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Sabadell V, Trébuchon A, Alario FX. An exploration of anomia rehabilitation in drug-resistant temporal lobe epilepsy. Epilepsy Behav Rep 2024; 27:100681. [PMID: 38881885 PMCID: PMC11178986 DOI: 10.1016/j.ebr.2024.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Around 40% of patients who undergo a left temporal lobe epilepsy (LTLE) surgery suffer from anomia (word-finding difficulties), a condition that negatively impacts quality of life. Despite these observations, language rehabilitation is still understudied in LTLE. We assessed the effect of a four-week rehabilitation on four drug-resistant LTLE patients after their surgery. The anomia rehabilitation was based on cognitive descriptions of word finding deficits in LTLE. Its primary ingredients were psycholinguistic tasks and a psychoeducation approach to help patients cope with daily communication issues. We repeatedly assessed naming skills for trained and untrained words, before and during the therapy using an A-B design with follow-up and replication. Subjective anomia complaint and standardized language assessments were also collected. We demonstrated the effectiveness of the rehabilitation program for trained words despite the persistence of seizures. Furthermore, encouraging results were observed for untrained items. Variable changes in anomia complaint were observed. One patient who conducted the protocol as self-rehabilitation responded similarly to the others, despite the different manner of intervention. These results open promising avenues for helping epileptic patients suffering from anomia. For example, this post-operative program could easily be adapted to be conducted preoperatively.
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Affiliation(s)
| | - Agnès Trébuchon
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
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2
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Shekari E, Mehrpour M, Joghataei MT, Modarres Zadeh A, Valinejad V, Adineh HA, Seyfi M, Goudarzi S. Focusing on the locus of the breakdown for treatment of anomia: a pilot study. CLINICAL LINGUISTICS & PHONETICS 2024; 38:477-507. [PMID: 37303193 DOI: 10.1080/02699206.2023.2221374] [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: 10/11/2021] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
The primary goal of this study was to evaluate the treatment effects of semantic feature analysis (SFA) and phonological components analysis (PCA) on word retrieval processing in persons with aphasia (PWAs). After identifying the locus of the breakdown in lexical retrieval processing, 15 monolingual native Persian speakers with aphasia were divided into two groups. After three naming trials, participants with dominant semantic deficits received SFA, and participants with primary phonological deficits were provided with PCA three times a week for eight weeks. Both approaches improved participants' naming and performance on language tests, including spontaneous speech, repetition, comprehension, and semantic processing. However, the correct naming of treated and untreated items was higher in mild-to-moderate participants, with mostly circumlocution and semantic paraphasias in the SFA group. The same holds for mild-to-moderate participants with mostly phonemic paraphasia who received PCA therapy. Moreover, the results showed that participants' baseline naming performance and semantic abilities could be associated with the treatment outcomes. Although limited by a lack of a control group, this study provided evidence supporting the possible benefits of focusing on the locus of the breakdown for treating anomia through SFA and PCA approaches, specifically in participants with mild to moderate aphasia. However, for those with severe aphasia, the treatment choice may not be as straightforward because several variables are likely to contribute to this population's word-finding difficulties. Replication with larger, well-stratified samples, use of a within-subjects alternating treatment design and consideration of treatments' long-term effects are required to better ascertain the effects of focusing on the locus of breakdown for treatment of anomia.
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Affiliation(s)
- Ehsan Shekari
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Mehrpour
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Innovation in Medical Education, Faculty of Medicine, Ottawa University, Ontario, Canada
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Modarres Zadeh
- Department of Speech-Language Pathology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Valinejad
- Department of Speech-Language Pathology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossain Ali Adineh
- Department of Epidemiology and Biostatistics, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Milad Seyfi
- Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Goudarzi
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
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Tilton-Bolowsky VE, Hillis AE. A Review of Poststroke Aphasia Recovery and Treatment Options. Phys Med Rehabil Clin N Am 2024; 35:419-431. [PMID: 38514227 DOI: 10.1016/j.pmr.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Poststroke aphasia, which impacts expressive and receptive communication, can have detrimental effects on the psychosocial well-being and the quality of life of those affected. Aphasia recovery is multidimensional and can be influenced by several baseline, stroke-related, and treatment-related factors, including preexisting cerebrovascular conditions, stroke size and location, and amount of therapy received. Importantly, aphasia recovery can continue for many years after aphasia onset. Behavioral speech and language therapy with a speech-language pathologist is the most common form of aphasia therapy. In this review, the authors also discuss augmentative treatment methodologies, collaborative goal setting frameworks, and recommendations for future research.
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Affiliation(s)
- Victoria E Tilton-Bolowsky
- Department of Neurology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 446F, Baltimore, MD 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 446F, Baltimore, MD 21287, USA.
