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Arheix-Parras S, de Goyne MDP, Franco J, Villain M, Glize B, Python G. Transcranial magnetic stimulation to improve aphasia after right hemispheric stroke: A single case experimental design. Ann Phys Rehabil Med 2024; 67:101858. [PMID: 38843561 DOI: 10.1016/j.rehab.2024.101858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/08/2024] [Accepted: 04/16/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Sophie Arheix-Parras
- ACTIVE team, Bordeaux Population Health, INSERM UMR 1219, University of Bordeaux, 146 rue Léo-Saignat, 33076 Bordeaux cedex, France; Institut Universitaire des Sciences de la Réadaptation, University of Bordeaux, 146 rue Léo-Saignat, 33076 Bordeaux, France.
| | - Mathilde du Puy de Goyne
- ACTIVE team, Bordeaux Population Health, INSERM UMR 1219, University of Bordeaux, 146 rue Léo-Saignat, 33076 Bordeaux cedex, France
| | - Julie Franco
- Faculty of Psychology and Educational Sciences, University of Geneva, 40 bd du Pont-d'Arve, 1211 Genève 4, Switzerland
| | - Marie Villain
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, 47-83 boulevard de l'Hôpital, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP, Sorbonne Université, Charles Foix 47/83 boulevard de l'Hôpital, F-75013, Paris, France; Brain and Spine Institute (ICM, INSERM, UMRS 1127; CNRS, UMR 7225), 47 boulevard de l'Hôpital, 75013 Paris, France
| | - Bertrand Glize
- ACTIVE team, Bordeaux Population Health, INSERM UMR 1219, University of Bordeaux, 146 rue Léo-Saignat, 33076 Bordeaux cedex, France; Institut Universitaire des Sciences de la Réadaptation, University of Bordeaux, 146 rue Léo-Saignat, 33076 Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, Place Amélie Raba-Léon, 33000 Bordeaux, France
| | - Grégoire Python
- Faculty of Psychology and Educational Sciences, University of Geneva, 40 bd du Pont-d'Arve, 1211 Genève 4, Switzerland; Neurorehabilitation Unit, Department of Clinical Neurosciences, Vaudois University Hospital Center and University of Lausanne, 46 rue du Bugnon, 1011 Lausanne, Switzerland
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Liu N, Ye TF, Yu QW. The role of the right hemispheric homologous language pathways in recovery from post-stroke aphasia: A systematic review. Psychiatry Res Neuroimaging 2024; 343:111866. [PMID: 39098261 DOI: 10.1016/j.pscychresns.2024.111866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/06/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024]
Abstract
The involvement of the right hemisphere, mainly the activation of the right cerebral regions, in recovery from post-stroke aphasia has been widely recognized. In contrast, the role of the right white matter pathways in the recovery from post-stroke aphasia is rarely understood. In this study, we aimed to provide a primary overview of the correlation between the structural integrity of the right hemispheric neural tracts based on the dual-stream model of language organization and recovery from post-stroke aphasia by systematically reviewing prior longitudinal interventional studies. By searching electronic databases for relevant studies according to a standard protocol, a total of 10 records (seven group studies and three case studies) including 79 participants were finally included. After comprehensively analyzing these studies and reviewing the literature, although no definite correlation was found between the right hemispheric neural tracts and recovery from post-stroke aphasia, our review provideds a new perspective for investigating the linguistic role of the right hemispheric neural tracts. This suggests that the involvement of the right hemispheric neural tracts in recovery from post-stroke aphasia may be mediated by multiple factors; thus, this topic should be comprehensively investigated in the future.
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Affiliation(s)
- Na Liu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu, China
| | - Tian-Fen Ye
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu, China
| | - Qi-Wei Yu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, Jiangsu, China.
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3
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Ashaie SA, Hernandez-Pavon JC, Houldin E, Cherney LR. Behavioral, Functional Imaging, and Neurophysiological Outcomes of Transcranial Direct Current Stimulation and Speech-Language Therapy in an Individual with Aphasia. Brain Sci 2024; 14:714. [PMID: 39061454 PMCID: PMC11274865 DOI: 10.3390/brainsci14070714] [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: 04/10/2024] [Revised: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Speech-language therapy (SLT) is the most effective technique to improve language performance in persons with aphasia. However, residual language impairments remain even after intensive SLT. Recent studies suggest that combining transcranial direct current stimulation (tDCS) with SLT may improve language performance in persons with aphasia. However, our understanding of how tDCS and SLT impact brain and behavioral relation in aphasia is poorly understood. We investigated the impact of tDCS and SLT on a behavioral measure of scripted conversation and on functional connectivity assessed with multiple methods, both resting-state functional magnetic resonance imaging (rs-fMRI) and resting-state electroencephalography (rs-EEG). An individual with aphasia received 15 sessions of 20-min cathodal tDCS to the right angular gyrus concurrent with 40 min of SLT. Performance during scripted conversation was measured three times at baseline, twice immediately post-treatment, and at 4- and 8-weeks post-treatment. rs-fMRI was measured pre-and post-3-weeks of treatment. rs-EEG was measured on treatment days 1, 5, 10, and 15. Results show that both communication performance and left hemisphere functional connectivity may improve after concurrent tDCS and SLT. Results are in line with aphasia models of language recovery that posit a beneficial role of left hemisphere perilesional areas in language recovery.
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Affiliation(s)
- Sameer A. Ashaie
- Think and Speak, Shirley Ryan AbilityLab, Chicago, IL 60611, USA; (S.A.A.); (E.H.)
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | | | - Evan Houldin
- Think and Speak, Shirley Ryan AbilityLab, Chicago, IL 60611, USA; (S.A.A.); (E.H.)
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Leora R. Cherney
- Think and Speak, Shirley Ryan AbilityLab, Chicago, IL 60611, USA; (S.A.A.); (E.H.)
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Teghipco A, Newman-Norlund R, Fridriksson J, Rorden C, Bonilha L. Distinct brain morphometry patterns revealed by deep learning improve prediction of post-stroke aphasia severity. COMMUNICATIONS MEDICINE 2024; 4:115. [PMID: 38866977 PMCID: PMC11169346 DOI: 10.1038/s43856-024-00541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Emerging evidence suggests that post-stroke aphasia severity depends on the integrity of the brain beyond the lesion. While measures of lesion anatomy and brain integrity combine synergistically to explain aphasic symptoms, substantial interindividual variability remains unaccounted. One explanatory factor may be the spatial distribution of morphometry beyond the lesion (e.g., atrophy), including not just specific brain areas, but distinct three-dimensional patterns. METHODS Here, we test whether deep learning with Convolutional Neural Networks (CNNs) on whole brain morphometry (i.e., segmented tissue volumes) and lesion anatomy better predicts chronic stroke individuals with severe aphasia (N = 231) than classical machine learning (Support Vector Machines; SVMs), evaluating whether encoding spatial dependencies identifies uniquely predictive patterns. RESULTS CNNs achieve higher balanced accuracy and F1 scores, even when SVMs are nonlinear or integrate linear or nonlinear dimensionality reduction. Parity only occurs when SVMs access features learned by CNNs. Saliency maps demonstrate that CNNs leverage distributed morphometry patterns, whereas SVMs focus on the area around the lesion. Ensemble clustering of CNN saliencies reveals distinct morphometry patterns unrelated to lesion size, consistent across individuals, and which implicate unique networks associated with different cognitive processes as measured by the wider neuroimaging literature. Individualized predictions depend on both ipsilateral and contralateral features outside the lesion. CONCLUSIONS Three-dimensional network distributions of morphometry are directly associated with aphasia severity, underscoring the potential for CNNs to improve outcome prognostication from neuroimaging data, and highlighting the prospective benefits of interrogating spatial dependence at different scales in multivariate feature space.
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Affiliation(s)
- Alex Teghipco
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Roger Newman-Norlund
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Christopher Rorden
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, School of Medicine, University of South Carolina, Columbia, SC, USA
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Alemanno F, Fedeli D, Monti A, Houdayer E, Della Rosa PA, Zangrillo F, Emedoli D, Pelagallo E, Corbo M, Iannaccone S, Abutalebi J. Increased interhemispheric functional connectivity after right anodal tDCS in chronic non-fluent aphasia: preliminary findings. Front Neurosci 2024; 18:1346095. [PMID: 38406588 PMCID: PMC10884287 DOI: 10.3389/fnins.2024.1346095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Anodal transcranial Direct Current Stimulation (tDCS) is a non-invasive, low-cost and environment-friendly brain neuromodulation technique that increases cortical excitability. In post-stroke aphasia, the role of the right hemisphere in language recovery remains debated. In this preliminary study, we aimed to investigate the efficacy of excitatory tDCS on the right hemisphere in chronic aphasic patients. Methods We applied anodal tDCS to the right homologous region of Broca's area in four chronic aphasic patients while performing a one-month naming rehabilitation treatment. Longitudinal data on language assessment and naming performance were collected. Resting-state fMRI images were acquired before and after treatment to measure changes in functional connectivity. Results Results showed enhanced positive functional connectivity of the right Broca homologous with the left middle frontal and middle temporal gyri. Every patient showed improvements in language functions, but no major changes in naming performance. Conclusion These preliminary findings suggest that tDCS applied over the unaffected hemisphere may result in longitudinal inter-hemispheric functional neuroplastic changes that could specifically improve language recovery and could potentially be included in therapeutic neurorehabilitative plans.
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Affiliation(s)
- Federica Alemanno
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Fedeli
- Centre for Neurolinguistics and Psycholinguistics, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Elise Houdayer
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Federica Zangrillo
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Emedoli
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pelagallo
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Sandro Iannaccone
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jubin Abutalebi
- Neuropsychology Service, Department of Rehabilitation and Functional Recovery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Centre for Neurolinguistics and Psycholinguistics, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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Meier EL, Sheppard SM, Sebastian R, Berube S, Goldberg EB, Shea J, Stein CM, Hillis AE. Resting state correlates of picture description informativeness in left vs. right hemisphere chronic stroke. Front Neurol 2023; 14:1288801. [PMID: 38145117 PMCID: PMC10744570 DOI: 10.3389/fneur.2023.1288801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Despite a growing emphasis on discourse processing in clinical neuroscience, relatively little is known about the neurobiology of discourse production impairments. Individuals with a history of left or right hemisphere stroke can exhibit difficulty with communicating meaningful discourse content, which implies both cerebral hemispheres play a role in this skill. However, the extent to which successful production of discourse content relies on network connections within domain-specific vs. domain-general networks in either hemisphere is unknown. Methods In this study, 45 individuals with a history of either left or right hemisphere stroke completed resting state fMRI and the Cookie Theft picture description task. Results Participants did not differ in the total number of content units or the percentage of interpretative content units they produced. Stroke survivors with left hemisphere damage produced significantly fewer content units per second than individuals with right hemisphere stroke. Intrinsic connectivity of the left language network was significantly weaker in the left compared to the right hemisphere stroke group for specific connections. Greater efficiency of communication of picture scene content was associated with stronger left but weaker right frontotemporal connectivity of the language network in patients with a history of left hemisphere (but not right hemisphere) stroke. No significant relationships were found between picture description measures and connectivity of the dorsal attention, default mode, or salience networks or with connections between language and other network regions. Discussion These findings add to prior behavioral studies of picture description skills in stroke survivors and provide insight into the role of the language network vs. other intrinsic networks during discourse production.
