Neuromodulation of the Right Motor Cortex of the Lips With Repetitive Transcranial Magnetic Stimulation to Reduce Phonological Impairment and Improve Naming in Three Persons With Aphasia: A Single-Case Experimental Design.

PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) can enhance aphasia recovery. Most studies have used inhibitory stimulation targeting the right inferior frontal gyrus. However, the motor cortex, observed to contribute to the prediction of aphasia recovery, is involved in word production and could be an appropriate target for rTMS. We aimed to observe behavioral changes in a picture naming task induced by inhibitory rTMS targeting the right motor cortex of the lips in people with poststroke aphasia. METHOD: Using a single-case experimental design, we included three participants with chronic poststroke aphasia who had phonological deficits. Each participant performed a verbal picture naming task 3 times a week for 2, 3, or 4 weeks (pseudorandom across participants) to establish a baseline naming ability for each participant. These were not therapy sessions, and no feedback was provided. Then, each participant received the intervention, inhibitory continuous theta burst stimulation targeting the right motor cortex of the lips, 3 times a week for 2 weeks. Naming testing continued 3 times a week, for these latter 2 weeks. No therapy was performed at any time during the study. RESULTS: Visual analysis of the graphs showed a positive effect of rTMS for P2 and P3 on picture naming accuracy and a tendency toward improvement for P1. Statistical analysis showed an improvement after rTMS for P1 (τ = 0.544, p = .013, SETau = 0.288) and P2 (τ = 0.708, p = .001, SETau = 0.235). For P3, even if the intervention allowed some improvement, this was statistically nonsignificant due to a learning effect during the baseline naming testing, which lasted the longest, 4 weeks. Regarding specific language features, phonological errors significantly decreased in all patients. CONCLUSIONS: The motor cortex of the lips could be an appropriate target for rTMS to improve naming in people with poststroke aphasia suffering from a phonological deficit. This suggests the possibility to individualize the target for rTMS, according to the patient's linguistic impairment.

[Post-stroke aphasia recovery: what are the predictors?] / Récupération de l'aphasie post-AVC: quels sont les facteurs prédictifs ?

Post-stroke aphasia recovery is multifactorial and results from a complex equation between four types of interrelated factors : a) neurobiological factors, such as lesion size and location, but also to some extent the neural reserve in undamaged brain areas ; b) behavioral factors, mostly related to the initial severity of stroke symptoms ; c) personal factors, such as age and gender, that remain however poorly investigated and debated and d) therapeutic factors, related to medical endovascular interventions and to speech and language therapy. Future studies are crucial to determine more precisely the weight and the interaction of these factors in the recovery process of post-stroke aphasia.

La récupération de l'aphasie post-AVC est multifactorielle et fait l'objet d'une équation complexe entre quatre types de facteurs interreliés : a) des facteurs neurobiologiques, comme la taille et la localisation de la lésion cérébrale, ou encore la réserve neuronale dans les régions non lésées ; b) des facteurs comportementaux, principalement en lien avec la sévérité initiale de la symptomatologie ; c) des facteurs personnels, comme l'âge ou le genre, qui restent toutefois peu explorés et encore débattus à l'heure actuelle et d) des facteurs thérapeutiques, liés aux traitements médicaux endovasculaires et aux traitements logopédiques prodigués. Seuls des travaux de recherche supplémentaires permettront de déterminer plus précisément le poids et l'interaction de ces facteurs dans le processus de récupération de l'aphasie vasculaire.

Comparison of In-Person and Online Recordings in the Clinical Teleassessment of Speech Production: A Pilot Study.

In certain circumstances, speech and language therapy is proposed in telepractice as a practical alternative to in-person services. However, little is known about the minimum quality requirements of recordings in the teleassessment of motor speech disorders (MSD) utilizing validated tools. The aim here is to examine the comparability of offline analyses based on speech samples acquired from three sources: (1) in-person recordings with high quality material, serving as the baseline/gold standard; (2) in-person recordings with standard equipment; (3) online recordings from videoconferencing. Speech samples were recorded simultaneously from these three sources in fifteen neurotypical speakers performing a screening battery of MSD and analyzed by three speech and language therapists. Intersource and interrater agreements were estimated with intraclass correlation coefficients on seventeen perceptual and acoustic parameters. While the interrater agreement was excellent for most speech parameters, especially on high quality in-person recordings, it decreased in online recordings. The intersource agreement was excellent for speech rate and mean fundamental frequency measures when comparing high quality in-person recordings to the other conditions. The intersource agreement was poor for voice parameters, but also for perceptual measures of intelligibility and articulation. Clinicians who plan to teleassess MSD should adapt their recording setting to the parameters they want to reliably interpret.

