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Cherney LR, Kozlowski AJ, Domenighetti AA, Baliki MN, Kwasny MJ, Heinemann AW. Defining Trajectories of Linguistic, Cognitive-Communicative, and Quality of Life Outcomes in Aphasia: Longitudinal Observational Study Protocol. Arch Rehabil Res Clin Transl 2024; 6:100339. [PMID: 39006119 PMCID: PMC11240047 DOI: 10.1016/j.arrct.2024.100339] [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] [Indexed: 07/16/2024] Open
Abstract
Objective To describe the trajectories of linguistic, cognitive-communicative, and health-related quality of life (HRQOL) outcomes after stroke in persons with aphasia. Design Longitudinal observational study from inpatient rehabilitation to 18 months after stroke. Setting Four US mid-west inpatient rehabilitation facilities (IRFs). Participants We plan to recruit 400 adult (older than 21 years) English speakers who meet the following inclusion criteria: (1) Diagnosis of aphasia after a left-hemisphere infarct confirmed by CT scan or magnetic resonance imaging (MRI); (2) first admission for inpatient rehabilitation due to a neurologic event; and (3) sufficient cognitive capacity to provide informed consent and participate in testing. Exclusion criteria include any neurologic condition other than stroke that could affect language, cognition or speech, such as Parkinson's disease, Alzheimer's disease, traumatic brain injury, or the presence of right-hemisphere lesions. Interventions Not applicable. Main Outcome Measures Subjects are administered a test battery of linguistic, cognitive-communicative, and HRQOL measures. Linguistic measures include the Western Aphasia Battery-Revised and the Apraxia of Speech Rating Scale. Cognitive-communicative measures include the Communication Participation Item Bank, Connor's Continuous Performance Test-3, the Communication Confidence Rating Scale for Aphasia, the Communication Effectiveness Index, the Neurological Quality of Life measurement system (Neuro-QoL) Communication short form, and the Neuro-QoL Cognitive Function short form. HRQOL measures include the 39-item Stroke & Aphasia Quality of Life Scale, Neuro-QoL Fatigue, Sleep Disturbance, Depression, Ability to Participate in Social Roles & Activities, and Satisfaction with Social Roles & Activities tests, and the Patient-Reported Outcome Measurement and Information System 10-item Global Health short form. The test battery is administered initially during inpatient rehabilitation, and at 3-, 6-, 12-, and 18-months post-IRF discharge. Biomarker samples are collected via saliva samples at admission and a subgroup of participants also undergo resting state fMRI scans. Results Not applicable. Conclusions This longitudinal observational study will develop trajectory models for recovery of clinically relevant linguistic, cognitive-communicative, and quality of life outcomes over 18 months after inpatient rehabilitation. Models will identify individual differences in the patterns of recovery based on variations in personal, genetic, imaging, and therapy characteristics. The resulting models will provide an unparalleled representation of recovery from aphasia resulting from stroke. This improved understanding of recovery will enable clinicians to better tailor and plan rehabilitation therapies to individual patient's needs.
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Affiliation(s)
- Leora R Cherney
- Shirley Ryan AbilityLab, Chicago, IL
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Allan J Kozlowski
- John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI
| | - Andrea A Domenighetti
- Shirley Ryan AbilityLab, Chicago, IL
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Marwan N Baliki
- Shirley Ryan AbilityLab, Chicago, IL
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mary J Kwasny
- Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Billot A, Kiran S. Disentangling neuroplasticity mechanisms in post-stroke language recovery. BRAIN AND LANGUAGE 2024; 251:105381. [PMID: 38401381 PMCID: PMC10981555 DOI: 10.1016/j.bandl.2024.105381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/28/2023] [Accepted: 01/12/2024] [Indexed: 02/26/2024]
Abstract
A major objective in post-stroke aphasia research is to gain a deeper understanding of neuroplastic mechanisms that drive language recovery, with the ultimate goal of enhancing treatment outcomes. Subsequent to recent advances in neuroimaging techniques, we now have the ability to examine more closely how neural activity patterns change after a stroke. However, the way these neural activity changes relate to language impairments and language recovery is still debated. The aim of this review is to provide a theoretical framework to better investigate and interpret neuroplasticity mechanisms underlying language recovery in post-stroke aphasia. We detail two sets of neuroplasticity mechanisms observed at the synaptic level that may explain functional neuroimaging findings in post-stroke aphasia recovery at the network level: feedback-based homeostatic plasticity and associative Hebbian plasticity. In conjunction with these plasticity mechanisms, higher-order cognitive control processes dynamically modulate neural activity in other regions to meet communication demands, despite reduced neural resources. This work provides a network-level neurobiological framework for understanding neural changes observed in post-stroke aphasia and can be used to define guidelines for personalized treatment development.
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Affiliation(s)
- Anne Billot
- Center for Brain Recovery, Boston University, Boston, USA; Department of Psychology, Center for Brain Science, Harvard University, Cambridge, Massachusetts, USA; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Swathi Kiran
- Center for Brain Recovery, Boston University, Boston, USA.
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Meier EL, Sheppard SM, Sebastian R, Berube S, Goldberg EB, Shea J, Stein CM, Hillis AE. Resting state correlates of picture description informativeness in left vs. right hemisphere chronic stroke. Front Neurol 2023; 14:1288801. [PMID: 38145117 PMCID: PMC10744570 DOI: 10.3389/fneur.2023.1288801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Despite a growing emphasis on discourse processing in clinical neuroscience, relatively little is known about the neurobiology of discourse production impairments. Individuals with a history of left or right hemisphere stroke can exhibit difficulty with communicating meaningful discourse content, which implies both cerebral hemispheres play a role in this skill. However, the extent to which successful production of discourse content relies on network connections within domain-specific vs. domain-general networks in either hemisphere is unknown. Methods In this study, 45 individuals with a history of either left or right hemisphere stroke completed resting state fMRI and the Cookie Theft picture description task. Results Participants did not differ in the total number of content units or the percentage of interpretative content units they produced. Stroke survivors with left hemisphere damage produced significantly fewer content units per second than individuals with right hemisphere stroke. Intrinsic connectivity of the left language network was significantly weaker in the left compared to the right hemisphere stroke group for specific connections. Greater efficiency of communication of picture scene content was associated with stronger left but weaker right frontotemporal connectivity of the language network in patients with a history of left hemisphere (but not right hemisphere) stroke. No significant relationships were found between picture description measures and connectivity of the dorsal attention, default mode, or salience networks or with connections between language and other network regions. Discussion These findings add to prior behavioral studies of picture description skills in stroke survivors and provide insight into the role of the language network vs. other intrinsic networks during discourse production.
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Affiliation(s)
- Erin L. Meier
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Shannon M. Sheppard
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - Shauna Berube
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer Shea
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Colin M. Stein
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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4
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Altered Spontaneous Brain Activity in Poststroke Aphasia: A Resting-State fMRI Study. Brain Sci 2023; 13:brainsci13020300. [PMID: 36831843 PMCID: PMC9954170 DOI: 10.3390/brainsci13020300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
PURPOSE Brain areas frequently implicated in language recovery after stroke comprise perilesional sites in the left hemisphere and homotopic regions in the right hemisphere. However, the neuronal mechanisms underlying language restoration are still largely unclear. METHODS AND MATERIALS In the present study, we investigated the brain function in 15 patients with poststroke aphasia and 30 matched control subjects by combining the regional homogeneity (ReHo) and amplitudes of low-frequency fluctuation (ALFF) analysis methods based on resting-state fMRI. RESULTS Compared to the control subjects, the patients with aphasia exhibited increased ReHo and ALFF values in the ipsilateral perilesional areas and increased ReHo in the contralesional right middle frontal gyrus. CONCLUSIONS The increased spontaneous brain activity in patients with poststroke aphasia during the recovery period, specifically in the ipsilateral perilesional regions and the homologous language regions of the right hemisphere, has potential implications for the treatment of patients with aphasia.