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Affiliation(s)
- Erin L. Meier
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Shannon M. Sheppard
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - Shauna Berube
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer Shea
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Colin M. Stein
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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7
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Neophytou K, Wiley R, Litovsky C, Tsapkini K, Rapp B. The right hemisphere's capacity for language: evidence from primary progressive aphasia. Cereb Cortex 2023; 33:9971-9985. [PMID: 37522277 PMCID: PMC10502784 DOI: 10.1093/cercor/bhad258] [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: 01/06/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
The role of the right hemisphere (RH) in core language processes is still a matter of intense debate. Most of the relevant evidence has come from studies of gray matter, with relatively little research on RH white matter (WM) connectivity. Using Diffusion Tensor Imaging-based tractography, the current work examined the role of the two hemispheres in language processing in 33 individuals with Primary Progressive Aphasia (PPA), aiming to better characterize the contribution of the RH to language processing in the context of left hemisphere (LH) damage. The findings confirm the impact of PPA on the integrity of the WM language tracts in the LH. Additionally, an examination of the relationship between tract integrity and language behaviors provides robust evidence of the involvement of the WM language tracts of both hemispheres in language processing in PPA. Importantly, this study provides novel evidence of a unique contribution of the RH to language processing (i.e. a contribution independent from that of the language-dominant LH). Finally, we provide evidence that the RH contribution is specific to language processing rather than being domain general. These findings allow us to better characterize the role of RH in language processing, particularly in the context of LH damage.
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Affiliation(s)
- Kyriaki Neophytou
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Robert Wiley
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Celia Litovsky
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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Altered Spontaneous Brain Activity in Poststroke Aphasia: A Resting-State fMRI Study. Brain Sci 2023; 13:brainsci13020300. [PMID: 36831843 PMCID: PMC9954170 DOI: 10.3390/brainsci13020300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
PURPOSE Brain areas frequently implicated in language recovery after stroke comprise perilesional sites in the left hemisphere and homotopic regions in the right hemisphere. However, the neuronal mechanisms underlying language restoration are still largely unclear. METHODS AND MATERIALS In the present study, we investigated the brain function in 15 patients with poststroke aphasia and 30 matched control subjects by combining the regional homogeneity (ReHo) and amplitudes of low-frequency fluctuation (ALFF) analysis methods based on resting-state fMRI. RESULTS Compared to the control subjects, the patients with aphasia exhibited increased ReHo and ALFF values in the ipsilateral perilesional areas and increased ReHo in the contralesional right middle frontal gyrus. CONCLUSIONS The increased spontaneous brain activity in patients with poststroke aphasia during the recovery period, specifically in the ipsilateral perilesional regions and the homologous language regions of the right hemisphere, has potential implications for the treatment of patients with aphasia.
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Tao Y, Tsapkini K, Rapp B. Inter-hemispheric synchronicity and symmetry: The functional connectivity consequences of stroke and neurodegenerative disease. NEUROIMAGE: CLINICAL 2022; 36:103263. [PMID: 36451366 PMCID: PMC9668669 DOI: 10.1016/j.nicl.2022.103263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
Stroke and neurodegenerative diseases differ along several dimensions, including their temporal trajectories -abrupt onset versus slow disease progression. Despite these differences, they can give rise to very similar cognitive impairments, such as specific forms of aphasia. What has been scarcely investigated, however, is the extent to which the underlying functional neuroplastic consequences are similar or different for these diseases. Here, for the first time, we directly compare changes in the brain's functional network connectivity, measured with resting-state fMRI, in stroke and progressive neurological disease. Specifically, we examined two groups of individuals with chronic post-stroke aphasia or non-fluent primary progressive aphasia, matched for their behavioral profiles and distribution of left-hemisphere damage. Using previous proposals regarding the neural functional connectivity (FC) phenotype of stroke as a starting point, we compared the two diseases in terms of homotopic FC, intra-hemispheric FC changes and also the symmetry of the FC patterns between the two hemispheres. We found, first, that progressive disease showed significantly higher levels of homotopic connectivity than neurotypical controls and, further, that stroke showed the reverse pattern. For both groups these effects were found to be behaviorally relevant. In addition, within the directly impacted left hemisphere, FC changes for the two diseases were significantly correlated. In contrast, in the right hemisphere, the FC changes differed markedly between the two groups, with the progressive disease group exhibiting rather symmetrical FC changes across the hemispheres whereas the post-stroke group showed asymmetrical FC changes across the hemispheres. These findings constitute novel evidence that the functional connectivity consequences of stroke and neurodegenerative disease can be very different despite similar behavioral outcomes and damage foci. Specifically, stroke may lead to greater independence of hemispheric responses, while neurodegenerative disease may produce more symmetrical changes across the hemispheres and more synchronized activity between the two hemispheres.
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Affiliation(s)
- Yuan Tao
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA,Corresponding author.
| | - Kyrana Tsapkini
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21217, USA
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA,Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, MD 21218, USA,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21218, USA
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Masson-Trottier M, Dash T, Berroir P, Ansaldo AI. French Phonological Component Analysis and aphasia recovery: A bilingual perspective on behavioral and structural data. Front Hum Neurosci 2022; 16:752121. [PMID: 36211123 PMCID: PMC9535680 DOI: 10.3389/fnhum.2022.752121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Studies show bilingualism entails an advantage in cognitive control tasks. There is evidence of a bilingual advantage in the context of aphasia, resulting in better cognitive outcomes and recovery in bilingual persons with aphasia compared to monolingual peers. This bilingual advantage also results in structural changes in the right hemisphere gray matter. Very few studies have examined the so-called bilingual advantage by reference to specific anomia therapy efficacy. This study aims to compare the effect of French-Phonological Component Analysis (Fr-PCA) in monolinguals and bilingual persons with aphasia, both at the linguistic and cognitive control level, and to examine the structural impact of left hemisphere lesion location and right hemisphere structural data. Eight participants with chronic aphasia received Fr-PCA for a total of 15 h over 5 weeks. The results showed improved accuracy for treated words and generalization to untreated items and discourse in both groups, and improved Flanker task performance for some participants. Bilingual participants improved more than monolinguals for picture-naming tasks and narrative discourse. Damage to the left postcentral gyrus and the middle frontal gyrus was associated with less therapy-induced improvement. Additionally, left hemisphere damage to the inferior parietal gyrus and postcentral gyrus was associated with reduced cognitive control pre-therapy. Undamaged right hemisphere cortical thicknesses were significantly different between groups; the inferior frontal gyrus and the middle frontal gyrus were greater for the bilingual participants and correlated with cognitive control skills. These results suggest a bilingual advantage in anomia recovery following Fr-PCA, potentially resulting from enhanced cognitive control abilities that could be supported by right hemisphere neural reserve.
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Affiliation(s)
- Michèle Masson-Trottier
- Laboratoire de Plasticité Cérébrale, Communication et Vieillissement, Centre de Recherche de l’Institut de Gériatrie de Montréal, Montréal, QC, Canada
- École d’Orthophonie et d’Audiologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Tanya Dash
- Laboratoire de Plasticité Cérébrale, Communication et Vieillissement, Centre de Recherche de l’Institut de Gériatrie de Montréal, Montréal, QC, Canada
| | - Pierre Berroir
- Laboratoire de Plasticité Cérébrale, Communication et Vieillissement, Centre de Recherche de l’Institut de Gériatrie de Montréal, Montréal, QC, Canada
| | - Ana Inés Ansaldo
- Laboratoire de Plasticité Cérébrale, Communication et Vieillissement, Centre de Recherche de l’Institut de Gériatrie de Montréal, Montréal, QC, Canada
- École d’Orthophonie et d’Audiologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- *Correspondence: Ana Inés Ansaldo,
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11
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Schneider HR, Wawrzyniak M, Stockert A, Klingbeil J, Saur D. fMRI informed voxel-based lesion analysis to identify lesions associated with right-hemispheric activation in aphasia recovery. Neuroimage Clin 2022; 36:103169. [PMID: 36037659 PMCID: PMC9440420 DOI: 10.1016/j.nicl.2022.103169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
Several mechanisms have been attributed to post-stroke loss and recovery of language functions. However, the significance and timing of domain-general and homotopic right-hemispheric activation is controversial. We aimed to examine the effect of left-hemispheric lesion location and time post-stroke on right-hemispheric activation. Voxel-based lesion analyses were informed by auditory language-related fMRI activation of 71 patients with left middle cerebral artery stroke examined longitudinally in the acute, subacute and early chronic phase. Language activation was determined in several right-hemispheric regions of interest and served as regressor of interest for voxel-based lesion analyses. We found that an acute to chronic increase of language activation in the right supplementary motor area was associated with lesions to the left extreme capsule as part of the ventral language pathway. Importantly, this activation increase correlated significantly with improvement of out-of-scanner comprehension abilities. We interpret our findings in terms of successful domain-general compensation in patients with critical left frontotemporal disconnection due to damage to the ventral language pathway but relatively spared cortical language areas.
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Affiliation(s)
| | - Max Wawrzyniak
- Corresponding author at: Klinik und Poliklinik für Neurologie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103 Leipzig, Germany.
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12
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Huang J, Cao Y, Zhang D, Lei X, Chang J. Research trends of the neuroimaging in aphasia: A bibliometric analysis and visualization analysis from 2004 to 2021. Front Hum Neurosci 2022; 16:945160. [PMID: 35911602 PMCID: PMC9334888 DOI: 10.3389/fnhum.2022.945160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To review the current research status of the neuroimaging of aphasia, and reveal the hotspots and frontiers of research in this field. Methods We searched articles related to the neuroimaging research on aphasia since Web of Science (WOS) database construction and extracted the data. CiteSpace and VOSviewer were used for the country/institution analysis, journal analysis, discipline analysis, burst keyword analysis and cited-reference cluster analysis. Results Of the studies retrieved from WOS, 2922 studies that related to the neuroimaging of aphasia were screened and finally included 2799 articles for research. The United States of America and University of California San Francisco were the main countries and institutions in this field. Brain had the highest impact factor in both published and cited journals. Through the discipline and topic analysis of this field, the most common category was Neurosciences and Neurology. The keyword with the strongest citation strength was “functional connectivity,” and the recent burst keywords were “functional connectivity” and “network.” The co-citation network showed seven clusters greater than 100. Among the top 5 clusters, the most recently formed cluster, Cluster #2 (progressive supranuclear palsy), had an average year of 2017. The literature in the top 5 clusters mainly focused on 3 aspects, specifically, the discovery of language processing models, injury and recovery mechanisms of post-stroke aphasia (PSA), and diagnosis of primary progressive aphasia (PPA) variants. Conclusion The results of this bibliometric study revealed the following three research hotspots in the neuroimaging of aphasia: clarifying the connotation of the most recognized language processing model, the dual-stream model, exploring the injury mechanism based on the dual-stream model and the recovery mechanism involving the left and right hemispheres of PSA, and determining the diagnostic criteria for PPA variants. A major research trend is to combine new neuroimaging technology, such as PET tracer technology, to realize the visual presentation of disease-specific proteins to improve the pathological diagnostic criteria of PPA variants. Accordingly, a visualized analysis of literature that uses CiteSpace provides a more rapid, repeatable and flexible method, which is more conducive to capturing research hotspots and emerging trends.
