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Riccardi N, Schwen Blackett D, Broadhead A, den Ouden D, Rorden C, Fridriksson J, Bonilha L, Desai RH. A Rose by Any Other Name: Mapping Taxonomic and Thematic Naming Errors Poststroke. J Cogn Neurosci 2024; 36:2251-2267. [PMID: 39106171 DOI: 10.1162/jocn_a_02236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Understanding the neurobiology of semantic knowledge is a major goal of cognitive neuroscience. Taxonomic and thematic semantic knowledge are represented differently within the brain's conceptual networks, but the specific neural mechanisms remain unclear. Some neurobiological models propose that the anterior temporal lobe is an important hub for taxonomic knowledge, whereas the TPJ is especially involved in the representation of thematic knowledge. However, recent studies have provided divergent evidence. In this context, we investigated the neural correlates of taxonomic and thematic confrontation naming errors in 79 people with aphasia. We used three complementary lesion-symptom mapping (LSM) methods to investigate how structure and function in both spared and impaired brain regions relate to taxonomic and thematic naming errors. Voxel-based LSM mapped brain damage, activation-based LSM mapped BOLD signal in surviving tissue, and network-based LSM mapped white matter subnetwork integrity to error type. Voxel- and network-based lesion symptom mapping provided converging evidence that damage/disruption of the left mid-to-anterior temporal lobe was associated with a greater proportion of thematic naming errors. Activation-based lesion symptom mapping revealed that higher BOLD signal in the left anterior temporal lobe during an in-house naming task was associated with a greater proportion of taxonomic errors on the Philadelphia Naming Test administered outside of the scanner. A lower BOLD signal in the bilateral angular gyrus, precuneus, and right inferior frontal cortex was associated with a greater proportion of taxonomic errors. These findings provide novel evidence that damage to the anterior temporal lobe is especially related to thematic naming errors.
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Jing K, Gu R, Chen F, Wan J, Sun Y, Guo P, Chen F, Feng J, Guo J, Liu X. Orosomucoid 2 is an endogenous regulator of neuronal mitochondrial biogenesis and promotes functional recovery post-stroke. Pharmacol Res 2024; 209:107422. [PMID: 39293585 DOI: 10.1016/j.phrs.2024.107422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 09/01/2024] [Accepted: 09/15/2024] [Indexed: 09/20/2024]
Abstract
Development of functional recovery therapies is critical to reduce the global impact of stroke as the leading cause of long-term disability. Our previous studies found that acute-phase protein orosomucoid (ORM) could provide an up to 6h therapeutic time window to reduce infarct volume in acute ischemic stroke by improving endothelial function. However, its role in neurons and functional recovery post-stroke remains largely unknown. Here, we showed that exogenous ORM administration with initial injection at 0.5h (early) or 12h (delayed) post-MCAO daily for consecutive 7 days significantly decreased infarct area, improved motor and cognitive functional recovery, and promoted mitochondrial biogenesis after MCAO. While neuron-specific knockout of ORM2, a dominant subtype of ORM in the brain, produced opposite effects which could be rescued by exogenous ORM. In vitro, exogenous ORM protected SH-SY5Y cells from OGD-induced damage and promoted mitochondrial biogenesis, while endogenous ORM2 deficiency worsened these processes. Mechanistically, inactivation of CCR5 or AMPK eliminated the protective effects of ORM on neuronal damage and mitochondrial biogenesis. Taken together, our findings demonstrate that ORM, mainly ORM2, is an endogenous regulator of neuronal mitochondrial biogenesis by activating CCR5/AMPK signaling pathway, and might act as a potential therapeutic target for the functional recovery post-stroke.
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Affiliation(s)
- Kai Jing
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Ruinan Gu
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Feng Chen
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Jingjing Wan
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Yang Sun
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Pengyue Guo
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Fei Chen
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Jiayi Feng
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China
| | - Jinmin Guo
- Department of Clinical Pharmacy, 960(th) Hospital of Joint Logistic Support Force, Shandong, Jinan, China.
| | - Xia Liu
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai 200082, China.
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3
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Liu N, Ye TF, Yu QW. The role of the right hemispheric homologous language pathways in recovery from post-stroke aphasia: A systematic review. Psychiatry Res Neuroimaging 2024; 343:111866. [PMID: 39098261 DOI: 10.1016/j.pscychresns.2024.111866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/06/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024]
Abstract
The involvement of the right hemisphere, mainly the activation of the right cerebral regions, in recovery from post-stroke aphasia has been widely recognized. In contrast, the role of the right white matter pathways in the recovery from post-stroke aphasia is rarely understood. In this study, we aimed to provide a primary overview of the correlation between the structural integrity of the right hemispheric neural tracts based on the dual-stream model of language organization and recovery from post-stroke aphasia by systematically reviewing prior longitudinal interventional studies. By searching electronic databases for relevant studies according to a standard protocol, a total of 10 records (seven group studies and three case studies) including 79 participants were finally included. After comprehensively analyzing these studies and reviewing the literature, although no definite correlation was found between the right hemispheric neural tracts and recovery from post-stroke aphasia, our review provideds a new perspective for investigating the linguistic role of the right hemispheric neural tracts. This suggests that the involvement of the right hemispheric neural tracts in recovery from post-stroke aphasia may be mediated by multiple factors; thus, this topic should be comprehensively investigated in the future.
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Affiliation(s)
- Na Liu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu, China
| | - Tian-Fen Ye
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu, China
| | - Qi-Wei Yu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu, China.
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Feng J, Lv M, Ma X, Li T, Xu M, Yang J, Su F, Hu R, Li J, Qiu Y, Liu Y, Shen Y, Xu W. Change of function and brain activity in patients of right spastic arm paralysis combined with aphasia after contralateral cervical seventh nerve transfer surgery. Eur J Neurosci 2024; 60:4254-4264. [PMID: 38830753 DOI: 10.1111/ejn.16436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
Left hemisphere injury can cause right spastic arm paralysis and aphasia, and recovery of both motor and language functions shares similar compensatory mechanisms and processes. Contralateral cervical seventh cross transfer (CC7) surgery can provide motor recovery for spastic arm paralysis by triggering interhemispheric plasticity, and self-reports from patients indicate spontaneous improvement in language function but still need to be verified. To explore the improvements in motor and language function after CC7 surgery, we performed this prospective observational cohort study. The Upper Extremity part of Fugl-Meyer scale (UEFM) and Modified Ashworth Scale were used to evaluate motor function, and Aphasia Quotient calculated by Mandarin version of the Western Aphasia Battery (WAB-AQ, larger score indicates better language function) was assessed for language function. In 20 patients included, the average scores of UEFM increased by .40 and 3.70 points from baseline to 1-week and 6-month post-surgery, respectively. The spasticity of the elbow and fingers decreased significantly at 1-week post-surgery, although partially recurred at 6-month follow-up. The average scores of WAB-AQ were increased by 9.14 and 10.69 points at 1-week and 6-month post-surgery (P < .001 for both), respectively. Post-surgical fMRI scans revealed increased activity in the bilateral hemispheres related to language centrals, including the right precentral cortex and right gyrus rectus. These findings suggest that CC7 surgery not only enhances motor function but may also improve the aphasia quotient in patients with right arm paralysis and aphasia due to left hemisphere injuries.
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Affiliation(s)
- Juntao Feng
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Xingyi Ma
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Tie Li
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Miaomiao Xu
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Jingrui Yang
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Fan Su
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Ruiping Hu
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Jie Li
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Yanqun Qiu
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Ying Liu
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
| | - Yundong Shen
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
- Institute of Brain Science, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Wendong Xu
- Department of Hand Surgery, Department of Rehabilitation, Jing'an District Central Hospital, branch of Huashan Hospital, the National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Shanghai, China
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Zhang Y, Tang YW, Peng YT, Yan Z, Zhou J, Yue ZH. Acupuncture, an effective treatment for post-stroke neurologic dysfunction. Brain Res Bull 2024; 215:111035. [PMID: 39069104 DOI: 10.1016/j.brainresbull.2024.111035] [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: 06/01/2024] [Revised: 07/19/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024]
Abstract
Stroke episodes represent a significant subset of cerebrovascular diseases globally, often resulting in diverse neurological impairments such as hemiparesis, spasticity, dysphagia, sensory dysfunction, cognitive impairment, depression, aphasia, and other sequelae. These dysfunctions markedly diminish patients' quality of life and impose substantial burdens on their families and society. Consequently, the restoration of neurological function post-stroke remains a primary objective of clinical treatment. Acupuncture, a traditional Chinese medicine technique, is endorsed by the World Health Organization (WHO) for stroke treatment due to its distinct advantages in managing cerebrovascular diseases, including ischemic stroke. Numerous clinical studies have substantiated the efficacy of acupuncture in ameliorating neurological dysfunctions following stroke. This review systematically examines the improvements in post-stroke neurological dysfunction attributable to acupuncture treatment and elucidates potential mechanisms of action proposed in recent years. Additionally, this article aims to present novel therapeutic concepts and strategies for the clinical management of post-stroke neurological dysfunction.
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Affiliation(s)
- You Zhang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Yi-Wen Tang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Yu-Ting Peng
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Zi Yan
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Jin Zhou
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Zeng-Hui Yue
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China.
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You T, Wang Y, Chen S, Dong Q, Yu J, Cui M. Vascular cognitive impairment: Advances in clinical research and management. Chin Med J (Engl) 2024:00029330-990000000-01159. [PMID: 39048312 DOI: 10.1097/cm9.0000000000003220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Indexed: 07/27/2024] Open
Abstract
ABSTRACT Vascular cognitive impairment (VCI) encompasses a wide spectrum of cognitive disorders, ranging from mild cognitive impairment to vascular dementia. Its diagnosis relies on thorough clinical evaluations and neuroimaging. VCI predominately arises from vascular risk factors (VRFs) and cerebrovascular disease, either independently or in conjunction with neurodegeneration. Growing evidence underscores the prevalence of VRFs, highlighting their potential for early prediction of cognitive impairment and dementia in later life. The precise mechanisms linking vascular pathologies to cognitive deficits remain elusive. Chronic cerebrovascular pathology is the most common neuropathological feature of VCI, often interacting synergistically with neurodegenerative processes. Current research efforts are focused on developing and validating reliable biomarkers to unravel the etiology of vascular brain changes in VCI. The collaborative integration of these biomarkers into clinical practice, alongside routine incorporation into neuropathological assessments, presents a promising strategy for predicting and stratifying VCI. The cornerstone of VCI prevention remains the control of VRFs, which includes multi-domain lifestyle modifications. Identifying appropriate pharmacological approaches is also of paramount importance. In this review, we synthesize recent advancements in the field of VCI, including its definition, determinants of vascular risk, pathophysiology, neuroimaging and fluid-correlated biomarkers, predictive methodologies, and current intervention strategies. Increasingly evident is the notion that more rigorous research for VCI, which arises from a complex interplay of physiological events, is still needed to pave the way for better clinical outcomes and enhanced quality of life for affected individuals.
