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Brownsett SLE, Carey LM, Copland D, Walsh A, Sihvonen AJ. Structural brain networks correlating with poststroke cognition. Hum Brain Mapp 2024; 45:e26665. [PMID: 38520376 PMCID: PMC10960554 DOI: 10.1002/hbm.26665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/03/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
Cognitive deficits are a common and debilitating consequence of stroke, yet our understanding of the structural neurobiological biomarkers predicting recovery of cognition after stroke remains limited. In this longitudinal observational study, we set out to investigate the effect of both focal lesions and structural connectivity on poststroke cognition. Sixty-two patients with stroke underwent advanced brain imaging and cognitive assessment, utilizing the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE), at 3-month and 12-month poststroke. We first evaluated the relationship between lesions and cognition at 3 months using voxel-based lesion-symptom mapping. Next, a novel correlational tractography approach, using multi-shell diffusion-weighted magnetic resonance imaging (MRI) data collected at both time points, was used to evaluate the relationship between the white matter connectome and cognition cross-sectionally at 3 months, and longitudinally (12 minus 3 months). Lesion-symptom mapping did not yield significant findings. In turn, correlational tractography analyses revealed positive associations between both MoCA and MMSE scores and bilateral cingulum and the corpus callosum, both cross-sectionally at the 3-month stage, and longitudinally. These results demonstrate that rather than focal neural structures, a consistent structural connectome underpins the performance of two frequently used cognitive screening tools, the MoCA and the MMSE, in people after stroke. This finding should encourage clinicians and researchers to not only suspect cognitive decline when lesions affect these tracts, but also to refine their investigation of novel approaches to differentially diagnosing pathology associated with cognitive decline, regardless of the aetiology.
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Affiliation(s)
- Sonia L. E. Brownsett
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneVictoriaAustralia
- Queensland Aphasia Research CentreSurgical, Treatment and Rehabilitation Service, University of QueenslandBrisbaneQueenslandAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Leeanne M. Carey
- Occupational Therapy, School of Allied Health Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- Neurorehabilitation and Recovery GroupThe FloreyMelbourneVictoriaAustralia
| | - David Copland
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneVictoriaAustralia
- Queensland Aphasia Research CentreSurgical, Treatment and Rehabilitation Service, University of QueenslandBrisbaneQueenslandAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Alistair Walsh
- Occupational Therapy, School of Allied Health Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- Neurorehabilitation and Recovery GroupThe FloreyMelbourneVictoriaAustralia
| | - Aleksi J. Sihvonen
- Centre of Research Excellence in Aphasia Recovery and RehabilitationLa Trobe UniversityMelbourneVictoriaAustralia
- Queensland Aphasia Research CentreSurgical, Treatment and Rehabilitation Service, University of QueenslandBrisbaneQueenslandAustralia
- School of Health and Rehabilitation SciencesUniversity of QueenslandBrisbaneQueenslandAustralia
- Centre of Excellence in Music, Mind, Body and Brain, Cognitive Brain Research Unit (CBRU)University of HelsinkiHelsinkiFinland
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Tolkacheva V, Brownsett SLE, McMahon KL, de Zubicaray GI. Perceiving and misperceiving speech: lexical and sublexical processing in the superior temporal lobes. Cereb Cortex 2024; 34:bhae087. [PMID: 38494418 PMCID: PMC10944697 DOI: 10.1093/cercor/bhae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Listeners can use prior knowledge to predict the content of noisy speech signals, enhancing perception. However, this process can also elicit misperceptions. For the first time, we employed a prime-probe paradigm and transcranial magnetic stimulation to investigate causal roles for the left and right posterior superior temporal gyri (pSTG) in the perception and misperception of degraded speech. Listeners were presented with spectrotemporally degraded probe sentences preceded by a clear prime. To produce misperceptions, we created partially mismatched pseudo-sentence probes via homophonic nonword transformations (e.g. The little girl was excited to lose her first tooth-Tha fittle girmn wam expited du roos har derst cooth). Compared to a control site (vertex), inhibitory stimulation of the left pSTG selectively disrupted priming of real but not pseudo-sentences. Conversely, inhibitory stimulation of the right pSTG enhanced priming of misperceptions with pseudo-sentences, but did not influence perception of real sentences. These results indicate qualitatively different causal roles for the left and right pSTG in perceiving degraded speech, supporting bilateral models that propose engagement of the right pSTG in sublexical processing.