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Shah-Basak P, Boukrina O, Li XR, Jebahi F, Kielar A. Targeted neurorehabilitation strategies in post-stroke aphasia. Restor Neurol Neurosci 2023; 41:129-191. [PMID: 37980575 PMCID: PMC10741339 DOI: 10.3233/rnn-231344] [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: 11/21/2023]
Abstract
BACKGROUND Aphasia is a debilitating language impairment, affecting millions of people worldwide. About 40% of stroke survivors develop chronic aphasia, resulting in life-long disability. OBJECTIVE This review examines extrinsic and intrinsic neuromodulation techniques, aimed at enhancing the effects of speech and language therapies in stroke survivors with aphasia. METHODS We discuss the available evidence supporting the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation, and functional MRI (fMRI) real-time neurofeedback in aphasia rehabilitation. RESULTS This review systematically evaluates studies focusing on efficacy and implementation of specialized methods for post-treatment outcome optimization and transfer to functional skills. It considers stimulation target determination and various targeting approaches. The translation of neuromodulation interventions to clinical practice is explored, emphasizing generalization and functional communication. The review also covers real-time fMRI neurofeedback, discussing current evidence for efficacy and essential implementation parameters. Finally, we address future directions for neuromodulation research in aphasia. CONCLUSIONS This comprehensive review aims to serve as a resource for a broad audience of researchers and clinicians interested in incorporating neuromodulation for advancing aphasia care.
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Affiliation(s)
| | - Olga Boukrina
- Kessler Foundation, Center for Stroke Rehabilitation Research, West Orange, NJ, USA
| | - Xin Ran Li
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Fatima Jebahi
- Department of Speech, Languageand Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Aneta Kielar
- Department of Speech, Languageand Hearing Sciences, University of Arizona, Tucson, AZ, USA
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Abstract
Although language deficits are the primary area of weakness, people with poststroke aphasia often experience challenges with nonlinguistic cognitive skills, including attention processing. The purpose of this review is to synthesize the evidence for the relationship between attention deficits and language deficits in people with poststroke aphasia. Three different types of studies are reviewed: (1) studies exploring whether people with poststroke aphasia exhibit concomitant attention and language deficits, (2) studies explicitly exploring the relationship between attention and language deficits in people with poststroke aphasia, and (3) either language or attention (or both) treatment studies exploring whether treatment gains in one domain generalize to the other. In the last section, we briefly review research evidence for the neural basis of the attention-language relationship in aphasia.
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Affiliation(s)
- Maria Varkanitsa
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health and Rehabilitation, Boston, MA, USA
| | - Erin Godecke
- Edith Cowan University and Sir Charles Gairdner Hospital, Perth, Australia
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Sargent College of Health and Rehabilitation, Boston, MA, USA
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Kristinsson S, den Ouden DB, Rorden C, Newman-Norlund R, Neils-Strunjas J, Fridriksson J. Predictors of Therapy Response in Chronic Aphasia: Building a Foundation for Personalized Aphasia Therapy. J Stroke 2022; 24:189-206. [PMID: 35677975 PMCID: PMC9194549 DOI: 10.5853/jos.2022.01102] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic aphasia, a devastating impairment of language, affects up to a third of stroke survivors. Speech and language therapy has consistently been shown to improve language function in prior clinical trials, but few clinicially applicable predictors of individual therapy response have been identified to date. Consequently, clinicians struggle substantially with prognostication in the clinical management of aphasia. A rising prevalence of aphasia, in particular in younger populations, has emphasized the increasing demand for a personalized approach to aphasia therapy, that is, therapy aimed at maximizing language recovery of each individual with reference to evidence-based clinical recommendations. In this narrative review, we discuss the current state of the literature with respect to commonly studied predictors of therapy response in aphasia. In particular, we focus our discussion on biographical, neuropsychological, and neurobiological predictors, and emphasize limitations of the literature, summarize consistent findings, and consider how the research field can better support the development of personalized aphasia therapy. In conclusion, a review of the literature indicates that future research efforts should aim to recruit larger samples of people with aphasia, including by establishing multisite aphasia research centers.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
- Correspondence: Sigfus Kristinsson Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, SC 29209, USA Tel: +1-803-553-4689 Fax: +1-803-777-9547 E-mail:
| | - Dirk B. den Ouden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Roger Newman-Norlund
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
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8
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Structural Integrity and Functional Neural Activity Associated with Oral Language Function after Stroke. J Clin Med 2022; 11:jcm11113028. [PMID: 35683416 PMCID: PMC9180994 DOI: 10.3390/jcm11113028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: The impairment of language function after a stroke is common. It is unclear how the brain reorganizes for language function after cerebral infarction. The aim of this observational study is to investigate the association of structural integrity and functional neural activity with language function in aphasic patients with middle cerebral artery infarction. (2) Methods: Magnetic resonance images and scores from the Western Aphasia Battery on 20 patients were retrieved from medical records. A Voxel-wise linear regression analysis was performed using fractional anisotropy maps or the fractional amplitude of low-frequency fluctuation maps as dependent variables and scores of oral language function as independent variables while controlling for age and time elapsed after stroke. (3) Results: Spontaneous speech was positively associated with fractional anisotropy in the left dorsal stream and the right posterior corpus callosum and with the fractional amplitude of the low-frequency fluctuation of cranial nuclei in the pontomedullary junction. Comprehension was positively associated with the left ventral stream. Naming was positively associated with the left ventral stream and the bilateral occipitofrontal fasciculus, as well as with the fractional amplitude of low-frequency fluctuation of the supramarginal gyrus in the left hemisphere. (4) Conclusions: The dorsal and ventral streams are important for articulation and meaning after the reorganization of neural circuits following stroke. Subdomains of oral language function with a visual component are dependent on the visual association areas located in the right hemisphere.
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9
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Meier EL, Kelly CR, Hillis AE. Dissociable language and executive control deficits and recovery in post-stroke aphasia: An exploratory observational and case series study. Neuropsychologia 2022; 172:108270. [PMID: 35597266 PMCID: PMC9728463 DOI: 10.1016/j.neuropsychologia.2022.108270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 04/30/2022] [Accepted: 05/13/2022] [Indexed: 01/04/2023]
Abstract
A growing body of evidence indicates many, but not all, individuals with post-stroke aphasia experience executive dysfunction. Relationships between language and executive function skills are often reported in the literature, but the degree of interdependence between these abilities remains largely unanswered. Therefore, in this study, we investigated the extent to which language and executive control deficits dissociated in 1) acute stroke and 2) longitudinal aphasia recovery. Twenty-three individuals admitted to Johns Hopkins Hospital with a new left hemisphere stroke completed the Western Aphasia Battery-Revised (WAB-R), several additional language measures (of naming, semantics, spontaneous speech, and oral reading), and three non-linguistic cognitive tasks from the NIH Toolbox (i.e., Pattern Comparison Processing Speed Test, Flanker Inhibitory Control and Attention Test, and Dimensional Change Card Sorting Test). Two participants with aphasia (PWA) with temporoparietal lesions, one of whom (PWA1) had greater temporal but less frontal and superior parietal damage than the other (PWA2), also completed testing at subacute (three months post-onset) and early chronic (six months post-onset) time points. In aim 1, principal component analysis on the acute test data (excluding the WAB-R) revealed language and non-linguistic executive control tasks largely loaded onto separate components. Both components were significant predictors of acute aphasia severity per the WAB-R Aphasia Quotient (AQ). Crucially, executive dysfunction explained an additional 17% of the variance in AQ beyond the explanatory power of language impairments alone. In aim 2, both case patients exhibited language and executive control deficits at the acute post-stroke stage. A dissociation was observed in longitudinal recovery of these patients. By the early chronic time point, PWA1 exhibited improved (but persistent) deficits in several language domains and recovered executive control. In contrast, PWA2 demonstrated mostly recovered language but persistent executive dysfunction. Greater damage to language and attention networks in these respective patients may explain the observed behavioral patterns. These results demonstrate that language and executive control can dissociate (at least to a degree), but both contribute to early post-stroke presentation of aphasia and likely influence longitudinal aphasia recovery.
