Background and Purpose Previous studies have suggested that patients’ potential for post-stroke language recovery is related to lesion size; however, lesion location may also be of importance, particularly when fiber tracts that are critical to the sensorimotor mapping of sounds for articulation (e.g. the arcuate fasciculus [AF]) have been damaged. In this study, we tested the hypothesis that lesion loads of the AF (i.e. volume of AF that is affected by a patient’s lesion) and of two other tracts involved in language processing (the extreme capsule [EmC] and the uncinate fasciculus [UF]) are inversely related to the severity of speech production impairments in stroke patients with aphasia. Methods Thirty chronic stroke patients with residual impairments in speech production underwent high-resolution anatomical MR imaging and a battery of cognitive and language tests. Impairment was assessed using three functional measures of spontaneous speech (e.g. rate, informativeness, and overall efficiency) as well as naming ability. To quantitatively analyze the relationship between impairment scores and lesion-load along the three fiber tracts, we calculated tract–lesion overlap volumes for each patient using probabilistic maps of the tracts derived from diffusion tensor images of ten age-matched healthy subjects. Results Regression analyses showed that AF-lesion load, but not EmC- or UF-lesion load or lesion size, significantly predicted rate, informativeness, and overall efficiency of speech, as well as naming ability. Conclusions A new variable, AF-lesion load, complements established voxel-based lesion-mapping techniques and, in the future, may potentially be used to estimate impairment and recovery potential after stroke and refine inclusion criteria for experimental rehabilitation programs.

It has been reported for more than 100 years that patients with severe nonfluent aphasia are better at singing lyrics than they are at speaking the same words. This observation led to the development of melodic intonation therapy (MIT). However, the efficacy of this therapy has yet to be substantiated in a randomized controlled trial. Furthermore, its underlying neural mechanisms remain unclear. The two unique components of MIT are the intonation of words and simple phrases using a melodic contour that follows the prosody of speech and the rhythmic tapping of the left hand that accompanies the production of each syllable and serves as a catalyst for fluency. Research has shown that both components are capable of engaging fronto-temporal regions in the right hemisphere, thereby making MIT particularly well suited for patients with large left hemisphere lesions who also suffer from nonfluent aphasia. Recovery from aphasia can happen in two ways: either through the recruitment of perilesional brain regions in the affected hemisphere, with variable recruitment of righthemispheric regions if the lesion is small, or through the recruitment of homologous language and speech-motor regions in the unaffected hemisphere if the lesion of the affected hemisphere is extensive. Treatment-associated neural changes in patients undergoing MIT indicate that the unique engagement of right-hemispheric structures (e.g., the superior temporal lobe, primary sensorimotor, premotor and inferior frontal gyrus regions) and changes in the connections across these brain regions may be responsible for its therapeutic effect. Keywords aphasia; arcuate fasciculus; auditory-motor mapping; connectivity; intervention; melodic intonation therapy; neuroimaging; nonfluent aphasia; speech therapy Of the estimated 750,000-800,000 new stroke cases occurring in the USA each year, approximately 25-50% present with some form of aphasia, an estimation that is based on studies performed in countries other than the USA [1,2]. Approximately 40% of these acute patients were available for follow-up at 1 year (attrition was due to death or inability to participate in trial). Approximately two-thirds of this 40% of patients from the original cohort showed abnormal scores on aphasia testing, with approximately a quarter of them being in the nonfluent category [1][2][3][4]. In right-handed individuals, nonfluent aphasia generally results from lesions in the left frontal lobe, including the portion of the left frontal lobe known as Broca's region. The region is named after Paul Broca (1864), who first linked this area of the brain with nonfluent aphasia; this region is thought to consist of the posterior inferior frontal gyrus †

Although up to 25% of children with autism are non-verbal, there are very few interventions that can reliably produce significant improvements in speech output. Recently, a novel intervention called Auditory-Motor Mapping Training (AMMT) has been developed, which aims to promote speech production directly by training the association between sounds and articulatory actions using intonation and bimanual motor activities. AMMT capitalizes on the inherent musical strengths of children with autism, and offers activities that they intrinsically enjoy. It also engages and potentially stimulates a network of brain regions that may be dysfunctional in autism. Here, we report an initial efficacy study to provide ‘proof of concept’ for AMMT. Six non-verbal children with autism participated. Prior to treatment, the children had no intelligible words. They each received 40 individual sessions of AMMT 5 times per week, over an 8-week period. Probe assessments were conducted periodically during baseline, therapy, and follow-up sessions. After therapy, all children showed significant improvements in their ability to articulate words and phrases, with generalization to items that were not practiced during therapy sessions. Because these children had no or minimal vocal output prior to treatment, the acquisition of speech sounds and word approximations through AMMT represents a critical step in expressive language development in children with autism.