1
|
Williams EER, Sghirripa S, Rogasch NC, Hordacre B, Attrill S. Non-invasive brain stimulation in the treatment of post-stroke aphasia: a scoping review. Disabil Rehabil 2024; 46:3802-3826. [PMID: 37828899 DOI: 10.1080/09638288.2023.2259299] [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: 03/08/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Aphasia is an acquired language impairment that commonly results from stroke. Non-invasive brain stimulation (NIBS) might accelerate aphasia recovery trajectories and has seen mounting popularity in recent aphasia rehabilitation research. The present review aimed to: (1) summarise all existing literature on NIBS as a post-stroke aphasia treatment; and (2) provide recommendations for future NIBS-aphasia research. MATERIALS AND METHODS Databases for published and grey literature were searched using scoping review methodology. 278 journal articles, conference abstracts/posters, and books, and 38 items of grey literature, were included for analysis. RESULTS Quantitative analysis revealed that ipsilesional anodal transcranial direct current stimulation and contralesional 1-Hz repetitive transcranial magnetic stimulation were the most widely used forms of NIBS, while qualitative analysis identified four key themes including: the roles of the hemispheres in aphasia recovery and their relationship with NIBS; heterogeneity of individuals but homogeneity of subpopulations; individualisation of stimulation parameters; and much remains under-explored in the NIBS-aphasia literature. CONCLUSIONS Taken together, these results highlighted systemic challenges across the field such as small sample sizes, inter-individual variability, lack of protocol optimisation/standardisation, and inadequate focus on aphasiology. Four key recommendations are outlined herein to guide future research and refine NIBS methods for post-stroke aphasia treatment.
Collapse
Affiliation(s)
- Ellen E R Williams
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Sabrina Sghirripa
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Nigel C Rogasch
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- Turner Institute of Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, The University of South Australia, Adelaide, Australia
| | - Stacie Attrill
- Speech Pathology, School of Allied Health Science and Practice, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
2
|
Odendaal I, Tönsing KM. Augmentative and alternative communication for individuals with post-stroke aphasia: perspectives of South African speech-language pathologists. Augment Altern Commun 2024:1-9. [PMID: 38995208 DOI: 10.1080/07434618.2024.2374303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024] Open
Abstract
This qualitative study aimed to describe speech-language pathologists' (SLPs') perspectives on augmentative and alternative communication (AAC) use for people with post-stroke aphasia focusing on: (a) current AAC practice, (b) factors that influence the use of AAC, and (c) the success and relevance of AAC interventions. Semi-structured interviews took place with ten South African SLPs with experience in aphasia intervention. The transcribed interviews were thematically analyzed using a six-phase process of inductive and deductive analysis within a phenomenological framework. All the participants use AAC with their clients, employing a variety of approaches that reflect their diverse settings, experiences, and perspectives on AAC. AAC use is complex, and SLPs make conscious choices considering multiple factors. Barriers to use were often associated with limited resources in the low- and middle-income country (LMIC) context, but most participants retained a positive view of AAC, actively working to circumvent barriers to use. Participants consistently emphasized the vital role of partners in communication interactions, linked to the importance of defining AAC broadly. It is necessary to advance the integration of AAC into rehabilitation plans to improve communication and social participation outcomes for people with post-stroke aphasia, especially in LMICs such as South Africa.
Collapse
Affiliation(s)
- Inge Odendaal
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Kerstin M Tönsing
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
3
|
Li L, Lu Y, Huang H, Ye B, Mao X, Song F, Chen Y. Clinical efficacy of scalp electroacupuncture combined with rehabilitation training for aphasia after head injury and its effect on patients' language function and quality of life: An observational study. Medicine (Baltimore) 2024; 103:e38263. [PMID: 38875369 PMCID: PMC11175891 DOI: 10.1097/md.0000000000038263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 06/16/2024] Open
Abstract
To explore the clinical efficacy of scalp electroacupuncture combined with rehabilitation training for aphasia after head injury, and analyze its effect on patients' language function and quality of life. Our hospital randomly enrolled 100 aphasia patients caused by head injury treated from March 2020 to March 2022 as the experimental object and divided them into the control group and experimental group, with 50 cases in each group. The general rehabilitation training was performed to the control group and the scalp electroacupuncture combined with rehabilitation training was performed to the experimental group to compare their mini-mental state examination scores, communicative activities in daily living scores, aphasia battery of Chinese scores, quality of life scores, mental status scale in nonpsychiatric settings scores, National Institutes of Health Stroke Scale scores, effective rates, satisfaction of patients, and adverse reaction rates. In the between-group comparison, the patients in the experimental group had significantly higher mini-mental state examination scores, communicative activities in daily living scores, aphasia battery of Chinese scores, quality of life scores, effective rates, and satisfaction, and significantly lower mental status scale in nonpsychiatric settings scores, National Institutes of Health Stroke Scale scores and adverse reaction rates, which was statistically significant (P < .05 in all cases). The combination treatment of scalp electroacupuncture and rehabilitation training can effectively improve the language function and quality of life of patients with aphasia after head injury and remarkably enhance the treatment effect.
Collapse
Affiliation(s)
- Lingzhe Li
- Department of Acupuncture and Tuina, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, Zhejiang, China
| | - Yuexian Lu
- Wenzhou Geriatric Hospital, Wenzhou, Zhejiang, China
| | - Haiqiong Huang
- Department of Acupuncture and Tuina, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, Zhejiang, China
| | - Bihong Ye
- Department of Acupuncture and Tuina, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, Zhejiang, China
| | - Xianyu Mao
- Department of Rehabilitation, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, Zhejiang, China
| | - Fengjun Song
- Department of Acupuncture and Tuina, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, Zhejiang, China
| | - Yuanyuan Chen
- Department of Acupuncture and Tuina, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, Zhejiang, China
| |
Collapse
|
4
|
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.
Collapse
Affiliation(s)
| | - Agnès Trébuchon
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | | |
Collapse
|
5
|
Kaufmann BC, Pastore-Wapp M, Bartolomeo P, Geiser N, Nyffeler T, Cazzoli D. Severity-Dependent Interhemispheric White Matter Connectivity Predicts Poststroke Neglect Recovery. J Neurosci 2024; 44:e1311232024. [PMID: 38565290 PMCID: PMC11112644 DOI: 10.1523/jneurosci.1311-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/15/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Left-sided spatial neglect is a very common and challenging issue after right-hemispheric stroke, which strongly and negatively affects daily living behavior and recovery of stroke survivors. The mechanisms underlying recovery of spatial neglect remain controversial, particularly regarding the involvement of the intact, contralesional hemisphere, with potential contributions ranging from maladaptive to compensatory. In the present prospective, observational study, we assessed neglect severity in 54 right-hemispheric stroke patients (32 male; 22 female) at admission to and discharge from inpatient neurorehabilitation. We demonstrate that the interaction of initial neglect severity and spared white matter (dis)connectivity resulting from individual lesions (as assessed by diffusion tensor imaging, DTI) explains a significant portion of the variability of poststroke neglect recovery. In mildly impaired patients, spared structural connectivity within the lesioned hemisphere is sufficient to attain good recovery. Conversely, in patients with severe impairment, successful recovery critically depends on structural connectivity within the intact hemisphere and between hemispheres. These distinct patterns, mediated by their respective white matter connections, may help to reconcile the dichotomous perspectives regarding the role of the contralesional hemisphere as exclusively compensatory or not. Instead, they suggest a unified viewpoint wherein the contralesional hemisphere can - but must not necessarily - assume a compensatory role. This would depend on initial impairment severity and on the available, spared structural connectivity. In the future, our findings could serve as a prognostic biomarker for neglect recovery and guide patient-tailored therapeutic approaches.
Collapse
Affiliation(s)
- Brigitte C Kaufmann
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
| | - Manuela Pastore-Wapp
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
| | - Paolo Bartolomeo
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris 75013, France
| | - Nora Geiser
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern 3012, Switzerland
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern 3012, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern 3010, Switzerland
| | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, Lucerne 6016, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern 3010, Switzerland
- Department of Psychology, University of Bern, Bern 3012, Switzerland
| |
Collapse
|
6
|
Cheng J, Jiang Y, Rao T, Yang Y, Liu Y, Zhan Y, Yang S. Repetitive transcranial magnetic stimulation for post-stroke non-fluent aphasia: a systematic review and meta-analysis of randomized controlled trials. Front Neurol 2024; 15:1348695. [PMID: 38751884 PMCID: PMC11094331 DOI: 10.3389/fneur.2024.1348695] [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: 12/05/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Objective To systematically evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) on language function in patients with non-fluent aphasia post-stroke. Methods We selected randomized clinical trials (RCT) that involved stroke patients with non-fluent aphasia, whose intervention was rTMS vs. no therapy or other therapy. Two researchers autonomously reviewed the literature based on the specified criteria for inclusion and exclusion and completed the process of data extraction, data verification, and quality evaluation. Meta-analysis was performed using RevMan 5.4 and Stata MP 17, while the assessment of risk of bias was carried out utilizing the Risk of Bias version 2 tool (RoB2). Results The meta-analysis involved 47 RCTs, encompassing 2,190 patients overall. The indexes indicated that rTMS has the potential to decrease the severity of non-fluent aphasia in stroke patients, including improvement of the capability of repetition, naming, and spontaneous language. The determination of BDNF in the serum of patients was also increased. In addition, rTMS reduced the likelihood of depression in stroke patients. Conclusion To summarize the relevant studies, rTMS has significant effects on improving the language abilities of stroke patients suffering from non-fluent aphasia, including the abilities of repetition, naming, and spontaneous language.
Collapse
Affiliation(s)
- Jing Cheng
- First School of Clinical Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yijing Jiang
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ting Rao
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yihan Yang
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yanping Liu
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ying Zhan
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shanli Yang
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| |
Collapse
|
7
|
Liu F, Yao Y, Zhu B, Yu Y, Ren R, Hu Y. The novel imaging methods in diagnosis and assessment of cerebrovascular diseases: an overview. Front Med (Lausanne) 2024; 11:1269742. [PMID: 38660416 PMCID: PMC11039813 DOI: 10.3389/fmed.2024.1269742] [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: 07/30/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Cerebrovascular diseases, including ischemic strokes, hemorrhagic strokes, and vascular malformations, are major causes of morbidity and mortality worldwide. The advancements in neuroimaging techniques have revolutionized the field of cerebrovascular disease diagnosis and assessment. This comprehensive review aims to provide a detailed analysis of the novel imaging methods used in the diagnosis and assessment of cerebrovascular diseases. We discuss the applications of various imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and angiography, highlighting their strengths and limitations. Furthermore, we delve into the emerging imaging techniques, including perfusion imaging, diffusion tensor imaging (DTI), and molecular imaging, exploring their potential contributions to the field. Understanding these novel imaging methods is necessary for accurate diagnosis, effective treatment planning, and monitoring the progression of cerebrovascular diseases.
