significant differences in the summary effect size as a function of dose frequency or treatment type. CONCLUSIONS This study established benchmarks of significant change on 3 standardized outcome measures used in aphasia rehabilitation.
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Affiliation(s)
- Natalie Gilmore
- Aphasia Research Laboratory, Speech, Language, and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA.
| | - Michaela Dwyer
- Aphasia Research Laboratory, Speech, Language, and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Swathi Kiran
- Aphasia Research Laboratory, Speech, Language, and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
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22
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Tao Y, Rapp B. The effects of lesion and treatment-related recovery on functional network modularity in post-stroke dysgraphia. NEUROIMAGE-CLINICAL 2019; 23:101865. [PMID: 31146116 PMCID: PMC6538967 DOI: 10.1016/j.nicl.2019.101865] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/22/2019] [Accepted: 05/19/2019] [Indexed: 01/21/2023]
Abstract
A better understanding of the neural network properties that support cognitive recovery after a brain lesion is important for our understanding of human neuroplasticity and may have valuable clinical implications. In fifteen individuals with chronic, acquired written language deficits subsequent to left-hemisphere stroke, we used task-based functional connectivity to evaluate the relationship between the graph-theoretic measures (modularity, participation coefficient and within-module degree z-score) and written language production accuracy before and after behavioral treatment. A reference modular structure and local and global hubs identified from healthy controls formed the basis of the analyses. Overall, the investigation revealed that less modular networks with greater global and lower local integration were associated with greater deficit severity and lower response to treatment. Furthermore, we found treatment-induced increases in modularity and local integration measures. In particular, local integration within intact ventral occipital-temporal regions of the spelling network showed the greatest increase in local integration following treatment. This investigation significantly extends previous research by using task-based (rather than resting-state) functional connectivity to examine a larger set of network characteristics in the evaluation of treatment-induced recovery and by including comparisons with control participants. The findings demonstrate the relevance of network modularity for understanding the neuroplasticity supporting functional neural reorganization.
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Affiliation(s)
- Yuan Tao
- Department of Cognitive Science, Johns Hopkins University, USA.
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, USA; Department of Neuroscience, Johns Hopkins University, USA; Department of Psychological and Brain Sciences, Johns Hopkins University, USA
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Kiran S, Thompson CK. Neuroplasticity of Language Networks in Aphasia: Advances, Updates, and Future Challenges. Front Neurol 2019; 10:295. [PMID: 31001187 PMCID: PMC6454116 DOI: 10.3389/fneur.2019.00295] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Researchers have sought to understand how language is processed in the brain, how brain damage affects language abilities, and what can be expected during the recovery period since the early 19th century. In this review, we first discuss mechanisms of damage and plasticity in the post-stroke brain, both in the acute and the chronic phase of recovery. We then review factors that are associated with recovery. First, we review organism intrinsic variables such as age, lesion volume and location and structural integrity that influence language recovery. Next, we review organism extrinsic factors such as treatment that influence language recovery. Here, we discuss recent advances in our understanding of language recovery and highlight recent work that emphasizes a network perspective of language recovery. Finally, we propose our interpretation of the principles of neuroplasticity, originally proposed by Kleim and Jones (1) in the context of extant literature in aphasia recovery and rehabilitation. Ultimately, we encourage researchers to propose sophisticated intervention studies that bring us closer to the goal of providing precision treatment for patients with aphasia and a better understanding of the neural mechanisms that underlie successful neuroplasticity.
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Affiliation(s)
- Swathi Kiran
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, The Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Paek EJ, Murray LL, Newman SD, Kim DJ. Test-retest reliability in an fMRI study of naming in dementia. BRAIN AND LANGUAGE 2019; 191:31-45. [PMID: 30807893 DOI: 10.1016/j.bandl.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 12/18/2018] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
fMRI has been used as an outcome measure in dementia treatment studies, with many previous studies comparing only single pre- and post-treatment fMRI scans to determine treatment-induced neural changes, while utilizing single subject experimental designs. The purpose of the current study was to evaluate fMRI test-retest reliability in dementia patients and typical older adults using noun and verb confrontation naming to evaluate the validity of using a single pre/post-treatment scan comparison. Seven individuals with dementia and 9 control participants were tested three times over two months using the same fMRI procedures. Differences in individual and group level activation patterns were observed that varied across time. Additionally, the extent of variability fluctuated across individuals, groups, and the grammatical category of target words. Our findings suggested that one time fMRI scanning may inadequately represent an individual's typical brain activation pattern, particularly an individual with dementia. Thus, multiple imaging baselines are recommended.
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Affiliation(s)
- Eun Jin Paek
- Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN 37996, United States.
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, Ontario N6G 1H1, Canada.
| | - Sharlene D Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47401, United States.
| | - Dae-Jin Kim
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47401, United States.
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Dietz A, Vannest J, Maloney T, Altaye M, Holland S, Szaflarski JP. The feasibility of improving discourse in people with aphasia through AAC: Clinical and functional MRI correlates. APHASIOLOGY 2018; 32:693-719. [PMID: 32999522 PMCID: PMC7523709 DOI: 10.1080/02687038.2018.1447641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIMS The purpose of this study is twofold: (1) to examine the feasibility of providing high-tech augmentative and alternative communication (AAC) treatment to people with chronic aphasia, with the goal of evoking changes in spoken language; and (2) to identify evidence of AAC-induced changes in brain activation. METHOD & PROCEDURES We employed a pre- post-treatment design with a control (usual care) group to observe the impact of an AAC treatment on aphasia severity and spoken discourse. Further, we used functional magnetic resonance imaging (fMRI) to examine associated neural reorganization. OUTCOMES & RESULTS Compared to the usual care group, the AAC intervention trended toward larger treatment effects and resulted in a higher number of responders on behavioral outcomes. Both groups demonstrated a trend toward greater leftward lateralization of language functions via fMRI. Secondary analyses of responders to treatment revealed increased activation in visual processing regions, primarily for the AAC group. CONCLUSIONS This study provides preliminary guidance regarding how to implement AAC treatment in a manner that simultaneously facilitates language recovery across a variety of aphasia types and severity levels while compensating for residual deficits in people with chronic aphasia. Further, this work motivates continued efforts to unveil the role of AAC-based interventions in the aphasia recovery process and provides insight regarding the neurobiological mechanisms supporting AAC-induced language changes.