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Affiliation(s)
- Tongyao You
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yingzhe Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shufen Chen
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jintai Yu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200040, China
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Arheix-Parras S, Franco J, Siklafidou IP, Villain M, Rogue C, Python G, Glize B. Neuromodulation of the Right Motor Cortex of the Lips With Repetitive Transcranial Magnetic Stimulation to Reduce Phonological Impairment and Improve Naming in Three Persons With Aphasia: A Single-Case Experimental Design. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:2023-2040. [PMID: 38875479 DOI: 10.1044/2024_ajslp-23-00215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
PURPOSE Repetitive transcranial magnetic stimulation (rTMS) can enhance aphasia recovery. Most studies have used inhibitory stimulation targeting the right inferior frontal gyrus. However, the motor cortex, observed to contribute to the prediction of aphasia recovery, is involved in word production and could be an appropriate target for rTMS. We aimed to observe behavioral changes in a picture naming task induced by inhibitory rTMS targeting the right motor cortex of the lips in people with poststroke aphasia. METHOD Using a single-case experimental design, we included three participants with chronic poststroke aphasia who had phonological deficits. Each participant performed a verbal picture naming task 3 times a week for 2, 3, or 4 weeks (pseudorandom across participants) to establish a baseline naming ability for each participant. These were not therapy sessions, and no feedback was provided. Then, each participant received the intervention, inhibitory continuous theta burst stimulation targeting the right motor cortex of the lips, 3 times a week for 2 weeks. Naming testing continued 3 times a week, for these latter 2 weeks. No therapy was performed at any time during the study. RESULTS Visual analysis of the graphs showed a positive effect of rTMS for P2 and P3 on picture naming accuracy and a tendency toward improvement for P1. Statistical analysis showed an improvement after rTMS for P1 (τ = 0.544, p = .013, SETau = 0.288) and P2 (τ = 0.708, p = .001, SETau = 0.235). For P3, even if the intervention allowed some improvement, this was statistically nonsignificant due to a learning effect during the baseline naming testing, which lasted the longest, 4 weeks. Regarding specific language features, phonological errors significantly decreased in all patients. CONCLUSIONS The motor cortex of the lips could be an appropriate target for rTMS to improve naming in people with poststroke aphasia suffering from a phonological deficit. This suggests the possibility to individualize the target for rTMS, according to the patient's linguistic impairment.
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Affiliation(s)
- Sophie Arheix-Parras
- ACTIVE Team, Bordeaux Population Health, University of Bordeaux, France
- Institut Universitaire des Sciences de la Réadaptation, University of Bordeaux, France
| | - Julie Franco
- Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
| | | | - Marie Villain
- Department of Physical and Rehabilitation Medicine, AP-HP La Pitié Salpêtrière - Charles Foix University Hospital, France
- AP-HP, Handicap Moteur et Cognitif & Réadaptation, Sorbonne Université, Paris, France
- ICM, INSERM UMRS 1127, CNRS, UMR 7225, Brain and Spine Institute, Paris, France
| | - Caroline Rogue
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier Universitaire de Bordeaux, France
| | - Grégoire Python
- Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital, Switzerland
| | - Bertrand Glize
- ACTIVE Team, Bordeaux Population Health, University of Bordeaux, France
- Institut Universitaire des Sciences de la Réadaptation, University of Bordeaux, France
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier Universitaire de Bordeaux, France
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Teghipco A, Newman-Norlund R, Fridriksson J, Rorden C, Bonilha L. Distinct brain morphometry patterns revealed by deep learning improve prediction of post-stroke aphasia severity. COMMUNICATIONS MEDICINE 2024; 4:115. [PMID: 38866977 PMCID: PMC11169346 DOI: 10.1038/s43856-024-00541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Emerging evidence suggests that post-stroke aphasia severity depends on the integrity of the brain beyond the lesion. While measures of lesion anatomy and brain integrity combine synergistically to explain aphasic symptoms, substantial interindividual variability remains unaccounted. One explanatory factor may be the spatial distribution of morphometry beyond the lesion (e.g., atrophy), including not just specific brain areas, but distinct three-dimensional patterns. METHODS Here, we test whether deep learning with Convolutional Neural Networks (CNNs) on whole brain morphometry (i.e., segmented tissue volumes) and lesion anatomy better predicts chronic stroke individuals with severe aphasia (N = 231) than classical machine learning (Support Vector Machines; SVMs), evaluating whether encoding spatial dependencies identifies uniquely predictive patterns. RESULTS CNNs achieve higher balanced accuracy and F1 scores, even when SVMs are nonlinear or integrate linear or nonlinear dimensionality reduction. Parity only occurs when SVMs access features learned by CNNs. Saliency maps demonstrate that CNNs leverage distributed morphometry patterns, whereas SVMs focus on the area around the lesion. Ensemble clustering of CNN saliencies reveals distinct morphometry patterns unrelated to lesion size, consistent across individuals, and which implicate unique networks associated with different cognitive processes as measured by the wider neuroimaging literature. Individualized predictions depend on both ipsilateral and contralateral features outside the lesion. CONCLUSIONS Three-dimensional network distributions of morphometry are directly associated with aphasia severity, underscoring the potential for CNNs to improve outcome prognostication from neuroimaging data, and highlighting the prospective benefits of interrogating spatial dependence at different scales in multivariate feature space.
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Affiliation(s)
- Alex Teghipco
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Roger Newman-Norlund
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Christopher Rorden
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, School of Medicine, University of South Carolina, Columbia, SC, USA
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Terruzzi S, Albini F, Massetti G, Etzi R, Gallace A, Vallar G. The Neuropsychological Assessment of Unilateral Spatial Neglect Through Computerized and Virtual Reality Tools: A Scoping Review. Neuropsychol Rev 2024; 34:363-401. [PMID: 36913099 PMCID: PMC10009867 DOI: 10.1007/s11065-023-09586-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 09/28/2022] [Indexed: 03/14/2023]
Abstract
Unilateral Spatial Neglect is a disabling neuropsychological deficit. Patients with spatial neglect fail to detect and report events, and to perform actions in the side of space contralateral to a hemispheric cerebral lesion. Neglect is assessed by evaluating the patients' abilities in daily life activities and by psychometric tests. Computer-based, portable and Virtual Reality technologies may provide more and precise data, and be more sensitive and informative, compared to current paper-and-pencil procedures. Studies since 2010, in which such technologies have been used, are reviewed. Forty-two articles meeting inclusion criteria are categorized according to their technological approaches (computer-, graphics tablet or tablet-, virtual reality-based assessment, and other). The results are promising. However, a definite golden standard, technologically based procedure cannot be still established. Developing technologically based tests is a laborious process, which requires technical and user experience improvements as well as normative data, to increase the evidence of efficacy for clinical evaluation of at least some of the tests considered in this review.
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Affiliation(s)
- Stefano Terruzzi
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy.
- Neurocognitive Rehabilitation Center (CeRiN), University of Trento, Rovereto, Italy.
| | - Federica Albini
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Gemma Massetti
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Roberta Etzi
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Alberto Gallace
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Vallar
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.
- Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy.
- Neuropsychological Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, Milan, Italy.
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10
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Han Y, Jing Y, Shi Y, Mo H, Wan Y, Zhou H, Deng F. The role of language-related functional brain regions and white matter tracts in network plasticity of post-stroke aphasia. J Neurol 2024; 271:3095-3115. [PMID: 38607432 DOI: 10.1007/s00415-024-12358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
The neural mechanisms underlying language recovery after a stroke remain controversial. This review aimed to summarize the plasticity and reorganization mechanisms of the language network through neuroimaging studies. Initially, we discussed the involvement of right language homologues, perilesional tissue, and domain-general networks. Subsequently, we summarized the white matter functional mapping and remodeling mechanisms associated with language subskills. Finally, we explored how non-invasive brain stimulation (NIBS) promoted language recovery by inducing neural network plasticity. It was observed that the recruitment of right hemisphere language area homologues played a pivotal role in the early stages of frontal post-stroke aphasia (PSA), particularly in patients with larger lesions. Perilesional plasticity correlated with improved speech performance and prognosis. The domain-general networks could respond to increased "effort" in a task-dependent manner from the top-down when the downstream language network was impaired. Fluency, repetition, comprehension, naming, and reading skills exhibited overlapping and unique dual-pathway functional mapping models. In the acute phase, the structural remodeling of white matter tracts became challenging, with recovery predominantly dependent on cortical activation. Similar to the pattern of cortical activation, during the subacute and chronic phases, improvements in language functions depended, respectively, on the remodeling of right white matter tracts and the restoration of left-lateralized language structural network patterns. Moreover, the midline superior frontal gyrus/dorsal anterior cingulate cortex emerged as a promising target for NIBS. These findings offered theoretical insights for the early personalized treatment of aphasia after stroke.
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Affiliation(s)
- Yue Han
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yuanyuan Jing
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yanmin Shi
- Health Management (Physical Examination) Center, The Second Norman Bethune Hospital of Jilin University, Changchun, China
| | - Hongbin Mo
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yafei Wan
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hongwei Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, China.
| | - Fang Deng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
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11
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Sihvonen AJ, Pitkäniemi A, Siponkoski ST, Kuusela L, Martínez-Molina N, Laitinen S, Särkämö ER, Pekkola J, Melkas S, Schlaug G, Sairanen V, Särkämö T. Structural Neuroplasticity Effects of Singing in Chronic Aphasia. eNeuro 2024; 11:ENEURO.0408-23.2024. [PMID: 38688718 DOI: 10.1523/eneuro.0408-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/28/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine the structural neuroplasticity changes underpinning group-based singing-induced treatment effects in chronic aphasia. Twenty-eight patients with at least mild nonfluent poststroke aphasia were randomized into two groups that received a 4-month multicomponent singing intervention (singing group) or standard care (control group). High-resolution T1 images and multishell diffusion-weighted MRI data were collected in two time points (baseline/5 months). Structural gray matter (GM) and white matter (WM) neuroplasticity changes were assessed using language network region of interest-based voxel-based morphometry (VBM) and quantitative anisotropy-based connectometry, and their associations to improved language outcomes (Western Aphasia Battery Naming and Repetition) were evaluated. Connectometry analyses showed that the singing group enhanced structural WM connectivity in the left arcuate fasciculus (AF) and corpus callosum as well as in the frontal aslant tract (FAT), superior longitudinal fasciculus, and corticostriatal tract bilaterally compared with the control group. Moreover, in VBM, the singing group showed GM volume increase in the left inferior frontal cortex (Brodmann area 44) compared with the control group. The neuroplasticity effects in the left BA44, AF, and FAT correlated with improved naming abilities after the intervention. These findings suggest that in the poststroke aphasia group, singing can bring about structural neuroplasticity changes in left frontal language areas and in bilateral language pathways, which underpin treatment-induced improvement in speech production.
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Affiliation(s)
- Aleksi J Sihvonen
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre and UQ Centre for Clinical Research, The University of Queensland, Brisbane QLD 4072, Australia
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Anni Pitkäniemi
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | - Sini-Tuuli Siponkoski
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | - Linda Kuusela
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Noelia Martínez-Molina
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | | | | | - Johanna Pekkola
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Gottfried Schlaug
- Department of Neurology, UMass Medical School, Springfield, Massachusetts 01655
- Department of Biomedical Engineering and Institute of Applied Life Sciences, UMass Amherst, Amherst, Massachusetts 01655
| | - Viljami Sairanen
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki 00029, Finland
| | - Teppo Särkämö
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
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12
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Fedorenko E, Ivanova AA, Regev TI. The language network as a natural kind within the broader landscape of the human brain. Nat Rev Neurosci 2024; 25:289-312. [PMID: 38609551 DOI: 10.1038/s41583-024-00802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/14/2024]
Abstract
Language behaviour is complex, but neuroscientific evidence disentangles it into distinct components supported by dedicated brain areas or networks. In this Review, we describe the 'core' language network, which includes left-hemisphere frontal and temporal areas, and show that it is strongly interconnected, independent of input and output modalities, causally important for language and language-selective. We discuss evidence that this language network plausibly stores language knowledge and supports core linguistic computations related to accessing words and constructions from memory and combining them to interpret (decode) or generate (encode) linguistic messages. We emphasize that the language network works closely with, but is distinct from, both lower-level - perceptual and motor - mechanisms and higher-level systems of knowledge and reasoning. The perceptual and motor mechanisms process linguistic signals, but, in contrast to the language network, are sensitive only to these signals' surface properties, not their meanings; the systems of knowledge and reasoning (such as the system that supports social reasoning) are sometimes engaged during language use but are not language-selective. This Review lays a foundation both for in-depth investigations of these different components of the language processing pipeline and for probing inter-component interactions.