Collapse
Affiliation(s)
- Fei Liu
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ying Yao
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bingcheng Zhu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yue Yu
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Reng Ren
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yinghong Hu
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| |
Collapse
|
8
|
Liu H, Zhong Y, Liu G, Su H, Liu Z, Wei J, Mo L, Tan C, Liu X, Chen L. Corpus callosum and cerebellum participate in semantic dysfunction of Parkinson's disease: a diffusion tensor imaging-based cross-sectional study. Neuroreport 2024; 35:366-373. [PMID: 38526949 DOI: 10.1097/wnr.0000000000002015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Language dysfunction is common in Parkinson's disease (PD) patients, among which, the decline of semantic fluency is usually observed. This study aims to explore the relationship between white matter (WM) alterations and semantic fluency changes in PD patients. 127 PD patients from the Parkinson's Progression Markers Initiative cohort who received diffusion tensor imaging scanning, clinical assessment and semantic fluency test (SFT) were included. Tract-based special statistics, automated fiber quantification, graph-theoretical and network-based analyses were performed to analyze the correlation between WM structural changes, brain network features and semantic fluency in PD patients. Fractional anisotropy of corpus callosum, anterior thalamic radiation, inferior front-occipital fasciculus, and uncinate fasciculus, were positively correlated with SFT scores, while a negative correlation was identified between radial diffusion of the corpus callosum, inferior longitudinal fasciculus, and SFT scores. Automatic fiber quantification identified similar alterations with more details in these WM tracts. Brain network analysis positively correlated SFT scores with nodal efficiency of cerebellar lobule VIII, and nodal local efficiency of cerebellar lobule X. WM integrity and myelin integrity in the corpus callosum and several other language-related WM tracts may influence the semantic function in PD patients. Damage to the cerebellum lobule VIII and lobule X may also be involved in semantic dysfunction in PD patients.
Collapse
Affiliation(s)
- Hang Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Han C, Tang J, Tang B, Han T, Pan J, Wang N. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e36880. [PMID: 38215135 PMCID: PMC10783273 DOI: 10.1097/md.0000000000036880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with poststroke aphasia (PSA) requires further validation. Here, we aimed to explore the efficacy and safety of the NIBS technique combined with speech training in PSA by traditional Meta-analysis and to compare the intervention effects of the 2 NIBS techniques by Network meta-analysis. METHODS Randomized controlled trials of the NIBS technique combined with speech training for treating PSA in 9 databases, including Web of Science, PubMed, and CNKI, and 2 clinical trial registries were searched by computer. Literature screening was performed using EndNote X9 software, and data analysis and presentation of results were performed using RevMan 5.4.1 and Stata 17.0 software. RESULTS Screening yielded 17 studies with 1013 patients with PSA. Meta-analysis showed that aphasia quotient scores were higher in the intervention group than in the control group [standardized mean difference (SMD) = 1.06, 95% confidence interval (CI) (0.63, 1.49), Z = 4.80, P < .00001]; Western aphasia battery scores on all 4 subscales were higher than those of the control group, the spontaneous language score is [SMD = 0.62, 95% CI (0.46, 0.78), Z = 7.52, P < .00001], the listening comprehension score is [SMD = 0.46, 95% CI (0.30, 0.62), Z = 5.62, P < .00001], the repetition score is [SMD = 1.14, 95% CI (0.59, 1.70), Z = 4.04, P < .0001], the naming score is [SMD = 1.06, 95% CI (0.79, 1.32), Z = 7.85, P < .00001]; The effective rate of the intervention group was higher than that of the control group [odd ratio = 4.19, 95% CI (2.39, 7.37), Z = 4.99, P < .00001]. The results of the Network meta-analysis showed that the best probability ranking of the 2 NIBS techniques combined with speech training in improving aphasia quotient scores was repetitive transcranial magnetic stimulation group (92.2%) > transcranial direct current stimulation group (55.7%). Regarding safety, it was not found that the NIBS technique combined with speech training to treat PSA increases the risk of adverse reactions. CONCLUSION The NIBS technique combined with speech training can effectively improve the recovery of language function in PSA patients with minimal adverse effects, and the clinic can give priority to r TMS combined with speech training in treating PSA.
Collapse
Affiliation(s)
- Congli Han
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jiqin Tang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Bingshun Tang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Tao Han
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jienuo Pan
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Nan Wang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| |
Collapse
|
10
|
Kundu S, Reinhardt A, Song S, Han J, Meadows ML, Crosson B, Krishnamurthy V. Bayesian longitudinal tensor response regression for modeling neuroplasticity. Hum Brain Mapp 2023; 44:6326-6348. [PMID: 37909393 PMCID: PMC10681668 DOI: 10.1002/hbm.26509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023] Open
Abstract
A major interest in longitudinal neuroimaging studies involves investigating voxel-level neuroplasticity due to treatment and other factors across visits. However, traditional voxel-wise methods are beset with several pitfalls, which can compromise the accuracy of these approaches. We propose a novel Bayesian tensor response regression approach for longitudinal imaging data, which pools information across spatially distributed voxels to infer significant changes while adjusting for covariates. The proposed method, which is implemented using Markov chain Monte Carlo (MCMC) sampling, utilizes low-rank decomposition to reduce dimensionality and preserve spatial configurations of voxels when estimating coefficients. It also enables feature selection via joint credible regions which respect the shape of the posterior distributions for more accurate inference. In addition to group level inferences, the method is able to infer individual-level neuroplasticity, allowing for examination of personalized disease or recovery trajectories. The advantages of the proposed approach in terms of prediction and feature selection over voxel-wise regression are highlighted via extensive simulation studies. Subsequently, we apply the approach to a longitudinal Aphasia dataset consisting of task functional MRI images from a group of subjects who were administered either a control intervention or intention treatment at baseline and were followed up over subsequent visits. Our analysis revealed that while the control therapy showed long-term increases in brain activity, the intention treatment produced predominantly short-term changes, both of which were concentrated in distinct localized regions. In contrast, the voxel-wise regression failed to detect any significant neuroplasticity after multiplicity adjustments, which is biologically implausible and implies lack of power.
Collapse
Affiliation(s)
- Suprateek Kundu
- Department of BiostatisticsUT MD Anderson Cancer CenterHoustonTexasUSA
| | - Alec Reinhardt
- Department of BiostatisticsUT MD Anderson Cancer CenterHoustonTexasUSA
| | - Serena Song
- Center for Visual and Neurocognitive RehabilitationAtlanta Veterans Affairs Medical CenterDecaturGeorgiaUSA
| | - Joo Han
- Center for Visual and Neurocognitive RehabilitationAtlanta Veterans Affairs Medical CenterDecaturGeorgiaUSA
| | - M. Lawson Meadows
- Center for Visual and Neurocognitive RehabilitationAtlanta Veterans Affairs Medical CenterDecaturGeorgiaUSA
| | - Bruce Crosson
- Department of NeurologyEmory UniversityAtlantaGeorgiaUSA
- Department of Imaging and Radiological SciencesEmory UniversityAtlantaGeorgiaUSA
| | | |
Collapse
|
11
|
Zhou D, Liang R, Zhu L, Tang Q. A meta-analysis of functional recovery of aphasia after stroke by acupuncture combined with language rehabilitation training. Medicine (Baltimore) 2023; 102:e36160. [PMID: 38013378 PMCID: PMC10681416 DOI: 10.1097/md.0000000000036160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The aim of this systematic review is to evaluate the effectiveness of combining acupuncture with speech rehabilitation training, compared to acupuncture alone or speech rehabilitation training alone, in the treatment of post-stroke aphasia. METHODS To gather data for this study, we searched 6 databases: PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WanFang Data, and Chongqing VIP Database. We included clinical randomized controlled trials on acupuncture combined with rehabilitation training for post-stroke aphasia published between January 1, 2011 and October 8, 2023. Two researchers independently screened the literature, evaluated its quality, and extracted the data using Stata 15.1 SE and RevMan 5.4 software. We conducted a meta-analysis using the random effects model, and expressed dichotomous variables as odds ratios (OR) with 95% confidence intervals (CIs) and continuous variables as weighted mean differences (WMD) with 95% confidence intervals. Specifically, the odds of improvement were significantly higher in the combination group (OR = 3.89, 95% CI = [2.62, 5.78]). Improvements were also seen in several language functions, including expression (WMD = 5.14, 95% CI = [3.87, 6.41]), understanding (WMD = 9.16, 95% CI = [5.20, 13.12]), retelling (WMD = 11.35, 95% CI = [8.70, 14.00]), naming (WMD = 11.36, 95% CI = [8.12, 14.61] ), reading (WMD = 9.20, 95% CI = [4.87, 13.52]), writing (WMD = 5.65, 95% CI = [3.04, 8.26]), and reading aloud (WMD = 7.45, 95% CI = [3.12, 11.78]). Scores on the Chinese Aphasia Complete Test Scale, Western Aphasia Complete Test Scale, and China Rehabilitation Research Center Aphasia Check Scale were also significantly higher in the combination group, with improvements of 7.89, 9.89, and 9.27, respectively. RESULTS A total of 16 clinical randomized controlled trials, including 1258 patients, were included in this meta-analysis. The results showed that compared to simple rehabilitation training or acupuncture treatment alone, the combination of acupuncture and language rehabilitation training was more effective in improving clinical outcomes for patients with post-stroke aphasia. CONCLUSIONS The results of this meta-analysis indicate that acupuncture combined with language rehabilitation training can effectively improve the language function of post-stroke aphasia patients and increase clinical effectiveness. However, further research is needed to confirm these findings and provide a more reliable evidence-based basis for clinical practice. In particular, additional studies with large sample sizes, high quality, and more specific and standardized outcome measures are needed to strengthen the evidence. The limited quantity and quality of the current studies may affect the generalizability of the results.
Collapse
Affiliation(s)
- Daguo Zhou
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Runyu Liang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Luwen Zhu
- Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qiang Tang
- Heilongjiang University of Chinese Medicine, Harbin, China
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Papageorgiou G, Kasselimis D, Laskaris N, Potagas C. Unraveling the Thread of Aphasia Rehabilitation: A Translational Cognitive Perspective. Biomedicines 2023; 11:2856. [PMID: 37893229 PMCID: PMC10604624 DOI: 10.3390/biomedicines11102856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Translational neuroscience is a multidisciplinary field that aims to bridge the gap between basic science and clinical practice. Regarding aphasia rehabilitation, there are still several unresolved issues related to the neural mechanisms that optimize language treatment. Although there are studies providing indications toward a translational approach to the remediation of acquired language disorders, the incorporation of fundamental neuroplasticity principles into this field is still in progress. From that aspect, in this narrative review, we discuss some key neuroplasticity principles, which have been elucidated through animal studies and which could eventually be applied in the context of aphasia treatment. This translational approach could be further strengthened by the implementation of intervention strategies that incorporate the idea that language is supported by domain-general mechanisms, which highlights the impact of non-linguistic factors in post-stroke language recovery. Here, we highlight that translational research in aphasia has the potential to advance our knowledge of brain-language relationships. We further argue that advances in this field could lead to improvement in the remediation of acquired language disturbances by remodeling the rationale of aphasia-therapy approaches. Arguably, the complex anatomy and phenomenology of aphasia dictate the need for a multidisciplinary approach with one of its main pillars being translational research.
Collapse
Affiliation(s)
- Georgios Papageorgiou
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Dimitrios Kasselimis
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Department of Psychology, Panteion University of Social and Political Sciences, 17671 Athens, Greece
| | - Nikolaos Laskaris
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Department of Industrial Design and Production Engineering, School of Engineering, University of West Attica, 12241 Athens, Greece
| | - Constantin Potagas
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| |
Collapse
|
14
|
Zhu D, Qi Z, Wang A, Zhang Y, Yu H. Emerging Validation for the Adapted Chinese Version of Quick Aphasia Battery. J Multidiscip Healthc 2023; 16:2557-2566. [PMID: 37667799 PMCID: PMC10475279 DOI: 10.2147/jmdh.s417810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/10/2023] [Indexed: 09/06/2023] Open
Abstract
Purpose The quick aphasia battery (QAB) was designed to evaluate language disorder from multi-dimension efficiently, which had been translated into several languages but lacked in Chinese. This study conducted cross-cultural adaption for the Chinese version and verified its psychometric properties. Material and Methods First, the Chinese Version of quick aphasia battery (CQAB) was adapted following WHO literature guidelines with steps of forward translation, expert panel, back-translation, pre-test, and interview, then develop the final version. Second, the psychometric properties tests were conducted in 128 post-stroke patients to identify if aphasia happens and verify the validity and reliability of CQAB. Results The Cronbach's alpha coefficient of the CQAB is 0.962, test-retest reliability 0.849, and inter-rater reliability 0.998. Content validity 0.917, KMO 0.861, exploratory factor analysis extracted 2 factors named "language understanding" and "language program", cumulative variance contribution rate is 91.588% >50%. Calibration association validity 0.977. Sensitivity 0.977, specificity 0.932, with the optimal cutoff point is 8.86. Conclusion The study supported CQAB, which adapted following standardized guidelines, is reliable and effective to assess language impairment in post-stroke patients.
