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Meier EL, Sheppard SM, Sebastian R, Berube S, Goldberg EB, Shea J, Stein CM, Hillis AE. Resting state correlates of picture description informativeness in left vs. right hemisphere chronic stroke. Front Neurol 2023; 14:1288801. [PMID: 38145117 PMCID: PMC10744570 DOI: 10.3389/fneur.2023.1288801] [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: 09/04/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Despite a growing emphasis on discourse processing in clinical neuroscience, relatively little is known about the neurobiology of discourse production impairments. Individuals with a history of left or right hemisphere stroke can exhibit difficulty with communicating meaningful discourse content, which implies both cerebral hemispheres play a role in this skill. However, the extent to which successful production of discourse content relies on network connections within domain-specific vs. domain-general networks in either hemisphere is unknown. Methods In this study, 45 individuals with a history of either left or right hemisphere stroke completed resting state fMRI and the Cookie Theft picture description task. Results Participants did not differ in the total number of content units or the percentage of interpretative content units they produced. Stroke survivors with left hemisphere damage produced significantly fewer content units per second than individuals with right hemisphere stroke. Intrinsic connectivity of the left language network was significantly weaker in the left compared to the right hemisphere stroke group for specific connections. Greater efficiency of communication of picture scene content was associated with stronger left but weaker right frontotemporal connectivity of the language network in patients with a history of left hemisphere (but not right hemisphere) stroke. No significant relationships were found between picture description measures and connectivity of the dorsal attention, default mode, or salience networks or with connections between language and other network regions. Discussion These findings add to prior behavioral studies of picture description skills in stroke survivors and provide insight into the role of the language network vs. other intrinsic networks during discourse production.
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Affiliation(s)
- Erin L. Meier
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Shannon M. Sheppard
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - Shauna Berube
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer Shea
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Colin M. Stein
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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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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Shekari E, Seyfi M, Modarres Zadeh A, Batouli SA, Valinejad V, Goudarzi S, Joghataei MT. Mechanisms of brain activation following naming therapy in aphasia: A systematic review on task-based fMRI studies. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:780-801. [PMID: 35666667 DOI: 10.1080/23279095.2022.2074849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The pattern of brain neuroplasticity after naming therapies in patients with aphasia can be evaluated using task-based fMRI. This article aims to review studies investigating brain reorganization after semantic and phonological-based anomia therapy that used picture-naming fMRI tasks. We searched for those articles that compared the activation of brain areas before and after aphasia therapies in the PubMed and the EMBASE databases from 1993 up to April 2020. All studies (single-cases or group designs) on anomia treatment in individuals with acquired aphasia were reviewed. Data were synthesized descriptively through tables to allow the facilitated comparison of the studies. A total of 14 studies were selected and reviewed. The results of the reviewed studies demonstrated that the naming improvement is associated with changes in the activation of cortical and subcortical brain areas. This review highlights the need for a more systematic investigation of the association between decreased and increased activation of brain areas related to anomia therapy. Also, more detailed information about factors influencing brain reorganization is required to elucidate the neural mechanisms of anomia therapy. Overall, regarding the theoretical and clinical aspects, the number of studies that used intensive protocol is growing, and based on the positive potential of these treatments, they could be suitable for the rehabilitation of people with aphasia.
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Affiliation(s)
- Ehsan Shekari
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Seyfi
- Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Modarres Zadeh
- Department of Speech Therapy, Faculty of Rehabilitation, Tehran University of Medical science, Tehran, Iran
| | - Seyed Amirhossein Batouli
- Neuroimaging and Analysis Group, Tehran University of Medical Sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Valinejad
- Department of Speech Therapy, Faculty of Rehabilitation, Tehran University of Medical science, Tehran, Iran
| | - Sepideh Goudarzi
- Department of Pharmacology and Toxicology, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
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Martin S, Frieling R, Saur D, Hartwigsen G. TMS over the pre-SMA enhances semantic cognition via remote network effects on task-based activity and connectivity. Brain Stimul 2023; 16:1346-1357. [PMID: 37704032 PMCID: PMC10615837 DOI: 10.1016/j.brs.2023.09.009] [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: 04/11/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The continuous decline of executive abilities with age is mirrored by increased neural activity of domain-general networks during task processing. So far, it remains unclear how much domain-general networks contribute to domain-specific processes such as language when cognitive demands increase. The current neuroimaging study explored the potential of intermittent theta-burst stimulation (iTBS) over a domain-general hub to enhance executive and semantic processing in healthy middle-aged to older adults. METHODS We implemented a cross-over within-subject study design with three task-based neuroimaging sessions per participant. Using an individualized stimulation approach, each participant received once effective and once sham iTBS over the pre-supplementary motor area (pre-SMA), a region of domain-general control. Subsequently, task-specific stimulation effects were assessed in functional MRI using a semantic and a non-verbal executive task with varying cognitive demand. RESULTS Effective stimulation increased activity only during semantic processing in visual and dorsal attention networks. Further, iTBS induced increased seed-based connectivity in task-specific networks for semantic and executive conditions with high cognitive load but overall reduced whole-brain coupling between domain-general networks. Notably, stimulation-induced changes in activity and connectivity related differently to behavior: While stronger activity of the parietal dorsal attention network was linked to poorer semantic performance, its enhanced coupling with the pre-SMA was associated with more efficient semantic processing. CONCLUSIONS iTBS modulates networks in a task-dependent manner and generates effects at regions remote to the stimulation site. These neural changes are linked to more efficient semantic processing, which underlines the general potential of network stimulation approaches in cognitive aging.
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Affiliation(s)
- Sandra Martin
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1a, 04103, Leipzig, Germany; Language & Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Regine Frieling
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1a, 04103, Leipzig, Germany
| | - Dorothee Saur
- Language & Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Gesa Hartwigsen
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1a, 04103, Leipzig, Germany; Wilhelm Wundt Institute for Psychology, Leipzig University, Neumarkt 9-19, 04109, Leipzig, Germany
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Zhu H, Fitzhugh MC, Keator LM, Johnson L, Rorden C, Bonilha L, Fridriksson J, Rogalsky C. How can graph theory inform the dual-stream model of speech processing? a resting-state fMRI study of post-stroke aphasia. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.17.537216. [PMID: 37131756 PMCID: PMC10153155 DOI: 10.1101/2023.04.17.537216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The dual-stream model of speech processing has been proposed to represent the cortical networks involved in speech comprehension and production. Although it is arguably the prominent neuroanatomical model of speech processing, it is not yet known if the dual-stream model represents actual intrinsic functional brain networks. Furthermore, it is unclear how disruptions after a stroke to the functional connectivity of the dual-stream model's regions are related to specific types of speech production and comprehension impairments seen in aphasia. To address these questions, in the present study, we examined two independent resting-state fMRI datasets: (1) 28 neurotypical matched controls and (2) 28 chronic left-hemisphere stroke survivors with aphasia collected at another site. Structural MRI, as well as language and cognitive behavioral assessments, were collected. Using standard functional connectivity measures, we successfully identified an intrinsic resting-state network amongst the dual-stream model's regions in the control group. We then used both standard functional connectivity analyses and graph theory approaches to determine how the functional connectivity of the dual-stream network differs in individuals with post-stroke aphasia, and how this connectivity may predict performance on clinical aphasia assessments. Our findings provide strong evidence that the dual-stream model is an intrinsic network as measured via resting-state MRI, and that weaker functional connectivity of the hub nodes of the dual-stream network defined by graph theory methods, but not overall average network connectivity, is weaker in the stroke group than in the control participants. Also, the functional connectivity of the hub nodes predicted specific types of impairments on clinical assessments. In particular, the relative strength of connectivity of the right hemisphere's homologues of the left dorsal stream hubs to the left dorsal hubs versus right ventral stream hubs is a particularly strong predictor of post-stroke aphasia severity and symptomology.
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Altered Spontaneous Brain Activity in Poststroke Aphasia: A Resting-State fMRI Study. Brain Sci 2023; 13:brainsci13020300. [PMID: 36831843 PMCID: PMC9954170 DOI: 10.3390/brainsci13020300] [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: 12/10/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
PURPOSE Brain areas frequently implicated in language recovery after stroke comprise perilesional sites in the left hemisphere and homotopic regions in the right hemisphere. However, the neuronal mechanisms underlying language restoration are still largely unclear. METHODS AND MATERIALS In the present study, we investigated the brain function in 15 patients with poststroke aphasia and 30 matched control subjects by combining the regional homogeneity (ReHo) and amplitudes of low-frequency fluctuation (ALFF) analysis methods based on resting-state fMRI. RESULTS Compared to the control subjects, the patients with aphasia exhibited increased ReHo and ALFF values in the ipsilateral perilesional areas and increased ReHo in the contralesional right middle frontal gyrus. CONCLUSIONS The increased spontaneous brain activity in patients with poststroke aphasia during the recovery period, specifically in the ipsilateral perilesional regions and the homologous language regions of the right hemisphere, has potential implications for the treatment of patients with aphasia.
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Marchina S, Norton A, Schlaug G. Effects of melodic intonation therapy in patients with chronic nonfluent aphasia. Ann N Y Acad Sci 2023; 1519:173-185. [PMID: 36349876 PMCID: PMC10262915 DOI: 10.1111/nyas.14927] [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: 11/11/2022]
Abstract
Patients with large left-hemisphere lesions and post-stroke aphasia often remain nonfluent. Melodic intonation therapy (MIT) may be an effective alternative to traditional speech therapy for facilitating recovery of fluency in those patients. In an open-label, proof-of-concept study, 14 subjects with nonfluent aphasia with large left-hemisphere lesions (171 ± 76 cc) underwent two speech/language assessments before, one at the midpoint, and two after the end of 75 sessions (1.5 h/session) of MIT. Functional MR imaging was done before and after therapy asking subjects to vocalize the same set of 10 bi-syllabic words. We found significant improvements in speech output after a period of intensive MIT (75 sessions for a total of 112.5 h) compared to two pre-therapy assessments. Therapy-induced gains were maintained 4 weeks post-treatment. Imaging changes were seen in a right-hemisphere network that included the posterior superior temporal and inferior frontal gyri, inferior pre- and postcentral gyri, pre-supplementary motor area, and supramarginal gyrus. Functional changes in the posterior right inferior frontal gyri significantly correlated with changes in a measure of fluency. Intense training of intonation-supported auditory-motor coupling and engaging feedforward/feedback control regions in the unaffected hemisphere improves speech-motor functions in subjects with nonfluent aphasia and large left-hemisphere lesions.