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Zheng K, Chen M, Shen Y, Xu X, Gao F, Huang G, Ji Y, Su B, Song D, Fang H, Liu P, Ren C. Cerebellar Continuous Theta Burst Stimulation for Aphasia Rehabilitation: Study Protocol for a Randomized Controlled Trial. Front Aging Neurosci 2022; 14:909733. [PMID: 35721014 PMCID: PMC9201405 DOI: 10.3389/fnagi.2022.909733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Language recovery is limited in moderate to severe post-stroke aphasia patients. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising tool in improving language dysfunctions caused by post-stroke aphasia, but the treatment outcome is as yet mixed. Considerable evidence has demonstrated the essential involvement of the cerebellum in a variety of language functions, suggesting that it may be a potential stimulation target of TMS for the treatment of post-stroke aphasia. Theta burst stimulation (TBS) is a specific pattern of rTMS with shorter stimulation times and better therapeutic effects. The effect of continuous TBS (cTBS) on the cerebellum in patients with aphasia with chronic stroke needs further exploration. Methods In this randomized, sham-controlled clinical trial, patients (n = 40) with chronic post-stroke aphasia received 10 sessions of real cTBS (n = 20) or sham cTBS (n = 20) over the right cerebellar Crus I+ a 30-min speech-language therapy. The Western Aphasia Battery (WAB) serves as the primary measure of the treatment outcome. The secondary outcome measures include the Boston Diagnostic Aphasia Examination, Boston Naming Test and speech acoustic parameters. Resting-state fMRI data were also obtained to examine treatment-induced changes in functional connectivity of the cerebro-cerebellar network. These outcome measures are assessed before, immediately after, and 12 weeks after cerebellar cTBS intervention. Discussion This protocol holds promise that cerebellar cTBS is a potential strategy to improve language functions in chronic post-stroke aphasia. The resting-state fMRI may explore the neural mechanism underlying the aphasia rehabilitation with cerebellar cTBS.
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Affiliation(s)
- Kai Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Mingyun Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Shen
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinlei Xu
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Fanglan Gao
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Guilan Huang
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Yingying Ji
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Bin Su
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Da Song
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Hui Fang
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Peng Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Caili Ren
- Department of Neurorehabilitation, Wuxi Tongren Rehabilitation Hospital, Wuxi, China
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
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14
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Structural Integrity and Functional Neural Activity Associated with Oral Language Function after Stroke. J Clin Med 2022; 11:jcm11113028. [PMID: 35683416 PMCID: PMC9180994 DOI: 10.3390/jcm11113028] [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: 05/10/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: The impairment of language function after a stroke is common. It is unclear how the brain reorganizes for language function after cerebral infarction. The aim of this observational study is to investigate the association of structural integrity and functional neural activity with language function in aphasic patients with middle cerebral artery infarction. (2) Methods: Magnetic resonance images and scores from the Western Aphasia Battery on 20 patients were retrieved from medical records. A Voxel-wise linear regression analysis was performed using fractional anisotropy maps or the fractional amplitude of low-frequency fluctuation maps as dependent variables and scores of oral language function as independent variables while controlling for age and time elapsed after stroke. (3) Results: Spontaneous speech was positively associated with fractional anisotropy in the left dorsal stream and the right posterior corpus callosum and with the fractional amplitude of the low-frequency fluctuation of cranial nuclei in the pontomedullary junction. Comprehension was positively associated with the left ventral stream. Naming was positively associated with the left ventral stream and the bilateral occipitofrontal fasciculus, as well as with the fractional amplitude of low-frequency fluctuation of the supramarginal gyrus in the left hemisphere. (4) Conclusions: The dorsal and ventral streams are important for articulation and meaning after the reorganization of neural circuits following stroke. Subdomains of oral language function with a visual component are dependent on the visual association areas located in the right hemisphere.
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15
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Martin KC, Seydell-Greenwald A, Berl MM, Gaillard WD, Turkeltaub PE, Newport EL. A Weak Shadow of Early Life Language Processing Persists in the Right Hemisphere of the Mature Brain. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2022; 3:364-385. [PMID: 35686116 PMCID: PMC9169899 DOI: 10.1162/nol_a_00069] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
Studies of language organization show a striking change in cerebral dominance for language over development: We begin life with a left hemisphere (LH) bias for language processing, which is weaker than that in adults and which can be overcome if there is a LH injury. Over development this LH bias becomes stronger and can no longer be reversed. Prior work has shown that this change results from a significant reduction in the magnitude of language activation in right hemisphere (RH) regions in adults compared to children. Here we investigate whether the spatial distribution of language activation, albeit weaker in magnitude, still persists in homotopic RH regions of the mature brain. Children aged 4-13 (n = 39) and young adults (n = 14) completed an auditory sentence comprehension fMRI (functional magnetic resonance imaging) task. To equate neural activity across the hemispheres, we applied fixed cutoffs for the number of active voxels that would be included in each hemisphere for each participant. To evaluate homotopicity, we generated left-right flipped versions of each activation map, calculated spatial overlap between the LH and RH activity in frontal and temporal regions, and tested for mean differences in the spatial overlap values between the age groups. We found that, in children as well as in adults, there was indeed a spatially intact shadow of language activity in the right frontal and temporal regions homotopic to the LH language regions. After a LH stroke in adulthood, recovering early-life activation in these regions might assist in enhancing recovery of language abilities.
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Affiliation(s)
- Kelly C. Martin
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
| | - Anna Seydell-Greenwald
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Madison M. Berl
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- Children’s National Hospital, Washington, DC
| | - William D. Gaillard
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- Children’s National Hospital, Washington, DC
| | - Peter E. Turkeltaub
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Elissa L. Newport
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
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16
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Cerebral Polymorphisms for Lateralisation: Modelling the Genetic and Phenotypic Architectures of Multiple Functional Modules. Symmetry (Basel) 2022. [DOI: 10.3390/sym14040814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Recent fMRI and fTCD studies have found that functional modules for aspects of language, praxis, and visuo-spatial functioning, while typically left, left and right hemispheric respectively, frequently show atypical lateralisation. Studies with increasing numbers of modules and participants are finding increasing numbers of module combinations, which here are termed cerebral polymorphisms—qualitatively different lateral organisations of cognitive functions. Polymorphisms are more frequent in left-handers than right-handers, but it is far from the case that right-handers all show the lateral organisation of modules described in introductory textbooks. In computational terms, this paper extends the original, monogenic McManus DC (dextral-chance) model of handedness and language dominance to multiple functional modules, and to a polygenic DC model compatible with the molecular genetics of handedness, and with the biology of visceral asymmetries found in primary ciliary dyskinesia. Distributions of cerebral polymorphisms are calculated for families and twins, and consequences and implications of cerebral polymorphisms are explored for explaining aphasia due to cerebral damage, as well as possible talents and deficits arising from atypical inter- and intra-hemispheric modular connections. The model is set in the broader context of the testing of psychological theories, of issues of laterality measurement, of mutation-selection balance, and the evolution of brain and visceral asymmetries.
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17
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Zumbansen A, Kneifel H, Lazzouni L, Ophey A, Black SE, Chen JL, Edwards D, Funck T, Hartmann AE, Heiss WD, Hildesheim F, Lanthier S, Lespérance P, Mochizuki G, Paquette C, Rochon E, Rubi-Fessen I, Valles J, Wortman-Jutt S, Thiel A. Differential Effects of Speech and Language Therapy and rTMS in Chronic Versus Subacute Post-stroke Aphasia: Results of the NORTHSTAR-CA Trial. Neurorehabil Neural Repair 2022; 36:306-316. [PMID: 35337223 PMCID: PMC9003806 DOI: 10.1177/15459683211065448] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND & OBJECTIVE Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5-45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (>6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. METHODS Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. RESULTS Adverse events were rare, mild, and did not differ between groups. Language outcomes improved significantly in all groups irrespective of treatment and recovery phase. At 30-day follow-up, there was a significant interaction of stimulation and recovery phase on naming recovery (P <.001). Naming recovery with rTMS was larger in subacute (Mdn = 1.91/IQR = .77) than chronic patients (Mdn = .15/IQR = 1.68/P = .015). There was no significant rTMS effect in the chronic aphasia group. CONCLUSIONS The addition of rTMS to SLT led to significant supplemental gains in naming recovery in the subacute phase only. While this needs confirmation in larger studies, our results clarify neuromodulatory vs training-induced effects and indicate a possible window of opportunity for contralesional inhibitory stimulation interventions in post-stroke aphasia. NORTHSTAR TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02020421.
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Affiliation(s)
- Anna Zumbansen
- Jewish General Hospital, McGill University, Montreal, QC, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Heike Kneifel
- Jewish General Hospital, McGill University, Montreal, QC, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Latifa Lazzouni
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Anja Ophey
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Sandra E. Black
- Department of Medicine-Neurology and Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Joyce L. Chen
- Faculty of Kinesiology and Physical Education, and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Dylan Edwards
- Burke Neurological Institute, White Plains, NY, USA
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Edith Cowan University, Joondalup, WA, Australia
| | - Thomas Funck
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Alexander Erich Hartmann
- Hospital of the City of Cologne and Department of Neurosurgery, University of Witten-Herdecke, Germany
| | - Wolf-Dieter Heiss
- Max Planck Institute für Stoffwechsel Forschung - MPI for Metabolism Research, and Universität zu Köln, Cologne, Germany
| | - Franziska Hildesheim
- Jewish General Hospital, McGill University, Montreal, QC, Canada
- Canadian Platform for Trials in Non-invasive Brain Stimulation (CanSTIM), Montreal, QC, Canada
| | - Sylvain Lanthier
- Hôpital du Sacré-Cœur de Montreal, Université de Montréal, Montreal, QC, Canada
| | | | - George Mochizuki
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | | | - Elizabet Rochon
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ilona Rubi-Fessen
- RehaNova, Neurological Rehabilitation Clinic, Cologne, Germany
- Department of Special Education and Rehabilitation, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Jennie Valles
- Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Susan Wortman-Jutt
- Burke Neurological Institute, White Plains, NY, USA
- Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Alexander Thiel
- Jewish General Hospital, McGill University, Montreal, QC, Canada
- Canadian Platform for Trials in Non-invasive Brain Stimulation (CanSTIM), Montreal, QC, Canada
| | - on behalf of the NORTHSTAR-study group
- Jewish General Hospital, McGill University, Montreal, QC, Canada
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- RehaNova, Neurological Rehabilitation Clinic, Cologne, Germany
- Department of Medicine-Neurology and Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
- Canadian Platform for Trials in Non-invasive Brain Stimulation (CanSTIM), Montreal, QC, Canada
- Faculty of Kinesiology and Physical Education, and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Burke Neurological Institute, White Plains, NY, USA
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Edith Cowan University, Joondalup, WA, Australia
- Hospital of the City of Cologne and Department of Neurosurgery, University of Witten-Herdecke, Germany
- Max Planck Institute für Stoffwechsel Forschung - MPI for Metabolism Research, and Universität zu Köln, Cologne, Germany
- Hôpital du Sacré-Cœur de Montreal, Université de Montréal, Montreal, QC, Canada
- CHUM, Université de Montréal, Montreal, QC, Canada
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
- Department of Special Education and Rehabilitation, Faculty of Human Sciences, University of Cologne, Cologne, Germany
- Burke Rehabilitation Hospital, White Plains, NY, USA
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18
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Martin KC, Ketchabaw WT, Turkeltaub PE. Plasticity of the language system in children and adults. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:397-414. [PMID: 35034751 PMCID: PMC10149040 DOI: 10.1016/b978-0-12-819410-2.00021-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The language system is perhaps the most unique feature of the human brain's cognitive architecture. It has long been a quest of cognitive neuroscience to understand the neural components that contribute to the hierarchical pattern processing and advanced rule learning required for language. The most important goal of this research is to understand how language becomes impaired when these neural components malfunction or are lost to stroke, and ultimately how we might recover language abilities under these circumstances. Additionally, understanding how the language system develops and how it can reorganize in the face of brain injury or dysfunction could help us to understand brain plasticity in cognitive networks more broadly. In this chapter we will discuss the earliest features of language organization in infants, and how deviations in typical development can-but in some cases, do not-lead to disordered language. We will then survey findings from adult stroke and aphasia research on the potential for recovering language processing in both the remaining left hemisphere tissue and in the non-dominant right hemisphere. Altogether, we hope to present a clear picture of what is known about the capacity for plastic change in the neurobiology of the human language system.