Collapse
Affiliation(s)
- Dan Zhu
- School of Medicine, Tongji University, Shanghai, 200082, People’s Republic of China
- Department of Pediatric, Shanghai United Family Healthcare, Shanghai, 200050, People’s Republic of China
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Zhi Qi
- School of Medicine, Tongji University, Shanghai, 200082, People’s Republic of China
- Department of Neurology, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, 200438, People’s Republic of China
| | - Aili Wang
- School of Medicine, Tongji University, Shanghai, 200082, People’s Republic of China
- Department of Pediatric, Shanghai United Family Healthcare, Shanghai, 200050, People’s Republic of China
| | - Yongqing Zhang
- School of Medicine, Tongji University, Shanghai, 200082, People’s Republic of China
| | - Haiping Yu
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| |
Collapse
|
15
|
Song SE, Krishnamurthy LC, Rodriguez AD, Han JH, Crosson BA, Krishnamurthy V. Methodologies for task-fMRI based prognostic biomarkers in response to aphasia treatment. Behav Brain Res 2023; 452:114575. [PMID: 37423319 DOI: 10.1016/j.bbr.2023.114575] [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: 11/16/2022] [Revised: 06/14/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
With the diversity in aphasia coupled with diminished gains at the chronic phase, it is imperative to deliver effective rehabilitation plans. Treatment outcomes have therefore been predicted using lesion-to-symptom mapping, but this method lacks holistic functional information about the language-network. This study, therefore, aims to develop whole-brain task-fMRI multivariate analysis to neurobiologically inspect lesion impacts on the language-network and predict behavioral outcomes in persons with aphasia (PWA) undergoing language therapy. In 14 chronic PWA, semantic fluency task-fMRI and behavioral measures were collected to develop prediction methodologies for post-treatment outcomes. Then, a recently developed imaging-based multivariate method to predict behavior (i.e., LESYMAP) was optimized to intake whole-brain task-fMRI data, and systematically tested for reliability with mass univariate methods. We also accounted for lesion size in both methods. Results showed that both mass univariate and multivariate methods identified unique biomarkers for semantic fluency improvements from baseline to 2-weeks post-treatment. Additionally, both methods demonstrated reliable spatial overlap in task-specific areas including the right middle frontal gyrus when identifying biomarkers of language discourse. Thus whole-brain task-fMRI multivariate analysis has the potential to identify functionally meaningful prognostic biomarkers even for relatively small sample sizes. In sum, our task-fMRI based multivariate approach holistically estimates post-treatment response for both word and sentence production and may serve as a complementary tool to mass univariate analysis in developing brain-behavior relationships for improved personalization of aphasia rehabilitation regimens.
Collapse
Affiliation(s)
- Serena E Song
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neuroscience and Behavioral Biology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Lisa C Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Joint GSU, Georgia Tech, and Emory Center for Translational Research in Neuroimaging and Data Science (TReNDS), Atlanta, GA, United States; Department of Physics and Astronomy, Georgia State University, Atlanta, GA 30302, United States; Department of Radiology and Imaging Sciences, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Amy D Rodriguez
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neurology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Joo H Han
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Physics and Astronomy, Georgia State University, Atlanta, GA 30302, United States
| | - Bruce A Crosson
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neurology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States
| | - Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd., Decatur, GA 30033, United States; Department of Neurology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States; Department of Medicine, Division of Geriatrics and Gerontology, Emory University, 201 Dowman Dr., Atlanta, GA 30322, United States.
| |
Collapse
|
16
|
Krishnamurthy LC, Glassman C, Han JH, Song SE, Denmon C, Weatherill M, Rodriguez AD, Crosson BA, Krishnamurthy V. ASL MRI informs blood flow to chronic stroke lesions in patients with aphasia. Front Physiol 2023; 14:1240992. [PMID: 37546533 PMCID: PMC10397521 DOI: 10.3389/fphys.2023.1240992] [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: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction: Response to post-stroke aphasia language rehabilitation is difficult to anticipate, mainly because few predictors can help identify optimal, individualized treatment options. Imaging techniques, such as Voxel-based Lesion Symptom Mapping have been useful in linking specific brain areas to language behavior; however, further development is required to optimize the use of structural and physiological information in guiding individualized treatment for persons with aphasia (PWA). In this study, we will determine if cerebral blood flow (CBF) mapped in patients with chronic strokes can be further used to understand stroke-related factors and behavior. Methods: We collected perfusion MRI data using pseudo-Continuous Arterial Spin Labeling (pCASL) using a single post-labeling delay of 2,200 ms in 14 chronic PWA, along with high-resolution structural MRI to compute maps of tissue damage using Tissue Integrity Gradation via T2w T1w Ratio (TIGR). To quantify the CBF in chronic stroke lesions, we tested at what point spatial smoothing should be applied in the ASL analysis pipeline. We then related CBF to tissue damage, time since stroke, age, sex, and their respective cross-terms to further understand the variability in lesion CBF. Finally, we assessed the feasibility of computing multivariate brain-behavior maps using CBF and compared them to brain-behavior maps extracted with TIGR MRI. Results: We found that the CBF in chronic stroke lesions is significantly reduced compared to its homologue grey and white matter regions. However, a reliable CBF signal (although smaller than expected) was detected to reveal a negative relationship between CBF and increasing tissue damage. Further, the relationship between the lesion CBF and age, sex, time since stroke, and tissue damage and cross-terms suggested an aging-by-disease interaction. This relationship was strongest when smoothing was applied in the template space. Finally, we show that whole-brain CBF relates to domain-general visuospatial functioning in PWA. The CBF-based brain-behavior maps provide unique and complementary information to structural (lesion-based) brain-behavior maps. Discussion: Therefore, CBF can be detected in chronic stroke lesions using a standard pCASL MRI acquisition and is informative at the whole-brain level in identifying stroke rehabilitation targets in PWAs due to its relationship with demographic factors, stroke-related factors, and behavior.
Collapse
Affiliation(s)
- Lisa C. Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
- Joint GSU, Georgia Tech, and Emory Center for Translational Research in Neuroimaging and Data Science (TReNDS), Atlanta, GA, United States
- Department of Physics and Astronomy, Georgia State University, Atlanta, GA, United States
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Clara Glassman
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
| | - Joo H. Han
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
| | - Serena E. Song
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
| | - Chanse Denmon
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
| | - Maryanne Weatherill
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
| | - Amy D. Rodriguez
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Bruce A. Crosson
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Venkatagiri Krishnamurthy
- Department of Neurology, Emory University, Atlanta, GA, United States
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
- Department of Veterans Affairs (VA) Health Care System, Decatur, GA, United States
| |
Collapse
|
17
|
Kumar J, Patel T, Sugandh F, Dev J, Kumar U, Adeeb M, Kachhadia MP, Puri P, Prachi F, Zaman MU, Kumar S, Varrassi G, Syed ARS. Innovative Approaches and Therapies to Enhance Neuroplasticity and Promote Recovery in Patients With Neurological Disorders: A Narrative Review. Cureus 2023; 15:e41914. [PMID: 37588309 PMCID: PMC10425702 DOI: 10.7759/cureus.41914] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/15/2023] [Indexed: 08/18/2023] Open
Abstract
Brain rehabilitation and recovery for people with neurological disorders, such as stroke, traumatic brain injury (TBI), and neurodegenerative diseases, depend mainly on neuroplasticity, the brain's capacity to restructure and adapt. This literature review aims to look into cutting-edge methods and treatments that support neuroplasticity and recovery in these groups. A thorough search of electronic databases revealed a wide range of research and papers investigating several neuroplasticity-targeting methods, such as cognitive training, physical activity, non-invasive brain stimulation, and pharmaceutical interventions. The results indicate that these therapies can control neuroplasticity and improve motor, mental, and sensory function. In addition, cutting-edge approaches, such as virtual reality (VR) and brain-computer interfaces (BCIs), promise to increase neuroplasticity and foster rehabilitation. However, many issues and restrictions still need to be resolved, including the demand for individualized treatments and the absence of defined standards. In conclusion, this review emphasizes the significance of neuroplasticity in brain rehabilitation. It identifies novel strategies and treatments that promise to enhance recovery in patients with neurological illnesses. Future studies should concentrate on improving these therapies and developing evidence-based standards to direct clinical practice and enhance outcomes for this vulnerable population.
Collapse
Affiliation(s)
- Jitesh Kumar
- Internal Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Tirath Patel
- Medical Student, American University of Antigua, St. John's, ATG
| | - Fnu Sugandh
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
- Medicine, Civil Hospital Karachi, Karachi, PAK
| | - Jyotishna Dev
- Pediatric Medicine, Green City Hospital, Kathmandu, NPL
- Internal Medicine, TUTH (Tribhuvan University Teaching Hospital) Institute Of Medicine, Kathmandu, NPL
| | - Umesh Kumar
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Maham Adeeb
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Meet Popatbhai Kachhadia
- Internal Medicine, PDU (Pandit Deendayal Upadhyay) Medical College, Civil Hospital Campus, Rajkot, IND
| | - Piyush Puri
- Internal Medicine, Adesh Institute of Medical Science and Research, Bathinda, IND
| | - Fnu Prachi
- Medicine, Guru Teg Bahadur Hospital, Delhi, IND
| | | | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | | | | |
Collapse
|
18
|
Vadinova V, Sihvonen AJ, Garden KL, Ziraldo L, Roxbury T, O'Brien K, Copland DA, McMahon KL, Brownsett SLE. Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke. Neurorehabil Neural Repair 2023; 37:218-227. [PMID: 37083133 PMCID: PMC10152219 DOI: 10.1177/15459683231168384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated. OBJECTIVE To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables. METHODS Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating. RESULTS The presence of severe WMH explained an additional 18% and 25% variance in early subacute (t = -3.00, p = .004) and chronic (t = -3.60, P = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores. CONCLUSIONS Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.
