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Marangolo P. The potential effects of transcranial direct current stimulation (tDCS) on language functioning: Combining neuromodulation and behavioral intervention in aphasia. Neurosci Lett 2020; 719:133329. [DOI: 10.1016/j.neulet.2017.12.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 02/08/2023]
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Johnson JP, Meier EL, Pan Y, Kiran S. Treatment-related changes in neural activation vary according to treatment response and extent of spared tissue in patients with chronic aphasia. Cortex 2019; 121:147-168. [PMID: 31627014 DOI: 10.1016/j.cortex.2019.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 06/21/2019] [Accepted: 08/23/2019] [Indexed: 11/25/2022]
Abstract
Neuroimaging studies of aphasia recovery have linked treatment-related improvements in language processing to changes in functional brain activation in left hemisphere language regions and their right hemisphere homologues. Although there is some consensus that better behavioral outcomes are achieved when activation is restored to the left hemisphere, the circumstances that dictate how and why regions in both hemispheres respond to naming therapy are still unclear. In this study, an fMRI picture-naming task was used to examine 16 regions of interest in 26 patients with chronic aphasia before and after 12 weeks of semantic naming treatment. Ten control patients who did not receive treatment and 17 healthy controls were also scanned. Naming therapy resulted in a significant increase in cortical activation, an effect that was largely driven by patients who responded most favorably to treatment, as patients who responded less favorably (as well as those who did not receive treatment) had little change in activation over time. Relative to healthy controls, patients had higher pre-treatment activation in the bilateral inferior frontal gyri (IFG) and lower activation in the bilateral angular gyri; after treatment, they had higher activation in bilateral IFG, as well as in the right middle frontal gyrus. These results suggest that the predominant effect of beneficial naming treatment was an upregulation of traditional language areas and their right hemisphere homologues and, in particular, regions associated with phonological and semantic/executive semantic processing, as well as broader domain general functions. Additionally, in some left hemisphere regions, post-treatment changes in activation were greater when there was more damage than when there was less damage, indicating that spared tissue in otherwise highly damaged regions can be modulated by treatment.
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Affiliation(s)
- Jeffrey P Johnson
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA.
| | - Erin L Meier
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Yue Pan
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
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Meier EL, Johnson JP, Kiran S. Left frontotemporal effective connectivity during semantic feature judgments in patients with chronic aphasia and age-matched healthy controls. Cortex 2018; 108:173-192. [PMID: 30243049 PMCID: PMC6234086 DOI: 10.1016/j.cortex.2018.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 12/15/2022]
Abstract
Traditional models of neural reorganization of language skills in patients with chronic stroke-induced aphasia (PWA) propose activation of reperfused or spared left hemisphere tissue results in the most favorable language outcomes. However, these models do not fully explain variable behavioral recovery patterns observed in chronic patients. Instead, investigation of connectivity patterns of critical network nodes may elucidate better-informed recovery models. In the present study, we combined fMRI and dynamic causal modeling (DCM) to examine effective connectivity of a simple three-node left hemisphere network during a semantic feature decision task in 25 PWA and 18 age-matched neurologically intact healthy controls. The DCM model space utilized in Meier, Kapse, & Kiran (2016), which was organized according to exogenous input to one of three regions (i.e., left inferior frontal gyrus, pars triangularis [LIFGtri], left posterior middle temporal gyrus [LpMTG], or left middle frontal gyrus [LMFG]) implicated in various levels of lexical-semantic processing, was interrogated. This model space included all possible combinations of uni- and bidirectional task-modulated connections between LIFGtri, LMFG and LpMTG, resulting in 72 individual models that were partitioned into three separate families (i.e., Family #1: Input to LIFGtri, Family #2: Input to LMFG, Family #3: Input to LpMTG). Family-wise Bayesian model selection revealed Family #2: Input to LMFG best fit both patient and control data at a group level. Both groups relied heavily on LMFG's modulation of the other two model regions. By contrast, between-group differences in task-modulated coupling of LIFGtri and LpMTG were observed. Within the patient group, the strength of activity in LIFGtri and connectivity of LpMTG → LIFGtri were positively associated with lexical-semantic abilities inside and outside of the scanner, whereas greater recruitment of LpMTG was associated with poorer lexical-semantic skills.