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Affiliation(s)
| | | | - Argye E Hillis
- Department of Neurology, USA; Physical Medicine and Rehabilitation, USA; Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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Pasquini L, Di Napoli A, Rossi-Espagnet MC, Visconti E, Napolitano A, Romano A, Bozzao A, Peck KK, Holodny AI. Understanding Language Reorganization With Neuroimaging: How Language Adapts to Different Focal Lesions and Insights Into Clinical Applications. Front Hum Neurosci 2022; 16:747215. [PMID: 35250510 PMCID: PMC8895248 DOI: 10.3389/fnhum.2022.747215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
When the language-dominant hemisphere is damaged by a focal lesion, the brain may reorganize the language network through functional and structural changes known as adaptive plasticity. Adaptive plasticity is documented for triggers including ischemic, tumoral, and epileptic focal lesions, with effects in clinical practice. Many questions remain regarding language plasticity. Different lesions may induce different patterns of reorganization depending on pathologic features, location in the brain, and timing of onset. Neuroimaging provides insights into language plasticity due to its non-invasiveness, ability to image the whole brain, and large-scale implementation. This review provides an overview of language plasticity on MRI with insights for patient care. First, we describe the structural and functional language network as depicted by neuroimaging. Second, we explore language reorganization triggered by stroke, brain tumors, and epileptic lesions and analyze applications in clinical diagnosis and treatment planning. By comparing different focal lesions, we investigate determinants of language plasticity including lesion location and timing of onset, longitudinal evolution of reorganization, and the relationship between structural and functional changes.
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Affiliation(s)
- Luca Pasquini
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
- Radiology Department, Castelli Hospital, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Emiliano Visconti
- Neuroradiology Unit, Cesena Surgery and Trauma Department, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, Rome, Italy
| | - Kyung K. Peck
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrei I. Holodny
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
- Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, New York, NY, United States
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Martin KC, Ketchabaw WT, Turkeltaub PE. Plasticity of the language system in children and adults. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:397-414. [PMID: 35034751 PMCID: PMC10149040 DOI: 10.1016/b978-0-12-819410-2.00021-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The language system is perhaps the most unique feature of the human brain's cognitive architecture. It has long been a quest of cognitive neuroscience to understand the neural components that contribute to the hierarchical pattern processing and advanced rule learning required for language. The most important goal of this research is to understand how language becomes impaired when these neural components malfunction or are lost to stroke, and ultimately how we might recover language abilities under these circumstances. Additionally, understanding how the language system develops and how it can reorganize in the face of brain injury or dysfunction could help us to understand brain plasticity in cognitive networks more broadly. In this chapter we will discuss the earliest features of language organization in infants, and how deviations in typical development can-but in some cases, do not-lead to disordered language. We will then survey findings from adult stroke and aphasia research on the potential for recovering language processing in both the remaining left hemisphere tissue and in the non-dominant right hemisphere. Altogether, we hope to present a clear picture of what is known about the capacity for plastic change in the neurobiology of the human language system.
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Affiliation(s)
- Kelly C Martin
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States
| | - W Tyler Ketchabaw
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States
| | - Peter E Turkeltaub
- Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington, DC, United States; Research Division, MedStar National Rehabilitation Hospital, Washington, DC, United States.
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12
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Meier EL. The role of disrupted functional connectivity in aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:99-119. [PMID: 35078613 DOI: 10.1016/b978-0-12-823384-9.00005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Language is one of the most complex and specialized higher cognitive processes. Brain damage to the distributed, primarily left-lateralized language network can result in aphasia, a neurologic disorder characterized by receptive and/or expressive deficits in spoken and/or written language. Most often, aphasia is the consequence of stroke-termed poststroke aphasia (PSA)-yet, aphasia can also manifest due to neurodegenerative disease, specifically, a disorder called primary progressive aphasia (PPA). In recent years, functional connectivity neuroimaging studies have provided emerging evidence supporting theories regarding the relationships between language impairments, structural brain damage, and functional network properties in these two disorders. This chapter reviews the current evidence for the "network phenotype of stroke injury" hypothesis (Siegel et al., 2016) as it pertains to PSA and the "network degeneration hypothesis" (Seeley et al., 2009) as it pertains to PPA. Methodologic considerations for functional connectivity studies, limitations of the current functional connectivity literature in aphasia, and future directions are also discussed.
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Affiliation(s)
- Erin L Meier
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, United States.
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Chapman LR, Hallowell B. The Unfolding of Cognitive Effort During Sentence Processing: Pupillometric Evidence From People With and Without Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4900-4917. [PMID: 34763522 PMCID: PMC9150667 DOI: 10.1044/2021_jslhr-21-00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/18/2021] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Arousal and cognitive effort are relevant yet often overlooked components of attention during language processing. Pupillometry can be used to provide a psychophysiological index of arousal and cognitive effort. Given that much is unknown regarding the relationship between cognition and language deficits seen in people with aphasia (PWA), pupillometry may be uniquely suited to explore those relationships. The purpose of this study was to examine arousal and the time course of the allocation of cognitive effort related to sentence processing in people with and without aphasia. METHOD Nineteen PWA and age- and education-matched control participants listened to relatively easy (subject-relative) and relatively difficult (object-relative) sentences and were required to answer occasional comprehension questions. Tonic and phasic pupillary responses were used to index arousal and the unfolding of cognitive effort, respectively, while sentences were processed. Group differences in tonic and phasic responses were examined. RESULTS Group differences were observed for both tonic and phasic responses. PWA exhibited greater overall arousal throughout the task compared with controls, as evidenced by larger tonic pupil responses. Controls exhibited more effort (greater phasic responses) for difficult compared with easy sentences; PWA did not. Group differences in phasic responses were apparent during end-of-sentence and postsentence time windows. CONCLUSIONS Results indicate that the attentional state of PWA in this study was not consistently supportive of adequate task engagement. PWA in our sample may have relatively limited attentional capacity or may have challenges with allocating existing capacity in ways that support adequate task engagement and performance. This work adds to the body of evidence supporting the validity of pupillometric tasks for the study of aphasia and contributes to a better understanding of the nature of language deficits in aphasia. Supplemental Material https://doi.org/10.23641/asha.16959376.
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Affiliation(s)
- Laura Roche Chapman
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
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14
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Johnson JP, Meier EL, Pan Y, Kiran S. Abnormally weak functional connections get stronger in chronic stroke patients who benefit from naming therapy. BRAIN AND LANGUAGE 2021; 223:105042. [PMID: 34695614 PMCID: PMC8638784 DOI: 10.1016/j.bandl.2021.105042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/07/2021] [Accepted: 10/12/2021] [Indexed: 06/03/2023]
Abstract
Language recovery in aphasia is likely supported by a network of brain regions, but few studies have investigated treatment-related changes in functional connectivity while controlling for the absence of treatment. We examined functional connectivity in a 38-region picture-naming network in 30 patients with chronic aphasia who did or did not receive naming therapy. Compared to healthy controls, patients had abnormally low connectivity in a subset of connections from the naming network. Linear mixed models showed that the connectivity of abnormal connections increased significantly in patients who benefited from therapy, but not in those who did not benefit from or receive therapy. Changes in responders were specific to abnormal connections and did not extend to the larger network. Thus, successful naming therapy was associated with increased connectivity in connections that were abnormal prior to treatment. The potential to strengthen such connections may be a prerequisite for a successful treatment response.