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Affiliation(s)
- Valeriya Tolkacheva
- Queensland University of Technology, School of Psychology and Counselling, O Block, Kelvin Grove, Queensland, 4059, Australia
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, University of Queensland, Surgical Treatment and Rehabilitation Services, Herston, Queensland, 4006, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Health Sciences Building 1, 1 Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| | - Katie L McMahon
- Herston Imaging Research Facility, Royal Brisbane & Women’s Hospital, Building 71/918, Royal Brisbane & Women’s Hospital, Herston, Queensland, 4006, Australia
- Queensland University of Technology, School of Clinical Sciences and Centre for Biomedical Technologies, 60 Musk Avenue, Kelvin Grove, Queensland, 4059, Australia
| | - Greig I de Zubicaray
- Queensland University of Technology, School of Psychology and Counselling, O Block, Kelvin Grove, Queensland, 4059, Australia
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Kearney E, Brownsett SLE, Copland DA, Drummond KJ, Jeffree RL, Olson S, Murton E, Ong B, Robinson GA, Tolkacheva V, McMahon KL, de Zubicaray GI. Relationships between reading performance and regional spontaneous brain activity following surgical removal of primary left-hemisphere tumors: A resting-state fMRI study. Neuropsychologia 2023; 188:108631. [PMID: 37356540 DOI: 10.1016/j.neuropsychologia.2023.108631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/08/2023] [Accepted: 06/23/2023] [Indexed: 06/27/2023]
Abstract
Left-hemisphere intraparenchymal primary brain tumor patients are at risk of developing reading difficulties that may be stable, improve or deteriorate after surgery. Previous studies examining language organization in brain tumor patients have provided insights into neural plasticity supporting recovery. Only a single study, however, has examined the role of white matter tracts in preserving reading ability post-surgery and none have examined the functional reading network. The current study aimed to investigate the regional spontaneous brain activity associated with reading performance in a group of 36 adult patients 6-24 months following left-hemisphere tumor resection. Spontaneous brain activity was assessed using resting-state fMRI (rs-fMRI) regional homogeneity (ReHo) and fractional amplitude low frequency fluctuation (fALFF) metrics, which measure local functional connectivity and activity, respectively. ReHo in the left occipito-temporal and right superior parietal regions was negatively correlated with reading performance. fALFF in the putamen bilaterally and the left cerebellum was negatively correlated with reading performance, and positively correlated in the right superior parietal gyrus. These findings are broadly consistent with reading networks reported in healthy participants, indicating that reading ability following brain tumor surgery might not involve substantial functional re-organization.
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Affiliation(s)
- Elaine Kearney
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, 4059, Australia.
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072, Australia; Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, University of Queensland and Metro North Health, Queensland, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072, Australia; Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, University of Queensland and Metro North Health, Queensland, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Katharine J Drummond
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, 3052, Australia
| | | | - Sarah Olson
- Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Emma Murton
- Department of Speech Pathology, Royal Melbourne Hospital, Parkville, 3050, Australia
| | - Benjamin Ong
- Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Gail A Robinson
- Queensland Brain Institute and School of Psychology, University of Queensland, Brisbane, 4072, Australia
| | - Valeriya Tolkacheva
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, 4059, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, 4059, Australia; Herston Imaging Research Facility, Royal Brisbane & Women's Hospital, Brisbane, 4029, Australia
| | - Greig I de Zubicaray
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, 4059, Australia
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Pitkäniemi A, Särkämö T, Siponkoski ST, Brownsett SLE, Copland DA, Sairanen V, Sihvonen AJ. Hodological organization of spoken language production and singing in the human brain. Commun Biol 2023; 6:779. [PMID: 37495670 PMCID: PMC10371982 DOI: 10.1038/s42003-023-05152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
Theories expounding the neural relationship between speech and singing range from sharing neural circuitry, to relying on opposite hemispheres. Yet, hodological studies exploring their shared and distinct neural networks remain scarce. In this study, we combine a white matter connectometry approach together with comprehensive and naturalistic appraisal of verbal expression during spoken language production and singing in a sample of individuals with post-stroke aphasia. Our results reveal that both spoken language production and singing are mainly supported by the left hemisphere language network and projection pathways. However, while spoken language production mostly engaged dorsal and ventral streams of speech processing, singing was associated primarily with the left ventral stream. These findings provide evidence that speech and singing share core neuronal circuitry within the left hemisphere, while distinct ventral stream contributions explain frequently observed dissociations in aphasia. Moreover, the results suggest prerequisite biomarkers for successful singing-based therapeutic interventions.