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4
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Harrington RM, Kristinsson S, Wilmskoetter J, Busby N, den Ouden D, Rorden C, Fridriksson J, Bonilha L. Dissociating reading and auditory comprehension in persons with aphasia. Brain Commun 2024; 6:fcae102. [PMID: 38585671 PMCID: PMC10998352 DOI: 10.1093/braincomms/fcae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/10/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
Language comprehension is often affected in individuals with post-stroke aphasia. However, deficits in auditory comprehension are not fully correlated with deficits in reading comprehension and the mechanisms underlying this dissociation remain unclear. This distinction is important for understanding language mechanisms, predicting long-term impairments and future development of treatment interventions. Using comprehensive auditory and reading measures from a large cohort of individuals with aphasia, we evaluated the relationship between aphasia type and reading comprehension impairments, the relationship between auditory versus reading comprehension deficits and the crucial neuroanatomy supporting the dissociation between post-stroke reading and auditory deficits. Scores from the Western Aphasia Battery-Revised from 70 participants with aphasia after a left-hemisphere stroke were utilized to evaluate both reading and auditory comprehension of linguistically equivalent stimuli. Repeated-measures and univariate ANOVA were used to assess the relationship between auditory comprehension and aphasia types and correlations were employed to test the relationship between reading and auditory comprehension deficits. Lesion-symptom mapping was used to determine the dissociation of crucial brain structures supporting reading comprehension deficits controlling for auditory deficits and vice versa. Participants with Broca's or global aphasia had the worst performance on reading comprehension. Auditory comprehension explained 26% of the variance in reading comprehension for sentence completion and 44% for following sequential commands. Controlling for auditory comprehension, worse reading comprehension performance was independently associated with damage to the inferior temporal gyrus, fusiform gyrus, posterior inferior temporal gyrus, inferior occipital gyrus, lingual gyrus and posterior thalamic radiation. Auditory and reading comprehension are only partly correlated in aphasia. Reading is an integral part of daily life and directly associated with quality of life and functional outcomes. This study demonstrated that reading performance is directly related to lesioned areas in the boundaries between visual association regions and ventral stream language areas. This behavioural and neuroanatomical dissociation provides information about the neurobiology of language and mechanisms for potential future treatment interventions.
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Affiliation(s)
- Rachael M Harrington
- Department of Communication Sciences and Disorders and Center for Research on the Challenges of Acquiring Language and Literacy, Georgia State University, Atlanta, GA 30310, USA
| | - Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Janina Wilmskoetter
- Department of Health and Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC 29464, USA
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Dirk den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Leonardo Bonilha
- School of Medicine Columbia, University of South Carolina, Columbia, SC 29208, USA
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Dignam J, Rodriguez AD, O'Brien K, Burfein P, Copland DA. Early within therapy naming probes as a clinically-feasible predictor of anomia treatment response. Neuropsychol Rehabil 2024; 34:196-219. [PMID: 36811618 DOI: 10.1080/09602011.2023.2177312] [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: 08/25/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
This study investigated the relationship between early within-therapy probe naming performance and anomia therapy outcomes in individuals with aphasia. Thirty-four adults with chronic, post-stroke aphasia participated in the Aphasia Language Impairment and Functioning Therapy (Aphasia LIFT) programme, comprised of 48 h of comprehensive aphasia therapy. Sets of 30 treated and 30 untreated items identified at baseline were probed during impairment therapy which targeted word retrieval using a combined semantic feature analysis and phonological component analysis approach. Multiple regression models were computed to determine the relationship between baseline language and demographic variables, early within-therapy probe naming performance (measured after 3 h of impairment therapy) and anomia treatment outcomes. Early within-therapy probe naming performance emerged as the strongest predictor of anomia therapy gains at post-therapy and at 1-month follow-up. These findings have important clinical implications, as they suggest that an individual's performance after a brief period of anomia therapy may predict response to intervention. As such, early within-therapy probe naming may provide a quick and accessible tool for clinicians to identify potential response to anomia treatment.
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Affiliation(s)
- Jade Dignam
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Hospital Service, Brisbane, Australia
| | - Amy D Rodriguez
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta GA, USA
| | - Kate O'Brien
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Hospital Service, Brisbane, Australia
| | - Penni Burfein
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Hospital Service, Brisbane, Australia
- Department of Speech Pathology and Audiology, Surgical Treatment and Rehabilitation Service, Metro North Hospital and Health Service, Brisbane, Australia
- Department of Speech Pathology and Audiology, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Hospital Service, Brisbane, Australia
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Johnson L, Newman-Norlund R, Teghipco A, Rorden C, Bonilha L, Fridriksson J. Progressive lesion necrosis is related to increasing aphasia severity in chronic stroke. Neuroimage Clin 2024; 41:103566. [PMID: 38280310 PMCID: PMC10835598 DOI: 10.1016/j.nicl.2024.103566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Volumetric investigations of cortical damage resulting from stroke indicate that lesion size and shape continue to change even in the chronic stage of recovery. However, the potential clinical relevance of continued lesion growth has yet to be examined. In the present study, we investigated the prevalence of lesion expansion and the relationship between expansion and changes in aphasia severity in a large sample of individuals in the chronic stage of aphasia recovery. METHODS Retrospective structural MRI scans from 104 S survivors with at least 2 observations (k = 301 observations; mean time between scans = 31 months) were included. Lesion demarcation was performed using an automated lesion segmentation software and lesion volumes at each timepoint were subsequently calculated. A linear mixed effects model was conducted to investigate the effect of days between scan on lesion expansion. Finally, we investigated the association between lesion expansion and changes on the Western Aphasia Battery (WAB) in a group of participants assessed and scanned at 2 timepoints (N = 54) using a GLM. RESULTS Most participants (81 %) showed evidence of lesion expansion. The mixed effects model revealed lesion volumes significantly increase, on average, by 0.02 cc each day (7.3 cc per year) following a scan (p < 0.0001). Change on language performance was significantly associated with change in lesion volume (p = 0.025) and age at stroke (p = 0.031). The results suggest that with every 10 cc increase in lesion size, language performance decreases by 0.9 points, and for every 10-year increase in age at stroke, language performance decreases by 1.9 points. CONCLUSIONS The present study confirms and extends prior reports that lesion expansion occurs well into the chronic stage of stroke. For the first time, we present evidence that expansion is predictive of longitudinal changes in language performance in individuals with aphasia. Future research should focus on the potential mechanisms that may lead to necrosis in areas surrounding the chronic stroke lesion.