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Affiliation(s)
- Kelly C Martin
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States
| | - W Tyler Ketchabaw
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States
| | - Peter E Turkeltaub
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States; Research Division, MedStar National Rehabilitation Hospital, Washington, DC, United States.
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19
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Fan R, Gao Y, Zhang H, Xin X, Sang F, Tan Z, Zhang B, Li X, Huang X, Li S, Chang J. Lesion Distribution and Early Changes of Right Hemisphere in Chinese Patients With Post-stroke Aphasia. Front Aging Neurosci 2022; 13:632217. [PMID: 34987373 PMCID: PMC8722470 DOI: 10.3389/fnagi.2021.632217] [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: 11/22/2020] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
The role of the right hemisphere (RH) in post-stroke aphasia (PSA) has not been completely understood. In general, the language alterations in PSA are normally evaluated from the perspective of the language processing models developed from Western languages such as English. However, the successful application of the models for assessing Chinese-language functions in patients with PSA has not been reported. In this study, the features of specific language-related lesion distribution and early variations of structure in RH in Chinese patients with PSA were investigated. Forty-two aphasic patients (female: 13, male: 29, mean age: 58 ± 12 years) with left hemisphere (LH) injury between 1 and 6 months after stroke were included. The morphological characteristics, both at the levels of gray matter (GM) and white matter (WM), were quantified by 3T multiparametric brain MRI. The Fridriksson et al.’s dual-stream model was used to compare language-related lesion regions. Voxel-based lesion-symptom mapping (VLSM) analysis has been performed. Our results showed that lesions in the precentral, superior frontal, middle frontal, and postcentral gyri were responsible for both the production and comprehension dysfunction of Chinese patients with PSA and were quite different from the lesions described by using the dual-stream model of Fridriksson et al. Furthermore, gray matter volume (GMV) was found significantly decreased in RH, and WM integrity was disturbed in RH after LH injury in Chinese patients with PSA. The different lesion patterns between Chinese patients with PSA and English-speaking patients with PSA may indicate that the dual-stream model of Fridriksson et al. is not suitable for the assessment of Chinese-language functions in Chinese patients with PSA in subacute phase of recovery. Moreover, decreased structural integrity in RH was found in Chinese patients with PSA.
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Affiliation(s)
- Ruiwen Fan
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Key Laboratory of Encephalopathy Treatment of Chinese Medicine, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China
| | - Hua Zhang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiyan Xin
- TCM Department of Peking University Third Hospital, Peking University, Beijing, China
| | - Feng Sang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Zhongjian Tan
- Key Laboratory of Encephalopathy Treatment of Chinese Medicine, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China
| | - Binlong Zhang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaolin Li
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xing Huang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shuren Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jingling Chang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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20
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Figeys M, Kim ES, Hopper T. Does Right-Hemispheric Anodal tDCS Enhance the Impact of Script Training in Chronic Aphasia? A Single-Subject Experimental Study. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:793451. [PMID: 36188817 PMCID: PMC9397953 DOI: 10.3389/fresc.2021.793451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/02/2021] [Indexed: 12/03/2022]
Abstract
Background: Script training is an aphasia treatment approach that has been demonstrated to have a positive effect on communication of individuals with aphasia; however, it is time intensive as a therapeutic modality. To augment therapy-induced neuroplasticity, transcranial direct current stimulation (tDCS) may be implemented. tDCS has been paired with other speech-language treatments, however, has not been investigated with script training. Aims: The purpose of this study was to determine if tDCS improves communication proficiency when paired with script training, compared to script training alone. Methods and Procedures: A single-subject experimental design was implemented with a participant with non-fluent aphasia, using two scripts across treatment conditions: script training with sham-tDCS, and script training with anodal-tDCS. Treatment sessions were 75 min long, administered three times weekly. Anodal tDCS was implemented for 20 min with a current of 1.5 mA over the right inferior frontal gyrus. Results: Large effect sizes were obtained on script mastery for both stimulation conditions (anodal d2 = 9.94; sham d2 = 11.93). tDCS did not improve script accuracy, however, there was a significant improvement in the rate of change of script pace relative to baseline (3.99 seconds/day, p < 0.001) in the anodal tDCS condition. Conclusion: Despite a null tDCS result on accuracy, the script training protocol increased script performance to a near-fluent level of communication. There is preliminary evidence to suggest that tDCS may alter the rate of script acquisition, however, further research to corroborate this finding is required. Implications for future studies are discussed.
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Affiliation(s)
- Mathieu Figeys
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Esther Sung Kim
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Esther Sung Kim
| | - Tammy Hopper
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
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21
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Meier EL. The role of disrupted functional connectivity in aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:99-119. [PMID: 35078613 DOI: 10.1016/b978-0-12-823384-9.00005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Language is one of the most complex and specialized higher cognitive processes. Brain damage to the distributed, primarily left-lateralized language network can result in aphasia, a neurologic disorder characterized by receptive and/or expressive deficits in spoken and/or written language. Most often, aphasia is the consequence of stroke-termed poststroke aphasia (PSA)-yet, aphasia can also manifest due to neurodegenerative disease, specifically, a disorder called primary progressive aphasia (PPA). In recent years, functional connectivity neuroimaging studies have provided emerging evidence supporting theories regarding the relationships between language impairments, structural brain damage, and functional network properties in these two disorders. This chapter reviews the current evidence for the "network phenotype of stroke injury" hypothesis (Siegel et al., 2016) as it pertains to PSA and the "network degeneration hypothesis" (Seeley et al., 2009) as it pertains to PPA. Methodologic considerations for functional connectivity studies, limitations of the current functional connectivity literature in aphasia, and future directions are also discussed.
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Affiliation(s)
- Erin L Meier
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States.
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22
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Neuronavigated repetitive transcranial magnetic stimulation as novel mapping technique provides insights into language function in primary progressive aphasia. Brain Imaging Behav 2021; 16:1208-1216. [PMID: 34964088 PMCID: PMC9107445 DOI: 10.1007/s11682-021-00605-6] [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] [Accepted: 11/15/2021] [Indexed: 11/13/2022]
Abstract
Navigated repetitive transcranial magnetic stimulation (nrTMS) is an innovative technique that provides insight into language function with high accuracy in time and space. So far, nrTMS has mainly been applied in presurgical language mapping of patients with intracranial neoplasms. For the present study, nrTMS was used for language mapping in primary progressive aphasia (PPA). Seven patients (median age: 70 years, 4 males) with the non-fluent variant of PPA (nfvPPA) were included in this pilot study. Trains of nrTMS (5 Hz, 100% resting motor threshold) caused virtual lesions at 46 standardized cortical stimulation targets per hemisphere. Patients’ errors in a naming task during stimulation were counted. The majority of errors induced occurred during frontal lobe stimulation (34.3%). Timing errors and non-responses were most frequent. More errors were induced in the right hemisphere (58%) than in the left hemisphere (42%). Mapping was tolerated by all patients, however, discomfort or pain was reported for stimulation of frontal areas. The elevated right-hemispheric error rate in our study could be due to a partial shift of language function to the right hemisphere in neurodegenerative aphasia during the course of disease and therefore points to the existence of neuronal plasticity in nfvPPA. While this is an interesting finding for neurodegenerative disorders per se, its promotion might also harbor future therapeutic targets.
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Masson-Trottier M, Sontheimer A, Durand E, Ansaldo AI. Resting-State Functional Connectivity following Phonological Component Analysis: The Combined Action of Phonology and Visual Orthographic Cues. Brain Sci 2021; 11:1458. [PMID: 34827457 PMCID: PMC8615968 DOI: 10.3390/brainsci11111458] [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: 09/16/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Anomia is the most frequent and pervasive symptom for people with aphasia (PWA). Phonological component analysis (PCA) is a therapy incorporating phonological cues to treat anomia. Investigations of neural correlates supporting improvements following PCA remain scarce. Resting-state functional connectivity (rsFC) as a marker of therapy-induced neuroplasticity has been reported by our team. The present study explores the efficacy of PCA in French and associated therapy-induced neuroplasticity using whole-brain rsFC analysis. Ten PWA participated in a pre-/post-PCA fMRI study with cognitive linguistic assessments. PCA was delivered in French following the standard procedure. PCA led to significant improvement with trained and untrained items. PCA also led to changes in rsFC between distributed ROIs in the semantic network, visual network, and sub-cortical areas. Changes in rsFC can be interpreted within the frame of the visual and phonological nature of PCA. Behavioral and rsFC data changes associated with PCA in French highlight its efficacy and point to the importance of phonological and orthographic cues to consolidate the word-retrieval strategy, contributing to generalization to untrained words.
