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Yu Q, Sun Y, Ju X, Ye T, Liu K. Prediction models of the aphasia severity after stroke by lesion load of cortical language areas and white matter tracts: An atlas-based study. Brain Res Bull 2024; 217:111074. [PMID: 39245352 DOI: 10.1016/j.brainresbull.2024.111074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 07/28/2024] [Accepted: 09/06/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVE To construct relatively objective, atlas-based multivariate models for predicting early aphasia severity after stroke, using structural magnetic resonance imaging. METHODS We analyzed the clinical and imaging data of 46 patients with post-stroke aphasia. The aphasia severity was identified with a Western Aphasia Battery Aphasia Quotient. The assessments of stroke lesions were indicated by the lesion load of both the cortical language areas (Areas-LL) and four white matter tracts (i.e., the superior longitudinal fasciculus, SLF-LL; the inferior frontal occipital fasciculi, IFOF-LL; the inferior longitudinal, ILF-LL; and the uncinate fasciculi, UF-LL) extracted from human brain atlas. Correlation analyses and multiple linear regression analyses were conducted to evaluate the correlations between demographic, stroke- and lesion-related variables and aphasia severity. The predictive models were then established according to the identified significant variables. Finally, the receiver operating characteristic (ROC) curve was utilized to assess the accuracy of the predictive models. RESULTS The variables including Areas-LL, the SLF-LL, and the IFOF-LL were significantly negatively associated with aphasia severity (p < 0.05). In multiple linear regression analyses, these variables accounted for 59.4 % of the variance (p < 0.05). The ROC curve analyses yielded the validated area under the curve (AUC) 0.84 both for Areas-LL and SLF-LL and 0.76 for IFOF-LL, indicating good predictive performance (p < 0.01). Adding the combination of SLF-LL and IFOF-LL to this model increased the explained variance to 62.6 % and the AUC to 0.92. CONCLUSIONS The application of atlas-based multimodal lesion assessment may help predict the aphasia severity after stroke, which needs to be further validated and generalized for the prediction of more outcome measures in populations with various brain injuries.
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Affiliation(s)
- Qiwei Yu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China.
| | - Yan Sun
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China
| | - Xiaowen Ju
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China
| | - Tianfen Ye
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China
| | - Kefu Liu
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China.
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Hildesheim FE, Ophey A, Zumbansen A, Funck T, Schuster T, Jamison KW, Kuceyeski A, Thiel A. Predicting Language Function Post-Stroke: A Model-Based Structural Connectivity Approach. Neurorehabil Neural Repair 2024; 38:447-459. [PMID: 38602161 PMCID: PMC11097606 DOI: 10.1177/15459683241245410] [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: 04/12/2024]
Abstract
BACKGROUND The prediction of post-stroke language function is essential for the development of individualized treatment plans based on the personal recovery potential of aphasic stroke patients. OBJECTIVE To establish a framework for integrating information on connectivity disruption of the language network based on routinely collected clinical magnetic resonance (MR) images into Random Forest modeling to predict post-stroke language function. METHODS Language function was assessed in 76 stroke patients from the Non-Invasive Repeated Therapeutic Stimulation for Aphasia Recovery trial, using the Token Test (TT), Boston Naming Test (BNT), and Semantic Verbal Fluency (sVF) Test as primary outcome measures. Individual infarct masks were superimposed onto a diffusion tensor imaging tractogram reference set to calculate Change in Connectivity scores of language-relevant gray matter regions as estimates of structural connectivity disruption. Multivariable Random Forest models were derived to predict language function. RESULTS Random Forest models explained moderate to high amount of variance at baseline and follow-up for the TT (62.7% and 76.2%), BNT (47.0% and 84.3%), and sVF (52.2% and 61.1%). Initial language function and non-verbal cognitive ability were the most important variables to predict language function. Connectivity disruption explained additional variance, resulting in a prediction error increase of up to 12.8% with variable omission. Left middle temporal gyrus (12.8%) and supramarginal gyrus (9.8%) were identified as among the most important network nodes. CONCLUSION Connectivity disruption of the language network adds predictive value beyond lesion volume, initial language function, and non-verbal cognitive ability. Obtaining information on connectivity disruption based on routine clinical MR images constitutes a significant advancement toward practical clinical application.
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Affiliation(s)
- Franziska E. Hildesheim
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Department of Neurology & Neurosurgery, McGill University, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
| | - Anja Ophey
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention, University Hospital Cologne, Medical Faculty of the University of Cologne, Cologne, Germany
| | - Anna Zumbansen
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
- Music and Health Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Thomas Funck
- Institute of Neurosciences and Medicine INM-1, Research Centre Jülich, Jülich, Germany
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Keith W. Jamison
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Alexander Thiel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Department of Neurology & Neurosurgery, McGill University, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
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Roelofs A. Wernicke's functional neuroanatomy model of language turns 150: what became of its psychological reflex arcs? Brain Struct Funct 2024:10.1007/s00429-024-02785-5. [PMID: 38581582 DOI: 10.1007/s00429-024-02785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/05/2024] [Indexed: 04/08/2024]
Abstract
Wernicke (Der aphasische Symptomencomplex: Eine psychologische Studie auf anatomischer Basis. Cohn und Weigert, Breslau. https://wellcomecollection.org/works/dwv5w9rw , 1874) proposed a model of the functional neuroanatomy of spoken word repetition, production, and comprehension. At the heart of this epoch-making model are psychological reflex arcs underpinned by fiber tracts connecting sensory to motor areas. Here, I evaluate the central assumption of psychological reflex arcs in light of what we have learned about language in the brain during the past 150 years. I first describe Wernicke's 1874 model and the evidence he presented for it. Next, I discuss his updates of the model published in 1886 and posthumously in 1906. Although the model had an enormous immediate impact, it lost influence after the First World War. Unresolved issues included the anatomical underpinnings of the psychological reflex arcs, the role of auditory images in word production, and the sufficiency of psychological reflex arcs, which was questioned by Wundt (Grundzüge der physiologischen Psychologie. Engelmann, Leipzig. http://vlp.mpiwg-berlin.mpg.de/references?id=lit46 , 1874; Grundzüge der physiologischen Psychologie (Vol. 1, 5th ed.). Engelmann, Leipzig. http://vlp.mpiwg-berlin.mpg.de/references?id=lit806 , 1902). After a long dormant period, Wernicke's model was revived by Geschwind (Science 170:940-944. https://doi.org/10.1126/science.170.3961.940 , 1970; Selected papers on language and the brain. Reidel, Dordrecht, 1974), who proposed a version of it that differed in several important respects from Wernicke's original. Finally, I describe how new evidence from modern research has led to a novel view on language in the brain, supplementing contemporary equivalents of psychological reflex arcs by other mechanisms such as attentional control and assuming different neuroanatomical underpinnings. In support of this novel view, I report new analyses of patient data and computer simulations using the WEAVER++/ARC model (Roelofs 2014, 2022) that incorporates attentional control and integrates the new evidence.
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Affiliation(s)
- Ardi Roelofs
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, Thomas van Aquinostraat 4, 6525 GD, Nijmegen, The Netherlands.
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Ding J, Middleton EL, Mirman D. Impaired discourse content in aphasia is associated with frontal white matter damage. Brain Commun 2023; 5:fcad310. [PMID: 38025278 PMCID: PMC10664411 DOI: 10.1093/braincomms/fcad310] [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: 12/23/2022] [Revised: 09/04/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Aphasia is a common consequence of stroke with severe impacts on employability, social interactions and quality of life. Producing discourse-relevant information in a real-world setting is the most important aspect of recovery because it is critical to successful communication. This study sought to identify the lesion correlates of impaired production of relevant information in spoken discourse in a large, unselected sample of participants with post-stroke aphasia. Spoken discourse (n = 80) and structural brain scans (n = 66) from participants with aphasia following left hemisphere stroke were analysed. Each participant provided 10 samples of spoken discourse elicited in three different genres, and 'correct information unit' analysis was used to quantify the informativeness of speech samples. The lesion correlates were identified using multivariate lesion-symptom mapping, voxel-wise disconnection and tract-wise analyses. Amount and speed of relevant information were highly correlated across different genres and with total lesion size. The analyses of lesion correlates converged on the same pattern: impaired production of relevant information was associated with damage to anterior dorsal white matter pathways, specifically the arcuate fasciculus, frontal aslant tract and superior longitudinal fasciculus. Damage to these pathways may be a useful biomarker for impaired informative spoken discourse and informs development of neurorehabilitation strategies.
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Affiliation(s)
- Junhua Ding
- Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK
| | | | - Daniel Mirman
- Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK
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Vavassori L, Venturini M, Zigiotto L, Annicchiarico L, Corsini F, Avesani P, Petit L, De Benedictis A, Sarubbo S. The arcuate fasciculus: Combining structure and function into surgical considerations. Brain Behav 2023; 13:e3107. [PMID: 37280786 PMCID: PMC10454270 DOI: 10.1002/brb3.3107] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/19/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Two Centuries from today, Karl Friedrich Burdach attributed the nomenclature "arcuate fasciculus" to a white matter (WM) pathway connecting the frontal to the temporal cortices by arching around the Sylvian fissure. Although this label remained essentially unvaried, the concepts related to it and the characterization of the structural properties of this bundle evolved along with the methodological progress of the past years. Concurrently, the functional relevance of the arcuate fasciculus (AF) classically restricted to the linguistic domain has extended to further cognitive abilities. These features make it a relevant structure to consider in a large variety of neurosurgical procedures. OBJECTIVE Herein, we build on our previous review uncovering the connectivity provided by the Superior Longitudinal System, including the AF, and provide a handy representation of the structural organization of the AF by considering the frequency of defined reports in the literature. By adopting the same approach, we implement an account of which functions are mediated by this WM bundle. We highlight how this information can be transferred to the neurosurgical field by presenting four surgical cases of glioma resection requiring the evaluation of the relationship between the AF and the nearby structures, and the safest approaches to adopt. CONCLUSIONS Our cumulative overview reports the most common wiring patterns and functional implications to be expected when approaching the study of the AF, while still considering seldom descriptions as an account of interindividual variability. Given its extension and the variety of cortical territories it reaches, the AF is a pivotal structure for different cognitive functions, and thorough understanding of its structural wiring and the functions it mediates is necessary for preserving the patient's cognitive abilities during glioma resection.
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Affiliation(s)
- Laura Vavassori
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
- Center for Mind and Brain Sciences (CIMeC)University of TrentoTrento Provincia Autonoma di TrentoItaly
| | - Martina Venturini
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Luca Zigiotto
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Luciano Annicchiarico
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Francesco Corsini
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
| | - Paolo Avesani
- Center for Mind and Brain Sciences (CIMeC)University of TrentoTrento Provincia Autonoma di TrentoItaly
- Neuroinfrmatics Laboratory (NiLab)Bruno Kessler FoundationPovo Provincia Autonoma di TrentoItaly
| | - Laurent Petit
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives (GIN‐IMN), UMR5293, CNRS, CEAUniversity of BordeauxBordeauxFrance
| | | | - Silvio Sarubbo
- Department of NeurosurgeryAzienda Provinciale per i Servizi Sanitari (APSS), “S. Chiara” HospitalTrento Provincia Autonoma di TrentoItaly
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6
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Kernbach JM, Hartwigsen G, Lim JS, Bae HJ, Yu KH, Schlaug G, Bonkhoff A, Rost NS, Bzdok D. Bayesian stroke modeling details sex biases in the white matter substrates of aphasia. Commun Biol 2023; 6:354. [PMID: 37002267 PMCID: PMC10066402 DOI: 10.1038/s42003-023-04733-1] [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: 07/26/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Ischemic cerebrovascular events often lead to aphasia. Previous work provided hints that such strokes may affect women and men in distinct ways. Women tend to suffer strokes with more disabling language impairment, even if the lesion size is comparable to men. In 1401 patients, we isolate data-led representations of anatomical lesion patterns and hand-tailor a Bayesian analytical solution to carefully model the degree of sex divergence in predicting language outcomes ~3 months after stroke. We locate lesion-outcome effects in the left-dominant language network that highlight the ventral pathway as a core lesion focus across different tests of language performance. We provide detailed evidence for sex-specific brain-behavior associations in the domain-general networks associated with cortico-subcortical pathways, with unique contributions of the fornix in women and cingular fiber bundles in men. Our collective findings suggest diverging white matter substrates in how stroke causes language deficits in women and men. Clinically acknowledging such sex disparities has the potential to improve personalized treatment for stroke patients worldwide.