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Affiliation(s)
- Jeffrey P Johnson
- Aphasia Research Laboratory, Department of Speech, Language, & Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, USA.
| | - 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
| | - 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
| | - 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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15
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Truzman T, Rochon E, Meltzer J, Leonard C, Bitan T. Simultaneous Normalization and Compensatory Changes in Right Hemisphere Connectivity during Aphasia Therapy. Brain Sci 2021; 11:1330. [PMID: 34679395 PMCID: PMC8534113 DOI: 10.3390/brainsci11101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
Changes in brain connectivity during language therapy were examined among participants with aphasia (PWA), aiming to shed light on neural reorganization in the language network. Four PWA with anomia following left hemisphere stroke and eight healthy controls (HC) participated in the study. Two fMRI scans were administered to all participants with a 3.5-month interval. The fMRI scans included phonological and semantic tasks, each consisting of linguistic and perceptual matching conditions. Between the two fMRI scans, PWA underwent Phonological Components Analysis treatment. Changes in effective connectivity during the treatment were examined within right hemisphere (RH) architecture. The results illustrate that following the treatment, the averaged connectivity of PWA across all perceptual and linguistic conditions in both tasks increased resemblance to HC, reflecting the normalization of neural processes associated with silent object name retrieval. In contrast, connections that were specifically enhanced by the phonological condition in PWA decreased in their resemblance to HC, reflecting emerging compensatory reorganization in RH connectivity to support phonological processing. These findings suggest that both normalization and compensation play a role in neural language reorganization at the chronic stage, occurring simultaneously in the same brain.
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Affiliation(s)
- Tammar Truzman
- Communication Sciences and Disorders Department and IIPDM, University of Haifa, Haifa 3498838, Israel
- The Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
| | - Elizabeth Rochon
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- KITE Research Institute, Toronto Rehab, University Health Network (UHN), Toronto, ON M5G 2A2, Canada
| | - Jed Meltzer
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- Psychology Department, University of Toronto, Toronto, ON M5S 1A1, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada
| | - Carol Leonard
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Tali Bitan
- The Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- Psychology Department and IIPDM, University of Haifa, Haifa 3498838, Israel
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16
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Chen Q, Shen W, Sun H, Shen D, Cai X, Ke J, Zhang L, Fang Q. Effects of mirror therapy on motor aphasia after acute cerebral infarction: A randomized controlled trial. NeuroRehabilitation 2021; 49:103-117. [PMID: 34180428 DOI: 10.3233/nre-210125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mirror therapy (MT) has proven to be beneficial for treating patients suffering from motor aphasia after stroke. However, the impacts of MT on neuroplasticity remain unexplored. OBJECTIVE In this paper we conducted a randomized controlled trial to evaluate the treatment using the MT on motor aphasia following acute cerebral infarction. METHODS We randomly assigned 30 patients into test and control groups, with test group patients treated with MT, whereas control group patients were treated with sham MT. At 24 hours prior to and after the intervention, we obtained functional magnetic resonance imaging (fMRI) data from study subjects. At baseline, after treatment and 12-week follow-up, we additionally evaluated patients with the Modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the aphasia quotient (AQ) in the western aphasia test. RESULTS After 2 weeks of treatment, the test group demonstrated significant improvements in AQ values, naming, repetition, spontaneous speech, and mRS scores compared to the control group (P < 0.05). Furthermore, in the follow-up time point (12 weeks), we found that the test group exhibited significantly better NIHSS scores and AQ evaluation indicators than the control group (P < 0.05). Specifically, the fMRI study shows that functional connectivity significantly improved in test group patients mainly among frontal, temporal, and parietal lobes of the left hemisphere with each other than controls group. Meanwhile, we found significantly enhanced functional connectivity with the hippocampus (P < 0.01). CONCLUSIONS Our results indicate that the MT can expedite the recovery of language function during the early phases of stroke recovery. These findings may elucidate the underlying mechanism of MT and the application of this therapy as an adjunct rehabilitation technique in language recovery.
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Affiliation(s)
- Qingmei Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.,Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wenjun Shen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Haiwei Sun
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Dan Shen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiuying Cai
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Lichi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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17
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Yourganov G, Stark BC, Fridriksson J, Bonilha L, Rorden C. Effect of Stroke on Contralateral Functional Connectivity. Brain Connect 2021; 11:543-552. [PMID: 33757303 DOI: 10.1089/brain.2020.0901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Stroke can induce large-scale functional reorganization of the brain; however, the spatial patterns of this reorganization remain largely unknown. Methods: Using a large (N = 116) sample of participants who were in the chronic stages of stroke, we present a systematic study of the association between brain damage and functional connectivity (FC) within the intact hemisphere. We computed correlations between regional cortical damage and contralateral FC. Results: We identified left-hemisphere regions that had the most pronounced effect on the right-hemisphere FC, and, conversely, right-hemisphere connections where the effect of damage was particularly strong. Notably, the vast majority of significant correlations were positive: damage was associated with an increase in regional contralateral connectivity. Discussion: These findings lend evidence of the reorganization of contralateral cortical networks as a response to brain damage, which is more pronounced in a set of well-connected regions where connectivity increases with the amount of damage.
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Affiliation(s)
- Grigori Yourganov
- Advanced Computing and Data Science, Cyberinfrastructure and Technology Integration, Clemson University, Clemson, South Carolina, USA
| | - Brielle C Stark
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington, Indiana, USA.,Program in Neuroscience, Indiana University, Bloomington, Indiana, USA
| | - Julius Fridriksson
- Department of Communication Science and Disorders, University of South Carolina, Columbia, South Carolina, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christopher Rorden
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
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18
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Predicting language recovery in post-stroke aphasia using behavior and functional MRI. Sci Rep 2021; 11:8419. [PMID: 33875733 PMCID: PMC8055660 DOI: 10.1038/s41598-021-88022-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/22/2021] [Indexed: 11/22/2022] Open
Abstract
Language outcomes after speech and language therapy in post-stroke aphasia are challenging to predict. This study examines behavioral language measures and resting state fMRI (rsfMRI) as predictors of treatment outcome. Fifty-seven patients with chronic aphasia were recruited and treated for one of three aphasia impairments: anomia, agrammatism, or dysgraphia. Treatment effect was measured by performance on a treatment-specific language measure, assessed before and after three months of language therapy. Each patient also underwent an additional 27 language assessments and a rsfMRI scan at baseline. Patient scans were decomposed into 20 components by group independent component analysis, and the fractional amplitude of low-frequency fluctuations (fALFF) was calculated for each component time series. Post-treatment performance was modelled with elastic net regression, using pre-treatment performance and either behavioral language measures or fALFF imaging predictors. Analysis showed strong performance for behavioral measures in anomia (R2 = 0.948, n = 28) and for fALFF predictors in agrammatism (R2 = 0.876, n = 11) and dysgraphia (R2 = 0.822, n = 18). Models of language outcomes after treatment trained using rsfMRI features may outperform models trained using behavioral language measures in some patient populations. This suggests that rsfMRI may have prognostic value for aphasia therapy outcomes.
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19
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Dalton SGH, Cavanagh JF, Richardson JD. Spectral Resting-State EEG (rsEEG) in Chronic Aphasia Is Reliable, Sensitive, and Correlates With Functional Behavior. Front Hum Neurosci 2021; 15:624660. [PMID: 33815079 PMCID: PMC8010195 DOI: 10.3389/fnhum.2021.624660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
We investigated spectral resting-state EEG in persons with chronic stroke-induced aphasia to determine its reliability, sensitivity, and relationship to functional behaviors. Resting-state EEG has not yet been characterized in this population and was selected given the demonstrated potential of resting-state investigations using other neuroimaging techniques to guide clinical decision-making. Controls and persons with chronic stroke-induced aphasia completed two EEG recording sessions, separated by approximately 1 month, as well as behavioral assessments of language, sensorimotor, and cognitive domains. Power in the classic frequency bands (delta, theta, alpha, and beta) was examined via spectral analysis of resting-state EEG data. Results suggest that power in the theta, alpha, and beta bands is reliable for use as a repeated measure. Significantly greater theta and lower beta power was observed in persons with aphasia (PWAs) than controls. Finally, in PWAs theta power negatively correlated with performance on a discourse informativeness measure, while alpha and beta power positively correlated with performance on the same measure. This indicates that spectral rsEEG slowing observed in PWAs in the chronic stage is pathological and suggests a possible avenue for directly altering brain activation to improve behavioral function. Taken together, these results suggest that spectral resting-state EEG holds promise for sensitive measurement of functioning and change in persons with chronic aphasia. Future studies investigating the utility of these measures as biomarkers of frank or latent aphasic deficits and treatment response in chronic stroke-induced aphasia are warranted.