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Affiliation(s)
- Michèle Masson-Trottier
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada;
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Anna Sontheimer
- Centre National de la Recherche Scientifique, Institut National Polytechnique-Clermont, Institut Pascal, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
- Centre Hospitalier Universitaire de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Edith Durand
- U.F.R. Lettres, Cultures et Sciences Humaines, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France;
| | - Ana Inés Ansaldo
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada;
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada
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New Treatment Strategy Using Repetitive Transcranial Magnetic Stimulation for Post-Stroke Aphasia. Diagnostics (Basel) 2021; 11:diagnostics11101853. [PMID: 34679550 PMCID: PMC8534572 DOI: 10.3390/diagnostics11101853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) for post-stroke aphasia (PSA) has been suggested to promote improvement of language function when used in combination with rehabilitation. However, many challenges remain. In some reports examined by category of language function, only naming has good evidence of improvement, and the improvement effect on other language modalities is low. Therefore, it is necessary to establish methods that contribute to the improvement of language functions other than naming. Therapeutic methods for PSA based on the mechanism of rTMS are mainly inhibitory stimulation methods for language homologous areas. However, the mechanisms of these methods are controversial when inferred from the process of recovery of language function. Low-frequency rTMS applied to the right hemisphere has been shown to be effective in the chronic phase of PSA, but recent studies of the recovery process of language function indicate that this method is unclear. Therefore, it has been suggested that evaluating brain activity using neuroimaging contributes to confirming the effect of rTMS on PSA and the elucidation of the mechanism of functional improvement. In addition, neuroimaging-based stimulation methods (imaging-based rTMS) may lead to further improvements in language function. Few studies have examined neuroimaging and imaging-based rTMS in PSA, and further research is required. In addition, the stimulation site and stimulation parameters of rTMS are likely to depend on the time from onset to intervention. However, there are no reports of studies in patients between 90 and 180 days after onset. Therefore, research during this period is required. New stimulation methods, such as multiple target methods and the latest neuroimaging methods, may contribute to the establishment of new knowledge and new treatment methods in this field.
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Morrison RA, Hays SA, Kilgard MP. Vagus Nerve Stimulation as a Potential Adjuvant to Rehabilitation for Post-stroke Motor Speech Disorders. Front Neurosci 2021; 15:715928. [PMID: 34489632 PMCID: PMC8417469 DOI: 10.3389/fnins.2021.715928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 01/22/2023] Open
Abstract
Stroke often leaves lasting impairments affecting orofacial function. While speech therapy is able to enhance function after stroke, many patients see only modest improvements after treatment. This partial restoration of function after rehabilitation suggests that there is a need for further intervention. Rehabilitative strategies that augment the effects of traditional speech therapy hold promise to yield greater efficacy and reduce disability associated with motor speech disorders. Recent studies demonstrate that brief bursts of vagus nerve stimulation (VNS) can facilitate the benefits of rehabilitative interventions. VNS paired with upper limb rehabilitation enhances recovery of upper limb function in patients with chronic stroke. Animal studies reveal that these improvements are driven by VNS-dependent synaptic plasticity in motor networks. Moreover, preclinical evidence demonstrates that a similar strategy of pairing VNS can promote synaptic reorganization in orofacial networks. Building on these findings, we postulate that VNS-directed orofacial plasticity could target post-stroke motor speech disorders. Here, we outline the rationale for pairing VNS with traditional speech therapy to enhance recovery in the context of stroke of speech motor function. We also explore similar treatments that aim to enhance synaptic plasticity during speech therapy, and how VNS differs from these existing therapeutic strategies. Based on this evidence, we posit that VNS-paired speech therapy shows promise as a means of enhancing recovery after post-stroke motor speech disorders. Continued development is necessary to comprehensively establish and optimize this approach, which has the potential to increase quality of life for the many individuals suffering with these common impairments.
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Affiliation(s)
- Robert A Morrison
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States
| | - Seth A Hays
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States.,Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX, United States
| | - Michael P Kilgard
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States
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26
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Yourganov G, Stark BC, Fridriksson J, Bonilha L, Rorden C. Effect of Stroke on Contralateral Functional Connectivity. Brain Connect 2021; 11:543-552. [PMID: 33757303 DOI: 10.1089/brain.2020.0901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Stroke can induce large-scale functional reorganization of the brain; however, the spatial patterns of this reorganization remain largely unknown. Methods: Using a large (N = 116) sample of participants who were in the chronic stages of stroke, we present a systematic study of the association between brain damage and functional connectivity (FC) within the intact hemisphere. We computed correlations between regional cortical damage and contralateral FC. Results: We identified left-hemisphere regions that had the most pronounced effect on the right-hemisphere FC, and, conversely, right-hemisphere connections where the effect of damage was particularly strong. Notably, the vast majority of significant correlations were positive: damage was associated with an increase in regional contralateral connectivity. Discussion: These findings lend evidence of the reorganization of contralateral cortical networks as a response to brain damage, which is more pronounced in a set of well-connected regions where connectivity increases with the amount of damage.
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Affiliation(s)
- Grigori Yourganov
- Advanced Computing and Data Science, Cyberinfrastructure and Technology Integration, Clemson University, Clemson, South Carolina, USA
| | - Brielle C Stark
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington, Indiana, USA.,Program in Neuroscience, Indiana University, Bloomington, Indiana, USA
| | - Julius Fridriksson
- Department of Communication Science and Disorders, University of South Carolina, Columbia, South Carolina, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christopher Rorden
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
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Krishna S, Kakaizada S, Almeida N, Brang D, Hervey-Jumper S. Central Nervous System Plasticity Influences Language and Cognitive Recovery in Adult Glioma. Neurosurgery 2021; 89:539-548. [PMID: 33476391 DOI: 10.1093/neuros/nyaa456] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/05/2020] [Indexed: 01/01/2023] Open
Abstract
Gliomas exist within the framework of complex neuronal circuitry in which network dynamics influence both tumor biology and cognition. The generalized impairment of cognition or loss of language function is a common occurrence for glioma patients. The interface between intrinsic brain tumors such as gliomas and functional cognitive networks are poorly understood. The ability to communicate effectively is critically important for receiving oncological therapies and maintaining a high quality of life. Although the propensity of gliomas to infiltrate cortical and subcortical structures and disrupt key anatomic language pathways is well documented, there is new evidence offering insight into the network and cellular mechanisms underpinning glioma-related aphasia and aphasia recovery. In this review, we will outline the current understanding of the mechanisms of cognitive dysfunction and recovery, using aphasia as an illustrative model.
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Affiliation(s)
- Saritha Krishna
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Sofia Kakaizada
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Nyle Almeida
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - David Brang
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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28
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Obayashi S. Cognitive and linguistic dysfunction after thalamic stroke and recovery process: possible mechanism. AIMS Neurosci 2021; 9:1-11. [PMID: 35434274 PMCID: PMC8941189 DOI: 10.3934/neuroscience.2022001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022] Open
Abstract
<abstract>
<p>Thalamic stroke may result in cognitive and linguistic problems, but the underlying mechanism remains unknown. Especially, it is still a matter of debate why thalamic aphasia occasionally occurs and then mostly recovers to some degree. We begin with a brief overview of the cognitive dysfunction and aphasia, and then review previous hypotheses of the underlying mechanism. We introduced a unique characteristic of relatively transient “word retrieval difficulty” of patients in acute phase of thalamic stroke. Word retrieval ability involves both executive function and speech production. Furthermore, SMA aphasia and thalamic aphasia may resemble in terms of the rapid recovery, thus suggesting a shared neural system. This ability is attributable to the supplementary motor area (SMA) and inferior frontal cortex (IFG) via the frontal aslant tract (FAT). To explore the possible mechanism, we applied unique hybrid neuroimaging techniques: single-photon emission computed tomography (SPECT) and functional near-infrared spectroscopy (f-NIRS). SPECT can visualize the brain distribution associated with word retrieval difficulty, cognitive disability or aphasia after thalamic stroke, and f-NIRS focuses on SMA and monitors long-term changes in hemodynamic SMA responses during phonemic verbal task. SPECT yielded common perfusion abnormalities not only in the fronto–parieto–cerebellar–thalamic loop, but also in bilateral brain regions such as SMA, IFG and language-relevant regions. f-NIRS demonstrated that thalamic stroke developed significant word retrieval decline, which was intimately linked to posterior SMA responses. Word retrieval difficulty was rapidly recovered with increased bilateral SMA responses at follow-up NIRS. Together, we propose that the cognitive domain affected by thalamic stroke may be related to the fronto–parieto–cerebellar–thalamic loop, while the linguistic region may be attributable to SMA, IFG and language-related brain areas. Especially, bilateral SMA may play a crucial role in the recovery of word retrieval, and right language-related region, including IFG, angular gyrus and supramarginal gyrus may determine recovery from thalamic aphasia.</p>
</abstract>
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Affiliation(s)
- Shigeru Obayashi
- Department of Rehabilitation Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
- Department of Rehabilitation Medicine, Chiba-Hokusoh hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba 270-1694, Japan
- * Correspondence:
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29
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A unified neurocomputational bilateral model of spoken language production in healthy participants and recovery in poststroke aphasia. Proc Natl Acad Sci U S A 2020; 117:32779-32790. [PMID: 33273118 PMCID: PMC7768768 DOI: 10.1073/pnas.2010193117] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Studies of healthy and impaired language have generated many verbally described hypotheses. While these verbal descriptions have advanced our understanding of language processing, some explanations are mutually incompatible, and it is unclear how they work mechanistically. We constructed a neurocomputational bilateral model of spoken language production to simulate a range of phenomena in healthy participants and patients with aphasia simultaneously, including language lateralization, impaired performance after left but not right damage, and hemispheric involvement in plasticity-dependent recovery. The model demonstrates how seemly contradictory findings can be simulated within a single framework. This provides a coherent mechanistic account of language lateralization and recovery from poststroke aphasia. Understanding the processes underlying normal, impaired, and recovered language performance has been a long-standing goal for cognitive and clinical neuroscience. Many verbally described hypotheses about language lateralization and recovery have been generated. However, they have not been considered within a single, unified, and implemented computational framework, and the literatures on healthy participants and patients are largely separated. These investigations also span different types of data, including behavioral results and functional MRI brain activations, which augment the challenge for any unified theory. Consequently, many key issues, apparent contradictions, and puzzles remain to be solved. We developed a neurocomputational, bilateral pathway model of spoken language production, designed to provide a unified framework to simulate different types of data from healthy participants and aphasic patients. The model encapsulates key computational principles (differential computational capacity, emergent division of labor across pathways, experience-dependent plasticity-related recovery) and provides an explanation for the bilateral yet asymmetric lateralization of language in healthy participants, chronic aphasia after left rather than right hemisphere lesions, and the basis of partial recovery in patients. The model provides a formal basis for understanding the relationship between behavioral performance and brain activation. The unified model is consistent with the degeneracy and variable neurodisplacement theories of language recovery, and adds computational insights to these hypotheses regarding the neural machinery underlying language processing and plasticity-related recovery following damage.
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30
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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.
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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
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31
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Cargnelutti E, Ius T, Skrap M, Tomasino B. What do we know about pre- and postoperative plasticity in patients with glioma? A review of neuroimaging and intraoperative mapping studies. NEUROIMAGE-CLINICAL 2020; 28:102435. [PMID: 32980599 PMCID: PMC7522801 DOI: 10.1016/j.nicl.2020.102435] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023]
Abstract
Brain reorganization can take place before and after surgery of low- and high-grade gliomas. Plasticity is observed for low-grade but also for high-grade gliomas. The contralesional hemisphere can be vital for successful compensation. There is evidence of plasticity for both the language system and the sensorimotor system. Partial compensation can also occur at the white-matter level. Subcortical connectivity is crucial for brain reorganization.