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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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Georgiou AM, Kambanaros M. Therapies and Challenges in the Post-Stroke Aphasia Rehabilitation Arena: Current and Future Prospects. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1674. [PMID: 37763793 PMCID: PMC10537631 DOI: 10.3390/medicina59091674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Aphasia is a serious consequence of stroke that results in a breakdown in communication. The course of aphasia recovery differs between afflicted individuals, and responsiveness to treatment cannot be predicted. Aphasiologists continue to investigate numerous behavioral treatment protocols that have shifted their focus to complimentary rehabilitation strategies. The aim of this study is threefold. First, to summarize the different categories of aphasia interventions post-stroke, considering their respective protocols, and present available evidence on the effectiveness of those protocols. Second, to document the challenges regarding the prediction of aphasia treatment response post-stroke in individual patients. Third, to report the challenges faced by researchers in recruiting people with aphasia (PWA) for treatment studies, and provide recommendations on how to increase participant recruitment and retention. This study provides up-to-date information on (i) effective therapies and aphasia recovery processes, and (ii) research recruitment hurdles together with potential strategies for overcoming them.
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Affiliation(s)
- Anastasios M. Georgiou
- The Brain and Neurorehabilitation Lab, Department of Rehabilitation Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus;
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Jacobs M, Evans E, Ellis C. Intersectional sociodemographic and neurological relationships in the naming ability of persons with post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2023; 105:106352. [PMID: 37331326 DOI: 10.1016/j.jcomdis.2023.106352] [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: 12/24/2022] [Revised: 05/16/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Significant attention has been given to the role of brain function and disruption in determining performance on naming tasks among individuals with aphasia. However, scholarly pursuit of a neurological explanation has overlooked the fundamental cornerstone of individual health-the underlying social, economic, and environmental factors that shape how they live, work, and age, also known as the social determinants of health (SDOH). This study examines the correlation between naming performance and these underlying factors. METHODS Individual level data from the 2010 Moss Aphasia Psycholinguistic Project Database (MAPPD) was matched with the 2009-2011 Medical Expenditure Panel Survey (MEPS) using a propensity score algorithm based on functional, health, and demographic characteristics. Multilevel, generalized, nonlinear regression models were applied to the resulting data set to assess the correlation between the Boston Naming Test (BNT) percentile score and age, income, sex, race, household size, marital status, aphasia type, and region of residence. Poisson regression models with bootstrapped standard errors were used to estimate these relationships RESULTS: Discrete dependent variable estimation with non-normal prior specification included individual level (age, marital status, years of education), socioeconomic (family income), health (aphasia type), household (family size), and environmental (region of residence) characteristics. Regression results indicated that, relative to individuals with Wernicke's, individuals with Anomic (0.74, SE = 0.0008) and Conduction (0.42, SE = 0.0009) aphasia performed better on the BNT. While age at the time of testing was not significantly correlated, higher income level (0.15, SE = 0.0003) and larger family size (0.002, SE = 0.002) was associated with higher BNT score percentiles. Finally, Black persons with aphasia (PWA) (-0.0124, SE = 0.0007) had lower average score percentiles when other factors were held constant. CONCLUSIONS The findings reported here suggest higher income and larger family size are associated with better outcomes. As expected, aphasia type was significantly associated with naming outcomes. However, poorer performance by Black PWA and individuals with low income suggests that SDOH can play a critical role (positive and negative) in naming impairment in some populations with aphasia.
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Affiliation(s)
- Molly Jacobs
- Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, United States
| | - Elizabeth Evans
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, United States
| | - Charles Ellis
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, United States.
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10
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Wilmskoetter J, Busby N, He X, Caciagli L, Roth R, Kristinsson S, Davis KA, Rorden C, Bassett DS, Fridriksson J, Bonilha L. Dynamic network properties of the superior temporal gyrus mediate the impact of brain age gap on chronic aphasia severity. Commun Biol 2023; 6:727. [PMID: 37452209 PMCID: PMC10349039 DOI: 10.1038/s42003-023-05119-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
Brain structure deteriorates with aging and predisposes an individual to more severe language impairments (aphasia) after a stroke. However, the underlying mechanisms of this relation are not well understood. Here we use an approach to model brain network properties outside the stroke lesion, network controllability, to investigate relations among individualized structural brain connections, brain age, and aphasia severity in 93 participants with chronic post-stroke aphasia. Controlling for the stroke lesion size, we observe that lower average controllability of the posterior superior temporal gyrus (STG) mediates the relation between advanced brain aging and aphasia severity. Lower controllability of the left posterior STG signifies that activity in the left posterior STG is less likely to yield a response in other brain regions due to the topological properties of the structural brain networks. These results indicate that advanced brain aging among individuals with post-stroke aphasia is associated with disruption of dynamic properties of a critical language-related area, the STG, which contributes to worse aphasic symptoms. Because brain aging is variable among individuals with aphasia, our results provide further insight into the mechanisms underlying the variance in clinical trajectories in post-stroke aphasia.