Collapse
Affiliation(s)
- Veronika Vadinova
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Aleksi J Sihvonen
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
- Cognitive Brain Research Unit (CBRU), University of Helsinki, Helsinki, Finland
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland
| | - Kimberley L Garden
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Laura Ziraldo
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Tracy Roxbury
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Kate O'Brien
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - David A Copland
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Queensland, Australia
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
| |
Collapse
|
19
|
Barbieri E, Thompson CK, Higgins J, Caplan D, Kiran S, Rapp B, Parrish T. Treatment-induced neural reorganization in aphasia is language-domain specific: Evidence from a large-scale fMRI study. Cortex 2023; 159:75-100. [PMID: 36610109 PMCID: PMC9931666 DOI: 10.1016/j.cortex.2022.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 08/14/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
Studies investigating the effects of language intervention on the re-organization of language networks in chronic aphasia have resulted in mixed findings, likely related to-among other factors-the language function targeted during treatment. The present study investigated the effects of the type of treatment provided on neural reorganization. Seventy individuals with chronic stroke-induced aphasia, recruited from three research laboratories and meeting criteria for agrammatism, anomia or dysgraphia were assigned to either treatment (N = 51) or control (N = 19) groups. Participants in the treatment group received 12-weeks of language intervention targeting sentence comprehension/production, naming, or spelling. At baseline and post-testing, all participants performed an fMRI story comprehension task, with blocks of auditorily-presented stories alternated with blocks of reversed speech. Participants in the treatment, but not control, group significantly improved in the treated language domain. FMRI region-of-interest (ROI) analyses, conducted within regions that were either active (or homologous to active) regions in a group of 22 healthy participants on the story comprehension task, revealed a significant increase in activation from pre-to post-treatment in right-hemisphere homologues of these regions for participants in the sentence and spelling, but not naming, treatment groups, not predicted by left-hemisphere lesion size. For the sentence (but not the spelling) treatment group, activation changes within right-hemisphere homologues of language regions were positively associated with changes in measures of verb and sentence comprehension. These findings support previous research pointing to recruitment of right hemisphere tissue as a viable route for language recovery and suggest that sentence-level treatment may promote greater neuroplasticity on naturalistic, language comprehension tasks, compared to word-level treatment.
Collapse
Affiliation(s)
- Elena Barbieri
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL 60208, USA.
| | - Cynthia K Thompson
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 70 Arts Circle Drive, Evanston, IL 60208, USA; Department of Neurology, Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA
| | - James Higgins
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Chicago, IL 60611, USA
| | - David Caplan
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA 02114, USA
| | - Swathi Kiran
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Speech, Language, And Hearing, College of Health & Rehabilitation, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA
| | - Brenda Rapp
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Cognitive Science, Krieger School of Arts & Sciences, Johns Hopkins Univeristy, 3400 N Charles Street, Baltimore, MD 21218, USA
| | - Todd Parrish
- Center for the Neurobiology of Language Recovery, Northwestern University, 2240 Campus Drive, Evanston, IL 60208, USA; Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Chicago, IL 60611, USA
| |
Collapse
|
20
|
Edmonds LA, Morgan J. Two-Year Longitudinal Evaluation of Community Aphasia Center Participation on Linguistic, Functional Communication, and Quality of Life Measures Across People With a Range of Aphasia Presentations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2378-2394. [PMID: 36260759 DOI: 10.1044/2022_ajslp-21-00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The purpose of this study was to evaluate potential changes on a hierarchy of language tasks and measures of functional communication and quality of life in a group of people with aphasia (PWA) who attended a community aphasia center for 2 years. A secondary purpose was to determine whether there were any predictors of change. METHOD Twenty-seven PWA who attended Brooks Rehabilitation Aphasia Center (BRAC) were evaluated on an aphasia battery, confrontation naming, and structured discourse in addition to completing self-reported measures of functional communication and quality of life at three time points: before attending BRAC and after 1 (N = 27) and 2 (N = 20) years of BRAC participation. Twenty-six communication partners who communicated regularly with the PWA completed a questionnaire about their functional communication at the same time points. A mixed linear model was conducted for all dependent variables to determine change over time. Tau-b correlations were conducted between demographic and aphasia-related variables and difference scores for outcome measures that exhibited significant improvements. RESULTS At 1-year testing, significant improvements were observed on the aphasia battery, object and action naming, and all self- and communication partner-reported measures. At 2-year testing, all improvements were maintained except for the self-reported measure of functional communication. Structured discourse showed increases in average number of words, percentage of meaningful words and utterances, and efficiency of meaningful word production after 2 years. No significant correlations were observed between predictor variables and difference scores. CONCLUSIONS Participation in aphasia centers can result in significant changes in language, functional communication, and quality of life in people with chronic aphasia. These findings support the importance of aphasia centers in the continuum of care for PWA. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21313689.
Collapse
Affiliation(s)
- Lisa A Edmonds
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jodi Morgan
- Brooks Rehabilitation Aphasia Center, Jacksonville, FL
- Department of Communication Sciences and Disorders, Jacksonville University, FL
| |
Collapse
|
21
|
Gravier ML, Hula WD, Johnson JP, Autenreith A, Dickey MW. Is there a Relationship Between Cortisol and Treatment Response in Chronic Aphasia? TOPICS IN LANGUAGE DISORDERS 2022; 42:193-211. [PMID: 36406142 PMCID: PMC9670258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Michelle L Gravier
- Department of Speech, Language, and Hearing Sciences, California State East Bay, Hayward, CA, USA
| | - William D Hula
- Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh PA, USA
| | - Jeffrey P Johnson
- Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA, USA
| | - Alyssa Autenreith
- Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA, USA
| | - Michael Walsh Dickey
- Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh PA, USA
| |
Collapse
|
22
|
Garrido del Águila D, Niño AL, Carballo G. Medidas de Calidad de Vida en Personas con Afasia. Revisión Sistemática. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2022. [DOI: 10.5209/rlog.79102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La afasia después de un daño cerebral y sus diferentes condiciones negativas derivadas, afectan a la calidad de vida (CdV) de la persona. El objetivo de este estudio es describir y analizar la literatura de los años comprendidos entre 2016 y 2020 para identificar y cuantificar aspectos relevantes de la CdV y su evaluación en personas con afasia (PWA). Para lo anterior, se consultaron tres bases de datos (PsycINFO, Medline y Psicodoc). Se incluyeron 38 estudios. Se codificaron y analizaron las características de los estudios y se evaluó la calidad de los trabajos siguiendo las pautas marcadas por la STROBE y la NIH. Los resultados muestran que la prueba de evaluación de CdV más utilizada fue la Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) (n= 19, 50.00%). En la mayoría de los estudios, independientemente de las pruebas de evaluación, las PWA presentan una baja CdV. Los estudios seleccionados presentan una calidad metodológica media-alta. Como conclusión cabe destacar que, además de limitar aspectos de la comunicación y el lenguaje, la afasia afecta negativamente a la CdV de forma global de la persona que la padece. El desarrollo de pruebas de evaluación de la CdV puede ayudar a los profesionales a planificar una intervención adecuada.
Collapse
|
23
|
Huang J, Cao Y, Zhang D, Lei X, Chang J. Research trends of the neuroimaging in aphasia: A bibliometric analysis and visualization analysis from 2004 to 2021. Front Hum Neurosci 2022; 16:945160. [PMID: 35911602 PMCID: PMC9334888 DOI: 10.3389/fnhum.2022.945160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To review the current research status of the neuroimaging of aphasia, and reveal the hotspots and frontiers of research in this field. Methods We searched articles related to the neuroimaging research on aphasia since Web of Science (WOS) database construction and extracted the data. CiteSpace and VOSviewer were used for the country/institution analysis, journal analysis, discipline analysis, burst keyword analysis and cited-reference cluster analysis. Results Of the studies retrieved from WOS, 2922 studies that related to the neuroimaging of aphasia were screened and finally included 2799 articles for research. The United States of America and University of California San Francisco were the main countries and institutions in this field. Brain had the highest impact factor in both published and cited journals. Through the discipline and topic analysis of this field, the most common category was Neurosciences and Neurology. The keyword with the strongest citation strength was “functional connectivity,” and the recent burst keywords were “functional connectivity” and “network.” The co-citation network showed seven clusters greater than 100. Among the top 5 clusters, the most recently formed cluster, Cluster #2 (progressive supranuclear palsy), had an average year of 2017. The literature in the top 5 clusters mainly focused on 3 aspects, specifically, the discovery of language processing models, injury and recovery mechanisms of post-stroke aphasia (PSA), and diagnosis of primary progressive aphasia (PPA) variants. Conclusion The results of this bibliometric study revealed the following three research hotspots in the neuroimaging of aphasia: clarifying the connotation of the most recognized language processing model, the dual-stream model, exploring the injury mechanism based on the dual-stream model and the recovery mechanism involving the left and right hemispheres of PSA, and determining the diagnostic criteria for PPA variants. A major research trend is to combine new neuroimaging technology, such as PET tracer technology, to realize the visual presentation of disease-specific proteins to improve the pathological diagnostic criteria of PPA variants. Accordingly, a visualized analysis of literature that uses CiteSpace provides a more rapid, repeatable and flexible method, which is more conducive to capturing research hotspots and emerging trends.
Collapse
|
24
|
Weatherill M, Tibus E, Rodriguez AD. Motivation as a Predictor of Aphasia Treatment Outcomes: A Scoping Review. TOPICS IN LANGUAGE DISORDERS 2022; 43:252-265. [PMID: 36950030 PMCID: PMC10026711 DOI: 10.1097/tld.0000000000000286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Motivation is a complex phenomenon that can influence a person's ability to make progress in treatment. We sought to understand how motivation is currently measured and utilized in aphasia rehabilitation by identifying treatment studies that (1) include measurement of motivation and (2) use motivation to predict treatment response. METHOD A scoping review was conducted by systematically searching PubMed, CINAHL, EBSCO, Ovid MEDLINE, and APA PsycInfo using the following search terms: (measurement OR treatment OR rehabilitation OR predict*) AND (motiv* OR engagement OR adherence OR compliance) AND (aphasia OR dysphasia). RESULTS Two studies met our inclusion criteria. Motivation was measured differently across studies. No studies used motivation to predict treatment outcomes. DISCUSSION/CONCLUSIONS Despite the importance of motivation in aphasia rehabilitation success, studies that include its measurement are sparse. Additional research is needed and should include development of measurement tools and evaluation of the predictive value of motivation on treatment outcomes.
Collapse
Affiliation(s)
- Maryanne Weatherill
- VA RR&D Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia
| | - Elizabeth Tibus
- VA RR&D Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia
| | - Amy D. Rodriguez
- VA RR&D Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
25
|
Dresang HC, Harvey DY, Xie SX, Shah-Basak PP, DeLoretta L, Wurzman R, Parchure SY, Sacchetti D, Faseyitan O, Lohoff FW, Hamilton RH. Genetic and Neurophysiological Biomarkers of Neuroplasticity Inform Post-Stroke Language Recovery. Neurorehabil Neural Repair 2022; 36:371-380. [PMID: 35428413 PMCID: PMC9133188 DOI: 10.1177/15459683221096391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is high variability in post-stroke aphasia severity and predicting recovery remains imprecise. Standard prognostics do not include neurophysiological indicators or genetic biomarkers of neuroplasticity, which may be critical sources of variability. OBJECTIVE To evaluate whether a common polymorphism (Val66Met) in the gene for brain-derived neurotrophic factor (BDNF) contributes to variability in post-stroke aphasia, and to assess whether BDNF polymorphism interacts with neurophysiological indicators of neuroplasticity (cortical excitability and stimulation-induced neuroplasticity) to improve estimates of aphasia severity. METHODS Saliva samples and motor-evoked potentials (MEPs) were collected from participants with chronic aphasia subsequent to left-hemisphere stroke. MEPs were collected prior to continuous theta burst stimulation (cTBS; index for cortical excitability) and 10 minutes following cTBS (index for stimulation-induced neuroplasticity) to the right primary motor cortex. Analyses assessed the extent to which BDNF polymorphism interacted with cortical excitability and stimulation-induced neuroplasticity to predict aphasia severity beyond established predictors. RESULTS Val66Val carriers showed less aphasia severity than Val66Met carriers, after controlling for lesion volume and time post-stroke. Furthermore, Val66Val carriers showed expected effects of age on aphasia severity, and positive associations between severity and both cortical excitability and stimulation-induced neuroplasticity. In contrast, Val66Met carriers showed weaker effects of age and negative associations between cortical excitability, stimulation-induced neuroplasticity and aphasia severity. CONCLUSIONS Neurophysiological indicators and genetic biomarkers of neuroplasticity improved aphasia severity predictions. Furthermore, BDNF polymorphism interacted with cortical excitability and stimulation-induced neuroplasticity to improve predictions. These findings provide novel insights into mechanisms of variability in stroke recovery and may improve aphasia prognostics.