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Affiliation(s)
- Julius M Kernbach
- Neurosurgical Artificial Intelligence Laboratory Aachen (NAILA), RWTH Aachen University Hospital, Aachen, Germany
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Music, Neuroimaging, and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Lise Meitner Research Group Cognition and Plasticity, Leipzig, Germany
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Gottfried Schlaug
- Music, Neuroimaging, and Stroke Recovery Laboratory, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Anna Bonkhoff
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Danilo Bzdok
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, Faculty of Medicine, School of Computer Science, McGill University, Montreal, QC, Canada.
- Mila - Quebec Artificial Intelligence Institute, Montreal, QC, Canada.
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7
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Janssen N, Kessels RPC, Mars RB, Llera A, Beckmann CF, Roelofs A. Dissociating the functional roles of arcuate fasciculus subtracts in speech production. Cereb Cortex 2023; 33:2539-2547. [PMID: 35709759 PMCID: PMC10016035 DOI: 10.1093/cercor/bhac224] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/12/2022] Open
Abstract
Recent tractography and microdissection studies have shown that the left arcuate fasciculus (AF)-a fiber tract thought to be crucial for speech production-consists of a minimum of 2 subtracts directly connecting the temporal and frontal cortex. These subtracts link the posterior superior temporal gyrus (STG) and middle temporal gyrus (MTG) to the inferior frontal gyrus. Although they have been hypothesized to mediate different functions in speech production, direct evidence for this hypothesis is lacking. To functionally segregate the 2 AF segments, we combined functional magnetic resonance imaging with diffusion-weighted imaging and probabilistic tractography using 2 prototypical speech production tasks, namely spoken pseudoword repetition (tapping sublexical phonological mapping) and verb generation (tapping lexical-semantic mapping). We observed that the repetition of spoken pseudowords is mediated by the subtract of STG, while generating an appropriate verb to a spoken noun is mediated by the subtract of MTG. Our findings provide strong evidence for a functional dissociation between the AF subtracts, namely a sublexical phonological mapping by the STG subtract and a lexical-semantic mapping by the MTG subtract. Our results contribute to the unraveling of a century-old controversy concerning the functional role in speech production of a major fiber tract involved in language.
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Affiliation(s)
- Nikki Janssen
- Corresponding author: Donders Institute for Brain, Cognition and Behaviour, Radboud University, Thomas van Aquinostraat 3, 6525 GD, Nijmegen, the Netherlands.
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, PO Box 9104, 6500 HE Nijmegen, the Netherlands
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
- Vincent van Gogh Institute for Psychiatry, Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, D'n Herk 90, 5803 DN, Venray, the Netherlands
| | - Rogier B Mars
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, PO Box 9104, 6500 HE Nijmegen, the Netherlands
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX39DU, United Kingdom
| | - Alberto Llera
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, PO Box 9104, 6500 HE Nijmegen, the Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre Nijmegen, Postbus 9101, Nijmegen, 6500 HB, the Netherlands
| | - Christian F Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, PO Box 9104, 6500 HE Nijmegen, the Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre Nijmegen, Postbus 9101, Nijmegen, 6500 HB, the Netherlands
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX39DU, United Kingdom
| | - Ardi Roelofs
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, PO Box 9104, 6500 HE Nijmegen, the Netherlands
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Marchina S, Norton A, Schlaug G. Effects of melodic intonation therapy in patients with chronic nonfluent aphasia. Ann N Y Acad Sci 2023; 1519:173-185. [PMID: 36349876 PMCID: PMC10262915 DOI: 10.1111/nyas.14927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with large left-hemisphere lesions and post-stroke aphasia often remain nonfluent. Melodic intonation therapy (MIT) may be an effective alternative to traditional speech therapy for facilitating recovery of fluency in those patients. In an open-label, proof-of-concept study, 14 subjects with nonfluent aphasia with large left-hemisphere lesions (171 ± 76 cc) underwent two speech/language assessments before, one at the midpoint, and two after the end of 75 sessions (1.5 h/session) of MIT. Functional MR imaging was done before and after therapy asking subjects to vocalize the same set of 10 bi-syllabic words. We found significant improvements in speech output after a period of intensive MIT (75 sessions for a total of 112.5 h) compared to two pre-therapy assessments. Therapy-induced gains were maintained 4 weeks post-treatment. Imaging changes were seen in a right-hemisphere network that included the posterior superior temporal and inferior frontal gyri, inferior pre- and postcentral gyri, pre-supplementary motor area, and supramarginal gyrus. Functional changes in the posterior right inferior frontal gyri significantly correlated with changes in a measure of fluency. Intense training of intonation-supported auditory-motor coupling and engaging feedforward/feedback control regions in the unaffected hemisphere improves speech-motor functions in subjects with nonfluent aphasia and large left-hemisphere lesions.
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Affiliation(s)
- Sarah Marchina
- Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Norton
- Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Gottfried Schlaug
- Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Music, Neuroimaging and Stroke Recovery Laboratories, University of Massachusetts Chan Medical School – Baystate Campus, Springfield, Massachusetts, USA
- Department of Biomedical Engineering and Institute of Applied Life Sciences, University of Massachusetts, Amherst, Amherst, Massachusetts, USA
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9
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Ding J, Schnur TT. Anterior connectivity critical for recovery of connected speech after stroke. Brain Commun 2022; 4:fcac266. [PMID: 36382224 PMCID: PMC9651028 DOI: 10.1093/braincomms/fcac266] [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: 01/29/2022] [Revised: 07/20/2022] [Accepted: 10/17/2022] [Indexed: 01/11/2023] Open
Abstract
Connected speech recovers to different degrees across people after left hemisphere stroke, but white matter predictors of differential recovery from the acute stage of stroke are unknown. We assessed changes in lexical-syntactic aspects of connected speech in a longitudinal analysis of 40 individuals (18 females) from the acute stage of left hemisphere stroke (within an average of 4 days post-stroke) to subacute (within 2 months) and chronic stages (early: 6 months, late: 1 year) while measuring the extent of acute lesions on white matter tracts to identify tracts predictive of recovery. We found that acute damage to the frontal aslant tract led to a decreased recovery of the fluency and structural complexity of connected speech during the year following left hemisphere stroke. The results were independent of baseline performance, overall lesion volume and the proportion of damage to tract-adjacent grey matter. This longitudinal analysis from acute to chronic stroke provides the first evidence that recovery of fluent and structurally complex spontaneous connected speech requires intact left frontal connectivity via the frontal aslant tract. That the frontal aslant tract was critical for recovery at early as well as later stages of stroke demonstrates that anterior connectivity plays a lasting and important role for the reorganization of function related to the successful production of connected speech.
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Affiliation(s)
- Junhua Ding
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Tatiana T Schnur
- Correspondence to: Tatiana T. Schnur Department of Neurosurgery Baylor College of Medicine 1 Baylor Plaza, Houston, TX 77030, USA E-mail:
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Braun EJ, Billot A, Meier EL, Pan Y, Parrish TB, Kurani AS, Kiran S. White matter microstructural integrity pre- and post-treatment in individuals with chronic post-stroke aphasia. BRAIN AND LANGUAGE 2022; 232:105163. [PMID: 35921727 PMCID: PMC9641951 DOI: 10.1016/j.bandl.2022.105163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
While previous studies have found that white matter damage relates to impairment severity in individuals with aphasia, further study is required to understand the relationship between white matter integrity and treatment response. In this study, 34 individuals with chronic post-stroke aphasia underwent behavioral testing and structural magnetic resonance imaging at two timepoints. Thirty participants within this sample completed typicality-based semantic feature treatment for anomia. Tractography of bi-hemispheric white matter tracts was completed via Automated Fiber Quantification. Associations between microstructural integrity metrics and behavioral measures were evaluated at the tract level and in nodes along the tract. Diffusion measures of the left inferior longitudinal, superior longitudinal, and arcuate fasciculi were related to aphasia severity and diffusion measures of the left inferior longitudinal fasciculus were related to naming and treatment response. This study also found preliminary evidence of left inferior longitudinal fasciculus microstructural changes following treatment.
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Affiliation(s)
- Emily J Braun
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences, Sargent College, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02115, USA.
| | - Anne Billot
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences, Sargent College, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02115, USA; School of Medicine, Boston University, Boston, MA, USA
| | - Erin L Meier
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences, Sargent College, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02115, USA
| | - Yue Pan
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences, Sargent College, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02115, USA
| | - Todd B Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Avenue, Suite 1600, Chicago, IL 60611, USA
| | - Ajay S Kurani
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Avenue, Suite 1150, Chicago, IL 60611, USA
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences, Sargent College, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02115, USA
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Integrity of the Left Arcuate Fasciculus Segments Significantly Affects Language Performance in Individuals with Acute/Subacute Post-Stroke Aphasia: A Cross-Sectional Diffusion Tensor Imaging Study. Brain Sci 2022; 12:brainsci12070907. [PMID: 35884714 PMCID: PMC9313217 DOI: 10.3390/brainsci12070907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023] Open
Abstract
Objective: To investigate the correlation between the left arcuate fasciculus (AF) segments and acute/subacute post-stroke aphasia (PSA). Methods: Twenty-six patients underwent language assessment and MRI scanning. The integrity of the AF based on a three-segment model was evaluated using diffusion tensor imaging. All patients were classified into three groups according to the reconstruction of the left AF: completely reconstructed (group A, 8 cases), non-reconstructed (group B, 6 cases), and partially reconstructed (group C, 12 cases). The correlations and intergroup differences in language performance and diffusion indices were comprehensively estimated. Results: A correlation analyses showed that the lesion load of the language areas and diffusion indices on the left AF posterior and long segments was significantly related to some language subsets, respectively. When controlled lesion load was variable, significant correlations between diffusion indices on the posterior and long segments and comprehension, repetition, naming, and aphasia quotient were retained. Multiple comparison tests revealed intergroup differences in diffusion indices on the left AF posterior and long segments, as well as these language subsets. No significant correlation was found between the anterior segment and language performance. Conclusions: The integrity of the left AF segments, particularly the posterior segment, is crucial for the residual comprehension and repetition abilities in individuals with acute/subacute PSA, and lesion load in cortical language areas is an important factor that should be taken into account when illustrating the contributions of damage to special fiber tracts to language impairments.