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Affiliation(s)
- Evelina Fedorenko
- Brain and Cognitive Sciences Department, Massachusetts Institute of Technology, Cambridge, MA, USA.
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- The Program in Speech and Hearing in Bioscience and Technology, Harvard University, Cambridge, MA, USA.
| | - Anna A Ivanova
- School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Tamar I Regev
- Brain and Cognitive Sciences Department, Massachusetts Institute of Technology, Cambridge, MA, USA
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
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13
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Billot A, Kiran S. Disentangling neuroplasticity mechanisms in post-stroke language recovery. BRAIN AND LANGUAGE 2024; 251:105381. [PMID: 38401381 PMCID: PMC10981555 DOI: 10.1016/j.bandl.2024.105381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/28/2023] [Accepted: 01/12/2024] [Indexed: 02/26/2024]
Abstract
A major objective in post-stroke aphasia research is to gain a deeper understanding of neuroplastic mechanisms that drive language recovery, with the ultimate goal of enhancing treatment outcomes. Subsequent to recent advances in neuroimaging techniques, we now have the ability to examine more closely how neural activity patterns change after a stroke. However, the way these neural activity changes relate to language impairments and language recovery is still debated. The aim of this review is to provide a theoretical framework to better investigate and interpret neuroplasticity mechanisms underlying language recovery in post-stroke aphasia. We detail two sets of neuroplasticity mechanisms observed at the synaptic level that may explain functional neuroimaging findings in post-stroke aphasia recovery at the network level: feedback-based homeostatic plasticity and associative Hebbian plasticity. In conjunction with these plasticity mechanisms, higher-order cognitive control processes dynamically modulate neural activity in other regions to meet communication demands, despite reduced neural resources. This work provides a network-level neurobiological framework for understanding neural changes observed in post-stroke aphasia and can be used to define guidelines for personalized treatment development.
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Affiliation(s)
- Anne Billot
- Center for Brain Recovery, Boston University, Boston, USA; Department of Psychology, Center for Brain Science, Harvard University, Cambridge, Massachusetts, USA; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Swathi Kiran
- Center for Brain Recovery, Boston University, Boston, USA.
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14
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Dai Z, Song L, Luo C, Liu D, Li M, Han Z. Hemispheric lateralization of language processing: insights from network-based symptom mapping and patient subgroups. Cereb Cortex 2024; 34:bhad437. [PMID: 38031356 DOI: 10.1093/cercor/bhad437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
The hemispheric laterality of language processing has become a hot topic in modern neuroscience. Although most previous studies have reported left-lateralized language processing, other studies found it to be bilateral. A previous neurocomputational model has proposed a unified framework to explain that the above discrepancy might be from healthy and patient individuals. This model posits an initial symmetry but imbalanced capacity in language processing for healthy individuals, with this imbalance contributing to language recovery disparities following different hemispheric injuries. The present study investigated this model by analyzing the lateralization patterns of language subnetworks across multiple attributes with a group of 99 patients (compared to nonlanguage processing) and examining the lateralization patterns of language subnetworks in subgroups with damage to different hemispheres. Subnetworks were identified using a whole-brain network-based lesion-symptom mapping method, and the lateralization index was quantitatively measured. We found that all the subnetworks in language processing were left-lateralized, while subnetworks in nonlanguage processing had different lateralization patterns. Moreover, diverse hemisphere-injury subgroups exhibited distinct language recovery effects. These findings provide robust support for the proposed neurocomputational model of language processing.
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Affiliation(s)
- Zhiyun Dai
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Luping Song
- Shenzhen Sixth People's Hospital (Nanshan Hospital), Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518052, China
| | - Chongjing Luo
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Di Liu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Mingyang Li
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Yuquan Campus, Hangzhou 310027, China
| | - Zaizhu Han
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
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15
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Močilnik V, Rutar Gorišek V, Sajovic J, Pretnar Oblak J, Drevenšek G, Rogelj P. Integrating EEG and Machine Learning to Analyze Brain Changes during the Rehabilitation of Broca's Aphasia. SENSORS (BASEL, SWITZERLAND) 2024; 24:329. [PMID: 38257423 PMCID: PMC10818958 DOI: 10.3390/s24020329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
The fusion of electroencephalography (EEG) with machine learning is transforming rehabilitation. Our study introduces a neural network model proficient in distinguishing pre- and post-rehabilitation states in patients with Broca's aphasia, based on brain connectivity metrics derived from EEG recordings during verbal and spatial working memory tasks. The Granger causality (GC), phase-locking value (PLV), weighted phase-lag index (wPLI), mutual information (MI), and complex Pearson correlation coefficient (CPCC) across the delta, theta, and low- and high-gamma bands were used (excluding GC, which spanned the entire frequency spectrum). Across eight participants, employing leave-one-out validation for each, we evaluated the intersubject prediction accuracy across all connectivity methods and frequency bands. GC, MI theta, and PLV low-gamma emerged as the top performers, achieving 89.4%, 85.8%, and 82.7% accuracy in classifying verbal working memory task data. Intriguingly, measures designed to eliminate volume conduction exhibited the poorest performance in predicting rehabilitation-induced brain changes. This observation, coupled with variations in model performance across frequency bands, implies that different connectivity measures capture distinct brain processes involved in rehabilitation. The results of this paper contribute to current knowledge by presenting a clear strategy of utilizing limited data to achieve valid and meaningful results of machine learning on post-stroke rehabilitation EEG data, and they show that the differences in classification accuracy likely reflect distinct brain processes underlying rehabilitation after stroke.
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Affiliation(s)
- Vanesa Močilnik
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia (J.P.O.); (G.D.)
| | | | - Jakob Sajovic
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia (J.P.O.); (G.D.)
- University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Janja Pretnar Oblak
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia (J.P.O.); (G.D.)
- University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Gorazd Drevenšek
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia (J.P.O.); (G.D.)
- Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, 6000 Koper, Slovenia;
| | - Peter Rogelj
- Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, 6000 Koper, Slovenia;
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16
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Cao Y, Fan C, Li G, Huang J, Zhang J. A computer-aid speech rehabilitation system with mirrored video generating. Technol Health Care 2024; 32:543-553. [PMID: 38759075 PMCID: PMC11191434 DOI: 10.3233/thc-248047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND Aphasia is a communication disorder that affects the ability to process and produce language, which severely impacting their lives. Computer-aid exercise rehabilitation has shown to be highly effective for these patients. OBJECTIVE In our study, we proposed a speech rehabilitation system with mirrored therapy. The study goal is to construct a effective rehabilitation software for aphasia patients. METHODS This system collects patients' facial photos for mirrored video generation and speech synthesis. The visual feedback provided by the mirror creates an engaging and motivating experience for patients. And the evaluation platform employs machine learning technologies for assessing speech similarity. RESULTS The sophisticated task-oriented rehabilitation training with mirror therapy is also presented for experiments performing. The performance of three tasks reaches the average scores of 83.9% for vowel exercises, 74.3% for word exercies and 77.8% for sentence training in real time. CONCLUSIONS The user-friendly application system allows patients to carry out daily training tasks instructed by the therapists or the prompt information of menu. Our work demonstrated a promising intelligent mirror software system for reading-based aphasia rehabilitation.
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Affiliation(s)
- Yang Cao
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Chunjiang Fan
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Gang Li
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Jian Huang
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Jinli Zhang
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Wuxi, Jiangsu, China
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17
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Luo Y, Wang K, Jiao S, Zeng J, Han Z. Distinct parallel activation and interaction between dorsal and ventral pathways during phonological and semantic processing: A cTBS-fMRI study. Hum Brain Mapp 2024; 45:e26569. [PMID: 38224540 PMCID: PMC10785560 DOI: 10.1002/hbm.26569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024] Open
Abstract
Successful visual word recognition requires the integration of phonological and semantic information, which is supported by the dorsal and ventral pathways in the brain. However, the functional specialization or interaction of these pathways during phonological and semantic processing remains unclear. Previous research has been limited by its dependence on correlational functional magnetic resonance imaging (fMRI) results or causal validation using patient populations, which are susceptible to confounds such as plasticity and lesion characteristics. To address this, the present study employed continuous theta-burst stimulation combined with fMRI in a within-subject design to assess rapid adaptation in regional activity and functional connectivity of the dorsal and ventral pathways during phonological and semantic tasks. This assessment followed the precise inhibition of the left inferior parietal lobule and anterior temporal lobe in the dorsal and ventral pathways, respectively. Our results reveal that both the dorsal and ventral pathways were activated during phonological and semantic processing, while the adaptation activation and interactive network were modulated by the task type and inhibited region. The two pathways exhibited interconnectivity in phonological processing, and disruption of either pathway led to rapid adaptation across both pathways. In contrast, only the ventral pathway exhibited connectivity in semantic processing, and disruption of this pathway alone resulted in adaptive effects primarily in the ventral pathway. These findings provide essential evidence supporting the interactive theory, phonological information processing in particular, potentially providing meaningful implications for clinical populations.
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Affiliation(s)
- Yudan Luo
- National Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain ResearchBeijing Normal UniversityBeijingChina
| | - Ke Wang
- National Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain ResearchBeijing Normal UniversityBeijingChina
- School of System ScienceBeijing Normal UniversityBeijingChina
| | - Saiyi Jiao
- National Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain ResearchBeijing Normal UniversityBeijingChina
| | - Jiahong Zeng
- National Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain ResearchBeijing Normal UniversityBeijingChina
| | - Zaizhu Han
- National Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain ResearchBeijing Normal UniversityBeijingChina
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18
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Stulberg EL, Sachdev PS, Murray AM, Cramer SC, Sorond FA, Lakshminarayan K, Sabayan B. Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review. J Clin Med 2023; 12:7413. [PMID: 38068464 PMCID: PMC10706919 DOI: 10.3390/jcm12237413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 01/22/2024] Open
Abstract
Significant advancements have been made in recent years in the acute treatment and secondary prevention of stroke. However, a large proportion of stroke survivors will go on to have enduring physical, cognitive, and psychological disabilities from suboptimal post-stroke brain health. Impaired brain health following stroke thus warrants increased attention from clinicians and researchers alike. In this narrative review based on an open timeframe search of the PubMed, Scopus, and Web of Science databases, we define post-stroke brain health and appraise the body of research focused on modifiable vascular, lifestyle, and psychosocial factors for optimizing post-stroke brain health. In addition, we make clinical recommendations for the monitoring and management of post-stroke brain health at major post-stroke transition points centered on four key intertwined domains: cognition, psychosocial health, physical functioning, and global vascular health. Finally, we discuss potential future work in the field of post-stroke brain health, including the use of remote monitoring and interventions, neuromodulation, multi-morbidity interventions, enriched environments, and the need to address inequities in post-stroke brain health. As post-stroke brain health is a relatively new, rapidly evolving, and broad clinical and research field, this narrative review aims to identify and summarize the evidence base to help clinicians and researchers tailor their own approach to integrating post-stroke brain health into their practices.