Collapse
Affiliation(s)
- Haley C. Dresang
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104,Moss Rehabilitation Research Institute, Einstein Medical Center, 50 Township Line Road, Philadelphia, PA 19027,Corresponding author:, Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Denise Y. Harvey
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Sharon Xiangwen Xie
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, 607 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104
| | - Priyanka P. Shah-Basak
- Medical College of Wisconsin, Department of Neurology, 8701 Watertown Plank Road Milwaukee, WI 53226
| | - Laura DeLoretta
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Rachel Wurzman
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Shreya Y. Parchure
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Daniela Sacchetti
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Olufunsho Faseyitan
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Falk W. Lohoff
- National Institute for Alcohol Abuse and Alcoholism, National Institutes of Health (NIH), 10 Center Drive (10CRC/2-2352), Bethesda, MD 20892
| | - Roy H. Hamilton
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| |
Collapse
|
26
|
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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 04/20/2022] [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.
Collapse
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
| | - 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
| |
Collapse
|
27
|
Drucker JH, Epstein CM, McGregor KM, Hortman K, Gopinath KS, Crosson B. Reduced Interference and Serial Dependency Effects for Naming in Older but Not Younger Adults after 1 Hz rTMS of Right Pars Triangularis. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2022; 3:256-271. [PMID: 37215557 PMCID: PMC10158568 DOI: 10.1162/nol_a_00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 11/25/2021] [Indexed: 05/24/2023]
Abstract
1 Hz repetitive transcranial magnetic stimulation (rTMS) was used to decrease excitability of right pars triangularis (R PTr) to determine whether increased R PTr activity during picture naming in older adults hampers word finding. We hypothesized that decreasing R PTr excitability would reduce interference with word finding, facilitating faster picture naming. 15 older and 16 younger adults received two rTMS sessions. In one, speech onset latencies for picture naming were measured after both sham and active R PTr stimulation. In the other session, sham and active stimulation of a control region, right pars opercularis (R POp), were administered before picture naming. Order of active vs. sham stimulation within session was counterbalanced. Younger adults showed no significant effects of stimulation. In older adults, a trend indicated that participants named pictures more quickly after active than sham R PTr stimulation. However, older adults also showed longer responses during R PTr than R POp sham stimulation. When order of active vs. sham stimulation was modeled, older adults receiving active stimulation first had significantly faster responding after active than sham R PTr stimulation and significantly faster responding after R PTr than R POp stimulation, consistent with experimental hypotheses. However, older adults receiving sham stimulation first showed no significant differences between conditions. Findings are best understood, based on previous studies, when the interaction between the excitatory effects of picture naming and the inhibitory effects of 1 Hz rTMS on R PTr is considered. Implications regarding right frontal activity in older adults and for design of future experiments are discussed.
Collapse
Affiliation(s)
- Jonathan H. Drucker
- VA Rehabilitation Research & Development Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, USA
- Department of Neurology, Emory University, Atlanta, GA, USA
- Aptima, Inc., Woburn, MA, USA
| | | | - Keith M. McGregor
- VA Rehabilitation Research & Development Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, USA
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Kyle Hortman
- VA Rehabilitation Research & Development Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, USA
| | | | - Bruce Crosson
- VA Rehabilitation Research & Development Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, USA
- Department of Neurology, Emory University, Atlanta, GA, USA
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| |
Collapse
|
28
|
Cheng BBY, Ryan BJ, Copland DA, Wallace SJ. Prognostication in Poststroke Aphasia: Perspectives of Significant Others of People With Aphasia on Receiving Information About Recovery. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:896-911. [PMID: 35050706 DOI: 10.1044/2021_ajslp-21-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Knowing what to expect poststroke is important for many significant others of people with aphasia, yet an understanding of their perceptions and preferences in receiving prognostic information is limited. This knowledge is needed to inform the formulation and delivery of aphasia prognoses as conversations about prognosis can be harmful or helpful depending on their alignment with key stakeholder perspectives. Our preliminary study sought insight into the perspectives of significant others of people with aphasia on receiving prognostic information, with an aim toward informing evidence-based practice in aphasia prognostication. METHOD We interviewed seven significant others of people with aphasia, 3-12 months poststroke. The interviews were semistructured, conducted one-to-one, and analyzed qualitatively using reflexive thematic analysis. RESULTS Five themes were drawn from the interviews: (a) You don't know what you don't know. (b) Having them alive is the best you can ask for. (c) Recovery in the eye of the beholder. (d) Outcomes don't matter unless they help me help them. (e) It's my prognosis too if I'm living with aphasia. CONCLUSIONS A significant other's prognosis-related perceptions and preferences are products of their poststroke reality and may inadvertently shape that of the person with aphasia. In order to facilitate recovery, prognostication practices need to consider the needs of significant others both as providers of care and as requiring care themselves for their first-hand experiences of third-party disability.
Collapse
Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Brooke J Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
29
|
Harvey DY, Hamilton R. Noninvasive brain stimulation to augment language therapy for poststroke aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:241-250. [PMID: 35078601 DOI: 10.1016/b978-0-12-823384-9.00012-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral language treatment approaches represent the standard of care for persons with aphasia (PWA), but the benefits of these treatments are variable. Moreover, due to the logistic and financial limitations on the amount of behavioral therapy available to patients, it is often infeasible for PWA to receive behavioral interventions with the level of frequency, intensity, or duration that would provide significant and lasting benefit, underscoring the need for novel, effective treatment approaches. Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), have emerged as promising neurally-based tools to enhance language abilities for PWA following stroke. This chapter first provides an overview of the methods and physiologic basis motivating the use of NIBS to enhance aphasia recovery followed by a selective review of the growing evidence of its potential as a novel therapeutic tool. Subsequent sections discuss some of the principles that may prove most useful in guiding and optimizing the effects of NIBS on aphasia recovery, focusing on how the functional state of the brain at the time of stimulation interacts with the behavioral aftereffects of neuromodulation. We conclude with a discussion of current challenges and future directions for NIBS in aphasia treatment.
Collapse
Affiliation(s)
- Denise Y Harvey
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Roy Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
| |
Collapse
|
30
|
Ailion AS, You X, Mbwana JS, Fanto EJ, Krishnamurthy M, Vaidya CJ, Sepeta LN, Gaillard WD, Berl MM. Functional Connectivity as a Potential Mechanism for Language Plasticity. Neurology 2022; 98:e249-e259. [PMID: 34795045 PMCID: PMC8792810 DOI: 10.1212/wnl.0000000000013071] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/02/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Task fMRI is a clinical tool for language lateralization, but has limitations, and cannot provide information about network-level plasticity. Additional methods are needed to improve the precision of presurgical language mapping. We investigate language resting-state functional connectivity (RS fMRI; FC) in typically developing children (TD) and children with epilepsy. Our objectives were to (1) understand how FC components differ between TD children and those with epilepsy; (2) elucidate how the location of disease (frontal/temporal epilepsy foci) affects FC; and (3) investigate the relationship between age and FC. METHODS Our sample included 55 TD children (mean age 12 years, range 7-18) and 31 patients with focal epilepsy (mean age 13 years, range 7-18). All participants underwent RS fMRI. Using a bilateral canonical language map as target, vertex-wise intrahemispheric FC map and interhemispheric FC map for each participant were computed and thresholded at top 10% to compute an FC laterality index (FCLI; [(L - R)/(L + R)]) of the frontal and temporal regions for both integration (intrahemispheric FC; FCLIi) and segregation (interhemispheric FC; FCLIs) maps. RESULTS We found FC differences in the developing language network based on disease, seizure foci location, and age. Frontal and temporal FCLIi was different between groups (t[84] = 2.82, p < 0.01; t[84] = 4.68, p < 0.01, respectively). Frontal epilepsy foci had the largest differences from TD (Cohen d frontal FCLIi = 0.84, FCLIs = 0.51; temporal FCLIi = 1.29). Development and disease have opposing influences on the laterality of FC based on groups. In the frontal foci group, FCLIi decreased with age (r = -0.42), whereas in the temporal foci group, FCLIi increased with age (r = 0.40). Within the epilepsy group, increases in right frontal integration FCLI relates to increased right frontal task activation in our mostly left language dominant group (r = 0.52, p < 0.01). Language network connectivity is associated with higher verbal intelligence in children with epilepsy (r = 0.45, p < 0.05). DISCUSSION These findings lend preliminary evidence that FC reflects network plasticity in the form of adaptation and compensation, or the ability to recruit support and reallocate resources within and outside of the traditional network to compensate for disease. FC expands on task-based fMRI and provides complementary and potentially useful information about the language network that is not captured using task-based fMRI alone.
Collapse
Affiliation(s)
- Alyssa S Ailion
- From the Departments of Psychiatry and Neurology (A.S.A.), Boston Children's Hospital, Harvard Medical School, MA; Departments of Neurology (X.Y., J.S.M., E.J.F., M.K., W.D.G.) and Neuropsychology (L.N.S., M.M.B.), Children's National Hospital; and Department of Psychology (C.J.V.), Georgetown University, Washington, DC.