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Affiliation(s)
- Sarah Marchina
- Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Norton
- Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Gottfried Schlaug
- Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Music, Neuroimaging and Stroke Recovery Laboratories, University of Massachusetts Chan Medical School – Baystate Campus, Springfield, Massachusetts, USA
- Department of Biomedical Engineering and Institute of Applied Life Sciences, University of Massachusetts, Amherst, Amherst, Massachusetts, USA
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8
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Ledwidge PS, Jones CM, Huston CA, Trenkamp M, Bator B, Laeng J. Electrophysiology reveals cognitive-linguistic alterations after concussion. BRAIN AND LANGUAGE 2022; 233:105166. [PMID: 35970083 DOI: 10.1016/j.bandl.2022.105166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
Language deficits and alterations to the N400 ERP are commonly reported in aphasia and moderate-to-severe traumatic brain injury (TBI), but have seldomly been investigated after mild TBI, such as concussion. In the present study, the N400 was recorded from young adults within 1-month after concussion and matched controls during a sentence processing task. The N400 recorded to semantically incongruent sentence-final words was significantly more negative and with a more anterior distribution in the concussion group than control group. Among the concussion group, a weaker N400 was associated with more concussion symptoms, slower response time, and poorer executive functioning. Multiple regression results showed that concussion occurrence and male gender were independently associated with a more negative N400-effect, whereas symptoms were associated with a weaker N400. These findings provide novel evidence that alterations to lexical-semantic networks may occur after concussion and vary based on individual differences in post-concussion symptoms and cognitive function.
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Affiliation(s)
- Patrick S Ledwidge
- Department of Psychology, Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017, USA.
| | - Christa M Jones
- Department of Communication Sciences & Disorders, Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017, USA
| | - Chloe A Huston
- Department of Psychology, Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017, USA
| | - Madison Trenkamp
- Department of Psychology, Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017, USA
| | - Bryan Bator
- Department of Psychology, Baldwin Wallace University, 275 Eastland Rd., Berea, OH 44017, USA
| | - Jennie Laeng
- Cleveland Clinic, Taussig Cancer Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Katsuno Y, Ueki Y, Ito K, Murakami S, Aoyama K, Oishi N, Kan H, Matsukawa N, Nagao K, Tatsumi H. Effects of a new speech support application on intensive speech therapy and changes in functional brain connectivity in patients with post-stroke aphasia. Front Hum Neurosci 2022; 16:870733. [PMID: 36211132 PMCID: PMC9535658 DOI: 10.3389/fnhum.2022.870733] [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: 02/07/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Aphasia is a language disorder that occurs after a stroke and impairs listening, speaking, reading, writing, and calculation skills. Patients with post-stroke aphasia in Japan are increasing due to population aging and the advancement of medical treatment. Opportunities for adequate speech therapy in chronic stroke are limited due to time constraints. Recent studies have reported that intensive speech therapy for a short period of time or continuous speech therapy using high-tech equipment, including speech applications (apps, can improve aphasia even in the chronic stage. However, its underlying mechanism for improving language function and its effect on other cognitive functions remains unclear. In the present study, we investigated whether intensive speech therapy using a newly developed speech support app could improve aphasia and other cognitive functions in patients with chronic stroke. Furthermore, we examined whether it can alter the brain network related to language and other cortical areas. Thus, we conducted a prospective, single-comparison study to examine the effects of a new speech support app on language and cognitive functions and used resting state functional MRI (rs-fMRI) regions of interest (ROI) to ROI analysis to determine changes in the related brain network. Two patients with chronic stroke participated in this study. They used the independent speech therapy system to perform eight sets of 20 randomly presented words/time (taking approximately 20 min), for 8 consecutive weeks. Their language, higher cognitive functions including attention function, and rs-fMRI, were evaluated before and after the rehabilitation intervention using the speech support app. Both patients had improved pronunciation, daily conversational situations, and attention. The rs-fMRI analysis showed increased functional connectivity of brain regions associated with language and attention related areas. Our results show that intensive speech therapy using this speech support app can improve language and attention functions even in the chronic stage of stroke, and may be a useful tool for patients with aphasia. In the future, we will conduct longitudinal studies with larger numbers of patients, which we hope will continue the trends seen in the current study, and provide even stronger evidence for the usefulness of this new speech support app.
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Affiliation(s)
- Yuta Katsuno
- Department of Rehabilitation Medicine, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yoshino Ueki
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- *Correspondence: Yoshino Ueki
| | - Keiichi Ito
- Department of Rehabilitation Medicine, Kamiida Rehabilitation Hospital, Nagoya, Japan
| | - Satona Murakami
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Satona Murakami
| | - Kiminori Aoyama
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naoya Oishi
- Medical Innovation Centre, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirohito Kan
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Matsukawa
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Katashi Nagao
- Department of Intelligent Systems, Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Hiroshi Tatsumi
- Department of Health Science, Aichi Gakuin University, Nagoya, Japan
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Schneider HR, Wawrzyniak M, Stockert A, Klingbeil J, Saur D. fMRI informed voxel-based lesion analysis to identify lesions associated with right-hemispheric activation in aphasia recovery. Neuroimage Clin 2022; 36:103169. [PMID: 36037659 PMCID: PMC9440420 DOI: 10.1016/j.nicl.2022.103169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
Several mechanisms have been attributed to post-stroke loss and recovery of language functions. However, the significance and timing of domain-general and homotopic right-hemispheric activation is controversial. We aimed to examine the effect of left-hemispheric lesion location and time post-stroke on right-hemispheric activation. Voxel-based lesion analyses were informed by auditory language-related fMRI activation of 71 patients with left middle cerebral artery stroke examined longitudinally in the acute, subacute and early chronic phase. Language activation was determined in several right-hemispheric regions of interest and served as regressor of interest for voxel-based lesion analyses. We found that an acute to chronic increase of language activation in the right supplementary motor area was associated with lesions to the left extreme capsule as part of the ventral language pathway. Importantly, this activation increase correlated significantly with improvement of out-of-scanner comprehension abilities. We interpret our findings in terms of successful domain-general compensation in patients with critical left frontotemporal disconnection due to damage to the ventral language pathway but relatively spared cortical language areas.
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Affiliation(s)
| | - Max Wawrzyniak
- Corresponding author at: Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103 Leipzig, Germany.
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Kristinsson S, den Ouden DB, Rorden C, Newman-Norlund R, Neils-Strunjas J, Fridriksson J. Predictors of Therapy Response in Chronic Aphasia: Building a Foundation for Personalized Aphasia Therapy. J Stroke 2022; 24:189-206. [PMID: 35677975 PMCID: PMC9194549 DOI: 10.5853/jos.2022.01102] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic aphasia, a devastating impairment of language, affects up to a third of stroke survivors. Speech and language therapy has consistently been shown to improve language function in prior clinical trials, but few clinicially applicable predictors of individual therapy response have been identified to date. Consequently, clinicians struggle substantially with prognostication in the clinical management of aphasia. A rising prevalence of aphasia, in particular in younger populations, has emphasized the increasing demand for a personalized approach to aphasia therapy, that is, therapy aimed at maximizing language recovery of each individual with reference to evidence-based clinical recommendations. In this narrative review, we discuss the current state of the literature with respect to commonly studied predictors of therapy response in aphasia. In particular, we focus our discussion on biographical, neuropsychological, and neurobiological predictors, and emphasize limitations of the literature, summarize consistent findings, and consider how the research field can better support the development of personalized aphasia therapy. In conclusion, a review of the literature indicates that future research efforts should aim to recruit larger samples of people with aphasia, including by establishing multisite aphasia research centers.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
- Correspondence: Sigfus Kristinsson Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, SC 29209, USA Tel: +1-803-553-4689 Fax: +1-803-777-9547 E-mail:
| | - Dirk B. den Ouden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Roger Newman-Norlund
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
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12
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Xie X, Zhang T, Bai T, Chen C, Ji GJ, Tian Y, Yang J, Wang K. Resting-State Neural-Activity Alterations in Subacute Aphasia after Stroke. Brain Sci 2022; 12:brainsci12050678. [PMID: 35625064 PMCID: PMC9139890 DOI: 10.3390/brainsci12050678] [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: 03/20/2022] [Revised: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
Linguistic deficits are frequent symptoms among stroke survivors. The neural mechanism of post-stroke aphasia (PSA) was incompletely understood. Recently, resting-state functional magnetic resonance imaging (rs-fMRI) was widely used among several neuropsychological disorders. However, previous rs-fMRI studies of PSA were limited to very small sample size and the absence of reproducibility with different neuroimaging indexes. The present study performed comparisons with static and dynamic amplitude of low-frequency fluctuations (ALFF) and functional connectivity (FC) based on modest sample size (40 PSA and 37 healthy controls). Compared with controls, PSA showed significantly increased static ALFF predominantly in the bilateral supplementary motor area (SMA) and right hippocampus-parahippocampus (R HIP-ParaHip) and decreased static ALFF in right cerebellum. The increased dynamic ALFF in SMA and decreased dynamic ALFF in right cerebellum were also found in PSA. The static and dynamic ALFF in right cerebellum was positively correlated with spontaneous speech. The FC between the SMA and R HIP-ParaHip was significantly stronger in patients than controls and positively correlated with ALFF in bilateral SMA. In addition, the FC between the R HIP-ParaHip and the right temporal was also enhanced in patients and negatively correlated with repetition, naming, and comprehension score. These findings revealed consistently abnormal intrinsic neural activity in SMA and cerebellum, which may underlie linguistic deficits in PSA.
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Affiliation(s)
- Xiaohui Xie
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230032, China; (X.X.); (T.Z.); (T.B.); (C.C.); (Y.T.)
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China;
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
| | - Ting Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230032, China; (X.X.); (T.Z.); (T.B.); (C.C.); (Y.T.)
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China;
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
| | - Tongjian Bai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230032, China; (X.X.); (T.Z.); (T.B.); (C.C.); (Y.T.)
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China;
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
| | - Chen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230032, China; (X.X.); (T.Z.); (T.B.); (C.C.); (Y.T.)
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China;
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
| | - Gong-Jun Ji
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China;
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230032, China; (X.X.); (T.Z.); (T.B.); (C.C.); (Y.T.)