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Affiliation(s)
- Anni Pitkäniemi
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland.
| | - Teppo Särkämö
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland
| | - Sini-Tuuli Siponkoski
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
| | - Viljami Sairanen
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Aleksi J Sihvonen
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland
- Queensland Aphasia Research Centre, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia
- Department of Neurology, Helsinki University Hospital and Department of Neurosciences, University of Helsinki, Helsinki, Finland
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Vadinova V, Sihvonen AJ, Garden KL, Ziraldo L, Roxbury T, O'Brien K, Copland DA, McMahon KL, Brownsett SLE. Early Subacute White Matter Hyperintensities and Recovery of Language After Stroke. Neurorehabil Neural Repair 2023; 37:218-227. [PMID: 37083133 PMCID: PMC10152219 DOI: 10.1177/15459683231168384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND White matter hyperintensities (WMH) are considered to contribute to diminished brain reserve, negatively impacting on stroke recovery. While WMH identified in the chronic phase after stroke have been associated with post-stroke aphasia, the contribution of premorbid WMH to the early recovery of language across production and comprehension has not been investigated. OBJECTIVE To investigate the relationship between premorbid WMH severity and longitudinal comprehension and production outcomes in aphasia, after controlling for stroke lesion variables. METHODS Longitudinal behavioral data from individuals with a left-hemisphere stroke were included at the early subacute (n = 37) and chronic (n = 28) stage. Spoken language comprehension and production abilities were assessed at both timepoints using word and sentence-level tasks. Magnetic resonance imaging (MRI) was performed at the early subacute stage to derive stroke lesion variables (volume and proportion damage to critical regions) and WMH severity rating. RESULTS The presence of severe WMH explained an additional 18% and 25% variance in early subacute (t = -3.00, p = .004) and chronic (t = -3.60, P = .001) language comprehension abilities respectively, after controlling for stroke lesion variables. WMH did not predict additional variance of language production scores. CONCLUSIONS Subacute clinical MRI can be used to improve prognoses of recovery of aphasia after stroke. We demonstrate that severe early subacute WMH add to the prediction of impaired longitudinal language recovery in comprehension, but not production. This emphasizes the need to consider different domains of language when investigating novel neurobiological predictors of aphasia recovery.
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Affiliation(s)
- Veronika Vadinova
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Aleksi J Sihvonen
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
- Cognitive Brain Research Unit (CBRU), University of Helsinki, Helsinki, Finland
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland
| | - Kimberley L Garden
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Laura Ziraldo
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Tracy Roxbury
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Kate O'Brien
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - David A Copland
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Queensland, Australia
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Australia
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de Zubicaray GI, Brownsett SLE, Copland DA, Drummond K, Jeffree RL, Olson S, Murton E, Ong B, Robinson GA, Tolkacheva V, McMahon KL. Chronic aphasias after left-hemisphere resective surgery. Brain and Language 2023; 239:105244. [PMID: 36889018 DOI: 10.1016/j.bandl.2023.105244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/23/2023] [Accepted: 02/23/2023] [Indexed: 05/10/2023]
Abstract
Surgical resection of brain tumours is associated with an increased risk of aphasia. However, relatively little is known about outcomes in the chronic phase (i.e., >6 months). Using voxel-based lesion symptom mapping (VLSM) in 46 patients, we investigated whether chronic language impairments are related to the location of surgical resection, residual tumour characteristics (e.g., peri-resection treatment effects, progressive infiltration, oedema) or both. Approximately 72% of patients scored below the cut-off for aphasia. Action naming and spoken sentence comprehension deficits were associated with lesions in the left anterior temporal and inferior parietal lobes, respectively. Voxel-wise analyses revealed significant associations between ventral language pathways and action naming deficits. Reading impairments were also associated with increasing disconnection of cerebellar pathways. The results indicate chronic post-surgical aphasias reflect a combination of resected tissue and tumour infiltration of language-related white matter tracts, implicating progressive disconnection as the critical mechanism of impairment.