Brain plasticity potential is a central theme in neuro-oncology and is currently receiving increased attention. Advances in treatment have prolonged life expectancy in neuro-oncological patients and the long-term preservation of their quality of life is, therefore, a new challenge. To this end, a better understanding of brain plasticity mechanisms is vital as it can help prevent permanent deficits following neurosurgery. Indeed, reorganization processes can be fundamental to prevent or recover neurological and cognitive deficits by reallocating brain functions outside the lesioned areas. According to more recent studies in the literature, brain reorganization taking place following neurosurgery is associated with good neurofunctioning at follow-up. Interestingly, in the last few years, the number of reports on plasticity has notably increased. Aim of the current review was to provide a comprehensive overview of pre- and postoperative neuroplasticity patterns. Within this framework, we aimed to shed light on some tricky issues, including i) involvement of the contralateral healthy hemisphere, ii) role and potential changes of white matter and connectivity patterns, and iii) reorganization in low- versus high-grade gliomas. We finally discussed the practical implications of these aspects and role of additional potentially relevant factors to be explored. Final purpose was to provide a guideline helpful in promoting increase in the extent of tumor resection while preserving the patients’ neurological and cognitive functioning.
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Affiliation(s)
- Elisa Cargnelutti
- Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, Udine, Italy
| | - Tamara Ius
- SOC Neurochirurgia, Azienda Sanitaria Universitaria Friuli Centrale ASU FC, Italy
| | - Miran Skrap
- SOC Neurochirurgia, Azienda Sanitaria Universitaria Friuli Centrale ASU FC, Italy
| | - Barbara Tomasino
- Scientific Institute, IRCCS E. Medea, Dipartimento/Unità Operativa Pasian di Prato, Udine, Italy.
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32
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Cocquyt EM, Vandewiele M, Bonnarens C, Santens P, De Letter M. The sensitivity of event-related potentials/fields to logopedic interventions in patients with stroke-related aphasia. Acta Neurol Belg 2020; 120:805-817. [PMID: 32474880 DOI: 10.1007/s13760-020-01378-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/12/2020] [Indexed: 12/27/2022]
Abstract
Recovery of stroke-related aphasia can be affected by language therapy in the early and chronic stage. Objectively monitoring therapy-induced neuroplasticity is possible by several measurement techniques including electro- and magneto-encephalography. The obtained event-related potentials (ERPs) and fields (ERFs) provide insights into the neural basis of intact or deficient language processing with milliseconds precision. In this literature review, we highlight the sensitivity of ERPs and ERFs to logopedic interventions by providing an overview of therapy-induced changes in the amplitude, latency and topography of early and mid-to-late components.
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Affiliation(s)
- Elissa-Marie Cocquyt
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Ghent, Belgium.
| | - Marie Vandewiele
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Ghent, Belgium
| | - Cindy Bonnarens
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Ghent, Belgium
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 13K12, 9000, Ghent, Belgium
| | - Miet De Letter
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000, Ghent, Belgium
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33
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Blom-Smink M, Verly M, Spielmann K, Smits M, Ribbers GM, van de Sandt-Koenderman MWME. Change in Right Inferior Longitudinal Fasciculus Integrity Is Associated With Naming Recovery in Subacute Poststroke Aphasia. Neurorehabil Neural Repair 2020; 34:784-794. [PMID: 32672494 DOI: 10.1177/1545968320940982] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background. Despite progress made in understanding functional reorganization patterns underlying recovery in subacute aphasia, the relation between recovery and changes in white matter structure remains unclear. Objective. To investigate changes in dorsal and ventral language white matter tract integrity in relation to naming recovery in subacute poststroke aphasia. Methods. Ten participants with aphasia after left-hemisphere stroke underwent language testing and diffusion tensor imaging twice within 3 months post onset, with a 1-month interval between sessions. Deterministic tractography was used to bilaterally reconstruct the superior longitudinal fasciculus (SLF), inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), middle longitudinal fasciculus (MdLF), and uncinate fasciculus (UF). Per tract, the mean fractional anisotropy (FA) was extracted as a measure of microstructural integrity. Naming accuracy was assessed with the Boston Naming Test (BNT). Correlational analyses were performed to investigate the relationship between changes in FA values and change in BNT score. Results. A strong positive correlation was found between FA change in the right ILF within the ventral stream and change on the BNT (r = 0.91, P < .001). An increase in FA in the right ILF was associated with considerable improvement of naming accuracy (range BNT change score: 12-14), a reduction with limited improvement or slight deterioration. No significant correlations were found between change in naming accuracy and FA change in any of the other right or left ventral and dorsal language tracts. Conclusions. Naming recovery in subacute aphasia is associated with change in the integrity of the right ILF.
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Affiliation(s)
- Marieke Blom-Smink
- Rijndam Rehabilitation, Rotterdam, The Netherlands.,Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Kerstin Spielmann
- Rijndam Rehabilitation, Rotterdam, The Netherlands.,Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marion Smits
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Rijndam Rehabilitation, Rotterdam, The Netherlands.,Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Zumbansen A, Black SE, Chen JL, J Edwards D, Hartmann A, Heiss WD, Lanthier S, Lesperance P, Mochizuki G, Paquette C, Rochon EA, Rubi-Fessen I, Valles J, Kneifel H, Wortman-Jutt S, Thiel A. Non-invasive brain stimulation as add-on therapy for subacute post-stroke aphasia: a randomized trial (NORTHSTAR). Eur Stroke J 2020; 5:402-413. [PMID: 33598559 DOI: 10.1177/2396987320934935] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Non-invasive brain stimulation (NIBS) with speech therapy might improve recovery from post-stroke aphasia. This three-armed sham-controlled blinded prospective proof-of-concept study tested 1 Hz subthreshold repetitive transcranial magnetic stimulation (rTMS) and 2-mA cathodal transcranial direct current stimulation (ctDCS) on the right pars triangularis in subacute post-stroke aphasia. Patients and methods Sixty-three patients with left middle cerebral artery infarcts were recruited in five hospitals (Canada/United States/Germany, 01-2014/03-2018) and randomized to receive rTMS (N = 20), ctDCS (N = 24) or sham stimulation (N = 19) with ST for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Secondary outcome variable was the percent change in the Unified Aphasia Score. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment with a pre-planned subgroup analysis for lesion location (affecting Broca's area or not). Results Naming was significantly improved by rTMS (median = 1.91/interquartile range = 0.77/p = .01) at 30 days versus ctDCS (median = 1.11/interquartile range = 1.51) and sham stimulation (median = 1.02/interquartile range = 1.71). All other primary results were non-significant. The rTMS effect was driven by the patient subgroup with intact Broca's area where NIBS tended to improve UnAS (median = 33.2%/interquartile range = 46.7%/p = .062) versus sham stimulation (median = 12.5%/interquartile range = 7.9%) at day 30. Conversely, in patients with infarcted Broca's area, UnAS tended to improve more with sham stimulation (median = 75.0%/interquartile range = 86.9%/p = .053) versus NIBS (median = 12.7%/interquartile range = 31.7).Conclusion: We found a delayed positive effect of low-frequency rTMS targeting the right pars triangularis on the recovery of naming performance in subacute post-stroke aphasia. This intervention may be beneficial only in patients with morphologically intact Broca's area.
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Affiliation(s)
- Anna Zumbansen
- Jewish General Hospital, Lady Davis Institute for Medical Research, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec
| | - Sandra E Black
- Department of Medicine-Neurology and Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario
| | - Joyce L Chen
- Faculty of Kinesiology and Physical Education, and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario
| | - Dylan J Edwards
- Burke Neurological Institute, White Plains, NY, USA.,Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Alexander Hartmann
- Department of Neurosurgery, Hospital of the City of Cologne, University of Witten-Herdecke, Germany
| | - Wolf-Dieter Heiss
- Max Planck Institute für Stoffwechsel Forschung -- MPI for Metabolism Research, and Department of Neurology, Universität zu Köln, Cologne, Germany
| | - Sylvain Lanthier
- Hôpital du Sacré-Cœur de Montreal, and Department of medicine, Université de Montréal, Quebec
| | | | - George Mochizuki
- School of Kinesiology and Health Science, York University, Toronto, Ontario
| | - Caroline Paquette
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec
| | - Elizabeth A Rochon
- Toronto Rehabilitation Institute, and Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario
| | | | - Jennie Valles
- Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Heike Kneifel
- RehaNova Neurologische Rehabilitationsklinik, Cologne, Germany
| | - Susan Wortman-Jutt
- Burke Neurological Institute, White Plains, NY, USA.,Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Alexander Thiel
- Jewish General Hospital, Lady Davis Institute for Medical Research, Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec
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Breining BL, Sebastian R. Neuromodulation in post-stroke aphasia treatment. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:44-56. [PMID: 33344066 PMCID: PMC7748105 DOI: 10.1007/s40141-020-00257-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW This paper aims to review non-invasive brain stimulation (NIBS) methods to augment speech and language therapy (SLT) for patients with post-stroke aphasia. RECENT FINDINGS In the past five years there have been more than 30 published studies assessing the effect of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) for improving aphasia in people who have had a stroke. Different approaches to NIBS treatment have been used in post-stroke aphasia treatment including different stimulation locations, stimulation intensity, number of treatment sessions, outcome measures, type of aphasia treatment, and time post-stroke. SUMMARY This review of NIBS for post-stroke aphasia shows that both tDCS and TMS can be beneficial for improving speech and language outcomes for patients with stroke. Prior to translating NIBS to clinical practice, further studies are needed to determine optimal tDCS and TMS parameters as well as the mechanisms underlying tDCS and TMS treatment outcomes.
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Affiliation(s)
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
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The Supplementary Motor Area Responsible for Word Retrieval Decline After Acute Thalamic Stroke Revealed by Coupled SPECT and Near-Infrared Spectroscopy. Brain Sci 2020; 10:brainsci10040247. [PMID: 32331319 PMCID: PMC7226437 DOI: 10.3390/brainsci10040247] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 11/22/2022] Open
Abstract
Damage to the thalamus may affect cognition and language, but the underlying mechanism remains unknown. In particular, it remains a riddle why thalamic aphasia occasionally occurs and then mostly recovers to some degree. To explore the mechanism of the affected cognition and language, we used two neuroimaging techniques—single-photon emission computed tomography (SPECT), suitable for viewing the affected brain distribution after acute thalamic stroke, and functional near-infrared spectroscopy (f-NIRS), focusing on hemodynamic responses of the supplementary motor area (SMA) responsible for speech production in conjunction with the frontal aslant tract (FAT) pathway. SPECT yielded common perfusion abnormalities not only in the fronto–parieto–cerebellar loop, but also in the SMA, IFG and surrounding language-relevant regions. In NIRS sessions during a phonemic verbal fluency task, we found significant word retrieval decline in acute thalamic patients relative to age-matched healthy volunteers. Further, NIRS showed strong correlation between word retrieval and posterior SMA responses. In addition, follow-up NIRS exhibited increased bilateral SMA responses linked to improving word retrieval ability. The findings suggest that cognitive dysfunction may be related to the fronto–parieto–cerebellar loop, while language dysfunction is attributed to the SMA, IFG and language-related brain areas. SMA may contribute to the recovery of word retrieval difficulty and aphasia after thalamic stroke.