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China;
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
| | - Jinying Yang
- Laboratory Center for Information Science, University of Science and Technology of China, Hefei 230026, China;
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230032, China; (X.X.); (T.Z.); (T.B.); (C.C.); (Y.T.)
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China;
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei 231299, China
- Correspondence: ; Tel.: +86-0551-62923704
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Pasquini L, Di Napoli A, Rossi-Espagnet MC, Visconti E, Napolitano A, Romano A, Bozzao A, Peck KK, Holodny AI. Understanding Language Reorganization With Neuroimaging: How Language Adapts to Different Focal Lesions and Insights Into Clinical Applications. Front Hum Neurosci 2022; 16:747215. [PMID: 35250510 PMCID: PMC8895248 DOI: 10.3389/fnhum.2022.747215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
When the language-dominant hemisphere is damaged by a focal lesion, the brain may reorganize the language network through functional and structural changes known as adaptive plasticity. Adaptive plasticity is documented for triggers including ischemic, tumoral, and epileptic focal lesions, with effects in clinical practice. Many questions remain regarding language plasticity. Different lesions may induce different patterns of reorganization depending on pathologic features, location in the brain, and timing of onset. Neuroimaging provides insights into language plasticity due to its non-invasiveness, ability to image the whole brain, and large-scale implementation. This review provides an overview of language plasticity on MRI with insights for patient care. First, we describe the structural and functional language network as depicted by neuroimaging. Second, we explore language reorganization triggered by stroke, brain tumors, and epileptic lesions and analyze applications in clinical diagnosis and treatment planning. By comparing different focal lesions, we investigate determinants of language plasticity including lesion location and timing of onset, longitudinal evolution of reorganization, and the relationship between structural and functional changes.
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Affiliation(s)
- Luca Pasquini
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
- Radiology Department, Castelli Hospital, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Emiliano Visconti
- Neuroradiology Unit, Cesena Surgery and Trauma Department, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Kyung K. Peck
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrei I. Holodny
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
- Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, New York, NY, United States
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14
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Meier EL. The role of disrupted functional connectivity in aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:99-119. [PMID: 35078613 DOI: 10.1016/b978-0-12-823384-9.00005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Language is one of the most complex and specialized higher cognitive processes. Brain damage to the distributed, primarily left-lateralized language network can result in aphasia, a neurologic disorder characterized by receptive and/or expressive deficits in spoken and/or written language. Most often, aphasia is the consequence of stroke-termed poststroke aphasia (PSA)-yet, aphasia can also manifest due to neurodegenerative disease, specifically, a disorder called primary progressive aphasia (PPA). In recent years, functional connectivity neuroimaging studies have provided emerging evidence supporting theories regarding the relationships between language impairments, structural brain damage, and functional network properties in these two disorders. This chapter reviews the current evidence for the "network phenotype of stroke injury" hypothesis (Siegel et al., 2016) as it pertains to PSA and the "network degeneration hypothesis" (Seeley et al., 2009) as it pertains to PPA. Methodologic considerations for functional connectivity studies, limitations of the current functional connectivity literature in aphasia, and future directions are also discussed.
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Affiliation(s)
- Erin L Meier
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States.
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15
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LaCroix AN, James E, Rogalsky C. Neural Resources Supporting Language Production vs. Comprehension in Chronic Post-stroke Aphasia: A Meta-Analysis Using Activation Likelihood Estimates. Front Hum Neurosci 2021; 15:680933. [PMID: 34759804 PMCID: PMC8572938 DOI: 10.3389/fnhum.2021.680933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/22/2021] [Indexed: 02/04/2023] Open
Abstract
In post-stroke aphasia, language tasks recruit a combination of residual regions within the canonical language network, as well as regions outside of it in the left and right hemispheres. However, there is a lack of consensus as to how the neural resources engaged by language production and comprehension following a left hemisphere stroke differ from one another and from controls. The present meta-analysis used activation likelihood estimates to aggregate across 44 published fMRI and PET studies to characterize the functional reorganization patterns for expressive and receptive language processes in persons with chronic post-stroke aphasia (PWA). Our results in part replicate previous meta-analyses: we find that PWA activate residual regions within the left lateralized language network, regardless of task. Our results extend this work to show differential recruitment of the left and right hemispheres during language production and comprehension in PWA. First, we find that PWA engage left perilesional regions during language comprehension, and that the extent of this activation is likely driven by stimulus type and domain-general cognitive resources needed for task completion. In contrast to comprehension, language production was associated with activation of the right frontal and temporal cortices. Further analyses linked right hemisphere regions involved in motor speech planning for language production with successful naming in PWA, while unsuccessful naming was associated with the engagement of the right inferior frontal gyrus, a region often implicated in domain-general cognitive processes. While the within-group findings indicate that the engagement of the right hemisphere during language tasks in post-stroke aphasia differs for expressive vs. receptive tasks, the overall lack of major between-group differences between PWA and controls implies that PWA rely on similar cognitive-linguistic resources for language as controls. However, more studies are needed that report coordinates for PWA and controls completing the same tasks in order for future meta-analyses to characterize how aphasia affects the neural resources engaged during language, particularly for specific tasks and as a function of behavioral performance.
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Affiliation(s)
- Arianna N LaCroix
- College of Health Sciences, Midwestern University, Glendale, AZ, United States
| | - Eltonnelle James
- College of Health Sciences, Midwestern University, Glendale, AZ, United States
| | - Corianne Rogalsky
- College of Health Solutions, Arizona State University, Tempe, AZ, United States
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New Treatment Strategy Using Repetitive Transcranial Magnetic Stimulation for Post-Stroke Aphasia. Diagnostics (Basel) 2021; 11:diagnostics11101853. [PMID: 34679550 PMCID: PMC8534572 DOI: 10.3390/diagnostics11101853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) for post-stroke aphasia (PSA) has been suggested to promote improvement of language function when used in combination with rehabilitation. However, many challenges remain. In some reports examined by category of language function, only naming has good evidence of improvement, and the improvement effect on other language modalities is low. Therefore, it is necessary to establish methods that contribute to the improvement of language functions other than naming. Therapeutic methods for PSA based on the mechanism of rTMS are mainly inhibitory stimulation methods for language homologous areas. However, the mechanisms of these methods are controversial when inferred from the process of recovery of language function. Low-frequency rTMS applied to the right hemisphere has been shown to be effective in the chronic phase of PSA, but recent studies of the recovery process of language function indicate that this method is unclear. Therefore, it has been suggested that evaluating brain activity using neuroimaging contributes to confirming the effect of rTMS on PSA and the elucidation of the mechanism of functional improvement. In addition, neuroimaging-based stimulation methods (imaging-based rTMS) may lead to further improvements in language function. Few studies have examined neuroimaging and imaging-based rTMS in PSA, and further research is required. In addition, the stimulation site and stimulation parameters of rTMS are likely to depend on the time from onset to intervention. However, there are no reports of studies in patients between 90 and 180 days after onset. Therefore, research during this period is required. New stimulation methods, such as multiple target methods and the latest neuroimaging methods, may contribute to the establishment of new knowledge and new treatment methods in this field.
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Simic T, Leonard C, Laird L, Stewart S, Rochon E. The effects of intensity on a phonological treatment for anomia in post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2021; 93:106125. [PMID: 34166970 DOI: 10.1016/j.jcomdis.2021.106125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The evidence regarding optimal treatment intensity is mixed, and differing definitions have further confounded existing findings. The primary objective of this study was to compare the efficacy of Phonological Components Analysis (PCA) treatment for anomia delivered at intense and non-intense schedules, using a well-controlled design. The number of teaching episodes and active ingredients of therapy are important considerations when defining intensity. We hypothesized that an active ingredient of PCA is the self-generation of phonological components during therapy sessions. Our secondary aim was to examine whether component generation predicted treatment outcome. METHODS Sixteen adults (M = 52.63 years old, SD = 11.40) with chronic post-stroke aphasia (M = 4.52 years post-onset, SD = 5.55) were randomly assigned to intensive (IT) or standard (ST) PCA treatment conditions. Cumulative treatment intensity in both conditions was equivalent: ST participants received PCA 1 hour/day, 3 days/week for 10 weeks, whereas IT participants received PCA 3 hours/day, 4 days/week for 2.5 weeks. The primary outcome was naming accuracy on a set of treated and (matched) untreated words, measured pre- and post-treatment, and at four- and eight-week follow-ups. RESULTS IT and ST conditions were similarly efficacious. However, secondary analyses suggest an advantage for the IT condition in naming of the treated words immediately post-treatment, but not at follow-ups. The self-generation of phonological components emerged as a significant positive predictor of naming accuracy for both the treated and untreated words. However, this relationship did not reach significance once baseline anomia severity was accounted for. CONCLUSIONS Although replication in a larger sample is warranted, results suggest that PCA treatment is similarly efficacious when delivered at different intensities. Other factors related to the quality of treatment (i.e., active ingredients such as cue-generation) may play an important role in determining treatment efficacy and must also be considered when comparing treatment intensities.
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Affiliation(s)
- Tijana Simic
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada; Department of Psychology, Université de Montréal, 90 Vincent d'Indy Avenue, Montreal, QC H2V 2S9, Canada; Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal (CRIUGM), 4545 Queen Mary Rd., Montreal, QC H3W 1W4, Canada.
| | - Carol Leonard
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Rd., Ottawa, ON K1H 8M5, Canada
| | - Laura Laird
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Steven Stewart
- KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada; Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, 600 Peter Morand Cres., Suite 206, Ottawa, ON K1G 5Z3, Canada; KITE Research Institute, Toronto Rehab, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2, Canada
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18
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DeMarco AT, Dvorak E, Lacey E, Stoodley CJ, Turkeltaub PE. An Exploratory Study of Cerebellar Transcranial Direct Current Stimulation in Individuals With Chronic Stroke Aphasia. Cogn Behav Neurol 2021; 34:96-106. [PMID: 34074864 PMCID: PMC8186819 DOI: 10.1097/wnn.0000000000000270] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aphasia is a common, debilitating consequence of stroke, and speech therapy is often inadequate to achieve a satisfactory outcome. Neuromodulation techniques have emerged as a potential augmentative treatment for improving aphasia outcomes. Most studies have targeted the cerebrum, but there are theoretical and practical reasons that stimulation over the cerebral hemispheres might not be ideal. On the other hand, the right cerebellum is functionally and anatomically linked to major language areas in the left hemisphere, making it a promising alternative target site for stimulation. OBJECTIVE To provide preliminary effect sizes for the ability of a short course of anodal transcranial direct current stimulation (tDCS) targeted over the right cerebellum to enhance language processing in individuals with chronic poststroke aphasia. METHOD Ten individuals received five sessions of open-label anodal tDCS targeting the right cerebellum. The effects of the tDCS were compared with the effects of sham tDCS on 14 controls from a previous clinical trial. In total, 24 individuals with chronic poststroke aphasia participated in the study. Behavioral testing was conducted before treatment, immediately following treatment, and at the 3-month follow-up. RESULTS Cerebellar tDCS did not significantly enhance language processing measured either immediately following treatment or at the 3-month follow-up. The effect sizes of tDCS over sham treatment were generally nil or small, except for the mean length of utterance on the picture description task, for which medium to large effects were observed. CONCLUSION These results may provide guidance for investigators who are planning larger trials of tDCS for individuals with chronic poststroke aphasia.