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Affiliation(s)
- Janina Wilmskoetter
- Department of Health and Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Xiaosong He
- Department of Psychology, University of Science and Technology of China, Beijing, China
| | - Lorenzo Caciagli
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Roth
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Kathryn A Davis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Dani S Bassett
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Electrical and Systems Engineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Department of Physics & Astronomy, School of Arts & Sciences, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Santa Fe Institute, Santa Fe, New Mexico, NM, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
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11
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Roth R, Busby N, Wilmskoetter J, Schwen Blackett D, Gleichgerrcht E, Johnson L, Rorden C, Newman-Norlund R, Hillis AE, den Ouden DB, Fridriksson J, Bonilha L. Diabetes, brain health, and treatment gains in post-stroke aphasia. Cereb Cortex 2023; 33:8557-8564. [PMID: 37139636 PMCID: PMC10321080 DOI: 10.1093/cercor/bhad140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 05/05/2023] Open
Abstract
In post-stroke aphasia, language improvements following speech therapy are variable and can only be partially explained by the lesion. Brain tissue integrity beyond the lesion (brain health) may influence language recovery and can be impacted by cardiovascular risk factors, notably diabetes. We examined the impact of diabetes on structural network integrity and language recovery. Seventy-eight participants with chronic post-stroke aphasia underwent six weeks of semantic and phonological language therapy. To quantify structural network integrity, we evaluated the ratio of long-to-short-range white matter fibers within each participant's whole brain connectome, as long-range fibers are more susceptible to vascular injury and have been linked to high level cognitive processing. We found that diabetes moderated the relationship between structural network integrity and naming improvement at 1 month post treatment. For participants without diabetes (n = 59), there was a positive relationship between structural network integrity and naming improvement (t = 2.19, p = 0.032). Among individuals with diabetes (n = 19), there were fewer treatment gains and virtually no association between structural network integrity and naming improvement. Our results indicate that structural network integrity is associated with treatment gains in aphasia for those without diabetes. These results highlight the importance of post-stroke structural white matter architectural integrity in aphasia recovery.
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Affiliation(s)
- Rebecca Roth
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Janina Wilmskoetter
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Deena Schwen Blackett
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Ezequiel Gleichgerrcht
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Lisa Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | | | - Argye E Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Dirk B den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, USA
| | - Leonardo Bonilha
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
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12
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Busby N, Wilmskoetter J, Gleichgerrcht E, Rorden C, Roth R, Newman-Norlund R, Hillis AE, Keller SS, de Bezenac C, Kristinsson S, Fridriksson J, Bonilha L. Advanced Brain Age and Chronic Poststroke Aphasia Severity. Neurology 2023; 100:e1166-e1176. [PMID: 36526425 PMCID: PMC10074460 DOI: 10.1212/wnl.0000000000201693] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic poststroke language impairment is typically worse in older individuals or those with large stroke lesions. However, there is unexplained variance that likely depends on intact tissue beyond the lesion. Brain age is an emerging concept, which is partially independent from chronologic age. Advanced brain age is associated with cognitive decline in healthy older adults; therefore, we aimed to investigate the relationship with stroke aphasia. We hypothesized that advanced brain age is a significant factor associated with chronic poststroke language impairments, above and beyond chronologic age, and lesion characteristics. METHODS This cohort study retrospectively evaluated participants from the Predicting Outcomes of Language Rehabilitation in Aphasia clinical trial (NCT03416738), recruited through local advertisement in South Carolina (US). Primary inclusion criteria were left hemisphere stroke and chronic aphasia (≥12 months after stroke). Participants completed baseline behavioral testing including the Western Aphasia Battery-Revised (WAB-R), Philadelphia Naming Test (PNT), Pyramids and Palm Trees Test (PPTT), and Wechsler Adult Intelligence Scale Matrices subtest, before completing 6 weeks of language therapy. The PNT was repeated 1 month after therapy. We leveraged modern neuroimaging techniques to estimate brain age and computed a proportional difference between chronologic age and estimated brain age. Multiple linear regression models were used to evaluate the relationship between proportional brain age difference (PBAD) and behavior. RESULTS Participants (N = 93, 58 males and 35 females, average age = 61 years) had estimated brain ages ranging from 14 years younger to 23 years older than chronologic age. Advanced brain age predicted performance on semantic tasks (PPTT) and language tasks (WAB-R). For participants with advanced brain aging (n = 47), treatment gains (improvement on the PNT) were independently predicted by PBAD (T = -2.0474, p = 0.0468, 9% of variance explained). DISCUSSION Through the application of modern neuroimaging techniques, advanced brain aging was associated with aphasia severity and performance on semantic tasks. Notably, therapy outcome scores were also associated with PBAD, albeit only among participants with advanced brain aging. These findings corroborate the importance of brain age as a determinant of poststroke recovery and underscore the importance of personalized health factors in determining recovery trajectories, which should be considered during the planning or implementation of therapeutic interventions.