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Affiliation(s)
- Erin L Meier
- Sargent College of Health & Rehabilitation Sciences, Boston University, United States.
| | - Jeffrey P Johnson
- Sargent College of Health & Rehabilitation Sciences, Boston University, United States
| | - Swathi Kiran
- Sargent College of Health & Rehabilitation Sciences, Boston University, United States
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Lucchese G, Pulvermüller F, Stahl B, Dreyer FR, Mohr B. Therapy-Induced Neuroplasticity of Language in Chronic Post Stroke Aphasia: A Mismatch Negativity Study of (A)Grammatical and Meaningful/less Mini-Constructions. Front Hum Neurosci 2017; 10:669. [PMID: 28111545 PMCID: PMC5216683 DOI: 10.3389/fnhum.2016.00669] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 12/15/2016] [Indexed: 12/20/2022] Open
Abstract
Clinical language performance and neurophysiological correlates of language processing were measured before and after intensive language therapy in patients with chronic (time post stroke >1 year) post stroke aphasia (PSA). As event-related potential (ERP) measure, the mismatch negativity (MMN) was recorded in a distracted oddball paradigm to short spoken sentences. Critical 'deviant' sentence stimuli where either well-formed and meaningful, or syntactically, or lexico-semantically incorrect. After 4 weeks of speech-language therapy (SLT) delivered with high intensity (10.5 h per week), clinical language assessment with the Aachen Aphasia Test battery demonstrated significant linguistic improvements, which were accompanied by enhanced MMN responses. More specifically, MMN amplitudes to grammatically correct and meaningful mini-constructions and to 'jabberwocky' sentences containing a pseudoword significantly increased after therapy. However, no therapy-related changes in MMN responses to syntactically incorrect strings including agreement violations were observed. While MMN increases to well-formed meaningful strings can be explained both at the word and construction levels, the neuroplastic change seen for 'jabberwocky' sentences suggests an explanation in terms of constructions. The results confirm previous reports that intensive SLT leads to improvements of linguistic skills in chronic aphasia patients and now demonstrate that this clinical improvement is associated with enhanced automatic brain indexes of construction processing, although no comparable change is present for ungrammatical strings. Furthermore, the data confirm that the language-induced MMN is a useful tool to map functional language recovery in PSA.
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Affiliation(s)
- Guglielmo Lucchese
- Brain Language Laboratory, Department of Philosophy and Humanities Freie Universität Berlin, Berlin Germany
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and HumanitiesFreie Universität Berlin, Berlin Germany; Berlin School of Mind and Brain, Humboldt-Universität zu BerlinBerlin, Germany
| | - Benjamin Stahl
- Brain Language Laboratory, Department of Philosophy and HumanitiesFreie Universität Berlin, Berlin Germany; Department of Neurology, Charité Universitätsmedizin Berlin, Campus MitteBerlin, Germany; Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
| | - Felix R Dreyer
- Brain Language Laboratory, Department of Philosophy and Humanities Freie Universität Berlin, Berlin Germany
| | - Bettina Mohr
- Department of Psychiatry, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin Germany
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Sul B, Kim JS, Hong BY, Lee KB, Hwang WS, Kim YK, Lim SH. The Prognosis and Recovery of Aphasia Related to Stroke Lesion. Ann Rehabil Med 2016; 40:786-793. [PMID: 27847708 PMCID: PMC5108705 DOI: 10.5535/arm.2016.40.5.786] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/07/2016] [Indexed: 11/10/2022] Open
Abstract