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Affiliation(s)
- Andrew T DeMarco
- Departments of Rehabilitation Medicine
- Neurology, Georgetown University, Washington, DC
| | | | - Elizabeth Lacey
- Neurology, Georgetown University, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | | | - Peter E Turkeltaub
- Neurology, Georgetown University, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
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19
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Dreyer FR, Doppelbauer L, Büscher V, Arndt V, Stahl B, Lucchese G, Hauk O, Mohr B, Pulvermüller F. Increased Recruitment of Domain-General Neural Networks in Language Processing Following Intensive Language-Action Therapy: fMRI Evidence From People With Chronic Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:455-465. [PMID: 32830988 PMCID: PMC7613191 DOI: 10.1044/2020_ajslp-19-00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose This study aimed to provide novel insights into the neural correlates of language improvement following intensive language-action therapy (ILAT; also known as constraint-induced aphasia therapy). Method Sixteen people with chronic aphasia underwent clinical aphasia assessment (Aachen Aphasia Test [AAT]), as well as functional magnetic resonance imaging (fMRI), both administered before (T1) and after ILAT (T2). The fMRI task included passive reading of single written words, with hashmark strings as visual baseline. Results Behavioral results indicated significant improvements of AAT scores across therapy, and fMRI results showed T2-T1 blood oxygenation-level-dependent (BOLD) signal change in the left precuneus to be modulated by the degree of AAT score increase. Subsequent region-of-interest analysis of this precuneus cluster confirmed a positive correlation of T2-T1 BOLD signal change and improvement on the clinical aphasia test. Similarly, the entire default mode network revealed a positive correlation between T2-T1 BOLD signal change and clinical language improvement. Conclusion These results are consistent with a more efficient recruitment of domain-general neural networks in language processing, including those involved in attentional control, following aphasia therapy with ILAT. Supplemental Material https://doi.org/10.23641/asha.12765755.
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Affiliation(s)
- Felix R. Dreyer
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Germany
- Cluster of Excellence Matters of Activity, Image Space Material, Humboldt Universität zu Berlin, Germany
| | - Lea Doppelbauer
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Germany
- Einstein Center for Neurosciences Berlin, Germany
- Berlin School of Mind and Brain, Humboldt University Berlin, Germany
| | - Verena Büscher
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Germany
| | - Verena Arndt
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Germany
| | - Benjamin Stahl
- Department of Neurology, University Medicine Greifswald, Germany
- Department of Neurology, Charité Universitätsmedizin Berlin, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Psychologische Hochschule Berlin, Germany
| | | | - Olaf Hauk
- Medical Research Council Cognition and Brain Science Unit, Cambridge, United Kingdom
| | - Bettina Mohr
- ZeNIS-Centre for Neuropsychology and Intensive Language Therapy, Berlin, Germany
- Department of Psychiatry, Charité Universitätsmedizin Berlin, Germany
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Germany
- Cluster of Excellence Matters of Activity, Image Space Material, Humboldt Universität zu Berlin, Germany
- Einstein Center for Neurosciences Berlin, Germany
- Berlin School of Mind and Brain, Humboldt University Berlin, Germany
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20
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Wilson SM, Schneck SM. Neuroplasticity in post-stroke aphasia: A systematic review and meta-analysis of functional imaging studies of reorganization of language processing. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2021; 2:22-82. [PMID: 33884373 PMCID: PMC8057712 DOI: 10.1162/nol_a_00025] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Recovery from aphasia is thought to depend on neural plasticity, that is, functional reorganization of surviving brain regions such that they take on new or expanded roles in language processing. We carried out a systematic review and meta-analysis of all articles published between 1995 and early 2020 that have described functional imaging studies of six or more individuals with post-stroke aphasia, and have reported analyses bearing on neuroplasticity of language processing. Each study was characterized and appraised in detail, with particular attention to three critically important methodological issues: task performance confounds, contrast validity, and correction for multiple comparisons. We identified 86 studies describing a total of 561 relevant analyses. We found that methodological limitations related to task performance confounds, contrast validity, and correction for multiple comparisons have been pervasive. Only a few claims about language processing in individuals with aphasia are strongly supported by the extant literature: first, left hemisphere language regions are less activated in individuals with aphasia than neurologically normal controls, and second, in cohorts with aphasia, activity in left hemisphere language regions, and possibly a temporal lobe region in the right hemisphere, is positively correlated with language function. There is modest, equivocal evidence for the claim that individuals with aphasia differentially recruit right hemisphere homotopic regions, but no compelling evidence for differential recruitment of additional left hemisphere regions or domain-general networks. There is modest evidence that left hemisphere language regions return to function over time, but no compelling longitudinal evidence for dynamic reorganization of the language network.
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Affiliation(s)
- Stephen M. Wilson
- Address for correspondence: Stephen M. Wilson, Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Ave S, MCE 8310, Nashville, TN 37232. Phone: 615-936-5810.
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Riccardi N, Yourganov G, Rorden C, Fridriksson J, Desai R. Degradation of Praxis Brain Networks and Impaired Comprehension of Manipulable Nouns in Stroke. J Cogn Neurosci 2020; 32:467-483. [PMID: 31682566 PMCID: PMC10274171 DOI: 10.1162/jocn_a_01495] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Distributed brain systems contribute to representation of semantic knowledge. Whether sensory and motor systems of the brain are causally involved in representing conceptual knowledge is an especially controversial question. Here, we tested 57 chronic left-hemisphere stroke patients using a semantic similarity judgment task consisting of manipulable and nonmanipulable nouns. Three complementary methods were used to assess the neuroanatomical correlates of semantic processing: voxel-based lesion-symptom mapping, resting-state functional connectivity, and gray matter fractional anisotropy. The three measures provided converging evidence that injury to the brain networks required for action observation, execution, planning, and visuomotor coordination are associated with specific deficits in manipulable noun comprehension relative to nonmanipulable items. Damage or disrupted connectivity of areas such as the middle posterior temporal gyrus, anterior inferior parietal lobe, and premotor cortex was related specifically to the impairment of manipulable noun comprehension. These results suggest that praxis brain networks contribute especially to the comprehension of manipulable object nouns.
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22
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Riccardi N, Yourganov G, Rorden C, Fridriksson J, Desai RH. Dissociating action and abstract verb comprehension post-stroke. Cortex 2019; 120:131-146. [PMID: 31302507 PMCID: PMC6825884 DOI: 10.1016/j.cortex.2019.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/30/2019] [Accepted: 05/23/2019] [Indexed: 11/30/2022]
Abstract
The neural bases of action and abstract concept representations remain a topic of debate. While several lines of research provide evidence for grounding of action-related conceptual content into sensory-motor systems, results of traditional lesion-deficit studies have been somewhat inconsistent. Further, few studies have directly compared the neural substrates of action and relatively abstract verb comprehension post-stroke. Here, we investigated the impact of the disruption of two neural networks on comprehension of action and relatively abstract verbs in 48 unilateral left-hemisphere stroke patients using two methodologies: 1) lesion-deficit association and 2) resting-state functional connectivity (RSFC) analyses. Disruption of RSFC between the left inferior frontal gyrus and right hemisphere primary and secondary sensory-motor areas predicted greater relative impairment of action semantics. Voxel-based lesion-symptom mapping revealed that damage to frontal white matter, extending towards the inferior frontal gyrus, also predicted greater relative impairment of action semantics. On the other hand, damage to the left anterior middle temporal gyrus significantly impaired the more abstract category relative to action. These findings support the view that action and non-action/abstract semantic processing rely on partially dissociable brain networks, with action concepts relying more heavily on sensory-motor areas. The results also have wider implications for lesion-deficit association studies and show how the contralateral hemisphere can play a compensatory role following unilateral stroke.
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Affiliation(s)
- Nicholas Riccardi
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Grigori Yourganov
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA; Institute for Mind and Brain, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA; Institute for Mind and Brain, University of South Carolina, Columbia, SC, USA
| | - Rutvik H Desai
- Department of Psychology, University of South Carolina, Columbia, SC, USA; Institute for Mind and Brain, University of South Carolina, Columbia, SC, USA.
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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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Orthographic Visualisation Induced Brain Activations in a Chronic Poststroke Global Aphasia with Dissociation between Oral and Written Expression. Case Rep Neurol Med 2019; 2019:8425914. [PMID: 31355031 PMCID: PMC6632504 DOI: 10.1155/2019/8425914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/03/2019] [Indexed: 11/17/2022] Open
Abstract
We propose a method of orthographic visualisation strategy in a poststroke severe aphasia person with dissociation between oral and written expression. fMRI results suggest that such strategy may induce the engagement of alternative nonlanguage networks and visual representations may help improving oral output. This choice of rehabilitation method can be based on the remaining capacities and, therefore, on written language. Most notably, no study so far addressed how orthographic visualisation strategy during speech rehabilitation might influence clinical outcomes in nonfluent aphasia and apraxia patients.