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Affiliation(s)
- Natalie Busby
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom.
| | - Janina Wilmskoetter
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
| | - Ezequiel Gleichgerrcht
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
| | - Chris Rorden
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
| | - Rebecca Roth
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
| | - Roger Newman-Norlund
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
| | - Argye Elizabeth Hillis
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
| | - Simon S Keller
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
| | - Christophe de Bezenac
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
| | - Sigfus Kristinsson
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
| | - Julius Fridriksson
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
| | - Leonardo Bonilha
- From the Departments of Communication Sciences and Disorders (N.B., J.F.), and Psychology (C.R., R.N.N.), University of South Carolina, Columbia; Department of Health and Rehabilitation Sciences (J.W., E.G., S.K., J.F.), Medical University of South Carolina, Charleston; Department of Neurology (R.R., L.B.), Emory University, Atlanta, GA; Department of Neurology (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pharmacology and Therapeutics (S.S.K., C.d.B.), Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; The Walton Centre NHS Foundation Trust (S.S.K., C.d.B.), Liverpool, United Kingdom
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Kristinsson S, Basilakos A, den Ouden DB, Cassarly C, Spell LA, Bonilha L, Rorden C, Hillis AE, Hickok G, Johnson L, Busby N, Walker GM, McLain A, Fridriksson J. Predicting Outcomes of Language Rehabilitation: Prognostic Factors for Immediate and Long-Term Outcomes After Aphasia Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1068-1084. [PMID: 36827514 PMCID: PMC10205105 DOI: 10.1044/2022_jslhr-22-00347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/23/2022] [Accepted: 11/30/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND Aphasia therapy is an effective approach to improve language function in chronic aphasia. However, it remains unclear what prognostic factors facilitate therapy response at the individual level. Here, we utilized data from the POLAR (Predicting Outcomes of Language Rehabilitation in Aphasia) trial to (a) determine therapy-induced change in confrontation naming and long-term maintenance of naming gains and (b) examine the extent to which aphasia severity, age, education, time postonset, and cognitive reserve predict naming gains at 1 week, 1 month, and 6 months posttherapy. METHOD A total of 107 participants with chronic (≥ 12 months poststroke) aphasia underwent extensive case history, cognitive-linguistic testing, and a neuroimaging workup prior to receiving 6 weeks of impairment-based language therapy. Therapy-induced change in naming performance (measured as raw change on the 175-item Philadelphia Naming Test [PNT]) was assessed 1 week after therapy and at follow-up time points 1 month and 6 months after therapy completion. Change in naming performance over time was evaluated using paired t tests, and linear mixed-effects models were constructed to examine the association between prognostic factors and therapy outcomes. RESULTS Naming performance was improved by 5.9 PNT items (Cohen's d = 0.56, p < .001) 1 week after therapy and by 6.4 (d = 0.66, p < .001) and 7.5 (d = 0.65, p < .001) PNT items at 1 month and 6 months after therapy completion, respectively. Aphasia severity emerged as the strongest predictor of naming improvement recovery across time points; mild (ß = 5.85-9.02) and moderate (ß = 9.65-11.54) impairment predicted better recovery than severe (ß = 1.31-3.37) and very severe (ß = 0.20-0.32) aphasia. Age was an emergent prognostic factor for recovery 1 month (ß = -0.14) and 6 months (ß = -0.20) after therapy, and time postonset (ß = -0.05) was associated with retention of naming gains at 6 months posttherapy. CONCLUSIONS These results suggest that therapy-induced naming improvement is predictable based on several easily measurable prognostic factors. Broadly speaking, these results suggest that prognostication procedures in aphasia therapy can be improved and indicate that personalization of therapy is a realistic goal in the near future. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22141829.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Alexandra Basilakos
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Dirk B. den Ouden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Christy Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Leigh Ann Spell
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia
| | - Argye E. Hillis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD
| | - Gregory Hickok
- Department of Cognitive Sciences, School of Social Sciences, University of California, Irvine
| | - Lisa Johnson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Natalie Busby
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
| | - Grant M. Walker
- Department of Cognitive Sciences, School of Social Sciences, University of California, Irvine
| | - Alexander McLain
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Julius Fridriksson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia
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14
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Schnur TT, Lei CM. Assessing naming errors using an automated machine learning approach. Neuropsychology 2022; 36:709-718. [PMID: 36107705 PMCID: PMC9970144 DOI: 10.1037/neu0000860] [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: 01/11/2023] Open
Abstract
OBJECTIVE After left hemisphere stroke, 20%-50% of people experience language deficits, including difficulties in naming. Naming errors that are semantically related to the intended target (e.g., producing "violin" for picture HARP) indicate a potential impairment in accessing knowledge of word forms and their meanings. Understanding the cause of naming impairments is crucial to better modeling of language production as well as for tailoring individualized rehabilitation. However, evaluation of naming errors is typically by subjective and laborious dichotomous classification. As a result, these evaluations do not capture the degree of semantic similarity and are susceptible to lower interrater reliability because of subjectivity. METHOD We investigated whether a computational linguistic measure using word2vec (Mikolov, Chen, et al., 2013) addressed these limitations by evaluating errors during object naming in a group of patients during the acute stage of a left-hemisphere stroke (N = 105). RESULTS Pearson correlations demonstrated excellent convergent validity of word2vec's semantically related estimates of naming errors and independent tests of access to lexical-semantic knowledge (p < .0001). Further, multiple regression analysis showed word2vec's semantically related estimates were significantly better than human error classification at predicting performance on tests of lexical-semantic knowledge. CONCLUSIONS Useful to both theorists and clinicians, our word2vec-based method provides an automated, continuous, and objective psychometric measure of access to lexical-semantic knowledge during naming. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Tatiana T. Schnur