Electrophysiological Changes in Patients with Post-stroke Aphasia: A Systematic Review.

Background Magnetoencephalography (MEG) and electroencephalography (EEG) record two main types of data: continuous measurements at rest or during sleep, and event-related potentials/evoked magnetic fields (ERPs/EMFs) that involve specific and repetitive tasks. In this systematic review, we summarized longitudinal studies on recovery from post-stroke aphasia that used continuous or event-related temporal imaging (EEG or MEG). Methods We searched PubMed and Scopus for English articles published from 1950 to May 31, 2022. Results 34 studies were included in this review: 11 were non-interventional studies and 23 were clinical trials that used specific rehabilitation methods, neuromodulation, or drugs. The results of the non-interventional studies suggested that poor language recovery was associated with slow-wave activity persisting over time. The results of some clinical trials indicated that behavioral improvements were correlated with significant modulation of the N400 component. Discussion Compared with continuous EEG, ERP/EMF may more reliably identify biomarkers of therapy-induced effects. Electrophysiology should be used more often to explore language processes that are impaired after a stroke, as it may highlight treatment challenges for patients with post-stroke aphasia.

Facilitating Word Retrieval in Aphasia: Which Type of Cues for Which Aphasic Speakers?

Background: Even if both phonological and semantic cues can facilitate word retrieval in aphasia, it remains unclear if their respective effectiveness varies according to the underlying anomic profile. Aim: The aim of the present facilitation study is to compare the effect of phonological and semantic cues on picture naming accuracy and speed in different types of anomia. Methods: In the present within-subject design study, 15 aphasic persons following brain damage underwent picture naming paradigms with semantic cues (categorically- or associatively related) and phonological cues (initial phoneme presented auditorily, visually or both). Results: At the group level, semantic cueing was as effective as phonological cueing to significantly speed up picture naming. However, while phonological cues were effective regardless of the anomic profile, semantic cueing effects varied depending on the type of anomia. Participants with mixed anomia showed facilitation after both semantic categorical and associative cues, but individuals with lexical-phonological anomia only after categorical cues. Crucially, semantic cues were ineffective for participants with lexical-semantic anomia. These disparities were confirmed by categorical semantic facilitation decreasing when semantic/omission errors prevailed in the anomic profile, but increasing alongside phonological errors. Conclusion: The effectiveness of phonological vs semantic cues seems related to the underlying anomic profile: phonological cues benefit any type of anomia, but semantic cues only lexical-phonological or mixed anomia.

A systematic review of repetitive transcranial magnetic stimulation in aphasia rehabilitation: Leads for future studies.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool that induces neuromodulation in the brain. Several studies have shown that rTMS improves language recovery in patients with post-stroke aphasia. OBJECTIVE: This systematic review summarizes the role of rTMS in aphasia rehabilitation. METHODS: We searched MEDLINE via PubMed and Scopus on 30October, 2020, for English articles (1996-2020). Eligible studies involved post-stroke aphasia rehabilitation with rTMS. In some of these studies, rTMS was also combined with speech therapy. RESULTS: In total, seven meta-analyses and 59studies (23randomized clinical trials) were included in this systematic review. The methods used in these studies were heterogeneous. Only six studies did not find that rTMS had a significant effect on language performance. CONCLUSIONS: The evidence from the peer-reviewed literature suggests that rTMS is an effective tool in post-stroke aphasia rehabilitation. However, the precise mechanisms that underlie the effects of rTMS and the reorganization of language networks in patients who have had a stroke remain unclear. We discuss these crucial challenges in the context of future studies.

The involvement of left inferior frontal and middle temporal cortices in word production unveiled by greater facilitation effects following brain damage.