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Affiliation(s)
- Greig I de Zubicaray
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD 4059, Australia.
| | - Sonia L E Brownsett
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Kate Drummond
- Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | | | - Sarah Olson
- Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Emma Murton
- Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Benjamin Ong
- Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Gail A Robinson
- Queensland Brain Institute and School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia
| | - Valeriya Tolkacheva
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4059, Australia; Herston Imaging Research Facility, Royal Brisbane & Women's Hospital, Brisbane, QLD 4029, Australia
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Sihvonen AJ, Vadinova V, Garden KL, Meinzer M, Roxbury T, O'Brien K, Copland D, McMahon KL, Brownsett SLE. Right hemispheric structural connectivity and poststroke language recovery. Hum Brain Mapp 2023; 44:2897-2904. [PMID: 36852658 PMCID: PMC10089089 DOI: 10.1002/hbm.26252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/01/2023] Open
Abstract
Poststroke aphasia typically results from brain damage to the left-lateralized language network. The contribution of the right-lateralized homologues in aphasia recovery remains equivocal. In this longitudinal observational study, we specifically investigated the role of right hemisphere structural connectome in aphasia recovery. Twenty-two patients with aphasia after a left hemispheric stroke underwent comprehensive language assessment at the early subacute and chronic stages. A novel structural connectometry approach, using multi-shell diffusion-weighted MRI data collected at the early subacute stage, was used to evaluate the relationship between right hemisphere white matter connectome and language production and comprehension abilities at early subacute stage. Moreover, we evaluated the relationship between early subacute right hemisphere white matter connectome and longitudinal change in language production and comprehension abilities. All results were corrected for multiple comparisons. Connectometry analyses revealed negative associations between early subacute stage right hemisphere structural connectivity and language production, both cross-sectionally and longitudinally (pFDR < .0125). In turn, only positive associations between right hemisphere structural connectivity and language comprehension were observed, both cross-sectionally and longitudinally (pFDR < .0125). Interhemispheric connectivity was highly associated with comprehension scores. Our results shed light on the discordant interpretations of previous findings, by providing evidence that while some right hemisphere white matter pathways may make a maladaptive contribution to the recovery of language, other pathways support the recovery of language, especially comprehension abilities.
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Affiliation(s)
- Aleksi J Sihvonen
- Queensland Aphasia Research Centre, University of Queensland, Herston, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia.,Cognitive Brain Research Unit (CBRU), University of Helsinki, Helsinki, Finland.,Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, Helsinki, Finland
| | - Veronika Vadinova
- Queensland Aphasia Research Centre, University of Queensland, Herston, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Kimberley L Garden
- Queensland Aphasia Research Centre, University of Queensland, Herston, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Tracy Roxbury
- Queensland Aphasia Research Centre, University of Queensland, Herston, Australia
| | - Kate O'Brien
- Queensland Aphasia Research Centre, University of Queensland, Herston, Australia
| | - David Copland
- Queensland Aphasia Research Centre, University of Queensland, Herston, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, University of Queensland, Herston, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
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Harvey S, Rose ML, Brogan E, Pierce JE, Godecke E, Brownsett SLE, Churilov L, Copland D, Dickey MW, Dignam J, Lannin NA, Nickels L, Bernhardt J, Hayward KS. Examining Dose Frameworks to Improve Aphasia Rehabilitation Research. Arch Phys Med Rehabil 2022; 104:830-838. [PMID: 36572201 DOI: 10.1016/j.apmr.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022]
Abstract
The effect of treatment dose on recovery of post-stroke aphasia is not well understood. Inconsistent conceptualization, measurement, and reporting of the multiple dimensions of dose hinders efforts to evaluate dose-response relations in aphasia rehabilitation research. We review the state of dose conceptualization in aphasia rehabilitation and compare the applicability of 3 existing dose frameworks to aphasia rehabilitation research-the Frequency, Intensity, Time, and Type (FITT) principle, the Cumulative Intervention Intensity (CII) framework, and the Multidimensional Dose Articulation Framework (MDAF). The MDAF specifies dose in greater detail than the CII framework and the FITT principle. On this basis, we selected the MDAF to be applied to 3 diverse examples of aphasia rehabilitation research. We next critically examined applicability of the MDAF to aphasia rehabilitation research and identified the next steps needed to systematically conceptualize, measure, and report the multiple dimensions of dose, which together can progress understanding of the effect of treatment dose on outcomes for people with aphasia after stroke. Further consideration is required to enable application of this framework to aphasia interventions that focus on participation, personal, and environmental interventions and to understand how the construct of episode difficulty applies across therapeutic activities used in aphasia interventions.
