Behavioral and neurophysiologic response to therapy for chronic aphasia.

UNLABELLED: Breier JI, Juranek J, Maher LM, Schmadeke S, Men D, Papanicolaou AC. Behavioral and neurophysiologic response to therapy for chronic aphasia. OBJECTIVE: To characterize the relationship between neurophysiologic changes in the brain and behavioral response to constraint-induced language therapy (CILT) by using magnetoencephalography (MEG). DESIGN: Case series. SETTING: Medical school. PARTICIPANTS: Patients (N=23) with chronic aphasia after first-time unilateral stroke in the left hemisphere. INTERVENTIONS: Constraint-induced language therapy administered for 3 hours 4 times per week for 3 weeks. Language testing and functional imaging during a language comprehension task using MEG before, immediately after, and 3 months after CILT with a subgroup of patients undergoing additional MEG scanning and language testing 3 weeks before CILT. MAIN OUTCOME MEASURES: The percent of correct information units and the number of late dipoles normalized to total activation. RESULTS: Three patterns of behavioral and neurophysiologic response to CILT were identified. Patients with significant improvement in language immediately after CILT who lost these gains at follow-up had greater right hemisphere activation than other patients at all MEG scanning sessions. Patients with significant improvement in language immediately after CILT who maintained these gains at follow-up exhibited an increase in left temporal activation after CILT, whereas patients who did not exhibit significant improvement in language after CILT exhibited comparably greater activation in left parietal areas. CONCLUSIONS: Results suggest that although the right hemisphere may support recovery of language function in response to therapy, this recovery may not be stable, and some participation of perilesional areas of the left hemisphere may be necessary for a stable behavioral response.

Translational research in aphasia: from neuroscience to neurorehabilitation.

PURPOSE: In this article, the authors encapsulate discussions of the Language Work Group that took place as part of the Workshop in Plasticity/NeuroRehabilitation Research at the University of Florida in April 2005. METHOD: In this narrative review, they define neuroplasticity and review studies that demonstrate neural changes associated with aphasia recovery and treatment. The authors then summarize basic science evidence from animals, human cognition, and computational neuroscience that is relevant to aphasia treatment research. They then turn to the aphasia treatment literature in which evidence exists to support several of the neuroscience principles. CONCLUSION: Despite the extant aphasia treatment literature, many questions remain regarding how neuroscience principles can be manipulated to maximize aphasia recovery and treatment. They propose a framework, incorporating some of these principles, that may serve as a potential roadmap for future investigations of aphasia treatment and recovery. In addition to translational investigations from basic to clinical science, the authors propose several areas in which translation can occur from clinical to basic science to contribute to the fundamental knowledge base of neurorehabilitation. This article is intended to reinvigorate interest in delineating the factors influencing successful recovery from aphasia through basic, translational, and clinical research.

Combined Dextroamphetamine and Transcranial Direct Current Stimulation in Poststroke Aphasia.

There is a growing need for various effective adjunctive treatment options for speech recovery after stroke. A pharmacological agent combined with noninvasive brain stimulation has not been previously reported for poststroke aphasia recovery. In this "proof of concept" study, we aimed to test the safety of a combined intervention consisting of dextroamphetamine, transcranial direct current stimulation, and speech and language therapy in subjects with nonfluent aphasia. Ten subjects with chronic nonfluent aphasia underwent two experiments where they received dextroamphetamine or placebo along with transcranial direct current stimulation and speech and language therapy on two separate days. The Western Aphasia Battery-Revised was used to monitor changes in speech performance. No serious adverse events were observed. There was no significant increase in blood pressure with amphetamine or deterioration in speech and language performance. Western Aphasia Battery-Revised aphasia quotient and language quotient showed a statistically significant increase in the active experiment. Comparison of proportional changes of aphasia quotient and language quotient in active experiment with those in placebo experiment showed significant difference. We showed that the triple combination therapy is safe and implementable and seems to induce positive changes in speech and language performance in the patients with chronic nonfluent aphasia due to stroke.

Management of anomia.

Anomia is a complex, commonly occurring symptom of aphasia with different underlying causes. A number of behavioral approaches to rehabilitation of anomia have been described. Some are restitutive in nature and attempt to reactivate lexical-semantic or phonological representations to improve word retrieval. Others are intended to reorganize language functions by engaging alternative cognitive systems to mediate word retrieval or by exploiting residual abilities to circumvent the impairment. A better appreciation of the characteristics of an individual's naming deficit may assist the clinician in selecting appropriate interventions for restitution or substitution of function in the management of this disorder.

Changes in maps of language activity activation following melodic intonation therapy using magnetoencephalography: two case studies.