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Basilakos A. Contemporary Approaches to the Management of Post-stroke Apraxia of Speech. Semin Speech Lang 2018; 39:25-36. [PMID: 29359303 DOI: 10.1055/s-0037-1608853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Apraxia of speech (AOS) is a motor speech disorder that disrupts the planning and programming of speech motor movements. In the acute stage of stroke recovery, AOS following unilateral (typically) left hemisphere stroke can occur alongside dysarthria, an impairment in speech execution and control, and/or aphasia, a higher-level impairment in language function. At this time, perceptual evaluation (the systematic, although subjective, description of speech and voice characteristics) is perhaps the only "gold standard" for differential diagnosis when it comes to motor speech disorders. This poses a challenge for speech-language pathologists charged with the evaluation of poststroke communication abilities, as distinguishing production impairments associated with AOS from those that can occur in aphasia and/or dysarthria can be difficult, especially when more than one deficit is present. Given the need for more objective, reliable methods to identify and diagnose AOS, several studies have turned to acoustic evaluation and neuroimaging to supplement clinical assessment. This article focuses on these recent advances. Studies investigating acoustic evaluation of AOS will be reviewed, as well as those that have considered the extent that neuroimaging can guide clinical decision making. Developments in the treatment of AOS will also be discussed. Although more research is needed regarding the use of these methods in everyday clinical practice, the studies reviewed here show promise as emerging tools for the management of AOS.
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Affiliation(s)
- Alexandra Basilakos
- Arnold School of Public Health, Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina
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Hartwigsen G, Saur D. Neuroimaging of stroke recovery from aphasia - Insights into plasticity of the human language network. Neuroimage 2017; 190:14-31. [PMID: 29175498 DOI: 10.1016/j.neuroimage.2017.11.056] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
The role of left and right hemisphere brain regions in language recovery after stroke-induced aphasia remains controversial. Here, we summarize how neuroimaging studies increase the current understanding of functional interactions, reorganization and plasticity in the language network. We first discuss the temporal dynamics across the time course of language recovery, with a main focus on longitudinal studies from the acute to the chronic phase after stroke. These studies show that the functional contribution of perilesional and spared left hemisphere as well as contralesional right hemisphere regions to language recovery changes over time. The second section introduces critical variables and recent advances on early prediction of subsequent outcome. In the third section, we outline how multi-method approaches that combine neuroimaging techniques with non-invasive brain stimulation elucidate mechanisms of plasticity and reorganization in the language network. These approaches provide novel insights into general mechanisms of plasticity in the language network and might ultimately support recovery processes during speech and language therapy. Finally, the neurobiological correlates of therapy-induced plasticity are discussed. We argue that future studies should integrate individualized approaches that might vary the combination of language therapy with specific non-invasive brain stimulation protocols across the time course of recovery. The way forward will include the combination of such approaches with large data sets obtained from multicentre studies.
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Affiliation(s)
- Gesa Hartwigsen
- Research Group Modulation of Language Networks, Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Dorothee Saur
- Language & Aphasia Laboratory, Department of Neurology, University of Leipzig, Germany.
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Mohr B. Neuroplasticity and Functional Recovery after Intensive Language Therapy in Chronic Post Stroke Aphasia: Which Factors Are Relevant? Front Hum Neurosci 2017; 11:332. [PMID: 28701937 PMCID: PMC5487528 DOI: 10.3389/fnhum.2017.00332] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/08/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bettina Mohr
- Department of Psychiatry, Campus Benjamin Franklin, Charité Universitätsmedizin BerlinBerlin, Germany
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Lukic S, Barbieri E, Wang X, Caplan D, Kiran S, Rapp B, Parrish TB, Thompson CK. Right Hemisphere Grey Matter Volume and Language Functions in Stroke Aphasia. Neural Plast 2017; 2017:5601509. [PMID: 28573050 PMCID: PMC5441122 DOI: 10.1155/2017/5601509] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/09/2017] [Accepted: 03/21/2017] [Indexed: 11/17/2022] Open
Abstract
The role of the right hemisphere (RH) in recovery from aphasia is incompletely understood. The present study quantified RH grey matter (GM) volume in individuals with chronic stroke-induced aphasia and cognitively healthy people using voxel-based morphometry. We compared group differences in GM volume in the entire RH and in RH regions-of-interest. Given that lesion site is a critical source of heterogeneity associated with poststroke language ability, we used voxel-based lesion symptom mapping (VLSM) to examine the relation between lesion site and language performance in the aphasic participants. Finally, using results derived from the VLSM as a covariate, we evaluated the relation between GM volume in the RH and language ability across domains, including comprehension and production processes both at the word and sentence levels and across spoken and written modalities. Between-subject comparisons showed that GM volume in the RH SMA was reduced in the aphasic group compared to the healthy controls. We also found that, for the aphasic group, increased RH volume in the MTG and the SMA was associated with better language comprehension and production scores, respectively. These data suggest that the RH may support functions previously performed by LH regions and have important implications for understanding poststroke reorganization.