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Affiliation(s)
- Sam Harvey
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Miranda L Rose
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - Emily Brogan
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - John E Pierce
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Erin Godecke
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Sonia L E Brownsett
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Queensland Aphasia Research Centre, University of Queensland, Brisbane, Australia; Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Leonid Churilov
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - David Copland
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Queensland Aphasia Research Centre, University of Queensland, Brisbane, Australia; Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Michael Walsh Dickey
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh PA; Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA
| | - Jade Dignam
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Queensland Aphasia Research Centre, University of Queensland, Brisbane, Australia; Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Natasha A Lannin
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Brain Recovery and Rehabilitation Group, Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Lyndsey Nickels
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Julie Bernhardt
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Kathryn S Hayward
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
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Geranmayeh F, Brownsett SLE, Wise RJS. Task-induced brain activity in aphasic stroke patients: what is driving recovery? Brain 2014; 137:2632-48. [PMID: 24974382 PMCID: PMC4163030 DOI: 10.1093/brain/awu163] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/03/2014] [Accepted: 04/27/2014] [Indexed: 12/24/2022] Open
Abstract
The estimated prevalence of aphasia in the UK and the USA is 250 000 and 1 000 000, respectively. The commonest aetiology is stroke. The impairment may improve with behavioural therapy, and trials using cortical stimulation or pharmacotherapy are undergoing proof-of-principle investigation, but with mixed results. Aphasia is a heterogeneous syndrome, and the simple classifications according to the Broca-Wernicke-Lichtheim model inadequately describe the diverse communication difficulties with which patients may present. Greater knowledge of how intact neural networks promote recovery after aphasic stroke, either spontaneously or in response to interventions, will result in clearer hypotheses about how to improve the treatment of aphasia. Twenty-five years ago, a pioneering study on healthy participants heralded the introduction of functional neuroimaging to the study of mechanisms of recovery from aphasia. Over the ensuing decades, such studies have been interpreted as supporting one of three hypotheses, which are not mutually exclusive. The first two predate the introduction of functional neuroimaging: that recovery is the consequence of the reconstitution of domain-specific language systems in tissue around the lesion (the 'perilesional' hypothesis), or by homotopic cortex in the contralateral hemisphere (the 'laterality-shift' hypothesis). The third is that loss of transcallosal inhibition to contralateral homotopic cortex hinders recovery (the 'disinhibition' hypothesis). These different hypotheses at times give conflicting views about rehabilitative intervention; for example, should one attempt to activate or inhibit a contralateral homotopic region with cortical stimulation techniques to promote recovery? This review proposes that although the functional imaging data are statistically valid in most cases, their interpretation has often favoured one explanation while ignoring plausible alternatives. In our view, this is particularly evident when recovery is attributed to activity in 'language networks' occupying sites not observed in healthy participants. In this review we will argue that much of the distribution of what has often been interpreted as language-specific activity, particularly in midline and contralateral cortical regions, is an upregulation of activity in intact domain-general systems for cognitive control and attention, responding in a task-dependent manner to the increased 'effort' when damaged downstream domain-specific language networks are impaired. We further propose that it is an inability fully to activate these systems that may result in sub optimal recovery in some patients. Interpretation of the data in terms of activity in domain-general networks affords insights into novel approaches to rehabilitation.