Objective To investigate the effects of specific brain lesions on prognosis and recovery of post-stroke aphasia, and to assess the characteristic pattern of recovery. Methods Total of 15 subjects with first-ever, left hemisphere stroke, who were right handed, and who completed language assessment using the Korean version of the Western Aphasia Battery (K-WAB) at least twice during the subacute and chronic stages of stroke, were included. The brain lesions of the participants were evaluated using MRI-cron, SPM8, and Talairach Daemon software. Results Subtraction of the lesion overlap map of the participants who showed more than 30% improvement in the aphasia quotient (AQ) by the time of their chronic stage (n=9) from the lesion overlap map of those who did not show more than 30% improvement in the AQ (n=6) revealed a strong relationship with Broca's area, inferior prefrontal gyrus, premotor cortex, and a less strong relationship with Wernicke's area and superior and middle temporal gyri. The culprit lesion related to poor prognosis, after grouping the subjects according to their AQ score in the chronic stage (a cut score of 50), revealed a strong relationship with Broca's area, superior temporal gyrus, and a less strong relationship with Wernicke's area, prefrontal cortex, and inferior frontal gyrus. Conclusion Brain lesions in the Broca's area, inferior prefrontal gyrus, and premotor cortex may be related to slow recovery of aphasia in patients with left hemisphere stroke. Furthermore, involvement of Broca's area and superior temporal gyrus may be associated with poor prognosis of post-stroke aphasia.
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Affiliation(s)
- Bomi Sul
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Joon Sung Kim
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Kyoung Bo Lee
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Woo Seop Hwang
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Young Kook Kim
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Meier EL, Kapse KJ, Kiran S. The Relationship between Frontotemporal Effective Connectivity during Picture Naming, Behavior, and Preserved Cortical Tissue in Chronic Aphasia. Front Hum Neurosci 2016; 10:109. [PMID: 27014039 PMCID: PMC4792868 DOI: 10.3389/fnhum.2016.00109] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 02/29/2016] [Indexed: 11/17/2022] Open
Abstract
While several studies of task-based effective connectivity of normal language processing exist, little is known about the functional reorganization of language networks in patients with stroke-induced chronic aphasia. During oral picture naming, activation in neurologically intact individuals is found in "classic" language regions involved with retrieval of lexical concepts [e.g., left middle temporal gyrus (LMTG)], word form encoding [e.g., left posterior superior temporal gyrus, (LpSTG)], and controlled retrieval of semantic and phonological information [e.g., left inferior frontal gyrus (LIFG)] as well as domain-general regions within the multiple demands network [e.g., left middle frontal gyrus (LMFG)]. After stroke, lesions to specific parts of the left hemisphere language network force reorganization of this system. While individuals with aphasia have been found to recruit similar regions for language tasks as healthy controls, the relationship between the dynamic functioning of the language network and individual differences in underlying neural structure and behavioral performance is still unknown. Therefore, in the present study, we used dynamic causal modeling (DCM) to investigate differences between individuals with aphasia and healthy controls in terms of task-induced regional interactions between three regions (i.e., LIFG, LMFG, and LMTG) vital for picture naming. The DCM model space was organized according to exogenous input to these regions and partitioned into separate families. At the model level, random effects family wise Bayesian Model Selection revealed that models with driving input to LIFG best fit the control data whereas models with driving input to LMFG best fit the patient data. At the parameter level, a significant between-group difference in the connection strength from LMTG to LIFG was seen. Within the patient group, several significant relationships between network connectivity parameters, spared cortical tissue, and behavior were observed. Overall, this study provides some preliminary findings regarding how neural networks for language reorganize for individuals with aphasia and how brain connectivity relates to underlying structural integrity and task performance.