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Affiliation(s)
- Sladjana Lukic
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Elena Barbieri
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Xue Wang
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David Caplan
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Swathi Kiran
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Speech, Language, and Hearing, College of Health & Rehabilitation, Boston University, Boston, MA, USA
| | - Brenda Rapp
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Cognitive Science, Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Todd B. Parrish
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cynthia K. Thompson
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
- Department of Neurology, Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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30
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Roy A. Examining dynamic functional relationships in a pathological brain using evolutionary computation. Soft comput 2017. [DOI: 10.1007/s00500-017-2496-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Lucchese G, Pulvermüller F, Stahl B, Dreyer FR, Mohr B. Therapy-Induced Neuroplasticity of Language in Chronic Post Stroke Aphasia: A Mismatch Negativity Study of (A)Grammatical and Meaningful/less Mini-Constructions. Front Hum Neurosci 2017; 10:669. [PMID: 28111545 PMCID: PMC5216683 DOI: 10.3389/fnhum.2016.00669] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 12/15/2016] [Indexed: 12/20/2022] Open
Abstract
Clinical language performance and neurophysiological correlates of language processing were measured before and after intensive language therapy in patients with chronic (time post stroke >1 year) post stroke aphasia (PSA). As event-related potential (ERP) measure, the mismatch negativity (MMN) was recorded in a distracted oddball paradigm to short spoken sentences. Critical 'deviant' sentence stimuli where either well-formed and meaningful, or syntactically, or lexico-semantically incorrect. After 4 weeks of speech-language therapy (SLT) delivered with high intensity (10.5 h per week), clinical language assessment with the Aachen Aphasia Test battery demonstrated significant linguistic improvements, which were accompanied by enhanced MMN responses. More specifically, MMN amplitudes to grammatically correct and meaningful mini-constructions and to 'jabberwocky' sentences containing a pseudoword significantly increased after therapy. However, no therapy-related changes in MMN responses to syntactically incorrect strings including agreement violations were observed. While MMN increases to well-formed meaningful strings can be explained both at the word and construction levels, the neuroplastic change seen for 'jabberwocky' sentences suggests an explanation in terms of constructions. The results confirm previous reports that intensive SLT leads to improvements of linguistic skills in chronic aphasia patients and now demonstrate that this clinical improvement is associated with enhanced automatic brain indexes of construction processing, although no comparable change is present for ungrammatical strings. Furthermore, the data confirm that the language-induced MMN is a useful tool to map functional language recovery in PSA.
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Affiliation(s)
- Guglielmo Lucchese
- Brain Language Laboratory, Department of Philosophy and Humanities Freie Universität Berlin, Berlin Germany
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and HumanitiesFreie Universität Berlin, Berlin Germany; Berlin School of Mind and Brain, Humboldt-Universität zu BerlinBerlin, Germany
| | - Benjamin Stahl
- Brain Language Laboratory, Department of Philosophy and HumanitiesFreie Universität Berlin, Berlin Germany; Department of Neurology, Charité Universitätsmedizin Berlin, Campus MitteBerlin, Germany; Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
| | - Felix R Dreyer
- Brain Language Laboratory, Department of Philosophy and Humanities Freie Universität Berlin, Berlin Germany
| | - Bettina Mohr
- Department of Psychiatry, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin Germany
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32
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Dietz A, Vannest J, Maloney T, Altaye M, Szaflarski JP, Holland SK. The Calculation of Language Lateralization Indices in Post-stroke Aphasia: A Comparison of a Standard and a Lesion-Adjusted Formula. Front Hum Neurosci 2016; 10:493. [PMID: 27790102 PMCID: PMC5061744 DOI: 10.3389/fnhum.2016.00493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/16/2016] [Indexed: 12/28/2022] Open
Abstract
Background: The language lateralization index (LI) is a valuable tool in functional magnetic resonance imaging (fMRI) research, especially in people with post-stroke aphasia. However, there is inconsistent consideration for the overlap of lesions with regions of interest (ROIs). The purpose of this study was to determine whether standard LI (SLI) and lesion-adjusted LI (LALI) formulae generate different LI values and language lateralization classification for people with post-stroke chronic aphasia. Methods: SLI and LALI were calculated for an event-related (overt) verb generation task in an anterior and a posterior language ROI. Twelve people with aphasia due to a single left-hemispheric infarct (11 right-handed; 1 left-handed; 77.2 ± 41.7 months post-stroke) were included (eight females; 57 ± 8.88 years). Spearman correlation coefficients and intraclass correlation coefficients were calculated to determine the relationship of the LI values generated by the SLI and the LALI formulas. Fischer’s exact test and a weighted Cohen’s Kappa determined the difference in language lateralization classification and agreement in the classification. Spearman correlation was used to examine the relationship between the difference in lateralization values produced by the LALI and SLI calculations with (1) lesion size, (2) the percentage of lesion overlap in each ROI, and (3) aphasia severity. Results: The two calculation methods were highly correlated and produced similar LI Values, yet yielded significantly different classification for language lateralization. Further, a more leftward LI resulted from application of the LALI formula in 10 participants, in either the anterior ROI (n = 3) or the posterior ROI (n = 7). Finally, for the posterior ROI only, significant correlations were revealed between the two calculation methods and the (1) lesion size and (2) percent of overlap with the ROI. Discussion: While both approaches produce highly correlated LI values, differences in activation lateralization between formulas were observed, including changes in lateralization classification. Examination of the issues raised in the current investigation need to be replicated with a larger sample to determine the utility of a LALI formula in predicting behavioral performance; the findings may have implications for understanding and interpreting fMRI data of people with post-stroke aphasia.