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Turkeltaub PE. A Taxonomy of Brain-Behavior Relationships After Stroke. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3907-3922. [PMID: 31756155 PMCID: PMC7203524 DOI: 10.1044/2019_jslhr-l-rsnp-19-0032] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Purpose Understanding the brain basis of language and cognitive outcomes is a major goal of aphasia research. Prior studies have not often considered the many ways that brain features can relate to behavioral outcomes or the mechanisms underlying these relationships. The purpose of this review article is to provide a new framework for understanding the ways that brain features may relate to language and cognitive outcomes from stroke. Method Brain-behavior relationships that may be important for aphasia outcomes are organized into a taxonomy, including features of the lesion and features of brain tissue spared by the lesion. Features of spared brain tissue are categorized into those that change after stroke and those that do not. Features that change are further subdivided, and multiple mechanisms of brain change after stroke are discussed. Results Features of the stroke, including size, location, and white matter damage, relate to many behavioral outcomes and likely account for most of the variance in outcomes. Features of the spared brain tissue that are unchanged by stroke, such as prior ischemic disease in the white matter, contribute to outcomes. Many different neurobiological and behavioral mechanisms may drive changes in the brain after stroke in association with behavioral recovery. Changes primarily driven by neurobiology are likely to occur in brain regions with a systematic relationship to the stroke distribution. Changes primarily driven by behavior are likely to occur in brain networks related to the behavior driving the change. Conclusions Organizing the various hypothesized brain-behavior relationships according to this framework and considering the mechanisms that drive these relationships may help investigators develop specific experimental designs and more complete statistical models to explain language and cognitive abilities after stroke. Eight main recommendations for future research are provided. Presentation Video https://doi.org/10.23641/asha.10257578.
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Affiliation(s)
- Peter E Turkeltaub
- Department of Neurology, Georgetown University Medical Center, Washington, DC
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC
- Research Division, MedStar National Rehabilitation Hospital, Washington, DC
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Role of Functional Imaging Techniques to Assess Motor and Language Cortical Plasticity in Glioma Patients: A Systematic Review. Neural Plast 2019; 2019:4056436. [PMID: 31814822 PMCID: PMC6878806 DOI: 10.1155/2019/4056436] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/05/2019] [Indexed: 01/19/2023] Open
Abstract
Cerebral plasticity is the ability of the central nervous system to reorganize itself in response to different injuries. The reshaping of functional areas is a crucial mechanism to compensate for damaged function. It is acknowledged that functional remodeling of cortical areas may occur also in glioma patients. Principal limits of previous investigations on cortical plasticity of motor and language functions included scarce reports of longitudinal evaluations and limited sample sizes. This systematic review is aimed at elucidating cortical brain plasticity for motor and language functions, in adult glioma patients, by means of preoperative and intraoperative mapping techniques. We systematically reviewed the literature for prospective studies, assessing cortical plasticity of motor and language functions in low-grade and high-grade gliomas. Eight longitudinal studies investigated cortical plasticity, evaluated by motor and language task-based functional MRI (fMRI), motor navigated transcranial magnetic stimulation (n-TMS), and intraoperative mapping with cortical direct electrocortical stimulation (DES) of language and motor function. Motor function reorganization appeared relatively limited and mostly characterized by intrahemispheric functional changes, including secondary motor cortices. On the other hand, a high level of functional reshaping was found for language function in DES studies. Occurrence of cortical functional reorganization of language function was described focusing on the intrahemispheric recruitment of perilesional areas. However, the association between these functional patterns and recovery of motor and language deficits still remains partially clear. A number of relevant methodological issues possibly affecting the finding generalization emerged, such as the complexity of plasticity outcome measures and the lack of large longitudinal studies. Future studies are required to further confirm these evidences on cortical plasticity in larger samples, combining both functional imaging and intraoperative mapping techniques in longitudinally evaluations.
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Johnson JP, Meier EL, Pan Y, Kiran S. Treatment-related changes in neural activation vary according to treatment response and extent of spared tissue in patients with chronic aphasia. Cortex 2019; 121:147-168. [PMID: 31627014 DOI: 10.1016/j.cortex.2019.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 06/21/2019] [Accepted: 08/23/2019] [Indexed: 11/25/2022]
Abstract
Neuroimaging studies of aphasia recovery have linked treatment-related improvements in language processing to changes in functional brain activation in left hemisphere language regions and their right hemisphere homologues. Although there is some consensus that better behavioral outcomes are achieved when activation is restored to the left hemisphere, the circumstances that dictate how and why regions in both hemispheres respond to naming therapy are still unclear. In this study, an fMRI picture-naming task was used to examine 16 regions of interest in 26 patients with chronic aphasia before and after 12 weeks of semantic naming treatment. Ten control patients who did not receive treatment and 17 healthy controls were also scanned. Naming therapy resulted in a significant increase in cortical activation, an effect that was largely driven by patients who responded most favorably to treatment, as patients who responded less favorably (as well as those who did not receive treatment) had little change in activation over time. Relative to healthy controls, patients had higher pre-treatment activation in the bilateral inferior frontal gyri (IFG) and lower activation in the bilateral angular gyri; after treatment, they had higher activation in bilateral IFG, as well as in the right middle frontal gyrus. These results suggest that the predominant effect of beneficial naming treatment was an upregulation of traditional language areas and their right hemisphere homologues and, in particular, regions associated with phonological and semantic/executive semantic processing, as well as broader domain general functions. Additionally, in some left hemisphere regions, post-treatment changes in activation were greater when there was more damage than when there was less damage, indicating that spared tissue in otherwise highly damaged regions can be modulated by treatment.
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Affiliation(s)
- Jeffrey P Johnson
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA.
| | - Erin L Meier
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Yue Pan
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
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Lin LF, Chang KH, Huang YZ, Lai CH, Liou TH, Lin YN. Simultaneous stimulation in bilateral leg motor areas with intermittent theta burst stimulation to improve functional performance after stroke: a feasibility pilot study. Eur J Phys Rehabil Med 2019; 55:162-168. [DOI: 10.23736/s1973-9087.18.05245-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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41
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Resting-state functional connectivity: An emerging method for the study of language networks in post-stroke aphasia. Brain Cogn 2019; 131:22-33. [DOI: 10.1016/j.bandc.2017.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 12/15/2022]
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Fiori V, Nitsche MA, Cucuzza G, Caltagirone C, Marangolo P. High-Definition Transcranial Direct Current Stimulation Improves Verb Recovery in Aphasic Patients Depending on Current Intensity. Neuroscience 2019; 406:159-166. [PMID: 30876982 DOI: 10.1016/j.neuroscience.2019.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/24/2019] [Accepted: 03/06/2019] [Indexed: 12/28/2022]
Abstract
High-definition transcranial direct current stimulation (HD-tDCS) is a variant of tDCS, which produces more focal stimulation, delimiting brain current flow to a defined region compared to conventional tDCS. To date, only one study has been conducted to investigate HD-tDCS effects on language recovery in aphasia. Here, we aimed to assess the effects of cathodal HD-tDCS on verb naming by comparing two current intensities: 1 vs 2 mA. In a double-blinded cross over study, two groups of 10 aphasic individuals were submitted to active cathodal HD-tDCS and sham stimulation over the right homolog of Broca's area, while performing a verb naming task. Indeed, we reasoned that, by applying inhibitory current over the right Broca's area, we would decrease the inhibitory impact from the right hemisphere to the left perilesional cortex, thus boosting language recovery. The groups differed in the intensity of the active stimulation (1 mA or 2 mA). In both groups, each condition was carried out in five consecutive daily sessions with one week of interval between the two experimental conditions. A significant improvement in verb naming was found only after cathodal HD-tDCS at 2 mA, which endured one week after the end of treatment. The improvement was not observed on the group receiving cathodal HD-tDCS at 1 mA. Our findings showed that HD-tDCS applied to the right intact hemisphere are efficacious for language recovery. These results indicate that HD-tDCS represents a promising new technique for language rehabilitation. However, systematic determination of stimulation intensity appears to be crucial for obtaining relevant effects.
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Affiliation(s)
| | - Michael A Nitsche
- Department Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, BG University Hospital Bergmannsheil, Bochum, Germany
| | | | - Carlo Caltagirone
- IRCCS, Fondazione Santa Lucia, Rome, Italy; Università degli Studi di Tor Vergata, Rome, Italy
| | - Paola Marangolo
- IRCCS, Fondazione Santa Lucia, Rome, Italy; Università Federico II, Naples, Italy.
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Meier EL, Johnson JP, Kiran S. Left frontotemporal effective connectivity during semantic feature judgments in patients with chronic aphasia and age-matched healthy controls. Cortex 2018; 108:173-192. [PMID: 30243049 PMCID: PMC6234086 DOI: 10.1016/j.cortex.2018.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 12/15/2022]
Abstract
Traditional models of neural reorganization of language skills in patients with chronic stroke-induced aphasia (PWA) propose activation of reperfused or spared left hemisphere tissue results in the most favorable language outcomes. However, these models do not fully explain variable behavioral recovery patterns observed in chronic patients. Instead, investigation of connectivity patterns of critical network nodes may elucidate better-informed recovery models. In the present study, we combined fMRI and dynamic causal modeling (DCM) to examine effective connectivity of a simple three-node left hemisphere network during a semantic feature decision task in 25 PWA and 18 age-matched neurologically intact healthy controls. The DCM model space utilized in Meier, Kapse, & Kiran (2016), which was organized according to exogenous input to one of three regions (i.e., left inferior frontal gyrus, pars triangularis [LIFGtri], left posterior middle temporal gyrus [LpMTG], or left middle frontal gyrus [LMFG]) implicated in various levels of lexical-semantic processing, was interrogated. This model space included all possible combinations of uni- and bidirectional task-modulated connections between LIFGtri, LMFG and LpMTG, resulting in 72 individual models that were partitioned into three separate families (i.e., Family #1: Input to LIFGtri, Family #2: Input to LMFG, Family #3: Input to LpMTG). Family-wise Bayesian model selection revealed Family #2: Input to LMFG best fit both patient and control data at a group level. Both groups relied heavily on LMFG's modulation of the other two model regions. By contrast, between-group differences in task-modulated coupling of LIFGtri and LpMTG were observed. Within the patient group, the strength of activity in LIFGtri and connectivity of LpMTG → LIFGtri were positively associated with lexical-semantic abilities inside and outside of the scanner, whereas greater recruitment of LpMTG was associated with poorer lexical-semantic skills.