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Affiliation(s)
- Sarah G. H. Dalton
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI, United States
| | - James F. Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Jessica D. Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States
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20
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Chapman LR, Hallowell B. Expecting Questions Modulates Cognitive Effort in a Syntactic Processing Task: Evidence From Pupillometry. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:121-133. [PMID: 33375842 PMCID: PMC8608151 DOI: 10.1044/2020_jslhr-20-00071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/23/2020] [Accepted: 09/27/2020] [Indexed: 06/12/2023]
Abstract
Purpose Pupillary responses captured via pupillometry (measurement of pupillary dilation and constriction during the performance of a cognitive task) are psychophysiological indicators of cognitive effort, attention, arousal, and resource engagement. Pupillometry may be a promising tool for enhancing our understanding of the relationship between cognition and language in people with and without aphasia. Interpretation of pupillary responses is complex. This study was designed as a stepping-stone for future pupillometric studies involving people with aphasia. Asking comprehension questions is common in language processing research involving people with and without aphasia. However, the influence of comprehension questions on pupillometric indices of task engagement (tonic responses) and cognitive effort (task-evoked responses of the pupil [TERPs]) is unknown. We tested whether asking comprehension questions influenced pupillometric results of adults without aphasia during a syntactic processing task. Method Forty adults without aphasia listened to easy (canonical) and difficult (noncanonical) sentences in two conditions: one that contained an explicit comprehension task (question condition) and one that did not (no-question condition). The influence of condition and canonicity on pupillary responses was examined. Results The influence of canonicity was only significant in the question condition: TERPs for difficult sentences were larger than TERPs for easy sentences. Tonic responses did not differ between conditions. Conclusions Although participants had similar levels of attentiveness in both conditions, increases in indices of cognitive effort during syntactic processing were significant only when participants expected comprehension questions. Results contribute to a body of evidence indicating the importance of task design and careful linguistic stimulus control when using pupillometry to study language processing. Supplemental Material https://doi.org/10.23641/asha.13480368.
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Affiliation(s)
- Laura Roche Chapman
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
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21
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Hula WD, Panesar S, Gravier ML, Yeh FC, Dresang HC, Dickey MW, Fernandez-Miranda JC. Structural white matter connectometry of word production in aphasia: an observational study. Brain 2020; 143:2532-2544. [PMID: 32705146 DOI: 10.1093/brain/awaa193] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/12/2020] [Accepted: 04/22/2020] [Indexed: 11/15/2022] Open
Abstract
While current dual-steam neurocognitive models of language function have coalesced around the view that distinct neuroanatomical networks subserve semantic and phonological processing, respectively, the specific white matter components of these networks remain a matter of debate. To inform this debate, we investigated relationships between structural white matter connectivity and word production in a cross-sectional study of 42 participants with aphasia due to unilateral left hemisphere stroke. Specifically, we reconstructed a local connectome matrix for each participant from diffusion spectrum imaging data and regressed these matrices on indices of semantic and phonological ability derived from their responses to a picture-naming test and a computational model of word production. These connectometry analyses indicated that both dorsally located (arcuate fasciculus) and ventrally located (inferior frontal-occipital, uncinate, and middle longitudinal fasciculi) tracts were associated with semantic ability, while associations with phonological ability were more dorsally situated, including the arcuate and middle longitudinal fasciculi. Associations with limbic pathways including the posterior cingulum bundle and the fornix were also found. All analyses controlled for total lesion volume and all results showing positive associations obtained false discovery rates < 0.05. These results challenge dual-stream accounts that deny a role for the arcuate fasciculus in semantic processing, and for ventral-stream pathways in language production. They also illuminate limbic contributions to both semantic and phonological processing for word production.
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Affiliation(s)
- William D Hula
- Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA, USA.,Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh PA, USA
| | - Sandip Panesar
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | - Michelle L Gravier
- Department of Speech, Language, and Hearing Sciences, California State East Bay, Hayward, CA, USA
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Haley C Dresang
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh PA, USA
| | - Michael Walsh Dickey
- Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA, USA.,Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh PA, USA
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22
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Du Y, Lee Y, He C, Peng L, Yong Q, Cen Z, Chen Y, Liu X, Wang X. The changed functional status of the brain was involved in patients with poststroke aphasia: Coordinate-based (activation likelihood estimation) meta-analysis. Brain Behav 2020; 10:e01867. [PMID: 33022141 PMCID: PMC7749604 DOI: 10.1002/brb3.1867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 08/08/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Although many functional magnetic resonance imaging (fMRI) studies have investigated the language architecture and neurobiological mechanism underlying poststroke aphasia (PSA), the pathophysiological mechanisms of PSA still remain poorly understood. In addition to a limited number of subjects (<20) tested with different methodologies and stimuli, inconsistent reports of the brain regions involved have been a major factor. Thus, we conducted a meta-analysis of 12 peer-reviewed studies of abnormal brain activation regions in PSA patients at rest using activation likelihood estimation (ALE). RESULTS A meta-analysis was performed based on 24 experiments with 497 total participants in 12 studies to establish the ALE of regional activation in PSA. Through experiments with PSA patients and healthy controls, we found that hypoactivation in PSA converged on the left superior frontal gyrus and the left parietal postcentral gyrus, whereas there was hyperactivation in the right cerebellar anterior lobe, left fusiform gyrus, left superior parietal lobule, and right subgyral hippocampus. CONCLUSION Our study verified that dominant and nondominant language networks play roles in the recovery of language function.
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Affiliation(s)
- Ying Du
- Nursing Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yujun Lee
- Foreign Language Department, North Sichuan Medical College, Nanchong, China.,Nursing Department, North Sichuan Medical College, Nanchong, China
| | - Chuan He
- Nursing Department, North Sichuan Medical College, Nanchong, China
| | - Lihan Peng
- Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qian Yong
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhiyi Cen
- Nursing Department, North Sichuan Medical College, Nanchong, China
| | - Yuqin Chen
- Nursing Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xin Liu
- Department of Neurology, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Xiaoming Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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23
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Buchwald A, Khosa N, Rimikis S, Duncan ES. Behavioral and neurological effects of tDCS on speech motor recovery: A single-subject intervention study. BRAIN AND LANGUAGE 2020; 210:104849. [PMID: 32905863 PMCID: PMC7554139 DOI: 10.1016/j.bandl.2020.104849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 07/22/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
This paper reports a feasibility study designed to evaluate the behavioral and neurological effects of using transcranial direct current stimulation (tDCS) in conjunction with speech motor learning treatment for individuals with acquired speech impairment subsequent to stroke. Most of the research using tDCS to enhance treatment outcomes in stroke recovery has focused on either limb motor control or aphasia treatment. Using a multiple-baseline multiple-probe crossover design, we compared both behavioral and brain connectivity-based outcomes following speech motor learning treatment with both Active tDCS and Sham tDCS. We observed that both treatment phases led to improvement in short-term maintenance, but that Active tDCS was associated with greater long-term maintenance improvement. Active tDCS was also associated with an increase in functional connectivity in the left hemisphere and interhemispherically in an ROI-based network analysis examining correlations among areas associated with speech production and acquired speech impairment. This report supports the possibility that tDCS may enhance both behavioral and neurological outcomes and indicates the importance of additional work in this area, although replication is required to confirm the extent and consistency of tDCS benefits on speech motor learning treatment outcomes.