In stroke-induced aphasia, left hemispheric lesions generally disturb the word production network. The left inferior frontal gyrus (LIFG) and the left middle temporal gyrus (LMTG) are involved in word production, but their respective contribution remains ambiguous. Previous investigations have largely focused on semantic interference to gather information about word production. Here we assessed the sensitivity of twenty-five aphasic speakers with either LIFG or LMTG lesions and matched controls to both semantic facilitation and interference in word production using the picture-word (PWP) and the blocked-cyclic naming (BCNP) paradigms. In the PWP (Exp. 1), semantic facilitation was exaggerated in participants with LIFG damage as compared to age-matched controls. In the BCNP (Exp. 2), repetition priming on production speed was larger in participants with LMTG damage than in controls, without any decrease of semantic errors. In the light of the results in the PWP, the LIFG appears to be a necessary structure to shape semantic facilitation. It might play an important role in properly adjusting the lexical selection threshold within the word production network. The results in the BCNP suggest that the LMTG conveys semantic-to-lexical connections likely involved in repetition priming and in mapping concepts to their correct lexical label. As consequences, participants with LIFG lesions possibly rely more on strategic vs automatic processes to efficiently select lexical entries in semantically competitive contexts, whereas participants with LMTG might exploit residual semantic-to-lexical activation.

When Wine and Apple Both Help the Production of Grapes: ERP Evidence for Post-lexical Semantic Facilitation in Picture Naming.

Background: Producing a word in referential naming requires to select the right word in our mental lexicon among co-activated semantically related words. The mechanisms underlying semantic context effects during speech planning are still controversial, particularly for semantic facilitation which investigation remains under-represented in contrast to the plethora of studies dealing with interference. Our aim is to study the time-course of semantic facilitation in picture naming, using a picture-word "interference" paradigm and event-related potentials (ERPs). Methods: We compared two different types of semantic relationships, associative and categorical, in a single word priming and a double word priming paradigm. The primes were presented visually with a long negative Stimulus Onset Asynchrony (SOA), which is expected to cause facilitation. Results: Shorter naming latencies were observed after both associative and categorical primes, as compared to unrelated primes, and even shorter latencies after two primes. Electrophysiological results showed relatively late modulations of waveform amplitudes for both types of primes (beginning ~330 ms post picture onset with a single prime and ~275 ms post picture onset with two primes), corresponding to a shift in latency of similar topographic maps across conditions. Conclusion: The present results are in favor of a post-lexical locus of semantic facilitation for associative and categorical priming in picture naming and confirm that semantic facilitation is as relevant as semantic interference to inform on word production. The post-lexical locus argued here might be related to self-monitoting or/and to modulations at the level of word-form planning, without excluding the participation of strategic processes.

ERP evidence of distinct processes underlying semantic facilitation and interference in word production.

In everyday conversations, we take advantage of lexical-semantic contexts to facilitate speech production, but at the same time, we also have to reduce interference and inhibit semantic competitors. The blocked cyclic naming paradigm (BCNP) has been used to investigate such context effects. Typical results on production latencies showed semantic facilitation (or no effect) during the first presentation cycle, and interference emerging in subsequent cycles. Even if semantic contexts might be just as facilitative as interfering, previous BCNP studies focused on interference, which was interpreted as reflecting lemma selection and self-monitoring processes. Facilitation in the first cycle was rarely considered/analysed, although it potentially informs on word production to the same extent as interference. Here we contrasted the event-related potential (ERP) signatures of both semantic facilitation and interference in a BCNP. ERPs differed between homogeneous and heterogeneous blocks from about 365 msec post picture onset in the first cycle (facilitation) and in an earlier time-window (270 msec post picture onset) in the third cycle (interference). Three different analyses of the ERPs converge towards distinct processes underlying semantic facilitation and interference (post-lexical vs lexical respectively). The loci of semantic facilitation and interference are interpreted in the context of different theoretical frameworks of language production: the post-lexical locus of semantic facilitation involves interactive phonological-semantic processes and/or self-monitoring, whereas the lexical locus of semantic interference is in line with selection through increased lexical competition.

Dynamics of phonological-phonetic encoding in word production: evidence from diverging ERPs between stroke patients and controls.

While the dynamics of lexical-semantic and lexical-phonological encoding in word production have been investigated in several event-related potential (ERP) studies, the estimated time course of phonological-phonetic encoding is the result of rather indirect evidence. We investigated the dynamics of phonological-phonetic encoding combining ERP analyses covering the entire encoding process in picture naming and word reading tasks by comparing ERP modulations in eight brain-damaged speakers presenting impaired phonological-phonetic encoding relative to 16 healthy controls. ERPs diverged between groups in terms of local waveform amplitude and global topography at ∼400 ms after stimulus onset in the picture naming task and at ∼320-350 ms in word reading and sustained until 100 ms before articulation onset. These divergences appeared in later time windows than those found in patients with underlying lexical-semantic and lexical-phonological impairment in previous studies, providing evidence that phonological-phonetic encoding is engaged around 400 ms in picture naming and around 330 ms in word reading.