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Affiliation(s)
- Erin L Meier
- Sargent College of Health & Rehabilitation Sciences, Boston University, United States.
| | - Jeffrey P Johnson
- Sargent College of Health & Rehabilitation Sciences, Boston University, United States
| | - Swathi Kiran
- Sargent College of Health & Rehabilitation Sciences, Boston University, United States
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Buklina SB, Batalov AI, Smirnov AS, Poddubskaya AA, Pitskhelauri DI, Kobyakov GL, Zhukov VY, Goryaynov SA, Kulikov AS, Ogurtsova AA, Golanov AV, Varyukhina MD, Pronin IN. [Dynamics of functional MRI and speech function in patients after resection of frontal and temporal lobe tumors]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 81:17-29. [PMID: 28665385 DOI: 10.17116/neiro201781317-29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
RATIONALE There are no studies on application of functional MRI (fMRI) for long-term monitoring of the condition of patients after resection of frontal and temporal lobe tumors. PURPOSE The study purpose was to correlate, using fMRI, reorganization of the speech system and dynamics of speech disorders in patients with left hemisphere gliomas before surgery and in the early and late postoperative periods. MATERIAL AND METHODS A total of 20 patients with left hemisphere gliomas were dynamically monitored using fMRI and comprehensive neuropsychological testing. The tumor was located in the frontal lobe in 12 patients and in the temporal lobe in 8 patients. Fifteen patients underwent primary surgery; 5 patients had repeated surgery. Sixteen patients had WHO Grade II and Grade III gliomas; the others had WHO Grade IV gliomas. Nineteen patients were examined preoperatively; 20 patients were examined at different times after surgery. Speech functions were assessed by a Luria's test; the dominant hand was determined using the Annette questionnaire; a family history of left-handedness was investigated. Functional MRI was performed on an HDtx 3.0 T scanner using BrainWavePA 2.0, Z software for fMRI data processing program for all calculations >7, p<0.001. RESULTS In patients with extensive tumors and recurrent tumors, activation of right-sided homologues of the speech areas cold be detected even before surgery; but in most patients, the activation was detected 3 months or more after surgery. Therefore, reorganization of the speech system took time. Activation of right-sided homologues of the speech areas remained in all patients for up to a year. Simultaneous activation of right-sided homologues of both speech areas, the Broca's and Wernicke's areas, was detected more often in patients with frontal lobe tumors than in those with temporal lobe tumors. No additional activation foci in the left hemisphere were found at the thresholds used to process fMRI data. Recovery of the speech function, to a certain degree, occurred in all patients, but no clear correlation with fMRI data was found. CONCLUSION Complex fMRI and neuropsychological studies in 20 patients after resection of frontal and temporal lobe tumors revealed individual features of speech system reorganization within one year follow-up. Probably, activation of right-sided homologues of the speech areas in the presence of left hemisphere tumors depends not only on the severity of speech disorder but also reflects individual involvement of the right hemisphere in enabling speech function. This is confirmed by right-sided activation, according to the fMRI data, in right-sided patients without aphasia and, conversely, the lack of activation of right-sided homologues of the speech areas in several patients with severe postoperative speech disorders during the entire follow-up period.
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Affiliation(s)
- S B Buklina
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A I Batalov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A S Smirnov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - G L Kobyakov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - V Yu Zhukov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A S Kulikov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A V Golanov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - I N Pronin
- Burdenko Neurosurgical Institute, Moscow, Russia
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Santhanam P, Duncan ES, Small SL. Therapy-Induced Plasticity in Chronic Aphasia Is Associated with Behavioral Improvement and Time Since Stroke. Brain Connect 2018; 8:179-188. [PMID: 29338310 PMCID: PMC5899281 DOI: 10.1089/brain.2017.0508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cortical reorganization after stroke is thought to underlie functional improvement. Patterns of reorganization may differ depending on the amount of time since the stroke or the degree of improvement. We investigated these issues in a study of brain connectivity changes with aphasia therapy. Twelve individuals with chronic aphasia participated in a 6-week trial of imitation-based speech therapy. We assessed improvement on a repetition test and analyzed effective connectivity during functional magnetic resonance imaging of a speech observation task before and after therapy. Using structural equation modeling, patient networks were compared with a model derived from healthy controls performing the same task. Independent of the amount of time since the stroke, patients demonstrating behavioral improvement had networks that reorganized to be more similar to controls in two functional pathways in the left hemisphere. Independent of behavioral improvement, patients with remote infarcts (2-7 years poststroke; n = 5) also reorganized to more closely resemble controls in one of these pathways. Patients with far removed injury (>10 years poststroke; n = 3) did not show behavioral improvement and, despite similarities to the normative model and overall network heterogeneity, reorganized to be less similar to controls following therapy in a distinct right-lateralized pathway. Behavioral improvement following aphasia therapy was associated with connectivity more closely approximating that of healthy controls. Individuals who had a stroke more than a decade before testing also showed plasticity, with a few pathways becoming less like controls, possibly representing compensation. Better understanding of these mechanisms may help direct targeted brain stimulation.
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Affiliation(s)
- Priya Santhanam
- Department of Neurology, The University of Chicago, Chicago, Illinois
| | - E. Susan Duncan
- Department of Neurology, University of California, Irvine, Orange, California
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge, Louisiana
| | - Steven L. Small
- Department of Neurology, The University of Chicago, Chicago, Illinois
- Department of Neurology, University of California, Irvine, Orange, California
- Department of Neurobiology and Behavior, University of California, Irvine, California
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Rosso C, Arbizu C, Dhennain C, Lamy JC, Samson Y. Repetitive sessions of tDCS to improve naming in post-stroke aphasia: Insights from an individual patient data (IPD) meta-analysis. Restor Neurol Neurosci 2018; 36:107-116. [PMID: 29439369 DOI: 10.3233/rnn-170783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Small clinical trials reported that repetitive sessions of tDCS could improve naming abilities in post-stroke aphasia. However, systematic meta-analyses found no effect, but all of these analyses pooled data from both single and repetitive sessions at the group level. The aim of this paper was to perform a meta-analysis based on individual patient data to explore the effects of repetitive tDCS sessions on naming in post-stroke aphasia and in prespecified subgroups. METHODS We searched for published sham-controlled trials using the keywords "aphasia OR language" AND "transcranial direct current stimulation OR tDCS" AND "stroke". We computed an active and sham improvement ratio by dividing the difference between naming scores after and before the active or sham sessions, respectively, by the total number of picture items. Because of heterogeneity (I2 = 66%, p: 0.002), we used random-effects models to estimate the standardized mean difference (SMD) for the naming outcome. We then analyzed subgroups according to number of sessions, polarity, side/location of the active electrode, post-stroke delay, aphasia severity and comprehension disorders. RESULTS Seven eligible studies were identified, including 68 chronic stroke patients. tDCS was beneficial on naming ability (35% ±34% in the active vs. 25% ±37% in the sham condition). An SMD of 0.8 (95% CI: 0.27-1.33) was found for the naming outcome. Additionally, there was a dose-dependent effect (5 vs. >5 sessions). We also demonstrated a prevalence of anodal vs. cathodal condition and left vs. right targeting electrode. Finally, repetitive sessions were beneficial regardless of the severity of aphasia, comprehension disorders or post-stroke delay. CONCLUSION Repetitive sessions of tDCS are likely to be valuable in enhancing naming accuracy in post-stroke aphasia.
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Affiliation(s)
- Charlotte Rosso
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Céline Arbizu
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France.,IM2A, Hôpital Pitié-Salpêtrière, Paris, France
| | - Claire Dhennain
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Charles Lamy
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Yves Samson
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
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47
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Sebastian R, Breining BL. Contributions of Neuroimaging to Understanding Language Deficits in Acute Stroke. Semin Speech Lang 2018; 39:66-78. [PMID: 29359306 PMCID: PMC5840876 DOI: 10.1055/s-0037-1608854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advances in structural and functional imaging techniques have provided new insights into our understanding of brain and language relationships. In this article, we review the various structural and functional imaging methods currently used to study language deficits in acute stroke. We also discuss the advantages and the limitations of each imaging modality and the applications of each modality in the clinical and research settings in the study of language deficits.
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Affiliation(s)
- Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bonnie L Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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48
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Abstract
BACKGROUND Post-stroke aphasia syndromes as a clinical entity arise from the disruption of brain networks specialized in language production and comprehension due to permanent focal ischemia. This approach to post-stroke aphasia is based on two pathophysiological concepts: 1) Understanding language processing in terms of distributed networks rather than language centers and 2) understanding the molecular pathophysiology of ischemic brain injury as a dynamic process beyond the direct destruction of network centers and their connections. While considerable progress has been made in the past 10 years to develop such models on a systems as well as a molecular level, the influence of these approaches on understanding and treating clinical aphasia syndromes has been limited. OBJECTIVE & METHODS In this article, we review current pathophysiological concepts of ischemic brain injury, their relationship to altered information processing in language networks after ischemic stroke and how these mechanisms may be influenced therapeutically to improve treatment of post-stroke aphasia. CONCLUSION Understanding the pathophysiological mechanism of post-stroke aphasia on a neurophysiological systems level as well as on the molecular level becomes more and more important for aphasia treatment, as the field moves from standardized therapies towards more targeted individualized treatment strategies comprising behavioural therapies as well as non-invasive brain stimulation (NIBS).
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Sebastian R, Long C, Purcell JJ, Faria AV, Lindquist M, Jarso S, Race D, Davis C, Posner J, Wright A, Hillis AE. Imaging network level language recovery after left PCA stroke. Restor Neurol Neurosci 2018; 34:473-89. [PMID: 27176918 PMCID: PMC5003759 DOI: 10.3233/rnn-150621] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose: The neural mechanisms that support aphasia recovery are not yet fully understood. Our goal was to evaluate longitudinal changes in naming recovery in participants with posterior cerebral artery (PCA) stroke using a case-by-case analysis. Methods: Using task based and resting state functional magnetic resonance imaging (fMRI) and detailed language testing, we longitudinally studied the recovery of the naming network in four participants with PCA stroke with naming deficits at the acute (0 week), sub acute (3–5 weeks), and chronic time point (5–7 months) post stroke. Behavioral and imaging analyses (task related and resting state functional connectivity) were carried out to elucidate longitudinal changes in naming recovery. Results: Behavioral and imaging analysis revealed that an improvement in naming accuracy from the acute to the chronic stage was reflected by increased connectivity within and between left and right hemisphere “language” regions. One participant who had persistent moderate naming deficit showed weak and decreasing connectivity longitudinally within and between left and right hemisphere language regions. Conclusions: These findings emphasize a network view of aphasia recovery, and show that the degree of inter- and intra- hemispheric balance between the language-specific regions is necessary for optimal recovery of naming, at least in participants with PCA stroke.
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Affiliation(s)
- Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charltien Long
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeremy J Purcell
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - Andreia V Faria
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin Lindquist
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Samson Jarso
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Race
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cameron Davis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph Posner
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Wright
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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50
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Bilateral hemispheric changes and language outcomes in chronic left hemisphere stroke. Neuroreport 2018; 29:30-35. [DOI: 10.1097/wnr.0000000000000929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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