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12
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Kristinsson S, den Ouden DB, Rorden C, Newman-Norlund R, Neils-Strunjas J, Fridriksson J. Predictors of Therapy Response in Chronic Aphasia: Building a Foundation for Personalized Aphasia Therapy. J Stroke 2022; 24:189-206. [PMID: 35677975 PMCID: PMC9194549 DOI: 10.5853/jos.2022.01102] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic aphasia, a devastating impairment of language, affects up to a third of stroke survivors. Speech and language therapy has consistently been shown to improve language function in prior clinical trials, but few clinicially applicable predictors of individual therapy response have been identified to date. Consequently, clinicians struggle substantially with prognostication in the clinical management of aphasia. A rising prevalence of aphasia, in particular in younger populations, has emphasized the increasing demand for a personalized approach to aphasia therapy, that is, therapy aimed at maximizing language recovery of each individual with reference to evidence-based clinical recommendations. In this narrative review, we discuss the current state of the literature with respect to commonly studied predictors of therapy response in aphasia. In particular, we focus our discussion on biographical, neuropsychological, and neurobiological predictors, and emphasize limitations of the literature, summarize consistent findings, and consider how the research field can better support the development of personalized aphasia therapy. In conclusion, a review of the literature indicates that future research efforts should aim to recruit larger samples of people with aphasia, including by establishing multisite aphasia research centers.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Dirk B. den Ouden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Roger Newman-Norlund
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
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13
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Gordon JK, Clough S. How Do Clinicians Judge Fluency in Aphasia? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1521-1542. [PMID: 35271379 DOI: 10.1044/2021_jslhr-21-00484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Aphasia fluency is multiply determined by underlying impairments in lexical retrieval, grammatical formulation, and speech production. This poses challenges for establishing a reliable and feasible tool to measure fluency in the clinic. We examine the reliability and validity of perceptual ratings and clinical perspectives on the utility and relevance of methods used to assess fluency. METHOD In an online survey, 112 speech-language pathologists rated spontaneous speech samples from 181 people with aphasia (PwA) on eight perceptual rating scales (overall fluency, speech rate, pausing, effort, melody, phrase length, grammaticality, and lexical retrieval) and answered questions about their current practices for assessing fluency in the clinic. RESULTS Interrater reliability for the eight perceptual rating scales ranged from fair to good. The most reliable scales were speech rate, pausing, and phrase length. Similarly, clinicians' perceived fluency ratings were most strongly correlated to objective measures of speech rate and utterance length but were also related to grammatical complexity, lexical diversity, and phonological errors. Clinicians' ratings reflected expected aphasia subtype patterns: Individuals with Broca's and transcortical motor aphasia were rated below average on fluency, whereas those with anomic, conduction, and Wernicke's aphasia were rated above average. Most respondents reported using multiple methods in the clinic to measure fluency but relying most frequently on subjective judgments. CONCLUSIONS This study lends support for the use of perceptual rating scales as valid assessments of speech-language production but highlights the need for a more reliable method for clinical use. We describe next steps for developing such a tool that is clinically feasible and helps to identify the underlying deficits disrupting fluency to inform treatment targets. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19326419.
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Affiliation(s)
- Jean K Gordon
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Sharice Clough
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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14
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Roth R, Wilmskoetter J, Bonilha L. The role of disrupted structural connectivity in aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:121-127. [PMID: 35078594 DOI: 10.1016/b978-0-12-823384-9.00006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lesion-based studies are among the most informative approaches to determine a critical relationship between a particular brain region and specific function. Importantly, brain lesions cause disconnection of other brain areas that appear to be intact and may cause functional deficits in these regions due to a lack of afferent projections. If only the location of necrosis and gliosis after the stroke is considered to be the lesion, the full spectrum of brain dysfunction is only partly assessed, and there is a high probability that incomplete region-to-function inferences are made. In this chapter we (1) outline how structural connectivity can be measured in individuals with stroke, and (2) provide an overview of the importance of disrupted structural connectivity in aphasia. We conclude that connection-based and region/voxel-based symptom mapping yield complementary information and together provide an in-depth picture of brain and function relationships.
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Affiliation(s)
- Rebecca Roth
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Janina Wilmskoetter
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Leonardo Bonilha
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
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15
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Gleichgerrcht E, Roth R, Fridriksson J, den Ouden D, Delgaizo J, Stark B, Hickok G, Rorden C, Wilmskoetter J, Hillis A, Bonilha L. Neural bases of elements of syntax during speech production in patients with aphasia. BRAIN AND LANGUAGE 2021; 222:105025. [PMID: 34555689 PMCID: PMC8546356 DOI: 10.1016/j.bandl.2021.105025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
The ability to string together words into a structured arrangement capable of conveying nuanced information is key to speech production. The assessment of the neural bases for structuring sentences has been challenged by the need of experts to delineate the aberrant morphosyntactic structures in aphasic speech. Most studies have relied on focused tasks with limited ecological validity. We characterized syntactic complexity during connected speech produced by patients with chronic post-stroke aphasia. We automated this process by employing Natural Language Processing (NLP). We conducted voxel-based and connectome-based lesion-symptom mapping to identify brain regions crucially associated with sentence production and syntactic complexity. Posterior-inferior aspects of left frontal and parietal lobes, as well as white matter tracts connecting these areas, were essential for syntactic complexity, particularly the posterior inferior frontal gyrus. These findings suggest that sentence structuring during word production depends on the integrity of Broca's area and the dorsal stream of language processing.
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Affiliation(s)
| | - Rebecca Roth
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Dirk den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - John Delgaizo
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Brielle Stark
- Department of Speech and Hearing Sciences, Indiana University, Bloomington, IN, USA
| | - Gregory Hickok
- Department of Cognitive Sciences, University of California, Irvine, CA, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Janina Wilmskoetter
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Argye Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
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16
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Ivanova MV, Zhong A, Turken A, Baldo JV, Dronkers NF. Functional Contributions of the Arcuate Fasciculus to Language Processing. Front Hum Neurosci 2021; 15:672665. [PMID: 34248526 PMCID: PMC8267805 DOI: 10.3389/fnhum.2021.672665] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022] Open
Abstract
Current evidence strongly suggests that the arcuate fasciculus (AF) is critical for language, from spontaneous speech and word retrieval to repetition and comprehension abilities. However, to further pinpoint its unique and differential role in language, its anatomy needs to be explored in greater detail and its contribution to language processing beyond that of known cortical language areas must be established. We address this in a comprehensive evaluation of the specific functional role of the AF in a well-characterized cohort of individuals with chronic aphasia (n = 33) following left hemisphere stroke. To evaluate macro- and microstructural integrity of the AF, tractography based on the constrained spherical deconvolution model was performed. The AF in the left and right hemispheres were then manually reconstructed using a modified 3-segment model (Catani et al., 2005), and a modified 2-segment model (Glasser and Rilling, 2008). The normalized volume and a measure of microstructural integrity of the long and the posterior segments of the AF were significantly correlated with language indices while controlling for gender and lesion volume. Specific contributions of AF segments to language while accounting for the role of specific cortical language areas – inferior frontal, inferior parietal, and posterior temporal – were tested using multiple regression analyses. Involvement of the following tract segments in the left hemisphere in language processing beyond the contribution of cortical areas was demonstrated: the long segment of the AF contributed to naming abilities; anterior segment – to fluency and naming; the posterior segment – to comprehension. The results highlight the important contributions of the AF fiber pathways to language impairments beyond that of known cortical language areas. At the same time, no clear role of the right hemisphere AF tracts in language processing could be ascertained. In sum, our findings lend support to the broader role of the left AF in language processing, with particular emphasis on comprehension and naming, and point to the posterior segment of this tract as being most crucial for supporting residual language abilities.
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Affiliation(s)
- Maria V Ivanova
- Aphasia Recovery Lab, Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.,Center for Language, Imaging, Mind & Brain, VA Northern California Health Care System, Martinez, CA, United States
| | - Allison Zhong
- Center for Language, Imaging, Mind & Brain, VA Northern California Health Care System, Martinez, CA, United States.,School of Medicine, New York Medical College, Valhalla, NY, United States
| | - And Turken
- Center for Language, Imaging, Mind & Brain, VA Northern California Health Care System, Martinez, CA, United States
| | - Juliana V Baldo
- Center for Language, Imaging, Mind & Brain, VA Northern California Health Care System, Martinez, CA, United States
| | - Nina F Dronkers
- Aphasia Recovery Lab, Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.,Center for Language, Imaging, Mind & Brain, VA Northern California Health Care System, Martinez, CA, United States.,Department of Neurology, University of California, Davis, Davis, CA, United States
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17
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Lee JK, Ko MH, Park SH, Kim GW. Prediction of Aphasia Severity in Patients with Stroke Using Diffusion Tensor Imaging. Brain Sci 2021; 11:304. [PMID: 33673638 PMCID: PMC7997243 DOI: 10.3390/brainsci11030304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/31/2021] [Accepted: 02/23/2021] [Indexed: 11/26/2022] Open
Abstract
This study classified the severity of aphasia through the Western Aphasia Battery and determined the optimal cut-off value for each Language-Related White Matter fiber and their combinations, we further examined the correlations between Language-Related White Matter and Western Aphasia Battery subscores. This retrospective study recruited 64 patients with aphasia. Mild/moderate and severe aphasia were classified according to cut-off Aphasia Quotient score of 51 points. Diffusion tensor imaging and fractional anisotropy reconstructed Language-Related White Matter in multiple fasciculi. We determined the area under the covariate-adjusted receiver operating characteristic curve to evaluate the accuracy of predicting aphasia severity. The optimal fractional-anisotropy cut-off values for the individual fibers of the Language-Related White Matter and their combinations were determined. Their correlations with Western Aphasia Battery subscores were analyzed. The arcuate and superior longitudinal fasciculi showed fair accuracy, the inferior frontal occipital fasciculus poor accuracy, and their combinations fair accuracy. Correlations between Language-Related White Matter parameters and Western Aphasia Battery subscores were found between the arcuate, superior longitudinal, and inferior frontal occipital fasciculi and spontaneous speech, auditory verbal comprehension, repetition, and naming. Diffusion-tensor-imaging-based language-Related White Matter analysis may help predict the severity of language impairment in patients with aphasia following stroke.
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Affiliation(s)
- Jin-Kook Lee
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea; (J.-K.L.); (M.-H.K.); (S.-H.P.)
- Department of Speech-Language Therapy, The Graduate School, Jeonbuk National University, Jeonju 54907, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea; (J.-K.L.); (M.-H.K.); (S.-H.P.)
- Department of Speech-Language Therapy, The Graduate School, Jeonbuk National University, Jeonju 54907, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
| | - Sung-Hee Park
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea; (J.-K.L.); (M.-H.K.); (S.-H.P.)
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
| | - Gi-Wook Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea; (J.-K.L.); (M.-H.K.); (S.-H.P.)
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
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18
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Schevenels K, Price CJ, Zink I, De Smedt B, Vandermosten M. A Review on Treatment-Related Brain Changes in Aphasia. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2020; 1:402-433. [PMID: 37215585 PMCID: PMC10158631 DOI: 10.1162/nol_a_00019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 06/29/2020] [Indexed: 05/24/2023]
Abstract
Numerous studies have investigated brain changes associated with interventions targeting a range of language problems in patients with aphasia. We strive to integrate the results of these studies to examine (1) whether the focus of the intervention (i.e., phonology, semantics, orthography, syntax, or rhythmic-melodic) determines in which brain regions changes occur; and (2a) whether the most consistent changes occur within the language network or outside, and (2b) whether these are related to individual differences in language outcomes. The results of 32 studies with 204 unique patients were considered. Concerning (1), the location of treatment-related changes does not clearly depend on the type of language processing targeted. However, there is some support that rhythmic-melodic training has more impact on the right hemisphere than linguistic training. Concerning (2), we observed that language recovery is not only associated with changes in traditional language-related structures in the left hemisphere and homolog regions in the right hemisphere, but also with more medial and subcortical changes (e.g., precuneus and basal ganglia). Although it is difficult to draw strong conclusions, because there is a lack of systematic large-scale studies on this topic, this review highlights the need for an integrated approach to investigate how language interventions impact on the brain. Future studies need to focus on larger samples preserving subject-specific information (e.g., lesion effects) to cope with the inherent heterogeneity of stroke-induced aphasia. In addition, recovery-related changes in whole-brain connectivity patterns need more investigation to provide a comprehensive neural account of treatment-related brain plasticity and language recovery.