- Departments of Neurosurgery & Neuroscience, Baylor College of Medicine
| | - Chia-Ming Lei
- Department of Communication Sciences & Disorders, Radford University
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15
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Schwen Blackett D, Varkey J, Wilmskoetter J, Roth R, Andrews K, Busby N, Gleichgerrcht E, Desai RH, Riccardi N, Basilakos A, Johnson LP, Kristinsson S, Johnson L, Rorden C, Spell LA, Fridriksson J, Bonilha L. Neural network bases of thematic semantic processing in language production. Cortex 2022; 156:126-143. [PMID: 36244204 PMCID: PMC10041939 DOI: 10.1016/j.cortex.2022.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/10/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
Semantic processing is a central component of language and cognition. The anterior temporal lobe is postulated to be a key hub for semantic processing, but the posterior temporoparietal cortex is also involved in thematic associations during language. It is possible that these regions act in concert and depend on an anteroposterior network linking the temporal pole with posterior structures to support thematic semantic processing during language production. We employed connectome-based lesion-symptom mapping to examine the causal relationship between lesioned white matter pathways and thematic processing language deficits among individuals with post-stroke aphasia. Seventy-nine adults with chronic aphasia completed the Philadelphia Naming Test, and semantic errors were coded as either thematic or taxonomic to control for taxonomic errors. Controlling for nonverbal conceptual-semantic knowledge as measured by the Pyramids and Palm Trees Test, lesion size, and the taxonomic error rate, thematic error rate was associated with loss of white matter connections from the temporal pole traversing in peri-Sylvian regions to the posterior cingulate and the insula. These findings support the existence of a distributed network underlying thematic relationship processing in language as opposed to discrete cortical areas.
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Affiliation(s)
- Deena Schwen Blackett
- Department of Otolaryngology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA; Division of Speech-Language Pathology, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Jesse Varkey
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Janina Wilmskoetter
- Division of Speech-Language Pathology, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Rebecca Roth
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Keeghan Andrews
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Natalie Busby
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Ezequiel Gleichgerrcht
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Rutvik H Desai
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC, USA.
| | - Nicholas Riccardi
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC, USA.
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Lorelei P Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Lisa Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, SC, USA.
| | - Leigh A Spell
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA.
| | - Leonardo Bonilha
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA.
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Durfee AZ, Harnish SM. Using word-picture verification to inform language impairment locus in chronic post-stroke aphasia. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1012588. [DOI: 10.3389/fresc.2022.1012588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
Word-picture verification, a task that requires a yes/no response to whether a word and a picture match, has been used for both receptive and expressive language; however, there is limited systematic investigation on the linguistic subprocesses targeted by the task. Verification may help to identify linguistic strengths and weaknesses to ultimately provide more targeted, individualized lexical retrieval intervention. The current study assessed the association of semantic and phonological skills with verification performance to demonstrate early efficacy of the paradigm as an aphasia assessment. Sixteen adults with chronic post-stroke aphasia completed a battery of language assessments in addition to reading and auditory verification tasks. Verification scores were positively correlated with auditory and reading comprehension. Accuracy of semantic and phonological verification were positively correlated with accuracy on respective receptive language tasks. More semantic errors were made during verification than naming. The relationship of phonological errors between naming and verification varied by modality (reading or listening). Semantic and phonological performance significantly predicted verification response accuracy and latency. In sum, we propose that verification tasks are particularly useful because they inform semantics pre-lemma selection and phonological decoding, helping to localize individual linguistic strengths and weaknesses, especially in the presence of significant motor speech impairment that can obscure expressive language abilities.
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Elman RJ. Still Searching for Understanding: The Importance of Diverse Research Designs, Methods, and Perspectives. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2444-2453. [PMID: 36001820 DOI: 10.1044/2022_ajslp-21-00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Evidence-based medicine and evidence hierarchies have been widely adopted and have strongly influenced decision making across many fields, including clinical aphasiology. However, questions remain about the creation, usefulness, and validity of current evidence hierarchies. AIMS This article builds on ideas about scientific approaches and evidence originally shared by Elman (1995, 1998, 2006). This article reviews the history of evidence hierarchies and argues that improving the diversity of research designs, methods, and perspectives will improve understanding of the numerous and complex variables associated with aphasia intervention. Researchers and clinicians are encouraged to synthesize diverse types of scientific evidence. It is hoped that this article will stimulate thought and foster discussion in order to encourage high-caliber research of all types. MAIN CONTRIBUTION Concepts from a wide variety of fields including philosophy of science, research design and methodology, and precision medicine are brought together in an attempt to focus research on the scientific understanding of aphasia treatment effects. CONCLUSION It is hoped that by incorporating diverse research designs, methods, and perspectives, clinical aphasiologists will become better able to provide effective, personalized treatments, ensuring that each person with aphasia is able to improve their communication ability and quality of life.