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Affiliation(s)
- Erin L. Meier
- Department of Speech Language and Hearing Sciences, Aphasia Research Laboratory, Sargent College, Boston University, BostonMA, USA
| | | | - Swathi Kiran
- Department of Speech Language and Hearing Sciences, Aphasia Research Laboratory, Sargent College, Boston University, BostonMA, USA
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Costa V, Giglia G, Brighina F, Indovino S, Fierro B. Ipsilesional and contralesional regions participate in the improvement of poststroke aphasia: a transcranial direct current stimulation study. Neurocase 2015; 21:479-88. [PMID: 24957199 DOI: 10.1080/13554794.2014.927508] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the past few years, noninvasive cerebral stimulations have been used to modulate language task performance in healthy and aphasic patients. In this study, a dual transcranial direct current stimulation (tDCS) on anterior and posterior language areas was applied for 2 weeks to a patient with a possible crossed aphasia following a right hemisphere stroke. Inhibitory cathodal stimulation of the right Brodmann areas (BA) 44/45 and simultaneous anodal stimulation of the left BA 44/45 improved the patient's performance in picture naming. Conversely, the same bilateral montage on BA 39/40 did not produce any significant improvement; finally, electrode polarity inversion over BA 39/40 yielded a further improvement compared with the first anterior stimulation. Our findings suggest that ipsilesional and contralesional areas could be useful in poststroke functional reorganization and provide new evidences for the therapeutic value of tDCS in aphasia.
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Affiliation(s)
- Vanessa Costa
- a Department of Experimental BioMedicine and Clinical Neurosciences (BioNeC) , University of Palermo , Palermo , Italy
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de Mendonça LIZ. Transcranial brain stimulation (TMS and tDCS) for post-stroke aphasia rehabilitation: Controversies. Dement Neuropsychol 2014; 8:207-215. [PMID: 29213905 PMCID: PMC5619396 DOI: 10.1590/s1980-57642014dn83000003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Transcranial brain stimulation (TS) techniques have been investigated for use in
the rehabilitation of post-stroke aphasia. According to previous reports,
functional recovery by the left hemisphere improves recovery from aphasia, when
compared with right hemisphere participation. TS has been applied to stimulate
the activity of the left hemisphere or to inhibit homotopic areas in the right
hemisphere. Various factors can interfere with the brain's response to TS,
including the size and location of the lesion, the time elapsed since the causal
event, and individual differences in the hemispheric language dominance pattern.
The following questions are discussed in the present article: [a] Is inhibition of the right hemisphere truly beneficial?; [b] Is the transference of the language network to the left
hemisphere truly desirable in all patients?; [c] Is the use of TS during the post-stroke subacute phase truly
appropriate? Different patterns of neuroplasticity must occur in
post-stroke aphasia.
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Jarso S, Li M, Faria A, Davis C, Leigh R, Sebastian R, Tsapkini K, Mori S, Hillis AE. Distinct mechanisms and timing of language recovery after stroke. Cogn Neuropsychol 2014; 30:454-75. [PMID: 24472056 PMCID: PMC3979443 DOI: 10.1080/02643294.2013.875467] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The "language network" is remarkably stable across language tasks but changes in response to injury to specific components or in response to "disconnection" of input to one component. We investigated network changes during language recovery, hypothesizing that language recovery takes place through distinct mechanisms: (a) reperfusion; (b) recovery from diaschisis; (c) recovery from structural disconnection; and (d) "reorganization" of language, whereby various components assume function of a damaged component. We also tested the hypothesis that "reorganization" depends on: the language task, level of performance, size and site of stroke, and time post onset. We tested these hypotheses in five participants who had structural, perfusion, and functional imaging utilizing spelling, reading, word generation, and picture naming tasks at acute and subsequent stages after ischaemic stroke. These cases illustrate different mechanisms of aphasia recovery or illustrate that reorganization of language acutely depends on individual variables in addition to size and site of stroke.