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Affiliation(s)
- Eric L. Stulberg
- Department of Neurology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW 2052, Australia;
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Minneapolis, MN 55415, USA;
- Department of Medicine, Geriatrics Division, Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA
| | - Steven C. Cramer
- Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA;
- California Rehabilitation Institute, Los Angeles, CA 90067, USA
| | - Farzaneh A. Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Behnam Sabayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Neurology, Hennepin Healthcare Research Institute, Minneapolis, MN 55404, USA
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19
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Abstract
Neurological insults, such as congenital blindness, deafness, amputation, and stroke, often result in surprising and impressive behavioural changes. Cortical reorganisation, which refers to preserved brain tissue taking on a new functional role, is often invoked to account for these behavioural changes. Here, we revisit many of the classical animal and patient cortical remapping studies that spawned this notion of reorganisation. We highlight empirical, methodological, and conceptual problems that call this notion into doubt. We argue that appeal to the idea of reorganisation is attributable in part to the way that cortical maps are empirically derived. Specifically, cortical maps are often defined based on oversimplified assumptions of 'winner-takes-all', which in turn leads to an erroneous interpretation of what it means when these maps appear to change. Conceptually, remapping is interpreted as a circuit receiving novel input and processing it in a way unrelated to its original function. This implies that neurons are either pluripotent enough to change what they are tuned to or that a circuit can change what it computes. Instead of reorganisation, we argue that remapping is more likely to occur due to potentiation of pre-existing architecture that already has the requisite representational and computational capacity pre-injury. This architecture can be facilitated via Hebbian and homeostatic plasticity mechanisms. Crucially, our revised framework proposes that opportunities for functional change are constrained throughout the lifespan by the underlying structural 'blueprint'. At no period, including early in development, does the cortex offer structural opportunities for functional pluripotency. We conclude that reorganisation as a distinct form of cortical plasticity, ubiquitously evoked with words such as 'take-over'' and 'rewiring', does not exist.
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Affiliation(s)
- Tamar R Makin
- MRC Cognition and Brain Sciences Unit, University of CambridgeCambridgeUnited Kingdom
| | - John W Krakauer
- Department of Neuroscience, Johns Hopkins University School of MedicineBaltimoreUnited States
- Department of Neurology, Johns Hopkins University School of MedicineBaltimoreUnited States
- The Santa Fe InstituteSanta FeUnited States
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20
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Campos B, Choi H, DeMarco AT, Seydell-Greenwald A, Hussain SJ, Joy MT, Turkeltaub PE, Zeiger W. Rethinking Remapping: Circuit Mechanisms of Recovery after Stroke. J Neurosci 2023; 43:7489-7500. [PMID: 37940595 PMCID: PMC10634578 DOI: 10.1523/jneurosci.1425-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 11/10/2023] Open
Abstract
Stroke is one of the most common causes of disability, and there are few treatments that can improve recovery after stroke. Therapeutic development has been hindered because of a lack of understanding of precisely how neural circuits are affected by stroke, and how these circuits change to mediate recovery. Indeed, some of the hypotheses for how the CNS changes to mediate recovery, including remapping, redundancy, and diaschisis, date to more than a century ago. Recent technological advances have enabled the interrogation of neural circuits with ever greater temporal and spatial resolution. These techniques are increasingly being applied across animal models of stroke and to human stroke survivors, and are shedding light on the molecular, structural, and functional changes that neural circuits undergo after stroke. Here we review these studies and highlight important mechanisms that underlie impairment and recovery after stroke. We begin by summarizing knowledge about changes in neural activity that occur in the peri-infarct cortex, specifically considering evidence for the functional remapping hypothesis of recovery. Next, we describe the importance of neural population dynamics, disruptions in these dynamics after stroke, and how allocation of neurons into spared circuits can restore functionality. On a more global scale, we then discuss how effects on long-range pathways, including interhemispheric interactions and corticospinal tract transmission, contribute to post-stroke impairments. Finally, we look forward and consider how a deeper understanding of neural circuit mechanisms of recovery may lead to novel treatments to reduce disability and improve recovery after stroke.
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Affiliation(s)
- Baruc Campos
- Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095
| | - Hoseok Choi
- Department of Neurology, Weill Institute for Neuroscience, University of California-San Francisco, San Francisco, California 94158
| | - Andrew T DeMarco
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
| | - Anna Seydell-Greenwald
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
- MedStar National Rehabilitation Hospital, Washington, DC 20010
| | - Sara J Hussain
- Movement and Cognitive Rehabilitation Science Program, Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas 78712
| | - Mary T Joy
- The Jackson Laboratory, Bar Harbor, Maine 04609
| | - Peter E Turkeltaub
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Georgetown University, Washington, DC 20057
- MedStar National Rehabilitation Hospital, Washington, DC 20010
| | - William Zeiger
- Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095
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21
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Wu W, Hoffman P. Age differences in the neural processing of semantics, within and beyond the core semantic network. Neurobiol Aging 2023; 131:88-105. [PMID: 37603932 DOI: 10.1016/j.neurobiolaging.2023.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023]
Abstract
Aging is associated with functional activation changes in domain-specific regions and large-scale brain networks. This preregistered Functional magnetic resonance imaging (fMRI) study investigated these effects within the domain of semantic cognition. Participants completed 1 nonsemantic and 2 semantic tasks. We found no age differences in semantic activation in core semantic regions. However, the right inferior frontal gyrus showed difficulty-related increases in both age groups. This suggests that age-related upregulation of this area may be a compensatory response to increased processing demands. At a network level, older people showed more engagement in the default mode network and less in the executive multiple-demand network, aligning with older people's greater knowledge reserves and executive declines. In contrast, activation was age-invariant in semantic control regions. Finally, older adults showed reduced demand-related modulation of multiple-demand network activation in the nonsemantic task but not the semantic tasks. These findings provide a new perspective on the neural basis of semantic cognition in aging, suggesting that preserved function in specialized semantic networks may help to maintain semantic cognition in later life.
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Affiliation(s)
- Wei Wu
- School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, UK.
| | - Paul Hoffman
- School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, UK.
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22
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Pulvermüller F. Neurobiological mechanisms for language, symbols and concepts: Clues from brain-constrained deep neural networks. Prog Neurobiol 2023; 230:102511. [PMID: 37482195 PMCID: PMC10518464 DOI: 10.1016/j.pneurobio.2023.102511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/02/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
Neural networks are successfully used to imitate and model cognitive processes. However, to provide clues about the neurobiological mechanisms enabling human cognition, these models need to mimic the structure and function of real brains. Brain-constrained networks differ from classic neural networks by implementing brain similarities at different scales, ranging from the micro- and mesoscopic levels of neuronal function, local neuronal links and circuit interaction to large-scale anatomical structure and between-area connectivity. This review shows how brain-constrained neural networks can be applied to study in silico the formation of mechanisms for symbol and concept processing and to work towards neurobiological explanations of specifically human cognitive abilities. These include verbal working memory and learning of large vocabularies of symbols, semantic binding carried by specific areas of cortex, attention focusing and modulation driven by symbol type, and the acquisition of concrete and abstract concepts partly influenced by symbols. Neuronal assembly activity in the networks is analyzed to deliver putative mechanistic correlates of higher cognitive processes and to develop candidate explanations founded in established neurobiological principles.
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Affiliation(s)
- Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, WE4, Freie Universität Berlin, 14195 Berlin, Germany; Berlin School of Mind and Brain, Humboldt Universität zu Berlin, 10099 Berlin, Germany; Einstein Center for Neurosciences Berlin, 10117 Berlin, Germany; Cluster of Excellence 'Matters of Activity', Humboldt Universität zu Berlin, 10099 Berlin, Germany.
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23
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Meier EL, Bunker LD, Kim H, Hillis AE. Resting-State Connectivity in Acute and Subacute Poststroke Aphasia: A Functional Near-Infrared Spectroscopy Pilot Study. Brain Connect 2023; 13:441-452. [PMID: 37097208 PMCID: PMC10618818 DOI: 10.1089/brain.2022.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Background: Understanding how brain function and language skills change during early (acute and subacute) stroke phases is critical for maximizing patient recovery, yet functional neuroimaging studies of early aphasia are scarce. In this pilot study, we used functional near-infrared spectroscopy (fNIRS) to investigate how resting-state functional connectivity (rs-FC) in early aphasia differs from neurologically healthy adults and is related to language deficits. Materials and Methods: Twenty individuals with aphasia (12 acute and 8 subacute phase) and 15 healthy controls underwent rs-fNIRS imaging with a 46-channel montage centered over bilateral perisylvian language areas. FC was computed using a prewhitening, autoregressive Pearson correlation routine applied to preprocessed oxyhemoglobin (HbO) data. Connections were classified as left intra-, right intra-, or interhemispheric. We then compared rs-FC between groups by connection type and examined Spearman correlations between rs-FC averages and language measures within patients. Results: Participants in the acute phase had significantly reduced global rs-FC across all HbO-based connections compared to healthy controls. No significant differences were found in rs-FC between controls and patients in the subacute phase. Controlling for days since stroke, stronger right intra- and interhemispheric rs-FC was related to milder aphasia across all patients. Exploratory correlations revealed that relationships between language measures and rs-FC differed between acute and subacute patient groups. Conclusion: This study provides preliminary evidence that fNIRS-based rs-FC measures may be a viable metric to index the early impacts of stroke in people with aphasia.
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Affiliation(s)
- Erin L. Meier
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lisa D. Bunker
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hana Kim
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, Maryland, USA
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24
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Ren J, Ren W, Zhou Y, Dahmani L, Duan X, Fu X, Wang Y, Pan R, Zhao J, Zhang P, Wang B, Yu W, Chen Z, Zhang X, Sun J, Ding M, Huang J, Xu L, Li S, Wang W, Xie W, Zhang H, Liu H. Personalized functional imaging-guided rTMS on the superior frontal gyrus for post-stroke aphasia: A randomized sham-controlled trial. Brain Stimul 2023; 16:1313-1321. [PMID: 37652135 DOI: 10.1016/j.brs.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Aphasia affects approximately one-third of stroke patients and yet its rehabilitation outcomes are often unsatisfactory. More effective strategies are needed to promote recovery. OBJECTIVE We aimed to examine the efficacy and safety of the theta-burst stimulation (TBS) on the language area in the superior frontal gyrus (SFG) localized by personalized functional imaging, in facilitating post-stroke aphasia recovery. METHODS This randomized sham-controlled trial uses a parallel design (intermittent TBS [iTBS] in ipsilesional hemisphere vs. continuous TBS [cTBS] in contralesional hemisphere vs. sham group). Participants had aphasia symptoms resulting from their first stroke in the left hemisphere at least one month prior. Participants received three-week speech-language therapy coupled with either active or sham stimulation applied to the left or right SFG. The primary outcome was the change in Western Aphasia Battery-Revised (WAB-R) aphasia quotient after the three-week treatment. The secondary outcome was WAB-R aphasia quotient improvement after one week of treatment. RESULTS Ninety-seven patients were screened between January 2021 and January 2022, 45 of whom were randomized and 44 received intervention (15 in each active group, 14 in sham). Both iTBS (estimated difference = 14.75, p < 0.001) and cTBS (estimated difference = 13.43, p < 0.001) groups showed significantly greater improvement than sham stimulation after the 3-week intervention and immediately after one week of treatment (p's < 0.001). The adverse events observed were similar across groups. A seizure was recorded three days after the termination of the treatment in the iTBS group. CONCLUSION The stimulation showed high efficacy and SFG is a promising stimulation target for post-stroke language recovery.