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25
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How Does iReadMore Therapy Change the Reading Network of Patients with Central Alexia? J Neurosci 2019; 39:5719-5727. [PMID: 31085605 DOI: 10.1523/jneurosci.1426-18.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 03/07/2019] [Accepted: 03/16/2019] [Indexed: 11/21/2022] Open
Abstract
Central alexia (CA) is an acquired reading disorder co-occurring with a generalized language deficit (aphasia). The roles of perilesional and ipsilesional tissue in recovery from poststroke aphasia are unclear. We investigated the impact of reading training (using iReadMore, a therapy app) on the connections within and between the right and left hemisphere of the reading network of patients with CA. In patients with pure alexia, iReadMore increased feedback from left inferior frontal gyrus (IFG) region to the left occipital (OCC) region. We aimed to identify whether iReadMore therapy was effective through a similar mechanism in patients with CA. Participants with chronic poststroke CA (n = 23) completed 35 h of iReadMore training over 4 weeks. Reading accuracy for trained and untrained words was assessed before and after therapy. The neural response to reading trained and untrained words in the left and right OCC, ventral occipitotemporal, and IFG regions was examined using event-related magnetoencephalography. The training-related modulation in effective connectivity between regions was modeled at the group level with dynamic causal modeling. iReadMore training improved participants' reading accuracy by an average of 8.4% (range, -2.77 to 31.66) while accuracy for untrained words was stable. Training increased regional sensitivity in bilateral frontal and occipital regions, and strengthened feedforward connections within the left hemisphere. Our data suggest that iReadMore training in these patients modulates lower-order visual representations, as opposed to higher-order, more abstract representations, to improve word-reading accuracy.SIGNIFICANCE STATEMENT This is the first study to conduct a network-level analysis of therapy effects in participants with poststroke central alexia. When patients trained with iReadMore (a multimodal, behavioral, mass practice, computer-based therapy), reading accuracy improved by an average 8.4% on trained items. A network analysis of the magnetoencephalography data associated with this improvement revealed an increase in regional sensitivity in bilateral frontal and occipital regions and strengthening of feedforward connections within the left hemisphere. This indicates that in patients with CA iReadMore engages lower-order, intact resources within the left hemisphere (posterior to their lesion locations) to improve word reading. This provides a foundation for future research to investigate reading network modulation in different CA subtypes, or for sentence-level therapy.
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Meier EL, Johnson JP, Pan Y, Kiran S. A lesion and connectivity-based hierarchical model of chronic aphasia recovery dissociates patients and healthy controls. NEUROIMAGE-CLINICAL 2019; 23:101919. [PMID: 31491828 PMCID: PMC6702239 DOI: 10.1016/j.nicl.2019.101919] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 06/05/2019] [Accepted: 06/30/2019] [Indexed: 12/28/2022]
Abstract
Traditional models of left hemisphere stroke recovery propose that reactivation of remaining ipsilesional tissue is optimal for language processing whereas reliance on contralesional right hemisphere homologues is less beneficial or possibly maladaptive in the chronic recovery stage. However, neuroimaging evidence for this proposal is mixed. This study aimed to elucidate patterns of effective connectivity in patients with chronic aphasia in light of healthy control connectivity patterns and in relation to damaged tissue within left hemisphere regions of interest and according to performance on a semantic decision task. Using fMRI and dynamic causal modeling, biologically-plausible models within four model families were created to correspond to potential neural recovery patterns, including Family A: Left-lateralized connectivity (i.e., no/minimal damage), Family B: Bilateral anterior-weighted connectivity (i.e., posterior damage), Family C: Bilateral posterior-weighted connectivity (i.e., anterior damage) and Family D: Right-lateralized connectivity (i.e., extensive damage). Controls exhibited a strong preference for left-lateralized network models (Family A) whereas patients demonstrated a split preference for Families A and C. At the level of connections, controls exhibited stronger left intrahemispheric task-modulated connections than did patients. Within the patient group, damage to left superior frontal structures resulted in greater right intrahemispheric connectivity whereas damage to left ventral structures resulted in heightened modulation of left frontal regions. Lesion metrics best predicted accuracy on the fMRI task and aphasia severity whereas left intrahemispheric connectivity predicted fMRI task reaction times. These results are discussed within the context of the hierarchical recovery model of chronic aphasia. The semantic network in neurologically-intact, healthy controls was characterized by left-lateralized connectivity. Patient connectivity was split between left-lateralized and bilateral, posterior-weighted (i.e., anterior damage) models. Controls solely recruited LITG-driven connections whereas patients recruited a distributed network of connections. Within the patient group, intra- and inter-hemispheric connections were related to lesion site and/or size. Lesion size predicted aphasia severity and fMRI task accuracy, and effective connectivity predicted task reaction times.
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Affiliation(s)
- Erin L Meier
- Department of Speech, Language, & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, United States of America.
| | - Jeffrey P Johnson
- Department of Speech, Language, & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, United States of America
| | - Yue Pan
- Department of Speech, Language, & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, United States of America
| | - Swathi Kiran
- Department of Speech, Language, & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, United States of America
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Kiran S, Thompson CK. Neuroplasticity of Language Networks in Aphasia: Advances, Updates, and Future Challenges. Front Neurol 2019; 10:295. [PMID: 31001187 PMCID: PMC6454116 DOI: 10.3389/fneur.2019.00295] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Researchers have sought to understand how language is processed in the brain, how brain damage affects language abilities, and what can be expected during the recovery period since the early 19th century. In this review, we first discuss mechanisms of damage and plasticity in the post-stroke brain, both in the acute and the chronic phase of recovery. We then review factors that are associated with recovery. First, we review organism intrinsic variables such as age, lesion volume and location and structural integrity that influence language recovery. Next, we review organism extrinsic factors such as treatment that influence language recovery. Here, we discuss recent advances in our understanding of language recovery and highlight recent work that emphasizes a network perspective of language recovery. Finally, we propose our interpretation of the principles of neuroplasticity, originally proposed by Kleim and Jones (1) in the context of extant literature in aphasia recovery and rehabilitation. Ultimately, we encourage researchers to propose sophisticated intervention studies that bring us closer to the goal of providing precision treatment for patients with aphasia and a better understanding of the neural mechanisms that underlie successful neuroplasticity.
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Affiliation(s)
- Swathi Kiran
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, The Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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28
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Transcranial direct current stimulation (tDCS) facilitates verb learning by altering effective connectivity in the healthy brain. Neuroimage 2018; 181:550-559. [DOI: 10.1016/j.neuroimage.2018.07.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 12/23/2022] Open
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Nenert R, Allendorfer JB, Martin AM, Banks C, Vannest J, Holland SK, Hart KW, Lindsell CJ, Szaflarski JP. Longitudinal fMRI study of language recovery after a left hemispheric ischemic stroke. Restor Neurol Neurosci 2018; 36:359-385. [PMID: 29782329 DOI: 10.3233/rnn-170767] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recovery from stroke-induced aphasia is typically protracted and involves complex functional reorganization. The relative contributions of the lesioned and non-lesioned hemispheres to this process have been examined in several cross-sectional studies but longitudinal studies involving several time-points and large numbers of subjects are scarce. OBJECTIVE The aim of this study was to address the gaps in the literature by longitudinally studying the evolution of post-stroke lateralization and localization of language-related fMRI activation in the first year after single left hemispheric ischemic stroke. METHOD Seventeen patients with stroke-induced aphasia were enrolled to undergo detailed behavioral testing and fMRI at 2, 6, 12, 26, and 52 weeks post-stroke. Matched for age, handedness and sex participants were also enrolled to visualize canonical language regions. RESULTS Behavioral results showed improvements over time for all but one of the behavioral scores (Semantic Fluency Test). FMRI results showed that the left temporal area participates in compensation for language deficits in the first year after stroke, that there is a correlation between behavioral improvement and the left cerebellar activation over time, and that there is a shift towards stronger frontal left-lateralization of the fMRI activation over the first year post-stroke. Temporary compensation observed in the initial phases of post-stroke recovery that involves the non-lesioned hemisphere may not be as important as previously postulated, since in this study the recovery was driven by activations in the left fronto-temporal regions. CONCLUSION Language recovery after left hemispheric ischemic stroke is likely driven by the previously involved in language and attention left hemispheric networks.
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Affiliation(s)
- Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber M Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christi Banks
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Jennifer Vannest
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott K Holland
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly W Hart
- Department of Emergency Medicine, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Christopher J Lindsell
- Department of Emergency Medicine, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.,currently at Department of Biostatistics, Vanderbilt University, Department of Biostatistics, Nashville, TN, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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Marcotte K, Laird L, Bitan T, Meltzer JA, Graham SJ, Leonard C, Rochon E. Therapy-Induced Neuroplasticity in Chronic Aphasia After Phonological Component Analysis: A Matter of Intensity. Front Neurol 2018; 9:225. [PMID: 29686646 PMCID: PMC5900891 DOI: 10.3389/fneur.2018.00225] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
Despite the growing evidence regarding the importance of intensity and dose in aphasia therapy, few well-controlled studies contrasting the effects of intensive and non-intensive treatment have been conducted to date. Phonological components analysis (PCA) treatment for anomia has been associated with improvements in some patients with chronic aphasia; however, the effect of treatment intensity has not yet been studied with PCA. Thus, the aim of the present study was to identify the effect of intensity on neural processing associated with word retrieval abilities after PCA treatment. We used functional magnetic resonance imaging to examine therapy-induced changes in activation during an overt naming task in two patients who suffered from a stroke in the left middle cerebral artery territory. P1 received intensive PCA treatment whereas P2 received the standard, non-intensive, PCA treatment. Behavioral results indicate that both standard and intensive conditions yielded improved naming performance with treated nouns, but the changes were only significant for the patient who received the intensive treatment. The improvements were found to be long lasting as both patients maintained improved naming at 2-months follow-ups. The associated neuroimaging data indicate that the two treatment conditions were associated with different neural activation changes. The patient who received the standard PCA showed significant increase in activation with treatment in the right anterior cingulate, as well as extensive areas in bilateral posterior and lateral cortices. By contrast, the patient who received intensive PCA showed more decreases in activation following the treatment. Unexpectedly, this patient showed subcortical increase in activation, specifically in the right caudate nucleus. We speculate that the recruitment of the caudate nucleus and the anterior cingulate in these patients reflects the need to suppress errors to improve naming. Thus, both short-term intensive and standard, non-intensive, PCA treatment can improve word retrieval in chronic aphasia, but neuroimaging data suggest that improved naming is associated with different neural activation patterns in the two treatment conditions.
