Neuroanatomical correlates of speech and singing production in chronic post-stroke aphasia

Abstract

A classical observation in neurology is that aphasic stroke patients with impairments in speech production can nonetheless sing the same utterances. This preserved ability suggests a distinctive neural architecture for singing that could contribute to speech recovery. However, to date, these structural correlates remain unknown. Here, we combined a multivariate lesion-symptom mapping and voxel-based morphometry approach to analyse the relationship between lesion patterns and grey matter volume and production rate in speech and singing tasks. Lesion patterns for spontaneous speech and cued repetition extended into frontal, temporal and parietal areas typically reported within the speech production network. Impairment in spontaneous singing was associated with damage to left anterior-posterior superior and middle temporal gyri. Preservation of grey matter volume in the same regions where damage led to poor speech and singing production supported better performance in these tasks. When dividing the patients into fluent and dysfluent singers based on singing performance from demographically matched controls, we found that preservation of left middle temporal gyrus was related to better spontaneous singing. These findings provide insights into the structural correlates of singing in chronic aphasia and may serve as biomarkers to predict treatment response in clinical trials using singing-based interventions for speech rehabilitation.

Segregated circuits for phonemic and semantic fluency: A novel patient-tailored disconnection study

“…At the same time, this analysis is not the focus of our study, as it was used to verify the cortical damage association in our cohort; nevertheless, our result confirmed previous studies with a larger sample. Moreover, the use of this analysis in a similar sample size is often reported in the literature (see for instance Martínez-Molina et al, 2022 , Viganò et al, 2022 , Zhang et al, 2021 ). Another limitation is represented by the quality of diffusion images acquired in a 1.5T scanner (60 directions, 50 slices, 2.4 mm of voxel size); however, it must be considered that similar parameters, or also lower number of directions, are often used in clinical studies and that this protocol is considered reliable and with a good balance between quality of data and acquisition time (see for instance Ashmore et al, 2020 , Becker et al, 2022 , Toselli et al, 2017 , Zacà et al, 2018 ), which is crucial in clinical practice.…”

Segregated Circuits for Phonemic and Semantic Fluency: A Novel Patient-Tailored Disconnection Study

“…At the same time, this analysis is not the focus of our study, as it was used to verify the cortical damage association in our cohort; nevertheless, our result confirmed previous studies with a larger sample. Moreover, the use of this analysis in a similar sample size is often reported in the literature (see for instance Martínez-Molina et al, 2022;Viganò et al, 2022;Zhang et al, 2021). Another limitation is represented by the quality of diffusion images acquired in a 1.5T scanner (60 directions, 50 slices, 2.4 mm of voxel size); however, it must be considered that similar parameters, or also lower number of directions, are often used in clinical studies and that this protocol is considered reliable and with a good balance between quality of data and acquisition time (see for instance Ashmore et al, 2020;Becker et al, 2022;Toselli et al, 2017;Zacà et al, 2018), which is crucial in clinical practice.…”

Effects of repetitive transcranial magnetic stimulation combined with music therapy in non‐fluent aphasia after stroke: A randomised controlled study

“…As for the mechanism of music therapy to improve the language function of patients with non‐fluent aphasia after stroke, existing studies have shown that the brain regions activated by music and speech overlapped extensively, mainly including the mirror neuron system (Lahav et al., 2007; Martínez‐Molina et al., 2022). Therefore, patients can improve their language function by singing to alter the excitability of the cerebral cortex to promote brain reorganisation and neuroplasticity.…”

“…There is a hypothesis of hemispheric asymmetry in the analysis of music, meaning that different musical elements play a role in activating specific areas of the brain, which can promote brain reorganisation to improve language function. Furthermore, it is suggested that the brain regions activated by singing and speech partially overlap, so singing as a musical therapy can be used to promote language recovery (Martínez‐Molina et al., 2022).…”