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Affiliation(s)
- Jianxun Ren
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Weijing Ren
- Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China; University of Health and Rehabilitation Sciences, Qingdao, Shandong, 266000, China
| | - Ying Zhou
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Louisa Dahmani
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Xinyu Duan
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Xiaoxuan Fu
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Yezhe Wang
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Ruiqi Pan
- Neural Galaxy Inc., Beijing, 102206, China
| | - Jingdu Zhao
- Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China
| | - Ping Zhang
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Bo Wang
- Department of Hearing and Language Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Weiyong Yu
- Department of Radiology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Zhenbo Chen
- Department of Radiology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Xin Zhang
- Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China
| | - Jian Sun
- Neural Galaxy Inc., Beijing, 102206, China
| | | | - Jianting Huang
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Biomedical Pioneering Innovation Center (BIOPIC), Peking University, Beijing, 100871, China
| | - Liu Xu
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Shiyi Li
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | | | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, 100191, China
| | - Hao Zhang
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China; University of Health and Rehabilitation Sciences, Qingdao, Shandong, 266000, China; Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250100, China.
| | - Hesheng Liu
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Biomedical Pioneering Innovation Center (BIOPIC), Peking University, Beijing, 100871, China.
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25
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Lambon Ralph MA, Stefaniak JD, Halai AD, Geranmayeh F. Reply: Are recovery of fluency and recovery of phonology antagonistic? Brain 2023; 146:e52-e54. [PMID: 36730037 DOI: 10.1093/brain/awad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 02/03/2023] Open
Affiliation(s)
| | - James D Stefaniak
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, UK
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, UK
| | - Fatemeh Geranmayeh
- Clinical Language and Cognition Group, Department of Brain Sciences, Imperial College London, Hammersmith Hospital Campus, London, W12 0NN, UK
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26
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Yan Z, He X, Cheng M, Fan X, Wei D, Xu S, Li C, Li X, Xing H, Jia J. Clinical study of melodic intonation therapy combined with transcranial direct current stimulation for post-stroke aphasia: a single-blind, randomized controlled trial. Front Neurosci 2023; 17:1088218. [PMID: 37397451 PMCID: PMC10308281 DOI: 10.3389/fnins.2023.1088218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Background Globally, more than 10 million new stroke cases occur annually, of which aphasia accounts for about one-third. Aphasia has become an independent predictor of functional dependence and death for the stroke population. The closed-loop rehabilitation of combining behavioral therapy with central nerve stimulation seems to be the research trend of post-stroke aphasia (PSA) due to its advantages in improving linguistic deficits. Objective To verify the clinical efficacy of a closed-loop rehabilitation program combining melodic intonation therapy (MIT) with transcranial direct current stimulation (tDCS) for PSA. Methods This was a single-center, assessor-blinded, randomized controlled clinical trial, which screened 179 patients and included 39 PSA subjects, with the registration number ChiCTR2200056393 in China. Demographic and clinical data were documented. The primary outcome was the Western Aphasia Battery (WAB) used to assess language function, and the secondary outcomes included Montreal Cognitive Assessment (MoCA), Fugl-Meyer Assessment (FMA), and Barthel Index (BI) for evaluating cognition, motor, and activities of daily living, respectively. With the computer-generated randomization sequence, subjects were randomly divided into the conventional group (CG), MIT combined with sham stimulation group (SG), and MIT combined with tDCS group (TG). After the three-week intervention, the functional changes in each group were analyzed by the paired sample T-test, and the functional difference between the three groups was analyzed by ANOVA. Results There was no statistical difference on the baseline. After the intervention, the WAB's aphasia quotient (WAB-AQ), MoCA, FMA, and BI were statistically different in SG and TG, including all the sub-items in WAB and FMA, while only listening comprehension, FMA, and BI were statistically different in CG. The differences of WAB-AQ, MoCA, and FMA were statistically different among the three groups, but BI was not. The post hoc test results revealed that the changes of WAB-AQ and MoCA in TG were more significant than the others. Conclusion MIT combined with tDCS can augment the positive effect on language and cognitive recovery in PSA.
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Affiliation(s)
- Zhijie Yan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinyuan He
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mangmang Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xiaoqing Fan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Dongshuai Wei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuo Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chong Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaofang Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Hongxia Xing
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Jie Jia
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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27
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Li T, Feng J, Hu R, Lv M, Chang W, Ma X, Qi W, Zhang Y, Chen X, Ding L, Gu Y, Xu W. Effect and safety of C7 neurotomy at the intervertebral foramen in patients with chronic poststroke aphasia: a multicentre, randomised, controlled study protocol. BMJ Open 2023; 13:e065173. [PMID: 37130672 PMCID: PMC10163524 DOI: 10.1136/bmjopen-2022-065173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Aphasia affects many stroke survivors; therefore, effective treatments are urgently needed. Preliminary clinical findings have suggested an association between contralateral C7-C7 cross nerve transfer and recovery from chronic aphasia. Randomised controlled trials supporting the efficacy of C7 neurotomy (NC7) are lacking. This study will explore the efficacy of NC7 at the intervertebral foramen for improving chronic poststroke aphasia. METHODS AND ANALYSIS This study protocol reports a multicentre, randomised, assessor-blinded active-controlled trial. A total of 50 patients with chronic poststroke aphasia for over 1 year and with a aphasia quotient calculated by Western Aphasia Battery Aphasia Quotient (WAB-AQ) score below 93.8 will be recruited. Participants will be randomly assigned to 1 of 2 groups (25 individuals each) to receive NC7 plus intensive speech and language therapy (iSLT), or iSLT alone programme. The primary outcome is the change in Boston Naming Test score from baseline to the first follow-up after NC7 plus 3 weeks of iSLT or iSLT alone. The secondary outcomes include the changes in the WAB-AQ, Communication Activities of Daily Living-3, International Classification of Functioning, Disability and Health (ICF) speech language function, Barthel Index, Stroke Aphasic Depression Questionnaire-hospital version and sensorimotor assessments. The study will also collect functional imaging outcomes of naming and semantic violation tasks through functional MRI and electroencephalogram to evaluate the intervention-induced neuroplasticity. ETHICS AND DISSEMINATION This study was approved by the institutional review boards of Huashan Hospital, Fudan University, and all participating institutions. The study findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2200057180.
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Affiliation(s)
- Tie Li
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Juntao Feng
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Ruiping Hu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Minzhi Lv
- Center of Evidence-Based Medicine, Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Wenshuo Chang
- Institute of Linguistics, Shanghai International Studies University, Shanghai, People's Republic of China
| | - Xingyi Ma
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wenjun Qi
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China
| | - Xiuen Chen
- Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Ling Ding
- Department of Rehabilitation, Shanghai Pudong Hospital, Shanghai, People's Republic of China
| | - Yudong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, People's Republic of China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, People's Republic of China
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28
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Zhao Y, Cox CR, Lambon Ralph MA, Halai AD. Using in vivo functional and structural connectivity to predict chronic stroke aphasia deficits. Brain 2023; 146:1950-1962. [PMID: 36346107 PMCID: PMC10151190 DOI: 10.1093/brain/awac388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Focal brain damage caused by stroke can result in aphasia and advances in cognitive neuroscience suggest that impairment may be associated with network-level disorder rather than just circumscribed cortical damage. Several studies have shown meaningful relationships between brain-behaviour using lesions; however, only a handful of studies have incorporated in vivo structural and functional connectivity. Patients with chronic post-stroke aphasia were assessed with structural (n = 68) and functional (n = 39) MRI to assess whether predicting performance can be improved with multiple modalities and if additional variance can be explained compared to lesion models alone. These neural measurements were used to construct models to predict four key language-cognitive factors: (i) phonology; (ii) semantics; (iii) executive function; and (iv) fluency. Our results showed that each factor (except executive ability) could be significantly related to each neural measurement alone; however, structural and functional connectivity models did not explain additional variance above the lesion models. We did find evidence that the structural and functional predictors may be linked to the core lesion sites. First, the predictive functional connectivity features were found to be located within functional resting-state networks identified in healthy controls, suggesting that the result might reflect functionally specific reorganization (damage to a node within a network can result in disruption to the entire network). Second, predictive structural connectivity features were located within core lesion sites, suggesting that multimodal information may be redundant in prediction modelling. In addition, we observed that the optimum sparsity within the regularized regression models differed for each behavioural component and across different imaging features, suggesting that future studies should consider optimizing hyperparameters related to sparsity per target. Together, the results indicate that the observed network-level disruption was predicted by the lesion alone and does not significantly improve model performance in predicting the profile of language impairment.
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Affiliation(s)
- Ying Zhao
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Christopher R Cox
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | | | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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29
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Vadinova V, Sihvonen AJ, Garden KL, Ziraldo L, Roxbury T, O'Brien K, Copland DA, McMahon KL, Brownsett SLE. Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke. Neurorehabil Neural Repair 2023; 37:218-227. [PMID: 37083133 PMCID: PMC10152219 DOI: 10.1177/15459683231168384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated. OBJECTIVE To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables. METHODS Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating. RESULTS The presence of severe WMH explained an additional 18% and 25% variance in early subacute (t = -3.00, p = .004) and chronic (t = -3.60, P = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores. CONCLUSIONS Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.
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Affiliation(s)
- Veronika Vadinova
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Aleksi J Sihvonen
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
- Cognitive Brain Research Unit (CBRU), University of Helsinki, Helsinki, Finland
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland
| | - Kimberley L Garden
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Laura Ziraldo
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Tracy Roxbury
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Kate O'Brien
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - David A Copland
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Queensland, Australia
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
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30
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Zhuo B, Deng S, Li B, Zhu W, Zhang M, Qin C, Meng Z. Possible Effects of Acupuncture in Poststroke Aphasia. Behav Neurol 2023; 2023:9445381. [PMID: 37091130 PMCID: PMC10115536 DOI: 10.1155/2023/9445381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 12/30/2022] [Accepted: 04/02/2023] [Indexed: 04/25/2023] Open
Abstract
Neural plasticity promotes the reorganization of language networks and is an essential recovery mechanism for poststroke aphasia (PSA). Neuroplasticity may be a pivotal bridge to elucidate the potential recovery mechanisms of acupuncture for aphasia. Therefore, understanding the neuroplasticity mechanism of acupuncture in PSA is crucial. However, the underlying therapeutic mechanism of neuroplasticity in PSA after acupuncture needs to be explored. Excitotoxicity after brain injury affects the activity of neurotransmitters and disrupts the transmission of normal neuron information. Thus, a helpful strategy of acupuncture might be to improve PSA by affecting the availability of these neurotransmitters and glutamate receptors at synapses. In addition, the regulation of neuroplasticity by acupuncture may also be related to the regulation of astrocytes. Considering the guiding significance of acupuncture for clinical treatment, it is necessary to carry out further study about the influence of acupuncture on the recovery of aphasia after stroke. This study summarizes the current research on the neural mechanism of acupuncture in treating PSA. It seeks to elucidate the potential effect of acupuncture on the recovery of PSA from the perspective of synaptic plasticity and integrity of gray and white matter.