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Affiliation(s)
- Aimee Dietz
- Department of Communication Sciences and Disorders, University of Cincinnati Cincinnati, OH, USA
| | - Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA
| | - Thomas Maloney
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Scott K Holland
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical CenterCincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital Medical CenterCincinnati, OH, USA
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Jokel R, Kielar A, Anderson ND, Black SE, Rochon E, Graham S, Freedman M, Tang-Wai DF. Behavioural and neuroimaging changes after naming therapy for semantic variant primary progressive aphasia. Neuropsychologia 2016; 89:191-216. [DOI: 10.1016/j.neuropsychologia.2016.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 10/21/2022]
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Holland R, Johns SL, Woollams AM. The impact of phonological versus semantic repetition training on generalisation in chronic stroke aphasia reflects differences in dorsal pathway connectivity. Neuropsychol Rehabil 2016; 28:548-567. [DOI: 10.1080/09602011.2016.1190384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rachel Holland
- Division of Language and Communication Science, City University London, London, England
| | - Sasha L. Johns
- Neuroscience and Aphasia Research Unit, School of Psychological Sciences, University of Manchester, Manchester, England
| | - Anna M. Woollams
- Neuroscience and Aphasia Research Unit, School of Psychological Sciences, University of Manchester, Manchester, England
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Kielar A, Deschamps T, Jokel R, Meltzer JA. Functional reorganization of language networks for semantics and syntax in chronic stroke: Evidence from MEG. Hum Brain Mapp 2016; 37:2869-93. [PMID: 27091757 DOI: 10.1002/hbm.23212] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/29/2016] [Accepted: 04/04/2016] [Indexed: 11/09/2022] Open
Abstract
Using magnetoencephalography, we investigated the potential of perilesional and contralesional activity to support language recovery in patients with poststroke aphasia. In healthy young controls, left-lateralized ventral frontotemporal regions responded to semantic anomalies during sentence comprehension and bilateral dorsal frontoparietal regions responded to syntactic anomalies. Older adults showed more extensive bilateral responses to the syntactic anomalies and less lateralized responses to the semantic anomalies, with decreased activation in the left occipital and parietal regions for both semantic and syntactic anomalies. In aphasic participants, we observed compensatory recruitment in the right hemisphere (RH), which varied depending on the type of linguistic information that was processed. For semantic anomalies, aphasic patients activated some preserved left hemisphere regions adjacent to the lesion, as well as homologous parietal and temporal RH areas. Patients also recruited right inferior and dorsolateral frontal cortex that was not activated in the healthy participants. Responses for syntactic anomalies did not reach significance in patients. Correlation analyses indicated that recruitment of homologous temporoparietal RH areas is associated with better semantic performance, whereas higher accuracy on the syntactic task was related to bilateral superior temporoparietal and right frontal activity. The results suggest that better recovery of semantic processing is associated with a shift to ventral brain regions in the RH. In contrast, preservation of syntactic processing is mediated by dorsal areas, bilaterally, although recovery of syntactic processing tends to be poorer than semantic. Hum Brain Mapp 37:2869-2893, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Aneta Kielar
- Rotman Research Institute, Baycrest Health Sciences Toronto, Toronto, Ontario, Canada.,Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | - Tiffany Deschamps
- Rotman Research Institute, Baycrest Health Sciences Toronto, Toronto, Ontario, Canada
| | - Regina Jokel
- Rotman Research Institute, Baycrest Health Sciences Toronto, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Jed A Meltzer
- Rotman Research Institute, Baycrest Health Sciences Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
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36
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BOLD fMRI and DTI in strabismic amblyopes following occlusion therapy. Int Ophthalmol 2015; 36:557-68. [PMID: 26659010 DOI: 10.1007/s10792-015-0159-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
Evaluation of brain cluster activation using the functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) was sought in strabismic amblyopes. In this hospital-based case-control cross-sectional study, fMRI and DTI were conducted in strabismic amblyopes before initiation of any therapy and after visual recovery following the administration of occlusion therapy. FMRI was performed in 10 strabismic amblyopic subjects (baseline group) and in 5 left strabismic amblyopic children post-occlusion therapy after two-line visual improvement. Ten age-matched healthy children with right ocular dominance formed control group. Structural and functional MRI was carried out on 1.5T MR scanner. The visual task consisted of 8 Hz flickering checkerboard with red dot and occasional green dot. Blood-oxygen-level-dependent (BOLD) fMRI was analyzed using statistical parametric mapping and DTI on NordicIce (NordicNeuroLab) softwares. Reduced occipital activation was elicited when viewing with the amblyopic eye in amblyopes. An 'ipsilateral to viewing eye' pattern of calcarine BOLD activation was observed in controls and left amblyopes. Activation of cortical areas associated with visual processing differed in relation to the viewing eye. Following visual recovery on occlusion therapy, enhanced activity in bilateral hemispheres in striate as well as extrastriate regions when viewing with either eye was seen. Improvement in visual acuity following occlusion therapy correlates with hemodynamic activity in amblyopes.
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37
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Kiran S, Meier EL, Kapse KJ, Glynn PA. Changes in task-based effective connectivity in language networks following rehabilitation in post-stroke patients with aphasia. Front Hum Neurosci 2015; 9:316. [PMID: 26106314 PMCID: PMC4460429 DOI: 10.3389/fnhum.2015.00316] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 05/18/2015] [Indexed: 11/19/2022] Open
Abstract
In this study, we examined regions in the left and right hemisphere language network that were altered in terms of the underlying neural activation and effective connectivity subsequent to language rehabilitation. Eight persons with chronic post-stroke aphasia and eight normal controls participated in the current study. Patients received a 10 week semantic feature-based rehabilitation program to improve their skills. Therapy was provided on atypical examples of one trained category while two control categories were monitored; the categories were counterbalanced across patients. In each fMRI session, two experimental tasks were conducted: (a) picture naming and (b) semantic feature verification of trained and untrained categories. Analysis of treatment effect sizes revealed that all patients showed greater improvements on the trained category relative to untrained categories. Results from this study show remarkable patterns of consistency despite the inherent variability in lesion size and activation patterns across patients. Across patients, activation that emerged as a function of rehabilitation on the trained category included bilateral IFG, bilateral SFG, LMFG, and LPCG for picture naming; and bilateral IFG, bilateral MFG, LSFG, and bilateral MTG for semantic feature verification. Analysis of effective connectivity using Dynamic Causal Modeling (DCM) indicated that LIFG was the consistently significantly modulated region after rehabilitation across participants. These results indicate that language networks in patients with aphasia resemble normal language control networks and that this similarity is accentuated by rehabilitation.
