Poststroke Aphasia Recovery Assessed With Functional Magnetic Resonance Imaging and a Picture Identification Task

Szaflarski, Jerzy P.; Eaton, Kenneth P.; Ball, Angel; Banks, Christi; Vannest, Jennifer; Allendorfer, Jane B.; Page, Stephen J.; Holland, Scott K.

doi:10.1016/j.jstrokecerebrovasdis.2010.02.003

Cited by 52 publications

(45 citation statements)

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“…Post-stroke neuroimaging studies that have evaluated recovery from aphasia in adults with unilateral lesions show evidence of cortical reorganization and migration of language functions to the non-dominant hemisphere after a dominant hemisphere insult [20,23,39]. Interestingly, one study that showed such a redistribution pattern using PET and fMRI language tasks also found negative association between increased non-dominant inferior frontal gyrus activation and recovery after an ischemic stroke [40].…”

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confidence: 99%

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Szaflarski

Vannest

et al. 2011

Med Sci Monit

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SummaryBackgroundAphasia affects 1/3 of stroke patients with improvements noted only in some of them. The goal of this exploratory study was to provide preliminary evidence regarding safety and efficacy of fMRI-guided excitatory repetitive transcranial magnetic stimulation (rTMS) applied to the residual left-hemispheric Broca’s area for chronic aphasia treatment.Material/MethodsWe enrolled 8 patients with moderate or severe aphasia >1 year after LMCA stroke. Linguistic battery was administered pre-/post-rTMS; a semantic decision/tone decision (SDTD) fMRI task was used to localize left-hemispheric Broca’s area. RTMS protocol consisted of 10 daily treatments of 200 seconds each using an excitatory stimulation protocol called intermittent theta burst stimulation (iTBS). Coil placement was targeted individually to the left Broca’s.Results6/8 patients showed significant pre-/post-rTMS improvements in semantic fluency (p=0.028); they were able to generate more appropriate words when prompted with a semantic category. Pre-/post-rTMS fMRI maps showed increases in left fronto-temporo-parietal language networks with a significant left-hemispheric shift in the left frontal (p=0.025), left temporo-parietal (p=0.038) regions and global language LI (p=0.018). Patients tended to report subjective improvement on Communicative Activities Log (mini-CAL; p=0.075). None of the subjects reported ill effects of rTMS.ConclusionsFMRI-guided, excitatory rTMS applied to the affected Broca’s area improved language skills in patients with chronic post-stroke aphasia; these improvements correlated with increased language lateralization to the left hemisphere. This rTMS protocol appears to be safe and should be further tested in blinded studies assessing its short- and long-term safety/efficacy for post-stroke aphasia rehabilitation.

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Section: Discussionmentioning

confidence: 99%

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Szaflarski

Vannest

et al. 2011

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“…Most studies focused on the spontaneous recovery of language, [1][2][3][4][5][6][7] but only a few, often single case descriptions, focused on patients submitted to language rehabilitation. [8][9][10][11][12][13] All of these were conducted on chronic patients. The rate of complete spontaneous (ie, without language therapy) aphasia recovery poststroke has been estimated at ≈33% in the first month, 43% after 4 months, and 50% 12 months later.…”

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Early Aphasia Rehabilitation Is Associated With Functional Reactivation of the Left Inferior Frontal Gyrus

Mattioli

Ambrosi

Mascaro

et al. 2014

Stroke

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A n important issue for language rehabilitation after stroke is the relationship between the effects of therapeutic interventions and the functional changes observed in brain language-related areas. Most studies focused on the spontaneous recovery of language, [1][2][3][4][5][6][7] but only a few, often single case descriptions, focused on patients submitted to language rehabilitation. [8][9][10][11][12][13] All of these were conducted on chronic patients. The rate of complete spontaneous (ie, without language therapy) aphasia recovery poststroke has been estimated at ≈33% in the first month, 43% after 4 months, and 50% 12 months later.14 However, the concept of spontaneous recovery of language may not be appropriate (as human beings are extensively exposed to language). The term language therapy commonly relates to formal interventions provided by speech therapists aimed at improving different language abilities with specific exercises.Evidence supports the use of language rehabilitation in stroke, particularly if intensively administered for short courses in chronic aphasics. 15,16 In a pilot study, Godecke et al 17 found that daily aphasia therapy in early stroke, that is, mean 3 days poststroke (dps), resulted in improved communication outcomes in moderate to severe aphasia. Brain plasticity induced by language training has not been extensively investigated to date. Several studies, conducted in chronic patients, suggested that functional correlates of aphasia recovery could be either the activation of predominantly left hemisphere (LH) language-related areas [18][19][20][21][22] or of the homologous right hemisphere (RH) areas, 2,23-25 but often the authors do not clarify whether patients were formally treated and to what extent, or not. Saur et al 4 suggest that in the postacute stages of recovery (2 weeks poststroke), the LH areas would be reduced in activation, whereas after months Background and Purpose-Early poststroke aphasia rehabilitation effects and their functional MRI (fMRI) correlates were investigated in a pilot, controlled longitudinal study. Methods-Twelve patients with mild/moderate aphasia (8 Broca, 3 anomic, and 1 Wernicke) were randomly assigned to daily language rehabilitation for 2 weeks (starting 2.2 [mean] days poststroke) or no rehabilitation. The Aachen Aphasia Test and fMRI recorded during an auditory comprehension task were performed at 3 time intervals: mean 2.2 (T1), 16.2 (T2), and 190 (T3) days poststroke. Results-Groups did not differ in terms of age, education, aphasia severity, lesions volume, baseline fMRI activations, and in task performance during fMRI across examinations. Rehabilitated patients significantly improved in naming and written language tasks (P<0.05) compared with no rehabilitation group both at T2 and T3. Functional activity at T1 was reduced in language-related cortical areas (right and left inferior frontal gyrus and middle temporal gyrus, right inferior parietal lobule and superior temporal gyrus) in patients compared with controls. T2 and T3 follow-ups r...

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“…Aphasia may be one of the best-studied clinical conditions when it comes to the attempted mapping of the neural substrate of functional recovery. Aphasias primarily result from injury to the left hemisphere, and ipsilateral contributions to the mediation of reacquired linguistic functions have been documented by for instance Szaflarski et al (2011), Perani et al (2003), Specht et al (2009), andMeinzer et al (2008). Meinzer et al (2008) demonstrated treatment-induced reintegration of various perilesional areas.…”

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Cognitive Recovery and Rehabilitation After Brain Injury: Mechanisms, Challenges and Support

Mogensen¹

2012

Brain Injury - Functional Aspects, Rehabilitation and Prevention

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Poststroke Aphasia Recovery Assessed With Functional Magnetic Resonance Imaging and a Picture Identification Task

Abstract: Background-Stroke patients often display deficits in language function such as correctly naming objects. Our aim was to evaluate the reliability and the patterns of post-stroke language recovery using a picture identification task during fMRI at 4T.

Cited by 52 publications

References 56 publications

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Early Aphasia Rehabilitation Is Associated With Functional Reactivation of the Left Inferior Frontal Gyrus

Cognitive Recovery and Rehabilitation After Brain Injury: Mechanisms, Challenges and Support

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