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Affiliation(s)
- Bifang Zhuo
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shizhe Deng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Boxuan Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Weiming Zhu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Menglong Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chenyang Qin
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zhihong Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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31
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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: 3] [Impact Index Per Article: 3.0] [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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Pei S, Weiwei L, Mengqin Z, Xiaojun H. Effect of an extension speech training program based on Chinese idioms in patients with post-stroke non-fluent aphasia: A randomized controlled trial. PLoS One 2023; 18:e0281335. [PMID: 36753505 PMCID: PMC9907817 DOI: 10.1371/journal.pone.0281335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Chinese idioms have potential to act as preliminary training material in studies on post-stroke aphasia. OBJECTIVE To explore an extension speech training program that takes Chinese idioms as context and expands them into characters, words, sentences and paragraphs and evaluate the effects of this program in patients with post-stroke non-fluent aphasia. METHODS This was a randomized controlled trial. We recruited patients with post-stroke non-fluent aphasia from the Renmin Hospital of Wuhan University from January 2021 to January 2022. Participants were randomly assigned to group I and group II. Patients in group I had treatment with extension speech training based on Chinese idioms, and those in group II had treatment with conventional speech rehabilitation training. The training period in both groups was 40 min daily for 2 weeks. RESULTS A total of 70 patients (group I, n = 34; and group II, n = 36) completed the trial and were analyzed according to protocol. There were no significant differences in baseline values between both groups. After intervention, the scores of oral expression, comprehension, and reading in the Aphasia Battery Of Chinese scale and the scores of the Comprehensive Activities of Daily Living questionnaire significantly improved in both groups (P <0.05), with group I benefiting more (P <0.05). CONCLUSION This extension speech training program based on Chinese idioms can improve the language function and daily communication ability of the patients with post-stroke non-fluent aphasia. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000031825.
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Affiliation(s)
- Sun Pei
- Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Li Weiwei
- Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Zhang Mengqin
- Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - He Xiaojun
- Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan, PR China
- Department of Cadre Health Office, Renmin Hospital of Wuhan University, Wuhan, PR China
- * E-mail:
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Morozova OG, Kosheleva AN, Fedak BS, Ponomaryov VI, Yaroshevskiy AA, Kravchenko IM, Reminiak IV. PRACTICAL ASPECTS AND RESULTS OF COGNITIVE THERAPY IN THE EARLY RECOVERY PERIOD OF ISCHEMIC STROKE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2619-2623. [PMID: 36591743 DOI: 10.36740/wlek202211112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim: To determine the impact of cognitive training on the degree of cognitive functions recovery and quality of life in the early recovery period of ischemic stroke. PATIENTS AND METHODS Materials and methods: 108 patients with cerebral infarction were examined outpatiently, follow-up from 1 to 3 months from the onset of the disease. Basic assessment methods: screening index of cognitive disorders according to the Montreal Cognitive Assessment Scale (MoCA), SF-36 questionnaire. RESULTS Results and Conclusions: Comprehensive rehabilitation measures for the early recovery period of ischemic stroke achieve improvement of the cognitive sphere: a significant increase in the average score on the Montreal scale of cognitive functions assessment (MoCA scale) in both observation groups.
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Affiliation(s)
- Olga G Morozova
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
| | - Anna N Kosheleva
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
| | - Bogdan S Fedak
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
| | - Volodymyr I Ponomaryov
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
| | - Aleksandr A Yaroshevskiy
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
| | - Iryna M Kravchenko
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
| | - Inna V Reminiak
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
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Yan Z, Xu S, Wei D, He X, Li C, Zhang Y, Chen M, Zhang J, Li X, Yang Q, Jia J. Comparison of three cognitive assessment methods in post-stroke aphasia patients. Front Psychol 2022; 13:896095. [PMID: 36337480 PMCID: PMC9631299 DOI: 10.3389/fpsyg.2022.896095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background The cognitive level of post-stroke aphasia (PSA) patients is generally lower than non-aphasia patients, and cognitive impairment (CI) affects the outcome of stroke. However, for different types of PSA, what kind of cognitive assessment methods to choose is not completely clear. We investigated the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and the Non-language-based Cognitive Assessment (NLCA) to observe the evaluation effect of CI in patients with fluent aphasia (FA) and non-fluent aphasia (NFA). Methods 92 stroke patients were included in this study. Demographic and clinical data of the stroke group were documented. The language and cognition were evaluated by Western Aphasia Battery (WAB), MoCA, MMSE, and NLCA. PSA were divided into FA and NFA according to the Chinese aphasia fluency characteristic scale. Pearson’s product–moment correlation coefficient test and multiple linear regression analysis were performed to explore the relationship between the sub-items of WAB and cognitive scores. The classification rate of CI was tested by Pearson’s Chi-square test or Fisher’s exact test. Results The scores of aphasia quotient (AQ), MoCA, MMSE, and NLCA in NFA were lower than FA. AQ was positively correlated with MoCA, MMSE, and NLCA scores. Stepwise multiple linear regression analysis suggested that naming explained 70.7% of variance of MoCA and 79.9% of variance of MMSE; comprehension explained 46.7% of variance of NLCA. In the same type of PSA, there was no significant difference in the classification rate. The classification rate of CI in NFA by MoCA and MMSE was higher than that in FA. There was no significant difference in the classification rate of CI between FA and NFA by NLCA. Conclusion MoCA, MMSE, and NLCA can be applied in FA. NLCA is recommended for NFA.
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Affiliation(s)
- Zhijie Yan
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Shuo Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongshuai Wei
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinyuan He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chong Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yongli Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengye Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jingna Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xiaofang Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Qing Yang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Qing Yang,
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Jie Jia,
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Ding J, Schnur TT. Anterior connectivity critical for recovery of connected speech after stroke. Brain Commun 2022; 4:fcac266. [PMID: 36382224 PMCID: PMC9651028 DOI: 10.1093/braincomms/fcac266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/20/2022] [Accepted: 10/17/2022] [Indexed: 01/11/2023] Open
Abstract
Connected speech recovers to different degrees across people after left hemisphere stroke, but white matter predictors of differential recovery from the acute stage of stroke are unknown. We assessed changes in lexical-syntactic aspects of connected speech in a longitudinal analysis of 40 individuals (18 females) from the acute stage of left hemisphere stroke (within an average of 4 days post-stroke) to subacute (within 2 months) and chronic stages (early: 6 months, late: 1 year) while measuring the extent of acute lesions on white matter tracts to identify tracts predictive of recovery. We found that acute damage to the frontal aslant tract led to a decreased recovery of the fluency and structural complexity of connected speech during the year following left hemisphere stroke. The results were independent of baseline performance, overall lesion volume and the proportion of damage to tract-adjacent grey matter. This longitudinal analysis from acute to chronic stroke provides the first evidence that recovery of fluent and structurally complex spontaneous connected speech requires intact left frontal connectivity via the frontal aslant tract. That the frontal aslant tract was critical for recovery at early as well as later stages of stroke demonstrates that anterior connectivity plays a lasting and important role for the reorganization of function related to the successful production of connected speech.
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Affiliation(s)
- Junhua Ding
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Tatiana T Schnur
- Correspondence to: Tatiana T. Schnur Department of Neurosurgery Baylor College of Medicine 1 Baylor Plaza, Houston, TX 77030, USA E-mail:
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Chupina I, Sierpowska J, Zheng XY, Dewenter A, Piastra M, Piai V. Time course of right-hemisphere recruitment during word production following left-hemisphere damage: A single case of young stroke. Eur J Neurosci 2022; 56:5235-5259. [PMID: 36028218 PMCID: PMC9826534 DOI: 10.1111/ejn.15813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 01/11/2023]
Abstract
Our understanding of post-stroke language function is largely based on older age groups, who show increasing age-related brain pathology and neural reorganisation. To illustrate language outcomes in the young-adult brain, we present the case of J., a 23-year-old woman with chronic aphasia from a left-hemisphere stroke affecting the temporal lobe. Diffusion MRI-based tractography indicated that J.'s language-relevant white-matter structures were severely damaged. Employing magnetoencephalography (MEG), we explored J.'s conceptual preparation and word planning abilities using context-driven and bare picture-naming tasks. These revealed naming deficits, manifesting as word-finding difficulties and semantic paraphasias about half of the time. Naming was however facilitated by semantically constraining lead-in sentences. Altogether, this pattern indicates disrupted lexical-semantic and phonological retrieval abilities. MEG revealed that J.'s conceptual and naming-related neural responses were supported by the right hemisphere, compared to the typical left-lateralised brain response of a matched control. Differential recruitment of right-hemisphere structures (330-440 ms post-picture onset) was found concurrently during successful naming (right mid-to-posterior temporal lobe) and word-finding attempts (right inferior frontal gyrus). Disconnection of the temporal lobes via corpus callosum was not critical for recruitment of the right hemisphere in visually guided naming, possibly due to neural activity right lateralising from the outset. Although J.'s right hemisphere responded in a timely manner during word planning, its lexical and phonological retrieval abilities remained modest.
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Affiliation(s)
- Irina Chupina
- Donders Centre for CognitionRadboud UniversityNijmegenThe Netherlands
| | - Joanna Sierpowska
- Donders Centre for CognitionRadboud UniversityNijmegenThe Netherlands,Cognition and Brain Plasticity Unit, Department of Cognition, Development and Educational PsychologyInstitut de Neurociències, Universitat de BarcelonaBarcelonaSpain
| | - Xiaochen Y. Zheng
- Donders Centre for Cognitive NeuroimagingRadboud UniversityNijmegenThe Netherlands
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD)University Hospital, LMU MunichMunichGermany
| | - Maria‐Carla Piastra
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands,Department of Neuroinformatics, Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands,Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
| | - Vitória Piai
- Donders Centre for CognitionRadboud UniversityNijmegenThe Netherlands,Department of Medical Psychology, Donders Centre for Medical NeuroscienceRadboud University Medical CenterNijmegenThe Netherlands
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Zhao J, Li Y, Zhang X, Yuan Y, Cheng Y, Hou J, Duan G, Liu B, Wang J, Wu D. Alteration of network connectivity in stroke patients with apraxia of speech after tDCS: A randomized controlled study. Front Neurol 2022; 13:969786. [PMID: 36188376 PMCID: PMC9521848 DOI: 10.3389/fneur.2022.969786] [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: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed to examine the changes in the functional connectivity of the cortical speech articulation network after anodal transcranial direct current stimulation (A-tDCS) over the left lip region of the primary motor cortex (M1) in subacute post-stroke patients with apraxia of speech (AoS), and the effect of A-tDCS on AoS. Methods A total of 24 patients with post-stroke AoS were randomized into two groups and received A-tDCS over the left lip region of M1 (tDCS group)/ sham tDCS (control group) as well as speech and language therapy two times per day for 5 days. Before and after the treatment, the AoS assessments and electroencephalogram (EEG) were evaluated. The cortical interconnections were measured using the EEG non-linear index of cross approximate entropy (C-ApEn). Results The analysis of EEG showed that, after the treatment, the activated connectivity was all in the left hemisphere, and not only regions in the speech articulation network but also in the dorsal lateral prefrontal cortex (DLPFC) in the domain-general network were activated in the tDCS group. In contrast, the connectivity was confined to the right hemisphere and between bilateral DLPFC and bilateral inferior frontal gyrus (IFG) in the control group. In AoS assessments, the tDCS group improved significantly more than the control group in four of the five subtests. The results of multivariate linear regression analyses showed that only the group was significantly associated with the improvement of word repetition (P = 0.002). Conclusion A-tDCS over the left lip region of M1 coupled with speech therapy could upregulate the connectivity of both speech-specific and domain-general networks in the left hemisphere. The improved articulation performance in patients with post-stroke AoS might be related to the enhanced connectivity of networks in the left hemisphere induced by tDCS. Clinical trial registration ChiCTR-TRC-14005072.