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Affiliation(s)
- Swathi Kiran
- Aphasia Research Laboratory, Speech Language and Hearing Sciences, Sargent College, Boston University Boston MA, USA
| | - Erin L Meier
- Aphasia Research Laboratory, Speech Language and Hearing Sciences, Sargent College, Boston University Boston MA, USA
| | - Kushal J Kapse
- Aphasia Research Laboratory, Speech Language and Hearing Sciences, Sargent College, Boston University Boston MA, USA
| | - Peter A Glynn
- Feinberg School of Medicine, Northwestern University Chicago IL, USA
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38
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Heath S, McMahon KL, Nickels LA, Angwin A, MacDonald AD, van Hees S, McKinnon E, Johnson K, Copland DA. An fMRI investigation of the effects of attempted naming on word retrieval in aphasia. Front Hum Neurosci 2015; 9:291. [PMID: 26074801 PMCID: PMC4443028 DOI: 10.3389/fnhum.2015.00291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/06/2015] [Indexed: 11/13/2022] Open
Abstract
In healthy controls, picture naming performance can be facilitated by a single prior exposure to the same picture (“priming”). This priming phenomenon is utilized in the treatment of aphasia, which often includes repeated picture naming as part of a therapeutic task. The current study sought to determine whether single and/or multiple exposures facilitate subsequent naming in aphasia and whether such facilitatory effects act through normal priming mechanisms. A functional magnetic resonance imaging paradigm was employed to explore the beneficial effects of attempted naming in two individuals with aphasia and a control group. The timing and number of prior exposures was manipulated, with investigation of both short-term effects (single prior exposure over a period of minutes) and long-term effects (multiple presentations over a period of days). Following attempted naming, both short-term and long-term facilitated items showed improvement for controls, while only the long-term condition showed benefits at a behavioral level for the participants with aphasia. At a neural level, effects of long-term facilitation were noted in the left precuneus for one participant with aphasia, a result also identified for the equivalent contrast in controls. It appears that multiple attempts are required to improve naming performance in the presence of anomia and that for some individuals with aphasia the source of facilitation may be similar to unimpaired mechanisms engaged outside the language network.
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Affiliation(s)
- Shiree Heath
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney NSW, Australia ; Language Neuroscience Laboratory, University of Queensland Centre for Clinical Research, St Lucia QLD, Australia
| | - Katie L McMahon
- Centre for Advanced Imaging, University of Queensland, St Lucia QLD, Australia
| | - Lyndsey A Nickels
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney NSW, Australia ; NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation, St Lucia QLD, Australia
| | - Anthony Angwin
- NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation, St Lucia QLD, Australia ; School of Health and Rehabilitation Sciences, University of Queensland, St Lucia QLD, Australia
| | - Anna D MacDonald
- Language Neuroscience Laboratory, University of Queensland Centre for Clinical Research, St Lucia QLD, Australia ; NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation, St Lucia QLD, Australia
| | - Sophia van Hees
- Language Neuroscience Laboratory, University of Queensland Centre for Clinical Research, St Lucia QLD, Australia ; NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation, St Lucia QLD, Australia
| | - Eril McKinnon
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia QLD, Australia
| | - Kori Johnson
- Centre for Advanced Imaging, University of Queensland, St Lucia QLD, Australia
| | - David A Copland
- Language Neuroscience Laboratory, University of Queensland Centre for Clinical Research, St Lucia QLD, Australia ; NHMRC Centre for Clinical Research Excellence in Aphasia Rehabilitation, St Lucia QLD, Australia ; School of Health and Rehabilitation Sciences, University of Queensland, St Lucia QLD, Australia
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Abel S, Weiller C, Huber W, Willmes K, Specht K. Therapy-induced brain reorganization patterns in aphasia. ACTA ACUST UNITED AC 2015; 138:1097-112. [PMID: 25688082 DOI: 10.1093/brain/awv022] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Both hemispheres are engaged in recovery from word production deficits in aphasia. Lexical therapy has been shown to induce brain reorganization even in patients with chronic aphasia. However, the interplay of factors influencing reorganization patterns still remains unresolved. We were especially interested in the relation between lesion site, therapy-induced recovery, and beneficial reorganization patterns. Thus, we applied intensive lexical therapy, which was evaluated with functional magnetic resonance imaging, to 14 chronic patients with aphasic word retrieval deficits. In a group study, we aimed to illuminate brain reorganization of the naming network in comparison with healthy controls. Moreover, we intended to analyse the data with joint independent component analysis to relate lesion sites to therapy-induced brain reorganization, and to correlate resulting components with therapy gain. As a result, we found peri-lesional and contralateral activations basically overlapping with premorbid naming networks observed in healthy subjects. Reduced activation patterns for patients compared to controls before training comprised damaged left hemisphere language areas, right precentral and superior temporal gyrus, as well as left caudate and anterior cingulate cortex. There were decreasing activations of bilateral visuo-cognitive, articulatory, attention, and language areas due to therapy, with stronger decreases for patients in right middle temporal gyrus/superior temporal sulcus, bilateral precuneus as well as left anterior cingulate cortex and caudate. The joint independent component analysis revealed three components indexing lesion subtypes that were associated with patient-specific recovery patterns. Activation decreases (i) of an extended frontal lesion disconnecting language pathways occurred in left inferior frontal gyrus; (ii) of a small frontal lesion were found in bilateral inferior frontal gyrus; and (iii) of a large temporo-parietal lesion occurred in bilateral inferior frontal gyrus and contralateral superior temporal gyrus. All components revealed increases in prefrontal areas. One component was negatively correlated with therapy gain. Therapy was associated exclusively with activation decreases, which could mainly be attributed to higher processing efficiency within the naming network. In our joint independent component analysis, all three lesion patterns disclosed involved deactivation of left inferior frontal gyrus. Moreover, we found evidence for increased demands on control processes. As expected, we saw partly differential reorganization profiles depending on lesion patterns. There was no compensatory deactivation for the large left inferior frontal lesion, with its less advantageous outcome probably being related to its disconnection from crucial language processing pathways.