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Affiliation(s)
- Adam Buchwald
- New York University, Department of Communicative Sciences and Disorders, 665 Broadway Suite 900, New York, NY 10012, USA.
| | - Nicolette Khosa
- New York University, Department of Communicative Sciences and Disorders, 665 Broadway Suite 900, New York, NY 10012, USA
| | - Stacey Rimikis
- New York University, Department of Communicative Sciences and Disorders, 665 Broadway Suite 900, New York, NY 10012, USA
| | - E Susan Duncan
- Louisiana State University, Department of Communication Sciences and Disorders, 68 Hatcher Hall, Baton Rouge, LA 70803, USA
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24
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Tao Y, Rapp B. How functional network connectivity changes as a result of lesion and recovery: An investigation of the network phenotype of stroke. Cortex 2020; 131:17-41. [PMID: 32781259 DOI: 10.1016/j.cortex.2020.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 03/15/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Abstract
This study, through a series of univariate and multivariate (classification) analyses, investigated fMRI task-based functional connectivity (FC) at pre- and post-treatment time-points in 18 individuals with chronic post-stroke dysgraphia. The investigation examined the effects of lesion and treatment-based recovery on functional organization, focusing on both inter-hemispheric (homotopic) and intra-hemispheric connectivity. The work confirmed, in the chronic stage, the "network phenotype of stroke injury" proposed by Siegel et al. (2016) consisting of abnormally low inter-hemispheric connectivity as well as abnormally high intra-hemispheric (ipsilesional) connectivity. In terms of recovery-based changes in FC, this study found overall hyper-normalization of these abnormal inter and intra-hemispheric connectivity patterns, suggestive of over-correction. Specifically, treatment-related homotopic FC increases were observed between left and right dorsal frontal-parietal regions. With regard to intra-hemispheric connections, recovery was dominated by increased ipsilateral connectivity between frontal and parietal regions along with decreased connectivity between the frontal regions and posterior parietal-occipital-temporal areas. Both inter and intra-hemispheric changes were associated with treatment-driven improvements in spelling performance. We suggest an interpretation according to which, with treatment, as posterior orthographic processing areas become more effective, executive control from frontal-parietal networks becomes less necessary.
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Affiliation(s)
- Yuan Tao
- Department of Cognitive Science, Johns Hopkins University, USA.
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, USA; Department of Neuroscience, Johns Hopkins University, USA; Department of Psychological and Brain Sciences, Johns Hopkins University, USA
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25
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Rodrigues de Almeida L, Pope PA, Hansen PC. Task load modulates tDCS effects on brain network for phonological processing. Cogn Process 2020; 21:341-363. [PMID: 32152767 PMCID: PMC7381442 DOI: 10.1007/s10339-020-00964-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 02/20/2020] [Indexed: 02/07/2023]
Abstract
Motor participation in phonological processing can be modulated by task nature across the speech perception to speech production range. The pars opercularis of the left inferior frontal gyrus (LIFG) would be increasingly active across this range, because of changing motor demands. Here, we investigated with simultaneous tDCS and fMRI whether the task load modulation of tDCS effects translates into predictable patterns of functional connectivity. Findings were analysed under the "multi-node framework", according to which task load and the network structure underlying cognitive functions are modulators of tDCS effects. In a within-subject study, participants (N = 20) performed categorical perception, lexical decision and word naming tasks [which differentially recruit the target of stimulation (LIFG)], which were repeatedly administered in three tDCS sessions (anodal, cathodal and sham). The LIFG, left superior temporal gyrus and their right homologues formed the target network subserving phonological processing. C-tDCS inhibition and A-tDCS excitation should increase with task load. Correspondingly, the larger the task load, the larger the relevance of the target for the task and smaller the room for compensation of C-tDCS inhibition by less relevant nodes. Functional connectivity analyses were performed with partial correlations, and network compensation globally inferred by comparing the relative number of significant connections each condition induced relative to sham. Overall, simultaneous tDCS and fMRI was adequate to show that motor participation in phonological processing is modulated by task nature. Network responses induced by C-tDCS across phonological processing tasks matched predictions. A-tDCS effects were attributed to optimisation of network efficiency.
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Affiliation(s)
| | - Paul A Pope
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Peter C Hansen
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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26
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Johnson JP, Meier EL, Pan Y, Kiran S. Pre-treatment graph measures of a functional semantic network are associated with naming therapy outcomes in chronic aphasia. BRAIN AND LANGUAGE 2020; 207:104809. [PMID: 32505940 PMCID: PMC7338231 DOI: 10.1016/j.bandl.2020.104809] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/28/2020] [Accepted: 04/17/2020] [Indexed: 05/29/2023]
Abstract
Naming treatment outcomes in post-stroke aphasia are variable and the factors underlying this variability are incompletely understood. In this study, 26 patients with chronic aphasia completed a semantic judgment fMRI task before receiving up to 12 weeks of naming treatment. Global (i.e., network-wide) and local (i.e., regional) graph theoretic measures of pre-treatment functional connectivity were analyzed to identify differences between patients who responded most and least favorably to treatment (i.e., responders and nonresponders) and determine if network measures predicted naming improvements. Responders had higher levels of global integration (i.e., average network strength and global efficiency) than nonresponders, and these measures predicted treatment effects after controlling for lesion volume and age. Group differences in local measures were identified in several regions associated with a variety of cognitive functions. These results suggest there is a meaningful and possibly prognostically-informative relationship between patients' functional network properties and their response to naming therapy.
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Affiliation(s)
- Jeffrey P Johnson
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, USA.
| | - Erin L Meier
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, USA.
| | - Yue Pan
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, USA.
| | - Swathi Kiran
- Aphasia Research Laboratory, Department of Speech, Language & Hearing Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, USA.
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Copland DA. Elizabeth Usher Memorial Lecture: Lost in Translation? Challenges and future prospects for a neurobiological approach to aphasia rehabilitation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:270-280. [PMID: 32686593 DOI: 10.1080/17549507.2020.1768287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While there has been considerable progress in conducting trials of aphasia therapy, there is no consistent evidence for long-term benefits of aphasia treatment, suggesting the need to reconsider current approaches. There are also no accurate methods for determining the amount, type and timing of aphasia therapy that should be provided for an individual. At the same time, there has been increasing interest in applying various principles of neuroplasticity to aphasia treatment and using measures of brain structure and function to predict recovery. This article will consider the potential of neuroplasticity principles and neurobiological predictors to improve our current approach to aphasia rehabilitation and optimise outcomes. Reviewing these principles highlights some of the challenges of translating animal model-based principles and emphases the need to also consider relevant theories of human learning. While considerable progress has been made in considering neurobiological principles and using measures of brain structure and function to predict recovery, there is significant work required to achieve the full potential of this neurobiological approach to aphasia management.
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Affiliation(s)
- David A Copland
- School of Health and Rehabilitation Sciences, Centre for Clinical Research, Queensland Aphasia Rehabilitation Centre, The University of Queensland, St Lucia, Australia
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Kiran S, Meier EL, Johnson JP. Neuroplasticity in Aphasia: A Proposed Framework of Language Recovery. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3973-3985. [PMID: 31756154 PMCID: PMC7203519 DOI: 10.1044/2019_jslhr-l-rsnp-19-0054] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/21/2019] [Accepted: 08/27/2019] [Indexed: 05/20/2023]
Abstract
Purpose Despite a tremendous amount of research in this topic, the precise neural mechanisms underlying language recovery remain unclear. Much of the evidence suggests that activation of remaining left-hemisphere tissue, including perilesional areas, is linked to the best treatment outcomes, yet recruitment of the right hemisphere for various language tasks has also been linked to favorable behavioral outcomes. In this review article, we propose a framework of language recovery that incorporates a network-based view of the brain regions involved in recovery. Method We review evidence from the extant literature and work from our own laboratory to identify findings consistent with our proposed framework and identify gaps in our current knowledge. Results Expanding on Heiss and Thiel's (2006) hierarchy of language recovery, we identify 4 emerging themes: (a) Several bilateral regions constitute a network engaged in language recovery; (b) spared left-hemisphere regions are important components of the network engaged in language recovery; (c) as damage increases in the left hemisphere, activation expands to the right hemisphere and domain-general regions; and (d) patients with efficient, control-like network topology show greater improvement than patients with abnormal topology. We propose a mechanistic model of language recovery that accounts for individual differences in behavior, network topology, and treatment responsiveness. Conclusion Continued work in this topic will lead us to a better understanding of the mechanisms underlying language recovery, biomarkers that influence recovery, and, consequently, more personalized treatment options for individual patients. Presentation Video https://doi.org/10.23641/asha.10257590.