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Affiliation(s)
- Jiayi Zhao
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Yuanyuan Li
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Xu Zhang
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Ying Yuan
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yinan Cheng
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jun Hou
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Guoping Duan
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Baohu Liu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Jie Wang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
- Jie Wang
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
- *Correspondence: Dongyu Wu
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Segregated circuits for phonemic and semantic fluency: A novel patient-tailored disconnection study. Neuroimage Clin 2022; 36:103149. [PMID: 35970113 PMCID: PMC9400120 DOI: 10.1016/j.nicl.2022.103149] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 12/14/2022]
Abstract
Phonemic and semantic fluency are neuropsychological tests widely used to assess patients' language and executive abilities and are highly sensitive tests in detecting language deficits in glioma patients. However, the networks that are involved in these tasks could be distinct and suggesting either a frontal (phonemic) or temporal (semantic) involvement. 42 right-handed patients (26 male, mean age = 52.5 years, SD=±13.3) were included in this retrospective study. Patients underwent awake (54.8%) or asleep (45.2%) surgery for low-grade (16.7%) or high-grade-glioma (83.3%) in the frontal (64.3%) or temporal lobe (35.7%) of the left (50%) or right (50%) hemisphere. Pre-operative tractography was reconstructed for each patient, with segmentation of the inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus (AF), uncinate fasciculus (UF), inferior longitudinal fasciculus (ILF), third branch of the superior longitudinal fasciculus (SLF-III), frontal aslant tract (FAT), and cortico-spinal tract (CST). Post-operative percentage of damage and disconnection of each tract, based on the patients' surgical cavities, were correlated with verbal fluencies scores at one week and one month after surgery. Analyses of differences between fluency scores at these timepoints (before surgery, one week and one month after surgery) were performed; lesion-symptom mapping was used to identify the correlation between cortical areas and post-operative scores. Immediately after surgery, a transient impairment of verbal fluency was observed, that improved within a month. Left hemisphere lesions were related to a worse verbal fluency performance, being a damage to the left superior frontal or temporal gyri associated with phonemic or semantic fluency deficit, respectively. At a subcortical level, disconnection analyses revealed that fluency scores were associated to the involvement of the left FAT and the left frontal part of the IFOF for phonemic fluency, and the association was still present one month after surgery. For semantic fluency, the correlation between post-surgery performance emerged for the left AF, UF, ILF and the temporal part of the IFOF, but disappeared at the follow-up. This approach based on the patients' pre-operative tractography, allowed to trace for the first time a dissociation between white matter pathways integrity and verbal fluency after surgery for glioma resection. Our results confirm the involvement of a frontal anterior pathway for phonemic fluency and a ventral temporal pathway for semantic fluency. Finally, our longitudinal results suggest that the frontal executive pathway requires a longer interval to recover compared to the semantic one.
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Huang J, Cao Y, Zhang D, Lei X, Chang J. Research trends of the neuroimaging in aphasia: A bibliometric analysis and visualization analysis from 2004 to 2021. Front Hum Neurosci 2022; 16:945160. [PMID: 35911602 PMCID: PMC9334888 DOI: 10.3389/fnhum.2022.945160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To review the current research status of the neuroimaging of aphasia, and reveal the hotspots and frontiers of research in this field. Methods We searched articles related to the neuroimaging research on aphasia since Web of Science (WOS) database construction and extracted the data. CiteSpace and VOSviewer were used for the country/institution analysis, journal analysis, discipline analysis, burst keyword analysis and cited-reference cluster analysis. Results Of the studies retrieved from WOS, 2922 studies that related to the neuroimaging of aphasia were screened and finally included 2799 articles for research. The United States of America and University of California San Francisco were the main countries and institutions in this field. Brain had the highest impact factor in both published and cited journals. Through the discipline and topic analysis of this field, the most common category was Neurosciences and Neurology. The keyword with the strongest citation strength was “functional connectivity,” and the recent burst keywords were “functional connectivity” and “network.” The co-citation network showed seven clusters greater than 100. Among the top 5 clusters, the most recently formed cluster, Cluster #2 (progressive supranuclear palsy), had an average year of 2017. The literature in the top 5 clusters mainly focused on 3 aspects, specifically, the discovery of language processing models, injury and recovery mechanisms of post-stroke aphasia (PSA), and diagnosis of primary progressive aphasia (PPA) variants. Conclusion The results of this bibliometric study revealed the following three research hotspots in the neuroimaging of aphasia: clarifying the connotation of the most recognized language processing model, the dual-stream model, exploring the injury mechanism based on the dual-stream model and the recovery mechanism involving the left and right hemispheres of PSA, and determining the diagnostic criteria for PPA variants. A major research trend is to combine new neuroimaging technology, such as PET tracer technology, to realize the visual presentation of disease-specific proteins to improve the pathological diagnostic criteria of PPA variants. Accordingly, a visualized analysis of literature that uses CiteSpace provides a more rapid, repeatable and flexible method, which is more conducive to capturing research hotspots and emerging trends.
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DeMarco AT, van der Stelt C, Paul S, Dvorak E, Lacey E, Snider S, Turkeltaub PE. Absence of Perilesional Neuroplastic Recruitment in Chronic Poststroke Aphasia. Neurology 2022; 99:e119-e128. [PMID: 35508398 PMCID: PMC9280993 DOI: 10.1212/wnl.0000000000200382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/25/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A prominent theory proposes that neuroplastic recruitment of perilesional tissue supports aphasia recovery, especially when language-capable cortex is spared by smaller lesions. This theory has rarely been tested directly and findings have been inconclusive. We tested the perilesional plasticity hypothesis using 2 fMRI tasks in 2 groups of patients with previous aphasia diagnosis. METHODS Two cohorts totaling 82 patients with chronic left-hemisphere stroke with previous aphasia diagnosis and 82 control participants underwent fMRI using either a naming task or a reliable semantic decision task. Individualized perilesional tissue was defined by dilating anatomical lesions and language regions were defined using meta-analyses. Mixed modeling examined differences in activity between groups. Relationships with lesion size and aphasia severity were examined. RESULTS Patients exhibited reduced activity in perilesional language tissue relative to controls in both tasks. Although a few cortical regions exhibited greater activity irrespective of distance from the lesion, or only when distant from the lesion, no regions exhibited increased activity only when near the lesion. Larger lesions were associated with reduced language activity irrespective of distance from the lesion. Using the reliable fMRI task, reduced language activity was related to aphasia severity independent of lesion size. DISCUSSION We found no evidence for neuroplastic recruitment of perilesional tissue in aphasia beyond its typical role in language. Rather, our findings are consistent with alternative hypotheses that changes in left-hemisphere activation during recovery relate to normalization of language network dysfunction and possibly recruitment of alternate cortical processors. These findings clarify left-hemisphere neuroplastic mechanisms supporting language recovery after stroke.
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Affiliation(s)
- Andrew Tesla DeMarco
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Candace van der Stelt
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Sachi Paul
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Elizabeth Dvorak
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Elizabeth Lacey
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Sarah Snider
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC
| | - Peter E Turkeltaub
- From the Departments of Rehabilitation Medicine (A.T.D., P.E.T.) and Neurology (A.T.D., C.v.d.S., S.P., E.D., E.L., S.S., P.E.T.), Georgetown University; and MedStar National Rehabilitation Hospital (E.L., P.E.T.), Washington, DC.
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Aberrant Beta-band Brain Connectivity Predicts Speech Motor Planning Deficits in Post-Stroke Aphasia. Cortex 2022; 155:75-89. [DOI: 10.1016/j.cortex.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/24/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022]
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A Comparative Analysis of Functional Status and Mobility in Stroke Patients with and without Aphasia. J Clin Med 2022; 11:jcm11123478. [PMID: 35743548 PMCID: PMC9225387 DOI: 10.3390/jcm11123478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/04/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
All researchers agree that aphasia is a serious consequence of a stroke, but they also report contradictory data regarding the functional outcome. The aim of this study was, therefore, to assess the functional outcomes of stroke patients with and without aphasia, who were undertaking a regular rehabilitation programme. MATERIALS AND METHODS The study group consisted of 116 post-stroke patients, including 54 patients without aphasia (G1) and 62 patients with aphasia (G2). The following tests were used before (T1) and after (T2) rehabilitation measurement points: Barthel Index (BI), Sitting Assessment Scale (SAS), Berg Balance Scale (BBS), Trunk Control Test (TCT), Test Up & Go (TUG) and the Timed Walk Test (TWT). RESULTS The group of post-stroke patients with aphasia had a significantly longer time since a stroke on admission, a significantly longer length of stay in the ward and significantly worse SAS and TCT scores at T2, compared to patients without aphasia. Both groups achieved significant improvement in all studied parameters (SAS, TCT, BI, BBS, TUG and TWT). Aphasia was a predictor of functional status in the stroke patients group, but only at the time of admission to the ward. CONCLUSIONS Patients with and without aphasia have an equal likelihood of improving their functional status and returning to independence. Aphasia should not be an absolute factor that excludes stroke patients from research studies on their functional status.
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Xu C, He Z, Shen Z, Huang F. Potential Benefits of Music Therapy on Stroke Rehabilitation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9386095. [PMID: 35757506 PMCID: PMC9217607 DOI: 10.1155/2022/9386095] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Abstract
Stroke is associated with a high rate of disability and mortality, and survivors are usually accompanied with dysphagia, aphasia, motor dysfunction, cognitive impairment, depression, and other complications. In the past decades, many studies have been conducted to reveal the pathogenesis and pathological mechanisms of stroke. Furthermore, treatment methods have been developed that contribute to the elevated survival rate of stroke patients. Early rehabilitation poststroke is starting to be recognized as important and has been receiving increasing attention in order to further improve the quality of life of the patients. As an emerging method of poststroke rehabilitation, music therapy can help attenuate dysphagia and aphasia, improve cognition and motor function, alleviate negative moods, and accelerate neurological recovery in stroke patients. This review helps summarize the recent progress that has been made using music therapy in stroke rehabilitation and is aimed at providing clinical evidence for the treatment of stroke patients.
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Affiliation(s)
- Chengyan Xu
- Department of Neurosurgery, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zixia He
- Department of Outpatient, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhipeng Shen
- Department of Neurosurgery, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fei Huang
- Department of Science and Education, Hangzhou Women's Hospital, Hangzhou Maternity and Child Health Care Hospital, Hangzhou, China
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Effect of Rehabilitation on Brain Functional Connectivity in a Stroke Patient Affected by Conduction Aphasia. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12125991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Stroke is a medical condition that affects the brain and represents a leading cause of death and disability. Associated with drug therapy, rehabilitative treatment is essential for promoting recovery. In the present work, we report an EEG-based study concerning a left ischemic stroke patient affected by conduction aphasia. Specifically, the objective is to compare the brain functional connectivity before and after an intensive rehabilitative treatment. The analysis was performed by means of local and global efficiency measures related to the execution of three tasks: naming, repetition and reading. As expected, the results showed that the treatment led to a balancing of the values of both parameters between the two hemispheres since the rehabilitation contributed to the creation of new neural patterns to compensate for the disrupted ones. Moreover, we observed that for both name and repetition tasks, shortly after the stroke, the global and local connectivity are lower in the affected lobe (left hemisphere) than in the unaffected one (right hemisphere). Conversely, for the reading task, global and local connectivity are higher in the impaired lobe. This apparently contrasting trend can be due to the effects of stroke, which affect not only the site of structural damage but also brain regions belonging to a functional network. Moreover, changes in network connectivity can be task-dependent. This work can be considered a first step for future EEG-based studies to establish the most suitable connectivity measures for supporting the treatment of stroke and monitoring the recovery process.