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Affiliation(s)
- Stefanie Abel
- 1 Department of Neurology, Section Neuropsychology, RWTH Aachen, Germany 2 School of Psychological Sciences, Faculty of Medical and Human Sciences, University of Manchester, UK 3 SRH University of Applied Sciences, Gera, Germany 4 JARA-BRAIN, Aachen Juelich Research Alliance, Translational Brain Medicine, Germany
| | - Cornelius Weiller
- 5 Department of Neurology, University Medical Centre Freiburg, Germany
| | - Walter Huber
- 4 JARA-BRAIN, Aachen Juelich Research Alliance, Translational Brain Medicine, Germany
| | - Klaus Willmes
- 1 Department of Neurology, Section Neuropsychology, RWTH Aachen, Germany 4 JARA-BRAIN, Aachen Juelich Research Alliance, Translational Brain Medicine, Germany 6 Interdisciplinary Centre for Clinical Research, RWTH Aachen, Germany
| | - Karsten Specht
- 7 Department of Biological and Medical Psychology, University of Bergen, and Department of Clinical Engineering, Haukeland University Hospital Bergen, Norway
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Harnish SM, Neils-Strunjas J, Lamy M, Eliassen J. Use of fMRI in the Study of Chronic Aphasia Recovery After Therapy: A Case Study. Top Stroke Rehabil 2015; 15:468-83. [DOI: 10.1310/tsr1505-468] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Geranmayeh F, Brownsett SLE, Wise RJS. Task-induced brain activity in aphasic stroke patients: what is driving recovery? Brain 2014; 137:2632-48. [PMID: 24974382 PMCID: PMC4163030 DOI: 10.1093/brain/awu163] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/03/2014] [Accepted: 04/27/2014] [Indexed: 12/24/2022] Open
Abstract
The estimated prevalence of aphasia in the UK and the USA is 250 000 and 1 000 000, respectively. The commonest aetiology is stroke. The impairment may improve with behavioural therapy, and trials using cortical stimulation or pharmacotherapy are undergoing proof-of-principle investigation, but with mixed results. Aphasia is a heterogeneous syndrome, and the simple classifications according to the Broca-Wernicke-Lichtheim model inadequately describe the diverse communication difficulties with which patients may present. Greater knowledge of how intact neural networks promote recovery after aphasic stroke, either spontaneously or in response to interventions, will result in clearer hypotheses about how to improve the treatment of aphasia. Twenty-five years ago, a pioneering study on healthy participants heralded the introduction of functional neuroimaging to the study of mechanisms of recovery from aphasia. Over the ensuing decades, such studies have been interpreted as supporting one of three hypotheses, which are not mutually exclusive. The first two predate the introduction of functional neuroimaging: that recovery is the consequence of the reconstitution of domain-specific language systems in tissue around the lesion (the 'perilesional' hypothesis), or by homotopic cortex in the contralateral hemisphere (the 'laterality-shift' hypothesis). The third is that loss of transcallosal inhibition to contralateral homotopic cortex hinders recovery (the 'disinhibition' hypothesis). These different hypotheses at times give conflicting views about rehabilitative intervention; for example, should one attempt to activate or inhibit a contralateral homotopic region with cortical stimulation techniques to promote recovery? This review proposes that although the functional imaging data are statistically valid in most cases, their interpretation has often favoured one explanation while ignoring plausible alternatives. In our view, this is particularly evident when recovery is attributed to activity in 'language networks' occupying sites not observed in healthy participants. In this review we will argue that much of the distribution of what has often been interpreted as language-specific activity, particularly in midline and contralateral cortical regions, is an upregulation of activity in intact domain-general systems for cognitive control and attention, responding in a task-dependent manner to the increased 'effort' when damaged downstream domain-specific language networks are impaired. We further propose that it is an inability fully to activate these systems that may result in sub optimal recovery in some patients. Interpretation of the data in terms of activity in domain-general networks affords insights into novel approaches to rehabilitation.
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Affiliation(s)
- Fatemeh Geranmayeh
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Sonia L E Brownsett
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Richard J S Wise
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
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Galletta EE, Barrett AM. Impairment and Functional Interventions for Aphasia: Having it All. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014; 2:114-120. [PMID: 25133085 PMCID: PMC4132891 DOI: 10.1007/s40141-014-0050-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aphasia, a cognitive-linguistic disorder secondary to stroke, is a frequent and often chronic consequence of stroke with detrimental effects on autonomy and health-related quality of life. Treatment of aphasia can be approached in a number of ways. Impairment-based approaches that focus on training a specific linguistic form can be implemented. Additionally, functionally oriented intervention such as supported conversation and aphasia groups are also frequently utilized when providing a treatment program for an individual with aphasia. Creating a treatment approach that includes both impairment and functional methodologies and considers how these relate to the three domains proposed by the International Classification of Functioning Disability and Health (ICF)-body functions and structure, activity, and participation-can provide an individual with aphasia an optimal treatment program that is person-centered and multi-faceted.
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Affiliation(s)
- Elizabeth E. Galletta
- Department of Speech-Language Pathology and Audiology, Hunter College, The City University of New York, 425 East 25th Street, P.O. Box 625, New York, NY 10010, USA
- Kessler Foundation Research Center, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, NJ Medical School, Rutgers-the State University of New Jersey, Newark, NJ, USA
| | - A. M. Barrett
- Kessler Foundation Research Center, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, NJ Medical School, Rutgers-the State University of New Jersey, Newark, NJ, USA
- Kessler Institute of Rehabilitation, West Orange, NJ, USA
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Neural underpinnings for model-oriented therapy of aphasic word production. Neuropsychologia 2014; 57:154-65. [DOI: 10.1016/j.neuropsychologia.2014.03.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/03/2014] [Accepted: 03/20/2014] [Indexed: 11/23/2022]
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Mattioli F, Ambrosi C, Mascaro L, Scarpazza C, Pasquali P, Frugoni M, Magoni M, Biagi L, Gasparotti R. Early Aphasia Rehabilitation Is Associated With Functional Reactivation of the Left Inferior Frontal Gyrus. Stroke 2014; 45:545-52. [DOI: 10.1161/strokeaha.113.003192] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Flavia Mattioli
- From Neuropsychology Unit (F.M., C.S., P.P., M.F.), Department of Diagnostic Imaging, Medical Physics Unit (L.M.), and Stroke Unit (M.M.), Spedali Civili di Brescia, Brescia, Italy; Department of Diagnostic Imaging, Neuroradiology Unit, University of Brescia, Brescia, Italy (C.A., R.G.); and IRCCS Stella Maris Foundation, Pisa, Italy (L.B.)
| | - Claudia Ambrosi
- From Neuropsychology Unit (F.M., C.S., P.P., M.F.), Department of Diagnostic Imaging, Medical Physics Unit (L.M.), and Stroke Unit (M.M.), Spedali Civili di Brescia, Brescia, Italy; Department of Diagnostic Imaging, Neuroradiology Unit, University of Brescia, Brescia, Italy (C.A., R.G.); and IRCCS Stella Maris Foundation, Pisa, Italy (L.B.)