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Affiliation(s)
- Karine Marcotte
- Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.,École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Laura Laird
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Tali Bitan
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Psychology, IIPDM, IBBR, University of Haifa, Haifa, Israel
| | - Jed A Meltzer
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Rotman Research Institute - Baycrest Centre, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada.,Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Carol Leonard
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.,Audiology and Speech-Language Pathology Program, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.,Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Hartwigsen G, Saur D. Neuroimaging of stroke recovery from aphasia - Insights into plasticity of the human language network. Neuroimage 2017; 190:14-31. [PMID: 29175498 DOI: 10.1016/j.neuroimage.2017.11.056] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
The role of left and right hemisphere brain regions in language recovery after stroke-induced aphasia remains controversial. Here, we summarize how neuroimaging studies increase the current understanding of functional interactions, reorganization and plasticity in the language network. We first discuss the temporal dynamics across the time course of language recovery, with a main focus on longitudinal studies from the acute to the chronic phase after stroke. These studies show that the functional contribution of perilesional and spared left hemisphere as well as contralesional right hemisphere regions to language recovery changes over time. The second section introduces critical variables and recent advances on early prediction of subsequent outcome. In the third section, we outline how multi-method approaches that combine neuroimaging techniques with non-invasive brain stimulation elucidate mechanisms of plasticity and reorganization in the language network. These approaches provide novel insights into general mechanisms of plasticity in the language network and might ultimately support recovery processes during speech and language therapy. Finally, the neurobiological correlates of therapy-induced plasticity are discussed. We argue that future studies should integrate individualized approaches that might vary the combination of language therapy with specific non-invasive brain stimulation protocols across the time course of recovery. The way forward will include the combination of such approaches with large data sets obtained from multicentre studies.
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Affiliation(s)
- Gesa Hartwigsen
- Research Group Modulation of Language Networks, Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Dorothee Saur
- Language & Aphasia Laboratory, Department of Neurology, University of Leipzig, Germany.
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32
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Pierce JE, Menahemi-Falkov M, O’Halloran R, Togher L, Rose ML. Constraint and multimodal approaches to therapy for chronic aphasia: A systematic review and meta-analysis. Neuropsychol Rehabil 2017; 29:1005-1041. [DOI: 10.1080/09602011.2017.1365730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- John E. Pierce
- School of Allied Health, La Trobe University, Melbourne, Australia
- Speech Pathology, Cabrini Health, Melbourne, Australia
| | | | - Robyn O’Halloran
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Miranda L. Rose
- School of Allied Health, La Trobe University, Melbourne, Australia
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Nenert R, Allendorfer JB, Martin AM, Banks C, Ball A, Vannest J, Dietz AR, Szaflarski JP. Neuroimaging Correlates of Post-Stroke Aphasia Rehabilitation in a Pilot Randomized Trial of Constraint-Induced Aphasia Therapy. Med Sci Monit 2017; 23:3489-3507. [PMID: 28719572 PMCID: PMC5529460 DOI: 10.12659/msm.902301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Recovery from post-stroke aphasia is a long and complex process with an uncertain outcome. Various interventions have been proposed to augment the recovery, including constraint-induced aphasia therapy (CIAT). CIAT has been applied to patients suffering from post-stroke aphasia in several unblinded studies to show mild-to-moderate linguistic gains. The aim of the present study was to evaluate the neuroimaging correlates of CIAT in patients with chronic aphasia related to left middle cerebral artery stroke. Material/Methods Out of 24 patients recruited in a pilot randomized blinded trial of CIAT, 19 patients received fMRI of language. Eleven of them received CIAT (trained) and eight served as a control group (untrained). Each patient participated in three fMRI sessions (before training, after training, and 3 months later) that included semantic decision and verb generation fMRI tasks, and a battery of language tests. Matching healthy control participants were also included (N=38; matching based on age, handedness, and sex). Results Language testing showed significantly improved performance on Boston Naming Test (BNT; p<0.001) in both stroke groups over time and fMRI showed differences in the distribution of the areas involved in language production between groups that were not present at baseline. Further, regression analysis with BNT indicated changes in brain regions correlated with behavioral performance (temporal gyrus, postcentral gyrus, precentral gyrus, thalamus, left middle and superior frontal gyri). Conclusions Overall, our results suggest the possibility of language-related cortical plasticity following stroke-induced aphasia with no specific effect from CIAT training.
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Affiliation(s)
- Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber M Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christi Banks
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jennifer Vannest
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
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Gow DW, Ahlfors SP. Tracking reorganization of large-scale effective connectivity in aphasia following right hemisphere stroke. BRAIN AND LANGUAGE 2017; 170:12-17. [PMID: 28364641 PMCID: PMC5472378 DOI: 10.1016/j.bandl.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/22/2016] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
In this paper we demonstrate the application of new effective connectivity analyses to characterize changing patterns of task-related directed interaction in large (25-55 node) cortical networks following the onset of aphasia. The subject was a left-handed woman who became aphasic following a right-hemisphere stroke. She was tested on an auditory word-picture verification task administered one and seven months after the onset of aphasia. MEG/EEG and anatomical MRI data were used to create high spatiotemporal resolution estimates of task-related cortical activity. Effective connectivity analyses of those data showed a reduction of bilateral network influences on preserved right-hemisphere structures, and an increase in intra-hemispheric left-hemisphere influences. She developed a connectivity pattern that was more left lateralized than that of right-handed control subjects. Her emergent left hemisphere network showed a combination of increased functional subdivision of perisylvian language areas and recruitment of medial structures.
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Affiliation(s)
- David W Gow
- Neuropsychology Laboratory, Massachusetts General Hospital, 175 Cambridge St., CPZ S340, Boston, MA 02114, United States; Department of Psychology, Salem State University, 352 Lafayette St., Salem, MA 01970, United States; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth St., S2301, Charlestown, MA 02129, United States; Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Ave., E25-519, Cambridge, MA 02139, United States.
| | - Seppo P Ahlfors
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth St., S2301, Charlestown, MA 02129, United States
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35
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Hara T, Abo M, Kakita K, Mori Y, Yoshida M, Sasaki N. The Effect of Selective Transcranial Magnetic Stimulation with Functional Near-Infrared Spectroscopy and Intensive Speech Therapy on Individuals with Post-Stroke Aphasia. Eur Neurol 2017; 77:186-194. [DOI: 10.1159/000457901] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/22/2017] [Indexed: 11/19/2022]
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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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Mohr B, MacGregor LJ, Difrancesco S, Harrington K, Pulvermüller F, Shtyrov Y. Hemispheric contributions to language reorganisation: An MEG study of neuroplasticity in chronic post stroke aphasia. Neuropsychologia 2016; 93:413-424. [PMID: 27063061 DOI: 10.1016/j.neuropsychologia.2016.04.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/24/2016] [Accepted: 04/06/2016] [Indexed: 01/08/2023]
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Raizes M, Elkana O, Franko M, Ravona Springer R, Segev S, Beeri MS. Higher Fasting Plasma Glucose Levels, within the Normal Range, are Associated with Decreased Processing Speed in High Functioning Young Elderly. J Alzheimers Dis 2016; 49:589-92. [PMID: 26484908 DOI: 10.3233/jad-150433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We explored the association of plasma glucose levels within the normal range with processing speed in high functioning young elderly, free of type 2 diabetes mellitus (T2DM). A sample of 41 participants (mean age = 64.7, SD = 10; glucose 94.5 mg/dL, SD = 9.3), were examined with a computerized cognitive battery. Hierarchical linear regression analysis showed that higher plasma glucose levels, albeit within the normal range (<110 mg/dL), were associated with longer reaction times (p < 0.01). These findings suggest that even in the subclinical range and in the absence of T2DM, monitoring plasma glucose levels may have an impact on cognitive function.
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Affiliation(s)
- Meytal Raizes
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Israel
| | - Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Israel
| | - Motty Franko
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Israel
| | - Ramit Ravona Springer
- Department of Psychiatry, Sheba Medical Center, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Segev
- Institute of Medical Screening, Sheba Medical Center Tel Hashomer, Israel
| | - Michal Schnaider Beeri
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,The Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
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Balaev V, Petrushevsky A, Martynova O. Changes in Functional Connectivity of Default Mode Network with Auditory and Right Frontoparietal Networks in Poststroke Aphasia. Brain Connect 2016; 6:714-723. [DOI: 10.1089/brain.2016.0419] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Vladislav Balaev
- Institute of Higher Nervous Activity and Neurophysiology Russian Academy of Sciences, Moscow, Russian Federation
| | - Alexey Petrushevsky
- Center for Speech Pathology and Neurorehabilitation, Moscow, Russian Federation
| | - Olga Martynova
- Institute of Higher Nervous Activity and Neurophysiology Russian Academy of Sciences, Moscow, Russian Federation
- Centre for Cognition and Decision Making, National Research University Higher School of Economics, Moscow, Russian Federation
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Carlson HL, Jadavji Z, Mineyko A, Damji O, Hodge J, Saunders J, Hererro M, Nowak M, Patzelt R, Mazur-Mosiewicz A, MacMaster FP, Kirton A. Treatment of dysphasia with rTMS and language therapy after childhood stroke: Multimodal imaging of plastic change. BRAIN AND LANGUAGE 2016; 159:23-34. [PMID: 27262774 DOI: 10.1016/j.bandl.2016.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 02/18/2016] [Accepted: 05/11/2016] [Indexed: 06/05/2023]
Abstract
Expressive dysphasia accompanies left inferior frontal gyrus (IFG/Broca) injury. Recovery may relate to interhemispheric balance with homologous, contralesional IFG but is unexplored in children. We evaluated effects of inhibitory rTMS to contralesional IFG combined with intensive speech therapy (SLT). A 15year-old, right-handed male incurred a left middle cerebral artery stroke. After 30months, severe non-fluent dysphasia impacted quality of life. Language networks, neuronal metabolism and white matter pathways were explored using MRI. Language function was measured longitudinally. An intensive SLT program was combined with contralesional inhibitory rTMS of right pars triangularis. Procedures were well tolerated. Language function improved persisting to four months. Post-treatment fMRI demonstrated increased left perilesional IFG activations and connectivity at rest. Bilateral changes in inositol and glutamate metabolism were observed. Contralesional, inhibitory rTMS appears safe in childhood stroke-induced dysphasia. We observed clinically significant improvements after SLT coupled with rTMS. Advanced neuroimaging can evaluate intervention-induced plasticity.