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Braun EJ, Kiran S. Stimulus- and Person-Level Variables Influence Word Production and Response to Anomia Treatment for Individuals With Chronic Poststroke Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3854-3872. [PMID: 36201169 PMCID: PMC9927625 DOI: 10.1044/2022_jslhr-21-00527] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/28/2022] [Accepted: 06/28/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The impact of stimulus-level psycholinguistic variables and person-level semantic and phonological processing skills on treatment outcomes in individuals with aphasia requires further examination to inform clinical decision making in treatment prescription and stimuli selection. This study investigated the influence of stimulus-level psycholinguistic properties and person-level semantic and phonological processing skills on word production accuracy and treatment response. METHOD This retrospective analysis included 35 individuals with chronic, poststroke aphasia, 30 of whom completed typicality-based semantic feature treatment. Mixed-effects logistic regression models were used to predict binary naming accuracy (a) at baseline and (b) over the course of treatment using stimulus-level psycholinguistic word properties and person-level semantic and phonological processing skills as predictors. RESULTS In baseline naming, words with less complex lexical-semantic and phonological properties showed greater predicted accuracy. There was also an interaction at baseline between stimulus-level lexical-semantic properties and person-level semantic processing skills in predicting baseline naming accuracy. With treatment, words that were more complex from a lexical-semantic standpoint (vs. less complex) and less complex from a phonological standpoint (vs. more complex) improved more. Individuals with greater baseline semantic and phonological processing skills showed a greater treatment response. CONCLUSIONS This study suggests that future clinical research and clinical work should consider semantic and phonological properties of words in selecting stimuli for semantically based treatment. Furthermore, future clinical research should continue to evaluate baseline individual semantic and phonological profiles as predictors of response to semantically based treatment. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21256341.
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Affiliation(s)
- Emily J. Braun
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Boston University College of Health & Rehabilitation Sciences: Sargent College, MA
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Boston University College of Health & Rehabilitation Sciences: Sargent College, MA
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Varkanitsa M, Kiran S. Understanding, facilitating and predicting aphasia recovery after rehabilitation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:248-259. [PMID: 35603543 PMCID: PMC9398975 DOI: 10.1080/17549507.2022.2075036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Purpose: This paper reviews several studies whose aim was to understand the nature of language recovery in chronic aphasia and identify predictors of how people may recover their language functions after a brain injury.Method: Several studies that mostly draw from data collected within the Centre for Neurobiology of Language Recovery were reviewed and categorised in four aspects of language impairment and recovery in aphasia: (a) neural markers for language impairment and recovery, (b) language and cognitive markers for language impairment and recovery, (c) effective treatments and (d) predictive modelling of treatment-induced rehabilitation.Result: Language impairment and recovery in stroke-induced aphasia is multi-factorial, including patient-specific and treatment-specific factors. A combination of these factors may help us predict treatment responsiveness even before treatment begins.Conclusion: Continued work on this topic will lead to a better understanding of the mechanisms that underly language impairment and treatment-induced recovery in aphasia, and, consequently, use this information to predict each person's recovery profile trajectory and provide optimal prescriptions regarding the type and dosage of treatment.
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Affiliation(s)
- Maria Varkanitsa
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
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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: 14] [Impact Index Per Article: 7.0] [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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21
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Language Recovery after Brain Injury: A Structural Network Control Theory Study. J Neurosci 2022; 42:657-669. [PMID: 34872927 PMCID: PMC8805614 DOI: 10.1523/jneurosci.1096-21.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/20/2021] [Accepted: 11/29/2021] [Indexed: 01/16/2023] Open
Abstract
Aphasia recovery after stroke depends on the condition of the remaining, extralesional brain network. Network control theory (NCT) provides a unique, quantitative approach to assess the interaction between brain networks. In this longitudinal, large-scale, whole-brain connectome study, we evaluated whether controllability measures of language-related regions are associated with treated aphasia recovery. Using probabilistic tractography and controlling for the effects of structural lesions, we reconstructed whole-brain diffusion tensor imaging (DTI) connectomes from 68 individuals (20 female, 48 male) with chronic poststroke aphasia who completed a three-week language therapy. Applying principles of NCT, we computed regional (1) average and (2) modal controllability, which decode the ability of a region to (1) spread control input through the brain network and (2) to facilitate brain state transitions. We tested the relationship between pretreatment controllability measures of 20 language-related left hemisphere regions and improvements in naming six months after language therapy using multiple linear regressions and a parsimonious elastic net regression model with cross-validation. Regional controllability of the inferior frontal gyrus (IFG) pars opercularis, pars orbitalis, and the anterior insula were associated with treatment outcomes independently of baseline aphasia severity, lesion volume, age, education, and network size. Modal controllability of the IFG pars opercularis was the strongest predictor of treated aphasia recovery with cross-validation and outperformed traditional graph theory, lesion load, and demographic measures. Regional NCT measures can reflect the status of the residual language network and its interaction with the remaining brain network, being able to predict language recovery after aphasia treatment.SIGNIFICANCE STATEMENT Predicting and understanding language recovery after brain injury remains a challenging, albeit a fundamental aspect of human neurology and neuroscience. In this study, we applied network control theory (NCT) to fully harness the concept of brain networks as dynamic systems and to evaluate their interaction. We studied 68 stroke survivors with aphasia who underwent imaging and longitudinal behavioral assessments coupled with language therapy. We found that the controllability of the inferior frontal regional network significantly predicted recovery in language production six months after treatment. Importantly, controllability outperformed traditional demographic, lesion, and graph-theoretical measures. Our findings shed light on the neurobiological basis of human language and can be translated into personalized rehabilitation approaches.