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Affiliation(s)
- Fatemeh Geranmayeh
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Sonia L E Brownsett
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
| | - Richard J S Wise
- Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK
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Abstract
Aphasic deficits are usually only interpreted in terms of domain-specific language processes. However, effective human communication and tests that probe this complex cognitive skill are also dependent on domain-general processes. In the clinical context, it is a pragmatic observation that impaired attention and executive functions interfere with the rehabilitation of aphasia. One system that is important in cognitive control is the salience network, which includes dorsal anterior cingulate cortex and adjacent cortex in the superior frontal gyrus (midline frontal cortex). This functional imaging study assessed domain-general activity in the midline frontal cortex, which was remote from the infarct, in relation to performance on a standard test of spoken language in 16 chronic aphasic patients both before and after a rehabilitation programme. During scanning, participants heard simple sentences, with each listening trial followed immediately by a trial in which they repeated back the previous sentence. Listening to sentences in the context of a listen–repeat task was expected to activate regions involved in both language-specific processes (speech perception and comprehension, verbal working memory and pre-articulatory rehearsal) and a number of task-specific processes (including attention to utterances and attempts to overcome pre-response conflict and decision uncertainty during impaired speech perception). To visualize the same system in healthy participants, sentences were presented to them as three-channel noise-vocoded speech, thereby impairing speech perception and assessing whether this evokes domain general cognitive systems. As expected, contrasting the more difficult task of perceiving and preparing to repeat noise-vocoded speech with the same task on clear speech demonstrated increased activity in the midline frontal cortex in the healthy participants. The same region was activated in the aphasic patients as they listened to standard (undistorted) sentences. Using a region of interest defined from the data on the healthy participants, data from the midline frontal cortex was obtained from the patients. Across the group and across different scanning sessions, activity correlated significantly with the patients’ communicative abilities. This correlation was not influenced by the sizes of the lesion or the patients’ chronological ages. This is the first study that has directly correlated activity in a domain general system, specifically the salience network, with residual language performance in post-stroke aphasia. It provides direct evidence in support of the clinical intuition that domain-general cognitive control is an essential factor contributing to the potential for recovery from aphasic stroke.
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Affiliation(s)
- Sonia L E Brownsett
- 1 Cognitive, Clinical and Computational Neuroimaging Group, Imperial College, Hammersmith Hospital, London, W12 0NN, UK
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Geranmayeh F, Brownsett SLE, Leech R, Beckmann CF, Woodhead Z, Wise RJS. The contribution of the inferior parietal cortex to spoken language production. Brain Lang 2012; 121:47-57. [PMID: 22381402 DOI: 10.1016/j.bandl.2012.02.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/19/2012] [Accepted: 02/03/2012] [Indexed: 05/31/2023]
Abstract
This functional MRI study investigated the involvement of the left inferior parietal cortex (IPC) in spoken language production (Speech). Its role has been apparent in some studies but not others, and is not convincingly supported by clinical studies as they rarely include cases with lesions confined to the parietal lobe. We compared Speech with non-communicative repetitive tongue movements (Tongue). The data were analyzed with both univariate contrasts between conditions and probabilistic independent component analysis (ICA). The former indicated decreased activity of left IPC during Speech relative to Tongue. However, the ICA revealed a Speech component in which there was correlated activity between left IPC, frontal and temporal cortices known to be involved in language. Therefore, although net synaptic activity throughout the left IPC may not increase above baseline conditions during Speech, one or more local systems within this region are involved, evidenced by the correlated activity with other language regions.
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Affiliation(s)
- Fatemeh Geranmayeh
- Division of Experimental Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK.
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Abstract
The left parietal lobe has been proposed as a major language area. However, parietal cortical function is more usually considered in terms of the control of actions, contributing both to attention and cross-modal integration of external and reafferent sensory cues. We used positron emission tomography to study normal subjects while they overtly generated narratives, both spoken and written. The purpose was to identify the parietal contribution to the modality-specific sensorimotor control of communication, separate from amodal linguistic and memory processes involved in generating a narrative. The majority of left and right parietal activity was associated with the execution of writing under visual and somatosensory control irrespective of whether the output was a narrative or repetitive reproduction of a single grapheme. In contrast, action-related parietal activity during speech production was confined to primary somatosensory cortex. The only parietal area with a pattern of activity compatible with an amodal central role in communication was the ventral part of the left angular gyrus (AG). The results of this study indicate that the cognitive processing of language within the parietal lobe is confined to the AG and that the major contribution of parietal cortex to communication is in the sensorimotor control of writing.
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Affiliation(s)
- Sonia L E Brownsett
- Division of Neuroscience and Mental Health and Medical Research Council Clinical Sciences Centre, Imperial College, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
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