Lesion Site Patterns in Severe, Nonverbal Aphasia to Predict Outcome With a Computer-Assisted Treatment Program

Naeser, Margaret A.; Baker, Errol; Palumbo, Carole L.; Nicholas, Marjorie; Alexander, Michael P.; Samaraweera, Ranji; Prete, Malee N.; Hodge, Steven; Weissman, Tamily A.

doi:10.1001/archneur.55.11.1438

Cited by 25 publications

(20 citation statements)

References 30 publications

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“…They received either gestural or semantic and phonological cuing treatments for aphasias. Degree of lesion in 29 left-hemisphere regions was rated using a modification of Naeser's system (Naeser et al, 1998;Naeser & Hayward, 1978;Naeser, Palumbo, Helm-Estabrooks, Stianssny-Eder & Albert, 1987). When degree of basal ganglia lesion was statistically controlled, there was a high positive correlation between degree of left frontal lesion and improvement during treatment.…”

Section: Functional Neuroimaging and Recovery From Aphasiamentioning

confidence: 99%

Functional MRI of Language in Aphasia: A Review of the Literature and the Methodological Challenges

et al. 2007

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Animal analogue studies show that damaged adult brains reorganize to accommodate compromised functions. In the human arena, functional magnetic resonance imaging (fMRI) and other functional neuroimaging techniques have been used to study reorganization of language substrates in aphasia. The resulting controversy regarding whether the right or the left hemisphere supports language recovery and treatment progress must be reframed. A more appropriate question is when left-hemisphere mechanisms and when right-hemisphere mechanisms support recovery of language functions. Small lesions generally lead to good recoveries supported by left-hemisphere mechanisms. However, when too much language eloquent cortex is damaged, right-hemisphere structures may provide the better substrate for recovery of language. Some studies suggest that recovery is particularly supported by homologues of damaged left-hemisphere structures. Evidence also suggests that under some circumstances, activity in both the left and right hemispheres can interfere with recovery of function. Further research will be needed to address these issues. However, daunting methodological problems must be managed to maximize the yield of future fMRI research in aphasia, especially in the area of language production. In this review, we cover six challenges for imaging language functions in aphasia with fMRI, with an emphasis on language production: (1) selection of a baseline task, (2) structure of language production trials, (3) mitigation of motion-related artifacts, (4) the use of stimulus onset versus response onset in fMRI analyses, (5) use of trials with correct responses and errors in analyses, and (6) reliability and stability of fMRI images across sessions. However, this list of methodological challenges is not exhaustive. Once methodology is advanced, knowledge from conceptually driven fMRI studies can be used to develop theoretically driven, mechanism-based treatments that will result in more effective therapy and to identify the best patient candidates for specific treatments. While the promise of fMRI in the study of aphasia is great, there is much work to be done before this technique will be a useful clinical tool.

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Section: Functional Neuroimaging and Recovery From Aphasiamentioning

confidence: 99%

Functional MRI of Language in Aphasia: A Review of the Literature and the Methodological Challenges

et al. 2007

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“…Lesion size and location influence not only the spontaneous recovery of aphasia, but also the success of language therapy [84][85][86]. Non-fluent aphasics with bilateral lesions or a lesion including Wernicke's area or the temporal isthmus [84] have poor response to MIT.…”

Section: Therapy For Aphasiamentioning

confidence: 99%

“…Temporal basal lesions can disconnect persylvian language areas from the hippocampal formation and hinder explicit learning of linguistic knowledge and compensatory strategies [85]. Naeser et al [86] showed in a case series that patients with bilateral lesions were not able to learn an icon-based computer-assisted visual communication. Le-…”

Section: Therapy For Aphasiamentioning

confidence: 99%

Recovery from Aphasia and Neglect

1999

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“…1 The efficacy of aphasia treatment, including computer-based interventions, has been widely evaluated by individual studies, [2][3][4][5][6][7][8][9][10][11][12][13] by expert opinion after literature review, 14,15 and by meta-analysis. 16,17 The general consensus is that aphasia therapy is helpful for improving specific measures of language function if delivered over a sufficient period of time with adequate intensity.…”

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confidence: 99%

Improving Outcomes for Persons With Aphasia in Advanced Community-Based Treatment Programs

Aftonomos¹,

Appelbaum²,

Steele³

1999

Stroke

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Background and Purpose-Studies have yet to document that community-based aphasia treatment programs routinely produce results comparable or superior to published research protocols. We explore this issue here in an outcome study of individuals with aphasia enrolled in 2 community-based, comparably managed and equipped therapy programs, which use a specially designed computer-based tool that is employed therapeutically in adherence to an extensive, detailed, and formally trained patient care algorithm. Methods-Patients (nϭ60) were assessed before and after treatment with standardized instruments at both the impairment and the disability levels. Pretreatment and posttreatment means were calculated and compared, with statistical significance of differences established with the use of 1-tailed matched t tests. One-way ANOVAs were used to analyze the comparability of patient performance changes among various subgroups, eg, patients in acute versus chronic stages of aphasia, patients by aphasia diagnostic type at start of care, patients by severity level at start of care, and patients by treatment location. Results-Analysis shows that patients spanned a wide range of aphasia diagnostic types, impairment severity levels at start of care, and times after onset. Patients' mean performance scores improved significantly in response to treatment in all measures assessed at both the impairment level and the functional communication level. Mean overall improvements ranged from 6.6% to 19.8%, with statistical significance ranging from Pϭ0.0006 to PϽ0.0001. ANOVAs revealed no significant differences between improvements in patients in the acute versus chronic stages of aphasia, between those at different impairment severity levels at start of care, between those treated at different locations, or, at the functional level, between those with different diagnostic types of aphasia at start of care. Conclusions--Measures of both language impairment and functional communication can be broadly, positively, and significantly influenced by therapy services that are delivered to persons with aphasia in these community-based programs. The significant improvements are shown to be available to individuals with chronic as well as acute aphasia and independent of diagnostic type of aphasia, impairment severity at start of care, or geographic program location.

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Lesion Site Patterns in Severe, Nonverbal Aphasia to Predict Outcome With a Computer-Assisted Treatment Program

Abstract: Lesion site patterns on computed tomographic scans are helpful to define candidacy for C-ViC training, and to predict outcome level. A practical method is presented for clinical application of these lesion site results in combination with aphasia test scores.

Cited by 25 publications

References 30 publications

Functional MRI of Language in Aphasia: A Review of the Literature and the Methodological Challenges

Functional MRI of Language in Aphasia: A Review of the Literature and the Methodological Challenges

Recovery from Aphasia and Neglect

Improving Outcomes for Persons With Aphasia in Advanced Community-Based Treatment Programs

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