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Affiliation(s)
- Klara Schevenels
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Cathy J. Price
- Welcome Centre for Human Neuroimaging, Institute of Neurology, University College London, UK
| | - Inge Zink
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Bert De Smedt
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Maaike Vandermosten
- Experimental Oto-Rhino-Laryngology, Department of Neurosciences, KU Leuven, Leuven, Belgium
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19
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Keser Z, Meier EL, Stockbridge MD, Hillis AE. The role of microstructural integrity of major language pathways in narrative speech in the first year after stroke. J Stroke Cerebrovasc Dis 2020; 29:105078. [PMID: 32807476 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105078] [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: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Left hemisphere stroke often results in a variety of language deficits due to varying patterns of damage to language networks. The Cookie Theft picture description task, a classic, quick bedside assessment, has been shown to quantify narrative speech reliably. In this study, we utilized diffusion tensor imaging (DTI) to assess language network white matter tract correlates of lexical-semantic and syntactic impairments longitudinally. METHODS Twenty-eight patients with mild to severe language impairments after left hemispheric lobar and/or subcortical ischemic stroke underwent the Cookie Theft picture description test and DTI up to three different time points: within the first three months, six months and twelve months after stroke. Dorsal and ventral stream language pathways were segmented to obtain DTI integrity metrics of both hemispheres. Multivariable regression models and partial correlation analyses adjusted for age, education, and lesion load were conducted to evaluate the temporal DTI profile of the white matter microstructural integrity of the language tracts as neural correlates of narrative speech within the first year after stroke. RESULTS Among all the major language white matter pathways, the integrity of the left arcuate (AF), inferior fronto-occipital, and inferior longitudinal fasciculi (ILF) were related to picture description performance. After FDR correction, left ILF fractional anisotropy correlated with syntactic cohesiveness (r=0.85,p=0.00087) within the first three months after stroke, whereas at one year post-stroke, the strongest correlations were found between lexical-semantic performance and left AF radial diffusivity (r = -0.71, p = 0.00065). CONCLUSION Our study provides a temporal profile of associations between the integrity of the main language pathways and lexical semantics and syntactic impairments in left hemispheric strokes.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, The University of Texas Health Science Center, Houston TX, United States; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Erin L Meier
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Melissa D Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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20
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Clinical and neuroimaging factors associated with aphasia severity in stroke patients: diffusion tensor imaging study. Sci Rep 2020; 10:12874. [PMID: 32733102 PMCID: PMC7393375 DOI: 10.1038/s41598-020-69741-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/13/2020] [Indexed: 11/24/2022] Open
Abstract
This study investigated factors associated with aphasia severity at both 2 weeks and 3 months after stroke using demographic and clinical variables, brain diffusion tensor imaging (DTI) parameters, and lesion volume measurements. Patients with left hemisphere stroke were assessed at 2 weeks (n = 68) and at 3 months (n = 20) after stroke. Demographic, clinical, and neuroimaging data were collected; language functions were assessed using the Western Aphasia Battery. For neuroimaging, DTI parameters, including the laterality index (LI) of fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity, mean diffusivity and fibre density (FD) of the arcuate fasciculus (AF), and lesion volume, were measured. Lesion volume, cortical involvement, and the National Institutes of Health Stroke Scale score significantly predicted aphasia severity at 2 weeks after stroke, whereas the aphasia quotient and presence of depression during the early subacute stage were significant predictors at 3 months after stroke. According to Pearson correlation, LI-AD and LI-FD were significantly correlated with the aphasia quotient 2 weeks after ischaemic stroke, and the LI-FA was significantly correlated with the aphasia quotient 2 weeks after haemorrhagic stroke, suggesting that the extent and mechanism of AF injuries differ between ischaemic and haemorrhagic strokes. These differences may contribute to aphasia severity.
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21
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Meier EL, Johnson JP, Pan Y, Kiran S. The utility of lesion classification in predicting language and treatment outcomes in chronic stroke-induced aphasia. Brain Imaging Behav 2020; 13:1510-1525. [PMID: 31093842 DOI: 10.1007/s11682-019-00118-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Stroke recovery models can improve prognostication of therapy response in patients with chronic aphasia, yet quantifying the effect of lesion on recovery is challenging. This study aimed to evaluate the utility of lesion classification via gray matter (GM)-only versus combined GM plus white matter (WM) metrics and to determine structural measures associated with aphasia severity, naming skills, and treatment outcomes. Thirty-four patients with chronic aphasia due to left hemisphere infarct completed T1-weighted and DTI scans and language assessments prior to receiving a 12-week naming treatment. GM metrics included the amount of spared tissue within five cortical masks. WM integrity was indexed by spared tissue and fractional anisotropy (FA) from four homologous left and right association tracts. Clustering of GM-only and GM + WM metrics via k-medoids yielded four patient clusters that captured two lesion characteristics, size and location. Linear regression models revealed that both GM-only and GM + WM clustering predicted baseline aphasia severity and naming skills, but only GM + WM clustering predicted treatment outcomes. Spearman correlations revealed that without controlling for lesion volume, the majority of left hemisphere metrics were related to language measures. However, adjusting for lesion volume, no relationships with aphasia severity remained significant. FA from two ventral left WM tracts was related to naming and treatment success, independent of lesion size. In sum, lesion volume and GM metrics are sufficient predictors of overall aphasia severity in patients with chronic stroke, whereas diffusion metrics reflecting WM tract integrity may add predictive power to language recovery outcomes after rehabilitation.
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Affiliation(s)
- Erin L Meier
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, room 326, Boston, MA, 02215, USA. .,Neurology Department, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Phipps 546C, Baltimore, MD, 21287, USA.
| | - Jeffrey P Johnson
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, room 326, Boston, MA, 02215, USA.,Geriatric Research Education and Clinical Center, Audiology and Speech Pathology, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15260, USA
| | - Yue Pan
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, room 326, Boston, MA, 02215, USA.,Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, 460 W. 12th Avenue, Columbus, OH, 43210, USA
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, room 326, Boston, MA, 02215, USA
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22
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de Aguiar V, Zhao Y, Faria A, Ficek B, Webster KT, Wendt H, Wang Z, Hillis AE, Onyike CU, Frangakis C, Caffo B, Tsapkini K. Brain volumes as predictors of tDCS effects in primary progressive aphasia. BRAIN AND LANGUAGE 2020; 200:104707. [PMID: 31704518 PMCID: PMC7709910 DOI: 10.1016/j.bandl.2019.104707] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 05/28/2023]
Abstract
The current study aims to determine the brain areas critical for response to anodal transcranial direct current stimulation (tDCS) in PPA. Anodal tDCS and sham were administered over the left inferior frontal gyrus (IFG), combined with written naming/spelling therapy. Thirty people with PPA were included in this study, and assessed immediately, 2 weeks, and 2 months post-therapy. We identified anatomical areas whose volumes significantly predicted the additional tDCS effects. For trained words, the volumes of the left Angular Gyrus and left Posterior Cingulate Cortex predicted the additional tDCS gain. For untrained words, the volumes of the left Middle Frontal Gyrus, left Supramarginal Gyrus, and right Posterior Cingulate Cortex predicted the additional tDCS gain. These findings show that areas involved in language, attention and working memory contribute to the maintenance and generalization of stimulation effects. The findings highlight that tDCS possibly affects areas anatomically or functionally connected to stimulation targets.
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Affiliation(s)
- Vânia de Aguiar
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Center for Language and Cognition Groningen (CLCG), University of Groningen, Netherlands.
| | - Yi Zhao
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Andreia Faria
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kimberly T Webster
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Haley Wendt
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Zeyi Wang
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States; Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States; Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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23
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Kyeong S, Kang H, Kyeong S, Kim DH. Differences in Brain Areas Affecting Language Function After Stroke. Stroke 2019; 50:2956-2959. [DOI: 10.1161/strokeaha.119.026222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background and Purpose—
Brain areas associated with functional improvement differ between acute and chronic phases after stroke. This study investigated brain areas associated with language function, according to time after stroke.
Methods—
Patients with aphasia after stroke were divided into subacute (≤3 months after stroke, 17 patients) and chronic groups (>12 months after stroke, 23 patients). Voxel-wise linear regression analyses in each group were conducted by using fractional anisotropy mapping in diffusion tensor images as a dependent variable, while scores of spontaneous speech, comprehension, repetition, and naming were used as independent variables.
Results—
Structural connectivity in the left dorsal pathway (eg, superior temporal gyrus, inferior parietal lobule, and superior longitudinal fasciculus) was positively associated with spontaneous speech, repetition, and naming, whereas structural connectivity in the corona radiata, internal capsule, and corpus callosum of the right hemisphere was negatively associated with language function in the subacute phase. Comprehension was associated with the left superior temporal gyrus and the right corona radiata in the subacute phase and the right corpus callosum in the chronic phase (
P
FWE
<0.05).
Conclusions—
More lateralized language function related to the dorsal pathway was influenced in the bilateral brain areas in the subacute phase but not in the chronic phase. Less lateralized language function related to the ventral pathway was influenced in the bilateral brain areas during both subacute and chronic phases after stroke.
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Affiliation(s)
- Sunghyon Kyeong
- From the Department of Physical Medicine and Rehabilitation (Sohyon Kyeong, D.H.K.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Hyunkoo Kang
- Department of Radiology (H.K.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Sohyon Kyeong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Sunghyon Kyeong)
| | - Dae Hyun Kim
- From the Department of Physical Medicine and Rehabilitation (Sohyon Kyeong, D.H.K.), Veterans Health Service Medical Center, Seoul, South Korea
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24
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Chenausky K, Paquette S, Norton A, Schlaug G. Apraxia of speech involves lesions of dorsal arcuate fasciculus and insula in patients with aphasia. Neurol Clin Pract 2019; 10:162-169. [PMID: 32309035 DOI: 10.1212/cpj.0000000000000699] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/29/2019] [Indexed: 11/15/2022]
Abstract
Objective To determine the contributions of apraxia of speech (AOS) and anomia to conversational dysfluency. Methods In this observational study of 52 patients with chronic aphasia, 47 with concomitant AOS, fluency was quantified using correct information units per minute (CIUs/min) from propositional speech tasks. Videos of patients performing conversational, how-to and picture-description tasks, word and sentence repetition, and diadochokinetic tasks were used to diagnose AOS using the Apraxia of Speech Rating Scale (ASRS). Anomia was quantified by patients' scores on the 30 even-numbered items from the Boston Naming Test (BNT). Results Together, ASRS and BNT scores accounted for 51.4% of the total variance in CIUs/min; the ASRS score accounted for the majority of that variance. The BNT score was associated with lesions in the left superior temporal gyrus, left inferior frontal gyrus, and large parts of the insula. The global ASRS score was associated with lesions in the left dorsal arcuate fasciculus (AF), pre- and post-central gyri, and both banks of the central sulcus of the insula. The ASRS score for the primary distinguishing features of AOS (no overlap with features of aphasia) was associated with less AF and more insular involvement. Only ∼27% of this apraxia-specific lesion overlapped with lesions associated with the BNT score. Lesions associated with AOS had minimal overlap with the frontal aslant tract (FAT) (<1%) or the extreme capsule fiber tract (1.4%). Finally, ASRS scores correlated significantly with damage to the insula but not to the AF, extreme capsule, or FAT. Conclusions Results are consistent with previous findings identifying lesions of the insula and AF in patients with AOS, damage to both of which may create dysfluency in patients with aphasia.
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Affiliation(s)
- Karen Chenausky
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
| | - Sébastien Paquette
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
| | - Andrea Norton
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
| | - Gottfried Schlaug
- Sargent College (KC), Boston University; Department of Neurology (KC, SP, GS), Harvard Medical School; and Music, Neuroimaging, and Stroke Recovery Laboratory (KC, SP, AN, GS), Beth Israel Deaconess Medical Center, Boston
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25
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Schlaug G. Even when right is all that's left: There are still more options for recovery from aphasia. Ann Neurol 2019; 83:661-663. [PMID: 29573028 DOI: 10.1002/ana.25217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Gottfried Schlaug
- Department of Neurology; Division of Stroke Recovery and Neurorestoration, and Division of Cerebrovascular Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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26
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Harmon TG, Jacks A, Haley KL. Speech Fluency in Acquired Apraxia of Speech During Narrative Discourse: Group Comparisons and Dual-Task Effects. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:905-914. [PMID: 31306594 DOI: 10.1044/2018_ajslp-msc18-18-0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Slowed speech and interruptions to the flow of connected speech are common in aphasia. These features are also observed during dual-task performance for neurotypical adults. The purposes of this study were to determine (a) whether indices of fluency related to cognitive-linguistic versus motor processing would differ between speakers with aphasia plus apraxia of speech (AOS) and speakers with aphasia only and (b) whether cognitive load reduces fluency in speakers with aphasia with and without AOS. Method Fourteen speakers with aphasia (7 with AOS) and 7 neurotypical controls retold short stories alone (single task) and while simultaneously distinguishing between a high and a low tone (dual task). Their narrative samples were analyzed for speech fluency according to sample duration, speech rate, pause/fill time, and repetitions per syllable. Results As expected, both speaker groups with aphasia spoke slower and with more pauses than the neurotypical controls. The speakers with AOS produced more repetitions and longer samples than controls, but they did not differ on these measures from the speakers with aphasia without AOS. Relative to the single-task condition, the dual-task condition increased the duration of pauses and fillers for all groups but reduced speaking rate only for the control group. Sample duration and frequency of repetitions did not change in response to cognitive load. Conclusions Speech output in aphasia becomes less fluent when speakers have to engage in simultaneous tasks, as is typical in everyday conversation. Although AOS may lead to more sound and syllable repetitions than normal, speaking tasks other than narrative discourse might better capture this specific type of disfluency. Future research is needed to confirm and expand these preliminary findings. Supplemental Material https://doi.org/10.23641/asha.8847845.