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22
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Baboyan V, Basilakos A, Yourganov G, Rorden C, Bonilha L, Fridriksson J, Hickok G. Isolating the white matter circuitry of the dorsal language stream: Connectome-Symptom Mapping in stroke induced aphasia. Hum Brain Mapp 2021; 42:5689-5702. [PMID: 34469044 PMCID: PMC8559486 DOI: 10.1002/hbm.25647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/21/2021] [Indexed: 12/02/2022] Open
Abstract
The application of ℓ1-regularized machine learning models to high-dimensional connectomes offers a promising methodology to assess clinical-anatomical correlations in humans. Here, we integrate the connectome-based lesion-symptom mapping framework with sparse partial least squares regression (sPLS-R) to isolate elements of the connectome associated with speech repetition deficits. By mapping over 2,500 connections of the structural connectome in a cohort of 71 stroke-induced cases of aphasia presenting with varying left-hemisphere lesions and repetition impairment, sPLS-R was trained on 50 subjects to algorithmically identify connectomic features on the basis of their predictive value. The highest ranking features were subsequently used to generate a parsimonious predictive model for speech repetition whose predictions were evaluated on a held-out set of 21 subjects. A set of 10 short- and long-range parieto-temporal connections were identified, collectively delineating the broader circuitry of the dorsal white matter network of the language system. The strongest contributing feature was a short-range connection in the supramarginal gyrus, approximating the cortical localization of area Spt, with parallel long-range pathways interconnecting posterior nodes in supramarginal and superior temporal cortex with anterior nodes in both ventral and-notably-in dorsal premotor cortex, respectively. The collective disruption of these pathways indexed repetition performance in the held-out set of participants, suggesting that these impairments might be characterized as a parietotemporal disconnection syndrome impacting cortical area Spt and its associated white matter circuits of the frontal lobe as opposed to being purely a disconnection of the arcuate fasciculus.
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Affiliation(s)
- Vatche Baboyan
- Department of Cognitive ScienceUniversity of CaliforniaIrvineCaliforniaUSA
| | - Alexandra Basilakos
- Department of Communication Sciences and DisordersUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Grigori Yourganov
- Department of PsychologyUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Chris Rorden
- Department of PsychologyUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Leonardo Bonilha
- Department of NeurologyMedical University of South CarolinaColumbiaSouth CarolinaUSA
| | - Julius Fridriksson
- Department of Communication Sciences and DisordersUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Gregory Hickok
- Department of Cognitive ScienceUniversity of CaliforniaIrvineCaliforniaUSA
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Truzman T, Rochon E, Meltzer J, Leonard C, Bitan T. Simultaneous Normalization and Compensatory Changes in Right Hemisphere Connectivity during Aphasia Therapy. Brain Sci 2021; 11:1330. [PMID: 34679395 PMCID: PMC8534113 DOI: 10.3390/brainsci11101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
Changes in brain connectivity during language therapy were examined among participants with aphasia (PWA), aiming to shed light on neural reorganization in the language network. Four PWA with anomia following left hemisphere stroke and eight healthy controls (HC) participated in the study. Two fMRI scans were administered to all participants with a 3.5-month interval. The fMRI scans included phonological and semantic tasks, each consisting of linguistic and perceptual matching conditions. Between the two fMRI scans, PWA underwent Phonological Components Analysis treatment. Changes in effective connectivity during the treatment were examined within right hemisphere (RH) architecture. The results illustrate that following the treatment, the averaged connectivity of PWA across all perceptual and linguistic conditions in both tasks increased resemblance to HC, reflecting the normalization of neural processes associated with silent object name retrieval. In contrast, connections that were specifically enhanced by the phonological condition in PWA decreased in their resemblance to HC, reflecting emerging compensatory reorganization in RH connectivity to support phonological processing. These findings suggest that both normalization and compensation play a role in neural language reorganization at the chronic stage, occurring simultaneously in the same brain.
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Affiliation(s)
- Tammar Truzman
- Communication Sciences and Disorders Department and IIPDM, University of Haifa, Haifa 3498838, Israel
- The Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
| | - Elizabeth Rochon
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- KITE Research Institute, Toronto Rehab, University Health Network (UHN), Toronto, ON M5G 2A2, Canada
| | - Jed Meltzer
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- Psychology Department, University of Toronto, Toronto, ON M5S 1A1, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada
| | - Carol Leonard
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Tali Bitan
- The Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- Psychology Department and IIPDM, University of Haifa, Haifa 3498838, Israel
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