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Affiliation(s)
- Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada.
| | - Zeanna Jadavji
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Aleksandra Mineyko
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Omar Damji
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jacquie Hodge
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jenny Saunders
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Mia Hererro
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada
| | - Michele Nowak
- Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada
| | - Rebecca Patzelt
- Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada
| | - Anya Mazur-Mosiewicz
- Department of Clinical Psychology, Chicago School of Professional Psychology, Chicago, IL, USA
| | - Frank P MacMaster
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, AB, Canada; The Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada; Child and Adolescent Imaging Research (CAIR) Programs, Alberta Children's Hospital, Calgary, AB, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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41
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Hayward W, Snider SF, Luta G, Friedman RB, Turkeltaub PE. Objective support for subjective reports of successful inner speech in two people with aphasia. Cogn Neuropsychol 2016; 33:299-314. [PMID: 27469037 DOI: 10.1080/02643294.2016.1192998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People with aphasia frequently report being able to say a word correctly in their heads, even if they are unable to say that word aloud. It is difficult to know what is meant by these reports of "successful inner speech". We probe the experience of successful inner speech in two people with aphasia. We show that these reports are associated with correct overt speech and phonologically related nonword errors, that they relate to word characteristics associated with ease of lexical access but not ease of production, and that they predict whether or not individual words are relearned during anomia treatment. These findings suggest that reports of successful inner speech are meaningful and may be useful to study self-monitoring in aphasia, to better understand anomia, and to predict treatment outcomes. Ultimately, the study of inner speech in people with aphasia could provide critical insights that inform our understanding of normal language.
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Affiliation(s)
- William Hayward
- a Department of Neurology , Georgetown University , Washington , DC , USA
| | - Sarah F Snider
- a Department of Neurology , Georgetown University , Washington , DC , USA
| | - George Luta
- b Department of Biostatistics, Bioinformatics, and Biomathematics , Georgetown University , Washington , DC , USA
| | - Rhonda B Friedman
- a Department of Neurology , Georgetown University , Washington , DC , USA
| | - Peter E Turkeltaub
- a Department of Neurology , Georgetown University , Washington , DC , USA.,c Research Division , MedStar National Rehabilitation Hospital , Washington , DC , USA
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42
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Altered Intrinsic Regional Activity and Interregional Functional Connectivity in Post-stroke Aphasia. Sci Rep 2016; 6:24803. [PMID: 27091494 PMCID: PMC4835729 DOI: 10.1038/srep24803] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 04/05/2016] [Indexed: 01/16/2023] Open
Abstract
Several neuroimaging studies have examined cerebral function in patients who suffer from aphasia, but the mechanism underlying this disorder remains poorly understood. In this study, we examined alterations in the local regional and remote interregional network cerebral functions in aphasia combined with amplitude of low-frequency fluctuations and interregional functional connectivity (FC) using resting-state functional magnetic resonance imaging. A total of 17 post-stroke aphasic patients, all having suffered a stroke in the left hemisphere, as well as 20 age- and sex-matched healthy controls, were enrolled in this study. The aphasic patients showed significantly increased intrinsic regional activity mainly in the contralesional mesial temporal (hippocampus/parahippocampus, [HIP/ParaHIP]) and lateral temporal cortices. In addition, intrinsic regional activity in the contralesional HIP/ParaHIP was negatively correlated with construction score. Aphasic patients showed increased remote interregional FC between the contralesional HIP/ParaHIP and fusiform gyrus, but reduced FC in the ipsilesional occipital and parietal cortices. These findings suggested that the intrinsic regional brain dysfunctions in aphasia were related to interregional functional connectivity. Changes in the intrinsic regional brain activity and associated remote functional connectivity pattern would provide valuable information to enhance the understanding of the pathophysiological mechanisms of aphasia.
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Xing S, Lacey EH, Skipper-Kallal LM, Jiang X, Harris-Love ML, Zeng J, Turkeltaub PE. Right hemisphere grey matter structure and language outcomes in chronic left hemisphere stroke. Brain 2015; 139:227-41. [PMID: 26521078 DOI: 10.1093/brain/awv323] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/23/2015] [Indexed: 11/13/2022] Open
Abstract
The neural mechanisms underlying recovery of language after left hemisphere stroke remain elusive. Although older evidence suggested that right hemisphere language homologues compensate for damage in left hemisphere language areas, the current prevailing theory suggests that right hemisphere engagement is ineffective or even maladaptive. Using a novel combination of support vector regression-based lesion-symptom mapping and voxel-based morphometry, we aimed to determine whether local grey matter volume in the right hemisphere independently contributes to aphasia outcomes after chronic left hemisphere stroke. Thirty-two left hemisphere stroke survivors with aphasia underwent language assessment with the Western Aphasia Battery-Revised and tests of other cognitive domains. High-resolution T1-weighted images were obtained in aphasia patients and 30 demographically matched healthy controls. Support vector regression-based multivariate lesion-symptom mapping was used to identify critical language areas in the left hemisphere and then to quantify each stroke survivor's lesion burden in these areas. After controlling for these direct effects of the stroke on language, voxel-based morphometry was then used to determine whether local grey matter volumes in the right hemisphere explained additional variance in language outcomes. In brain areas in which grey matter volumes related to language outcomes, we then compared grey matter volumes in patients and healthy controls to assess post-stroke plasticity. Lesion-symptom mapping showed that specific left hemisphere regions related to different language abilities. After controlling for lesion burden in these areas, lesion size, and demographic factors, grey matter volumes in parts of the right temporoparietal cortex positively related to spontaneous speech, naming, and repetition scores. Examining whether domain general cognitive functions might explain these relationships, partial correlations demonstrated that grey matter volumes in these clusters related to verbal working memory capacity, but not other cognitive functions. Further, grey matter volumes in these areas were greater in stroke survivors than healthy control subjects. To confirm this result, 10 chronic left hemisphere stroke survivors with no history of aphasia were identified. Grey matter volumes in right temporoparietal clusters were greater in stroke survivors with aphasia compared to those without history of aphasia. These findings suggest that the grey matter structure of right hemisphere posterior dorsal stream language homologues independently contributes to language production abilities in chronic left hemisphere stroke, and that these areas may undergo hypertrophy after a stroke causing aphasia.
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Affiliation(s)
- Shihui Xing
- 1 Department of Neurology, Georgetown University Medical Center, Washington, D.C., USA 2 Department of Neurology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Elizabeth H Lacey
- 1 Department of Neurology, Georgetown University Medical Center, Washington, D.C., USA 3 Research Division, MedStar National Rehabilitation Hospital, Washington, D.C., USA
| | | | - Xiong Jiang
- 4 Department of Neuroscience, Georgetown University Medical Center, Washington, D.C., USA
| | - Michelle L Harris-Love
- 3 Research Division, MedStar National Rehabilitation Hospital, Washington, D.C., USA 5 Department of Rehabilitation Science, George Mason University, Fairfax, V.A., USA
| | - Jinsheng Zeng
- 2 Department of Neurology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peter E Turkeltaub
- 1 Department of Neurology, Georgetown University Medical Center, Washington, D.C., USA 3 Research Division, MedStar National Rehabilitation Hospital, Washington, D.C., USA
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44
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Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation Combined with Intensive Speech Therapy on Cerebral Blood Flow in Post-Stroke Aphasia. Transl Stroke Res 2015; 6:365-74. [DOI: 10.1007/s12975-015-0417-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/08/2015] [Accepted: 07/12/2015] [Indexed: 10/23/2022]
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45
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Barbancho MA, Berthier ML, Navas-Sánchez P, Dávila G, Green-Heredia C, García-Alberca JM, Ruiz-Cruces R, López-González MV, Dawid-Milner MS, Pulvermüller F, Lara JP. Bilateral brain reorganization with memantine and constraint-induced aphasia therapy in chronic post-stroke aphasia: An ERP study. BRAIN AND LANGUAGE 2015; 145-146:1-10. [PMID: 25932618 DOI: 10.1016/j.bandl.2015.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/06/2015] [Accepted: 04/11/2015] [Indexed: 06/04/2023]
Abstract
Changes in ERP (P100 and N400) and root mean square (RMS) were obtained during a silent reading task in 28 patients with chronic post-stroke aphasia in a randomized, double-blind, placebo-controlled trial of both memantine and constraint-induced aphasia therapy (CIAT). Participants received memantine/placebo alone (weeks 0-16), followed by drug treatment combined with CIAT (weeks 16-18), and then memantine/placebo alone (weeks 18-20). ERP/RMS values (week 16) decreased more in the memantine group than in the placebo group. During CIAT application (weeks 16-18), improvements in aphasia severity and ERP/RMS values were amplified by memantine and changes remained stable thereafter (weeks 18-20). Changes in ERP/RMS occurred in left and right hemispheres and correlated with gains in language performance. No changes in ERP/RMS were found in a healthy group in two separated evaluations. Our results show that aphasia recovery induced by both memantine alone and in combination with CIAT is indexed by bilateral cortical potentials.
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Affiliation(s)
- Miguel A Barbancho
- Universidad de Málaga, Andalucía TECH-IBIMA, Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico-Sanitarias (CIMES), Marqués de Beccaria, 3, 29010 Málaga, Spain
| | - Marcelo L Berthier
- Universidad de Málaga, Andalucía TECH-IBIMA, Unidad de Afasia y Neurología Cognitiva, Centro de Investigaciones Médico-Sanitarias (CIMES) y Cátedra Fundación Morera y Vallejo de Afasia, Marqués de Beccaria, 3, 29010 Málaga, Spain
| | - Patricia Navas-Sánchez
- Universidad de Málaga, Andalucía TECH-IBIMA, Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico-Sanitarias (CIMES), Marqués de Beccaria, 3, 29010 Málaga, Spain
| | - Guadalupe Dávila
- Universidad de Málaga, Andalucía TECH-IBIMA, Unidad de Afasia y Neurología Cognitiva, Centro de Investigaciones Médico-Sanitarias (CIMES) y Cátedra Fundación Morera y Vallejo de Afasia, Marqués de Beccaria, 3, 29010 Málaga, Spain
| | - Cristina Green-Heredia
- Departamento de Neurociencia, Hospital Quirón, Av. Imperio Argentina, 1, 29004 Málaga, Spain
| | | | - Rafael Ruiz-Cruces
- Universidad de Málaga, Andalucía TECH-IBIMA, Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico-Sanitarias (CIMES), Marqués de Beccaria, 3, 29010 Málaga, Spain
| | - Manuel V López-González
- Universidad de Málaga, Andalucía TECH-IBIMA, Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico-Sanitarias (CIMES), Marqués de Beccaria, 3, 29010 Málaga, Spain
| | - Marc S Dawid-Milner
- Universidad de Málaga, Andalucía TECH-IBIMA, Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico-Sanitarias (CIMES), Marqués de Beccaria, 3, 29010 Málaga, Spain
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Freie Universität Berlin, Germany; Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - J Pablo Lara
- Universidad de Málaga, Andalucía TECH-IBIMA, Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico-Sanitarias (CIMES), Marqués de Beccaria, 3, 29010 Málaga, Spain.