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Affiliation(s)
- Swathi Kiran
- Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences: Sargent College, Boston University, MA
| | - Erin L. Meier
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Jeffrey P. Johnson
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, PA
- Audiology and Speech Pathology Program, VA Pittsburgh Healthcare System, PA
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29
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Meier EL, Johnson JP, Pan Y, Kiran S. A lesion and connectivity-based hierarchical model of chronic aphasia recovery dissociates patients and healthy controls. NEUROIMAGE-CLINICAL 2019; 23:101919. [PMID: 31491828 PMCID: PMC6702239 DOI: 10.1016/j.nicl.2019.101919] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 06/05/2019] [Accepted: 06/30/2019] [Indexed: 12/28/2022]
Abstract
Traditional models of left hemisphere stroke recovery propose that reactivation of remaining ipsilesional tissue is optimal for language processing whereas reliance on contralesional right hemisphere homologues is less beneficial or possibly maladaptive in the chronic recovery stage. However, neuroimaging evidence for this proposal is mixed. This study aimed to elucidate patterns of effective connectivity in patients with chronic aphasia in light of healthy control connectivity patterns and in relation to damaged tissue within left hemisphere regions of interest and according to performance on a semantic decision task. Using fMRI and dynamic causal modeling, biologically-plausible models within four model families were created to correspond to potential neural recovery patterns, including Family A: Left-lateralized connectivity (i.e., no/minimal damage), Family B: Bilateral anterior-weighted connectivity (i.e., posterior damage), Family C: Bilateral posterior-weighted connectivity (i.e., anterior damage) and Family D: Right-lateralized connectivity (i.e., extensive damage). Controls exhibited a strong preference for left-lateralized network models (Family A) whereas patients demonstrated a split preference for Families A and C. At the level of connections, controls exhibited stronger left intrahemispheric task-modulated connections than did patients. Within the patient group, damage to left superior frontal structures resulted in greater right intrahemispheric connectivity whereas damage to left ventral structures resulted in heightened modulation of left frontal regions. Lesion metrics best predicted accuracy on the fMRI task and aphasia severity whereas left intrahemispheric connectivity predicted fMRI task reaction times. These results are discussed within the context of the hierarchical recovery model of chronic aphasia. The semantic network in neurologically-intact, healthy controls was characterized by left-lateralized connectivity. Patient connectivity was split between left-lateralized and bilateral, posterior-weighted (i.e., anterior damage) models. Controls solely recruited LITG-driven connections whereas patients recruited a distributed network of connections. Within the patient group, intra- and inter-hemispheric connections were related to lesion site and/or size. Lesion size predicted aphasia severity and fMRI task accuracy, and effective connectivity predicted task reaction times.
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Affiliation(s)
- Erin L Meier
- Department of Speech, Language, & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, United States of America.
| | - Jeffrey P Johnson
- Department of Speech, Language, & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, United States of America
| | - Yue Pan
- Department of Speech, Language, & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, United States of America
| | - Swathi Kiran
- Department of Speech, Language, & Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Room 326, Boston, MA 02215, United States of America
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Guo J, Biswal BB, Han S, Li J, Yang S, Yang M, Chen H. Altered dynamics of brain segregation and integration in poststroke aphasia. Hum Brain Mapp 2019; 40:3398-3409. [PMID: 31016854 DOI: 10.1002/hbm.24605] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/30/2019] [Accepted: 04/08/2019] [Indexed: 01/06/2023] Open
Abstract
Poststroke aphasia (PSA) results from direct effect of focal lesions and dysfunction of distributed language networks. However, how flexible the activity at specific nodes control global dynamics is currently unknown. In this study, we demonstrate that alterations in the regional activity may cause imbalances between segregation and integration in temporo-spatial pattern, and the transient dynamics are disrupted in PSA patients. Specifically, we applied dynamic framework to eyes-closed resting-state functional MRI data from PSA patients (n = 17), and age-, gender-, and education-matched healthy controls (HCs, n = 20). Subsequently, we calculated two basis brain organizational principles: "dynamic segregation," obtained from dynamic amplitude of low-frequency fluctuations (dALFF), which represent the specialized processing within interconnected brain regions; and "dynamic integration," obtained from dynamic functional connectivity, which measures the efficient communication between interconnected brain regions. We found that both measures were decreased in the PSA patients within the left frontal and temporal subregions compared to the HCs. PSA patients displayed increased flexibility of interaction between left temporo-frontal subregions and right temporo-parieto-frontal subnetworks. Furthermore, we found that dALFF in the pars triangularis of left inferior frontal gyrus was associated with aphasia quotient. These findings suggest that the reduced temporal flexibility of regional activity in language-relevant cortical regions in PSA is related to the disrupted organization of intrahemispheric networks, leading to a loss of the corresponding functions. By using dynamic framework, our results offer valuable information about the alterations in segregation and integration of spatiotemporal information across networks and illuminate how dysfunction in flexible activity may underlie language deficits in PSA.
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Affiliation(s)
- Jing Guo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bharat B Biswal
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Shaoqiang Han
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiao Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Siqi Yang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mi Yang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.,School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Kiran S, Thompson CK. Neuroplasticity of Language Networks in Aphasia: Advances, Updates, and Future Challenges. Front Neurol 2019; 10:295. [PMID: 31001187 PMCID: PMC6454116 DOI: 10.3389/fneur.2019.00295] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Researchers have sought to understand how language is processed in the brain, how brain damage affects language abilities, and what can be expected during the recovery period since the early 19th century. In this review, we first discuss mechanisms of damage and plasticity in the post-stroke brain, both in the acute and the chronic phase of recovery. We then review factors that are associated with recovery. First, we review organism intrinsic variables such as age, lesion volume and location and structural integrity that influence language recovery. Next, we review organism extrinsic factors such as treatment that influence language recovery. Here, we discuss recent advances in our understanding of language recovery and highlight recent work that emphasizes a network perspective of language recovery. Finally, we propose our interpretation of the principles of neuroplasticity, originally proposed by Kleim and Jones (1) in the context of extant literature in aphasia recovery and rehabilitation. Ultimately, we encourage researchers to propose sophisticated intervention studies that bring us closer to the goal of providing precision treatment for patients with aphasia and a better understanding of the neural mechanisms that underlie successful neuroplasticity.
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Affiliation(s)
- Swathi Kiran
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, The Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Resting-state functional connectivity: An emerging method for the study of language networks in post-stroke aphasia. Brain Cogn 2019; 131:22-33. [DOI: 10.1016/j.bandc.2017.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 12/15/2022]
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33
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Abnormal Functional Connectivity Density in Post-Stroke Aphasia. Brain Topogr 2018; 32:271-282. [DOI: 10.1007/s10548-018-0681-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/03/2018] [Indexed: 12/17/2022]
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Kurland J, Liu A, Stokes P. Effects of a Tablet-Based Home Practice Program With Telepractice on Treatment Outcomes in Chronic Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1140-1156. [PMID: 29710115 PMCID: PMC6195077 DOI: 10.1044/2018_jslhr-l-17-0277] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/10/2017] [Accepted: 12/19/2017] [Indexed: 05/14/2023]
Abstract
Purpose The aim of this study was to determine if a tablet-based home practice program with weekly telepractice support could enable long-term maintenance of recent treatment gains and foster new language gains in poststroke aphasia. Method In a pre-post group study of home practice outcomes, 21 individuals with chronic aphasia were examined before and after a 6-month home practice phase and again at follow-up 4 months later. The main outcome measure studied was change in naming previously treated or untreated, practiced or unpracticed pictures of objects and actions. Individualized home practice programs were created in iBooks Author with semantic, phonemic, and orthographic cueing in pictures, words, and videos in order to facilitate naming of previously treated or untreated pictures. Results Home practice was effective for all participants with severity moderating treatment effects, such that individuals with the most severe aphasia made and maintained fewer gains. There was a negative relationship between the amount of training required for iPad proficiency and improvements on practiced and unpracticed pictures and a positive relationship between practice compliance and same improvements. Conclusion Unsupervised home practice with weekly video teleconferencing support is effective. This study demonstrates that even individuals with chronic severe aphasia, including those with no prior smart device or even computer experience, can attain independent proficiency to continue practicing and improving their language skills beyond therapy discharge. This could represent a low-cost therapy option for individuals without insurance coverage and/or those for whom mobility is an obstacle to obtaining traditional aphasia therapy.