| | - Lorella Mascaro
- From Neuropsychology Unit (F.M., C.S., P.P., M.F.), Department of Diagnostic Imaging, Medical Physics Unit (L.M.), and Stroke Unit (M.M.), Spedali Civili di Brescia, Brescia, Italy; Department of Diagnostic Imaging, Neuroradiology Unit, University of Brescia, Brescia, Italy (C.A., R.G.); and IRCCS Stella Maris Foundation, Pisa, Italy (L.B.)
| | - Cristina Scarpazza
- From Neuropsychology Unit (F.M., C.S., P.P., M.F.), Department of Diagnostic Imaging, Medical Physics Unit (L.M.), and Stroke Unit (M.M.), Spedali Civili di Brescia, Brescia, Italy; Department of Diagnostic Imaging, Neuroradiology Unit, University of Brescia, Brescia, Italy (C.A., R.G.); and IRCCS Stella Maris Foundation, Pisa, Italy (L.B.)
| | - Patrizia Pasquali
- From Neuropsychology Unit (F.M., C.S., P.P., M.F.), Department of Diagnostic Imaging, Medical Physics Unit (L.M.), and Stroke Unit (M.M.), Spedali Civili di Brescia, Brescia, Italy; Department of Diagnostic Imaging, Neuroradiology Unit, University of Brescia, Brescia, Italy (C.A., R.G.); and IRCCS Stella Maris Foundation, Pisa, Italy (L.B.)
| | - Marina Frugoni
- From Neuropsychology Unit (F.M., C.S., P.P., M.F.), Department of Diagnostic Imaging, Medical Physics Unit (L.M.), and Stroke Unit (M.M.), Spedali Civili di Brescia, Brescia, Italy; Department of Diagnostic Imaging, Neuroradiology Unit, University of Brescia, Brescia, Italy (C.A., R.G.); and IRCCS Stella Maris Foundation, Pisa, Italy (L.B.)
| | - Mauro Magoni
- From Neuropsychology Unit (F.M., C.S., P.P., M.F.), Department of Diagnostic Imaging, Medical Physics Unit (L.M.), and Stroke Unit (M.M.), Spedali Civili di Brescia, Brescia, Italy; Department of Diagnostic Imaging, Neuroradiology Unit, University of Brescia, Brescia, Italy (C.A., R.G.); and IRCCS Stella Maris Foundation, Pisa, Italy (L.B.)
| | - Laura Biagi
- From Neuropsychology Unit (F.M., C.S., P.P., M.F.), Department of Diagnostic Imaging, Medical Physics Unit (L.M.), and Stroke Unit (M.M.), Spedali Civili di Brescia, Brescia, Italy; Department of Diagnostic Imaging, Neuroradiology Unit, University of Brescia, Brescia, Italy (C.A., R.G.); and IRCCS Stella Maris Foundation, Pisa, Italy (L.B.)
| | - Roberto Gasparotti
- From Neuropsychology Unit (F.M., C.S., P.P., M.F.), Department of Diagnostic Imaging, Medical Physics Unit (L.M.), and Stroke Unit (M.M.), Spedali Civili di Brescia, Brescia, Italy; Department of Diagnostic Imaging, Neuroradiology Unit, University of Brescia, Brescia, Italy (C.A., R.G.); and IRCCS Stella Maris Foundation, Pisa, Italy (L.B.)
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Martin PI, Treglia E, Naeser MA, Ho MD, Baker EH, Martin EG, Bashir S, Pascual-Leone A. Language improvements after TMS plus modified CILT: Pilot, open-protocol study with two, chronic nonfluent aphasia cases. Restor Neurol Neurosci 2014; 32:483-505. [PMID: 25015701 PMCID: PMC4592134 DOI: 10.3233/rnn-130365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE The purpose of this study was to investigate: 1) the feasibilty of administering a modified CILT (mCILT) treatment session immediately after TMS; and 2) if this combined therapy could improve naming and elicited propositional speech in chronic, nonfluent aphasia. METHODS Two chronic stroke patients with nonfluent aphasia (mild-moderate and severe) each received twenty minutes of rTMS to suppress the right pars triangularis, followed immediately by three hours of mCILT (5 days/week, 2 weeks). (Each patient had received TMS alone, 2-6 years prior.) Language evaluations were performed pre- TMS+mCILT, and post- at 1-2 months, and 6 or 16 months. RESULTS Both patients showed significant improvements in naming pictures, and elicited propositional speech at 1-2 months post- TMS+mCILT. The improved naming was still present at 6 months post- TMS+mCILT for P2; but not at 16 months post- TMS+mCILT for P1. CONCLUSIONS It is feasible to administer mCILT for three hours immediately after a TMS session. It is unknown if the significant improvements in naming pictures, and elicited propositional speech were associated with the second series of TMS, or this first series of mCILT, or a combination of both. A larger, sham controlled clinical trial is warranted.
