Poststroke Aphasia Rehabilitation: Why All Talk and No Action?

Abstract

Aphasia is a debilitating language disorder that often follows stroke. It can affect any or all aspects of linguistic expression and comprehension, whether verbal, written, or gestural. Despite a growing understanding of the phenomenology of aphasia, new treatment paradigms are needed that directly target the underlying impairment. There are varying aphasia types and levels of severity, determined largely by the site and extent of stroke lesion as well as the degree of white matter integrity. 1 Herein, we will focus largely on the nonfluent or expressive poststroke aphasias, emphasizing how the affected anterior brain regions of the dominant hemisphere are interwoven with proximate cortical areas supporting upper limb and hand movement. Speech therapy is beneficial for patients with aphasia; however, no single treatment has proven most advantageous. 2 Many patients with aphasia experience chronic language deficits. Promising strategies to reduce permanent language deficits, such as pharmacological agents 3 and noninvasive brain stimulation 4 alone or in combination with speech therapy, have yet to be tested in appropriately powered clinical trials. One exciting perspective that is emerging from these multidisciplinary studies is the potential interaction between motor and aphasia recovery. 5,6 Increasingly, collateral effects on language production and comprehension have been reported as a result of the observation of movement. 7 Not coincidentally, given the close proximity of handarm and speech-language neural structures, in many patients with poststroke aphasia, the contralesional hand and arm are often simultaneously impaired. While the extent and limitations of hand-arm and speech-language cortical reciprocity remain under debate, it is likely that hand-arm movement and spoken language have at least a parallel, if not primary, relationship. 8 Nonetheless, stroke patients receiving speech-language therapy for aphasia are frequently seated during treatment, with hands and arms impassive. The use of hand-arm movement and exercise (eg, reaching, grasping, lifting) has not been sufficiently explored for direct use in aphasia rehabilitation. Objects that may be named in aphasia treatment, however, may also be simultaneously grasped. Manual tasks may be accompanied by verbal language, as they often are during activities of daily living. In this "Point-of-View" article, we provide an overview of data supporting hand-arm and language cortical reciprocity garnered from literature across multiple disciplines. Toward this aim, a PubMed search was conducted using multiple combinations of the terms "Limb," "Arm," "Gesture," "Speech," "Language" "Motor," "Action Verbs" and "Aphasia," yielding 652 articles. We excluded 384 articles due to their lack of relevance to our topic. For example, if the terms were combined incongruously or as part of a larger unrelated topic, these articles were excluded.

Analysis of Prognostic Risk Factors Determining Poor Functional Recovery After Comprehensive Rehabilitation Including Motor-Imagery Brain-Computer Interface Training in Stroke Patients: A Prospective Study

“…Previous studies have suggested that complications such as depression, cognitive impairment, aphasia, hemianopia, and unilateral neglect after stroke also affect the recovery of motor function (38). The presence of spontaneous speech is a favorable factor for the recovery of motor function (39,40). The present study showed that concomitant aphasia was an independent influencing factor of modest functional improvement of the distal UL in the patients.…”

“…The simplified FMA-UL score was categorized as severe (0-12), severe-moderate (13-30), moderate-mild (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47), and mild (48-60) (2). Because the initial FMA-UL scores of most patients were between severe-moderate to moderate-mild, a score of 30 was selected as the watershed in the following regression analysis.…”

Comparative Assessment of Robotic versus Classical Physical Therapy Using Muscle Strength and Ranges of Motion Testing in Neurological Diseases

“…For both radio-carpal flexion and radio-carpal extension, the center of the goniometer is positioned on the lateral epicondyle of the ulna, the fixed arm of the goniometer is parallel to the ulna, and the mobile arm moves together with the hand. More detailed information and imagery is described in the literature [ 31 ].…”

Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke

“…This parallel pattern was also observed and confirmed in the pairwise correlation analyses between behavioral total score results, with a tendency of becoming even more strongly correlated at A2 (Table 4). Even though several earlier studies have suggested a link between motor and language abilities [e.g., see (15,16,23,63)] studies focusing on simultaneous motor and language impairments after stroke and on concurrent recovery are scarce. To our knowledge, the only study so far that investigated longitudinal recovery after stroke in multiple domains is Ramsey et al (1), who reported similar patterns of recovery across motor and cognitive domains indicative of common underlying mechanisms.…”