| | - Xiaozhen You
- From the Departments of Psychiatry and Neurology (A.S.A.), Boston Children's Hospital, Harvard Medical School, MA; Departments of Neurology (X.Y., J.S.M., E.J.F., M.K., W.D.G.) and Neuropsychology (L.N.S., M.M.B.), Children's National Hospital; and Department of Psychology (C.J.V.), Georgetown University, Washington, DC
| | - Juma S Mbwana
- From the Departments of Psychiatry and Neurology (A.S.A.), Boston Children's Hospital, Harvard Medical School, MA; Departments of Neurology (X.Y., J.S.M., E.J.F., M.K., W.D.G.) and Neuropsychology (L.N.S., M.M.B.), Children's National Hospital; and Department of Psychology (C.J.V.), Georgetown University, Washington, DC
| | - Eleanor J Fanto
- From the Departments of Psychiatry and Neurology (A.S.A.), Boston Children's Hospital, Harvard Medical School, MA; Departments of Neurology (X.Y., J.S.M., E.J.F., M.K., W.D.G.) and Neuropsychology (L.N.S., M.M.B.), Children's National Hospital; and Department of Psychology (C.J.V.), Georgetown University, Washington, DC
| | - Manu Krishnamurthy
- From the Departments of Psychiatry and Neurology (A.S.A.), Boston Children's Hospital, Harvard Medical School, MA; Departments of Neurology (X.Y., J.S.M., E.J.F., M.K., W.D.G.) and Neuropsychology (L.N.S., M.M.B.), Children's National Hospital; and Department of Psychology (C.J.V.), Georgetown University, Washington, DC
| | - Chandan J Vaidya
- From the Departments of Psychiatry and Neurology (A.S.A.), Boston Children's Hospital, Harvard Medical School, MA; Departments of Neurology (X.Y., J.S.M., E.J.F., M.K., W.D.G.) and Neuropsychology (L.N.S., M.M.B.), Children's National Hospital; and Department of Psychology (C.J.V.), Georgetown University, Washington, DC
| | - Leigh N Sepeta
- From the Departments of Psychiatry and Neurology (A.S.A.), Boston Children's Hospital, Harvard Medical School, MA; Departments of Neurology (X.Y., J.S.M., E.J.F., M.K., W.D.G.) and Neuropsychology (L.N.S., M.M.B.), Children's National Hospital; and Department of Psychology (C.J.V.), Georgetown University, Washington, DC
| | - William D Gaillard
- From the Departments of Psychiatry and Neurology (A.S.A.), Boston Children's Hospital, Harvard Medical School, MA; Departments of Neurology (X.Y., J.S.M., E.J.F., M.K., W.D.G.) and Neuropsychology (L.N.S., M.M.B.), Children's National Hospital; and Department of Psychology (C.J.V.), Georgetown University, Washington, DC
| | - Madison M Berl
- From the Departments of Psychiatry and Neurology (A.S.A.), Boston Children's Hospital, Harvard Medical School, MA; Departments of Neurology (X.Y., J.S.M., E.J.F., M.K., W.D.G.) and Neuropsychology (L.N.S., M.M.B.), Children's National Hospital; and Department of Psychology (C.J.V.), Georgetown University, Washington, DC
| |
Collapse
|
31
|
Chang AJ, Wilmskoetter J, Fridriksson J, McKinnon ET, Johnson LP, Basilakos A, Jensen JH, Rorden C, Bonilha L. Cortical microstructural changes associated with treated aphasia recovery. Ann Clin Transl Neurol 2021; 8:1884-1894. [PMID: 34406705 PMCID: PMC8419405 DOI: 10.1002/acn3.51445] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 01/17/2023] Open
Abstract
Objectives To investigate the hypothesis that language recovery in post‐stroke aphasia is associated with structural brain changes. Methods We evaluated whether treatment‐induced improvement in naming is associated with reorganization of tissue microstructure within residual cortical regions. To this end, we performed a retrospective longitudinal treatment study using comprehensive language‐linguistic assessments and diffusion MRI sequences optimized for the assessment of complex microstructure (diffusional kurtosis imaging) to evaluate the relationship between language treatment response and cortical changes in 26 individuals with chronic stroke‐induced aphasia. We employed elastic net statistical models controlling for baseline factors including age, sex, and time since the stroke, as well as lesion volume. Results We observed that improved naming accuracy (Philadelphia Naming Test) was statistically associated with increased post‐treatment microstructural integrity in the left posterior superior temporal gyrus. Moreover, increase in microstructural integrity in the left middle temporal gyrus and left inferior temporal gyrus was specifically associated with a decrease in semantic paraphasias. This longitudinal relationship between brain tissue integrity and language improvement was not observed in other non‐language related brain regions. Interpretation Our findings provide evidence that structural brain changes in the preserved left hemisphere regions are associated with treatment‐induced language recovery in aphasia and are part of the mechanisms supporting language and brain injury recovery.
Collapse
Affiliation(s)
- Allen J Chang
- College of Graduate Studies, Neuroscience Institute, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Janina Wilmskoetter
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina, USA
| | - Emilie T McKinnon
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lorelei P Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina, USA
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina, USA
| | - Jens H Jensen
- Department of Neuroscience, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Leonardo Bonilha
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
32
|
Krishnamurthy LC, Krishnamurthy V, Rodriguez AD, McGregor KM, Glassman CN, Champion GS, Rocha N, Harnish SM, Belagaje SR, Kundu S, Crosson BA. Not All Lesioned Tissue Is Equal: Identifying Pericavitational Areas in Chronic Stroke With Tissue Integrity Gradation via T2w T1w Ratio. Front Neurosci 2021; 15:665707. [PMID: 34421509 PMCID: PMC8378269 DOI: 10.3389/fnins.2021.665707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/05/2021] [Indexed: 11/14/2022] Open
Abstract
Stroke-related tissue damage within lesioned brain areas is topologically non-uniform and has underlying tissue composition changes that may have important implications for rehabilitation. However, we know of no uniformly accepted, objective non-invasive methodology to identify pericavitational areas within the chronic stroke lesion. To fill this gap, we propose a novel magnetic resonance imaging (MRI) methodology to objectively quantify the lesion core and surrounding pericavitational perimeter, which we call tissue integrity gradation via T2w T1w ratio (TIGR). TIGR uses standard T1-weighted (T1w) and T2-weighted (T2w) anatomical images routinely collected in the clinical setting. TIGR maps are analyzed with relation to subject-specific gray matter and cerebrospinal fluid thresholds and binned to create a false colormap of tissue damage within the stroke lesion, and these are further categorized into low-, medium-, and high-damage areas. We validate TIGR by showing that the cerebral blood flow within the lesion reduces with greater tissue damage (p = 0.005). We further show that a significant task activity can be detected in pericavitational areas and that medium-damage areas contain a significantly lower magnitude of hemodynamic response function than the adjacent damaged areas (p < 0.0001). We also demonstrate the feasibility of using TIGR maps to extract multivariate brain-behavior relationships (p < 0.05) and show general agreement in location compared to binary lesion, T1w-only, and T2w-only maps but that the extent of brain behavior maps may depend on signal sensitivity as denoted by the sparseness coefficient (p < 0.0001). Finally, we show the feasibility of quantifying TIGR in early and late subacute stroke phases, where higher-damage areas were smaller in size (p = 0.002) and that lesioned voxels transition from lower to higher damage with increasing time post-stroke (p = 0.004). We conclude that TIGR is able to (1) identify tissue damage gradient within the stroke lesion across different post-stroke timepoints and (2) more objectively delineate lesion core from pericavitational areas wherein such areas demonstrate reasonable and expected physiological and functional impairments. Importantly, because T1w and T2w scans are routinely collected in the clinic, TIGR maps can be readily incorporated in clinical settings without additional imaging costs or patient burden to facilitate decision processes related to rehabilitation planning.
Collapse
Affiliation(s)
- Lisa C. Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
- Department of Physics and Astronomy, Georgia State University, Atlanta, GA, United States
| | - Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Amy D. Rodriguez
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Keith M. McGregor
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Clara N. Glassman
- Department of Nuclear and Radiological Engineering and Medical Physics, Georgia Institute of Technology, Atlanta, GA, United States
| | - Gabriell S. Champion
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| | - Natalie Rocha
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
| | - Stacy M. Harnish
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, United States
| | - Samir R. Belagaje
- Department of Neurology, Emory University, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Suprateek Kundu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | - Bruce A. Crosson
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| |
Collapse
|
33
|
Liu M, Qian Q, Wang W, Chen L, Wang L, Zhou Y, Xu S, Wu J, Feng T, Zhu Z, Xiang J. Improvement in Language Function in Patients with Aphasia using Computer-Assisted Executive Function Training: A Controlled Clinical Trial. PM R 2021; 14:913-921. [PMID: 34310072 DOI: 10.1002/pmrj.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/13/2021] [Accepted: 07/02/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Non-verbal cognitive training has gained popularity for the management of aphasia. The correlation between language function and cognitive control has been explored previously. Cognitive status affects language to a certain degree. In this study, we aimed to determine whether non-verbal computer-assisted executive control training (CAET) to improve cognitive status affects language performance in patients with aphasia (PWA). DESIGN A total of 73 participants were included in the study, and 5 subjects dropped out. A total of 68 individuals were randomly divided into two groups and underwent treatment. The experimental group was treated with traditional speech and language therapy (SLT) combined with CAET. The control group underwent SLT only. RESULTS Differences between pre- and post-treatment language outcomes expect oral naming (group × time, P = 0.236) were significantly greater in the experimental group compared with the control group: Spontaneous speech (group × time, P = 0.026), Auditory Comprehension (group × time, P < 0.001), Speech repetition (group × time, P = 0.001), AQ (group × time, P < 0.001). A similar effect was observed for cognitive function such as TMT-A (group × time, P = 0.006), TMT-B (group × time, P = 0.005) and VFT-V (group × time, P = 0.018). CONCLUSION Our study demonstrates that CAET combined with SLT can yield favorable language outcomes for PWA, especially improvements in auditory comprehension and AQ. CAET combined with SLT generates benefits in both cognitive function and language performance. Therefore, CAET may be applied as an adjuvant aphasia therapy in conjunction with traditional SLT. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Mengting Liu
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qiuchen Qian
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Wang
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lu Chen
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lingmin Wang
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yeqing Zhou
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Siwei Xu
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jie Wu
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Tao Feng
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zude Zhu
- School of Linguistic Sciences and Arts, Jiangsu Normal University, Xuzhou, China
| | - Jie Xiang
- Department of Rehabilitation, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| |
Collapse
|
34
|
Vitti E, Hillis AE. Treatment of post-stroke aphasia: A narrative review for stroke neurologists. Int J Stroke 2021; 16:1002-1008. [PMID: 33949274 DOI: 10.1177/17474930211017807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review is intended to help physicians guide patients to optimal management of post-stroke aphasia. We review literature on post-stroke aphasia treatment, focusing on: (1) when and for whom language therapy is most effective, (2) the variety of approaches that can be effective for different individuals, and (3) the extent to which behavioral therapy might be augmented by non-invasive brain stimulation and/or medications.
Collapse
Affiliation(s)
- Emilia Vitti
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
35
|
Fridriksson J, Hillis AE. Current Approaches to the Treatment of Post-Stroke Aphasia. J Stroke 2021; 23:183-201. [PMID: 34102754 PMCID: PMC8189855 DOI: 10.5853/jos.2020.05015] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/21/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022] Open
Abstract
Aphasia, impairment of language after stroke or other neurological insult, is a common and often devastating condition that affects nearly every social activity and interaction. Behavioral speech and language therapy is the mainstay of treatment, although other interventions have been introduced to augment the effects of the behavioral therapy. In this narrative review, we discuss advances in aphasia therapy in the last 5 years and focus primarily on properly powered, randomized, controlled trials of both behavioral therapies and interventions to augment therapy for post-stroke aphasia. These trials include evaluation of behavioral therapies and computer-delivered language therapies. We also discuss outcome prediction trials as well as interventional trials that have employed noninvasive brain stimulation, or medications to augment language therapy. Supported by evidence from Phase III trials and large meta-analyses, it is now generally accepted that aphasia therapy can improve language processing for many patients. Not all patients respond similarly to aphasia therapy with the most severe patients being the least likely responders. Nevertheless, it is imperative that all patients, regardless of severity, receive aphasia management focused on direct therapy of language deficits, counseling, or both. Emerging evidence from Phase II trials suggests transcranial brain stimulation is a promising method to boost aphasia therapy outcomes.
Collapse
Affiliation(s)
- Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Argye Elizabeth Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
36
|
Kristinsson S, Zhang W, Rorden C, Newman‐Norlund R, Basilakos A, Bonilha L, Yourganov G, Xiao F, Hillis A, Fridriksson J. Machine learning-based multimodal prediction of language outcomes in chronic aphasia. Hum Brain Mapp 2021; 42:1682-1698. [PMID: 33377592 PMCID: PMC7978124 DOI: 10.1002/hbm.25321] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 12/26/2022] Open
Abstract
Recent studies have combined multiple neuroimaging modalities to gain further understanding of the neurobiological substrates of aphasia. Following this line of work, the current study uses machine learning approaches to predict aphasia severity and specific language measures based on a multimodal neuroimaging dataset. A total of 116 individuals with chronic left-hemisphere stroke were included in the study. Neuroimaging data included task-based functional magnetic resonance imaging (fMRI), diffusion-based fractional anisotropy (FA)-values, cerebral blood flow (CBF), and lesion-load data. The Western Aphasia Battery was used to measure aphasia severity and specific language functions. As a primary analysis, we constructed support vector regression (SVR) models predicting language measures based on (i) each neuroimaging modality separately, (ii) lesion volume alone, and (iii) a combination of all modalities. Prediction accuracy across models was subsequently statistically compared. Prediction accuracy across modalities and language measures varied substantially (predicted vs. empirical correlation range: r = .00-.67). The multimodal prediction model yielded the most accurate prediction in all cases (r = .53-.67). Statistical superiority in favor of the multimodal model was achieved in 28/30 model comparisons (p-value range: <.001-.046). Our results indicate that different neuroimaging modalities carry complementary information that can be integrated to more accurately depict how brain damage and remaining functionality of intact brain tissue translate into language function in aphasia.