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Stefaniak JD, Geranmayeh F, Lambon Ralph MA. The multidimensional nature of aphasia recovery post-stroke. Brain 2022; 145:1354-1367. [PMID: 35265968 PMCID: PMC9128817 DOI: 10.1093/brain/awab377] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/20/2021] [Accepted: 09/18/2021] [Indexed: 12/28/2022] Open
Abstract
Language is not a single function, but instead results from interactions between neural representations and computations that can be damaged independently of each other. Although there is now clear evidence that the language profile in post-stroke aphasia reflects graded variations along multiple underlying dimensions ('components'), it is still entirely unknown if these distinct language components have different recovery trajectories and rely on the same, or different, neural regions during aphasia recovery. Accordingly, this study examined whether language components in the subacute stage: (i) mirror those observed in the chronic stage; (ii) recover together in a homogeneous manner; and (iii) have recovery trajectories that relate to changing activation in distinct or overlapping underlying brain regions. We analysed longitudinal data from 26 individuals with mild-moderate aphasia following left hemispheric infarct who underwent functional MRI and behavioural testing at ∼2 weeks and ∼4 months post-stroke. The language profiles in early post-stroke aphasia reflected three orthogonal principal components consisting of fluency, semantic/executive function and phonology. These components did not recover in a singular, homogeneous manner; rather, their longitudinal trajectories were uncorrelated, suggesting that aphasia recovery is heterogeneous and multidimensional. Mean regional brain activation during overt speech production in unlesioned areas was compared with patient scores on the three principal components of language at both the early and late time points. In addition, the change in brain activation over time was compared with the change on each of the principal component scores, both before and after controlling for baseline scores. We found that different language components were associated with changing activation in multiple, non-overlapping bilateral brain regions during aphasia recovery. Specifically, fluency recovery was associated with increasing activation in bilateral middle frontal gyri and right temporo-occipital middle temporal gyrus; semantic/executive recovery was associated with reducing activation in bilateral anterior temporal lobes; while phonology recovery was associated with reducing activation in bilateral precentral gyri, dorso-medial frontal poles and the precuneus. Overlapping clusters in the ventromedial prefrontal cortex were positively associated with fluency recovery but negatively associated with semantic/executive and phonology recovery. This combination of detailed behavioural and functional MRI data provides novel insights into the neural basis of aphasia recovery. Because different aspects of language seem to rely on different neural regions for recovery, treatment strategies that target the same neural region in all stroke survivors with aphasia might be entirely ineffective or even impair recovery, depending on the specific language profile of each individual patient.
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Affiliation(s)
- James D Stefaniak
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9GB, UK
| | - Fatemeh Geranmayeh
- Computational Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
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Ramazanu S, Chisale MRO, Baby P, Wu VX, Mbakaya BC. Meta-synthesis of family communication patterns during post-stroke vascular aphasia: Evidence to guide practice. Worldviews Evid Based Nurs 2022; 19:282-296. [PMID: 35587739 DOI: 10.1111/wvn.12580] [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: 08/07/2021] [Revised: 11/14/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies have predominantly focused on the needs of persons with aphasia (PWA), after a stroke diagnosis. However, aphasia is found to cause communication challenges in persons with stroke and their family caregivers as a unit. Evidence is inconclusive about the communication patterns of both persons with aphasia and their family caregivers after a stroke. Studies have not been synthesized on facilitators and barriers of communication patterns between PWA and family caregivers after a stroke. AIMS A meta-synthesis of qualitative evidence was conducted to explore family communication patterns after post-stroke vascular aphasia. METHODS An electronic literature search of PubMed, CINAHL, Cochrane Library, PsyINFO, and Scopus was performed from January to March 2021. The methods of qualitative meta-synthesis were underpinned by Sandelowski and Barosso's guidelines. Data analysis was facilitated by Braun and Clarke thematic analysis, using NVivo 11 software. RESULTS A total of twenty studies were included for meta-synthesis. Three themes with corresponding subthemes were identified: (1) changes in family communication patterns (subthemes: adapting to the changes in PWA after a stroke, striving toward communication recovery); (2) facilitators of family communication patterns (subthemes: supportive communication techniques, hope of recovery, time to re-adjust, and community engagement [recreational activities]); and (3) barriers of communication (subthemes: emotional turmoil and daunting tasks of rehabilitation). LINKING EVIDENCE TO ACTION Although persons with aphasia and family caregivers are striving to achieve normalcy in communication, they are often challenged by communication deficits and protective family behaviors. Therefore, to establish effective communication, it is of paramount importance for nursing professionals to educate PWAs and their caregivers on facilitators and barriers of family communication patterns. Technology-based family communication facilitation and support groups for PWA and their family caregivers are recommended to promote family communication. The review was registered with PROSPERO (CRD42021235519).
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Affiliation(s)
- Sheena Ramazanu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Singapore, Singapore
| | | | - Priya Baby
- College of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
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Tang J, Xiang X, Cheng X. The Progress of Functional Magnetic Resonance Imaging in Patients with Poststroke Aphasia. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3270534. [PMID: 35494510 PMCID: PMC9050274 DOI: 10.1155/2022/3270534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022]
Abstract
Aphasia after stroke is one of the common complications of cerebral infarction. Early diagnosis and treatment of aphasia after stroke is of great significance for the recovery of language function. At present, there are different views on the pathogenesis of aphasia after stroke. Functional magnetic resonance imaging (fMRI) can reflect the brain function, brain tissue metabolism, and the level of brain local blood flow. It has the advantages of noninvasive, high resolution and sensitivity, low price, and so on. It has been widely used in the study of sensory aphasia after stroke. This study focuses on the development of functional magnetic resonance imaging in patients with poststroke aphasia and summarizes the published studies on functional magnetic resonance imaging in patients with poststroke aphasia. Evidence acquisition: A literature search was conducted in PubMed, Hindawi, PLoS, IEEE, Wiley, ScienceDirect, Springer, EMBASE, and web of science, with the keywords of "stroke" and "Aphasia" and "functional magnetic resonance imaging", "RS fMRI", or "DTI", to review the research of functional magnetic resonance imaging in patients with aphasia after stroke. The results included clinical evaluation, diagnostic scale, and imaging analysis; the study design was a randomized controlled trial, case series and case report, and observational study. A total of 67 articles were identified in the first search and 43 after the second search. Based on the analysis of 43 selected articles, 19 articles were included, and 24 articles were excluded. The selected information is shown in Table 1. Eleven of them did not contain imaging-related data. Six articles are related review articles. Four studies were conducted on patients without poststroke aphasia. Three studies studied the effect of poststroke aphasia on patients' social participation.
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Affiliation(s)
- Jinping Tang
- The First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei, China
| | - Xuli Xiang
- The Second People's Hospital of Gongan County, Jingzhou 434000, Hubei, China
| | - Xianglin Cheng
- The First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei, China
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Graviotto HG, Sorbara MG, Rodriguez CMT, Serrano C. 12-item version of Boston Naming Test: usefulness in the diagnosis of primary progressive aphasia, frontotemporal dementia, and Alzheimer's disease. Dement Neuropsychol 2022; 16:181-186. [PMID: 35720650 PMCID: PMC9173795 DOI: 10.1590/1980-5764-dn-2021-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/05/2021] [Accepted: 10/16/2021] [Indexed: 11/22/2022] Open
Abstract
The 12-item version of the Boston Naming Test (BNT) was adapted to Argentina for the detection of dementia due to Alzheimer's disease (AD), with scores similar to the original 60-item version (sensitivity and specificity of 85 and 94%, respectively) without demographic influence (age and educational level). To date, no publications on the use of abbreviated BNT in other degenerative pathologies with language impairment have been reported.
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Affiliation(s)
| | - Marcos German Sorbara
- Unidad Asistencial Dr César Milstein, Department of Neurology - Buenos Aires, Argentina
| | | | - Cecilia Serrano
- Unidad Asistencial Dr César Milstein, Department of Neurology - Buenos Aires, Argentina
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Lin BF, Yeh SC, Kao YCJ, Lu CF, Tsai PY. Functional Remodeling Associated With Language Recovery After Repetitive Transcranial Magnetic Stimulation in Chronic Aphasic Stroke. Front Neurol 2022; 13:809843. [PMID: 35330805 PMCID: PMC8940300 DOI: 10.3389/fneur.2022.809843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) has shown promising efficacy in improving the language functions in poststroke aphasia. However, randomized controlled trials were lacking to investigate the rTMS-related neuroimaging changes underlying the therapeutic effects on language improvement in chronic aphasia. Objective In this study, we aimed to evaluate the effects of low-frequency rTMS (LF-rTMS) on chronic poststroke aphasia. We hypothesized that the deactivation of the right pars triangularis could restore the balance of interhemispheric inhibition and, hence, facilitated the functional remodeling of language networks in both the hemispheres. Furthermore, the rTMS-induced functional reorganization should underpin the language recovery after rTMS. Methods A total of 33 patients (22 males; age: 58.70 ± 13.77 years) with chronic stroke in the left hemisphere and nonfluent aphasia were recruited in this randomized double-blinded study. The ratio of randomization between the rTMS and sham groups is 17:16. All the patients received real 1-Hz rTMS or sham stimulation (placebo coil delivered < 5% of magnetic output with similar audible click-on discharge) at the right posterior pars triangularis for 10 consecutive weekdays (stroke onset to the first stimulation: 10.97 ± 10.35 months). Functional connectivity of language networks measured by resting-state fMRI was calculated and correlated to the scores of the Concise Chinese Aphasia Test by using the stepwise regression analysis. Results After LF-rTMS intervention, significant improvement in language functions in terms of comprehension and expression abilities was observed compared with the sham group. The rTMS group showed a significant decrease of coupling strength between right pars triangularis and pars opercularis with a strengthened connection between right pars orbitalis and angular gyrus. Furthermore, the LF-rTMS significantly enhanced the coupling strength associated with left Wernicke area. Results of regression analysis showed that the identified functional remodeling involving both the hemispheres could support and predict the language recovery after LF-rTMS treatment. Conclusion We reported the therapeutic effects of LF-rTMS and corresponding functional remodeling in chronic poststroke aphasia. Our results provided neuroimage evidence reflecting the rebalance of interhemispheric inhibition induced by LF-rTMS, which could facilitate future research in the refinement of rTMS protocol to optimize the neuromodulation efficacy and benefit the clinical management of patients with stroke.
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Affiliation(s)
- Bing-Fong Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ching Yeh
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan
| | - Yu-Chieh Jill Kao
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Yi Tsai
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Regional Alteration within the Cerebellum and the Reorganization of the Cerebrocerebellar System following Poststroke Aphasia. Neural Plast 2022; 2022:3481423. [PMID: 35360259 PMCID: PMC8964230 DOI: 10.1155/2022/3481423] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/24/2022] [Indexed: 12/26/2022] Open
Abstract
Recently, an increasing number of studies have highlighted the role of the cerebellum in language processing. However, the role of neural reorganization within the cerebellum as well as within the cerebrocerebellar system caused by poststroke aphasia remains unknown. To solve this problem, in the present study, we investigated regional alterations of the cerebellum as well as the functional reorganization of the cerebrocerebellar circuit by combining structural and resting-state functional magnetic resonance imaging (fMRI) techniques. Twenty patients diagnosed with aphasia following left-hemispheric stroke and 20 age-matched healthy controls (HCs) were recruited in this study. The Western Aphasia Battery (WAB) test was used to assess the participants' language ability. Gray matter volume, spontaneous brain activity, functional connectivity, and effective connectivity were examined in each participant. We discovered that gray matter volumes in right cerebellar lobule VI and right Crus I were significantly lower in the patient group, and the brain activity within these regions was significantly correlated with WAB scores. We also discovered decreased functional connectivity within the crossed cerebrocerebellar circuit, which was significantly correlated with WAB scores. Moreover, altered information flow between the cerebellum and the contralateral cerebrum was found. Together, our findings provide evidence for regional alterations within the cerebellum and the reorganization of the cerebrocerebellar system following poststroke aphasia and highlight the important role of the cerebellum in language processing within aphasic individuals after stroke.
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