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Affiliation(s)
- Tyson G Harmon
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Adam Jacks
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Katarina L Haley
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina at Chapel Hill
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27
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Yu Q, Wang H, Li S, Dai Y. Predictive role of subcomponents of the left arcuate fasciculus in prognosis of aphasia after stroke: A retrospective observational study. Medicine (Baltimore) 2019; 98:e15775. [PMID: 31169676 PMCID: PMC6571406 DOI: 10.1097/md.0000000000015775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/31/2019] [Accepted: 05/01/2019] [Indexed: 12/14/2022] Open
Abstract
The relationship between the left arcuate fasciculus (AF) and stroke-related aphasia is unclear. In this retrospective study, we aimed to investigate the role of subcomponents of the left AF in predicting prognosis of aphasia after stroke. Twenty stroke patients with aphasia were recruited and received language assessment as well as diffusion tensor tractography scanning at admission. According to injury of the left AF, the participants were classified into four groups: group A (4 cases), the AF preserved intactly; group B (6 cases), the anterior segment injured; group C (4 cases), the posterior segment injured; and group D (6 cases), completely injured. After a consecutive speech therapy, language assessment was performed again. Changes of language functions among the groups were compared and the relation between these changes with segments injury of the AF was analyzed. After therapy, relatively high increase score percentage changes in terms of all the subcategories of language assessment were observed both in group A and C; by contrast, only naming in group B, and spontaneous speech in group D. Although no statistical difference was demonstrated among the four groups. In addition, there was no significant correlation between improvement of language function with segments injury of the AF. The predictive role of subcomponents of the left AF in prognosis of aphasia is obscure in our study. Nevertheless, it indicates the importance of integrity of the left AF for recovery of aphasia, namely that preservation of the left AF on diffusion tensor tractography could mean recovery potential of aphasia after stroke.
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Affiliation(s)
- Qiwei Yu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University
| | - Hong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University
- Integrated Traditional Chinese And Western Medicine Hospital Affiliated of Jinan University, Guangzhou, Guangdong, China
| | - Shuqing Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University
| | - Yanhong Dai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University
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28
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Kiran S, Thompson CK. Neuroplasticity of Language Networks in Aphasia: Advances, Updates, and Future Challenges. Front Neurol 2019; 10:295. [PMID: 31001187 PMCID: PMC6454116 DOI: 10.3389/fneur.2019.00295] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Researchers have sought to understand how language is processed in the brain, how brain damage affects language abilities, and what can be expected during the recovery period since the early 19th century. In this review, we first discuss mechanisms of damage and plasticity in the post-stroke brain, both in the acute and the chronic phase of recovery. We then review factors that are associated with recovery. First, we review organism intrinsic variables such as age, lesion volume and location and structural integrity that influence language recovery. Next, we review organism extrinsic factors such as treatment that influence language recovery. Here, we discuss recent advances in our understanding of language recovery and highlight recent work that emphasizes a network perspective of language recovery. Finally, we propose our interpretation of the principles of neuroplasticity, originally proposed by Kleim and Jones (1) in the context of extant literature in aphasia recovery and rehabilitation. Ultimately, we encourage researchers to propose sophisticated intervention studies that bring us closer to the goal of providing precision treatment for patients with aphasia and a better understanding of the neural mechanisms that underlie successful neuroplasticity.
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Affiliation(s)
- Swathi Kiran
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, The Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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29
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Geller J, Thye M, Mirman D. Estimating effects of graded white matter damage and binary tract disconnection on post-stroke language impairment. Neuroimage 2019; 189:248-257. [PMID: 30654172 DOI: 10.1016/j.neuroimage.2019.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/05/2019] [Accepted: 01/08/2019] [Indexed: 11/18/2022] Open
Abstract
Despite the critical importance of close replications in strengthening and advancing scientific knowledge, there are inherent challenges to conducting replications of lesion-based studies. In the present study, we conducted a close conceptual replication of a study (i.e., Hope et al., 2016) that found that fluency and naming scores in post-stoke aphasia were more strongly associated with a binary measure of structural white matter integrity (tract disconnection) than a graded measure (lesion load). Using a different sample of stroke patients (N = 128) and four language deficit measures (aphasia severity, picture naming, and composite scores for speech production and semantic cognition), we examined tract disconnection and lesion load in three white matter tracts that have been implicated in language processing: arcuate fasciculus, uncinate fasciculus, and inferior fronto-occipital fasciculus. We did not find any consistent evidence that binary tract disconnection was more strongly associated with language impairment over and above lesion load, though individual deficit measures differed with respect to whether lesion load or tract disconnection was the stronger predictor. Given the mixed findings, we suggest caution when using such indirect estimates of structural white matter integrity, and direct individual measurements (for example, using diffusion weighted imaging) should be preferred when they are available. We end by highlighting the complex nature of replication in lesion-based studies and offer some potential solutions.
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30
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Boyd LA, Hayward KS, Ward NS, Stinear CM, Rosso C, Fisher RJ, Carter AR, Leff AP, Copland DA, Carey LM, Cohen LG, Basso DM, Maguire JM, Cramer SC. Biomarkers of Stroke Recovery: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2018; 31:864-876. [PMID: 29233071 DOI: 10.1177/1545968317732680] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The most difficult clinical questions in stroke rehabilitation are "What is this patient's potential for recovery?" and "What is the best rehabilitation strategy for this person, given her/his clinical profile?" Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
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Affiliation(s)
- Lara A Boyd
- 1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kathryn S Hayward
- 2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nick S Ward
- 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Cathy M Stinear
- 4 Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Charlotte Rosso
- 5 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, France; AP-HP, Stroke Unit, Pitié-Salpêtrière Hospital, France
| | - Rebecca J Fisher
- 6 Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Alexandre R Carter
- 7 Department of Neurology, Washington University in Saint Louis, St Louis, MO, USA
| | - Alex P Leff
- 8 Department of Brain Repair and Rehabilitation, Institute of Neurology & Institute of Cognitive Neuroscience, University College London, Queens Square, London, UK
| | - David A Copland
- 9 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia; and University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Leeanne M Carey
- 10 School of Allied Health, College of Science, Health and Engineering, La Trobe, University, Bundoora, Australia; and Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonardo G Cohen
- 11 Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - D Michele Basso
- 12 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Jane M Maguire
- 13 Faculty of Health, University of Technology Sydney, Ultimo, Sydney, Australia
| | - Steven C Cramer
- 14 University of California, Irvine, CA, USA; Depts. Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, Irvine, CA, USA
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31
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Wright A, Tippett D, Saxena S, Sebastian R, Breining B, Faria A, Hillis AE. Leukoaraiosis is independently associated with naming outcome in poststroke aphasia. Neurology 2018; 91:e526-e532. [PMID: 29980639 DOI: 10.1212/wnl.0000000000005945] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/08/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that severity of leukoaraiosis in the noninfarcted hemisphere at onset is associated with poorer language outcome after poststroke aphasia independently of volume of infarct, damage to 3 critical language areas (left inferior frontal gyrus, superior longitudinal fasciculus, and superior temporal gyrus), comorbid conditions, and time since stroke. METHODS In this cross-sectional study, we evaluated naming outcome (>3 months after stroke) in 42 individuals who initially had aphasia after stroke. We rated leukoaraiosis in the right hemisphere 1 to 4 weeks from onset of stroke using the Cardiovascular Health Study rating scale. We evaluated associations between severity of leukoaraiosis and each measure of naming using Spearman correlations and evaluated the independent contributions of leukoaraiosis, lesion volume, months since onset, comorbid conditions, and damage to critical nodes of the language network on language outcomes using logistic regression. We also evaluated associations between dichotomously defined leukoaraiosis and language outcomes using χ2 tests. RESULTS Severity of leukoaraiosis at onset correlated with object naming (ρ = -0.56, p = 0.0008) and word fluency (ρ = -0.37, p = 0.01) outcomes. Severe leukoaraiosis was associated with failure to achieve the highest quartile of object naming and word fluency. Severity of leukoaraiosis was associated with degree of naming outcome with the use of both measures after controlling for lesion volume, months since stroke, comorbid conditions, and damage to specific locations. CONCLUSION Naming outcome after poststroke aphasia is influenced by the initial severity of right hemisphere leukoaraiosis independently of other variables. Degree of recovery from aphasia may depend on the integrity of the noninfarcted brain tissue.
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Affiliation(s)
- Amy Wright
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Donna Tippett
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Sadhvi Saxena
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Rajani Sebastian
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Bonnie Breining
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Andreia Faria
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Argye E Hillis
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD.
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32
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Improved accuracy of lesion to symptom mapping with multivariate sparse canonical correlations. Neuropsychologia 2018; 115:154-166. [DOI: 10.1016/j.neuropsychologia.2017.08.027] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 01/06/2023]
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33
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Boyd LA, Hayward KS, Ward NS, Stinear CM, Rosso C, Fisher RJ, Carter AR, Leff AP, Copland DA, Carey LM, Cohen LG, Basso DM, Maguire JM, Cramer SC. Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2018; 12:480-493. [PMID: 28697711 DOI: 10.1177/1747493017714176] [Citation(s) in RCA: 234] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The most difficult clinical questions in stroke rehabilitation are "What is this patient's potential for recovery?" and "What is the best rehabilitation strategy for this person, given her/his clinical profile?" Without answers to these questions, clinicians struggle to make decisions regarding the content and focus of therapy, and researchers design studies that inadvertently mix participants who have a high likelihood of responding with those who do not. Developing and implementing biomarkers that distinguish patient subgroups will help address these issues and unravel the factors important to the recovery process. The goal of the present paper is to provide a consensus statement regarding the current state of the evidence for stroke recovery biomarkers. Biomarkers of motor, somatosensory, cognitive and language domains across the recovery timeline post-stroke are considered; with focus on brain structure and function, and exclusion of blood markers and genetics. We provide evidence for biomarkers that are considered ready to be included in clinical trials, as well as others that are promising but not ready and so represent a developmental priority. We conclude with an example that illustrates the utility of biomarkers in recovery and rehabilitation research, demonstrating how the inclusion of a biomarker may enhance future clinical trials. In this way, we propose a way forward for when and where we can include biomarkers to advance the efficacy of the practice of, and research into, rehabilitation and recovery after stroke.