Collapse
Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia RecoveryUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Wanfang Zhang
- Department of Epidemiology and BiostatisticsUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Chris Rorden
- Department of PsychologyUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | | | - Alexandra Basilakos
- Center for the Study of Aphasia RecoveryUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Leonardo Bonilha
- Department of NeurologyMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Grigori Yourganov
- Advanced Computing and Data Science, Cyberinfrastructure and Technology IntegrationClemson UniversityClemsonSouth CarolinaUSA
| | - Feifei Xiao
- Department of Epidemiology and BiostatisticsUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Argye Hillis
- Department of Neurology and Physical Medicine and RehabilitationJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Cognitive ScienceJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Julius Fridriksson
- Center for the Study of Aphasia RecoveryUniversity of South CarolinaColumbiaSouth CarolinaUSA
| |
Collapse
|
37
|
Hybbinette H, Schalling E, Plantin J, Nygren-Deboussard C, Schütz M, Östberg P, Lindberg PG. Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke. Front Neurol 2021; 12:634065. [PMID: 33868144 PMCID: PMC8044583 DOI: 10.3389/fneur.2021.634065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/03/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. In addition, we also explored factors predicting recovery from AOS. Methods: Seventy participants with mild to severe paresis in the upper extremity were assessed; 50% of these (n = 35) had left hemisphere (LH) lesions. Aphasia, AOS and hand motor assessments and magnetic resonance imaging were conducted at 4 weeks (A1) and at 6 months (A2) after stroke onset. Recovery was characterized in 15 participants showing initial aphasia that also had complete follow-up data at 6 months. Results: All participants with AOS and/or aphasia had LH lesions. In LH lesioned, the prevalence of aphasia was 71% and of AOS 57%. All participants with AOS had aphasia; 80% of the participants with aphasia also had AOS. Recovery in aphasia (n = 15) and AOS (n = 12) followed a parallel pattern to that observed in hand motor impairment and recovery correlated positively across speech-language and motor domains. The majority of participants with severe initial aphasia and AOS showed a limited but similar amount of recovery across domains. Lesion volume did not correlate with results from behavioral assessments, nor with recovery. The initial aphasia score was the strongest predictor of AOS recovery. Conclusion: Our findings confirm the common occurrence of AOS and aphasia in left hemisphere stroke patients with a hand motor impairment. Recovery was similar across speech-language and motor domains, even in patients with severe impairment, supporting the shared recovery hypothesis and that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. These observations contribute to the knowledge of AOS and its relation to motor and language functions and add information that may serve as a basis for future studies of post stroke recovery. Studies including neuroimaging and/or biological assays are required to gain further knowledge on shared brain recovery mechanisms.
Collapse
Affiliation(s)
- Helena Hybbinette
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Ellika Schalling
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette Plantin
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Catharina Nygren-Deboussard
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Marika Schütz
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Per Östberg
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Påvel G. Lindberg
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Institut de Psychiatrie et Neurosciences Paris, Inserm U1266, Université de Paris, Paris, France
| |
Collapse
|
38
|
Krishnamurthy V, Sprick JD, Krishnamurthy LC, Barter JD, Turabi A, Hajjar IM, Nocera JR. The Utility of Cerebrovascular Reactivity MRI in Brain Rehabilitation: A Mechanistic Perspective. Front Physiol 2021; 12:642850. [PMID: 33815146 PMCID: PMC8009989 DOI: 10.3389/fphys.2021.642850] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/22/2021] [Indexed: 01/06/2023] Open
Abstract
Cerebrovascular control and its integration with other physiological systems play a key role in the effective maintenance of homeostasis in brain functioning. Maintenance, restoration, and promotion of such a balance are one of the paramount goals of brain rehabilitation and intervention programs. Cerebrovascular reactivity (CVR), an index of cerebrovascular reserve, plays an important role in chemo-regulation of cerebral blood flow. Improved vascular reactivity and cerebral blood flow are important factors in brain rehabilitation to facilitate desired cognitive and functional outcomes. It is widely accepted that CVR is impaired in aging, hypertension, and cerebrovascular diseases and possibly in neurodegenerative syndromes. However, a multitude of physiological factors influence CVR, and thus a comprehensive understanding of underlying mechanisms are needed. We are currently underinformed on which rehabilitation method will improve CVR, and how this information can inform on a patient's prognosis and diagnosis. Implementation of targeted rehabilitation regimes would be the first step to elucidate whether such regimes can modulate CVR and in the process may assist in improving our understanding for the underlying vascular pathophysiology. As such, the high spatial resolution along with whole brain coverage offered by MRI has opened the door to exciting recent developments in CVR MRI. Yet, several challenges currently preclude its potential as an effective diagnostic and prognostic tool in treatment planning and guidance. Understanding these knowledge gaps will ultimately facilitate a deeper understanding for cerebrovascular physiology and its role in brain function and rehabilitation. Based on the lessons learned from our group's past and ongoing neurorehabilitation studies, we present a systematic review of physiological mechanisms that lead to impaired CVR in aging and disease, and how CVR imaging and its further development in the context of brain rehabilitation can add value to the clinical settings.
Collapse
Affiliation(s)
- Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Justin D. Sprick
- Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Lisa C. Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Physics & Astronomy, Georgia State University, Atlanta, GA, United States
| | - Jolie D. Barter
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Aaminah Turabi
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Ihab M. Hajjar
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Joe R. Nocera
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VAMC, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| |
Collapse
|
39
|
Sheppard SM, Sebastian R. Diagnosing and managing post-stroke aphasia. Expert Rev Neurother 2021; 21:221-234. [PMID: 33231117 PMCID: PMC7880889 DOI: 10.1080/14737175.2020.1855976] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Introduction: Aphasia is a debilitating language disorder and even mild forms of aphasia can negatively affect functional outcomes, mood, quality of life, social participation, and the ability to return to work. Language deficits after post-stroke aphasia are heterogeneous. Areas covered: The first part of this manuscript reviews the traditional syndrome-based classification approach as well as recent advances in aphasia classification that incorporate automatic speech recognition for aphasia classification. The second part of this manuscript reviews the behavioral approaches to aphasia treatment and recent advances such as noninvasive brain stimulation techniques and pharmacotherapy options to augment the effectiveness of behavioral therapy. Expert opinion: Aphasia diagnosis has largely evolved beyond the traditional approach of classifying patients into specific syndromes and instead focuses on individualized patient profiles. In the future, there is a great need for more large scale randomized, double-blind, placebo-controlled clinical trials of behavioral treatments, noninvasive brain stimulation, and medications to boost aphasia recovery.
Collapse
Affiliation(s)
- Shannon M. Sheppard
- Department of Communication Sciences and Disorder, Chapman University, Irvine, CA, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
40
|
Bislick L. A Phonomotor Approach to Apraxia of Speech Treatment. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:2109-2130. [PMID: 32997520 DOI: 10.1044/2020_ajslp-19-00116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This study continued Phase I investigation of a modified Phonomotor Treatment (PMT) Program on motor planning in two individuals with apraxia of speech (AOS) and aphasia and, with support from prior work, refined Phase I methodology for treatment intensity and duration, a measure of communicative participation, and the use of effect size benchmarks specific to AOS. Method A single-case experimental design with multiple baselines across behaviors and participants was used to examine acquisition, generalization, and maintenance of treatment effects 8-10 weeks posttreatment. Treatment was distributed 3 days a week, and duration of treatment was specific to each participant (criterion based). Experimental stimuli consisted of target sounds or clusters embedded nonwords and real words, specific to each participants' deficit. Results Findings show improved repetition accuracy for targets in trained nonwords, generalization to targets in untrained nonwords and real words, and maintenance of treatment effects at 10 weeks posttreatment for one participant and more variable outcomes for the other participant. Conclusions Results indicate that a modified version of PMT can promote generalization and maintenance of treatment gains for trained speech targets via a multimodal approach emphasizing repeated exposure and practice. While these results are promising, the frequent co-occurrence of AOS and aphasia warrants a treatment that addresses both motor planning and linguistic deficits. Thus, the application of traditional PMT with participant-specific modifications for AOS embedded into the treatment program may be a more effective approach. Future work will continue to examine and maximize improvements in motor planning, while also treating anomia in aphasia.
Collapse
Affiliation(s)
- Lauren Bislick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| |
Collapse
|
41
|
Sebastian R, Kim JH, Brenowitz R, Tippett DC, Desmond JE, Celnik PA, Hillis AE. Cerebellar neuromodulation improves naming in post-stroke aphasia. Brain Commun 2020; 2:fcaa179. [PMID: 33241212 PMCID: PMC7677607 DOI: 10.1093/braincomms/fcaa179] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Transcranial direct current stimulation has been shown to increase the efficiency of language therapy in chronic aphasia; however, to date, an optimal stimulation site has not been identified. We investigated whether neuromodulation of the right cerebellum can improve naming skills in chronic aphasia. Using a randomized, double-blind, sham-controlled, within-subject crossover study design, participants received anodal cerebellar stimulation (n = 12) or cathodal cerebellar stimulation (n = 12) + computerized aphasia therapy then sham + computerized aphasia therapy, or the opposite order. There was no significant effect of treatment (cerebellar stimulation versus sham) for trained naming. However, there was a significant order x treatment interaction, indicating that cerebellar stimulation was more effective than sham immediately post-treatment for participants who received cerebellar stimulation in the first phase. There was a significant effect of treatment (cerebellar stimulation versus sham) for untrained naming immediately post-treatment and the significant improvement in untrained naming was maintained at two months post-treatment. Greater gains in naming (relative to sham) were noted for participants receiving cathodal stimulation for both trained and untrained items. Thus, our study provides evidence that repetitive cerebellar transcranial direct stimulation combined with computerized aphasia treatment can improve picture naming in chronic post-stroke aphasia. These findings suggest that the right cerebellum might be an optimal stimulation site for aphasia rehabilitation and this could be an answer to handle heterogeneous participants who vary in their size and site of left hemisphere lesions.
Collapse
Affiliation(s)
- Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ji Hyun Kim
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Brenowitz
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donna C Tippett
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John E Desmond
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
42
|
Matar SJ, Sorinola IO, Newton C, Pavlou M. Transcranial Direct-Current Stimulation May Improve Discourse Production in Healthy Older Adults. Front Neurol 2020; 11:935. [PMID: 32982943 PMCID: PMC7479316 DOI: 10.3389/fneur.2020.00935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/20/2020] [Indexed: 01/10/2023] Open
Abstract
Background: The use of transcranial direct-current stimulation (tDCS) for therapeutic and neurorehabilitation purposes has become increasingly popular in recent years. Previous research has found that anodal tDCS may enhance naming ability and verbal fluency in healthy participants. However, the effect of tDCS on more functional, higher level language skills such as discourse production has yet to be understood. Aims: The present study aimed to investigate in healthy, older adults (a) the effect of anodal tDCS on discourse production vs. sham stimulation and (b) optimal electrode placement for tDCS to target language improvement at the discourse level. Methods: Fourteen healthy, older right-handed participants took part in this sham controlled, repeated measures pilot study. Each participant experienced three different experimental conditions; anodal tDCS on the left inferior frontal gyrus (IFG), anodal tDCS on the right IFG and sham stimulation while performing a story telling task. Significant changes in language performance before and after each condition were examined in three discourse production tasks: recount, procedural and narrative. Results: Left and right IFG conditions showed a greater number of significant within-group improvements (p < 0.05) in discourse production compared to sham with 6/12 for left IFG, 4/12 for right IFG and 2/12 for sham. There were no significant differences noted between tDCS conditions. No relationship was noted between language performance and physical activity, age, or gender. Conclusions: This study suggests that anodal tDCS may significantly improve discourse production in healthy, older adults. In line with previous tDCS language studies, the left IFG is highlighted as an optimal stimulation site for the modulation of language in healthy speakers. The findings support further exploration of tDCS as a rehabilitative tool for higher-level language skills in persons with aphasia.