Two patients with chronic expressive aphasia underwent two blocks of melodic intonation therapy (MIT) each. Maps of language-specific neurophysiological activity were obtained prior to and after each MIT block during a covert action naming task using magnetoencephalography. Both patients exhibited increased left hemisphere activation after MIT. The patient who responded positively to therapy exhibited decreasing activation within areas of the right hemisphere homotopic to left hemisphere language areas compared to baseline after both blocks of MIT. In contrast, the patient who did not show improvement after therapy exhibited increasing activation in these areas of the right hemisphere after therapy. Results are consistent with hypotheses that melodic intonation therapy acts through promotion of left hemisphere activation.

Changes in language-specific brain activation after therapy for aphasia using magnetoencephalography: a case study.

A patient with chronic aphasia underwent functional imaging during a language comprehension task using magnetoencephalography (MEG) before and after constraint induced language therapy (CILT). In the pre- and immediate post-treatment (TX) scans MEG activity sources were observed within right hemisphere only, and were located in areas homotopic to left hemisphere language areas. There was a significant increase in activation in these areas between the two sessions. This change was not observed in an age-matched patient with chronic aphasia who underwent sequential language testing and MEG scanning across a similar time period without being administered therapy. In the 3-month post-TX scan bilateral activation was observed, including significant activation within the left temporal lobe. The changes in the spatial parameters of the maps of receptive language function after therapy were accompanied by improvement in language function. Results provide support, in the same individual, for a role for both hemispheres in recovery of language function after therapy for chronic aphasia.

Functional imaging before and after constraint-induced language therapy for aphasia using magnetoencephalography.

Five patients with chronic aphasia underwent functional imaging using magnetoencephalography (MEG) before and after constraint-induced language therapy (CILT). Patients who responded well to CILT exhibited a greater degree of late MEG activation in posterior language areas of the left hemisphere and homotopic areas of the right hemisphere prior to therapy than those who did not respond well. Response to CILT, however, was positively correlated with the degree of pre-therapy MEG activity within posterior areas of the right hemisphere only on an individual basis.

A pilot study of use-dependent learning in the context of Constraint Induced Language Therapy.

This investigation reports the results of a pilot study concerning the application of principles of use-dependent learning developed in the motor rehabilitation literature as Constraint Induced Therapy to language rehabilitation in a group of individuals with chronic aphasia. We compared treatment that required forced use of the language modality, Constraint Induced Language Therapy, (CILT) to treatment allowing all modes of communication. Both treatments were administrated intensively in a massed practice paradigm, using the same therapeutic stimuli and tasks. Results suggest that whereas both interventions yielded positive outcomes, CILT participants showed more consistent improvement on standard aphasia measures and clinician judgments of narrative discourse. These findings suggest that CILT intervention may be a viable approach to aphasia rehabilitation.

Neural substrates of syntactic mapping treatment: an fMRI study of two cases.

Two patients (G01, J02) with chronic nonfluent aphasia and sentence production deficits received syntactic mapping treatment to improve sentence production. The patients had dramatically different outcomes in that improved syntax production generalized to nontreatment tasks for G01, but not for JO2. To learn how treatment influenced the neural substrates for syntax production, both patients underwent pre- and posttreatment functional magnetic resonance imaging (fMRI) of sentence generation. G01 showed more robust activity posttreatment than pretreatment in Broca's area; ventral temporal activity decreased slightly from pre- to posttreatment. Comparison of J02's pretreatment and posttreatment images revealed little change, although activity was more diffuse pre- than posttreatment. Findings suggest that for G01, rehabilitation led to engagement of an area (Broca's area) used minimally during the pretreatment scan, whereas for J02, rehabilitation may have led to more efficient use of areas already involved in sentence generation during the pretreatment scan. fMRI findings are discussed in the context of sentence-production outcome and generalization.

Comparison of baseline conditions to investigate syntactic production using functional magnetic resonance imaging.

Functional magnetic resonance imaging (fMRI) in humans has revealed increases in brain activity associated with various mental activities that are task-dependent. However, changes in brain activity have been dependent on baseline as well as experimental tasks. In the present study, fMRI was applied to investigate the most appropriate baseline task, picture naming or passive viewing of nonsense objects, to isolate syntactic processes related to 14.7-s blocks of silent sentence generation in 10 neurologically normal adults. The aim of this comparison was to determine the most suitable baseline task for the purpose of elucidating changes in the neural substrates of sentence generation following therapy for syntax production problems. Use of naming but not passive object viewing as a baseline task obscured activity in Broca's area, a region previously shown to be involved in syntactic processing. These results suggest that passive viewing of nonsense objects serves as a more appropriate baseline comparison than object naming for investigating sentence processing.