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Affiliation(s)
- Lara A Boyd
- 1 Department of Physical Therapy & the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Kathryn S Hayward
- 2 Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nick S Ward
- 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Cathy M Stinear
- 4 Department of Medicine and Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Charlotte Rosso
- 5 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,6 AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Rebecca J Fisher
- 7 Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Alexandre R Carter
- 8 Department of Neurology, Washington University in Saint Louis, St Louis, MO, USA
| | - Alex P Leff
- 9 Department of Brain Repair and Rehabilitation, Institute of Neurology & Institute of Cognitive Neuroscience, University College London, Queens Square, London, UK
| | - David A Copland
- 10 School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia; and University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Leeanne M Carey
- 11 School of Allied Health, College of Science, Health and Engineering, La Trobe, University, Bundoora, Australia; and Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonardo G Cohen
- 12 Human Cortical Physiology and Neurorehabilitation Section, NINDS, NIH, Bethesda, MD, USA
| | - D Michele Basso
- 13 School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Jane M Maguire
- 14 Faculty of Health, University of Technology, Ultimo, Sydney, Australia
| | - Steven C Cramer
- 15 University of California, Irvine, CA, USA; Depts. Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, Irvine, CA, USA
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34
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Hillis AE, Beh YY, Sebastian R, Breining B, Tippett DC, Wright A, Saxena S, Rorden C, Bonilha L, Basilakos A, Yourganov G, Fridriksson J. Predicting recovery in acute poststroke aphasia. Ann Neurol 2018; 83:612-622. [PMID: 29451321 DOI: 10.1002/ana.25184] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many stroke patients show remarkable recovery of language after initial severe impairment, but it is difficult to predict which patients will show good recovery. We aimed to identify patient and lesion characteristics that together predict the best naming outcome in 4 studies. METHODS We report 2 longitudinal studies that identified 2 variables at onset that were strongly associated with good recovery of naming (the most common residual deficit in aphasia) in the first 6 months after stroke: damage to left posterior superior temporal gyrus (pSTG) and/or superior longitudinal fasciculus/arcuate fasciculus (SLF/AF), and selective serotonin reuptake inhibitor (SSRI) use. We then tested these variables in 2 independent cohorts of chronic left hemisphere stroke patients, using chi-square tests and multivariate logistic regression for dichotomous outcomes and t tests for continuous outcomes. RESULTS Lesion load in left pSTG and SLF/AF was associated with poorer naming outcome. Preservation of these areas and use of SSRIs were associated with naming recovery, independent of lesion volume, time since stroke, and depression. Patients with damage to these critical areas showed better naming outcome if they took SSRIs for 3 months after stroke. Those with preservation of these critical areas achieved good recovery of naming regardless of SSRI use. INTERPRETATION Lesion load in left pSTG and SLF/AF at onset predicts later naming performance. Although based on a small number of patients, our preliminary results suggest outcome might be modulated by SSRIs, but these associations need to be confirmed in a larger randomized controlled trial. Ann Neurol 2018;83:612-622.
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Affiliation(s)
- Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Otolaryngology and Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yuan Ye Beh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bonnie Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Donna C Tippett
- Department of Otolaryngology and Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amy Wright
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sadhvi Saxena
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chris Rorden
- Department of Cognitive Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC
| | - Grigori Yourganov
- Department of Cognitive Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC
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35
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Shuster LI. Considerations for the Use of Neuroimaging Technologies for Predicting Recovery of Speech and Language in Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:291-305. [PMID: 29497745 DOI: 10.1044/2018_ajslp-16-0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The number of research articles aimed at identifying neuroimaging biomarkers for predicting recovery from aphasia continues to grow. Although the clinical use of these biomarkers to determine prognosis has been proposed, there has been little discussion of how this would be accomplished. This is an important issue because the best translational science occurs when translation is considered early in the research process. The purpose of this clinical focus article is to present a framework to guide the discussion of how neuroimaging biomarkers for recovery from aphasia could be implemented clinically. METHOD The genomics literature reveals that implementing genetic testing in the real-world poses both opportunities and challenges. There is much similarity between these opportunities and challenges and those related to implementing neuroimaging testing to predict recovery in aphasia. Therefore, the Center for Disease Control's model list of questions aimed at guiding the review of genetic testing has been adapted to guide the discussion of using neuroimaging biomarkers as predictors of recovery in aphasia. CONCLUSION The adapted model list presented here is a first and useful step toward initiating a discussion of how neuroimaging biomarkers of recovery could be employed clinically to provide improved quality of care for individuals with aphasia.
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Affiliation(s)
- Linda I Shuster
- Department of Speech, Language, and Hearing Sciences, Western Michigan University, Kalamazoo
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36
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Marchina S, Norton A, Kumar S, Schlaug G. The Effect of Speech Repetition Rate on Neural Activation in Healthy Adults: Implications for Treatment of Aphasia and Other Fluency Disorders. Front Hum Neurosci 2018; 12:69. [PMID: 29535619 PMCID: PMC5835070 DOI: 10.3389/fnhum.2018.00069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/07/2018] [Indexed: 11/13/2022] Open
Abstract
Functional imaging studies have provided insight into the effect of rate on production of syllables, pseudowords, and naturalistic speech, but the influence of rate on repetition of commonly-used words/phrases suitable for therapeutic use merits closer examination. Aim: To identify speech-motor regions responsive to rate and test the hypothesis that those regions would provide greater support as rates increase, we used an overt speech repetition task and functional magnetic resonance imaging (fMRI) to capture rate-modulated activation within speech-motor regions and determine whether modulations occur linearly and/or show hemispheric preference. Methods: Twelve healthy, right-handed adults participated in an fMRI task requiring overt repetition of commonly-used words/phrases at rates of 1, 2, and 3 syllables/second (syll./sec.). Results: Across all rates, bilateral activation was found both in ventral portions of primary sensorimotor cortex and middle and superior temporal regions. A repeated measures analysis of variance with pairwise comparisons revealed an overall difference between rates in temporal lobe regions of interest (ROIs) bilaterally (p < 0.001); all six comparisons reached significance (p < 0.05). Five of the six were highly significant (p < 0.008), while the left-hemisphere 2- vs. 3-syll./sec. comparison, though still significant, was less robust (p = 0.037). Temporal ROI mean beta-values increased linearly across the three rates bilaterally. Significant rate effects observed in the temporal lobes were slightly more pronounced in the right-hemisphere. No significant overall rate differences were seen in sensorimotor ROIs, nor was there a clear hemispheric effect. Conclusion: Linear effects in superior temporal ROIs suggest that sensory feedback corresponds directly to task demands. The lesser degree of significance in left-hemisphere activation at the faster, closer-to-normal rate may represent an increase in neural efficiency (and therefore, decreased demand) when the task so closely approximates a highly-practiced function. The presence of significant bilateral activation during overt repetition of words/phrases at all three rates suggests that repetition-based speech production may draw support from either or both hemispheres. This bihemispheric redundancy in regions associated with speech-motor control and their sensitivity to changes in rate may play an important role in interventions for nonfluent aphasia and other fluency disorders, particularly when right-hemisphere structures are the sole remaining pathway for production of meaningful speech.
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Affiliation(s)
- Sarah Marchina
- Music, Stroke Recovery, and Neuroimaging Laboratories, Department of Neurology, Harvard Medical School, Harvard University, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Andrea Norton
- Music, Stroke Recovery, and Neuroimaging Laboratories, Department of Neurology, Harvard Medical School, Harvard University, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Sandeep Kumar
- Music, Stroke Recovery, and Neuroimaging Laboratories, Department of Neurology, Harvard Medical School, Harvard University, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Gottfried Schlaug
- Music, Stroke Recovery, and Neuroimaging Laboratories, Department of Neurology, Harvard Medical School, Harvard University, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
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37
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Feenaughty L, Basilakos A, Bonilha L, den Ouden DB, Rorden C, Stark B, Fridriksson J. Non-fluent speech following stroke is caused by impaired efference copy. Cogn Neuropsychol 2017; 34:333-346. [PMID: 29145761 DOI: 10.1080/02643294.2017.1394834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Efference copy is a cognitive mechanism argued to be critical for initiating and monitoring speech: however, the extent to which breakdown of efference copy mechanisms impact speech production is unclear. This study examined the best mechanistic predictors of non-fluent speech among 88 stroke survivors. Objective speech fluency measures were subjected to a principal component analysis (PCA). The primary PCA factor was then entered into a multiple stepwise linear regression analysis as the dependent variable, with a set of independent mechanistic variables. Participants' ability to mimic audio-visual speech ("speech entrainment response") was the best independent predictor of non-fluent speech. We suggest that this "speech entrainment" factor reflects integrity of internal monitoring (i.e., efference copy) of speech production, which affects speech initiation and maintenance. Results support models of normal speech production and suggest that therapy focused on speech initiation and maintenance may improve speech fluency for individuals with chronic non-fluent aphasia post stroke.
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Affiliation(s)
- Lynda Feenaughty
- a Department of Neurosciences , Medical University of South Carolina , Charleston , SC , USA.,b Department of Communication Sciences and Disorders , University of South Carolina , Columbia , SC , USA
| | - Alexandra Basilakos
- b Department of Communication Sciences and Disorders , University of South Carolina , Columbia , SC , USA
| | - Leonardo Bonilha
- a Department of Neurosciences , Medical University of South Carolina , Charleston , SC , USA
| | - Dirk-Bart den Ouden
- b Department of Communication Sciences and Disorders , University of South Carolina , Columbia , SC , USA
| | - Chris Rorden
- c Department of Psychology , University of South Carolina , Columbia , SC , USA
| | - Brielle Stark
- b Department of Communication Sciences and Disorders , University of South Carolina , Columbia , SC , USA
| | - Julius Fridriksson
- b Department of Communication Sciences and Disorders , University of South Carolina , Columbia , SC , USA
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38
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McKinnon ET, Fridriksson J, Glenn GR, Jensen JH, Helpern JA, Basilakos A, Rorden C, Shih AY, Spampinato MV, Bonilha L. Structural plasticity of the ventral stream and aphasia recovery. Ann Neurol 2017. [PMID: 28628946 DOI: 10.1002/ana.24983] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Restrengthening of the residual language network is likely to be crucial for speech recovery in poststroke aphasia. Eight participants with chronic aphasia received intensive speech therapy for 3 weeks, with standardized naming tests and brain magnetic resonance imaging before and after therapy. Kurtosis-based diffusion tensor tractography was used to measure mean kurtosis (MK) along a segment of the inferior longitudinal fasciculus (ILF). Therapy-related reduction in the number of semantic but not phonemic errors was associated with strengthening (renormalization) of ILF MK (r = -0.90, p < 0.05 corrected), suggesting that speech recovery is related to structural plasticity of language-specific components of the residual language network. Ann Neurol 2017;82:147-151.
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Affiliation(s)
- Emilie T McKinnon
- Department of Neurology, Medical University of South Carolina, Charleston, SC.,Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC
| | - G Russell Glenn
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC
| | - Jens H Jensen
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Joseph A Helpern
- Department of Neurology, Medical University of South Carolina, Charleston, SC.,Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC
| | - Andy Y Shih
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC
| | - M Vittoria Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC
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39
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Nozari N, Faroqi-Shah Y. Investigating the origin of nonfluency in aphasia: A path modeling approach to neuropsychology. Cortex 2017; 95:119-135. [PMID: 28866301 DOI: 10.1016/j.cortex.2017.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/07/2017] [Accepted: 08/01/2017] [Indexed: 11/16/2022]
Abstract
A major challenge in understanding the origin of clinical symptoms in neuropsychological impairments is capturing the complexity of the underlying cognitive structure. This paper presents a practical guide to path modeling, a statistical approach that is well-suited for modeling multivariate outcomes with a multi-factorial origin. We discuss a step-by-step application of such a model to the problem of nonfluency in aphasia. Individuals with aphasia are often classified into fluent and nonfluent groups for both clinical and research purposes, but despite a large body of research on the topic, the origin of nonfluency remains obscure. We propose a model of nonfluency inspired by the psycholinguistic approach to sentence production, review several bodies of work that have independently suggested a relationship between fluency and various elements in this model, and implement it using path modeling on data from 112 individuals with aphasia from the AphasiaBank. The results show that word production, comprehension, and working memory deficits all contribute to nonfluency, in addition to syntactic impairment which has a strong and direct impact on fluency. More generally, we demonstrate that a path model is an excellent tool for exploring complex neuropsychological symptoms such as nonfluency.
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Affiliation(s)
- Nazbanou Nozari
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA.
| | - Yasmeen Faroqi-Shah
- Department of Hearing and Speech Sciences, University of Maryland, College Park, MD, USA.