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46
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Abel S, Weiller C, Huber W, Willmes K, Specht K. Therapy-induced brain reorganization patterns in aphasia. ACTA ACUST UNITED AC 2015; 138:1097-112. [PMID: 25688082 DOI: 10.1093/brain/awv022] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Both hemispheres are engaged in recovery from word production deficits in aphasia. Lexical therapy has been shown to induce brain reorganization even in patients with chronic aphasia. However, the interplay of factors influencing reorganization patterns still remains unresolved. We were especially interested in the relation between lesion site, therapy-induced recovery, and beneficial reorganization patterns. Thus, we applied intensive lexical therapy, which was evaluated with functional magnetic resonance imaging, to 14 chronic patients with aphasic word retrieval deficits. In a group study, we aimed to illuminate brain reorganization of the naming network in comparison with healthy controls. Moreover, we intended to analyse the data with joint independent component analysis to relate lesion sites to therapy-induced brain reorganization, and to correlate resulting components with therapy gain. As a result, we found peri-lesional and contralateral activations basically overlapping with premorbid naming networks observed in healthy subjects. Reduced activation patterns for patients compared to controls before training comprised damaged left hemisphere language areas, right precentral and superior temporal gyrus, as well as left caudate and anterior cingulate cortex. There were decreasing activations of bilateral visuo-cognitive, articulatory, attention, and language areas due to therapy, with stronger decreases for patients in right middle temporal gyrus/superior temporal sulcus, bilateral precuneus as well as left anterior cingulate cortex and caudate. The joint independent component analysis revealed three components indexing lesion subtypes that were associated with patient-specific recovery patterns. Activation decreases (i) of an extended frontal lesion disconnecting language pathways occurred in left inferior frontal gyrus; (ii) of a small frontal lesion were found in bilateral inferior frontal gyrus; and (iii) of a large temporo-parietal lesion occurred in bilateral inferior frontal gyrus and contralateral superior temporal gyrus. All components revealed increases in prefrontal areas. One component was negatively correlated with therapy gain. Therapy was associated exclusively with activation decreases, which could mainly be attributed to higher processing efficiency within the naming network. In our joint independent component analysis, all three lesion patterns disclosed involved deactivation of left inferior frontal gyrus. Moreover, we found evidence for increased demands on control processes. As expected, we saw partly differential reorganization profiles depending on lesion patterns. There was no compensatory deactivation for the large left inferior frontal lesion, with its less advantageous outcome probably being related to its disconnection from crucial language processing pathways.
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Affiliation(s)
- Stefanie Abel
- 1 Department of Neurology, Section Neuropsychology, RWTH Aachen, Germany 2 School of Psychological Sciences, Faculty of Medical and Human Sciences, University of Manchester, UK 3 SRH University of Applied Sciences, Gera, Germany 4 JARA-BRAIN, Aachen Juelich Research Alliance, Translational Brain Medicine, Germany
| | - Cornelius Weiller
- 5 Department of Neurology, University Medical Centre Freiburg, Germany
| | - Walter Huber
- 4 JARA-BRAIN, Aachen Juelich Research Alliance, Translational Brain Medicine, Germany
| | - Klaus Willmes
- 1 Department of Neurology, Section Neuropsychology, RWTH Aachen, Germany 4 JARA-BRAIN, Aachen Juelich Research Alliance, Translational Brain Medicine, Germany 6 Interdisciplinary Centre for Clinical Research, RWTH Aachen, Germany
| | - Karsten Specht
- 7 Department of Biological and Medical Psychology, University of Bergen, and Department of Clinical Engineering, Haukeland University Hospital Bergen, Norway
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Manenti R, Petesi M, Brambilla M, Rosini S, Miozzo A, Padovani A, Miniussi C, Cotelli M. Efficacy of semantic-phonological treatment combined with tDCS for verb retrieval in a patient with aphasia. Neurocase 2015; 21:109-19. [PMID: 24417248 DOI: 10.1080/13554794.2013.873062] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent studies reported enhanced performance on language tasks induced by transcranial direct current stimulation (tDCS) in patients with aphasia. One chronic patient with non-fluent aphasia received 20 sessions of a verb anomia training combined with off-line bihemispheric tDCS applied to the dorsolateral prefrontal cortex (DLPFC) - anodal tDCS over left DLPFC plus cathodal tDCS over right DLPFC. A significant improvement in verb naming was observed at all testing times (4, 12, 24, and 48 weeks from post-entry/baseline testing) for treated and untreated verbs. Our findings show beneficial effects of verb anomia training in combination with tDCS in chronic aphasic patient, suggesting a long-lasting effect of this treatment.
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Affiliation(s)
- Rosa Manenti
- a IRCCS Centro San Giovanni di Dio Fatebenefratelli , Brescia , Italy
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48
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Ertelt D, Binkofski F. Action observation as a tool for neurorehabilitation to moderate motor deficits and aphasia following stroke. Neural Regen Res 2015; 7:2063-74. [PMID: 25624838 PMCID: PMC4296427 DOI: 10.3969/j.issn.1673-5374.2012.26.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 06/30/2012] [Indexed: 01/05/2023] Open
Abstract
The mirror neuron system consists of a set of brain areas capable of matching action observation with action execution. One core feature of the mirror neuron system is the activation of motor areas by action observation alone. This unique capacity of the mirror neuron system to match action perception and action execution stimulated the idea that mirror neuron system plays a crucial role in the understanding of the content of observed actions and may participate in procedural learning. These features bear a high potential for neurorehabilitation of motor deficits and of aphasia following stroke. Since the first articles exploring this principle were published, a growing number of follow-up studies have been conducted in the last decade. Though, the combination of action observation with practice of the observed actions seems to constitute the most powerful approach. In the present review, we present the existing studies analyzing the effects of this neurorehabilitative approach in clinical settings especially in the rehabilitation of stroke associated motor deficits and give a perspective on the ongoing trials by our research group. The data obtained up to date showed significant positive effect of action observation on recovery of motor functions of the upper limbs even in the chronic state after stroke, indicating that our approach might become a new standardized add-on feature of modern neurorehabilitative treatment schemes.
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Affiliation(s)
- Denis Ertelt
- Center for Clinical Trials, University of Luebeck, University Hospital Schleswig-Holstein - Campus Luebeck, Lübeck 23562, Schleswig-Holstein, Germany
| | - Ferdinand Binkofski
- Cognitive Neurology, Department of Neurology, RWTH Aachen University Hospital, Aachen 52062, North Rhine-Westphalia, Germany
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49
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MacGregor LJ, Difrancesco S, Pulvermüller F, Shtyrov Y, Mohr B. Ultra-rapid access to words in chronic aphasia: the effects of intensive language action therapy (ILAT). Brain Topogr 2014; 28:279-91. [PMID: 25403745 PMCID: PMC4330459 DOI: 10.1007/s10548-014-0398-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 09/06/2014] [Indexed: 12/02/2022]
Abstract
Effects of intensive language action therapy (ILAT) on automatic language processing were assessed using Magnetoencephalography (MEG). Auditory magnetic mismatch negativity (MMNm) responses to words and pseudowords were recorded in twelve patients with chronic aphasia before and immediately after two weeks of ILAT. Following therapy, Patients showed significant clinical improvements of auditory comprehension as measured by the Token Test and in word retrieval and naming as measured by the Boston Naming Test. Neuromagnetic responses dissociated between meaningful words and meaningless word-like stimuli ultra-rapidly, approximately 50 ms after acoustic information first allowed for stimulus identification. Over treatment, there was a significant increase in the left-lateralisation of this early word-elicited activation, observed in perilesional fronto-temporal regions. No comparable change was seen for pseudowords. The results may reflect successful, therapy-induced, language restitution in the left hemisphere.
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Affiliation(s)
- Lucy J MacGregor
- Medical Research Council, Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, CB2 7EF, UK,
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50
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Mohr B, Difrancesco S, Harrington K, Evans S, Pulvermüller F. Changes of right-hemispheric activation after constraint-induced, intensive language action therapy in chronic aphasia: fMRI evidence from auditory semantic processing. Front Hum Neurosci 2014; 8:919. [PMID: 25452721 PMCID: PMC4231973 DOI: 10.3389/fnhum.2014.00919] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/28/2014] [Indexed: 11/28/2022] Open
Abstract
The role of the two hemispheres in the neurorehabilitation of language is still under dispute. This study explored the changes in language-evoked brain activation over a 2-week treatment interval with intensive constraint induced aphasia therapy (CIAT), which is also called intensive language action therapy (ILAT). Functional magnetic resonance imaging (fMRI) was used to assess brain activation in perilesional left hemispheric and in homotopic right hemispheric areas during passive listening to high and low-ambiguity sentences and non-speech control stimuli in chronic non-fluent aphasia patients. All patients demonstrated significant clinical improvements of language functions after therapy. In an event-related fMRI experiment, a significant increase of BOLD signal was manifest in right inferior frontal and temporal areas. This activation increase was stronger for highly ambiguous sentences than for unambiguous ones. These results suggest that the known language improvements brought about by intensive constraint-induced language action therapy at least in part relies on circuits within the right-hemispheric homologs of left-perisylvian language areas, which are most strongly activated in the processing of semantically complex language.
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Affiliation(s)
- Bettina Mohr
- Department of Psychiatry, Charité Universitätsmedizin, Campus Benjamin FranklinBerlin, Germany
| | | | | | - Samuel Evans
- Institute of Cognitive Neuroscience, University College LondonLondon, UK
- Medical Research Council, Cognition and Brain Sciences UnitCambridge, UK
| | - Friedemann Pulvermüller
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität BerlinBerlin, Germany
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