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Affiliation(s)
- Paula I Martin
- Veterans Affairs Boston Healthcare System and the Harold Goodglass Boston University Aphasia Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Ethan Treglia
- Veterans Affairs Boston Healthcare System and the Harold Goodglass Boston University Aphasia Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Margaret A Naeser
- Veterans Affairs Boston Healthcare System and the Harold Goodglass Boston University Aphasia Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael D Ho
- Veterans Affairs Boston Healthcare System and the Harold Goodglass Boston University Aphasia Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Errol H Baker
- Veterans Affairs Boston Healthcare System and the Harold Goodglass Boston University Aphasia Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Elizabeth G Martin
- Veterans Affairs Boston Healthcare System and the Harold Goodglass Boston University Aphasia Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Shahid Bashir
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA Institut Universitari de Neurorehabilitació Guttmann-UAB, Badalona, Spain
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Thompson CK, Riley EA, den Ouden DB, Meltzer-Asscher A, Lukic S. Training verb argument structure production in agrammatic aphasia: behavioral and neural recovery patterns. Cortex 2013; 49:2358-76. [PMID: 23514929 PMCID: PMC3759546 DOI: 10.1016/j.cortex.2013.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 09/06/2012] [Accepted: 02/04/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neuroimaging and lesion studies indicate a left hemisphere network for verb and verb argument structure processing, involving both frontal and temporoparietal brain regions. Although their verb comprehension is generally unimpaired, it is well known that individuals with agrammatic aphasia often present with verb production deficits, characterized by an argument structure complexity hierarchy, indicating faulty access to argument structure representations for production and integration into syntactic contexts. Recovery of verb processing in agrammatism, however, has received little attention and no studies have examined the neural mechanisms associated with improved verb and argument structure processing. In the present study we trained agrammatic individuals on verbs with complex argument structure in sentence contexts and examined generalization to verbs with less complex argument structure. The neural substrates of improved verb production were examined using functional magnetic resonance imaging (fMRI). METHODS Eight individuals with chronic agrammatic aphasia participated in the study (four experimental and four control participants). Production of three-argument verbs in active sentences was trained using a sentence generation task emphasizing the verb's argument structure and the thematic roles of sentential noun phrases. Before and after training, production of trained and untrained verbs was tested in naming and sentence production and fMRI scans were obtained, using an action naming task. RESULTS Significant pre- to post-training improvement in trained and untrained (one- and two-argument) verbs was found for treated, but not control, participants, with between-group differences found for verb naming, production of verbs in sentences, and production of argument structure. fMRI activation derived from post-treatment compared to pre-treatment scans revealed upregulation in cortical regions implicated for verb and argument structure processing in healthy controls. CONCLUSIONS Training verb deficits emphasizing argument structure and thematic role mapping is effective for improving verb and sentence production and results in recruitment of neural networks engaged for verb and argument structure processing in healthy individuals.
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Affiliation(s)
- Cynthia K. Thompson
- Aphasia and Neurolinguistics Research Laboratory, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
- Department of Neurology, Northwestern University, Evanston, IL, USA
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern University, Evanston, IL, USA
| | - Ellyn A. Riley
- Department of Communication Sciences and Disorders, Bowling Green State University, USA
| | - Dirk-Bart den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, USA
| | - Aya Meltzer-Asscher
- Linguistics Department, Tel Aviv University, Israel
- Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Sladjana Lukic
- Aphasia and Neurolinguistics Research Laboratory, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
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Kiran S, Ansaldo A, Bastiaanse R, Cherney LR, Howard D, Faroqi-Shah Y, Meinzer M, Thompson CK. Neuroimaging in aphasia treatment research: standards for establishing the effects of treatment. Neuroimage 2013; 76:428-35. [PMID: 23063559 PMCID: PMC3552150 DOI: 10.1016/j.neuroimage.2012.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 07/06/2012] [Accepted: 10/05/2012] [Indexed: 11/29/2022] Open
Abstract
The goal of this paper is to discuss experimental design options available for establishing the effects of treatment in studies that aim to examine the neural mechanisms associated with treatment-induced language recovery in aphasia, using functional magnetic resonance imaging (fMRI). We present both group and single-subject experimental or case-series design options for doing this and address advantages and disadvantages of each. We also discuss general components of and requirements for treatment research studies, including operational definitions of variables, criteria for defining behavioral change and treatment efficacy, and reliability of measurement. Important considerations that are unique to neuroimaging-based treatment research are addressed, pertaining to the relation between the selected treatment approach and anticipated changes in language processes/functions and how such changes are hypothesized to map onto the brain.
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Affiliation(s)
- Swathi Kiran
- Boston University, Sargent College of Health and Rehabilitation Sciences, Boston, MA 02215, USA.
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Marcotte K, Perlbarg V, Marrelec G, Benali H, Ansaldo AI. Default-mode network functional connectivity in aphasia: therapy-induced neuroplasticity. BRAIN AND LANGUAGE 2013; 124:45-55. [PMID: 23274798 DOI: 10.1016/j.bandl.2012.11.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 11/06/2012] [Accepted: 11/07/2012] [Indexed: 05/14/2023]
Abstract
Previous research on participants with aphasia has mainly been based on standard functional neuroimaging analysis. Recent studies have shown that functional connectivity analysis can detect compensatory activity, not revealed by standard analysis. Little is known, however, about the default-mode network in aphasia. In the current study, we studied changes in the default-mode network in subjects with aphasia who underwent semantic feature analysis therapy. We studied nine participants with chronic aphasia and compared them to 10 control participants. For the first time, we identified the default-mode network using spatial independent component analysis, in participants with aphasia. Intensive therapy improved integration in the posterior areas of the default-mode network concurrent with language improvement. Correlations between integration and improvement did not reach significance, but the trend suggests that pre-therapy integration of the default-mode network may predict therapy outcomes. Functional connectivity allows a better understanding of the impact of semantic feature analysis in aphasia.
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Affiliation(s)
- Karine Marcotte
- Unité de neuroimagerie fonctionnelle, Research Center, Institut Universitaire de Gériatrie de Montréal, 4565 Queen Mary Road, Montreal, Quebec, Canada.
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Kiran S. What is the nature of poststroke language recovery and reorganization? ISRN NEUROLOGY 2012; 2012:786872. [PMID: 23320190 PMCID: PMC3540797 DOI: 10.5402/2012/786872] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/05/2012] [Indexed: 12/16/2022]
Abstract
This review focuses on three main topics related to the nature of poststroke language recovery and reorganization. The first topic pertains to the nature of anatomical and physiological substrates in the infarcted hemisphere in poststroke aphasia, including the nature of the hemodynamic response in patients with poststroke aphasia, the nature of the peri-infarct tissue, and the neuronal plasticity potential in the infarcted hemisphere. The second section of the paper reviews the current neuroimaging evidence for language recovery in the acute, subacute, and chronic stages of recovery. The third and final section examines changes in connectivity as a function of recovery in poststroke aphasia, specifically in terms of changes in white matter connectivity, changes in functional effective connectivity, and changes in resting state connectivity after stroke. While much progress has been made in our understanding of language recovery, more work needs to be done. Future studies will need to examine whether reorganization of language in poststroke aphasia corresponds to a tighter, more coherent, and efficient network of residual and new regions in the brain. Answering these questions will go a long way towards being able to predict which patients are likely to recover and may benefit from future rehabilitation.
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Affiliation(s)
- Swathi Kiran
- Department of Speech, Language, and Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA ; Massachusetts General Hospital, Boston, MA, USA
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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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