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40
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Pustina D, Coslett HB, Ungar L, Faseyitan OK, Medaglia JD, Avants B, Schwartz MF. Enhanced estimations of post-stroke aphasia severity using stacked multimodal predictions. Hum Brain Mapp 2017; 38:5603-5615. [PMID: 28782862 DOI: 10.1002/hbm.23752] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/13/2017] [Accepted: 07/23/2017] [Indexed: 01/03/2023] Open
Abstract
The severity of post-stroke aphasia and the potential for recovery are highly variable and difficult to predict. Evidence suggests that optimal estimation of aphasia severity requires the integration of multiple neuroimaging modalities and the adoption of new methods that can detect multivariate brain-behavior relationships. We created and tested a multimodal framework that relies on three information sources (lesion maps, structural connectivity, and functional connectivity) to create an array of unimodal predictions which are then fed into a final model that creates "stacked multimodal predictions" (STAMP). Crossvalidated predictions of four aphasia scores (picture naming, sentence repetition, sentence comprehension, and overall aphasia severity) were obtained from 53 left hemispheric chronic stroke patients (age: 57.1 ± 12.3 yrs, post-stroke interval: 20 months, 25 female). Results showed accurate predictions for all four aphasia scores (correlation true vs. predicted: r = 0.79-0.88). The accuracy was slightly smaller but yet significant (r = 0.66) in a full split crossvalidation with each patient considered as new. Critically, multimodal predictions produced more accurate results that any single modality alone. Topological maps of the brain regions involved in the prediction were recovered and compared with traditional voxel-based lesion-to-symptom maps, revealing high spatial congruency. These results suggest that neuroimaging modalities carry complementary information potentially useful for the prediction of aphasia scores. More broadly, this study shows that the translation of neuroimaging findings into clinically useful tools calls for a shift in perspective from unimodal to multimodal neuroimaging, from univariate to multivariate methods, from linear to nonlinear models, and, conceptually, from inferential to predictive brain mapping. Hum Brain Mapp 38:5603-5615, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Dorian Pustina
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Radiology, Penn Image Computing and Science Lab, University of Pennsylvania, Pennsylvania
| | | | - Lyle Ungar
- Department of Computer and Information Science Department, University of Pennsylvania, Pennsylvania
| | | | - John D Medaglia
- Department of Psychology, University of Pennsylvania, Pennsylvania
| | - Brian Avants
- Department of Radiology, Penn Image Computing and Science Lab, University of Pennsylvania, Pennsylvania
| | - Myrna F Schwartz
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
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41
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Berthier ML, De-Torres I, Paredes-Pacheco J, Roé-Vellvé N, Thurnhofer-Hemsi K, Torres-Prioris MJ, Alfaro F, Moreno-Torres I, López-Barroso D, Dávila G. Cholinergic Potentiation and Audiovisual Repetition-Imitation Therapy Improve Speech Production and Communication Deficits in a Person with Crossed Aphasia by Inducing Structural Plasticity in White Matter Tracts. Front Hum Neurosci 2017; 11:304. [PMID: 28659776 PMCID: PMC5470532 DOI: 10.3389/fnhum.2017.00304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/26/2017] [Indexed: 12/18/2022] Open
Abstract
Donepezil (DP), a cognitive-enhancing drug targeting the cholinergic system, combined with massed sentence repetition training augmented and speeded up recovery of speech production deficits in patients with chronic conduction aphasia and extensive left hemisphere infarctions (Berthier et al., 2014). Nevertheless, a still unsettled question is whether such improvements correlate with restorative structural changes in gray matter and white matter pathways mediating speech production. In the present study, we used pharmacological magnetic resonance imaging to study treatment-induced brain changes in gray matter and white matter tracts in a right-handed male with chronic conduction aphasia and a right subcortical lesion (crossed aphasia). A single-patient, open-label multiple-baseline design incorporating two different treatments and two post-treatment evaluations was used. The patient received an initial dose of DP (5 mg/day) which was maintained during 4 weeks and then titrated up to 10 mg/day and administered alone (without aphasia therapy) during 8 weeks (Endpoint 1). Thereafter, the drug was combined with an audiovisual repetition-imitation therapy (Look-Listen-Repeat, LLR) during 3 months (Endpoint 2). Language evaluations, diffusion weighted imaging (DWI), and voxel-based morphometry (VBM) were performed at baseline and at both endpoints in JAM and once in 21 healthy control males. Treatment with DP alone and combined with LLR therapy induced marked improvement in aphasia and communication deficits as well as in selected measures of connected speech production, and phrase repetition. The obtained gains in speech production remained well-above baseline scores even 4 months after ending combined therapy. Longitudinal DWI showed structural plasticity in the right frontal aslant tract and direct segment of the arcuate fasciculus with both interventions. VBM revealed no structural changes in other white matter tracts nor in cortical areas linked by these tracts. In conclusion, cholinergic potentiation alone and combined with a model-based aphasia therapy improved language deficits by promoting structural plastic changes in right white matter tracts.
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Affiliation(s)
- Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain
| | - Irene De-Torres
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain.,Unit of Physical Medicine and Rehabilitation, Regional University Hospital, MalagaMalaga, Spain
| | - José Paredes-Pacheco
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain
| | - Núria Roé-Vellvé
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain
| | - Karl Thurnhofer-Hemsi
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain.,Department of Computer Languages and Computer Science, Superior Technical School of Engineering in Informatics, University of MalagaMalaga, Spain
| | - María J Torres-Prioris
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain.,Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of MalagaMalaga, Spain
| | - Francisco Alfaro
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain
| | - Ignacio Moreno-Torres
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain.,Department of Spanish Language I, University of MalagaMalaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain.,Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of MalagaMalaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga, University of MalagaMalaga, Spain.,Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of MalagaMalaga, Spain
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42
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Skipper‐Kallal LM, Lacey EH, Xing S, Turkeltaub PE. Functional activation independently contributes to naming ability and relates to lesion site in post-stroke aphasia. Hum Brain Mapp 2017; 38:2051-2066. [PMID: 28083891 PMCID: PMC6867020 DOI: 10.1002/hbm.23504] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/27/2016] [Accepted: 12/15/2016] [Indexed: 11/06/2022] Open
Abstract
Language network reorganization in aphasia may depend on the degree of damage in critical language areas, making it difficult to determine how reorganization impacts performance. Prior studies on remapping of function in aphasia have not accounted for the location of the lesion relative to critical language areas. They rectified this problem by using a multimodal approach, combining multivariate lesion-symptom mapping and fMRI in chronic aphasia to understand the independent contributions to naming performance of the lesion and the activity in both hemispheres. Activity was examined during two stages of naming: covert retrieval, and overt articulation. Regions of interest were drawn based on over- and under-activation, and in areas where activity had a bivariate relationship with naming. Regressions then tested whether activation of these regions predicted naming ability, while controlling for lesion size and damage in critical left hemisphere naming areas, as determined by lesion-symptom mapping. Engagement of the right superior temporal sulcus (STS) and disengagement of the left dorsal pars opercularis (dPOp) during overt naming was associated with better than predicted naming performance. Lesions in the left STS prevented right STS engagement and resulted in persistent left dPOp activation. In summary, changes in activity during overt articulation independently relate to naming outcomes, controlling for stroke severity. Successful remapping relates to network disruptions that depend on the location of the lesion in the left hemisphere. Hum Brain Mapp 38:2051-2066, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Elizabeth H. Lacey
- Department of NeurologyGeorgetown University Medical CenterWashingtonDC
- Research Division, MedStar National Rehabilitation HospitalWashingtonDC
| | - Shihui Xing
- Department of NeurologyGeorgetown University Medical CenterWashingtonDC
- First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Peter E. Turkeltaub
- Department of NeurologyGeorgetown University Medical CenterWashingtonDC
- Research Division, MedStar National Rehabilitation HospitalWashingtonDC
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43
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Cramer SC, Wolf SL, Adams HP, Chen D, Dromerick AW, Dunning K, Ellerbe C, Grande A, Janis S, Lansberg MG, Lazar RM, Palesch YY, Richards L, Roth E, Savitz SI, Wechsler LR, Wintermark M, Broderick JP. Stroke Recovery and Rehabilitation Research: Issues, Opportunities, and the National Institutes of Health StrokeNet. Stroke 2017; 48:813-819. [PMID: 28174324 DOI: 10.1161/strokeaha.116.015501] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/14/2016] [Accepted: 01/05/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Steven C Cramer
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH.
| | - Steven L Wolf
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Harold P Adams
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Daofen Chen
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Alexander W Dromerick
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Kari Dunning
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Caitlyn Ellerbe
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Andrew Grande
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Scott Janis
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Maarten G Lansberg
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Ronald M Lazar
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Yuko Y Palesch
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Lorie Richards
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Elliot Roth
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Sean I Savitz
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Lawrence R Wechsler
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Max Wintermark
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
| | - Joseph P Broderick
- From the Departments of Neurology, Anatomy and Neurobiology (S.C.C.), and Physical Medicine and Rehabilitation (S.C.C.), and the Sue and Bill Gross Stem Cell Research Center (S.C.C.), University of California, Irvine; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.); Atlanta VA Center for Visual and Neurocognitive Rehabilitation, GA (S.L.W.); Department of Neurology, University of Iowa, Iowa City (H.P.A.); Extramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (D.C.); Department of Rehabilitation Medicine, MedStar National Rehabilitation Hospital, Georgetown University, Washington, DC (A.W.D.); Washington DC VA Medical Center (A.W.D.); Department of Rehabilitation Sciences, University of Cincinnati, OH (K.D.); Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (C.E., Y.Y.P.); Department of Neurosurgery, University of Minnesota, Minneapolis (A.G.); Office of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.J.); Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L.); Stroke Division, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (R.M.L.); Department of Occupational Therapy, University of Utah, Salt Lake City (L.R.); Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL (E.R.); Department of Neurology, University of Texas, Houston (S.I.S.); Department of Neurology, University of Pittsburgh Medical School, PA (L.R.W.); Neuroradiology Section, Department of Radiology, Stanford Healthcare and School of Medicine, CA (M.W.); University of Cincinnati Gardner Neuroscience Institute (J.P.B.) and Department of Neurology and Rehabilitation Medicine (J.P.B.), University of Cincinnati, OH
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Koyama T, Domen K. Reduced Diffusion Tensor Fractional Anisotropy in the Left Arcuate Fasciculus of Patients with Aphasia Caused by Acute Cerebral Infarct. Prog Rehabil Med 2016; 1:20160008. [PMID: 32789205 DOI: 10.2490/prm.20160008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/20/2016] [Indexed: 12/23/2022] Open
Abstract
Background Magnetic resonance diffusion tensor imaging (DTI) is a new technique that evaluates neural fiber integrity within the brain. We conducted DTI in patients exhibiting aphasia during the acute stage post-infarct and investigated the neural tracts responsible by comparison with DTI data from age-matched controls. Methods Fractional anisotropy (FA) maps were generated from diffusion tensor brain images obtained from aphasic patients 14-21 days following their first infarct. Tract-based spatial statistics (TBSS) analysis was then applied. In addition, regions of interest (ROIs) were set within the right and left arcuate fasciculus, and mean FA values were extracted from individual TBSS data. The ratios between FA values in the left and right hemispheres were compared with those of the control group. Results The study examined 10 aphasic patients and 21 age-matched controls. Brain maps from TBSS analysis revealed significantly reduced FA in the left arcuate fasciculus of the patient group compared with that in the control group. Further ROI analyses confirmed significantly lower left/right arcuate fasciculus FA ratios in aphasic patients versus controls (median [range]: 0.955 [0.739-1.023] vs. 1.006 [0.982-1.088]; P = 0.0001 by Wilcoxon rank sum test). Conclusions These results suggest that FA in the left arcuate fasciculus decreased in association with aphasia after cerebral infarct. Because patients in the acute stage have not yet experienced the neural recovery that occurs in the chronic stage, the findings indicate that the left arcuate fasciculus is a crucial neural structure in aphasia.