Collapse
Affiliation(s)
- Shereen J Matar
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Isaac O Sorinola
- Department of Public Health Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Caroline Newton
- Division of Psychology & Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Marousa Pavlou
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| |
Collapse
|
43
|
Cheng BBY, Worrall LE, Copland DA, Wallace SJ. Prognostication in post-stroke aphasia: How do speech pathologists formulate and deliver information about recovery? INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:520-536. [PMID: 32347640 DOI: 10.1111/1460-6984.12534] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/06/2020] [Accepted: 03/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Prognostication is a complex clinical task that involves forming a prediction about recovery and communicating prognostic information to patients and families. In aphasia, recovery is difficult to predict and evidence-based guidance on prognosis delivery is lacking. Questions about aphasia prognosis commonly arise, but it is unknown how speech pathologists formulate and deliver information about expected recovery. An understanding of current practice in prognostication is needed to develop evidence-based guidelines for this process, and is necessary in order to ensure successful future implementation of recommended practice regarding prognosis delivery. AIMS To identify the factors speech pathologists consider important when responding to questions about aphasia prognosis; to examine how they respond in different scenarios; and to evaluate their current attitudes towards aphasia prognostication. METHODS & PROCEDURES A total of 54 speech pathologists participated in an online survey featuring hypothetical aphasia prognosis delivery scenarios, short-response questions and ratings. Open responses were analysed thematically. Multiple-choice responses were analysed using descriptive statistics and non-parametric tests. OUTCOMES & RESULTS Speech pathologists regarded factors relating to the nature and severity of post-stroke deficits, an individual's level of motivation and the availability of social support as most important for forming an aphasia prognosis. When delivering prognostic information, considerations of the recipient's emotional well-being, hope and expectations, and comprehension of information were regarded as most important. Speech pathologists' prognosis responses varied in content and manner of communication. The content of the responses included predictions of recovery and information about various attributes and activities contributing to recovery. Prognostic information was most frequently communicated through qualitative probability expressions, general statements and uncertainty-based expressions. A need for more professional support in aphasia prognostication was indicated. CONCLUSIONS & IMPLICATIONS There is variation in the way speech pathologists respond to questions about aphasia prognosis, and it is unknown how these conversations affect people with aphasia and their significant others. Further research to understand speech pathologists' clinical reasoning and professional support needs, and the perspectives of people living with aphasia, may help to develop an evidence-based approach to prognostication in aphasia. What this paper adds What is already known on this subject Questions about aphasia prognosis are difficult to answer. Current methods for predicting aphasia recovery are yet to demonstrate the reliability and individual specificity required for clinical application. At present, there is no evidence-based guidance or support for prognosis delivery in aphasia. What this study adds to existing knowledge There is variation in the way speech pathologists predict aphasia recovery, the prognostic information they deliver and the manner in which they communicate prognoses. Current approaches to aphasia prognostication are reliant on experience and professional judgement, and speech pathologists desire more support for undertaking this task. What are the potential or actual clinical implications of this work? Speech pathologists lack a consistent approach to aphasia prognostication and desire more support in this task. The present findings offer insight into clinician attitudes and practice, and provide a direction for future research to establish best-practice guidelines for this complex and demanding area of aphasia management.
Collapse
Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Rehabilitation Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Linda E Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Rehabilitation Centre, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, VIC, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Rehabilitation Centre, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, VIC, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Queensland Aphasia Rehabilitation Centre, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, VIC, Australia
| |
Collapse
|
44
|
Brogan E, Ciccone N, Godecke E. An exploration of aphasia therapy dosage in the first six months of stroke recovery. Neuropsychol Rehabil 2020; 31:1254-1288. [PMID: 32538277 DOI: 10.1080/09602011.2020.1776135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aphasia research uses the length of time within rehabilitation sessions as the main measure of dosage. Few papers detail therapeutic ingredients or outline the number of times these were delivered over the treatment period. The present observational study identified therapeutic ingredients in the Very Early Rehabiltiation in SpEech (VERSE) trial and explored the dosage provided using a model of cumulative intervention intensity (CII). Therapists video recorded one therapy session per week and 53 (12%) randomly selected therapy videos were analysed. The videos were coded for number of error productions, self-corrections and type and frequency of therapist cueing. The Western Aphasia Battery Revised-Aphasia Quotient (WABR-AQ) was used for measuring patient outcome with total verbal utterances (p < 0.001) and cues used with success (p < 0.001) being independent positive predictors of WABR-AQ score at six months post stroke and hypothesized as key therapeutic ingredients. The CII was calculated by counting identified therapeutic ingredients and multiplying this by the number of sessions completed. Collectively, the key ingredients occurred on average 504 times per session and over 10,000 times per participant during the treatment period. This paper reports a novel approach for identifying key treatment ingredients and detailing the dosage delivered within an early aphasia rehabilitation trial.
Collapse
Affiliation(s)
- Emily Brogan
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Speech Pathology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.,Speech Pathology, Sir Charles Gairdner Hospital, Perth, Australia
| |
Collapse
|
45
|
Copland DA. Elizabeth Usher Memorial Lecture: Lost in Translation? Challenges and future prospects for a neurobiological approach to aphasia rehabilitation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:270-280. [PMID: 32686593 DOI: 10.1080/17549507.2020.1768287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While there has been considerable progress in conducting trials of aphasia therapy, there is no consistent evidence for long-term benefits of aphasia treatment, suggesting the need to reconsider current approaches. There are also no accurate methods for determining the amount, type and timing of aphasia therapy that should be provided for an individual. At the same time, there has been increasing interest in applying various principles of neuroplasticity to aphasia treatment and using measures of brain structure and function to predict recovery. This article will consider the potential of neuroplasticity principles and neurobiological predictors to improve our current approach to aphasia rehabilitation and optimise outcomes. Reviewing these principles highlights some of the challenges of translating animal model-based principles and emphases the need to also consider relevant theories of human learning. While considerable progress has been made in considering neurobiological principles and using measures of brain structure and function to predict recovery, there is significant work required to achieve the full potential of this neurobiological approach to aphasia management.
Collapse
Affiliation(s)
- David A Copland
- School of Health and Rehabilitation Sciences, Centre for Clinical Research, Queensland Aphasia Rehabilitation Centre, The University of Queensland, St Lucia, Australia
| |
Collapse
|
46
|
The patient with severe traumatic brain injury: clinical decision-making: the first 60 min and beyond. Curr Opin Crit Care 2020; 25:622-629. [PMID: 31574013 DOI: 10.1097/mcc.0000000000000671] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW There is an urgent need to discuss the uncertainties and paradoxes in clinical decision-making after severe traumatic brain injury (s-TBI). This could improve transparency, reduce variability of practice and enhance shared decision-making with proxies. RECENT FINDINGS Clinical decision-making on initiation, continuation and discontinuation of medical treatment may encompass substantial consequences as well as lead to presumed patient benefits. Such decisions, unfortunately, often lack transparency and may be controversial in nature. The very process of decision-making is frequently characterized by both a lack of objective criteria and the absence of validated prognostic models that could predict relevant outcome measures, such as long-term quality and satisfaction with life. In practice, while treatment-limiting decisions are often made in patients during the acute phase immediately after s-TBI, other such severely injured TBI patients have been managed with continued aggressive medical care, and surgical or other procedural interventions have been undertaken in the context of pursuing a more favorable patient outcome. Given this spectrum of care offered to identical patient cohorts, there is clearly a need to identify and decrease existing selectivity, and better ascertain the objective criteria helpful towards more consistent decision-making and thereby reduce the impact of subjective valuations of predicted patient outcome. SUMMARY Recent efforts by multiple medical groups have contributed to reduce uncertainty and to improve care and outcome along the entire chain of care. Although an unlimited endeavor for sustaining life seems unrealistic, treatment-limiting decisions should not deprive patients of a chance on achieving an outcome they would have considered acceptable.
Collapse
|
47
|
Perioperative neurocognitive functions in patients with neuroepithelial intracranial tumors. J Neurooncol 2020; 147:77-89. [DOI: 10.1007/s11060-020-03398-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
|
48
|
Thompson CK. Neurocognitive Recovery of Sentence Processing in Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3947-3972. [PMID: 31756151 PMCID: PMC7203523 DOI: 10.1044/2019_jslhr-l-rsnp-19-0219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/20/2019] [Accepted: 09/09/2019] [Indexed: 05/04/2023]
Abstract
Purpose Reorganization of language networks in aphasia takes advantage of the facts that (a) the brain is an organ of plasticity, with neuronal changes occurring throughout the life span, including following brain damage; (b) plasticity is highly experience dependent; and (c) as with any learning system, language reorganization involves a synergistic interplay between organism-intrinsic (i.e., cognitive and brain) and organism-extrinsic (i.e., environmental) variables. A major goal for clinical treatment of aphasia is to be able to prescribe treatment and predict its outcome based on the neurocognitive deficit profiles of individual patients. This review article summarizes the results of research examining the neurocognitive effects of psycholinguistically based treatment (i.e., Treatment of Underlying Forms; Thompson & Shapiro, 2005) for sentence processing impairments in individuals with chronic agrammatic aphasia resulting from stroke and primary progressive aphasia and addresses both behavioral and brain variables related to successful treatment outcomes. The influences of lesion volume and location, perfusion (blood flow), and resting-state neural activity on language recovery are also discussed as related to recovery of agrammatism and other language impairments. Based on these and other data, principles for promoting neuroplasticity of language networks are presented. Conclusions Sentence processing treatment results in improved comprehension and production of complex syntactic structures in chronic agrammatism and generalization to less complex, linguistically related structures in chronic agrammatism. Patients also show treatment-induced shifts toward normal-like online sentence processing routines (based on eye movement data) and changes in neural recruitment patterns (based on functional neuroimaging), with posttreatment activation of regions overlapping with those within sentence processing and dorsal attention networks engaged by neurotypical adults performing the same task. These findings provide compelling evidence that treatment focused on principles of neuroplasticity promotes neurocognitive recovery in chronic agrammatic aphasia. Presentation Videohttps://doi.org/10.23641/asha.10257587.
Collapse
Affiliation(s)
- Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Department of Neurology and Mesulam Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, Evanston/Chicago, IL
| |
Collapse
|
49
|
Kiran S. Introduction to the 2018 Research Symposium Forum. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3905-3906. [PMID: 31756157 PMCID: PMC7203522 DOI: 10.1044/2019_jslhr-19-00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Abstract
Purpose The purpose of this introduction is to provide an overview of the articles contained within this forum of Journal of Speech, Language, and Hearing Research (JSLHR). Each of these articles is based upon presentations from the Research Symposium at the 2018 annual convention of the American Speech-Language-Hearing Association held in Boston, MA.
Collapse
Affiliation(s)
- Swathi Kiran
- Sargent College of Health and Rehabilitation Sciences, Boston University, MA
| |
Collapse
|