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Affiliation(s)
- Jacquie Kurland
- Department of Communication Disorders, University of Massachusetts Amherst
| | - Anna Liu
- Department of Mathematics and Statistics, University of Massachusetts Amherst
| | - Polly Stokes
- Department of Communication Disorders, University of Massachusetts Amherst
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Jiménez de la Peña MM, Gómez Vicente L, García Cobos R, Martínez de Vega V. Neuroradiologic correlation with aphasias. Cortico-subcortical map of language. RADIOLOGIA 2018; 60:250-261. [PMID: 29439808 DOI: 10.1016/j.rx.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/20/2017] [Accepted: 12/23/2017] [Indexed: 11/18/2022]
Abstract
Aphasia is an acquired language disorder due to a cerebral lesion; it is characterized by errors in production, denomination, or comprehension of language. Although most aphasias are mixed, from a practical point of view they are classified into different types according to their main clinical features: Broca's aphasia, Wernicke's aphasia, conduction aphasia, transcortical aphasia, and alexia with or without agraphia. We present the clinical findings for the main subtypes of aphasia, illustrating them with imaging cases, and we provide an up-to-date review of the language network with images from functional magnetic resonance imaging and tractography.
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Affiliation(s)
- M M Jiménez de la Peña
- Departamento de Diagnóstico por la Imagen, Hospital Universitario Quirón, Madrid, España.
| | - L Gómez Vicente
- Departamento de Neurología, Hospital Universitario Quirón, Madrid, España
| | - R García Cobos
- Departamento de Neurología, Hospital Universitario Quirón, Madrid, España
| | - V Martínez de Vega
- Departamento de Diagnóstico por la Imagen, Hospital Universitario Quirón, Madrid, España
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Sebastian R, Breining BL. Contributions of Neuroimaging to Understanding Language Deficits in Acute Stroke. Semin Speech Lang 2018; 39:66-78. [PMID: 29359306 PMCID: PMC5840876 DOI: 10.1055/s-0037-1608854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advances in structural and functional imaging techniques have provided new insights into our understanding of brain and language relationships. In this article, we review the various structural and functional imaging methods currently used to study language deficits in acute stroke. We also discuss the advantages and the limitations of each imaging modality and the applications of each modality in the clinical and research settings in the study of language deficits.
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Affiliation(s)
- Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bonnie L Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hartwigsen G, Saur D. Neuroimaging of stroke recovery from aphasia - Insights into plasticity of the human language network. Neuroimage 2017; 190:14-31. [PMID: 29175498 DOI: 10.1016/j.neuroimage.2017.11.056] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
The role of left and right hemisphere brain regions in language recovery after stroke-induced aphasia remains controversial. Here, we summarize how neuroimaging studies increase the current understanding of functional interactions, reorganization and plasticity in the language network. We first discuss the temporal dynamics across the time course of language recovery, with a main focus on longitudinal studies from the acute to the chronic phase after stroke. These studies show that the functional contribution of perilesional and spared left hemisphere as well as contralesional right hemisphere regions to language recovery changes over time. The second section introduces critical variables and recent advances on early prediction of subsequent outcome. In the third section, we outline how multi-method approaches that combine neuroimaging techniques with non-invasive brain stimulation elucidate mechanisms of plasticity and reorganization in the language network. These approaches provide novel insights into general mechanisms of plasticity in the language network and might ultimately support recovery processes during speech and language therapy. Finally, the neurobiological correlates of therapy-induced plasticity are discussed. We argue that future studies should integrate individualized approaches that might vary the combination of language therapy with specific non-invasive brain stimulation protocols across the time course of recovery. The way forward will include the combination of such approaches with large data sets obtained from multicentre studies.
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Affiliation(s)
- Gesa Hartwigsen
- Research Group Modulation of Language Networks, Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Dorothee Saur
- Language & Aphasia Laboratory, Department of Neurology, University of Leipzig, Germany.
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Abstract
We examined the effect of lesion on the resting-state functional connectivity in chronic post-stroke patients. We found many instances of strong correlations in BOLD signal measured at different locations within the lesion, making it hard to distinguish from the connectivity between intact and strongly connected regions. Regression of the mean cerebro-spinal fluid signal did not alleviate this problem. The connectomes computed by exclusion of lesioned voxels were not good predictors of the behavioral measures. We came up with a novel method that utilizes Independent Component Analysis (as implemented in FSL MELODIC) to identify the sources of variance in the resting-state fMRI data that are driven by the lesion, and to remove this variance. The resulting functional connectomes show better correlations with the behavioral measures of speech and language, and improve the out-of-sample prediction accuracy of multivariate analysis. We therefore advocate this preprocessing method for studies of post-stroke functional connectivity, particularly in samples with large lesions. fMRI signal is correlated across spatial locations within a post-stroke lesion. These high correlations present problems for functional connectivity analysis. Regression of mean CSF signal does not solve this issue. ICA can be used to successfully remove these artifacts.
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Li J, Du D, Gao W, Sun X, Xie H, Zhang G, Li J, Li H, Li K. The regional neuronal activity in left posterior middle temporal gyrus is correlated with the severity of chronic aphasia. Neuropsychiatr Dis Treat 2017; 13:1937-1945. [PMID: 28790829 PMCID: PMC5530067 DOI: 10.2147/ndt.s140091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Aphasia is one of the most disabling cognitive deficits affecting >2 million people in the USA. The neuroimaging characteristics of chronic aphasic patients (>6 months post onset) remain largely unknown. OBJECTIVE The objective of this study was to investigate the regional signal changes of spontaneous neuronal activity of brain and the inter-regional connectivity in chronic aphasia. MATERIALS AND METHODS Resting-state blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) was used to obtain fMRI data from 17 chronic aphasic patients and 20 healthy control subjects in a Siemens Verio 3.0T MR Scanner. The amplitude of low-frequency fluctuation (ALFF) was determined, which directly reflects the regional neuronal activity. The functional connectivity (FC) of fMRI was assessed using a seed voxel linear correlation approach. The severity of aphasia was evaluated by aphasia quotient (AQ) scores obtained from Western Aphasia Battery test. RESULTS Compared with normal subjects, aphasic patients showed decreased ALFF values in the regions of left posterior middle temporal gyrus (PMTG), left medial prefrontal gyrus, and right cerebellum. The ALFF values in left PMTG showed strong positive correlation with the AQ score (coefficient r=0.79, P<0.05). There was a positive FC in chronic aphasia between left PMTG and left inferior temporal gyrus (BA20), fusiform gyrus (BA37), and inferior frontal gyrus (BA47\45\44). CONCLUSION Left PMTG might play an important role in language dysfunction of chronic aphasia, and ALFF value might be a promising indicator to evaluate the severity of aphasia.
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Affiliation(s)
- Jianlin Li
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Dunren Du
- Department of Radiology, Yantai Laishan Branch Hospital of Yuhuangding Hospital, Medical College of Qingdao University
| | - Wei Gao
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Xichun Sun
- Department of Radiology, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Gang Zhang
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Jian Li
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Honglun Li
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Kefeng Li
- School of Medicine, University of California, San Diego, CA, USA
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