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Affiliation(s)
- Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan.,Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Allendorfer JB, Hernando KA, Hossain S, Nenert R, Holland SK, Szaflarski JP. Arcuate fasciculus asymmetry has a hand in language function but not handedness. Hum Brain Mapp 2016; 37:3297-309. [PMID: 27144738 DOI: 10.1002/hbm.23241] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 11/09/2022] Open
Abstract
The importance of relationships between handedness, language lateralization and localization, and white matter tracts for language performance is unclear. The goal of the study was to investigate these relationships by examining arcuate fasciculus (AF) structural asymmetry (DTI) and functional asymmetry (fMRI) in language circuits, handedness, and linguistic performance. A large sample of right-handed (n = 158) and atypical-handed (n = 82) healthy adults underwent DTI at 3 T to assess number of streamlines and fractional anisotropy (FA) of the AF, and language fMRI. Language functions were assessed using standard tests of vocabulary, naming, verbal fluency, and complex ideation. Laterality indices (LIs) illustrated degree of asymmetry and lateralization patterns for the AF (streamlines and FA) and verb generation fMRI. Both handedness groups showed leftward lateralization bias for streamline and fMRI LIs and symmetry for FA LI. The proportion of subjects with left, right, or symmetric lateralization were similar between groups if based on AF LIs, but differed if based on fMRI LIs (p = 0.0016). Degree of right-handedness was not associated with AF lateralization, but was associated with fMRI language lateralization (p = 0.0014). FA LI was not associated with performance on language assessments, but streamline LI was associated with better vocabulary and complex ideation performance in atypical-handed subjects (p = 0.022 and p = 0.0098, respectively), and better semantic fluency in right-handed subjects (p = 0.047); however, these did not survive multiple comparisons correction. We provide evidence that AF asymmetry is independent of hand preference, and while degree of right-handedness is associated with hemispheric language lateralization, the majority of atypical-handed individuals are left-lateralized for language. Hum Brain Mapp 37:3297-3309, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kathleen A Hernando
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shyla Hossain
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Scott K Holland
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
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Pustina D, Coslett HB, Turkeltaub PE, Tustison N, Schwartz MF, Avants B. Automated segmentation of chronic stroke lesions using LINDA: Lesion identification with neighborhood data analysis. Hum Brain Mapp 2016; 37:1405-21. [PMID: 26756101 PMCID: PMC4783237 DOI: 10.1002/hbm.23110] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/21/2015] [Indexed: 12/12/2022] Open
Abstract
The gold standard for identifying stroke lesions is manual tracing, a method that is known to be observer dependent and time consuming, thus impractical for big data studies. We propose LINDA (Lesion Identification with Neighborhood Data Analysis), an automated segmentation algorithm capable of learning the relationship between existing manual segmentations and a single T1-weighted MRI. A dataset of 60 left hemispheric chronic stroke patients is used to build the method and test it with k-fold and leave-one-out procedures. With respect to manual tracings, predicted lesion maps showed a mean dice overlap of 0.696 ± 0.16, Hausdorff distance of 17.9 ± 9.8 mm, and average displacement of 2.54 ± 1.38 mm. The manual and predicted lesion volumes correlated at r = 0.961. An additional dataset of 45 patients was utilized to test LINDA with independent data, achieving high accuracy rates and confirming its cross-institutional applicability. To investigate the cost of moving from manual tracings to automated segmentation, we performed comparative lesion-to-symptom mapping (LSM) on five behavioral scores. Predicted and manual lesions produced similar neuro-cognitive maps, albeit with some discussed discrepancies. Of note, region-wise LSM was more robust to the prediction error than voxel-wise LSM. Our results show that, while several limitations exist, our current results compete with or exceed the state-of-the-art, producing consistent predictions, very low failure rates, and transferable knowledge between labs. This work also establishes a new viewpoint on evaluating automated methods not only with segmentation accuracy but also with brain-behavior relationships. LINDA is made available online with trained models from over 100 patients.
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Affiliation(s)
- Dorian Pustina
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Penn Image Computing and Science Lab, Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - H. Branch Coslett
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Peter E. Turkeltaub
- Department of NeurologyGeorgetown UniversityWashingtonDC
- Research DivisionMedStar National Rehabilitation HospitalWashingtonDC
| | - Nicholas Tustison
- Department of Radiology and Medical ImagingUniversity of Virginia, Virginia
| | - Myrna F. Schwartz
- Language and Aphasia Lab, Moss Rehabilitation Research InstituteElkins ParkPennsylvania
| | - Brian Avants
- Penn Image Computing and Science Lab, Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPennsylvania
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Pani E, Zheng X, Wang J, Norton A, Schlaug G. Right hemisphere structures predict poststroke speech fluency. Neurology 2016; 86:1574-81. [PMID: 27029627 DOI: 10.1212/wnl.0000000000002613] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/19/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We sought to determine via a cross-sectional study the contribution of (1) the right hemisphere's speech-relevant white matter regions and (2) interhemispheric connectivity to speech fluency in the chronic phase of left hemisphere stroke with aphasia. METHODS Fractional anisotropy (FA) of white matter regions underlying the right middle temporal gyrus (MTG), precentral gyrus (PreCG), pars opercularis (IFGop) and triangularis (IFGtri) of the inferior frontal gyrus, and the corpus callosum (CC) was correlated with speech fluency measures. A region within the superior parietal lobule (SPL) was examined as a control. FA values of regions that significantly predicted speech measures were compared with FA values from healthy age- and sex-matched controls. RESULTS FA values for the right MTG, PreCG, and IFGop significantly predicted speech fluency, but FA values of the IFGtri and SPL did not. A multiple regression showed that combining FA of the significant right hemisphere regions with the lesion load of the left arcuate fasciculus-a previously identified biomarker of poststroke speech fluency-provided the best model for predicting speech fluency. FA of CC fibers connecting left and right supplementary motor areas (SMA) was also correlated with speech fluency. FA of the right IFGop and PreCG was significantly higher in patients than controls, while FA of a whole CC region of interest (ROI) and the CC-SMA ROI was significantly lower in patients. CONCLUSIONS Right hemisphere white matter integrity is related to speech fluency measures in patients with chronic aphasia. This may indicate premorbid anatomical variability beneficial for recovery or be the result of poststroke remodeling.
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Affiliation(s)
- Ethan Pani
- From the Department of Neurology, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Xin Zheng
- From the Department of Neurology, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Jasmine Wang
- From the Department of Neurology, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Andrea Norton
- From the Department of Neurology, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Gottfried Schlaug
- From the Department of Neurology, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
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Berthier ML, Dávila G, Moreno-Torres I, Beltrán-Corbellini Á, Santana-Moreno D, Roé-Vellvé N, Thurnhofer-Hemsi K, Torres-Prioris MJ, Massone MI, Ruiz-Cruces R. Loss of regional accent after damage to the speech production network. Front Hum Neurosci 2015; 9:610. [PMID: 26594161 PMCID: PMC4633569 DOI: 10.3389/fnhum.2015.00610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/23/2015] [Indexed: 11/18/2022] Open
Abstract
Lesion-symptom mapping studies reveal that selective damage to one or more components of the speech production network can be associated with foreign accent syndrome, changes in regional accent (e.g., from Parisian accent to Alsatian accent), stronger regional accent, or re-emergence of a previously learned and dormant regional accent. Here, we report loss of regional accent after rapidly regressive Broca's aphasia in three Argentinean patients who had suffered unilateral or bilateral focal lesions in components of the speech production network. All patients were monolingual speakers with three different native Spanish accents (Cordobés or central, Guaranítico or northeast, and Bonaerense). Samples of speech production from the patient with native Córdoba accent were compared with previous recordings of his voice, whereas data from the patient with native Guaranítico accent were compared with speech samples from one healthy control matched for age, gender, and native accent. Speech samples from the patient with native Buenos Aires's accent were compared with data obtained from four healthy control subjects with the same accent. Analysis of speech production revealed discrete slowing in speech rate, inappropriate long pauses, and monotonous intonation. Phonemic production remained similar to those of healthy Spanish speakers, but phonetic variants peculiar to each accent (e.g., intervocalic aspiration of /s/ in Córdoba accent) were absent. While basic normal prosodic features of Spanish prosody were preserved, features intrinsic to melody of certain geographical areas (e.g., rising end F0 excursion in declarative sentences intoned with Córdoba accent) were absent. All patients were also unable to produce sentences with different emotional prosody. Brain imaging disclosed focal left hemisphere lesions involving the middle part of the motor cortex, the post-central cortex, the posterior inferior and/or middle frontal cortices, insula, anterior putamen and supplementary motor area. Our findings suggest that lesions affecting the middle part of the left motor cortex and other components of the speech production network disrupt neural processes involved in the production of regional accent features.
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Affiliation(s)
- Marcelo L. Berthier
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
- Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of MalagaMalaga, Spain
| | - Ignacio Moreno-Torres
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
- Department of Spanish Language I, University of MalagaMalaga, Spain
| | - Álvaro Beltrán-Corbellini
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
| | - Daniel Santana-Moreno
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
| | - Núria Roé-Vellvé
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain
| | - Karl Thurnhofer-Hemsi
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of MalagaMalaga, Spain
- Department of Applied Mathematics, Superior Technical School of Engineering in Informatics, University of MalagaMalaga, Spain
| | - María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
| | - María Ignacia Massone
- Centro de Investigaciones en Antropología Filosófica y Cultural, Consejo Nacional de Investigaciones Científicas y TécnicasBuenos Aires, Argentina
| | - Rafael Ruiz-Cruces
- Cognitive Neurology and Aphasia Unit and Cathedra Foundation Morera and Vallejo of Aphasia, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain
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Distinguishing the effect of lesion load from tract disconnection in the arcuate and uncinate fasciculi. Neuroimage 2015; 125:1169-1173. [PMID: 26388553 PMCID: PMC4692449 DOI: 10.1016/j.neuroimage.2015.09.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/10/2015] [Indexed: 12/19/2022] Open
Abstract
Brain imaging studies of functional outcomes after white matter damage have quantified the severity of white matter damage in different ways. Here we compared how the outcome of such studies depends on two different types of measurements: the proportion of the target tract that has been destroyed (‘lesion load’) and tract disconnection. We demonstrate that conclusions from analyses based on two examples of these measures diverge and that conclusions based solely on lesion load may be misleading. First, we reproduce a recent lesion-load-only analysis which suggests that damage to the arcuate fasciculus, and not to the uncinate fasciculus, is significantly associated with deficits in fluency and naming skills. Next, we repeat the analysis after replacing the measures of lesion load with measures of tract disconnection for both tracts, and observe significant associations between both tracts and both language skills: i.e. the change increases the apparent relevance of the uncinate fasciculus to fluency and naming skills. Finally we show that, in this dataset, disconnection data explains significant variance in both language skills that is not accounted for by lesion load or volume, but lesion load data explains no unique variance in those skills, once disconnection and lesion volume are taken into account.
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50
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Bonilha L, Gleichgerrcht E, Nesland T, Rorden C, Fridriksson J. Success of Anomia Treatment in Aphasia Is Associated With Preserved Architecture of Global and Left Temporal Lobe Structural Networks. Neurorehabil Neural Repair 2015; 30:266-79. [PMID: 26150147 DOI: 10.1177/1545968315593808] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Targeted speech therapy can lead to substantial naming improvement in some subjects with anomia following dominant-hemisphere stroke. We investigated whether treatment-induced improvement in naming is associated with poststroke preservation of structural neural network architecture. METHODS Twenty-four patients with poststroke chronic aphasia underwent 30 hours of speech therapy over a 2-week period and were assessed at baseline and after therapy. Whole brain maps of neural architecture were constructed from pretreatment diffusion tensor magnetic resonance imaging to derive measures of global brain network architecture (network small-worldness) and regional network influence (nodal betweenness centrality). Their relationship with naming recovery was evaluated with multiple linear regressions. RESULTS Treatment-induced improvement in correct naming was associated with poststroke preservation of global network small worldness and of betweenness centrality in temporal lobe cortical regions. Together with baseline aphasia severity, these measures explained 78% of the variability in treatment response. CONCLUSIONS Preservation of global and left temporal structural connectivity broadly explains the variability in treatment-related naming improvement in aphasia. These findings corroborate and expand on previous classical lesion-symptom mapping studies by elucidating some of the mechanisms by which brain damage may relate to treated aphasia recovery. Favorable naming outcomes may result from the intact connections between spared cortical areas that are functionally responsive to treatment.
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Affiliation(s)
| | | | - Travis Nesland
- Medical University of South Carolina, Charleston, SC, USA
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