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Affiliation(s)
- Samson Jarso
- a Russell H. Morgan Department of Radiology and Radiological Science , The Johns Hopkins University School of Medicine , Baltimore , MA , USA
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Marangolo P, Caltagirone C. Options to enhance recovery from aphasia by means of non-invasive brain stimulation and action observation therapy. Expert Rev Neurother 2013; 14:75-91. [PMID: 24308276 DOI: 10.1586/14737175.2014.864555] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aphasia is a highly disabling language disorder usually caused by a left-lateralized brain damage. Even if traditional linguistic-based therapies have been proved to induce an adequate clinical improvement, a large percentage of patients are left with some degree of language impairments. Therefore, new approaches to common speech therapies are urgently needed in order to maximize the recovery from aphasia. The recent application of non-invasive neurostimulation techniques to language rehabilitation has already provided promising results particularly for the recovery of word-retrieval deficits in chronic stroke aphasic patients. Positive outcomes also come from action observation therapy. Indeed, some very recent studies have shown that the observation and/or execution of gestures positively influences language recovery especially for words related to human actions. This article gives an overview of the most important results achieved using these two approaches and discusses how the application of these treatments might potentiate aphasia recovery.
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Affiliation(s)
- Paola Marangolo
- Dipartimento di Medicina Sperimentale e Clinica, Facoltà di Medicina, Ancona, Italy
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Chieffo R, Ferrari F, Battista P, Houdayer E, Nuara A, Alemanno F, Abutalebi J, Zangen A, Comi G, Cappa SF, Leocani L. Excitatory Deep Transcranial Magnetic Stimulation With H-Coil Over the Right Homologous Broca’s Region Improves Naming in Chronic Post-stroke Aphasia. Neurorehabil Neural Repair 2013; 28:291-8. [DOI: 10.1177/1545968313508471] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The role of the right hemisphere in poststroke aphasia recovery is still controversial and the effects of repetitive transcranial magnetic stimulation (rTMS) over the right homologous Broca’s region have been seldom investigated. Objective. This study aimed to compare the effect of excitatory, inhibitory, and sham rTMS delivered with H-coil over the right inferior frontal gyrus in chronic aphasic patients. Methods. Five right-handed poststroke aphasic patients underwent a picture naming task before and immediately after each of 3 sessions of rTMS: excitatory (10 Hz), inhibitory (1 Hz), and sham rTMS, in random sequence and separated by at least 1 week. Results. Only the excitatory 10-Hz stimulation was associated with a significant improvement in naming performance ( P = .043) and was significantly more effective than 1-Hz rTMS ( P = .043). Conclusions. A single session of excitatory deep brain rTMS over the right inferior frontal gyrus with H-coil significantly improves naming in right-handed chronic poststroke aphasic patients. This result is in line with the hypothesis of a positive, rather than detrimental, role of the right hemisphere in chronic aphasia due to a left-hemispheric stroke.
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Affiliation(s)
- Raffaella Chieffo
- Scientific Institute Hospital San Raffaele, Milan, Italy
- Vita-Salute University and San Raffaele Scientific Institute, Milan, Italy
| | - Federico Ferrari
- Vita-Salute University and San Raffaele Scientific Institute, Milan, Italy
| | | | - Elise Houdayer
- Scientific Institute Hospital San Raffaele, Milan, Italy
| | - Arturo Nuara
- Scientific Institute Hospital San Raffaele, Milan, Italy
- Vita-Salute University and San Raffaele Scientific Institute, Milan, Italy
| | - Federica Alemanno
- Scientific Institute Hospital San Raffaele, Milan, Italy
- Vita-Salute University and San Raffaele Scientific Institute, Milan, Italy
| | - Jubin Abutalebi
- Vita-Salute University and San Raffaele Scientific Institute, Milan, Italy
| | | | - Giancarlo Comi
- Scientific Institute Hospital San Raffaele, Milan, Italy
- Vita-Salute University and San Raffaele Scientific Institute, Milan, Italy
| | - Stefano F. Cappa
- Vita-Salute University and San Raffaele Scientific Institute, Milan, Italy
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Miniussi C, Vallar G. Brain stimulation and behavioural cognitive rehabilitation: A new tool for neurorehabilitation? Neuropsychol Rehabil 2011; 21:553-9. [DOI: 10.1080/09602011.2011.622435] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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